All Rh negative women be given 2 injections of Rhogam anti-D to prevent sensitization against Rh + foetal blood cells and subsequent production of anti-Rh antibodies, and subsequent ERYTHROBLASTOSIS FOETALIS in next pregnancy:
@ 28 completed gestational week,
@ delivery
D/D CMV , parvo virus intrauterine infection.
But in these D/Ds there is only ánemia'as erythropoiesis is affected,
while in Rh incompatibility, in addition to anemia there is hyperbilirubinemia as may be noted in amniotic fluid analysis
(& obviously there is Hydrops in all D/D)(edema in 2 foetal ocmpartments)
___________________
HOW TO CLINICALLY DIFFERENTIATE B/W OBSTRUCTIVE VS RESTRICTIVE LUNG DISEASES?
SPIROMETRY GRAPHS , THE CLASSICAL ONES.....??
FORMULAE USED TO DIFFERENTIATE !!
______________
variable intensity of S1 ??___________________________________ atrial fibrillation
reverse splitting in AS / HOCM ( delayed closure of aortic valve)
__________
both 3rd n 4th heart sounds are diastolic.,may be produced from both ventricles., see that if best heard at APEX?> LEFT SIDED ,& if best head at LLSB then its RIGHT SIDED.
3rd heart sound is due to VOLUME overload
>heart failure (3rd)
>pregnancy
>dilated cardiomyopathy
4th heart sound is due to PRESSURE overload
>HTN
>IHD
_______________
MSOS (MS Opening Snap)
___________---
CLICKS with S (AS, PS)
eSm with AS , PS (both murmurs on the LEFT SIDE )(1 space down, 1 space up)(both are KITE/DIAMONd/Crescendo-Decrescendo murmurs ! )
AS click at apex !!! (distant from valve so no change with breathing)
PS click at P2 (intensity increases with expiration (WHAT))
Murmur of PS radiates to left shoulder, that of AS radiates to neck.
___________
AR is not a single murmur. It is: 2 mumurs and 2 femoral findings.
early diastolic murmur at A2 , mid diastolic murmur at Apex(austin flints)
PistolShots femorals, & to n fro murmur over femorals (Duroziez's murmur)
__________--
MIDSYSTOLIC CLICK with late systolic murmur of MVP
___________-
IN PATIENTS WITH PRIOR HEART SURGERY, GRADE iv MURMUR MAY BE THERE WITHOUT A THRILL
,,,,,,,,,,,,,,,,
Now , if valvular replacement is done with animal valves (biologic prosethic valves) , the heart sounds are saem as those of human valves.
But, if the replacement of valves is done with MECHANICNAL/ARTIFICAL VALVES, then the VALVES produce sounds with CLOSING as well as with OPENING .
So there are 4 heart sounds instead of 2 .
__________--
Venous bruits in the neck are maximum in intensity with patient standing or reclining(these are due to kinking of neck veins ?>) , these disappear when patient lies down. ..(gravity effect more while standing?)
_____________________
In MR , mitral valve BLOWS THROUGHOUT SYSTOLE .
____________
In MS loud S1 , other wise with all murmurs associated heart sound is soft.
And it is also MS where there is LOW pitch , otherwise all others ( with exception of MS, and non-restrictive VSD ) have low pitch .
_________________________
ASD also has 2 murmurs:
(the actual murmur at ) LUSB is ESM at pulmonary area, high pitched
while .
there is also a mid diastolic murmur at LLSB
_____________
BRUITS ARE SOUNDS SIMILAR TO MURMURS THAT ORIGINATE OUTSIDE HEART .
WHILE VENOUS HUMS ARE SOUNDS PRODUCED THROUGH KINKED VEINS?
(to ausucultate both in the vicinty of neck or chest, ask the patient to hold neck)
Both are heard with BELL.
Differentiate between Venous HUM and Carotid Bruit in the neck: press the bell against neck, ask patient to hold breath, now press above the steth-bell, if it is venous HUM it will disappear.
IT WILL ALSO DISAPPEAR on lying down.
>>>>> TO DIFFERENTIATE BETWEEN CAROTID BRUIT AND MURMUR RADIATING FROM HEART????
auscultate from neck to clavicles, if the sound increases in intensity , such that maximum below clavilce, it is originating from heart(murmur), if it is decreasing in intensity - it is orginating from artery (bruit).
__________________________
Plummer vinson syndrome ( iron def anemia, esophageal webs, dysphagia, glossitis, cheilitis)
Schatzki ring (mucosaL ring at LES causing dysphagia)
LEPTIN> satiety (ghrelin hunger)
_____________
Van der Woude Sydrome : familial cleft lip , autosomal dominant inheritance,
(50% recurrence risk)cleft of Lip is mostly on Left Side.
repair cleft lip at 3 mo of age.
For cleft palate, adequate bone growth? is needed so repair is around 1 year, but not beyond 3 years. After repair of Cleft palate, suture care, plus arms restriction. + only liquid or semi liquid diet for 3 wks.
Cleft palate can be associated with CNS abnormalitis, while cleft of the Lip can be associated with facial dysmorphism.
_____________________
Pierre Robin Sequence can have features of connective tissue disorder (Stickler syndrome) , or it may be associated with cardio facial abnormalities (veloCardioFacial- CATCH22q11) Di George
____________________
HemiFacial microsomia may be associated with facial abnormalities, dental malocvcluson,
and vertebral anomalies (GOLDENHAR syndrome)(oculo-auriculo-vertebral)
____________________-
Sweet Syndrome is febrile neutrophillic tender-dermatosis , associated with SLE, Crohns, Leukemia., repsonds to topical steroids (2nd line dapsone, cyclospoine,indomehtacin)
__________________
Behcet diseas is inflammatory disease involving blood vessels and results in Oral and Genital Ulcers, Uveitis, SKin rash , and in 15 % cases neuro-behcet.e
Pathergy is an exaggerated skin injury occurring after minor trauma such as bump, bruise, needle stick injury. A more severe injury, such as a surgical procedure, can result in persistent ulceration in a patient with pathergy. It typically occurs in patients with Behcet disease.
For Ulcers (colchicine, dapsone, azathioprine)
for cutaneous lesions colchicine or dapsone
for uveitis azathioprine
arthritis/cns disease (steroids)
____________
Geographic tongue, no t/m needed.
_____________________-
most common(87% of TEF is , where upper esophagus end in a blind pouch while lower esophagus is connected to trachea.) It has associated asp of gastric contents and is more damaging than other forms. Stomach bubble confirms this type.
conversely, a pure esophageal atresia will be associated with airless scaphioid abdomen.
KEEP in PRONE POSITION TO MINIMIZE GASTRIC CONTENTS ASPIRATION.
&
avoid mechanical ventilation with ETT to max as there is a risk of abdominal distension.
VATER, VACTERL, CHARGE,
___________________
AIR FLUID level in chest radiograph ???? ??>>>>>>>>>>>>>>>>>>>>>>>>>achlasia
&
the most sensitive test
for achlasia , is , .........................................................Mannometry
___________________________________
Sliding hernia type (bottled up shape) is the most common, other types are para-esophageal , and mixed.
__________________________
@ 28 completed gestational week,
@ delivery
D/D CMV , parvo virus intrauterine infection.
But in these D/Ds there is only ánemia'as erythropoiesis is affected,
while in Rh incompatibility, in addition to anemia there is hyperbilirubinemia as may be noted in amniotic fluid analysis
(& obviously there is Hydrops in all D/D)(edema in 2 foetal ocmpartments)
___________________
HOW TO CLINICALLY DIFFERENTIATE B/W OBSTRUCTIVE VS RESTRICTIVE LUNG DISEASES?
SPIROMETRY GRAPHS , THE CLASSICAL ONES.....??
FORMULAE USED TO DIFFERENTIATE !!
______________
variable intensity of S1 ??___________________________________ atrial fibrillation
reverse splitting in AS / HOCM ( delayed closure of aortic valve)
__________
both 3rd n 4th heart sounds are diastolic.,may be produced from both ventricles., see that if best heard at APEX?> LEFT SIDED ,& if best head at LLSB then its RIGHT SIDED.
3rd heart sound is due to VOLUME overload
>heart failure (3rd)
>pregnancy
>dilated cardiomyopathy
4th heart sound is due to PRESSURE overload
>HTN
>IHD
_______________
MSOS (MS Opening Snap)
___________---
CLICKS with S (AS, PS)
eSm with AS , PS (both murmurs on the LEFT SIDE )(1 space down, 1 space up)(both are KITE/DIAMONd/Crescendo-Decrescendo murmurs ! )
AS click at apex !!! (distant from valve so no change with breathing)
PS click at P2 (intensity increases with expiration (WHAT))
Murmur of PS radiates to left shoulder, that of AS radiates to neck.
___________
AR is not a single murmur. It is: 2 mumurs and 2 femoral findings.
early diastolic murmur at A2 , mid diastolic murmur at Apex(austin flints)
PistolShots femorals, & to n fro murmur over femorals (Duroziez's murmur)
__________--
MIDSYSTOLIC CLICK with late systolic murmur of MVP
___________-
IN PATIENTS WITH PRIOR HEART SURGERY, GRADE iv MURMUR MAY BE THERE WITHOUT A THRILL
,,,,,,,,,,,,,,,,
Now , if valvular replacement is done with animal valves (biologic prosethic valves) , the heart sounds are saem as those of human valves.
But, if the replacement of valves is done with MECHANICNAL/ARTIFICAL VALVES, then the VALVES produce sounds with CLOSING as well as with OPENING .
So there are 4 heart sounds instead of 2 .
__________--
Venous bruits in the neck are maximum in intensity with patient standing or reclining(these are due to kinking of neck veins ?>) , these disappear when patient lies down. ..(gravity effect more while standing?)
_____________________
In MR , mitral valve BLOWS THROUGHOUT SYSTOLE .
____________
In MS loud S1 , other wise with all murmurs associated heart sound is soft.
And it is also MS where there is LOW pitch , otherwise all others ( with exception of MS, and non-restrictive VSD ) have low pitch .
_________________________
ASD also has 2 murmurs:
(the actual murmur at ) LUSB is ESM at pulmonary area, high pitched
while .
there is also a mid diastolic murmur at LLSB
_____________
BRUITS ARE SOUNDS SIMILAR TO MURMURS THAT ORIGINATE OUTSIDE HEART .
WHILE VENOUS HUMS ARE SOUNDS PRODUCED THROUGH KINKED VEINS?
(to ausucultate both in the vicinty of neck or chest, ask the patient to hold neck)
Both are heard with BELL.
Differentiate between Venous HUM and Carotid Bruit in the neck: press the bell against neck, ask patient to hold breath, now press above the steth-bell, if it is venous HUM it will disappear.
IT WILL ALSO DISAPPEAR on lying down.
>>>>> TO DIFFERENTIATE BETWEEN CAROTID BRUIT AND MURMUR RADIATING FROM HEART????
auscultate from neck to clavicles, if the sound increases in intensity , such that maximum below clavilce, it is originating from heart(murmur), if it is decreasing in intensity - it is orginating from artery (bruit).
__________________________
Plummer vinson syndrome ( iron def anemia, esophageal webs, dysphagia, glossitis, cheilitis)
Schatzki ring (mucosaL ring at LES causing dysphagia)
LEPTIN> satiety (ghrelin hunger)
_____________
Van der Woude Sydrome : familial cleft lip , autosomal dominant inheritance,
(50% recurrence risk)cleft of Lip is mostly on Left Side.
repair cleft lip at 3 mo of age.
For cleft palate, adequate bone growth? is needed so repair is around 1 year, but not beyond 3 years. After repair of Cleft palate, suture care, plus arms restriction. + only liquid or semi liquid diet for 3 wks.
Cleft palate can be associated with CNS abnormalitis, while cleft of the Lip can be associated with facial dysmorphism.
_____________________
Pierre Robin Sequence can have features of connective tissue disorder (Stickler syndrome) , or it may be associated with cardio facial abnormalities (veloCardioFacial- CATCH22q11) Di George
____________________
HemiFacial microsomia may be associated with facial abnormalities, dental malocvcluson,
and vertebral anomalies (GOLDENHAR syndrome)(oculo-auriculo-vertebral)
____________________-
Sweet Syndrome is febrile neutrophillic tender-dermatosis , associated with SLE, Crohns, Leukemia., repsonds to topical steroids (2nd line dapsone, cyclospoine,indomehtacin)
__________________
Behcet diseas is inflammatory disease involving blood vessels and results in Oral and Genital Ulcers, Uveitis, SKin rash , and in 15 % cases neuro-behcet.e
Pathergy is an exaggerated skin injury occurring after minor trauma such as bump, bruise, needle stick injury. A more severe injury, such as a surgical procedure, can result in persistent ulceration in a patient with pathergy. It typically occurs in patients with Behcet disease.
For Ulcers (colchicine, dapsone, azathioprine)
for cutaneous lesions colchicine or dapsone
for uveitis azathioprine
arthritis/cns disease (steroids)
____________
Geographic tongue, no t/m needed.
_____________________-
most common(87% of TEF is , where upper esophagus end in a blind pouch while lower esophagus is connected to trachea.) It has associated asp of gastric contents and is more damaging than other forms. Stomach bubble confirms this type.
conversely, a pure esophageal atresia will be associated with airless scaphioid abdomen.
KEEP in PRONE POSITION TO MINIMIZE GASTRIC CONTENTS ASPIRATION.
&
avoid mechanical ventilation with ETT to max as there is a risk of abdominal distension.
VATER, VACTERL, CHARGE,
___________________
AIR FLUID level in chest radiograph ???? ??>>>>>>>>>>>>>>>>>>>>>>>>>achlasia
&
the most sensitive test
for achlasia , is , .........................................................Mannometry
___________________________________
Sliding hernia type (bottled up shape) is the most common, other types are para-esophageal , and mixed.
__________________________
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