drugs which cause exacerbations of psoriasis
lithium
inderal( beta blockers)
anti malarials (chloroquin)
, beta-blockers, aspirin).
....//////////////
Which of the following drugs is the least sedating and anticholinergic, which can be prescribed safely to elderly patients with depression?
a.fluoxetine
b.MAOI
c.Imipramine
d.Sertraline
e.Trazodone
/////////////////////
Amantadine. ----is class of chemotherapy
///////////////
metronidazole taking mother---- not to feed for 24 hours
///////////////
LYME disease /pregnant
amoxicillin or cefta if CNS involved NO tetracycline because she is pregnant
If this patient was not pregnant then tetracycline is doc ten day therapy is usually reserved for isolalated erythema migrans....if systemic or severe symptoms therapy is recommended for 21 days.
any one of the following
tetracycline 250 po qid
doxycycline 100 mg po bid
amoxicillin 500 po tid
/////////////////////
minimum age is 2 years.. both nephritic and sickle cele will nedd vaccine
//////////////////////
45 years old woman with history of DM and mild Hypertension with occational history of seizure for last 6 month came to your office with 6 hours h/o headach right sided partial ptosis,pain in lower half of face and neck rigidity.what would be the cause?
a)Trigeminal neuralgia
b)SAH of Post communicating artery
c)SAH of PICA
d)Brainstem glioma
e)Lacunar stroke
Answer is C…..Ipselateral facial pain sensetion,ipselateral horner's syndrom
and involvement of V11 nerve (bells palsy).
/////////////////////
incontinence with no urinary symptoms.side effect of---Phenytoin therapy
////////////// lchen planus-- on biopsy it is hyperkeratosis
////////////////////
ACETAMINPHEN--------acute hepatic necrosis
/////////////////
best test for confirming rupture of membrane -- nitrazine test
//////////////
girl with DM1 now reach puberty,---- increase insulin.
///////////////////
HOW to follow Multiple sclerosis -- f/u with MRI……
INITIAL diagnosis made by MRI
/////////
baseball pichter with shoulder injury,xray with compound fracture of clavicle --- open reduction internal fixation
he can play the game after 2-3 months
///////////////
TCA toxicity ---alkalinize urine with Nacho3
/////////////////
histoplasmosis in moist cave and cocci in dry caves,,,
//////////////
Current recommendations are to initiate treatment for HIV-infected patients with CD4 cells < 350/µL
or viral load > 30,000 copies/mL by branched-chain DNA or
55,000 copies/mL by PCR testing.
/////////////////////
complications of meniscus injury ?
tear of medial meniscus is more common than lateral.
Cmplication
Hemarthrosis
Locked knee
Locked knee should be reduced in 24 hrs, because beyond this period, effusion cause loss of elasticity of the meniscus, preventing it to snap back into its normal position.
///////////////////
girl 13 yr left shoulder/scapula is higher 4 cm than right. (no degree info. provided). You recommend:
ref to ortho. surgeon
greater then 2 cm needs referral to ortho.
There are three basic options for the treatment of scoliosis. These include observation, bracing, or surgery. Alternative treatments, although currently popular, have no proven benefit in the current orthopedic scientific literature. Observation is the preferred management choice for curves at low risk of further progression, and where the natural history is favorable. This would include curves less than 20o, or curves under 40o after the child has reached skeletal maturity. Bracing is preferred for curves in which there is documented progression of the curve and where the child has not reached skeletal maturity. These curves are at risk for progression, and the goal of the bracing is to stop this progression. The final option for scoliosis is surgical treatment. This is generally reserved for curves which are out of balance or those in excess of 50o. Curves of this magnitude tend to progress after the onset of skeletal maturity and ultimately cause significant functional compromise.
according to this the patient shoud be followe for 6 months & if any progression is found then suggest a brace !!
///////////////////////////
family history of breast cancer cancer is not a contraindication of HRT
//////////////////
Levothyroxine to a pregnant pt --- increased dose
because …. Pt. who are pregnant, on HRT, or infection have increases in TBG
///////////////////////
1 wk baby turn blue when feeding but when cry is pinkish??
Answer is choanol atresia
/////////////
pt.need immunoglobulins you give develop severe anaphylaxis.
chronic granulomatous dz,regular allergic reaction,Iga def.
Answer is IGA deficiency Patients with IgA deficiency may develop antibodies to IgA, and can have severe reactions (including anaphylaxis, a potentially life-threatening allergic reaction) to transfusions of blood and blood products. If transfusions are necessary, they should ideally come from another IgA-deficient individual.
Treatment of spasticity in post stroke patient
Answer is beclofen
///////////////Treatment of influenza. Indications and limitation of AMANTADINE
Answer is
influ. A amantidine within 48-72 hrs
////////////////
male constipation, no other abnormalities, -------Functional causes.
//////////////////////
ileojejunum bypass, diarrhea, what kind of fluid you give?
Total parental nutrition ,BUT normal saline+calcium and magnasium replacement
//////////////////shoulder dystocia.first step tell mom not to push…then ******* manouver then c- section…breaking of clavicle is the last resort
/////////////////
primigravida 28 weeks, rh negative ,husband positive
anti ***** antibody positive what next
1)give anti rhd2)
dont give anti rhd3)
do amniocentesis,
answer,,,, DON’T DO ANYTHING
////////////
During a flu. Season, a pt who did got get flu. Shot and had a flu.s/s for 4 days came in for treatment. You provide for him:
1. amantadine 2. zanamivir 3. only symptomatic support including (Tyleno)
Symptomatic treatment ( amantadine or zanamivir is given within 72 hours of influnza… ZANAMIVIR is the best treatment it covers both A and B)
//////////////////// 4 month-old-boy who is diagnosed as having OM without fever yesterday is brought by his mother for his regular vaccination scheduled. At this time, as his PMD, you: 1. give the boy vaccines scheduled 2. Wait after he recovered from his disease 3. others.
Answer is give vaccination ( ever is not a contraindication )
////////////////
Most common parasitic infection in usa
Answer is PINWORM (Entrobius vermicularis)
///////////////////////
A boy (5 may 8 yrs old) was brought by his mother with c/o right hip pain for 3 days. The boy had upper respiratory infection prior this hip pain. After working up, it is dx as septic arthritis.
1. what is the cause ? a. strep. Pneumo. B. staph. A. c. other bacteria (no surgical intervention)
2. what antibiotics ? a. methicillin b. penicillin c. vancomycin d others
3. 2 days after antbx, now there are a few small maculae (2-3 mm in diameter) without itching or redness. What do you do ? a. d/c antx b. continue the treatment c change to another antx. D others
Answers…………………..1) staph aureus 2) methicillin 3) change the antibiotics
Q)23 yrs old women with a vaginal presure symptoms and on pe has a 5 cm cystic mass,use diaphram for contraception, pregnancy test negative
next step
1.u/s
2.observation for 6-8 weeks
3.birth control pills
4.laprotomy
ultrasound
///////////////
Cocaine induced HTN - treated with Benzo, Nitroglycerin or Nitroprusside drip and Phentolamine 1 mg IV
No beta blockers like propranolol
////////////////
Q)29 yo M c severe diarrhea
o/e listless but responsive
vitals stable
Na 118,K 2.9, hco3 12,,urine na <10
R
a IV hypetonic saline
b hypotonic
c isotonic
d fluid restriction
e hco3
answer is isotonic solution
//////////////////A 3-month-old child was exposed to an adult with active pulmonary tuberculosis. ..........
Administer a TST, perform a CXR, administer INH, and reevaluate in 3 months.
////////////////////////////
the kid should be given INH prophylaxis even if CXR/PPD are negative. You have to reevaluate in 3 months with a skin test:
. if the test is negative :- to D/C INH
. if the test is positive :- to coninue INH for another 6 months (total 9 months )
/////////////
?????????you want give quinolon to a pt. whuch drug of the following should you worn him from:
2- theophyllin
////////////////////
A diabetic man with sexual dysfunction,,comes in for evalutaion of depression,, he is found to be depress..what is the best treatment
a)paroxitine (paxil)
b)fluoxetine (prozac)
c)sertraline (zoloft)
d)citalopram (celexa)
e) bupriopram (wellbutrin)
Answer is E.
wellbutrin and serzone are the only antidepressant that have least effect on sextual function.
///////////////////////
Painless gross and microscopic hematuira: THESE ARE THE STEPS>>>>U/A > IVP > CT..
Q)Painful gross or microscopic hematuira (s/s -> kidney stone):these are the steps >>>> U/A > KUB > IVP > CT ??
/////////////////
thyroid disorders,
early menopause
or somethign else???
answer is osteoprosis and early menopause AND STRESS FRACTURES
/////////////////////////
paNIC DISORDER---DEPRESSION
/////
Atropine should not be used to treat Mobitz type II block associated with BBB
Hemodynamically unstable pts should be treated initially temporary transvenous pacemaker insertion followed by permanent pacemaker implantation.
///////////////
Infection of which valve is most likely to be associated with the development of heartblock.
Mitral valve
///////////////
Q1) how do u check the progression of multiple sclerosis?
Q2) how to u follow Multiple sclerosis?
Q3) Diagnostic test of Multiple sclerosis
Q4) Effect of pregnancy on multiple sclerosis?
Answers to above question
1) Progression based on clinic
2) F/U depend on clinical course
3) Dx MRI
4) Pregnancy? Pregnancy exacerbate MS symptom.
/////////////////////
person with symptoms of Obstructive sleep apnea...what is the first/next step?
a) sleep study
b)medical workup
c)CPAP treatment
Answer is Medical w/u as below
1.r/o hypothyrid.ent exam
2.polysomnogram
3.treat-weight reduction(doenot work) >>>cpap
/////////////////////////////////
A mother is concern about obese child 3 y. what is the reason child is obese
mother behaviour problem
child neglect
genetic
eating disorder
ANSWER IS MOTHERS behavioral problems excessive eating may lead to childs excessive eating
///////////////////
Methyldopa (Aldomet) -- Centrally acting antihypertensive agent widely considered the first-line agent for treatment of hypertension during pregnancy.
Studies have revealed no adverse effects on cognitive development up to the age of 7.5 y among children with in utero exposure to methyldopa.
Hydralazine (Apresoline) -- Intravenous form is useful when treating severe hypertension due to preeclampsia/eclampsia.
///////////////////
Lead poisoning case
I. complete physical exam
II. cbc,sma7 blood lead level, lft, glucose,
peripherial blood smear, serrum ferritin
III. <25 environmental intervention
25-44 environmental and oral dimercaprol
44-69 IM or IV edetate disodium
>70 IM or IV dimercaprol
IV. Plan to admit or d/c home
V. console: Inspect home for lead paint
remove child from lead hazard
//////////////Meniere¡¯s disease. Triad. ---1-Vertigo 2.Hearing loss 3.Tinnitus
//////////////////////
Sarcoidosis patient gets affection of eye.---uveitis and. Glaucoma
/////////////////////
This case clearly indicated the PD pt presented psychiatic s/s, not depression.. So, the management step by step is (MKSAP, in Neurology, parkinson's dis, Table, 39):
Hallucinations, delusions TX: (step by step):
1). Discontinue non-levodopa drugs, if failed..
2)/. Reduce dose of carbidopa/levodopa (to the minimum theraputic dose), if failed...
3). Clozapine, quetiapine, donepezil, respiridone, olanzapine
For the depression in PD pt:
MKSAP: SSRIs.
Swanson: TCAs
/////////////////
HIV is a major no no for breast feeding, pretty much anything else, except meds like (antipsychotics, lithium), drug abuse, etc, you can encourage breast feeding. even with jaundice, you can usually keep breast feeding. The AAP does not recommed very much not to breast feed.
//////////////////////
PMR : --No muscle tenderness, but muscle ache..
-- Weakness: yes, it is main s/s of PMR
polymyositis -- weakness and muscle pain and tenderness..
FM is almost always dx in a <40yo and ESR=NL. PM and PMR are dx in the same age range, but PM has proximal muscle weakness and muscle bx is=AbNL. PMR= no proximal muscle weakness and muscle bx=NL
///////////////////////
polymyositis has specific weakness which always demonstrated by something like cannot raise from chair or cannot climb stair because of their severe proximal muscle weakness. Polymyositis pt does not complaint pain that much although they have tenderness in PE. the diagnostic for polymyositis is EMG, biopsy and CK etc. Fibromyalgia is a very vague similar to chronic fatigue syndrom. those pt complaint everything but find nothing conclusive (alway negative on labs etc, unless coexist with other dis).
/////////////////////////Which one of the following treatment strategies has been shown to decrease mortality in adult patients with ARDS?
C. Mechanical ventilation that delivers lower tidal volumes and limits plateau pressure.
A patient is found to have prostate cancer metastasis in the spine. Which one of the following is the initial treatment of choice ?
B. Dexamethasone i.v if the presence of spinal cord compression otherwise
E. Leuprolide (or LHRH antagonist, or orchiectomy)
A patient is found to have lactose-intolerance. What food you advise him to take?
D. Yogurt with live activated cultures.
Which one of the following is the mainstay of treatment for pemphigus vulgaris?
B.Prednisone
A mother brought her 5-year boy because of “bed-wetting? She told you that she found on the internet that alarms are more effective than the mediciation. What's the best choice?
C. Data reflect that alarms are most useful when augmented by other behavioral approaches.
////////////////////////
Valproic acid (dapakote)is generally regarded the drug of first choice in primary generalized epilepsy, particularly in patients with more than one seizure type, because of its broad spectrum of activity. Lamotrigine and topiramate also have a broad spectrum of activity and show promise in the management of these patients. Phenytoin, carbamazepine, and phenobarbital are effective in primary generalized tonic-clonic seizures but are ineffective against generalized absence and myoclonic seizures. Felbamate is effective in primary generalized seizures but is relegated to the refractory population because of its potential for toxicity
///////////
BLL <10 mcg/dL: No action is required.
BLL 10-14 mcg/dL: Obtain a confirmatory venous lead level within 1 month. If the BLL is still within this range, patient education about lead exposure is needed, and the BLL test should be repeated in 3 months.
BLL 15-19 mcg/dL: Same as #2, but repeat the BLL in 2 months.
BLL 20-44 mcg/dL: Obtain a confirmatory venous BLL in 1 week. If the BLL is still within this range, assess complete medical, nutritional, and environmental hazards. Environmental evaluation by the local health department is also needed. A 2001 large-scale study reported no improvement in neurologic and behavioral test scores after succimer chelation of children with BLL in this range.
BLL 45-69 mcg/dL: Obtain a confirmatory BLL within 2 days. If still within this range, undergo complete evaluation as in #4. At this level, chelation therapy is recommended. Treatment should be in a lead-free environment. If this is not possible, hospitalization is necessary. Chelation can be started with oral succimer, or, if the patient is hospitalized, calcium disodium edetate (calcium EDTA) can be used. These agents have potential toxicities, and monitoring of the CBC, electrolytes, and LFTs is necessary.
BLL >70 mcg/dL: Hospitalize, obtain a confirmatory venous BLL, and initiate chelation with dimercaprol and calcium EDTA. Because calcium EDTA does not cross the blood-brain barrier, its use as the only agent in this situation is not recommended because of the possibility of lead redistribution from the soft tissues to the CNS. Pretreatment with dimercaprol (which crosses the blood-brain barrier) is recommended.
////////////////The measles (rubeola) vaccine recommended for use in this country is a live attenuated vaccine. It is recommended for use at 15 months of age, but whenever there is likely exposure to natural measles, infants as young as 6 months should be vaccinated and then revaccinated at 15 months to ensure protection. Exposure to measles is not a contraindication to vaccination, and if the vaccination is given within 72 hours of exposure, it may provide protection. Studies indicate that measles vaccine, by protecting against measles, significantly reduces an individual's chances of developing SSPE, a "slow virus" infection of the central nervous system associated with a measles-like virus.
///////////////
Eye movement and pupil size, such as miosis in opioid, organophos intox and barbiturate coma, or pontine lesion etc and mydriasis in TCA, amphetamin/cocaine, higher level herniation, brain hemorrhage etc. And that bilaterally dilated and fixed pupils are due to inadequate cerebral perfusion.
nystagmus: Vertical -damage to the brain stem; horizontal more related to drug.
Cushing's triad, which includes bradycardia, hypertension, and a change in respiratory pattern, is seen in head injuries with increased intracranial pressure (ICP).
Head injuries rarely cause hypotension therefore, if it does, other causes of hypotension must be sought.
if pt injested TCA, neither serum or urine give you any good information, because the level does not correlate with symptoms, EKG is key in TCA
////////////////////////
wilson diease-diagnostic test is --Inability to incorporate a copper isotope into ceruloplasmin
/////////////////
Raloxifene is FDA approved for osteoporosis and is anti estrogenic. Its however not approved for chemoprevention like Tamoxifen, the latter is more superior than raloxifene as a chemopreventor and is FDA approved for chemoprevention.
Tamoxifen complication- hypercalcemic crisis, both predispose to thromboembolic complications.
INDICATIONS FOR CARDIOVERSION///CHF August 19 2003, 1:23 PM
DC VERSION SHOULD BE DONE IN THE PRESENCE OF
1.SYS. BP <90
2.MENTAL STATUS CHANGES
3.CHF
4. CHEST PAIN
////////////////////its LR--- dont give renal pt lactate ringer bcz they r already having hyperkalemia. neverin neurosurgical pts also
////////////////////////
ranson's criteria include
wbc>16000
age>55yrs
ldh>350 units
glucose>200mg/dl
AST>250units/lt.
////////////////////
AVOID DIGOXIN AND VERAPAMIL in WPW syndrome
////////////////////mn
Polyarteritis nodosa
Fever, abd pain, weight loss, renal disturbances.
Labs: elevated ESR, leukocytosis, anemia, hematuria, proteinuria.
Dx: Biopsy
DO NOT MISS HEPATITIS B!!!!!
////////////////////////////////
Tourette's associations:
Attention-Deficit/Hyperactivity Disorder (ADHD)
Difficulties with Impulse Control (disinhibition)
Obsessive-Compulsive Disorder (OCD)highest prevalance
Various Learning Disabilities (such as dyslexia)
Various Sleep Disorders
Remember, Tourette's is an Axis I disorder in DSM IV.
/////////////////
purigo gravidarum
it says that 3rd trimester pruritic rash after jaundice for a couple of weeks...i dunno how jaundice occurs...resolves after delivery.....recurs in future pregnancies...may also recur with OCP use if happened once/////////////////////
cerebellar ataxia
25% after 1to2 months of varicella inf
5% after vaccination
resolves over weeks to months
/////////////////////////
prostate ca with bony mets and pain
this is acute conditioin
we have to stop testosterone
bilateral orchiectomy...castrate testo levels achieved in 3 hrs
ketoconazole...in pts who cannot undergo surgery...it blocks cytochrome 450 system and thus stops adrenal and gonadal tetsto..castrate levels achieved in 8 hrs
LHRH...its increases the FSH and LH in the begining by the flare phenomenon and thus is not good for acute setting..castrate levels in 30 days
if there is spinal cord compression due to bone metastasis...give steroids also...it will decrease edema and testosterone
/////////////////////////
In an unconscious pt with an intact brain stem, the fast component of the nystagmus disappears ,so that the eyes deviate toward the irrigated side for 2-3 minutes before returning to their original position.
With impairment of brain stem function,the response becomes peverted and finally disappears.
Ref CMDT
I think if the pt. is UNCONCIOUS the nystagmus disappears and eyes are tonically deviated to the side of applied irrigation for 2/3 min. If in this case nystagmus is present, that means pt. is concious.
//////////////////
long acting biphosphnates,pamidronate or zolendronate r the drug ofchoice for the treatment of hypercalcemia
//////////////////GIVE testosterone TO MAINTAIN ERRECTION.
///////////////
STARRING INTO THE SKY=GENERALISED COMPLEX SZ.TEMP. LOBE EPILEPSY= DEPAKOTE
//////////////
aida /needle stick/GIVE POST EXPO PROPX FOR 28DAYS
3 DRUGS
DDI+AZT +ANY NRTI
/////////////////////
cmdt says renal osteodystrophy confirms the diagnosis of CRF
///////////
both DI and polydipsia has low urin osmolarity; however; when you do water deprivation test, the urin osmolarity does not change in DI, but increases in polydipsia.
so for discussion to differentiat causes of DI;
what is the best initial diagnostic test? water deprivation test. it will differentiate btw polydipsia and the other two.
what is the most accurate test:--- vassopressing stimulation test. it wii differentiate btw central vs nephrogenic DI
////////
Mohs surgery for skin cancer.
///////////
No I/m laoding dose of phenoytin-- erratic absorption/SLOW ABSORPTION
/////////////////
NSAID/ methotrexate: parenteral steroid is not used for psoriasis,
//////////
viral pericarditis---pericardial tamponade, ---Pulsus Paradoxsus,
///////// LEGS FOR ERYTHEMA NODOSUM, it's associated with Chrohn's disease
//////////////Ceftriaxone displaces bilirubin in albumin thus affecting conjugation.
It is generally avoided in neonates less than 1 month old for fear of exacerbating jaundice!
After 1 month of age, it is safe to use Ceftriaxone already!
///////////////////
PID---IV Cefotetan or IV Cefoxitin plus IV Doxycycline is generally use for inpatient treatment of PID.
IM Ceftriaxone x 1 plus oral Doxycyline x 14 days is the outpatient treatment of PID.
You will shift IV antibiotics to PO antibiotics after patient has been AFEBRILE for at least 24 hours and there are clinical signs of improvement!
order wet mount + Koh ( associated STD infection ), RPR , HIV Eliza, HBAgn, vaccination ( HB vaccine if she does not have the infection)
/////////////////////////
Cause of increased erythropoiten - the renal cell carcinoma.
////pt on penicilin and developed autoimmune hemol--do direct coomb test
////SBP_
cefotaxime,if sever
ceftriaxon also we ,treating E-coli, gram +'s,,polys>250 absolute neutrophil count.
//////////Tourette's disorder is a neuropsychiatric disorder characterised clinically by motor and vocal tics, which may be associated to conductual disorders such as obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). Although the neurochemistry of Tourette's disorder is not well known, there are some effective therapies for tics, OCD and ADHD. However, these are not devoid of adverse effects. Tics only require treatment when they interfere with the functioning of the patient. If therapy is needed, monotherapy at the minimal effective dose is desirable, but some patients may require two or more drugs. The most frequently used drugs for tics are antipsychotics (mainly pimozide and haloperidol) and clonidine ..The drugs of choice for OCD in patients with Tourette's disorder are the selective serotonin reuptake inhibitors (SSRIs), although the tricyclic antidepressant clomiplamine, which inhibits both serotonin and noradrenaline uptake, has also been found to be useful. ADHD can be treated with some psychostimulants, mainly methylphenidate, although these drugs must be used with caution. Other potentially useful drugs for the treatment of ADHD in patients with Tourette's disorder are clonidine, guanfacine, selegiline, some tricyclic antidepressants, sertraline, pimozide and clonazepam. Finally, the potential value of some nonpharmacological therapies (hypnotherapy, biofeedback, conductual therapies, electroconvulsive therapy, acupuncture and surgery) is briefly reviewed.
///////
Saw palmetto is utilized throughout the world mainly for its effects on BPH. (B9 prostatic hyper) saw palmetto led to an increase in flow rate in men with BPH....It will increase your urine stream.
///////////////////////
Ipecac, an over-the-counter emetic agent, has been a drug of choice for abuse by patients with eating disorders. Its alkaloid emetine has been associated with serious cardiac toxicity.
/////////////
///toddlers, under the age of 5, are treated differently from children 5 years and older.
According to www.eMedicine.com, infants and toddlers are susceptible to Streptococcus pneumoniae, H. influenzae type B, and Staphylococcus aureus, so they should be treated with cephalosporins, such as ceftriaxone, cefotaxime, or cefuroxime, or a penicillin such as ampicillin.
Children of 5 years, ready to start school, are susceptible to Mycoplasma pneumoniae, so they should be treated with macrolides, such as azythromycin, clarithromycin, or erythromycin
///DM is the most important risk factor for CAD.
///Q 1) Rx of DHB after Premarine > I will choose Low and low ( because her endometrium is stable by premarine)so try low/low , if pt. have spotting with it then high esro or med estro with low progesterone.
If was not treated with premarine try high estro and low progesterone.
Q2) In turner - before fusion > Conjugate estrogen 0.3 q.d 21 days. Add DMPA 5mg q.d from 15 - 25th day of cycle to induce period.
Can use OCP also ( not my choice) should be low and low.
After fusion - estrogen 0.625mg ( can use higher according to tolerance )add progestreone as above
OCP try high estro and med progesterone.
///False elevation of PSA.. March 26 2003, 1:23 AM
1)* PSA levels have been demonstrated to be elevated in acute prostatitis, subclinical or chronic prostatitis, and urinary retention.
2)* An increase in PSA levels has been reported following ejaculation. In 67% of the men older than 50 years who were tested, a 41% mean increase (0.8 ng/mL) in PSA occurred 1 hour after ejaculation.
3)* Performing a prostate needle biopsy increases PSA by a median of 7.9 ng/mL or 6.5 times baseline values within 5 minutes following the biopsy, and this level persists for 24 hours
4) * vigorous prostate massage
***No significant change occurs in the PSA level following a DRE . Cystoscopy, urethral catheterization, and transrectal prostate ultrasonography do not tend to elevate the PSA.
///Only nocardia is weakly acid fast other than Mycobacteria.
In nocardia thre will be mainly pulmonary involvment, begins with malaise, weight loss, fever night sweats and cough, dont know about hepatoslenomegaly.
Choice of Abx is TMP/SMZ
///Legionnaire's disease is caused by L.Pneumophilia followed by L micdadie
Sputum examination on Gram stain show..
Typically, many leukocytes and a paucity of organisms are observed.
If visible, the organisms are small, faintly staining, gram-negative bacillii. Erythromycin was considered the drug of choice for L pneumophila, but the newer macrolides and quinolones have begun to replace erythromycin.Fluoroquinolones, primarily levofloxacin, sparfloxacin, and trovafloxacin, as well as newer macrolides (eg, azithromycin)are now used for treating it.
///Sturge Weber Syndrome?
Laser for capillary angioma...
opthalmology referal
anti convulcent med when needed
///ASCUS and LGSIL - atypia /mild dysplasia - CIN 1
HGSIL -moderate CIN II
severe dysplasia - CIN III
* If your Pap test is normal, you will continue routine screening.
* If your Pap test is atypical ( ASCUS, not able to be categorized as normal or abnormal), you will repeat the test in 4 months.( if Pt is compliant otherwise do colpo )
* If the repeat test is abnormal, your doctor will do a colposcopy.
.
If there are abnormal cells on the cervix, the doctor will perform a biopsy.
* If your test is abnormal and suggestive of cancer, you will have a colposcopy, ECC and biopsy.
In a biopsy your doctor will take a small sample of the tissue of your cervix to see if cancer cells are present.
A biopsy is the only way to tell for certain if you have precancer, true cancer, or neither.
.
Sometimes, the biopsy itself is used to treat a precancer or a very early cancer.
If the biopsy is normal and you have a normal Pap test, the Pap test will be performed again in 4 months.
If the biopsy is normal but a Pap test is abnormal, your doctor will repeat the colposcopy and biopsy.
If the biopsy is abnormal and suggestive of cervical intraepithelial neoplasia (CIN) or cancer, you will be treated for cervical cancer.
///"Is there any benefit to giving varicella vaccine to a child who's been exposed to the disease and who hasn't been previously immunized?"
IVIG is not generally recommended for everybody whoever exposed to chickenpox(large quantity of imunoglobuline is needed to modify the disease)
IT is only recommended in :
1. pregnent women after exposure
2. newborne whose mother developed chickenpox 5 days before or 2-5 days after delivery.
3 Exposed leukemic pt. any imunodeficient state, svere debilitating illness(after exposure)
Varivax can be offered within 3 days of exposure who is more than 12 month old in epidemics.
Because of benign nature of disease in healthy children vaccine is not rutine after exposure.
Yes, you immunize exposed child if prev unimmunized. March 25 2003, 2:01 AM
Will post-exposure use of the vaccine prevent or modify varicella?
Yes, the vaccine may prevent or modify illness when administered within 3 to 5 days after exposure. The ACIP now recommends vaccination of susceptible persons who are eligible for vaccination as soon as possible after exposure--ideally within 3 days but possibly up to 5 days of an exposure--to prevent illness or modify disease severity. If a person has already been infected, and the vaccine is given soon enough, disease may be modified or prevented. If the person was infected >5 days prior to vaccination, there is unlikely to be any benefit from vaccination but vaccination is not known to be harmful. Finally, exposure even in a household setting does not result in transmission 100% of the time. So, if the exposed person has not been infected, vaccination will confer protection against subsequent exposures.
///Bronchoscopy and bronchoalveolar lavage for direct identification of organism is specific diagonostic test.
But if this pt.is HIV +iv, chest X-ray show bilateral infiltret and has +iv S/S , low CD4 count
then Rx of PCP can be started before confirmation of DX,
Admit Pt >>I/V abx.
Steriod is indicated in severe case when PO2is <70
or A-a gradiant >35.
///Use of ACE inhibitors as tolerated, with close monitoring for renal deterioration and for hyperkalemia (avoid in advanced renal failure, bilateral renal artery stenosis [RAS], RAS in a solitary kidney)
///TMP-SMX is considered to be the initial drug of choice for mild, moderate, or severe PCP infection. Alternative therapies for mild-to-moderate PCP include oral therapy with dapsone/trimethoprim, clindamycin/primaquine, and atovaquone. Alternative therapies for patients with moderate-to-severe PCP include intravenous (IV) trimetrexate, IV pentamidine, and IV clindamycin with oral primaquine. In addition, corticosteroids are indicated for patients infected with HIV who have severe PCP and hypoxemia.
///if someone is on carbamezapine with measure CBC periodically. serum conc. to be done for monitoring.
In the event of toxicity..do EKG
beccause in acute toxicity it can cause bradycardia and cardiovascular collapse,Also has cns symtom (Ataxia, nystagmus, stupor convulsion and coma)in acute toxicity.
* can cause aplastic anemia and agrnulocytosis, should f/u CBC
* cause liver damage and seriuos hepatotoxicty f/u liver funtion.
///Coronary artery disease and hypertension are the leading causes of heart failure
/// heart block is most likely associated with mitral valve infections
///Ticlopidine can be used in patients intolerant to Aspirin but they should be monitored for the development of neutropenia or agranulocytosis That's why clopidogrel is preferred over ticlopidine
///DOWN SYNDROME
Affected individuals rarely reproduce. Between 15-30% of females with trisomy 21 are fertile and they have 50% risk of having an affected child. There is no evidence of an affected male fathering a child.
So far there is no known case of a "MALE" down syndrome patient fathering a child
In female's About 70% are infertile, and the risk to child getting down is 50% if the mother has down syndrome,
Few facts about down syndrome,,,,
most common disease associated with down
mental retardation ,congenital heart disease,(endocardial cushion defect most common then VSD and asd, tof, pda)
leukemia, GI defect, hearing loss, cataract.
single best test to perform on a down patient,, is ECHOcardiogram,,, even the patient is asymptomatic,
most death's in down are related to heart diease
///In pregnancy and with OCP there will be increase thyriod binding globuline, that will bind with thyroxine and will decrease free thyroxine available for work, but total T4 will be normal so in hypothyroid pt ,u have to increase the thyroxine dose
///DMII in case with hepatic failure give Insulin -all other anidiabetics are cotraindicated
/// Child asthma/maintenance therapy if symp>2times a wk and nighttime symp>2/mth
You can start inhaled steroids or montelukast
///For insomnia in alzheimer's
For long term use - it is trazodone
short term use is ativan (lorazepam)
///CF /A.Recessive
.( in hetero + hetero) 25% affected (1 in 4), 50% carrier ( should be 1in 2 ) and 25% (1 in 4) normal
Thus two- thirds (3 in 4 ) of all clinically unaffected offspring are carriers.
A healthy older brother of cystic fibrosis ask what is the chance that he could be carrier- it's - 3 in 4
///Diuretics use should be carefully monitor to avoid
volume deplation. Loop diurectics e.g furosemide is the drug of choce. (Effective even when renal function is markedly reduced)
////Diuretics use should be carefully monitor to avoid
volume deplation. Loop diurectics e.g furosemide is the drug of choce. (Effective even when renal function is markedly reduced)
///As s3 indicate impaird ventricular compliance, so I peak s3. Though s3 is very signufican in CHF, s4 is happen to be significant in angina and MI.
this is from Merck manual.
The fourth heart sound (S4) is produced by the augmented diastolic ventricular filling near the end of diastole caused by atrial contraction
It is absent in atrial fibrillation but almost always present during active myocardial ischemia or early after MI.
The third heart sound (S3), or pericardial knock, occurs in early diastole, when the ventricle is dilated and noncompliant (hear Audio 197-8). It occurs during passive diastolic ventricular filling and indicates serious ventricular dysfunction, except in children, in whom it can be normal
http://www.merck.com/pubs/mmanual/se...er197/197c.htm
Fourth heart sound is common in Angina
http://www.merck.com/pubs/mmanual/se...er202/202c.htm
///Hypotension and tachycardia are often late findings of shock in young athletes.
///A diabetic with poor glucose control on maximum dose of glyburide?
add metformin
///.AAM teen ager boy with snycope come with mother and Ekg classic for wpw asked for imediate management(procainamide) and next q how do u treat permanently(radio ablation)
/// Campylobactor -common bloody diorrhea in neonate
///E coli and shigella-positive systemic symptoms.
/// Genetics of following disorder.( tansmission in off spring, if one sibling has this chances for the next one, if parent is diseased etc etc )
Turner syndrome
down syndrome
cystic fibrosis
sickle cell disease
questions like....ABOve mentioned patients wants to become pregnant.... what advice. chances of prganacy , complications of pregnancy.. et cetc
///
Down syndrom can be confirm by amnio- by Kariotype and culture of fetal cell.
///PCP -Vivid hallucination
Insects crawling on body common in cocaine.
///aspirin. displace thyroxine from biding site so in Hyperthyroid crisis or thyroid storm Like hyperthermia, atrial fibrillation, confusion the easpirin is ABSOLUTELY contraindicated.
/// Heparin induced thrombocytopenia.
Warfarin should be avoided in acute HIT unless it is used in combination with therapeutic-dose danaparoid, lepirudin, or argatroban. Warfarin has been associated with worsening venous thrombosis, venous limb gangrene, and/or skin necrosis when used alone or in combination with ancrod in acute HIT. However, warfarin is appropriate for longer term anticoagulation in patients with HIT and thrombosis. Warfarin should be delayed until therapeutic anticoagulation with danaparoid, lepirudin or argatroban is achieved, and ideally, until there is substantial resolution of the thrombocytopenia. Warfarin-induced thrombotic complications have been described in patients in whom the alternative anticoagulant was stopped prior to resolution of thrombocytopenia
///A 75-year-old man , metastatic prostate ,,no spinal cord compression or impending bone fractures, but he has diffuse skeletal metastases.
What course of therapy would you recommend?
(A) Single-agent diethylstilbestrol
(B) A single luteinizing hormone–releasing hormone (LHRH) analogue
(C) A single nonsteroidal antiandrogen such as flutamide
(D) An LHRH analogue plus flutamide (complete androgen blockade)
(E) An LHRH analogue plus chemotherapy (mitoxantrone
/// ENDOCARDITIS prophylaxis,,,,,, ONLY ASD with ostium secundum type defect and MITRAL VALUE PROLAPSE wihout murmur requires NO PROPHYLAXIS every thing else requires prophylaxis..i.e VALVULAR disease///congenetial diseases///prosthethic valve disease.
///In an adult pt with dehydration and volume contraction, some of the signs/symptoms are hypotension and tachycardia, and the management is to expand the intravascular volume, regardless of [Na+] level, with normal saline solution. We've all seen nursing home pt's with [Na+] > 150, hypotensive, tachycardic, dry mucosa, skin tenting, etc., and the first thing we do is infuse normal saline for volume expansion, and correct hypernatremia after the pt is hemodynamically stable.
///1/4 NS or 1/2 NS March 21 2003, 9:43 PM
depends on the weight of the infant. It could be 1/2 NS or 1/4 NS
Saline guide (Rough):
Weight <28 kg: D5 1/4NS (38 meq/L)
Weight >28 kg: D5 1/2NS (77 meq/L)
Summary: 35 kg Child with isotonic dehydration
First 8 hours: D5 1/2NS with 20 KCl at 250 cc/hour
Next 16 hours: D5 1/2NS with 20 KCl at 163 cc/hour
///NG losses usually replaced with D5 1/2NS with 20 mEq/L of KCl.
Diarrhea usually replaced with D5 1/4NS with 40 mEq/L of KCl.
General principles in treating dehydration.
///COMPLICATION OF TURP
IMMEDIATE COMPLICATION.
* Most immediate and serious complication is hyponatremia >>nausia, vomiting, confusion , hypertension,bradycardia, visual disturbance, skin changes, coma.(TUR syndrom)
*Hemorrhage
*perforation of prostate capsule with extravesion.
LATE COMPLICATION
*Tertrograde Ejaculation and Impotence
* Urethral stricture and bladder neck contacture
*Urinery incontinence >> Urge. stress,Total
///Using reference ranges of 0-2.5 for men aged 40-49 years, 0-3.5 for men aged 50-59 years, 0-4.5 for men aged 60-69 years, and 0-6.5 for men aged 70-79 years, they reported an overall specificity of 95%.
/// postpartum female, develops oliguria, dark urine,and petechiae on lower limb.Labs: normal INR, decreased platelet count, decreased Hemoglobin, normal U/A.The most likely dg is HUS
///The risk of a diagnosis of breast cancer is slightly increased during OC use but diminishes after discontinuance and is not increased among former OC users who have discontinued OCs for >= 10 yr.
Several epidemiologic studies show that the incidence of cervical neoplasia, particularly adenocarcinoma of the cervix, is increased in OC users, particularly those who have used OCs for > 5 yr. A causal relationship has not been established, but OC users should have a Papanicolaou test at least annually.
A number of studies have shown that OC use decreases the risk of lethal endometrial and ovarian cancers by about 50%; this reduced risk persists for at least 10 to 15 yr after discontinuance. Other documented benefits of OC use include decreased incidence of abnormal uterine bleeding (including menorrhagia), dysmenorrhea, premenstrual tension, iron-deficiency anemia, benign breast disease, and functional ovarian cysts; the reduced incidence of ectopic pregnancy and of salpingitis associated with OC use should decrease infertility
If breakthrough bleeding persists, the woman should be given a combination with a higher dose of estrogen (ie, a more estrogenic formulation).
**If amenorrhea develops, the progestin component should be decreased.
Gulf war syndrome
Veterans of Persian Gulf War (8/90-6/91)
25,000 troops with unexplained symptoms post exposure
Etiology
Thought to be related to Neurotoxin exposure
Ammunition detonated in March 1991
Ammunition dump contained Sarin
Likely 100,000 troops exposed
Symptoms
Fatigue
Headache
Joint pain
Stiffness
Muscle pain
Hair loss
General weakness
Nasal and sinus congestion
Diarrhea
Excessive Flatulence
Abdominal pain
Memory problems
Impaired concentration
Word finding
Insomnia
No decrease in fertility in Gulf war veterans and no increase in teratogenicity.
///DKA
blood electrolyte value,ABG and serum osmolality
Use of sodium bicarbonate has some unwanted effect on DKA, if PH is 7.0 or less or HCO3 is below 9meq then NaHCO3 should be given once ph reach 7.1 d/c bicarb.
if potssium < 5 then give potassium( pt.should have good urine out put)
if phosphate is < 3 -add phosphate replacement
if
Is glucose < 250- add dextrose
///AZT-side effects
Lactic acidosis one of seriuos complication.
myositis is most common
///best predictor of good htn control is preserved target organ dammage.
///difinitive symptom of left heart failure is dyspnea and Sign is s3,
///Bactrim and Cipro both increase Warfarin's concen ,interferes witht he mechanism of warfarin redultant increae bleding tendencies
Tetracycline is not interact with warfarin, but not good choice for UTI.
///emergent oral contraceptives.- high dose estrogen, high dose progestin
High dose ehtinyl estradiol for 5days (estro)
or
high dose Levonorgestrel bid (progestro)single dose
or
Ovral 2 tab Bid (high estro + high progestro)
All have start within 72 hrs
or
mifepristone within 120hrs
or
IUD within 5days.
Emergency contraception (also known as the morning-after pill) is a high dosage of the birth control pill. It is recommended to be used after sexual intercourse, over a period of 72 hours, to achieve the goal of preventing or ending pregnancy. There are three different ways birth control pills are currently being promoted for this use: progesterone alone, estrogen alone, or both of these artificial steroids together. These are the same steroids found in the typical birth control pill.
ccs case.
my ccs were
UTI
ADENOCARCINOMA IN WOMEN IN FIFTIES
DOUDENAL ATRESIA
LEAD POISINING IN 18 MO OLD
PERICARDITIS
PERICARDIAL EFFUSION
DUB
UNCONSCIOUS MAN IN 40 WITH R/R 8
there was also a question set on Gulf war syndrome 4 qustions, mostly how would u responde to his qustions
/// sign of rotator cuff injury
pain with abduction at shoulder joint
///acalculous cholycystitis laperoscopic cholecystectomy
///ac choly in first trimester-conservative, u operate in sec trimester
Surgery in 2nd trimester,
Only concern about acalculous cholecystitis is prognosis is gaurded without surgery.
/// pedigree thalassemia
Rx of Elderly insomnia
Type of DM with grand pa thyroid and father parathyriod ca
chronic metal exposer with crystal in perepheral smear
///Pt with dig subendocardial MI next step asa and heparin
///Leukocoria (white pupillary reflex or cat's eye reflex) is the most common presenting sign in retinoblastoma.
////Best treat for WPWS is procanamide
Adenosine used to temporarily treat CMTs
But Procainamide blocks the accessory Pathway.
stable--procainamide, unstable--cardioversion
////ASA" IS BEST for post MI, for Mortality Reduction
////primary and secondary syphilis both r transmissible
///quinolone Decreases excretion oh thyephyline
quinolone +coumadin=Incr risk of bleeding,causesincr
///Tension headache typically occur daily, begin later in the day.
Cluster headaches are different from tension headaches.
Waking up at night charac of cluster headaches.
///morning after pills.maost common side effects nausea and vomitting
///Scombroid: allergic-like symptoms due to histamine ,begin within 15-90 min.Nausea, omitting,diarrhea, flushing, itching
chinese restaurant syndrome? It is due to oversensivity of people to monosodium glutamate.
Ciguterafish)
1-6 hrs after ingestion, victims develop GI sx accompanied by a variety of neurologic sx.
Scombroidfish)
Allergic-like SXs usually begin within 15-90 mins also with GI Sx.
Bacilus cereus:
The incubation period is 1-6 hrs.
BZ_BEE PEARLS:
!)most cc of hypothyroidism is hashimotos..
2) most cc of dizziness in elderly is their medciation
3)most cc of impotency is antihypertensive medciation and ssris..
4)tumor marker for melignant melanoma is s-100
5)if family history of ovarian ca is positive then yrly pelvic exam and ultrasound is screening test...
6)no bone scan for melignany melonoma bcz these r lytic bone lesion not osteoblastic...
7)dontjust give ca for steoporosis or jut s vitD both along with alendronate
8)if pt on alendronate or any of these easophagitis is the most common risk so ask pt that take medcine with galss of water and sit up for 30 minutes after take medciation
9)griseofulvin is beetr absorb if taken with fatty foood..not for kids just liek cipro u cant give pt less tahn 10(cipro)
10)if pt is having meliganncy or some bed ridden condition he or she needs anti coag for life
11) d/c ocp i month b4 surgery and restart i month after
12 )d/c coumadin at least 48 h b4 surgery
13) d/c asp 10 days b4
14)d/c heparin 4 h b4 going to or...half life for heparin is 90 minutes
15) if heparin reversal is reqguired then reverse 100 unit ofheparin with 1 mg of protamine sulfate and thats how u calculate the dose...
16)b4 giving all protein inhibiters plez check all th ept medciation bcz of lots of inter action
17) if ptis on pis..then no rifampine but rifabutin
18)if ca is high recheck ist
19)if recheck ca is still high then check pth
20) if pth is low and ca is high then think of sarcoidosis
21)if pt is hypovolemic and has ccf always put central line so u can measure cvp....but remmber ccfis not a contraindication forivfluids if can always give lasix
22)if ca is low always check albuminist
23) never ever pick hypertonic soulutionin exam unless pt is not seizing or na is less than 115...always restrict fluids..
24)in siadh urin eosmolaity will b higher than th e serum..
25)in melig ca is high bcz it s produced by pth like protein which is also produced by granuloma in sarcoidosiss...and for melignancy hypercalcemia steroid will b best forothers ist try ns and lasix then iv palmidronate...
28)mallet fx close reduction is goood
29)collls fx close reduction withlong arm cast
30) supracondylar fx in a kid is a surgical emergency ...orif is th e ans and asap...but of nerve palsy risk...
31)smith fx...fx of distal radius withventral displacement due to fall when forearm is supinated and hand is extended...
32)scaphoid fx..risk of avascular necrosis,dont do xray its is neagtive until 2 wks...
33)fall on feet calcanious fx...orif is req
34)dont give flumazenil if mix drug over dose bcz it dec threshold for seizure and dont ever give in tricyclic od...
35)plez read dif bet tricuspid atresia and transposition of great v..both cause cyanosis on ist day...but dif is on t e xtay in vascularity of pul v ..i dont recall rt now bcz its middleof th enite i dont wana put anything which i am not sure about...but its vvvimp...
36)if 6 wks of abx is not able to bring fever down in acut e bec endocarditis....call cardiology asap...
37)any kid wit fever ifless tahn 3 month admit her or him to r/o sepsis
38)suction rectal biopsy is best to diag hursprung
diease butist will b kub
39) plez remmber ist test for stess incontinence or heamturia or enuresis will b ua
40)cobble stone aaprence is in crohnand appple core lesion is in colorectal ca
41)central incisor dental carries r due to nocturnal bottle feeding...
42)last but not th eleast just remmber where u c xray ,ultrasound,excercise behaviour therapy,diet ,reassurance,smoking cessation,alcohal abstinence ,nsaid thatis most likely the ans..
if u dont get any ans then go for th elongest choice do thatin ur practice test and u will c
always go forur ist intusion..dont change ur ans its 80-90% correct
relax b4 exam....24 b4 just listen to music..watch movie...dont go out to eat u might get sick eat light dinner sleep early and uwill b fresh when u wil wake up and do som e revisionin th emorning from ur notes only.....so u can have som e memory of what ever is imp.....
dont read any new materail in last 2 wks
practice practice practice ob usmle cd....its worth....it......bye guys and gooodluck....jerry ,gulabooo,hbnorhbs sorry i cant recall ur name atthis time ofnight but best of luck to naz natisha and alll others ...and welcome to new commers just stick to this great site..and pray for waheed and his family...i do...;-)whothought of such great site....for alll of ius..thanks doc.waheed!!!
fasinopril is best medicine for hypertention due to conn syndrome...
for perioperative control of htn bb is always prefered
ace inhibiter is goood only if uni lat renal artery stenosis in bilateral its contraindicated
in exam dont order tft just order tsh ist its cost efective and best way to know about hypo or hyperthyrodism..
after treatmentof hyperthyroidism f/u with free thyroxine level not tsh...
dont give rai to a preg lady...no pregancy 6 m b4 or after use of rai...cause hypothyrodism....and teratogenic for baby..
if u want prescrive isotrention bcz its best drug for nodular cystic acne do preg test ist...
no pnumovac b4 2 yrs of age its not effective and no imunoglobulin with in 11 month with mmr other vaccination pd is 3-6 m but for mmr its 11 months...
if some body have reaction after gettingimunoglobulin then they r IGA DEFIENCT...
NSALINE IS BEST FOR MVA...WHY BCZ NO LR IN TRUMAA BCZ OF RHABDO ORPOSSIBLE HISTORY OF RENAL PROB SO NS...ONLY
NS IS ALSO GOOOD FOR RENAL FAILURE PT AND NEURO SURGERY PT BCZ LESS K..AND WILL NOT CAUSE HARMFUL EFEFCT...
NO SUCCINYCHOLINE FOR A BURN PT BCZ OF INC CHANCE OF HYPERKALEMIA BCZ THEY HAVE EXTRA POTASSIUM RECEPTERS..
MORPHINE I/V B4 DRESSING CHANGE IN THE BURN PT
NO INHALATIONAL AGENT AND SUCCINYLCHOLINE IF HISTORY OF MELIGNANAT HYPERTHERMIAA....GIVE DENTROLINE..MUSCLE WEAKNESS IS CHEIF SIDE EFFECT OF DENTROLIN ITS IS ALSO BEST FOR NEUROMELIGNANT SYNDROME WHICH IS DUE TO INC CA RELEASED FROM SARCOPLASMIC RETICULAUM AND CAUSE FEVER AND RIGIDITY
IF PT HAS PARKISNISM DONT GIVE REGLON FOR VOMITTING BCZ IT IS HIBITER OF DOPAMINE HE NEEDS DOPAMINE ..
IF CYSTIC BREAT SNODULE DO FNA WITHOUT MAMO IF PT IS LESS THAN 35
IF NONPALPABLE MASS BUT SUSPICIOUS CALFICATIONON MAMO THEN DO NEEDLE DIRECTED BIOPSY..
the dif bet primary and secondry addison diease is primiry start with p and p is for pigmentation so in c pigmentation due to inc acth in primary addison diease and secondry no pigmentaion due to dec acth..
in diabtes kidney will b double in size remmber d for diabetes and d for double.....but in htn its shrinked...see the dif..
TBG WILLL INC IF TOTAL T4 WILL INC BUT FREE T4 WILL B NORMAL...
IF THYROID MASS AND TSH IS NORMAL DO FNA
IF INC TSH DO THYROID SCAN
IF PT HAS AAA AND ANY CARDIAC DIEASE TERAT CARDIAC IST LIKE DO CABG BCZ MOST CC OF DEATH FROM ALL MAJOT VASCULAR DIEASE LEIKE CAROTID ENDARTERCTOMYOR AAA REPAIR IS AMI..SO FIX HEART IST IF NOT URGET...
IF BPIS MORE THAN 180/85 AND PT SAID IT WAS HIGH IN MALLL TOOO TREAT IT BCZ THATS WH THEY GIVE U THIS SENARIO...OTHERWISE RECHECK I MORE TIME....AND THEN EXCERCISE AND DIET IST AND IF FAIL THEN START WITH DIURETIC AND BB..
TOOO SLEEPY MORE LATER ..GOOOD LUCK DOCS.....UR DAY IS COMING ...ALLUR HARD WORK WILL PAID OFFF SO KEEP ON DOING TH EGREAT WORK...GN
epidural hematoma is lenticular in shape on ct head while subdural hematoma is cresent shape..
do physical ist and report child abuse later bcz u have to have som e solid evidence ist...on physical exam to report otherwise its worthless even though if u r just suspicious and u report falsely u will not b panished...
plez plez plez move pt before last 5 minute on ccs cases bcz u will not b bale to go back and do any thing even u cant see the lab result...just u can write new order do councliing and delete som eorders...so plez dont forget otherwise no marks on that most impstep of ccs..
pertussis and bronchiolitis both can b diag by nashophrangeal wash ingor culture
catthral phase of the pertusis is mos contageous and
abx erythromycine act best if given early not efeective if given late in sec phase
pertussis is the only diease which if mom had will not provide immunity through antibody frommom u have to protect the baby tooo
the most comom cause ofinfection with pertusis in incomplete vaccinationagaisnt pertusis...7-10% cases still occurs even after child is immunized
erythromycine to close contact is imp to save them from this contagious diease..
pertusis is reportable disease
isolate the child dont send to day care or schoool until cough is not gone...
sever cases need steroid and mild need humidified oxygenand erythro...
if gcs is less than 7 must intubate
if in nutropenic fever pipercillin is not helping and fever is more athn 7 days addd ampho b bcz fungal infection is also cause this
after every transplant cmv infection r most common
to differentiate bet the inc bun/creatinin weather its due to transplant rejection orcyclosporin..do ultrasound...and see if the transplant site is tender and pt has fever if both r present then its rejectionand if both r negative its due to cyclosporin,never d/c cyclosporin just dec the dose..and recheck bun/creatinine
the idea behind giving lactulose in heaptic encephalopathy is toconvert nh3 to nh4 ion so ph of th e stool should b inc and we give neomycin to stablize the bowel...so both go hand in hand
if sclerotherapy or banding didnt help to stop bleed and pt dont want surgery or not stable for surgery then do TIPS...
eevn though they say do medical management always calll consult when u think its neccessary.....but plez dont calll surgery for chest tube..if u r er doc...imeanif pt comes in e r...but definatel;y call if pt r/i for mi or bect endocarditis or aortic stenosis or a fib ,som etimes we forget in exam we think its normal....but it gives u negative marking...andits not goood for ur over all score...
some body ask if they ask u u wana stop clock or not...stoping clock will help u gret adeal if u forgot som eimp thing to order suppose ifptis unconscious and u didnt order head ct yest just stop clock and order it and then farward clock by clicking on clock.cz just farwarding clock will not do any goood only thing will happpen that soft wear willl sense it wrong and 5minute sign will come if u dont belive me do it on practice cd and c yrself...bcz its writtenin direction..that when u did every thing and u hav e any else left then just move clock farward so soft wear will end ur case...when i failed i was just farwarding clock in exam and i was wondering why case is ending in just 15 minutes instead of 25......that was the cause and all those pppl who finish at 230 or 3 on sec day that is the most common cause..so stop the clock when u need it to b stopped...usually u should stop it when nurse message u like pt is asking for edciation or pt is till pale or still dizzy it means u r just farwarding the clock u should calm down and give her some basic treatment like medciations morphine or demerol or tylenol...so alll these nursing messages there for a reason...some one just ask that how we will know that we did goood in ccs or bad...my friened u will com eto know rt away..bcz if u r doing rt thing for the pt....things will change messages will b telling u pt is not drwosyanymore,pt is hungry wants foood...or kids with meningitis will accept bottleand playing with mom...so that mean u did goood...
like in my persoanl case ...in nortryptaline od..i did every thing ato z corerct and pt was stable abg wise and vital sign and ekg wise but was still unconstious.and i was looking at vitals and was thinking i did goood...but b4 i callled psych consult message appeared taht pych will coming shortly as sooon as pt will bgetting constiousness..and i said dammm i didnt do ct head bcz he was found in garage..so i order ct and as soon as i orderd ct it showed hematomaa ..i callled nuro consult and soon after they say pt isgotten better after heamtomaa evacuation....so plez pay attention to every single message...that isto put u in rt path...butthat will only b happeneing if u did otehr stufff rt...
ike my case with 9 mont old kid brought bymom that he is throwingup and irritable and not taking feederfever was 102.5 i send everything ua,blood culture.started abtibiotic,did lp send to lab csf was turbid..i was happy that i was on the rt path...ceftrioxne and vanco...iv was working...kid temp cam edown and he was taking bottle againand i was happy ...and suuudenlywhen i move him to icu message came mom is still saying my kid is still pale....i recheck bili it was normal i thought 9 month old will iron deficient so i should give iron syp...but stupid 5minutes showed up and i only checked the g6passey in rbc...couldnt c the result bcz in those 65 minutes u cant go back..to labs results but i guess my approac was corrects so i passed...i will post more pearls later...this is just bcz jerry has exam in 2 wks.....and my dear fd gulaboooo in 3 days..so i guess this will help them..and others...c we can learn alot from pthers mistakes....;-)best of luck every body!!!
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