motorola
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26. eculizumab, a complement antagonist is the new drug used in PNH.
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What is this medical device? What is pentalogy of Cantrell?
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| motorola
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Topics: 74
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27 )
Various secondary Glomerulonephritis
HBV - Membranous
HCV - MPGN
Hodgkins - MCD
HIV - FSGS
typical of SLE - Diffuse Proliferative
___________________
What is this medical device? What is pentalogy of Cantrell?
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| drbcshah
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These are not my notes but I found them to be useful short form of kaplan OB gyn
Gynecology jillus notes
1. Progression to malignancy in complete mole is 20 %
2. Progrssion to malignancy in incomplete mole is 10 %
3. Taiwan and Philippines history, and H.T < 20wks, AND passage of grape like vesicles < 16wks , suspect molar pregnancy
4. Theca luetin cysts in molar pregnancy
5. MOST COMMON SITE OF MET OF MOLAR PREGNANCY IS THE LUNG
6. Squamous hyperplasia of the vulva =whitish, focal, firm areas
Lichen sclerosis =bluish white papules coalesce to form white plaques
Squamous dysplasia =white red or pigmented and multifocal in location
melanoma of vulva = dark black lesion in vulva
Paget’s disease = red lesion in a postmenopausal female
7. All vulvar lesions should be biopsied
8. Paget’s disease of vulva related to other cancers of git , g.u.,Trt and breast
9. Treatment of vulvar cancer -study
10.The most common cause of death in ovarian ca is BOWEL OBSTRUCTION
11.TUMOUR MARKER FOR OVARIAN CA IS CA 125
12. Ovulation and ocp’s decrease the risk for ovarian carcinoma
13.ovarian cancer is the most common form of gynecological ca leading to death
14. T he current screening test for the ovarian ca is bimanual pelvic examination
15.dysgerminoma is a tumor sensitive toxicity- RAY
16.chemotheraphy to ovarian cancer only if there is metastasis
17.carcinoid syndrome has been described originating from the dermoid cyst
18. The most common cause of post menopausal bleeding is NOT END .CA BUT ITS VAGINAL OR ENDOMETRIAL ATROPHY
19.ADENOMYOSIS is differentiated from endometriosis by the cf of secondary dysmenorrhea and menorarhagia , And tenderness most common immediately before and after the menses and the utx is globular and diffusely enlarged 2- 3 times
20.treat adenomyosis with LVG [levonorgestrol] ius surgery definitive treatment
21.ENDO CERVICAL CURETTAGE IS CONTRAINDICATED IN THE PREGNANCY , AND after the suspicious pap positive do only ecto cervical biopsy ..
22. Before 24wks , treat invasive cervical cancer with radical hysterectomy and radiation therapy
23. After 24 wks , treat cervical cancer invasive with conservative management and then c.s after the lung maturity has completed
24. The pt with distant met from the invasive cerrvical cancer, shud be consisdered chemo and the most effective chemo drug is cisplatin .
25. The initial test for the cervical cancer , [sq ,cell .ca ] is cervical boiopsy
26. Ascus ==hpv 6 r 11 = repeat PAP in one yr
27. Ascus =HPV ?DNA =16 R 18 = EVALUATE WITH colposcopy and biopsy .
28. HPV 6 and 11 asso. with condylomata accuminata
29. Indications for the cone biopsy.
a. abnormal pap
b. abnormal ECC histology
c. lesion seen entering the endocervical canal
d. biopsy showing microinvasive carcinoma of the cx
30 .Most common complication of cone biopsy -incompetent cervix and cervical stenosis.
31. Sexual excitement is by hte parasympathetic connections
32. Sexual orgasm is by the sympathetic connections
33.desire of sexual activty is by the Dopamine stimulationa and seratonin inhibition
34.difficulty in vaginal lubrication becoz of estrogen deficiency
35. After an sexual assualt , the female shud be treated with cphalosporin , doxy and metronidazole and hep b and for pregnancy prevention , 2 large dose tablets of progesterone in 12hrs or LNG tablets are prescribed
36.vaginismus is the only sexual dysfunction tat can be diagniosed on physical examination and treatment is with the vaginal dilators ...
37.in pregnancy post sterlization , suspect == Ectopic
38.copper t =contraception nearly for about 10 yrs
39.. The risk factors for IUD are ,recent chlamydia inf ,vaginal inf , HIV , immunosuppression , and pts with crohns with the treatment of steroids
40. The subserosal fundal fibroid shud not interfere with the IUD placement
41 . If too large sized vaginal diaphragm are used, it results in urinary incontinence
42.T he frequent side effect of POP, i.e. minipill, depot provera , LNG TABLETS ARE ALL BREAK THRO bleeding
43,. Low doses of ocp’s apart from regularising the menses does not cause serious side effects
44.Yeast vaginitis transmitted by candida albicans , is not transmitted sexually ....so partner is not to be treated
45.Mtz IS SAFE TO USE DURING THE PREGNANCY including the first trimester
46. 3RD MOST COMMON Cause of STD in USA is T.V
47.ACUTE SALPHINGO OPHORITIS IS A CLINICAL DIAGNOSIS
48.out patient treatment for PID =oflox + metro =14days
49. Inpatient treatment in toxic pts with PID , is i.v cefoxitin, cefotetan plus doxy or i.v clinda + gentamycin
50.condyloma accuminata - HPV -16 and 18 =cauliflower like mass - clinical diagnosis - treat it with podophyllin , TCA acid , imiquinod
51. Number one STD in females is == Chlamydia
52.transmission of Chlamydia infection from mother to baby may present as Chlamydia conj or otitis media
53. THE CLASSIC CLINICAL FINDING OF CHLAMYDIA IS =mucopurulent cervical discharge
54. DISSEMINATED gonorrhea Presents as DERMATITIS, POLYARTHRALGIAS AND TENOSYNOVITIS
55. SINCE COINFECTION is present between Chlamydia and gono , treat with both ceftriaxone and azithro or doxy
56. Bartholin’s abscess present in gono.. Infection needs Marsupilation
57. PCR AND DNA PROBE FOR CHLAMYDIA
58. SWABS AND THAYER MARTIN MEDIA FOR GONORRHEA
59. The most common site of ectopic is in OVIDUCT AND IN IS IS THE DISTAL AMPULLA
60.SUCTION AND CYRETTAGE IS DONE IN hydatidiform mole and not dilatation and curettage because of the risk of perforation of Uterus.
61 Hormone replacement treatment mainly for the vasomotor symptoms in the female [hot flashes, genitourinary atrophy and dyspareunia ]
62. Hormone replacement therapy for postmenopausal osteoporosis, -anti estrogen med.
63.Tamoxifen is a SERM with Bone and endometrium agonist and breast antagonist
64.Hormone replacement should not be given primarily for prevention of cardiovascular risk
65.Raloxifene has bone agonist and endometrial antagonistic effect
66. Estrogen replacement therapy should be given for a max of 4 yrs ....because of the risk of breast cancer after prolonged period of treatment
67.the most bone type for osteoporosis is trabercular bone and the most common involved site are the vertebral bodies
68.In the postmenopausal female, here is increased gonadotropins [FSH , LH ]AND DECREASED ESTROGEN and the main reason fro all the post menopausal vasomotor effects is because of decreased estrogen
69. The most common cause of mortality in he postmenopausal female is cardiovascular disease
70.clomid acts by fitting into the estrogen receptors and fools the pit by creating a low estrogen state and thus secretes gonadotropins for the For the ovulation induction
71. With clomid the patient is stimulated with the persons own gonadotropins but with HMG , the patient is being stimulated with exogenous gonadotropins
72.LH , FSH ratio increased in PCOD , 3;1 , normal 1.5:1 and sex hormone binding globulin [SHBG] IS DECREASED IN PCOS . OCP’S act by suppressing the testosterone in 2 ways in the treatment of the PCOS BY
1. SUPP THE LH stimulation
2. By increasing SHBG with decreases the free testosterone level
73. IDIOPATHIC OLIGOZOOSPERMIA IS THE MOST COMMON MALE INFERTILITY FACTOR
74 .Ovarian failure occurs before age of 30 yrs and may be associated with autoimmune disease of Y CHROMOSOME mosaicism and so karyotyping is done
75. The most common method of assessing the bone density is with DEXA scan .
76.SSRI;s are the treatment of choice fro the emotional symotoms Of PREMENSTURAL SYNDROME
77. High doses of vit b6 thatis pyridoxine in PREMENSTURAL SYNDROME causes permanent sensory neuropathy and so the consumption of vit b6 shud be discouraged
78.kallman’s syndrome is the inability of hypothalamus to produce GNRH and also anosmia
79. The important cause of premenarcheal vaginal bleeding is the FOREIGN BODY, and the other causes r estrogen medications, sarcoma botryoids , pit . Adrenal and ovarian tumor ,sexual abuse and idiopathic precocious puberty ... and the patient pelvic examination should be done under SEDATION
80.The normal pubertal dev stages can be remembered as T>A>G>M [TAGM] that is thelarchae , adnarchea , growth spurt , menarche
81. Classification of precocious puberty -study
82. FSH stimulates INHIBIN but it is SUPPRESED by INHIBIN
83. DURING the cyclical changes of menstruation the functionalis zone is sloughed off and basalis zone does not undergo any changes and basalis has the basilar arteries.
89. The drug of choice for idiopathic hirsuitism is spironolactone
90. Axillary lymph node status is the important factor in prognosis of patients with breast cancer
91. Hormone receptor status determination is a critical importance as a predictive factor
92.Over expression of HER-2, shows a bad prognosis in the breast cancer
93.The criteria for the excision biopsy in the breast are
#bloody fluid on aspiration of the cyst
#mass does not disappear on fluid aspiration
#bloody nipple discharge with or without the mass
#skin edema and erythema suggestive of inflammatory ca , so needle biopsy could not be performed
#pt who has undergone FNAC before
94.PhyLLODES TUMOUR of the breast behaves like a sarcoma .
95. Mammography should not be performed until 2 wks after the aspiration of cyst or mass in the breast . USG distinguishes the cyst from a solid mass
96. Hyperthyroidism in pregnancy suspect hydatidiform mole
97 .choriocarcinoma is always treated by chemo
98.stress incontinence is treated by surgery
99. Neurogenic bladder treated by medications
100.definitive diagnosis of endometriosis is only by laparoscopy
101 .Flagyl is CONTRAINDICATED IN APREGNANT FEMALE IN THE first trimester but can be given in 2nd and third trimester
102.The best time for the physician to examine the breast is 10-14 days after the menses
103. Fibrocystic disease of the breast is not usually seen in the postmenopausal females
104 . The contraception which is safe for nursing mothers is depot provera
105 . Do regular endometrial samplings on the pt with tamoxifen- because INCREASED RISK FOR ENDOMETRIAL CANCER
106.MICROADENOMA OF THE BREAST < 1cm is treated with bromocriptine , where as macroadenoma is treated with >1cm is treated with surgery
107.The most common side effects of HMG [PERGANOL ] is increased twin pregnancy, ovarian hyperstimulation syndrome, hypovolemia, tachycardia and electrolyte imbalance.
108. Do not remove the testis in less than 20 yrs in testicular feminization syndrome, since testis is the source of estrogen for the breast development and > 20yrs it can be removed since the risk for the testicular cancer
109. External iliac artery ligation in the treatment of PPH , results in the ischemia of the lower limbs
110.ALL ENDOMETRIAL HYPERPLASIAS R TREATED BY PROVERA EXCEPT ATYPICAL HYPERPLASIA WHICH IS TREATED BY HYTERECTOMY SINCE U NEVER CAN sample the entire uterus so 10- 15% is always a carcinoma
111 . Most common epithelial CA of the ovary is SEROUS
112. Dysgerminoma responds well to the radiation
113. Clear serous discharge in the post menopausal female suspect FALLOPIAN TUBE CARCINOMA
114.Hormone replacement therapy does not have a negative effect on the postmenopausal female smokers since the dose of the estrogen is decreased.
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| drbcshah
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Some more notes made by Dr. Jiggy and his step 3 experience
GI questions:
- pt c hematemesis, not actively bleeding -> sclerotherapy
- pt had hematochezia and bluish dicoloration of the cecum -> I don’t know I put angiodysplasia
- toxic megacolon, NPO/IVF/NGT wasn’t enough, then more pain and more fever c free air in abdomen ->laparotomy
- kid swallowed some acid, what to do in ER -> esophagoduodenoscopy
- no questions on h.pylori
- easy question to diagnose achalasia
- question on sjogrens what is next step -> SSA/SSB Ab or parotid biopsy
- guy had halitosis -> zenkers
- several questions on gout -> trial of PPIs
- question on esophageal scleroderma -> trial of PPIs
- guy has heartburn well controlled with antacids, used to have trouble swallowing only steaks, now cannot swallow many solids but liquids is ok -> PPIs or EGD
- diagnose esophageal cancer
- diverticulitis -> ct scan
- woman with jaundice, only + result was HAV IgG, what is she at risk for in the future? HAV, HBV, Hemachromatosis, Hepatocellular Ca, etc.
- pt with hepatic encephalopathy and high Cr -> dialysis
- question was very long, said pt had epigastric pain radiating to upper quadrants, fever, no jaundice, labs weren’t that bad (mildy elevated alk phos) what does she have -> cholecystitis, choledochilithiasis, pancreatitis, bla bla bla…
- Cholecystitis -> abdm U/S
- Older woman with h/o CABG and history of A.fib gets diffuse abdm pain after eating, and has abdm bruit, what does she have? Embolis in SMA, abdm aortic aneurysm, polycystic kidney disease?
- Acute pancreatitis question
- Question on malabsorption, pt had steatorrhea… lol I don’t remember the rest
- Guy had bloody stools and passed out on the floor, recent history of aortofemoral bypass -> I put fistula
- Dx pyloric stenosis
- What is the cause of intussuseption of small bowel in a 65yo? Idiopathic, tumor, cancer of small bowel, lymphadenitis?
- Dx meckels
CARDIO
- Question said positional chest pain, showed EKG of diffuse ST elevation -> pericarditis
- Had two heart murmur audio questions
- IVDA and vegetations on the heart -> tricuspid regurge
- Guy with angina and a.fib -> I put ECG stress test
- Which is the greatest risk factor for CAD? LDL-chol ration, HDL chol ratio, triglycerides, lipids
- Murmur got worse with standing and valsalva -> HOCM
- Kid with cyanosis in the 1st 24hrs of life -> transposition
- Diagnose tamponade
- Kid with holosytolic murmur -> left to right shunt (it’s a vsd)
- Diagnose MVP (said mid-systolic click)
- Diagnose ASD (said wide, fixed S2)
- Endocarditis prophylaxis for dental procedure in a kid with h/o reaction to ampicillin -> clinda
- Teenager with cramps in the legs, muscles on top are bulky, weak on the bottom, bad LE pulses -> coarctation
- Hyperaldosteronism -> PRA ratio
- 3 questions on temporal arteritis (2 dx 1tx)
- woman with renal artery stenosis what is elevated? Rennin
- diagnose dissecting aortic aneurysm -> TEE
- pt had low Na, low K, high Cl on thiazides and ACEI what is the reason for the labs? I put thiazide and ACEI reaction, other choices were hyperaldosteronism, hypoaldosteronism, other stuff
SKIN
- picture of some bad bad acne -> proprionobacterium
- HSV
- How do you treat ringworm > clotrimazole, permethrin, hydrocortisone?
- Pt had dermatitis herpetiformis -> gluten free diet
- Pt had optic glioma what will you find on skin -> café au lait
- Guys nose had a pearly looking thing on it -> basal cell
- Mentally retarted kid with seizures and a skin disorder -> tuberous sclerosis
- Acathosis nigrans -> check glucose
- Kid with DIC
- Picture of a hand with DIP inflammation and said his ankle was very tender -> gout
- Kid went into the woods now has itchyness and rash in a linear pattern -> contact dermatitis
- Mom wants to prevent daughter from getting sunburns ->advise not to go out before 2pm
- Contact dermatitis question -> cell-mediated hypersensitivity
ENDOCRINE
- Guy is depressed after his wife died and labs show high tsh, low t4 -> depression due to medical conidition, other choices were MDD, Adjustment disorder
- Graves disease what Abs are after -> TSH receptor
- Guy with A.fib what must you rule out -> hyperthyroid
- SOOO many questions on diabetes I and II soooooo many. Guy with DKA (give fluids and what type of insulin), guy with DM and foot ulcer (angiography or foot amputation), soooo many know your DM inside out
- Health care worker comes in after fainting has sugar of 40, normal c-peptide -> took insulin
- Guy with low insulin and high c-peptide -> insulinoma
- Guy with rash and high sugar -> glucagonoma
- Dx hyperparathyroidism
- Guy on lithium -> nephrogenic DI
- Dx SIADH
- Guy with loss of facial hair, small testes and is infertile -> check pituitary
- Pt cannot lactate after birth, had postpartum hemorrhage, what is deficient? GnRH, inhibin, progesterone?
- Dx PCOS
Hematology
- 3-4 questions on B12 deficiency
- 3-4 questions on folate deficiency
- what is low in goats milk? folate
- What is low in breast milk? Vit D
- Guy from Saudi Arabia has rash on the face that resolves, MCV is low? Thalassemia
- Sickle cell crisis, after analgesia what do you give? Fluids or transfuse?
- 4-5 questions on iron deficiency
- kid eats anything now has low MCV -> lead poisoning
- I had like 4 questions that starts with a pt who had recurrent nosebleeds.
- One said pt c recurrent nosebleeds on lithium, bupropion and valproic acid, lithium levels are too high what to do next? D/c lithium, d/c valproic acid, d/c buproprion, check platelet level, check AST levels?
- Dx Hemophilia A (question said effusion of blood in the knee)
- Dx von Willebrands
- Question said besides the stockings how else can you prevent DVT? LMW heparin, warfarin, aspirin, tPA.
- Question on HUS (said history of recent infection)
- Dx Henosh-schonlein (said palpable purpura)
ID
- Dx otitis media
- Hard question on sinusitis, know how to differentiate chronic s/s from acute.
- Kid with barking cough -> laryngotrachietis
- A lot of wheezing questions in children
- CSF has RBCs -> HSV
- Pt exposed to so many things, one of them was unpasteurized milk, CSF was normal -> listeria
- Ring-enhanced lesion in the brain in an aids pt prophylaxis -> TMP-SMX
- Kid with h/o meningitis what is the diagnosis to the most common sequela -> confused between tympanometry or air-conduction hearing studies (I know the answer was hearing loss)
- Encephalitis question -> HSV
- Kid c wheezing and has tonsillar inflammation and had trouble opening his mouth but uvula was not displaced and it showed a picture of the lateral neck and asked what it was-> peritonsillar abscess or retropharyngeal abscess im not to sure, know the pix
- Dx pharyngitis
- Nurse with pernichila (the finger infection) that gets it drained, warm compress and Abx, what is next? Keep her away from pts, prophylax all pts, treat all the pateints she was exposed to, etc.
- 2 questions on mycoplasma dx (college students)
- 2 questions on aspiration pneumona
- PPD positive next step -> cxr
- Guy with white fluffy things that don’t scrap off, what is next test? HIV
- 3 questions on Lyme disease
- MANY MANY STD questions, all of them like syphilis, chancroid, gonorrhea, chlamydia, trichomonas (like 4), candida (2)…at least 2 on each one
- Guy with everything that seemed like gout, what is next step? Aspirate fluid from joint (treatment wasn’t an option)
- Had maybe 9-10 questions on the immunodefiencies, know them real well.
- Guy with indurated 5cm mass on thigh and fever, what do you do next? Surgical debridement or I&D?
- Pt has on several meds gets hearing loss, what is the cause? Gentamycin
- CO was low, resistance was high, PCWP was low, what kind of shock?
Rhematology
- How do you treat pseudogout? Indomethacin, hyaluronidase injections, aspirin?
- 3-4 questions on RA
- 2-3 questions on Gout
- 1-2 questions on OA
- pt c psoriasis what else should you find? Clubbing of the finger
- 3 questions on Kawakaki’s disease (2 to dx, 1 to tx)
- dx polymalgia rheumatic
- tx SLE (prednisone)
- how do you treat fibromyalgia
- dx polymyositis
- dx DMD
- kid with recurrent fractures and blue sclera -> collagen 1 deficiency
- Showed picture of carpal tunnels -> median nerve at wrist
- Dx slipped capitus femoral (fat kid with a limp)
- Dx Osgood shlatter (showed picture of tibial tuberosity)
- Dx developmental hip displasia (said mom heard popping when changing diapers)
- Picture of chondrocalcinosis -> pseudogout
OBGYN
- Almost every other question started with G-P- (my test was A LOT of obgyn)
- Dx and tx ectopic
- 4 questions on mole (2 dx like HTN in 1st TM and enlarged uterus 2 tx)
- pt is 31weeks and gets in a car accident now has vaginal bleeding and uterine tenderness -> abruptio placenta
- pt is 11 weeks and has passage of fetal contents but no fetal parts noted, very high hCG -> 46XX
- Pt with TOA keeps getting worse and fever getting higher -> surgery
- Pt c cyst on labia majora, nowhere else, only on the majora -> labial abcess, bartholins abscess, bartholin cyst
- HSV at 39 weeks c 4min contractions c no breakouts while pregnant but she feels weird and said that usually when she feels weird she breaks out, what do you do? C-section, augmentation of labor, tocolysis
- 10cm dilation and after 10 minutes all you get is a “palpable minimal caput” what do you do next? Vacuum, continue contractions, c-section
- 37yo c breast mass and gets lumpectomy and after it showed noninvasive intraductal cancer without margins, what is next step? Tamoxifen, radiation, chemo, observe, or sentinel node bx
- Woman at 28wks had an amnio before and got RhoGAm what do you do now? Administer rhogam again
- Woman has baby that’s too small for gestation age, stress test shows late decelerations what is the cause of the IUGR? Uteroplacental insufficiency
- Mom is smoker while pregnant? IUGR
- What is high in a pt with gestational DM? HPL
- Mom is 34wks and gets severe preeclampsia what will the child suffer from? Sepsis, pulmonary insufficiency (that’s what I put).
- High AFP on triple screen? Anencephaly (other choices were trisomy 21, 13, 18)
- Tx gbs
- Pt with vaginal discharge, turns out fern+ what is the d/c? PROM
- Pt with postpartum hemorrhage, what do you do? Give oxytocin, give prostaglandin, surgery, artery ligation (massage was not an answer)
- Macrosomic kid whose mom had gestation DM gets seizures -> hypoglycemia, hyperglycemia, hypo or hypercalcemia, kalemia, natremia, etc.
- 3 questions on cervical dysplasia
- woman with PCOS is at risk for -> endometrial cancer
- woman who has BMI 33 is at risk for ->endometrial cancer
- woman with menopause and fracture -> dexa
- 2-3 questions on endometriosis
- 2 questions on fibroids
- 57yo with vaginal pruritis -> vulvar cancer
- 14yo girl has not had menses, all her friends make fun of her, physical exam is completely normal, what is the dx? Normal, hypothalamic problem, adrogen insensitivity, turners, etc.
- post menopausal bleeding -> endometrial cancer
- obese F with menstrual cycle problems that when you take pap smear what else should you do? Endometrial biopsy
- woman feels bulging from her vagina, she had a total hysterectomy in the past, she has absolutely no other s/s besides the bulging which gets worse when she stands up -> cystole, rectocele, uterine prolapse?
- Guy who gets urge to pee but pisses on himself before he makes it to the bathroom -> detrusor hyperactivity.
- Know how to treat your STDs!!
- Bloody discharge -> intraductal papilloma
- 37yo woman with breast mass -> mammo, FNA, biopsy, sonogram?
- Menopause lady wants to prevent bone fractures that she seen in her sister, takes no HRT, what should she do? Calcium supplements, estrogen replacement, etc.
SURGERY
- Bleeding from urethral meatus ->retrograde urethrogram
- Dx tension ptx
- Stab wound to stomach -> ex lap
- Guy was on motorcycle crashed into truck and now feels abdm pain, VS are stable, what do you do next? DPL, CT, ex-lap
- Picture of a severely displaced radial bone and pt had no pulses, loss of sensation, and pallor. They said the feeling of the forearm was still very soft, what do you do next? ORIF, fasciotomy, angiography, cast.
- Not too much surgery
Growth development/preventative medicine
- 3yo rides a tricycle, still pees in his bed, can say two worded sentences, is he normal delayed (in each field like social, developmental, motor)
- dx separation anxiety
- kid wants to get circumcised, want should you tell him? Need parents consent
- no formula questions (sensitivity, specificity, odds ratio, bla bla bla)
- dx t-test
- what is the best test to measure incidence? Cohort study
- no bias questions
- if an HIV ELISA test is 99% sensitive and 95% specific, what happens to the sensitivity and specifity if you do “another test” (I don’t know if that meant another ELISA test or a western-blot, so I assumed another elisa and put stays the same)
NEURO
- carotid stenosis of 90% in an asymptomatic pt -> CEA
- how to treat cluster headache? Oxygen
- 3 questions on temporal arteritis
- a question about tremor at rest, not with motion or walking, the answer was related to parkinsons
- Showed a picture of the brain and said the pt had no memory problems but had personality changes, frontal area and temporal area looked atrophied -> Picks
- Guy is taking care of his wife (both really old) and she is getting worse, he promised he wont send her to a nursing facility. He cant afford a nursing aid anymore. Now his wife is making sexual advances and hes disgusted by it. What do you do? Put his wife in assisted living, give him sexual therapy, give him SSRI, give her diazepam.
- Woman with alzheimers is getting more crazy (screaming at her son for stupid reasons), what do you do? Tell her son its normal
- A LOT of dementia questions (not that hard)
- Wet wacky wobbly -> normal pressure hydrocephalus
- Woman who is one week ok and one week very bad (demented c loss of motor function), has history of CABG and her BP is still high -> multi-infarct dementia
- Dx MS
- 2 questions on Guillian barre (both diagnosis, one was hard)
- One question was on ALS, where is the problem -> motor neuron
- Dx subarachnoid
- One question asked what is the fastest way to treat high intracranial pressure? Intubation and hyperventilation, manitol, trendelenburg, head elevation
- Dx Narcolepsy
- Construction worker in the sun all day gets an episode of confusion (just confusion), he is otherwise healthy and on no medications, what is the dx? Heat stroke, malignant hyperthermia, some other dumb answers.
- Old pt with long history of DM and HTN gets progressive loss of vision, on physical exam the eye has no hemorrhages, no cotton wool spots, no neovascularization, what is the dx? Glaucoma, DM retinopathy, HTN retinopathy, cataracts
PULM
- Acute asthma attack tx
- Pt with situs inverses, recurrent pneumonia and bronchiectasis (so your thinking CF) but it says sweat-chloride was negative -> nasal scrapings
- Many questions on pneumonia
- No questions on pulmonary effusions
- 2 questions on sarcoidosis
- Dx asbestosis
- Dx chronic bronchitis (really easy)
- One question said what is the pathyphysiology of chronic bronchitis (what happens to the vessel walls, something about elasticity)
- 13month old kid with sudden inspiratory wheezing, CXR shows hyperinflation of just the right lung but no foreign object what is next step? Scope
- Dx Aspiration pneumonia. One question said what is the pneumonia consisting of? Gram + only, gram – only, both, gram + and anaerobes, gram – and anaerobes, etc.
- Dx TB (question even said positive PPD)
- Dx atelectasis (fever a few hours after surgery)
- 2-3 questions on ARDS
- One on neonatal ARDS, what to tx with? Surfactant
- Women suspected of having PE, the V/Q scan was negative what do you do next? Spiral CT, d-dimer, CXR, ekg (angiography wasn’t there)
- Pt with PE what do you give? Heparin
RENAL
- I had about 10-15 renal questions, some really hard. 6 of them were in that category where you have a million answers and they give you 2 or 3 questions on the same answers. What else can I say but know your renal!!
- Guy had testicular mass, ultrasound confirms that it is a solid mass, what is the next step? Excisional biopsy or orchiectomy?
- 2 questions on BPH (dx)
- Pathophysiology of post-strep GN? I put destruction of foot processes (they didn’t have fusion)
- Muddy casts -> ATN
- Pt in car accident, CK level is off the roof, what is he at risk of? ATN
PSYCH
- Pt with depression and starts hearing voices for ONE week -> MDD, schizoaffective, schizophrenia, bipolar.
- Guy with narcolepsy, how to treat? I put methylphenidate
- Dx ADHD
- Dx anorexia
- Dx delerium
- Kid wondering the street at 2am, high BP, dilated pupils, combative and paranoid, what drug did he abuse
- Girl is found unconscious, high BP, dilated pupils, what drug?
- Woman is found wondering the streets, not oriented, dilated pupils, question said what should you give her, I put thiamine (other choices were naloxone, flumazenil, etc)
- Guy feels spiders on hit feet when hes trying to fall asleep, and he cant fall asleep because of it, what is the dx? Restless leg syndrome
- Another question on restless leg syndrome, the drug is aimed at what? Dopamine, serotinin, NE, Ach, etc.
- Girl is in love with the TV anchorman, keeps writing him letters, waits at his job, believes they will marry, what is the dx? Delusional
- 2 questions on the adverse effects of phenytoin, one was rash
- dx adjustment disorder
- dx normal bereavement
- Professor gets sweating and nervous when he gets on stage in any other place but his own university – panic disorder
- Dx social phobia
- Person feels like theyre in another place (sounds like depersonalization), but it happened after they were put at gunpoint and robbed. Now she has nightmares and can never go to the same place again, but denies having flashbacks -> PTSD, depersonalization, and other stupid answers
- Dx primary insomnia
- Woman has twins that are 2yo and now she feels loss of interest, cant sleep, hates doing anything, what is the next step? Assess suicide.
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pyschotic - 10/20/07 14:11
hi dear bdj were you looking for these question from dr jiggy i have just got it.
GI questions:
- pt c hematemesis, not actively bleeding -> sclerotherapy
- pt had hematochezia and bluish dicoloration of the cecum -> I don’t know I put angiodysplasia
- toxic megacolon, NPO/IVF/NGT wasn’t enough, then more pain and more fever c free air in abdomen ->laparotomy
- kid swallowed some acid, what to do in ER -> esophagoduodenoscopy
- no questions on h.pylori
- easy question to diagnose achalasia
- question on sjogrens what is next step -> SSA/SSB Ab or parotid biopsy
- guy had halitosis -> zenkers
- several questions on gout -> trial of PPIs
- question on esophageal scleroderma -> trial of PPIs
- guy has heartburn well controlled with antacids, used to have trouble swallowing only steaks, now cannot swallow many solids but liquids is ok -> PPIs or EGD
- diagnose esophageal cancer
- diverticulitis -> ct scan
- woman with jaundice, only + result was HAV IgG, what is she at risk for in the future? HAV, HBV, Hemachromatosis, Hepatocellular Ca, etc.
- pt with hepatic encephalopathy and high Cr -> dialysis
- question was very long, said pt had epigastric pain radiating to upper quadrants, fever, no jaundice, labs weren’t that bad (mildy elevated alk phos) what does she have -> cholecystitis, choledochilithiasis, pancreatitis, bla bla bla…
- Cholecystitis -> abdm U/S
- Older woman with h/o CABG and history of A.fib gets diffuse abdm pain after eating, and has abdm bruit, what does she have? Embolis in SMA, abdm aortic aneurysm, polycystic kidney disease?
- Acute pancreatitis question
- Question on malabsorption, pt had steatorrhea… lol I don’t remember the rest
- Guy had bloody stools and passed out on the floor, recent history of aortofemoral bypass -> I put fistula
- Dx pyloric stenosis
- What is the cause of intussuseption of small bowel in a 65yo? Idiopathic, tumor, cancer of small bowel, lymphadenitis?
- Dx meckels
CARDIO
- Question said positional chest pain, showed EKG of diffuse ST elevation -> pericarditis
- Had two heart murmur audio questions
- IVDA and vegetations on the heart -> tricuspid regurge
- Guy with angina and a.fib -> I put ECG stress test
- Which is the greatest risk factor for CAD? LDL-chol ration, HDL chol ratio, triglycerides, lipids
- Murmur got worse with standing and valsalva -> HOCM
- Kid with cyanosis in the 1st 24hrs of life -> transposition
- Diagnose tamponade
- Kid with holosytolic murmur -> left to right shunt (it’s a vsd)
- Diagnose MVP (said mid-systolic click)
- Diagnose ASD (said wide, fixed S2)
- Endocarditis prophylaxis for dental procedure in a kid with h/o reaction to ampicillin -> clinda
- Teenager with cramps in the legs, muscles on top are bulky, weak on the bottom, bad LE pulses -> coarctation
- Hyperaldosteronism -> PRA ratio
- 3 questions on temporal arteritis (2 dx 1tx)
- woman with renal artery stenosis what is elevated? Rennin
- diagnose dissecting aortic aneurysm -> TEE
- pt had low Na, low K, high Cl on thiazides and ACEI what is the reason for the labs? I put thiazide and ACEI reaction, other choices were hyperaldosteronism, hypoaldosteronism, other stuff
SKIN
- picture of some bad bad acne -> proprionobacterium
- HSV
- How do you treat ringworm > clotrimazole, permethrin, hydrocortisone?
- Pt had dermatitis herpetiformis -> gluten free diet
- Pt had optic glioma what will you find on skin -> café au lait
- Guys nose had a pearly looking thing on it -> basal cell
- Mentally retarted kid with seizures and a skin disorder -> tuberous sclerosis
- Acathosis nigrans -> check glucose
- Kid with DIC
- Picture of a hand with DIP inflammation and said his ankle was very tender -> gout
- Kid went into the woods now has itchyness and rash in a linear pattern -> contact dermatitis
- Mom wants to prevent daughter from getting sunburns ->advise not to go out before 2pm
- Contact dermatitis question -> cell-mediated hypersensitivity
ENDOCRINE
- Guy is depressed after his wife died and labs show high tsh, low t4 -> depression due to medical conidition, other choices were MDD, Adjustment disorder
- Graves disease what Abs are after -> TSH receptor
- Guy with A.fib what must you rule out -> hyperthyroid
- SOOO many questions on diabetes I and II soooooo many. Guy with DKA (give fluids and what type of insulin), guy with DM and foot ulcer (angiography or foot amputation), soooo many know your DM inside out
- Health care worker comes in after fainting has sugar of 40, normal c-peptide -> took insulin
- Guy with low insulin and high c-peptide -> insulinoma
- Guy with rash and high sugar -> glucagonoma
- Dx hyperparathyroidism
- Guy on lithium -> nephrogenic DI
- Dx SIADH
- Guy with loss of facial hair, small testes and is infertile -> check pituitary
- Pt cannot lactate after birth, had postpartum hemorrhage, what is deficient? GnRH, inhibin, progesterone?
- Dx PCOS
Hematology
- 3-4 questions on B12 deficiency
- 3-4 questions on folate deficiency
- what is low in goats milk? folate
- What is low in breast milk? Vit D
- Guy from Saudi Arabia has rash on the face that resolves, MCV is low? Thalassemia
- Sickle cell crisis, after analgesia what do you give? Fluids or transfuse?
- 4-5 questions on iron deficiency
- kid eats anything now has low MCV -> lead poisoning
- I had like 4 questions that starts with a pt who had recurrent nosebleeds.
- One said pt c recurrent nosebleeds on lithium, bupropion and valproic acid, lithium levels are too high what to do next? D/c lithium, d/c valproic acid, d/c buproprion, check platelet level, check AST levels?
- Dx Hemophilia A (question said effusion of blood in the knee)
- Dx von Willebrands
- Question said besides the stockings how else can you prevent DVT? LMW heparin, warfarin, aspirin, tPA.
- Question on HUS (said history of recent infection)
- Dx Henosh-schonlein (said palpable purpura)
ID
- Dx otitis media
- Hard question on sinusitis, know how to differentiate chronic s/s from acute.
- Kid with barking cough -> laryngotrachietis
- A lot of wheezing questions in children
- CSF has RBCs -> HSV
- Pt exposed to so many things, one of them was unpasteurized milk, CSF was normal -> listeria
- Ring-enhanced lesion in the brain in an aids pt prophylaxis -> TMP-SMX
- Kid with h/o meningitis what is the diagnosis to the most common sequela -> confused between tympanometry or air-conduction hearing studies (I know the answer was hearing loss)
- Encephalitis question -> HSV
- Kid c wheezing and has tonsillar inflammation and had trouble opening his mouth but uvula was not displaced and it showed a picture of the lateral neck and asked what it was-> peritonsillar abscess or retropharyngeal abscess im not to sure, know the pix
- Dx pharyngitis
- Nurse with pernichila (the finger infection) that gets it drained, warm compress and Abx, what is next? Keep her away from pts, prophylax all pts, treat all the pateints she was exposed to, etc.
- 2 questions on mycoplasma dx (college students)
- 2 questions on aspiration pneumona
- PPD positive next step -> cxr
- Guy with white fluffy things that don’t scrap off, what is next test? HIV
- 3 questions on Lyme disease
- MANY MANY STD questions, all of them like syphilis, chancroid, gonorrhea, chlamydia, trichomonas (like 4), candida (2)…at least 2 on each one
- Guy with everything that seemed like gout, what is next step? Aspirate fluid from joint (treatment wasn’t an option)
- Had maybe 9-10 questions on the immunodefiencies, know them real well.
- Guy with indurated 5cm mass on thigh and fever, what do you do next? Surgical debridement or I&D?
- Pt has on several meds gets hearing loss, what is the cause? Gentamycin
- CO was low, resistance was high, PCWP was low, what kind of shock?
Rhematology
- How do you treat pseudogout? Indomethacin, hyaluronidase injections, aspirin?
- 3-4 questions on RA
- 2-3 questions on Gout
- 1-2 questions on OA
- pt c psoriasis what else should you find? Clubbing of the finger
- 3 questions on Kawakaki’s disease (2 to dx, 1 to tx)
- dx polymalgia rheumatic
- tx SLE (prednisone)
- how do you treat fibromyalgia
- dx polymyositis
- dx DMD
- kid with recurrent fractures and blue sclera -> collagen 1 deficiency
- Showed picture of carpal tunnels -> median nerve at wrist
- Dx slipped capitus femoral (fat kid with a limp)
- Dx Osgood shlatter (showed picture of tibial tuberosity)
- Dx developmental hip displasia (said mom heard popping when changing diapers)
- Picture of chondrocalcinosis -> pseudogout
OBGYN
- Almost every other question started with G-P- (my test was A LOT of obgyn)
- Dx and tx ectopic
- 4 questions on mole (2 dx like HTN in 1st TM and enlarged uterus 2 tx)
- pt is 31weeks and gets in a car accident now has vaginal bleeding and uterine tenderness -> abruptio placenta
- pt is 11 weeks and has passage of fetal contents but no fetal parts noted, very high hCG -> 46XX
- Pt with TOA keeps getting worse and fever getting higher -> surgery
- Pt c cyst on labia majora, nowhere else, only on the majora -> labial abcess, bartholins abscess, bartholin cyst
- HSV at 39 weeks c 4min contractions c no breakouts while pregnant but she feels weird and said that usually when she feels weird she breaks out, what do you do? C-section, augmentation of labor, tocolysis
- 10cm dilation and after 10 minutes all you get is a “palpable minimal caput” what do you do next? Vacuum, continue contractions, c-section
- 37yo c breast mass and gets lumpectomy and after it showed noninvasive intraductal cancer without margins, what is next step? Tamoxifen, radiation, chemo, observe, or sentinel node bx
- Woman at 28wks had an amnio before and got RhoGAm what do you do now? Administer rhogam again
- Woman has baby that’s too small for gestation age, stress test shows late decelerations what is the cause of the IUGR? Uteroplacental insufficiency
- Mom is smoker while pregnant? IUGR
- What is high in a pt with gestational DM? HPL
- Mom is 34wks and gets severe preeclampsia what will the child suffer from? Sepsis, pulmonary insufficiency (that’s what I put).
- High AFP on triple screen? Anencephaly (other choices were trisomy 21, 13, 18)
- Tx gbs
- Pt with vaginal discharge, turns out fern+ what is the d/c? PROM
- Pt with postpartum hemorrhage, what do you do? Give oxytocin, give prostaglandin, surgery, artery ligation (massage was not an answer)
- Macrosomic kid whose mom had gestation DM gets seizures -> hypoglycemia, hyperglycemia, hypo or hypercalcemia, kalemia, natremia, etc.
- 3 questions on cervical dysplasia
- woman with PCOS is at risk for -> endometrial cancer
- woman who has BMI 33 is at risk for ->endometrial cancer
- woman with menopause and fracture -> dexa
- 2-3 questions on endometriosis
- 2 questions on fibroids
- 57yo with vaginal pruritis -> vulvar cancer
- 14yo girl has not had menses, all her friends make fun of her, physical exam is completely normal, what is the dx? Normal, hypothalamic problem, adrogen insensitivity, turners, etc.
- post menopausal bleeding -> endometrial cancer
- obese F with menstrual cycle problems that when you take pap smear what else should you do? Endometrial biopsy
- woman feels bulging from her vagina, she had a total hysterectomy in the past, she has absolutely no other s/s besides the bulging which gets worse when she stands up -> cystole, rectocele, uterine prolapse?
- Guy who gets urge to pee but pisses on himself before he makes it to the bathroom -> detrusor hyperactivity.
- Know how to treat your STDs!!
- Bloody discharge -> intraductal papilloma
- 37yo woman with breast mass -> mammo, FNA, biopsy, sonogram?
- Menopause lady wants to prevent bone fractures that she seen in her sister, takes no HRT, what should she do? Calcium supplements, estrogen replacement, etc.
SURGERY
- Bleeding from urethral meatus ->retrograde urethrogram
- Dx tension ptx
- Stab wound to stomach -> ex lap
- Guy was on motorcycle crashed into truck and now feels abdm pain, VS are stable, what do you do next? DPL, CT, ex-lap
- Picture of a severely displaced radial bone and pt had no pulses, loss of sensation, and pallor. They said the feeling of the forearm was still very soft, what do you do next? ORIF, fasciotomy, angiography, cast.
- Not too much surgery
Growth development/preventative medicine
- 3yo rides a tricycle, still pees in his bed, can say two worded sentences, is he normal delayed (in each field like social, developmental, motor)
- dx separation anxiety
- kid wants to get circumcised, want should you tell him? Need parents consent
- no formula questions (sensitivity, specificity, odds ratio, bla bla bla)
- dx t-test
- what is the best test to measure incidence? Cohort study
- no bias questions
- if an HIV ELISA test is 99% sensitive and 95% specific, what happens to the sensitivity and specifity if you do “another test” (I don’t know if that meant another ELISA test or a western-blot, so I assumed another elisa and put stays the same)
NEURO
- carotid stenosis of 90% in an asymptomatic pt -> CEA
- how to treat cluster headache? Oxygen
- 3 questions on temporal arteritis
- a question about tremor at rest, not with motion or walking, the answer was related to parkinsons
- Showed a picture of the brain and said the pt had no memory problems but had personality changes, frontal area and temporal area looked atrophied -> Picks
- Guy is taking care of his wife (both really old) and she is getting worse, he promised he wont send her to a nursing facility. He cant afford a nursing aid anymore. Now his wife is making sexual advances and hes disgusted by it. What do you do? Put his wife in assisted living, give him sexual therapy, give him SSRI, give her diazepam.
- Woman with alzheimers is getting more crazy (screaming at her son for stupid reasons), what do you do? Tell her son its normal
- A LOT of dementia questions (not that hard)
- Wet wacky wobbly -> normal pressure hydrocephalus
- Woman who is one week ok and one week very bad (demented c loss of motor function), has history of CABG and her BP is still high -> multi-infarct dementia
- Dx MS
- 2 questions on Guillian barre (both diagnosis, one was hard)
- One question was on ALS, where is the problem -> motor neuron
- Dx subarachnoid
- One question asked what is the fastest way to treat high intracranial pressure? Intubation and hyperventilation, manitol, trendelenburg, head elevation
- Dx Narcolepsy
- Construction worker in the sun all day gets an episode of confusion (just confusion), he is otherwise healthy and on no medications, what is the dx? Heat stroke, malignant hyperthermia, some other dumb answers.
- Old pt with long history of DM and HTN gets progressive loss of vision, on physical exam the eye has no hemorrhages, no cotton wool spots, no neovascularization, what is the dx? Glaucoma, DM retinopathy, HTN retinopathy, cataracts
PULM
- Acute asthma attack tx
- Pt with situs inverses, recurrent pneumonia and bronchiectasis (so your thinking CF) but it says sweat-chloride was negative -> nasal scrapings
- Many questions on pneumonia
- No questions on pulmonary effusions
- sarcoidosis
- Dx asbestosis
- Dx chronic bronchitis (really easy)
- One question said what is the pathyphysiology of chronic bronchitis (what happens to the vessel walls, something about elasticity)
- 13month old kid with sudden inspiratory wheezing, CXR shows hyperinflation of just the right lung but no foreign object what is next step? Scope
- Dx Aspiration pneumonia. One question said what is the pneumonia consisting of? Gram + only, gram – only, both, gram + and anaerobes, gram – and anaerobes, etc.
- Dx TB (question even said positive PPD)
- Dx atelectasis (fever a few hours after surgery)
- 2-3 questions on ARDS
- One on neonatal ARDS, what to tx with? Surfactant
- Women suspected of having PE, the V/Q scan was negative what do you do next? Spiral CT, d-dimer, CXR, ekg (angiography wasn’t there)
- Pt with PE what do you give? Heparin
RENAL
- Guy had testicular mass, ultrasound confirms that it is a solid mass, what is the next step? Excisional biopsy or orchiectomy?
- 2 questions on BPH (dx)
- Pathophysiology of post-strep GN? I put destruction of foot processes (they didn’t have fusion)
- Muddy casts -> ATN
- Pt in car accident, CK level is off the roof, what is he at risk of? ATN
PSYCH
- Pt with depression and starts hearing voices for ONE week -> MDD, schizoaffective, schizophrenia, bipolar.
- Guy with narcolepsy, how to treat? I put methylphenidate
- Dx ADHD
- Dx anorexia
- Dx delerium
- Kid wondering the street at 2am, high BP, dilated pupils, combative and paranoid, what drug did he abuse
- Girl is found unconscious, high BP, dilated pupils, what drug?
- Woman is found wondering the streets, not oriented, dilated pupils, question said what should you give her, I put thiamine (other choices were naloxone, flumazenil, etc)
- Guy feels spiders on hit feet when hes trying to fall asleep, and he cant fall asleep because of it, what is the dx? Restless leg syndrome
- Another question on restless leg syndrome, the drug is aimed at what? Dopamine, serotinin, NE, Ach, etc.
- Girl is in love with the TV anchorman, keeps writing him letters, waits at his job, believes they will marry, what is the dx? Delusional
- 2 questions on the adverse effects of phenytoin, one was rash
- dx adjustment disorder
- dx normal bereavement
- Professor gets sweating and nervous when he gets on stage in any other place but his own university – panic disorder
- Dx social phobia
- Person feels like theyre in another place (sounds like depersonalization), but it happened after they were put at gunpoint and robbed. Now she has nightmares and can never go to the same place again, but denies having flashbacks -> PTSD, depersonalization, and other stupid answers
- Dx primary insomnia
- Woman has twins that are 2yo and now she feels loss of interest, cant sleep, hates doing anything, what is the next step? Assess suicide.
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| drbcshah
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Topics: 48
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i have copy pasted above notes so may have mistakes. They are made by Dr. Jiggy So thank him / her not me
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| drbcshah
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KaplanQbankNotes:Neeraj 15
• Thyroid nodule? Benign or malignantnodule large enough to cause airway or digestive tract obstruction emergent thyroid surgery without further evaluation.
Step-1:TSHDecreased =hyperactive nodule=typically benignA
Step-2:TSHNormal or elevated TSH = non-functioning or normally functioning nodule.
Step-3:Imaging and/or a biopsy to obtain a tissue diagnosisultrasoundmost useful diagnostic tool fine needle aspirate (FNA)result from an FNA
1. First, the sample can represent benign lesions= no further treatment (unless the lesion continues to grow causing obstruction to breathing or eating, or causing unacceptable cosmetic disfigurement in the neck).
2. Second, the specimen can be a follicular lesion = treated with a surgical removal of part or all of the thyroid gland to determine whether it is a benign or malignant type.
3. Third, the biopsy can show a clearly malignant lesion = treated with surgical removal of the thyroid gland.
4. Finally, the sample can be nondiagnostic = requires a repeat FNA. However, after three nondiagnostic biopsies, a surgical removal of the affected thyroid lobe is usually recommended.
• Approach towards Breast Lump:
1. Nipple discharge: Pathologic discharges are spontaneous, bloody or associated with a mass. These discharges are usually unilateral. The most common cause of pathologic nipple discharge is intraductal papilloma, followed by duct ectasia.10 If a palpable mass is present in association with a discharge, the likelihood of cancer is greatly increased.
2. Dominant breast mass Dx macrocyst (clinically evident cyst), fibroadenoma, prominent areas of fibrocystic change, fat necrosis and cancer. KaplanQbankNotes:Neeraj 16
(a)Solid Masses in Women Less Than 40 Years of Age
1. Physical Examination No evidence of mass reassured and instructed in breast self-examination.
2. Physical Examination physical finding is uncertain directed ultrasound examinationnot demonstrate a massRepeat physical examination?mammogram (35 to 40 years not in younger)
3. Physical Examination dominant mass (? suspicious mass is solitary, discrete, hard and often, adherent to adjacent tissue) mammographypathologic diagnosis.
4. Physical Examination dominant mass (? Not a suspicious mass or clinically benign) discus options of surgical excision or follow-up with the patientpatient desires surgical excisionno additional testing is donepatient opts for further work-upan ultrasound examination and fine-needle aspiration are performed to confirm that the mass is benign. "Triple test" (clinical examination, ultrasonography [or mammography] and fine-needle aspiration).
• The size of the lesion must be measured with a ruler at presentation and on subsequent visits to allow an accurate assessment of size over time.
• patient is examined every three or four months for one year to ensure stability of the mass.
(B)Solid Masses in Women More Than 40 Years of Age.
1. Abnormalities detected on physical examination in older women should be regarded as possible cancers until they are documented to be benign.
2. mammography is a standard part of the evaluation of a solid breast mass.
3. In the presence of a dominant breast mass, a normal mammogram should never be considered proof of the absence of breast cancer.
• Premenstrual dysphoric disorder: constellation of physical and emotional symptoms occurring during the late luteal phase of the menstrual cyclesymptoms must be present during most cycles in the past year and during at least two subsequent cyclesat least five of the following symptoms: depressed mood, marked anxiety, affective lability, decreased interest, decreased energy, sleep disturbance, craving food, feeling overwhelmed, and difficulties concentratinginterfere with social or occupational functioning and are not due to other psychiatric or medical disorders.
• Exposure therapya type of behavior therapymost commonly used treatment of specific phobia desensitizes the patient by a gradual exposure to the phobic stimulusRelaxation and breathing control are important parts of the treatment.
• Alprazolam belongs to the group of short-acting benzodiazepines. Even though it has a short half-life, it can produce confusion, disinhibition, and amnestic problems like blackouts in the elderly population. The risk is increased if it is combined with CYP3A inhibitors.
• In pseudodementia of depression, the patient often tends to emphasize disability related to memory loss much more than patients experiencing true dementia.
• Olanzapine is an atypical antipsychotic indicated for the management of psychotic disorders. It is said to be associated with weight gain.
• HIV dementia is characterized by affective, cognitive, behavioral, and motor symptoms and signs. It presents as a subcortical process and is most likely to occur in patients with a CD4 count below 200/mm3. It usually has a slow onset, and, after a period of stability, there can be a precipitous decline. The diagnosis is made when other causes of delirium are excluded; the disease may present with psychosis within HIV dementia. The symptoms are controlled with low doses of neuroleptics.
• Circumstantiality refers to speech that is delayed from reaching the point, characterized by overinclusion of details.DDxTangentiality : patient never gets to the desired goal from the starting point of discussion.
• Patients with disorganized type schizophrenia are likely to exhibit disorganized speech, disorganized behavior, and flat or inappropriate affect. Examples of disorganized thoughts and speech include: loosening
KaplanQbankNotes:Neeraj 17
of associations or derailment, flight of ideas, tangentiality, circumstantiality, word salad, neologisms, and clang associations.
• The newer atypical antipsychotics have minimal, if any effect on plasma prolactin concentrations, except for risperidone, which is associated with elevated prolactin.
• A Papanicolaou smear should ideally be a sampling of the transformation zone(adequate sample should show endocervical cells)endocervical cells not present?whether the transformation zone was fully sampledRepeat the sample if high risk individual or after 1 yr if with no high risk and had all earlier pap normalEvery woman should have yearly pap smear after first intercourse or 18yrs whatever comes earlier
• Rarely struma ovarii is a cause of hyperthyroidism and patients with this manifestation may have symptoms of hyperthyroidism, as well as elevated levels of thyroid hormones and decreased levels of thyroid stimulating hormone (TSH).
• There is no evidence that breast-feeding increases HCV transmission to the baby.
• Postpartum endometritis Cesarean section is the major risk factorOrganisms ascending from the vagina and causing a polymicrobial infection of the endometrium fever and chills, lower abdominal pain, a foul-smelling vaginal discharge and malaise abdominal tenderness, and uterine tendernessRx clindamycin and gentamicin ( prophylactic antibiotics are recommended in all cases of nonscheduled cesarean delivery i.e. a cesarean delivery that is not anticipated like with membranes broke but non-progressing/Breech etc and are given before or after the umbilical cord is clamped)
• Discharge criteria patient should be alert, able to ambulate (if this was her preoperative level of function), able to tolerate adequate oral intake(Patient on IV intake should not be discharged), have stable vital signs, and have satisfactory bowel and urinary tract function.
• Chorioamnionitis (can develop at any time before and during delivery)fever and uterine tendernessRx ampicillin or penicillin with gentamicin.
• Asymptomatic bacteriuria in pregnant womenassociation with preterm delivery/low birth weight Rx trimethoprim-sulfamethoxazole, nitrofurantoin, and cephalexinfollow-up urine culture after 10 days of completing the medicationtest-of-cure.
• Gestational diabetesusually diagnosed by means of oral glucose tolerance testingPatients with gestational diabetes and normal fasting glucosetwo major risksfetal macrosomia & eventual development of overt diabetes(within the next 20 years)with gestational diabetes and abnormal fasting glucose increased risk of stillbirth.
• Significant mitral stenosis during pregnancy should be monitored invasively using a Swan-Ganz catheter second stage of labor be shortened using forceps or vacuum to prevent excess maternal Valsalva efforts and maternal tachycardia.
• HIV Positive mother combination of ZDV therapy + cesarean delivery decreases the risk of transmission to approximately 2% Amniocentesis should be avoided, if possible, in the HIV-positive woman.
1. 2% vertical transmission with ZDV + Scheduled CS prior to the onset of labor or rupture of membranes
2. 8% antiretroviral therapy in mother + Infant
3. 25% when none used
• Constitutional delay is normal pubertal progression at a delayed rate or onset. The average age at menarche is 12 1/2 years, but it may be delayed until 16 or may begin as early as age 10.
• Current recommendations are that pregnant women who will be in the second or third trimester during the flu epidemic season should be given the influenza vaccination.
• "once a cesarean, always a cesarean." This is no longer the case. Some women are allowed to approximately 70% of all women attempt vaginal birth after a prior cesarean delivery will be successful.
KaplanQbankNotes:Neeraj 18
• Face presentationCauses: anencephalic fetus, pelvic contraction, and high parityvaginal delivery is possible when the fetus is in a mentum anterior position (i.e., the fetal chin is oriented toward the maternal pubic symphysis.)Fetus can flex its head, thereby allowing delivery Vacuum delivery /Forceps delivery with a non-vertex presentation would be contraindicated.
• The presence of a classic uterine scar (vertical incision into the uterus that extends from the lower uterine segment up into the active myometrial portion toward the fundus of the uterus) mandates elective repeat cesarean delivery when the fetus is mature as patients with a previous classic cesarean delivery have roughly a 10% risk of uterine rupture.
• Oxytocin or Prostaglandin (PGE2) gel is an effective agent to use for labor inductionshown to improve the Bishop's score, to shorten the length of labor and delivery, to decrease the amount of oxytocin needed, and to decrease the cesarean delivery ratemain complication from its use is uterine hyperstimulationincreased frequency of contractions (greater than 5 every 10 minutes) or an increased length of each contraction (greater than 2 minutes) or contractions of normal duration occurring within 1 minute of each other and a non-reassuring fetal heart rate tracing Rx IV or subcutaneous terbutaline or IV magnesium sulfate(MgSo4 also most effective medication for seizure prophylaxis in women with preeclampsia) in case of PGE2 or discontinuing the oxytocin (bradycardia to the 80s) or reducing its dosage (where the fetal heart rate tracing is not as non-reassuring)
• Home uterine activity monitoring (HUAM) women are monitored at home with a tocodynamometer (a way to measure uterine contractions)will allow for preterm labor to be recognized and treated in its earliest stagesto prevent preterm birthsIn practice not been proven to prevent preterm birthpossible benefit early recognition of preterm laborwould allow for the administration of corticosteroids to bring about fetal pulmonary maturity (Steroid administration in a Diabetic mother may lead to increased dosage of Insulin).
• Fetal scalp sampling (FSS):method of fetal assessment with fetal blood pH When the fetal heart rate tracing is not reassuring, FSS can be used to determine the acid-base status of the fetus, which will help with management of the laborpH is > 7.25 then the patient may be managed expectantly pH is between 7.20 and 7.25:repeat in 15 to 30 minutespH is < 7.20, steps should be taken to bring about delivery(Acidemia likely to cause damage to the fetus appears to occur at values < 7.00, by using a cutoff of 7.20, there is a margin for error to protect the fetus)
• Forceps and the vacuum extractorTo expedite the deliveryindications:
1. non-reassuring fetal heart rate tracing,
2. maternal exhaustion
3. maternal contraindications to pushing (such as maternal cardiac disease.
Choice of forceps or vacuum ? Forceps may be used in face presentation with a mentum anterior presentation(vacuum is contraindicated) Vaccum extractor does not occupy space next to the fetal head; this should lead to less trauma to maternal tissuesBoth the vacuum and forceps should preferably be used only in low- or outlet- situations (i.e., with the fetal vertex at +2 station or lower.)
• A major advantage of chorionic villus sampling is that it can be performed at 10-12 weeks, as opposed to amniocentesis, which is performed in the second trimester. CVS thus allows a woman to undergo an earlier termination than amniocentesis allows for. However, there is some evidence that one subtype of limb defect, called transverse digital deficiency, is more common with CVS.
• The Bartholin's glands are bilateral structures that are present near the posterior fourchette of the vagina at the 5 and 7 o'clock positions. They secrete mucus, particularly during sexual stimulation, which drains into the posterior vagina.They undergo rapid growth during the process of puberty and they shrink after the menopause. When the duct of the Bartholin's gland becomes obstructed, a Bartholin's cyst resultscyst becomes infectedBartholin's abscesspolymicrobial /gonococcus implicated in 25% Rx placement of a Word catheter.( This is a small balloon-tipped catheter)allows drainage of the cyst and the formation of an epithelialized tract that will allow continued drainage once the catheter is removedtract should prevent the cyst from reformingIf Bartholin's cysts continue to form in spite of the use of the Word catheter, a marsupialization procedure may be tried. In this procedure, the cyst walls are sutured open to the surrounding skin to prevent re-closure and re-formation of the cystinterestingly; one cannot make this assumption in a postmenopausal patientcystic mass on the vulva in a postmenopausal woman must be biopsied(as there is a higher likelihood that this lesion represents a Bartholin's gland carcinoma)
• High-grade squamous intraepithelial lesion (HGSIL) will progress to invasive cervical cancercolposcopically directed biopsydiagnosis of HGSIL is confirmedthe distribution of the lesion
KaplanQbankNotes:Neeraj 19
is known, removal or destruction of the entire transformation zone should be performeddone with a loop electrode excision procedure (LEEPa thin-wire loop electrode is used to excise the entire transformation zoneLEEP can thus be used as both a diagnostic and therapeutic procedure immediate risks of LEEP are bleeding and infection. The possible long-term risks include cervical incompetence and cervical stenosis.
• The American Heart Association guidelines for the prevention of bacterial endocarditisantibiotic prophylaxis is not necessary for cesarean delivery or normal vaginal delivery Except patient with "high risk" cardiac conditions, which include women with a history of endocarditis, or who have prosthetic heart valves, complex cyanotic congenital heart disease, or surgically corrected systemic pulmonary shunts Mitral valve prolapse if associated with mitral regurgitation (demonstrated by Doppler or a murmur) is considered a moderate risk condition and therefore antibiotic prophylaxis is not necessary.
• Physiologic leukorrhea can be seen during 2 different periods of childhood. Some female neonates develop a physiologic leukorrhea shortly after birth as maternal circulating estrogens stimulate the newborn's endocervical glands and vaginal epithelium. Physiologic leukorrhea can also be seen during the months preceding menarche. During this time, rising estrogen levels lead to a whitish discharge not associated with any symptoms of irritation or infection.
• With each uterine contraction, blood flow to the placenta decreases, and the fetus is exposed to transient hypoxia. As the labor progresses and more and more contractions occur, this hypoxia can eventually lead to a change from aerobic to anaerobic metabolisfetal academiamost fetuses tolerate the stressprotective mechanismsincluding a blood buffering system and the diving reflex (a lowering of the heart rate in times of hypoxic stress)Electronic fetal monitoring is used to determine whether the fetus is becoming dangerously acidemic or "stressed"? But many fetuses with a non-reassuring fetal heart rate tracing do not have academiaThus, the delivery of many fetuses is expedited because of the concern for fetal acidemia when, in fact, the fetus is not acidemic at all!
• Group B Streptococcus part of the normal bacterial colonization of many women which women will receive antibiotics during labor? likelihood of infection is increased if following risk factors are present:
1. The five risk factors are: 1. History of a GBS-affected neonate. 2. Urine culture with GBS (GBS bacteriuria) 3. Preterm labor (<37 weeks). 4. Membranes ruptured for greater than eighteen hours in labor. 5. Temperature greater than 38.0 C (100.4 F) in labor. A woman with any one of these five risk factors should receive antibiotics in labor.
2. also provide antibiotic if pregnant women being screened for GBS and found positive at 35 to 37 weeks with a culture of the vagina, perineum, and anus.
Rx penicillin.
• Needle prick injury may transmit HBV>HIV during operative procedures etc
• BRCA1 is associated with high risk for breast and ovarian cancer.
BRCA2 is associated with a high risk of female and male breast cancer.
But total number of breast cancer cases associated with BRCA1 and BRCA2 mutations is a small percentage of the total number Therefore, screening of the general population is not recommended.
• RhoGAM (anti-D immune globulin) is given at 28 weeks' gestation, within 72 hours after the birth of an Rh-positive infant, after a spontaneous abortion, or after invasive procedures such as amniocentesis, threatened abortion, antenatal bleeding, external cephalic version, or abdominal traumaThe amount is 300 μg (covers a fetal to maternal hemorrhage of 30 mL or 15 mL of fetal cells)when fetal to maternal hemorrhage in excess of this 30 mL like with manual removal of the placenta (like this patient had) or placental abruption. To determine the amount of fetal to maternal hemorrhage that occurred, it is necessary to perform a Kleihauer-Betke test This acid-dilution procedure allows fetal red blood cells to be identified and counted.
• Aspiration pneumonitis is a major cause of anesthesia-related death in obstetrics Rx treatment positive-pressure ventilation with 100% oxygen administered through an endotracheal tube when an epidural is going to be placed, the patient should be given an antacid
• Two of the major risk factors for uncomplicated UTI are sexual intercourse and hypoestrogenism. Hypoestrogenism is believed to be a risk factor for UTI because it is known that postmenopausal women not receiving estrogen replacement therapy (ERT) are at greater risk for developing a UTI compared with those women who do use ERT.
KaplanQbankNotes:Neeraj 20
• There is no effective screening test for endometrial cancer .It is not cost-effective to screen asymptomatic women for endometrial cancer.
• Cancer screening should be an essential part of an annual examination. Colorectal cancer screening should begin at age 50 with no significant family history. Screening consists of a digital rectal examination with fecal occult blood testing. This can be performed at the same time that pelvic examination is performed. Sigmoidoscopy should be performed every 3-5 years.
• Various studies have also shown that rates of preeclampsia, placental abruption, and heart failure may be increased in pregnant patients with hypothyroidism. Pregnancy often leads to an increased requirement for thyroid hormone replacement (thyroxine) as the pregnancy progresses.
• Coumadin is contraindicated during the first trimester because of the risk of birth defects. Coumadin embryopathy is a syndrome consisting of nasal hypoplasia and stippled vertebral and femoral epiphyses. Second- and third-trimester exposure to Coumadin can lead to hydrocephaly, microcephaly, ophthalmologic abnormalities, fetal growth retardation, and developmental delay. Low-molecular-weight heparin has been shown to be an excellent anticoagulant because it has a longer half-life and a more predictable dose-response relationship,also less likely to cause thrombocytopenia and hemorrhagic complications than unfractionated heparin.
• Tubal ligation failure may result from many factors including recannalization of the tube and poor surgical technique. The most commonly quoted failure rate is about 1 in 100, although a more accurate figure may be closer to 1 in 300.
• Raloxifene is selective estrogen receptor modulators (SERMs) have pro-estrogenic effects in some tissues and anti-estrogenic effects in other tissuesapproved for prevention of osteoporosisno effect on hot flashes.
• Patient post-hysterectomy for Endometrial CA asking for HRT? if any neoplasm is remaining in body it will grow and recur earlier! +Standard risk of venous thrombosis
• Hot flashes can respond to estrogen or progestin bothWhen both are contraindicated(like H/o pulmonary embolus for estrogen or depression for progestin) Rx alternative treatment Clonidine in low doses.
• Vitamin A supplementation during pregnancy is not needed or recommended for most women. In fact, vitamin A supplementation has been associated with birth defects, including cranial neural crest malformations. Most commonly used prenatal vitamins contain 5000 IU or less, and this is considered acceptable.
• Ovarian hyperstimulation syndrome (OHSS)in patients undergoing ovulation induction mild OHSS (ovaries <5 cm) mild weight gain and pelvic discomfortmoderate OHSS, (up to 10 cm)least a 10-pound weight gain, nausea, and vomitingsevere OHSS, (>10 cm) with ascites, hydrothorax, hemoconcentration, and oliguria Rx mild cases: conservatively, more severe cases: paracentesis, thoracentesis, or surgery. Pelvic or abdominal examinations can lead to rupture of the ovarian capsule hence ultrasound examination is preferred.
• During pregnancy: gastric acid secretion & motility is reduced and mucus secretion increased Reduced peptic ulcer disease Similarly 70% of women with migraines will have improvement(Rx acetaminophen and antiemetics or Codeine or meperidine may be given for severe headachesErgotamine preparations should be avoided in pregnancy) safety of sumatriptan during pregnancy has not been established?
• Mode of delivery with twin gestations:
1. Vertex-vertex twins are generally allowed to have a vaginal delivery.
2. presenting twin that is non-vertex are generally advised to have a cesarean delivery
3. Presenting twin vertex and the non-presenting twin non-vertex may decide which mode of delivery they would preferOnce the presenting (vertex) twin has deliveredfirst option is an external cephalic version, in which the head of the second twin is guided into the pelvis so that it becomes a vertex presentationsecond option is a breech extraction of the second twin(Breech extraction may be performed so long as there is an adequate pelvis, a fetal weight greater than 2,000g, an experienced physician, a flexed fetal head, and available general anesthesia)
KaplanQbankNotes:Neeraj 21
• DNA-based molecular analysis can be used to diagnose fragile X syndrome. This can be performed on cultured amniocytes obtained at amniocentesis. Chorionic villus sampling is not considered to be reliable for the diagnosis of fragile X syndrome because of different methylation patterns in the trophoblast compared with the fetus.
• Kallmann syndrome (i.e., isolated gonadotropin deficiency or familial hypogonadotropic hypogonadism) can present with primary amenorrhea ,anosmia or hyposmia, color blindness, and cleft lip or cleft palate(during embryogenesis the GnRH neurons originally develop in the epithelium of the olfactory placode and normally migrate into the hypothalamusThus exists the link between the midline defects and the amenorrhea)Rx exogenous estrogen and progestin replacement therapyIf pregnancy is desired, ovulation induction can be brought about with the pulsatile administration of exogenous GnRH.
• In case of PID: The partner of the patient must be treated as well as the patient herself in order to prevent reinfection. A test of cure (TOC) should be performed 4 to 6 weeks after treatment is given to ensure that the organism has been completely eradicated from the patient and her partner or partners.
• PID in preganacyRx Clindamycin + gentamycin
• Meperidine can be used as a systemic analgesic during labor. It is an opioid and readily crosses the placenta; therefore, the fetus is exposed to the medication. As an opioid, it causes respiratory depression. Neonates are at greatest risk for respiratory depression when delivery occurs approximately 2 to 3 hours after meperidine is administered to the mother.Rx nalaxone
• Compound presentation:when an extremity prolapses alongside the fetal presenting partbrought about when the pelvic inlet is not completely occluded by the fetal head(Most often with premature fetuses) compound presentation can be allowed to undergo a normal labor and delivery.
• Women of child-bearing age should consume 0.4 mg/day of folic acid starting preconceptionally and continuing for the first 3 months of pregnancy.
• Molar preganancy: Once there is pathologic confirmation of the diagnosis, it is essential that the patient continued to be followed weekly until the beta-hCG value returns to 0. The patient should then be followed monthly for an additional year to ensure that the values stay at 0 and that there is no evidence of persistent or metastatic disease.
• Syphillis in preganancy :Only Rx is penicillin as no other drug permits safe and effective treatment of the fetus as well as the motherIn a patient who is allergic to penicillin, oral desensitization must be performed first in a hospital setting with appropriate facilities.
• Genital herpes: no "cure" for herpes genitalis. Acyclovir can be used to shorten the duration of symptoms. In patients who have more than 6 outbreaks per year, daily oral acyclovir is recommended to prevent these frequent outbreaks.
• In all other solid organ transplants, deterioration of function 10 days out would suggest an acute rejection episode, and appropriate biopsies would be done to confirm the diagnosis. In the case of the liver, however, antigenic reactions are less common, whereas technical problems with the biliary and vascular anastomosis are the most common cause of early functional deterioration. They are, therefore, the first anomalies to be sought.
• Fluid replacement in a case of burns the Parkland calculations made by standard formulas are only an educated guess. Once fluid administration begins, we judge its adequacy by the information provided by urinary output and central venous pressure, aiming for an output of 1-2 mL/kg/hr, while not exceeding a venous pressure of 10 or 15.
• Parkland formula: 4 mL of Ringer's lactate x body weight in Kg x percentage of the body surface burned + 2000 mL of dextrose 5% in water
• The treatment of breast cancer in a pregnant woman should be the same as that in a nonpregnant woman, except for two restrictions: no chemotherapy during the first trimester, and no radiation therapy during the pregnancy. It is not necessary to terminate the pregnancy. The surgical option could be mastectomy or lumpectomyas per the size.Should axillary nodes be positive, systemic therapy should be done later.
KaplanQbankNotes:Neeraj 22
• 2nd postoperative day after an operative procedureurinary output in the past 2 hours has been zero (ARF ruled out as some urine is still produced in ARF, although it is a small volume)Rule out catheter block?
• Lumpectomy alone has an unacceptably high incidence of local recurrenceAlways add local radiation therapyIf metastatic disease found in axillary nodesAdd systemic therapy. As a rule, chemotherapy is preferred for premenopausal women & receptor positive.
• Never operate a patient under GA if liver function marginal would be tipped into overt liver failure by an anesthetic and an operation
• Any gunshot wound below the nipples involves the abdomen, and the management of all gunshot wounds of the abdomen requires exploratory laparotomy.
• Compartment syndrometriggered by prolonged ischemia followed by reperfusion (the arm pressed against the park bench until he woke up and changed position), and located in one of the two most common sites (forearm and lower leg)reliable physical finding pain on passive extension and the diagnosis is not ruled out by normal pulses. Only a fasciotomy will solve his problem.
• Amputed finger under transportmust be kept from drying outmust not be injured with any direct chemical agentsmust not be placed in direct contact with ice or allowed to freeze.
• There is some evidence that high-dose corticosteroids administered as soon as possible after the injury will result in a better ultimate outcome
• A rough guideline to quantify water loss every 3 mEq/L that the serum sodium concentration is above normal, represents about 1 L of water deficit E.g Na+ 155 = excess of 15 = water deficit of about 5 L. While correcting hypernatremia the tonicity correction should not happen with the same speed with which the volume is going to be corrected (Brain should adapt with osmolality changes) That delay is achieved by choosing a fluid that is not pure water, but one that has some sodium in it to dampen the effect on tonicityE.g Dextrose with half NS
• Severe head trauma sufficient to produce coma + facial injuriesalways evaluate with CT to R/o bleed and include Neck also
• All failed regimen in anal fissure Opt for Forceful dilatation under anesthesia, lateral sphincterotomy, or botulinum toxin injections
• Abdominal compartment syndromethe life-saving massive fluid infusions produce severe edema in the surgical fieldForced closure would compromise ventilation and venous returnA temporary plastic coverage, or a mesh, allows the bowel to be protected without undue pressure.
• Pelvic bone fracture Falling BP but no free fluid within abdomen Pelvic fractures can bleed massively, and often the source is torn veins that are not easily controlledMinimizing the motion of the bone fragments by external fixation can be helpful Comminuted fractures of the femurs are also known to be one of the few places in the body where enough occult blood loss may occur to lead to hypovolemic shock.
• Hyperthyroid state But the thyroid gland normalRadioactive iodine uptake should be high if her gland is indeed hyperfunctioning but it will be near zero if it is suppressed by the exogenous hormone.
• Breast mass found after trauma not regressing after week might not be a hematoma or fat necrosistrivial trauma sometimes brings to the attention of the patient an area of the body that had not been examined beforeA breast mass in a >40-year-old woman requires a mammogram and biopsy.
• Gunshot wounds to the base of the neck may injure major vessels, the tracheobronchial tree, and the esophagus diagnostic studies should precede surgical intervention if time allows
• Several months after sustaining a crushing injury to armconstant, burning, agonizing pain in that armNot responding to usual analgesic medications aggravated by the slightest stimulation of the area, such as rubbing from the shirt sleevesarm not swollen and pulses normalneurologic function of major
KaplanQbankNotes:Neeraj 23
nerves intactcausalgia (reflex sympathetic dystrophy)If sympathetic block relieves the symptoms, permanent cure will be obtained with surgical sympathectomy.
• Small umbilical hernias can close spontaneously up to the age of 2 years.
• Enucleation of EyeOften done for two malignant tumorsretinoblastoma and melanomamelanoma may present as metastatic tumour after even 20-some yearsA patient with a glass eye or missing toe and a liver full of tumor is classic examples to illustrate the unpredictable behavior of melanoma.
• Suspected Skin CA Always perform biopsy edge of the lesion offers the best information for the pathologistAn excision before pathologic diagnosis risks doing too much (a basal cell cancer needs only 1 or 2 mm of margins) or too little (a melanoma should have at least 2 cm).
• most important thing that can be done for caustic chemical burns is to wash away the caustic agent as soon as possible
• When coagulopathy develops during operative procedure provide fresh frozen plasma and platelet packs. when hypothermia complicates the pictureClose the abdomen immediately bleeding surfaces have to be packed, waiting for a more propitious time in which to attempt hemostasis, once coagulation function and body temperature have improved
• Diffuse esophageal spasm v/s Nutcracker esophagus on manometry there is a mean distal esophageal peristaltic amplitude of more than 180 mm Hg, including an elevated baseline pressure in the lower sphincter in Nutcracker (Normal pressure and relaxation in diffuse esophageal spasm).
• De Quervain's tenosynovitis: Tenosynovitis of the abductor or extensor tendons of the thumb positive Finkelstein sign (the pain produced by ulnar deviation to stretch the affected tendons).
• Advanced breast CARad/chemo to make it operable
• A high spinal anesthetic can produce vasomotor shock by inducing widespread vasodilation. Vasoconstrictors are the appropriate therapy, but since the capacity of the vascular tree is also increased under these circumstances, filling it up with additional volume is also helpful.
• Follicular thyroid cancers can metastasize by way of the blood stream to the liver, lung, brain, or bones. Because the tumor has rudimentary functional capability, it can be traced with and ablated by radioactive iodine; however, the tumor cannot compete successfully with normal thyroid tissue for the capture of iodine. After removal of the entire gland, the tumor becomes the most effective iodine trapper in the body.
• Very tender spot in the third interspace foot(between the third and fourth toes)no redness, limitation of motion, or signs of inflammationclassic for Morton's neuroma, a benign neuroma of the third plantar interdigital nerve.
• A fracture from such trivial strain signifies a very weakened bone. In this age and gender, the most likely cause would be a lytic lesion from metastatic breast cancer.
• Post-traumatic hemothoraxcriteria to perform thoracotomy if the initial blood recovery exceeds 1000 mL, or if subsequent drainage adds up to 600 mL or more, over the ensuing 6 hours.
• wound dehiscence after abdominal surgerydraining copious amounts of clear pink fluid from his midline laparotomy woundcould have been handled by taping the wound securely Immediate surgical repair is mandatoryNot allowed to strain abdomen or move aroundOnce the bowel came out, the problem became an evisceration
• Acute ‘Senility’ within short periods of weeks Suspect chronic SDH.
• In case of Pheochromocytoma presence of catabolites from epinephrine indicates that the tumor is in the adrenal glands, and not at an extra-adrenal site.
KaplanQbankNotes:Neeraj 24
• When hitting the knees against the dashboard, the femurs can be driven backward and out of the acetabulum, resulting in posterior dislocation of the hips. Because of the tenuous blood supply of the femoral heads, such injury must be promptly recognized and treated.
• Postoperative complications:
1. Atelectasis : seen on day 1
2. Fever day 3 is usually from the urinary tract infection.
3. Deep thrombophlebitis 5-7 days after surgery
4. Intra-abdominal abscess 7-10 days
• Intraoperative myocardial infarction is mostly seen in elderly men, and the most common triggering event is prolonged hypotension. Furthermore, the mortality greatly surpasses that of a myocardial infarction de novo (ie, unrelated to surgery), reaching upto 50-90%
• heel pain every time foot strikes the groundworse in the mornings, preventing him from putting any weight on the heelwhen the ankle is dorsiflexed, the entire inner border of the fascia is tender to palpation plantar fasciitis.
• central cord syndrome:mechanism of injury (hyperextension)relative sparing of the lower extremities in the presence of upper extremity deficits are classic
• Anterior cord syndrome all functions are lost, except for positional and vibratory sense. Those injuries occur with blowout of the vertebral bodies.
• Posterior cord syndrome is quite rare, and it would show loss of positional and vibratory sense.
• Anorectal signs and mass with Inguinal nodes has to be anal SCCAdenoCa of rectum will never metastasize to inguinal nodes.
• Ogilvie syndrome is the acute pseudoobstruction and dilation of the colon in the absence of any mechanical obstruction in severely ill patients
• Brain tumor with increased intracranial pressuredevelopment of hypertension and bradycardia (Cushing's reflex) signifies that the brain has run out of compensatory mechanisms to minimize the intracranial pressure elevation generated by increased intracranial volume. When that point is reached, brain perfusion suffers and death is imminent.
• Posterior dislocation of the shoulder: Can be missed in AP view mechanism of injury (massive contraction of all muscles in the area)
Axillary view x-ray films are needed to make the diagnosis.
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| docnikki
Forum Guru
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thanks alot for this input...Im sure it will be very useful.
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| damian33
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Great notes thanks a lot
___________________
Expect the worst and you won't be disappointed
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| werther
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In that long list something is wrong:
NO NEED TO ROUTINE BIOPSY IN WOMEN ON TAMOXIFEN.
he American College of Obstetricians and Gynecologists has developed the following recommendations for monitoring women on tamoxifen [94]:
* Premenopausal women have no known increased risk of uterine cancer with tamoxifen, and require no additional monitoring beyond routine gynecologic care.
* For postmenopausal women, perform an annual gynecologic examination.
* Monitor for symptoms of endometrial hyperplasia or cancer. Women should be educated to report any abnormal vaginal symptoms (eg, bloody discharge, spotting, staining, leukorrhea).
* Investigate any abnormal vaginal symptoms.
* Limit tamoxifen use to five years duration because benefit beyond this time has not been demonstrated.
* If atypical endometrial hyperplasia develops, the use of tamoxifen should be reassessed and appropriate gynecologic management should be initiated. Hysterectomy should be considered for women with atypical endometrial hyperplasia in whom tamoxifen therapy must be continued.
Endometrial protection from the effects of tamoxifen may be possible with local application of intrauterine levonorgestrel, a progestational agent. In one randomized trial, 122 women receiving at least one year of adjuvant tamoxifen treatment for breast cancer were randomly assigned to endometrial surveillance alone, or endometrial surveillance before and after the insertion of a levonorgestrel-releasing intrauterine device for 12 months [95]. There were no new polyps in women fitted with the intrauterine device, and 13 percent fewer fibroids than in controls. Further evaluation of this method is warranted.
Guys be careful with what you post, whenever is not checked by yourself, it lowers the forum resource trustfulness.
There are a few more to check.
Thanks!
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| profane76
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Why not, I'll bite...
USMLE Step 3 Nuggets
UGI bleeding in HIV is either related to Kaposi’s or Lymphoma. LGI bleeding is usu. CMV, or HSV, or bacteria.
Kaposis is usu characterized by purplish lesions (macules, papules, tumors etc.) most commonly on face, LN, lungs and GI tract.
Basal cell Ca is characterized as a papule w/ central ulcerations and a "pearly" border.
Squamous cell ca is characterized by an indurated and hyperkeratotic plaque w/ crusting and ulceration.
Actinic keratosis may undergo malignant transformationà charact as macules or papules, hyperkeratotic, adherent scale with a "cutaneous horn".
A keratoacanthoma is a rapidly growing nodule w/ keratinous debris in middle and is related to squamous cell ca.
seborrheic keratoses usu has a waxy "stuck on" appearance.
In pedsà set hot water heaters to less than 130 F
Always think of fungal infxn w/ immunocompromised pts’.
In pts’ in DKA, if you lower the blood glc level to quickly you will get cerebral edema.
In pregnancy you will see increased elevated Alk phos secreted by the placenta, so just reassure pts and there is no need for a work-up.
Abd wound dehiscence typically occurs 7-10d post-op; look for new onset serous d/c. tx is to re-do the laparotomy.
For chlamydia positive females, tx them and their partners; pt’s w/ gonorrhea need tx for both chlamydia and gonorrhea.
classic EKG for PEà S wave in I, Q wave and T wave inversion in III, or ST-T wave changes in V1-4.
In family thryroid ca, think of medullary thyroid Ca.
Acute glaucoma (elevation of intraocular pressure) often presents w/ abd pain, n/v and is an emergency which can lead to blindness. Dx it by measuring intraocular pressure and possibly give acetazolamide, topical BB, mannitol or pilocarpine.
cocaine is contraindicated during breastfeeding.
SE’s of testosterone tx (for erectile dysfxn) are increase in PSA, erythrocytosis and exacerbation of sleep apnea.
Skin necrosis will happen in a pt w/ deficiency of protein C and who is started on Coumadin without heparin at the same time.
u/s of molar pregnancyà "Snowstorm" pattern. The content of the uterus are hydropic villi and are grapelike in appearance. They are at risk for choriocarcinoma, thus monitor their BhCG for one year afterwards, therefore they can’t get pregnant and thus need to be on OCPs.
A pt w/ an LDL >160 and >2 risk factors should be started on drug tx as well as diet/exercise.
Prinzmetal’s angina is a variant angina charact by coronary vasospasm that causes reversible ST elevation. Tx is CCB and nitrates.
"Nursemaids elbow"(sublaxation of radial head)à tx is supination of the forearm w/ the elbow flexed.
Do not do a percutaneous needle bx of a suspected renal cell Ca, just do a nephrectomy. You can seed the tumor.
Esophageal rupture is a complication of EGD. The first step is to get an esophagram w/ a water soluble agent. A thoracotomy is the tx.
Screening w/ mammograms and annual clinical breast exams should begin at 40yo. In woman w/ FmHx (1st degree), screening w/ annual mammograms should begin 10 years b/f the age of the youngest affected pt.
pt post-op an ortho procedure needs to be on warfarin or LMWHep post op for 6wks to 6 months.
A modified radical mastoidectomy spares the tympanic membrane (a bad case of cholesteatoma).
Do a direct coombs test to test for blood incompatability of mother and fetus when you get hyperbilirubinemia in an infant soon after being born. When the level of unconjugated bili reaches >20 worry about kernicturus (deposit in the basal ganglia).
A woman should get mammograms yearly.
In treating DKA, pt’s can get cerebral edema if the glc level drops to rapidly which presents as acute change in MS, vomiting and HA. Give mannitol and dexamethasone. If this doesn’t work, hyperventilate pt. A CT scan makes the dx.
In a pt who had a subarachnoid bleed and who got treated but then declines in MS, think of a vasospasm (blood in csf is an irritant) and give nimodipine (no other CCB works).
Ulcerating granulomatous lesions of the upper and lower resp tract is the hallmarks for Wegener’s granulomatosis as are cavitating lesions.
An IVP is performed to est the presence or absence of both kidneys, to define renal outlines and cortical borders, and to outline the collecting system and ureters.
A retrograde urethrogram is used for pts suspected of having a urethral injury. They typically have blood at the meatus, high-riding prostate, perineal hematoma, pelvic fx,
A varicocele is the most common cause of male factor infertility.
...Keep 'em coming...
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