| Original Message |
rose (no login)
Posted Oct 28, 2007 9:45 PM
primary amenorrhea.
1st step BHCG
2nd: Get TSH and Prolactin levels
3rd: Physical exam with U/S to see if there are breasts and uterus
(+) breasts, (+) Uterus - R/o Imperforate hymen or continue to 2 amenorrhea
(+) breasts, (-) Uterus - R/o Rokitansky Hauser Syndrome
(-) breasts, (+) Uterus - R/o Turners (get karyotype to see if its 45XO)
(-) breasts, (-) uterus - well..you gotta man!!
CI to Tocolytic Agents
1.Choreoamnionitis
2.Preeclampsia
3.Placental Abruption
4.Severe Placenta Previa Bleeding
5.Fetal Demise & Fetal Anomalies Incompatible w/ Life
. Algorithm of infertility from doyoudig
1. Hx & P/E
2. Semen Analysis for – Sperm Concentration. Motility & Morphology to I Azoospermia & Severe Oligospermia
* If High WBC was found on Sperm Count – Can do a Sperm Culture or Ab’s Therapy
* Testis on US – Indicated if an Anomaly was seen on Testicular Exam
3. Hormonal Studies (Endocrine) – To R/o
1. TSH Levels - To R/o Hypothyroidism
2. Testosterone Levels - To Indicate Presence of Absence of Hypogonadism
3. LH/FSH - To see if Hypogonadism is Central or Testicular
4. Prolactin Levels
Diferential diagnosis in back pain and problems
ANKY.SPON.- REGULAR EXERCISE
FIBROMYALGIA- AMITRYPTILINE
POLYMYAL.RHEU. Low dose predisone, if assoc with GIANT CELL ART. HIGH DOSE PREDNISO.
REITER- NSAIDS + TETRACYCLINE IF ( CHLAMYDIA)
POLYMYOSITIS- STEROIDS
OSTEOMYELITIS
cHILDREN and infants......staphilo aureus
Prostetic device Staphilo epidermidis
Sickle...salmonella
UTI or instrumentation...gram neg like klebsillea or pseudo
LESS THAN 1 YEAR....strepto B
MOST OF THE PEOPLE... S. aureus
OVARIAN CANCER
The risk factors that increase ovarian cancer are
Presence of BRCA1 gen
positive family history
high number of lifetime ovulations
infertily
Onthe other hand...facts that protect are
less number of lifetime ovulations...like use of OCP
chronic anovulation
breat feedin
short reproductive life (early menopause)
BLOODY DIAREEA:
The bloody ones are
Salmonella
Shiguella
Yersinia
E. coli
Campilobacter
Contraindication of lactancy
Maternal HIV
Active or untreated tuberculosis
Syphilis
Galactosemia
Varicella in mother
Active HSV + lesions on breast
Prostate problems
prostatodynea...terazozin
chronic bacter. prostatitis.....TMP SMX
Non bacterian prostatitis....erytromicin ( possible micoplasma o ureaplasm)
Acute Prostatitis in young....there is STD hystory.......
endometriosis
young woman that do not desire have family righ now but in future.....ocp
if ocp are not tolerated or if it fails .....danazol or gnrh
if pt wants to conceive soon......laser
if older than 40 and do not want more kids.....hysterectomy
Some dermatology perls
1rash that is desquamative on hands and feet with hypotension...TOXIC SHOCK SYNDROME (KAPLAN NOTES)
2malar rash and joint pain an plaquetopenia (SLE - UWORLD)
3rash spreads centripetall and invove palms and soles with fever( ROCKY MOUNTAIN-KAPLAN)
4malar rash and murmur ( MITRAL STENOSIS - U WORLD)
5petequial or purpuric rash with polyarticular compromise usually knee involved and fever ( COULD BE SEVERAL THING...KNEE INVOLVMENT THINK IN GONORREA ARTHRITIS)
6rash ( kind of flushing face) + telangectais+ papules and pustules ( ROSACEA)
7sudden onset of eritematose rash with target lession usually follows an infection of herpes(ERITEMA MULTIFORME MINOR..U.W.)
same as before and mucocutaneous lessions and general 8symptoms as sezures, hypotension (STEVEN JHONSON OR ERYTEMAMULTIFORME MAJOR)
9 rash in a teen with acne ( TETRACYCLINES AND SUN EXPOSURE. U.W.)
10 rash pruritic in legs after camping in streak pattern. ( POISON IVY. HYPERSENSIBILITY TYPE 4)
11sand paper rash (SCARLET)
12 maculopapular rash with lymp nodes in back of the neck(RUBELLA, CERVICALPOSTERIOR LIMPH NODES INVOLVEMENT)
:hyponatremia?
#932252
roh - 09/17/07 23:56
Na 120-130 (asymptomatic Pt.)--TX 1st Water Restriction 2nd Demcylocline or lithium
Na 110-120 (asymptomatic Pt.)-TX NS (0.9%) & Loop diurectic
Severe Hyponatrimia < 110 or Symptomatic pt.--TX Hypertonic Saline (3%) +/- Loop diuretic
*hope this helps
Cause of amenohrrea in athletic person
low adipose tissue
–estrogen biosynthesis shifts to 2-hydroxylation with increased synthesis of catechol
estrogens
–catechol estrogens compete with catecholamines for COMT
–results in inreased dopamine
–dopamine decreases GnRH release
–results in secondary amenorrhea
cluster headache---prophylaxis?
The recommended prophylactic medications include verapamil, lithium and ergotamine. The treatment for an acute attack is inhalation of 100% oxygen and subcutaneous sumatriptan
EYE DISESES
1.painful red eye: when shining light stimulates the unaffected eye the pain is worse....
This is a uveitis, because the consensual light relfex in with the affected pupil will constrict even when light is shined in the normal eye. In uveitis the iris and ciliar body are compromised, and imflamed so....pupillary movement produce pain.
2.HIV pt with acute retinal necrosis...the herplex simple keratitis can evolve to acute retinal necrosis syndrome in some HIV pt.
3. sudden loss of vision, redness and no pain, retinal hemorrages..This is a venous obstuction of retina. Retinalhemorrhages are the main way of distinguishing venous obstruction from artrial obstruction
4. red, hard eye, painful with fixed midpoint pupil..closed angel galucoma
5. slowly loss of vision in elderly with visible drusen on dilated eye exam...age realted macular degeneration
6. gradually loss of vision in pt wich cafe au latte spots and fleckles in underarm region...glioma optic
Malazezia furfur.ptinea versicolor
hypopigmentation due to activity of ac. azelaic
hyperpigmentation lipoperoxidasas activity
right?
via the posterior descending coronary arte
cjay - 08/26/07 21:13
CO PCWP SVR BP HR *** DIAGNOSIS
Dn Up Up Dn Up *** Cardiogenic Shock
Dn Dn Up Dn Up *** HypoVolemic Shock
Dn Dn Up Dn Up *** Septic Shock
All CO Dn; All BP & HR Dn
Yeah, my Mnemonic works - ANS - 2
see below
:::Alphabetically --
*** PCWP SVR
Cardio *** Up Up
HypoVolemic *** Dn Up
Septic *** Dn Dn
so ur workout is UP and UP, DOWN AND UP, DOWN AND DOWN 
SVR = Systemic Vascular Resistance
PCWP - SVR
Up - Up Cardiogenic
Dn -- Up Hypovolemic
Dn --Dn Septic/Anaphylactic
Just double checked it with my source , IM Kaplan, 2007 First Aid pg 460
This is what Dr. Fischer believes is absolute high yield for seizures. Try to think of the answer before looking at it, its th only way you remember it:
1 - Dx and Tx of Absent seizures -
2 - Pregnant c seizures tx -
3 - Adverse effect of phenytoin -
4 - Adverse effect of Lamotrigine -
5 - Driver c h/o seizures, next step -
6 - Diagnostic test to stop seizure meds -
7 - Must be seizure free for how long before stopping meds - 8 - Do NOT treat first time seizures unless:
9 - Another disease you where use Carbamazepine -
10 - Status Epilepticus Diagnostic tests (IN ORDER) -
11 - Status Epilepticus Tx (In order) -
Answers:
1 - kid staring in space, blinking eyes/lip smacking, 3 waves, tx c ethosuximide
2 - Carbamazepine (or MgSO4)
3 - gingival hyperplasia, teratogenicity
4 - Steven-Johnson syndrome
5 - advise to stop (thats all you do, do not report him)
6 - Sleep-deprived EEG
7 - >2 years
8 - 1 - family h/o seizures, 2 - status epilepticus, 3 - EEG abnormality
9 - Trigeminal Neurolgia
10 - 1st - Serum Sodium, 2nd Serum Glucose, 3rd low calcium, 4th low O2, 5th Toxicology (TCA, Cocain, Benzo, barbs), 6th CT head, 7th EEG (LAST RESORT)
11 - 1st benzo, 2nd Phenytoin, 3rd barbiturate, 4th General anasthesia (does not stop seizure, just stops the shaking)
y.
Subarachnoid hemorhhage - best next step in diagnosis is CT scan, if negative do LP, best next step in treatment is control BP
2 - Benign paroxysmal vertigo - best next step in diagnosis is Dix-Hallpike maneuver, best next step in treatment is NOTHING, it subsides on its own
3 - Myasthenia gravis - best initial test assay for Anti-ACh receptor Abs, most accurate test is Repitition nerve stimulation, best treatment: <60yo gets thymectomy, >60yo gets steroids then azathioprine
4 - Myasthenia crisis - pt in respiratory distress. best treatment is IVIG + Plasmapharesis
5 - Eaton-Lambort Syndrome - associated with what small-cell cancer. Unlike M.Gravis, this gets better with repitition (not worse). best diagnostic test is assay for anti-presynaptic Calcium channel Abs best treatment Guanidine hydrochloride
6 - Alzheimer's Disease treatment: 1st line is anticholinesterase inhibitors (donepezil, rivastigmine, galantamine), but if moderate to severe Kaplan says to look for memantine c anticholinergics.
7 - Parkinson's treatment: For mild s/s: <60 gets anticholinergics (bromocriptine), >60yo gets amantidine. For severe s/s: Levo/carbidopa is first, then add ropinerol, selegiline, primapaxel or talcapone if not enough.
8 - Normal Pressure Hydrocephalus (wet, wacky, wobbly), best next diagnostic test is CT scan (shows ventricular dilatation), best treatment shunt
9 - Multiple Sclerosis - best diagnostic test is MRI, best treatment for attack is steroids, best disease modifying treatment ABC (Avonex (inf-a), Betaseron (inf-B), Capoxone) or Glatiramor
10 - Guillian Barre Syndrome - associated with campylobacter. most important next diagnostic test is pulmonary function test (they die from pulm dysfunction). most accurate test is EMG. best tx is Plasmaphareisis and IVIG.
11 - ALS - best treatment is Rilazone
12 - Neurofibramotosis - Cafe-au-lait spots, optic gliomas, B/L acoustic neuromas (NF2) , best next step in diagnosis is MRI of brain/brain stem/spine
13 - Broca's aphasia - affects posterior inferior frontal gyrus
14 - Wernicke's aphasia - affects left posterior superior temporal lobe
15 - Hemineglect - affects non-dominant parietal lobe
16 - Pt with Locked-In Syndrome - insult to basilar artery
17 - Criteria for Carotid Endarterectomy is >70% stenosis, Amourosis Fugax/TIA and small, non-debilatating stroke. Criteria for just aspirin without CEA is stenosis <70%, stroke in evolution or large, debilatating stroke.
ANTIBODIES
anti ds Dna.....SLE...good indicator of disease activity and lupus nephritis
Anti SM......lupus too
Anti histone...... agree with jot...drug induced
Anti Ro........neonatal lupues
Anti centromere....agree with jot.....CREST
anti RNP ..mixed CT
C-ANCA.......Wegener
p_anca polyarteritis nodosa
anti ss .. sjogrens syndrome
p_anca polyarteritis nodosa
anti ss .. sjogrens syndrome
parvovirus infection....anti b19 IgM is diagnostic
Anti- Jo 1 in Inflammatory Myopathies
anti hetrophilic antibodies - inf. monomuncleosis
anti phospholipid antibody synd
antitiroid peroxidasa antibodyuies…hashimoto
hypertension
This is not a strict rule or algorithm. It is just the approach that UW id soing in the cases in Cardio
HTA + claudication....block Ca chanel......periferic dilat.
HTA + angina..........metoprolol......antiangina effect
HTA + osteoporosis.......tiazidics......increase Ca
HTA + Infract..........metoprolol...reduce probability of new one
HTA + infract + EF decrease.......ECA
HTA + Diabetes........ECA
HTA + ASThma......tiazidics
HTN +PROSTRATE .......ALPHA BLOCKER
HTN+PHEOCHROMOCYTOMA=ALPHA BLOCKER
HTN +COCAIN INDUCE=PURE ALPHA BLOCKER/CCB
ACEI will be used in HTN with ARF.....as usually renovascular HTN will be due to GN resulting in nephritic syndrome-ARF and ACEI will also dec the proteinuria
diuretics will be CI as need to preserve fluid...CCBs BBs wont help the ARF
ASTHMA MANAGEMENT
4 types for Chronic Maintenance Therapy
1) Mild Intermittent – Symptoms < = twice a week/nocturnal symp occur < = twice a month
Rx: Inhaled short acting beta 2 agonist/flares with inh steroids if needed ...Note:daily medicatn not needed
2) Mild persistent - Symptoms > twice a week/noc sym occur >twice a month
Rx: Low dose Inh steroids/flares with short acting b2agonist...............long term control only req daily trt
While In Children Mast Cell Stabilizers
3) Moderate Persistent - daily symptoms +exacerbatn >=twice a week
Rx: Low dose Inhaled corticosteroids + long acting beta agonist or medium dose inhaled steroids
4) Severe persistent - High dose Inhaled steroids + long acting beta agonist/also leukotriene antagonist and systemic steroids if needed
* When a Pt who was on High Dose Inhaled Steroids is now Stable – Continue Long Acting B Agonist & Taper High Inhaled Dose to Mod. Inhaled Steroids
Add:
NPH, Pseudomotor Cerebri, Benign Intracranial HTN
they are the same.....when there is an empty sella it is known as pseudotumor....
Rx of NPH
acetazolamide given 1st to prevent blindness, loops also used
steroids also used if refractory..multiples lp also done ....
surgeries......optic n fenestration and ventriculoperitoneal shunts
This is a really stupid question. It's a tricky one b/c of the word "RISK"....
Risk factors for CAD:
1. Age: men>=45, Women>=55;
2. Family history of premature CAD (<55 y/o in male 1st degree relatives; <65 in female 1st degree relatives)
3. current cigarette smoking (or quicked smoking <15 years)
4. hypertension ( on antihypertension treatment)
5. HDL<40
CAD-equivalent diseases:
1. DM
2. peripheral arteria disease
3. abdominal aortic aneurysm
4. symptomatic carotid artery disease.
Therefore, DM is an equivalent of CHD but not a RISK factor....
hypertension
ht and osteoporosis...tiazidicos
ht and anterior infract...metoprolol ( prevent new inarction)....also ACE if EF is low
ht and diabetes....ACE
ht and young pt or no complication....hidroclorotiazidics
ht and asthma....diuretic.( HCZ)
ht and angina.....metoprolol ( antiangine)
ht and tremor....propanolol
anticoagulation
Contraindications
#953179
doyoudig - 09/28/07 10:40
Contraindications to Heparin include
- Haemophilia,
- Active Haemorrhage,
- Thrombocytopenia,
- Known Hypersensitivity,
- Severe Liver Disease,
- Severe Uncontrolled Hypertension,
- Recent Major Trauma or Surgery.
CI to Warfarin:
- Pregnancy,
- Active Haemorrhage,
- Recent CNS surgery,
- Severe Uncontrolled Hypertension
- Acoholism/Severe Liver Disease
CI to Thrombolytics
- Dissecting Aortic Aneurysm
- Uncontrolled HTN > 180/110 (Control BP 1st then give Thromb)
- Active PUD or Active Bleeding
- Recent Head Trauma (w/in 2 wks), Previous Hx. of CVA anytime
- Recent Invasive Procedure or Surgery (2 wks)
- Traumatic CardioPulmonary Resuscitation (CPR)
- Proliferate Diabetic Nephropathy
- Intracranial Malignancy (1º Tumor or Metastasis), Seizures
- Recent IV or Arterial Punctures at Non-Compressible Sites
Breast mass
ok lets go by order accodrng to UW
1. Female in Reproductive Age < 40 y/o w/ a Palpable Breast Mass & NO Lymphadenopathy
Sum: Since it is very difficult to Differentiate btw Benign vs. Malignancy by Hx and P/E alone Further Workup is frequently necessary
↓
1st Ask her to Return Shortly after her LMP (ca. 7 dys after LMP)
if no obvious signs of Malignancy are Present.
↓
1. If Mass at the 2nd Visit decreases in Size Probability of a Benign Disease is Very High
2. If Mass is the Same Size
↓
Do a US – Differentiates btw Solid vs a Cystic Mass
FNA and / or Excisional Biopsy
if cystic.. aspirate... clear fluid ..then follow up after 6 week...repeat us..the size decreased..if not excision biopsy
if bloody discharge..then cytology...and excision biopsy...
correct me if i am wrong
Asthma
1. Avoid Triggers
2. Acute Sx’s or Prohylactic use Before Exercise -> Short Acting B Agonist
3. Mild Intermittent - Sx’s ≤ 2x wk or Noct ≤ 2x mo
-> Short Acting B. A. as Needed – PRN (Not Daily)
-> Treat Falres w/ Inhaled or Systemic Steriods if needed
4. Mild Persistent – Sx > 2x wkly or Noct > 2x mo
-> Lomg Term Control w/ Daily AntiInflammat’s
-- Low dose Inhaled Steroids (Alternative is Cromylin Nebulizer)
-- Short Acting B 2 Agonist may be added if Pt is Symmptomatic
5. Mod- Persistent – Daily Sx + Exacerbation ≥ 2x wk
-> Low dose Inhaled ICS & Long Acting B. A or
-> Medium Dose ICS
(Altern: Low Dose ICS w/ Leukotriene Recep. Inhbitor)
6. Severe Persistent – Continual Sx’s w/ Frequent Exacerbations. Daily Meds
-> High Dose ICS and LABA
-> Consider Leukotriene Antagaonist
-> If Needed may add Systemic Steroids
-> Make Reapeated Efforts to Reduce Systemic Steroids & Maintain Control
w/ High Dose Inhaled Steroids
* Use Oral Steroids when Sx;s can be controlled w/ Inhaled Steroids
So Quick Relief Meds: Acute Rescue
-> Short Acting B Agonist (minutes), Anticholinergics, Systemic CS (hrs)
Long Term Control Meds: Maintenance
-> ICS
-> Long Acting B Agonist
-> Leukotriene Recept Antagonist Modifiers
-> Mast Cell Stabilizers
-> Methylxhanthines
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