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 HY NOTES ALHPHABETICALY ORDERED  
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  #21

Ulnar Nerve entrapment
Decreased sensation to 4 & 5 digits, and weak grip. The mc site is the elbow, in medial epicondyl groove.

Umbilical cord compression
is asso with Variable deceleration. Fetal sleep presents with decreased logn term variability. Fetal Head compression is asso with EARLY deceleration. Uteroplacential insufficiency presents with LATE deceleration. Intrauterine infection presents with tachycardia.

Umbilical Hernia
Is due to imperfect closure or weakness of the umbilical ring. Commonin low weight and Black infants. Its covered with skin and is easily reduced. > most disappear by one year. Surey is advised if hernia persists to the age of 3-4, exceeds 2cm in diameter, causes symptoms, becomes strangulated or progresily enlarges after 1-2 years.

Urethral injury, posterior - 2
Hallmark of Urethral injury is triad of 1-Blood at urethral meatus. 2-Inability to void, 3-Distended bladder. We have two types of UI: 1-Anterior, urethral inury anterior to perineal membrane. AUI are mc due to blaunt trauma to perinuem (saddle injuries). An immediate surgert is tx. 2-Posterior urethra, consists of prostate urethra and membaneous urethra. PUI are mc asso with pelvic fracture and high riding prostate. Initial mgmnt is retrograde urethrogram and then suprapubic catheterization. Remember Urethrogram with post void film is for Bladder injuries.

Urethritis
A/01/03. Tx for uncomlicated infections, Tetracycline, Azithromycin. For Pregnant women Erythromycin.

Uric acid stones
Are visualized via CT of abdomen, or IV pyelography.*****Needle shape crystals on urine analysis indicate urc acid stones. Uric acid stones which are radiolucent have to be evaluated with either CT of abdomen ar IVP. The stone can cause Ileus, possibly due to vagal reaction due to ureteral colic. The result will be absent bowel sounds, constipation, signs of obstruction, no gas passing. Ileus will be over once ureterolithiasis is tx. Stones
Uterine Rupture - 2
Presents with intense abdominal pain asso w vaginal bleeding, ranging from spotting to massive hemorrhage.****Risk in transverse line is 0.5% and in Vertical its 5.0%. If pt does not want any more children, total hysterectomy is the Tx of xhoice. If she wants more kids then Debridment and closure is indicated.****difficult to ddx from abrupta placenta. UR is preceeded by agitation, rapid breathing, tachycardia.

UTI in females - 3
The mcc in order are: 1-Shorter urethra compare tomen, 2-Contraceptives, 3-wt periuretral envoronment, 4-close proximity to anus.*****E.Coli is the mcc but it dos not produce uease so it doesn’t alter the normal Acidic pH of urine. Proteus is a urease producing bacteria and a frequent cause of UTI. Protease makes the urine Alkaline. ****In a female that there is no response to trimetasulfa and yellow/green mucopurulent endocervical dischage and edematous friable cervix, suspect C.Trochomatis. Dx is cervical culture. Asingle doze of Azithromycin for both partners is tx of choice. DDX is Chlamydia Urethritis, suspect in sexulay active pt with prolonged dysuria (7-10) days unresponsive to therapy for Chlamydial CYSTITIS. In Chlamydia, Gonocoal prophylaxis in not needed, but in Gonococal infection, empiric tx of chlamydia is recommended. Hospitalization and IV tx is recommended for severe PID (abdomial pain, uterine.adnexal tenderness on bimanual exam, and cervical motion tenderness).

Uveitis
Is the mcc of red eye in pt with Ankylosing spondolytis.

Vaginismus - 2
Involuntary spasm of the perineal musculature that interferes with sextual intercourse.****Unlike Dysparunia, Vaginismus is not due to any medical cause. In ALL cases its due to ignorant of women's anatomy, ahuge apprehention about penetration, and an uncontrolable fear of pain. Tx includes relaxation, Kegel excercise (to relax vaginal muscle), and graduation dialation (penetration).

Vaginitis, Candida
Its not an STD. It may appear in presence of risk factors like DM, OCP, pregnancy and immunosupresive therapy. It can also trigger by Alkaline pH of the vagina during menses that is favorable for growth of Candida. Symptoms are vaginal and vulvar pruritis, burning and dysparunia. Discharge has cottage cheese appearance. Its NOT malodorous and pH is 4-4.5. Dx is by KOH wet mount preparation and visualization os pseudohypha and spores. Tx is Imidazole cream or 10 day oral Ketoconazole (especially if recurrent). Fluconazole is the new drug with fewer SE. Give 2 doses, a week apart. Most recurrences are due to non-compliance. If that is OK, then suspect anoterh oraganism and culture on Sabourausd. 50% of reccurence is due to other organism like like T.Glabrata and Candida tropicalis. In addition, 35% of pt with recurrent yeast infection and who have negative cultures, have HPV on biopsy. DDX1:Trichomonas (Metro) DDX2:Gardenella Vaginitis (Metro).

Varicose Veins
Symptoms are fatigue, tiredness in the leg, aching swelling. They are worsend by prolonged sittingor standing.The sweeling and pain rapipdly goes away when leg is elevated. The edema is asso with perforator incompetence. Ulcers occur in medial aspect of the leg. DDX Arterial insufficiencysticking out tongueresents with claudication that is worsened by leg elevation. Pulse is weak or absent and the ulcers are deep and at the distal parts of the leg. There is NO SWELLING in arterial insuff but hair loss and muscle atrophy is noted. DDX2 DM ulcers are like arterial but they are at the pressure points. DDX3 DVT related ulcers take years to develop and they are unlikely in active pts.

Vasa Previa - 2
Hemorrhage w fetal heart rate changes, progresing from tachycardia to bradycardia to a sinusoidal pattern. "Apt" test distinguishes maternal from fetal blood. Mortality risk is 75%. Dx w transvaginal US in combination w Doppler. VP necessitates emergency C section.

Ventricular Tachycardia
When a pt has recurrent VT first thing to do after stabilization(Amiodarone) first thing to do is to look for the cause, Most probabelt its due Diuretics (ie Furesamide causes HypOkalemia). So order electrolytes and correct them if needed.

Ventriculat Fibrilation.
Tx is defibrilation with 200-360 joules. If it fails, lidocaine or Amiodarone (DOC) can be loaded and pt shocked again. Epinephrine can sensitize and lower the treshold for conversion.

Verapamil poisoning
May cause bracardia, hypotension, AV block and cardiac arrest. Like hypotension caused by other poisons, IV saline is the first thing. Then Calcium Chloride is useful in reversing the effect of Calcium channel blocker including bradycardia, AV block and hypotension.

Vesicoureteral Reflux:
Is retrograde flow of urine from bladder to ureter and renal pelvis. It’s a risk for recurret UTI and renal scarring ultimately. Renal scaring is the major cause of end stage disease in children. Reflux exists in all children with renal scars and renal scars are in 60% of children with gross reflux. Dx is made with voiding cystourethrogram.

VIPoma
Is a Pancreatic tumor. Produce Vasoactive Intestinal Peptide. It causes diarrhea, hypokalemia resulting in leg cramp, and decrease in amount of acid in stomach. Woman are more affected. Other symptoms include weight loss, facial flushing and redness. Dx is high VIP in blood. CT or MRI find location. Tx: first goal is to treat dehydration. Next is to slow the diarrhea with Octreotide. If tumor has not metastasized, surgery is indicated.

Vitami K def - 2
Vit K def presenting as hemorrhagic dis of the new born occurs in infants born at home with no prenatal care. Its given to all infants after birth. Newborns are suseptible due to low fat stores, low vit K breast milk and liver immaturity. It can present as intracranial bleeding as well as skin and GI. In adults it is seen in pts with chronic small bowel disease, after small bowel resection or prolonged anbiotic therapy. Dx is elevated Pt or decreased clotting factors. BT is normal. Platelet in normal, PTT may or may not be elevated. DDX1:Von Willerbrand, Auto Dom, BT & PTT are elevated, PT is normal. Factor VIII is low. DDX2:Hemophilia ia X-link, PTT is elevated, BT and Pt are normal. DDX3:Liver disease, Pt is elevated, PTT & BT are normal. DDX4:ITP, platelets are low.

Vitamin D Def
Most commonly due to MALABSORPTION causes reduced plasma Calcium and Phosphorous. DDX w Hyperparathyroidism and Pseudoparahypothyroidism is that they cause decreased in Ca but increase in phosphate.****In infants: presents with bone abnormality like softness or deformity. Typical pts ar low birth weight, Unsupplimented dark skin infants, infants with inadequate exposure to the sun, and breast fed infants.Pthology is defective mineralization of the bone.*****Rickets is developed due to Vit D def in children who stay indoors all the time and eating is not blanced. Presents with costochondral junctions are enlarged, wrist and ankle are thick and xray shows cupping and frying of the distal end of radius and ulna, large anterior fontanel.

Vitamin D Toxicity, Misc. 6/2
Confusion, HA, nausea from hypercalcemia. Mental status changes. Constipation is the mc GI SE. Renal SE is nephorolithiasis, ARInsiff and CRI. Tx is stopping the vitamin, low Ca diet, keep urine acidic and giving corticosteriods.

Vitamine Def
1-Riboflavin Def (B2) is unusual in industrialized nations. Symptoms are Photophobia, Dermatitis and Anemia. 2-Vit C : Ecchymosis, petechia, bleeding gums, Hyperkeratosis, Sjogren's. 3-Niacin (B3) presents with Diarrhea, Dementia, Dermatitis. 4-Thiamin def (B1) asso with infantile and adult Beri Beri as well as Werneki-Korsakoff. Dry beri beri is symetrical peripherla neuropathy with sensory and motor involvment. Wet beriberi is includes neuropathy in addition to cardiac involvment.

Vitiligo - 2
Presents with pale patches of skin, symetrically around themouth and areola. Borders are well circumscribed and hyperpigmented. Pathology is destruction of melanocytes. Few experience spontaneous remission. ***Its asso with Pernicious anemia, Grave's dis, DM-I, alopecia areata.

Vitreous Hemorrhage -2
Sudden loss of vision with floaters in the visual field. Diabetic Retinopathy is the mcc. Fundus is hard to visualize. Basically there are 3 types of Ophtalmological Hemorrhages:1-Conjunctival, cause is minor trauma,cough, sneeze or strain, no tx needed, resolves w/i 2 weeks. 2-VH, produces blavk reflex in exam, cause is DM and retinal vein occulsionretinal tears,its absorped slowly, bleeding is controlled with photocoag. 3-Retinal Hemorrhage which is flame shaped in HT and dot&blot in DM or septic infarction, its always significant.

Volkman’s Ischemic Contracture:
Displaced anterior fat pad is a radio-G sign of Supracondylar fracture which may be complicated by VIC

Volvulus, midgut
Present in a child <1 month old with billus vomit, abdominal distension and passage of blood stained stools. Child is irritable but no signs of pain. DDX1:Pyloric stenosis is non bilus vomit. Duedal Atresia has no blood in stool. In Down synd infants. Hirshprung fails to pass stool. Meconium Ileus, fails to pass meconium, asso with CF.

Von Willerbrand disease:
Vwf is decreased.

VSD
Harsh and hollosystolic murmur heard at the left lower sternal border, is the mc cardiac congenital defect. If its small and causes no symptms for the infant, 40% of the times it closes spontaneously by 3 years and 70% chance of closure by 10years. Risk of Infective endocarditis is increased so peophylaxis for dental is indicated. If the defect is large (Soft murmur) then it might turn in to Eisenmenger syndrome and reverse of the blood flow which is irreversible. Medx and surgery is then indicated prioe to irreversible stage.

Vulvar Hypertrophic Dystrophy
Thick and hyperkeratotic due to long term scratching. Mostly seen in PM women.


Vulvar Papillomatosis
or Condylomata acuminata. Caused by HPV 6,11. Present as exophytic lesionswith araised papilloatous or spiked surfacemay grow into a calliflowerlike formation.

Waldenstrum Macroglobulinemia
is a rare chronic plasma cell neoplasm. Plasma cells multiple and invade BM,spleen and lymph nodes. They produce excess IgM that causes thickening of the blood, Hyperviscosity. Major S&S are: 1-Increase size of spleen, liver, lymph node, 2-Tiredness (from anemia) 3-Bleed easily(little platelet), 4-Night sweats, 5-HA and dizzy, 6-Visual problems, 7-Pain and numbness in extremities. DDX:MultipleMYeloma, there is IgA/G not IgM. Also No hyperviscocity (Engorgment of the retianl vein) like in WM.

Warfarin induced skin necrosis - 2. Dermo. 6/3
Ita a serious complication of oral anticoags. Sometimes its asso with protein C deficiency. Female are more prone. Its a hypercoagular state.Commonly affected sites are breast, thighs, buttucks and abdomen. Initial complain is pain followed by bullae and skin necrosis. It occurs w/I weeks of starting therapy. VitK should be administered in the early stage and Warfarin discontinued if lesion progresses. Heparin should be used until necrotic lesion heals. **** Note os the dise: Warfarin treated pts should be given FFP instead of VitK when emergency surgery is to be performed. DDX with Cholesterol Embolic synd, dont be fooled with Bruit, see the whole picture.

Washing cells
Febrile reaction is a common transfusion reaction that is caused by antibodies in the pt's plasma reacting with donors leukocytes. Leukocyte depletion technique, like cell washing , decreases the probability of febrile, NON-hemolytic transfusion reaction.

Waterhouse-Friedrichsen
Or Adrenal Glands Hemorrhage is a very serious complication of Menigococcial meningitis caused by Nisseria. Its bilateral bleedng into adrenal gland due to DIC, carries 100% mortality. So in an infant with Meningococcemia watch out for WFS, which is characterized by a sudden vasomotor collapse and skin rash due to adrenal hemrr.

Wegener granulomatosis - 2
Hematuria+Hemoptysis+Sinusitis. Underlying pathology involves Necrotizing vasculitis with granuloma formation. Postive C-anca. Typical Xray shows nodular cavities. ****Demonstration of Anti Neutrophil Cytoplasmic Antibodies confirm dx. The Cytoplasmic pattern (C-ANCA) is highly specific. Cxr shows infiltrates, nodule, cavities and masses.

Werdnig-Hoffman:
An auto recessive disorderinvolves degeneration of anterior horn cells and crnial nerve motor nuclei. It causes floppr baby synd (like Botulism)

Wernicke encephalopathy
Characterized by Ataxia, opthalmoplegia, nystagmus, and altered mental status. It's seen in chronic alcoholics due to B1 (THIAMINE) deficiency. DDx1:is Folate def which is common in alcoholics but wont prestn with B1 def symptoms. Remember B3(NIACIN) causes Pelegra, 3D, due to corn base diet. B2(FLAVIN) causes Cheilosis an Glositis.

Whipple's disease - 4
Caused by bacterium T. Whippelli, affects men 30-60yo. Presents with joint pain + abdominal pain + diarrhea + weight loss. PAS+ foamy macrophages containing a glycoprotein in intestine is Dx. Also skin Hyperpigmentation. Untreated dis is fatal and progressive. Tx is Procaine pencillin G followed by tetracycline. *Dx is by PAS staining, it can be confirmed with upper GI endoscopy with biopsy on the small intestine. ***D-Xylose absorption is abnormal in both Whipple and bacterial overgrowth. However, the test becomes normal after antibiotic tx.

Whopping cough - 2
B. Pertusis. Tx Erythromycin and cough suppresants. Hospitalize if serious. Pt might develop rectal prolapse, epistaxis and Pulmonary pathology.*****Its highy contagious. Presents with severe bouts of coughing spells after an URI. They are so severe that they can cause rectal prolapse, epistaxis, pneumothoraces and subconjunctival hemorrhage.


Wilms Tumor - 2
B/t ages of 2-5. It’s the mc primary tumor of renals in childhood. 80% have asymptomatic abdominal mass discovered by mother. In 10% massis bilteral. Tx is Nephrectomy. . If tx at early age majority have long term survival. DDX1:Neuroblastoma, if the child has <1 year suspect it. It presents with abdominal mass, fever, weight loss, hepatomegaly and HT. It usually crosses the mid line and dx is made by measuring urinary cathecholamine products. ****4yo with right flank mass, and both kidneys being palpable with stable vital signs is Willms. Thi stumor orignates from METANEPHRONS. DDX is Neuroblastoma, a unilaterla mss, w/o bilateral enlargment of kidneys. This tumor is a malignancy of neural crest cells. DDX2:Polycystic kiney dis presents with BILATERAL flank masses.

Wilson's disease - 2
Dx is decreased serum ceruloplasmin, increased urinary copper and slit lamp examination of the eye. There is also Mallory's hyaline on liver biopsy. Its recessive disease. Decreased ceruloplasmin leads to copper deposition in liver, cornea, basal ganglia (hepatolenticular degeneration). Disese starts in infancy, but since all infants have increased level of copper for the first 3 months, its best to diagnose it after the first year. f not treated thi disease is fatal.****Dx is finding Ceruloplasmin ,increased urinary copper and hepatic copper deposition in liver biopsy. Tx is Penicilamine . Fulminant Hepatitis needs liver transplantation.

Wiskott Aldrich
Characterized by recuurent Pyogenic infections, atopic eczema and thmbocytopenia. Presents w/I one year of age. First manifestationis hemorrhagic episodes followed by pyogenic infections. Its X-linked. IgM is decreased but IgA & IgG are normal. The defecy lies in inability to produce immune response to capsulated polysaccharide antigens. Pt are predisposed to ALL and Hodgkins. Thrombocytopenia is due to spleenic desrtuction of Platelets. Tx is continues antibiotics, spleenectomy and BMT. DDX1:CGD, presents under 2 years of age, defect is inability to generate oxydative burst to kill organism after being phagocytosed. Lack of NADPH oxidase. In lab, it can be confirmed with Nitro Blue Tetrazolium, which will be NEGATIVE. DDX2:Chediak-Hegashi is recurrent pyogenic infections. the defect is in neutrophils as their lysosomes fail to empty their contents. B&T cell function are normal. NBT is normal. Pt will have partial Albinism and neuropathies and Nystagmus.

Wrist fractures:
1-Colles: the mc fractureof distal radius in outstretched hand. Characterized by dorsal displacement & dorsal angulation.
2-Smith : reverse of Colles. 3-chauffer’s: fracture of radial styloid process. 4-galleizi: isolated fracture anywhere in radius with asso injury to radio-ulna joint.

Zenker Diverticulum - 2
Pt presents with orophareangeal dysphasia, neck mass and are >50yo. UES dysfunction and esophageal dysmotility (motor dysfunction and motility problem) are believed to be the cause. Barium exam helps to delineate the diverticulum, the surgical tx includes excision and frequently cricophareangeal myotomy. ****Zenker is defined as herniation of mucosa through the fibers of cricopharyngeal muscle. Barieum Esophagograpghy is the confirmatory test od choice, not Esophagoscopy.

Zinc Def
Alopecia, mental changes, diarrhea, dysgeusia, smell abnormalities, maculopapular rash around the mouth and eyes and impaired wound healing.

Zollinger Ellison (Gastrinoma) -4
Characterized by multiple severe drug resistant ulcerations in GI track. The mcc of ZE is a gastrin-producing pancreatic tumor. As a result of uncontrolled gastrin production, parietal cell hyperplasia occurs and stomach acid production is significantly increased. Multiple Duedenal ulcer are typical, and a Jejunal ulcer is almost pathognomic for this condition. Steatorrhea may develop, becuase increased production of stomach acid inactivates pancreatic enzymes. Tx of choice is K-H atpase inhibitor Omeprazole, indefenitely until surgery. If medx fails we have to go to toal Gastrectomy. *Is Asso with MEN-I, Hyperparathyroidism,Pancreatic carcinoma and Pituitary tumors.






  #22

The above post completes the list. These are notes from UW Qs and i got them from my friend. Plz dont use it as ur basic tool, but while doing the topic u can add points and make them perfect. I posted them in the forum for the maximum benifit of ppl.
GL to all in CK.


  #23

man, what a great thing you did!!! Thanks a lot!!!


  #24

Whereas all these highlights are nor suitable as a main source of study, they may become indespensable during lat days of the prep to CK exam, especially when there is no time to go through the UW Q bank again.
Thanks!!!


  #25

Thank you so much! It is indispensable indeed!


  #26

Wow, thanks again! This saves me a LOT of time from taking more notes from UW... I'll just print out and add to yours if necessary.
Good organization, and summary of the main points!



  #27

I know great notes, thanks FLORIDAGUY! If you know what I mean ;-)


  #28

Hi coolmavs
see the previous page where i wrote this " The above post completes the list. These are notes from UW Qs and i got them from my friend. Plz dont use it as ur basic tool, but while doing the topic u can add points and make them perfect. I posted them in the forum for the maximum benifit of ppl.
GL to all in CK."
I never claimed that these are mine notes. But i posted here for maximum benifit for all.



  #29

great drtanvir nod
really great work....
thank you very much for your effort


  #30

thnks a lot tanvir!
this is great review for me in time !!
god bless yu!!smiling face


  #31

OH THANKS So much someone make this a sticky. nod


  #32

OH well I see it already is !!!!!!!!!!!11 PPL are fast! I wish i was in the vote toosticking out tongue but consider it given Tanvir!!!!!!!!!!!!!! grin


  #33

Hi all
Its nice that all ppl are liking this post. But the origional credit goes to the person who made them. I just got this file from the friend and posted here as i wanted to use this by maximum ppl and taking benefit of it.
and its nice that its helping the forum.



  #34

Thank you for your effort drtanvir...... and many thanks to your friend too... God Bless you


  #35

The notes are a great contribution, thank you very muchwink


  #36

Thank you, it's nice you are sharing the info, May you blessed with the score you want!


  #37

great work indeed!
thank you very much for your effort and sharing.


  #38

I don't know what's up with the smiley faces in the text. But I'll take it. Thanks alot man, you just saved me 187 pages worth of typing


  #39

thanks a lot... very helpful for both step 1 & 2


  #40

gr8 work....smiling face





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