Tony Shared "Tony's picmonics" - 165 Picmonics
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Tony's picmonics
7 months of development
- Parachute reflex begins
- rolls from back to front (completion from the 6 mos front to back)
- Commando crawling
- Polysyllabic vowels
- rake grasp may start here
Tangier Syndrome
- Orange-yellow colored TONSIL HYPERPLASIA
- rare CO-dominant disease
- If Homozygous, No HDL, if hetero- LOW HDL
- Polyneuropathy
- Hepatosplenomegaly
- Lymphadenopathy
Wallenburg syndrome clinical (lateral medullary Syndrome)
- Muscle movement Spaired (minus bulbar muscles)
- Vertigo, Ipsilateral falling
- Ipsilateral Facial sensory Pain and temp loss [read caveat]
- Don't PICA HOARSE who can't EAT
- bulbar motor weakness
- Dysphagia + hoarse voice
- PICA ischemia
- Rest of the body
- Contralateral loss of Pain and temp on trunk and extremities
- Ipsilateral Horner Syndrome
- Nystagmus (vertical and horizontal)
- Intractable hiccups
- Lack of automatic respiration (esp during sleep)
- Extra
- In test world- "VERTEBRAL artery" is often the answer
- PICA vasculature insult
Polyarticular Idiopathic Juvenile Arthritis
- SYmmetrical upper and lower Arthritis
- almost same presentation is Systemic Idiopathic Juvenile Arthritis, except this is without the Rash and fevers (possibly low grade- but not classic)
- >/= 5 joints (usually symmetrical)
- Symmetric Arthritis for at least 6 weeks
- Hypergammaglobulinemia
- +/- (maybe) Thrombocytosis (up to millions)
- Anemia
- Hyperferritinemia
- most common Morbidity of any type of JRA is "anterior uveitis" aka "iridocyclitis"
- excellent prognosis if positive ANA
- usually post viral, post mycoplasma, or even post borrelia
AFLP - Acute Fatty Liver disease of Pregnancy
- Nausea and Vomiting
- Abdominal Pain
- many things overlap with HELLP syndrome
- significant Elevation of AST and ALT
- more likely in 3rd trimester
- Extrahepatic comlications such as those below are MORE likely in AFLP than in HELLP
- Leukocytosis
- HYPOGLYCEMIA
- Acute Kidney injury
- HELLP is more likely to have severe HTN, not AFLP.... but I have seen AFLP Q's where BP is 160/105
- PT and PTT increase
- DIC is common---- so low platelets and even schistocytes
Mirizzi Syndrome
- Cystic Duct stone
- blocks Common Hepatic duct
Saxitoxin shellfish
- Shellfish
- which ingest PARTICULAR dinoflagellates
- Cranial Nerve Dysfunction
- Muscle Weakness
- Respiratory Distress (due to muscle weakness)
Ciguaterra poisoning
- American fish cuisine
- barracuda
- snapper
- Groupper
- Jack fish
- CLassic- Hot feel like cold, cold feels like hot
- Less Common, but happen
- Red Maculopapular Rash and Pruritis
- Autonomic Dysfunction
Tetrodotoxin - puffer fish
- expressed by the Puffer fish
- Asian delicacy (look for asian in vignette)
- Perioral numbness
- Respiratory distress 2/2 Muscle weakness
- Neurological dysfunction
- GI symptoms
Scromboid poisoning canned fish
- HIstamine related - "anaphylaxis/hives"
- trouble breathing
- CANNED fish
- Histamine producing bacterial overgrowth
BOOP - Bronchiogenic Obliterans Organizing Pneumonia (aka COP?)
- interstitial disease
- Bronchial Thickening
- Patchy Bilateral Alveolar infiltrates
- doesnt respond to antibiotics
- unknown etiology
- Sputum Culture negative
Assessing for GI bleeding Site- FLip book- only works in "play mode"
- Key
- Average man
- 2x average man
- 0.5 man
- GI assessment based on bleeding rate
- > 2 Ml/min - angiography
- < 0.5 mL Wait for bleeding to stop, Colonoscopy after
- colonoscopy bonus (< 0.5)
- 0.5-2 ml/min - Tagged RBC
- end
3 mins
Fetal Hydantoin Syndrome
- Pregnant women on phenytoin
- Broad Nasal Bridge
- low hairline
- Cleft lip/cleft palate
- Microcephaly
- Low set ears
- Hypoplasia of distal Phalanges
- Small or Absent NAILS
- Face picture
- Wide Fontanelle
- Epicantal folds
- Short neck
- Congenital Heart Defects
Guttate Psoriasis
- Associations
- Post Streptococcal (beta hemolytic) infection (classically strep throat)
- Rheumatoid Arthritis association (especially if on infliximab)
- possibly any URTI
- Rash
- Widely Scattered
- Photo of Actual lesion
- thorax and proximal extremities-............................but CAN be anywhere
- Rash (usually) appear app 2 weeks after illness associated illness
- Treatment
- Topical steroids
- Phototherapy
- VIt D related "stuff"
Dequervain's Tenosynovitis
- Positive Finklstein Test
- usually occurs in women
- pain on radial side of wrist
- From overuse
- hard bony surface palpated on radial wrist
- Classic vignette- new mom "holding a baby a lot"
- Classicaly affects: Abductor or Extensor tendons of thumb
Sialadenosis
- ENlargment of SUBMANDIBULAR Glands
- Non-tender
- DUe to alcoholic liver disease or NAFLD
- or malnutrition
- bulimia
- Diabetes
- non inflammatory
- ABnormal Autonomic innervation to glands
Behcet syndrome
- Recurrent oral mucosa ulcers
- recurrent genital ulcers
- Anterior Uveitis
- Erythema nodosum
- Arthritis
- Thrombosis- cause of morbidity
- Dx: Pathergy (needle stick sore exaggeration)
- Turkish, MIddle eastern or Asian descent
- Acne
- rare associations
- Aortic aneurysm
- General Treatments (not necessarily organ specific)
- associated vasculitis
- steroids for flares
- colchicine for maintenance
- Apremilast (if colchicine fails)
Pilonidal disease
- Painful fluctuant mass, cephalad tothe anus- in intergluteal region
- Risks
- Fat (Obese)
- Young male 15-30
- Sedentary
- Deep gluteal clefts
- Characteristics
- leaks Mucoid, bloody, purulent fluids
- bending over hurts
- pathophysiology
- infected hair follicle becomes occluded
- abcess formation
- can develop sinus tracts
Hypersensitivity pneumonitis
- inflamed alveoli
- "Bird fancier's lung"repeated inhalation of bird droppings
- Farmer's lung-- inhaling mold
- Pulmonary Fibrosis with chronic exposure
- if acute- fever, cough, malaise
- XRAY- "haziness", ground glass-- LOWER lung fields
- Treatment: Avoid antigen
- avoid antigen
- steroids do prevent disease progression
Focal NOdular Hyperplasia
- Central stellate scar
- benign
- bile ducts scattered throughout
- ultrasound: spoke wheel vessels
- not altered by hormones or OCP
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