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Flashcard 1425518234892

Tags
#cfa-level-1 #economics #economics-in-a-global-context #los #reading-20-international-trade-and-capital-flows
Question
[...] is more widely used as a measure of economic activity occurring within the country, which, in turn, affects employment, growth, and the investment environment.
Answer
GDP

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GDP is more widely used as a measure of economic activity occurring within the country, which, in turn, affects employment, growth, and the investment environment.</htm

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2.1. Basic Terminology
f citizens who work abroad (for example, Pakistan and Portugal), and/or pay more for the use of foreign-owned capital in domestic production than they earn on the capital they own abroad (for example, Brazil and Canada). Therefore, <span>GDP is more widely used as a measure of economic activity occurring within the country, which, in turn, affects employment, growth, and the investment environment. Imports are goods and services that a domestic economy (i.e., households, firms, and government) purchases from other countries. For example, the US economy imports (purch







Flashcard 1425528458508

Tags
#cfa-level-1 #economics #economics-in-a-global-context #los #reading-20-international-trade-and-capital-flows
Question
Net exports is the difference between the value of a country’s exports and the value of its imports i.e., [...].
Answer
value of exports minus imports)

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Net exports is the difference between the value of a country’s exports and the value of its imports (i.e., value of exports minus imports). If the value of exports equals the value of imports, then trade is balanced. If the value of exports is greater (less) than the value of imports, then there is a trade surplus (defici

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2.1. Basic Terminology
e while those in Europe and the Middle East (which benefited from rising prices of their petroleum exports) experienced a substantial increase. Africa also experienced a small improvement in its terms of trade during this period. <span>Net exports is the difference between the value of a country’s exports and the value of its imports (i.e., value of exports minus imports). If the value of exports equals the value of imports, then trade is balanced. If the value of exports is greater (less) than the value of imports, then there is a trade surplus (deficit) . When a country has a trade surplus, it lends to foreigners or buys assets from foreigners reflecting the financing needed by foreigners running trade deficits with that country. Similarly, when a country has a trade deficit, it has to borrow from foreigners or sell some of its assets to foreigners. Section 4 on the balance of payments explains these relationships more fully. Autarky is a state in which a country does not trade with other countries. This means that all goods and services are produced and consumed domestically. The price of a go







Flashcard 1425578790156

Tags
#cfa-level #economics #microeconomics #reading-13-demand-and-supply-analysis-introduction #study-session-4
Question
Reading 16 completes the picture by addressing revenue and explains the types of markets in which firms [...].
Answer
sell output

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Reading 16 completes the picture by addressing revenue and explains the types of markets in which firms sell output. Overall, the study session provides the economic tools for understanding how product and resource markets function and the competitive characteristics of different industries.</

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Study Session 4
nsumption. Reading 15 deals with the theory of the firm, focusing on the supply of goods and services by profit-maximizing firms. That reading provides the basis for understanding the cost side of firms’ profit equation. <span>Reading 16 completes the picture by addressing revenue and explains the types of markets in which firms sell output. Overall, the study session provides the economic tools for understanding how product and resource markets function and the competitive characteristics of different industries.<span><body><html>







Flashcard 1425657171212

Tags
#cfa-level-1 #economics #economics-in-a-global-context #los #reading-20-international-trade-and-capital-flows
Question
Because each country exports and imports a large number of goods and services, the terms of trade of a country are usually measured as an [...]
Answer
index number

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Because each country exports and imports a large number of goods and services, the terms of trade of a country are usually measured as an index number

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2.1. Basic Terminology
e to a South African diamond exporter, Britain would classify the cost of the insurance as an export of services to South Africa. Other examples of services exported/imported include engineering, consulting, and medical services. <span>The terms of trade are defined as the ratio of the price of exports to the price of imports, representing those prices by export and import price indices, respectively. The terms of trade capture the relative cost of imports in terms of exports. If the prices of exports increase relative to the prices of imports, the terms of trade have improved because the country will be able to purchase more imports with the same amount of exports.2 For example, when oil prices increased during 2007–2008, major oil exporting countries experienced an improvement in their terms of trade because they had to export less oil in order to purchase the same amount of imported goods. In contrast, if the price of exports decreases relative to the price of imports, the terms of trade have deteriorated because the country will be able to purchase fewer imports with the same amount of exports. Because each country exports and imports a large number of goods and services, the terms of trade of a country are usually measured as an index number (normalized to 100 in some base year) that represents a ratio of the average price of exported goods and services to the average price of imported goods and services. Exhibit 1shows the terms of trade reported in Salvatore (2010). A value over (under) 100 indicates that the country, or group of countries, experienced better (worse) terms of trade rel







Flashcard 1427736759564

Tags
#12-dic-2016 #el-financiero #noticias
Question
El precio de gas LP -usado en el [...] por ciento de los hogares del país-, será liberalizado a partir del próximo año
Answer
70

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El precio de gas LP -usado en el 70 por ciento de los hogares del país-, será liberalizado a partir del próximo año

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Esto es lo que pasará con la liberalización del precio de gas LP en 2017
tico a partir de enero dejará de ser controlado, con lo que estará sujeto a la estacionalidad y a que se reconozcan costos de transportación y logística, lo que provocará variaciones semanales. Así es como funcionarán los cambios. <span>El precio de gas LP -usado en el 70 por ciento de los hogares del país-, será liberalizado a partir del próximo año, lo que implica que su valor estará sujeto a estacionalidades, además de que a partir de 2017 se reconocerán los costos de logística y transporte del combustible, lo que generará variac







Flashcard 1429111966988

Tags
#sister-miriam-joseph #trivium
Question
[...] is the norm of phonetics, spelling, and grammar
Answer
Correct ness

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Correct ness is the norm of phonetics, spelling, and grammar

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Flashcard 1465054268684

Tags
#48-laws-of-power #law-3-conceal-your-intentions
Question
If at any point in the deception practice [...], all is lost.
Answer
people suspect your intentions

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If at any point in the deception you practice people have the slightest suspicion as to your intentions, all is lost. Do not give them the chance to sense what you are up to: Throw them off the scent by dragging red herrings across the path. Use false sincerity, send ambiguous signals, se

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Flashcard 1471429610764

Tags
#bayes #programming #r #statistics
Question
What is probability density?
Answer
The ratio of the probability mass to the interval width, where the width is infinitesamally narrow

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erefore, what we will do is make the intervals infinitesimally narrow, and instead of talking about the infinitesimal probability mass of each infinitesimal interval, we will talk about the ratio of the probability mass to the interval width. <span>That ratio is called the probability density.<span><body><html>

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Flashcard 1473666485516

Tags
#cfa-level-1 #fra-introduction #reading-22-financial-statement-analysis-intro
Question
The balance sheet (also called the statement of financial position or [...]

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The balance sheet (also called the statement of financial position or statement of financial condition )

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3.1.1. Balance Sheet
The balance sheet (also called the statement of financial position or statement of financial condition ) presents a company’s current financial position by disclosing the resources the company controls (assets) and its obligations to lenders and other creditors (liabilities) at a specific







Flashcard 1473889832204

Tags
#cfa-level-1 #reading-22-financial-statement-analysis-intro
Question
The [...] method of reporting cash flows from operating activities discloses major classes of gross cash receipts and gross cash payments.
Answer
direct method

Examples are cash received from customers and cash paid to suppliers and employees.

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The direct method of reporting cash flows from operating activities discloses major classes of gross cash receipts and gross cash payments. Examples of such classes are cash received from customers and c

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3.1.4. Cash Flow Statement
rrals, and transactions of an investing and financing nature to arrive at the amount of cash generated from operating activities of €12,741 million. This approach to reporting cash flow from operating activities is termed the indirect method. <span>The direct method of reporting cash flows from operating activities discloses major classes of gross cash receipts and gross cash payments. Examples of such classes are cash received from customers and cash paid to suppliers and employees. The indirect method emphasizes the different perspectives of the income statement and cash flow statement. On the income statement, income is reported when earned, not nece







Flashcard 1474070449420

Tags
#cfa-level-1 #reading-22-financial-statement-analysis-intro
Question
In [...], management reporting has been required since 1931 and is audited.
Answer
Germany

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In Germany, management reporting has been required since 1931 and is audited.

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3.1.6. Management Commentary or Management’s Discussion and Analysis
nagement report is recommended by the International Organization of Securities Commissions and frequently required by regulatory authorities, such as the US Securities and Exchange Commission (SEC) or the UK Financial Reporting Council (FRC). <span>In Germany, management reporting has been required since 1931 and is audited. The discussion by management is arguably one of the most useful parts of a company’s annual report besides the financial statements themselves; however, other than excerpts from the fin







Flashcard 1474559610124

Tags
#ir #peds
Question
A 14yo ♂ with 1y Hx of FTT. He is pale and has diffuse abdominal pain. What are tests you would do to narrow your differential?
Answer
Ix:
CBC/Fe (occult inf, anemias, immune deficiency)
Celiac screen (tTG) - antibody test
U/A & culture (hydration status, inf, renal tubular acidosis)
renal function (lytes, BUN, cr)
Liver function (LFTs considered if signs of protein wasting or organomegaly)
Sweat test for CF
Metabolic/Endo tests PRN (TSH - hyperthyroidism)

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A 14yo ♂ with 1y Hx of FTT. He is pale and has diffuse abdominal pain. What are possible causes? What are 5 tests you would do to narrow your differential? DDx: non-organic, celiac, IBD, CF, T1DM, haematologic, malignancy, liver disease, obstructive uropathy Ix: CBC/Fe, celiac screen (tTGT), lytes, urea, Cr, TSH, U/A, Ca 2+ ,

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Growth
GROWTH Failure to Thrive: cross 2 %-tiles, wt <3%-tile, <80% ideal body wt A 14yo ♂ with 1y Hx of FTT. He is pale and has diffuse abdominal pain. What are possible causes? What are 5 tests you would do to narrow your differential? DDx: non-organic, celiac, IBD, CF, T1DM, haematologic, malignancy, liver disease, obstructive uropathy Ix: CBC/Fe, celiac screen (tTGT), lytes, urea, Cr, TSH, U/A, Ca 2+ , Vit ADE 14yo at 3 rd %ile weight + 10 th %ile height is not eating well. What are 3 possible causes? See above A full term baby presents with an eating







#matlab #programming
5.2 Logical operators 115 Table 5.1 Logical Operators Operator Meaning ~ NOT & AND | O
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#matlab #programming
However, the expression 0<1 is evaluated as 0. This is because the left hand operation (0 < 0.5)isfirst evaluated to 1 (true), followed by 1<1which is false. Inequalities like this should rather be coded as (0<1
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#matlab #programming
In general, if x and v are vectors, where v has n elements, then x(v) means [x(v(1)), x(v(2)), ..., x(v(n))]
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#matlab #programming
The function logical(v) returns a logical vector, with elements which are 1 or 0 according as the elements of v are non-zero or 0
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#matlab #programming
A summary of the rules for the use of a logical vector as a subscript are as follows: A logical vector v may be a subscript of another vector x. Only the elements of x corresponding to 1s in v are returned. x and v mustbethesamesize
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#matlab #programming
Logical vector subscripts provide an elegant way of removing certain elements from a vector, e.g., a=a(a>0) removes all the non-positive elements from a, because a>0returns the log- ical vector [00111].
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#bayes #programming #r #statistics
A probability distribution can refer to probability of measurement values or of parameter values. The probability can be interpreted either as how much a value could be sampled from a generative process, or as how much credibility the value has relative to other values.
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#bayes #programming #r #statistics
When p(θ) represents credibility values of θ, instead of the probability of sampling θ, then the mean of p(θ ) can be thought of as a value of θ that represents a typical credible value
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#bayes #programming #r #statistics
The standard deviation of θ, which measures how wide the distribution is, can be thought of as a measure of uncertainty across candidate values. If the standard deviation is small, then we believe strongly in values of θ near the mean. If the standard deviation is large, then we are not very certain about what value of θ to believe in.
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#bayes #programming #r #statistics
A value represents the central tendency of the distribution if the value is close to the highly probable values of the distribution
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#bayes #programming #r #statistics
Therefore, we define the central tendency of a distribution as whatever value M minimizes the long-run expected distance between it and all the other values of x.
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#bayes #programming #r #statistics
how should we define “distance” between values? One way to define distance is as squared difference: The distance between x and M is (x − M) 2 . One virtue of this definition is that the distance from x to M isthesameasthedistancefromM to x, because (x −M) 2 = (M −x)
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#bayes #programming #r #statistics
The central tendency is, therefore, the value M that minimizes the expected value of (x − M) 2 . Thus, we want the value M that minimizes dxp(x)(x −M) 2
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#bayes #programming #r #statistics
In other words, the mean of the distribution is the value that minimizes the expected squared deviation. In this way, the mean is a central tendency of the distribution
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#bayes #programming #r #statistics
As an aside, if the distance between M and x is defined instead as |x − M|, then the value that minimizes the expected distance is called the median of the distribution. An analogous statement applies to the modes of a distribution, with distance defined as zero for any exact match, and one for any mismatch
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#bayes #programming #r #statistics
The HDI indicates which points of a distribution are most credible, and which cover most of the distribution. Thus, the HDI summarizes the distribution by specifying an interval that spans most of the distribution, say 95% of it, such that every point inside the interval has higher credibility than any point outside the interval
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Flashcard 1474636942604

Tags
#ir #peds
Question
A full term baby presents with an eating disorder (i.e. FTT). What are the 5 broad categories of ddx?
Answer
↓ intake
↓ absorption
↑ loss
↑ demand
ineffective use

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A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑T

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Growth
obstructive uropathy Ix: CBC/Fe, celiac screen (tTGT), lytes, urea, Cr, TSH, U/A, Ca 2+ , Vit ADE 14yo at 3 rd %ile weight + 10 th %ile height is not eating well. What are 3 possible causes? See above <span>A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, respiratory Ineffective use: inborn error of metabolism Obesity 14yo ♂ with weight of 67 kg, height 150cm. Calculate BMI: 29.8 kg/m 2 4 complications of obesity: HTN, dyslipidemia, OSA, SCFE, nonEtO







Flashcard 1474640874764

Tags
#ir #peds
Question
A full term baby presents with an eating disorder (i.e. FTT). What is your ↓ intake DDx?
Answer
non-organic, genetic ,CNS ,GERD, structural

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A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, res

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Growth
obstructive uropathy Ix: CBC/Fe, celiac screen (tTGT), lytes, urea, Cr, TSH, U/A, Ca 2+ , Vit ADE 14yo at 3 rd %ile weight + 10 th %ile height is not eating well. What are 3 possible causes? See above <span>A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, respiratory Ineffective use: inborn error of metabolism Obesity 14yo ♂ with weight of 67 kg, height 150cm. Calculate BMI: 29.8 kg/m 2 4 complications of obesity: HTN, dyslipidemia, OSA, SCFE, nonEtO







Flashcard 1474643234060

Tags
#ir #peds
Question
A full term baby presents with an eating disorder (i.e. FTT). What is your ↓ absorption DDx?
Answer
CMPA (cow's milk protein allergy), CF, biliary atresia, short gut, GI (IBD, CD)

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A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, res

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Growth
obstructive uropathy Ix: CBC/Fe, celiac screen (tTGT), lytes, urea, Cr, TSH, U/A, Ca 2+ , Vit ADE 14yo at 3 rd %ile weight + 10 th %ile height is not eating well. What are 3 possible causes? See above <span>A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, respiratory Ineffective use: inborn error of metabolism Obesity 14yo ♂ with weight of 67 kg, height 150cm. Calculate BMI: 29.8 kg/m 2 4 complications of obesity: HTN, dyslipidemia, OSA, SCFE, nonEtO







Flashcard 1474645593356

Tags
#ir #peds
Question
A full term baby presents with an eating disorder (i.e. FTT). What is your ↑ loss DDx?
Answer
gastroenteritis

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A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, res

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Growth
obstructive uropathy Ix: CBC/Fe, celiac screen (tTGT), lytes, urea, Cr, TSH, U/A, Ca 2+ , Vit ADE 14yo at 3 rd %ile weight + 10 th %ile height is not eating well. What are 3 possible causes? See above <span>A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, respiratory Ineffective use: inborn error of metabolism Obesity 14yo ♂ with weight of 67 kg, height 150cm. Calculate BMI: 29.8 kg/m 2 4 complications of obesity: HTN, dyslipidemia, OSA, SCFE, nonEtO







Flashcard 1474647952652

Tags
#ir #peds
Question
A full term baby presents with an eating disorder (i.e. FTT). What is your ↑ demand DDx?
Answer
↑thyroid
resp
cardiac
infection

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A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, res

Original toplevel document

Growth
obstructive uropathy Ix: CBC/Fe, celiac screen (tTGT), lytes, urea, Cr, TSH, U/A, Ca 2+ , Vit ADE 14yo at 3 rd %ile weight + 10 th %ile height is not eating well. What are 3 possible causes? See above <span>A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, respiratory Ineffective use: inborn error of metabolism Obesity 14yo ♂ with weight of 67 kg, height 150cm. Calculate BMI: 29.8 kg/m 2 4 complications of obesity: HTN, dyslipidemia, OSA, SCFE, nonEtO







Flashcard 1474650311948

Tags
#ir #peds
Question
A full term baby presents with an eating disorder (i.e. FTT). What is your ineffective use DDx?
Answer
inborn error of metabolism

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A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, res

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Growth
obstructive uropathy Ix: CBC/Fe, celiac screen (tTGT), lytes, urea, Cr, TSH, U/A, Ca 2+ , Vit ADE 14yo at 3 rd %ile weight + 10 th %ile height is not eating well. What are 3 possible causes? See above <span>A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, respiratory Ineffective use: inborn error of metabolism Obesity 14yo ♂ with weight of 67 kg, height 150cm. Calculate BMI: 29.8 kg/m 2 4 complications of obesity: HTN, dyslipidemia, OSA, SCFE, nonEtO







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At birth = 50cm (avg)
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Height • At birth = 50cm (avg) • Doubles height by 4 years • Measure recumbent length until 2 years, then standing height

Original toplevel document

Growth
• At birth = 35cm (avg) o <32cm 􀃆 small head = small brain until proven otherwise • May be inaccurate at birth due to caput succedaneum, molding • 0‐3mths = +2cm/mth • 3‐6mths =+1cm/mth • 6‐12mths = +0.5cm/mth <span>Height • At birth = 50cm (avg) • Doubles height by 4 years • Measure recumbent length until 2 years, then standing height Normal Growth Velocity Growth Charts • Critical to use gender and age appropriate growth charts • In 2010, the CPS, RCFPC and the Dieticians of Can




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Doubles height by 4 years
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Height • At birth = 50cm (avg) • Doubles height by 4 years • Measure recumbent length until 2 years, then standing height

Original toplevel document

Growth
• At birth = 35cm (avg) o <32cm 􀃆 small head = small brain until proven otherwise • May be inaccurate at birth due to caput succedaneum, molding • 0‐3mths = +2cm/mth • 3‐6mths =+1cm/mth • 6‐12mths = +0.5cm/mth <span>Height • At birth = 50cm (avg) • Doubles height by 4 years • Measure recumbent length until 2 years, then standing height Normal Growth Velocity Growth Charts • Critical to use gender and age appropriate growth charts • In 2010, the CPS, RCFPC and the Dieticians of Can




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Measure recumbent length until 2 years, then standing height
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Height • At birth = 50cm (avg) • Doubles height by 4 years • Measure recumbent length until 2 years, then standing height

Original toplevel document

Growth
• At birth = 35cm (avg) o <32cm 􀃆 small head = small brain until proven otherwise • May be inaccurate at birth due to caput succedaneum, molding • 0‐3mths = +2cm/mth • 3‐6mths =+1cm/mth • 6‐12mths = +0.5cm/mth <span>Height • At birth = 50cm (avg) • Doubles height by 4 years • Measure recumbent length until 2 years, then standing height Normal Growth Velocity Growth Charts • Critical to use gender and age appropriate growth charts • In 2010, the CPS, RCFPC and the Dieticians of Can




Flashcard 1474657389836

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#ir #peds
Question
use BMI after age [...].
Answer
10

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use BMI after age 10.

Original toplevel document

Growth
the use of the 2006 WHO Growth Standards and Reference charts • WHO Growth Standards based on longitudinal data from solely breast fed for first six months, healthy children from diverse ethnic and geographic backgrounds; <span>use BMI after age 10. • Growth charts are also available for premature infants and certain syndromes • Use corrected age up to 2 years for plotting premature infants Failure to Thri







Flashcard 1474658962700

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Question
Failure to Thrive
Definition
• Weight < [...]%ile (the further below the curve the more likely to be
pathologic in origin)
• Weight falls across major %ile lines
• Weight < 80% of ideal body weight*
* use appropriate growth charts for gender and certain genetic conditions
Answer
3

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Failure to Thrive Definition • Weight < 3%ile (the further below the curve the more likely to be pathologic in origin) • Weight falls across major %ile lines • Weight < 80% of ideal body weight* * use app

Original toplevel document

Growth
om diverse ethnic and geographic backgrounds; use BMI after age 10. • Growth charts are also available for premature infants and certain syndromes • Use corrected age up to 2 years for plotting premature infants <span>Failure to Thrive Definition • Weight < 3%ile (the further below the curve the more likely to be pathologic in origin) • Weight falls across major %ile lines • Weight < 80% of ideal body weight* * use appropriate growth charts for gender and certain genetic conditions Factors Affecting Physical Growth • Genetics • Intrauterine factors • "Internal time clock" • Nutrition • Endocrine hormones • Chronic infec







Flashcard 1474660535564

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#ir #peds
Question
Failure to Thrive
Definition
• Weight < 3%ile (the further below the curve the more likely to be
pathologic in origin)
• Weight [...does what with lines]
• Weight < 80% of ideal body weight*
* use appropriate growth charts for gender and certain genetic conditions
Answer
falls across major %ile lines

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Failure to Thrive Definition • Weight < 3%ile (the further below the curve the more likely to be pathologic in origin) • Weight falls across major %ile lines • Weight < 80% of ideal body weight* * use appropriate growth charts for gender and certain genetic conditions

Original toplevel document

Growth
om diverse ethnic and geographic backgrounds; use BMI after age 10. • Growth charts are also available for premature infants and certain syndromes • Use corrected age up to 2 years for plotting premature infants <span>Failure to Thrive Definition • Weight < 3%ile (the further below the curve the more likely to be pathologic in origin) • Weight falls across major %ile lines • Weight < 80% of ideal body weight* * use appropriate growth charts for gender and certain genetic conditions Factors Affecting Physical Growth • Genetics • Intrauterine factors • "Internal time clock" • Nutrition • Endocrine hormones • Chronic infec







Flashcard 1474662894860

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#ir #peds
Question
Failure to Thrive
Definition
• Weight < 3%ile (the further below the curve the more likely to be
pathologic in origin)
• Weight falls across major %ile lines
• Weight < [...]% of ideal body weight*
* use appropriate growth charts for gender and certain genetic conditions
Answer
80

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Failure to Thrive Definition • Weight < 3%ile (the further below the curve the more likely to be pathologic in origin) • Weight falls across major %ile lines • Weight < 80% of ideal body weight* * use appropriate growth charts for gender and certain genetic conditions

Original toplevel document

Growth
om diverse ethnic and geographic backgrounds; use BMI after age 10. • Growth charts are also available for premature infants and certain syndromes • Use corrected age up to 2 years for plotting premature infants <span>Failure to Thrive Definition • Weight < 3%ile (the further below the curve the more likely to be pathologic in origin) • Weight falls across major %ile lines • Weight < 80% of ideal body weight* * use appropriate growth charts for gender and certain genetic conditions Factors Affecting Physical Growth • Genetics • Intrauterine factors • "Internal time clock" • Nutrition • Endocrine hormones • Chronic infec







Flashcard 1474664467724

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#ir #peds
Question
  • Developmental milestones for 6mo.
  • Normal: [...] sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts
Answer
tripod

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Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts

Original toplevel document

Development
ogic, communication, psychologic) 5yo has been developing normally, but his father has been concerned he's been showing poor speech. What's the first Ix to do? MCQ: audiology testing, NOT genetic testing <span>Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts Lists developmental progress for a 12mo, what type of delay does this child have - language, fine motor, gross motor, or global delay? Normal: gets into sitti







Flashcard 1474666040588

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#ir #peds
Question
  • Developmental milestones for 6mo.
  • Normal: tripod sits, [...] in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts
Answer
pivots

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Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts

Original toplevel document

Development
ogic, communication, psychologic) 5yo has been developing normally, but his father has been concerned he's been showing poor speech. What's the first Ix to do? MCQ: audiology testing, NOT genetic testing <span>Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts Lists developmental progress for a 12mo, what type of delay does this child have - language, fine motor, gross motor, or global delay? Normal: gets into sitti







Flashcard 1474667613452

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#ir #peds
Question
  • Developmental milestones for 6mo.
  • Normal: tripod sits, pivots in [...] position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts
Answer
prone

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Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts

Original toplevel document

Development
ogic, communication, psychologic) 5yo has been developing normally, but his father has been concerned he's been showing poor speech. What's the first Ix to do? MCQ: audiology testing, NOT genetic testing <span>Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts Lists developmental progress for a 12mo, what type of delay does this child have - language, fine motor, gross motor, or global delay? Normal: gets into sitti







Flashcard 1474669186316

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#ir #peds
Question
  • Developmental milestones for 6mo.
  • Normal: tripod sits, pivots in prone position, [...] objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts
Answer
reaches/grasps

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Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts

Original toplevel document

Development
ogic, communication, psychologic) 5yo has been developing normally, but his father has been concerned he's been showing poor speech. What's the first Ix to do? MCQ: audiology testing, NOT genetic testing <span>Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts Lists developmental progress for a 12mo, what type of delay does this child have - language, fine motor, gross motor, or global delay? Normal: gets into sitti







Flashcard 1474670759180

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#ir #peds
Question
  • Developmental milestones for 6mo.
  • Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to [...], babbles, squeals when excited, grunts in anger, stranger anxiety starts
Answer
mouth

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Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts

Original toplevel document

Development
ogic, communication, psychologic) 5yo has been developing normally, but his father has been concerned he's been showing poor speech. What's the first Ix to do? MCQ: audiology testing, NOT genetic testing <span>Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts Lists developmental progress for a 12mo, what type of delay does this child have - language, fine motor, gross motor, or global delay? Normal: gets into sitti







Flashcard 1474672332044

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#ir #peds
Question
  • Developmental milestones for 6mo.
  • Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, [...communication related], squeals when excited, grunts in anger, stranger anxiety starts
Answer
babbles

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Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts

Original toplevel document

Development
ogic, communication, psychologic) 5yo has been developing normally, but his father has been concerned he's been showing poor speech. What's the first Ix to do? MCQ: audiology testing, NOT genetic testing <span>Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts Lists developmental progress for a 12mo, what type of delay does this child have - language, fine motor, gross motor, or global delay? Normal: gets into sitti







Flashcard 1474674691340

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#ir #peds
Question
  • Developmental milestones for 6mo.
  • Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, [...] when excited, grunts in anger, stranger anxiety starts
Answer
squeals

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Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts

Original toplevel document

Development
ogic, communication, psychologic) 5yo has been developing normally, but his father has been concerned he's been showing poor speech. What's the first Ix to do? MCQ: audiology testing, NOT genetic testing <span>Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts Lists developmental progress for a 12mo, what type of delay does this child have - language, fine motor, gross motor, or global delay? Normal: gets into sitti







Flashcard 1474676264204

Tags
#ir #peds
Question
  • Developmental milestones for 6mo.
  • Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, [...] in anger, stranger anxiety starts
Answer
grunts

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Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts

Original toplevel document

Development
ogic, communication, psychologic) 5yo has been developing normally, but his father has been concerned he's been showing poor speech. What's the first Ix to do? MCQ: audiology testing, NOT genetic testing <span>Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts Lists developmental progress for a 12mo, what type of delay does this child have - language, fine motor, gross motor, or global delay? Normal: gets into sitti







Flashcard 1474677837068

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#ir #peds
Question
  • Developmental milestones for 6mo.
  • Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, [...] starts
Answer
stranger anxiety

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Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts

Original toplevel document

Development
ogic, communication, psychologic) 5yo has been developing normally, but his father has been concerned he's been showing poor speech. What's the first Ix to do? MCQ: audiology testing, NOT genetic testing <span>Developmental milestones for 6mo. Normal: tripod sits, pivots in prone position, reaches/grasps objects, brings toy to mouth, babbles, squeals when excited, grunts in anger, stranger anxiety starts Lists developmental progress for a 12mo, what type of delay does this child have - language, fine motor, gross motor, or global delay? Normal: gets into sitti







Flashcard 1474683866380

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#peds
Question
Developmental milestones at age 2mo - gross motor
Answer
briefly raises chin & chest when prone; briefly holds head erect when held upright

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Flashcard 1474685701388

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#peds
Question
Developmental milestones at age 2mo - fine motor
Answer
none

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Flashcard 1474687536396

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#peds
Question
Developmental milestones at age 2mo - language
Answer
has variety of sounds (coos)

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Flashcard 1474689371404

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#peds
Question
Developmental milestones at age 2mo - social/behav
Answer
smiles; recognizes & calm down to familiar gentle voice; follows mvnt w/ eyes

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Flashcard 1474691992844

Tags
#test
Question
Foo
Answer
Bar

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cont from 4mo
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The milestones cited are, on average, those at the 50th percentile for age.

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Development
out 6-10 yrs? 16 wks? See chart Developmental Milestones There are four main areas of developement – gross motor, fine motor, language and social. All areas should be explored when exploring a developmental history. <span>The milestones cited are, on average, those at the 50th percentile for age. Developmental Problems Differential Diagnosis • Motor o Problems with CNS (e.g., Cerebral palsy) o Problems with PNS (e.g., Muscul




Flashcard 1474696187148

Tags
#peds
Question
Developmental milestones at age 1mo - gross motor
Answer
turn head side to side when supine

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Flashcard 1474698022156

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#peds
Question
Developmental milestones at age 1mo - fine motor
Answer
hands fisted, thumb in fist

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Flashcard 1474699857164

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#peds
Question
Developmental milestones at age 1mo - language
Answer
cries; startles to sudden/loud noises

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Flashcard 1474701692172

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#peds
Question
Developmental milestones at age 1mo - social/behav
Answer
calms down when comforted

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Flashcard 1474703527180

Question
the main axis is the horizontal one, and the cross axis is the vertical one
Answer
[default - edit me]

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Learn CSS Flexbox in 3 Minutes – Learning New Stuff – Medium
erty. .container { display: flex;} Which will result in this layout: Notice that you don’t need to do anything with the items yet. They’ll be nicely positioned along the horizontal axis automatically. Vertical layout In the layout above, <span>the main axis is the horizontal one, and the cross axis is the vertical one. The concept of axes are important to understand in order to use flex properly. You can swap the two axes by adding flex-direction: column. .container { display: flex; flex-dire







Flashcard 1474709556492

Question
[default - edit me]
Answer
To create a flex layout, simply give the container the following CSS property.

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Learn CSS Flexbox in 3 Minutes – Learning New Stuff – Medium
s of a flexbox layout is the container (blue) and the items (red). In the example we’ll be looking at in this tutorial, both the container and item are div’s. Check out the boilerplate code here if you’re interested. Horizontal layout <span>To create a flex layout, simply give the container the following CSS property. .container { display: flex;} Which will result in this layout: Notice that you don’t need to do anything with the items yet. They’ll be nicely positioned along the horizontal axis







#bayes #programming #r #statistics
The 95% HDI includes all those values of x for which the density is at least as big as some value W , such that the integral over all those x values is 95%. Formally, the values of x in the 95% HDI are those such that p(x)>W where W satisfies x : p(x)>W dxp(x) = 0.95
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#bayes #programming #r #statistics
When the distribution refers to credibility of values, then the width of the HDI is another way of measuring uncertainty of beliefs. If the HDI is wide, then beliefs are uncertain. If the HDI is narrow, then beliefs are relatively certain.
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#bayes #programming #r #statistics
We denote the conditional probability of hair color given eye color as p(h|e), which is spoken “the probability of h given e
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#bayes #programming #r #statistics
p(h|e) = p(e, h)/p(e). This equation is taken as the definition of conditional probability. Recall that the marginal probability is merely the sum of the cell probabilities, and therefore the definition can be written p(h|e) = p(e, h)/p(e) = p(e, h)/ h p(e, h).
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#bayes #programming #r #statistics
The definition of conditional probability can be written using more general variable names, with r referring to an arbitrary row attribute and c referring to an arbitrary column attribute. Then, for attributes with discrete values, conditional probability is defined as p(c|r) = p(r, c) c ∗ p(r, c ∗ ) = p(r, c) p(r)
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#bayes #programming #r #statistics
When the column attribute is continuous, the sum becomes an integral: p(c|r) = p(r, c) dcp(r, c) = p(r, c) p(r)
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#bayes #programming #r #statistics
It is also important to recognize that there is no temporal order in conditional probabilities. When we say “the probability of x given y”wedonot mean that y has already happened and x has yet to happen. All we mean is that we are restricting our calculations of probability to a particular subset of possible outcomes.
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#bayes #programming #r #statistics
A better gloss of p(x|y) is, “among all joint outcomes with value y, this proportion of them also has value x.”
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#bayes #programming #r #statistics
Among other contexts, independence will come up when we are constructing mathematical descriptions of our beliefs about more than one parameter. We will create a mathematical description of our beliefs about one parameter, and another mathematical description of our beliefs about the other parameter. Then, to describe what we believe about combinations of parameters, we will often assume independence, and simply multiply the separate credibilities to specify the joint credibilities
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Flashcard 1475112733964

Tags
#cfa-level-1 #reading-22-financial-statement-analysis-intro
Question
Is There a requirement to present earnings per share information for preferred shareowners?
Answer
Hells no

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Volkswagen has two types of shareholders, ordinary and preferred, and presents earnings per share information for both, although there is no requirement to present earnings per share information for preferred shareowners.

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Statement of comprehensive income
standing if potentially dilutive claims on common shares (e.g., stock options or convertible bonds) were exercised or converted by their holders—and an appropriately adjusted profit or loss attributable to the common shareowners. <span>Volkswagen has two types of shareholders, ordinary and preferred, and presents earnings per share information for both, although there is no requirement to present earnings per share information for preferred shareowners. Volkswagen’s basic earnings per ordinary share was €2.38. A note to the company’s financial statements explains that this number was calculated as follows: €960 million profit attributa







Flashcard 1475123481868

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#cfa-level-1 #reading-22-financial-statement-analysis-intro
Question
IOSC
Answer
International Organization of Securities Commissions

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Inclusion of a management report is recommended by the International Organization of Securities Commissions and frequently required by regulatory authorities, such as the US Securities and Exchange Commission (SEC) or the UK Financial Reporting Council (FRC).

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3.1.6. Management Commentary or Management’s Discussion and Analysis
he nature of the business, past results, and future outlook. This section is referred to by a variety of names, including management report(ing), management commentary, operating and financial review, and management’s discussion and analysis. <span>Inclusion of a management report is recommended by the International Organization of Securities Commissions and frequently required by regulatory authorities, such as the US Securities and Exchange Commission (SEC) or the UK Financial Reporting Council (FRC). In Germany, management reporting has been required since 1931 and is audited. The discussion by management is arguably one of the most useful parts of a company’s annual report besides







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Question
(SEC)
Answer
US Securities and Exchange Commission

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Inclusion of a management report is recommended by the International Organization of Securities Commissions and frequently required by regulatory authorities, such as the US Securities and Exchange Commission (SEC) or the UK Financial Reporting Council (FRC).

Original toplevel document

3.1.6. Management Commentary or Management’s Discussion and Analysis
he nature of the business, past results, and future outlook. This section is referred to by a variety of names, including management report(ing), management commentary, operating and financial review, and management’s discussion and analysis. <span>Inclusion of a management report is recommended by the International Organization of Securities Commissions and frequently required by regulatory authorities, such as the US Securities and Exchange Commission (SEC) or the UK Financial Reporting Council (FRC). In Germany, management reporting has been required since 1931 and is audited. The discussion by management is arguably one of the most useful parts of a company’s annual report besides







Flashcard 1475127151884

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#cfa-level-1 #reading-22-financial-statement-analysis-intro
Question
(FRC).
Answer
UK Financial Reporting Council

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Inclusion of a management report is recommended by the International Organization of Securities Commissions and frequently required by regulatory authorities, such as the US Securities and Exchange Commission (SEC) or the UK Financial Reporting Council (FRC).

Original toplevel document

3.1.6. Management Commentary or Management’s Discussion and Analysis
he nature of the business, past results, and future outlook. This section is referred to by a variety of names, including management report(ing), management commentary, operating and financial review, and management’s discussion and analysis. <span>Inclusion of a management report is recommended by the International Organization of Securities Commissions and frequently required by regulatory authorities, such as the US Securities and Exchange Commission (SEC) or the UK Financial Reporting Council (FRC). In Germany, management reporting has been required since 1931 and is audited. The discussion by management is arguably one of the most useful parts of a company’s annual report besides







Article 1475130297612

3.2. Accounting Equations
#cfa-level-1 #reading-23-financial-reporting-mechanics

The five financial statement elements noted previously serve as the inputs for equations that underlie the financial statements. This section describes the equations for three of the financial statements: balance sheet, income statement, and statement of retained earnings. A statement of retained earnings can be viewed as a component of the statement of stockholders’ equity, which shows all changes to owners’ equity, both changes resulting from retained earnings and changes resulting from share issuance or repurchase. The fourth basic financial statement, the statement of cash flows, will be discussed in a later section. The balance sheet presents a company’s financial position at a particular point in time. It provides a listing of a company’s assets and the claims on those assets (liabilities and equity claims). The equation that underlies the balance sheet is also known as the “basic accounting equation.” A company’s financial position is reflected using the following equation: Equation



#cfa-level-1 #reading-23-financial-reporting-mechanics
The five financial statement elements noted previously serve as the inputs for equations that underlie the financial statements.
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3.2. Accounting Equations
The five financial statement elements noted previously serve as the inputs for equations that underlie the financial statements. This section describes the equations for three of the financial statements: balance sheet, income statement, and statement of retained earnings. A statement of retained earnings can be




#cfa-level-1 #reading-23-financial-reporting-mechanics
A statement of retained earnings can be viewed as a component of the statement of stockholders’ equity, which shows all changes to owners’ equity, both changes resulting from retained earnings and changes resulting from share issuance or repurchase.
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3.2. Accounting Equations
ements noted previously serve as the inputs for equations that underlie the financial statements. This section describes the equations for three of the financial statements: balance sheet, income statement, and statement of retained earnings. <span>A statement of retained earnings can be viewed as a component of the statement of stockholders’ equity, which shows all changes to owners’ equity, both changes resulting from retained earnings and changes resulting from share issuance or repurchase. The fourth basic financial statement, the statement of cash flows, will be discussed in a later section. The balance sheet presents a company’s financial position at a pa




Flashcard 1475135278348

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#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
A [...] shows all changes to owners’ equity, (retained earnings and share issuance or repurchase)
Answer
statement of retained earnings

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A statement of retained earnings can be viewed as a component of the statement of stockholders’ equity, which shows all changes to owners’ equity, both changes resulting from retained earnings and changes resulting fro

Original toplevel document

3.2. Accounting Equations
ements noted previously serve as the inputs for equations that underlie the financial statements. This section describes the equations for three of the financial statements: balance sheet, income statement, and statement of retained earnings. <span>A statement of retained earnings can be viewed as a component of the statement of stockholders’ equity, which shows all changes to owners’ equity, both changes resulting from retained earnings and changes resulting from share issuance or repurchase. The fourth basic financial statement, the statement of cash flows, will be discussed in a later section. The balance sheet presents a company’s financial position at a pa







Flashcard 1475136851212

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
Wht is the balance sheet equation?
Answer
Assets = Liabilities + Owners’ equity

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3.2. Accounting Equations
liabilities and equity claims). The equation that underlies the balance sheet is also known as the “basic accounting equation.” A company’s financial position is reflected using the following equation: Equation (1a)  <span>Assets = Liabilities + Owners’ equity Presented in this form, it is clear that claims on assets are from two sources: liabilities or owners’ equity. Owners’ equity is the residual claim of the owners (i.e., t







#cfa-level-1 #reading-23-financial-reporting-mechanics
Other terms are used to denote owners’ equity, including shareholders’ equity, stockholders’ equity, net assets, equity, net worth, net book value, and partners’ capital.
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3.2. Accounting Equations
llustrated by the slightly rearranged balance sheet equation, roughly equivalent to the structure commonly seen in the balance sheets of UK companies: Equation (1b)  Assets – Liabilities = Owners’ equity <span>Other terms are used to denote owners’ equity, including shareholders’ equity, stockholders’ equity, net assets, equity, net worth, net book value, and partners’ capital. The exact titles depend upon the type of entity, but the equation remains the same. Owners’ equity at a given date can be further classified by its origin: capital contributed by owners




#cfa-level-1 #reading-23-financial-reporting-mechanics
Owners’ equity at a given date can be further classified by its origin: capital contributed by owners, and earnings retained in the business up to that date
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3.2. Accounting Equations
are used to denote owners’ equity, including shareholders’ equity, stockholders’ equity, net assets, equity, net worth, net book value, and partners’ capital. The exact titles depend upon the type of entity, but the equation remains the same. <span>Owners’ equity at a given date can be further classified by its origin: capital contributed by owners, and earnings retained in the business up to that date:4 Equation (2)  Owners’ equity = Contributed capital + Retained earnings The income statement presents the performance of a business for a speci




Flashcard 1475142356236

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
What is owners equity equation?
Answer
Owners’ equity = Contributed capital + Retained earnings

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3.2. Accounting Equations
entity, but the equation remains the same. Owners’ equity at a given date can be further classified by its origin: capital contributed by owners, and earnings retained in the business up to that date:4 Equation (2)  <span>Owners’ equity = Contributed capital + Retained earnings The income statement presents the performance of a business for a specific period of time. The equation reflected in the income statement is the following: E







Flashcard 1475144715532

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
What is the income statement equation?
Answer
Revenue – Expenses = Net income (loss)

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3.2. Accounting Equations
ted capital + Retained earnings The income statement presents the performance of a business for a specific period of time. The equation reflected in the income statement is the following: Equation (3)  <span>Revenue – Expenses = Net income (loss) Note that net income (loss) is the difference between two of the elements: revenue and expenses. When a company’s revenue exceeds its expenses, it reports net income; whe







#cfa-level-1 #reading-23-financial-reporting-mechanics
Note that net income (loss) is the difference between two of the elements: revenue and expenses.
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3.2. Accounting Equations
come statement presents the performance of a business for a specific period of time. The equation reflected in the income statement is the following: Equation (3)  Revenue – Expenses = Net income (loss) <span>Note that net income (loss) is the difference between two of the elements: revenue and expenses. When a company’s revenue exceeds its expenses, it reports net income; when a company’s revenues are less than its expenses, it reports a net loss. Other terms are used synonymously with




#cfa-level-1 #reading-23-financial-reporting-mechanics
Revenue and expenses generally relate to providing goods or services in a company’s primary business activities.

Gains (losses) relate to increases (decreases) in resources that are not part of a company’s primary business activities.
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3.2. Accounting Equations
ss than its expenses, it reports a net loss. Other terms are used synonymously with revenue, including sales and turnover (in the United Kingdom). Other terms used synonymously with net income include net profit and net earnings. <span>Also, as noted earlier, revenue and expenses generally relate to providing goods or services in a company’s primary business activities. In contrast, gains (losses) relate to increases (decreases) in resources that are not part of a company’s primary business activities. Distinguishing a company’s primary business activities from other business activities is important in financial analysis; however, for purposes of the accounting equation, gains are inc




Flashcard 1475150482700

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#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
[...] and [...] generally relate to providing goods or services in a company’s primary business activities.

Answer
Revenue

expenses

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Revenue and expenses generally relate to providing goods or services in a company’s primary business activities. Gains (losses) relate to increases (decreases) in resources that are

Original toplevel document

3.2. Accounting Equations
ss than its expenses, it reports a net loss. Other terms are used synonymously with revenue, including sales and turnover (in the United Kingdom). Other terms used synonymously with net income include net profit and net earnings. <span>Also, as noted earlier, revenue and expenses generally relate to providing goods or services in a company’s primary business activities. In contrast, gains (losses) relate to increases (decreases) in resources that are not part of a company’s primary business activities. Distinguishing a company’s primary business activities from other business activities is important in financial analysis; however, for purposes of the accounting equation, gains are inc







Flashcard 1475152841996

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question

[...] relate to increases (decreases) in resources that are not part of a company’s primary business activities.
Answer
Gains (losses)

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Revenue and expenses generally relate to providing goods or services in a company’s primary business activities. Gains (losses) relate to increases (decreases) in resources that are not part of a company’s primary business activities.

Original toplevel document

3.2. Accounting Equations
ss than its expenses, it reports a net loss. Other terms are used synonymously with revenue, including sales and turnover (in the United Kingdom). Other terms used synonymously with net income include net profit and net earnings. <span>Also, as noted earlier, revenue and expenses generally relate to providing goods or services in a company’s primary business activities. In contrast, gains (losses) relate to increases (decreases) in resources that are not part of a company’s primary business activities. Distinguishing a company’s primary business activities from other business activities is important in financial analysis; however, for purposes of the accounting equation, gains are inc







#cfa-level-1 #reading-23-financial-reporting-mechanics
Distinguishing a company’s primary business activities from other business activities is important in financial analysis; however, for purposes of the accounting equation, gains are included in revenue and losses are included in expenses.
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3.2. Accounting Equations
ue and expenses generally relate to providing goods or services in a company’s primary business activities. In contrast, gains (losses) relate to increases (decreases) in resources that are not part of a company’s primary business activities. <span>Distinguishing a company’s primary business activities from other business activities is important in financial analysis; however, for purposes of the accounting equation, gains are included in revenue and losses are included in expenses. The balance sheet and income statement are two of the primary financial statements. Although these are the common terms for these statements, some variations in the names o




#cfa-level-1 #reading-23-financial-reporting-mechanics
Balance sheet and Income statements are linked together through the retained earnings component of owners’ equity.

Beginning retained earnings is the balance in this account at the beginning of the accounting period, and ending retained earnings is the balance at the end of the period.
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3.2. Accounting Equations
xpense 50 Owners’ equity 1,500 Net income 200 2,000 The balance sheet represents a company’s financial position at a point in time, and the income statement represents a company’s activity over a period of time. <span>The two statements are linked together through the retained earnings component of owners’ equity. Beginning retained earnings is the balance in this account at the beginning of the accounting period, and ending retained earnings is the balance at the end of the period. A company’s ending retained earnings is composed of the beginning balance (if any), plus net income, less any distributions to owners (dividends). Accordingly, the equation underlying r




Flashcard 1475158609164

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
Balance sheet and Income statements are linked together through the [...].
Answer
retained earnings component of owners’ equity

Beginning retained earnings is the balance in this account at the beginning of the accounting period, and ending retained earnings is the balance at the end of the period.

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Balance sheet and Income statements are linked together through the retained earnings component of owners’ equity. Beginning retained earnings is the balance in this account at the beginning of the accounting period, and ending retained earnings is the balance at the end of the period.</

Original toplevel document

3.2. Accounting Equations
xpense 50 Owners’ equity 1,500 Net income 200 2,000 The balance sheet represents a company’s financial position at a point in time, and the income statement represents a company’s activity over a period of time. <span>The two statements are linked together through the retained earnings component of owners’ equity. Beginning retained earnings is the balance in this account at the beginning of the accounting period, and ending retained earnings is the balance at the end of the period. A company’s ending retained earnings is composed of the beginning balance (if any), plus net income, less any distributions to owners (dividends). Accordingly, the equation underlying r







#cfa-level-1 #reading-23-financial-reporting-mechanics
A company’s ending retained earnings is composed of the beginning balance (if any), plus net income, less any distributions to owners (dividends).
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3.2. Accounting Equations
ed together through the retained earnings component of owners’ equity. Beginning retained earnings is the balance in this account at the beginning of the accounting period, and ending retained earnings is the balance at the end of the period. <span>A company’s ending retained earnings is composed of the beginning balance (if any), plus net income, less any distributions to owners (dividends). Accordingly, the equation underlying retained earnings is: Equation (4a)  Endingretainedearnings=Beginningretainedearnings+Netincome−DividendsEndingretainedear




Flashcard 1475162017036

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
A company’s [...] is composed of the beginning balance (if any), plus net income, less any distributions to owners (dividends).
Answer
ending retained earnings

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A company’s ending retained earnings is composed of the beginning balance (if any), plus net income, less any distributions to owners (dividends).

Original toplevel document

3.2. Accounting Equations
ed together through the retained earnings component of owners’ equity. Beginning retained earnings is the balance in this account at the beginning of the accounting period, and ending retained earnings is the balance at the end of the period. <span>A company’s ending retained earnings is composed of the beginning balance (if any), plus net income, less any distributions to owners (dividends). Accordingly, the equation underlying retained earnings is: Equation (4a)  Endingretainedearnings=Beginningretainedearnings+Netincome−DividendsEndingretainedear







#cfa-level-1 #reading-23-financial-reporting-mechanics
Ending retained earnings = Beginning retained earnings + Net income − Dividends

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3.2. Accounting Equations
mpany’s ending retained earnings is composed of the beginning balance (if any), plus net income, less any distributions to owners (dividends). Accordingly, the equation underlying retained earnings is: Equation (4a)  <span>Endingretainedearnings=Beginningretainedearnings+Netincome−DividendsEndingretainedearnings=Beginningretainedearnings+  Netincome−Dividends Or, substituting Equation 3 for Net income, equivalently: Equation (4b)  Endingretainedearnings=Beginningretainedearnings+Revenues−Expenses−Divide




Flashcard 1475165424908

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
What the retained earnings equation?
Answer
Ending retained earnings = Beginning retained earnings + Net income − Dividends

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Ending retained earnings = Beginning retained earnings + Net income − Dividends

Original toplevel document

3.2. Accounting Equations
mpany’s ending retained earnings is composed of the beginning balance (if any), plus net income, less any distributions to owners (dividends). Accordingly, the equation underlying retained earnings is: Equation (4a)  <span>Endingretainedearnings=Beginningretainedearnings+Netincome−DividendsEndingretainedearnings=Beginningretainedearnings+  Netincome−Dividends Or, substituting Equation 3 for Net income, equivalently: Equation (4b)  Endingretainedearnings=Beginningretainedearnings+Revenues−Expenses−Divide







Flashcard 1475167784204

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
What is the fully expressed retained earnings equation?
Answer
Ending retained earnings = Beginning retained earnings + Revenues − Expenses− Dividends

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3.2. Accounting Equations
tainedearnings=Beginningretainedearnings+Netincome−DividendsEndingretainedearnings=Beginningretainedearnings+  Netincome−Dividends Or, substituting Equation 3 for Net income, equivalently: Equation (4b)  <span>Endingretainedearnings=Beginningretainedearnings+Revenues−Expenses−DividendsEndingretainedearnings=Beginningretainedearnings+Revenues−  Expenses−Dividends As its name suggests, retained earnings represent the earnings (i.e., net income) that are retained by the company—in other words, the amount not distributed as dividends t







#cfa-level-1 #reading-23-financial-reporting-mechanics
Retained earnings represent the amount not distributed as dividends to owners.
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3.2. Accounting Equations
uivalently: Equation (4b)  Endingretainedearnings=Beginningretainedearnings+Revenues−Expenses−DividendsEndingretainedearnings=Beginningretainedearnings+Revenues−  Expenses−Dividends As its name suggests, <span>retained earnings represent the earnings (i.e., net income) that are retained by the company—in other words, the amount not distributed as dividends to owners. Retained earnings is a component of owners’ equity and links the “as of” balance sheet equation with the “activity” equation of the income statement. To provide a combined representatio




Flashcard 1475171978508

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
[...] represent the amount not distributed as dividends to owners.
Answer
Retained earnings

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Retained earnings represent the amount not distributed as dividends to owners.

Original toplevel document

3.2. Accounting Equations
uivalently: Equation (4b)  Endingretainedearnings=Beginningretainedearnings+Revenues−Expenses−DividendsEndingretainedearnings=Beginningretainedearnings+Revenues−  Expenses−Dividends As its name suggests, <span>retained earnings represent the earnings (i.e., net income) that are retained by the company—in other words, the amount not distributed as dividends to owners. Retained earnings is a component of owners’ equity and links the “as of” balance sheet equation with the “activity” equation of the income statement. To provide a combined representatio







#cfa-level-1 #reading-23-financial-reporting-mechanics
Retained earnings is a component of owners’ equity and links the “as of” balance sheet equation with the “activity” equation of the income statement.
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3.2. Accounting Equations
gretainedearnings+Revenues−  Expenses−Dividends As its name suggests, retained earnings represent the earnings (i.e., net income) that are retained by the company—in other words, the amount not distributed as dividends to owners. <span>Retained earnings is a component of owners’ equity and links the “as of” balance sheet equation with the “activity” equation of the income statement. To provide a combined representation of the balance sheet and income statement, we can substitute Equation 2 into Equation 1a. This becomes the expanded accounting equation:




Flashcard 1475174599948

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#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
[...] is a component of owners’ equity and links the “as of” balance sheet equation with the “activity” equation of the [...]
Answer
Retained earnings

income statement.

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Retained earnings is a component of owners’ equity and links the “as of” balance sheet equation with the “activity” equation of the income statement.

Original toplevel document

3.2. Accounting Equations
gretainedearnings+Revenues−  Expenses−Dividends As its name suggests, retained earnings represent the earnings (i.e., net income) that are retained by the company—in other words, the amount not distributed as dividends to owners. <span>Retained earnings is a component of owners’ equity and links the “as of” balance sheet equation with the “activity” equation of the income statement. To provide a combined representation of the balance sheet and income statement, we can substitute Equation 2 into Equation 1a. This becomes the expanded accounting equation:







Flashcard 1475176959244

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
To provide a combined representation of the balance sheet and income statement, we can expand the accounting equation:
Answer
Assets = Liabilities + Contributed capital + Ending retained earnings

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3.2. Accounting Equations
on of the income statement. To provide a combined representation of the balance sheet and income statement, we can substitute Equation 2 into Equation 1a. This becomes the expanded accounting equation: Equation (5a)  <span>Assets = Liabilities + Contributed capital + Ending retained earnings Or equivalently, substituting Equation 4b into Equation 5a, we can write: Equation (5b)  Assets=Liabilities+Contributedcapital+Beginningretainedea







#cfa-level-1 #reading-23-financial-reporting-mechanics
Assets=Liabilities+Contributedcapital+Beginningretainedearnings+Revenue−Expenses−DividendsAssets=Liabilities+Contributedcapital+Beginningretainedearnings+  Revenue−Expenses−Dividends
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3.2. Accounting Equations
on: Equation (5a)  Assets = Liabilities + Contributed capital + Ending retained earnings Or equivalently, substituting Equation 4b into Equation 5a, we can write: Equation (5b)  <span>Assets=Liabilities+Contributedcapital+Beginningretainedearnings+Revenue−Expenses−DividendsAssets=Liabilities+Contributedcapital+Beginningretainedearnings+  Revenue−Expenses−Dividends The last five items, beginning with contributed capital, are components of owners’ equity. The statement of retained earnings shows the linkage between the b




Flashcard 1475180367116

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Question
Really expanded accounting equation
Answer
Assets = Liabilities + Contributed capital + Beginning retained earnings + Revenue − Expenses− Dividends

The last five items, beginning with contributed capital, are components of owners’ equity.

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Assets=Liabilities+Contributedcapital+Beginningretainedearnings+Revenue−Expenses−DividendsAssets=Liabilities+Contributedcapital+Beginningretainedearnings+  Revenue−Expenses−Dividends

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3.2. Accounting Equations
on: Equation (5a)  Assets = Liabilities + Contributed capital + Ending retained earnings Or equivalently, substituting Equation 4b into Equation 5a, we can write: Equation (5b)  <span>Assets=Liabilities+Contributedcapital+Beginningretainedearnings+Revenue−Expenses−DividendsAssets=Liabilities+Contributedcapital+Beginningretainedearnings+  Revenue−Expenses−Dividends The last five items, beginning with contributed capital, are components of owners’ equity. The statement of retained earnings shows the linkage between the b







#cfa-level-1 #reading-23-financial-reporting-mechanics
The basic accounting equation reflected in the balance sheet (Assets = Liabilities + Owners’ equity) implies that every recorded transaction affects at least two accounts in order to keep the equation in balance, hence the term double-entry accounting
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3.2. Accounting Equations
. Statement of Retained Earnings Year Ended 31 December 20X1 Beginning retained earnings 250 Plus net income 200 Minus dividends 0 Ending retained earnings 450 <span>The basic accounting equation reflected in the balance sheet (Assets = Liabilities + Owners’ equity) implies that every recorded transaction affects at least two accounts in order to keep the equation in balance, hence the term double-entry accounting that is sometimes used to describe the accounting process. For example, the use of cash to purchase equipment affects two accounts (both asset accounts): cash decreases and equipment i




Flashcard 1475184561420

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#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
Assets = Liabilities + Owners’ equity implies that every recorded transaction affects at least two accounts in order to keep the equation in balance, hence the term [...]
Answer
double-entry accounting

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dy>The basic accounting equation reflected in the balance sheet (Assets = Liabilities + Owners’ equity) implies that every recorded transaction affects at least two accounts in order to keep the equation in balance, hence the term double-entry accounting<body><html>

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3.2. Accounting Equations
. Statement of Retained Earnings Year Ended 31 December 20X1 Beginning retained earnings 250 Plus net income 200 Minus dividends 0 Ending retained earnings 450 <span>The basic accounting equation reflected in the balance sheet (Assets = Liabilities + Owners’ equity) implies that every recorded transaction affects at least two accounts in order to keep the equation in balance, hence the term double-entry accounting that is sometimes used to describe the accounting process. For example, the use of cash to purchase equipment affects two accounts (both asset accounts): cash decreases and equipment i







acute myositis secondary to virus
#peds
Influenza is the most common cause of acute myositis in otherwise healthy children.
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Flashcard 1475196882188

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Question
[...] is the most common cause of acute myositis in otherwise healthy children.
Answer
Influenza

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acute myositis secondary to virus
Influenza is the most common cause of acute myositis in otherwise healthy children.







Flashcard 1475198455052

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Question
Influenza is the most common cause of [...] in otherwise healthy children.
Answer
acute myositis

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acute myositis secondary to virus
Influenza is the most common cause of acute myositis in otherwise healthy children.







Flashcard 1475200027916

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Question
What is the management of acute myositis secondary to influenza?
Answer
Conservative management (lots of hydration & advil PRN)

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Consult notes
#clerk
CONSULT NOTES
A good consult note contains the following elements, and should be prepared in this order:

HISTORY
ID and RFR (reason for referral)
• ID = Gender and age
• Include occupation and handedness if a hand consult
HPI
• Hand injuries: Mechanism, time of injury, any treatment so far
• Tetanus status if open wounds
PMHx
• Include PSHx (past surgical history)
Medications
• *Blood thinners*
SocHx
• Include smoking, EtOH, and recreational drug use (esp. IVDU)
Allergies
• Clarify the reaction to any stated allergy

PHYSICAL EXAMINATION

INVESTIGATIONS

ASSESSMENT AND PLAN


Example
ID 28M R-handed, works in construction
RFR Query flexor tenosynovitis
HPI 3d ago puncture wound to volar distal phalanx left index finger from drill bit. Reports pain locally and in palm x1 week. Similar episode hand pain 1 year ago without Hx trauma, resolved spontaneously. Denies fevers and chills. Tetanus UTD.
PMHx Healthy. Appendectomy @6yo
Meds None
SocHx Lives with girlfriend. Nonsmoker, no EtOH, no rec drug use
ALL None
O/E Looks well. BP 130/90, HR 75 bpm, RR12, SaO2 99% room air, afebrile.
R hand mildly swollen compared to L, mild palmar erythema. All digits NVI.
R index: swollen with 0.5 mm puncture wound mid DP radially, no purulence. Pain on passive extension but no tenderness over flexor sheath, no fusiform swelling, and digit held in neutral position.
Wound explored and irrigated in sterile conditions under local anaesthesia: maximal wound depth is to subcutaneous tissue only
Ix WBC 6.0
XR R hand: normal
A+P Inconsistent with flexor tenosynovitis as wound not adjacent to flexor sheath and pain began before injury.
Likely tenosynovitis given previous episode with spontaneous recovery.
Rx given for Naproxen x1 week. F/U Dr. X in 1 week, or call office if worsening or becomes unwell.
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progress notes (for inpatients)
#clerk
All progress notes should begin with a line summarizing the patient.
The remainder of the note follows the format “SOAP”:

Subjective
• How is the patient feeling, any concerns
• Pain control, nausea/vomiting
• Ambulating?
• Tolerating diet?
Objective
• Vital signs
• Drain outputs
• Urine output if relevant
• Findings on physical examination
Assessment
• How is the patient doing overall, what are the issues
Plan
• Summarize plan for each issue

Example
55F POD #3 bilateral immediate breast reconstruction with DIEP flaps
S: Patients feels well, pain controlled. Eating well. Ambulating.
O: AVSS. JP output: #1 50cc, #2 60cc – both serosanguinous. Flaps: good colour, cap refill, turgor. Both warm. Small blue discoloration lateral aspect right breast, 2x1 cm. Abdomen soft. Incisions clean, dry and intact.
A/P: Doing well. Continue to monitor flaps as per protocol. Reassess lateral aspect right breast this afternoon.
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admission orders
#clerk
For this, you can use of the mnemonic AD DAVID.

A
dmit to (ward/department/nicu), under Dr. Surgeon
Diagnosis: confirmed or suspected (UTI w/ 2ndary dehydration)
Diet: DAT (diet as tolerated), NPO (if surg/procedures), sips only, CF (clear fluids), ff (full fluids), thickened fluids (dysphagia), advancing diet, diabetic diet (indicate calories eg. 1800kcal), cardiac diet, TPN, etc
Include amount, freq, rate if applicable.
Activity: AAT (activity as tolerated), NWB (non-weight bearing), FWB (full weight bearing), BR (bed rest), BR with BRP (bed rest w/ bathroom privileges), ambulation (up in chair tid, ambulate bid)
Vitals: VSR (vital signs routine - HR, RR, BP, O2 sat, Temp q8-12h, q shift), VS q4h (was told this is routine), special parameters (eg postural vitals, neuro vitals)
IVF, Investigations, Ins and outs
-ins & outs: surg/volume status pts
-daily weights: eg renal failure, edematous, infants
-investigations: heme (CBC + diff, PTT/INR), biochem (lytes - Na, K, Cl, HCO; urea, Cr, Ca, Mg, PO4, glu, CSF cell count, CSF protein & glucose) microbio (urine R&M/C&S, blood cultures, CSF from LP for gram stain, C&S; just rmb all the things you can culture - CSF, sputum, urine, feces, pus from wounds, blood), imaging (cxr, ct, mri, ekg, pft, spirometry), consults (sw, neuro, ID)
Drugs
-all meds pt's already on (Past)
-meds pt needs right now (present)
-anticipate what pt might need: prophylaxis, sleep, nausea & pain (future)
-10 patient P's: Problems (specific med issues), Pain (analgesia), Pus (antimicrobials), Puke (anti-emetics, prokinetics, antacids), Pee (IV fluids, diuretics, lytes), Poop (bowel routine), Pillow (sedation), PE (anticoag), Psych (DTs), Prev meds

Example
Admit to Plastic Surgery, under Dr. X
Diagnosis: Flexor tenosynovitis L D3

NPO (patient is pre-op. May be NPO @ midnight if OR not planned until following day)
AAT (activity as tolerated); Splint L hand
Vitals q8h (vitals can be more frequent if patient unstable)
IV RL @ 100cc/hr while NPO (note: maintenance IVF should be based on the 4:2:1rule)
CBC, lytes, BUN, Cr, PTT, INR qAM x2
Monitor ins and outs (for unstable patients)
Group and screen (or type and cross if ++ blood loss probable in OR – check with staff/seniors if this is needed)
EKG (if >40y pre-op)
CXR (if >50y pre-op)
Ancef 1g IV x1 on call to OR (Clindamycin 600mg IV x1 if pen-allergic)
Antibiotics for infection need to be prescribed around the clock: check with your staff/senior which you should prescribe
Gravol 25-50 mg PO/IV q6h PRN
Dressing orders (check with staff/seniors)
Patients home meds
Anaesthesia consult (if patient has other co-morbidities and high risk for surgery)

Please note that all orders should be reviewed and co-signed by a resident. Be mindful of patient’s allergies before ordering medications.
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OR note
#clerk
Pre-Operative Dx:
Post-Operative Dx:
Procedure:
Surgeon:
Assistants:
Anaesthesia:
EBL:
Complications:
Disposition:

Example
Pre-Operative Dx: Dupuytren’s contracture
Post-Operative Dx: Same
Procedure: Palmar fasciectomy R D4 + D5
Surgeon: Dr. Martin
Assistants: Willoughbail (R3), Ramjam (R2)
Anaesthesia: Bier block with neurolept anaesthesia, Dr. X
EBL: nil
Complications: None
Disposition: Extubated in OR. Stable to recovery room
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POST-OPERATIVE ORDERS
#clerk
For this, you can again use of the mnemonic AD DAVID

Admit to Plastic Surgery, under Dr. Surgeon
Diagnosis

Diet
Activity
Vitals
IVF, Investigations, Ins and outs
Drugs (the 5 P’s)
• Pain (analgesia)
• Puke (anti-emetic)
• Prophylactic (anti-coagulation)
• Pus (antibiotic)
• Precedent medications (restart appropriate home meds)

Example (post-op orders, patient for same day discharge)
Admit to Plastic Surgery, under Dr. Martin
Diagnosis: Flexor tenosynovitis L D3

Sips to DAT
AAT (activity as tolerated)
Splint L hand
Vitals q8h
IV RL @ 100cc/hr; SLIV (Saline lock IV) when drinking well
Tylenol #3 PO 1 -2 tabs q4h PRN
Gravol 25-50 mg PO/IV q6h PRN
*No DVT prophylaxis (patient ambulatory, low risk for DVT/PE)
*No home meds
Discharge home when well
Rx on chart
F/u with Dr. Martin in 2 weeks

Please note that all orders should be reviewed and co-signed by a resident. Be mindful of patient’s allergies before ordering medications.
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DISCHARGE SUMMARY
#clerk
Date of admission:
Date of discharge:
*start of dictation*

Discharge diagnosis: (1, 2, etc)
Other (non-active) dx:
Follow-up: (appts, pending ix, home care)
Discharge meds: (dose, freq, route, duration)
Summary of presenting illness:
• 1-2 line summary of presenting illness & reason for admission. Refer to separately dictated note for full hx & px of admission. Only if no admission dictation completed, indicate full HPI, PMH, and initial px prior to ‘Course in Hospital’
Course in hospital:
• Describe briefly the events and progression of illness while in hospital including status upon discharge
• If multiple medical issues, this section can be done by system (cardiovascular, respiratory, fluids and nutrition, ID, hematological, CNS, etc)
Operations performed in hospital:
Investigations in hospital:
• Include if any significant findings
Discharge plan:
• Who the patient is following up with
• Any issues the GP needs to follow up on
• Dressings (CCAC)
• Return to ER if..

Example
Date of admission: June 20, 2015
Date of discharge: June 30, 2015
Admission diagnosis:
1. Scald burn to bilateral thighs, TBSA = 15%
Discharge diagnosis:
1. Second degree scald burns to bilateral thighs, TBSA = 15%
2. Hypertension
Operations performed in hospital: Split thickness skin grafting left thigh June 23
History of presenting illness: Ms. X is a 65 yo F admitted to Hamilton General Hospital on June 22 after sustaining scald burns to her thighs from hot tea. She was transferred to our hospital from Brantford due to concerns of full thickness burns of TBSA 15%. She was admitted for monitoring and wound management as we suspected she may require skin grafting.
Course in hospital: It became apparent on the second day of admission that her left thigh burns were deep partial thickness and wound benefit from split thickness skin grafting to expedite healing. This procedure occurred on June 23, 2015. Post-operatively she was stable, though she was hypertensive throughout her admission with systolic pressures in the 180s. She was started on hydrochlorothiazide. The patient was kept in hospital until her dressings were manageable by CCAC on an outpatient basis.
Investigations in hospital: Routine bloodwork was unremarkable.
Discharge medications:
1. Hydrochlorothiazide 12.5 mg PO daily
2. Tylenol #3 x 40 tabs
3. Colace x 20 days
Discharge plan:
1. CCAC will be providing dressing changes q2days.
2. She will return for reassessment at the outpatient burn clinic on X day.
3. We kindly ask her family doctor, Dr. Y, to follow up on her hypertension and adjust her medications as necessary.
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Flashcard 1475228339468

Tags
#peds
Question
What are 4 key risk factors for hypoglycemia in a newborn?
Answer
SGA
LGA
DM mom
SEPSIS****

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Flashcard 1475231223052

Tags
#peds
Question
It is normal to see a drop in blood glucose in newborns at [...] ​h after birth.
Answer
1-2 h

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Flashcard 1475234893068

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#peds
Question
Newborn blood glucose at 2h should be [...] , then rise to >2.6
Answer
2.0 or greater

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Flashcard 1475237252364

Tags
#peds
Question
Newborn blood glucose at 2h should be 2.0 or greater , then rise to [...]
Answer
>2.6

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Neonatal Parents Spiel
#peds
1) Umbilical cord falls off
2) Poop changes colour (black tarry to yellow seedy). Red is not normal.
3) BACK TO BED, NO BED SHARING
4) Fever!! (axilla is best, 37.5 bad)
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
Suppose that truth is a woman – and why not? Aren’t there reasons for suspecting that all philosophers, to the extent that they have been dogma- tists, have not really understood women? That the grotesque seriousness of their approach towards the truth and the clumsy advances they have made so far are unsuitable ways of pressing their suit with a woman? What is certain is that she has spurned them – leaving dogmatism of all types standing sad and discouraged.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
Because there are those who make fun of dogmatism, claiming that it has fallen over, that it is lying flat on its face, or more, that dogmatism is in its last gasps. But seriously, there are good reasons for hoping that all dogmatizing in philos- ophy was just noble (though childish) ambling and preambling, however solemn, settled and decisive it might have seemed.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
And perhaps the time is very near when we will realize again and again just what actually served as the cornerstone of those sublime and unconditional philosophical edifices that the dogmatists used to build – some piece of folk super- stition from time immemorial (like the soul-superstition that still causes trouble as the superstition of the subject or I), some word-play perhaps, a seduction of grammar or an over-eager generalization from facts that are really very local, very personal, very human-all-too-human.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
Let us hope that the dogmatists’ philosophy was only a promise over the millennia, as was the case even earlier with astrology, in whose service perhaps more la- bor, money, ingenuity, and patience was expended than for any real science so far. We owe the great style of architecture in Asia and Egypt to astrol- ogy and its “supernatural” claims.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
We should not be ungrateful towards dogmatism, but it must nonetheless be said that the worst, most prolonged, and most dangerous of all errors to this day was a dogmatist’s error, namely Plato’s invention of pure spirit and the Good in itself. But now that it has been overcome, and Europe breathes a sigh of relief after this nightmare, and at least can enjoy a healthier – well – sleep, we, whose task is wakefulness itself, are the heirs to all the force cultivated through the struggle against this error.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
Of course: talking about spirit and the Good like Plato did meant standing truth on its head and disowning even perspectivism, which is the fundamental condition of all life. In fact, as physicians we could ask: “How could such a disease infect Plato, the most beautiful outgrowth of antiquity? Did the evil Socr ates corrupt him after all? was Socrates in fact the corrupter of youth? did he deserve his hemlock?” – But the struggle against Plato, or, to use a clear and “popular” idiom, the struggle against the Christian-ecclesiastical pressure of millennia – since Christianity is Platonism for the “people” – has created a magnificent tension of spirit in Europe, the likes of which the earth has never known: with such a tension in our bow we can now shoot at the furthest goals
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
Granted, the European experiences this tension as a crisis or state of need; and twice already there have been attempts, in a grand fashion, to unbend the bow, once through Jesuitism, and the second time through the democratic Enlightenment: – which, with the help of freedom of the press and circu- lation of newspapers, might really insure that spirit does not experience itself so readily as “need”! (Germans invented gunpowder – all honors due! But they made up for it – they invented the press.) But we, who are neither Jesuits nor democrats, nor even German enough, we good Europeans and free, very free spirits – we still have it, the whole need of spirit and the whole tension of its bow! And perhaps the arrow too, the task, and – who knows?
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
The will to truth that still seduces us into taking so many risks, this famous truthfulness tha t all philosophers so far have talked about with veneration: what questions this will to truth has already laid before us! What strange, terrible, questionable questio ns! That is already a long story – and yet it seems to have hardly begun? Is it any wonder if we finally become suspicious, lose patience, turn impatiently away? That we ourselves are also learning from this Sphinx to pose questions? Who is it really that questions us here? What in us really wills the truth? In fact, we paused for a lo ng time before the question of the cause of this will – until we finally came to a complete standstill in front of an even more fundamental question. We asked about the value of this will. Granted, we will truth: why not untruth instead? And uncertainty? Even ignorance? The problem of the value of truth came before us, – or was it we who came before the problem? Which of us is Oedipus? Which one is the Sphinx? It seems we have a rendezvous of questions and question-marks.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
Things of the highest value must have another, separate origin of their own, – they cannot be derived from this ephemeral, seductive, deceptive, lowly world, from this mad chaos of con- fusion and desire. Look instead to the lap of being, the everlasting, the hidden God, the ‘thing-in-itself ’ – this is where their ground must be, and nowhere else!” – This way of judging typifies the prejudices by which metaphysicians of all ages can be recognized: this type of valuation lies be- hind all their logical procedures. From these “beliefs” they try to acquire their “knowledge,” to acquire something that will end up being solemnly christened as “the truth.” The fundamental belief of metaphysicians is the belief in oppositions of values.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
It has not occurred to even the most cautious of them to start doubting right here at the threshold, where it is actually needed the most – even though they had vowed to themselves “de omnibus dubitandum.” But we can doubt, first, whether opposites even exist and, second, whether the popular valuations and value oppositions that have earned the metaphysicians’ seal of approval might not only be foreground appraisals. Perhaps they are merely provisional perspectives, perhaps they are not even viewed head-on; perhaps they are even viewed from below, like a frog-perspective, to borrow an expression that painters will recognize.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
Whatever value might be attributed to truth, truthfulness, and selflessness, it could be possible that appearance, the will to deception, and craven self-interest should be accorded a higher and more fundamen- tal value for all life. It could even be possible that whatever gives value to those good and honorable things has an incriminating link, bo nd, or tie to the very things that look like their evil opposites; perhaps they are even essentially the same. Perhaps! – But who is willing to take charge of such a dangerous Perhaps! For this we must await the arrival of a new breed of philosophers, ones whose taste and inc lination are somehow the reverse of those we have seen so far – philosophers of the dangerous Per- haps in every sense. – And in all seriousness: I see these new philosophers approaching.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
This issue needs re-examination in the same way that heredity and “innate characteristics” have been re-examined. Just as the act of birth makes no difference to the overall course of heredity, neither is “consciousness” opposed to instinct in any decisive sense – most of a philosopher’s conscious thought is secretly directed and forced into determinate channels by the instincts. Even behind all logic and its au- tocratic posturings stand valuations or, stated more clearly, physiological requirements for the preservation of a particular type of life.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
For example, that the deter minate is worth more than the indeterminate, appearance worth less than the “truth”: despite all their regulative importance for us, these sorts of appraisals could still be just foreground appr aisals, a particular type of niaiserie, precisely what is needed for the preservation of beings like us. But this assumes that it is not man who is the “measure of things”
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
We do not consider the falsity of a judgment as itself an objection to a judg- ment; this is perhaps where our newlanguage will sound most foreign.The question is how far the judgment promotes and preserves life, how well it preserves, and perhaps even cultivates, the type. And we are fundamen- tally inclined to c laim that the falsest judgments (which include synthetic judgments a priori) are the most indispensable to us, and that without ac- cepting the fictio ns of logic, without measuring reality against the wholly invented world of the unconditioned and self-identical, without a constant falsification of the world through numbers, people could not live – that a renunciation of false judgments would be a renunciatio n of life, a negation of life.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
To acknowledge untruth as a condition of life: this clearly means resisting the usual value feelings in a dangerous manner; and a philoso- phy that risks such a thing would by that gesture alone place itself beyond good and evil.
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how often and easily they err and stray, in short, their childish childlikeness – but rather tha t there is not enough genuine honesty about them: even though they all make a huge, virtuous racket as soon as the problem of truthfulness is even remotely touched upon. They all act as if they had discovered and arrived at their genuine convictions through the self-development of a cold, pure, divinely insouciant dialectic (in contrast to the mystics of every rank, who are more honest than the philosophers and also sillier – they talk about “inspiration” –): while what essentially happens is that they take a conjecture, a whim, an “inspiration” or, more typically, they take some fervent wish that they have sifted through and made properly abstract – and they defend it with rationaliza tions after the fact.
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They are all advocates who do not want to be seen as such; for the most part, in fact, they are sly spokesmen for prejudices that they christen as “truths” – and very far indeed from the courage of conscience that confesses to this fact, this very fact; and very far from having the good taste of courage that also lets this be known, perhaps to warn a friend or foe, or out of a high-spirited attempt at self-satire.
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The stiff yet demure tartuffery used by the old Kant to lure us along the clandestine, dialectical path that leads the way (or r ather: astray) to his “categorical imperative” – this spectacle provides no small amusement for discriminating spectators like us, who keep a close eye on the cunning tricks of the old moralists and preachers of morals. Or even that hocus pocus of a mathematical form used by Spinoza to arm and outfit his philosophy (a term which, when all is said and done, really means “his love of wisdom”) and thus, from the very start, to strike terror into the heart of the attacker who would dare to cast a glance at the unconquerable maiden and Pallas Athena: – how much personal timidity and vulnerability this sick hermit’s masquerade reveals!
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But anyone who looks at people’s basic drives, to see how far they may have played their little game right here as inspiring geniuses (or daemons or sprites –), will find that they all practiced philosophy at some point, – and that every single one of them would be only too pleased to present itself as the ultimate pur- pose of existence and as rightful master of all the other drives. Because every drive craves mastery, and this leads it to try philosophizing.
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Of course: with scholars, the truly scientific people, things might be differ- ent – “better” if you will –, with them, there might really be something like a drive for knowledge, some independent little clockwork mechanism that, once well wound, ticks bravely away without essentially involving the rest of the scholar’s drives. For this reason, the scholar’s real “interests” usually lie somewhere else entirely, with the family, or earning money, or in politics; in fact, it is almost a matter of indifference whether his little engine is put to work in this or that field of research, and whether the “promising” young worker turns himself into a good philologist or fungus expert or chemist: – it doesn’t signify anything about him that he becomes one thing or the other.
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In contrast, there is absolutely nothing impersonal about the philosopher; and in particular his morals bear de- cided and decisive witness to whoheis– which means, in what order of rank the innermost drives of his nature stand with respect to each other.
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So you want to live “according to nature?” Oh, you noble Stoics, what a fraud is in this phrase! Ima gine something like nature, profligate with- out measure, indifferent without measure, without purpose and regard, without merc y and justice, fertile and barren and uncertain at the same time, think of indifference itself as power – how could you live according to this indifference? Living – isn’t that wanting specifically to be something other than this nature? Isn’t living assessing, preferring, being unfair, being limited, wanting to be different? And assuming your imper ative to “live according to nature” basically amounts to “living according to life” – well how could you not? Why make a principle out of what you yourselves are and must be? – But in fact, something quite different is going on: while pretending with delight to read the canon of your law in nature, you want the opposite, you strange actors and self-deceivers! Your pride wants to dictate and annex your morals and ideals onto nature – yes, nature itself –, you demand that it be nature “according to Stoa” and you want to make all existence exist in your own image alone – as a huge eternal glorification and universalization of Stoicism! For all your love of truth, you have forced yourselves so long, so persistently, and with such hypnotic rigidity to have a false, namely Stoic, view of nature, that you can no longer see it any other way, – and some abysmal piece of arro- gance finally gives you the madhouse hope that because you know how to tyrannize yourselves
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because isn’t the Stoic a piece of nature? ... But this is an old, eternal story: what happened back then with the Stoics still happens today, just as soon as a philosophy begins believing in itself. It always creates the world in its own image, it cannot do otherwise; philos- ophy is this tyrannical drive itself, the most spiritual will to power, to the “creation of the world,” to the causa prima.
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All over Europe these days, the problem “of the real and the apparent world” gets taken up so eagerly and with such acuity–Iwould even say: shrewdness – that you really start to think and listen; and anyone who hears only a “will to truth” in the background here certainly does not have the sharpest of ears. In r are and unusual cases, some sort of will to truth might actually be at issue, some wild and adventurous streak of courage, a metaphysician’s ambition to hold on to a lost cause, that, in the end, will still prefer a handful of “certainty” to an entire wagonload of pretty possibilities.
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There might even be puritanical fanatics of conscience who would rather lie dying on an assured nothing than an uncertain something. But this is nihilism, and symptomatic of a desperate soul in a state of deadly exhaustion, however brave such virtuous posturing may appear. With stronger, livelierthinkers,however, thinkers who still have a thirst for life, things look different. By taking sides against appearance and speaking about “perspective” in a newly arrogant tone, by granting their own bodies about as little credibility as they grant the visual evidence that says “the earth stands still,” and so, with seemingly good spirits, relinquishing their most secure possession (since what do people believe in more securely these days than their bodies?), who knows whether they are not basically trying to re-appropriate something that was once possessed even more securely, something from the old estate of a bygone faith, perhaps “the immortal soul” or perhaps “the old God,” in short, ideas that helped make life a bit better, which is to say stronger and more cheerful than “modern ideas” can do?
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There is a mistrust of these modern ideas here, there is a disbelief in everything built yesterday and today; perhaps it is mixed with a bit of antipathy and contempt that can no longer stand the bric-a-brac of concepts from the most heterogeneous sources
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how so-called positivism puts itself on the market these days, a disgust felt by the more discriminating taste at the fun-fair colors and flimsy scraps of all these reality-philosophaster s who have nothing new and genuine about them except these colors. Here, I think, we should give these skeptical anti-realists and epistemo-microscopists their just due: the instinct that drives them away from modern reality is unassailable, – what do we care for their retrograde shortcut! The essential thing about them is not that they want to go “back”: but rather, that they want to get – away. A bit more strength, flight, courage, artistry: and they would want to get up and out, – and not go back!
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It seems to me that people everywhere these days are at pains to divert attention away from the real influence Kant exer ted over German phi- losophy, and, in particular, wisely to overlook the value he attributed to himself. First and foremost, Kant was proud of his table of categories, and he said with this table in his hands: “This is the hardest thing that ever could have been undertaken on behalf of metaphysics.” – But let us be clear about this “could have been”! He was proud of having discovered a new faculty in humans, the faculty of synthetic judgments a priori.
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Of course he was deceiving himself here, but the development and rapid blossoming of German philosophy depended on this pride, and on the competitive zeal of the younger generatio n who wanted, if possible, to dis- cover something even prouder – and in any event “new faculties”! – But the time has come for us to think this over. How are synthetic judgments a priori possible? Kant asked himself, – and what really was his answer? By virtue of a faculty, which is to say: enabled by an ability: unfortunately, though, not in these few words, but rather so laboriously, reverentially, and with such an extravagance of German frills and profundity that peo- ple failed to hear the comical niaiserie allemande in such an answer. In fact, people were beside themselves with joy over this new faculty, and the jubilation reached its peak when Kant discovered yet another faculty, a moral faculty
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Realpolitik. – The honeymoon of German philosophy had arrived; all the young theologians of the T ¨ ubingen seminary ran off into the bushes – they were all looking for “faculties.” And what didn’t they find – in that innocent, abundant, still youthful age of the German spirit, when Romanticism, that malicious fairy, whispered, whistled, and sang, when people did not know how to tell the difference between “dis- covering” and “inventing”! Above all, a faculty of the “supersensible”: Schelling christened it intellectual intuition, and thus gratified the heart’s desire of his basically piety-craving Germans. We can do no grea ter in- justice to this whole high-spirited and enthusiastic movement (which was just youthfulness, however boldly it might have clothed itself in gray and hoary concepts) than to take it seriously or especially to treat it with moral indignation. Enough, we grew up, – the dream faded away. There came a time when people scratched their heads: some still scra tch them to- day. There had been dreamers: first and foremost – the old Kant. “By virtue of a f aculty” – he had said, or at least meant. But is that really – an answer? An explanation? Or instead just a re petition of the questio n? So how does opium cause sleep? “By virtue of a faculty,” namely the virtus dormitiva – replies the doctor in Moli ` ere, quia est in eo virtus dormitiva, cujus est natura sensus assoupire. But answers like this belong in comedy, and the time has finally come to replace the Kantian question “How are synthetic judgments a priori possible?” with another question, “Why is the belief in such judgments necessary?” – to realize, in other words, that such judgments must be believed true for the purpose of preserving beings of our type; which is why these judgments could of course still be false! Or, to be blunt, basic and clearer still: synthetic judgments a priori do not have “to be possible” at all: we have no right to them, and in our mouths they are nothing but f alse judgments. It is only the belief in their truth that is necessary as a foreground belief and piece of visual evidence, belonging to the perspectival optics of life.
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I hope, understood? – has had all over Europe, a certain virtus dormitiva has undoubtedly had a role: the noble idlers, the virtuous, the mystics, artists, three-quarter-Christians, and political obscurantists of all nations were all delighted to have, thanks to German philosophy, an antidote to the still overpowering sensualism that was spilling over into this century from the previous one, in short – “sensus assoupire”
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Beyond Good and Evil is, I hope, understood? – has had all over Europe, a certain virtus dormitiva has undoubtedly had a role: the noble idlers, the virtuous, the mystics, artists, three-quarter-Christians, and political obscurantists of all nations were all delighted to have, thanks to German philosophy, an antidote to the still overpowering sensualism that was spilling over into this century from the previous one, in short – “sensus assoupire” ... As far as materialistic a tomism goes: this is one of the most well-refuted things in existence. In Europe these days, nobody in the scholarly com- munity is likely to be so unscholarly as to attach any real significance to it, except as a handy household tool (that is, as an abbreviated figure of speech). For this, we can thank that Pole, Boscovich, who, together with the Pole, Copernicus, was the greatest, most successful opponent of the visual evidence.
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While Copernicus convinced us to believe, contrary to all our senses, that the earth does not stand still, Boscovich taught us to renounce belief in the last bit of earth that did “stand still,” the belief in “matter,” in the “material,” in the residual piece of earth and clump of an atom: it was the greatest triumph over the senses that the world had ever known. – But we must go further still and declare war–aruthless fight to the finish – o n the “atomistic need” that, like the more famous “meta- physical need,” still leads a dangerous afterlife in regions where nobody would think to look. First of all, we must also put an end to that other and more disastrous atomism, the one Christianity has taught best and longest, the atomism of the soul.
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Let this expression signify the belief that the soul is something indestructible, eternal, indivisible, that it is a monad, an atomon: this belief must be thrown out of science! Between you and me, there is absolutely no need to give up “the soul” itself, and relinquish one of the oldest and most venerable hypotheses – as often happens with naturalists: given their clumsiness, they barely need to touch “the soul” to lose it. But the path lies open for new versions and sophistications of the soul hypothesis – and concepts like the “mortal soul” and the “soul as subject-multiplicity” and the “soul as a society constructed out of drives and affects” want henceforth to have civil rights in the realm of science. By putting an end to the superstition that until now has grown around the idea of the soul with an almost tropical luxuriance, the new psychologist clearly thrusts himself into a new wasteland and a new suspicion.
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in the end, the new psychologist knows by this very token that he is condemned to invention – and, who knows? perhaps to discovery.
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On the prejudices of philosophers old psychologists might have found things easier and more enjoyable –: but, in the end, the new psychologist knows by this very token that he is condemned to invention – and, who knows? perhaps to discovery. – Physiologists should think twice before positioning the drive for self- preservation as the cardinal drive of an organic being. Above all, a living thing wants to discharge its strength – life itself is will to power –: self- preservation is only one of the indirect and most frequent consequences of this. – In short, here as elsewhere, watch out for superfluous teleological principles! – such as the drive for preservation (which we owe to Spinoza’s inconsistency –). This is demanded by method, which must essentially be the economy of principles.
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Now it is beginning to dawn on maybe five or six brains that physics too is only an interpreta tion and arrangement of the world (according to ourselves! if I may say so) and not an explanation of the world. But to the extent that physics rests on belief in the senses, it passes for more, and will continue to pass for more, namely for an explanation, for a long time to come. It has our eyes and our fingers as its allies, it has visual evidence and tangibility as its allies. This helped it to enchant, persuade, convince an age with a basically plebeian taste – indeed, it instinctively follows the canon of truth of the eternally popular sensualism. What is plain, what “explains”? Only wha t can be seen and felt, – this is as far as any problem has to be pursued. Conversely: the strong attraction of the Platonic way of thinking consisted in its opposition to precisely this empiricism. It was a noble way of thinking, suitable perhaps for people who enjoyed even stronger and more discriminating senses than our contemporaries, but who knew how to find a higher triumph in staying master over these senses. And they did this by throwing drab, cold, gray nets of concepts over the brightly colored whirlwind of the senses – the r abble of the senses, as Plato said.
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interpreting the world in the manner of Plato, different from the enjoyment offered by today’s physicists, or by the Darwinians and anti- teleologists who work in physiology, with their principle of the “smallest possible force” and greatest possible stupidity. “Where man has nothing more to see and grasp, he has nothing more to do” – this imperative is certainly different from the Platonic one, but for a sturdy, industrious race of machinists and bridge-builders of the future, people with tough work to do, it just might be the right imperative for the job.
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To study physiology with a good conscience, we must insist that the sense organs are not appearances in the way idealist philosophy uses that term: as such, they certainly could not be causes! Sensualism, therefore, at least as a regulative principle, if not as a heuristic principle. – What? and other people even say that the external world is the product of our org ans? But then our body, as a piece of this external world, would really be the product of our organs! But then our organs themselves would really be – the prod- uct of our organs! This looks to me like a thorough reductio ad absurdum: given that the co ncept of a causa sui is something thoroughly absurd. So does it follow that the external world is not the product of our org ans –?
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There are still harmless self-observers who believe in the existence of “immediate certainties,” such as “I think,” or the “I will” that was Scho- penhauer’s superstition: just as if knowledge had been given an object here to seize, stark naked, as a “thing-in-itself,” and no falsification took place from either the side of the subject or the side of the object. But I will say this a hundred times: “immediate certainty,” like “absolute knowledge” and the “thing in itself ” contains a contradictio in adjecto. For once and for all, we should free our selves from the seductio n of words!
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e seen in myself, in order to determine what it is: and because of this retro- spective comparison with other types of ‘knowing,’ this present state has absolutely no ‘immediate certainty’ for me.” – In place of that “imme- diate cer tainty” which may, in this case, win the faith of the people, the philosopher gets handed a whole assortment of metaphysical questions, genuinely probing intellectual questions of conscience, such as: “Where do I get the concept of thinking from? Why do I believe in causes and effects? What gives me the right to speak about an I, and, for that mat- ter, about an I as cause, and, finally, about an I as the cause of thoughts?” Whoever dares to answer these metaphysical questions right away with an appeal to a sort of intuitive knowledge, like the person who says: “I think and know that at least this is true, real, certain” – he will find the philoso- pher of today ready with a smile and two question-marks. “My dear sir,” the philosopher will perhaps give him to understand, “it is improbable that you are not mistaken: but why insist on the truth?”
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On the prejudices of philosophers ‘I think,’ I get a whole set of bold claims that are difficult, perhaps impos- sible, to establish, – for instance, that I am the one who is thinking, that there must be something that is thinking in the fir st place, that thinking is an activity and the effect of a being who is considered the cause, that there is an ‘I,’ and finally, that it has already been determined what is meant by thinking, – that I know what thinking is. Because if I had not already made up my mind what thinking is, how could I tell whether what had just happened was not perhaps ‘willing’ or ‘feeling’? Enough: this ‘I think’ presupposes that I compare my present state with other states that I have seen in myself, in order to determine what it is: and because of this retro- spective comparison with other types of ‘knowing,’ this present state has absolutely no ‘immediate certainty’ for me.” – In place of that “imme- diate cer tainty” which may, in this case, win the faith of the people, the philosopher gets handed a whole assortment of metaphysical questions, genuinely probing intellectual questions of conscience, such as: “Where do I get the concept of thinking from? Why do I believe in causes and effects? What gives me the right to speak about an I, and, for that mat- ter, about an I as cause, and, finally, about an I as the cause of thoughts?” Whoever dares to answer these metaphysical questions right away with an appeal to a sort of intuitive knowledge, like the person who says: “I think and know that at least this is true, real, certain” – he will find the philoso- pher of today ready with a smile and two question-marks. “My dear sir,” the philosopher will perhaps give him to understand, “it is improbable that you are not mistaken: but why insist on the truth?” – As far as the superstitions of the logicians are concerned: I will not stop emphasizing a tiny little fact that these superstitious men are loath to admit: that a thought comes when “it” wants, and not when “I” want. It is, therefore, a falsification of the facts to say that the subject “I” is the condition of the predicate “think.” It thinks: but to say the “it” is just that famous old “I” – well tha t is just an assumption or opinion, to put it mildly, and by no means an “immediate certainty.” In fact, there is already too much packed into the “it thinks”: even the “it” contains an interpretation of the process, and does not belong to the process itself.
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Following the same basic scheme, the older atomism looked behind every “force” that produces effects for that little lump of matter in which the force resides, and out of which the effects are produced, which is to say: the atom. More rigorous minds finally learned how to make do without that bit of “residual earth,” and perhaps one day even logicians will get used to making do without this little “it” (into which the honest old I has disappeared)
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Beyond Good and Evil active, therefore –.” Following the same basic scheme, the older atomism looked behind every “force” that produces effects for that little lump of matter in which the force resides, and out of which the effects are produced, which is to say: the atom. More rigorous minds finally learned how to make do without that bit of “residual earth,” and perhaps one day even logicians will get used to making do without this little “it” (into which the honest old I has disappeared). That a theory is refutable is, frankly, not the least of its charms: this is precisely how it attracts the more refined intellects. The theory of “free will,” which has been refuted a hundred times, appears to owe its endurance to this charm alone –: somebody will always come alo ng and feel strong enough to refute it.
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Philosophers tend to talk about the will as if it were the most familiar thing in the world. In fact, Schopenhauer would have us believe that the will is the only thing that is really familiar, familiar through and through, familiar without pluses or minuses. But I have always thought that, here too, Schopenhauer was only doing what philosophers always tend to do: adopting and exaggerating a popular prejudice. Willing strikes me as, above all, something complicated, something unified only in a word – and this single word contains the popular prejudice that has overruled whatever minimal precautions philosophers might take. So let us be more cautious, for once – let us be “unphilosophical.” Let us say: in every act of willing there is, to begin with, a plurality of feelings, namely: the feeling of the state away from which, the feeling of the state towards which, and the feeling of this “away from” and “towards” themselves. But this is accompanied by a feeling of the muscles that comes into play through a sort of habit as soon as we “will,” even without our putting “arms and legs” into motion. Just as feeling – and indeed many feelings – must be recognized as ingredients of the will, thought must be as well. In every act of will there is a commandeering thought, – and we really should not believe this thought can be divorced from the “willing,” as if some will would then be left over!
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it is fundamentally an affect: and specifically the affect of the command. What is called “freedom of the will” is essentially the affect of superiority with respect to something that must obey: “I am free, ‘it’ must obey” – this consciousness lies in every will, along with a certain straining of attention, a straight look that fixes on one thing and one thing only, an unconditional evaluation “now this is necessary and nothing else,” an inner certainty that it will be obeyed, and whatever else comes with the position of the commander. A person who wills –, commands something inside himself that obeys, or that he believes to obey. But now we notice the strangest thing about the will – about this multifarious thing that people have only one word for.
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On the o ne hand, we are, under the circumstances, both the one who commands and the one who obeys, and as the obedient one we are familiar with the feelings of compulsion, force, pressure, resistance, and motion that generally start right after the act of willing. On the other hand, however, we are in the habit of ignoring and deceiving ourselves about this duality by means of the synthetic concept of the “I.” As a result, a whole chain of erroneous conclusions, and, consequently, false evaluations have become attached to the will, – to such an extent that the o ne who wills believes, in good faith, that willing suffices for action. Since it is almost always the case that there is will only where the effect of command, and therefore obedience, and therefore action, may be expected, the appearance translates into the feeling, as if there were a necessity of effect. In short, the one who wills believes with a reasonable degree of certainty that will and action are somehow one; he attributes the success, the performance of the willing to the will itself, and consequently enjoys an increase in the feeling of power that accompanies all success.
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“Freedom of the will” – that is the word for the multi-faceted state of pleasure of one who commands and, at the same time, identifies himself with the accomplished act of willing. As such, he enjoys the triumph over resistances, but thinks to himself that it was his will alone that truly overcame the resistance. Accordingly, the one who wills takes his feeling of pleasure as the commander, and adds to it the feelings of pleasure from the successful instruments that carry out the task, as well as from the useful “under-wills” or under-souls – our body is, after all, only a society constructed out of many souls
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the ruling class identifies itself with the successes of the community. All willing is simply a matter of commanding and obeying, on the groundwork, as I have said, of a society constructed out of many “souls”: from which a philosopher should claim the right to understand willing itself within the framework of morality: morality understood as a doctrine of the power relations under which the phenomenon of “life” arises.
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That individual philosophical concepts are not arbitrary and do not grow up on their own, but rather grow in reference and relation to each other; that however suddenly and randomly they seem to emerge in the history of thought, they still belo ng to a system just as much as all the members of the fauna of a continent do: this is ultimately revealed by the certainty with which the most diverse philosophers will always fill out a definite basic scheme of possible philosophies. Under an invisible spell, they will each start out anew, only to end up revolving in the same orbit once again. However independent of each other they might feel themselves to be, with their critical or systematic wills, something inside of them drives them on, something leads them into a particular order, one after the other, and this something is precisely the innate systematicity and relationship of concepts. In fact, their thinking is not nearly as much a discovery as it is a recognition, remembrance, a returning and homecoming into a distant, primordial, total economy of the soul, from which each conce pt once grew: – to this extent, philosophizing is a type of atavism of the highest order.
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The str ange family resemblance of all Indian, Greek, and German philosophizing speaks for itself clearly enough. Where there are linguistic affinities, then because of the common philosophy of grammar (I mean: due to the unconscious domination and direction through similar gram- matical functions), it is obvious that everything lies ready from the very start for a similar development and sequence of philosophical systems; on the other hand, the way seems as good as blocked for certain other possibilities of interpreting the world. Philosophers of the Ural-Altaic language group (where the concept of the subject is the most poorly de- veloped) are more likely to “see the world” differently, and to be found on paths different from those taken by the Indo-Germans or Muslims: the spell of particular grammatical functions is in the last analysis
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The causa sui is the best self-contradiction that has ever been conceived, a type of logical rape and abomination. But humanity’s excessive pride has got itself profoundly and horribly entangled with precisely this piece of nonsense. The longing for “freedom of the will” in the superlative meta- physical sense (which, unfortunately, still rules in the heads of the half- educated), the longing to bear the entire and ultimate responsibility for your actio ns yourself and to relieve God, world, ancestors, chance, and so- ciety of the burden – all this means nothing less than being that very causa sui and, with a courage greater than M ¨ unchhausen’s, pulling yourself by the hair from the swamp of nothingness up into existence. Suppose some- one sees through the boorish naivet ´ e of this famous concept of “free will” and manages to get it out of his mind; I would then ask him to carry his “enlightenment” a step further and to rid his mind of the reversal of this misconceived concept of “free will”: I mean the “un-free will,” which is basically an abuse of cause and effect. We should not erroneously objectify “cause” and “effect” like the natural scientists do (and whoever else thinks naturalistically these days –) in accordance with the dominant mechanis- tic stupidity which would have the cause push and shove until it “effects” something; we should use “cause” and “effect” only as pure concepts, which is to say as conventio nal fictions for the purpose of description and communication, not explana tion. In the “in-itself ” there is nothing like “causal association,” “necessity,” or “psychological un-freedom.” There, the “effect” does not follow “from the cause,” there is no rule of “law.” We are the ones who invented causation, succession, for-each-other, rel- ativity, compulsion, numbers, law, freedom, grounds, pur pose; and if we project and inscribe this symbol world onto things as an “in-itself,” then this is the way we have always done things, namely mythologically. The “un-free will” is mythology; in real life it is only a matter of strong and weak wills. It is almost always a symptom of what is lacking in a thinker when he senses some compulsion, need, having-to-follow, pressure, un- freedom in every “causal connection” and “psychological necessity.”
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And in general, if I have observed correctly, “un-freedom of the will” is regarded as a problem by two completely opposed parties, but always in a profoundly personal manner. The one party would never dream of relinquishing their “responsibility,” a belief in themselves, a per sonal right to their own merit (the vain races belong to this group –). Those in the other party, on the contrary, do not want to be responsible for anything or to be guilty of anything; driven by an inner self-contempt, they long to be able to shift the blame for themselves to something else. When they write books these days, this latter group tends to side with the criminal; a type of socialist pity is their most attractive disguise. And, in fact, the fatalism of the weak of will starts to look surprisingly attractive when it can present itself as “la religion de la souffrance humaine”: this is its “good taste.”
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You must forgive an old philologist like me who cannot help maliciously putting his finger on bad tricks of interpretation: but this “conformity of nature to law,” which you physicists are so proud of, just as if – – exists only because of your interpretation and bad “philology.” It is not a matter of fact, not a “text,” but instead only a naive humanitarian correction and a distortion of meaning that you use in order to comfortably accommodate the democratic instincts of the modern soul! “Everywhere, equality before the law, – in this respect, nature is no different and no better off than we are”: a lovely case of ulterior motivation; and it serves once more to disguise the plebeian antagonism against all privilege and autocracy together with a second and more refined atheism. “Ni dieu, ni maˆıtre” – you want this too: and therefore “hurray for the laws of nature!” – right? But, as I have said, this is interpretation, not text; and somebody with an opposite intention and mode of interpretation could come along and be able to read from the same nature, and with reference to the same set of appearances, a tyrannically ruthless and pitiless execution of power claims. This sor t of interpreter would show the unequivocal and unconditional nature of all “will to power” so vividly and graphically that almost every word, and even the word “tyranny,” would ultimately seem useless or like weakening and mollifying metaphors – and too humanizing.
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On the prejudices of philosophers interpreter might nevertheless end up claiming the same thing about this world as you, namely that it follows a “necessary” and “calculable” course, although not because laws are dominant in it, but rather because laws are totally absent, and every power draws its final consequences at every moment. Granted, this is only an interpretation too – and you will be eager enough to make this objection? – well then, so much the better.
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#beyond-good-and-evil #frederick-nietzsche #nietzsche #nihilism #philosophy
On the prejudices of philosophers interpreter might nevertheless end up claiming the same thing about this world as you, namely that it follows a “necessary” and “calculable” course, although not because laws are dominant in it, but rather because laws are totally absent, and every power draws its final consequences at every moment. Granted, this is only an interpretation too – and you will be eager enough to make this objection? – well then, so much the better. All psychology so far has been stuck in moral prejudices and fears: it has not ventured into the depths. To grasp psychology as morphology and the doctrine of the development of the will to power, which is what I have done – nobody has ever come close to this, not even in thought: this, of course, to the extent that we are permitted to regard what has been written so far as a symptom of what has not been said until now. The power of moral prejudice has dee ply affected the most spiritual world, which seems like the coldest world, the one most likely to be devoid of any presuppositions – and the effect has been manifestly harmful, hindering, dazzling, and distorting.
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A genuine physio-psychology has to contend with unconscious resistances in the heart of the researcher, it has “the hear t” against it. Even a doctrine of the reciprocal dependence of the “good” and the “bad” drives will (as a refined immorality) cause distress and aversion in a strong and sturdy conscience – as will, to an even greater extent, a doctrine of the derivation of all the good drives from the bad. But suppose somebody considers even the affects of hatred, envy, greed, and power-lust as the conditioning affects of life, as elements that fundamentally and essentially need to be present in the total economy of life, and consequently need to be enhanced where life is enhanced, – this person will suffer from such a train of thought as if from sea-sickness. And yet even this hypothesis is far from being the most uncomfortable and unfamiliar in this enormous, practically untouched realm of dangerous knowledge: – and there are hundreds of good reasons for people to keep out of it, if they – can! On the other hand, if you are ever cast loose here with your ship, well now! come on! clench your teeth! open your eyes! and grab hold of the helm! – we are sailing straight over and away from morality; we are crushing and perhaps destroying the remnants of our own morality by daring to travel there – but what do we matter!
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and the psychologist who “makes sacrifices” (they are not the sacrifizio dell’intelletto – to the contrary!) can at least demand in return that psychology again be recognized as queen of the sciences, and that the rest of the sciences exist to serve and prepare for it. Because, from now on, psychology is again the path to the fundamental problems.
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Flashcard 1475648032012

Question
Some businesses thrive by providing [...], and others focus on providing a lot of value to only a few people.
Answer
a little value to many

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The best businesses in the world are the ones that create the most value for other people. Some businesses thrive by providing a little value to many, and others focus on providing a lot of value to only a few people. Regard- less, the more real value you create for other people, the better your business will be and the more prosper

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Jaundice is the physical finding associated with hyperbilirubinemia and may result from both unconjugated and conjugated forms of bilirubin.
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CLIPP 8 - neonatal jaundice
8. 6-day-old with jaundice - Meghan February 1, 2017 1:39:29 PM EST Knowledge Jaundice Jaundice is the physical finding associated with hyperbilirubinemia and may result from both unconjugated and conjugated forms of bilirubin. Unconjugated hyperbilirubinemia can have serious consequences. Kernicterus Definition Kernicterus is the pathological term used to de




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Unconjugated hyperbilirubinemia can have serious consequences
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CLIPP 8 - neonatal jaundice
ebruary 1, 2017 1:39:29 PM EST Knowledge Jaundice Jaundice is the physical finding associated with hyperbilirubinemia and may result from both unconjugated and conjugated forms of bilirubin. <span>Unconjugated hyperbilirubinemia can have serious consequences. Kernicterus Definition Kernicterus is the pathological term used to describe staining of the basal ganglia and cranial nerve nuclei by bilirubin.




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Kernicterus is the pathological term used to describe staining of the basal ganglia and cranial nerve nuclei by bilirubin. Kernicterus also describes the clinical condition that results from the toxic effects of high levels of unconjugated bilirubin.
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CLIPP 8 - neonatal jaundice
ociated with hyperbilirubinemia and may result from both unconjugated and conjugated forms of bilirubin. Unconjugated hyperbilirubinemia can have serious consequences. Kernicterus Definition <span>Kernicterus is the pathological term used to describe staining of the basal ganglia and cranial nerve nuclei by bilirubin. Kernicterus also describes the clinical condition that results from the toxic effects of high levels of unconjugated bilirubin. Sequelae Severely affected newborn infants may: lose the suck reflex become lethargic develop hyperirritability and seizures, and ultimately die &




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Severely affected newborn infants may:

lose the suck reflex become lethargic develop hyperirritability and seizures, and ultimately die

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CLIPP 8 - neonatal jaundice
o describe staining of the basal ganglia and cranial nerve nuclei by bilirubin. Kernicterus also describes the clinical condition that results from the toxic effects of high levels of unconjugated bilirubin. Sequelae <span>Severely affected newborn infants may: lose the suck reflex become lethargic develop hyperirritability and seizures, and ultimately die Infants who survive may develop: opisthotonus (abnormal posturing that involves rigidity and severe arching of the back, with the head thrown backward) rigidit




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Infants who survive may develop:

opisthotonus (abnormal posturing that involves rigidity and severe arching of the back, with the head thrown backward) rigidity oculomotor paralysis tremors

Cho Sooyoung - sooyoung.cho@mail.utoronto.ca 1/22

hearing loss, and ataxia

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CLIPP 8 - neonatal jaundice
cts of high levels of unconjugated bilirubin. Sequelae Severely affected newborn infants may: lose the suck reflex become lethargic develop hyperirritability and seizures, and ultimately die <span>Infants who survive may develop: opisthotonus (abnormal posturing that involves rigidity and severe arching of the back, with the head thrown backward) rigidity oculomotor paralysis tremors Cho Sooyoung - sooyoung.cho@mail.utoronto.ca 1/22 hearing loss, and ataxia Screening and Treatment In the past, kernicterus among full-term newborn infants primarily resulted from the hemolysis and subsequent unconjugated hyperbilirub




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Screening and Treatment

In the past, kernicterus among full-term newborn infants primarily resulted from the hemolysis and subsequent unconjugated hyperbilirubinemia that was caused by Rh incompatibility (erythroblastosis fetalis). These infants typically were severely anemic, in shock and acidotic, and had total bilirubin levels well above 25 mg/dL (428 μmol/L). Screening for Rh incompatibility and the use of anti-Rh immunoglobulin (RhoGAM®) have markedly reduced Rh-induced hemolysis and the incidence of kernicterus. In addition, treatment of unconjugated hyperbilirubinemia with phototherapy has had an important impact on management of hyperbilirubinemia.

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CLIPP 8 - neonatal jaundice
ing that involves rigidity and severe arching of the back, with the head thrown backward) rigidity oculomotor paralysis tremors Cho Sooyoung - sooyoung.cho@mail.utoronto.ca 1/22 hearing loss, and ataxia <span>Screening and Treatment In the past, kernicterus among full-term newborn infants primarily resulted from the hemolysis and subsequent unconjugated hyperbilirubinemia that was caused by Rh incompatibility (erythroblastosis fetalis). These infants typically were severely anemic, in shock and acidotic, and had total bilirubin levels well above 25 mg/dL (428 μmol/L). Screening for Rh incompatibility and the use of anti-Rh immunoglobulin (RhoGAM®) have markedly reduced Rh-induced hemolysis and the incidence of kernicterus. In addition, treatment of unconjugated hyperbilirubinemia with phototherapy has had an important impact on management of hyperbilirubinemia. See the associated reference ranges in conventional and SI units. (http://www.med- u.org/virtual_patient_cases/labreferences) Newborn Bilirubin Physiology &#13




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Most (~75%) of the bilirubin produced in the healthy newborn comes from physiological breakdown of red blood cells.
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CLIPP 8 - neonatal jaundice
tant impact on management of hyperbilirubinemia. See the associated reference ranges in conventional and SI units. (http://www.med- u.org/virtual_patient_cases/labreferences) Newborn Bilirubin Physiology <span>Most (~75%) of the bilirubin produced in the healthy newborn comes from physiological breakdown of red blood cells. Pathway The hemoglobin released from the red cells is converted to unconjugated bilirubin that is insoluble in aqueous solutions and binds to albumin in the bl




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The hemoglobin released from the red cells is converted to unconjugated bilirubin that is insoluble in aqueous solutions and binds to albumin in the blood stream. In the liver the bilirubin is extracted by the hepatocytes where it binds to cytosolic proteins and is then conjugated with glucuronide by uridine diphosphate glucuronyl transferase (UDPGT, also known as glucuronosyl transferase). The conjugated bilirubin is water-soluble and is excreted into the bile and then into the intestine.
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CLIPP 8 - neonatal jaundice
/virtual_patient_cases/labreferences) Newborn Bilirubin Physiology Most (~75%) of the bilirubin produced in the healthy newborn comes from physiological breakdown of red blood cells. Pathway <span>The hemoglobin released from the red cells is converted to unconjugated bilirubin that is insoluble in aqueous solutions and binds to albumin in the blood stream. In the liver the bilirubin is extracted by the hepatocytes where it binds to cytosolic proteins and is then conjugated with glucuronide by uridine diphosphate glucuronyl transferase (UDPGT, also known as glucuronosyl transferase). The conjugated bilirubin is water-soluble and is excreted into the bile and then into the intestine. In adults, most of the bile is metabolized by the intestinal flora to urobilin and excreted in the stool. The newborn infant, however, lacks the gastrointestinal flora to m




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In adults, most of the bile is metabolized by the intestinal flora to urobilin and excreted in the stool. The newborn infant, however, lacks the gastrointestinal flora to metabolize bile, which allows the β-glucuronidase present in the meconium to hydrolyze the conjugated bilirubin back to its unconjugated form.

The unconjugated bilirubin is then reabsorbed into the blood stream where it binds to albumin. Newborns absorb significant quantities of bilirubin through this process, known as enterohepatic circulation.

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CLIPP 8 - neonatal jaundice
then conjugated with glucuronide by uridine diphosphate glucuronyl transferase (UDPGT, also known as glucuronosyl transferase). The conjugated bilirubin is water-soluble and is excreted into the bile and then into the intestine. <span>In adults, most of the bile is metabolized by the intestinal flora to urobilin and excreted in the stool. The newborn infant, however, lacks the gastrointestinal flora to metabolize bile, which allows the β-glucuronidase present in the meconium to hydrolyze the conjugated bilirubin back to its unconjugated form. The unconjugated bilirubin is then reabsorbed into the blood stream where it binds to albumin. Newborns absorb significant quantities of bilirubin through this process, known as enterohepatic circulation. Etiologies of Jaundice 2/22 Physiologic Jaundice This is defined as a total bilirubin level ≤ 15 mg/dL (≤ 257 μmol/L) in full-term i




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Physiologic Jaundice

This is defined as a total bilirubin level ≤ 15 mg/dL (≤ 257 μmol/L) in full-term infants who are otherwise healthy and have no other demonstrable cause for elevated bilirubin.

Almost all newborn infants have hyperbilirubinemia, but it is benign and self- limited.

Physiologic jaundice in a full-term baby is usually first noticed on the second or third day of life, with the bilirubin level reaching its peak at day three or four of life.

Numerous factors promote the increased enterohepatic circulation that results in physiologic jaundice:

Increased bilirubin production (from the breakdown of the short-lived fetal red cells) Relative deficiency of hepatocyte proteins and UDPGT Lack of intestinal flora to metabolize bile High levels of β-glucuronidase in meconium Minimal oral (enteral) intake in the first 2-4 days of life, resulting in slow excretion of meconium (especially common with breastfed infants).

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CLIPP 8 - neonatal jaundice
then reabsorbed into the blood stream where it binds to albumin. Newborns absorb significant quantities of bilirubin through this process, known as enterohepatic circulation. Etiologies of Jaundice 2/22 <span>Physiologic Jaundice This is defined as a total bilirubin level ≤ 15 mg/dL (≤ 257 μmol/L) in full-term infants who are otherwise healthy and have no other demonstrable cause for elevated bilirubin. Almost all newborn infants have hyperbilirubinemia, but it is benign and self- limited. Physiologic jaundice in a full-term baby is usually first noticed on the second or third day of life, with the bilirubin level reaching its peak at day three or four of life. Numerous factors promote the increased enterohepatic circulation that results in physiologic jaundice: Increased bilirubin production (from the breakdown of the short-lived fetal red cells) Relative deficiency of hepatocyte proteins and UDPGT Lack of intestinal flora to metabolize bile High levels of β-glucuronidase in meconium Minimal oral (enteral) intake in the first 2-4 days of life, resulting in slow excretion of meconium (especially common with breastfed infants). 3/22 Jaundice Associated with Breastfeeding Some clinicians divide this into two separate entities--breastfeeding jaundice and breast-milk jaundi




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Jaundice Associated with Breastfeeding

Some clinicians divide this into two separate entities--breastfeeding jaundice and breast-milk jaundice.

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CLIPP 8 - neonatal jaundice
ora to metabolize bile High levels of β-glucuronidase in meconium Minimal oral (enteral) intake in the first 2-4 days of life, resulting in slow excretion of meconium (especially common with breastfed infants). 3/22 <span>Jaundice Associated with Breastfeeding Some clinicians divide this into two separate entities--breastfeeding jaundice and breast-milk jaundice. There is probably overlap, where a combination of both of these problems occurs simultaneously. 1. Breastfeeding jaundice Happens early in the first week of li




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Breastfeeding jaundice

Happens early in the first week of life and occurs when the milk supply is relatively or absolutely low, resulting in limited enteral intake. This may be referred to as a "lack-of-breast milk jaundice" or "breastfeeding- associated jaundice." The low intake results in decreased gastrointestinal motility that in turn promotes retention of meconium. The β-glucuronidase in meconium deconjugates bilirubin and the unconjugated bilirubin is reabsorbed via the enterohepatic circulation, causing an elevation of serum levels. Breast milk production typically increases greatly once "let-down" occurs. Occasionally, persistently low volume of breast milk can cause the neonate to become dehydrated and malnourished. Breastfeeding jaundice is often difficult to distinguish from physiologic jaundice.

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CLIPP 8 - neonatal jaundice
reastfeeding Some clinicians divide this into two separate entities--breastfeeding jaundice and breast-milk jaundice. There is probably overlap, where a combination of both of these problems occurs simultaneously. 1. <span>Breastfeeding jaundice Happens early in the first week of life and occurs when the milk supply is relatively or absolutely low, resulting in limited enteral intake. This may be referred to as a "lack-of-breast milk jaundice" or "breastfeeding- associated jaundice." The low intake results in decreased gastrointestinal motility that in turn promotes retention of meconium. The β-glucuronidase in meconium deconjugates bilirubin and the unconjugated bilirubin is reabsorbed via the enterohepatic circulation, causing an elevation of serum levels. Breast milk production typically increases greatly once "let-down" occurs. Occasionally, persistently low volume of breast milk can cause the neonate to become dehydrated and malnourished. Breastfeeding jaundice is often difficult to distinguish from physiologic jaundice. 2. Breast-milk jaundice Begins in the first 4 to 7 days of life but may not peak until about 10 to 14 days. Not the result of low breast milk volume. While the




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Breast-milk jaundice

Begins in the first 4 to 7 days of life but may not peak until about 10 to 14 days. Not the result of low breast milk volume. While the cause is not completely understood, one explanation is that β- glucuronidase present in breast milk deconjugates bilirubin in the intestinal tract; the unconjugated bilirubin is then reabsorbed via enterohepatic circulation. Breast-milk jaundice can persist for up to 12 weeks, but total bilirubin concentration rarely, if ever, reaches concerning levels. The time course of breast-milk jaundice is quite different from that of physiologic jaundice.

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CLIPP 8 - neonatal jaundice
"let-down" occurs. Occasionally, persistently low volume of breast milk can cause the neonate to become dehydrated and malnourished. Breastfeeding jaundice is often difficult to distinguish from physiologic jaundice. 2. <span>Breast-milk jaundice Begins in the first 4 to 7 days of life but may not peak until about 10 to 14 days. Not the result of low breast milk volume. While the cause is not completely understood, one explanation is that β- glucuronidase present in breast milk deconjugates bilirubin in the intestinal tract; the unconjugated bilirubin is then reabsorbed via enterohepatic circulation. Breast-milk jaundice can persist for up to 12 weeks, but total bilirubin concentration rarely, if ever, reaches concerning levels. The time course of breast-milk jaundice is quite different from that of physiologic jaundice. 4/22 In pathological processes hemolysis causes breakdown of red blood cells (RBCs). The hemoglobin released is metabolized to unconjugated bilirubin, which r




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Antibody-positive hemolysis is labeled "direct Coombs" or "direct antibody test (DAT)" positive. The most common forms of antibody-positive hemolysis include:

Hemolysis

Rh incompatibility (mother is Rh-negative and baby is Rh-positive) ABO incompatibility (mother is type O and baby is type A or B) Incompatibilities with minor blood group antigens (much less common)

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of physiologic jaundice. 4/22 In pathological processes hemolysis causes breakdown of red blood cells (RBCs). The hemoglobin released is metabolized to unconjugated bilirubin, which results in jaundice. <span>Antibody-positive hemolysis is labeled "direct Coombs" or "direct antibody test (DAT)" positive. The most common forms of antibody-positive hemolysis include: Hemolysis Rh incompatibility (mother is Rh-negative and baby is Rh-positive) ABO incompatibility (mother is type O and baby is type A or B) Incompatibilities with minor blood group antigens (much less common) Antibody-negative hemolysis occurs in infants who have red blood cell membrane defects (e.g., spherocytosis) or red blood cell enzyme defects (glucose-6- phosphate dehydrog




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Antibody-negative hemolysis occurs in infants who have red blood cell membrane defects (e.g., spherocytosis) or red blood cell enzyme defects (glucose-6- phosphate dehydrogenase or pyruvate kinase deficiency).
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CLIPP 8 - neonatal jaundice
Hemolysis Rh incompatibility (mother is Rh-negative and baby is Rh-positive) ABO incompatibility (mother is type O and baby is type A or B) Incompatibilities with minor blood group antigens (much less common) <span>Antibody-negative hemolysis occurs in infants who have red blood cell membrane defects (e.g., spherocytosis) or red blood cell enzyme defects (glucose-6- phosphate dehydrogenase or pyruvate kinase deficiency). Other Causes Non-hemolytic red cell breakdown causes increased bilirubin production and development of jaundice and occurs in a variety of conditions, includin




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Non-hemolytic red cell breakdown causes increased bilirubin production and development of jaundice and occurs in a variety of conditions, including:

Extensive bruising from birth trauma Large cephalohematoma or other hemorrhage (e.g., intracranial) Polycythemia Swallowed blood (large amounts) during delivery.

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CLIPP 8 - neonatal jaundice
dy-negative hemolysis occurs in infants who have red blood cell membrane defects (e.g., spherocytosis) or red blood cell enzyme defects (glucose-6- phosphate dehydrogenase or pyruvate kinase deficiency). Other Causes <span>Non-hemolytic red cell breakdown causes increased bilirubin production and development of jaundice and occurs in a variety of conditions, including: Extensive bruising from birth trauma Large cephalohematoma or other hemorrhage (e.g., intracranial) Polycythemia Swallowed blood (large amounts) during delivery. Metabolic errors Crigler-Najjar syndrome: hyperbilirubinemia results from decreased bilirubin clearance caused by deficient or completely absent UDPGT. Galacto




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Metabolic errors

Crigler-Najjar syndrome: hyperbilirubinemia results from decreased bilirubin clearance caused by deficient or completely absent UDPGT. Galactosemia and hypothyroidism also have jaundice as prominent clinical findings.

These congenital disorders are detected by neonatal screening.

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CLIPP 8 - neonatal jaundice
dice and occurs in a variety of conditions, including: Extensive bruising from birth trauma Large cephalohematoma or other hemorrhage (e.g., intracranial) Polycythemia Swallowed blood (large amounts) during delivery. <span>Metabolic errors Crigler-Najjar syndrome: hyperbilirubinemia results from decreased bilirubin clearance caused by deficient or completely absent UDPGT. Galactosemia and hypothyroidism also have jaundice as prominent clinical findings. These congenital disorders are detected by neonatal screening. Ethnicity Hyperbilirubinemia is more common in Asian newborn infants than in Caucasian infants and is less common in black infants. These addition




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Hyperbilirubinemia is more common in Asian newborn infants than in Caucasian infants and is less common in black infants.
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CLIPP 8 - neonatal jaundice
caused by deficient or completely absent UDPGT. Galactosemia and hypothyroidism also have jaundice as prominent clinical findings. These congenital disorders are detected by neonatal screening. Ethnicity <span>Hyperbilirubinemia is more common in Asian newborn infants than in Caucasian infants and is less common in black infants. These additional factors can also contribute to hyperbilirubinemia: Prematurity Bowel obstruction Birth at high altitude See the associated refere




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These additional factors can also contribute to hyperbilirubinemia:

Prematurity
Bowel obstruction
Birth at high altitude

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CLIPP 8 - neonatal jaundice
; These congenital disorders are detected by neonatal screening. Ethnicity Hyperbilirubinemia is more common in Asian newborn infants than in Caucasian infants and is less common in black infants. <span>These additional factors can also contribute to hyperbilirubinemia: Prematurity Bowel obstruction Birth at high altitude See the associated reference ranges in conventional and SI units. (http://www.med- u.org/virtual_patient_cases/labreferences) 5/22 Typical Breast




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A successfully breastfed baby typically nurses 8-12 times in 24 hours.
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CLIPP 8 - neonatal jaundice
ction Birth at high altitude See the associated reference ranges in conventional and SI units. (http://www.med- u.org/virtual_patient_cases/labreferences) 5/22 Typical Breastfeeding Pattern <span>A successfully breastfed baby typically nurses 8-12 times in 24 hours. Feedings may initially last up to 60 minutes but gradually become shorter in duration, ~10-15 minutes at each breast. (Increasingly frequent or consistently lengthy feeding




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Feedings may initially last up to 60 minutes but gradually become shorter in duration, ~10-15 minutes at each breast. (Increasingly frequent or consistently lengthy feeding sessions may indicate a problem, especially if the infant is not gaining weight.)
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CLIPP 8 - neonatal jaundice
ventional and SI units. (http://www.med- u.org/virtual_patient_cases/labreferences) 5/22 Typical Breastfeeding Pattern A successfully breastfed baby typically nurses 8-12 times in 24 hours. <span>Feedings may initially last up to 60 minutes but gradually become shorter in duration, ~10-15 minutes at each breast. (Increasingly frequent or consistently lengthy feeding sessions may indicate a problem, especially if the infant is not gaining weight.) Benefits of Breastfeeding For Infants Maternal-infant bonding Protection against some infections (e.g. otitis media, respiratory infections, diarr




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Benefits of Breastfeeding

For Infants

Maternal-infant bonding Protection against some infections (e.g. otitis media, respiratory infections, diarrhea) Reduced rates of Sudden Infant Death Syndrome Reduced rates of some allergic reactions

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CLIPP 8 - neonatal jaundice
st up to 60 minutes but gradually become shorter in duration, ~10-15 minutes at each breast. (Increasingly frequent or consistently lengthy feeding sessions may indicate a problem, especially if the infant is not gaining weight.) <span>Benefits of Breastfeeding For Infants Maternal-infant bonding Protection against some infections (e.g. otitis media, respiratory infections, diarrhea) Reduced rates of Sudden Infant Death Syndrome Reduced rates of some allergic reactions For Mothers Decreased postpartum bleeding and more rapid uterine involution Lactational amenorrhea and delayed resumption of ovulation with increased child spa




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For Mothers

Decreased postpartum bleeding and more rapid uterine involution Lactational amenorrhea and delayed resumption of ovulation with increased child spacing Earlier return to pre-pregnant weight (compared with women who formula-feed) Improved bone remineralization postpartum with reduction in hip fractures in the postmenopausal period Decreased cost, relative to formula Ready availability without preparation time

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CLIPP 8 - neonatal jaundice
13; For Infants Maternal-infant bonding Protection against some infections (e.g. otitis media, respiratory infections, diarrhea) Reduced rates of Sudden Infant Death Syndrome Reduced rates of some allergic reactions <span>For Mothers Decreased postpartum bleeding and more rapid uterine involution Lactational amenorrhea and delayed resumption of ovulation with increased child spacing Earlier return to pre-pregnant weight (compared with women who formula-feed) Improved bone remineralization postpartum with reduction in hip fractures in the postmenopausal period Decreased cost, relative to formula Ready availability without preparation time Common Breastfeeding Problems Enlarged, tender breasts-commonly caused by engorgement, mastitis, or plugged ducts (galactocele) Improper latch, suckle Prolonge




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Common Breastfeeding Problems

Enlarged, tender breasts-commonly caused by engorgement, mastitis, or plugged ducts (galactocele) Improper latch, suckle Prolonged feedings Infants fall asleep before they finish feeding Maternal inexperience/anxiety: This often represents an expectation that breastfeeding is "natural" and should therefore be intuitive.

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CLIPP 8 - neonatal jaundice
weight (compared with women who formula-feed) Improved bone remineralization postpartum with reduction in hip fractures in the postmenopausal period Decreased cost, relative to formula Ready availability without preparation time <span>Common Breastfeeding Problems Enlarged, tender breasts-commonly caused by engorgement, mastitis, or plugged ducts (galactocele) Improper latch, suckle Prolonged feedings Infants fall asleep before they finish feeding Maternal inexperience/anxiety: This often represents an expectation that breastfeeding is "natural" and should therefore be intuitive. Many obstetrical services in the U.S. routinely provide lactation counseling and education by highly trained certified lactation consultants and lactation educators. They provide practi




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Breast Milk Nutrients

Breast milk has the perfect balance of carbohydrates, fats (lipids), and proteins for human infants.

In addition, it provides antibodies, oligosaccharides, lactoferrin, lysozyme, growth factors, bifidobacteria, and other non-nutritive substances that protect against infection and promote growth.

These non-nutritive substances are especially concentrated in colostrum, the yellowish fluid produced in first few days postpartum. Mature human milk gradually replaces colostrum as nursing progresses.

If a mother cannot breastfeed, or chooses to not do so, she may feed her infant with a formula made from cow's milk or soy protein isolate, with assurance that the major nutrients will be provided by either.

Infants younger than 12 months should not be fed unmodified cow's milk.

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CLIPP 8 - neonatal jaundice
vide practical instruction on topics such as proper latch and suckling, holding infant(s) during feeding, proper use of breast pumps, and breast care. Breast pumps are often available for rental from hospitals. 6/22 <span>Breast Milk Nutrients Breast milk has the perfect balance of carbohydrates, fats (lipids), and proteins for human infants. In addition, it provides antibodies, oligosaccharides, lactoferrin, lysozyme, growth factors, bifidobacteria, and other non-nutritive substances that protect against infection and promote growth. These non-nutritive substances are especially concentrated in colostrum, the yellowish fluid produced in first few days postpartum. Mature human milk gradually replaces colostrum as nursing progresses. If a mother cannot breastfeed, or chooses to not do so, she may feed her infant with a formula made from cow's milk or soy protein isolate, with assurance that the major nutrients will be provided by either. Infants younger than 12 months should not be fed unmodified cow's milk. Carbohydrates Both human milk and standard infant formulas contain lactose as the major carbohydrate. Lactose intolerance is uncommon in the first year of life




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Carbohydrates

Both human milk and standard infant formulas contain lactose as the major carbohydrate. Lactose intolerance is uncommon in the first year of life.

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CLIPP 8 - neonatal jaundice
feed her infant with a formula made from cow's milk or soy protein isolate, with assurance that the major nutrients will be provided by either. Infants younger than 12 months should not be fed unmodified cow's milk. <span>Carbohydrates Both human milk and standard infant formulas contain lactose as the major carbohydrate. Lactose intolerance is uncommon in the first year of life. Lipids Approximately 50% of calories in human milk come from lipids. The lipid concentration in breast milk increases as the nursing episode proceeds; therefor




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Lipids

Approximately 50% of calories in human milk come from lipids. The lipid concentration in breast milk increases as the nursing episode proceeds; therefore, it is important that an infant empty the breast before going to the next breast.

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CLIPP 8 - neonatal jaundice
s should not be fed unmodified cow's milk. Carbohydrates Both human milk and standard infant formulas contain lactose as the major carbohydrate. Lactose intolerance is uncommon in the first year of life. <span>Lipids Approximately 50% of calories in human milk come from lipids. The lipid concentration in breast milk increases as the nursing episode proceeds; therefore, it is important that an infant empty the breast before going to the next breast. Proteins Human milk contains a combination of whey proteins (70%) and casein (30%). Formulas provide nutrition comparable for all major nutrients to human milk




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Human milk contains a combination of whey proteins (70%) and casein (30%). Formulas provide nutrition comparable for all major nutrients to human milk, although they contain slightly more protein than human milk. The casein:whey ratio of cow-milk-based formulas varies. Unmodified cow milk contains approximately three times the protein content of human milk and has ~80% casein and 20% whey proteins. As mentioned above, it is not suitable for young infants.
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CLIPP 8 - neonatal jaundice
s in human milk come from lipids. The lipid concentration in breast milk increases as the nursing episode proceeds; therefore, it is important that an infant empty the breast before going to the next breast. Proteins <span>Human milk contains a combination of whey proteins (70%) and casein (30%). Formulas provide nutrition comparable for all major nutrients to human milk, although they contain slightly more protein than human milk. The casein:whey ratio of cow-milk-based formulas varies. Unmodified cow milk contains approximately three times the protein content of human milk and has ~80% casein and 20% whey proteins. As mentioned above, it is not suitable for young infants. Hereditary Forms of Hemolysis Because many causes of hemolysis are hereditary, a family history of anemia or jaundice can provide important information.




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Because many causes of hemolysis are hereditary, a family history of anemia or jaundice can provide important information.
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CLIPP 8 - neonatal jaundice
odified cow milk contains approximately three times the protein content of human milk and has ~80% casein and 20% whey proteins. As mentioned above, it is not suitable for young infants. Hereditary Forms of Hemolysis <span>Because many causes of hemolysis are hereditary, a family history of anemia or jaundice can provide important information. 7/22 Hemolysis leading to elevated circulating bilirubin and possible jaundice can be caused by a variety of disorders in the red blood cell, including:




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Hemolysis leading to elevated circulating bilirubin and possible jaundice can be caused by a variety of disorders in the red blood cell, including:

Intrinsic cell membrane defects (such as spherocytosis and elliptocytosis) Enzyme disorders (such as G6PD deficiency and pyruvate kinase deficiency) Hemoglobinopathies (such as the thalassemias and sickle cell anemia)

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CLIPP 8 - neonatal jaundice
not suitable for young infants. Hereditary Forms of Hemolysis Because many causes of hemolysis are hereditary, a family history of anemia or jaundice can provide important information. 7/22 <span>Hemolysis leading to elevated circulating bilirubin and possible jaundice can be caused by a variety of disorders in the red blood cell, including: Intrinsic cell membrane defects (such as spherocytosis and elliptocytosis) Enzyme disorders (such as G6PD deficiency and pyruvate kinase deficiency) Hemoglobinopathies (such as the thalassemias and sickle cell anemia) These disorders have varied modes of inheritance (X-linked, autosomal dominant, autosomal recessive) and may be found with greater prevalence among certain ethnicities, or




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glucose-6-phosphate dehydrogenase (G6PD) deficiency, an X-linked disorder, is more common in families of Mediterranean or West African origin than in other ethnic groups.
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CLIPP 8 - neonatal jaundice
cell anemia) These disorders have varied modes of inheritance (X-linked, autosomal dominant, autosomal recessive) and may be found with greater prevalence among certain ethnicities, or in certain parts of the world. For example, <span>glucose-6-phosphate dehydrogenase (G6PD) deficiency, an X-linked disorder, is more common in families of Mediterranean or West African origin than in other ethnic groups. Biliary Atresia A healthy-appearing infant who develops jaundice, dark urine, and acholic (pale) stools between 3 and 6 weeks of age may have biliary atresia.




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A healthy-appearing infant who develops jaundice, dark urine, and acholic (pale) stools between 3 and 6 weeks of age may have biliary atresia.

Any infant who develops jaundice after two weeks of age must be evaluated with fractionated bilirubin (i.e., total and direct bilirubin levels).

A patient suspected of having biliary atresia generally will be referred to a pediatric gastroenterologist or pediatric surgeon.

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CLIPP 8 - neonatal jaundice
ts of the world. For example, glucose-6-phosphate dehydrogenase (G6PD) deficiency, an X-linked disorder, is more common in families of Mediterranean or West African origin than in other ethnic groups. Biliary Atresia <span>A healthy-appearing infant who develops jaundice, dark urine, and acholic (pale) stools between 3 and 6 weeks of age may have biliary atresia. Any infant who develops jaundice after two weeks of age must be evaluated with fractionated bilirubin (i.e., total and direct bilirubin levels). A patient suspected of having biliary atresia generally will be referred to a pediatric gastroenterologist or pediatric surgeon. Treatment When diagnosed early, biliary atresia can be treated surgically with the Kasai procedure (anastomosis of the i ntrahepatic bile ducts to a loop of intestine to al




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Treatment:
When diagnosed early, biliary atresia can be treated surgically with the Kasai procedure (anastomosis of the intrahepatic bile ducts to a loop of intestine to allow bile to drain directly into the intestine). If done early, the Kasai procedure will restore bile flow and prevent liver damage.
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CLIPP 8 - neonatal jaundice
ust be evaluated with fractionated bilirubin (i.e., total and direct bilirubin levels). A patient suspected of having biliary atresia generally will be referred to a pediatric gastroenterologist or pediatric surgeon. <span>Treatment When diagnosed early, biliary atresia can be treated surgically with the Kasai procedure (anastomosis of the i ntrahepatic bile ducts to a loop of intestine to allow bile to drain directly into the intestine). If done early, the Kasai procedure will restore bile flow and prevent liver damage. Voiding and Stooling Patterns in the Newborn Voiding Urination changes in the first days after birth: Day 3: The baby should be voidi




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Urination changes in the first days after birth:

Day 3: The baby should be voiding 3-4 times a day.

Day 6: Baby should be voiding at least 6-8 times a day.

Urine should be pale yellow.

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CLIPP 8 - neonatal jaundice
to allow bile to drain directly into the intestine). If done early, the Kasai procedure will restore bile flow and prevent liver damage. Voiding and Stooling Patterns in the Newborn Voiding <span>Urination changes in the first days after birth: Day 3: The baby should be voiding 3-4 times a day. Day 6: Baby should be voiding at least 6-8 times a day. Urine should be pale yellow. Stooling 8/22 The stooling pattern also changes: Day 3: Meconium should no longer appear in the stool and bowel movements should beg




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The stooling pattern also changes:

Day 3: Meconium should no longer appear in the stool and bowel movements should begin to appear yellow.

Day 6 or 7: Most newborns have 3-4 stools per day, although many infants pass stool with every feeding.

Stool passed by breastfed infants has little odor. You should be concerned if an infant's stool gradually loses color and becomes "acholic," as this may be a sign of biliary atresia.

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CLIPP 8 - neonatal jaundice
after birth: Day 3: The baby should be voiding 3-4 times a day. Day 6: Baby should be voiding at least 6-8 times a day. Urine should be pale yellow. Stooling 8/22 <span>The stooling pattern also changes: Day 3: Meconium should no longer appear in the stool and bowel movements should begin to appear yellow. Day 6 or 7: Most newborns have 3-4 stools per day, although many infants pass stool with every feeding. Stool passed by breastfed infants has little odor. You should be concerned if an infant's stool gradually loses color and becomes "acholic," as this may be a sign of biliary atresia. Prognosis of Hyperbilirubinemia in the Newborn Kernicterus is the most serious outcome of unconjugated hyperbilirubinemia, but it is rare in healthy, term babi




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Kernicterus is the most serious outcome of unconjugated hyperbilirubinemia, but it is rare in healthy, term babies who do not have hemolysis.

Most jaundiced newborns do not have major risks for adverse outcomes.

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CLIPP 8 - neonatal jaundice
ed infants has little odor. You should be concerned if an infant's stool gradually loses color and becomes "acholic," as this may be a sign of biliary atresia. Prognosis of Hyperbilirubinemia in the Newborn <span>Kernicterus is the most serious outcome of unconjugated hyperbilirubinemia, but it is rare in healthy, term babies who do not have hemolysis. Most jaundiced newborns do not have major risks for adverse outcomes. The American Academy of Pediatrics Clinical Practice Guideline Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation (http://pediatrics.aappu




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Major Risk Factors

Pre-discharge total serum bilirubin (TSB) or total conjugated bilirubin (TcB) level in the high- risk zone Jaundice observed in the first 24 hours of life Blood group incompatibility, with positive direct antiglobulin test Gestational age 35-36 week Previous sibling received phototherapy Cephalohematoma or significant bruising Exclusive breastfeeding, particularly if nursing is not going well and weight loss is excessive East Asian race

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CLIPP 8 - neonatal jaundice
h hyperbilirubinemia as "Low," "Intermediate," or "High" based on age and bilirubin level. It also lists clinical risk factors for severe hyperbilirubinemia in infants of 35 or more weeks' gestation: <span>Major Risk Factors Pre-discharge total serum bilirubin (TSB) or total conjugated bilirubin (TcB) level in the high- risk zone Jaundice observed in the first 24 hours of life Blood group incompatibility, with positive direct antiglobulin test Gestational age 35-36 week Previous sibling received phototherapy Cephalohematoma or significant bruising Exclusive breastfeeding, particularly if nursing is not going well and weight loss is excessive East Asian race Minor Risk Factors Pre-discharge TSB or TcB level in the high intermediate-risk zone Gestational age 37-38 week Jaundice observed before discharge Previous sib




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Minor Risk Factors

Pre-discharge TSB or TcB level in the high intermediate-risk zone Gestational age 37-38 week Jaundice observed before discharge Previous sibling with jaundice Macrosomic infant of a diabetic mother Maternal age >25 y

9/22

Male gender

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CLIPP 8 - neonatal jaundice
obulin test Gestational age 35-36 week Previous sibling received phototherapy Cephalohematoma or significant bruising Exclusive breastfeeding, particularly if nursing is not going well and weight loss is excessive East Asian race <span>Minor Risk Factors Pre-discharge TSB or TcB level in the high intermediate-risk zone Gestational age 37-38 week Jaundice observed before discharge Previous sibling with jaundice Macrosomic infant of a diabetic mother Maternal age >25 y 9/22 Male gender Decreased Risk TSB or TcB level in the low-risk zone Gestational age 41 week Exclusive bottle feeding Black race Discharge from hospital after 72 hours &




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Decreased Risk

TSB or TcB level in the low-risk zone Gestational age 41 week Exclusive bottle feeding Black race Discharge from hospital after 72 hours

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CLIPP 8 - neonatal jaundice
the high intermediate-risk zone Gestational age 37-38 week Jaundice observed before discharge Previous sibling with jaundice Macrosomic infant of a diabetic mother Maternal age >25 y 9/22 Male gender <span>Decreased Risk TSB or TcB level in the low-risk zone Gestational age 41 week Exclusive bottle feeding Black race Discharge from hospital after 72 hours Key Physical Findings A cephalohematoma (see photo) is a subperiosteal hemorrhage that is localized to the cranial bone that was traumatized during delivery. &




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A cephalohematoma (see photo) is a subperiosteal hemorrhage that is localized to the cranial bone that was traumatized during delivery.

The swelling does not extend across a suture line. As the blood is reabsorbed from the cephalohematoma it will contribute to hyperbilirubinemia.

Bruising on the head-or elsewhere on the body-from birth trauma or any other bleeding can also lead to increased bilirubin production because blood extravasated into tissues will be broken down and converted to bilirubin.

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CLIPP 8 - neonatal jaundice
3; Male gender Decreased Risk TSB or TcB level in the low-risk zone Gestational age 41 week Exclusive bottle feeding Black race Discharge from hospital after 72 hours Key Physical Findings <span>A cephalohematoma (see photo) is a subperiosteal hemorrhage that is localized to the cranial bone that was traumatized during delivery. The swelling does not extend across a suture line. As the blood is reabsorbed from the cephalohematoma it will contribute to hyperbilirubinemia. Bruising on the head-or elsewhere on the body-from birth trauma or any other bleeding can also lead to increased bilirubin production because blood extravasated into tissues will be broken down and converted to bilirubin. Hyperlink "(see photo) " This Multimedia material is not included in this Summary, please open Case to review. Developmental Dysplasia o




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It is important to assess every newborn for DDH (previously known as congenital dislocation of the hip).
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CLIPP 8 - neonatal jaundice
and converted to bilirubin. Hyperlink "(see photo) " This Multimedia material is not included in this Summary, please open Case to review. Developmental Dysplasia of the Hip (DDH) <span>It is important to assess every newborn for DDH (previously known as congenital dislocation of the hip). Clinical features include: Partial or complete dislocation Instability of the femoral head. Risk factors include: Breech position (30




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Clinical features include:

Partial or complete dislocation Instability of the femoral head.

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CLIPP 8 - neonatal jaundice
not included in this Summary, please open Case to review. Developmental Dysplasia of the Hip (DDH) It is important to assess every newborn for DDH (previously known as congenital dislocation of the hip). <span>Clinical features include: Partial or complete dislocation Instability of the femoral head. Risk factors include: Breech position (30-50% of DDH cases occur in infants born in the breech position) Gender (9:1 female predominance) Family history




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Risk factors include:

Breech position (30-50% of DDH cases occur in infants born in the breech position) Gender (9:1 female predominance) Family histor

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CLIPP 8 - neonatal jaundice
It is important to assess every newborn for DDH (previously known as congenital dislocation of the hip). Clinical features include: Partial or complete dislocation Instability of the femoral head. <span>Risk factors include: Breech position (30-50% of DDH cases occur in infants born in the breech position) Gender (9:1 female predominance) Family history 10/22 Screening recommendations There are varied recommendations regarding screening for DDH: American Academy of Pediatrics (AAP):




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Untreated Congenital Hypothyroidism

Hypothyroidism that is not detected early in life can cause the following:

Prolonged jaundice Lethargy Large fontanelles Macroglossia (enlargement of the tongue) Umbilical hernia Constipation Abdominal distention Severe developmental delay

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CLIPP 8 - neonatal jaundice
elines and routinely screen all infants by physical examination and by ultrasonography in the circumstances indicated above. View hip exam. (https://www.youtube.com/watch?v=tKIVxI4LkcE&t=5s) Signs and Symptoms of <span>Untreated Congenital Hypothyroidism Hypothyroidism that is not detected early in life can cause the following: Prolonged jaundice Lethargy Large fontanelles Macroglossia (enlargement of the tongue) Umbilical hernia Constipation Abdominal distention Severe developmental delay Timing of Neonatal Screen The optimal time for testing is ≥ 24 hours after birth. A specimen obtained before 24 hours of age may miss PKU and other disorders w




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Timing of Neonatal Screen

The optimal time for testing is ≥ 24 hours after birth. A specimen obtained before 24 hours of age may miss PKU and other disorders with metabolite accumulation. If the first specimen is obtained prior to 24 hours, a second specimen should be obtained in the next one to two weeks.

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CLIPP 8 - neonatal jaundice
not detected early in life can cause the following: Prolonged jaundice Lethargy Large fontanelles Macroglossia (enlargement of the tongue) Umbilical hernia Constipation Abdominal distention Severe developmental delay <span>Timing of Neonatal Screen The optimal time for testing is ≥ 24 hours after birth. A specimen obtained before 24 hours of age may miss PKU and other disorders with metabolite accumulation. If the first specimen is obtained prior to 24 hours, a second specimen should be obtained in the next one to two weeks. Clinical Skills Interviewing New Parents When seeing a newborn or young infant, there are a variety of ways to help bring up issues or concerns th




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Screening for maternal depression is important, as major depression can occur before, during, or after delivery of a baby in an estimated 10-20% of women. Ask about sources of support for the family, including transportation and finances.
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CLIPP 8 - neonatal jaundice
some of your questions?" If there are other children in the family, you might ask how they have reacted to the new baby. 12/22 Also, be aware of the mood of the parents, especially the new mother: <span>Screening for maternal depression is important, as major depression can occur before, during, or after delivery of a baby in an estimated 10-20% of women. Ask about sources of support for the family, including transportation and finances. For a resource that provides helpful advice on age-appropriate interview questions, child development, and guidance for families, see the American Academy of Pediatrics' Br




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Observing breastfeeding is an excellent way to assess mother-infant interaction as well as many of the factors that contribute to the success of breastfeeding.
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CLIPP 8 - neonatal jaundice
nfants, Children and Adolescents. (http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html) Clinical Observation A skilled clinician observes a great deal during any clinical encounter. <span>Observing breastfeeding is an excellent way to assess mother-infant interaction as well as many of the factors that contribute to the success of breastfeeding. It is essential to observe feedings if there are nutritional or growth concerns. Weight Gain in Newborns It is very important to monitor weight ga




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It is essential to observe feedings if there are nutritional or growth concerns.
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CLIPP 8 - neonatal jaundice
ian observes a great deal during any clinical encounter. Observing breastfeeding is an excellent way to assess mother-infant interaction as well as many of the factors that contribute to the success of breastfeeding. <span>It is essential to observe feedings if there are nutritional or growth concerns. Weight Gain in Newborns It is very important to monitor weight gain for all infants. Breastfed infants may lose up to 7%-10% of their birth weight during the f




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Breastfed infants may lose up to 7%-10% of their birth weight during the first 4 to 5 days of life, and typically regain birth weight by at least 2 weeks of age. A more rapid weight loss in the first days after birth or delayed weight gain would mandate further assessment and intervention.
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CLIPP 8 - neonatal jaundice
bute to the success of breastfeeding. It is essential to observe feedings if there are nutritional or growth concerns. Weight Gain in Newborns It is very important to monitor weight gain for all infants. <span>Breastfed infants may lose up to 7%-10% of their birth weight during the first 4 to 5 days of life, and typically regain birth weight by at least 2 weeks of age. A more rapid weight loss in the first days after birth or delayed weight gain would mandate further assessment and intervention. Reminders When monitoring a newborn infant, it is helpful to compare the birth weight and the discharge weight with the current office weight. Remember, some d




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When monitoring a newborn infant, it is helpful to compare the birth weight and the discharge weight with the current office weight.
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CLIPP 8 - neonatal jaundice
5 days of life, and typically regain birth weight by at least 2 weeks of age. A more rapid weight loss in the first days after birth or delayed weight gain would mandate further assessment and intervention. Reminders <span>When monitoring a newborn infant, it is helpful to compare the birth weight and the discharge weight with the current office weight. Remember, some differences between an infant's weight in the nursery and in the office could be caused by differences in scales. It is also important to be consistent in the method of w




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Jaundice typically is first noticed on a newborn's face at a bilirubin level of approximately 4-5 mg/dL (68-86 μmol/L). It then progresses down the trunk to the extremities (cephalocaudal progression) as the bilirubin level rises.
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CLIPP 8 - neonatal jaundice
ination of the newborn (https://youtu.be/UaDf35HiVio). (This video is 15 minutes long and recommended only for users with fast internet access.) 13/22 Jaundice Evaluation Methods Inspection <span>Jaundice typically is first noticed on a newborn's face at a bilirubin level of approximately 4-5 mg/dL (68-86 μmol/L). It then progresses down the trunk to the extremities (cephalocaudal progression) as the bilirubin level rises. In most infants, experienced pediatricians would estimate the bilirubin level to be in the 10-15 mg/dL (171-257 μmol/L) range when jaundice is visible below the knees, but




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Whenever there is concern about hyperbilirubinemia, a serum total bilirubin level should be obtained.
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CLIPP 8 - neonatal jaundice
serum bilirubin levels. Serum Bilirubin Measurement A visual estimate of bilirubin level is not a substitute for serum bilirubin levels as it can easily understimate the true level of hyperbilirubinemia. <span>Whenever there is concern about hyperbilirubinemia, a serum total bilirubin level should be obtained. Transcutaneous Bilirubin Measurement Devices that measure transcutaneous bilirubin are effective tools for monitoring jaundice, although they cannot substitute




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Age at which jaundice begins

Can help determine the risk for severe hyperbilirubinemia and can direct you to specific causes of jaundice, especially hemolysis.

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CLIPP 8 - neonatal jaundice
es/labreferences). Clinical Reasoning Evaluation of the Etiology of Hyperbilirubinemia in a Newborn The following information is all necessary in determining the cause of hyperbilirubinemia: <span>Age at which jaundice begins Can help determine the risk for severe hyperbilirubinemia and can direct you to specific causes of jaundice, especially hemolysis. 14/22 Breastfed infants may lose up to 7-10% of their birth weight during the first 4 to 5 days of life and typically regain birth weight by at least 2 weeks




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Weight history

Breastfed infants may lose up to 7-10% of their birth weight during the first 4 to 5 days of life and typically regain birth weight by at least 2 weeks of age.

A more rapid weight loss in the first days after birth or delayed weight gain mandates further assessment and intervention.

Inadequate weight gain indicates a potential insufficient fluid and calorie intake making a diagnosis of breastfeeding jaundice more likely.

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CLIPP 8 - neonatal jaundice
of hyperbilirubinemia: Age at which jaundice begins Can help determine the risk for severe hyperbilirubinemia and can direct you to specific causes of jaundice, especially hemolysis. 14/22 <span>Breastfed infants may lose up to 7-10% of their birth weight during the first 4 to 5 days of life and typically regain birth weight by at least 2 weeks of age. Weight history A more rapid weight loss in the first days after birth or delayed weight gain mandates further assessment and intervention. Inadequate weight gain indicates a potential insufficient fluid and calorie intake making a diagnosis of breastfeeding jaundice more likely. Feeding history Aids in distinguishing among possible causes of jaundice. Pregnancy history Maternal infections may affect the fetus




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Feeding history

Aids in distinguishing among possible causes of jaundice.

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CLIPP 8 - neonatal jaundice
st days after birth or delayed weight gain mandates further assessment and intervention. Inadequate weight gain indicates a potential insufficient fluid and calorie intake making a diagnosis of breastfeeding jaundice more likely. <span>Feeding history Aids in distinguishing among possible causes of jaundice. Pregnancy history Maternal infections may affect the fetus in utero, resulting in congenital infection and intrauterine growth restriction (IUGR). The conseque




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Pregnancy history

Maternal infections may affect the fetus in utero, resulting in congenital infection and intrauterine growth restriction (IUGR). The consequence may be a newborn who is born small for gestational age (SGA) with risk of direct hyperbilirubinemia.

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CLIPP 8 - neonatal jaundice
weight gain indicates a potential insufficient fluid and calorie intake making a diagnosis of breastfeeding jaundice more likely. Feeding history Aids in distinguishing among possible causes of jaundice. <span>Pregnancy history Maternal infections may affect the fetus in utero, resulting in congenital infection and intrauterine growth restriction (IUGR). The consequence may be a newborn who is born small for gestational age (SGA) with risk of direct hyperbilirubinemia. Signs of illness in the newborn It is important to inquire about fever or other signs of illness in jaundiced newborns because septic infants can have jaundice




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It is important to inquire about fever or other signs of illness in jaundiced newborns because septic infants can have jaundice (with elevated total and direct bilirubin) as one sign of serious infection, along with other clinical manifestations, such as:

Temperature instability Respiratory distress Apnea Irritability Lethargy Poor tone Vomiting Poor feeding

When jaundice is the only clinical finding, sepsis is highly unlikely as the cause of the increased bilirubin levels.

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CLIPP 8 - neonatal jaundice
in congenital infection and intrauterine growth restriction (IUGR). The consequence may be a newborn who is born small for gestational age (SGA) with risk of direct hyperbilirubinemia. Signs of illness in the newborn <span>It is important to inquire about fever or other signs of illness in jaundiced newborns because septic infants can have jaundice (with elevated total and direct bilirubin) as one sign of serious infection, along with other clinical manifestations, such as: Temperature instability Respiratory distress Apnea Irritability Lethargy Poor tone Vomiting Poor feeding When jaundice is the only clinical finding, sepsis is highly unlikely as the cause of the increased bilirubin levels. Differential Diagnosis for Jaundice in the Newborn Diagnosis Comment Breast milk jaundice Begins in the middle of the first week of l




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Breast milk jaundice

Begins in the middle of the first week of life (usually day 4 through 7) but may not reach its peak until the second week.

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CLIPP 8 - neonatal jaundice
ing When jaundice is the only clinical finding, sepsis is highly unlikely as the cause of the increased bilirubin levels. Differential Diagnosis for Jaundice in the Newborn Diagnosis Comment <span>Breast milk jaundice Begins in the middle of the first week of life (usually day 4 through 7) but may not reach its peak until the second week. 15/22 Physiologic Physiologic jaundice jaundice typically appears earlier than on day 4. The level of hyperbilirubinemia and the time course help




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Physiologic jaundice

jaundice typically appears earlier than on day 4. The level of hyperbilirubinemia and the time course helps to distinguish physiologic from breast milk jaundice.

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CLIPP 8 - neonatal jaundice
3; Diagnosis Comment Breast milk jaundice Begins in the middle of the first week of life (usually day 4 through 7) but may not reach its peak until the second week. 15/22 Physiologic <span>Physiologic jaundice jaundice typically appears earlier than on day 4. The level of hyperbilirubinemia and the time course helps to distinguish physiologic from breast milk jaundice. Hemolysis Possible reasons for hemolysis include: ABO incompatibility Rh incompatibility G6PD deficiency To completely investigate th




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Possible reasons for hemolysis include:

ABO incompatibility Rh incompatibility G6PD deficiency

To completely investigate the possiblity of a hemolytic process you need a laboratory test (a peripheral smear).

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CLIPP 8 - neonatal jaundice
hysiologic Physiologic jaundice jaundice typically appears earlier than on day 4. The level of hyperbilirubinemia and the time course helps to distinguish physiologic from breast milk jaundice. Hemolysis <span>Possible reasons for hemolysis include: ABO incompatibility Rh incompatibility G6PD deficiency To completely investigate the possiblity of a hemolytic process you need a laboratory test (a peripheral smear). Hypothyroidism Typically detected by the neonatal screen. Metabolic disease Often children with inborn errors of metabolism-such as galactosemia o




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Hypothyroidism Typically detected by the neonatal screen.
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CLIPP 8 - neonatal jaundice
ible reasons for hemolysis include: ABO incompatibility Rh incompatibility G6PD deficiency To completely investigate the possiblity of a hemolytic process you need a laboratory test (a peripheral smear). <span>Hypothyroidism Typically detected by the neonatal screen. Metabolic disease Often children with inborn errors of metabolism-such as galactosemia or urea cycle defects-present with liver dysfunction, including jaundice




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Metabolic disease

Often children with inborn errors of metabolism-such as galactosemia or urea cycle defects-present with liver dysfunction, including jaundice, in addition to other features (like seizures, sepsis, ascites) depending on the defect. The newborn screen can help rule out these diagnoses.

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CLIPP 8 - neonatal jaundice
incompatibility G6PD deficiency To completely investigate the possiblity of a hemolytic process you need a laboratory test (a peripheral smear). Hypothyroidism Typically detected by the neonatal screen. <span>Metabolic disease Often children with inborn errors of metabolism-such as galactosemia or urea cycle defects-present with liver dysfunction, including jaundice, in addition to other features (like seizures, sepsis, ascites) depending on the defect. The newborn screen can help rule out these diagnoses. Biliary atresia Typically presents after 2 weeks of age with progressive jaundice and acholic stools. Causes a direct hyperbilirubinemia. Intrinsi




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Biliary atresia

Typically presents after 2 weeks of age with progressive jaundice and acholic stools. Causes a direct hyperbilirubinemia.

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CLIPP 8 - neonatal jaundice
galactosemia or urea cycle defects-present with liver dysfunction, including jaundice, in addition to other features (like seizures, sepsis, ascites) depending on the defect. The newborn screen can help rule out these diagnoses. <span>Biliary atresia Typically presents after 2 weeks of age with progressive jaundice and acholic stools. Causes a direct hyperbilirubinemia. Intrinsic liver disease Very rare cause of neonatal jaundice Birth trauma (cephalohematoma or other bruising) Reabsorption of blood a




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Intrinsic liver disease

Very rare cause of neonatal jaundice

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CLIPP 8 - neonatal jaundice
the defect. The newborn screen can help rule out these diagnoses. Biliary atresia Typically presents after 2 weeks of age with progressive jaundice and acholic stools. Causes a direct hyperbilirubinemia. <span>Intrinsic liver disease Very rare cause of neonatal jaundice Birth trauma (cephalohematoma or other bruising) Reabsorption of blood and metabolism of red blood cells can cause jaundice. Sepsis W




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Birth trauma (cephalohematoma or other bruising)

Reabsorption of blood and metabolism of red blood cells can cause jaundice.

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CLIPP 8 - neonatal jaundice
atresia Typically presents after 2 weeks of age with progressive jaundice and acholic stools. Causes a direct hyperbilirubinemia. Intrinsic liver disease Very rare cause of neonatal jaundice <span>Birth trauma (cephalohematoma or other bruising) Reabsorption of blood and metabolism of red blood cells can cause jaundice. Sepsis While sepsis can lead to jaundice, jaundice as the only sign of sepsis is rare. Breastfeeding offers some protection against infection, particularly ear




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Sepsis

While sepsis can lead to jaundice, jaundice as the only sign of sepsis is rare. Breastfeeding offers some protection against infection, particularly early on when colostrum provides preformed antibodies, cells, and other anti-infective substances.

16/22

In utero exposure to one of the TORCH infections can lead to jaundice. TORCH infection

Physical findings may include hepatosplenomegaly, microcephaly, and/or rash.

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CLIPP 8 - neonatal jaundice
13; Intrinsic liver disease Very rare cause of neonatal jaundice Birth trauma (cephalohematoma or other bruising) Reabsorption of blood and metabolism of red blood cells can cause jaundice. <span>Sepsis While sepsis can lead to jaundice, jaundice as the only sign of sepsis is rare. Breastfeeding offers some protection against infection, particularly early on when colostrum provides preformed antibodies, cells, and other anti-infective substances. 16/22 In utero exposure to one of the TORCH infections can lead to jaundice. TORCH infection Physical findings may include hepatosplenomegaly, microcephaly, and/or rash. Gilbert syndrome Gilbert's syndrome (reduced activity of the enzyme glucuronyltransferase) is a relatively common cause of harmless jaundice (~5% of the popula




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Gilbert's syndrome (reduced activity of the enzyme glucuronyltransferase) is a relatively common cause of harmless jaundice (~5% of the population). Final diagnosis usually does not occur until later in life, when it is found that hyperbilirubinemia persists, with no other abnormalities.
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CLIPP 8 - neonatal jaundice
; 16/22 In utero exposure to one of the TORCH infections can lead to jaundice. TORCH infection Physical findings may include hepatosplenomegaly, microcephaly, and/or rash. Gilbert syndrome <span>Gilbert's syndrome (reduced activity of the enzyme glucuronyltransferase) is a relatively common cause of harmless jaundice (~5% of the population). Final diagnosis usually does not occur until later in life, when it is found that hyperbilirubinemia persists, with no other abnormalities. Crigler-Najjar syndrome Due to the absence or low levels of UDP glucuronosyltransferase 1 family, polypeptide A1. Can cause severe (type I) or mild/moderate (t




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Crigler-Najjar syndrome

Due to the absence or low levels of UDP glucuronosyltransferase 1 family, polypeptide A1. Can cause severe (type I) or mild/moderate (type II) jaundice. Also very rare.

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CLIPP 8 - neonatal jaundice
yltransferase) is a relatively common cause of harmless jaundice (~5% of the population). Final diagnosis usually does not occur until later in life, when it is found that hyperbilirubinemia persists, with no other abnormalities. <span>Crigler-Najjar syndrome Due to the absence or low levels of UDP glucuronosyltransferase 1 family, polypeptide A1. Can cause severe (type I) or mild/moderate (type II) jaundice. Also very rare. Studies Evaluation of Neonatal Hyperbilirubinemia Test Indication Maternal ABO and Rh typing and screen for unusual isoimmune antibod




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Evaluation of Neonatal Hyperbilirubinemia
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CLIPP 8 - neonatal jaundice
; Crigler-Najjar syndrome Due to the absence or low levels of UDP glucuronosyltransferase 1 family, polypeptide A1. Can cause severe (type I) or mild/moderate (type II) jaundice. Also very rare. Studies <span>Evaluation of Neonatal Hyperbilirubinemia Test Indication Maternal ABO and Rh typing and screen for unusual isoimmune antibodies During prenatal testing, this test identifies an Rh-sensiti




Flashcard 1475791424780

Tags
#contabilidad #vocabulario
Question
Salvage Value

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill






Adolescent medicine (day 7)
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  1. ADOLESCENT MEDICINE (HEADSSS)

HEADDSSS

  • Home: How are things at home? Who lives at home, age, occupation? How does everyone get along? What do you argue about? Have there been any changes lately? Have you ever run away from home?

  • Education / Employment: Name of school, grade level, attendance pattern, amount of school missed, academic performance,favourite/least favourite courses, marks, behaviour at school, current and past jobs

  • Activities: What do you do when not at school? For fun? On weekends? Do you feel you have enough friends? Who are your bestfriends? What do you do together? Sports / exercise, extra‐curricularactivities, hobbies, social groups? Do you go out to parties a lot? Howdo you pay for things you do?

  • Drugs: Have you ever tried smoking or drinking alcohol? What did you think? What about other drugs? Have you ever tried Marijuana? Ever been drunk? Friends’ use and peer pressure? What age did you start? Frequency? Amount? What do you like/dislike? Why do you use? Use alone? Have you ever gotten into trouble because of using these substances? What would/does your family think if they knew that? What do you think about it?

  • Dieting: Do you have concerns about/have you tried to change your weight/shape (dieting/exercise)? Presence of bingeing/purging behaviours, use of diuretics/laxatives. Tell me what you eat/drink in an average day

  • Safety: Do you regularly use: seatbelts? Bike helmets? Appropriate gear when snowboarding/skateboarding? Does anyone at home own a gun? Has anyone ever hurt you or touched you in a way that was hurtful or inappropriate? Driving?

  • Sexuality: Are you interested in the same sex, opposite sex or both? (DO NOT assume heterosexuality!) Are you dating someone now? Are you having sex? What do you use for contraception/STI prevention? Number of sexual partners /age of first sexual activity/STI history / last pelvic exam in females / ever tested for STIs, HIV? History of pregnancy? Sexual abuse?

  • Suicide / Depression: Screen for depression (SIGMECAPS). Does the teen see themselves as generally happy or unhappy? Do they have difficulties with anger? When they feel sad, how do they cope with it? Have they ever thought about killing themselves? How recently? Has the teen had any prior suicide attempts?

    1. STIs

  • 14yo ♂ comes after having urethral discharge and has had 3 sexual contacts (anal but no oral sex, I think). What should you do? What should you tell the child? What are the 5 tests you would do? (choose from menu)

  • Plan: further Hx (S+S, sexual behaviours, RFs)

    • chlamydia

      • female: vag discharge, dysuria, abn vag bleed, lower abdo pain, dyspareunia, +/- fever, +/- conjunctivitis

      • male: urethral discharge, urethral pruritus, dysuria, testicular pain, +/- fever, +/- conjunctivitis

    • gonorrhea

      • female: cervicitis, PID, urethritis, inflm of lower 1/3 of vulva, vag discharge, dysuria, abn vag bleed, lower abdo pain, deep dyspareunia, +/- fever

      • male: urethritis, epididymitis, testicular pain, urethral itch, urethral discharge, +/- fever

      • both: pharyngeal inf, purulent conjunctiviti

...
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Flashcard 1475808201996

Tags
#ir #peds
Question
Developmental assessment
Primitive reflexes
Mnemonic: MPRAG
M [...]
P Placing reflex
R Rooting
A Atonic neck reflex
G Grasp reflex
Answer
Moro

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

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Open it
Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex

Original toplevel document

Development
n one foot to undress, so she and mom can read a story together. A Wrinkle in Time. 5 years: Skip, Tie shoes, Difference between reality/fantasy Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas <span>Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 5







Flashcard 1475809774860

Tags
#ir #peds
Question
Developmental assessment
Primitive reflexes
Mnemonic: MPRAG
M Moro
P [...]
R Rooting
A Atonic neck reflex
G Grasp reflex
Answer
Placing reflex

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex

Original toplevel document

Development
n one foot to undress, so she and mom can read a story together. A Wrinkle in Time. 5 years: Skip, Tie shoes, Difference between reality/fantasy Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas <span>Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 5







Flashcard 1475811347724

Tags
#ir #peds
Question
Developmental assessment
Primitive reflexes
Mnemonic: MPRAG
M Moro
P Placing reflex
R [...]
A Atonic neck reflex
G Grasp reflex
Answer
Rooting

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex

Original toplevel document

Development
n one foot to undress, so she and mom can read a story together. A Wrinkle in Time. 5 years: Skip, Tie shoes, Difference between reality/fantasy Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas <span>Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 5







Flashcard 1475812920588

Tags
#ir #peds
Question
Developmental assessment
Primitive reflexes
Mnemonic: MPRAG
M Moro
P Placing reflex
R Rooting
A [...]
G Grasp reflex
Answer
Asymmetric tonic neck reflex

statusnot learnedmeasured difficulty37% [default]last interval [days]               
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scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex

Original toplevel document

Development
n one foot to undress, so she and mom can read a story together. A Wrinkle in Time. 5 years: Skip, Tie shoes, Difference between reality/fantasy Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas <span>Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 5







Flashcard 1475815542028

Tags
#ir #peds
Question
Developmental assessment
Primitive reflexes
Mnemonic: MPRAG
M Moro
P Placing reflex
R Rooting
A Atonic neck reflex
G [...]
Answer
Grasp reflex

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex

Original toplevel document

Development
n one foot to undress, so she and mom can read a story together. A Wrinkle in Time. 5 years: Skip, Tie shoes, Difference between reality/fantasy Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas <span>Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 5







cardiology (day 8)
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  1. CARDIOLOGY

  • Down's + murmur, query VSD: name 3 things that would make you suspect it’s pathologic

  • Innocent: Sensitive (position, resp), Short, Single, Small (area), Soft, Sweet, Systolic

  • Pathologic: loud (>3/6), harsh, pansystolic/diastolic/late systolic/conntinuous, cannot modify with position, abnormal exam, PHx congenital heart disease, RFs (high LSB, pansystolic/diastolic, radiates to back/neck, >II, harsh, click

Congenital Heart Disease Functionally significant structural abnormalities of the heart and great vessels present at birth presented below.

Ebstein’s anomaly – opening of tricuspid valve is displaced towards the apex of the right ventricle = “atrialization” of the right ventricle. * CHD with cyanosis/tachypnea in first hours of life: TGA, Ebstein’s, Pulmonary atresia ^ CHD with CHF (excess pulm. flow): large VSD, AVSD, PDA, coarctation of the aorta # CHD with shock/catastrophy: critical coarctation or AS, interrupted aortic arch, Hypoplastic left heart5 most common types of Cyanotic Congenital Heart Defects (Five T’s)

• Tetralogy of Fallot (TOF): PA stenosis, RV hypertrophy, VSD,
overriding aorta
• Truncus arteriosus: A single trunk gives rise to the aortic arch,
pulmonary arteries and coronary arteries
• Transposition of Great Arteries (TGA): RV to aorta, LV to PA – the
pulmonary and systemic circulations are in parallel rather than in
series
• Tricuspid Atresia: Absence of the tricuspid valve forces all of the
systemic venous return across an ASD to mix with the pulmonary
venous return, often associated with pulmonary stenosis or atresia
• Total anomalous pulmonary venous connections (TAPVC): PV not
connected to LA
Note: Clinical presentations of these lesions usually differ markedly and may not
present with apparent cyanosis.

Ventricular Septal Defect
Defect in the formation of the intraventricular septum (varies in
size/location: muscular, perimembranous, or trabecular)
Clinical Findings
• Murmur: Holosystolic (soft or harsh):
o Soft murmur suggests the right sided pressures are high
o Harsh murmur suggests right sided pressures are relatively low
o Best heard at LLSB 􀃆 at >1 week old (when pulmonary vascular
resistance decreases enough for shunting L􀃆R)
• Heart sounds: loss of splitting of the second heart sound and a loud P2
suggests pulmonary hypertension
• CHF symptoms: respiratory distress, difficulty feeding (+diaphoresis),
FTT
Pathophysiology
Left to right shunt 􀃆 increased blood flow to lungs 􀃆 increased PV return
with LV overload and dysfunction, and later right heart dysfunction +/‐
pulmonary hypertension
Management
• For CHF symptoms: Diuretics and nutritional support
• If defect shows signs of closing, then monitor closely for any signs of
pulmonary hypertension
• Surgical correction of VSD if significant clinical symptoms not managed
medically (to avoid pulmonary vascular disease)

Atrial Septal Defect
Defect in the formation of the interatrial septum (varies in size/location:
ostium secundum, ostium primum, sinus venosus). Patent foramen ovale
does not ordinarily produce intracardiac shunts.
Clinical Findings
• Murmur: Systolic ejection murmur at pulmonic valve:
o Pressure gradient between atria is relatively small so shunt occurs
throughout cardiac cycle, the left‐to‐right shunt is silent.
o Murmur originates from pulmonary valve due to increased blood
flow producing a relative stenosis of the pulmonary valve (2‐3/6)
• Heart sounds: widely, fixed split S2
...
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dermatology (day 8)
#ir #peds
  1. DERMATOLOGY

    1. Dermatitis

  • Atopic dermatitis: what is Tx?

  • MCQ: emollients and topical GCs for 10 d

  • Child with itchy, erythematous, crusty eruption. DDx and 4 Tx?

  • DDx: atopic dermatitis, nummular dermatitis, allergic contact dermatitis, scabies, psoriasis, tinea, drug eruption

  • Tx (atopic dermatitis): avoid triggers, emollients, topical GCs, calcineurin inhibitors

  • "Pruritic eruption" over child's finger web space, axilla, and neck web; sister has the same thing, but parents asymptomatic. What is the Dx (1 mark), 3 DDx (3 marks), the lab Ix that will definitively establish the Dx (1 mark), and most popular/standard Tx (1mark)?

  • Dx: scabies Ix: microscopy (mites, ova feces)

  • DDx: Urticaria Contact dermatitis Scabies Chicken pox Atopic dermatitis Bites

  • Tx: permethrin 5% cream, 2 x 1wk apart for even asymptomatic family members

  • A child presents to you with a diaper rash or is it? What else could it be?

  • DDx: diaper candidiasis, irritant contact dermatitis, infantile psoriasis, others

    1. Rash/Exanthems

  • A young ♂ with asthma gets a rash on his arms: itchy, red, and found on flexural surfaces. What are 2 possibilities?

  • DDx: topic dermatitis, scabies, Pastia’s lines

  • Rosy cheeks + lacy rash: give the Dx, causative organism, 1 complication, and Tx.

  • Dx: erythema infectiosum (fifth disease) Causative agent: parvovirus B19

  • Tx: NSAIDs (symptomatic arthropathy), otherwise none

  • Complications: STAR (sore throat, arthritis, rash), glove and sock, aplastic crisis (sickle cell patients), fetal infection (anemia, fetal hydrops)

  • Fever + erythematous rash: most likely Dx?

  • MCQ: child is UTD on all immunizations, which eliminates 3 choices right away and narrows it down to either MRSA or GAS, take your pick ;-)

  • Child with high fever x 4 days goes to walk-in clinic and gets amoxicillin. On the following day, he breaks out into generalized maculopapular rash.

  • DDx (2 marks): Kawasaki disease, roseola, scarlet fever, drug reaction, etc.

  • Tx (2 marks): depends on etiology

Definitions
MACULE
‐ Flat, circumscribed area of colour change
‐ Large (>1 cm) macule: patch
‐ E.g. vitiligo, port‐wine stain, café au lait
PAPULE
‐ Elevated, palpable lesion
‐ Large (>1cm) papule: plaque
‐ E.g. wart, mollusca
VESICLE
‐ Fluid‐filled elevation (pus, sanguinous)
‐ Large (>1 cm) vesicle: bulla
‐ E.g. impetigo
PUSTULE ‐ Circumscribed elevation of skin containing purulent exudate
‐ E.g. herpes simplex, varicella zoster
NODULE
‐ Palpable solid lesion
‐ Large (>1 cm) nodule: tumour
‐ E.g. dermatofibroma...
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endo (day 8)
#has-images #ir #peds
  1. ENDOCRINOLOGY

    1. Diabetes mellitus

  • Best marker for insulin resistance?

  • MCQ: acanthosis nigricans

    1. Puberty

  • 13yo ♀, no onset of menarche. What questions would you ask on Hx (6)? What would you do O/E? When and how would you investigate?

  • Hx: Breast development, weight loss, pubic hair development, short stature, FHx, athlete, medical illness, high performance athlete

  • O/E: assess nutritional status, dysmorphism, evidence of chronic disease, signs of abuse or neglect, sexual development (“boobs→pubes→grow→flow”)

  • Ix (if no menarche >16 or pubertal >12): always (bone age, CBC/lytes, CRP, FSH/LH, EST/TEST, TSH/T4, IGF, U/A), consider (IBD panel, Celiac panel, etc.)

  • Precocious puberty in ♀: when are you worried and which tests would you order?

Ix (if bone age > height age, <6, OR psychological issues): always (bone age, FSH/LH, EST/TEST, DHEAs/17-hydroxyPRO, TSH/T4), consider (pelvic U/S, MRI head, β-hCG, GnRH/ACTH stimulation)

Hypoglycemia (Infants and Children)
Definition
Plasma glucose (PG) ≤2.8 mmol/L
Etiology
• Endocrine causes: Ketotic hypoglycemia, GH deficiency,
panhypopituitarism, ACTH deficiency, Addisons disease, excess
exogenous insulin
• Nonendocrine
causes: Sepsis/shock, liver disease, ingestion (e.g.
ethanol, salicylates, beta‐blockers), inborn error of metabolism
Clinical Presentation
• Autonomic symptoms: Sweating, weakness, tachycardia, tremor,
feelings of nervousness and/or hunger
• Neuroglycopenic symptoms: Lethargy, irritability, confusion, unusual
behaviour, hypothermia, seizure and coma
Investigations
Send critical labs (prior to initiating treatment) if PG ≤2.8 mmol/L:
Serum glucose, blood gas, electrolytes, insulin, GH, cortisol, free fatty acids,
ß‐hydroxybutyrate, acylcarnitines, total and free carnitine, serum amino
acids, NH4, lactate, urine organic acids, c‐peptide, urine sample for glucose,
ketones and reducing substances
Management
• Treat if PG <3.3 mmol/L and neurologic symptoms (confusion, seizure)
or PG ≤ 2.8 mmol/L
• Initial bolus of dextrose (5 mL/kg of D10W or 2 mL/kg of D25W),
then continuous dextrose infusion to maintain PG
• If no IV access, give glucagon IM or SC. Children <20 kg = 0.03 mg/kg,
max 0.5 mg/dose. Children >20 kg = 1 mg/dose. May repeat q20
minutes as needed

Diabetes Mellitus
Introduction
• Type 1 DM (DM1) accounts for 5‐10% of all diabetes
• Most commonly presents in childhood
o Age of onset has bimodal distribution: peaks at 4‐6 and 10‐14 yrs
o Family history a significant risk factor (5% for first‐degree
relatives)
• Incidence varies with geographical location
• Major Emergencies
o Diabetic ketoacidosis (DKA) ‐ initial presentation in 15‐67%
- Risk for DKA increases if age < 6 yrs or low SES
o Intercurrent illness
o Hypoglycemia
Pathophysiology
Genetic susceptibility + environmental trigger 􀃆 autoimmune β‐cell
destruction 􀃆 progressive insulin deficiency
Differential Diagnosis
• Type 2 Diabetes Mellitus (DM2)
o Disorder of insulin resistance
o Typically presents after puberty
o Associated symptoms: metabolic syndrome, obesity, PCOS,
acanthosis nigracans
• Genetic defects in β‐cell function
• Medications: atypical anti‐psychotics, immunosuppressants...
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