On top of all that, I have to somehow help a little bit for the wedding which is right around application week. The families are doing most of it all so that part is not too bad but I still have some things out of respect to everyone. My last clerkship was psychiatry and it's been eons since I've reviewed anything from the previous clerkships of MS That subscription ran out a long time ago and just purchased a new one to activate tomorrow.
Mediocre shelf scores in the low-mid 70's with Internal Medicine being my very 1st one that long ago. In order to ensure that user-safety is not compromised and you enjoy faster downloads, we have used trusted 3rd-party repository links that are not hosted on our website.
At Medicalstudyzone. We hope that you people find our blog beneficial! It is very good book to study a a day before your exam. It can also cover your viva questions and will help you to score very high. Gastroenterology Cirrhosis.
Gastroenterology Colon Cancer. Gastroenterology Diverticula. Gastroenterology Esophagitis. Gastroenterology Esophagus. Gastroenterology Gallbladder. Gastroenterology Gerd. Gastroenterology Ibd. Gastroenterology Jaundice. Gastroenterology Malabsorption. Gastroenterology Misc Gastric. Gastroenterology Pancreatitis. Gastroenterology Peptic Ulcer. Gastroenterology Viral Hepatitis. Gynecology Adnexal Mass. Gynecology Cancer Intro. Gynecology Cervical Cancer. Gynecology Endometrial Cancer. Gynecology Gyn Infections.
Gynecology Incontinence. Gynecology Infertility. Gynecology Menopause. 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. Examination will show increased rectal tone the ganglions contribute to relaxation. If done, a KUB may show dilated colon actually the normal part and a normal distal colon the abnormal part. The preferred initial test is a contrast enema which will show a transition zone.
Suction biopsy is the next step to confirm diagnosis. Resect the affected area and connect pull-through procedure. Severe cases perforation, full colon involvement require colostomy.
Intussusception When part of the bowel telescopes into another the blood supply Acute colicky pain with abrupt onset and resolution can be compromised. This causes an abrupt onset of colicky Can diagnose with ultrasound abdominal pain in an otherwise healthy baby.
It occurs in kids 3 Air enema can be diagnostic and therapeutic months to 3 years. Kids will typically assume the knee- chest position and there may be some vomiting. Occasionally currant jelly diarrhea can be seen. A sausage-shaped mass can be felt in the abdomen.
While a KUB may show evidence late in the disease, an air enema is sufficient to both diagnose and treat. An abdominal ultrasound is a non-invasive test that can increase pre-test probability. Additional testing is done if still unsure. HIDA scan after days of phenobarbital stimulation can show lack of bile reaching duodenum. Intraoperative cholangiogram can be done if still uncertain.
Differential includes autoimmune and metabolic disorders. Fatal without intervention, ultimately treat with Kasai procedure hepatoportoenterostomy. Physical exam will reveal an olive-shaped mass and visible peristaltic waves. A CMP will reveal a hypochloremic, hypokalemic, metabolic alkalosis which should prompt immediate IVF for rehydration. They can occur individually or in combination. The cleft lip can be minimal and only involve superficial structures or it can run deeper down to the teeth and bone.
It can be unilateral or bilateral. Cleft palate can involve the soft and hard palate. Exposure of the nasal cavities through the palate can occur when these two conditions occur together.
Feeding is the biggest issue up front. Cleft lips are repaired by weeks and palates by months to preserve speech function. Complications can include frequent episodes of otitis media, feeding difficulties, possible hearing difficulties, and speech pathology if not repaired appropriately. Choanal Atresia This is an atretic or anatomically stenosed connection between the nose and mouth.
It can be unilateral or bilateral which is an emergency. In severe cases the baby will be blue at rest as they are obligate nose breathers think breathing and breastfeeding simultaneously. Surgery is required to open the atretic passage.
It comes from sun-exposure. There are sun- - Number of times sunburned occupations sailor, farmer, construction , there are sun- - Severity of times sunburned locations hands, face, back, shoulders , and there are sun-people - Early-life burns worse than late-life burns those who easily burn — fair skinned, fair haired — and those who - Fair Skin, Fair Hair have burned — the worse the burn the higher the risk.
The The tricks about treating Basal Cell Carcinoma diagnosis is made by excisional or incisional biopsy. Squamous Cell Carcinoma A malignancy of keratinocytes. The lesion is described as a well- The tricks about diagnosing Squamous Cell Carcinoma demarcated red papule in sun-exposed areas.
For high-risk tumors, add radiation therapy to surgical resection. If you miss a melanoma, the patient will die. The progression of melanoma is sporadic. It naturally waxes and wanes throughout its course of metastasis.
The patient can live 10 years or 2 months. Melanoma is a cancer of melanocytes. Melanocytes have pigment in them. Thus, the cancer is going to be a pigmented lesion. The classic board picture is a jet black, smooth lesion on sun-exposed skin.
The point of this is if the lesion is suspicious, get the biopsy. You need ANY 1 to suspect cancer If the lesion is large or the suspicion for melanoma is low, choose a punch biopsy. This captures good tissue next to cancer tissue. It spares the cosmetic deformity of excision.
NEVER do a shave biopsy of melanoma. Studies using immunotherapy This is not how melanoma is treated. If you work at an advanced academic center will get you the right idea.
Do a CT scan to find the tumor, adrenal vein sampling to lateralize, and then resect. Secondary Hyperaldosteronism Renovascular Hypertension Secondary hyperaldo is caused either by bilateral renal artery stenosis old man, atherosclerotic disease, not amendable to surgery or fibromuscular dysplasia young woman, you should stent these ladies.
Diagnosis begins with aldo:renin ratio which shows that renin is driving the aldosterone approaches 1. But do the angiogram only when intervention is planned fibromuscular dysplasia and not RAS. Measure hr urinary metanephrines and catecholamines VMA is most sensitive. Clonidine suppression, serum catecholamines are also potentials, but will be the wrong thing on the test.
When faced with this condition, get a hr free cortisol level and confirm with 1mg Low Dose Dexamethasone Suppression test. Confirm pituitary Cushings with an MRI followed by transsphenoidal resection. There should be rib notching on the chest x-ray.
Surgical correction is sufficient. See the difference between this and claudication in an old man who was a hypertensive, diabetic smoker who has PVD. It is NOT premalignant. DRE reveals a smooth, rubbery prostate and essentially rules out cancer. Then, its medical therapy — no biopsies!
Transurethral resection of prostate is the surgical management, but should be avoided if able. NO PSA. Do this with nighttime tumescence to Nighttime determine if nocturnal erections occur. Organic causes of atherosclerosis or diabetes are usually Organic Resection gradual onset and can be treated with phosphodiesterase- Pumps and inhibitors. Other organic causes may include a spinal injury or Prosthesis an Arteriovenous malformation which will not be helped by Atherosclerosis PDE-i.
Instead, he can try vacuum pumps, or as the last option, Sildenafil prosthetic devices. Control Diseases 3 Stones Kidney stones presents as colicky flank pain with hematuria. Septic Nephrostomy tube 4 Bacterial Prostatitis In a patient who has UTI symptoms but also fever, chills, and low back pain pyelo might be suspected. Send him home on long term fluoroquinolones.
On the other hand, a person with a tender prostate but no bacteria in the urine has a prostatitis noninfectious and just needs NSAIDs. The testis will be exquisitely tender with a horizontal lie. Elevation will cause Horizontal Lie Nontender Cord pain. Ultrasound with Doppler will show decreased blood flow.
Physical Exam Torsion This is a urologic emergency and requires surgical intervention. If you untwist the testicle and it lives, do bilateral orchiopexy tac Surgery is down. If the testicle does, do orchiectomy. The Poor Blood Flow testicle is in normal lie and the cord is tender differentiating it Torsed Testicle from torsion. Local resection Contained disease Prostate cancer is an androgen-responsive malignancy that can GnRH Analogs First line for medication metastasize. On physical exam Orchiectomy Refractory to medications if they give you the exam look for a firm, nodular prostate on Radiation Mets the rectal exam.
In the presence of a suspicious finding and an elevated diagnostic PSA, the diagnosis is likely made. The Renal Cell Carcinoma preferred method of biopsy is a transrectal biopsy with multiple Presents with hematuria, flank pain, and a flank mass.
Only samples taken. Staging is performed with a CT scan. Local disease of the Board patients will have it. Surgery is the options. GnRH analogs Leuprolide, the preferred first line shut treatment. Suspect this in a patient with hematuria without off the axis. Anti-androgens Flutamide is a backup. If urgency, frequency, and dysuria.
If there are mets, use radiation. The first test is trans-illumination which does not transilluminate. Since most tumors are malignant and Bladder Cancer FNA just spreads the tumor, a biopsy is done by orchiectomy. It may present with voiding symptoms but usually be known. Luckily, Seminomas are exquisitely sensitive to has a painless hematuria.
An ultrasound could be chosen if there chemo and radiation. Unlike in women, cystoscopy with biopsy. Since most bladder cancers are Teratomas are malignant in men. This recurs, so there must be surveillance for recurrence with cystoscopy. This is caused by redundant tissue within the urethra. Think of it as the pediatric equivalent to Kidneys bladder outlet obstruction from prostate hypertrophy in older Malignancy men. Perform a catheterization to relieve the pressure on the Hematuria glomerular bladder.
Failure to do so will cause pressure within the bladder to rise leading to reflux up the ureters which can lead to hydronephrosis and renal dysfunction. There may be a history of oligohydramnios. Confirm the diagnosis with a VCUG. Ureters Surgical intervention is typically needed. Hypospadias is hypo, on the bottom, and therefore the urethral opening is on the ventral surface of the penis. Epispadias is epi, on top of, and so the urethral opening is Bladder on top dorsal surface.
This is clinical and cosmetic. You must Hematuria non-glomerular not do a circumcision; that skin is needed to rebuild the penis correctly. Repair is purely cosmetic; epispadias may present with incontinence. However, during a Epispadias high flow state such as diuresis from an alcohol binge the lumen is too narrow to handle the flow; the patient develops colicky pain.
This resolves when the flow returns to normal. Diagnose with an ultrasound hydronephrosis without hydroureter. Infants should also have a VCUG to evaluate for contralateral reflux. Males maintain continence as the ureter is implanted proximal to the external sphincter. Check with ultrasound, VCUG, and radionuclide scan to evaluate anatomy and renal function.
Reimplant the bad one. The severity of ureter dilatation and distance of reflux determine the stage. The reflux can lead to recurrent urinary tract infections and renal scarring.
Antibiotic prophylaxis can be used in mild stages but ultimately surgical correction may be needed. Diagnose with VCUG. The dye should not go to the ureters. This is most commonly used in IV pyelogram Anatomy outdated study evaluating pediatric patients with urinary tract infections. Ultrasound looks at the tubes. It can see how large they are - not where they go or where they come from.
That is, they can see hydronephrosis and hydroureter. Hydro is caused by obstruction. Cystoscopy gets a camera into the bladder and the ureters.
It's like a colonoscopy for the bladder instead of the colon. It allows direct visualization from inside the lumen. It also allows for biopsy of a mass and placement of stents. CT scan has a large radiation burden. Its use should be minimized in children. A contrasted scan shows the GU anatomy well, and includes the rest of the peritoneal contents.
Intravenous pyelogram is an injected material that moves into the kidneys and down into the GU system. Imaging is captured via X-ray. Isolated microscopic is usually benign and transient.
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