Comlex Ii & Usmle Ii Cram Sheets - Gastroenterology Vitamins Obesity
Comlex Ii & Usmle Ii Cram Sheets - Gastroenterology Vitamins Obesity
Comlex Ii & Usmle Ii Cram Sheets - Gastroenterology Vitamins Obesity
-GASTROENTEROLOGY
mild 20-40%, moderate 41-100, severe <101%; age,
Vitamins black women, low income
Night blindness, conjunctival dryness, corneal Pickwickian Syndrome = obesity, dyspnea, hypovent,
keratinization CO2 retention, hypoxia
Ricketts - kids, long bone bowing; Osteomalacia-adults, esophageal rupture due to forceful vomit;
demineralization Gastromediastinal fistula, dyspnea w/o hemetemesis, +
Hammonds sign = pneumomediastinum, L lung effusion
Vitamin K
Dysphagia
Clotting deficiency with prolonged PT
Obstructive - solids 1st; Motor -solids = liquids
Thiamine (B1)
Infectious Esophagitis
Beriberi - peripheral neuropathy, Cardiomyopathy - dry
or wet (high output failure) Candida (thrush), HSV, CMV, immunocomp, diabetics,
Dysphagia & odynophagia
Wernicke-Korsakoff - Alcoholics, confabulation,
nystagmus, confusion Esophageal Atresia
Org.= wt gain w/ other disease; Nonorg.=growth failure Risk Factors = NSAIDS, Alcohol, H.Pylori
due to neglect stimulation
PUD
< 80% wt for Ht
Gastric = NSAIDS, eating no help, COPD,blood type A; bowel with thin mucosal folds; most common cause of
25% malbsorption
Adeno, H.Pylori gastritis, Virchow's Nodes, Types = Children & young adults; cong or acquired telangiectasia
ulcerating (shallow edges); polyploid (intraluminal late of intramucosal lymphatic
mets); superficial (early CA) ; Linitus Plastica (all layers
elasticity) Mets to ovary = Krukenberg Tumor Massive extremity edema w/ diarrhea, N/V; Tx: low fat w/
triglyceride supplement
Diarrhea
Toxic Megacolon
Osmotic = H2O lumen solutes in bowel; Secretory =
electrolytes & H2O secreted not absorbed; Dilation > 6cm, Adults preceded by IBD (UC or Crohn's)
Malabsorption; Exudative secretion of blood plasma & Kids preceded by Hirschsprungs Ds; Sx: severely ill,
mucus (mucosal inflammation); transit time (short temp, abd pain, rebound, leukocytosis; X-ray -
bowel); transit (bact. Proliferation) intraluminal gas along continuous seg of dilated bowel;
Tx: NPO, IV fluids & electrolytes, Antibiotics & Steroids,
Ischemic Colitis Rectal tube may alleviate but can cause perforation
Diverticular Disease
Lactase deficiency, bloating & explosive diarrhea after
milk; Ages 10-20
Diverticulosis = false diverticulae, pearl sign on xray
Celiac Sprue
Diverticulitis = infection, acute abd pain usually on left,
st may form fistulas to bladder, vagina or skin, CT w/ water
Gluten sensitivity (wheat, rye, barley); amenorrhea 1 sx
soluble contrast during acute attack
girls, Infants = FTT, abnormal stool, bloating, Adults =
malabsorption, vit deficiency; X-ray - dilated loops of
Crohn's Disease
Granulomatous colitis; No bloody stools, 1st in terminal Norwalk = yr round, Rota (kids) = winter; Coxsackie A1;
ileum, transmural, skip lesions, cobblestoning: echo, adeno
Complications=small bowel abscess, obstruction,
perianal disease, malabsorption, toxic megacolo, Colon Botulism
CA. Surgery is not curative
Clostridium Botulinum, neuromuscular; onset 12-36 hrs;
Colon CA N/V/D, cranial nerve palsy, fixed dilated pupils, resp
failure, no fever, Wound induced = neuro w/o gi sx
Right Sided=napkin ring, anemia Left Sided=Apple core,
pencil stools; Genetic; Annual rectal>40, Annual Guaiac Infants constipation 1st=> cranial nerve sx => cranial
>50; Flex Sig q3-5y >50; Rectal CA-hematochezia nerve Sx => Neuromuscular
Rotation of Bowel; Newborns & elderly; Double Bubble; E coli 157, cramps, => watery diarrhea => bloody
Birds Beak on Barium Enema, Tx: Left Sided = diarrhea Complications= Hemolytic-Uremic Syndrome,
decompression; Rt sided & kids = surgery thrombotic thrombocytopenic pupura
Telescoping of large bowel into an adjacent section; Antibiotic induced (clindamycin, ampicillin,
most common cause of obstruction in kids under 2; cephalosporin) C. Diff; mail -> severe bloody diarrhea;
Episodic Abd pain 1-2 min. Reflex = early vomit; Tx: stop antibiotics, oral metronidazole in severe cases
Obstructive = omit late; Currant Jelly Stool; Small Infants
= Pallor, sweating, and vomiting. Leukocytosis with Acute Pancreatitis
hemoconcentration, BE to reduce x 2 before surgery
Pain radiates to back w/ N/V; Grey Turner's Sign (blue
Necrotizing Enterocolitis flank) Cullen's Sign (blue at umbilicus; Amylase & Lipase
;
Premature, birth weight, older infants with malnutrition;
bilious vomit, abd distention, bloody stool, lethargy; Ranson's Criteria: 3 or more = incr mortality
Thrombocytopenia; Small Bowel Distention;
pneumatosis (air in bowel wall) TX; NG, TPN, IV
antibiotics, surgical Rx necrotic part Admission: >55, gluc>200, LDH >350, AST >250 WBC >
16000
Cholera
Within 48 hrs: Hct 10%, BUN >5, Ca< 8, PaO2 < 60,
Base Def > 4, Fluid Seq>6L
Fecal - Oral, Rice Water Stools, Vibro Cholera; Endemic
gulfcoast, Asia, Africa, Mid East; Severe dehydration,
Metabolic Acidosis, Tx: Tetracycline or Doxycycline Chronic Pancreatitis
Staph Enteritis Hep A = Fecal oral, shedding before Sx; IG to travelers &
contact with HAV infected
Onset 3-6 hrs; "Church Picnic epidemic; N/V/D, HA,
fever recovery w/in 24 hrs Heb B= Blood & STD; HbsAg early if persists = carrier;
HbcIGM then HbcIgG for life
Salmonella Enteritis
HBIG for needle sticks and infants born to + moms;
assoc w/ hepatocell CA
Undercooked Poultry; nausea & cramps => watery &/or
bloody diarrhea; No antibiotics prolongs excretion of the
organism Hep C Most common post transfusion hepatitis
Exocrine Pancreatic CA Fatty liver => ETOH hepatitis => cirrhosis; AST > ALT ;
PT; II, VII, IX, X Clot
Ductal CA, Courvoiser's Law=palpable nontender GB in
a jaundiced patient is a head of Pancreas tumor. Tumor Cirrhosis
Body or Tail=splenic vein obstruction=> splenomegaly,
gastritis, esoph varices necrosis and fibrosis, serum albumin, anemia PT, Not
curable or reversible
Insulin hypersecretion, hypoglycemic symptoms, Insulin veins that expand to circumvent congested hepatic flow;
levels still after fasting Tx: vasopressin, balloon tamponade, endoscopic
sclerotherapy, transjugular hepatoporto shunt (TIPS
Whipple Triad: confirms hypoglycemia as source of Sx 1.
Hypoglycemia, 2. Relieved with carb ingestion 3. Sx Hepatic Encephalopathy
occur while fasting
altered consciousness, ammonia glutamine in CSF, EEG
VIPoma abnormal
Projectile vomit in neonates, visible peristaltic wave, Acute: S.aureus, Group A strep, N Gonh., Sub acute:
String Sign Strep Viridans; New heart murmurs, petechia over half of
body, Splinter hemorrhages on fingernails, Osler's
Meconium Ileus Nodules (nodules on fingertips) Roth's Spots (retinal
hemorrhages)
Abnormal thick Meconium with undigested protein,
associated with CF Noninfective Endocarditis
Dyspnea, Orthopnea, Paroxysmal nocturnal dyspnea, uvula away; Head tilted toward, Trismus (can't open
LVH mouth)Strep or Bacteroides
Most common cause is Left sided failure; Neck vein H.flu type B, Insp. Stridor, Dysphagia with drooling,
distention, Liver big, Edema Thumbprint sign on xray
MI Larengitracheitis
ST elevation, T wave inversion; CPK-MB 12 - 40 hr for Croup; Paraflu #1, RSV, Flu, barking cough, stridor
peak; LDH peaks 3-6 days hoarse, r/o epiglottitis
Acute Bronchitis Extrapulmonary manifestations= meningitis, pericarditis,
bone invasion (Pott's Disease)
non smokers = M. pneumonia; smokers=S.pneumonia &
H.flu Bronchiectasis
Red-brown sputum, lobar pneumonia, most common Destroyed alveolar walls, Risks: smoking, alpha 1
adult community acquired antitrypsin deficiency;
Pneumovax vaccine = >65, immunocompromised, PFTS: FEV1; VC, FEV1/FVC < 60% normal
chronic disease
Blue Bloaters
H.Flu Pneumonia
Bronchitis>Emphysema; cough w/ mucous 3mos/yr x 2y;
COPD, children, slow onset with URI sx 1st, patchy cyanosis, pulm HTN
bronchial infiltration on xray
Pink Puffers
Viral Pneumonia
Emphysema >Bronchitis; gradual dyspnea not hypoxic,
Most common cause in kids, flu like prodrome, patchy underweight
infiltrates; WBC not a lot
Cystic Fibrosis
Klebsiella Pneumonia
auto recessive, COPD, Pancreatic insufficiency;
Alcoholics, aspiration, Currant Jelly Sputum, meconium illeus, sweat chloride
Encapsulated gram neg rod
Sarcoidosis
Staph Pneumonia
non caseating granulomatous, increased Calcium,
Salmon colored sputum, Nosocomial, pneumatoceles on ground glass, bilateral hilar & paratracheal adenopathy
xray are pathognomic is pathognomic
atypical no cell wall to stain, young adults in close Increased risk of lung CA & mesothelioma, gradual
contact; xray worse than pt looks dyspnea, nonproductive cough; no wheeze; diffuse
linear opacities on xray
Pseudomonas Pneum.
Silicosis
hospital acquired, CF, immunocompromised
increased risk of TB, SiO2 inhalation; metal mining;
multiple small nodules & calcification of hilar lymph
Legionella Pneumonia
nodes
atypical, CNS & GI sx; confusion & ataxia, aerosolized
Resp Failure
water (air conditioning)
Laryngeal CA
fever, night sweats, wt loss, bloody sputum, Miliary =
disseminated; Acid fast stain, PPD>10mm
nonimmunocompromised; ppd>5mm AIDS; squamous cell, smoking & alcohol, hoarsness for several
weeks
Lung CA <37 wks gestation, Lung maturity: L/S ratio >2, + PG;
Beclomethasone hastens maturity; artificial surfactant for
squamous>adeno>small(oat) cell; Squamous = hilar; kid
Adeno = peripheral; Horner's Syndrome=invasion of the
cervical symp. Ganglion= miosis, ptosis, anhydrosis Pulm HTN
Pancoast tumor = Horners + pain in arm or shoulder on Primary = dx of exclusion; secondary valvular heart
affected side disease, L=>R shunt, chronic ateletasis (localized
collapse of alveoli)ENDOCRINOLOGY
Asthma
Hypothyroid
PFTs FEV1; ABG resp alkalosis, CO2; If CO2 or normal
resp failure imminet Weight gain, Lethargy, Coarse hair & dry skin, irregular
menses, cold intolerance, myxedema; Acquired =
Massive Hemoptysis Hashimoto's; Congenital = cretinism, severe I deficiency
= hoarse cry; resp distress, cyanosis, poor feeding, decr
bone growth, T4 TSH
>600 ml blood in 24 hrs; trauma; PE, aortic aneurysm,
heart failure
Wolff Chaikoff effect = inhibition of thyroid hormone
release due to high doses of I during thyroid scan
Pneumothorax
Hyperthyroid
Spontaneous = 15-35 y/o males; Tension = pressure in
pleural spaces; displaces heart & lungs (mediastinal
shift) = surgical emergency 1. GRAVES: most common, autoimmune, antibodies
bind to TSH receptors; incr thyroid hormone, pretibial
myxedema, Incr radio I uptake
ARDS
Type II: insulin resistance; no HLA association, hemorrhagic infarct of adrenals, assoc w/
endogenous production enough so no ketoacidosis but meningococcemia
do get hyperosmolar coma(dehydrated, glucose 600-
2000 Pheochromocytoma
SIADH MEN II
Excess ADH, Tumor, trauma, pulm disease, drugs; Pheochromocytoma, Parathyroid & medullary thyroid
Hypoatremia, Conc. urine; tumors
Acromegaly Hemochromatosis
Excess GH; bone & tissue enlargement; glucose Auto recessive, GI absorption of Fe; Excessive Fe,
intolerance, osteoarthritis Ferritin, Transferrin saturation, cirrhosis, diabetes,
bronze skin
Addison's Disease
Wilson's Disease
Decreased cortisol (aldosterone) Wt loss, fatigue, skin
pigmentation, eosinophilia; Decr aldosterone, decr Na, Auto recessive, excessive Cu accumulation, ataxia &
incr K; Give ACTH if cortisol doesn't increase Dx made dementia, Kayser Fleisher rings on cornea
Bladder control requires: intact sensation(full) motor Hematuria, proteinuria, RBC casts: Post strep = give
function (start void) Cerebral control (timing) Antibiotics only if still strep +, steroids no help;
Goodpastures- autoimmune, high dose steroids, uremia
3-9 mos.
Atonic, distended with overflow= acute spinal cord injury
or sensory impaired
Nephrotic Syndrome
Motor defect = sense full bladder but can't start emptying
Proteinuria > 3g/day, Edema, hypoalbuminemia &
hyperlipidemia (milky serum); minimal chg disease in
Autonomous = spinal cord injuries after acute; bladder
kids; idiopathic Glomerulonephritis in adults
fills & empties reflexively
> 5.5 mEq/L; muscle weakness, cardiac arrhythmia, met pre-auricular skin tag and kidney agenesis
acidosis, oliguria, K sparring diuretics
INFECTIOUS DISEASES & IMMUNOLOGY
Hypokalaemia
Fever
<3.5 mEq/L; muscle weakness, cardiac arrhythmias,
resp failure, GI or renal loss most common cause immed post op = atelectasis; 3-5
days postop = infection; > 2 wks post op = PE or
Urethritis thrombophlebitis
Varicocele Septicemia
Painless lump; does not transilluminate, most common HEP B = mom + HbsAG = HBIG & 1st Hep B vaccine at
testicular neoplasm in men < 30; Undescended testes at birth
greater risk even after surgical correction
DTP = contraindications => progressive neuro disorder,
Prostatitis Hx encephalopathy w/ in 7 days of previous dose;
Pertussis not given if > 7 y/o or if currently have
Nonbacterial > bacterial (GI organisms); recurrent UTIs; pertussis
Rectal - warm, tender, boggy prostate; Tx TMP/SMX
H FLU = not in kids > 5 Severe Combined Immunodeficiency
POLIO = IPV if immunocompromised Deficits of B & T cells, IgA deficiency, recurrent infections
esp resp & GI, IG administration
MMR = not effective before age 1; don't give if less than contraindicatedHEMATOLOGY & ONCOLOGY
3 months since transfussion or IG use; ok for HIV +;
suppresses TB - give Tine(PPD) & MMR at same time or Microcytic Anemia
4-6 weeks apart.
MCV < 80; IRON DEFICIENCY = ferritin; CHRONIC
Adult Immunizations DISEASE Fe, Transferrin, Ferritin; LEAD POISONING;
THALASSEMIA
TETANUS = booster q10y, No Hx immunization 2 td 1-2
mos apart then booster at 6-12 mos then on normal 10 y Normocytic Anemia
cycle
MCV 80 - 100; Hemolysis, Chronic disease, Bone
FLU = chronic resp problems, metabolic diseases, adults marrow suppression (drugs, leukemia) (aplastic)
> 65; can cause false positive HIV test
Macrocytic Anemia
HIV/AIDS
MCV > 100; FOLATE DEF. = most common cause,
RNA retro, CD4 cells, Dx based on concurrent related folate normal B12;
diseases &/or CD4 , 200 cells/mm3; Flu-like illness,
antibodies 1 - 6 months after infection B12 DEFICIENCY: B12 absorbed when linked with IF
from parietal cells, neuro sx,
AIDS related infections
Alpha Thalassemia
CMV, HSV, VZV, EBV, TB, mycoplasma avium-
intracellular, candida coccidioides, histoplasmosis, Acanthocytes (rounded projections from cells);
cryptococcus, Pneumocystic carnii (protozoa) Poikilocytosis (variable size); target cells, Very low MCV
Toxoplasmosis, cryptosporidiosis, Giardiasis but mild anemia, Hemoglobin H = chain missing; Asians,
Dx by Hb electrophoresis,
DeGeorge's Syndrome
Beta Thalassemia
Thymic aplasia, Absent T cells, congenital heart disease,
craniofacial abnormalities
Peripheral Smear = basophillic stippling, nucleated RBC,
Wiskcott- Aldrich Syndrome anisocytosis (chgs in size) Mediterranean & African
heritage; Minor = heterozygous, Major = homozygous
X linked, no antibodies against encapsulated bacteria,
eczema, platelets, Sickle Cell Anemia
Chronic Granulamatous Disease sickled cells, Hct & reticulocyte count, electrophoresis
HbS + HbA neg. Salmonella osteomyelitis, S.
Autosomal recessive, defect in phagocytic enzymes, pneumonia sepsis.
recurrent bacterial & fungal infections
Hemophilia
Chediak-Higashi Syndrome
X linked factor VIII (A) or IX (B) deficiency; Prolonged
Autosomal recessive, recurrent strep & staph infections PTT, Joint & soft tissue bleeding; Tx cryoprecipitate &
FFP
Bruton's Disease
Von Willebrand's Disease
x-liked, agammaglobulinemia, N B cells or antibodies
autosomal dominant deficiency of VIII & vWF, epistaxis,
Ataxia Telangectasia menorrhagia, bruising, increased PTT & bleeding time
adults > kids, women > men; platelets consumed in affects myeloid cells (N,B,E,erythrocytes,
clotting reactions, Fluctuating neurologic defects, megakarocytes) adults > kids; DIC possible, gram neg
platelets, HCT, retic count, LDH, acute onset not and fungal infections, Auer Rods (red staining
autoimmune intracellular inclusions.
kids > adults, autoimmune destruction of platelets, Philadelphia Chromosome (acquired translocation
Purpurea & Petechia , Platelets<10000, Epistaxis, chromosome 9 & 22), tumor cells are more mature, Dx in
menorrhagia middle aged, WBC > 150000; uric acid, B12 (B12 carrier
protein produced by WBC); leukocyte alkaline phos decr
Hemolytic Uremic Syndrome or absent, RBC normal
Usually caused by E. coli toxin, RBC fragments on Blast crisis transforms it to acute leukemia
smear, RBC destruction => acute renal failure, 2o
thrombocytopenia, abd pain & diarrhea after a flu or URI Chronic Lymphocytic Leukemia
prodrome; platelets derc, LDH greatly increased
Disorder of mature B cells (rarely T); B cells don't
Hodgkin's Lymphoma differentiate into plasma cells, men > women; usually >
50; No Blast Crisis
Painless cervical lymphadenopathy, Reed Sternberg
cells (multinucleated reticular cells), 80% survival Hairy Cell Leukemia
Burkitt's Lymphoma B cell transformed into tumor cell with fine hair like
projections; pancytopenia, red pulp of spleen infiltrated
B cell lymphoma, Associated with Epstein-Barr virus,
children & young adults Multiple Myeloma
neutrophils = decr production or incr destruction Clonal proliferation of CD4 T cells; infiltrates dermis &
epidermis, thickened & nodular skin lesions
DIC
Polycythemia Vera
wide spread activation of coagulation cascade. platelets,
fragmented RBC, PT & PTT ; fibrinogen, Pregnancy, overproduction of all 3 cell lines; RBC > 1,000,000, Hct >
malignancy, infections, massive trauma 60%; men & women peak age 60; Bone biopsy-
hypercellular with absent Fe stores; R/O spurious
polycythemia = RBC due to dehydration; R/O 2o
Acute Lymphocytic Leukemia
polycythemia = RBC mass due to oxygenation.
Eaton Lambert NEVI
90% assoc w/ small cell CA, presynaptic Ca release = PIGMENTED: (Benign) sun exposed areas in children &
proximal muscle weakness; hyporeflexia, dysautonomia, adolescents
function w/ stimulation; weakest in AM (opposite MG) Tx
Tubocurare DYSPLASTIC: 2-12 mm, more irregular, unexposed
areas, Multiple dysplastic Nevi = familial risk of
DERMATOLOGYSeborrheic Dermatitis melanoma
Red skin with greasy scales, worse in winter & when Hemangiomas
under stress, Se or Tar soap
NEVUS FLAMMEUS: Port wine stain - flat, purple, does
Psoriasis not fade
HLA-B27, Similiar sx to RA but w/ neg RF, Silvery scaled CAPILLARY: strawberry mark, raised, bright red, regress
plaques w/ sharp demarcations, Pitted fingernails spontaneously by age 5
Basal Cell > Squamous; Basal Cell = pearly papule w/ Rheumatoid Arthritis
dilated blood vessels and central depression; Squamous
Cell: Red papule w/ crusted surface, later nodular and Symmetric, PIP & MCP joints NOT DIP, Subcutaneous
ulcerated, rarely mets; Assoc w/ sun exposure nodules, 70% +RF
Change in size, shape or color of a mole, Usually Affects big toe (Podagra), pinna of ear; Negatively
superficial spreading, Mets as invasion goes deeper birefringent crystals; Sodium urate; Colchicine or
than 0.76 mm; itchy & ulcerated NASIDS for acute attacks
1o = irritant contact - direct injury, all w/ contact affected, Calcium pyrophosphate dihydrate; Knee most affected;
Occurs w/ 1st exposure Positively birefringent
Closed Angle Glaucoma Rinne's Test: hold against mastoid process then adjacent
to pinna, norm = pinna louder, if not maybe conductive
Rapid rise in pressure due to blockage of aqueous loss; Weber Test: Midline of forehead, unilateral
drainage in the eye; Severe pain, blurred vision, halos, conductive loss = louder in affected ear; unilateral
Nausea, Abd pain; Reddened eye, upper lid edema, sensorineural = louder in unaffected ear
steamy cornea, dilated non-reactive pupil; mannitol, oral
glycerin or carbonic anhydrase in acute attack, Beta Presbycusis
adrenergic blockers for prevention
normal loss of hearing associated with age,
Diabetic Retinopathy sensorineural
Tic douloureux; severe, "lightening" pain in V1 & V2 Chronic HTN or local thrombus 2o to ischemia;
distribution of CN V; Trigger Pts Supratentorial: transtentorial herniation, w/ brainstem
compression & midbrain bleeding, hemiparesis;
Tx: carbamazepine & phenytoin; Surgical Cerebellar : acute hydrocephalus due to CFS flow
decompression of CN V blockage; Acute onset HA w/ progressive neurological
chgs.
Partial Seizures
Stroke
Simple = focal sx, conscious, Jacksonian = simple
muscle twitch that spreads progressively; 2o Middle Cerebral: most often, contralateral limb
generalization = simple becomes grand mal; Complex weakness, sensory loss, homonymous hemianopsia,
Partial = automatism, olfactory hallucinations, fear, deja dominant hemisphere = aphasia, nondominant =
vu, loss of contact w/ environment; postictal confussion sensory neglect & apraxia
localized vessel dilation, Berry Aneurysm = circle of Delayed formation of a subdural clot, Sx weeks after
Willis assoc w/ polycystic kidney disease & coarction of head injury, Elderly & alcoholics; Progressive daily HA,
aorta fluctuating consciousness & mild hemeparesis
between pia & arachoid; usually rupture of a cerebral Between dura & skull, less common than subdural, injury
artery aneurysm or AV malformation; Worst HA, to arteries (middle meningeal); Rapid brain compression,
syncope, nuchal rigidity, vomiting, nonfocal permanent neurological problems or death; Brief lucid
abnormalities, decr consciousness, CT first if neg then period after head injury; progressive neuro signs
lumbar puncture mandatory.
Concussion
Injury due to blunt trauma; short loss of consciousness nonbacterial meningeal irritation; CSF = lymphocytes,
w/ intact brainstem function; post traumatic confussion normal glucose, neg gram stain & bacterial cultures, mild
syndrome w/ transient retrograde or anterograde protein, normal opening pressure; supportive Tx
amnesia; HA, vertigo, mild cognitive dysfunction
Fungal/TB Meningitis
Toxic Vestibulopathies
CSF: lymphocytes, glucose, protein, opening pressure;
Alcohol: positional vertigo & nystagmus w/ in 2 hrs of AIDS = cryptococcal meningitis
ingestion
Encephalitis
Aminoglycosides: ototoxic, vertigo, N/V ataxia, sx last 1-
2 wks after ending tx Inflammation of brain tissue; Viral etiology = CSF
lymphocytes, normal glucose & negative bacterial
Salicylates: reversible vertigo, tinnitus, sensorineural cultures; Acylcovir x10 days
hearing loss
Reye's Syndrome
Quinine & Quinidine: cinchonism (color vision defects,
tinnitus, hearing loss, vertigo, flushed skin, N/V, abd pain follows viral infection; fatty infiltrate of organs; Usually
& sweating kids; Salicylates can induce
Cisplatin: ototoxic, reversible vertigo, tinnitus, hearing Sudden onset of encephalopathy, severe vomiting, &
loss, sensory neuropathy liver dysfunction; liver biopsy w/ fatty infiltrates confirms
Dx.
Toxic Neuropathies
Neurosyphillis
Lead: multi motor neuropathy; acute encephalopathy in
children Argyll Robertson Pupil (small, reacts to light but not
accommodation); Psych disorders, Tabes Dorsalis; Tx:
Organophosphates: delayed motor neuropathies, Procaine Penn G x 21 days; Examine CSF q 3-6 months
cholinergic crisis until normal x 2 yrs.
1st month life = group B strep & E. coli; Older kids = H. Fecal-oral; aseptic meningitis, paralysis w/o loss of
flu; Adults = S. pneumonia sensation; Asymmetric paralysis during a febrile illness
suggests it; Tx is palliative; OPV for all except
N. meningiditis at any age = 50% have petechial rash immunocompromised who get IPV
ALS Coma
KOH whiff test = fish; Clue cells, most common Polycystic Ovarian Disease
symptomatic infection; Metronidazole
LH, or normal FSH; hirsutism, obesity, menstrual
Condyloma Acuminata irregularities, infertility
PID Avg age =51; FSH & LH; Hot flashes, Atrophic vaginal
epithelium
Cervical motion tenderness, Purulent discharge, assoc
w/ ectopic pregnancy & infertility; Leukocytosis, Urinary Incontinence
neutrophilia, ESR
Stress = intra abd pressure, leak small amts of urine;
Candida Kegel exercises, estrogen
cottage cheese, red vulva; Pseudohypahe & spores on Urge = detrussor instability; lg amts of urine leaked
wet mount, DM, antibiotics, OC, pregnancy immediately after urge to void
UTI 1o Amenorrhea
E coli, Dysuria, frequency, urgency; Tx: TMP-SMX, Absence age 16 w/ 2o sex development or absence by
Bactrim, Septra age 14 w/o 2o characteristics
Toxic Shock Syndrome Anatomic Abnormalities; Ovary Failure ( FSH & LH,
estradiol) (XO, turners, no ovary); Pituitary =
Staph aureus exotoxin, rash, high fever, hypotensive Prolactinoma presents w/ galactorrhea (Bromocriptine to
shock Tx), Hypothalamic = FSH & LH, (anorexia, exercise,
stress); XY karotype
Chancroid
2o Amenorrhea
H. Ducreyi, tropical & sub tropical climates, gram neg; Tx
Emycin or Ceftriaxne Absence for 6 mos if prev normal; absence for 12
months if prev oligomenorrhea; r/o pregnancy;
Galactorrhea = prolactinoma; Hirsutism = polycystic
Chlamydia Trachomatis
ovarian; Tx: 1st = progestin challenge (bleed w/ in 2 wks)
if no bleed measure FSH levels
Intracellular, columnar epithelium, mucopurulent,
Immunofluoresent discharge, Tx: Doxycycline (Emycine
1o Dysmenorrhea
if pregnant)
Ovarian CA
Malignant: Invasive= molar villi; Choriocarcinoma = no Adv maternal age, abn AFP - Spina bifida, Down's,
villi, any pregnancy; Placental Site = non molar detect lung maturity, early 2nd trimester
gestations
CVS
S/Sx: size > dates, hyperemesis, hyperthyroid, large
theca lutein cyst Adv. Maternal age, late 1st trimester
F/U = CBC. Liver function, BUN, CR, TSH, HCG, US, Non stress Test
CXR; TX = D&C
> 2 fetal movements accompanied by FHR of 15 bpm for
Weekly HCG' until 3 values that are non detectable then at least 15 sec w/ in 20 min period
1/mo x 1yr, BCP x 1 yr
Contraction Stress Test
Ca in Pregnancy
Negative = 3 contractions in 10 min, lasting 40 sec w/o
Melanoma = worsened by preg, can met to placenta or late decelerations
fetus
Positive = consistent & late decelerations
Breast CA = most common CA in pregnancy
Biophysical Profile
Chemotherapy
Nonstress test, fetal breathing, movement, adeq,
Cyclophosphamide (Cytoxan) = ovarian, hem, cystits, amniotic fluid, limb extension
alopecia, bone marrow, N/V
Fetal HR
Cisplatinum = ovaian, renal toxic, ototoxic, bone
marrow , N/V normal 120-160, Brady = mild 100-120, < 100 severe;
Tachy = mild 161-180; severe > 180
Adrimycin (Doxyrubicin)= endomet, ovarian; cardiotoxic
(heart failure) Decelerations
Bleomycin= cervical, germ cell, Pulmonary fibrosis Early = shape is mirror of contraction, head compression
Vincristine= cervical germ cell; neurotoxic Variable = shape varies, cord compression
Methotrexate = GTN, germ cell, hepatic & renal toxic, Late = starts as contraction peaks, recovery after
bone marrow contraction is terminated, uteroplacental insufficiency
1 hr > 140 then do 3 hr; 3hr test = fast > 120, 1 hr > 190; Pooling of fluid in vagina, + nitrazine test, + ferning test,
2 hr > 165, 3 hr > 145; Macrosomia, RSD, Cong risk of endometritis
abnormalities
Polyhydraminos
Types of Pelvises
Duodenal Atresia, Tracheoesophageal fistula,
Gynecoid = round inlet, nonprominent spines, wide Anencephaly
subpubic angle
Oligohydraminos
Anthropoid = heart shaped inlet, transverse and AP
diameters, subpubic angle Renal Agenesis, Pulmonary hypoplasia
1. Onset contract => full dilation 2. Full dilation to Fetal Cocaine Exposure
delivery of head 3. Delivery of fetus to delivery of
placenta 4. Delivery of placenta to 1 hr later Limb reduction malformations, Intestinal Atresia, Jittery,
tremors
Cardinal Movements
Grey Baby Syndrome
Engagement, descent, flexion, int rotation, extension, ext
rotation, expulsion chloramphenicol use, metabolism due to immature liver,
CV collapse, maybe fatal
Post Partum Hemorrhage
Erythroblastosis Fetalis
Uterine Atony (most common); Placental Accreta:
Accreta = superficial invasion into myometrium, Increta = Rh neg mom Rh + baby; Subsequent Rh + babies are at
deeper, Percreta = invasion to serosa of uterus; risk; Give RhoGam - binds to fetal RBC, prevents
Undiagnosed lacerations, Coag defect; Retained Antibodies from being made
placental fragments
Beckwith Weiderman
Apgar Scoring
neonatal hypoglycemia d/t hyperinsulinemia,
Heart Rate, Resp. Effort, Muscle Tone, Reflex Irritability, macroglossia, giantism, omphalocele, kidney anomalies,
Color facial nevus flammus, poor prognosis
Maternal obesity, diabetes mellitus, postterm pregnancy Determine cause of neonatal rectal bleed; differentiates
adult vs fetal hemoglobin
Cesarean Section Indications
Dubin Johnson
Health of mom or baby endangered by labor, Dystocia
precludes vag delivery, Emergent situation, Herpes, Prev Chronic idiopathic jaundice
C section if contributing factor still exists,
Malpresentation of fetus
Erb Duchenne unbound bili crosses blood brain barrier resulting in
neuro problems or death
C5-C6, flail arm (int rotation & abduction) due to traction
on head during delivery; If c4 involved - paralytic Prolonged Hyperbili
diaphragm also present
Bili > 10 at 10 days of life
Henoch Schoenlein Pupura
Photo therapy can be used as long as direct isn't > 1 mg
kids, allergic vasculitis, non-blanching petechiae or %
pupura on lower extremities only, arthralgias, abd pain,
hematuria, proteinuria, coag & platelets are WNL; Hemorrhagic Disease of Newborn
Immune mediated after virus or strep
Deficiency of vitamin K dependent factors (2-7-9-10)
Kawasaki's
Intrauterine Shunts
look sick w/ fever > 5d, truncal rash, cervical nodes, URI
sx, "glove" desquamation on palms, feet, lips; Assoc w/ placental, ductus venousus , foramen ovale, ductus
coronary artery aneurysm; TX: High dose asa, IV arteriosus
gammaglobin, Steroids contraindicated
Ductus venosus = ligamentum venosus; Ductus
4 out of 5 =bulbar conjunctivitis, erythematous mouth, Arteriosus = Ligamentum Arteriosus
lips & tongue; polymorphous erythematous rash,
induration of hands & feet w/ erythema, solitary unilateral
cervical lymph node < 1.5 cm; Thrombocytosis after 10 th Growth & Development
dy is common
1st teeth - 6-9 mos; Neuromuscular development in
Kleinfeltters cephalocaudid direction; 4 wks regard face, smile 4-6
wks, social laugh 4-5 mos; 15 mos stack 2 blocks; 18
mos stack 3 blocks; walk up stairs 20 mos ; w/ alt feet 3
XXY, most common hypogonadal syndrome; + BARR yrs;
body, small firm testicle, azospermia, FSH
Drawing = circle 2.5-3; cross 3-4; Square 4-5; Triangle 5;
Meckel's Diverticulum Diamond 6 yr
2 ft from ileocoecal valve, 2 in long, 2& population, 2 Wt Gain = BW by 10d; 15 lbs 1st yr, 6-7 lb 2nd yr
tissue types (gastric or pancreatic) sx before 2 yrs old
Length = 10 in 1st yr, 5 in 2nd yr; < 2in / yr is abnormal
Newborn Blood
Head Circumference: 0-35; 3-40, 9-45, 3-50, 9-55 cm
85 cc/kg, Hgb 14 - 22 gms/dl HCT 44-64%; alk phos
than adults & is until adolescent growth spurt
# Alveoli increase as lungs grow; # nephrons don't
increase after term
TORCH
ADHD
Toxoplasmosis, syphillis, rubella, CMV, herpes
3x more male than female; inattentiveness, impulsivity,
CMV hyperactivity
Von Gierke, Pompe, Forbes Neuroectodermal malignancy , most occur before age 5;
Leukocoria (white pupil reflex)
Tay Sachs
G6PDase Defic
Lipid Storage, Jewish , defic of hexosaminidase A;
normal at birth then loss of motor milestones & most common red cell enzyme deficiency that causes
hypotonia at 6 mos, Death by age 2; Cherry red macula hemolytic anemia; usually asymptomatic until exposed to
stress, infection or certain foods; Cause of
ALL hyperbilirubinemia in Chinese or Mediterranean but NOT
BLACK infants; Avoid sulfa drugs
most common malig of childhood, peak at age 4;
thrombocytopenia, anemia, elevated uric acid & LDH; Dx PSYCH
by bone marrow biopsy showing infiltration of leukemia
blast cells; CXR = mediastinal mass or widening, 2o ary Axis Determination
to lymphadenopathy
I = clinical psych disorders II personality disorders, III
Brain Tumors Coexisting medical conditions IV psychosocial stressors,
V global assessment of functioning
most common solid tumor of childhood; < 2 intratentorial
tumors > 2 supreatntorial tumors Schizophrenia
Morning vomiting = posterior fossa ependymoma Positive Sx: delusions, hallucinations, bizarre behavior;
Negative Sx: alteration of affect, ambivalence, apathy,
Astrocytoma most common brain tumor loosening of associations; males=females; industrial
nations have prevalence; Misalignment of cells in cortex;
Hodgkins Lymphoma ventricle size; activity in frontal cortex on PET scan.
Reed Sternberg Cells; Painless cervical Disorganized: insidious, incoherent, inappropriate affect,
lymphadenopathy social impaired
Neurolyptic Malignant Syndrome = temp, CPK, rigidity intrusive recollections, daydreams, nightmares, poor
concentration, psychic numbing; Tx: don't treat w/ meds
Schizophrenifrom unless compulsion component
same sx as schizophrenia but have lasted for less than 6 Studies: Buffalo Creek Disaster, Beverly Hills Nightclub
months
Dissociative Disorder
Schizoaffective
Amnesia = loss of memory, Fugue = assoc w/ physical
mood disorder and separate psychotic sx. Must flight, Identity Disorder = multiple ego states;
experience 2 weeks of psychotic sx w/o mood Depersonalization = feelings of self estrangement or
impairment for dx to be made; Antidepressants are 1 st unreality
line tx
Whirndingo
Major Depression
Fear of becoming a cannibal
loss of interest in activities, sleep, wt, concentration,
hopelessness, suicidal ideation, nihilism; Seasonal Amok
affective, Vegetative (non functioning can be terminal)
Dysthymia(chronic low level); Reactive related to sudden unprovoked outburst of wild rage usually ending
environment w/o severity id sx; Masked 1o depression in homicide
denied or hidden by other sx
Coprolalia
Depression & anxiety can occur together & can be
treated w/ an antidepressent; Left anterior or rt posterior Feces & filth
stroke => possibility of depression; Tx: 1st Tricyclic
(Imiprimine); SSRI = side effects; Trazadone=priapism
Koro
Asendin (Amoxipine) = Extrapyramidal Symptoms
penis is shrinking and may disappear
BiPolar
Latah
Bimodal peak 20's & 30'sCycling mood= highs w/
euphoria, hyperactive, pressured speech, flight of ideas, imitate words or actions to which they are exposed
decr need for sleep, delusions, inflated self esteem,
risks, poor judgement; Lows are major depressive Piblotko
episodes tx: lithium
Run around in snow naked
Panic Attacks
White Out Syndrome
Sudden, unprovoked onset of fear, impending doom,
palpitations, SOB, chest pain, smothering, dizziness. lack of diverse stimuli in snow clad environment
May be associated w/ agoraphobia Tx: with SSRI's
Narcolepsy
Phobias
REM sleep, sudden onset of daytime sleep and
Persistent and irrational fear of a specific object or cataplexy; REM sleep is inappropriately present at
activity or situation. Tx like a phobia beginning
POISONING & ACCIDENTS <10 yrs old, fall on outstretched hand w/ elbow in full
extension; Compression or radial or median nerve or
Burns brachial artery; Improper care => Volkman's Ischemic
Contracture
1st= only epidermis, red no blister; 2nd = hyperemic,
blister; partial thickness; 3rd = full thickness, leathery no Pelvic Fx
pain; 4th = electrical injuries, damage to nerves & bone;
entry & exit burn; Fluid resc. If > 20% Parkland formula = MVA, 30% blood volume can be lost; Tx as if shock
3-4 ml/kg LR x % burn RULE of 9's: head = 9; ant trunk= victim
18 post trunk = 18, each ext = 9; each ext = 18,
Perineum = 1 Tibial Fx
Black Widow: Vomiting, abd pain, shock; Tx Calcium 10 Biliary Cirrhosis = Anti mitochondrial antibody
gluconate & methocarbamol; Local bite Tx not needed
Wilson's Disease = Ceroluplasmin Antibody
Brown Recluse: bite becomes black scab w/ assoc fever,
rash, vomiting & jaundice; DIC can occur; Tx: Liver = Alpha 1 antitrypsin
Dexamethasone, dapsone, colchcine & total excision of
lesion Thyroid - Antimicrosomal antibody, Thyroglobin antibody
Hemorrhage, Burns, Vomiting, Diarrhea; pale skin, JVD, Prevalence # cases at a given time / total pop at that
vasc resistance, pulse Tx: rehydrate, transfusions, time
Cardiogenic Shock
Relative Risk Only from cohort study; a/a+b divided by
Pale skin, flat neck veins, pulse, vascular resistance; Tx: c/c+d; >1 positive assoc, < 1 negative association, =1 no
medication for underlying problem, pacemaker, association ==> disease if exposed /disease if not
exposed
Neurogenic Shock
Spinal cord injuries, drug OD; Pink skin, flat neck veins, Odds Ratio Only from case control; odds of getting if
normal => low pulse, low vascular resistance Tx: exposed / odds of getting if not exposed (ad/bc)
ventilation, fluids, drainage
PUBLIC HEALTH
Mortality Rate # people that die w/ in current population
Levels of Prevention: 1o = actions to incidence of
health problems (prenatal care, immunizations) Std Mortality Rate Adjusted according to age
distribution
2o = interventions at early stage of disease to limit
development (DM screen, PAP)
Attributable Risk exposed rate - unexposed rate
o
3 = interventions to treat problem and prevent further
morbidity & mortality
Sensitivity a/a+c; accurate diagnose ; False +
Sjogrens -SSA Anti Ro, Anti LA 1. Side bending then rotation in neutral position
Prostate = PSA, Pancreatic = CA 19-9,Ovarian=CA125; 2. Flexion or extension with rotation then side bending
Breast = CA15-3 & CA27-29
3. Motion free in one direction is restricted in the other Absolute = Weak bony structure, spinal cord, nerve
compressions, Danger of vascular damage;
Ribs
Relative: lax ligament, acute inflammation, pregnancy,
1-5 pump handle, 6-10 bucket handle, 11-12 caliper; Calcification of aorta, Recent MI, spondylosis, Ankylosin
Elevated = expiration restricted Treat lower ribs 1 st; Spondylitis, Osteoporosis, Chronic Steroid use, Acute
Depressed = inhalation restriction, treat upper ribs 1 st disk disease, Extreme scoliosis, Cauda Equina
Syndrome, Adv. Degenerative disease, Severe DM, Hx
or current malignancy, Agenesis Odontoid process,
Flexion Test
Vertigo
Standing = ilia sacral; Seated = sacroiliac; false neg =
Counter Strain
tight hamstrings on standing flexion; False positive =
tight quads on standing flexion
Passive Indirect
Sympathetic Innervations
Put joint into position of greatest comfort; Agonist-
Antagonist pair; Strain due to rapid stretching followed
Head & Neck = T1-4; Lung T2-5 bilat; Heart T2-5 Left,
by protective immediate shortening of agonist along with
Stomach T5-9 Left; Duodenum T10 rt; Gall Bladder T9 rt;
rapid shortening then lengthening of antagonist
Liver T5-9 Rt, Pancreas T6-9 bilat, Kidneys, Ovaries,
Testes T10-L1 of respective side; Adrenals T10-11,
Appendix T11-12 Rt, Bladder L3-4, Uterus L4-5, Rectum Most comfort of pt (70%) Hold for 90 sec (120 secs for
& Anus L4-5 ribs) Reactions to Tx: generalized soreness, treat no
more than 6 TP at a time, 3 days between Tx;
Parasympathetic Innervations
Muscle Energy
Eyes=CN III; Nasal sinuses, Eustachian Tube=CN VII;
Soft Palate, Salivary Glands=CN IX; Thyroid thru Active then passive, direct
Transverse Colon=CN X (Vagus); Right Colon & Pelvis=
Pelvic Splanchnic Nerves S2-4 Type I = Joint mobilization using direct muscle force
Direct, Passive
Superior transverse axis, Located at S2, Only area of
anterior convergence & posterior divergence of the SI
joint
Coordination of motion
Strain Patterns
Naming Convention
Type of Motion