BIG- M

BIG-M Barium enema for Dx/Rx of Intususseption Gastrograffin enema for Dx/Rx of Meconium ileus.

Neonatal distress

1. THE MISFITS
   1. Tumor, Thermal, Trauma (non-accidental Trauma)
   2. Heart disease, hypovolemia, or Hypoxia
   3. Endocrine
      1. Hyperthyroidism
      2. Congenital Adrenal Hyperplasia
   4. Metabolic disease
      1. Electrolyte disturbances
   5. Inborn Errors of Metabolism
   6. Sepsis
   7. Formula or Feeding abnormalities (Too concentrated or dilute)
   8. Intestinal Emergencies
      1. Volvulus
      2. Intussusception
      3. Necrotizing Enterocolitis
      4. Incarcerated Hernia
      5. Diaphragmatic Hernia
   9. Toxins
   10. Seizures

Cough (chronic) : differential

Cough (chronic): differential "CRADLE":
Cystic fibrosis
Rings, slings, and airway things (tracheal rings)/ Respiratory infections
Aspiration (swallowing dysfunction, TE fistula, gastroesphageal reflux)
Dyskinetic cilia
Lung, airway, and vascular malformations (tracheomalacia, vocal cord dysfunction)
Edema (heart failure)

Hemorrhagic metastases

Hemorrhagic metastases

MR CT BB
Melanoma
Renal cell carcinoma
Choriocarcinoma
Thyroid carcinoma, Teratoma
Bronchogenic carcinoma
Breast carcinoma

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Cerebral ring enhancing lesions

Cerebral ring enhancing lesions

MAGIC DR
Metastases
Abscess
Glioma
Infarction (resolving)
Contusion/hematoma (resolving)
Demyelinating disease
Radiation necrosis

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Russell - Silver syndrome

ABCDEF

Russell-Silver syndrome features:

Asymmetric limb (hemihypertrophy)
Bossing (frontal)
Clinodactyly / Cafe au lait spots
Dwarf (short stature)
Excretion (GU malformation)
Face (triangular face, micrognathia)

Cranial deformities

Cranial deformities

BOSCA

Brachcephaly
Oxycephaly
Scaphocephaly, Saggital sutures
Coronal
All Sutures closed

Vitamin toxicity in newborns

Vitamin Toxicity:

Excess vitamin A: Anomalies (teratogenic)
Excess vitamin E: Enterocolitis (necrotizing enterocolitis)
Excess vitamin K: Kernicterus (hemolysis)

Neonatal jaundice

"HOT BILE"

Frequent causes of unconjugated neonatal jaundice:

Hereditary sphaerocytosis
Obstruction of bowel
Thalassaemia alpha
Blood group incompatibility
Infection
Lucey-Discroll syndrome
Enzyme deficiency (G6PD,PK)

Frequent causes of haemolytic neonatal jaundice at 24 hours of age:

RAGS

Rhesus incompatibility
ABO incompatibility
G6PD deficiency
Spherocytosis

Frequent causes of neonatal jaundice caused by increased bilirubin production):

FIRST

Feto maternal blood incomptability e.g. Rh or ABO
Infections, Increased enterohepatic circulation (large bowel obstruction)
Red Cell enzymopathies: (G6PD or Pyruvate kinase deficiency)
Spherocytosis hereditary
Thalassemia alpha

Congenital pyloric stenosis

3 Ps

Presentation of congenital pyloric stenosis:

Palpable mass
Paristalsis visible
Projectile vomiting (2-4 weeks after birth)

Necrotising enterocolitis

HAT

Triad of laboratory results in necrotizing enterocolitis:

Hyponatremia
Acidosis (metabolic)
Thrombocytopenia

Essential Amino acids

CAT

Additional essential amino acids in preterm babies:

Cystine
Arginine
Taurine

Benefits of breast feeding

ABCDEFGH

Benefits of breastfeeding:

Infant:

Allergic condition reduced
Best food for infant
Close relationship with mother
Development of IQ, jaws, mouth

Mother:

Economical
Fitness: quick return to pre-pregnancy body shape
Guards against cancer: breast, ovary, uterus
Haemorrhage (postpartum) reduced

Breast feeding : contraindicated drugs

BREAST

Breast feeding: contraindicated drugs:

Bromocriptine/ Benzodiazepines
Radioactive isotopes/ Rizatriptan
Ergotamine/ Ethosuximide
Amiodarone/ Amphetamines
Stimulant laxatives/ Sex hormones
Tetracycline/ Tretinoin

Avascular necrosis

PLASTIC RAGS
Pancreatitis
Lupus
Alcohol
Steroids
Trauma
Idiopathic, Infection
Caisson disease, Collagen vascular disease
Radiation, Rheumatoid arthritis
Amyloid
Gaucher disease
Sickle cell disease

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Chondrocalcinosis

3 C's
Crystals: CPPD, Gout
Cations: Calcium (hyper), Copper, Iron
Cartilage degeneration: OA, Acromegaly, Ochronosis

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Pulmonary fibrosis

Predominantly upper lobe pulmonary fibrosis

CASSET P
Cystic fibrosis
Ankylosing spondylitis
Silicosis
Sarcoidosis
Eosinophilic granuloma
Tuberculosis
PCP

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Papillary necrosis

Papillary necrosis (causes in order of incidence)

AD SPORT C
Analgesic abuse
Diabetes mellitus
Sickle cell disease
Pyelonephritis (especially in children)
Obstruction
Renal vein thrombosis
Tuberculosis (not usually confined to the papillae)
Cirrhosis

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Posterior fossa tumours in children

BEAM
Brainstem glioma
Ependymoma
Astrocytoma (pilocytic) - 85%
Medulloblastoma

Universal differential diagnosis

Universal differential diagnosis

VINDICATE
Vascular
Infection
Neoplasm
Drugs
Inflammatory/Idiopathic
Congenital
Autoimmune
Trauma
Endocrine/Metabolic

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Cerebellopontine angle masses

Cerebellopontine angle masses

SAME
Schwannoma (Acoustic >> Trigeminal)
Aneurysm, Arachnoid cyst
Meningioma, Metastasis
Epidermoid cyst, Ependymoma

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Salter Harris Classification

SALTR
Slipped (Type I)
Above (Type II) - 75% Meta
Lower (Type III) Epi
Through (Type IV) Both
Rammed (Type V) Crush

Elbow ossification

Elbow ossification centers, in sequence CRITOE:
Capitellum
Radial head
Internal epicondyle
Trochlea
Olecranon
External epicondyle
· In order: appear at 1, 3, 5, 7, 9, 11
years; each closes 2 years later.

Osteoarthritis

Osteoarthritis: x-ray signs LOSS:
Loss of joint space
Osteopyhtes
Subcondral sclerosis
Subchondral cysts

Difficult airway

Difficult intubation = LEMON

• Look externally
• Evaluate 3-3-2 rule
• Mallampati score
• Obstruction
• Neck Mobility

Difficult BVM = BONES

• Beard
• Obese
• No teeth
• Elderly
• Sleep Apnea / Snoring

Difficult LMA = RODS

• Restricted mouth opening
• Obstruction
• Distorted airway
• Stiff lungs or c-spine

Difficult surgical airway = SHORT

• Surgery
• Hematoma
• Obesity
• Radiation distortion or other deformity
• Tumor