20 Eylül 2010 Pazartesi

Medical reminders - ( P-R-S )

Sponsorlu Bağlantılar:

Pancreatitis
(Ranson’s poor prognostic factors)
ABG (PO2) < 60
BUN increase > 5
Calcium < 8
Deficit of base > 4
Erythrocyte loss (Htc) > 10%
Fluid accumuliation > 6000cc

Pancreatitis
(high risc factors for complication)
Age > 55
Blood sugar > 200
Cell count (WBC) >16,000
Dehydrogenase (LDH) >350
Enzyme (OT) > 250

Pancreatitis (management)
Pain control
Antibiotics
NPO/NG-tube
Coagulopathy (DIC)
Renal function (UOP, S-Gravity)
Electrolyte monitoring
Airway (O2 for hypoxia)
Support with IVF

Parrot fever  (clinical features)
Pneumonitis
Adenopathy
Rashes
Rigid neck (meningismus)
Organomegaly
Throat (pharyngitis)

Pelvic inflammatory disease
(diagnostic criteria of at least three)
Discharge, vaginal
Identified GC or Chlamydia
Sed Rate increase
Elevation of temperature
Abdominal tenderness (m)
Sex organ tenderness, bilateral adnexal (m)
Extreme cervix tenderness (m)

Peptic Ulcer Disease (management)
Proton-pump inhibitor (Omeprazole)
Enhance mucose protection (Sucralfate)
Prostoglandin (Misoprostol)
Treating H. Pylori
Inhibitor of H2
CaCO3
Surgery for perforation
Pfeiffer syndrome
Premature closure of cranial sutures
Frontal bossing
Exophthalmos
Imperforate anus
Feet (broad hallux, delta phalanx)
Fused vertebra
Extremity anomaly (broad thumb)
Retarded

Pierre Robin sequence
Retrognathia
Ocular anomalies (Stickler syndrome)
Breathing problem
Incomplete palate (cleft)
Neonatal FTT

Pneumothorax (risk factors)
Tall stature
Thin body mass
Twenties of age
Tobacco smoking
Trauma
Tumors

Poisoning (contraindications for charcoal use)
Cyanide
Hydrocarbon
Acid/alkali
Relative small compounds
Charged (iron, heavy metals)
Organophosphate
Alcohol
Lithium

Poland syndrome
Pectoralis muscle defect
Oblige/syn/brachydactyly
Limb anomaly
Agenesis of kidney
Nipple anomaly
Dextrocardia

Polyarteritis nodosa (clinical featurues)
Abdominal pain
Rashes
Temperature
Extremity (arthralgia)
Renal failure
Intestinal infarction
Tip of fingers (necrosis)
Increased blood pressure
Seizure

Polycystic ovarian syndrome
(clinical featurues)
Obesity
Virilization
Anovulationte                                     
Resistance to insulin (diabetes)
Increased hair
Androgen increase
No period

Polymyositis/Dermatomyositis
(diagnostic criteria)
Myositis
Unidentification of infectious agent
Symmetric muscle weakness
Cuteneous rashes
Level of enzyme increase (CPK, Aldolase)
EMG shows myopathy

Portal hypertension
(emergency management)
Hemostasis (Fluid/RBC/Plt)
Endoscopic sclerotherapy/ligation
Portal-systemic shunting
ADH and Anti-H2 (Zantac)
Tamponade
Insertion of NG-tube (lavage)
Coagulopathy prevention (Vit K, FFP)

Prader-Willi syndrome
Poor tone (hypotonia)
Retarded (MR)
Abnormal genitalia
Dysmorphic face
Eating problem (obesity)
Reduce pigmentation

Preeclampsia (PRE)/eclampsia (E)
(clinical features)
Proteinuria
Rise in blood pressure
Edema
Epileptic activity confirm eclampsia

Pregnancy (physiological compensations)
Alkaline phosphatase
Blood volume
Cardiac output
Dilutional anemia
ESR
Factors 7, 8, 9, 10
GFR
Heart rate
Inspiration (tidal volume)

Premenstrual syndrome (management)
Progesterone/pyridoxine/Prozac
Estrogen reduction (GnRH)
Regular aerobic exercise
Inflammatory control (NSAIDs)
OCP. Omega 3 fatty acids (fish oil)
Danazol (reduce mastalgie)
Spironolactone (aldosterone antagonist)

Primary adrenal insufficiency
(clinical features)
Amenorrhea
Derma (hairless)
Reduced blood sugar
Electrolyte interference (/K/CabáNa)
Nutrition (weight loss, anorexia)
Arthralgia/myoralgia
Low BP
Skin (hyperpigmentation)

Primary adrenal insufficiency
(etiologies)
Addison’s disease
ACTH resistance
Adrenolekodytrophy
Adrenal hypoplasia

Prolong QT syndrome
(clinical features--first three are the triad of EKG findings)
Asymmetric T waves
Bradycardia
Corrected QT>0.44 second
Death may ocur
Episodes of presyncope

Proteus syndrome
Pigmentation (café-au-lait spots)
Retarded >20%
Overgrowth with asymmetry
Tumor tendency
Extremity anomalies
Unilateral
Spinal anomaly

Prune-belly syndrome (clinical triad)
Abdominal musculature anomaly
Bladder/urinary tract abnormality
Cryptorchidism

Pruritus (differential diagnosis)
Psychologic
Rashes
Urticaria
Renal/Uremia
Irritants/Allergens
Tumor (Leukemia/Hodgkin)
Infection
Cholestasis (TPN/Pregnancy)
Systemic Medications

Pseudo-tumor cerebri
(clinical features)
Papilledema
Severe headache
Emesis
Unsteadiness (ataxia)
Dizziness
Oculomotor paralysis (diplopia)

Pseudo-tumor cerebri (management)
Prednisone
Spinal tap
Eye examination
Uncover underlying causes
Diamox (decrease CSF production)
Operation (shunt, optic nevre sheath fenestration)

Psoriasis (medication triggers)
Steroids
Chloroquine                    
Aspirin (NSAIDs)
Lithium
Esmolol (beta-blockers)

Psoriasis (clinical features-two phenomena, three triggers and four skin anomalies) include:
Plaque of skin
Scaly skin
Oily skin
Red skin
Isomorpic phenomenon (Koebner)
Auspitz phenomenon
Strep infection as trigger
Injury as trigger
Stres as trigger

Pulmonary embolism (management)
TPA (tissue plasminogen activator)
Heparin
Resection of bolus
Oxygen
Maintaining BP
Bicarbonate for acidosis
Urokinase
Streptokinase

Pulmonary hypertension (etiologies)
Pulmonary vasculitis
Upper airway obstruction
Lung diseases (CF)
Muscular hypoventilation
Occlusion of pulmonary vessel (pulmonary embolism)
Newborn (PPH)
Idiopathic
Cardiac (ASD, VSD, CHF, shunt)

Pyelonephritis (clinical features in newborn)
Poor feeding
Yellow (Jaundice)
Emesis
Lethargy
Odorous urine

Pyloric stenosis (clinical features)
Projectile vomiting
Young male (younger than 6 months)
Loss of fluid/CI (hypochloremic dehydration)
Olive-shaped mass
Reduced weight
Ultrasound with hypertophy
String/Shoulder signs on UGI film

Rabies (clinical data)
RNA rhabdovirus
Animal bite
Black inclusion (nigri bodies)
Involuntary motion
Encephalitis
Serological tool for diagnosis (FA stain)

Rape (management)
Reporting
Antibiotic prophylaxes
Pregnancy prevention
Immunization (HBV or tetanus PRN)
Support (emotional and psychosocial)
Testing for infection or semen

Reiter’s syndrome (reactive inflammation-clinical features)
Rashes
Enteritis
Arthritis
Conjunctivitis
Tract of genitourinary (urethritis)

Renal venous thrombosis (etiologies)
TOF (cyanotic CHD)
H2O deficit (dehydration)
Renal anomalies (congenital)
Overdose of contrast agent (hyperosmolar)
Maternal diabetes
Blood (hemoconcentration)
Oxygen insufficiency (asphyxia)
Shock
Increased muscle tone (hypertonia)
Sepsis

Retropharyngeal abscess (management)
Airway
Breathing
Start antibiotics ASAP
CT scan as gold standard
ENT consultation
Supportive (fluid/pain)
Surgery PRN

Reye’s syndrome (clinical features)
Respiratory distress
Encephalopathy
Yellow liver(fatty degeneration)
Elevation of mitochondrial enzymes
 Salicylates as trigger

Rhabdomyolysis (evaluation)
Myoglobinuria
Urinalysis
Serum potassium
Creatinine
Lysis sign on CBC (hemolysis)
Enzyme (CPK) increase

Rheumatic fever
[major (M) and/or minor (m) criteria]
Rashes (M)
Heart disease (M)
Extensor skin nodules (M)
Unique chorea(sydenham) (M)
Migrating arthritis (M)
Arthralgia (m)
Temperature (m)
İnflammatory (ESR, CRP) (m)
Cardiac blockage on EKG (m)

Rickets (risk factors)
Rapid growth (premie)
İnadequate intake of D and Ca
Chronic liver disease
Kidney insufficiency (calcitriol)
Enteral loss (IBD)
Tabular dysfunction (loss of Ca or Phos)
Sunlight deficit

Roseola infantum (clinical features)
Rashes
Occipital adenopathy
Seizure
Encephalopathy
Ocular (eyelid) edema
Low platelet
Aseptic meningitis

Rubella (clinical features)
Rash
URI
Birth defects
Eye involvement
Lymphadenopathy
Low grade fever
Artritis

Rubistein -Taybi syndrome
Retarded growth
Unsteady/stiff gait
Broad thumbs/toes
IQ impairment
Narrow palate with hypoplastic maxilla
Speech difficulties
Tone (hypotonia)
Eye (heavy eyebrows and long eyelashes)
Infection in infancy
Nose (beaked and prominent)

Russel-Silver syndrome
Retarded growth
Uniparental disomy 7
Small/Triangular face with normal HC
Short arm-span, limb asymmetry
Extremity anomaly (clinodactyly)
Low birth weight
Low blood sugar at birth

Salmonella infection (complications)
Sepsis
Adenopathy
Loss of fluids/electrolytes
Myocarditis
Osteomyelitis
Neurological
Enteritis
Lung involvement
Liver involvement
Arthritis

Sarcoidosis (clinical features)
Granuloma
Rashes
Adenopathy
Noncaseating
Uveitis
Lung infiltration
Organomegaly
Malaise
Arthritis

Scarlet fever (clinical features)
Strawberry tongue”
Circumoral pallor”
Adenopathy
Rashes (“sandpaper”)
Line of “Pastie”
Enlarged tonsils
Temperature (fever)

Scleroderma (pathogenesis)
Skin as major target
Collagen glycosylation anomaly
Laminin auto-antibodies
Endothelin anomaly
Raynaud phenomenon
Organ involvement

Scleroderma (skin cahanges)
Discoloration
Edema
Raynaud phenomenon
Morning stiffness
Atrophy

Scleroderma (organ involvement)
Skin
Cardiac
Lung
Esophagus/enteral/oral
Renal
Ocular
Skeletal
Intracranial nerves
Sicca syndrome with parotitis

Seckel syndrome
Short stature
Enlarged nose
CNS anomaly (MR)
Knee/hip anomalies
Eleven ribs
Low ears/large eyes

Sepsis (risk factors)
Sickle cell disease
Engrafted (BMT) patients
Polynuclear cell dysfunction
Steroid usage
Indwelling catheter
SCIDS
Serum sickness (clinical features)
Splenomegaly
Extremity (joint effusion)
Regional lymphadenopathy
Urticarial/maculopapular rashes
Mental change (CNS vasculities)

Short stature (evaluation)
Skeletal Age/Sweat
Turner’s (Genetics)
Anemia
TSH.T4.T3
UA (UTI.RTA)
Renal/electrolytes
ESR/Endocrine

SIADH (etiology)
Secretary tumors (pancreatic carcinoma)
Infection of brain (meningitis, encephalitis)
Asthma/lung disease (TB, CF, pneumonia)
Drugs (nicotine, clofibrate)
Head trauma

Slipped capital femoral epiphysis (clinical features)
Chronic-most common
Acute slip superimposed on chronic slip also common
Pain as major symptom
Internal rotation decreased
Thickening palpable
Atrophy of thigh
Limping or waddling gait

Smith-Magenis syndrome
Short stature
Mental retardation
Insertion of foreign bodies (Polyembolokoilamania)
Tendon reflex absence (neuropathy?)
Hypoplastic mid-face

Smoking (risk to kids with parental smoking)
SIDS
Meningitis
Otitis media
Killed by fire or cancers
Embryopathy (IUGR)
Respiratory (RAD, URI)
Speech problems (etiologies)
Autism/Anatomic
Blindness/Brain Injury
Chromosome/CNS
Deafness/DD
Environment Depression/Early Birth (Premature)

Speech delay (evaluation)
Social/family history
Parenting history
Ears (hearing loss)
Autism
Karyotyping/chromosomes
Infection
Neurological imaging
Gestation-related (preemie)

Spider bites (management for black widow)
Benzodazepine and muscle relaxant
Latrodectus antivenom
Analgesic (morphine)
Calcium
Keep wound clean

Splenomegaly (etiologies)
Sickle Cell Anemie
Portal Hypertension
Lupus
Enzyme Deficiencies (Metabolic)
EBV Infection
Neoplastic (Leukemia/Lymphoma)

Stevens-Johnson syndrome
(clinical features)
Sensitivity disorders
Temperature high
Erythema multiforme rash and bullae of skin
Ulceration of mucous membranes
Eye (conjunctivitis, uveitis)
Nephritis (hematuria)
Sepsis potential

Stickler syndrome
Spine (spondylo-epiphyseal dysplasia)
Thorax (MVP, disk herniation)
IQ-normal
Cleft palate
Knee/hip anomalies
Loss of hearing
Eye (myopia)
Robin sequence

Stroke (risk factors)
Sickle cell disease
Tobacco
Rise in Cholesterol
Obesity
Ketone (diabetes)
Elevated blood pressure

Sturge-Weber syndrome
Seizure
Trigeminal hemangioma
Unilateral eye involvement
Retarded (MR)
Glaucoma
Ear anomalies

Sudden infant death syndrome
(risk factors)
Sleeping position
IUGR/Premature
Defect of airway
Smoking

Supraventricular tachycardia (management)
Adenosine
Beta-blockers
Calcium blockers
Digoxin
Electrocardioversion

Syncope (pathologic etilogies)
Structural Abnormality of  Vessels (AVM)
Youngster’s Breath Holding
Neurological
Cardiac
Orthostatic Hypotension
Prolonged QT syndrome
Endocrine (adrenal insufficiency)







Systemic lupus erythematosus (diagnostic criteria)
Renal involvement
Hematological
Epidermal photosensitivity
Ulceration of mocous membranes (oral/nasal mucosa)
Mallor rashes
ANA (anti-nuclear antibody)
Thorax (pleural/cardial effusion)
Immunological (Anti-dsDNA)
CNS (encephalopathy, seizure etc)
Arthritis
Lupus (discoid lupus)