drtanvir
Topics: 19
Posts: 69
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These are notes from UW, Aster notes, Kaplan and mayo clinic review.
I request everyone to add Hy points here.
* Critical aortic stenosis: virtually zero chance of successful CPR.
* Gout with No peptic ulcer disease: Rx of choice - colchicine (not indomethacin).
* Pseudocyst <6w: external rainage >6w: internal drainage.
* St. John's Wort: is a herbal medication with some efficacy in treatment of depression (no FDA Approval)
* Vaginal d/c pH < 4.5 : Consider Candida
ph > 4.5 : Consider Bacterial Vaginosis
* Physiological Jaundice / Exaggerated Physio / Breast Milk Jaundice: no risk of Kernicterus
* Kernicterus occurs @ 1% x Birth Wt. (in grams) [Bilirubin Level].
* PKU screen can be negative at 48hrs of life (requires a repeat screen after 48 hrs. to confirm)
* Maternal SLE: Congenital Lupus & 3rd degree Ht. Block (Anti-Ro).
* Respi Failure: <60 mmHg 02 >60mHg C02.
* Maternal Solvent Abuse: assoc. with nail hypoplasia
* PDA closure achieved by Indomethacin.
* Neonatal CMV: confirm by isolation of virus from urine.
* Transplacental spread is highest in primary HSV, very low in recurrent HSV.
* Breast Milk (cf. Cow's Milk)
high carboydrate
low protein
low iron, but more bioavailable
inadequate Vit. D, Vit. K
supplement Iron @ > 6 m in exclusively breast fed
* Infants of Diabetic Mothers with proteinuria, hematuria: ? Renal Vein Thrombosis (ass. with maternal DM).
*Transfusion Reactions:
Febrile Reaction: WBCs in Donor Blood (Acetaminophen)
Anaphylaxis: Proteins in donor blood (Antihistaminics, SQ Epinephrine) Hemolysis: Mismatch (Hydration & Diuresis)
*Infantile Colic: (Wessel Criteria)
3 m child; 3 hrs/day; >3 days/week; > 3 wks. duration
*ADHD:
1.Methylphenidate / Dextroamph / Mg Pemoline
2.TCA / SRI (second line)
3.Don't use Benzodiazepines
4. consider drug holidays.
* ACEIs contraindicated in preg.
*HyperTG Rx: Gemfibrozil
*Hypercholesterolemia (Drug Rx): >190: 0- 1 risk factors
>160: >= 2 risk factors
>130: CAD equivalent / CAD
if > 15% reduction reqd: "statins"
if < 15% reduction reqd: (Low HDL) Niacin
(normal HDL) Cholestyramine.
*Obesity in Children Triceps Skin Fold Thickness
*OCP induced hepatic adenomas : tendency to rupture (Surgical resection)
*ELISA a-hCG (Urine) is (+) 14 d post conception RIA a-hCG (Serum) is (+) 14 d
*Symptomatic Gallstones: Lap Cholecstectomy.
*Ca. Tail of Pancreas: Poorest Prognosis.
*Lobular Ca in situ is not premalignant
*Digitalis Toxicity is enhanced by:
HYPERcalcemia, HYPOkalemia, HYPOmagnesemia
*Propranolol=drug of choice for HTN+beningn essential tremor.
*Reccurent chalazion=> do histopathologic examination because of risk of Squamous cellular carcinoma (SCC).
*PH=7.23, HCO3=16, PCO2=40-what is it?
=mixed metabolic+respiratory acidosis, because if it were simple metabolic acidosis, then PCO2 would have been=1.5*HCO3+8=1.5*16+8=32mmHg and in this case it is 40mmHg, so there is also a respiratory acidosis
*Know the formula for calculating the compensation in acidosis: PC02= 1.5*HCO3+8
Ex.: a diabetic suffering from COPD treated with metformin may have mixed acidosis, metabolic from metformin, respiratory from COPD.
*NSAID can give SIADH (innapropriate secreation of ADH).
* Tamsulosin=blocks alpha1-receptors only in prostate and bladder=>no side effects like hypoTN, headache, rhinitis as other alpha 1 blockers
*Sideroblastic anemia-high Fe, high TIBS, may be hypocromic and normocromic anemia in the same time=HIGH YIELD .
*Streptoccocus bovis endocarditis-asoc. with colorectal cancer=>do colonoscopy.
*Treatment of MG crisis=intubation+withdrawl of anticholinesterasic drugs for many days, then do plasmapheresis and iv IG.
* Foreign body in the eye=>first pen light exam=>fluoresceine exam, if still (-)=>CT or US, never MRI (it can dislocate the foreign body)
* Patient with XYY karyotype=severe acne, but not precocious puberty
21-hydroxylase deficiency=precocious pseudo-puberty, independent of the hypotalamic-hypophyseal-gonadal axe.
*Black widow spider bite=>treat with narcotics, muscle relaxants and Ca gluconate.
*Women with CIN (cervical intraepithelial neoplasia):
a) imunocpmpromized
b) in utero exposure to DES
c) hystory of CIN II/III
will have annual PAP smear done, regardless the normal previous ones.
*In severly depressed patient, even suffering from terminal illness with suicidal thoughts=>start antidepressant therapy.
*Systemic steroids=drug of choice in sarcoidosis with disabling symptoms, if not responding=>cyclosporine
if asymptomatic sarcoidosis=>no treatment.
* Lachman test is more sensitive than anterior drawer test in ACL rupture (anterior cruciate ligament).
*HTN+peripheral vascular disease=>give Ca channel blocker.
*Primary polydipsia=increased thrist first, can be given by antipsyhotic medication (phenotiazines) because they give a dry mouth. Look for a patient in the psychiatric ward on antipsychotics who gets diarhhea, polyuria and thrist
Insipid diabetes=increased polyuria first.
*Finkelstein Test: Chr. Stenosing Tenosynovitis (deQuervain's Disease)
*Rx for Chlamydial Ophthalmia: ORAL Erythromycin (to prevent chlamydial pneumonia)
* CPK-MM is increased in hypothyroidism (proximal myopathy)
*Fetal Weight Determination:
HC, BPD, AC, FL
* Fetal Age Determination: Transcerebellar Diameter
*RA: associated with atlanto-axial subluxation ("drop" attacks)
*Fever 24-48 hrs. Postop: #1 Atelectasis
* Pneumococcal Vaccination is required in CSF Leak
*Nephrotic Syndrome: Fatty Casts
Pyelonephritis: WBC Casts
Cystitis: WBCs
GN (PSGN): RBC Casts
CRF: Broad Casts
*Cold Antibody: IgM - Inravascualr Hemolysis
Warm Antibody: IgG - Extravascular Hemolysis
*Mx of Myesthenia Gravis: PYRIDOSTIGMINE
(not PHYSOSTIGMINE cuz of CNS effects)
*vWD & Aortic Stenosis: ass. with Angiodysplasia
*Alcoholic Cirrhosis: a-gamma bridge
*Penicillamine increases survival in Scleroderma
*Septic Pelvic Thrombophlebitis (Mx: i/v Heparin)
*HTN+peripheral vascular disease=>give Ca channel blocker
*Respiratory alkalosis-in liver insufficiency because of increased levels of progesterone (not metabolized anymore).
*Athlete's foot (in swimmers too)=fungal infection, treat with tolnaftate.
Alcohol withdrawl=>first-line give chlordiazepoxide (librium), then lorazepam=second-line
*Addison's: ACTH Simulation Test
Cushing's: Dexamethasone Suppresion Test
Conn's: Salt Loading Response
Diabetes Insipidus: Water Deprivation Test
*Hemophilia A: aPTT increased, BT normal
vWD: aPTT increased; BT increased
(Ristocetin Cofactor Assay)
Factor VII def.: PT increased, BT normal
Aspirin: prolonged BT, no effect on CT
*BCC (basal cell carcinoma)=most common tumor of the eyelid
=pearly, indurated
=>treat by chemosurgery of frozen section control excision.
*Hashimoto thyroiditis-can be eu/hypo/hyper thyroid
-anti preoxidase Antibodies are diagnostic
-risk (6 times) of thyroid lymphoma.
*Nasopharingeal carcinoma-appears in all age groups.
*Colonic villous adenoma, sessile adenoma or size>2.5 cm=> increased risk of malignancy=HIGH YIELD
No further work-up for hyperplastic polyps.
*US of KUB (kidney, ureter, bladder)=first step in evaluating BPH (benign proastate hypertrophy) with elevated Creatinine and normal urinalysis.
*MALT gastric lymphoma and no metastasis=>eradicate H.pylori infection, if this fails, then give chemotherapy (CHOP).
*Excessive bleeding (like abruptio placenta) in pregnant woman Rh (-)=>give higher dose of anti-D globulin.
*d-xylose test: abnormal in small bowel malabsorption, normal in pancreatic disease.
*Abciximab: decreases restenosis rates post-PTCA
*screening for malabsorption: 24 hour fecal fat
*Congenital Syphilis may be associated with severe osteochondritis. Child may refuse to move limbs (Pseudoparalysis of PARROT)
*PTCA: no effect on morbidity or mortality
*Diabetes Mellitus : assocation with hyperTG
First line management of newly diagnosed diabetic: DIET (not drugs)
DM+HTN: ACEIs
Hypercalcemia: IN Hydration + Loop Diuretics
*Obesity: BMI>27g/m2 or 120% of ideal body weight.
*Caloric Intake increase:
300 Cal (Pregnancy); 50 Cal (Lactation)
*Pulmonary Embolism: i/v Heparin
*COPD excacerbation: H.flu, Pneumo., Moraxella.
*Long term stabilization of exercize induced asthma: Salmetrol & Zafirlukast
*Severe acute asthma: < 50% best PEFR
Moderate acute attack: 60-80% best PEFR
Mild acute attack: >80% best PEFR
*#1 community acq. pneumonia: S. pneumoniae.
Ideal sputum sample: <10 epi./HPF & many PMNs
*GERD: Transient relaxation of LES.
*Always perform an EKG for any adult with chest pain (esp. with risk factors for CAD).
*Esophageal Ca.: most common type is AdenoCa. (Barrett's Esophagus).
*Sjogen syndrome=>diagnosis confirmed by lip biopsy (lymphoid foci in accessory salivary glands)=most specific.
*Allergic contact dermatitis=erythema, edema, pruritus, tiny vesicles, weepy&crusted lesions 24-48h after contact with the allergen-cell mediated hypersensitivity.
* Psammoma bodies=thyroid papillary cancer
Invasion of tumor capsule and blood vessels=folicular cancer
Hurtle cells-appears in both the above types (rarely)
*Defect in opsonisation=asplenia (infections with S. Pneumoniae are frecq)
*ACE inhibitors=>increase renin and kinin derivates=>cough
*Carcinoid syndrome=>develop deficiency of niacine (dermatitis, diarhea dementia) because Trp is mainly converted to serotonine and 5HIAA
Hyper Ca crisis=vomiting, oliguria/anuria, dizziness, coma.
*Invasive aspergillosis="halo sign" on CT scan of lung
=in imunocompromized people
=on CXR-cavitary nodule.
* Miastenia gravis=>thymectomy if:
-between age of puberty and 60
-if <12 years of age=>frecquent spontaneous remissions
-if>60 years of age=>give corticosteroids
-if only ocular disease=>no thymectomy
* Defect in Le adhesion=reccurent bacterial infections
-characteristic are: delayed separation of umbilical stump
necrotic periodontal infections
* Acute ingestion of masssive alcohol=> reduces the toxic effect of acetaminophen by inhibiting CYP2E1 like in suicide attemps with alcohol and acetaminophen together, but
*Chronic ingestion of alcohol reduces glutathion=>increases the toxicity of acetaminophen like in an alcoholic patient with some kind of fever due to common cold.
*Egg allergy=>contraindication to influenza vaccine and Q fever vaccine, and relative c.i. to MMR (which is however still recommended and is believed to due o gelatin)-HIGH YIELD
* Dermatomiositis=Gottron's sign=scaly patches on MCP and IP joints
=heliotrop rash (periorbital edema+purplish suffusion). =proximal muscle weakness
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