medical mnemonics

neonatal cranial ultrasound

2012-02-11T23:38:00.000-08:00

http://www.adhb.govt.nz/newborn/teachingresources/radiology/HUSS/NeonatalHUSSViews.htm

X-Linked recessive metabolic disorders

2012-02-11T12:28:00.000-08:00

Hunt Loaf
Hunters
Lesch-Nyhan
OTC deficency
Adrenoleucodystrophy
Fabrys Disease

(Note acute intermittent porphyria is autosomal dominant)

book list

2012-02-05T10:00:00.001-08:00

http://www.amazon.co.uk/Books-those-sitting-paediatric-MRCPCH/lm/R1SYDUUVN26BI0/ref=cm_lmt_dtpa_f_1_rdssss0

opthalmology

2012-02-05T03:16:00.001-08:00

http://www.ophthobook.com/

volume of distriburion

2012-02-04T17:14:00.001-08:00

http://www.edserv.musc.edu/clinpk/resources/lesson1/lesson.htm

renal

2012-02-04T11:35:00.001-08:00

renal tubular acidosis

type 1 distal renal stones muscular weakness urinary colic constipation; hyperchloraemic metabolic acidosis
type 2 proximal urinary bicarbonate wasting - dct urine acidification unaffected

rta type iv
cystinuria (inherited stones disorder) v cystinosis (lysosomal storage disorder fanconi syndrome)
hypokalaemic hypomagnaesic metabolic alkalosis: Barterrs (< 2 yrs learning difficulty renal failure poor urinary concentrating ability medullary nephrocalcinois) v Gittlemans (older no renal failure always no lg)

Oxygen dissociation curve factors

2012-02-04T04:00:00.000-08:00

CADET, face right!

The following factors shift the oxygen dissociation curve to the right:
CO2
Acidity (decreased pH)
2,3-DGP
Exercise
Temperature rise

Source: http://www.facebook.com/MedicalPneumonics

My Modification:

Right shifts increase the enhances haemoglobin to unloading O2 to tissues

Right CADET Unload!

nephritic and nephrotis

2012-02-03T16:33:00.000-08:00

nephritic

"busy urine" with mild proteinuea
Types

Post streptococcal gn

Often 10 days after infection
smoky urine
hypertensive
overloaded
c3 low resoves over weeks

HSP Nephritis
IgA Disease

haematuria within hours of infection

Mebranoproliferative glomerulonephritis

rare; presents in older children
I: low c3 c4
II: low c3 that keeps low; normal c4
acute nephritis

fsgs

steroid resistant nephrotic

nephrotic - oedematous dry protein in urine but usually not much else

minimal change nephrotic

Thinking about genetic conditions

2012-02-02T03:18:00.000-08:00

Whole chromosome
Single Gene
Imprinting

Preader Willi, Angleman's

Microdeletions

Williams, Beckwith Wiedemann

Trinucleotide repeats

Fragile X, myotonic dystrophy

medical management

2012-01-31T04:51:00.001-08:00

http://www.fmlm.ac.uk/

genetics primer

2012-01-30T18:03:00.001-08:00

http://www.uic.edu/classes/bms/bms655/index.html

Syndrome Study List

2012-01-30T16:55:00.001-08:00

Neurofibromatosis

NF 1

dominant chromosome 17
Cafe-Au-Lait patches

NF 2

dominant chromosome 22
bilateral acoustic neuroma

Cerebral Palsy
Praeder wili

hypotonia at birth poor feeding obstructive sleep apnoea chromosome 15 hyperphagia 2 yrs imprinting

Anglemanns

developmental delay happy chromosome 15 imprinting

Williams syndrome

low nasal bridge supravalvular aortic stenosis
chromosome 7
mostly de novo mutation but can be autosomal dominant
hypercalcaemia risk so don't give vitamin e

Noonans

low set ears downslanting palprebal fissures pulmonary stenosis
webbed neck
autosomal dominant (30-75%)

Retts Syndrome

X linked dominant mostly females cause of developmental regression

Duchenne Muscular Dystrophy

Recessive X linked
elevated CK

Cystic Fibrosis

1/25 population carriers
CFTR
delta f 508 mutation most common
Chromosome 7

Marfans Syndrome

Chromosome 15
Autosomal dominant

Tay Sachs

ashkenazi jews
development regression
cherry red spot
autosomal recessive
chromosome 15

Frederichs Ataxia

autosomal recessive chromosome 9

Long QT syndrome

Romano-Ward: Autosomal Dominant, Arrythmias
Jervell-Lang-Nielsen Syndrome: Senorineural deafness associated with arrythmias, autosomal recessive

Childhood absence epilepsy

dont give carbamazipine - could precipitate carbamazipine encephalitis

Infantile Spasms

Could be presentation of tuberous sclerosis - vigabatrin
West Syndrome - spasms, hypsarrythmia on EEG, developmental regression
Developmental Sequiliae common - association with non verbal communication skill loss

Hurler? Hunter? SanFilipo?

SanFilipo

most common cause of progressive neurological and intellectual decline in children
hip dyslasia characteristic
Mucopolysaccharidosis

Hunter

Coarse Facies
Cloudy Cornea
X linked recessive

Hurler

Autosomal recessive
No corneal clouding

paediatric ecg signs

2012-01-29T18:57:00.000-08:00

superior axis findings - WANT - wpt avsd tricuspid atresia noonans

asd - rsr partial rbbb

clinical examination of upper limb - nerves muscle testing

2012-01-29T18:19:00.000-08:00

Source: Neuroanatomy draw it to know it

Abbreviations
DIPJ = Distal Inter Phalangeal Joint
PIPJ = Proximal Inter Phalangeal Joint
MCPJ = Meta Carpo Phalangeal Joint
D1 Thumb
D2 Index finger
D3 Middle Finger
D4 Ring Finger
D5 Little Finger

Median nerve

forearm muscle supply

anterior interosseous nerve (deep forearm muscle group C7 - T1):
Flexot Digitorum Profundus 2+3 - flex DIPJ of index and middle fingers
Flexor Pollicus Longus - flex thumb at PIPJ
Pronator Quadratus: pronate the arms

superficial forearm group (C6, C7)
Flexor digitorum superficialis - flexes digits 2 to 5 at the PIPJ
Flexor carpi radialis
Pronator teres
Palmaris longus

Hand muscle supply

Recurrent motor branch of thumb (thenar group C8, T1)

abductor pollicus brevis - abducts the thumb perpendicular to the plane of the palm
opponens policis - touch other digits with your thumb
flexor pollicis brevis (note this has ulnar innervation too) - flex thumb at MCPJ

terminal group (1st and 2nd lumbricals, C8, T1):

flex index (lumbrical 1) and middle (lumbrical 1) at MCPJ and
extends the index (lumrical 1) and middle finger (lumbrical 2) at the PIPJ

Ulnar
Flexor digitorum profundus 4+5: flex DIPJ of D4 and D5
Lumbricals 3 + 4
Dorsal Interossei - Adduct fingers
Palmar Interossei - adduct fingers
Adductor pollicis

Radial
Abuctor pollicus longus (C7, C8) - abducts thumb in plane of palm

Meningitis - causes

2012-01-29T15:49:00.000-08:00

Neonatal - 3 month - LEG
Listeria
E-coli
Group B Strep

1month - 6 years
NHS
Neisseria mengitidis
Haemophilus Influenzar
Streptococcus Pneumoniae
[Source - http://www.facebook.com/MedicalPneumonics]

congenital heart conditions

2012-01-25T16:55:00.001-08:00

http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/cardiac/chdhub.html

Critical congenital heart disease

2012-01-25T15:50:00.000-08:00

R Heart Obstruction - eg Fallots
L Heart Obstruction - eg coarctation, hypoplastic left heart (where management includes NOT giving O2 and the norwood procedure)
Inadequate Mixing - eg transposition of great arteries (cxr tapered top)
Inadequate Gas Exchane - as TAVPR (cxr venous congestion)

Paediatric Cardiovascular Examination Findings

2012-01-24T15:43:00.000-08:00

Source: Dr C Wei

Cvs examination findings
1) murmurs (see table below also)
All the others are associated with additional heart sounds:
-a continuous murmur, best heard in the left infraclavicular region
------PDA,
-an ejection systolic murmur at the upper left sternal edge, sometimes w click, radiating to the back and shoulder.------ PS
- pulmonary stenosis typically results in an ejection systolic murmur heard best over the pulmonary area------ tetralogy of fallot.
- a harsh ejection systolic murmur at the upper right eternal edge- radiating to carotids------ aortic stenosis
- ejection systolic murmur maximum over the (back) posterior left interscapular area------severe coarctation of aorta ( check for ?weak femoral pulses and ? Radio femoral delay)
-a pan systolic murmur at the left lower sternal edge ------ VSD.

Other systolic murmur:
- Hypertrophic cardiomyopathy is associated with a systolic murmur.
- systolic murmur in Tetralogy of Fallot

Diastolic:
- Mitral stenosis gives rise to a mid diastolic murmur- heard best at the apex region.
- In ankylosing spondylitis, aortic regurgitation may be associated with an early diastolic murmur.
- In Eisenmenger’s syndrome a high-pitched early diastolic murmur of pulmonary regurgitation may be heard.

TABLE 1 (American academy of family physician)
Listening Areas for Common Pediatric Heart Murmurs
Area: Murmur
Upper right sternal border
-- Aortic stenosis, venous hum
Upper left sternal border
-- Pulmonary stenosis, pulmonary flow murmurs, atrial septal defect,
patent ductus arteriosus
Lower left sternal border
-- Still's murmur, ventricular septal defect, tricuspid valve regurgitation,
hypertrophic cardiomyopathy, subaortic stenosis
Apex
-- Mitral valve regurgitation

2) systolic murmur with a click
Differential dx:
- pulmonary stenosis
- ASD
- Bicuspid aortic valve
- Aortic stenosis (valvular)

3) loud 2nd heart sound
A loud pulmonary component of the second heart sound is commonly heard in the following conditions:
- Primary pulmonary hypertension
- Large ventricular septal defect

3) thrill- significance
An associated thrill indicates
- a very large shunt or
- the presence of pulmonic stenosis
- Aortic stenosis- at suprasternal notch +/- over the carotids

4) Left parasternal heave
- suggests right ventricle hypertrophy

CATS guidelines

2012-01-24T14:26:00.001-08:00

http://portal.cats.nhs.uk/?page_id=80

Drug Causes of Gynaecomastia

2012-01-23T16:46:00.000-08:00

DISCOS

Digoxin

Isoniazid

Spironolactone

Cimetidine

Oestrogens

Stilboestrol

Source: ValueMD

Madman's CK COG

Metoclopramide

Amitriptyline

Digoxin

Methyldopa

Alkylating Agents

Neuroleptics

Spironolactone

Cimetidine

Ketoconazole

Cyproterone

Oestrogens

Gonadotrophins
Source: Hands on guide clinical pharmacology

Working Haematology Notes

2012-01-22T07:37:00.000-08:00

Investigating Anemia

raised LDH

reflects red cell destruction
Unconjugated bilirubin will be raised too
can be due to

destruction of red cells in the circulation - haemolysis
destruction of red cells in the marrow - ineffective erythropoiesis

So how can we figure out which one it is?

Get a reticulocyte count

Reticulocyte Count

reflects release of young red blood cells in circulation - and thus the ability of the bone marrow to respond to anaemia
In the context of a raised LDH

Expect a high count if you suspect haemolysis is occuring
A low count suggests ineffective erythropoiesis
In a patient with a sickle cell crisis presenting with an acute drop in Hb, reticulocyte count can help determine whether this is due to haemolysis or an aplastic crisis

B12 deficiency

Low potassium

abnormal DNA synthesis affects renal tubule cells - leading to potassium wasting syndrome
It is important to monitor potassium in the first week of b12 treatment in the context of low K+ as potassium may drop further due to increased marrow activity and new cells being formed - leading to sudden death

Disorders of haemoglobin synthesis

HbSS is a qualitative disorder of haemoglobin synthesis
Thalassaemia is a quantitative disorder of haemoglobin synthesis

No HbA in beta thalassaemia due to defective beta globin chain synthesis

Some notes on interpreting the coagulation screen

thrombin (IIa) is required in the final pathway to convert fibrinogen to fibrin the stuff that forms the clots and gets cross linked
Vitamin K deficiency results in impaired synthesis of factors II (prothrombin), VIII, IX and X. It causes both PT and APTT to be prolonged. This makes sense if you consider that thrombin (IIa) sits in the final path that the intrinsic and extrinsic pathways feed into
What if the APTT it prolonged and the PT normal?

Well common things being common its likely to be haemophilia, an abnormality of the extrinsic clotting system;
this is due to deficiencies of factors VIII(8) or IX(9). This would result in a prolonged APTT but normal PT, because there is no deficiency in prothrombin

References

Case Based Haematolgy McCann et al

Meosis schematic

2012-01-21T10:26:00.000-08:00

securing a chest drain, uvc etc

2012-01-15T04:21:00.003-08:00

http://www.youtube.com/watch?v=f3688j7dBhY

chest drain insertion tutorial

2012-01-15T04:21:00.001-08:00

http://www.youtube.com/watch?v=nZjs0GczEEg&list=UU9OeIyAg9P9ygyJYGYGYXZg&index=2&feature=plcp

paeds site

2012-01-06T17:53:00.001-08:00

http://pedclerk.bsd.uchicago.edu/