Uword

Question Main

Su b Division

No t e s

Medicine

Cardiovascular System

In Sinus bradychardia use atropine, if hypotensive go EPI. IF still bad go for Transcutaneous Pacing

2145 2145

Medi Medic cine

Pulmo ulmona nary ry & Criti ritic cal Care are

PE cause ause Hypot ypoten ensi sion on,, JV JVD and and WA WAIT FO FOR IT RBBB

2156 2156

Medi Medici cine ne

Card Cardio iova vasc scul ular ar Syst System em

In RV MI (II, (II, III III and and AVf) Vf) avoi avoid d nitr nitrat ate e BB ,, give give IV flui fluid d to prev preven entt hyot hyoten ensi sion on

2166

Medicine

Gastrointestinal & Nu Nutrition

Retained gastric content over 3 hours will produce a splash upon stethoscope auscultation when move patient aka "succussion splash".. splash".. Happening in Gastric Outlet Obstruction

2169

Medicine

Renal, Urinary Systems & Electrolytes

Hyperclcemia is FIRST TREATED with IV SALINE .. CAN ALSO GIVE CALCITONIN,, FOR LONG TERM BISPHOSPHONATES BISPHOSPHONATES

2171

Medicine

Endocrine, Diabetes & Metabolism

DKA: DKA: Stupourous patient, rapid breathing, hx of weight loss, polydispia, polyuria

2174

Medicine


Cosyntropin stimulation stimulation test is like ACTH stimulation stimulation test to check etiology of adrenal insuffisciency

2174

Medicine


In Adrenal Insuffiscienct: First line DO COSYNTROPIN STIMULATION TEST (NOT 24h Urine collection cortisol)

2179

Medicine


Radioactive Radioactive iodine is definitive treatment for Graves and not Surgery (unless pregnant or have severe ophtalmopathy which are contraindications)

2180

Medicine


Chronic NSAID use can cause SIADH

2184

Medicine


In DKA: Give normal saline to restore IntraVascular volume Correct hyperglycemia with regular insulin, and correct electrolyte imbalance (Potassium) Treat precipitatingg cause (infection..) After recovery add 5% dextrose to fluids given to avoid hypoglycemia

2186

Medicine


In non ketotic hyperglycemia coma first GIVE NORMAL SALINE

2189

Medicine


In DKA follow follow up based on pH and anaion gap to assess improvement

2190

Medicine


Diabetic nephropathy: 1st control BP (more importnt than sugar level especially if controlled HbA1C)

2195

Medicine

Ear, Nose & T hroat (ENT)

Deviation of uvula unilateral lymphadenopaty: peritonsillar abscess (not epiglotittis)... epiglotittis)... drain it now

2199

Medicine


If have achalasia symptoms: Even after Barium done ==> Do endoscopy to rule out MALIGNANCY (In elderly ..)

2210 2210

Medi Medici cine ne

Gast Gastro roin inte test stin inal al & Nut Nutri riti tion on

A si single ngle nega negati tive ve occu occult lt bloo blood d tes testt doe does s not not excl exclud ude e col colon on CA CA

2212

Medicine

In esophageal motility disorders DO: BARIUM, THEN MANOMETRY.. (THINK ABOUT BIRD's PEAK APPEARRANCE THAT WE LIKE TO SEE FIRST) IF MECHANICAL START Gastrointestinal & Nu Nutrition endoscopy UNLESS HAVE A HX OF Sx, Caustic injury or PRIOR RADIATION BE SAFE AND DO BARIUM BARIUM FIRST

2218

Medicine


In ascites of cirrhosis ==> restrict water and Na+==> give sipronolactone ==> furosemide ==> if still still not enough: do parascentesis (2-4 L/day as long as renal are OK! )

2229

Medicine


If get a lot of blood in urinalysis (RBC) (RBC) but on microscopical analysis analysis no RBC are seen suspect the false positive of myoglobin which might indicate rhabdomyolisis which can occur following massive seizure maybe due to alcoholic withdrawal withdrawal LOL

2230

Medicine


HSP or IgA nephropathy occurs post-URI (few days later not weeks (post-strep) ) ==> diagnosis is IgA nephropathy if no rash and systemic symptoms etc.. (instead of HSP, which is more common in kids)

2238 2238

Medi Medici cine ne

Male Male Repro eprodu duct ctiv ive e Syste ystem m

Non infl inflam amat atoo oory ry chro chroni nic c pros prosta tati tis s exis exists ts !!!! !!!!!! !!

2239

Medicine

Infectious Di Diseases

EPIDIDMYT IS IS IN YOUNG = ST D = chalm yd ydia, Go Gonorhea IN IN elderly: Gr Gram ((-) ro rods

2242

Medicine


Sulfonamide and allergic interstitial nephritis BIG SHIT

2248

Medicine

Hem atology & Oncology

AIHA can ca cause sp splenomegaly

2249

Medicine


MGUS is multiple myeloma withotu RENAL, ANEMIA, HYPERCALCEMIA (and lytic bone lesions logically).. logically).. but it has the risk to become MM: so do xray

2264

Medicine

Infectious Diseases

Toxoplasma : AIDS patient with multiple ring enhanced lesion on CT. Give sulfadiazine and pyrimethamine (which are both diagnostic and therapeutic (SD) )

2265

Medicine

Infectious Diseases

When diagnose syphilis with dark field microscopy (VDRL and FT -ABS are serologies used for advance stages not chancres) suspect HIV and screen with ELISA since the patient is exposed to all the dirt that could potentially get you HIV

2268

Medicine

Infectious Diseases

MAC prophylaxis with AZYSTHROMYCIN Starts with CD4<50 .. It does nonspecific symptoms with lung involvment and no findings on CXR also have SPLENOMEGLAY and elevated ALP

2270

Medicine

Infectious Diseases

CMV: is Mono without lymphadenopathy and sore throat, of course - monospot or heterophile antibody. Present with atypical looking Lymphocytes

Id

Division

2141

2276

Medicine

Nervous System

IF AIDS and have EBV in CSF with PERIVENTRICULAR RING ENHANCED LESION = OF COURSE LYYMPHOMA .. Even if TOXO serology (+) coz MANY MANY PPLE ARE (+) for this (but only immunocompromised get it ) in addition to that patient is TAKING TMP-SMX

2277

Medicine

Infectious Diseases

Progressive multifocal leukoencephalopathy (JC vrius) is suspected in AIDS with focal neurological signs and multiple enhancing lesions with no mass on CT

2289

Medicine

Nervous System

Tick borne ascending paralysis (in colorado hiking trip) causes no autonomic dysffunction like in Guillain Guillain Barre symdrome and presents with no fever or other complaints

2298 2298

Medi Medici cine ne

Pulm Pulmon onar ary y & Crit Critic ical al Care Care

Hype Hypert rtro roph phic ic oste osteoa oart rthr hrop opat athy hy can can occu occurr in in lun lung g CA pati patien ents ts.. .. also also have have club clubbi bing ng

2305

Medicine

OA can present with crepitus due to cartilage erosion and incongruous join surfaces, it Rheumatology/Orthopedics has 10min mor ning stiffness if more than 30 min its inflmatorry.. INITIALLY INITIALLY GIVE & Sports ACETAMINOPHEN ACETAMINOPHEN Atheroem bolism aka ch olestero l emb olism is a com plication of an y kind of catheterisation.. can cause cutaneous findings (blue toe syndrome..) cerebral, intestinal ischemia, acute kidney injury .. Treatment: Supportie + give Statin and reduce risk factors..

2310

Medicine


2314

Medicine

Rheumatology/Orthopedics Birefringent crystals: crystals: Bseudogout not gout Calcium pyrrophosphate crystals & Sports

2315

Medicine

SLE: BLack 20-40 women Fatigue Fever, Weight loss Oral ulcers (not just Behcet) Rheumatology/Orthopedics Hematological abnormalites Proteinuria Rash Arthritis (MCP, PIP like RA but no bone & Sports erosion on Xray)

2317

Medicine

Rheumatology/Orthopedics Erythema nodosum and sx suggestive of sarcoid, or African American lady.. Do CXR to & Sports look for cause

2341 2341

Medi Medici cine ne

Gast Gastro roin inte test stin inal al & Nutr Nutrit itio ion n

Dive Divert rtic icul ulos osis is is most most commo common n ble bleed edin ing g LOWE LOWE GI BLEE BLEEDI DING NG in eled eleder erly ly

2342

Medicine


When suspect pancreatitis ==> Do GB U/S to narrow ur differential or get the cause since stones are most comm on cause of pancreatitis (if not alcoholic)

2375

Medicine

Ophthalm ology

Progressive and central bilateral vision loss in elderly >50= Age related macular degeneration

2380

Medicine

Rheumatology/Orthopedics Stop PAP SMEAR after 65.. Do DEXA scan for osteoporosis above 65 instead & Sports

2384

Medicine

Infectious Diseases

Hep B exposure algorithm: -Documented vaccine: Reassure (HBsAb positive) -Unknown status or not immune: HBIG (immunoglobulin) (immunoglobulin) and Vaccine series

2581

Medicine


IBD Has a bimodal distribution: 20's and 60's ==> In Both forms you see Neutrophilic cryptitis.. (Bimodal (Bimodal since there BiForm of the disease)

2582

Medicine


Ulcerative Ulcerative colitis: (increased colorectal cancer risk) Start colonoscopy 8 year afer diagnosis or a bit longer if not extensive. Repeat every 1-2 years

2597

Medicine


Waldenstrom: IgM spike Hyperviscosity Multiple myeloma: IgG and IgA (rarely hyperviscosity) hyperviscosity) MGUS are rarely symptomatik Heavy chain diseaseL IgA excess

2599

Medicine


In breast Ca mets to bones: go for bisphosphonate (zoledronic acid, etidronate sodium and pamidronate THE DRONATES), if >12 sever hyperCa2+ use calcitonin with bisphosphonate But radiation is always better for alleviating pain

2615

Medicine

Pulm onary & Critical Ca Care

AdenoCa o f lungs is most common in smo ker an d non smoker (think o f it in non smoker).. ususlay peripheral Large cell carcinoma also is peripheral but gives u large breast with galactorhhea

2616

Medicine


F eb ebrile ne neutropeniia: al always co cover fi first ps pseudomonas (c (cefepime, me mero, ta tazosin)

2623

Medicine


Chemotherapy malaise nausea vomiting is treated with Sertonin Antogonist rather than Dopamine antagonists

2624

Medicine


Trousseau's syndrome: Hypercoagualibility and thrombophlebitis at unusual sites (arm, chest.. ) ==> Indicative of possible visceral malignancy as pancreatic, stomach, lung or prostate CA

2633

Medicine


Sypmtomatik Hypercalcemia (>12 usually) require IV HYDRATION.. Bisphosphonate are long term managemetn of HYPERCALCEMIA of MALIGNANCY

2636

Medicine


SIADH SIADH treatment: 1-Fluid restriction.. If fail 2-Hypertonic saline and increase salt intake.. If fail 3-Demeclocycline (rarely needed)

2641

Medicine

Hem at atology & Oncology

T um umor ly lysis: HI HIGH K, K, PO PO4, UR URIC Ac Acid LO LOW: Ca Calcium

2642

Medicine

Social Sciences (Ethics/Legal/Professional)

Before the tests are out revieling bad news: Ask the patient how he wld like to be approaches as it is important to have a good strategy and plan to deliver the news according to patient's wish. In case of delivering bad news, first start with open ended discussion asking the patient to tell you what he thinks of his current situation, in order not to shock him if hes not expecting bad news

2646

Medicine


Progesterone analogues: (and steroids) increase apetite weight gain in cachexic cancerous patients.. USE FOR PALLIATIVE (less side effects than steroids so prefer it) THINK WOMAN LOVE TO EAT COZ OF THEIR HIGH PROGESTERONE

2659 2659

Medi Medici cine ne

Cardi ardiov ovas ascu cula larr Sys Syste tem m

Tors Torsad ades es:: If Stabl table e Give ive Mg, Mg, If not not Defi Defibr bril illa late te

2276

Medicine

Nervous System

IF AIDS and have EBV in CSF with PERIVENTRICULAR RING ENHANCED LESION = OF COURSE LYYMPHOMA .. Even if TOXO serology (+) coz MANY MANY PPLE ARE (+) for this (but only immunocompromised get it ) in addition to that patient is TAKING TMP-SMX

2277

Medicine

Infectious Diseases

Progressive multifocal leukoencephalopathy (JC vrius) is suspected in AIDS with focal neurological signs and multiple enhancing lesions with no mass on CT

2289

Medicine

Nervous System

Tick borne ascending paralysis (in colorado hiking trip) causes no autonomic dysffunction like in Guillain Guillain Barre symdrome and presents with no fever or other complaints

2298 2298

Medi Medici cine ne

Pulm Pulmon onar ary y & Crit Critic ical al Care Care

Hype Hypert rtro roph phic ic oste osteoa oart rthr hrop opat athy hy can can occu occurr in in lun lung g CA pati patien ents ts.. .. also also have have club clubbi bing ng

2305

Medicine

OA can present with crepitus due to cartilage erosion and incongruous join surfaces, it Rheumatology/Orthopedics has 10min mor ning stiffness if more than 30 min its inflmatorry.. INITIALLY INITIALLY GIVE & Sports ACETAMINOPHEN ACETAMINOPHEN Atheroem bolism aka ch olestero l emb olism is a com plication of an y kind of catheterisation.. can cause cutaneous findings (blue toe syndrome..) cerebral, intestinal ischemia, acute kidney injury .. Treatment: Supportie + give Statin and reduce risk factors..

2310

Medicine


2314

Medicine

Rheumatology/Orthopedics Birefringent crystals: crystals: Bseudogout not gout Calcium pyrrophosphate crystals & Sports

2315

Medicine

SLE: BLack 20-40 women Fatigue Fever, Weight loss Oral ulcers (not just Behcet) Rheumatology/Orthopedics Hematological abnormalites Proteinuria Rash Arthritis (MCP, PIP like RA but no bone & Sports erosion on Xray)

2317

Medicine

Rheumatology/Orthopedics Erythema nodosum and sx suggestive of sarcoid, or African American lady.. Do CXR to & Sports look for cause

2341 2341

Medi Medici cine ne


Dive Divert rtic icul ulos osis is is most most commo common n ble bleed edin ing g LOWE LOWE GI BLEE BLEEDI DING NG in eled eleder erly ly

2342

Medicine


When suspect pancreatitis ==> Do GB U/S to narrow ur differential or get the cause since stones are most comm on cause of pancreatitis (if not alcoholic)

2375

Medicine

Ophthalm ology

Progressive and central bilateral vision loss in elderly >50= Age related macular degeneration

2380

Medicine

Rheumatology/Orthopedics Stop PAP SMEAR after 65.. Do DEXA scan for osteoporosis above 65 instead & Sports

2384

Medicine

Infectious Diseases

Hep B exposure algorithm: -Documented vaccine: Reassure (HBsAb positive) -Unknown status or not immune: HBIG (immunoglobulin) (immunoglobulin) and Vaccine series

2581

Medicine


IBD Has a bimodal distribution: 20's and 60's ==> In Both forms you see Neutrophilic cryptitis.. (Bimodal (Bimodal since there BiForm of the disease)

2582

Medicine


Ulcerative Ulcerative colitis: (increased colorectal cancer risk) Start colonoscopy 8 year afer diagnosis or a bit longer if not extensive. Repeat every 1-2 years

2597

Medicine


Waldenstrom: IgM spike Hyperviscosity Multiple myeloma: IgG and IgA (rarely hyperviscosity) hyperviscosity) MGUS are rarely symptomatik Heavy chain diseaseL IgA excess

2599

Medicine


In breast Ca mets to bones: go for bisphosphonate (zoledronic acid, etidronate sodium and pamidronate THE DRONATES), if >12 sever hyperCa2+ use calcitonin with bisphosphonate But radiation is always better for alleviating pain

2615

Medicine


AdenoCa o f lungs is most common in smo ker an d non smoker (think o f it in non smoker).. ususlay peripheral Large cell carcinoma also is peripheral but gives u large breast with galactorhhea

2616

Medicine


F eb ebrile ne neutropeniia: al always co cover fi first ps pseudomonas (c (cefepime, me mero, ta tazosin)

2623

Medicine


Chemotherapy malaise nausea vomiting is treated with Sertonin Antogonist rather than Dopamine antagonists

2624

Medicine


Trousseau's syndrome: Hypercoagualibility and thrombophlebitis at unusual sites (arm, chest.. ) ==> Indicative of possible visceral malignancy as pancreatic, stomach, lung or prostate CA

2633

Medicine


Sypmtomatik Hypercalcemia (>12 usually) require IV HYDRATION.. Bisphosphonate are long term managemetn of HYPERCALCEMIA of MALIGNANCY

2636

Medicine


SIADH SIADH treatment: 1-Fluid restriction.. If fail 2-Hypertonic saline and increase salt intake.. If fail 3-Demeclocycline (rarely needed)

2641

Medicine

Hem at atology & Oncology

T um umor ly lysis: HI HIGH K, K, PO PO4, UR URIC Ac Acid LO LOW: Ca Calcium

2642

Medicine


Before the tests are out revieling bad news: Ask the patient how he wld like to be approaches as it is important to have a good strategy and plan to deliver the news according to patient's wish. In case of delivering bad news, first start with open ended discussion asking the patient to tell you what he thinks of his current situation, in order not to shock him if hes not expecting bad news

2646

Medicine


Progesterone analogues: (and steroids) increase apetite weight gain in cachexic cancerous patients.. USE FOR PALLIATIVE (less side effects than steroids so prefer it) THINK WOMAN LOVE TO EAT COZ OF THEIR HIGH PROGESTERONE

2659 2659

Medi Medici cine ne


Tors Torsad ades es:: If Stabl table e Give ive Mg, Mg, If not not Defi Defibr bril illa late te

2661

Medicine

Psychiatric/Behavioral & Substance Abuse

Treat alcohol withdawal (Delirium tremens: Fever, hallucination, hallucination, tremor, agitation) with benzo

2664

Medicine

Poisoning & Environmental Phenyton toxicity: Horizontal nystagmus Cerebellar ataxia Confusion (like CAN of Exposure Wernike in alcoholics)

2671

Medicine

Nervous System

In ER settings ALWAYS!!! CT without contrast (FOR BRAIN ONLY).. also for urine stones dont use contrast !

2672

Medicine

Nervous System

HTN bleeds into Basal Ganglia, Pons and Cerebellum and Lobes (less commonly).. Basal gglia sx: Contralateral Hemiparesis and Hemisensory loss, Homonymous Hemianospia and Gaze palsy

2673

Medicine

Nervous System

CN III opens eye, CN VII closes it.. The level of pons determine Upper face paralysis and Bell's palsy

2686 2686

Medi Medici cine ne


Hyper ypertr trop ophi hic c card cardio iomy myop opat athy hy = give give Beta eta bloc blocke kers rs

2687 2687

Medi Medici cine ne

Cardi ardiov ovas ascu cula larr Syste ystem m

Hyper ypertr trop ophi hic c card cardio iomy myop opat athy hy is Autos utosom omal al Domin ominan antt

2695

Medicine


MVP Is the most common MR in DEVELOPING COUNTRIES and is DUE TO MYXOMATOUS DEGENERATION DEGENERATION OF MITRAL VALVE LEAFLETS AND CHORDAE

2698 2698

Medi Medici cine ne

Card Cardio iova vasc scul ular ar Syste System m

Aort Aortic ic sten stenos osis is in pati patien entt belo belo 70 with with no rheum rheumat atic ic dise diseas ase e = Bisc Biscup upid id valv valve e

2711

Medicine


In hypertrophic cardiomyopathy the mitral valve leaflet motion is abnormal.. SAM (systolic anterior motion of mitral valve) SAM SAM and Septal hypertrophy cause the sound of murmur

2713

Medicine


MYXOMAS are MOST COMMON HEART TUMORS.. can cause embolic events or rupture chorda tendina..

2717 2717

Medi Medici cine ne


US is best best for for diag diagno nosi sis s and and f/u f/u of AAA use use CT w cont contra rast st if not not clea clearr imag image e for for ex

2722

Medicine


Variant angina is like angina bbut Prinzmetal (see ST elevation during episode, not depression.. ) it is similar to raynaud's phenomena

2723 2723

Medi Medici cine ne


PRin PRinzm zmet etal al angi angina na (fin (findi ding ngs s only only duri during ng epis episod odes es)) are are trea treate ted d with with CCB CCB

2731 2731

Medi Medici cine ne

Card Cardio iova vasc scul ular ar Sys Syste tem m

Post Post MI aneu aneury rysm sm caus causes es pesr pesrsi site tent nt ST elev elevat atio ion n on ECG FUN FUN FACT FACT

2732 2732

Medi Medici cine ne


ACEi ACEi redu reduce ce remod remodel elin ing g of hear heartt post post stre stress ss (mai (mainl nly y MI's MI's))

2741 2741

Medi Medici cine ne

Card Cardio iova vasc scul ular ar Sys Syste tem m

CHF CHF and and lung lung infe infect ctio ion n in youn young g patie patient nt ==> ==> VIRA VIRAL L INFE INFECT CTIO ION N

2742 2742

Medi Medici cine ne


SLE SLE and and STE STEROID ROIDS S can can acce accele lera rate te coro coronn nnary ary athe athero rosc scle lero rosi sis s

2743

Medicine


Pulmonary edema = give furosemide (even post M I.. and cz decompensated Heart failure dnt give Beta blockers)

2744

Medicine


Reversible causes of PAC's: Alcohol, Alcohol, Tobacco.. Do holter if get symptoms of arrythmias like Syncope or Palpitations

2750

Medicine

Derm atology

Scabies: pruritic rash on flexor surfaces of the wrist, lateral surfaces of the fingers and finger webs.. excoriations with with small crusted red papules scattered around affected areas. Dx by skin scrapngs and excoriated lesions. Tx: topical permethrin 5% cream or oral Ivermectin (more preferred in adults)

2762

Medicine

Derm atology

Basal cell Ca is slow growing (6months...) unlike SCC.. and can appear below the nose, in neck.... (not only up)

2771

Medicine

Derm atology

-Tetracycline: Photoxicity Photoxicity (exaggerated sunburn) -Erythromycin (marcolide) : GI upset and cholestatic jaundice -Steven Johnson: TMP-SMX. penicillin, sulfa drugs NSAIDs, Anticonvulsan t, allopurin ol

2774

Medicine

Derm atology

In Celiac, Treat Dermatitis Herpetiform with Gluten restrication and Dapsone (coz like leprosy lesions )

2817

Medicine


In endemic areas (Russia one of them) think TB if B symptoms --> Addisionian Addisionian presentation maybe --> Hypoaldosterone

2821

Medicine


Postictal Postictal lactic acidosis is common after tonic clonic episode. and resolve on its own

2836 2836

Medi Medici cine ne

Ear, Ear, Nose Nose & Throa Throatt (E (ENT) NT)

Pres Presby bycu cusi sis: s: Start tart at 60's 60's,, bil bilat ater eral al seun seunso sori rine neur ural al loss loss with with high high freq freque uenc ncy y sou sound nds s

2839

Medicine


Serous otitis media is definec as the presence of a midlle ear effusion without signs of active infection. Have a Dull Tympanic Membrane that is HIV lymphadenopathy, or obstructing Lymphoma... Get conductive hearing loss

2842 2842

Medi Medic cine

Ear, ar, Nose ose & Thro Throat at (EN (ENT)

Nasal asal pol polyps can can get get worse orse with NSAID use use

2844

Medicine


Oral leukplakia: White White patches or plaques over the oral mucosa and cannot be scraped off. Tobacco and Alcohol are risk factors: Like SCC and can progress to SCC.. butt SCC present with erosive ulcerative lesion with with surrounding erythema (white and red and ugly) with possible lymphadenopathy HSV gingivostomatitis: gingivostomatitis: multiple vesicularlesions vesicularlesions with erythematous and inflamatory base and erythematous border in oral cavity and perioral. without white plaques

2845

Medicine

Infectious Diseases

Epiglotitis can happen in adults..

2850

Medicine

Ophthalm ology

Cataract = progressive thickening of lens ==> Blurred vision

2852

Medicine

Ophthalm ology

Open angle glaucoma: More common in Blacks and is characterised by loss of peripheral vision

2856

2860

Medicine

Medicine

Ophthalm ology

Ophthalm ology

Optic neuritis: female 20-45 (usually seeni n MS) change in color perception, loss of afferent pupillary, central scotoma (bigger blind spot) Herpes simplex keratitis (common cause of blindness) Photophobia, pain, blurred vision, tearing and redness. Recurrence: associated with sun exposure (outdoor occupation), fever, immunodeficiency You see Corneal Vesicles and Dentritic Ulcers.. treat with Acyclovir

2863

Medicine

Ophthalm ology

Vitreous hemorrhage is a very comm on complication of diabetic retinopathy, where fundus is barely seen on exam and if seen its details are obscured.. It presents acutely (also patient sees floater like detachment; usually associated with metabolic stuff, trauma, vascular disease or myopia )

2868 2868

Medi Medici cine ne

Hemat ematol olog ogy y & Onco Oncolo logy gy

Tart Tartra rate te resi resist stan antt acid acid phos phosph phat atas ase e (TR (TRAP) seen seen in hair hairy y cell cell leuk leukem emia ia

2869

Medicine


Heterophile antibodies can be negative in early disease.. se leukocytosis and variant atypical lymphocytes on smear. A - test will not exclude disease.. Repea test

2869

Medicine


CAN HAVE M ONO WIT H NEGATIVE TESTS

2872

Medicine


Meglaoblastic anemia can cause anisocytosis, poikilocytosis.. poikilocytosis.. Basophilic stippling is not super sensitive can also happen here.. usually see it in lead poisoning, alcoholism, alcoholism, thalassemia..

2886

Medicine


Leukocyte alkaline phosphatase HIGH = Leukemoid reaction LOW in CML.. can be high with secondary infection so need a BCR ABL

2887

Medicine


CLL IS DIAGNOSED WITH FLOW CYTOMETRY JAK2 in myelodysplasia specially polycythemia like my patient with SAGHIR EL ZABER

2888

Medicine


CLL has a poor prognosis in thrombocytopenia Anemia is the second worst prognosis Its a B cell disease (but not plasma like multiple myeloma) It has smudge cells (lymphocytes that break down easily)

2889

Medicine


MULTIPLE MYELOMA: ELDERLY Anemia Renal Failure Hypercalcemia Diagnosis ==> Serum immunoelectrphoresis

2894

Medicine


BCR/ABL BCR/ABL is 9 22 chromosome translocation treated with Wyrosine Kinase inhibitors (inhibits abnormal BCR/ABL gene) AN AWSEOME TREATMENT FOR CML

2895

Medicine


Hepaticolenticular Hepaticolenticular degeneration = Wilson's disease affecrting liver basal ganglia with greenish brown deposits around cornea

2903

Medicine


U/S is better than HIDA. But HIDA is better in suspected Cholecystitis (especially acaluculous)

2905 2905

Medi Medici cine ne


Hep Hep A A vesr vesrio ion n to to cig cigar aret ette tes s and and rece recent nt trip trip wher where e sis sista ta has has same same dise diseas ase e

2911

Medicine

Alcoholic he patitis: No evide nce o f cirrh osis like gynecom astia, ascites, spider angioma but do have jaundice. AST/ALT >2 but absolute value less than 500 Also have high Gastrointestinal & Nu Nutrition gamma GT which is also present in liver cells and Ferritin (as an acute phase reactant) If values >25x upper limit it is toxic induced (acetaminophen), ischemic or viral

2919 2919

Medi Medici cine ne


Alph Alpha a 1 ant antit itry ryps psin in defi defici cien ency cy stai stain n wit with h PAS PAS (lik (like e PAN PAN anci ancina nar) r)

2923

Medicine


Gilbert is milder thand criggler 2 exacerbated with fasting low fat diet and hemolysis, stress fatigue, sport fever Unconugated <3 in crigler 2 <20

2930 2930

Medi Medici cine ne


Inci Incide dent ntal al Gall Gallst ston ones es on Imag Imagin ing g wit with h no no con conce cern rn or symp sympto toms ms:: Leav Leave e the them m alo alone ne

2936

Medicine


Cirhhotic patient shld undergo screening endocscopies to R/O esophageal varices, also screen for HCC every 6 months

2938

Medicine

Nervous System

Wilson's: young pple present with liver disease (with M allory bodies can also be suggestive of alcoholic liver damge) and neuropsychiatric disease (tremor, rigidity, depression, paranoisa, catatonia) and Kayser Fleischer rings in eye see decrease serum ceruloplasmin and increased urinary copper

2940

Medicine


EMPHYSEMATOUS CHOLECYSTITIS haapen in eledrely diabetics males as their GB get infected wwith gas forming bacteria

2946

Medicine


2950

Medicine


Primary biliary sclerosis is associated with AMA, and also can cause xanthomatous lesions in eyelids or skin and tendon.. First line is Ursodeoxycholic acid as it relieves symptoms and lengthens transplant free survival time

2953 2953

Medi Medici cine ne


Hepa Hepati ticE cEnc ncep epha halo lopa path thy: y: Suppo upport rtiv ive e car care. e... firs firstt fix fix elec electr trol olyt ytes es etc. etc...

2961

Medicine

Infectious Diseases

Hepc B with cirhosis and fucked up use ENTECAVIR or TENOFIVIR HepC RiBAVIRIN, IFN

2966

Medicine


2970

Medicine


Eginoccocus = Egg sh shell ca calcified cy cyst I KNOW TH THAT JU JUST A NOT IC ICE TO TO RE REMEMBER

Infectious Diseases

INH induced toxicity (AST (AST ALT<100) is self resolving no need to worry about it (10-20%), unless cirrhosis symptoms happen (in 2.5% of pple). If symptoms of "viral hepatitis" appear stop it and switch to second line treatment. (No need for liver bx since etiology is known). Continue on full regiment even when symptoms are out. Give steroids if disease beome fulminant.

2981

Medicine

Acalculous cholecystit is: (no stones) -Burns -Trau ma -TPN, Prolon ged fasting -Mechanical ventilation

Alcohol is assiociate d with chronic pancrea titis which is by itself a ssociated with pancreatic cancer. On the other hand smoking is directly associated with pancreatic CA.

2984

Medicine

Infectious Diseases

F ollow up on Hep B clearance with ALT and HBeAg until there is viral clearance

2994

Medicine

Infectious Diseases

M ucorm ycosis: Debridem ent + Amphotericin B (Naim Shraif who ddnt have it)

Infectious Diseases

Histoplasma: Southeastern US and central.. Acute pneumonia Blastomycosis: in southcentral and north central.. Lungs, skin, bones, joints and prostate (immunocompromised patients).. Primary pulmonary infection is flu like

2998

Medicine

2999

Medicine

Infectious Diseases

Blastomycosis is a fungal infection endemic to Central USA. It causes mild respiratory illness but dessiminated infection (even in immunocompetent pple) may cause cutaneous disease with WELL CIRCUMSCRIBED VERRUCEOUS NODULE AND PLAQUES THAT PROGRESS TO MICROABSCESSES

3011

Medicine

Infectious Diseases

HUMAN BITE GIVE AUGMENTIN

3012

Medicine

Infectious Diseases

In suspected Infective Endocarditis draw blood cultures

3013

Medicine

Infectious Diseases

Right sided endocarditis is treated empirically with VANCO coz u know US and MRSA..

3014

Medicine

Infectious Diseases

Strep sanguinis is part of Strep viridans ,, involved in IE

3016

Medicine

Pulmonary & Critical Care

Hypersensitivity pneumonitis also occurs from exposure to birds not only in a farmer. Remove exposure and all is good

3020

Medicine


ARDSL PaO2/FiO2<300 and bilateral alveolar infiltrate: Impaire d ga s exch ange, decreased lung compliance (stiff lungs) and Increased pulmonary arterial pressure (pulmonary HTN)

3021

Medicine


Bronchogenic is most common lung CA in Asbestos exposure

3029

Medicine


when suspect lung Ca on xray with previous xray positive, do a CT then Biopsy

3033

Medicine


Nocturnal polysomnography is done to diagnose Obstructive sleep apnea

Nervous System

Pseudotumor cerebri occurs in young obese female who take OCPS or excess VitA and can cause blindness Have to reduce weight and give acetazolamide and if necessary do optic nerve sheath fenestration or do shunting

3044

Medicine

3049

Medicine


Wegner can present with skin manifestation too like subcutaneous nodules, palpable purpura pr pyoderman gangrenosum like lesions.. Trest with cytotoxic agents and cyclophosphamide

3054

Medicine


Legionaire (clues: recent travel, moist AC, aerosols, droplets, abdominal pain, pneumonia, confusion, ataxia) ==> Macrolides or Fluoroquinolones

3059

Medicine

Polymyositis: Progressive 40-50 women with proximal muscle (hip, shoulder) weakness. It is usually Drug induces (statins, antipsychotics, and alcohol..). Elevated ESR ans Rheumatology/Orthopedics Creatine Kinase make the diagnosis (25% anti-JO) ==> Treat with STEROIDS give IVIG & Sports if life threatening Inclusion body myositis: same as up but >50 and male, with eosinophilia on bx In all EMG: spontaneous muscle stimulation with descreased amplitude

3067

Medicine

Hematology & Oncology

Pernicious anemia In EASTERN EUROPE: Causes vit B12 deficiency with Atrophic glossitis.. Vitiligo Thyroid disease Neurological abnormalities (ataxia, loss of position sense..)

3068

Medicine

Infectious Diseases

Nosocomial UTI may cause Enteroccocci endocarditis

3072

Medicine

Nervous System

Central cord syndrome occurs with Hyperextension injuries ==> Like synringomyelia (whichis central) affects mainly upper extremities but mototr first

3080

Medicine

Dermatology

celluitis: Group A strep is most common cause

3099

Medicine


Respiratory Alkalosis will Increase Calcium affinity to Albumin ==> Decrease free Calcium ==> Hypocalcemia signs (AWSEOME)

3101

Medicine


In bone mets it not tum or itself that directly break the bone but instead release factors that activate osteoclast (like in breat tumor, which also can cause PTHrP secretion)

3105

Medicine

Infectious Diseases

Trimethorpim sulfamethoxazole is gevien in transplant patients to prevent PCP.. shld also be vaccinated for influenca, pneumococcus and Hep B Bright red firm friable exophytic nodules in an HIV infected patient are most likely due to bacillary angiomatosis Molluscum contagiosum is umbilicated lesions non pruritic Herpes lesions are painful and vesicular Kaposi: On trunk, face and extremities, papules that become plaques or nodules and start from light brown to pink to dark violet

3107

Medicine

Infectious Diseases

3126

Medicine

Poisoning & Environmental TCA OD severity is assessed with QRS widening extent. Exposure

3131

Medicine

Infectious Diseases

associate EBV with autoimmune hemolytic anemia and thrombocytopenia due to cross reactivity of EBV induced antibodies against red blood cells and platelets. (IgM cold-agglutin antibodies aka anti-i-antibodies) Diphterium also present with sore throat but with pseudomembrane formation, and can cause dilated cardiomyopathy

3131

Medicine

Infectious Diseases

mononucleosis: Not splenic infarct but splenic rupture, can also hemolytic anemia and thrombocytopenia for 2-3 weeks

3134

Medicine

Poisoning & Environmental In organophosphate poisoning remove patient's clothes since they soacked with the Exposure poison

Medicine

Neuroleptic maligant syndrome is a side effect of antipsychotic: Fever, M uscle rigidity, Poisoning & Environmental Autonomic instabilty and m ental status change (high creatine kinase, leukocytos is and Exposure electrolytes abnormalitites are also seen).. a bit like parkinosim induced antipsychotic but with fever

3138

Medicine

Uses of NaHCO3 -Hyperkalemia: reduces it -Aspirin OD: Alkalanize urine and increase excretion -TCA OD (inhibit fast sodium channels in Purkinje and myocardium) so Poisoning & Environmental Increase QRS and Hypotension and possibly Vtach and Vfib (coz slow normal cndction Exposure and will then rely on ectopic beats) ==> Here the use og NaHCO3 will first increase Na+ which will decrease TCA binding on Na+ channels, and then Bicarb will alkalanise medium which decrease drug affinity for the channels

3139

Medicine

Poisoning & Environmental Typical Antipsychotics like Risperidone, F luphenazine can cause Hypothermia so AVOID Exposure Long cold Exposures

3151

Medicine

Rheumatology/Orthopedics HyperPTH can predispose to pseudogout other stuff too.. & Sports

3157

Medicine

Rheumatology/Orthopedics Spinal stenosis is also called Spinal canal narrowing & Sports

3161

Medicine

Poisoning & Environmental BOTH CAUSE HIGH ANION GAP ACIDOSIS To recognise difference: Methanol Affect Exposure EYES Ethylene Glycol Affect Kidneys (coz we know it also cause Stones)

3164

Medicine

Rheumatology/Orthopedics Visual sx in giant cell arteritis shld be treated with steroids. & Sports

3167

Medicine

Rheumatology/Orthopedics Ankylosing spo ndylitis is d iagnosed with XR not HLA B27 coz not spec ific & Sports

3171

Medicine

Parvo B19 can cause Rheumatoid like arthritis with MCP PIP involvement but morning Rheumatology/Orthopedics stifness less than 30 min and onset of disease is acute. Must resolve within 2 months.. & Sports dnt have slapped cheeks in adults. anyways cant diagnose RA if less than 6 weeks sx Psoriasi affects DIP (like Dactylitis "D" which means sausage digit)

3173

Medicine

Rheumatology/Orthopedics COMMON SIDE EFFECT of Hydroxychloroquine: Retinopathy & Sports

3177

Medicine

Rheumatology/Orthopedics In symptomatik sarcoid give steroids (steroid sounds like sarcoid TEKRAM) & Sports

3202

Medicine

Rheumatology/Orthopedics Fibromyalgia: SPORT and TCA's & Sports

3203

Medicine

Carpal tunnel: -Pregnancy: Flui accumulation *3rd trimester m ost of time) -Hypothyroid: Rheumatology/Orthopedics Mucopolysacchardie deposition with perineum and endoneurium of median nerve DA & Sports FUCK!!

3208

Medicine

Rheumatology/Orthopedics Polymyositis increase risks of many cancers & Sports

3209

Medicine

Rheumatology/Orthopedics Diagnose polymyositis with MUSCLE BX.. It presenest with muscle weakness, often with & Sports pain too, and difficulty climbing stairs or rising from a seated position

3230

Medicine


Hyperaldosteronism may not have primary hypokalemia but are to have so if with diuretic for ex

3231

Medicine


In hyperaldosteronism managed non surgically give Spironolactone or Eplerenone

3247

Medicine

Infectious Diseases

Ehrlichia some new shit But dont wry same treatment as Lyme,, Do leukocytosis, thrombocytopenia, elevated liver enzymes malaise, fever, confusion and very rar ely rash. IN SOUT CENTER US, AND SOUTH EAST not like lyme in NYC

3249

Medicine

Infectious Diseases

Cryptosporidium (can also be other parasites. cystoIsospora or Giardia.. ): Traveler's non bloody watery diarrhea for more than 2 weeks Entameba's diarrhea is bloody and is endemic in all areas except europe and north am erica

3254

Medicine

Infectious Diseases

Cryptococcal meningo encephelatis in AIDS with CD4<100.. Give Amphotericin and flucytosine then fluconazole.. MA MNENZAH IN SIDA with MENIGOENCEPHALITIS

3256

Medicine

Infectious Diseases

Primary Syphillis: Benzathine single dose IM (Penicillin G) If allergic give DOXYCYCLINE Unless Pregnant desensitive

3257

Medicine

Infectious Diseases

Pregnant women with lyme = Amoxicillin not doxy

3259

Medicine

Infectious Diseases

Sub saharan (ethiopia) Amazon , Asia are Chlroquine resistant malaria so give Mefloquine, atovaquone-proguanil or doxycycline for prophylaxis

3266

Medicine

Infectious Diseases

Measle Temperature >40 compared to ~ 38 in rubella.. and spread of rash is slower.. and no joint involvement like in Rubella Trichinellosis: In China, Thailand, Latin america.. Cause GI sx within 1 week of undercood meat ingestion: Abdominal pain, nausea, vomiting and Diarhhea Up to 4 week stage II Myositis, Periorbital edema and Eosinophilia (Triad, coz TRIchinellosis).. can also get fever and subungual splinter hemorrhages

3135

3267

Medicine

Infectious Diseases

3303

Medicine

Preplatellar syndrome is like ME.. Anserine bursitis: shaarply localised pain over the Rheumatology/Orthopedics anteromedial part of the tibia just below the joint line of the knee. Valgus test is (-) so & Sports MCL is ruled out : Causes are overuse, abnormal gait..

3317

Medicine

Polymyalgia rheumatica has HIGH ESR CRPand can be associated with temporal Rheumatology/Orthopedics arteritis.. Treat with STEROIDS (sometimes no arteritis ) It is bilateral,, worse in & Sports morning.. proximal arms thigh hip.. can have normocytic anemia

3320

Medicine

Infectious Diseases

3322

Medicine

Systemic sclerosis (scleroderma substype) presents with GERD, Right heat Faulure, Rheumatology/Orthopedics pulonary and renal arteries and esophagus as well. ANA and Anti Topoisomerase I & Sports antiibodies are likely to be +

3327

Medicine

Nervous System

If extraocular muscles are involved in eye infection think or orbital cellulitis that can give Cavernous sinus thrombosis which is right behind it

3330

Medicine

Ophthalmology

3 Kind of diabetic neuropathyL -Background or simpleL microaneurysms, hemorhages, retinal edema -Pre proliferative: cotton wool spot -Proliferative or malignant: Neovascularisation

3422

Medicine

Infectious Diseases

Treat zoster recurrence post stress with Valacyclovir and to present pain can give TCA's

3425

Medicine

Infectious Diseases

LeprosyL Asian with hypopigmented patch of skin affecting sensation of area too. Diagnose with skin BX showing acid-fast bacilli Ocular tonometry measure intraocular pressur when we have emergency suspecting acute cosed angle glaucoma.. Can be precipitated by Decongestant, Antiemetic and Anticholinerg ic dru gs in patient with pre disposed anatom y. Get headach e na usea, diminished vision and halos around lights and mid dilated non reactive pupil, redness and corneal opacification

Disseminated Gonococcus: Fever, poly arthralgia and pustular rash (not dessiminated rash all over body like in SSS)

3429

Medicine

Ophthalmology

3433

Medicine

Pulm onary & Critical Care

In ARDS have to incr ease PEEP

3446

Medicine

Nervous System

MS suspected Do MRi (Ms and Mr MS and MRI)

3453

Medicine


INCIDENTAL NODULE in LUNGS found ALGORITHM !! Check for previous Xrays. Stable over 2-3 yrs in non risk young patient==> let go Changing mass or no previous Xray==> CT CT benign ==> follow up later with CT's Suspicious CT==> Bx or Pet CT HIGHLY SUSPICIOUS==> Surgical Excisio n

3467

Medicine

Gastrointestinal & Nutrition

Acute episode of diverticulitis is best diagnosed with CT

3474

Medicine


Bronchiectasis: Dilated bronchi with thickened wall on CT .. Hemoptysis is a potential complication (often severe and require bronchial artery embolization).. See it in COPD

3475

Medicine

Infectious Diseases

In pyelonephritis or UTI sx do Imaging if sx do not resolve in 2-3 days of therapy.. or if have hx of nephrolithiasis, complicated pyelonephritis or unusual findings (gross hematuria, suspicion for obstruction... )

3481

Medicine


When have BPH and symptoms and DRE done, do Urinalysis to look for infection

3483

Medicine


Hypothyroid can cause elevated AST ALT, HyperLipidemia and Hyponatremia (the fuck)

3484

Medicine


Before any FNA of thyroid, do TSH level and US

3488

Medicine


RAI is likely to cause Hypothyroidism But ususally cause Hypothyroid when whole gland will absorb the radioactive Iodine like in GRAVES In toxic adenoma the radioactive Iodine will mainly be uptaken by this single mass..

3490

Medicine


Osteolmalavia (vit D deficiency): defective mineralisation of organic bone matrix.. can happen in celiac

3495

Medicine


Sick euthyroid syndrome aka "low T3 syndrome" occurs with acute, severe illness. Get a fall in total and free T3, with normal T4 and TSH levels

3497

Medicine


HASHIMOTO INCREASe LYMPHOMA OF THYROID RISK (MANTE2)

3513

Medicine

Nervous System

Primidone is an anticonvulsant usd for essential tremor but can precipitate acute intermittent porphyria (abdomincal pain, confusion, headache and hallucinations, dizziness)

3516

Medicine

Rheumatology/Orthopedics Paget: HYDOXYPROLINE IN URINE & Sports

3518

Medicine


Paget's labs: ALL GOOD WITH HIGH ALP TREAT ONLY IF SYMPTOMATIK

3526

Medicine


In limb embolisation dont forget to do an ECHO..

3583

Medicine

Infectious Diseases

As alread y said Early HIV = EBC symp toms (dnt f orget possible GI sympt oms, n ight sweats, lymphadenopathy.. )

3589

Medicine


Peptic ulcers are most commonly complication is Hemorrhage, and other less frequent complications are perforation, penetration and obstruction.

3605

Medicine


Lactose intolereanc eis easly diagnosed with a POSITIVE HYDROGEN BREATH TEST (bacteria metabolism of carbs not being absorbed)

3606

Medicine


INR goal 2-3 for DVT 2.5-3.5 for idiopathic venous thromboembolism

3610

Medicine


M acrovascular traum atic hem olysis is microcytic

3613

Medicine

Infectious Diseases

Post BMT Pneumonitis and colitis: CMV Only diarrhea no lungs: Cryptosporidum Skin rash, and less comm only intestine, liver, lung: GVHD (always get rash) Can get PCP pneumonia in early stage but very rare coz have good prophylaxis Cryptosporidium= Diarrhea NOT LIKE CRYPTOCOCCUS (IN HEAD)

3617

Medicine


Respect patient's opinion about not wanting life saving treatment, but first discuss issue.. DONT JUST SAY YEA ITS UR LIFE MOF O

3619

Medicine

Nervous System

TCA, Beta blocker; migraine prophylaxis During episodes give ANTIEMETICS: Chlorpromazine, prochlorperazine, metoclopramide..

3622

Medicine

Nervous System

Non traumatic subarachnoid hemorrhage is most commonly due to saccular or berry aneurysm rupture. we see bleeding in cisterns.. if CT - , do LP

3634

Medicine


Acromega ly get hug e hear ts then c ardiomy opathy

3635

Medicine


Constrictive pericarditis (calcification.. ) in Africa India china.. THINK TB

3637

Medicine

Nervous System

Pseudotumor cerebi aka idiopathic intracranial HTN in young obese women taking too much isotretinoin or tetracycline --> Treat with Acetazolamide +/- furosemide

3643

Medicine

Nervous System

Acute MS e xacerba tion = Ster oids bu t if u want to decreas e episo de fre quency give be ta interferom or glatiramer, cyclophosphamide,IVIG, or plasmapheresis

3644

Medicine

Nervous System

3644

Medicine

Nervous System

MS: (also have autonomous dysregulation) ==> See Oligoclonal bands and All the rest is normal in CSF (norm al proteins) Guillain Barre: Get elevated protein with Albumino-cy tologic diss ociation

MS CSF: Normal pressure, Oligoclonal bands (with normal overall protein level.

3674

Medicine

Infectious Diseases

Check Question for different rashes Cutaneous larva migrans: common in travel to tropics including SE USA characterised with pruritic speriginous lesions on skin which elongate ate rate of several mm/day as larvae migrate in epidermis and usually seen in lower extremitites and can also involve upper extremity.. associated with sand contact (soil contaminated with dog or cat feces containing infective larvae) Brown reclus spider cause papul with erythema flwd w ulceration

3680

Medicine


in mets to epidura from prostate Ca for ex. give steroids to alleviate the swelling and sx. Imaging Do MRI not bone Scan

3690

Medicine

Nervous System

Malignant hyperthermia: is uncontrolled accumulation of Ca2+ is cells (due to uncontrolled efflux from sarcoplasmic reticulum) ==> Susceptible patients gets the event after halothane and succynylcholine ==> Treat with dantrolene: BLOCKS Ca2+ ryanodine receptors

3691

Medicine

Nervous System

Heat stroke is managed with ICE cooled bath no chillin cold bath

3693

Medicine


In UTIs: Leukocyte esterase= pyuria.. Nitrites:conversion of nitrate to nitrite with enterobacteriacea (E.coli.. SO BOTH ARE POSITIVE IN UTI

3697

Medicine


In Afiv with rapid ventricular response need rate control with Betablockers or CCB.. Cardioversion is indicated if hemodinamycally unstable

3698

Medicine


Vfib and Vtack = DEfibrillate then give antiarrythmic if Dfib fails

3699

Medicine


3704

Medicine


Acute erosive gastritis is seen in NSAIDs or Aspirin OD's

3717

Medicine


Also treat before diagnosing if high suspicion of problem. THINK CLINICALLY

3725

Medicine

Nervous System

GLIOBLASTOMA OF BRAIN HAS A BUTTERFLY APPEARANCE

3727

Medicine

Nervous System

Mysthemia crisis can cause fever and respiratory distress ==> Give steroids and IVIG, but Intubate if desaturating and weak effort of respiration

3728

Medicine

Nervous System

HTN brain ischemia: Basal gglia, pons, cerebellar NEVER CORTEX

3738

Medicine

Nervous System

NON DOMINANT BROCA: AFFECT EMOTIONS RELATED TO SPEECH NOT SPEECH ITSELF

3750

Medicine


If there is somatization 3abber the patients as it can help him,, dont send him the psych

3763

Medicine


VTach: -Cardioversion: iIF hemodynamically unstable -IV Amiodarone: IF Stable

3771

Medicine

Nervous System

Riluzole In ALS Plasmapheresis in Guillain Barre

3775

Medicine


Germ c tumors are the only ones that produce both Bhcg and AFP.. usually AFP is in HCC and endodermal sinudoid (yolk sac )tumor and and Bhcg is choriocarcinoma a

3781

Medicine


Diabetic neuropathy is assessed with Monofilament testing which assess pressure sensation (altered in this disease)

3789

Medicine

Infectious Diseases

Echinococcus (Big round cyst and smaller cysts inside of it) occur in Mexico with Sheep contact (DAYM SHEEP)

3790

Medicine


Zinc deficiency results from TPN or malabsorption: Sx: Alopecia, skin lesions, abnormal taste and impaired wound healing

3797

Medicine


Diabetic gastroparesis is treated with prokinetic agents like METOCLOPRAMIDE, ERYTHROMYCIN, CISAPRIDE

Afib Hemod inamically stable: Digoxin Non Stable: DC cardiove rsion ( also in Vfib and Vtach)

3800

Medicine


TCA's are drug of choice for diabetic neuropathy pain so are NSAID's (but avoid in renal dysfunction)

3808

Medicine

Infectious Diseases

NEUROCYSTICERCOSIS: PArasite in BRAIN, Like name implies it cause several Cyst is brain it is caused by TANEIA SOLIUM

3819

Medicine

Infectious Diseases

cyst in liver after travel in endemic area: entameba histolytica ==> Treat with Metronidazole ==> IF fail go fo drainage

3820

Medicine


ACEi ARB Spirono BBlocker a nd ASPIRIN (if d ue to CAD) IMPROVE CHF surviva l but Digoxin and Furosemide DO NOT although are good for symptoms

3823

Medicine


Start statin in a high risk patient with bad lipids level.. not exercecice only

3829

Medicine


PVCs post MI are common or cardiac pathologies.. they indicate worse prognosis, but treating them with antiarrythmic will even worsen prognosis. So observe, or can give Beta Blockers.

3837

Medicine

Nervous System

In myasthemia DTR are preserved unlike Eaton Lambert (Ab's against voltage gated calcium channesls in presynaptic nerve terminal)

3847

Medicine


For prostate CA, aftr orchioectomy, go for radiation not hormonal (u already went too far by removing balls u wont go back to stupid meds go for the big shit the radiations)

3852

Medicine

Nervous System

Diagnose MS with MRI

3859

Medicine


In PE, if very likeley go do CT ANGIO (=with IV contrast)... If not likely Do dimer.. Leg doppler if DVT

3878

Medicine


Hypothyroid causes myopathies with elevaed Creatine Kinase

3887

Medicine


Foul smelling stool from a recent trip = Giardia = Metronidazole

3894

Young person with renal stenosis = fibromsucular dysplasis ==> treat with stent Use ACEi in old p eople with rena l steno sis (pr obably due t o athe rosclero sis) since they a re not candidate for stent

Medicine


3898

Medicine

SLE Nephropathy is Imune mediated involving also C3 thereby it lowers in the serum Ig Rheumatology/Orthopedics E medicated reaction is in allergic interstitial nephritis like methicillin induced interstitial & Sports nephrtis Goodpasture = Cytotoxic antibodies Non immune nephropathy in toxins, HTN, DM

3902

Medicine


3916

Medicine

Male Reproductive System

Trazodone causes boner

3920

Medicine


Peripheral CCB vasodilate veins ==> EdeMa

3930

Medicine


In alcoholism think FOLATE deficiency not B12

3934

Medicine

Biostatistics & Epidemiology

p value= N N is the probability that the results of the experiment are random (so the lower p the better)

3938

Medicine

Infectious Diseases

In AIDS PCP TMP-SMX is alway better if we add steroids if paO2 <70 and A-a gradient >35

3939

Medicine


Never forget Berry aneurysm and ADPKD

3943

Medicine


Elderly with bone pain, renal failure, HyperCa2+ = Multiple myeloma (50% of these devellop renal insuffisciency) by obstructing collecting and distal tubules with paraproteins (Bence Jones proteins)

3949

Medicine


Cystinuria is familial and causes recurretn stones. Hard radiopaque hexagonal crystals with positive Urinary Cyanide Nitroprusside Test

3952

Medicine


HTN Hypothyroid: Increase SVR Hyperthyroid: Decrease SVR +Increase heart contractility ==> Increase BP Overall Hypeparathyroid: Contractility increase and arterial effect Hyperthyroid can cause mild Hypercalcemia due to increase bone turnover

3956

Medicine


Aortic dissection algorithm

3958

Medicine


Hypovolemia BUN/Cr is elevates >20 Na+ excretion should also be low, unless using diuretic BE CAREFUL SO CHOOSE FIRST ONE IN DISEASED OLD FUCKER USING DIURETICS

3959

Medicine

Nervous System

IF ONLY MUSCLE PROBLEM POST STROKE THINK BASAL GGLIA (LACUNAR STROKE) NOT CORTICAL STROKE (PRESENT WITH SPEECH PROBLEMS TOO.. etc.) NOTE: Slurred speech is only muscular not related to cortex

ACEi decrease th e progr ession of diabetic n ephrop athy (NEVER FORGET THAT)

3962

Medicine


Vasovagal syncope: -triggered by: Stress, pain, prolonged standing (in OR doing nothing).. Get vagal induced bradychardia with a dizziness prodrome and black out for seconds to minutes. Wake up full oriented Do tilt table stress which is super stressful and will provoque episode

3965

Medicine


In goodpasture ==> go for plasmapheresis to remove antibodies

3966

Medicine


In carcinomas we see Membranous nephropathy But in HODGKIN: See Minimal change disease (as it is a minimal cancer)

3973

Medicine


niacin side effects are prostaglandin induced like NSAIDS in asthma

3977

Medicine


Malignant HTN (emergency; doesnt depend on values but on damage): severe HTN (>180/120) with retinal hemorrhafes, exudates or papilledema.. HtN encephalopathy is associated with cerebral edema

3978

Medicine


EPO side effects: -HTN -Headache -Flu like symptoms -Red cell aplasia

3979

Medicine


If get uremic carditis encephelitis.. DIALYSIS (BUN>60)

3980

Medicine

Allergy & Immunology

Check Immunosupressant side effects

3986

Medicine


Diabetes NEphropathy early on is due to GLOMERULAR HYPERINFILTRATION and ACEi Will decrea se Glom erular P, decre asing Ifurther GLOMERULAR DAMAGE (D"J"G Diabetes)

3997

Medicine


Suspect amyloidosis in RA (predisposes to that) With Hepatomegaly and enlarged kidneys ==> See amyloid deposits with apple-green birefringence under polarized light after congo red stain -Crescent shape in RPG (remember Hezbolla) -Linear immunoglobunin deposit in Goodpasture's -Granular deposits: In immune complex mediated glomerulonephritis like Lupus and Post strep

3997

Medicine


RA predisposes to amyloidosis.. Suspect amyloidosis also if hav hepatomegaly and enlarged kidneys

4000

Medicine

Rheumatology/Orthopedics After str enuous moveme nt: Even if leg raise test is positiv e but n o othe r neu rological & Sports symptoms ==> Use NSAIDs Early mobilization and Muscle relaxant

4004

Medicine


Long term analsegic can cause tubulointerstitial nephritis and hematuria due to papillary necrosis,

4007

Medicine


Analsegic abuse: Papillary necrosis or T ubulointe rstitial nephritis. . Get polyuria and sterile pyuris (WBC casts)

4011

Medicine

Dermatology

Herpetic withlow is a common viral infection of the hand. It is causedby either type 1 or 2 HSV and is self limiting. Dentisits who come in contact with infected orotracheal secretions get it

4015

Medicine

Ophthalmology

Fperign body in eye: Initially pen ligh examination id negative go for F LUORESCEIN EXAMINATION

4021

Medicine

Ophthalmology

Sympathetic ohptalmia aka "spread eye injury": immune mediated inflammation of one eye after penetrating injury to other eye. It is due to uncovering of hidden antigens which means that you have antigen that are not being attacked in the eye du to some natural barriers but breaking these barriers will induce an immune response and anterior uveitis...

4027

Medicine


Uric acid stones: Alkalanise them to make them soluble: Give K+ citrate (citrate also prevents stone formation) SAME TREATMENT AS CYSTEIBNE SOTONES

4034

Medicine


EVEN IF HYPOTENSiVE DNT USE CRYSTALLOIDS KEEP THEM FOR BURN AND HYPOPROTEINEMIA

4036

Medicine


Steroids= Demarginalisation: Increase WBC and PMN's but decrease basophils esonipholis..

4040

Medicine


COPD exacerbation, besides med management give NON INVASIVE Positive-pressure ventilation

4042

Medicine


In cocaine OD give benzos not beta blocker.. can also give CCB, Aspirin, Nitroglycerine

4049

Medicine

Nervous System

in NF type I can have optic gliomas or accoustic neuromas (we diagnose accoustic neuroma with MRI and gadolinium)

4065

Medicine


ASpirin med iated r espirato ry dise ase in Hay feve r in not Ig E mediat ed bu t from prostaglandin and leukotrienes.

4068

Medicine


in PVB in MI shld nt be treated since it wldnt change the prognosis (PVB are associated with worse prognosis) and increase the risk of asystole

4071

Medicine

Infectious Diseases

Intubated patients: Think Pseudomonas ==> Cefemin, piperacillin-tazobactam, meropenem

4074

Medicine


Crypt Abscess = UC Non caseating granuloma = Crohn

4075

Medicine


Post Hemothorax (good medium for infection) empyema is common also post pneumonia empyema.. Remove empyema if localised, complex with thick rim and is not draindable .. present with fever

4076

Medicine

Dermatology

Roacutan is mainly used in non inflamatory huge acne if its inflamatorry go for topical antibiotics first

4080

Medicine


Do Hep A vaccine when u go to developing countries

4083

Medicine

Vertebral compression fracture can happen in osteoporotic people and present with Rheumatology/Orthopedics acute pain following minimal trauma (bending, coughing, lifting..) ... GET POINT & Sports TENDERNESS, BUT NEURO WISE SUPER NORMAL

4085

Medicine

Angiodysplas ia: com mon recurr ent o r occ ult pa inless lo wer ab dominal bleeding in patients age>60. They cause lower GI bleeding in patient with AORTIC STENOSIS Gastrointestinal & Nutrition (HEYDE'S SYNDROME( AND ESRD. NO COLONO FINDINGS UNLIKE DIIVERTICULOSIS (WHICH IS MOST COM MON CAUSE)

4087

Medicine


Pleural effusion of unknown etiology ==> Thoracocentesis

4089

Medicine

Nervous System

Status epilepticus (>5min) can lead to CORTICAL NECROSIS Due to overexitation, and may lead to irreversible damage

4099

Medicine

Ophthalmology

CMV retintis is painless with fundoscopic hemorrhages and fluffy granular lesions around retinal vessels.. HSV and VZV pain with keratitis, uveitis, peripheral pale lesions and central retinal necrosis

4106

Medicine


In ZE syndrome pancreatic enzymes are inactivated by excess acid

4108

Medicine


Inferior wall MI is due to RCA:LCX, 5:1.. if RCA can get AV block bcoz it supllies the AV node, and can get a Mobitz II

4112

Medicine


Vit K deficiency occurs 7-10 days after inadequate dietary intake (post op), liver disease.. prolonged PT followed by prolonged PTT

4118

Medicine


Excessive alcohol factor is a BIG Risk factor for Aspiration, also GERD, Seizures and Achalasia can do so

4123

Medicine

Dermatomyositis can be a PARANEOPLASTIC FINDING affecting muscle fibers (Unlikw Rheumatology/Orthopedics Lambert eaton affecting presynpatic membr ane calcium channels),, with symetrical & Sports muscle weakness and erythematous rash over dorsum of fingers or upper eyelids

4127

Medicine


Beta blockers are best initial treatment of STABLE ANGINA (use CCB or nitrate if BB contraindicated or not enough)

4128

Medicine


In Men II can screen with RET genetic testing if have + family history

4131

Medicine


COPD with PaO2<55 mmHg or SaO2<89 : Start on O2 OR Pulmonary HTN (cor pulmonale) OR HCT>55% (polycythemia) OR patient who become hypoxic at night (like my patient)

4147

Medicine


Phenytoin = folate

4151

Medicine

Dermatology

GVHD: T cell of donor against host HLA. ALWAYS involve SKIN also can involve intestine, liver.. (mentionned in another question)

4154

Medicine


Since OCP increase binding of thryoid hormone, if on HRT for thyroid u shld increase doe

4161

Medicine


Post pelvic fracture we might have neurogenic penile dysfunction .. Venous dysfunction is usually post tunica albuginea disruption

4165

Medicine


Once diagnose gastric AdenoCA do CT for staging

4168

Medicine

Infectious Diseases

Post ulcer osteomylitis in diabetes is through contiguous spread Direct inoculation osteomylitis is post trauma

4169

Medicine

Infectious Diseases

With acute pyelnephritis always start IV Antibiotics like Ceftriaxone.. when start to have response switch to PO like Fluoroquinolone or Trimetoprim sulfamethoxazole

4170

Medicine

Nervous System

MOST COMMON LOCATION OF ULNAR ENTRAPMNT IS ELBOW (medial epicondyle) Primary pulmonary HTN can be seen in middle aged patients, with exertional breathlenssness. Lungs are clear on auscultation. CXR show enlargement of pulmonary arteries and enlargement of right ventricle UNLIKE Pulmonary fibrosis which is associated with auscultation findings (crackles..) and lung Xray abnorm alities

4177

Medicine


4178

Medicine

Biostatistics & Epidemiology Beautiful table about bias in epidemio

4181

Medicine


Simple renal cysts are almost always benign AND REAUSSURE PATIENT TELL HIM TO GO WATCH TV. Malignancy fear include Multilocular mass, Irregular walls, Thickened septae and Constrast enhancement (COOL FACT CONTRAST IN KIDNEY MALIGNANCY unlike CYST)

4188

Medicine


Zenker which occurs in >60's ususally males with neck mass (possible) is mainly due to upper sphincter dysfunction and eosophageal dysmolity (motor issues) and is diagnosed with Barium esophgram or Eosophageal mannometry since it is motor in nature.

4190

Medicine


Remember from pharmaco TBL that late stage CHF comes with Hyponatremia

4191

Medicine


IF U GIVE SILDENAFIL AND ALPHA BLOCKER TOGETHER GIVE THEM 4h APART TO PREVENT HYPOSTENSION

4202

Medicine

Ophthalmology

When pigmentation is stated think of neurofibromatosis, and associated eye mass is Optic Glioma

4203

Medicine

Nervous System

Thalamic stroke cause sensory problem

4210

Medicine

Pulm onary & Critical Care

Aspergilloma is a m obile lesion

4216

Medicine


Hypocalcemia can occur after major surgery and in patients requiring extensive transfusions.. Will have hyperactive DTRs

4218

Medicine

Nervous System

Most common Mutation in Neurofibromatosis II (on chromosome 22) is NONSENSE DA FUCKKKK

4226

Medicine


Diffuse esophageal spasm occur in young ladies with intermittent episodes of chest pain and dysphagia

4228

Medicine


Check table for diabetic neuropathy symptoms

4243

Medicine


CHF: (LV) Decrease CO, Incresed SVR, and logically since decrease CO we get Increase LVEDV

4257

Medicine

Infectious Diseases

Rusty nail (cloue) = Pseudomonas

4259

Medicine

Rheumatology/Orthopedics Prevent Alchol in Gout coz its metabolite lactate compete with uric acid exrection & Sports

4261

Medicine


Paget = Disorganised bone remodeling

4265

Medicine

Infectious Diseases

Meningococcus: Rash, strong myalgia..

4266

Medicine


In Nephrotic get Hypercoagulable state

4267

Medicine

Dermatology

Antihistamine in mild drug allergy keep s teroid and e pi for more systemic symptom s (anaphylaxis)

4284

Medicine

Infectious Diseases

Give Oseltamivir and Zenamivir for flu only in fucked up elderly no for healthy patient who require symptomatik treament

4288

Medicine


Only give Iv ca2+ gluconate if ECG changes otherwise look for etiology and abort it

4298

Medicine


Clopidogrel: Given to prevent MI after a NSTEMI for at least 12 months.. and following PCI (30days if bare metal stents) (1yr: drug eluting stents) or if aspirin not tolerated Otherwise only give: Aspirin BB ACEi Statins

4307

Medicine


Untreated Hyperthroid are at risk of for Tachyarrythmias and Rapid BONE LOSS from increased osteoclastic activity in bone cells

4316

Medicine


Heparin induced thrombocytopenia -Type I: More common 1-4 days after heparin Platelet > 100 000 Management: Continue heparin but slowlier and observe -Type II: Much less common 5-10 days, or less than 1 days if previous hep was given this month Incerased risk of thrombosis (venous, arterial).. Necrotic lesions at hep site injection STOP HEP GIVE OTHER ANTICOAGULATIONS Due to Ab agaisnt Heparin platelet factor 4

4321

Medicine


Nonalcoholic fatty liver occurs in Diabetes cause of insulin resistance causing lipolysis everywhere and uptake of the fatty acids by the liver and triglceride production

4322

Medicine

Nervous System

Parkinson TRAP Mnemonic: Tremor, Rigisity, Akinesia, Postural instability and Shuffling gait (equivalent to hypokinetic gait)

4326

Medicine


Hypovolemic shock: SVR Cardiogenic shock: Ra P, PCWP, SVR Septic shock: Mixed venous oxygen saturation, CO(1/~ to extraction) -CO, MVO2sat and SVR (inversely proportional)=> GD if vasodilation but will get less extraction coz no P (hypotension, sepsis.. -RA P and PCWP (proportional, increase if heart problem, decrease if blood loss from circulation)

4327

Medicine

Infectious Diseases

cr ystal induced nephropathy is a well known side effects of indinavir

4328

Medicine


Achalasia: High Esoph ageal sphincter tone Scleroderm a: L ow Esopha geal s phincter tone But in botch get lower or absent lower peristaltic activity

4329

Medicine


splenomegaly is rarely seen in bone marrow Aplasia,, but do happen in bone marrow infiltration

4336

Medicine


Give statin in diabetes above 40 r egardless of levels also in CAD

4337

Medicine


In acute ill patient with renall failure, liver failure or sepsis STOP METFORMIN coz it can cause LACTIC ACIDOSIS

4339

Medicine


TTP: Anemia (hemolysis) + thrombocytopenia + Neuro (unlike HUS) + Kidney : Lethal if untreated ==> Plasmapheresis (assess improvement with normalization of platelets and LDH coz Renal and Smear may still be abnormal few weeks post recovery)

4344

Medicine


Young ladis with OCP can cause PE .. present with tachypnea tachycardia pleuritic pain and hemoptysis

4345

Medicine


In tamponade since preqssure equalises in all chambers so naturally LV will be smaller and lower LV preload and Deacrease stroke volume and CO that may cause pulmo or neuro sx

4347

Medicine


Prussian blue positive for Hemosiderin which we see in RBC hemolysis..

4352

Medicine


Non tender firm solitary lymph nodes in neck are suggestive of head and neck scc metastasis to lymph node, especially in smokers

4357

Medicine


B9 B12 deficiency will both increase HOMOCYSTEINE, and B12 will also increae methylmalonic acid

4361

Medicine


In suspected renal calculi (lower abd pain radiating to groin ie.) US or cT of abdomen and pelvis is cool.. US in pregnant ladies

4366

Medicine

Nervous System

Metoclopramide is a prokinetic agent that can cause drug induced extapyramidal symptoms

4368

Medicine

Rheumatology/Orthopedics Cord compression: Do MRI Tumor red flag in back: Xray and ESR and if bad results do & Sports MRI to still r/o other ortho causes

4369

Medicine

Lumbar Disc Herniation: Back pain +/- radiation down to one leg (usually recall an Rheumatology/Orthopedics inciting event) Sitting and and flexion makes it worse. Lumbar spinal stenosis: We have & Sports radiation with neurological signs (tingling..) relieved by flexion.

4371

Medicine

Rheumatology/Orthopedics Osteomylistis Fever and WBC unreliable (ca be normal) rely only on ESR (Staph causes & Sports it especially in drug injectors)

4371

Medicine

Osteomylitis can happen without fever or leukocytosis, we rely on ESR (hx of injection Rheumatology/Orthopedics drug use, or other infection before that like UTI) and pain.. ==> Confirm with MRI & Sports STRAIGHT LEG RAISE TEST + = HERNIATED DISC

4373

Medicine

Infectious Diseases

Immunocompromised with visceral and cutaneous angioma like blood vessels growth: Bacillary angiomatosis caused by BARTONELLA QUINTANA.. give antibiotics to regress lesions

4376

Medicine

Ear, Nose & Throat (ENT)

Meniere diseaseL Vertigo, ear fullness, tinnitus and hearing loss ==> Start with lifesyle modification: Low Salt Diet..

4381

Medicine

Nervous System

Pronator drift is an Upper motor neuron thing

4382

Medicine


PROXIMAL MUSCLE WEAKNESS WITH OR WIT HOUT ATROPHY: SUSPECT HYPO OR HYPERThyroid especially when have weight changes, mood changes, energy changes... etc.

4383

Medicine


ITP: platelets are destroyed by IgG, it is a diagnosis of exclusion. Give steroids with low count (<30K)

4384

Medicine


Increase level of homocysteine can predispose to vascular damage.. (atheros..) give B6

4387

Medicine


Lung consolidation: -Dullness to percussion -Increased breath sound (better heard)

4397

Medicine

Nervous System

Vasovagal syncope (neucardiogenic) due to high vagal tone can be preceded with nausea, diaphoresism bradychardia and pallor due to Stress, urination or Prolonged Standing IN OR or OUT OR

4398

Medicine


Tricuspid endocarditis: can cause emboli that go to lungs and causes symptoms of cough, chest pain..

4402

Medicine


In Packed RBC there iscitrate which chelates Calcium and Mg and can lowers their levels in host

4403

Medicine

Dermatology

Cherry angioma are small, red, cutaneous papules common in aging adults. They do not regress spontaneously, but they are benign and generally do notrequire treatment

4410

Medicine

Dermatology

Aktinic ker atosis: Sun expo sure-> lesions are e rythem atous papules with cent ral sca le and sand paper texture.. ==> can become squamous cell carcinoma

4412

Medicine


SLE HYPERCOAGULABILITY = HIGH PTT ( WEIRD BUT TRUE )

4414

Medicine


To prevent Acyclovir crystalline nephropathy give agressive IV HYDRATION

4415

Medicine


Radioactive iodine fuck up exophtamous so avoid it

4416

Medicine


Non white child bearing women can get SLE: Get autoimmune pancytopenia (not alway all).. and in late stage the renal disease they get is FGS

4417

Medicine

Infectious Diseases

Branching: Nocardia, Actinom yce Acid Fast: M ycobacterium , Nocardia

4419

Medicine


Asthma m eds th ink of steroids or alb uterol: anywayz b oth will produce Hypokalem ia and muscle weakness

4428

Medicine


Never use Succinylcholine with Hyperkalemia like BURN or CRUSH injuries, TUMOR lysis or Demylinating like Guillain Barre

4431

Medicine


HERPES ZOSTER IS REACTIVATED WITH IL LNESS or SEVERED STRESS LIKE CA.. CLOVIRS WIL SHORTEN COURSE AND DECREASE CHANCES OF POST HEPETIC NEURALGIA

4435

Medicine


DIURETICS MUST BE USED WITH CARE TO PREVENT RENAL DAMAGE

4436

Medicine


Hyposthenuria: inabilty to concentrate urine in sickle cell disease and sickle trait (sciling in vasa rectae of inner medulla imparing counturcurrent exchange and free water reabsoption)

4443

Medicine

Nervous System

Steroids induced myopathy is similar to polymyalgia rheumatica (of giant cell arteritis) but with normal ESR but in both CK is normal In statin induced myopathy it is like Hypothyroid one with normal ESR and high CK Steroids myopathy both are normal

4446

Medicine


Headache, nause, diziness in a per son who works in an enclosed space.. CO poisoning especially if high HCT to compensate Pvera: get high RBC and others..

4447

Medicine


Osler Weber Rendu syndrome is a hereditary telegenctasisa (Autosomal Dominant) with Widespread AVM's causing telegenctasia, epistaxis, (AVM's everywhere) and AVM's in lungs causing pulmonary HTN and eventually high HCT (like polycythemia).

4449

Medicine

Rheumatology/Orthopedics Gout can happen in myeloproliferative disorders.. since we have increase catabolism & Sports turnover

4450

Medicine


Vagal maneuvers which are helpful in SVT like putting cold stuff on face will work by increasing vagal tone and decreasing AV conductivity

4451

Medicine


Not all that wheezes is asthma ,, if patient has Uncontrolled HTN for so long think of heart failure and pulmo edem a.. Tx: O2 and ventilation, Agressive diuresis (furosemide) and possible vasodilators..

4454

Medicine


In patient taking digoxin follow up on its level coz it can cause vomiting, diarrhea, vision changes and arrythmias

4459

Medicine


AVM can cause increase preload and AVM can happen with trauma, fistula or CA

4460

Medicine

Rheumatology/Orthopedics Giant cell arteritis can cause Aortic aneurysm as complication & Sports

4461

Medicine

Nervous System

Coerneal abrasion can happen due to V1 dysfunction of Trigerminal that supllies eye

4465

Medicine

Nervous System

Guillain barre is an ascending paralysis with elevated protein on CSF ONLYYY

4466

Medicine


MM patients can get recurrent infection due to inffective antibodies.. Also get bone pain

4468

Medicine


Sickle cell usually do normocytic anemia due to hemolysis.. but can get folate deficiency with increase cell turnover and increased folate consumption.. Suplement folate to all sickle cell patients

4469

Medicine


If have Afib with no other cardiopulmonary disease==> No treatment since there is super low risk of embolisation (CHADS score of 0)

4471

Medicine

Nervous System

Consider in DDx of dementia (old memory preserved) Hypothyroid

4476

Medicine

Infectious Diseases

Chronic liver disease vaccine workup: Hep A Hep B Tdap (then every 10 yrs Td) Pneumoccocal vaccine (start always with fancy PPSV23 then sequential PCV13 and redo PPSV23 at 65) Influenza anually

4488

Medicine

Infectious Diseases

women with PID which are high risks for infections are encouraged to go for HIV, syphillis, Hep B, Hep C (if use drugs or got transfusions before 1992)

4488

Medicine

Infectious Diseases

Screen for syphilis in youngs with STF (RPR test)

4492

Medicine


UC patient should regularly screened yearly for Colon CA 8-10 year after diagnosis. We dont screen for uveitis, erythema nodosum, spondyloarthropathy or sclerosing cholangitis

4502

Medicine


NEVER SCREEN FOR BLADDER CA

4513

Medicine

Nervous System

Brain abscess resulting from sinusitus usually is due to anaerobes like Strep Viridans.. (think like tooth abscess becoming brain abscess)

4517

Medicine

Infectious Diseases

S. aureus post viral pneumonia, causes acute necrotizing pneumonia with secondary pneumatoceles, and necrotizing pulmonary bronchopneumonia with multiple nodular infiltrates that cavitates and cause small abscesses

4519

Medicine


DONT forget postnasal drip in cHronic Cough.. also Asthma and GERD can do so

4520

Medicine


COPD patient can present with Pneumothorax if having catastrophic respiraatoy findings and is usully due to dilated alveolar blebs that rupture into pleural space

4522

Medicine

antipsychotic causing Neuroleptic Malignant Syndrome presents wiith fever , muscle Poisoning & Environmental rigidity and autonomic instability and mental status change ==> give DANTROLENE CZ Exposure SERUM CK IS HIGH SO U NEED TO RELAX MUSCLES

4523

Medicine


4532

Medicine


AAA screning: any 65 -75 m ale actu al or former smoker (at lea st one screenin g in a lifetime)

4536

Medicine


In PEEP increase intrathoracic pressure so decreasure RA filling, so be careful with heart disease

4564

Medicine

Rheumatology/Orthopedics Degenerative joint disease = Osteoarthritis & Sports

4565

Medicine

Rheumatology/Orthopedics Avascular necrosis (disrup tion of bone vasculatu re): Due to chronic steroid use a nd & Sports Excessive Alcohol.. Progressive anterior hip pain with limitation of range of motion

4566

Medicine


In afebrile acute bronchitis with no complications can just OBSERV And Follow up

4567

Medicine


IN DISEASED ELEDERLY WHO ARE ON ACEi OR NSAIDs, HAVE A DECREASED GLOMEULAR FILTRATION, and + they dont feel thirst.. beware

4574

Medicine

Rheumatology/Orthopedics When RA affects the spine it affects the CERVICAL PORTION & Sports

4576

Medicine

Rheumatology/Orthopedics In Ankylosing spondylitis can get ENTHESITIS which is pain at site of tendon and & Sports ligament attachment to bone.. Heel, tibial tuberosity, iliac crest

4578

Medicine

Rheumatology/Orthopedics Ankylosing spondyltis for lo ng tim e (~2de cades) cause decreas ed bo ne mineral density & Sports and Increased risk of bone fracture even with minimal trauma.

4583

Medicine

Rheumatology/Orthopedics Baker cyst = inflamed synovium & Sports

Medicine

Polycystic Kidney do not have Proteinuria or Edema Secondary amyloidosis can occur Rheumatology/Orthopedics sexondary to chronic infection or diseases like IBD or RA.. Leading to enlarged LV, & Sports palpable kidney and hepatomegaly

4585

If acute dyspnea and dysphagia think upper obstruction

4590

Medicine

Rheumatology/Orthopedics Disseminated gonoccocal triad: Polyarthralgia T enosynovitis Vesiculopapular rash & Sports

4594

Medicine


In CHF get efferent renal eterioles constriction as a response of ATII as a result get a high glomerular pressure

4603

Medicine


acute pancreatitis is a burn and causes fluid loss as any other inflamation with increased vascular permeability in addition to release of pancreatic enzyme which cause further vasodilation Mnemonic: since we give H2O to those patients, think that the also loose water (other thand coz of burns) due to increase vascular permeability (LOL)

4613

Medicine


PE: Sudden, Chest pain, Tachycardia, Tachypnea (dyspnea) with Hemorrhagic (as Dr. Sfeir once told us), Exudative pleural effusion (With no consolidation on CXR) (25% of time it is a transudate coz no infarct happened)

4615

Medicine


Disc herniation with autonomic dysfunction will cause urinary overflow incontinence and loss of anal sphincter.. not retention

4617

Medicine


Asthma t reatme nt: In haled albutero l PRN ==> Inhaled steroid ==> LABA ==> Oral prednisone

4626

Medicine


Any liver d isease we ther h ep C or not .. give he p A and hep B va ccines ( if not g iven) I f anti HAV is positive cant tell if coz of immunity or infection.. check symptoms

4633

Medicine


Spleen kill bacterias via PHAGOCYTOSIS by dentritis cells in white pulp.. SPleen eats these mofos

4634

Medicine

Infectious Diseases

Post splenectomty wait 2 weeks before or after Sx

4639

Medicine


Hemochromatosis cause PAncreas liver heart (sick sinus sindrome (conduction problem) or dilated cardiomyopathy) testicles atrophy (loss of libido too) and bronze skin

4641

Medicine

Nervous System

MS acute episodes must be treated with steroids

4645

Medicine


COPD Increase TOTAL LUNG CAPACITY and DECREASES VITAL CAPACITY.. LIMITS EXPIRATORY AIRFL OW

4646

Medicine


Weight loss is supper effective in HTN

4647

Medicine


Put IVC filter if reccurent DVT with therapeutic INR on warfarin, or if contraindication to anticoagulant (but if fail to get therapeutic INR, change m eds)

4649

Medicine


Warfarin reduces the risk of thromboembolityc events cause despite antiarrythmic u can still have these emboli showering that were previously formed

4653

Medicine


BRAIN DEAD EQUAL DEAD.. NO NEED LEGAL STUFF ARE NEEDED TO EXTUBATE

4659

Medicine

Rheumatology/Orthopedics Paget is due to osteoclast dysfunction & Sports

4663

Medicine


Chloride is exchanged with Bicarb if metabolic alkalosis compensation is needed

4665

Medicine


In COPD diaphragm flattens increasing the work of breathing

4668

Medicine


Endocarditis presentation

4676

Medicine


QT syndrome:congenital prolonged or shortened QT associated with deafness (+mild chance of developing Afib) Afib with no cardiac or pulmo disease, think of DM, Hyperthyroid, Obesity, Alcohol abuse, and stimulant abuse

4679

Medicine


In MI, can hear S4 like in hypertrophic cardiomyopathy because we have stiffness of the Ventricles due to ischemia.

4685

Medicine

Dermatology

Firm, Flesh colored, domed shape, umbilicated apules are typical of MOLLUSCUM CONTAGIOSUM due to Celluar immunodeficiency, Steroid use, Chemo, HIV

4693

Medicine

Dermatology

Hepes zoster may reappear after immunosupressant therapy (TNF alpha inhibitor: infliximab) in a dermatomal fashion starting with erythematous papules then to vesicles, bullaes the crusting a week later

4700

Medicine

Nervous System

confusion, ataxia, ophtalmoplegia (CAN) in malnourished alcoholics (homeless) : Wernicke's ==> Treat with Thiamine before giving anything else even if malnourished (Thiamine before Dextrose or worsen Wernicke's)

4706

Medicine


Acute ASTHMA COCKTAIL with low resp iratory drive and m uscles and r espirato y failur e INTUBATION VENTILATION SABA ANTICHOLINERGIC STEROIDS

4707

Medicine


Diastolic dysfunction is due to impaired ventricles relaxation which will diminish their compliance and will cause left atria dilation and Afib.. upon lying will have backflow to lungs and dyspnea ==> Treat with Diuretics and antihypertensives

4709

Medicine


IN HEMODYNAMICALY SVT: VAGAL MANEUVERS, ADENOSINE, CCB UNSTABLE: DC CARDIOVERSION

4714

Medicine

Infectious Diseases

Infective endocarditis can cause splenic abscess causing pleuritic chest pain

4716

Medicine


Malignancy and Respiratory sx ==> Hypercoagulable state: PE's ==> Right heart failure (RV dilation)

4718

Medicine


In COPD if u give too much O2 u will supress the drive for respiration (normally it is dependant on CO2 but in COPD it becomes dependant on low O2) .. So lower respiration and CO2 will accumulate and BAM seiures... etc (WEIRD SHIT)

4722

Medicine


high PTH cause HTN (WTF)

4725

Medicine


Only in Vtach Pulseless Electrical Activity DEFIBRILLATE, otherwise CPR

4726

Medicine


Grave's ophtalmopathy presents with impaired gaze and diploplia, with increase retroorbital tissue (ct, muscularm adipose tissue and lymphocityc infiltrate).. risk factor for ophtalmopathy is old (50 is old here) female smoker

4728

Medicine


With age baroreceptors get tired causing orthostatic decrease in BP

4730

Medicine


like my patient on 5 south: she stopped smokin but is still COPDer. On exacerbation we gave her O2, br onchodilators, AB's and systemic steroids

4738

Medicine


Smoking and AAA is MAX association

4740

Medicine


In MI, if get water in lungs and regurg murmur it is due to papillary muscle ischemia or rupture..

4742

Medicine


never use Beta Blocker with Asthma !!!

4747

Medicine


SAAG >1.1: Portal HTN <1.1:TB, Peritoneal CA, Pancreatic ascitis, Nephrotic syndrome Bloody: Trauma, TB, CA Milky: Chylous or Pancreatic. Turbid: infectious PMNs: <250: No peritonitis >250: Peritonitis Protein: <2.5; Cirhosis or Nephrotic (because loss or inability to produce proteins) >2.5: Everything else In liver early stage we have ascites due to venous pressure in Portal HTN, in cirhosis it cz low albumin

4749

Medicine


Urinary outflow obstruction presents with flank pain, low volume voids with occasiona High volume voids, and can cause renal dysfunction if bilateral

4750

Medicine


In diabetic nephropathy you get Glomerular basement membrane changes, with progressive GFR deecline. Pathologic hallmark is nodular glomerulosclerosis nodular or diffuse

4751

Medicine


Hematuria: Initial: Urethral Terminal: Bladder or Prostate Toral: Kidney or Ureter In Kidney bleeding dont see clots


In acute pneumonia with consolidation patients can have persitent blood flow to areas with impaired ventilation.. Positioning of patient with affected lung can worsen shunt (il left consolidation shld not position him on his left side but on right to draw away blood from poorly ventilated area)


Pulsus paradoxus (drop in BP of >10 on inspiration) in pericardial fluid (Tamponade or pericardial fluid by the same rationale we get variation in QRS; inspiration restricts LV volume so lower BP), Asthma, COPD (coz inspiration will drop intrathoracic pressure by much more than normally, so most of blood will be located in chest as in the lungs and less to systemic circulation and BAM lower BP

4770

4771

Medicine

Medicine

4807

Medicine


Interstitial cystitis (paiful bladder syndrome): idiopathic, chronic with Bladder Pain worsened by filling and relieved by urination (a bit like IBS). Also get Dyspareunia and Frequency Treat with Behavioral modification Amitryptilline and Analsegic for exacerbations (Like fibromyalgia, IBS etc..)

4860

Medicine


ITP should m ake you suspicious for HIV and Hep C

4860

Medicine


Low Platelets with no know cause or no clues: Test For Hep C and HIV which commonly cause ITP

4866

Medicine


In metabolic alkalosis give normal saline infusion

4867

Medicine

Infectious Diseases

post flu pneumonia is Staph pneumonia (superimposed)

4902

Medicine


Otosclerosis is a common cause of conductin hearing loss in 20s and 30s

4909

Medicine


S4 comes just before S1 can even confuse it with S1 and think there is a murmur.. it occurs from longstanding HTN causing LV hypertrophy MVP: mid systolic click and a late systolic murmur heard best over the cardia apex

4913

Medicine

Nervous System

Essential tremor: Bilateral action tremor of the hands, without leg involvement. No other neuro signs, can present with head trem or without dystonia Parkinson: Resting tremor and decrease with voluntary movements, involve legs and hands, and less commonly facial involvement Cerebellar: with ataxia, dysmetria or gait disorder. Increases with movement (finger to nose test) Physiologic: not vsible, increased with stimulants. Worse with movements and can involve face and extr

4914

Medicine

Nervous System

Essential T remor : Give Beta Blocker (caffeine not very m uch associated with the trem or)

4920

Medicine


PSVT: Dont see P waves Give Adenosine If sinus Tachycardia, see P waves So it most likely Anxiety

4922

Medicine


Dependat effect = seen when increase rate QRS widening in IC : coz they have not time to dissociate from the channels and will cause this widening (in normal rythm they have time to dissociate before furthur rythms) PR prolongation in CCB: coz they cause prolongation of the refractoy period of the AV node

4927

Medicine


Wathever is the case when someone is obtunded intubate even they talk about varice bleeding.. Before u put a scope intubate

4934

Medicine


Drugs that cause esophagitis: Aspirin, NSAIDs, Alendronate, Tetracycline, KCl Fe Quinidine

4938

Medicine

Infectious Diseases

Histosplasma in Central and South US diagnosed in urine, bone marrow if affecting it, or antigen but less sensitive and takes more time. Treated with amphotericin in AIDS or itraconazole (usually in immunocompetant pple)

4938

Medicine

Infectious Diseases

Histoplasma is diagnosed through urine testing

4939

Medicine

Infectious Diseases

Trest H(I)stoplasma with (I)troconazole

4940

Medicine


Salvage therapy is complementary post surgery, unlike Adjuvant is used if surgery fails

8331

Medicine


Trimethoprim cause Hyperkalemia (blocks epithelial sodium channel in collecting tubule).. and inhibitis with Cr filtration giving HIGH Cr but with no change in GFR

8819

Medicine


THINK of coarctation if epistaxis, headaches, LVH with ST and T waves changes and QRS increased voltage in left heart, HTN

8822

Medicine


Delayed (wake up late like chris who is always delayed)or Advanced (sleep early like ME i am advanced) sleep phase syndrome are independant of socoal stress or job etc.. if depends on activity etc. it is poor sleep hygiene

8823

Medicine


Advanced sleep phase disorder : like Chris can ot wake up well in mor ning Dela y sleep phase syndrome: Cannot sleep early like Chris too

8866

Medicine

Infectious Diseases

Quinolones can cause tendinopathies with Achilles most common (on average 8 days after the drug started, but can start as soon as 1 day).. Patient shld stop the drug avoid exercice..

8876

Medicine


Wilson and hemochromatosis can lower blood calcium!!! but with normal to low PTH (NOT HIGH LIKE EXPECTED)

8880

Medicine

Infectious Diseases

HACEK Endocarditis like other endocar ditis com e fom oral infection

8894

Medicine


Best screening test for thalassemia in preconception is CBC (THUG LIFE!!)

8905

Medicine


Sometimes asthma can presents first time in ADulthood How to tell Asthma from COPD: Diffusion capacity (DLCO): Reduced in COPD, Normal in Asthma

8918

Medicine


Risperidone causes hyperprolactinemia but doesnt affect rest of axis like thyroid..

8925

Medicine

Ophthalmology

Viral conjuctivitis or pink eye is self limited and just need cooling and moisting

8929

Medicine


Cystoscopy: Gross hematuria with no glomerular disease Microscopic hematuria with no glomerular disease or infection and increase risk of CA Recurrent UTIs Obstructive symptoms Irritative symptoms without UTI Abnormal imaging or urine cytology

8959

Medicine

Infectious Diseases

If candida eosophagitis u see oral thrush.. otherwise viral

9885

Medicine

Infectious Diseases

Cryptoccocal (no MRI findings) is chilling meningitis in AIDS unlike HSV (see temporal involvement in MRI) JC (white matter patchy area suggesting demylination on MRI) or Toxo who presents with ring lesion

10145

Medicine

Poisoning & Environmental Cyanide block oxidative phosphorylation and promote anaerobic metabolism causing Exposure LACTIC ACIDOSIS, by binding to ferrous in cytochrome oxidase a3 in mitochondrial ETC

10146

Medicine

smoke inhalation victims can get cyanide toxicity and shld be treated empirically with Poisoning & Environmental HYDROXOCOBALAMIN or SODIUM THIOSULFATE or with nitrites to induce Exposure METHEMOGLOBINEMIA

10179

Medicine


CCB can cause peripheral edema

10287

Medicine


Hematuria suggest GLOMERULAR DIASEASE IF have PROTEINURIA, DYSMORPHIC RBC and RBC casts (usually microscopic hematuria unlike non glomerular)

10434

Medicine

Rheumatology/Orthopedics Pyoderma gangrenosum: Purulent base painful ulcer with violaceous borders, & Sports Associated with IBD

10485

Medicine

Dermatology

HPV CAN DO PLANTAR WARTS (FOOT) IN YOUNG AUDLTS OR IMMUNOCOMPROMISED

10553

Medicine

Dermatology

Autoimune alopecia areata : rou nd los s Pressur e indu ced a lopecia: is post op.. Trichotillomania: is due to hair plucking but dont get regular loss pattern T inea capitis: Scaly, erythematous, with residual black dot. Possible painful lymphadenopathy. In Blacks. (Human to Human, or formite transmission) Diagnosed with KOH .. treated with Griseofulvin

10763

Medicine


Nitroprusside for long time = CN toxicity: lactic acidosis, seizure, coma, alterend mental status ==> treat with amyl nititre.. or glutathione

10764

Medicine


Constrictive pericarditis: Important cause of Right heart failure with progressive edema, ascites, elvated JVD and pericardial knock (m iddiastolyc sound) and pericardial calcification on CXR

10767

Medicine


Scleroderma crisis: Acute renal failure,, proteinuria malignant HTN microangiopathic hemolytic anemia: thrombocytopenia and fragmented RBCs

10904

Medicine

Infectious Diseases

In TNF antagonis beware of live vaccines like MMR, Varicella, yellow fever, and intranasal influenza. Meningococcal shld be give at 11 and regiven at 16 if high risk of first year college give back above 21 if high risk

2330

Obstetrics Female Reproductive & System & Breast Gynecology

In lower abd pain: Do HCG before any workup

2345


Palpable breast mass: If below 30 do only US if above do M ammo (+/- US).. if cyst do needle aspiration (not obliged) if suspicius for malignancy or complex cyst (solid mass) do image guided core biopsy

2362


Fat necrosis has similar radiographics than breast cancer, including skin or nipple retraction and calcifications on mammography. Biopsy will reveal fat globules and foamy histiocytes in fat necrosis. DONT TREAT

2372

Obstetrics Pregnancy, Childbirth & & Puerperium Gynecology

Post tonic clonic seizure can have Erb duchenne like presentation due to posterior shlder dislocation

2389


All ladies with abscence of men ses fo r mor e than 1 month sho uld be evaluatd for pregnancy wathever are the season

2391


Endometrial biopsy is indicated for evaluating abnormal uterine bleeding in: Women >45 and all postmenopausal women Women age <45 with persistent symptoms or risk factors fo endo CA like (obesity, diabetes, unopposed estrogen exposure, PCOS, early menarche/late menopause) Prolonged amenorhhea with anovulation

2392


Combined OCP reduce BREAST, OVARIAN and ENDORMETRIAL CA but increase BP

2393


Copper intrauterine device can be used within 3-5 days of unprotected intercourse and is effective fro precoital or postcotal with 99% efficacy. OCP are less effective (good for emergencies)


Primary dysmenorrhea is normal crampylower abdominal/back pain during menses which is due to prostaglandin release and is normal. Endometriosis triad: Pain (peaks before menses), Dyspareunia, infertility Fibroids: Heavy menses with clots, constipation, urinary frequency, pelvic mass/heaviness, enlarged uterus on exam Adenomyosis: Dysmenorhhea, pelvic pain, menorrhagia, bulky globular & tender uterus Pelvic congestion: Dull pelvic ache that worsens with standing + Dyspareu

2398

Obstetrics Renal, Urinary Systems & & Electrolytes Gynecology

Stress incontinence: Do Kegel exercicie to strenghten base of pelvis, and do urethropexy by adjusting angle of urethra It can be diagnosed by a cotton swab insertion intro urethral orifice showing an angle of >30degree upon increase in intrabdominal pressure Oxybutinin is given in urge incontinenece (detrusor hyperactivity; sudden urge to urinate not related to increase intaabdominal pressure)

2404

Obstetrics Endocrine, Diabetes & & Metabolism Gynecology

Oral glucose tolerance testing shld be performed in all pregnant ladies at 24-28 weeks of gestation to screen for gestational diabetes

2405

Obstetrics & Pulmonary & Critical Care Gynecology

Amniotic f lui emb olism s yndrom e typica lly pre sent with rapid onset respirat oy failu re, severe hypotension and DIC, during labor or immediate postpartum period. Clinical dx and Supportive management.. Bad condition with poor outcomes

2406

Obstetrics & Cardiovascular System Gynecology

Bilateral lower leg edema is normal in pregnancy.. Always be suspicious for DVT but if no signs just send patient home

2407


Placental abruption: (bleed in 80% of cases) Abdominal pain Uterine tenderness Uterine contractions with increased tone Recurrent late or variable decelrations with bradychardia and does not improve with resucitation measures

2408


Raloxifene: Antagonist in breast and vagina (good) Bone tisue agonist also good BUT BUT not so fast, it INCREASES RISK of thromboembolism

2409


Asthma dr ugs like inh aled bec lametha sone or albuter ol are sa fe durin g preg nancy

2410


Tamoxifen Antagnist on breast tissues Agonist on endometrium (increase risk of CA) Decrease risk of osteporosis

2411


Transvaginal US is better than Transabdominal US for ectopic diagnosis, and should be performed when BHCG are between 1500-6500 (coz below 1500 not visible.. a doubling bHCG every 2 days is normal pregnancy if rise is slower suspect abnormal pregnancy..

2412


Breech presentation before 37weeks is normal, and these convert to vertex by 37 week usually. External cephalic version is indicated after 37 weeks if still breech--> IF fail--> Csection must be planned

2413


PCOS patient have unbalanced estrogen (no progesterone) resulting in endom etrial hyperplasia and potential endometrial CA

2415


Pregnancy luteomas and thea lteum are most common causes of hyperandrogenism in pregnancy. Luteomas:Solid masses on US + virilization. DONT MANAGE Theca Luteum: Cysts and unlikely will cause virilization If underlying cause is molar pregnancy do D&C

2416

Obstetrics & Infectious Diseases Gynecology

PID: inpatient: If high fever, failure to respond to PO antibiotics, inability to take PO due to nausea, vomiting, pregnancy, and people with noncompliance risk GIVE cephalo + doxy

2394

2418


In women with AUB do endometrial biopsy. If hyperplasia with no atypia give Progestin (no mixed OCP to Obese >35 women to avoid DVTs.. ) If have atypia do Hysterectomy

2419


PMS: mood swing, irritability, fatigue, bloating and breast tenderness. Sx occur in the 1-2 weeks prior to menses and resolves with onset of menstrual flow. Dx is confirmed by menstrual diary Tx: first line is SSRI (intermitently of continuously throughout cycle)

2420


Vaginismus (pain and tightness upon intercourse): Tx with relaxation techniques, Kegel exercices (relax vaginal muscles) and insertion of objects gradually increasing in size to encourage desensitization

2423


Grave's in pregnancy: T SH antibodies cross placenta. So baby will have it Affected infant: Irritable, tachucardic, does not gain weight --> Give beta blocker and Methimazole until symptoms subside

2523


Placenta previa: Risk factor: Prior placenta previa, Csection or uterine surgery, multiparity and advanced age Painless 3rd trimester bleed with uterine contraction Dx: transabdominal US followed by transvaginal (dont do digital exam) The lack of abdominal pain r/o placental abruption (ischemic pain.. )

2525


In previa, hen bleeding and m om's vitals cannot be controlled do immediate Csection even if <34, and may discover accreta during surgery which can be the cause so must do hysterectomy. Reason can be uterine atony, DIC or placental abruption.. Give steroids and wait if situation stabilises

2527


Painful 3rd trimester vaginal bleed with hypertonic uterus is mostl likely abruption risk factor: HTN, smoking, cocaine..

2528


Placental abruption: Risk factor: HTN, trauma, cocaine, cigs Presentation: Sudden vaginal bleeding, Abdominal/back pain, high frequency low intensity contractions, Hypertonic tender uterus US to r/o previa: but if mentionned recent US was normal go immediatly for management If stable >34 NVD trial Unstable or bad fetal heart rate: Csection

2530


Placental abruption: risk factors: Maternal HTN, preeclampsia, eclampsia, abdominal trauma, prior abruption, cocaine, tobacco Presentation: Sudden onset vaginal bleeding, abdominal or back pain, high frequency, low inensity contractions, hypertonic tender uterus Dx: by clinical presentation, US to r/o previa. T x: Unstable or low fetal heart rate--> Csection Stable: >34 NVD trial

2531


Symptomatically uterine rupture can be discerned from placental abruption in that baby's position (station) will change and may feel abdominally his organs passing through the rupture Risk of Placenta accreta is also increased with previous Csection (when uterus is next to scar)and can also cause bleeding..

2532


Uterine rupture: Risk factors: Uterine scars or abdominal trauma Sx: Sudden onset abdominal pain, fetal heart rate abnormalities, and recession of babie's position when in active labor.

2533


Antepartu m ble ed: Nor mal: Intermit tent p ain with contract ion, cm all amo unt of blood-tinged mucus Placental abruption: Sudden-onset vaginal bleeding, abdominal pain, hypertonic/tender uterus Placenta previa: Painless vaginal bleed, low lying placenta Uterine rupture: Sudden-onset vaginal bleeding, constant abdominal pain, cessation of contraction, palpable fetal parts, fetal deterioration Vasa previa: Painless vaginal bleed occuring on ROM, fetal deterioration (bradycardia.. )

2535


If pregnant bleeds a lot, and hemodynamically unstable give her IV fluids first if still bad go for Csection not NVD as it can be previa..

2536


Incomplete abortion: Bleeding, partial passage of tissue (open cervix). If hemodynamically stable Tx: expectant, misoprostol or D&C

2541


Spontaneous abortion (mscarriage) can be managed with expectant management, prostaglandin (not oxytocin coz nt enough oxytocin receptors early in pr egnancy) or surgery D&C which is manadatory if hemodynamically unstable.. If abortion become septic take blood and endometrial cultures and start on broad spectrum

2542


Check For complete incomplete threatened abortion pictures..

2543


After an y proce dure or incid ent th ere is possibility of fet o mate rnal b lood m ixing. so give give Rhogam within 72 hrs in unsensitized Rh negative women.

2544


The only difference between inevitable and complete abortion is that in complete abortion the cervix has closed.

2545


Septic bortion: retain products of conceptions it can be also missed, incomplete or inevitable abortion (rare).. Fever, chills, lower abd pain, bloody or purulent vaginal discharge, Boggy, tender uterus with dilated cervix. See on US retained product of conception, increased vascularity, echogenic material in the cavity, thick endometrial strie.. Give IV antibiotic (and cultures of blood and endometrium) + D&C and hysterectomy if fully complicated.. Bad complications

2546


Endometriosis (also endometrioma in ovary) is a common cause of: infertility and chronic pelvic pain. Dx by laparo then Bx

2549


In Fetal demise shld induce mother into laber. F ibrinogen and platelets are in the low normal range indication begining of DIC

2552

Obstetrics Psychiatric/Behavioral & & Substance Abuse Gynecology

Pseudocyesis Women presents with sx and signs of pregnancy (amenorrhea, breast and abdominal enlargment, morning sickness, weight gin, sensation of fetal movement and reported positive urine pregnancy test per the patient) In clinic no pregnancy It is seen in women with strong desire to become pregnany. Depression caused by this condition will cause hormonal changes similar than those in pregnnacy Form of conversion disorder (psych evaluation)

2561


If have Hypermagnesemia while treating severe preeclampsia with delayed DTR stop it and give calcium gluconate

2567


Elevated AFP is seen in: neural tube defects, gastroschisis, omphalocele, and multiple gestation (in this case look for do not adequate estimate of date revieling multiple gestation).. Do US to evaluate anatomy etc.

2568


If abnormal quad screen do US to check natomy. then amnio if 16-20 or chorionic if 10-13

2572

Obstetrics & Nervous System Gynecology

Fetalhydantoin syndrome (Phenytoin use) Small body size, microcephaly, digital and nail hypoplasia, midfacial hypoplasia, hirsutism and cleft palate and rib anomalies

2607


Paget of breast: eczematous rash near nipple that does not improve with topical treatment (usually have underlying AdenoCa)

2608


In HER2 (+) Ca, which require Trastazumab aka Herceptin (adjuvant or for metastatic disease) It causes CARDIOTOXICITY, particularly if low EF so do echo before administration of drug

2611


In fibrocystic disease, aspirate cyst (shld show clear fluid and mass deisspearance otherwise do bx) then observe for 4 to 6 weeks

2612


In breast CA. FISH immunohistochemical staining will detect or not oncogene HER2 which is responsive to trastuzumab and anthracycline chemo

2613


Screening for ovarian cancer with CA125 and pelvic US is not recommended unless have some genetic predisposition such as BRCA

2804


In pregnancy: High progesterone stimulates respiratory centers in brain to cause increase tidal volume, increased minute ventilation, increased PaO2, so get a physiological compensated respiratory alkalosis

2925

Obstetrics & Gastrointestinal & Nutrition Gynecology

Pruritis, high bile acids, high liver enzymes = intrahepatic cholestasis of pregnancy. Dx of exclusion. Jaundice is uncommon (if there, need futher workup..)

3106


Vaccines in pregnancy Routine: Tdap, inactivated influenza Special circumstances: HepB, HepA, Pneumococcus (2n,3rd trimester), Hflu, Meningococcus (in addition to high risk if 19-21 livingin dorms), Rhogam Not recommended: HPV, MMR (but not a big deal if was given by mistake, dont treat), Varicella. Live influenza (in the last 3 avoid 4 weeks before pregnancy)

3110


IF low or absent fetal movement felt by mom fo Non Stress test..

3111


Non stress test shld be perfrormed at least weekly in the third trimester especially if there is maternal comorbidities as HTN.. Normal: >2 acceleration Abnormal: <2 accelerations or recurrent variable or late deceleration

3112


Late term pregnancies are at risk for uteroplacental insufisciency: Antenal surveillance should begin at 41 weeks gestation to detect fetal comprom ise suggested by abnormal heart rat patterns, decreased fetal activity and oligohydramnios

3116


Arrest o f labor : no cervical change for >4h rs de spite co ntraction s OR no cervical changes for >6hrs with inadequate cotraction Here give Oxytocin otherwise observe..

3118


Women with breech presentation >37 shld try externla cephalic version. Avoid ECV if Oligohydramnios, Placental abnormalities (previa, abr upto), Hyperextended fetal head, Fetal or uterine anom aly, Multiple gestation

3120


Check table differentiating fibroids, adenomyosis...

3269


Preterm labor <34 weeks shld receive TOCOLYTICS (ccb, bb) MgSO4 for neuroprotection and STEROIDS for lung maturity

3271


False labor (in last 4-8 weeks of pregnancy) Irregular contractions are felt in lower abdomen, occur at a stable interval (in true labor become more frequent). These are relieved by sedation unlike real labor GO HOME BITCH

3273


In severe congenital anomaly (renal agenesis.. ), and PROM. Labor shld be allowed to proceed even if very early in gestation since baby is not gna live anyway

3274


L/S < 2 = lung immaturity. Before 34 weeks ROM shld be treated with steroids

3275


Fetal distress (late deceleration etc. ) : C section urgently, even if premature

3277


GBS: Screening: 25-37 weeks Indication for prophylaxis with penicillin Prior birth to an infant with early ONSET GBS GBS bacteuria of UTI at any time during pregnancy Unknown status with 1 of the following: <37 weeks, intrapartum fever or ROM for >18 hrs

3278


Ultrasound dating with fetal crown-rump measurement in the first trimester is the most accurate way to determine estimated gestational age. It should not be changes if have contradictin values in 2nd and 3rd trimester. In other words early in pregnancy standard for giving an estimated age are more accurate since all babies will almost be alike..

3279


Cause of intrauterine growth restriction: Vascular diseases, HTN(asymemetric fetal growth restriction), aneuploidy, intrauterine infection and substance abuse (cocaine)

3280


Symmetric growth restriction is caused by Fetal anomalies Abnormal fetal karyotype Early maternal infection Asymetric (usually appear late in pregnancy) Vascular disease HTN DM Smoking

3281


Oligohydramnios is a common complication of late term and postterm pregnancies (if low amniotic fluid shld induce) THINK of it as in the baby is getting bigger so is taking place of amniotic fluid Long term pr egnancies risk Fetal: Oligo, meconium aspiration, stillbirth, macrosomia, convulsion MOM: Csection, infection, post partum hem orrhage, perineal trauma

3337


In pospartum settings: Low grade fever, Leukocytosis and vaginal discharge are normal findings. Initially bloody discharge, then serous and finally white to yellow in color days following delivery..

3338


When breast is congested in a lactating women that is not br eastfeeding, do not frequently empty breast as it would induce more prolactin and milk production..and dont give estrogen as it will increase risk of thromboembolism DO weartight fitting bra, avoid nipple stimulation and use ice packs and analsegics.. This will also supress milk production

3339


Lactation is not a reliable Contraception method so give these women Progestin only since combined OCP may decrease milk production

3340


LAcating women have prolactin which will inhibit GnRh hich will decrease FSH and LAH ==> anovulation and amenorrhea.

3359


Do PAP smear starting 21 OCP side effects: those that improve with continued use: nausea, bloating, breast tenderness those who are unrelated to course: Breakthrough bleeding (most common, and usually when estrogen is low.. ) HTN, increased risk for cervical cancer, Venous thromboembolism, amenorhhea.. NOT weight gain

3365


Structural abnormalities in uterus or fallopian tubes are assessed by a hysterosalpingogram: Risk factor for tubal disease: PID

3367


in PCOS give Clomiphene citrate to induce ovulation metformin also is good to be given

3368


Premature ovarian failure: Amenorrhea (3 month of duration), hypoestrogenism, High GnRH in women <40 Important to diagnose to prevent osteoporosis cause: follicular atresia or low initial number of primodial follicles, mumps, oophoritis, irradiation or chemo. Some autoimmuneAssociated with Hashimoto, Addison, Type I DM, Pernicious anemia If desire pregnancy do InVitro with donor oocyte

3370


In ovulatory phase unlike other stages, mucus is thin, pH 6.5 or higher (more basic than usually) and demonstrate "ferning" on microcope smear

3371


In hypogonadotripic hypogonadism (severe exercice, severe stress, eating disorder.. ) as amenorrhea cause give GnRH pulsatile therapy to induce ovulation and fertility

3480


Mittelschmerz phenomena occurs in midcycle (with no other problems cycle normal nor fever..) The pain results from ovulation itself (unilitareal at side of ovulation)

3639


Gonococcal cervicitis: Mucopurulent discharge and Friable cervix with easy bleeding Dx: Nucleic acid amplification testing Treatment: #3d Cephalo + Azithro or Doxy (to cover for chlamydia too)

3656


Nystatin for oral candidiasis. In vaginal (pseudohyphae on wet mount..) give Fluconazole. (parteners dnt need to be treeated)

3676


Toxo triad: chorioretinitis, hydrocephalus, intracranial calcifications

3678


HIV: prenatally start mom with 3 HAART drugs and prophylaxis AB's when <200CD4, and avoid amniocentesis (test HIV load avery 3 months) Intrapartum management, avoid artificial ROM, fetal scalp electrode or any kind of instrumentation IF mom not on HAART give zidovudine, and if viral load above 1000 do Csection too After birth give infant Zidovudine for>6weeks plus serial HIV PCR testing

3679


Trichonomas (flagellated) vaginitis: vaginal, malodorous (fishy), thin, frothy and yellow green discharge (pH>4.5) Candida: significant vulvar inflamation and thic vaginal sichage (normal pH) odorless (cottage cheese like)

3682


Trchonomas: thin vaginal discharge, erythematous vaginal mucosa, motile pear shaped organisms on wet-mount Tx: Metronidazole

3707


Gardenella = profuse gray malodorous (fishy odor accentuated with KOH) discharge with pH 5 to 6.5. See clue cells (epithelial cell coateed with bacteria) on wet mount prep. Itching and burning are not usual. Give metronidazole

3745


Vaginal cancer sx: Malodorous, bloody vaginal discharge. Irregular mass, plaque or ulcer on vagina SCC: >60, HPv (16,18), cigarette use (same risk factor as Cervical CA) and involve upper third of posterior vaginal wall. Dx by Bx Clear cell adenoCa: <20, in utero DES exposure, involve upper third of ANTERIOR vaginal wall. Dx by BX

3748

Obstetrics Social Sciences & (Ethics/Legal/Professional) Gynecology

A pregn ant wom en take s whatev er de cision she wants ev en if she pu ts her fetus is danger, as long as she is competent

3757


Ggenital warts (condyloma acuminata) HPV presents as clusters of pink skin colored lesionswith a smooth teardrop appearance on genitalia. Patients are asymptomatik, but pruritis pain and bleeding are all possible. Acetic acid will turn them white If smal Trichloroacetic acid or podophylin will remove them. If large excision or fulguration (electric current) is applied. Regardless of treatment there is high recurrence rate

3814


Menopause Increased FSH, LH with FSH/LH >1

3862


Endometriosis: Chronic pelvic pain, dyspareunia, infertility, sometimes bowel/bladder problems. Tx: NSAIDs, OCP, Progestins, GnRH agonists. If complicated, or refractory to treatment do sx

3869


Most cases or recurrent variable decelration is managed with O2 and change in maternal position. It is abrupt and less than 30 sec from nadir of contraction (what i wrote in other note is wrong)

3914


If have HTN while taking OCP, stop the meds as it can reduce the BP. And dont give OCP to HTN women

3953


Anorexia complicatio ns: Ost eoporo sis, hig h cho lestrol and caroten e, ca rdiac arrythm ia (prolonged QT interval), euthyroid sick syndrome, Hyothalamic axis fucked up and androgen deficinecy, hyponatremia due to excess water and other electrolyte abnormalitites due to purging. Women with current or previous anorexiaare at risk for miscarriage, IUGR, hypermemesis gravidarum, premature birth, Csection and postpartum depression

4122

Obstetrics Rheumatology/Orthopedics Osteoporosis risk factors: Advanced age, Menopause Thin body, M alnutrition Cigarette & & Sports Alchol in enxce ss Steroids Family h istory Asian, Cau casian Gynecology

4124


In pregnancy Free T 4 increase and TSH decrease therefore, since there is an increase in thyroid globulin binding protein. (Dont forget that also TSH is affected)

4135


HCG (by syncitiotrophoblast) preserves corpus luterum until the placenta produces progesterone itself

4136


Menopause (similar sx as hyperthyroid) Irregular, absent menses Heat intolerance flushing insomnia, night sweats Shld check serum TSH and FSH levels

4146


One side effect of epidural is Hypotension (10%) due to blood redistribution to Lower extremities (venous pooling) from symathetik blockage down there==> can result in decreased placental perfusion and fetal acidosis so give IV prior to anesthesiato expand intravascular volume and positioning to left to improve venous return, and can resort to vasopressor if need to Leakage of CSF is when by mistake puncture dura, so patient will have postural headache (LP) not hypotension

4148


BUN and Cr decrease in pregnancy as there is an increase renal plasma flow and glomerular filtration rate

4149


In obese menopausal women u have conversion of androgen to estrogen in fat !! mider menopausal sx

4156


Pregnant with syphyllis: Give penicillin, if allergic desensitize If untreates: stillbirth, neonatal death, mental retardation

4162

Obstetrics & Hematology & Oncology Gynecology

ABO incompat ibility cau ses less severe hemolyt ic diseas e of newborn (most are asymptomatik with mild anemia and neonata jaundice successfully treated with phototherapy) than Rh(D)

4174


Newborn care: Removal of airway secretions Drying the infant and keep it wrm Erythromycin in eye, Vit K supplementation

4193

Obstetrics & Hematology & Oncology Gynecology

Rhogam (anti-D antibodies) must be low in a women even after delivery of Rh(+) if high it is due to inadequate Rhogam infusion after delivery.. Kleihaue Betke test is done to determine the ammount of fetal blood in moms circulation to know how much rhogam we shld give her

4194

Obstetrics & Male Reproductive System Gynecology

Infertile couple: After Hx taking take semen analysis (easy cheap r/o male factor)

4220


Seconday amenorrhea is abscence of menses for >3cycles or >6 months in women who menstruated previously Workup: BetaHCG, followed by PROLACTIN, TSH and FSH (for premature ovarioan failure)

4221


TRH stimulates prolactin production .. (so hypothyroid --> Hyperprolactin)

4223


(2n 3rd trimester)Hyperinsulinemia due to hyperglycemia cause -Increase metabolic demand-> Hypoxemia-> Erythropoiesis-> Polycythemia -Organomegaly: Heart, liver.. -Macrosomia: Shoulder dystocia -Neonatal hypoglycemia In first trimester you get Congenital heart disease, neural tube defects, small left colon syndrome or even spontaneous abortion

4225


EPidural anesthesia in labor impairs bladder function causing urinary retention and overflow incontinence. Put short term indwelling catheter

4242


If young lady presents with a lump ask her to r eturn after menses to check if it has regressed

4245


Sheehan syndrome: Failure to lactate, hypothroid.. due to ischemic injury to puituitary pospartum..

4272


Give Hep A and B vaccines in pregnancy if potential risk that mom infected..

4283


Athletes with extreme exercicing will have rreduce GnRH, FSH, LH and h ence r educed estrogen producing amenorrhea associated with infertility, vaginal atrophy, breast atrophy and osteopenia

4294


Renal colic in pregnancy is done with ultrasound not CT (low dose CT may be done if 2nd,3rd trimester)

4472


UTI in pregnancy: GIVE: NITROFURANTOIN, AMOXICILLIN, AUGMENTIN, CEPHALEXIN AVOID Tetreacycyline, fluoroquinolone or TSM-SMX

4496


Aromatase deficiency: prevent s the convers ion of androg ens to estroge ns. Virilizatio n of the XX kid so affected girl have normal internal genitalia with ambiguous external genitalia, and low estrogen leading to high FSH (as feedback)

4528


Anti D shld be given at 2 8-32 wee ks and a fter de livery --> T o preve nt antib ody form ation

4529


TO do tests in pregnancy All: cervical cytology (nway doin it), Rh and antibody screen, CGC(for Hb MCV..), Rubella Varicella immunity checking, Urine culture, Syphyllis HepB Chlamydia HIV tests, Flu vaccines before season, Offer Cystic fibrosis genetic screen.. Patients at risk: Thyroid function (family hx or if have diabetes type I..), TB, Toxo, Hgb electrophoresis (for sickle cell), Lead level if at risk, Gonorhhea (<24, new partners, hx of STDs)

4530


Routine screen in pregnancy Syphillis, HepB, HIV. Gonorhhea, Chlamydia if <25 or at risk. Hep C if at risk

4543


Physiologic galactorrhea: Bilateral, milky or yellow, brown, gray or green. Hyperprolactinemia is most common cause. Order prolactin, TSH, possibly MRI If unilateral bloody (gross or occult) nipple discharge, palpable abnormalities or skin changes evaluate for malignancy

4636

Obstetrics Rheumatology/Orthopedics Estrogen depolymerize ground substance which cause interstitial edema in thands and & & Sports face.. Can cause Carpal Tunnel that you treat with steroids Gynecology

4666


Bilateral breast tenderness and swelling during breatfeeding (onset 24-72 hrs post partum peaks 3-5 days after delivery) is BREAST ENGORGMENT AND RESOLVES SPONTANEOUSLY.. (unlike mastitis which is unilateral and presents with fever' plugged cyst do dont fever)

4715


Some women with previous sore throat when children may have rheumatic fever that is silent.. It becomes apparent during pregnancy with mitral stenosis (LA enlargement and possible Afibs), dyspneic with pulmonary edema

4734

Obstetrics & Allergy & Immu nology Gynecology

Rubella is teratogenic in first trimester. Triad of cataract, PDA, sensorineural hearing loss. IUGR and purpura also. PRotect by maternal vaccination prior to conception

4735


Osteogenesis imperfecta: Autosomal dominant disease (mutation in type I collagen). In severe type II babies die in utero due to multiple fractures. They have limb deformities, growth retardation, multiple fractures and blue sclera

4745


Stillbirth management: 2nd trimester: D&C, induce labor or spontaneous NVD 3rd trimester: Induce labor +/- cervical ripening agents, spontaneous NVD, Csection if has a hx (even if has a hx shld consult cz less risk with NVD)

4756


Most common cause of decreased fertility in women in their 4th decade who are still having their cycle is AGE RELATED DECREASED OVARIAN RESERVE

4757


In unknown GBS status with PROM, give penicillin prophylaxis (if >18hrs). If >34 weeks delivery is recommended Give steroids if <32 (btw 32-34 grey zone)

4758


In pregnant lady with high grade squamous intraepithelial lesion on Pap smear --> Colposcopy--> if (-) repeat cytology and colposcopy after delivery Cervical biopsy and loop electrosurgery are not encouraged during surgery unless there is urgent need in cases of lesions suggestive of invasive cancer

4759


For pregnancy to be seen on US BHCG shld be 1500-2000. If <1000 both BHCG and transvaginal US shld be repeated in 2 3 days

4766


Asymptoma tik cham ydia in fection is trea ted with single d ose azit hro o r 7 day cou rse o f doxy.

4768


PCOS= anovulation

4769


First year or 2 year irregular menses are anovulatory

4773


With endometriosis, if no improvemetn with NSAIDS +/- OCPs go for LAPARO

4775


To confirm intrauterine fetal demise A REAL TIME US TO DEMONSTRATE ABSCENCE OF FETAL MOVEMENT AND CARDIAC ACTIVITY

4776


All cases of stillb irth shld have an AUTOPSY of placenta an d fetus shld be d one

4777


Prengnancy HTN before 20 weeks is primary HTN, if after 20 weeks Gestational HTN, if with Proteinuria Preeclampsia, If also have a grand mal seizure: Eclampsia Chronic primary with superimposed preeclampsia is presented with new onset proteinuria or worsening of existing proteinuria at >20 weeks, sudden worsening of HTN and sign or signs of end organ damage

4778


HTN complications --> placental abruption, superimposed preeclampsia, Oligohydramnios, IUGR, preterm and Csection DM: Macrosomia Placenta previa risk factors: Csection (previous), multiparity, multiple gestations, advanced age. Uterine atony (due to polyhramnia or multiple gestation)can cause pospartum hemorrhage and perdisposes to excessive uterine distention

4779


Severe preeclampsia: SBP >160 or DBP >110..

4780


Tx of preeclampsia: Hydralazine or Labetalol for BP and MgSO4 to prevent eclamptic seizures

4781


HELLP syndrome occurs in severe preeclampsia with RUQ pain (due to liver enlargement and distention of hepatic capsule), Hemolytic anemia, Elevated Liver enzymes and Low Platelets

4782


Pulmonary edema (respiratory distress) is alife threatening complication of severe preeclampsia. Caused increased SVR, capillary permeability and pulmonary capillary hydrostatic pressure and decrease albumin..

4784


In preeclampsia: transfuse platelets if <20K

4789


Hyperemesis gravidarum, characterised by severe, persistent nausea and vomiting and >5% loss of pregnancy weight. Women dehydrated and malnourished without another explanation for their symptoms. Multifetal pregnancy or molar pregnancy are at an increase risk for this condtion.. So do US

4790


Molar pregnancy: abnormal fertilization of trophoblastic tissue. See abnormal plaacenta, ssociated with bilateral ovarian enlargement seonday to hyperstimulationa and ovarian cyst formation (theca luthein cysts). Causes: Complete moles: 2 sperm fertilize an ovum lacking genetic material--> Placental trophoblastic tissue with noo fetal tissue Partial moles: 2 sperm fertilize a haploid ovum--> abnormal placenta and fetal tissu ewith a triploid karyotype (69XXY,XXX,XYY)

4793


First line treatment of gestational diabetes: -Diet + Exercice -If not enough FBS>95, 1hr level<140 or a 2hr level <120, Give insulin or PO meds

4794


Uncontrolled mother hyperglycemia can cause cogenital malformations, macrosomia, neonatal hypoglycemia and polycythemia..

4796


If patient has HELLP syndrome (life threatening) immediate delivery is warranted if >34 weeks or with deteriorating maternal or fetal status. Vaginal delivery is preferred if mother is alreay in labor, fetus is vertex and otherwise stable..

4797


Chorioamnionitis: MAternal fever with >1 of the following: Uterine tenderness, maternal or fetal tachycardia, malodorous amniotic flui or purulent vaginal discharge. Prolonged eupture of membranes is an important risk factor Placental abruption, presents with bleeding, uterine tenderness abnormal contractions too but no fever or leukocytosis Give antiobiotics and deliver (u might give oxytocin)

4799


Endometritis: Fever, intrauterine tenderness in postpartum period and is often associated with foul smelling locha. Risk factor: PROM, prolonged labor, tools used in NVD, Csection

4800


Post partum endometritis is usually a polymicrobial infection composed of gram (+) and gram (-) aerobicand anaerobic mainly.. Treat with clinda and genta (big coverage.. ) (gentle clitoris)

4802


Pelvic ultrasound is needed to diagnose missed abortion


Threatened abortion = any hemorrhage before 20 weeks of gestation with a live fetus and closed cervix Inevitable: dilated cervix, bleed.. US: ruptured or collapsed gestational sac with absence of fetal cardiac motion Incomplete: evacuation of some fetal tissue while some stay in uterine cavity. Vaginal discharge of blood and tissue like material, abdominal cramps and cervical dilation. See on transvaginal US retained products of conception

4804

4805


In threatened abortion, once fetal safty is assessed patient can go home and f/u a week later. She shld bed rest not have sex (to clear patient's m ind but no proof of har m otherwise)

4806


Mother with Herpes (primary or secondary) shld deliver by Csection painfu vesicles on an erythematous base Pregnant women with a hx of genital HSV shld receive prophylactic acyclovir or valacyclovir (at 36 weeks) reducing the risk of requiring Csection (therapy or prophylaxis at time of delivery will not reduce noanatal HSV)

4809


Uterine atony occurs when uterus gets huge due to huge baby, polyhydraminia, twins.. and results in bleeding.. Treat with oxytocin

4810


Liche sclerosus: Affect posmenoposal women Vulvar pruritis and discomfort with porcelian white atrophy. Punch bx shld r/o vulvar SCC Treat with high dose steroid

4892


Contraindication to breastfeeding: Untreated TB, HIV, illict drugs and alcohol, Galactosemia in child. HepB, C are not contraindications.

4915


Cervical insuficiency risk factore, trauma, gynecological procedurelike cervical LEEP or cone bx, DES exposure or multiple gestation. Previous hx of preterm birth or 2nd trimester pregnancy loss are also r isk factors for incompetent cervix

4916


Transvaginal ultrasound is the gold dtandard for evaluating the cervix for cervical incompetence in pregnancy. Cervical length below 10th percentile for gest age is considered short.

8868


Black are at increased risk for fetal macosomia and its complication as fetal dystocia. Erb duchenne.. They usually recover arm function spontaneously within few months (CHILLIN..)

8877


Atypical squ amous cells of undete rmined significance on cy tology workup women 21-24: repeat in 1 year women >25: HPV DNA test. If (+) do colposcopy if (-) repeat PAP Smear in 3 years

8888


Patient with hypothryoid shld increase their levothyroxine dose during pregnancy especially during the first trimester, because of an increase in Throid binding globulin levels.

8892


Obesity is a big cause of amenorhhea although norm al FSH and LH. Estrogen can be produced but not progesterone.. DONO WHY

8903


Needle aspiration is contraindicated in postmenopausal women with adnexal mass, it has poor sensitivity in detecting malignancy, and if cystic 25% of chance of recurrence after aspiration, if malignant ull spill it So followig ultrasound do CA125 level, if high suspect cancer, if normal a mass <10cm can be followed conservartly

8910

Obstetrics & Gastrointestinal & Nutrition Gynecology

If suspect appendicitis in pregnancy do US.. If dnt see appendix do MRI

8917


HPV vaccine to 9-26 age cateoory (except pregnant women) Pap smear: start at 21, If immunocompromised (HIV, SLE, organ transplant or on steroids, IBD drugs..) Start at onset of sexual activity twice a year

8939


Ovarian torsion will cause nausea and vomiting unlike ruptured cyst, althought a cyst will enlarge the ovary increasing its chance for torsion. Go for Laparoscopic surgery

8941


Ruptured ovarian cyst: Acute unilateral pelvic pain and m aybe nausea vomiting after severe exercice or sex. US: show free fluid near ovarian cyst Tx: supportive care (analsegia..) or surgery if needed

8948


If suspect any ovarian, uterine pathology go for ultrasound which has higher sensitivity than CT and is safer (no radiation exposure) Do Bx for suspected hyperplasia or Ca: Women >45 with abnormal or postmenopausal bleed

8962


Early deceleration occur at peak of contraction, late nadir is at end of contraction (both are more than 30 s see wide deceleration). In variable it is not dependant on contraction and is less than 30s so see a peak on monitoring: It is due to cord compression or prolapse or oligohydramnios

9984


Decreased fetal movement management: Non stress test, then contraction stress test (if no contraindication to labor: placenta previa, hx of extensive uterine surgery) ( especially if NST negative) or a biophysical profile (if (-) NST) If small fetus ( <10thpercentile) Do umbilical artery flow velocimetry (not related to decreased baby activity)

9985


When a contraction stress test turns out well repeat in one week

10441


Cell free fetal DNA testin is noninvasive highly sensitive and specific in screening for aneuploidy startin >10 weeks of gestation. Abnormal results are confirmed by chorionic villus sampling at 10-12 weeks or amniocentesis at 15-20 weeks

2134

Pediatrics


SCID: viral, fungal (T) and bacterial (B) infections Complement deficiency: S.pneumo, Hflu, Neisseria.. (encapsulated) Thymic hypoplasia (Di Georges): viral, fungal CGD: catalase positive organisms (Aspergillus, Staph.. ) B cell deficiency: (first present after 6 month of age); encapsulated organisms (Hflu, Spneumo..) and lack of IgA predisposes to Giardia

2196

Pediatrics

Infectious Diseases

Epiglotittis: abrupt onset of fever, sore throat, dysphagia and drooling. Airway obstruction is the most concerning potential complication of epiglotittis and requires nasotracheal intubation Keeping airway hyperextended provide some relief as it maximises the airway diameter

2226

Pediatrics


Chronic constipation will cause rectal distention which will compress the bladder and prevent good voiding then stasis of urine and infection

2234

Pediatrics


Transient proteinuria (caused by exerice, fever, seixure, stressor volume depletion) is a common cause of proteinuria when patient is upright (fall down when recumbent) (resolve on its own) Should be reevaluated with a repeat dipstick on two separate occasions to r/o persistent proteinuria which require further evaluation for underlying renal disease AKA ORTHOSTATIC PROTEINURIA

2253

Pediatrics


In SCC with stroke of any occlusion go for EXCHANGE TRANSFUSION. NOT HEPARIN NOT TPA.. Suspect stroke even if CT (-)

2279

Pediatrics

Nervous System

Abscence seizure: Ethosuximide or Valproate

2280

Pediatrics

Nervous System

Complex partial seizure: brief episodes of loss of consciousness, failure to respond to various timuli during the episode, staring spells, automatisms and post ictal confusion NORMAL EEG Unlike Abscence seizures (which also have no post ictal confusion)

2353

Pediatrics


Anorexia= Hospit alisation

2373

Pediatrics


2378

Pediatrics

In caustic ingestion.. Secure airway, breathing, circulation if compromised Poisoning & Environmental Decontaminate: remove contaminated clothing and visible chemicals; irrigate exposed Exposure skin CXR if respiratory sx endoscopy within 24 hrs

2388

Pediatrics

Female Reproductive System & Breast

Primary amenorrhea: FSH measurment shld be ordered if no breast development Pituitary MRI if FSH decreased Karyotype if FSH increased


ACute abn ormal uterine bleeding therap y: High dose IV estrog en High dose Progestin High dose OCP Tranexamic acid (stabilise fibrin matrix) D&C if persists longer than 24-36 hrs Transfuse if hem odynamically unstable or sx of anemia are strong, otherwise Iron supplementation later on will do the job

2390

Pediatrics

Hydrocele: wait 12 months for them to resolve, if dont go for Sx

2395

Pediatrics


Primary dysmenorrhea: Pelvis cramping during the first few days of menses in the context of normal physical exam with no adnexal pain or enlargmenets. It caused by prostaglanding release from endometrial sloughing during menses. Endometriosis: also common in asdolesents but presents with tenderness along uterosacral ligaments, nodularity on cul de cac, adnexal enlargement due to endometrioma AnD precedes menses by few d ays. THEY ALSO HAVE DYSPAREUNIA

2424

Pediatrics

Infectious Diseases

CROUP (whooping cough) can exacerbate with airway compromise.. Give EPI before thinking of intubation (very invasive) (PEDIATRICS)

2432

Pediatrics


Laryngomalacia: Inspiratory stridor that worsens in supine position and crying or feeding and peaks at 4-8 months. Dx by flexible laryngoscope, showing collapse of supraglottic structures during inspiration.. It self resolves by 18 months of age so REassure of Supreglottoplasty if severe (cyanotic etc..)

2435

Pediatrics


If suspected Diaphragmatic herniation do Endotracheal intubation and put NG to decompress

2439

Pediatrics

Nervous System

Friedrik's ataxia: Autosomal recessive, Trinucleotide repeat.. they are in wheelchair at 25 die at 35.. -Necrosis, degeneration of cardiac muscle fibers (T wave inversion due to myyocarditis not INFARCT) -And have ataxia of course T wave inversion: MI, Myocarditis, old pericarditis, myocardial contusion and DIGOCXIN Toxicity

2441

Pediatrics

Nervous System

Fragile X = CGG repeats: Low IQ, Language disability, short attention span, autism, large head, prominent jaw, large low set of ears and BIG testes

2443

Pediatrics

Nervous System

Cerebral palsy: MAin risk factor is prematurity

2444

Pediatrics

Nervous System

Fetal alcohol Syndrome: -Small palpebral fissure -Smooth Philtrum -Thin vermilion border

2450

Pediatrics

Rheumatology/Orthopedics HOW TO CONFIRM SLE: ANTI SMITH AB's and ANTI DOUBLE STRANDED DNA & Sports ANTBODIES

2451

Pediatrics


Sudden onset respiratory distress in a toddler with focal findings on exam is consistent with foreign body aspiration. CXR not very helpful since radioluscent object wont appear .. IMM EDIATE BRONCHOSCOPY TO REMOVE OBJECT

2456

Pediatrics

Gastrointestinal & N utrition

NEC: Premature baby Increase gastric residual volune, vomiting, abdominal distention Xray: pneumatosis intestinalis (intramural) and portal venous air

2463

Pediatrics


Intusception is usually due to Peyer's patch enlargement due to viral infection (+ROTA vaccine) leading to the condition. IF recurrent; think of Mecke;s diverticulum

2464

Pediatrics


Milk or Soy protein Enterocolitis is suspected in a well apearing neonate with PAINLESS BLOODY STOOLS. Bleeding shld stop within 2 weeks of eliminating dietary dairy and soy products Lactose intolerance: crampy abdom inal pain, bloating flatulence, NONBLOODY WATERY DIARRhea.. rare in child

2465

Pediatrics


Malrotation with midgut volvulus: bilious vomiting and abdom inal distentsion. ITs an Emergency.. Can pass stool.. (whats already there) Dx: Upper GI contrast study Hirschsprung and meconium ileus, present with failure to pass meconium in the first 2 days of life and dilated loop on Xray.. Do contrast Enema..

2466

Pediatrics


In neonatal ileus do Xray to r/o pneumoperitoneum then go for Contrast enema.. ( to determine level of obstruction..)

2468

Pediatrics


Edward's: micrognatia microcephaly overlapping finger, absent palmar crease VSD Most commonly

2469

Pediatrics

Nervous System

Infant botulinism can still happen even if had not eaten honey: Bulbar palsies constipation hypotonia


ADHD differs fr om con duct in that c onduct disorder violate major societal norms or others right's with agression, property distruction, theft.. ADHD: Inattention, impulsivity and hyperactivity .. results in impaired family and peers relationships ODD: angry/irritable mood and defiant toward authority. They are hostile, and defiantly brek rules..

2470

Pediatrics

2472

Pediatrics

Nervous System

Cephalhematoma: subperiosteal hemorrhage, presents few hrs after birth as scalp swelling limited to one cranial bone. Do not reuire treatments and resolve within 2 weeks to3 months dependin on size Caput is diffuse sometimes echymotic swelling of scalp. It involves portion of head presenting during vertex delivery. MAY EXTEND MIDLINE AND CROSS SUTURE LINES (unlike cephal)

2474

Pediatrics


Suspect NEC in Newborn with feeding intolerance, Abd distentsion and bloody stools. Risk factors: Prematurity, Hypotension and Congenital heart disease. on Xray: Pneumatosis intestinalis

2479

Pediatrics


Exculusively breastfed infant shld take vitD supplementations Iron shld be given IF Prematurity, Mom's Fe deficiency, Introduction of cow's mild before age of 1yr (until age of 1) Normal babies have good stores of F e and start having deficiencies at 4-6 months

2480

Pediatrics


VitA deficiency: 2-3 yr old boy with impaired darkness adaptation, photophobia, dry scaly skin (also in excess), xerosis (abnorm ally dry; like inexcess too) conjuctiva, xerosis cornea, keratomalacia (softening and necrosis of cornea), Bitot (like a silver spot on sclera) spot and follicular hyperkeratosis of the shoulders, buttocks and extensor surfaces

2485

Pediatrics

Pregnancy, Childbirth & Puerperium

In newborn clavicular fracture observe

2486

Pediatrics

Exlusivebreatfeeding, increased skin pigmentation and lack of sun exposure are risk Rheumatology/Orthopedics factores for vitD deficiency rickets. findings: -Craniotabes -rachitic rosary -genu varum & Sports -Xray: cupping and fraying of metaphysis of the long bones

2489

Pediatrics

General Principles

Cri du chat microcephaly, hypotonia, short stature and cat like cry 5p deletion (spell 5 transversally it is cr THUG LIFE!)

2504

Pediatrics


Methyphenidate given for ADHD is astimulant causing decrease in appettite

2513

Pediatrics


Enuresis: Bedwetting alarm, Desmopressin and Imipramine in last resort Do urinalysis if symptomatik..


Onchocerciasis "River blindness" Ocular lesion and dermatitis .. Treat with Ivermectin (like strongyloides) Battery ingestion Esophagus: endoscopic removal If beyond wait since it will be excreted

Nervous System

Neurofibromatosis type 1: Cafe au lait spots Macrocephaly Feeding problems Short stature Learning disabilities May later develop fibromas, neurofibromas or different tumors Nf2: cataracts and bilateral accoustic neuromas

2656

2669

Pediatrics

Pediatrics

2691

Pediatrics


HCM:maneuvers that increase preload or afterload (squatting, leg raise, hand grip) increase LV cavity size and decrease outflow obstructio, decrease murmur intensity. Decreasing LV capacity by decreasing preload (Valsalva, abrupt standing, amyl nitrate administration) do the complete opposite

2712

Pediatrics


GIve prophylaxis penicilin to rheumatic fever patients ..

2756

Pediatrics

Dermatology

Contact cell dermatitis presents with erythema, edema, pruritis, tiny veiscles and weepy crusted lesions 24-48 hrs after contact allergen (in woods etc.. ) It is type VI hypersensitivity

2758

Pediatrics

Dermatology

Atopic de rmatitis in infan t: pru ritis, sc aly ery themato us lesio ns on face, chest and extensor surfaces o the extremities. Flexural involvement is common in children and adults. Topical emmolient is first line treatment

2763

Pediatrics

Nervous System

Sturge Wekber: Port wine stain around eye (unilateral along trigerminal districution) and radiographic evidence of intra cranial calcifications that resemble a tramline

2773

Pediatrics


Celiac can cause dermatitis hepetiformis. It is associated with DMI

2778

Pediatrics

Dermatology

SSSS fever by generalised erythema and superficial flaccid blisters with positive Nikolsky sign.. Scaling and Desquamation follow. Affects children <10 yrs, Immunocompomised and Kidney patients

2783

Pediatrics

Infectious Diseases

Rubella low grade fever, tender lymphadenopathy, amculopapaular rash that spreads from up to down.


Cholesteatomas are either Congenital or Aquired dues to chronic middle ear disease.. New onset hearing loss with ear effusion despite antibiotics. Granulation tissue and skin debirs are seen within retraction pockets of the tympanic membranes on otoscopy

Ophthalmology

Trachoma (by chlamidya, major cause of blindness worldwilde) is charcterized by foLLICULAR COnjuctiVITIS and PANNUS (neavascularization) also get fet concurrent nasopharyngeal infection with nasal discharge.. Treat with Tetracycline or Oral azithrimycin. Dx by Giemsa stain of conjuctival scraping ALL: Conta in cytop lasmic aggreg ates o f PAS mater ial (no peroxida se act ivity). T dT is positive in 95% (expressed by preB and preT lymphoblast) Presentation: (2-10yrs) present with Infection, half come with lymphadenopathy and splenomegaly, varying anemia, neutropenia and thrombocytopenia. More than 25% of lymphoblast in BM is diagnostic

2831

2857

Pediatrics

Pediatrics

2867

Pediatrics


2896

Pediatrics


Reye syndrome: Microvesicular fatty infiltration & hepatic mitochondrial dysfunction

2945

Pediatrics


Biliary cysts can be acquired or congenital and can elvate bilirubin

3005

Pediatrics

Infectious Diseases

Staph aureus is most common cause of osteomylitis in both infants and children

3009

Pediatrics

Infectious Diseases

In mumos (bilateral parotitis), can get testes involvment and in rarer cases get pancreas involvement

3077

Pediatrics

Infectious Diseases

Measle: High grade fever and rash for the last 9 days. Brick-red, maculopapular rash on face and subsequent spread to trunk and extremities. Before that cough, eye tearing, runny nose, sneezing and intermittent nasal obstruction. Also Get Leukopenia and Thrombocytopenia Vitamin A helps the GI adn respiratory tracts' epithelium to regenerate. Plus it Enhances immunity ..

3078

Pediatrics


Pyloric stenosis do not present at birth but at 3-5 weeks for hypertophy to happen

3079

Pediatrics


Treat kawasaki(non purulent conjuctivitis.. ) with Aspirin + IVIG

3122

Pediatrics

Dermatology

Erythema toxicum neonatorum: Asymptomatik, scattered erythematous macules, papules & pustules thoughout body.. NO treatment Neonatal HSV: Vesicular clusters on skin, eyes, mucous membranes, CNS infection, Fulmnant disseminated multiorgan disease (GIVE ACYCLOVIR) Neonatal varicellaL Fever: different stages of lesions and can beocome fulminant disseminated disease (acyclovir) SSS: Fever, irritabilitym diffuse erythma, blistering, exofoliation, +Nikolsky (oxa, nafcillin, Van

3123

Pediatrics

Nervous System

Phenylketonuria: buildup of toxic phenyalaline and its bad metabolites. -Intellectual diability -fair complexion eczema -musty odor urine and body odor. TREAT WITH LOW PHENYLALANINE DIET

Nervous System

G6PD: 3-4 months of age kid with HYPOGLYCEMIA (may produce seizure), LACTIC ACIDOSIS, HYPERURECIMIA, HYPERLIPIDEMIA. Doll Like fa ce ( fat ch eeks), thin extremities, short statures and Protuberant Abdomen coz of HEPATOMEGALY and Enlarged KIDNEYS

3192

Pediatrics

3193

Pediatrics

Nervous System

Galactosemia (galactose 1 phosphate uridyl transferase deficiency) occur in newborn or young infant with failure to thrive, bilateral cataracts, jaundice and hypoglycemia Tx: Eliminate galactose from diet

3196

Pediatrics


Hyper IgM syndrome is caused by a CD40 defect ligand and is charachterized by high IgM levels, low or absent IgG and IgA and normal Lymphocyte population.. PRESENTS WITH RECURRENT SEVER SINOPULMONARY INFECTIONS.

3197

Pediatrics


Immunodeficiency: -Common variable immunodeficiency or aquired hypogammaglobulinemia is similar to Bruton's agammaglobulinemia but less severe and presents at later age (15-35 of age) IgG, A, M, E are decreased.. but normal B cells -Burton's X linked: asymptomatik 6-9 months; recurrent pyogenic infections (S.pneumo, H.flu).. DEcreased IgG,A,M,E with also low B cells(CD19), poor response to vaccine

3198

Pediatrics


Chronic granulomatous disease Recurrent lymphadenitis Hepatic abscesses Osteomylitis at multiple sites Catalase positive organisms infection (S.aureus, Aspergillus, Ser ratia, Burk holderia) Nitrozolin b lue test is abnorm al

3200

Pediatrics


Aquired aplastic anemia is suspe cted when th rombo cytopnia (rashe s) an d an emia following Drug intake, viruses or toxins of viruses

3235

Pediatrics


If parents dont want to give chemo to their child Obtain a court order for chemo

3236

Pediatrics


If no significant harm is likely to result from witholding therapy, parental wishes regarding the medical care of a child should be honored and the discussion documented in the chart

3282

Pediatrics


Hereditary spherocytosis in kids: Persistent jaundice Hemolytic anemia Splenomegaly Positive family history Spherocytes on per ipheral blood smear RBC fragility test on acidified glycerol lysis and eosin-5-maleimide binding test confirms the diagnosis

3284

Pediatrics


ALL: Presen ce of >25% of lym phoblast on bo ne marrow g ive Dx 2 -5 yrs Male>Fem ale Nonspecific sytemic sx Bone pain Lymphadenopathy Hepatosplenomegaly Pallor (from anemia) Petechia (from thrombocytopenia)

3286

Pediatrics

Infectious Diseases

Bacterial rhinosinusitis cause maily by Hflu and Strep pneumo (equal in prevalence) and less likely Moraxella catarhalis (~10%)

3288

Pediatrics

Infectious Diseases

Croup (parainfluenza): (<3yrs) Hoarsness, barking cough, varying degree of respiratory ddistress Whooping cough is due to Pertussis

3375

Pediatrics


Tourette (ticks and swearing ..) is treated with antipsychotic 2nd generation

3396

Pediatrics

Nervous System

Shaken baby syndrome: shearing of dural veins + vitreoretinal traction

3403

Pediatrics

Slipped capital femoral epiphysis is treated with SURGICAL PINNING OF SLIPPED Rheumatology/Orthopedics EPIPHYSIS WHERE IT LIES In order to lessen the risk of avascular necrosis of femoral & Sports head and chondrolysis

3416

Pediatrics

In radial head subluxation when a baby is being dragged or being turned while playing Rheumatology/Orthopedics (like I used to do) Before extrnally cating hand.. shld Hyperpronate the forearm or flex & Sports elbow and suppinate forearm

3418

Pediatrics

General Principles

In child, if peripheral line is not acessible go for INTRAOSSEOUS LINE IN EMERGENCY CASES (easier than central line insertion)

3438

Pediatrics

Miscellaneous (Multisystem)

HUS is a clinical syndrome of hemolytic anemia, Throm bocytopenia and acute renal failure. Caused by Shiga toxin mediated endothelial cell damage. After infection of Ecoli O157:H7 or Shigella Tx: supportive, 50% of these will require dialysis

3440

Pediatrics


ITP shld be suspected in children who develop isolated thrombocytopenia and petechia after a viral infection. They resolve spontaneously within 6 months so shld observe regrdless of platelet count. If bleeding shld recieve IVIG and steroids.. IF refractory do Splenectomy

3443

Pediatrics

Infectious Diseases

Group A step rheumatic fever: -sore throat -fever -pericarditis -erythema marginatum -arthritis -chorea -subcutaneous nodules

3457

Pediatrics

Infectious Diseases

In subcutaneous em physem a always Order CXR to r/o Pneumothorax

3458

Pediatrics

Infectious Diseases

Pertussis = whooP cough 3 phases: catarrhal: Mild cough rhinitis, paroxysmal: very bad cough and postussive emesis Convalescent: sx resolve gradually Treated with MARCOLIDE (azitro, erythro, clarithro) Dx: PCR or Culture.. have lymphocyte predominant leukocytosis

3459

Pediatrics


In severe asthma unresponsive to m eds whith fatigue, altered mental status, CO2 retention, worsening hypoxemia and poor aire movement

3538

Pediatrics


Systic fibrosis diagnosis: Sweat chloride testing by quantitative pilocarpine iontophoresis

3539

Pediatrics


Down syndrome get endocardial cushion fusion defucts resulting in AV septal defect

3544

Pediatrics


Duchenne (no dystrophin, 3-5 yrs die at 25 from respiratorhy failure, mental retardation, cardiomyopathy) vs becker (less dystrophin, 5-15, die at 45 from heart failure, normal intelectually have cardiomyopathy) Both are Xlincked recessive Myotonic dystrophy: Autosomal domina nt (CTG repeat in DMPK gen e on 19q13.3 ).. o nset 1 2-30, facial weakness, hand grip myotonia, dysphagia, arrythmias, cataracts, balding, testis atropy and die from respiratory failure

3545

Pediatrics


Di georges Conotruncal cardiac defects (truncus arteriosus) Abnormal facies Thymic a(hypo)plasia Cleft palate Hypoalcemia

3546

Pediatrics


Innocent cardiac murmur (normal blood flow sound) grade I or II and decrease with standing. Mid systolic in timing OBSERVE, REASSURE

3550

Pediatrics

Nervous System

Tuberous sclerosis have hypopigmented macules (not cafe au lait)


Suspect Wilm'sTumor (most common pediatric renal malignancy) when have a FIRM, SMOOTH, UNILATERAL ABDOMINAL MASS AND HEMATURIA Associated with WAGR, Beckwith-Wideman, Denys-Drash Syndrome Tx: Sx, Chemo +/- Radio

3552

Pediatrics

3553

Pediatrics


Bronchiolitis <2 yrs if age RSV is most common cause Nasal congestion discharge and cough, wheezing, crackles and respiratory distress.. Tx: supportive care Prophylaxis with Palivizumab for: Preterm infant<29 weeks Chronic lung disease of prematurity Hemodinamically significant Congenital heart disease Complications: Apnea, Respiratory failure can also cause OM do not cause bacterial superinfection which rarely happen at low Temperatures.. EBV=> Nasoph CA or Lymphom

3554

Pediatrics


Henosh Schenlein purpura is common in children < 15 Palpable purpura, Hematuria, Abdominal pain, Arthralgia, Scrotal Swelling At I NCREASE RISK FOR INTUSSUSCEPTION

3555

Pediatrics

Rheumatology/Orthopedics Growing pain occurs betwn 2-12 yrs in LE and occur at night & Sports

3612

Pediatrics

Infectious Diseases

Nocturnalpeianal pruritis = Enterobius vermicularis (highly contagious).. the pinworm lives in cecum and appendix. At night female migrate out to rectum lay eggs in perianal region causing pruritis. Also get abdom inal pain, nausea, vomiting and vulvovaginitis. Scotch tape test detect the eggs. Tx: Albendazole and pyrantel pamoate (this one mainly for pregnant) Chagas is treated with Benzindazole Ivermectin for strongyloides, which present with urticaria, abd pain and resp.

3624

Pediatrics


If mom wants treatmnt dad no.. its enough to give treatmnt; we need only one consent

3636

Pediatrics

Infectious Diseases

Lyme disease: Give amoxi not doxy to kids <8yrs

3640

Pediatrics

Infectious Diseases

Sepsis in Sickle cell is most commonly due to PNEUMOCOCCAL, then think of other ENCAPSULATED

Infectious Diseases

Impetigo Bullous (Staph) More fucked up and treat with PO Antibiotics (chepalexin, dicloxacillin or clinda) vs Non Bullous (Staph and/or Strep) Chillin painful non itchy honey crusty lesions and treat WITH Topical AB like MUPIROCIN ORDER ASO if have systemic complications

Ophthalmology

Erythromycin ointment at birth is effective against gonococcal conjuctivitis not chlamydial Maternal prenatal testing and treatment is the only effective strategy for prevention of this condition

Pediatrics

Nervous System

Myotonic muscular dystrophy: Age of onset 12-30 Facial weakness, hand grop, myotonia (delayed relaxation), dysphagia Arrythmias, cataract, Balding, Testicular atrophy

Pediatrics


Infant with hypothyroid appear normal at birth but gradually develop apathy, weakness, hypotonia, large tongue, sluggish movement, abdominal bloating and *umbilical hernia*. Screening newborn with phenylketonuria, galactosemia and hypothyroid is manadatory

3642

3660

3661

3662

Pediatrics

Pediatrics

3663

Pediatrics

Infectious Diseases

Congenital rubella: Sensorineural hearing loss, cardiac anomalies (PDA), cataract, glaucoma.. Children rubella: low grade fever, conjuctivitis, coryza, cervical lymphadenopathy, Forschheimer spots. Cephalocaudal spread of blanching erythematous maculopapular rash Tx: supportive

3665

Pediatrics


Retinoblastoma consists of bilateral retinoblastoma and pineal gland tumor Pineal tumor: Parinaud syndrome: limitation of upward gaze, bilateral ptosis and bilateral lid retraction.. headaches vomiting due to obstructive hydrocephalus

3667

Pediatrics

Nervous System

MEdulloblastoma arise IN VERMIS OF MEDULLA (TRUNCAL ATAXIA)

3669

Pediatrics


Duchenne: most common dystrophy presents at 2-5 age, w bilat calf pseudohypertrophy and Gower sign (pull himself up; cannot stand like normal dudes) (X linked recessive transmission so uncle might have it) -Dx Gold standard: Genetic testing show deletion of dystrophin gene on Xp21 (muscle bx is good bas cv genetic of course better)

3670

Pediatrics

Infectious Diseases

HIV infection in infant: Failure to thrive Lymphadenopathy thrush Mom Iv user Even if mom (-) still suspect since it takes 3 month to be (+) Dx with PCR

3671

Pediatrics

Infectious Diseases

Group B and Ecoli are the most common causes of neonatal sepsis.. Prevention is with maternal testing and treatment with intrapartum IV penicillin

3672

Pediatrics

Nervous System

CGD: nitro blue Wiskot aldrich: eczema, thrombocytopenia, excess bleeding from circumcision, bloody stools, low Ig A,M,E and low T and reccurent encapsulated vaccine Migraine in kids give advil or panadol and triptans if the 2 first fail

3685

Pediatrics

Clubfoot: Stretch and manipulate foot, then apply casts, malleable splints or taping. Do Rheumatology/Orthopedics surgery if conservative management fails (if surgery is needed do it between 3 and 6 & Sports months)

3686

Pediatrics


Marfan: Mutation of fibrillin- 1 gene

3692

Pediatrics


Children < 2 yrs with a first UTI shld be treated. Then Renal and bladder US shld be ordered to evaluate for abnormalities leading to UTI's Voiding cystourethrogram is not indicated for first febrile UTI, unless abnormality is seen on US

Pediatrics


Vesicoureteral reflux is the most common cause of chronic or recurrent pyelonephritis. (see parenchymal scarring, HTN and renal insufficiency) Dx by voiding cystourethrogram Posterior urethral valves (is a congenital membrane obstructing flow at level of urethra) it is most common cause of chronal renal insufciency in BOYSS

3694

3711

Pediatrics

Ophthalmology

Strabismus after 4 months is abnormal can cause amblyopia.. Diagnosed by Asymetric corneal reflection and deviations on cover test. Tx: Cover unaffected eye (to sensitize brain to bad eye and not let the brain trash it away)

3713

Pediatrics


Acute Splen ic sequ estration can wor sen t he an emia by incr easing extrava scular hemolysis

3721

Pediatrics


Hypothyroidism in kids (thyroid dysgenesis) Decreased activity, hoarse cry, jaundice .. majority are asymptomatik If find thyroid TSH antibody its hyperthyroid jitterness, tachycardia, weight loss poor feeding

3760

Pediatrics


Tourette and OCD, ADHD are highly associated (increase the risk of these)

3770

Pediatrics

Rheumatology/Orthopedics Osteogenesis imperfecta (mutation in type 1 collagen) -Blue sclera -Recurrent fractures, & Sports Joint laxity, Short stature, Scoliosis -Theeth loss early in age -Hearing loss

3773

Pediatrics


Normal vaginal discharge and bleeding are normal up to 3 months of age

3774

Pediatrics


Anemia o f pre maturity (IT FKIN EXISTS) in pr ematur e and low birth weight ba bies du e to low RBC production, shortened RBC lifespan and blood loss. Give Fe, transfuse and EPO if needed and of course follow up on Hgb with CBC

3783

Pediatrics


Pubertal gynecomastia occur in 2/3 of adolescent it can be unilateral, bilateral or painful. Reassure

3785

Pediatrics


DActylitis(pain and symetric swelling of hand and feet, sometimes get fever) is the earliest manifestation of vaso occlusive disease in sickle cell, usually appear between 6 months to 2 year

3786

Pediatrics


Hydoxyurea prevents sickle cell painful episodes, by incresing fetal hemoglobin

3787

Pediatrics


Sickle cell trait present mainly with Hematuria (not the full blown disease)

3788

Pediatrics

Infectious Diseases

Tetanus in newborn occurs in unimmunized mothers, following and umbilical stump infection. Child is with poor suckling with rigidity spasms ..

3791

Pediatrics

Infectious Diseases

Nocturnla valvular itching = Pinworm --> Scotch test.. GIVE MEBENDAZOLE

3817

Pediatrics

Nervous System

Lesh Nyhan (due to HYPOXANTHINE GUANINE PHOSPHORIBSYL TRANSFERASE defincency HPRT) -Self induced mutilation -Neuro failure (mental r etardation, dystonia, choreathosis, spasticity) -Gouty arthritis, tophus formation (only cause of gout in a child)

3818

Pediatrics


Diamond blackfan syndrome is a macrocytic pure red aplasia (like diamond is pure carbon here it is pure RBC) WITH ASSOCIATED CONGENITAL ANOMALIES (short stature, webbed neck, cleft lip, shielded chest and triphalyngeal thumbs)

Pediatrics

Iron posoning: -Abdominal pain -Vomiting (hematemesis) -Diarrhea (GI sx..) Poisoning & Environmental -Hypotensive shock, Anion gap Metabolic acidosis -Radiopage pills on Xray -Within 2 Exposure days: Hepatic necrosis -Within 2-8 weeks: Pyloric stenosis Tx: Deferoxamine, Whole bowel irrigation, Supportive respiratory and circulatory care

3830

Pediatrics

Infectious Diseases

Bacteria in Cystic Fbrosis: (-) rods: Pseudomonas aeruginosa, Burkholderia capacia complex (khayyo la pseudomonas) and Stenotrophomonas maltophilia (couseino) (-) coccobacilli: nontypable Hflu (+) cocci in clusters: STAPH AUREUS Staph is more common in children (<20) and Pseudomonas in older (>20)

3835

Pediatrics


Beckwith wideman: macrosomia, macroglossia, umbilical hernia/omphalocele, hemihyperplasia and hypoglycemia.. Check for Wilms tumor or hepatoblastoma

3836

Pediatrics

Rheumatology/Orthopedics Lyme arthritis is most common late man ifestation of disease.. Hx of travel to & Sports northeastern or upper midwestern US

3838

Pediatrics


In sickle cell: Acute severe anemia with low or absent reticulocytes is consistent with an aplastic crisis

3849

Pediatrics


TE fistula: newborn chokes and coughs during first feeding.. NG or OG tube fail and xray will show so

3854

Pediatrics


Hep B vaccine prevents hepatocellular carcinoma especially in endemic regions in Asia and Africa

3871

Pediatrics


McCune Albright 3 P's: Precocious puberty Pigmentation(cafe au lait) Polyostotis fibrous dysplasia resulting in several fracture

3896

Pediatrics


after Gi infection if u gt kiney problems think of HUS (microangiopathic hemolytic anemia)

3900

Pediatrics

Infectious Diseases

Lyme prophylaxis in endemic region trip: Permethrin-treated pants and long sleeved shirts, to apply insect repellant to skin and check entire body for ticks

3906

Pediatrics

Infectious Diseases

If someone gets pertussi in the house give Macrolide prophylaxis to all households regardless of age, vaccines or sx

3827

3910

Pediatrics


Prolonged QT (usually these patients have hearing loss), present with syncope, V arrythmias, sudden cardiac death. Should avoid electrolytes derangements so avoid CCB. Tx with BetaBlockers and Pacemaker TO PREVENT ARREST

3924

Pediatrics


Rib notching is seen in coarctation (even in young)

3926

Pediatrics


Growth failure, recurretn respiratory infection shld raise suspicion for Cystic Fibrosis. Pancreatic enzyme deficienxcy causes steatorrhea and fat soluble vitamin malabsorption, resulting in poor weight gain

3967

Pediatrics


Sickle cell trait can present with painless Hematuria (renal papillary necrosis), UTI, renal medullary cancer

Infectious Diseases

Scarlet fever: fever, toxicity, pharyngitis, sand paper like rash, curcumoral (perioral) pallor and strawberry. Caused by Group A step's erythrogneuc exotoxins START PENICILIN V

3969

Pediatrics

3972

Pediatrics


Acute Otitis media is com mon in childr en, e specially with cigar ette sm oke ex posure, recent or concurrent URI, day care attendance and formula intake. Spneumo, Hflu and Moraxella Give amoxi to prevent mastoditis

3974

Pediatrics


Kartegeners syndrome: recurrent sinusitis bronchiectasis dextrocardia

Friedrich ataxia: (most common type of spinocerebellar ataxia) -Ataxia, dysarthria(mototr speech disorder) -Skeletal (scoliosis, feet deformities "hammer toes") -Cardiomyopathy (concentric hypertrophic cardiomyopathy) --> Which kill them and respiratory complication are deadly too

3985

Pediatrics


3990

Pediatrics


VSD: HARSH HOLOSYSTOLIC MURMUR HEARD AT LEFT LOWER STERNAL BORDER (APEX like the tip of the V). IF HEAR IT SHLD DO ECHO to r/o other defects and assess size.. MOST WILL CLOSE SPONTANEOUSLY

3991

Pediatrics


Tricuspid atresia --> Hypoplastic RV + decreased pulmonary marking du to decrease blood to them--> Left axis deviation

4005

Pediatrics


Diaper children shld undergo stragiht catherization to obtain obtain sterile urine for urine culture, to avoid contamination from stool or skin flora

4018

Pediatrics


Minimal change disease is most common nephrotic in child<10 (edema (periorbital in morning, legs and genitals later in the day), proteinuria.. ).. Give steroids directly dont do anything else

4030

Pediatrics

Infectious Diseases

In cystic fibrosis patients with severe airway infection dont kid go FOR IV VANCO OH YEA

4038

Pediatrics

Rheumatology/Orthopedics Asceptic ne crosis o f fem oral h ead is common com plication of sickle cell, by occluding & Sports end arteries supplying femoral head.. and eventually fucking bone cartillage

4041

Pediatrics


4064

Pediatrics

Spondylolisthesis: Dvlpmntal disorder with forward slipping of vertebra; usually L5 over Rheumatology/Orthopedics S1.. In preadolescent with back pain, neurologic dysfunction (urinary incontinence), & Sports palpable "step off" at lumbosacral area in severe cases (can feel the slipping)

4090

Pediatrics


ODD Patient are non compliant and hostile If child is non compliant but friendly maybe he has some hearing deficits and doesnt understand shit

Cocaine abuse: wight loss, behavioral cahnges and erythema of th turbinates and nasal septum

4104

Pediatrics

Dermatology

Eczema hepeticum is a form of primary herpes simplex virus infection associated with atopic dermatitis; superimposed on healing atopic lesion after HSV exposure. Numerous umbilicated vesicles over the area of atopic dematitis are typical, with fever adenopathy. Tx with acyclor shld be immediate cz it can be life threatening

4117

Pediatrics


Internal carotid dissection: potential stroke in children Due to trauma to soft palate with a foreign body 9pencil penetrating).. Stroke sx do not happen directly (up to 24hts after traumatic episode).. Dx by MRI/MRA

4142

Pediatrics


In TURNER, due to ovarian dysgenesis and poor ovarian function FSH is High by negative feedback not active

4155

Pediatrics

Nervous System

Postictal paralysis (Todd paralysis)may follow generalised as well focal seizures. NOT UNDERSTOOD. Restoration of motor function improves within 24 hrs. Todd paralysis indicate structural abnormality causing the seizure

4183

Pediatrics


Meconium ileus is obstruction at ileus and these people are at increased risk of chronic rhinosinusitis

4186

Pediatrics

Infectious Diseases

Chikenpox (varcella) exposure algorithm: Immunity YES: OBSERVE NO: IMMUNOCOMPROMISED: VZIG within 10 days of exposure (DONT GIVE VACCINE COZ IT'S LIVE)(dont give to pregnant women too) IMMUNOCOMPETENT: JUST VACCINE

4187

Pediatrics


Prolonged PT: Problem in vit K factors 1972 CS can happen in cystic fibrosos due to poor absorption

Pediatrics


In Androgen insensitivity syndrome do bilateral gonadectomy after completion of puberty (attainment of adult height) todecrease risk of gonadal malignancy Unlike here gonads in Turner shld be removed before puberty coz they have a higher risk of m alignancy

Pediatrics


Granulosa cell tumor produce Estrogen Sertoli-leydig produce androgen Dysgerminoma and mature teratoma(dermoid cysts) are neutral. and serous cystadenoma are also neutral hormonally

4217

4230

4239

Pediatrics


If congenital hyperplasia occur at 7yr old think of nonclassic congenital adrenal hyperplasia (unlike Leydig cell tumors which present with unilateral testicular enlargment, it has no testis enlargement and in both LH and FSH are low despite GnRH infusion; due to feedback inhibition)

4244

Pediatrics


Induced by estrogen Neonate get: Breast Hypertrophy Swollen labia Physiological leukorrhea (whitish vaginal discharge) Uterine withdrawal bleeding

4249

Pediatrics


Hemearthrosis is hemosiderin deposition leading to synovitis and fibrosis within thejoint.. Prophylactic treatment with factor concentrate will reduce the risk of hemearthropathy

4258

Pediatrics


In DTaP if child had unstable neurological encephalopathy within a week of administration.. remove the pertussis part of it in further vaccination.. but if got fever and febrile seizure no prob regie vaccine later on

4271

Pediatrics

Nervous System

When diagnose guillain barre by CSF studies do respiratory workup to rule out respiratory failure

4279

Pediatrics


HSP IgA mediated vascultitis: get m esangial deposition og IgA in kidneys

4302

Pediatrics


Riboflavin deficiency: Malnourished patient wih Angular cheilitis, Stomatitis, Glossitis, Normocytic-normochromic anemia and Sebrrheic dermatitis

4313

Pediatrics

Dermatology

Sunscreen protection (factor 15-30) shld be applied 30 min prior t sun exposure to allow time for devellopment of a protective film

4317

Pediatrics

Infectious Diseases

CAt bite = pasteurella multicoda = Augmentin

4342

Pediatrics


sickle: black with hematuria, episodes of pain (abdominal..), high retic count.. dnt forget to give vaccines and BID penicilin prophylaxis until age of 5

Infectious Diseases

Unilateral cevical adenitis can be caused by: Staph, Strep (these 2 are acute and associated with cellulitis or suppuration), Anaerobic bacteria (the 3 of them treat with clinda), Non TB mycobacteria (macrolide +/- Rifampin), TB (3 or 4 anti TB druugs), Bartonella (requires no treement)

4353

Pediatrics

4438

Pediatrics


Fanconi anemia: Diagnosed dy age 16 -Aplastic anemia and progressive marrow failure -Short stature, microcephaly, abnormal thumbs, and hypogonadism -hypopigmented/ hyperpigmented areas, cafe au lait spots -Strabismus, low set ears, middle ear abnormalities (ie, hemorrhage, incomplete development, chronic infections, deafness..)

4439

Pediatrics


Sickle cell can cause childhood stroke

4479

Pediatrics


In preterm babies give vaccines normally according to age but dont give HepB unless >2kg

4495

Pediatrics


Chronic ganulomatous: inability to oxidise pathogens within phagocytes. Patients experience reccurent infections starting early in life. Pneumonia and suppurative adenitis are most common

4497

Pediatrics


Vascular ring: Presents before age of 1.. Persistent stridor that improve with neck extension, associated with cardiac abnormalities Visual screeing shld occur at well visit baby starting age 3 .. Lead levels shld be asked if pre 1978 house, occupational exposure from parents (pottery.. ) and recent immigration.. Not needed if no symptoms or risk factors

4531

Pediatrics

Ophthalmology

4533

Pediatrics

Rheumatology/Orthopedics Leg calve perthes is Bone necrosis (avscular) & Sports

4548

Pediatrics


4584

Pediatrics

Rheumatic fever do not happen if take antibiotics.. Serum sickness like reaction is most Rheumatology/Orthopedics commonly caused by beta lactam and sulfa drugs. Sx 1-2 weeks after exposure: Fever, & Sports urticarial rash, arhtralgia, lymphadenopathy Resolve with withdrawing agent

4638

Pediatrics


4642

Pediatrics

Rheumatology/Orthopedics Painful, Lytic bone lesion overlying swellin and hypercalcemia in a child SHLD SUSPECT & Sports LANGERHANS CELL HISTIOCYTOSIS OR OTHER NEOPLASTIC PROCESS

4661

Pediatrics


In congenital heart disease causing distress at birth give PgE1 to maintain PDA

Dermatology

Tinea corporis is seen in hot, humid climates. Pruritic, erythematous, scaly and have a red ring with central clearing. Exposure to animals, people and public places are risk factors, IT IS MOST COMMON IN PREADOLESCENT Dx: Skin scraping and KOH exam Tx: Antifunfal (Terbinafine..)

4704

Pediatrics

Posterior urethral valve cause urinary tract obstruction, oligohydramnia, hypoplastic lungs, flattened facies, clubfeet.. (most common cause)

patient with anaphylaxis Hx shld carry epi pen all the time

4705

Pediatrics


Large VSD: Failure to thrive, easy fatiguability and heart failure Pansystolic murmur loudest at left lower sternal border and a diastolic rumble at apex due to increased flow across mitral valve When Eisenmenger occur: Cyanosis, dyspnea secondary to shunting Tx diuretics, trancath surgical closure ideally before Eisenmengr syndrome

4761

Pediatrics


Acquired torticollis is comm on in kids: Cau se: URI, m inor tr auma, cervical lymphad enitis, retropharyngeal abscess Do Xray of neck to make sure no spine fracture or any dislocation..

4762

Pediatrics


Xlinked agammaglobulinemia or Bruton's agammaglobulinemia : Give them IVIG and live normally Biochem: Defect in Bruton's tyrosine kinase (signaling molecule expressed in B cells at all stages of development) Sx: Sinusitis, URI, OM, pneumonia btw 6 -18 months.. Absent tonsils and lymphoid tissue Nl CD3, Low CD19 (Bcells)

4767

Pediatrics


First year of m enses, axis is not well secreting so get irregular periods

4818

Pediatrics


Do phototherapy for bilirubin >20 and Exchange transfusion if >25 Neonates shld be breastfed 8-12 x / day every 2-3 hrs for >10-20 mins

4819

Pediatrics


In neonates, POLYCYTHEMIA is Hct >65% Risk factors: -Delayed cord clamping -Maternal HTN -Maternal DM Sx: Respratory distress, hypoglycemia and neurological manifestations

4822

Pediatrics

General Principles

By 1 year of age wight shld triple and height shld increase by 50%

4825

Pediatrics


Hydrea increases fetal Hgb

4826

Pediatrics


Pericardial effusion can occur within day or months after cardiac surgery and is referred to as postpericardiotomy syndrome. Life threatening flui accumulation characterised by distant heart sounds, hypotension and distended jugular veins and requires drainage

4828

Pediatrics


Renal Tubular Acidosis: Hydrogen excretion or Bicarb reabsorption defect. Presents with failure to thrive with normal anion gap metabolic acidosis. Give bicarb replacement

4829

Pediatrics


Enlarged thymus shadowing (above right silhouette of heart) make us suspect malignancy or pneumonia

4831

Pediatrics


Respiratory distress syndrome= surfactant deficiency Risk factors: Prematurity, Maternal Diabetes

4832

Pediatrics

Rheumatology/Orthopedics Osteogenesi imperfecta: Blue sclera, hearing loss, recurrent fractures, opalescent teeth & Sports HAVE NORMAL INTELLIGENCE

4834

Pediatrics

Kawasaki: Vasculitis with fever >5 days, nonexudative conjuctivitis, extremiry changes, Rheumatology/Orthopedics cervical lymhphadenopathy (unilateral usually), oral mucosal changes and & Sports polymorphous rash

4836

Pediatrics

Rheumatology/Orthopedics Rheumatic fever: Jones criteria: Joints (polyarthritis), Carditis, Nodules (subcutaneous), & Sports eryhtema marginatum, Syndenham 2 major is enough to Dx

4837

Pediatrics

Poisoning & Environmental Children with initial abnormal lead valure (on capillary fingerstick specimen) (have false Exposure positive) shld undergo venous draw Tx 5-44 observe and repeat 45-69: DMSA >70 EDTA

4838

Pediatrics


4840

Pediatrics

Rheumatology/Orthopedics AtlanTOAXIAL INSTABILITY SHLD BE SUSPECTED IN ANY PATIENT WIT H DOWN & Sports SYNDROME WHO PRESENT WITH UPPER MOTOR FINDINGS

4841

Pediatrics

Nervous System

FEbrile seizure with no severe post ictal state is no worrissome about brain problems.. REASSURE and DISCHARGE

4843

Pediatrics

Infectious Diseases

Acute un ilateral cevical lym phaden itis in children is infec tious u sually b yt STAPH AUREUS

4847

Pediatrics


Wiskot aldrich X linked disorder: TRIAD (like peaks of the W) Thrombocytopenia with small platelets Eczema Recurrent bactrial infections

4849

Pediatrics

Rheumatology/Orthopedics Osgood Schlatter is a traction apophysitis of tibial tuercle. Anterior soft tissue swelling .. & Sports

4850

Pediatrics

Infectious Diseases

Most common predisposing factor for acute bacterial sinusitis is a viral URI (not allergic rhinitis)

4851

Pediatrics


Intussuception: Target sign on Ultrasound Tx with air or water soluble contrast enema

4852

Pediatrics

Infectious Diseases

Congenital syphyllis: Hepatosplenomegaly Cutaneous lesions Jaundice Anemia Rhinorrhea Methaphyseal dystrophy and periostitis may be seen on radiograph

Pediatrics


Colic is common and begins in the first weeks of life with excessive cryring for >3 hrs a day (usually at night) >3 days/week for >3 weeks in an otherwise healthy infant. Soothing and feeding techniques shld be reviewed and parents shld be emotionally supported and reassured

4857

Pediatrics

Transient synovitis is the most common cause of hip pain in chuldren and treated with Rheumatology/Orthopedics rest and ibuprofen. No fever no leukocytosis. Do Bilat Hip Xray to r/o Legg Calve Perthes & Sports Disease Do arthrosyntecis for septic hip etc.. if FEVER, HIGH WBC EST SCRP and inability to bear weight (at least 3 of these)

4865

Pediatrics

Nervous System

Congenital heart disease and recurrent sinusitis are important predisposing factores for BRAIN ABSCESSES (that present with fever, headache and focal neurlogical deficits and seizures..)

4868

Pediatrics


Human milk: -Low vit D -low Ca and PO4 but great absorption so no prob -Many IgA's -Less relfux and colic than Cow's milk

4870

Pediatrics


In vaginal foreign body: Remove it with calcium alginate swab or irigation with warmed fluid after topical anesthesia is applied.. No need for CT

4871

Pediatrics

Nervous System

A child presenting with Hydrocephalus gor for CT or MRI

4856

Most common cause of painless Hematochezia in kids is Meckels ! (maroon colored stools..)

4872

Pediatrics


Breath holding spells: Cyanotis, crying followed by breath holding in forced expiration, apnea, cyanosis, limpness and LOC Pallid: Minor trauma followed by loss of counsciousness, breath holding, pallor and diaphoresis Associated with Fe deficiency anemia so ORDER CBC and Serum Ferritin

4875

Pediatrics


Thalassemia minor: RDW is normal, RBC normal or elevated.. MCV/RBC<13 see Target and Teardrop cells

4889

Pediatrics

Pregnancy, Childbirth & Puerperium

Small for gestational age babies (<10th percentile) are at risk for all hypo's Hypoxia, Hypoglycemia, Hypothermia, Hypocalcemia AND Polycythemia

4890

Pediatrics


jujenal atresia = triple bubble sign

4891

Pediatrics

Infectious Diseases

Retropharyngeal abscess shld be suspected in children who present with fever, dysphagia, inability to extend neck, myffled voice and lateral x ray showing a widened prevertebral space.

4893

Pediatrics


Heroin withdrawal in neonate: presents in few days of life IRRITABILITY, HIGH PITCHED CRY, POOR SLEEP, T REMORS, SEIZURES, SWEATING, SNEEZING, TACHYPNEA, POOR FEEDING, VOMITING and DIARRHEA

4898

Pediatrics


Imaginary friends is normal between age 2 and 6

4912

Pediatrics


In PDA get high pressure aorta with and low pressure pulmonary rtery thus exaggerated pulses

4923

Pediatrics

Nervous System

Epidural hematoma is a surgical emergency

4924

Pediatrics


Toddlers are curious about genital NOT A BIG DEAL CHILLOUT PARENTS THEYRE NOT GAY (have masturbatory movements etc.. )

4925

Pediatrics


Moderate to severe dehydration in children shld be treated with IV bolus Isotonic


Physiological gastroesophageal refulux is common in childs coz of their short esophagus, incomplete closure of lower esophageal sphincter and greater time spent in supine position REASSURE PARENTS and shld hold baby upright after feed In GERD Unlike this disease u get failure to thrive, irritability and sandifer syndrome Tx with thickened feeds, antacids can do esophageal pH probe monitoring and upper endoscopy Milk allergy: Regurg and vomiting, Eczema and Bloody stoolds

4926

Pediatrics

7726

Pediatrics

General Principles

Dry, flaky, peeling skin of the hands and feet is exprected in neonates as the skin adjusts to dry extrauterine environment Pink stain or brick dust in neonatal diapers represent uric acid crystals. They are seen during the first week as the mother's milk is coming in. Or months later in the morning void when infant begins to sleep through the night

8784

Pediatrics

Ophthalmology

Most common cause of ORBITAL CELLULITIS (ophtalmoplegia, proptosis and diploplia, pain with eye movement): BACTERIAL SINUSITIS Do surgery if have subperiosteal abscess

8791

Pediatrics


Esophageal coins in asymptomatik patients can be observed up to 24 hrs of ingestion If symptomatik or time of ingestion unknown, the coin shld be removed by flexible endoscopy

8820

Pediatrics


In low APGAR, with bad respiratory and cardiac do PEEP if RR<60 do Chest compression

8871

Pediatrics


In Anorexia with chrinic starvation and acute refeeding.. U get a surge of Insulin when reeat which can Fuckin lower ur Phosphorous Postassium Mg Thiamine (B1) and increase water and sodium retention.

8923

Pediatrics


PANDAS: pediatric autoimmune neuropsychiatric disorder associated with strep ==> Subtype of OCD Like other OCDs treat with SSRIs and Psychotherapy

8951

Pediatrics


Rota vaccine is contraindicated in patients with a hx of intussusception due to risk of this side effect

8952

Pediatrics


Cystic fibrosis patients have OBSTRUCTIVE AZOOSPERMIA from congenital bilateral abscence of vas deferens. Insipissated mucus acummulation will not allow vas deferens to develop ==> INFERTILITY

8955

Pediatrics


Constipation is a common problem in toddlers due to transition to solid food and cow's milk, toilet training and school entry. Complications include anal fissure, encoprsis, enuresis Start on PO laxatives

8956

Pediatrics

Cryptorchidism: Increased risk of torsion, infertility and increase detection of testes Male Reproductive System cancer Sx will decrease risk of torsion and improve fertility but sperm count and quality remain substandard so still have Subfertility risk

9566

Pediatrics


Turner Pelvic US will show: Infantile Uterus and Strek Ovaries

9849

Pediatrics

Infectious Diseases

Herpangina = Coxaki A (3-10yrs) Posterior Oropharyngeal vesicles/ulcerations, fever, pharyngitis. Tx is supportive (hydration adn pain control) In Herpetic gingivostomatitis (6mo-5 yrs) also have fever and pharyngitis but ANTERIOR cluster of small vesicles TX with ACYCLOVIR (Anterior:Acyclovir A's)

10742

Pediatrics

Dermatology

Burns sparing the flexors areas are suggestive of abuse since u hold them from there..or baby can easily keep them out of water ..

2354

Psychiatry


Unlike patient with anorexisa, bulemia patients have a normal body weight and not amenorheic

2357

Psychiatry


Dont use lithium in kidney patients

2494

Psychiatry


1- start SSRI for 4-6 weeks, if fail increase to max dose, if fail change to other SSRI, if fail go for Other class

2496

Psychiatry


Panic attack give Benzo Treat with SSRI and CBT

2503

Psychiatry


In depression try SSRI if doesnt work try antoher SSRI if still not working after 2 trials of same family switch to another family

2506

Psychiatry


OCD first line is SSRI or Clomipramine

2510

Psychiatry


Bipolar I: manic episodes without depression episodes Bipolar II: Hypomanic episodes (less severe, less impairement and no psychotic symptoms) and a hisotry of one or more depressive disorders

2521

Psychiatry


Somatic symptom disorder: 1 or more somatic complaints that are stressul and result in negative feelings related to these for more than 6 months.. It can happen in Sick people (khaldieh) or Healthy one

3144

Psychiatry


Delusions follow logical thinking

3185

Psychiatry


Risk of bipolar in General Population 1% If first degree relative has it it becomes 5-10%

3382

Psychiatry


Primary treatment of Adjustment disorder (cant adapt to Girlfriend that cheated) is Psychodynamic Psychotherapy.. SSRI can be given if depression is happening too (but not main treatment)

3385

Psychiatry


Kelptomania does not respond well to meds but responds to CBT

3535

Psychiatry


Passive agressive is a defense in which indivuduals expresses his agression toward another person with repeated passive failures to meet the other person's needs Displacement: I break up with my girlfriend. I crash my TV (bfesh khel2e be shi tene) Distortion: I take heroin I got hep C. I blame the CDC for inadequate control Acting out: Most direct. Someone insults me I punch him in the nose Introjection: Is when u agree with an authoritie's opinion..U learn it

3751

Psychiatry


Be very sensitive with Body dysmorphic patients like ask them to come back regularly

3762

Psychiatry


Benzo cessation abruptly can lead to seizure

3798

Psychiatry


Reaction formation is the transformation of an unwanted thought or feeling into its opposite .. Helping syrian refuges althougth i hate that they are competing with job demands

3843

Psychiatry


Continue antidepressant for 6 months after patient starting to response

3845

Psychiatry


In hypochondriatic patients, ask about emotional stressors

4043

Psychiatry


For bipolar with at least 2 manic episodes shld countinues Li forever.. Unless not tolerated

4063

Psychiatry


OCD is assiciated w serotonin problem thus the efficiency of SSRI

4067

Psychiatry


If patient not compliant to antipsychotics prescribe long acting injectable form

4141

Psychiatry


SSRI is first line treatment for Generalised Anxiety Disorder then Benzos and Buspirone follow

4285

Psychiatry


Panic disorder is associated with: -Agoraphobia -Depression -Bipolar -Substance abuse -Higher rate of suicide and ideations

4848

Psychiatry


Antipsychotics (doam one a ntagon ists) will natura lly cause weight g ain an d incr ease prolactin thus fucking up the periods

4883

Psychiatry


Adjustment disorder require clear impairem ent in social a nd o ccupation al fun ctioning.. otherwise normal reaction to event if there is stress

4885

Psychiatry


Beware of metabolic syndrome in patients taking 2nd generation antipsychotics (olanzapine, clozapine..)

4897

Psychiatry


DElusional disorder occur with no other psychotic behaviours for at least 1 month Brief psychotic symptoms is psychosis for less than 1 m onth

4905

Psychiatry


Specific phobia is treated with Behavioral therapy (expose the patient to the stimulus in controlled environment)

8875

Psychiatry


Hoarding disorder: The urge to keep things (magazines, valueless stuff.. ) despite their accumulations at home or WTVER.. Do CBT + give SSRI

8915

Psychiatry


Survivors of rape are at high risk of -PTSD -Depression -Suicide

8938

Psychiatry


CBT focuses on negative thoughts and avoidance behaviour focusing distress Psychodynamic therapy focuses on unconscious conflicts (in higher functional pple) Interpersonal psychotherapy is to dela with grief, bad relationships, conflicts.. Biofeedback; patients are thaught tocontrol their response to various stimuli, like learning to control their heart rate increase to stressful stimuli..

9841

Psychiatry


Introjection: People believe I'm fat so I start believing Projection: I think I' m fat so I believe people think I'm fat Access to guns is the greatest is the greatest risk to complete homocide

2143

Surgery


Acute me senteric ischemia: severe acute onset poorly localized abdomin al pain out o f proportion to physical exam initially, then with rebound tenderness and guarding, with nausea and vomiting, bloody stool. Cause blots emboli from Afib..

2144

2245

Surgery

Paget of bone is typically asymptomatik, have isolate elevated ALP. If symptomatik Rheumatology/Orthopedics present with pain associated with fractures or with arthritis resulting from bone deform ity. & Sports Can result in hearing loss

Surgery

Acalculous cholecystitis: Occurs in critically ill patien ts. It present s like its calculo us counterpart, but assessment is difficult due to underlying illness. Imaging: Gallbladder wall thickening and distention and perichlecystic fluid. Tx: ABs + percutaneous Gastrointestinal & Nutrition chelecytostomy (do cholecystectomy when patient gets better) Ileus, u get hypoactive bowel sounds + distention of both small and large bowel. Small bowel obstruction u get distention of only small+ hyper sound intially

2322

Surgery


Indication for OR in small bowel obstruction: Hemodynamic instability, fail to improve after conservative management (NPO, NG, IV fluids electrolyte correction) , devellop signs of strangulation (fever, tahycardia leukocytosis and acidosis) even if peritoneal signs are absent (meaning that necrosis has not occured but go to OR to reverse ischemia )

2327

Surgery


Most common injury in blunt trauma is spleen, and fluid accumulation in splenorenal area (even if peritoneal signs)

2337

Surgery


Post Heart surgery (within 14 days), can have mediastinitis: fever, Chest pain, leukocytosis and mediastinal widening on CXR. Tx: Drainage, Surgical debridement and Antibiotics 10 -50% morta lity even with treatm ent

2371

Surgery


Bowel ischemia and infarction are possible early complications of AAAR

2476

Surgery


Umbilical hernia is common in black infants. The usually close spontaneously before age of 5. Surgery is not required

2590

Surgery


Mediastinal mass ddx: 4 T's Thymoma Teratoma (and other germ cell tumors) -Seminoma: High BHCG -Non seminoma: High BHCG (not in all) and AFP Thyroid Terrible lymphoma

2666

Surgery


Limb ischemia: acute arterial occlusion 5P's (pain, pallor, pulseness, parasthesia and paralysis). Immediate anticoagulation and referral for emer gency vacular surgery evaluation is the right thing to do

2734

Surgery


Aortic disse ction ca n cau se spin al cord ischemia, and ca use LE weakness. Or ren al ischemia... Can extend to pleural cavity and cause hemothorax (similar to pleural effusion on CXR). Often see Widened mediastinum on CXR (not always) Confirm Dx with CT angio or TEE

2735

Surgery


Aortic disse ction: Sud den ch est pa in, tear ing rad iating t o the back. HT N is the cause. In Abdominal a neurysm Atheroscler osis

2788

Surgery


V/Q mismatch (elevated A-a gradient): get compensatory tachypnea and respiratoty alkalosis PE, Atelectasis, pleural effusion, pulmonary edema (so the 3 PE's and atelactasis).. On the other hand alveolar hypoventilation we have normal A-a gradient <15 (PAO2-PaO2= FiO2(Patm-PH2O)-(PaCO2/R)-PaO2=0.21(760-47)-PaCO2/8-PaO2= 150-PaCO2/8-PaO2 And get respiratory acidosis COPD, sleep apnea, scoliosis, NM disease (myasthemia.., Narcotics, Central etiology..)

2812

Surgery


In lactic acidosis from septic shock giv Isotonic IV saline +/- Vasopressor therapy and ABs to correct underly ing infectio n.. Give bic arb only if pH<7.2

2822

Surgery


Bowel ischemia: occurs in atherosclerotic patients (Afib, PVD, DM etc.. ) Acute abdominal pain out of proportion to examination findings and resulting in lactic acidosis hence metabolic acidosis (Peptic ulcer perforation wont cause lactic acidosis)

2846

Surgery

Infectious Diseases

Retropharyngeal abscess can spread infection to mediastinum and cause acute necrotizing mediastinitis

2847

Surgery

Infectious Diseases

Retropharyngeal abscess: sore throat, fever, difficulty swallowing (dysphagia), odynophagia, pain ith certain neck movement (extension particularly). Initiate treatment immediately (ABs + drainage) in order to prevent mediastinal involvement

2922

Surgery


In esophageal varice Establish vascular access with 2 large IV bore before Enoscopic sclerotherapy or band ligation..


Chlecystectomy is indicated with symptomatik gallstones who are m edically stable enough to undergo surgery (post pancreatitis due to gallstones) If pancreatitis is not getting better wth meds etc. Do ERCP.. or if chronic pancreatitis do ERCP to evaluate for possible ampullary CA..

2933

Surgery

2973

Surgery


Post cholecystectomy pain: Functional pain (chillin, dx of exclusion) Common bile stones (r/o by ERCP) Elevated biliary sphincter pressure, specific for spincter of Oddi dysfunction--> RUQ pain and elevation of liver enzymes which resolve after the attack--> Tx with ERCP sphincterotomy Nitrate, CCB or analsegic are useless

2978

Surgery


Acute cho langitis treatme nt is support ive and broad coverage ABs. If don t resp ond should undergo biliary drainage by ERCP, if fails place a large bore T tube.. At some point after treatment shld do cholecystectomy

2983

Surgery


Post op cholestasis can happen after prolonged surgery characterized by hypotension, extensive blood loss into tissues and massive blood replacement.

3064

Surgery


When there is full blown presentation of appendicitis dont do CT and go for surgery directly. IF suspicious presentation go for CT

3179

Surgery


Paralytic ileus: Absent vowel sounds with gaseous distention of both the small and large intestine. Classically happens post abdominal surgery, but can also happen in cases of retroperitoneal hemorrhages associated with vertebral fractures.

3181

Surgery


Psoas abscess: hematogenous spread of bacteria from skin.. (Staph aureus), bone or bowel. There is pain but no guarding rebound tenderness but have psoas signs.. Confirm with CT

3182

Surgery


Complicated diverticulitis with abscess formation can be dranied by percutaneous CT guided drainage. If it fails, surgical drainage can be done

3213

Surgery

General Principles

GCS score: Eye opeing (4) Verbal response (5) Motor response (6)

3220

Surgery


In rib fracture, give pain meds to restore good ventilation and prevent atelectasis, pneumonia

3221

Surgery

General Principles

Any pene trating wound b elow the 4th in tercosta l space (nipples level) is in the abdomen--> Laparotomy if unstable

3222

Surgery

General Principles

Hypotension not responsive to fluid following trauma is suggestive of ongoin blood loss. So exploratory Laparotomy coz other sites would be obvious on exam

3227

Surgery

General Principles

Cervical spine injuries require stabilisation of the cervical spine. Orotracheal intubation with rapid sequence intubation is preferred for establishing an airway in an apneic patient with a cervical spine injury.

3302

Surgery

Rheumatology/Orthopedics Fat embolism occurs after long bones fractures, and presents with dyspnea, confusion & Sports and petechia in upper part of body

3325

Surgery


Do tetanus vaccine every 10 years If clean minor wound Give vaccine if last was >10 years and dont give Immunoglobulin If dirty severe wound Give vaccine if last booster was given >5 yrs. IF MORE THAN 3 TOIXOID DOSES OVERALL IN LIFE DONT GIVE IMMUNOGLOBULIN OTHERWISE GIVE IT

3348

Surgery


Posterior urethral injury: Blood at meatus,scrotal hematoma, inability to void, Pelvic fracture (the cause), High riding prostate (which does not happen with anterior injury) and often palpable distended bladder

3349

Surgery


In suspected urethral injury do Rtrograde urethrograsm. Not foley as it can predispose to abscess formation and wprsens urethral damage

3352

Surgery


Penile fracture: Do retrograde urethrogram first to assess urethra then do penile surgery

3358

Surgery

General Principles

Blunt abdominal trauma often causes splenic injury which can present with delayed onset of hypotension, LUQ + Left shoulder pain. CT with IV contrast is needed. If Hemodynamically unstable do Hemodyalisis

3395

Surgery

Poisoning & Environmental In circumferential full thickness burns in extremitites or chest, do escharatomy to prevent Exposure vascular compromise or respiratory difficulty..

3398

Surgery

Circumferential full thickness burn with eschar causing edema and vascular constriction Poisoning & Environmental and decreased pulses: Escharotomy.. If no relief do F asciotomy (Escharotomy is more Exposure superficial than fasciotomy)

3413

Surgery

Rheumatology/Orthopedics Midshaft humerus fracture: Think radial nerve injury & Sports

3415

Surgery

Rheumatology/Orthopedics Non displaced saphoid fracture (fall on outstretched hand with <2 mm displacement and & Sports no angulation)--> Wrist immobilization for 6-10 weeks

3420

Surgery

General Principles

Penetrating abdominal trauma with unstable hemodynamically patients. --> Laparotomy to correction the source of perforation causing sepsis

3427

Surgery


Torus palatinus: Fleshy immobile mass on the m idline hard palate. No therapy needed unless symptomatik interfering with speech or eating

3428

Surgery


Post rhinoplasty whislting inspiration suspect nasal septum perfortion likely resulting in septal hematoma

3455

Surgery


Venous insufficiency (venous HTN): Valve incompetence. Ulcer seen on medial leg supperior to m edial malleolus + Edema, stsis dermatitis (brown discoloration)

3456

Surgery

Dermatology

Marjolin ulcer (SCC ulcers of skin) that grows on a wound that fails to heal after a prolonged period.

3463

Surgery

Compartment syndrome: Pain out of proportion to injury, pain on passive stretch, rapidly Rheumatology/Orthopedics increasing and tense swelling and early parasthesia. Pallor and loss of pulse are & Sports uncommon.. Do fasciotomy

3464

Surgery

General Principles

Coaglusa negative Staph (epiderdemis.. ) are the most frequent cause of nosocomial bloodstream infection in patient with intravascular devices. Get fever, leukocytosis, hypotension and blood culture growth ..

3500

Surgery


Nasopharyngeal CA is common in Mediterranean and F ar Eastern descent. Associated with EBV

3505

Surgery

General Principles

If u have tension pneumothorax before even giving IV fluid top atient to needle thoracostomy

Surgery

Suprachondylar fracture of humerus (must common ortho pediatric injury): Fall on Rheumatology/Orthopedics outstretched hand Complications: Median nerve, Brachial artery, Compartment & Sports syndrome leading to Volkmann ischemic contracture (fork like hand and arm.. you know), cubitus varus deformity (outward bluge of lateral epicondyle.. you know too)

3557

Surgery

Clavicular fracture: Most commonly, middle third of the clavicle. It occurs during athletic events and follows a fall on a n outstreched arm or a direct blow to the shoulder. These Rheumatology/Orthopedics patients present with pain and immobility of the affected arm. The contralateral hand is & Sports classically used to support the weight of the affected arm. The shoulder of the affected side is displaced inferiorly and posteriorly. First of all a careful Neurovascular exam should be done before tx

3562

Surgery

Clinical signs of scaphoid fracture following an injury, with possible fracture, shld get Rheumatology/Orthopedics thumb immobilization in a spica cast even if Xray is negative. Repeat xrayin a week or & Sports 10 days

3564

Surgery

Rheumatology/Orthopedics In a patient with hip fracture emergent surgery must be done but it can wait up to three & Sports days to assess good cardiac and respiratory activity in suspected patients.

3566

Surgery

Stress fracture: Most commonly affect the anterior part of the middle third of the tibia in Rheumatology/Orthopedics people involved in jumping sports (dancing etc.. ) and posteromedial part of the distal & Sports third of the tibia in Runners. X rays are often normal.

3569

Surgery

Rheumatology/Orthopedics In knee soft tissue injury (tendons etc.. ) MRI is best way to investigate further. In MCL & Sports tears, bracing and early ambulation is the preferred treatment (not sx)

3572

Surgery

Medial lemniscus tear: injury during forceful torsion of the knee with the foot planted. Get popping sound and severe pain during injury. McMurray's sign (flexion of knee with Rheumatology/Orthopedics internal and external rotation followed by extension) is positive with popping. Knee & Sports effusion is notdirect; it takes hours or days following injury as it is not directly perfused, unlike ligament injuries. MCL injury will be diagnosed vith Valgus stress test (extension and adduction then outward of leg

3578

Surgery

General Principles

In amputated injury: wrap amputated part in saline-moistened gauze, seal in a plastic bag and place the bag on ice --> GO TO ER then OR

3784

Surgery


In traumatic spinal cord injuries place urinary catheer to assess for urinay retention and prevent acute bladder distention and damage

3851

Surgery


Duodenela hematoma: (occurs in children ususally following abdominal trauma) Treated conservately with NG suction and TPN

3556

3877

Surgery


Bowel ischemia is a side effect of aortoiliac vessel surgery (7%). Due to loss of collateral circulation, manipulation of vessels with surgical instruments, prolonged aortic clamping and impaired blood flow through inferior mesenteric artery. Affect the distal left colon. Dull pain over ischemic bowel and hematochezia. Colonoscopy shows a discrete segment of cyanotic and ulcerated bowel. CT will show thickening of bowel wall.

4025

Surgery


Venous valve incompetene is most common cause of lower extremity edema. It worsens throughout the day and resolves overnight..


Dumping syndrome (common (50%) postgastrectomy complication): Rapidemptying of hypertonic gastric content in duodenum--> Fluid will shift from intravascular space to SI, release of intestinal vasoactive polypeptides and stimulation of autonomic reflexes.. Sx diminish with time, and dietary m odifications (avoid simple carbohydrate) will control sx. If dont Give OCTREOTIDE and if still intractable go for Surgery


Pulmonary contusion can occur after M VC. Sx occur in the first 24 hrs with patchy alveolar infiltrate on CXR. Presentation: Tachypnea, tachycardia and hypoxia, chest wall bruising and decreased breath sound in onvolved area. Fat embolism: Tachypnea, tachycardia, petechiae but HYPOTENSION and can get mental changes and thrombocytopenia

4062

4145

Surgery

Surgery

4204

Surgery

Nervous System

Anterior spinal cord in farction is a potential complicatio n of thoracic aortic aneur sym surgery and typially presents wtih spinal shock (Sx: abrupt onset flaccid paralysis and loss of Pain and Temperature sensation below the level of spinal injury). Upper motor neuron signs (spasticity and hyperreflexia) will develop over days to week. Posterir spinal cord is preserved so Vibration and Proprioception are preserved

4207

Surgery

General Principles

In blood loss first (when only 15% is lost or 750 mL ) vitals change is tachycardia a vasoconstriction to maintain BP.. then BP will drop

4212

Surgery

General Principles

Abdominal aortic aneury sm ru pture: Hypotensive and o n CT enlarge d aor tic silhou ette . . 60s smoker.. IMMEDIATE SURGERY


Diaphragmatic rupture usually happen in left side (coz right protected by liver). Patients have resppiratory distress and can have mediastinal shift to opposite side. IF smaller ruptures can have delayed presentation with nausea and vomiting. CXR: Might see elevation og hemiiphragm or NG in chest If bowel in chest go for surgery


Peripheral artery aneurysm: Pulsatile mass that can compress adjacent structures (nerves, veins) and can result in thrombosis and ischemia. Popliteal and Femoral aneurysms are most common peripheral aneurysms and aree associated with Abdominal a neurysm .

4229

4241

Surgery

Surgery

4250

Surgery

Persistent symptoms in patients with probable meniscal injury should be further Rheumatology/Orthopedics evaluated by MRI. Surgery is often necessary to correct problem If acute Tx with rest & Sports and NSAIDs

4251

Surgery


Appendicitis > 5 da ys have high in cidence of pe rforatio n and abscess formatio n (o ften contained abscess). Ifstable treat with IV fluids, ABs and bowel rest then appendectomy (6-8 weeks later)

4254

Surgery


Causes of hypoparathyroid: Post surgical, autoimmune and non autoimmune parathyroid destruction or defective calcium sensing receptor on the glands

4292

Surgery

General Principles

Splenic trauma after blunt injury depends on hemodynamic state of patient. If improve with fluids do CT. If dont SURGERY

4293

Surgery

Nervous System

Femoral nerve: Innervates the muscles of anterior thigh compartment (knee extension and hip flexion)+sensation to Anterior thigh and medial leg (via saphenous branch) Tibial nerve: posterior compartment of thigh muscles (flexion of knee and digits, platar flexion of foot)+sensation to leg (except medial part) and plantar foot Obturator: medial thigh compartment (adductors)+sensation there Peroneal: anterior and lateral leg muscles+sensation to anterolateral leg+dorsum foot

4364

Surgery


Complete small bowel obstruction usually presnts with nausea, vomiting, abdominal bloating and dilated loopd of bowel on xray (hypertympany). Previous surgery is most common cause.

4462

Surgery

General Principles

When see air under the diaphragm it means somewhere the bowel have perforated. Immediately open the patient

4485

Surgery

Stress (hairline) fractures of metatarsals are common in athletes, military. 2nd Rheumatology/Orthopedics metatarsal in most commonly involved. Whenever its 2nd,3rd or 4th no need for cast or & Sports splinting since they are already splinted by surrounding metatarsals.. SO REST AND ANALSEGICS

4486

Surgery


Gastric outlet obstruction: (mechanical) postprandial pain and vomiting with early satiety. nausea, nonbilious vomiting and weight loss. Due to malignancy, peptic ulcer, Crohns, strictures (pyloric stenosis), 2ary to caustic agent ingestion and gastric bezoars

4493

Surgery


DVT is treated with Heparin followed by warfarin for several months.

4494

Surgery


ABI >1.30 s uggestive of calcif ied an d un compre ssible ve ssels; a dditional vascular stidues shld be considered. Whenever have sx suggestive of peripheral vascular disease do ABI

4498

Surgery

General Principles

In suspected peritoneal bleeding do FAST examination. If equivocal or not diagnostic do DPL (diagnostic peritoneal lavage) and assess need for surgery or not

4500

Surgery

General Principles

In trauma causing peritoneal fluid, not response to IV fluid even in the absence of seen organ injury, since its not reliable for organ injury -->OPEN

4501

Surgery


Retroperitoneal hematoma (within 12 hrs of precedures): local vascular complication of cardiac cath due to vessel puncture.. and presents with sudden hemodynamic instability and ipsilateral flank or back pain. Do non contrast CT of abdomen and pelvis or US. Tx: Supportive, bed rest, monitoring, IV fluids +/- blood transfusion Other compliction: arterial dissection, acute thrombosis, pseudoaneurysm, AV fistula formation

4507

Surgery


Leg emboli P's Pain, Pulselessness, pallor, parasthesia and paralysis

4526

Surgery

Infectious Diseases

Blood transfusion reaction table

4527

Surgery


Aortic ru pture: High en ergy, blund, rapid deceler ation t rauma to che st. If contained rupture patient will make it to ER. See widened mediastinum and left sided hemothorax, deviating mediastinum to the right


In distal clavicle fracture need to correct surgically unlike middle portion which is more common. Pulmonary contusion: Severe blunt chest trauma injuring pulmo parenchyma. Dyspnea, tachypnea, hypoxemia worsened by Intravascular expansion and patchy irregular alveolar infiltrates on CXR

4537

Surgery

4538

Surgery


Tension pneumothorax: Tachypnes, tachycardia, distented neck veins, tracheal deviation IN blunt or penetrating trauma. If unstable hemodynacmically Immediated needle thoracostomy is done prior to intubation (since positive ventilation first with intubation will exacerbate condition)

4540

Surgery


Hypovolemic/hemorrhagic shock: Hypotension, tachycardia, flat neck veins, confusion and cold extremeties despite fluid rescucitation in a trauma setting

4541

Surgery


High PCWP and right atrial pressure (preload) is indicative of cardiogenic shock. In hypovolemic and cardiogenic shock we have increased SVR so increased O2 extraction from tissues therefore lower Mixed venous oxygen saturation (unlike septic shock)

4542

Surgery


Intraductal papilloma: (benign breast disease) Intermittent bloody discharge from one nipple. Cannot feel mass as it is small soft and directly beneath nipple

Infectious Diseases

Acute par otitis: pa inful swellin g of the pa rotid gland that is aggrava ted b y chewing . High fever and tender swollen erythematous parotid gland are common. This post op complication can be prevented with adequate fluid hydration and oral hygiene. Due to Staph

4544

Surgery

4546

Surgery

Tronchateruc bursitis (bursa surrounding the insertioon of the gluteus medius onto the femur's great trochanter): Excessive frictional forces secondary to overuse, trauma, joint Rheumatology/Orthopedics crystals or infection are possible. Middle aged adult, with superficial unilateral hip pain & Sports that is exacerbated by external pressure to the upper lateral thigh (as whn lying on the affected side in bed) suggest trochateric bursitis.

4550

Surgery

Dermatology

In severe burns the m ajor cause of morbidity is hypovolemic shock. If have adequate ressucitation, bacterial infection such as bronchopneumonia or burn wound infection can lead to sepsis and septic shock also another morbidity cause

4551

Surgery


Positive pressure mechanical ventilation increases intrathoracic pressure (dont be mistaken its not like normal respiration where intrathoracic pressure decrease and on the contrary increase preload) , which decreases venous return therefore preload. In hypovolemic patient this will exacerbate the condition. So replace intravascular volume first.

4552

Surgery

Nervous System

Transtentorial herniation herniation of the parahippocampal uncus occur during significant head trauma and leads to ipsilateral hemiparesis, Ipsilateral mydrasis and strabismus, contralateral hemianospia and altered mentation

4555

Surgery


Blunt trauma to the upper abdomen can cause a pancreatic contusion, crush injury, laceration or transection. Can be missed on CT during the first 6hrs If untreated can later be complicated by a retroperitoneal abscess or pseudocyst

4556

Surgery


In pericardial tamponade, u get a normal cardiac silhouette. It is a clinical Dx

4557

Surgery

General Principles

If an injury is causing pain in one or both shlder it is a subdiaphragmatic peritoneal injury. So in case of bladder it could only be the dome (only peritoneal component of bladder)

4558

Surgery

Pancreatic adenoCA: Risk factors: Smoking, hereditary or nonheriditary pancreatitis, Obesity and lack of ecercice Presentation: Weight loss, anorexia, fatigue, abdominal or back pain, jaundice (not all the time), Recent onset atypical DM, unexplained migratory Gastrointestinal & Nutrition superficial thrombophlebitis, Hepatomegaly & ascites with mets (possibly) Increased ALKP and dir ect biliru bin (d ue to obstruct ion) Elevat ed CA 19 -9 (n ot scre ening tool), US (if jaundiced) CT (if not) of abdomen..

4561

Surgery


In flail chest: Positive pressure mechanical ventilation will make chest move normally

4597

Surgery


In burn victims, injury to Upper airway or smoke inhalation injury to lungs is suspected with burns on the face, singing of the eyebrows, oropharynx inflammation/blistering or carbon deposits, carbonaceous sputum, stridor and carboxyhemoglobin >10% (or closed space burn).. If suspecting so even if no respiratory sx right now--> INTUBATE

4599

Surgery

Nervous System

Parotid surgery involving the deep lobe of the parotid gland carries a significant risk of facial nerve palsy resulting in facial droop

4600

Surgery


Upper abdominal surgery will cause respiratory complications so best thing to do to increase Functional Residual Capacity is to elevate bead head..

4601

Surgery


Acute GI perfor ation ( air un der diaphra gm) r equire emerg ent la parotom y. If patient is on Warfarin reverse immediately with FFP before surgery

4604

Surgery

Nervous System

Foregul abduction and external rotation of arm (blockshot style): can cause anterior shoulder dislocation (acute shoulder pain) and injure axillary (natation dos "arriere""axillary") nerve: Paralysis of deltoid (adduction) teres minor (external rotation) and loss of sensation over lateral upper arm

4606

Surgery


rate of carbondioxide produed to rate of oxygen depends on nutritional state (RQ) If 1 then u are eating carbs If proteins 0.8 and fat 0.7 (THE BEST)

4607

Surgery


In post op: Acute pre r enal failure from hypovolemia: Oligouria, azotemia, elevated BUN/Cr>20:1 Give IV fluid


Reperfusion of a limb following arterio-occlusive ischemia for longer than 4-6 hours can lead to intracellular and interstitial edema. Compartment syndrome may occur when edema causes pressure within a muscular fascial compartment to rise above 30 mm Hg, leading to further ischemic injury

Surgery


Post op Morphine and Opiates, increase sympathetik tone from spllanchic irritation.. decrease GI motility causing Ileus: nausea, vomiting, abdominal distention, failure to pass flatus or stool and hypoactive bowel sound (vs hyperactive in mechanical obstruction)

4640

Surgery

Acute pa in and swelling of the m idline s acrococcy geal skin an d subcutan eous tissues are most commonly due to pilonidal disease. The acute presentation involves infection Gastrointestinal & Nutrition of a dermal sinus tract originating over the coccyx. Bowen's disease is squamous cell carcinoma in situ if the skin. It typically presents as a thn erythematous plaquw with well defined irregular borders and an overlying scale or curst

4655

Surgery


Fenofibrate contribute to gallstone formation. Acute cholecystitis: surgery within 72 hrs of onset

4695

Surgery


Atelectasis (commo n po st op complicat ion): Results fr om sh allow br eathing and wea k cough due to pain. It happens day 2-3 followong abdominal or thoracoabdominal surgery--> Hypoxia which will stimulate respirations and cause alkalosis (lower PCO2)

4608

4609

Surgery

Uword

Recommend Documents