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(short cervix)preterm management- 18 months nL development (also compare

fibronectin at 22-34 weeks- a with 2 years)
negative test means undelivered for
1st line tt of bipolar dz
the next two weeks,(preterm less than
34-betamethasone &tocolytic) running,
kicking,
recurrent illness
scribbling,
Antibiotics if GBS is suspected cause pretend play.
of the preterm labor walk or run independently

ABI (less than or equal to 0.9 is dx) more sN

2-4 weeks after GAS pharyngitis is ARF
than arterial usg for PAD (abd aortic usg -65-
1st trim - next step otherwise very III is JIA
75yrs)

1st trimester preg check STD only in pink macular rash - JIA
ABPI-->non-invasive test
high risk pt reddish brown rash - ARF (pharyngitis &
symp pt
migratory , not in JIA)
preferred for dx in most cases

AIP=brief psychotic dzder+neurosx

neuropathies (vs Wilson-depression)
ACA stroke AIS vs Muellerian agenesis (axillary,pubic
hair + in MA)
acute abd pain
post-communicating artery - 3rd N
new onset
palsy MIF from testes-pri amenorrhea
neuropsych sx
"acute sx -episodic"-->days to weeks

AOM (buldging TM) vs otitis media with APLA- during preg dont give warfarin
ALL effusion (retracted TM) (without preg give warfarin)

>25 % blasts confirms dx AOM complication- facial N palsy & APLA- aPTT is inc + thrombocytopenia (vW
mastoiditis also has inc aPTT & inc BT)

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APML- DIC - epistaxis &
ecchymosis- DIC has inc
PT,aPTT,Hypofibrinogenemia
more than one cytopenias
ASD-amnesia of event,detachment
(vs dissociative amnesia-amnesia
extends beyond the time of
immediate trauma)
avoidance-panic dz and asd
hyperarousal in asd
AUB-immature HPO- Eg is high -
hence Pg withdrawl bleed- irregular
cycles - hence insuff fsh & lh still Eg
is high, high lh and Ag are char of
PCOS
Adolescents- irregular & anovulatory
dt HPO immaturity & insuff
secretion of GnRH
Pg withdrawl is bleed present in
Adolescent irreg cycle with HPO
axis immaturity
Absence seizures (vs ADHD are
responsive to tactile or verbal
stimuli)
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ARP (AR & ARR are same, RR-cohort- risk
ASA syndrome=spinal infarction vs(only
factor + or -, hence interpretration is risk
ischemic stroke- rt carotid atherosclerosis)
factor have __times more dz than without
rf)
Spinal infarction - flaccid paralysis (initially)
dt spinal shock later UMN signs
ARP - Absolute risk percent
AUB (MC endom thick)-endome biopsy in
AUB in young female next step,
young also if endom is thick dt obesity &
hemdynamically unstable pt use D&C with
PCOS), COC or POP after biopsy (once ca
packed RBC transfusion
or hyperplasia is ro)
AUB - high dose of OCPs to stabilize the
>45 or <45 years both require endo biopsy -
endometrium & stop the acute bleeding
obesity, chr anovulation
Abestosis 1
Abruptio placenta
Early inspiratory and expiratory crackles are
painful bleed
the hallmark of chronic bronchitis. Late
3rd trimester
inspiratory crackles may mean pneumonia,
tender uterus
CHF, or atelectasis.
Actinic keratosis vs (Seborrheic Keratosis( Acute HIV-similar sx as Whipple's & IBD
StucK on)) vs Seborrheic dermatitis(scaly (arthralgia with bloating and diarrhea and
oil skin, erythematous rash like rosacea) flatulence),HIV also has night
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Absence seizures- automatisms & scaly papules or plaques: sweats.Colnscopy with biopsy is invas hence
impairment of consciousness face test HIV 1st. Whiple, IBD later age
Focal seizures- automatisms & neck
impairment of consciousness hands
preserved postural tone
ethosux

Acute airway obstruction-ebv Adenomyosis

peritonsillar, retrophar- ul pharyngeal Adolescents menarche- immature HPO axis
wall swelling & less than 4 years
CPP
dysmenorrhea tt of AUB - stable - OCPs.
IM tt is steroid administration heavy menstrual bleeding unstable - D & C & packed RBC transfusion.
severe tonsillar enlargement boggy, globular, tender

African american with gross

hematuria- (think SCDz with renal
Akathisia (walking around in neighborhood-
pap necrosis) - inability to
sign of restlessness) tt-dec not discontinue
concentrate the urine- isosthenuria & All tests negative including bl gr is A -ve
antipsych+BB orBZD+antichl also,only
hyposthenuria next step
akathisia is bb or bzd

sickle cell trait have no change in life blood typing

psychotic pt - worsen clinically
expectancy Ab screeening
antipsychotic dose reduction
UTI
tt with propranolol
painless hematuria
renal medullary cancer

Allergic conjunctivitis (pruritus- Alport's syndrome-bl snhl- Electron me Amniotic fluid embolism- next step -
allergic, bac-purulent, viral-viral alternating areas of thinned & thick cap intubation & mech ventilation-adv mat age &
prodrome (watery mucoid discharge) loops with GBM splitting-aka thin basement high gravida
mem dz

topical therapy- antihistamines or resp failure

mast cell stabilizers- allergen thick bm in mem hypotension (since its a shock)
avoidance thin bm in Alport's DIC
recurrent hematuria
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fam history of renal failure

Amphetamine in preg
Anaphylaxis
Anaphylaxis 1
preterm delivery
preeclampsia
symptoms >1 organ system after exposure
abruptio venom immunotherapy
to offending Ag
FGR
IUD

Anemia of prematurity-phlebotomy-
Androgenic steroids se-angry &
frequent bl sampling-normocytic &
rebellious Anencephaly with PPROM next step (vaginal
normochromic anemia
delivery has lower mortality rates like PE,
infection, hemorrhage)
anabolic
dec EPO, shortened RBC life span, bl loss
hepatic dysfunction
dec Hb, Hct
dyslipidemia Lethal then focus on maternal care
relatively low RC (reticulocyte count not
virilization
RBC count)

Anorexia nervosa - lanugo-

depressed-cold-bmi less than 15-
everyone thinks that the pt is fat- Anti D given still has D antibody titires
body dysmorphic- not depression-tt- ratio 1 to 32 is +,placentl abrupt high risk, Anticoagulation with renal insufficiency-
NG feed maybe alloimm is sensitization DOC

hospitalization for A.Nervosa delivery Heparin acts on thrombin, LMWH acts on Xa

unstable vital signs procedures mainly.
cardiac dysrhythmias placental abruption risk
elec
low body wt

Aortic injury Asplenia PBS shows Atelectasis- cxr shows dense opacity in the
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widened mediastinum- aortic injury
& acute mediastinitis
hemothorax dt aortic injury - bl in
pleural space- flat neck veins
hemothorax - mediastinal shift
Atopic dermatitis -(vs indistinct
margins, older children & adults after
sensitization to allergen)-intense
pruritus
tt of atopic dermatitis
BPD co-occur with bipolar dzrder-
but here its BorderlinePersonalityDz
bcoz no sigecaps and good mood
birefly is dt mood reactivity in BPD
nt bipolar
BWS III to congenital
hypothyroidism without
hemihyperplasia, macrosomia &
hypoglycemia, BWS next step is
USG
Wilm's tumor is aka Nephroblastoma
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lower lung fields-2-5 days
Howell-Jolly bodies - Wright stain ("o"-
nuclear remnants)
Heinz bodies - dye - crystal violet hypocapnia
even in functional asplenia there is Howell- resp alkalosis
Jolly bodies
Atrophic vaginitis (aka vulvovaginal
atrophy) (vs lichen sclerosus affects only
BAT- FAST + for fluid next step (dx perit
vulvar skin & not vagina)
lavage only done if fast shows no fluid)
thin vulvar skin
fluid resus in BAT then FAST
narrowed introitus
dry vaginal canal
BPP-0-4-fetal hypoxia,6-repeat BPP in 24
hrs, 8-10 ro fetal hypoxia and repeat after a
week, vibroacoustic stim 4 fetal sleep
BPPV
Gestational HTN require antepart
vertigo and nystagmus
surveillance for fetal hypoxia --> fetal
compromise
Reactive NST- >2 HR accelerations
Bf failure jaundice-brick red urate crystals-
Bipolar dz (continu Li -lifelong Li-
also seen on diapers (vs Breast milk
psychotherap is an adjunct-nt alone)-if stop-
jaundice-same unconj bil, no signs of
cross taper to valp,quiet,lamotrigine-if nt then
dehydra,no feeding problems)
discontinue Li gradualy
Breastfeeding failure jaundice- "failure" to
dec risk of recurrent mood dz
thrive- hence dehydration
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Blastomycosis Blastomycosis 1 Brain abscess (triad, severe morning or

nocturnal headache)

mississipi -BH BC
sputum wart like is B brain abscess- fever
sarc like is H epidural abscess- no fever

Breastfeeding dec the risk of breast &

ovarian cancer not endometrial cancer
Breast enlargement (in Q they didnt
Broca's area- inferior frontal gyrus vs
mention about milk or colostrum),
Wernicke's area- superior temporal gyrus
vaginal bleed after uter massage is nl dec risk of otitis media
postpartum resp
git apraxia-not able to perform learned
uti movements even though there is physical
Breast fullness, tenderness, warmth
nec capacity- due to involvement of supplemental
without fever
breastfed infants have lower rates of type 1 cortex
Improvement with BFeeding
dm & childhood cancer
absolute infant ci to bf is galactossemia

Bronchial rupture-pneumothorax
persists despite chest tube placement
pneumothorax +pneumomediastinum
= tracheobronchial rupture
Bronchiolitis- Pavilizumab prophylaxis for
Bull's eye rash - Tinea corporis vs (Lymes no
RSV
raised border with pruiritus)
neonates - complications- apnea & rf

C peptide not in exogenous insulin, CAH CDH-cocave abdo, barrel chest, pul htn, pul
only in endogenous insulin hypoplasia, 85% on left, hence absent breath
sounds on left
dehydration
proinsulin high in endogenous insulin salt wasting
and not in sulfonylureas virilization scaphoid abdomen
partial CAH - hirsuitism without virilization ET intubn
BMV ci

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CFTR & pri ciliary dyskinesia ( 2 features

CF (pancreatic insuff+ resp sx) vs
pul cf & genital cf)
Celiac (no resp sx) dont be
confused!! CONS-only fever in Q on 6th post op day
All male pts
fetal genital tract
Growth failure & recurrent resp intravascular devices - CONS
infertility
infections in infants-CFTR
azoospermia
Pancreatic enzyme insuff
pri ciliary dyskinesia- aspermia

CVCatheter-(subclavian,jugular,azygous-
venous perforatn,pneumothorax,myocardial
perforn,pericard tamponade) not echo
(expert),skip xray if first insertion,no Caustic ingestion management- endoscopy
resistance within 24 hr (early- not seen anything, late-
CPN or L5 radiculopahty lesion
inc risk of perforation)

s.c
pt raises leg well above the ground
jug ABC--> Upper GI endoscopy to evaluate
azygous perforation extent of injury
p.thorax
myo perforation
per tmapnade

Celiac dz- MCV is low means Fe def

anemia- extensor rash- immune Cephalohematoma (vs Caput Succdaneum- Chylothorax-direct leakage of lymphatic
mediated gluten sN-destrucn of Crosses Sutures just like Subdural fluid (chyle) into the pl cavity
villous in sm bowel- Fe def hematoma)

chyle into pl cavity- lymphatic fluid (chyle)

type 1 dm subperiosteal hemorrhage Exudative effusion
dermatitis herpetiformis

Colic (vs Intussusception has nL Condyloma accuminata Confounding

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appetite, crying episodic,3-36 mnths

of age) verrucous papilliform lesions crude & adjusted measures of association.
confounding - bias - exposure- dz is mixed dt
confounders
first few weeks of life
soothing & feeding techniques
reviewed
emotionally supported & reassured

Congenital torticollis
Conjg. bilirubinemia with normal Conjunctivitis cause - time of onset
postural neck deformitiy atl,ast,alp= rotor's or DJ syndrome
SCM mass
tt is im ceftrixone
IL head tilt
CL chin deviation

Croup with resp failure- next step is not et

Contraception of choice while intubn with mech ventilation
Craniopharyngiomas- calcified seen like
breastfeeding-lactational
bone
amenorrhoea doesnt provide enough
contraceptn barky cough
inspiratory stridor
suprasellar region
stridor @ rest
DI
Pg IUD- thickenig mucus & corticosteroids (to reduce the subglottic
GH def
impairing implantaion edema) & nebulized epinephrine (
bronchodilation)

D2 antag causing EPS- drug induced

Cushing's syndrome- headache dt parkinsonism-recurrent fallsmuscle DA pathways (mesolimbic (efficacy of
hypertension-facial plethora and stiffness,symmetric tremors in both antipsychotics)) & nigrostriatal (EPS-
bruises hands,fine tapping is slow & irreg akathisia etc)

recurrent falls dt drug induced pL --> tubuloinfundibular pathway

parkinsonism- dt autonomic instabillity

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DM polyneuropathy- hammer toes due to

DDH-next step DM-1 (new house or boy only enruesis not
weak intrinsic muscle weakness
polyuria & polydipsia)(DI-not in children-
lots of urine & thirst)
hip USG
Small fiber- pain-stt
asymm gluteal/thigh/inguinal creases
large fiber- vib and propriop, reflex- dorsal
limb length discrepancy toddlers
column

Dec wet diapers + fever = UTI (diapers no

clean catch hence cath) (IVP gold std- but
DMD-2-5 yrs- confirmation is not muscle
DMD- death dt resp or heart failure radiation hence ivp is no longer used, hence
bipsy-thigh atrophy,walk on toes,calf
use CT)-first uti then think about pu-valve
hypertrophy, gower's+(dystrophin on xp21)
dystrophin (xp21)
UTI confirm first then renal & bladder usg to
ro anatomic causes of recurrent UTI

DiamondBlackfenSyndrome- low Diaphragmatic rupture- no clue with cf- Down's syndrome

reticulocyte count,triphala next step is chest & abd CT
thumb,webbed neck vs Fanconis
anemia-absent thumb with horse shoe Quadruple- Estriol
kidney, skin (cafe au lait) diaphragmatic rupture- lower lobe opacity trisomy 18- normal inh A rest all are
delayed presentation decreased
CT confirm the dx OTDs- elecvated MSAFP rest all are NL

EPBI (gross hematuria+urinary injury), signs

ECT-depressn wid psych(preg, imminent of chemical peritonitis- in IPBI,urethral
suicide,not eating or dirnking)-nt MAO-I as injury if foleys resistance +bl @ urethra+
Dual antiplatelet therapy (for they take 6-8 wks to work-only aud hallucin high prostate
cardiovascular death and not stroke) still psychosis +depression

struct involved in EPBI- pelvic fracture-

major dep wid psych - severely depressed signs of peritonitis not present
geriatric pt signs of chemical peritonitis (diffuse abd
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EPS- risperidone (serotonin, D2
antag) (vs bupropion (NE & DA
reuptake inhi))
serotonin binding reduces EPS
Em contraception- ulipristal is anti
progestin rest all LNG etc are
progestin
Nulliparous women
Adolescents
Endometriosis (uterus adherent to
one side and peak of pain just b4
menses)
CPP syndrome in Men is aka Chr
Prostatitis
Eso coins- asym- CXR chek the
whether trachea or eso (lat x ray eso-
straight line, trachea body- lat x -
round)
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Ectopic preg- vaginal spotting, no relation
of constipn, PID - vaginal discharge - if Edward syndrome - heart defect (rubella-pda,
resolved then dont think reinfection or tga & ta - DiGeorge)
incomplte tt & all
Edward- micrognathia, m/ecephaly, rocker
ectopic preg even if the pt had recent bottom feet, overlapping fingers & absent
menses & no ho amenorrhea palmar creases - VSD
ho std
EmOC- Misoprostol - medical abortion- not
in prevention of preg,LNG & ulipristal are
Endometrial ca-obesity is the most significant
more effective than COC for EMoC
risk factor
LNG (Plan B)
MC gyne malig is Endo Ca
Ulipristal
both EMoC- prevent pregnancy by delaying
ovulation
Epidural anesthesia-leakage of csfpostural
headache-worse with sittng improve with
Erythema toxicum neonatorum
lying but not hypotension(iv,vasopres,left
lat pos) in post headache
b9 neonatal rash with blanching
erythematous papules &/or pustules
in general sym causes alpha 1
resolves spontaneously within 2 wks after
vasconstriction (dont think B2)
birth
Hence its blockade causes vasodiln
bl redistribution to LE & venous pooling
Exclusive breastfed preterm infant next step FGR causes
adequate iron stores
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coin can be observed in esophagus
but not batteries bcoz coins dont have
sharp edges unlike batteries
FGR causes- anueploidy
(chromosomal abN- abN chrom
number in a cell (45,47))-asym- head
sparing
hypertension causes placental insuff
Fe def anemia labs, Thalassemia has
opp labs for both Alpha & beta thal
Thal minor has everything else
Normal like RBC count, RC count
(not elevated), Hb and all
Fibroadenoma (less than 35 years)
reexamine after the menstrual period
- dec in size or tenderness
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anemia for first 4-6 hrs
FH tracing- symmetric with contraction
(early)-head compressn,normal, (late) dec-
not sym-uteropla insuff, (variable) or if
symm - narrow-oligohyd,cord pro,
compressn
Fe poisoning
hematemesis
shock
meta acidosis
Desferoxamine / CN binds to Ferric iron
First febrile UTI next step
1-2 wk of antibiotics
renal & bladder usg abN to ro if there can
be a cause for recurrent UTI
neonate- voiding cystourethrogram
abN usg- neonate
Asymm (more alphabet, hence more
trimester, hence not congenital (bcoz they are
in first trimester), hence maternal or placental
causes)
abd growth >> head growth (Asymm)
Fall then hemiparesis with CT or MRI nL
then its Todd palsy not hemorrhage or stroke
(TIA or MS (days to weeks))
Fe poisoning (vs aspirin poisoning acute-
tinnitus,fever,hyperpnea (resp alkalosis), met
acidosis, not radioopaque,hence not seen on x
ray)
only mod to severe --> chelation therapy
Focal seizures-not provoked by
hyperventilatn,absence seizures-provoked by
hyperventiln,ADHD respond to verbal or
tactile stimuln
Focal seizures abN neuronal discharges in a
single hemisphere- motor, sensory,
autonomic.
Impaired consciouness & automatisms
(chewing) present
Automatism in focal & absence seizures
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Foreign body next step Fragile X syndrome- CGG- behavioral &
intellectual disability
focal findings on PE
CXR- radiolucent objects Macroorchidism - Fragile X
ho choking Testicular atrophy - Myotonic dystrophy
immediate bronchoscopy speech & motor delays
prominent jaw
large ears
macroorchidism
Friedreich ataxia- ataxia is main-next step-T
wave inversion dt to FA not MI- AR (vs
Charcot neuropathy main-hereditary sensory
& motor neuropathy-AD- MRI shows
spinocerebellar degeneration)
prenatal diagnosis for parents with one
affected child

GAD dx

GAD- more than or equal to 3 of sx GAD tt (bupropion is a nonserotonergic

GBS - ascd polyneuropathy - GI or Resp
for 6 mnths antidepressant vs buspirone - used for
infection
muscle tension GAD)
impaired sleep
restlessness sensory & autonomic nerves - not motor
BZD- non depressed pt without ho
fatigue nerves
substance abuse
poor concentration
irritability
muscle tension

GBS - spirometry - PEF is less

accurate than FVC GDM (screen at 24-28 wks), insulin &
GBS screening glyburide & metformin (nt ppars)-insulin
doesnt cross placenta
Resp & bulbar muscles involved in
GBS & MG vaginal & rectal culture
FVC- best means for monitoring resp euglycemia
function

GDM-shoulder dystocia-Klumpk's Galactorrhea (not antacids) can be any Galactosemia- Gal-1-Puridyl transferase-
palsy III to lower trunk-Anisocoria color. next step E.coli sepsis- (vs Galactokinase def only has
(unequal pupil) cataracts)

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MRI brain
Preg test bl cataracts
sr PL jaundice
sr TSH hypoglycemia
failure to thrive

Gastroesophageal reflux in infants is

nL (prone sleep- reduces GER in Grave's dz tt ci
Glioblastoma Multiforme
infants but causes SIDS)-abd usg for
pyloric stenosis
se of RAI can be minimized by gluco and
Check CT/MRI
antithyroid drugs
usg- pyloric stenosis 

HCM - dual carotid upstroke - strong apical HELLP syndrome

impulse
Grave's dz tt in addition to Beta
blocker therapy Preeclampsia
inc afterload-->inc LV cavity size-- RUQ pain
>decrease outflow obstruction-->decreasing Abd pain dt liver swelling with distension of
the intensity of murmur hepatic (Glisson's capsule)

HHS- urine ketone positive in trace-

HIV dem(altho CD4 in q is 220,bt
dt steroid (not mentioned in Q) for
noncompliant wid med){vas demen-stroke-
Polym Rheum HIV asso diarrhea
suden)-Alzhei-only memry los}macrophag-
genrl slow movement jerky
interruption of insulin both clos diarrhea are watery & non bloody
injury
subcortical
acute illness

HIV dementia-diffuse (symmetric) HIV- cryptococcal- inc ICP - papilledema HRT- no longer recommended for h ADOC,
inc white matter (vs PML-focal - MRI is normal- HSV-1- personality CAD is ci for hrt hence give ssri
with hiv-motor (ataxia+vision abnL)- changes, cognitive,focal neuro (nonhormonal in such patients)
asymm) deficit,seizure
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decline in multiple cognitive domains
mood & behavior disturbances
HSP (think Ig A nephropathy-
nephritic syndrome-hematuria)
palpable purpura on LE
arthralgia/arthritis
abd pain
renal dz
HUS- triad of anemia, lw platlts,
renal injury ( also renal injury after
diarrhea )
bl diarrhea E coli or Shigella
Hepatic laceration-persistent
hypotension- 8th & 9th rib fracture,
seat belt sign- ecchymosis in seat belt
pattern
free intraperitoneal fluid
RUQ pain
Bruising
Rt shoulder pain
Hidraadenitis suppurativa-
intertriginous- two skin area may
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HSV-1 and Toxo- focal neurological deficit <60 yr undergone menopause in last 10 years
HUS- diarrhea, anuria,inc creatinine, inc bun,
anemia,edema,blood in stools after food.-
HSP- non blanching rash over back & legs
Hamburger- HUS
(Mem- thickening, Alport- thin BM)
shiga toxin
HEMATURIA>>proteinuria
E.coli strain
acute kidney injury
Hemorrhagic transformation of ischemic
Hep C (no need of barrier protectn as
stroke (even though not tt with
sex&vertical transmssn is low),hepA&B
fibrinolytics)-noncontrst-CT-screening,
killed vacc
MRI-better
any chr liver dz- hep A & B vaccine, alc
emer noncontrast CT scan of head even if it
avoidance, PSV23
was done before
Hereditary spherocytosis - Coomb's
negative
Hereditary spherocytosis 1
increased RBC membrane fragility (not
Hyperbilirubinemia
decreased)
esoin-5 maleimidie binding & acidified
confirmatory test:
glycerol lysis test for HS
acidified glycerol lysis
eosin-5-maleimide binding test
Howell Jolly bodies - wright stain, Heinz Human milk protein
bodies- dye crystal violet
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touch or rub- digits, axilla, breats,

perianal Howell-Jolly bodies - "o" like nuclear Human milk for term infants
remnants preterm - Fe is required

fluctuant nodules with subcutaneous

fibrosis

Hydrocephalus- buldging anterior

fontanelle-inc head circum- widely
spaced sutures-prominent scalp veins
vs LP- meningitis &NPH
LP is not a ci to papilledema unless
obstuctive/non communicating
hydrocephalus & mass lesion.
CT brain
Hyperemesis gravidarum not hCG-diff from
typical nv by ketonuria-persistent dt molar
Hypovolemia (check low BP **or** dry
preg,multiple gestn,ho HV-protnruia -
mucus membrane) - in gallstone pancreatitis
preeclampsia
dt vomitting & 3rd space fluid
electrolyte abnormalities
ketonuria

IHPS- 3-5wks, projectile nonbil

vomiting-elongated & thickened
IM (many variant forms of lymphocyte with INH liver tox.
pylorus
vacuolated cytoplasm and convoluted
nuclei) vs ALL in children vs Hodgkin's
cytoplasm (RS cells) inh presents like viral hepatitis-fever,
iv rehydration & normalization of
malaise, icterus, mononuclear hepatic
electrolytes prior to pylorotomy to
necrosis
dec post-op apnea
IHPS- thickened pylorus

ITP tt
viral infection- petechiae, isolated
thrombocytopenia - HCV & HIV
both have initial manifestation
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IVH-head USG- ventricles enlarged & filled
with blood- maternal steroids is the tt less
than 30 weeks gestation- rapidly increasing
head circum & buldgin fontanelle
IVH-transfontanel USG shows germinal
matrix, lat ventricles, brain parenchyma-
although pt had tachycardia
IVH- premature infants & LBW infants
hypotension
seizures
focal neurologic signs
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buldging or tense fontanel

apnea
bradycardia

arachnoid villi - communicating

hydrocephalus
Obstruction in CSF flow @ aquedcut of
sylvius or fourth ventricular outlet

Infant botulism (honey, new construction

Ileus - non propulsive activity -
site, dust)
paralysis or obstruction or
pseudoobstruction
ingestion of spores
colonize the gut Infant- Fe def anemia- Cow milk has low Fe
causes: abd surg - retroper hemo / hence Fe def anemia
production of neurotoxin- descend flaccid
abd hemo or inflammn, intestinal
paralysis
ische & elec abNL (recent
bulbar palsy- dysphagia , dysarthria
surg,medicn,metabolic) dec RBC count in Fe def anemia
LIFE THREATENING !!
obstipation
constipation, hypotonia
abd distension
Human-derived botulism immune globulin
hypoactive bowel sounds
is tt
LARGE BOWEL DILn is charac
Antitoxin is tt not cholinergic drugs!!!

Infrarenal aortic repair with bloody Int validity-bias-systematic error(not Intus- a mass- (legs up- with pain- air or ns
diarrhea-IMA-rectosigmoid juncn selection bias), selection bias (think of enema is dx & tt or else surg)- Peyer's patch
ischemia external validity- Generalizability), MC than Meckel divert
reliability & reproducibility - random error

IMA - rect sigm junction - bloody episodic pain

diarrhea emesis
lethargy
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bowel ischemia & infarction - early currant jelly stools

complications of abd aorta eg AAA
repair

Intussuception-next step- usg more

imp than enema (air or saline
Juvenile idiopathic arthritis III to B19
enema)- painful hematochezia-
arthritis but not mentions about PIP or MCP
enema- peritonitis & perforation Jejunal atresia
hence not preferred
inc infl markers,
gasless colon
Acute phase reactants
emesis
anemia
rapid dx & tt with US guided air
contrast enema

Kartagener syndrome
Kawasaki complication LEMS

Normal growth vs ( CF- failure to

thrive dt pancreatic insuff, vit ADEK Bechet's also has thrombosis risk depressed deep tendon reflexes+symmetric
def)

Laryngomalacia - positional- also during

Langerhans cell histiocytosis- mild tummy time
hypercalcemia
Lateral MeduLLary infarct (WaLLenburg
Laryngomalacia - inspiratory stridor syndrome)
solitary, painful lytic long bone worSens in Supine position & imProve with
lesion Prone position
swelling Direct laryngoscopy - collapse of
hypercalcemia supraglottic structure during inspiration
Resolve spontaneously by 18 months of age

Legionnaire's dz 1-hypoNa and Leriche dz-hip & thigh pain can also be in Lesch Nyhan syndrome-urate crystals on
cruise osteoarthritis diaper- Bfeeding failure also has urate
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crystals
bl hip, thigh, buttock pain
symmetric atrophy dt chr ischemia
neurologic abN- MR, dystonia,
choreoathetosis, spasiticity

Lichen sclerosis next step

Lisch nodules - picture- dx
Levo-caribdopa combination se
Lichen sclerosus : pruritus, white atrophic
plaques involv vulva-perianal skin but not Neurofibromas (peripheral nerve sheath
HDHA
vagina tumors) - NF 1
Punch biopsy- ro vulvar Sq CC

Lyme vs sarcoidosis - both cause AV block,

Lyme arthritis
Lithium pregnancy se skin changes - sarcoidosis has more pul (also
hilar LAD) and skin symptoms than AV
knee block-pulse low
goiter
inflam synovial fluid
transient neonatal NM dysfunction
G stain & culutre - ve
dont think the type of AV block

MC SOLID (otherwise 2nd after leukemia)

MC risk factor for suicide or homicide
tumor not ac to sx- sx were III to
Lymes tt in children (Amox. bcoz
meningioma
Doxy CI), Doxy tt both anaplamosis
and lymes together, hence preferred. completing suicide- access to firearms
violent
Leukemia
subs abuse
CNS tumors
high levels of impulsivity
Solid tumors

MCD MDMA with SSRI or Li- MG (GBS only after Resp or GI infection
SS(inckinesia,clonus,inc reflex)(vs MH- and not UTI)
rapid,trismus,anesthetic)(NMS-long
preadolescent - MCD

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adolescent - MGN (MC) then FSGS onset,absent NM symtoms,Park sx,D2

(but check for the risk factors) antag)
renal biopsy --> kindey architecture
pt <10 yrs
steroids are tt of choice HTN
tachycardia
hyperthermia
serotonin syndrome
hypoNa (SIADH?)

Malingering-feigned or grossly exacerbated

findings
MLF-INO MTC

intentional production
MLF - UL vs BL screen for pheo prior to thyroidectomy physical or psych sx for sec gain
pt is reluctant to be examined or treated
discrepancy bw sx & objective findings

Mec ileus-enema(x ray)-me-colon-tt & dx- Medial meniscus tear

abd distensn, Hirs dz-constipn--both hve bil
emesis. chek forum. not ct dt expousre-
Measles twisting injuries with foot fixed
altho low bp stil nt surg
red extension
sensn of instability
fever-->3-5 days-->rash (reddish-
x ray for neonatal bil emesis effusion
brown)
Contrast studies in stable pt to determine the palpable locking or catching when jt is
level of obstruction- meconium ileus @ extended under load
ileum vs HD - @ rectosigmoid junction MRI or arthroscopy

Medicn indce psychosis-cogn nL-dt Medulloblastoma- vermis- truncl ataxia vs Meniscal tear- unable to extend the knee-
steroid- not given in Qasthama Pilo astrocytoma- tremor- cerebellar sense of catching in the knee-intermittent
exacen(vs medicn delirium-cogn dec- hemisphere pain- swelling several days after pain
attentn-disorientatn-antichl nt 4
asthama exacerbation)
gait ataxia intermittent pain
inc icp swelling after pain
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reduced range of motion

surgery in younger pt to relieve pain &
reduce the risk of further joint injury

Methemoglobinemia-doesnt imprve
with O2
Migraine tt ( visual aura- dark spots in front
Milk (calcium) alkali (bicarb) syndrome with
dapsone of eyes before the headache)- Migraine with
calcium carbonate
nitrites aura
local/topical anesthetics=numbing
cream AKI
triptans only if nsaids are not sufficient
O2-->1. Air-->2. Alveoli-->3.
dissolved-->4. saturation (also 5.
Hb)

Myotonic dystrophy- AD (all dystrophy are

AD (including Myotonic) except Duchenne
Mod to severe Dehydration tt & Becker)- temporal wasting - ptosis-
(sunken eyes,inability to eat or dysphagia- aspirn pneumonia
drink,dry mucus, delyaed crt (2- Molluscum contagiosum
3sec), dec urine outpt), not dextrose
but normal saline, mild dehyd with delayed muscle relaxation/reflexes-
oral rest of dehydration types are tt minor and self limited hypothyroidism (chr alco)
with iv HIV delayed muscle relaxation is myotonic
facial weakness
foot drop
dyspahgia
cardiac conductn abnL

NEC-oral feed-pneum intestnals-gas NF 1 NF 1 (cafe au lait- hyperpigmented macules)

into damage bowel wall-malrotatn
with midgut vol- gasless abdo,
intussception rare in neonate Neurofibroma = peripheral nerve sheath Neurocutaneous syndromes- neuro + skin
tumors tumors or symptoms
macrocephaly neurologic sx (chr headache, vision changes,
intussusception is rare in neonate feeding problems early morning vomiting)
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NEC is common short stature

NEC: hypotension; cong heart dz, learning disabilities
formula feeds or Cows milk than fibroma, neurofibroma, different tumors
human milk

NMS-tt is dantrolene or amantadine or

NF-esotropia- crossed eye movement bromocriptine-NMS-generalized rigidity
NMS-phenelzine - 2 wk washout prevents
hence nt able to move-cyproheptadine tt
the ss
serotonin syndrome
Esotropia is a form of strabismus in
which one or both eyes turns
long acting - diazepam & fluoxetine
inward.-crossed eye movement. don't improve with antipsychotic & intensive
supportive care 

Narcissistic personality disorder-also

grandiosity (q- doctor best - splitting query-
NPV Naltrexone (vs acamprosate (glutamate
splitting in borderline p dz but it also has self
modulator)) (vs Disulfiram (2nd line after
harm)-
Naltrex or acmapro) only in abstinent pt not
NPV - pretest probability & in active drinking pt))
prevalence
inc sense of self-importance
low probability of having a dz will
admiration
have high NPV opiod free pt without significant liver dz
entitlement
lack of empathy

Nasopharyngeal ca
Neimann-Pick dz (vs Tay Sach- areflexia &
Asia (south China) HSM absent in TS but both are present in
NP) Nephrotic syndrome- Hep B- dx
Africa
Middle East
Epistaxis, headaches, CN palsies, areflexia in syringomyelia & neimann-pick active hep B is a risk factor for MGN
Otitis media
dz 
cervical lymph node spread is
common

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Newborn with signs of puberty- Nocardia acid fast rods can cause upper Non-productive cough still TB-
bloody discharge of vagina, labia is cavitatry pul dz. (also apsergillus bt incarceration(imprisonment)- mycoplasma
swollen aspergillus is not acid fast) actinomyces- limited to 2-3 weeks. CXR Miliary TB vs
bacteria interstitial pneum non productive cough in
both
leukorrhea- whitish from vagina
physiological responses to
transplacental maternal Eg exposure
No work up indicated

OCPD-perfection-ego syntonic comfy with

OCD tt-not ssri with antipsychotics etc,only
ssri (vs dialectical behav therapy for bor per
OCD tt
dz=cognition + mindfulness & distress
tolerance)
SSRI
CBT
exposure & response prevention based
psychotherapy is for OCD not phobia
behavior bt anxiety about results & not finish
task but comfy with behav (vs OCD not
comfy wid behavior)
OCD not comfy with act
OCPD comfy with act (if not comfy then it
will be with somehting else)
Lack of true obsessions & compulsions

OE ( swimmer's ear) OHurea- inc fetal Hb more than 15%,

OH urea se- chemoman although sickle Hb is more than 80% (in scdz
not trait) but there is no sickling& zero
pain, erythema, edema, discharge HbA2- dt ohurea
children & adolescents OH urea is used in PV (especially when
Loss of cerumen dt swimming or there is increased risk of thrombosis)
excessive ear cleaning increases the OH urea is used especially when there is inc in fetal Hb- dilutes amount sickle Hb
risk vaso-occlusive crises OHurea- used in PV when there is inc risk of
P.aeruginosa thrombosis-has the se of BM suppression

OM then mastoiditis then nocturnal OT se- tachysystole (many contractions in Observer's bias (Respondent's bias-outcome
headache relieved by morning less time) vs hypertonia (1 contraction is obtained by pt's response)
vomiting- think temporal abscess- lasting for longer time)
intracranial mass- CT or MRI b4
mastoidectomy
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OT excess causes hypotension not

Ring enhancing lesion on CT or hypertension (even though ADH like action
MRI: of vasopressin and retention of water)
MAGICAL DR

Osteogenesis imperfecta in preg pt.vs

Amniotic band sequence (amputation, hand
defects, clubfoot, craniofacial defect, abd
wall defect) Ovarian cancer 1-myomectomy for uterine
Osgood-Schlatter dz III to CF
fibroid
Patellofemoral pain synd- PF
syndrome has pain with climbing type 1 collagen
down stairs or downheel walking type 2 more severe Pelvic mass & ascites
mutliple fetal fractures Staging & inspection of abd cavity -
IUD Laparotomy
Limb deformities
FGR
dec thoracic cavity

PCOS aka failure of follicular PCP tt

maturation, inc free test, inferti,
PCOS-hirsutism or alopecia - both are
amenrrhoea
related to androgens
CD 4 -<200- toxo, PCP
<50 - MAC
irregular menses
inc testoster <100- PDH
anovulation from failed follicular
TMP-SMX tt (P not with Pyridmidine P)
maturation

PCP- mutlidirectn nystagmus nt
amphetamine- tt of agitaion is BZD
here not haloperidol dt relative ci dt
seizure-also not acidify urine
PCP-agitation,psychosis,
disorientation, nystagmus
agitation
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PCP-all types of nystagmus-
rotatory,vertical,horizontal-bzds is the tt for
psychomotor agitation
dissociative feelings
psychotic
violent behavior
htn
PDA- mildly accentuated pulses
small continuous flow murmur
pda-murmur @ suprasternal notch or in the
left infraclavicular region
coarctation of aorta murmur- @ left
infraclavicular area and under the left scapula
may be systolic, but the murmur may also
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aggression hyperthermia sound continuous @ multiple places in the

bzds chest in the presence of multiple collateral
vessels or, occasionally, severe coarctation

PML (vs HIV dementia- gray matter- mri

PG then echo, worsening cyanosis in PKU cerebral atrophy and vent enlargement &
neonate- single S2 in both TOF & toxo posit sero (Ab) in 90% pt hence, non
TGA;TGA(egg on string, arterial specific
switch) neurotoxic metabolites
intellectual disability
eczema CD 4 -<200- toxo, PCP, PML
First few hours of life with cyanosis newborn screening <50 - MAC
Loud S2 normal health & development <100- PDH

PPH cause-retained placenta as it prevents

PP endometritis tt-vaginal flora into uterus-
PMS = PMDD tt both luteal phase polyme-tt continued until afebrile for more
only or continuous ssri are effective than 24 hr, neither blood nor endomet
culture for dx
PMS - 2 sx - physical (3) &
psychological sx (2) Purulent lochia
follicular phase resolve sx uterine tenderness
Clinda+Genta
uterus from contracting,bcoz thin endomet
stripe suggest empty & NL uterine cavity
hence not reatined placenta
uterine atony dt retained placenta
Risk factor for PPH:
Prolonged labor
Induction of labor
operative vaginal delivery
fetal weight >4 kg 

PPROM (pooling,ferning, nitrazine+ PPROM- sudden gush of fluid- closed PPV & NPV with prevalence
fluid-blue,ferning,no uter contractn) cervix- next step-im steroid
tt-leakage of fluid in third trimester is
PPROM-not necessarily gush- prevalence - PPV & NPV
steroids + antibiotics (uncomplicated & <34
weeks)
steroids + antibiotics (uncomplicated Delivery (complicated or >/= 34 weeks)
& <34 weeks)

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Delivery (complicated or >/= 34

weeks)
vs Prolonged rupture of mem- longer
time between the time of delivery &
time of rupture of membranes-more
than 18-24 hrs

Pancreatic cancer-painless jaundice - not in

PWS-poor suck-both genes 4m mother-mat
PPV complication in low SBP all pts vs duodenal ulcer (has wt gain vs
upd-loss of paternal gene-binge eating-
cancer has wt loss) (ho head trauma-
almond eyes-narrow forehead-downturned
cushings ulcer-distal eso,stomach,proximal
PPV causes - initiation mech mouth
duodenum)
ventilation - acute loss of rt v preload
loss of CO
PWS somewhat similar to Downs &
Cardiac arrest anorexia with wt loss + jaundice dt
Hypothyroidism
extrahepatic bil obstruction

Pancytopenia causes-Aplastic anemia

Parinaud Syndrome- ARP (neurosyph,
(vs Fanconis, but thumb, skin etc in
Parinaud,diabetic neuropathy
Fanconi) Penile fracture (popping and breaking sound)
- hematuria - next step
light-near dissociation =ARP
sickle cell- anemia (not
superior gaze palsy
pancytopenia) retrograde urethrogram
obstructive hydrocephalus- headache &
pancytopenia following drug intake,
vomiting
toxins, viral infections

Peritonsillar abscess - GAS

Pg test- no bleed then anatomic or Eg def.
Trismus, also called lockjaw, is NL Eg breaks osteockast, tt of stress amen Pheochromocytoma
reduced opening of the jaws (limited is inc caloric intake
jaw range of motion). It may be
surgery, anesthesia, medications
caused by spasm of the muscles of
dec bone mineral density
mastication or a variety of other
causes

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Physiologic jaundice-sterile gut, inc Placenta previa what advise to pt

Hb breakdown-tt exchange Pityriasis rosea-oval lesions along the lines
transfusion-unconjg hyperbil (vs bil of christams tree-preceded by viral
atresia- conjg- with hepatomegaly) prodrome Antepartum haemorrhage (APH) is defined
as bleeding from or in to the genital tract,
occurring from 20 weeks (some sources
in bil production solitary large herald patch mention 24 weeks) of pregnancy and prior to
dec bil clearance reassurance the birth of the baby. The most important
inc enterohepatic recycling sx relief of pruritus (eg antihistamines, causes of APH are placenta praevia and
phototherapy- rapidly rising hyperbil topical steroids) placental abruption, although these are not
to prevent kernicterus the most common.

Post op pneumonia - incentive spirometry

Placental accreta single most imp to prevent pneumonia
Post viral pneumonia what should be added
Pl adherence smoking to cefepime (pseudomonas) (also for CFTR
PPH preexisting pul dz age >50 with pneumonia tt)
C section thoracic or abd surg
D&C surg lasting >3hrs
adv maternal age are risk factor poor gen health

Post-partum thyroiditis Premature adrenarche vs (CAH- increased

Preg DM
bone age, inc height percentile)

Hashimotos-antithyroid peroxidase
placental somatomammotropin (placental
(antimicrosomal) and Precocious puberty - pubic & axillary hair,
GH)-hPL
antithyroglobulin antibodies. acne, body odor (androgen is not enough to
Maternal hyperglycemia
Grave's- anti TSH receptor antibody. cause the growth spurt)

Pressure ulcer vs arterial insuff(tip), Prim amenorrhea Prim amenorrhea dx

venous stasis (pretibial, above medial
malleolus), Diabetic foot ulcer
(charcot) delayed puberty dx confirmed by karyotype analysis

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Pelvic USG for internal female anatomy complete or partial deletion of an X chr
malnutrition
abN mental stat
red sensation
dec skin perfusion

Primary CNS lymph (solitary ring

Pul edema
enhancing lesion vs toxo multiple
Pulmonary contusion - irreg patchy alveolar
ring enhancing ring enhancing lesion
infiltrate
vs PML non enhancing ring lesion) SVR
cap permeab
PCHP within 24 hr
periventricular mass in pri CNS
dec albumin
lymphoma, CMV and MS

RCT (vs adhesive capsulitis- frozen shoulder-

Pyloric stenosis - gastric outlet
fibrosis of joint capsule-dec range in multiple
obstruction Pyloric stenosis- correction to prevent
planes)
postop apnea

3-5 wks
RCT - nL range of motion in all planes
projectile after each feed
compression of soft tissue structures bw
usg- IHPS
humeral head & acromion- RCT

RDS- also improves with O2 ( also

REM(if awakened then very transient
V-Q infinity improves ith O2 like PE,
confusn then alert)-sleep terror & walking
zero can't improve),@term-tansient RLS- DA agonist (pramiprexol, ropinirole,
are NREM-young-longer confusion-no recal
tachypnea,@term& post term-pul htn bromocriptine, cabergoline,pergolide)
of dream

CPAP- tt for RDS bugs crawling

REM sleep - mind active & body inactive
CXR- fine reticular granularity of the
(muscle atonia)
lungs

RTA= normal AG acidosis+ failure to Raloxifene se Refeeding syndrome

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thrive (1AG,2K,3urine pH(tricky

point here)) serm CP failure
Arrhythmias
cellular uptake of Phosphorus, Mg,
Potassium
tt consist of oral bicarb replacement

Retinal hemorrhage have been consistent

with abusive head trauma- next step check
Reye S
Refractory & atypical depression tt is CT non contrast for bleed, skeletal survey to
MAO-I- htn crisis (not hyperthermia identify other injuries-subdural hema
and all) vomiting
encephalopathy
bL retinal hemorrhage is virtually diagnostic
abnL behavior
cheese & wine of Shaken baby syndrome
avoid aspirin to children with viral infection
shearing of dural veins & vitreretinal
traction

Reye S - microvesicular steatosis vs

alc,nafld,hep C - macrovesicular
steatosis; aspirin in JIA, Kawasaki
only
Rosacea-flushing
RhD Ig (dont take into consideration the
Reye's syndrome in "small kids- blood group of fetus but only mother)
small- microvesicular steatosis" telangiectasias
coagulopathy burning discomfort
HM
altered mental status
fulminant hepatic failure
Enceph

SAD (negative evaluation) vs SBO((also has low BP)dt adhesions dt SCID

specific phobia (object or situation surgery & ladd bands (congenital))(vs bleed
(flying, height, animal) above lig of Treitz-PUD,eso,Gastritis vs
crhon-fever+nonbl diarrhea) failure to thrive in SCID and CVID

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SAD should be differentiated from

other DSM-5 anxiety dzrders such as abd bloating
panic dzrder (unexpected panic dilated loops of bowel on X ray
attacks) & specific phobias (specific
phobic stimulus)

SCID (no lad,severe lymphopenia) vs

HIV (lad,lymphocyte count is low or
SIADH tt
nL), CFTR(not opportunistic infectn SD & distribution %
like PCP nor lad)
hypertonic to hypotonic just give 0.9 % NS
only for normal (bell shaped distribution)
/0.45 % NS + 5% D
failure to thrive in HIV, SCID, CFTR
(not Kartagener)

SIDS prevention
SLE flare during Post partum and
pregnancy,lupus nepthritis vs preeclamp
SIDS - unexplained death of infant (lupus neph has jt pain, rash, dec compl,inc SLE- drugs- ICS- PCP if BL alveolar
<1 yr ANA) infiltrate- although WBC are high still ics
smoke avoidance
pacifier use
Proteinuria & RBC cast
sleeping in supine with firm bed
SLE flare complicated by nephritis
room share but not bed

SSSS III to Pem vulgaris Sarcoidosis Scabies (vs contact ( exposed allergen areas)
& atopic dermatitis (flexural areas
(sarcoidosis away from equator) (antecubital, popliteal fossa), both are non-
exfoliative toxin - SSSS infectious), ivermectin also 4 stron, onchocer
prodrome (fever, irritability, skin
tenderness)-->gen erythema & sup
flaccid blisters erythematous papules & burrows
Scaling & desq
resolution of dz
SSSS- affects children below 10,
adults with kidney dz, immune
compromise may be affected
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Scdz complication-complication
(isosthenuria- inability to concentrate
urine is also a common complication)
hyposthenuria & isosthenuria are
both the complication of SCDz
Painless hematuria just like RCC &
bladder cancer but the renal function
is normal
Seizures-bcoz of delayed return of
neurological functioning (vs
syncope- all forms of syncope have
rapid return of neurological
functioning-vasovagal have a
prodrome vs cardiogenic has no
prodrome (neurocardiogenic is
different from cardiogenic syncope)
Seizure defn- (3)
Strep pneu vs Kleb - both right lower
lobe- but kleb is with foul smell
sputum
current pt had only headache and
fever
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Seborrheic Dermatitis -cradle cap(vs Atopic
Dermatitis-fam ho + & Contact Dermatitis
have intense pruritus, Contact Dermatitis
Sch se confined to specific area like perioral or
hands)), Tinea capitis doesnt involve
eyebrows or Nasolabial folds
upregulation of post-synaptic Ach receptors
(skeletal muscle trauma, burn injury, stroke)
Non-depolarizing NM blockers scaly oily rash affecting scalp, eyelids,
(vecuronium, rocuronium) nasolabial folds, post-auricular area &
umbilicus
Spontaneous remission is common.
Nonmedicated shampoos
Simple brest cyst-follow up should be close
like 2-4 mn (fluid accumulte), if nL then
Severe asthama tt
resume annual screening mammogram-(post
acoustic enhancement- fluid)
ET intubn & mech ventiln
Aspiration - painful mas - yellow clear fluid
Successful randomization (eliminate bias
TCA overdose (felt like mixture of cocaine
based on pt charac) vs {subgroup analysis
(pupil diln) & opiods (dec bowel sounds)
(str analysis)- tt affects any particular age or
sex etc}
intestinal ileus
inc risk of arrhythmias &/or seizures-
1. dec selection bias
NaHCO3
2. near - equal tt & control gr sizes
QRS >100msec
3. low probability of confounding
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TOA- uterus tender (enlarged in
preg),CA-125(still TOA(check age
and cf), inc wbc,CRP)-polym/e
infection
thick wall
internal debris on USG
complex multiloculated adnexal mass
TOF-central cyanosis-lips & tongue-
also RVOT & harsh sys ejection
murmur- pul stenosis
hypercyanotic, hypoxic tet spell dt
obstruction of RVOT during exertion
Tinea versicolor-sphagetti &
meatballs
eruption
light macules on trunk & UE in
adults
hypo/hyper pigmented macules
Trousseau's sydnrome (sup.
migratory thrombophlebitis)
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TOF initial step - single S2 - tet spell - cre-
dec sys ejection mur dt rvot
crescendo-decrescendo murmur :
TOF
AS
HCM
inc pul bl flow; improves hypoxemia
Tension pneumothorax- complicn of
subcavian central catheter insertion
air in pleural space
cardiopul functn
rapid onset dyspnea
hypotension
distension of neck veins
needle thoraco"S"tomy
Traumatic carotid injury- brush in the post-
oropharynx
hemiplegia
facial droop
aphasia
Turner syndrome heart defect
absent palmar creases- Down's & Edward's
syndrome
Bicuspid aortic valve
TOF-SEM@ left upper sternal border-LOC
with exertion - tet spels- athough the age is
more than 2 years stil cyano heart dz & not
noncyanotic heart dz, vs breat hold spel
cyanosis reslve aftr spel is ovr
breath holding spells--> cyanosis resolve
after spell is over but not in TOF
Tinea capitis -scaly- black dot-dermatophyte
- trichophyton tonsurans- vs seborrheic
dermatitis (dandruff)-scaly oily erythematous
rash
superficial dermatophytosis- children & ICS
scaly erythematous patch -- alopecia with
inflammation, lymphadenopathy, scarring
oral griseofulvin or terbinafine
Travelre's diarrhea dt parasite (strongyloides
not diarrhea but lungs, GIT infection, skin
infection)
Turner's syndrome- cause of edema
nail dysplasia
congenital lymphedema dt abnL devp of
lymphatic system
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UP insuff-late term preg BPP is bad,
cause, UP insuff charac-late dec has
gradual dec in FHR & nadir after
peak of contraction &oligohyd (less
than AFI <5 or deepest pocket <2 on
USG)
VSD ( vs midsystolic ejection
murmur req no investigation)
Most VSD are small & close
spontaneously, hence no tt
VUR-even in F-complication is
calyceal clubbing aka blunting of
calyces,renal usg-screen for
hydroneph,scinti- scarring
VUR-->recurrent or chr PN-->
scarring, htn, renal insufficiency
voiding cystourethrogram--
>definitive dx
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Coarctation of aorta
Aortic root dilation
Upper GI series-dx malrotatn or midgt
volvulus-lig trietz on rt of abd-
malrot,contrst in corkscrew is voluvls-no
free air (DA ro),nobwel gas (no dil bowel-ro Uterine inversion
HD &MIleus)
smooth, round mass
corkscrew esophagus- DES uterus nonpalpable transabdominally, severe
corkscrew volvulus- Midgut volvulus
pain, PPH
no free air (DA ro),nobwel gas (no dil
bowel-ro HD &MIleus)- NEC, Midgut
volvulus, Malrotation
abd distension (NEC & midgut volvulus)
VUR complication
VSD murmur
VUR-->recurrent UTI--> renal scarring
first febrile UTI at age 2-24 months- renal
diastolic rumble- VSD murmur & MS usg anatomic abN
recurrent UTI-->voiding cystourethrogram
for VUR
Vaginal foreign bodies vs child abuse -
behav change, genital, urethral, anal trauma-
Vertebral osteomyleitis-s.aureus, lumbar
adult sex behav or curiosity
senosis(old age) & ank spon-(young) -all 3
worse with movement
topical anesthetic
sedation
osteomy even without fever
general anesthesia
irrigation with warm fluid & ca alginate
swab 
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Wilms tumor - 1. hematuria, no systemic sx,
Whipple dz is III to sx of HIV
infection - but only whipple has pas
+ve macrophage in small intestine
gram + & pas +
Xray Ewing's sarcoma- central lytic
lesion, moth eaten, onion skin &
extension into soft tissue
acalculous cholecystitis
percutaneous
active suicidality- involuntary admit
pt if he disagrees
care of pt with active suicidality -
safety - psych unit involuntarily if
necessary
acute Peptic ulcer perforation next
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(neurobla-2.age-first yr of life,3. crosses
midline with 4. systemi sx)
Leukemia
CNS tumors
Neuroblastoma
abruptio placentae minimal amount of
beeding- concealed hemorrhage
Abd pain, back pain
FHR abnormalities
acl tear (vs meniscus has subacute or
chronic tear and chronic or subacute
hemarthrosis)
acute MS (iv steroids) vs GBS
(Plasmapheresis or IVIG)
acute adrenal insuff- SLE in ho but nt given
Wiskott-Aldrich syndrome-cytoskeleton
regulation (vs Ataxia telangiectasia- DNA
repair)
thrombocytopenia is most consistent feature
& is charac by reduction in platelet volume &
size
absence seizures (automatisms- eyelid
fluttering & lip smacking)- ab seizure not
asso with post-ictal state-sleepiness
without loss of postural tone
Episodes occur throughout the day without
warning
acromegaly (coarsening facial features,
pharyngeal crowding and enlargement of
hands and feet-not edema) ,with heart
changes
acute PN CT indication
culture before antibiotics in APN
acute bacterial parotitis
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step not endoscopy
Definitive management with urgent
exploratory laparotomy
acute cervicitis - uterus is bl enlarged
still it is cervicitis- foul smel
discharge + bleed to touch
vulvovaginal inflammation
mucopurulent discharge
Az + cef
dox + cef
acute epididymitis although swelling
was not present (intense scrotal pain
with mild UTI) etio- not mumps dt
absence of prodrome (fever,
myalgia), only PDE-5 inh used in
BPH tadalafil
acute postop mediastinitis tt- not
antibiotics alone-postpericar syn-AI,
afib nL after cabg (within 24 hr give
bb & amiod if more than 24 hr then
cardiover with anticog
antibiotics
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ho steroids- check glucose & Na & K &
cushingoid features painful swelling of parotid gland
inc by chewing
dexa & hydrocortisone are both glucocort & high fever, tender swollen, erythematous
not mineralocorticoid (fludrocortisone) parotid gland
adequate fluid hydration & oral hygiene
staph aureus
acute cervicitis(bleed bw menses&pos-coit acute dystonia tt (vs only akathisia is tt wid
bleed,cer friab(bleed to touch),mucopur BB or bzds, tardive dyskinesia- no tt
discharge) vs vaginal (3 infections)-both (clozapine maybe useful) rest antichl or
with UTI esp candida antihist
Spont rupture of mem, acute cervicitis with benztropine
UTI, stress incont diphenhydramine
acute mesenteric ischemia - inc lactate(bowel
acute mesenteric ischemia - absent free air sounds are dec also in ileus) (appendicitis
on radio (embolic art occ) dt endocarditis rarely causes met acidosis)
complication (bowel sounds dec not inc (inc
in op withdrawl)), acal cholecyst-ill pt
elevated Hb
elevated amylase
met acidosis
acute urinary incont in elderly (1st step is
UA & culture to ro uti then antimusc or addison's dz - normal anion gap-
urodynamic study)(DIAPPERS full form) eosinophilia, hypoglycemia and hyperK+
fever may not present with lower UTI
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adhd (vs bipolar 2 -lack of xxx
episodes xxx of
mood,grandiosity,need 4 sleep)
teacher evalun is imp for assessing behavior
adhd- impaired family & peer
relationships
agorafbia dt panic dz(tt-ssri+cbt)
(bupropio-nt(sex se,smoking,seizure
serotonergic- no s-but not for
agorafbia)(vs interpersonal therapy-tt
f depresn)
antidepressant target avoidance
behavior  
enlarged, fatigue, wt gain (hCG even though
alcoholism-hypotonia with delayed
reflex (also in hypothyroidism)
truncal ataxia and tremor both are
present
amniotomy is risk factor for both- um
cord prolapse(cord is palpated@ +1
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adhd criteria- 2 different settings adjustment dzrder (tt is psychotherpay nt ssri
or snri with depressed mood III sx to major
depressive dzrder
in school
panic- psychotherapy
adjustment dz - psychotherapy
specific phobia
alc induced sleep disruption(also has
fatigue) (adjustment dzrder is wrong is sx
last more than 6 months after a stressor)
(AST-ALT more than 2)
alc withdrawl tt- only delirium tremens after
48 hrs
insomnia &/or anxiety
women & adults with age >/=65 --> >7
drinks/week or >3 in a day anxiety, insomnia, tremors & diaphoresis
men with age <65 --> >14 drinks/week or
>4 in a day
inc liver enzymes & macrocytosis-
screening for chr alc abuse
amenorrhea next step-uterus symm
old age)
aminoglycosides- saccadic eye movements is
controlled by PPRF and MLF-VOR
symm enlarged uterus- adenomyosis ( inc
bleeding), pregnancy (amenorrhoea)
atlhough perimenopausal still hCG for
amenorrhea
androgen secreting neoplasm source ovary androgenism in preg-usg- bl masses in
(not testes) or adrenal ovaries-spon resolve-female fetus at high risk
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station) vs um cord compressn-both of virilization, mass effect obstru labor,

variable dec check testosterone even in ovary andgrogen torsion,hydronep
neoplasm

Release of amniotic fluid with Luteomas & theca luteum cysts

rupture of mem can result in umb art
compression

ant uveitis asso wid Crhon's dz (vs ACG-55-

70yr, headache, n & v)(vs bac conjunc-
purulent discharge vs vir conjunc-watery
anemia in scdz- aplastic crisis(b19)- discharge)
dec rc & check mcv to diff bw them, ant shoulder dislocation
inc rc- sickle crisis
painful red eye with tearing & dec visual
frceful abduction & ext rotation acuity
folic acid def dt hemolysis ciliary flush
pupil constriction (<2 mm (2-4 mm is nL)
certain infections, sarcoidosis,
spondyloarthritis & IBD

anti-psychotic medicn-nonadherence-long
anti-diabetic causing weight loss
acting - 2-4weeks in-both 1st & 2nd gen are
GLP-1 agonists (exenatide,
available in long acting injectables antipsychotics - se- EPS- tt (beomocriptine
liraglutide)
also)

long-acting injectables of anti-psychotics if

weight gain/loss
nonadherence EPS-->first dose reducn-->then add
cost
oral antipsychotics who have previously cholinergic drugs
co-morbidities
responded to that particular medicn -->only
s/e
those long acting injectables are used

antipsychotics se (olanzapine ci in antisocial p dz vs narcissitc per dzrder (inc appendiceal abscess- psoas sign - retrocecal
DM-causes wt gain & metabolic self importance & lack empathy less appendix or abscess, obturator's- abscess,
effects)-pt is shouting dt psychosis aggresive & violent) rectal tenderness-abscess-elective = interval
not agitation and hence not BZD appendectomy

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Narcissitc- angry when oppposed

2nd gen antipsyhc- lower EPS - but
inc metabolic effects to varying
degrees

asd- stereotypic behavior- speech delay-

appendicitis in preg next step not
poor eye contact,restricted interest-
rupture bcoz pulse bp rr nl
distressed over small changes-fixed interest-
asym endometriosis next step
flat affect
graded compression technique
non compression of appendix APNC
variable degrees of language & intellectual
dilation of appendix
impairment may be present (but not
ionizing radiation
necessarily present)

atelectasis-dec breath sounds-

impaired cough & shallow breathing- atlectasis prevention - smoking cessation for
asthama- wheezing & dyspnea, atleast 8 wks prior reduces risk of post op pul
aspirn pneum-few hrs after surg atheletes with amenorrhea (2)- Ag complication
abuse(male pattern bald, deep
voice,clitoromegaly,aggresion,htn,mood dz)
even possible after abdo surgery vs hypothal Prevent using post op atelectasis: (5)
Prevent using post op atelectasis: (5) adequate pain control
adequate pain control deep breathing exercise
deep breathing exercise Eg dec- dec bone mineral density directed coughing
directed coughing early mobilization
early mobilization incentive spirometry
incentive spirometry

atonic uterus tt (not autoimmune (Acute )(postpartum or asso b9 breast dz-fat necrosis-breast
methylergonovine- as it causes HTN, with other autoimmune conditions) adrenal reducn,reconstruction,trauma(seatbelt injry)
hence CI in already HTN pt), if insuff. (vs cushing BP,Na, K) TB develops
retained placenta-tt-D&C gradual and bl adrenal hemorhage after
N.mening fat globules
foamy histiocytes
atonic uterus- retained placenta -
D&C
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hyperkal not in central ad insu because the

aldosterone synthe is preserved, because
ACTH doesn't control aldos

bac meningitis next step

bicornuate heart shaped uterus- risk factor for
bac meningitis on ho next step
sequelae of bac meningitis- (6) ectopic preg-fluid in the cul-de-sac (hcg after
hearing loss tvus,mtx-stable ec pre,mispro(contrac &
intellectual injury lethargy expel-incom,missed abortion)
cerebral palsy fever
learning disabilites poor oral intake
USG - gestational sac at upper outer corner
seizure disorder vomiting
of uterine fundus
audiologic screening & devp follow
up

biliary atresia (vs biliary cyst- abd biliary cyst - transform into
pain)-conjug hyperbil is always cholangiocarcinoma (bil atresia- early
pathologic- uncojg is physio (24hr- infancy- fatal without intervention)
1wk) & (bf (1st wk & peak at 2 wk) bipolar disorder

multiple/single
conjg hyperbil & HM - bil atresia extrahepatic chr- adhd
Abd USG - absent or abnL intrahepatic episodic- bipolar dzrder
gallbladder abd pain, jaundice
Kasai procedure- improves palpable mass
outcome!! surgical excision

brca (breast & ovary) hnpcc (colon &

body dysmorphic dzrder-dont offer breast abscess dx & tt
endometrial) bipsy thn CT,CT for metastatic
meds, reassurance doesnt help in
dz not dx-breast tendrness,pre or post
BDD so dont offer
menopausal bleedng-granulosa tumor- focal erythema/pain
ovarian mass & endomet thickenin needle aspirn
surgical tt is not helpful antibiotics

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breast cancer risk factor-
chronological age (not second degree
relatives (all cousin) but first degree
relatives (not first cousin or second
cousin) (immediate family) are a risk
factor)
nulliparity
prolonged hormone replacement
therapy
inc lifetime Eg exposure inc the risk
for breast cancer
breast pump leads to nip stimuln,ot&pl
release- lactation-inc milk producn not dec-
nsaids tt for br engorgement
breast engorgement is common 3-5 days of
breastfeeding when milk is replaced by
colostrum
fullness, tenderness, engorgement without
fever
resolves on its own
brusitis- pain with exquisite tenderness, dx by
apiration of bursal fluid for cell count &
gram stain,tt-drain+ antibiotics
prepatellar bursitis - ant kne pain,
TENDERNESS
stap aureus
penetrating trauma
extension from local cellulitis
repetitive friction

c.tamponade (pcwp high)- inc pcwp with iv

c.tamponade (jvd is not seen in
NS- tension pneumo (pcwp low)-no devitatn cannabis intox-marijuana- slow reaction
hemothorax)
of trachea & pcwp nL after iv infusion time- tachycardia- paranoia = psychosis

pul edema worsen despite it fluids in

jvd is high in both c.tamp & tens antichl - tachycardia, dry mouth
pul contusion but no jvd
pneumothorax

carboxyHb conc
carcinoid (wheezing, small intestine),
singing of eyebrows bronchi vs VIPoma (pancreatic cholera, carcinoid syndrome
oropharyngeal pancreas)-both have flushing and diarrhea
inflammation/blistering
secretory diarrhea are both VIPoma and
carbonaceous sputum
decreased gast acid secretion carcinoid syndrome
stridor (vascular ring - biphasic
secretory diarrhea
stridor)
carboxyHb >10%

catatonia - resists to any movement cellulitis vs ruptured baker's cyst- pain, cerebral palsy-3 types- spastic, dyskinetic,
of his limbs warmth,erythema not fever or leukocytosis, ataxic(spastic diplegia- dragging the legs-

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erysipelas-raised distinct border (vs equinovarus-claspknife,hypertonia,

posturing cellulitis flat indistinct) hyperreflexia- UMN lesion )
bzds & ECT- tt of choice

cerebral palsy is a "SAD" condition- spastic,

ataxic, dyskinetic
nonprogressive motor function
prematurity
uncoord & limited vol movements

cervical cancer (ectocervical mass &

heavy vaginal bleeding extending
laterally, hence not endometrial
cancer) risk factor (HPV 16,18,
smoking)
smoking for sq cc, not adenoCa?
cervical spine injuries-oral maxillofacial
chemical peritonitis - one sign is shoulder
trauma, hemor in retrophar space, neck &
pain (ro splenic rupture)
airway edema-nasotracheal intubn ci in
coma, hence do orotracheal intubn
subdiaphragmatic peritonitis

cherry hemangioma
cholesteatoma - skin in tymapnic mem
child abuse

regress spont
granulation tissue- OE (confirm IM Ear) &
b9 scald- burn with hot liquids
cholesteatoma
no tt

ci of breastfeeding
clozapine (wt gain-still dont give coarctn of arta-pg to maintain pda-sys eje
ziprasidone-doesnt cause wt gain,first mur at intrscaplar area,pda close day3,risk of
active, untt TB address tt resistant psyhcosis forget the wt hf(feed,inc rr,fussi),shock(l.acidosis-met, crt
varicella gain) incmore than 3sec, dec renal perf ur out
herpetic
chemo
quietiapine wtihout PG there is heart failure
illicit drug (mari, cocaine, opiod)

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comorbid depression next step
somatic sx of depression
(sleep,appetite, poor energy)-low
threshold for beginning the tt
compartment syndrome-rapid
swelling-pain inc with stretch,
paresthesia,pain outta prop(gas
gangrene not eschar)-circumferential
eschar- fasciotomy or escharotomy
venous & lymphatic drainage
third degree burns
circumferential
eschar formation
cong melan nevus (vs nevus simplex
& flammeus- birthmarks)
isolated hyperpig patches
contemplation(thinking to change or
taking suboptimal measures to
change)- ask pt how these measures
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compartment synd-aka soft tissue swelling-
burning pain (paresthesias) & pain inc with
passive stretch just like DVT but DVT-
usually asymp & asso with vague pain
burning pain in DM & compartment
syndrome
Reperfusion of a limb following arterio-
occlusive ischemia
intracellular & interstitial edema
complicated parapneumonic effusion vs
Emypema (has gross pus or bacteria on
gram stain)
loculation on CXR
const. pericarditis
coxsackie virus-( const. pericarditis-
diastolic dysfunction ) ; ( myocarditis-
DCM- systolic dysfunction)
conversion dzrder
(sensory,motor,nonepileptic seizures)-
education is 1st line tt and cbt is 2nd line tt
compartment syndrome-excrutiating pain-
tenderness of calf if in lower limb-not dx bt
direct fasciotomy- main prognostic factor
severe pain
pain with passive motion
paresthesia
pallor & loss of limb pulses are not common
findings
Compartment pressures measured
immediately
cong hypothyroidism ((thyroid dysgenesis
aplasia, hypoplasia,ectopic thyroid gland) -
not I2 def in devp country)
CNS devp injury
Dec activity
Hoarse cry
Jaundice
contact dermatitis (also neomycin a topical
dermatitis)
erythema, edema, vesicles >12 hrs after
contact with allergen (poison ivy, nickel)
cross-sectional study
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will help him-alc abuse-opd insead of if risk factors & outcome are present at the
ipd conversion - c not with c same time then its cross - sectional dz
otherwise other observational dz

conviction (importance of change)

confidence ( self-perceived ability to
change)

cryptorchidism- testes descent nL by

current urge incontinence- (previous stress
6 mnths- otherwise sx b4 1 yr- sx cushing's prox muscle weakness-facial
incont with cystocele req tt with sling
remove risk of torsion but not weakness, hirsuitism hence cushings
operation and vaginal pessary)
elimnate malig or inferti risk although pt has ho hypothyroid
(although decreased risk)
antimuscarinic like oxybutinin

cvs-10-13wk,amniocent-more than 15
cyclothymic dzrder-bipolar 2 if more than or
cut off point- sN & sP 2 weeks, usg nuchal translucency-screening,
equal to 3 of digfast
after usg no need for quadruple(15-22wk) as
it is screening
affect its sN & sP
less severe than bipolar 2 is cyclothymia

delayed puberty- testosterone

supplementation will speed up
puberty but shorten growth spurt & delirium tremens - autonomic hyperactivity dependent personality dzrder (also fear of
shorter final individual - diaphoresis, tremulous, confusn rejection)

advanced bone age - Precocious 48-96 hrs after the last drink thinks decision is always wrong.
puberty (dt GnRH stimulation)
delayed bone age- growth delay

depression nt improving with ssri- depression-headache,neck pain,back pain- dil loops of bowel- then me colon is Mec

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bupro, mirtaza(wt gain &
sleep),trazodone (very sedating)--tca
only 4 refrac depressn
not responding to ssri- switch not add
to another class
bupropion have activating effects
wt gain or ssri-related sexual se
displacement (vs projection- resident
feels student is angry when infact
resident is angry)
immature defense mech - displaces -
ve feelings asso with a person or
situation
duodenal atresia - absent intestinal
gas
jejunal atresia absent colon gas
duodenal obstruction
bilious vomiting in first 2 days of life
X ray
emph cholecystitis-hemolysis-
crepitus-gas in gallbladder not bil
system(vs Gallst ileus-intermittent
pain-air bil system=penumbilia)
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addresses substance abuse issue after
suicidal ideation
hopeless
somatic --> ask about suicidal ideation
drug ad-composite outcome
composite outcome read it.
" it increases the precision of the
study.
early neonatal care - apgar score is right-
next step is immediate dry & keep the infant
warm
initial physical assessment
removal of airway secretions
gonococcal ophthalmia prevention
vit K supplementation
endocard after UTI - org. GAS(stre
pyogenes doesn't cause IE)
Ileus otherwise HD-HD&MI both have abd
distension,bil emesis, no passage of
meconium
(NEC, midgut volvulus, HD & MIleus)- all
have abdominal distension
inspissated (viscous) meconium
life threatening obstruction @ level of ileum
(vs compared to more typical rectosigmoid
obstruction in infants with HD)
drug induced acne (no comedones) vs
chloracne- (chlorinated water) (has
comedones)
drug acne- systemic steroids
papules without cyst nodules
eclampsia (seizure with aura, postictal
..although WHOML, it is eclampsia not
SAH)
Ecalmpsia- MCC of seizures in preg
endometriosis
immobile uterus
endo glands & stroma
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clostridium induced hemolysis-

unconj hyperbil

epidural hematoma-uncal hernitation

endometriosis dx
epiglottitis ( vs peritonsillar abscess- ul
sphenoid bone trauma with laceration of tonsillar swelling iwht uvular deviation)
NSAIDs MMA
OCPs rapid hematoma expansion lead to inc ICP
drooling
Laparoscopy visualiztion (impaired consciousness, N/V, headache),
resp distress
biopsy- endometrial implants uncal herniation (IL 3rd nerve palsy, IL
weakness)

epiglottitis complication- airway

obstruction- still ET intubation
expanding -uncal herniation- epdiural
instead of tracheostomy
essential tremor-tt (BZDs also but they have hematoma (next step is not mannitol-reduce
dependence potential) icp, iv steroids-icp dt tumor or abscess)
stridor
tripod positioning
neurosurgical hematoma evacuation
dysphagia
drooling

facial plethora(red face) with inc hct factitious dzrder fanconi's anemia- ear, thumb (wbc, platelets
with normal cardiac fields on CXR- dec, rbc nL or inc in Q otherwise all cell lines
inutero hypoxia & poor placental dec,hypo/hyperpig, cafe au lait (skin))-
perfusn-tt iv hydration-inc RBC external incentive chromosomal breaks
causes dec BGL & ca

macrocytic anemia
inc hct with nL cardiac fields on poor growth
CXR congenital marrow failure
hct >65% in term neonates morphological abM (ear, thumb, cafe-au-
maternal DM lait,) 
maternal HTN
delayed cord clamping

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symptomatic neonates - resp distress

, hypoglycemia & neurological
manifestation (Resp, BGL, Neuro)

fat malasborption (fat soluble vit adek are

fat embolism-chest xray nL & breath not absorbed)
sounds nL
fatigue,wt loss-Sheehan syndrome(vs
hypoca depression-no hypotension dt ACTH low &
fracture of large, marrow containing bone pain, hence low cortisol)
bones (femur,pelvis) tenderness,
triad of Resp distress,neurologic muscle weakness,
dysfunctn, petechial rash cramps,
gait abN

fetal hydantoin syndrome (pheyn &

fibrcys br-cord like=nodular-bl-premen br
CMZ) vs patau-poldactyly, fibroid
pain-tt-ocps-nsaids(vs fat nec-nip
holoprosencephaly are extra vs
retractn+echymosis-firm ireg mas)
syphilis-is snuffle,saber shins, cns
(f.adenoma-size & pain wid menses) subserous - mass effect -incomplete voiding,
pelvic pressure etc+ size date discrepancy
hirsutism submucous - protrude- heavy bleeding
fibrocystic breast changes (>35) vs
cleft palate labor like pain dt to cervical distension by
fibroadenoma (<35) but still in the q age for
rib anomalies solid mass
fib.cystic was <35, so age doesnt matter
small body size

flail chest- inward chest movement with

flail chest - more than 3 rib # in 2 diff
inspirn
fibroids location

tt of flail chest is PPV which improves

subserosal & pedunculated pulmonary contusion - irreg alveolar patchy
oxygenation & causes flail segment to move
infiltrates within 24 hrs
normally

frontotemporal dementia-abusive gdm - clavicular #,absent moro,crepitus genital herpes

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language etc. also there is primitive over clavicle, gdm-polycythemia

reflexes appeared- grasp and snout pri genital herpes asso with high risk for
reflexes etc recurrence
polycythemia in hypoxia & gdm immunocompetent host
less frequent recurrences overtime
Personality , compulsive, **earlier
age of dementia**

gestational sac,yolk sac,embryo (- in missed

abortion),cardiac activity-molar preg (hcg
more than 100,000, usg-snowstorm)-missed
genital herpes HSV-UTI+ulcer (intrauterine) vs ectopic (extrauterine)
(hence not only UTI- urine culture is glucagonoma
dx), bl culture is dx for H.ducryei
less than 20 weeks
asym diarrhea
viral culture is less sensitive than loss of preg sx weight loss
PCR light vaginal bleeding
closed cervix
dec B hCG
USG-nonviable (no FHR) Intrauterine preg

hard stools+ anal fissure= constipation dt

excessive milk consumptn, start laxative
(PEG, mineral oil) until stool softens, more
hard signs of vascuar injury (5)
effective than juice
hCG (rises every 2 days) would nt be
needed if initial TVUS detected an
intraut preg or if gest sac with yolk Pulsatile bleeding
-->Anal fissures are common posteriorly in
sac in ect locatn-lapscp unstable pt- Bruits or thrills
the midline, probably because of the
gold std Hematoma
relatively unsupported nature and poor
signs of distal ischemia (absent pulses, cool
perfusion of the anal wall in that location
extremities)
-->Encopresis also known as paradoxical
1500-2000 hCG Penetrating injury
diarrhea, is voluntary or involuntary fecal
need for Urgent surg repair
soiling in children who have usually already
been toilet trained. Children with encopresis
often leak stool into their undergarments.

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hazard ratio (table check
significance)
Hazard ratio - event rate
ratio <1 tt arm- lower event rate
ratio >1 tt arm- higher event rate
histoplasma-bird and bat droppings-
bl aveolar reticulonodular
opa,LAD,HSM,inc transamin , LDH
inc,pancytopenia, mucocut papule
nodule, wasting, pul symptoms
CD 4 -<200- toxo, PCP
<50 - MAC
<100- PDH
hyperparathyroidism tt (HTN is present) but
hyperca etio
hyperCa dt malig is severe and
symptomatic
hyperthyroid complication (fetal
hyperthy can be seen in Grave's dz in
which the TSHRab crosses the
placenta, but not in the toxic
adenoma)
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healthy infants- dry flaky skin dt dry hemophilic arthropathy
extrauterine env & urate crystals in diapers
(also in bffailure jaundice & Lesch-nyhan
syn) hemosiderin deposition leading to synovitis
& fibrosis within the jt
risk of hem arthropathy dec by factor
but in bffailure jaundice there are signs of concentrates
dehydration
hsp-intussuception-intestinal edema +
bleeding- lead point- not jt destruction (in hydrocele
sle-not hemosiderin and all) or hem anemia
(in hus)
hydrocele- disappear spontaneously by 12
months
ileoileal intussusception
its not pheo, suspect pheo only when hypertensive ICH rapid & more severe than
episodic htn and other things then MEN lacunar stroke which is gradual
otherwise just htn is not MEN
BTPC
symp of pri hyperpara
hyperthyroidism(inc sN to B1 adr receptors
but dec in SVR)-wide pulse press & hypo hypoK+ causes
thyrodism cause hypertension
(hypothyroidism-htn dt inc in svr)
Mg++ inhibits potassium excretion
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hypocalcemia etio (hypophos coexist with

hypoNa+ tt
hypoMg in alco), hypoCa is in acute panc
hypocalcemia dt blood transfusion and not chr, pseudohypopara aka Albright
Always correct fluid loss first and charac facial feature (PTH resist- hyperphos)
then correct the electrolytes for
symptomatic
hypoNa+, if no fluid loss then correct
hypoMg causes Hypoparathyroidism and still
electrolytes directly.
causes hypophos

ichthyosis vulgaris (vs atopic dermatitis

(patchy sx with severe pruritus))

hypopit. aldosterone levels- dont check Na

hypocalcemia next step diffuse dermal scaling
and K levels
dry & rough with horny plates resembling
fish or reptile scales
fatigue and anxiety
anorexia EKT
emollients
keratolytics
topical retinoids

idio inc ICT imaginary friends nL in 3-6 yrs of age & it

idiopathic IIH-GH doesnt impact real friendship

papilledema is not a contraindication

to LP in absence of Obstructive 6th CN affected nL creative healthy behaviors - young
hydrocephalus or mass lesion children

impaired would healing in alc (not imperforate hymen impetigo

persistent wound infectn dt absent
warmth,tenderness,pain, purulent
discharge, but erythema can be cyclic lower abd pain S.aureus
present) amenorrhea Strep pyogenes
hematocolpos
blue vaginal mass
inc intrabd press
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settings of malnutrition - alcholism,

drug abuse, psychiatric illness
impaired wound healing
Plasma or Leukocyte vitamin C
levels

inc appetite & sleep seems like cannabis

intox (not abrupt) but it can also be cocaine inevitable abortion
inc Aldosterone-symptoms next step
or amphet withdrawl (crash following
abrupt cessation)
heavy vaginal bleeding
supression test for
cramping
hyperaldosteronism
depression in cocaine and amphetamine dil cervix
withdrawal not cannabis intox

infertility-endometriosis vs epi ov ca-

infertility (vs uterine synechiae is not
septated mass with solid components,mature inflammatory acne-pustular erythema-
answer if preg has occured after
teratoma-calcification&hyperechoic nodules anywhere acne tt
doing D&C) (hypothal dysfunc only
after strenous exercise-stress fracture
and menstrual problem and all) infertility- PCOS & endometriosis oral antibiotics
Mature teratoma-calcification & isotretinoin- severe or recalcitrant acne
hyperechoic nodules

inhalants abuse-pupil
diln,depressants of cns,transient intellectualizn (accepting & intellectual
euphoria & LOC-death problem) vs denial (refuse to accept dx intracerebral hemorrhage
inspite of labs & evidence)

effects are often rapid & transient - Basal ganglia (putamen), cerebellar nuclei,
life threatening avoid confronting its uncomfortable thalamus, pons
charac perioral skin changes (glue emotion
sniffer's rash)

intussusception- periodic pain- viral ischemic colitis-llq pain then gross bl ishcemic colitis dt low bp(bleeding or post
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infectn,polyp,meckel,HSP,hematoma, diarrhea-rectosigmoid juncn-ulcer also at surgery)-lactate levels elevated-small bowels

Peyer patches same locn- colon above & below it are nL mesent isch-pain-early,hematochezia- late-dt
TE or endovasc procedres nt low bp

usg- dx intussusception vascular surgery

older lower GI bleed  
atherosclerosis
thickening of bowel wall
ishcemic colitis- cyanotic mucosa &
hemorrhagic ulcerations

lactational amenorrhoea (dont think Sheehan

kallman syndrome-anosmia or
even if PPH bcoz she has laction & no
hyposmia (genotype is XX)-short knee swelling after fall- hemarthrosis
menses
stature with pri amenorrhea just like
Turner's syndrome
non-accidental trauma in children with
Lactional amenorrhoea- lactation, but no
injuries inconsistent with ho or devp stage
menses
ovaries nL in Kallmann syndrome
Sheehan- no lactation no menses

lacunar stroke (basal ganglia) vs late term (41wks), post term (42 wks) not lead tox (lead levels less than 45 no tt, 45-69
lobar hemorrhage (amyloid in uterine rupture as it is rare DMSA=succimer,more than 70 edta
vessels) +dimercaprol even if kids)

Delivery if amniotic fluid is low on USG

lochia rubra is NL(NL postpartum uterus also

firm uter 1-2 cm abo or below umb) (with
life threatening nonemergent blood)- PP fever more than 100.4,
condition with refusal of consent in liver dz tt endometritis-foul smell lochia,uteri tend
the minors- next step

&PSV23 Shivering
if emergency then tt directly uterine contraction
involution
lochia

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lt renal v(nutcrak) vs duodenum (sma

low ht in girl- Eg def- osteoporosis syndrome) bw sma & aorta. lt renal v- lymphedema-dt recurrent cellulits and
varicocele-thromb or malig-temp-infertility obesity is a risk factor-cannot lift skin over
& test atrophy the edema
short ht in Kallman & Turner's
syndrome- Kallman has nL ovarires
irregular mass

malodorous-bac vaginosis
marfan vs homocytinuria (cystathionine
marcus gunn pupil- RAPD-eye discomfort synthase def, tt give vitamin
in absence of vulvovaginal is same as eye pain supplementation, antiplatetlet,
inflammation anticoagulation)
pH>4.5
+ Whiff
Clue cells

marfan-skin elasticity!(also in eds)-

fibrillin 1 not 2 (vs eds- not
disproportionate tall stature,nt lens matching is for controlling confounding not
marjolin ulcer
dislocn,pectus carinatum) selection bias

UV sun exposure
Arachnodactyly ("spider fingers") or matching in case- control studies
chr wounded scarred or inflamed skin
achromachia is a condition in which potential confounders of study
SCC arising in chr wound tends to be more
the fingers and toes are abnormally both gr have similar distribution in
aggresive
long and slender, in comparison to accordance with variables
the palm of the hand and arch of the
foot.

maternal adaptation to pregnancy mature (b9- female) cystic teratoma-
calcified irreg object is teeth
SEM
sebaceous material with epi components
meds for augmentation of depressed pts-
bupropion or mirtazapine(causes wt gain &
more sleep=sedn & fatigue)

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augmentation is with class of drugs other

than main class of drugs
bupropion has activating effects
fatigue,obesity, ho sexual se

methapmhetamine-days without eating or

sleeping- manic episode III to mania + tactile
or visual hallucinatn+ PE(sympathetic inc
menarche (thelarche ("THE" breast
meningiomas act)
bud) ,pubarche (pubic hair) ,
menarche) (6mnth preceding
menarche growth spurt) partially calcified on neuroimaging pyschotic sx- paranoid delusions
B9 pri brain tumors wt loss
severe tooth decay
excoritaions
skin picking

most imp prognostic factor for br cancer is myasthenia gravis tt (vs myas crisis tt - IVIG
microscopy- acute cervicitis- no TNM staging-not ER,PR,Her-2-neu receptor and plasmapheresis with steroids)
organism-low sensitivity

er,PR + are good prognosis not crosses BBB (physostigmine crosses

her 2 neu + bad prognosis BBB and hence used for phyxing the BBB)

nL response @ preschool (nt separatn

anxiety dz extreme-persistent-
anxiety-physical sx-nightmare-nt nL stress response-performs @ narcolepsy (even though BMI is high)-OSA-
sleep alone-school refusal work,scoializing (vs adjustment dzrder- snoring,gasping,apneas
within 3 mnths-clear impairment in social
&occupn functioning)
preschool inc daytime sleepiness
persistent anxiety cataplexy
distress at separation major depressive & adjustment disorder rem- sleep paralysis
repeated somatic complaints
school refusal

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narcolepsy(cataplexy-emotion-loss of nec fasciitis (vs cellulitis has no signs of necrotizing enterocolitis (breastfed dec the
muscle tone)(amphet is 2nd line dt tissue necrosis,not severe pain,hypotension) risk)-dt gut immaturity & exposure to bac
abus,psychoss),modaf 1st line,rem (vs thrombophlebitis-cord like vein) from enteral feeds-no free air (DA ro), no
dec-Na oxyb8 & antidep 4 cataplexy) bwel gas (no Dil bowel-ro HD & MI)

erythema, swelling, pain out of proportion

Na oxyb8 & antidep 4 cataplexy to PE inc gastric residual volume
daytime sleepiness Crepitus abd distension
cataplexy purulent drainage vomiting
sleep hygiene radio - gas in deep tissues pneumatosis intestinalis - NEC- air WITHIN
scheduled naps skin & soft tissue infection is suspected the colonic WALL
avoid alc & drugs that cause rapid progression
drowsiness skin or soft tissue infection is suspected

neonate-opiate withdrawl-flu like vs

cocaine withdrawl-jitteriness, excess
sucking & hyperactive Moro (both
opia8 & cocaine have FGR) neuroblastoma-other sites - sym chain

Leukemia neurosyphilis(ARP)-ankle reflex dor col vs

high pitched cry - opia8 withdrawl & MS
cri-du chat syndrome CNS tumors
Neuroblastoma-->adrenal gland-->Neural
crest cells-->symp chain & adrenal medulla
iv penicillin not im!!!!!
MC site is abdomen
serum & urine catecholamines & HVA,
VMA are elevated

nightmare dzrder (vs REM sleep null hypothesis oph screening in children (meningococcal
behavior dzrder- repeated episodes of vacc @ 11-12 then again @ 16)
complex motor behaviors or
vocalization during REM sleep) stating null hypothesis depends on study
design -case control & cohort have different Visual acuity testing begin @ age of 3 witht
study null hypothesis tumbling E or Snellen Chart
partial arousals
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unresponsiveness
lack of dream content

opioid withdrawal
opoid misuse 4 back pain can be dec by drug-
opiod vs alcohol intox tt-temporal monitoring progrm data-4 undisclosed
wasting in alco not opiod piloerection coprescriptions (long acting opoid-worse
pup diln than short addictn)
irritability
MS-SIN yawning
Wernicke enceph- CAN- B1 lacrimation risk factors of opiod misuse (age<45)
temp- nL legal history
delirium is uncommon

oral azole-thrush & vaginitis,i.vagin azole-

oppositional defiant dzrder
pervasive pattern of arg & defiant
behavior
vaginitis (oral pref dt convinience), oral osteomalacia (Ca can be normal dt sec.
nyst-thrush, i.vagin nyst-vaginitis-atrop vagi hyperpara) causes- vit d def dt celiac sprue,
(invol vulva nt vagin) malabsorption, chr liver, chr kidney,
intestinal bypass surgery, inadequate calcium
intake
Aspergillus, Rhizopus, Candida - all look
branching- check the diff
Even in preg?

ovarian cancer
ovarian cyst-no malignant features still CA-
osteosarcoma (vs Ewings sarcoma-
125 (marker in post meno) next step- single
osteolytic lesion),osteomyelitis on PE Adnexal mass cyst- if dx confirmed then do laprascopy to
Pelvic pain check met implants,no asprn-seed
Bloating
osteosarcoma - MC pri bone tumor in
Ovarian epi
children & young adults- metaphyses
Tubal epi Dx confirmed
of long bones
Peritoneum Laparoscopy
thick mass with septation & ascites

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oxybutinin can worsen the
postpartum retetn-uretheral
cath(prostate enlarged) fail then
suprapubic cath
p value --> correct result dt chance alone -->
overflow incontinence
p value represents random variability, not
bias (which is a systematic error)
not correct result dt bias
painless hematochezia-milk protein induced
enterocolitis-diffuse eczema & regurgitatn
(also Meckle is painless & less common)
painless bloody stools
rectal bleeding stop within 2 weeks
of eliminating mat dairy & soy products or
switching to a hydrolyzed formula
NEONATE

panic dzrder
paralytic ileus- (ileus-opiods (dec bowel
panic dzrder
sounds,recent surg,medicn,metabolic, large
preoccupation with unexplained sx bowel diln +)vs sbo (prior sx)- gallstone ileus
ho high healthcare use maladaptive behavior in response to panic dx prior to surg
abrupt onset resolve within minutes - attack
-> panic dzrder 

pelvic organ prolapse- defectation, urinary

parapneumonic effusion = probl, not necessarily uterus (also bladder &
pediatric depression - tt is ssri only not snri
pneumonia + pl effusion (obscuring rectum)- valsalva-bulgin mass prominent
or other drugs- of ssri also the doc is
CP angle, layering fluid on lat film)
fluoxetine
pelvic pressure
Small effusions in children without urinary retention
fluoxetine & diazepam are long acting drugs
RDS tt? incontinence
obs voiding

per art aneurysm-ant thigh pain dt per neuropathy pertusiss next step
compresn of fem n which runs lat to
fem art- fem v (traumatic av fistula,
venous hypertension, hernia are not symmetric PCR confirms the dx of nasopharynx
pulsatile vaccination dec risk of pertussis but not
lifelong immunity

thrombosis & ischemia

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Popliteal & fem art aneurysm - per

art aneurysm
AAA

polyhydramnios-EA with TEF-asprin

physical abuse pneumo wid the first feed- air in the bowel
pid-tubal scarring & obstruction-first test
present-ro meconium aspiration syndrome if
tubal patency hsg(less inavasive), then
fluid is clear
injuries in unusual locations lapscopy(invasive)
elderly individuals - financial
exploitation, psychological abuse,sex MAS- fluid is clear then ro
dont think infection will spread with hsg
abuse, neglect polyhydramnios- EA with TEF- aspiration
pneumo wid first feed

post-partum blues -2 weeks post-

pr sp p.th-ct not imp-plain x ray only,mx of
partum vs post partum depression -
stble large pne-th decmp-needle-2or3 ics-mc
after 2 wks & more severe precocious puberty bone age is high, LH is
line or 5 ics ant axi line,unstble-tube
high, next step
thoractmy if nt needle decmp
psychotherapy &/or
pharmacotherapy GnRH agonist therapy
tube thoracotomy - unstable patients
SSRI are first line for comorbid
Sec spo pne.th in pt with ho lung dz
depression & post-partum depression

preg & kidney stone- flank pain not low

quad pain-tt conserva+ureteroscopy or
nephrostomy-usg- to differentiate
preeclampsia complication
physiologic or pathologic hydronephrosis
premature ovarian failure

HTN + proteinuria + end organ

Lithotripsy cannot be in pregnant pt
damage start with Eg def, hence Fsh, Lh are inc
USG of kidney & pelvis - renal colic in
Complications are (2)
pregnant pt
Low dose CT- urography- 2nd & 3rd
trimester

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premenopause-Eg def (Eg def causes prepregnant vs preg pt pressure ulcers- intervention- not skin
hot flashes, fatigue(only complaint in (GFR,RBF,permeability,BUN, cr,protein) massaging
this pt)-thyroid levels must be
controlled since taking meds
excretion of BUN, creatinine, protein- in dec skin perfusion
preg pt red skin sensation
start with low Eg as ovarian follicles PV inc- dil anemia skin care not massaging
are degenrated, hence inc GnRH & moisture control
inc FSH nutrition

pri hypoparathyroidism- similar to ckd ca & pri polydipsia - serum osm less than 290 &
pri hyperaldosteronism (much phos - if renal functn is nL then pri urine osm less than 100- both are low (if opp
hyperNa doesn't occur dt ANP hence hypopara then siadh)
check K level)

non-autoimmune parathyroid destruction hypoNa+-confusn, lethargy, psychosis,

defective Ca-SR seizures

primary dysmenorrhea
prohphyaxis of Lymes with doxy on when prophylactic mastectomy only after testing
tick is attached for more than 36 hrs for BRCA (not Her2neu)
pri dysmenorrhea - pelvic cramping
during first few days of menses - nL
PE prevention is not through preventing exercise and breastfeeding are protective
PG release from endometrial attatchment, not chemoprophylaxis against breast cancer
sloughing during menses

proteinuria (300mg per d,prot-creat pseudocyst dx and tt- amylase is inc dt psychosis with agitation -D2 antag NMS-
ratio more than 0.3,dipstick more+1) leakage throught the walls long onset - absent NM symptoms in this Q-
D2 antag- Park sx

high bp + prot = preeclampsia abd imaging confirms the dx

" + end organ dysfunction = " + expectant management is preferred initially mental status changes
severe features in pt with minimal or no sx & without autonomic instability
complications high fever
Endoscopic drainage with significant sx serum creatinine kinase & wbc also elevated

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DA- antag

pt stopped the meds antidepressant dt

sexual dysfuncn in F, nt relapse bt
pt with p.previa (not a ci for vaginal pts has delusion and ask the physician if he
discontin syndrome-
delivery if placenta lies more than 2 cm believes next step
myalgia,insomnia,dysphoria,fatigue,-
from int os)
tt not bupropion
acknowledge- pt experience & distress
ECV or C section without endorsing delusn or hallucinn
tt is starting long acting
antidepressant & then gradually taper

pui-bl @meatus,inab to void,peri or

scrotal hematoma,high prostate-dx
pyschosis-pt amphet(no arthralgia) 4 adhd-
inability of contrast to reach bladder rectovaginal fistula-3rd or 4th degree
ro sle has low
or extravastn of contrast from urethra laceration
platelet,proteinuria,creat,hematuria-ana-
bugs crawling sle,amphe,coc,alc widrwl
bl @ meatus- pui Obstetric trauma
peri or scrotal hematoma Post vaginal wall- red, velvety rectal mucosa
thyroiditis also causes psychosis.
high prostate
@ urethra injury - contrast

recurrent UTI even after nL Renal

USG (hydronephrosis) & Void renal calculi tt (increased Vit C intake
urethrogram (VUR) dx- vaginal pain, causes hyperoxaluria-promotes kidney renal transplantation + meds to prevent
anal pain, perineal pain then sex stone) rejection, what should be prophylaxis
abuse

high post-transplant two infections are common-

excessive cow milk can cause low PCP and CMV
constipation in children (hard stools normal
or even fissures)

resistant HTN causes- RAS vs resp alkalosis- Pg retroperitoneal hematoma (ecg- ischemia-
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hyperaldosteronism (both pri and
sec)
hypokalemia may not be present
always
hypernatremia may be mild (dt
aldosterone escape hence no hyperNa
and no edema)
retropharyngeal abscess
penetrating trauma to post pharynx --
>retropharyngeal space &
a.dissection
"p"q"rs"-->"r"etropharyngeal space
into "s"uperior mediastinum--
>posterior mediastinum--
>mediastinitis
extension through alar fascia
risk of pneumococcal sepsis upto
how many years after splenectomy
HE(x)NS
scaphoid # complication
non-displaced scaphoid # is not
visible on Xray hence CT/MRI or
stabilize it then again X ray later.
Displaced scaphoid # - surgical
intervention
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chr compensated resp alk
rib # next step
trauma- assume rib fracture even without
Xray
rt adnexal mass on PE, next step
premenopausal pts
pelvic USG to ro malignancy
scaphoid #-immobilization by thumb spica
splint
scaphoid # - avasc necrosis & nonunion
non-displaced # - not easily visible on x ray
CT/MRI is recommended if initial x ray are
nL
only then cardiac cath),echo- for peri
tamponade
local hematoma - complication of cardiac
cath- hem instability & il flank pain & back
pain
ct abd & pelvis or abd usg
bed rest
risk factor for p.previa is smoking, previous
C sec or surgery, p.previa and vasa previa are
painless 3rd trimester bleed,p.previa is p.
over internal cervical os
p.previa (SPS)
ruptured ectopic preg (ectopic preg risk
factor is PID)
Sx evaluation 
scdz- low hct, high rc, hematuria, pain,
recuurent abd pain-bl transfusion doesnt
decrease the risk of infections but vaccination
does
scdz - hematuria with normal renal function
vaccination of HE(x)NS before splenectomy
& oral penicillin as prophylaxis 3-5 year
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pt with serial X ray to ro daily after splenectomy

osteonecrosis of prox segment &
non-union of fracture

schizoid personality dzrder-flat affects-

emotionally detached-indiff to praise or
screening-sex active women-young age dt
criticism-loner
schizoaffective dzrder asym PID-infertility-all sex partners 4m
preced 2 mnth shud be tested-echo-high risk
lack the eccentric cognitions & perceptual eg marfans
at least 2 wk of psychotic-in absence
distortions - characteristic of schizotypal
of depressn
personality dzrder
Chlamydia, Neisseria- NAAT
fears of rejection-avoidant personality
dzrder

seborrheic dermatitis (erythematous)

vs rosacea (flushing)-triggered by septic abortion tt- not misoprostol as it is
spice, alco slow,mtx-not septic abortn but for
secondary syphilis sx rash involve palm and
GTN,ectopic preg
sole still begin on the trunk- morbilliform
first year of life, middle age rash (EBV)
Parkinson dz, HIV unsterile & incomplete abortion
Topical antifungal are effective tt vag bleeding
iv penicillin only for neurosyph
also with B2 def puru dischge
erythematous, pruritic plaques with a uter tenderness
greasy scale on scal p and face

serosanguinous discharge from incision is

NL- incisional infection if pain, erythema sertraline when to stop for depression
septic shock

Septic thrombophlebitis- postop or postpart acute response -->6 months of major

Mixed venous oxygen saturation is infected thrombosis depressive dzrder-->recurrent,chronic or
directly proportional to CO persistent fever unresponsive to antibitotics severe episodes (for maintainance for 1-3
anticoag years or indefinitely)
antibiotics

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severe hyperNa++ tt sga- fetus complication, lga- hip subluxn & shoulder dystocia
talipes calcaneovalgus dt intrauterine
deformation
severe hyperNa++ tt (first correct prolonged 1st & 2nd stage of labor
hypovolemia with 0.9 NS then Turtle sign
correct the hypernatremia with 0.45 hypoxia Mat obesity
NS) (euvolemic hyperNa++ tt with polycythemia
Dextrose) (mild hyperNa++ tt wid 5 hypoglycemia
Dex wid 0.45 NS) hypothermia
hyper to hypo 0.9% NS /0.45 NS +5 hypocalcemia
D other one req hypertonic NS

shoulder dystocia causing erb's palsy, shoulder dystocia next step, protracted labor
sinusitis organism
next step is prolonged labor (cervical diln& fetal
descent)
strep pneumonia
fetal macrosomia-African American
non-typeable H influ
Traction on neck - Erbs Palsy application of suprapubic pressure

sleep terrors (N3)-low dose bzds only

if freq episodes or impaired daytime
functning),RLS-fe def (also specific phobia- next step not ssris or
somatic sx dzrder
pica),other sleep dz-rls etc- psychodynamic therapy
Polysmgrm
dispropotionate preoccupatn with somatic
panic dz- next step is psychotherapy
sx
parasomnia- childhood specific phobia - next step is behav therapy
NREM - fear,
crying,screaming,amnesia (4)

spinal cord compression spinal cord injury - motor & seNs weakness splenic abscess in IE septic emboli-left sided
(malignancy, epi abscess, disk + urinary retention (atropine or ext pacing pl effusion and splenic fluid collection (TB
herniation, compression fractures (if only 4 sym bradycardia- involve liver, intestine,peritoneum)
you dont get much clue-PE, lightheadedness,pre-syncope,)
a.dissection) urgent surgical
evaluation) also mycoplasma has pl effusion
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motor, sensory, reflexes, urinary
retention, LMN like
splenic sequestration -rc count &
platelet count
Normocytic anemia(usually with Fe
deficiency)
reticulocyte count inc
RBC count is normal & RDW is
normal
strabismus ee
amblyopia- lazy eye- wandering eye
Asymmetric corneal light reflections
& deviation on cover test
penalization (blurring) or occlusion
(patching)
stress incont with multiparity &
obesity- no fluid from cervix on
valsalva or coughing (bcoz fluid
from urethra)-cervicitis-mucopur
disch
subclavian steal synd (coarc fo aorta
has III sx+ no bl ue claudicn
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stop isotretinoin, no need to wean it,
contraception continued at least one month
status epilepticus complication
after isotret is stopped
seizure-hypoxia- necrosis
Lithium should be weaned in already
pregnant pt with Bipolar disorder
streptococcal dematitis
stress incont (vs urge incont tt is anti
muscarinic bcoz the bladder is contracting a
young children lot)
pruritus & pain
B- lactam antibiotics
sturge-weber synd- MRetard-port wine
stain-nevus flammeus-birthmark- along the
trigeminal nerve-Ipsilateral cavernous
subacute de Quervain thyroiditis
glaucoma
neck pain
UL cavernous hemangioma
radiological - intracranial calcification-
tramline
superior pulmonary sulcus tumor 1 syphilis-penicillin (if allergic and non-preg
then doxy but if preg then )
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(htn),headache,epistaxis)
vertebro-basilar insuff (dizziness,
ataxia, dysequilibrium)
worsened by upper extremity
exercise
Radicular pain is a type of pain that radiates
into the lower extremity directly along the im penicillin G - benzathine
course of a spinal nerve root. Radicular pain
is caused by compression, inflammation
and/or injury to a spinal nerve root arising
from common conditions including
herniated disc, foraminal stenosis and
peridural fibrosis.

syringomyelia tardive dyskinesia-irreversible-orofacial

tamoxifen se
chorea (vs acute dystonia (oculogyric
crisis,muscle spasm & stiffness))
impaired strenght & pain/temp
tamoxifen is used as an adjuvant therapy in
sensation of UE
E+ breast cancer
MRI for def dx lip smacking -TD

telogen effluvium (hair shaft

tetanus
examination is N) (vs alopecia areata
tetanus
- circumscribed patches of hair loss
with narrowing close to the surface trismus
of hair shaft) trismus - inability to open mouth spasms
hypertonicity

thiazide with lithium causes li tox

thyroid nodule next step thyroid storm although mild lid lag- fever in
ACE-I thyroid storm but not necessarily in
TTC hyperthyroidism- Grave's
radionuclide scan - low TSH (hot nodules)
MTZ
FNAC- N or high TSH (cold nodules)
NSAIDS
Thiazides

thyroid storm dt the iodine load from tinea versicolor (Malasezzia) is not a torus palatinus - bony hard consistency

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the CT contrast dermatophyte- sun exposure-selenium

sulfide and KCZ-rest all the tinea are bony hard
dermatophytes fleshy immobile mass
midline hard palate
surgery No meds or surgery is req - bcoz usually
trauma asym
infection
I2 contrast
childbirth

(vs Pheo(surgery, anesthesia,

medicatio))

trauma with hypotension causes-

t.pneumothorax (jvd
transtentorial herniation
inc),hemothorax,c.tamponade,hypovolemic trichmonas-vaginal inflammation absent only
shock- in bac vaginosis
uncal herniation asso with epidural
hematoma
differentiate car tamponade & both are foul smelling- trich & bac vaginosis
strabismus
pneumothorax with pcwp not jvp as both only candidiasis has- normal pH (less than
CL hemianopsia
have jvd 4.5) & thick discharge
altered mentation
hemothroax & p.thorax differentiate using
dullness or hyperresonant on percussion

tricuspid atresia vs TAPVR -inc pul vasc

trichomonas tt- oral MTZ
markings, RVH (not Lt axis deviation) trigeminal neuralgia not V-1

Vaginal discharge, pruritus, dysuria,

hypoplastic RV dt the complete abscence of cavernous sinus not V-3
dyspareunia
TV in Tricuspid atresia

trochanteric bursitis tt of bac meningitis in ICS pt (dt to Liver turner

transplant)

middle aged adult, superficial ul hip PROF

pain steroid only for strep pneumoniae low Eg
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types of BHS (cyanotic (apnea & urticaria (hives) vs contact dermatitis uterine inversion tt
limpness)) vs pallid (following minor (vesicles)
trauma & has pallor)
Placental removal
 Uterotonic drugs
emotional trigger--> BHS Infections Uterus is replaced

uterine rupture (vs cord prolapse-cord

valgus stress test - imagine cs exam - with
palpated below the cervix in the vagina)
uterine rupture (loss of fetal station hands on knee and all
fetal parts-irreg protruberance
not in abruptio placenta)

Medial coll lig tear- severe twisting injury

prior C section or myomectomy
turtle sign- shoulder dystocia Medial meniscus injury
vaginal &/ intra-abdominal pain & bleeding
recession of the presenting part medial knee & valgus laxity
fetal distress/demise
FHR MRI is most sensitive & most patients are
Abdominally palpable fetal parts @ rupture
managed nonoperatively
site & no presenting fetal parts vaginally

valpro8-bl tremor-inc alt &

ast+weakness+anorexia-rare lw
paltlt(in Q it was nL)vshaloperi-nt variceal bleeding- next step not ocretoide
varicella vaccine is given only post-partum as
lver,lw potncy-clprmzine-chole jaund
it is LA &hence ci in pregnancy (also MMR)
2 large bore iv catheters to initiate
tremor: resuscitation with iv fluids
parkinsons dz
valpro8

vascular ring- not improve with the vasomotor sx- dreanched in sweat at night- venous insuff.- (lymphatic obstruction - dorsa
prone position, ageLess1yr-abN devp diff concentration-irreg menstrual periods of feet & causes thickening & rigidity of
of a.arch compress trach,bronch,eso- skin-lymph node obstructn or
biphasic murmur resection,malignancy,trauma,filariasis)
hyperthyroid
menopause in middle age women
TSH & FSH lymph node obstruction /resectoin
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Vascular ring encircle trachea &/or malig

esophagus trauma
dysphagia, vomiting, difficulty filariasis
feeding
stridor - neck extension

vit b2 def
vit A def- search Bitot's spots

meat, eggs, yeast, dairy products, green

2 or 3 year old child with
vit D def dt small bowel resection with vegetables & enriched foods
impaired adaptation to darkness
Crohn's dz INH can cause niacin def
photophobia
b2 def- normocytic normochromic anemia
dry scaly skin
seborheic dermatitis
xerosis
low-normal serum ca (first year of life, middle age
conjunctiva
low 25-OH vi D dandruff
xerosis cornea
inc ALP Parkinson dz, HIV
keratomalacia
vi D def has bl fractures Topical antifungal are effective tt, also
Bitot spots
emollients & Nonmedicated shampoos
Follicular hyperkeratosis
also with B2 def
SHOULDER, BUTTOCKS,
erythematous, pruritic plaques with a greasy
EXTENSOR SURFACES
scale on scalp and face)

von Gierke
hypoketotic hypoglycemia - Primary
Systemic carnitine def; MCAD def
vulvodynia- pain with superficial touch to
vestibule
hence pain with even vaginal examination
wilson dz (AST more than ALT but ratio
more than 2 is charac of alco ( mallory bodies
is common to boht and microvesicular
cirrhosis is more common to Alco ))

withdrawl dt short-acting
(parox,alprazolam,lorazepam)or t12
not long t12 (diazepam,fluox) -not
ssris or bzd check t12-tt is long
acting & taper

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life threatening benzos withdrawl-

psychosis & seizures & tremors
anxiety dz- mild withdrawl - diff to
distinguish from reemergence of
underlying dzrder

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