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62 Cards in this Set
- Front
- Back
Signs of c. botulinum infxn?
Cause? |
constipated, poor feed, hypotonia, loss DTRs, impaired gag reflex, resp difficulty, hypotn, neurogen bladder
-ingestion of c. botulinim (honey) in GI tract that then produces toxin that blocks ACh release |
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Klumpke paralysis=?
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From excessive traction of arm on delivery
Paralyzed hand (claw hand w/ lack of grasp reflex) w/ Horner syndrome (ptosis, miosis, anhydrosis) -C7-81 +/-T1 (confirm on MRI w/ nerve root avulsion/rupture) -Immobilize the arm |
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What predisposes baby to facial nerve palsy?
signs? |
pressure over facial nerve in utero/labor, forceps delivery
-Facial paralysis more noticable on baby crying (usually improves w/ time) |
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Differentiate swelling in newborn scalp
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cross suture lines=caput succedaneum (swollen soft tissue)
Does not cross=cephalohematoma (subperiosteal hemorrhage) |
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absent moro reflex w/ intact grasp reflex in newborn=?
What is the arm's position? |
Erb-Duchene paralysis (C5-C6) "waiter tip"
internally rotated adducted w/ pronated forearm |
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Differentiate chronic hep B and C
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chronic hep C has waxing and waining LFTs w/ arthralgias on occasion (cryoglobulinemia, porphyria cut tarda, ITP, glomerulonephritis, etc.)
Chronic hep B does not wax/wane |
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Hundred of adenomatous polyps in colon=?
Managment? |
Familial adenom polyposis (FAP): aut dom from mut APC gene
-elective proctocolectomy at time of dx (100% risk ca) |
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What is the most common cause of amblyopia in childhood.
Dx Test/ TMT? |
Strabismus (medial deviation of eye or esodeviation)
-Do cover test (the normal eye keeps position, but the abnormal one must change to refixate on object) -TMT w/ covering the normal eye (so prob eye can mature properly rather than go blind) |
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Type of renal problem in HSP?
Dx Test? TMT? |
IgA mediated vasculitis (mesangial IgA depot)
-usually clinical but bx w/ IgA depot on immunof in skin or renal (this is a leukocytoclastic vasculitis) -Resolves by self, steroids if abd pain/renal prob progressive |
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rupture of berry aneurysm=?
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subarrachnoid hemorrhage (they'll have a HA b4 any neuro findings) So if neuro findings + HTN=basal ganglia/putamen hemorrhage
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Name physiologic feet/leg problems in newborn that are seen commonly?
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metatarsus adductus: if overcorrects to abduction when passively or actively moved->reassurance, if only corrects to neutral->orthosis/corrective shoes, if do not correct/rigid->serial castings
internal tibial torsion: reassurance (corrects in 95% cases) |
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In what conditions can you breastfeed and when can't you?
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Can: mastitis, rubella, breast milk jaundice (only switch to formual for 2ddays and resume), hemolytic dz newborne (erythroblastosis fetalis->ab in milk are inactivated in baby GI tract), Hep B/C, malaria, toxoplasmosis,
Can't: HIV, on HAART/CHEMO/RADIATION, active TB, |
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How to tell it's not marfan's but homocystinuria?
How to tell homocystinuria from phenylketonuria? TMT of homoc |
Marfan's + Thromboembolic events/stroke=homocystinuria (also downard lens dislocation), marfans does not have retardation!
-It's cystathionine synthase deficiency -Phenylk and homo have fair skin, blue eyes, but only phenyl has musty odor & eczema -TMT w/ hi dose vit D |
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Differentiate papillary muscle rupture vs. free wall rupture post MI
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Pap muscle: requires RCA infart, 3-5days post MI, have acute pulm edema (SOB) + new holosystolic murmur
Free wall: requires LAD infarct: 5-2wk postMI, have JVD, distant heart sounds, shock from pericardial effusion/tamponade (no new murmur or lung sounds) |
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What is the arrythmia of dig toxicity?
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atrial tachy w/ AV block
EKG may show downsloping of ST seg in all leads |
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What are common drug-induced causes of pancreatitis and why are pts taking them?
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diuretics-lasix, thiazides
Seizure/bipolar: valproate IBD: sulfasalazine, 5-ASA AIDS: didanosine, pentamidine abx: metronidazole, tetracyclines Immunosuprresives: azathioprine, L-aspariginase |
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What are findings/complications of meningococcemia?
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meningitis, skin petechia/purpura, joint arthralgias, septic appearing
Complication: ADRENAL FAILURE (Waterhouse-friderichsen) and HEMORRHAGE=sudden hypotn and death |
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alternate name of croup?
Cause? TMT? |
Laryngotracheobronchitis (LTB)
-parainfluenza -racemic epi to prevent asphyxiation |
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TMT of croup vs epiglottitis vs whooping cough?
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Croup: racemic epi (young 0-5yo)
epiglottitis: intubate + ceftiaxone + rifampin to contacts (older children) Whoop: erythro/azithro if catarrhal stage, isolate, macrolide sto close contacts |
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What is bacillary angiomatosis? TMT
Differentiate from molluscum contagiosum and kaposi sarcoma |
bartonella (GNR) infxn->bright red fiable exophytic PRURITIC nodules in HIV pt: give po erythromycin
-Kaposi skin lesions are papules (light brown-violet) that become plaques or nodules on trunk/face/extrem -molluscum contagiosum (HPV): dome papules w/ central umbilication by poxvirus, NONPRURITIC |
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Management of minimal change dz?
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In kids and hodgkins: empiric steroid therapy (has benign course but frequently relapses after steroids stopped)
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wide fixed splitting of S2=>
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ASD (will see no sx) also ejection systolic murmur
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Types of chronic vs acute prostatitis?
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acute: irritative voiding, exquisitely tender, bacturia and pyuria on u/a
chronic bacterial: irritative voiding, afebrile, u/a normal, ucx w/ >10wbcs, and +cx inflammatory chronic: irritative, u/a normal, ucx w/ >10wbc, -cx non-inflammatory chronic: irritative, u/a normal, ucx w/ <10wbc, -cx |
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fever, chills, L lung base sounds less, LUQ tender, CT w/ fluid colleciton in spleen, wbc count 23500, 65% pmn, 11% band, elevated LFTs
ML Dx? |
Infective endocarditis! L sided causing septic emboli to spleen (can also go to liver, kidney, brain), possibly Hep C too (suggests IV drug use) Key things=hi WBC, fever chills, and random findings in distant organs from septic emboli in Hi Risk pt=IE
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Common findings associated w/ types of pna?
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HiB=COPD
Staph=recent viral/flu Kleb=alcohol, DM=currant jelly, hemop (necrotizing pna) Anaerobes=poor dent, demented, aspir=foul rot egg Myco=young military dorm=dry cough=PCR, cold agglutin, pmn on sputum gram stain Chlamydi=hoarseness=serologic titers Legionella=water source/ac=GI diarrhea, HA, confuse=urine antigen/cx charcoal-yeast agar |
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Hemi-neglect = lesion where?
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R parietal lobe (non-dom parietal lobe)
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Pt in MVA w/ internal bleeding u/s shows fluid at spleno-renal angle, but is hemodynamically responsive to fluids.
Next Step? |
Abd CT to document splenic injury in case of need for later surgery
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What is seen in CXR on staph aureus pna. When do you get it?
Differentiate from bronchiectasis |
multiple cavitary lesions (acute necrotizing pna w/ 2ndary pneumatocels), it's a super infection w/ bloody yellow sputum, hi fever, the worst stuff.
pna after recent viral URI/influenza -Bronchiectasis has same sputum production and is also necrotizing, but is chronic w/ dilated bronchi (not cavities) |
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What is pimozide?
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typical antipsychotic (that or haldol treat tourrettes_
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When to suspect chorioamniotnitis
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PPROM or prolonged ROM (no it by amniotic fluid pH 7-7.5 wheras vag fluid is 4-4.5) w/ fever and 1 of: mom HR>100, baby HR>160, mom WBCC >15000, uterine tenderness, foul-smelling amniotic fluid
-Deliver immediately (can be vaginal) |
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Pt when arm abducted past 90 degrees and asked lower arm slowley, suddenly drops when near the 90 degree=?
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Complete rotator cuff tear (drop arm test)->supraspinatus most likely
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"popeye sign" =
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rupture of long head tendon biceps (muscle belly pops up in mid arm w/ weakness on supination but can still flex foream)
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Differentiate findings nocardia vs. TB vs. actinomyces
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Nocardia: PARTIALLY acid-fast, gram+ beading rod (filamentous), aerobe in soil: like TB w/ weight loss, fever, night sweats, purulent cough, CXR w/ alveolar infiltrate/nodules and cavitation (even chest wall invasion), disseminates to anywhere but esp subq and brain abscess (look for immunocompromised or steroid user)->BACTRIM
TB: acid fast non branching rods do NOT gram stain (same sx nocardia) w/ cavitary lesion->RIPE Actinomyces: filamentous gram positive SULFUR granules ANAEROBIC so usually cervicofacial skin and sinus tract dz->PENICILLIN G |
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Management of child swallowing battery?
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CXR to determine location immediately
if in esophagus->immediate endoscopic removal (prevent esophageal ulceration) if passed esophagus: observe to confirm excretion in stool |
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Cri du chat=
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cry of the cat: 5p deletion: cat-like cry, hypotonia, short stature, mental retard, facial abnromalities
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Steps of tmt for pseudotumor cerebri?
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1. fundoscopy to routine monitor visual fields
2. weight loss 3. acetazolamide (inhibits chooid plexus carb anhydrase CSF prod) 4. Steroids (if waiting for surgery w/ deteriorating vision) 5. surgery w/ lumboperitoneal shunt (rpted lumbar puncture no longer the norm) |
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1st line tmt otitis media?
for sinusitis? for pharyngitis? |
-amoxicillin 10day course (strep pneumo 1, HiB 2)
-amoxicillin-clavulonate (or doxy or bactrim) w/ decongestant -amoxicillin or penicillin (cephalexin if penicillin rash, clinda or macroolide if pen anaphylaxis) |
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When to worry about neonatal jaundice (5 rules)
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1. appears 1st 24hrs life (phys jaundice happens day 2 or 3, if day 5 think neonatal sepsis, if b4 1day think erythroblastosis fatalis)
2. rate increase tbili >5mg/hr 3. bili level >12 or 10 in premie 4. jaundice after 10days old 5. conj bili every >2 |
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Differentiate hyaline membrane dz vs. transient tachypnea newborn vs. persistent pulm htn newborn vs meconium asp syndrome
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HMD: PREMATURE, immediate tachyp, grunt, use intercostal/sub muscles, nasal flare, cyanaosis, harsh tubular sound, CXR fine reticular granular esp over bases->mech vent and surfactant administer
TTN: TERM, cyanosis corrects w/ O2, flat diaphragm, fluid lines in fissures, prom vasc marking, pleural fluid PPHN: TERM, cyanosis, hypoxia not correcting w/ O2, XR normal or opacification MAS: TERM, resp distress in 1hr after deliver, ptx or pneumomediastinum, increased AP diameter/flat diaphragm (think emphysema findings) |
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2yo w/ otitis media has seizure-like episode for 3 min.
ML Dx? Criteria TMT? |
Simple febrile seizure (common in kids <6yo w/ viral/bacterial infxn, Dtap, MMR)
1. seizure w/ temp >38 (100.4) 2. age <6 3. no CNS infxn 4. no acute systemic metabolic cause 5. no hx of afebrile seizure -if <15min=simple->treat otitis media and send home, -if >15min=complex: at risk for future seizures (epilepsy) |
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Rules for chickenpox?
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usually get it b4 16yo. If exposed, has 10-14day incubation period b4 vesicles, are contagious 48hr b4 vesicles to when all are crusted over and should be isolated throughout. Get vacc w/in 5 days of exposure or not effective, only in immunocompitent. If don't get rash in 2wks, can give vaccine for future. If immunocompromised/pregnant, get VZIG w/in 96hr (does not always prevent infxn but can delay it).
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What is the cause of grave's opthalmopathy?
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autoimmune lymphocytic infiltrate of EOM causing fibroblast prolif and hyaluronic acid depot->edema and fibrosis
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Differentiate roseola from chickenpox.
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Roseola (Herpes virus 6): fever->5days later maculopap rash trunk spreads periph
Chickenpox (VZV): prodrome (fever/malaise/anorexia)->rash on trunk w/ vesicles that break and scab in crops |
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wedge shaped lesion on CT=?
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Pulm Embolism
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1st step in management of a suspected congenital diaphragmatic hernia?
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place OG tube and put to suction to prevent bowel distention and further lung compression
then CXR |
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Differentiate precocious adrenarche, thelarche, and pubarche
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adrenarche: activation adrenal glands b4 6yo, have dark axillary hair, benign->no workup
Pubarche: pubic hair growth b4 8yo, alarm->50% time CNS disorder Thelarche: breast development b4 8yo, benign, no prob |
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Managmenet of possible renal colic?
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Do pelvic u/s 1st (IVP, CT and shockwave lith are contraI in preg)
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What is seen in chlamydia conjunctivitis?
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purulent discharge, later goes to pna 3-19wks after bith (no wheezing or fever->otherwise thing RSV bronchiolitis)
TMT: po erythromycin |
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loud P2=?
Who gets this? |
endocardial cushion defect (AV canal) causing pulm HTN
Down's syndrome (most common defect in Down's) |
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Large kidneys bilat=(5)?
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Amyloidosis (look for GI/IBD, psoriasis, RA, chronic infxns, multiple myeloma)
HIV nephropathy Polycystic kidneys Diabetes Renal Cell Ca |
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Differentiate physical exam findings of vaginosis and pH
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Trichomonas: PRURITIC, INFLAMMED, MALODOROUS, frothy, pH up >4.5
Bacterial vaginosis: nonpruritic, noninflammed, stinky, up pH >4.5 Candida: thick clusters, down pH <4.5 |
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How do you treat PEA?
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start CPR, give O2, attache monitor/defibrillator->if asystole/PEA->CPRx2min, IV access, give epi q3min->shock->CPRx2min, epi q3->shock->CPRx2min, amiodarone push->treat reversible causes->rpt starting at shock
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5Hs & Ts of PEA
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Hypovol, hypoxia, H-acidosis, Hypo/perkalemia, hypothermia
Tension pneumo, tamponade, toxin (narcotic/benzo), thrombus, trauma |
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Differentiate milia and erythema toxicum and sebaceous hyperplasia
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milia: small pearly white cysts on baby usually around nose
sebaceous hyperpalsia: little yellowish flat papules on face/nose Erythema toxicum neon: erythematous papules and vesicles w/ surrounding erythema/halo (pustules have eosinophils) ALL BENIGN |
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asbestosis = what risk?
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BRONCHOGENIC CA >>>mesothelioma
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Todd's Paralysis=?
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LOC w/ disorientation, slow gain consciousness and postictal paralysis (todd paralysis) usually resolving w/in 24hr
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What is mech ondansetron?
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serotonin agonist (5HT3 receptor) use for chemo-induced vomiting ppx
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1mo old infant starts crying spontaneously at night and cannot be comorted, been going on for days.
ML Dx? TMT |
Infantile colic (benign crying of unknown etiology)
-from 1mo-4mo age (will spontaneously resolve) |
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MRI findings of friedreich ataxia:
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atrophy cervical spinal cord and cerebellar atrophy
-Get myocarditis w/ T-wave inversion (ddx MI, myocarditis, old pericarditis, dig tox, contusion) |
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What are the symptoms of Fragile X?
What is the cause? |
large head, long face, prominent forehead, chin, protruiding ears, large testes, hypereactivy autistic
-FMR1 methylation gene mut w/ CGG repeats |
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Galaktokinase def vs galactosemia vs fructosuria vs fructose intol
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-Galaktokinase def: cataracts, social smile, asx, aut rec
-Galactosemia: def galac-1-phosph-uridyl-transf, aut rec, bilat cataract, fail to thrive, hypoglycemia, jaundice (vomiting), hepatomegaly, retard (convulsions)->Galactitol buidliup in these 2 dz -Frucosuria (fructokinase def): aut rec, benign, fructose in urine/blood -Fruc intol: aldolase b def, aut rec, fructose-1-phosph builds up, hypoglyc, jaundice, cirrhosis, vomit w/in 20-30min of fructose meal or sucrose |
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When is bedwetting normal?
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up to 5yo (don't order a single test till then!)
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