Ophthalmology x. Urology y. Seizures z. Immunodeficiencies Psychiatry a. Anxiety Disorders b. Impulse Control Disorders c. OCD and Related Disorders d. Mood Disorders f. Mood II Life and Death g. Psychotic Disorders h. Eating Disorders i. Personality Disorders j. Dissociative Disorders k. Catatonia l. Peds: Neurodevelopmental m.
Peds: Behavioral n. Addiction I: Substance Abuse q. Addiction II: Drugs of Abuse r. Sleep I: Physiology s. Sleep II: Disorders t. Gender Dysphoria u. Gynecology a. Gynecologic Cancers b. Gestational Trophoblastic c. Incontinence d. Adnexal Mass e. Pelvic Anatomy f. Gyn Infections g. Vaginal Bleeding: Premenarchy h. Vaginal Bleeding: Reproductive Years i. Vaginal Bleeding: Anatomy j. Vaginal Bleeding: Puberty k. Primary Amenorrhea l. Secondary Amenorrhea m. Infertility n.
Menopause o. Virilization Obstetrics a. Physiology Of Pregnancy b. Normal Prenatal Care c. Genetic Diseases d. Third Trimester Labs e. Advanced Prenatal Evaluation f. Medical Disease g. Normal Labor h. Abnormal Labor i.
Eclampsia k. Multiple Gestations l. Post-Partum Hemorrhage m. Antenatal Testing n. Third Trimester Bleeding o.
Alloimmunization p. Prenatal Infections q. OB Operations r. Contraception Surgery: General a. Pre-op Evaluation b. Post-op Fever c. Chest Pain d. Abdominal Distention e. Fistula f. They must undergo emergency surgery. An organic no anticoagulation needed echocardiogram shows the lesion. Surgical replacement is the sort of, definitely no bridge needed right answer.
Balloon valvotomy is absolutely wrong. Just like regurg, replace it when desired or treat with LV dilation. Aortic Insufficiency Aortic regurgitation is caused by infection, infarction, or in the case of aortic dissection. Other signs of chronic AI are widened pulse pressure, water-hammer pulses, pistol-shot pulses, and head bobbing.
This will require emergent replacement. Mitral Stenosis Caused almost exclusively by rheumatic heart disease. This murmur can lead to CHF and Afib dilation of the left atrium.
Options are a commissurotomy balloon dilation or simply replacement of the valve. However, in a euthyroid patient nodules can be cancer. FNA is the mainstem of management. If for cancer proceed to Thyroidectomy. Follicular cancer can be treated with radioactive iodine. Use the Sestamibi scan to find which one is enlarged. Take caution after resection for hypocalcemia perioral tingling, Chvostek Sign, Trousseau sign ; as the atrophied glands kick in they may not produce enough initially. Cut it out.
A CT scan locates the adenoma so it can be resected. Do a CT to find it, then try to resect it often, this fails. Now, they will have pain, can be anywhere from meningeal signs to coma, and may have a focal neurologic deficit. The diagnosis is made with a CT scan without contrast.
It will show blood but outside the parenchyma and between the gyri separating it from other bleeds. The best radiographic test is to obtain a MR angiogram or CT angiogram. The arteriogram with the wire is reserved for intervention. Clipping is a neurosurgical procedure. To prevent vasospasm acute infarct after SAH the patient needs to be on calcium channel blockers. This and seizures are the late complications.
This occurs most often at the caudate and putamen. There are some herniation syndromes you could learn, but the yield is silly low. The CT head will show blood in the parenchyma. Consider this the same as SAH — seizure prophylaxis, hydrocephalus, etc. Follow up with CT scans track how rapidly the hematoma is expanding. If they survive, rehabilitation is key. Patients may have complaints of headaches that are Glioblastoma worse in the morning.
Diagnose a lesion using an MRI. Definitive diagnosis is made by biopsy. Resection is rarely curative.
Posterior Fossa Tumor Pituitary Tumors Tumors in children are usually in the posterior fossa and in the Craniopharyngioma Medulloblastoma anterior fossa in adults. Resect and the patient will improve. I 7 Medulloblastoma also arises in the 4th ventricle. Resection chemo AND radiation are required. Mets usually make it through the medium caliber vessels and get stuck as a single or multiple lesions at the grey-white border.
Because the axillary nerve may be injured there may also be deltoid paresthesia. Relocate and sling. If there was a - Seizures and Lightning Strikes seizure or electrical injury, treat those as well. It looks like a dinner fork two prongs sticking up - Dorsally displaced radius Diagnose with an X-ray and cast it.
The ulna breaks while the radius - Upward block and a downward blow dislocates. An x-ray diagnoses it. In this wound the Galeazzi Fracture radius breaks gets hit first while the ulna dislocates. An x-ray - Downward block and a downward blow diagnoses it. Do casting or ORIF for the fracture. Initially, the x-ray will be normal. Do an x-ray and cast it. Ensure there is intact vascular and neural - Shortened Leg and Externally Rotated function distal to break.
An intertrochanteric fx gets plates. MRI is used for the knee. The posterior draw sign indicates PCL tear.
A valgus stress is from the lateral side and is more common because the Collateral Ligament Tear lateral side is exposed , rupturing the medial collateral ligament. But, a healthy active athlete Meniscus Tear complaining of pain and a click on full extension is likely to have - Pain in the knee, click on full extension a torn meniscus.
Pushing a frail bone too Stress Fracture far can cause a fracture. This is seen in out-of-shape weekend - Weekend warrior or forced march warriors or in people on forced march. The patient will - Pinpoint tibia pain complain of pinpoint tibia pain. Like the scaphoid fracture, the - X-ray normal X-ray is normal for 2 weeks. Use a cast if severe and crutches - Cast anyway and watch the fracture unfold on repeat X-ray. This requires direct trauma pedestrian - Adult pedestrian struck struck, adult.
The deformity is usually obvious, confirmed by - X-ray x-ray, repaired by casting if closed, nailing if open with ORIF. They will all be swollen, tender, and - Running, Popping, Limping painful. Compartment Syndrome Compartment Syndrome After reperfusion to a previously ischemic extremity clot, - Reperfusion or Crush crush , the leg will swell.
Confined by the fascial planes, the - Vascular compromise extremity becomes tense with an excruciating pain on passive - Excruciating pain on passive flexion flexion. Measure pressures. Release the tension with fasciotomy. The extension of the thumb mother cradling baby, guy lifting heavy median nerve innervates the plantar surface sensation and motor weights in the overhead position, anything where you have to of the first three digits. This is seen in people who do repetitive push. The major presenting complaint is thumb inside a closed fist and performing an ulnar deviation.
Pain gives way to paresthesias and weakness, ultimately Radial deviation, no pain. Ulnar deviation pain. With increased with thenar atrophy. This syndrome can be reproduced using the pain, the diagnosis is clear.
Surgical reattachment is median nerve. The diagnosis is clinical, so we start with possible but will not be the answer on the test.
Should that fail, intraarticular steroids can be attempted. But we see it often in to the OR, obtain an electromyography to confirm the diagnosis. The hand will be Carpal tunnel syndrome may be the presenting symptom of unable to extend because the fascia is contracted and balled up rheumatoid arthritis. The fascia actually pulls the hand closed.
Treat by typically following a penetrating injury. If that fails, use intraarticular injections. There will also be a fever. See this as mini-compartment test. Surgical reattachment is possible but will not be the answer on the test. Trigger Finger Inflammatory There is no sports injury but instead is a stenosing tenosynovitis.
The patient is unable to extend finger caution confusing this for Mallet Finger. For pediatrics every disease has its own case you are studying surgery only unique presentation. Developmental Dysplasia of the hip nontraumatic The hip is insufficiently deep so the femur head constantly Septic Any Joint pain Aspirate Drain and Abx pops out.
Confirm the diagnosis with an ultrasound at Transient Any Joint pain after History Supportive weeks as there can be physiologic laxity initially around Synovitis viral illness time of birth which may resolve.
Once diagnosed put the child in a harness to keep the femur approximated to the join as the joint grows out. Legg-Calve-Perthe Disease When a child is around six years old they can suffer from avascular necrosis of the hip. Diagnose by x-ray and then cast. Dx Patient Sxs Dx Tx iii. Slipped Capital Femoral Epiphysis Osgood- Teenage Knee pain with Clinical Support An orthopedic emergency, it can occur in adolescents who Schlatter athlete swelling are either obese or in a growth spurt. Get a frog-leg position usually girl Rods x-ray to confirm.
Surgery is required. It shows up in any age though Onion-skin usually a toddler during a febrile illness with complaints Fractures If a plate involved do open reduction and internal fixation of joint pain.
Do an x-ray first then a joint aspiration with Gram stain and culture. It needs to be drained and antibiotics should be started. Transient Synovitis On the differential for septic hip. Treat supportively. The athlete has two options: stop exercising curative or play through it.
If they work through, it there may be a palpable nodule. Otherwise, it causes no permanent sequelae but it does hurt. Their thorax will tip to the side causing a cosmetic deformity. More severe disease can cause respiratory issues. Treat by bracing with the goal of slowing progression not curing. Surgery with rod placement is reserved for severe cases. Have two in mind: osteogenic sarcoma presents with a sunburst onion skin pattern typically at the distal femur. Resection is treatment in both cases.
If the fracture involves the growth plate an ORIF is needed to ensure the plate is realigned. Otherwise the kid will grow up with one leg shorter than the other.
That means murmurs. Each murmur has a characteristic sound, appearance, and association. They can represent any number of high flow states typical in kids. This Right Ventricular Hypertrophy causes increased vascular markings on chest X-ray. Atrial Septal Defect Because the atria are low pressure, the consequences are small so this can be found at any age.
Closure if needed is typically achieved via catheter-directed device closure. Ventricular Septal Defect This is the most common congenital heart disease. Depending on the type, some may close spontaneously and do not require intervention. Children that have evidence of right-sided hypertrophy, increased right-sided pressures, failure to thrive, or heart failure need immediate repair. Patent Ductus Arteriosus A connection between the aorta and the pulmonary artery. The murmur may not be apparent on day one but may be noticed on the exit exam.
In term infants, these usually are no big deal and most self-resolve within 7 days if they are going to. In preterm infants, these often need closed indomethacin or surgery as they can cause hemodynamic instability. Use prostaglandins if the PDA is needed for a critical heart lesion.
This results in cyanosis blue baby and decreased Blue Baby Syndrome vascular markings on chest X-ray. They present either with acute cyanosis or chronic effects such as clubbing. While there are others, these two are most commonly seen, discussed, and tested. During the Deoxygenated first 8 weeks of embryogenesis the heart forms and twists. Without a PDA this is fatal so give prostaglandins. It presents Pulm Artery on day 1 as a blue baby. If severe, we get a blue baby and it requires immediate intervention.
The tricky way of presenting is in a toddler with tet Spells cyanosis relieved by squatting. Squatting causes an increase in systemic vascular resistance, pushing more right ventricular blood into the lungs. Look for a boot-shaped heart on chest X-ray. This is associated with Down and DiGeorge syndromes. Surgery is definitive therapy. The others are rare. Review Step 1 notes for clarity or to impress your attending. First, get blood pressures on arms and legs; there will be a large disparity.
Do an echocardiogram to definitely diagnose. Surgically correct. The A nal imperforate most common type is type C. This is where the proximal esophagus is C ardiac Echo blind and the distal esophagus has an aberrant connection running from T racheal the trachea to the stomach. These kids will vomit everything including E sophageal secretions from birth. Place a NG tube and obtain an x-ray. NG tube R enal ultrasound should coil up in the esophagus. There will be gas in the abdomen if the L imbs thumbs in particular distal esophagus is connected to either the proximal esophagus or to the trachea.
Keep NG tube in, start parenteral nutrition, and call surgery. Do a cross table X-ray on the prone child with radiopaque perineal marking. This will give a relationship between gas bubble and anus. Low lesions closer to the anus can be corrected via dilation or a minor surgical procedure. There is also a higher chance of maintaining continence. High lesions away from the anus need a colostomy with future correction.
These are from holes in the diaphragm. They are most commonly posterior Bochdalek most common but can be anterolateral Morgagni. Stabilize from a cardiac perspective before repairing surgically. Bilious Vomiting in Bilious Vomiting a Neonate A bilious vomit is indicative of an obstruction distal to the ampulla of vater.
The first step in working up Babygram bilious vomiting is to get a babygram. What it returns is highly nonspecific, but there are clues. Multiple air-fluid levels are indicative of intestinal atresia a vascular accident in utero, i. The double-bubble sign is associated with duodenal atresia, Malrotation Annular Pancreas Intestinal annular pancreas, and malrotation. The chances are greater for or Atresia malrotation if there is a normal gas pattern distally gas had to get Duodenal Atresia Enema Surgically here before the obstruction arose.
The amount of viscera on the outside usually determines the severity. Treatment of these conditions has significant overlap. Basically, cover viscera in a sterile bag and place saline-soaked gauze over extruded contents to prevent desiccation and infection.
Place NG tube to keep the bowel decompressed. Fluid balance is important as there can be a lot of loss from the exposed areas. Gastroschisis is right of midline and without a membrane. It is typically not associated with chromosomal abnormalities but is more susceptible to twisting and infection.
Omphalocele is in the midline and is covered with a membrane. It is more commonly associated with chromosomal abnormalities such as Beckwith-Wiedemann syndrome. Keep covered with plastic barrier to prevent drying out. These are typically corrected surgically within 2 days to 2 weeks for best outcomes.
One eye will be normal while the other eye will go blind. Attempt to treat by patching the dominant eye but the best way is to prevent the cause in the first place. Congenital esotropia should be corrected around 6 months. Later onset can often be treated with patching of dominant eye, glasses if caused by refraction , and surgery. Retinoblastoma In the nursery, instead of a red light reflex, a pure white retina can be seen in the back of the eye.
The tumor needs to be resected. Observe the patient for future osteosarcoma - especially in the distal femur. Cataracts Congenital cataracts have a milky white appearance in the front of the eye.
Think of the TORCH infections, genetics if born with them, or a galactosemia if acquired early in life. Surgically correct it before amblyopia sets in. Retinopathy of Prematurity Premature neonates requiring high-flow O2 can get these growths on the retina. Using laser ablation can improve vision in life. Look also for intraventricular hemorrhage, bronchopulmonary dysplasia, and necrotizing enterocolitis in Type Timing Purulent Problems Treatment a preemie in the ICU.
Chemical 24 hrs Varies Bilateral Caused by silver nitrate — stop it! We should screen and treat Check for ppx mothers with either gonorrhea or Chlamydia to prevent systemic ophthalmologic infections. All infants should receive prophylaxis illness! Chemical conjunctivitis occurs in watery then bilateral the first day of life think silver nitrate. If a baby has no then No topical conjunctivitis on day one but then subsequently develops it, purulent, Check for antibiotics! The causes are vast, but bloody systemic gonorrhea and Chlamydia are at the top of the list.
There are illness - can some physical features that separate the two, but because multiple turn into bugs can cause it get a culture or at least a PCR to know what pneumonia needs to be treated. Meconium Ileus Usually seen in patients with cystic fibrosis, this is a collection This is cystic fibrosis until further notice of meconium that too thick and viscous to pass as a result of pancreatic insufficiency.
This can cause any combination of bilious vomiting or failure to pass meconium. X-ray can show an area of obstruction with a gas-filled plug. Perform water-soluble contrast enema to help breakdown the obstruction. Sometime surgical intervention is required. Complications include perforation which can lead to meconium peritonitis which is an emergency.
This means no motility — the bowel unable to relax hence the increased rectal tone. There will be a history of overflow incontinence in the older child or a stool eruption after doing a digital examination in the nursery.
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