Notes

Congenital Defects

Abdominal Abnormalities Diaphragm Hernia Presentation Respiratory distress Bowel sounds heard in chest Air fluid level on CXR Types Morgagni → retrosternal/parasternal defect Bochdalek → posterolateral defect (most common) More common on the Left side Omphalocele Failure of GI tract retraction at 10-12w Highly associated with Edwards syndrome (trisomy 18) Diagnosis Intestines...

Neonatal Jaundice

Jaundice Prehepatic Hemolysis Hemorrhage ↑ Enterohepatic corculation Breastfeeding jaundice → <7d → Poor feeding → Feed more Breast milk jaundice → >7d → No gut bacteria → Feed formula Pyloric stenosis Intrahepatic Uptake Craigler-Najjar Gilbert Physiologic jaundice Secretion Dubin-Johnson Rotor Hepatitis Posthepatic Billiary atresia Sepsis Metabolic Gallstone Cancer Pathologic...

Neonatal ICU

Respiratory Distress Syndrome (RDS) Hyaline Membrane Disease Etiology Preterm Surfactant deficiency Presentation First 48-72h RR >60 Progressive hypoxemia Cyanosis Nasal flaring Intercostal retraction Expiratory grunting Diagnosis Clinical Rule out infection CXR Ground-glass Air bronchogram No focal opacity Treatment CPAP or intubation Artificial surfactant → ↓ Mortality Prevention Corticosteroid to...

Peds – Ophthalmology

Amblyopia → Cortical blindness Causes Strabismus Congenital cataract Strabismus → Lazy eye Patch good eye Congenital cataracts Genetic TORCH Galactosemia Retinoblastoma Rb gene White reflex Surgery NO radiation Later → Osteosarcoma Retinopathy of prematurity High O2 to neonates Laser ablation Ophthalmia Neonatorum Day 1 → Chemical (Silver nitrate) 2-7d → Gonorrhea Bilateral Eyelid edema Purulent discharge Ceftriaxone...

Behçet Syndrome

Etiology Asian Middle Eastern Presentation Painful ulcers Oral Genital Ocular lesion Uveitis Blindness Erythema nodosum-like skin lesion Arthritis CNS lesions (mimics MS) Pathergy → Sterile skin pustules from minor trauma or needle stick Diagnosis Clinical No characteristic lab Treatment Corticosteroids To wean off Azathioprine Cyclophosphamide Colchicine Thalidomide

Joint Pain

Obsessive Compulsive Disorder

OCD Treatment Best initial → CBT Adjunct → SSRIs Fluoxetine Paroxetine Sertraline Citalopram Fluvoxamine If all choices TCAs → Clomipramine Behavioral → Exposure and response prevention Hoarding Disorder → Treatment → SSRIs, Behavioral modification, Psychotherapy Body Dysmorphic Disorder → Treatment → SSRIs, Psychotherapy

Impulse Control

Intermittent Explosive Disorder Adults with rage out of proportion Disruptive Mood Dysregulation Disorder In kids <18y A kind of moor disorder with frequent outbursts and such Pyromania Urge to put stuff on fire Kleptomania Urge to shoplift and such

Coma

Vertigo

Menier’s Disease Etiology Unknown Presentation Hearing loss Tinnitus Vertigo 30m-1h episodes Diagnosis Clinical Treatment Salt restriction HCTZ Meclizine Betahistine

Jaundice

Jaundice Pre-Hepatic → Isolated ↑Bilirubin Unconjugated ↑ Production Hemolysis Hemorrhage ↑ Enterohepatic circulation Breastfeeding J. → <7d → Poor feeding → Feed more Breast milk J. → >7d → No gut bacteria → Feed formula Pyloric stenosis Intra-Hepatic → Isolated ↑Bilirubin Unconjugated Uptake/Conjugation defect Physiologic J. Gilbert → Stress → Phenobarbital Craigler-Najjar Type 1...

Cirrhosis Complications

Cirrhosis → Chronic liver injury ⇒ Bridging fibrosis + Nodular regeneration Presentations and Treatments ↓Albumin Edema Coagulopathy (Except factor 8) FFP/Platelet → In bleeding Vitamin K is WRONG! Ammonia increase Asterixis → Liver flap Hepatic Encephalopathy Lactulose Rifaximin Estrogen metabolism problems Gynecomastia Spider angiomata Palmar erythema Portal hypertension ↓PLT → Splenic sequestration Ascites SAAG >1.1...