• must defer surgery for 6 mos
• pt should have a stress test at that time

MTB p. 379

• EKG
• stress testing
• echo for structural disease and to assess ejection fraction.

MTB p. 380

• sepsis
• blood and urine cultures.
• LP is newborn displays neurological signs such as irritability, lethargy. temp irregularity, and feeding problems.

MTB p. 407

• Erb (C5-6): waiter's tip appearance 2° to shoulder dystocia (anterior shoulder gets stuch behind pubic bone); infant unable to abduct or externally rotate & supinate arm.
• Klumpke (C7-8, T1): claw hand with Horner's syndrome (ptosis, miosis, anhydrosis).

MTB p. 408

• hypsarrythmia (dancing eyes)
• opsoclonus (dancing feet)
• ↑ vanillyl mandelic acid (VMA) and metanephrines

MTB p. 410

• there are only 3
• mitral regurgitation
• tricuspid regurgitation
• VSD (common in Down-21, Edward-18, Patau-13)

MTB p. 413

• serum electrolytes
• ↑ 17-OH progesterone

MTB p. 431

• truncus arteriosus (there is only 1 semilunar valve)
• VSD → Eisenmenger syndrome

MTB p. 415

• Long QT syndrome
• there are 13 differenty types, but no the above presentation.

MTB p. 418

• String sign: thin column of barium leaking through tightened muscle.
• Shoulder sign: filling defect in antrum due to prolapse of muscle inward.
• Mushroom sign: hypertrophic pylorus against duodenum.
• Railroad track sign: excess mucosa in pyloric lumen → 2 columns of barium.
• pyloric stenosis presents not at birth, but by the first month of life.
• auscultation will reveal a succussion splash: sound of stomach contents slapping into pylorus.

MTB p. 421

• Coloboma
• Heart defects
• Atresia of Choanae
• Retardation of growth or development
• Genital or urinary defects (hypogonadism)
• Ear anomalies/deafness

1. Vertebral anomalies
2. anal atresia
3. cardiovascular anomalies
4. tracheoesophageal fistula
5. esophageal atresia
6. renal anomalies
7. limb anomalies

MTB p. 422

• hypochloremic, hypokalemic, metabolic alkalosis

MTB p. 421

• Rotavirus vaccine
• Henoch-Schölein purpura
• most commonly, however, with polyp, hard stool, or lymphoma.
• 10% will recur within 24hrs, child must be carefully observed.

MTB p. 425

• innate kidney defect where it is unable to retain phosphate.
• vitamin D → reabsorption of both Ca²⁺ and PO₄^-
• normal calcium
• normal levels of 25(OH)-vitamin D and 1,25(OH)₂- vitamin D.
• lack of PO₄^-→ inadequate bone mineralization

MTB p. 431

• sepsis
• sepsis workup: CBC w/ diff, urine culture, UA, CXR, and LP.
• irritability or lethargy, also think meningitis
• tx: ampicillin and gentamicin

MTB p. 433

• Haemophilus influenza type B
• rifampin for close contacts
• child: after intubation in OR → ceftrixone 7-10 days

MTB p. 436

• G = # of pregnancies
• P = F-PAL
• full term, preterm, abortions, living

• Goodell sign: softening of cervix felt first at 4 weeks.

MTB p. 443

• if not ruptured → 1st dose of methotrexate
• if > 15% ↓ β-hCG → observe
• if < 15% ↓ β-hCG → 2nd dose of methotrexate
• persistent ↑ levels of β-hCG → surgery
• Exclusion criteria for MTX: immunodeficiency, noncompliant pts (cannot be lost to f/u), liver disease (MTX = hepatotoxic), ectopic > 3.5 cm/fetal heart beat (↑ risk of tx failure).

MTB p. 449

• Complete: no products of abortion found; f/u in office.
• Incomplete: some products of conception found; D&C/medical.
• Inevitable: products of conception intact, intrauterine bleeding, dilation of cervix; D&C/medical.
• Threatened: products of conception intact, intrauterine bleeding, no dilation of cervic; bed rest/pelvic rest.
• Missed: death of fetus, but all products of conception present in uterus; D&C/medical.
• Septic: infection of the uterus and surrounding areas; D&C + IV abx.
• Note: you can only answer these questions wih an U/S.
• medical tx = misoprostol (prostaglandin E₁ analog) → dilates cervix, expels fetus.

MTB p. 451

• it is a combination of contractions with cervical dilation.
• contractions → abdominal pain, lower back pain, or pelvic pain.
• occurs btw 20 and 37 weeks.
• cervical incompetence → no hx of contractions, but painless dilation of cervix.

MTB p. 452

• maternal severe HTN
• maternal cardiac disease
• cervical dilation > 4 cm
• maternal hemorrhage (abruptio placenta, DIC)
• fetal death
• chorioamnionitis
• 34-37 weeks

MTB p. 453

• Term fetus w/ no chorioamnionitis → wait 6-12 hours for spontaneous delivery → then induce labor.
• preterm w/ no chorioamnionitis → betametasone, tocolytics, ampicillin +  1 dose azithromycin; penicillin rash → cefazolin + azithro; penicillin anaphylaxis → clindamycin + azithro.
• chorioamnionitis → immediate delivery.

MTB p. 455

• painless vaginal bleeding
• never perform a digintal vaginal exam for bleeding during the 3rd trimester; it can ↑ separation btw placenta and uterus → severe hemorrhage.
• placental abruption → painful vaginal bleeding.

MTB p. 455

• cervix dilated > 4 cm

MTB p. 457

• amniocentesis
• abortion
• vaginal bleeding
• placental abruption
• delivery
• Prophylaxis w/ RhoGAM at 28 weeks and delivery. 

MTB p. 462

• HTN that starts after 20 weeks
• no proteinuria or edema
• tx only during pregnancy w/ methyldopa, labetalol, or nifedipine.

MTB . p. 463

• glucose load test (50g) → glucose > 140 after 1 hour → glucose tolerance test (100g)
• screening occurs at 24-28 weeks

• ovarian carcinoma
• endometrial carcinoma
• ectopic pregnancy

MTB p. 484

• IV acetazolamide (↓ production of aqeous humor)
• IV mannitol
• pilocarpine (cholinergic agent) → constrict pupil

MTB p. 498

• prostaglandin analogues: latanoprost, travoprost, bimatoprost (↑ aqueous outflow).
• topical β-blockers: ↓ aqueous humor production by ciliary body.
• topical carbonic anhydrase inhibitor: ↓ aqueous humor production (HCO₃^- formation → Na⁺ production → osmotic draw).
• α₂ agonist: apraclonidine (↓ aqueous humor production & (↑ aqueous outflow).

MTB p. 498

• oral acyclovir, famiciclovir, or valacyclovir
• no steroids
• uveitis → topical steroids

MTB p. 499

• there are 2 types: atrophic (dry) and neovascular (wet).
• neovascular is more rapid and severe
• tx: VEGF inhibitors (ranibizumab, bevacizumab, aflibercept).
• no effective thx for atrophic

MTB p. 501

• Cognitive: agitation, confusion, hallucinations, hypomania.
• Autonomic effects: sweating, hyperthermia, tachycardia, nausea, diarrhea, shivering.
• Somatic effects: tremors, myoclonus.

MTB p. 513

• duration
• brief psychosis: > 1 day, < 1 mo
• schizophreniform: > 1 mo, < 6 mos
• schizophrenia: > 6 mos
• always rule out cocaine/amphetamine use with U-tox.

MTB p. 513

• 4 pain
• 2 GI
• 1 sexual
• 1 pseudoneurological

MTB p. 524

• attempt up until 2 hours
• pills can enter duodenum within 30-60 minutes
• rarely done
• dangerous in altered mental status (aspiration) and caustic ingestion.
• do not use ipecac in the ED/hospital!!! recommend usage at home.
• Never perform gastric empyting (lavage, whole bowel irrigation, ipecac) with caustics, AMS, and acetaminophen overdose.
• Charcoal is superior to all of the above.

MTB p. 533

• tinnitus & hyperventilation
• overall alkalosis
• respiratory alkalosis & metabolic acidosis
• ASA inhibits oxidative phosphorylation → anaerobic glucose metabolism → lactic acidosis
• ↑ anion gap
• tx: alkalinize urine → ↑ excretion
• abg: pH 7.46, pCO₂ 22, HCO₃^- 16

MTB p. 536

• 100% O₂
• if severe disease is present → hyperbaric O₂
• severe disease: CNS symptoms, cardiac symptoms, or metabolic acidosis.
• CO presents with dyspnea, lightheadedness, confusion, seizures, and ultimately death via MI; acts functionally like anemia.
• blood is bright red; normal pO₂ b/c O₂ does not detach from Hb.
• same SSx with methemoglobinemia, but blood is brown; however, normal pO₂ (cyanosis + normal pO₂ = methemoglobinemia). tx: methylene blue.

MTB p. 539

• naloxone and dextrose
• opiate ingestion and DM are extremely common
• opioid overdose is fatal; give naloxone immediately.
• do not give flumazenil; benzo overdose by itself is not fatal and withdrawal → seizures.

MTB p. 535

• toxicity: ingestion > 8-10g, fatal > 12-15g
• if toxic dose ingested → N-acetylcysteine
• overdose > 24 hrs → no thx
• amount of ingestion unclear → obtain drug levels
• obtain drug levels at 4 hours.
• charcoal can be administered immediately; however, N-acetylcysteine should be withheld until drug levels are obtained.
• Effective as long as N-acetylcysteine is administered within 8 hours of ingestion.
• charcoal can be administered with N-acetylcysteine

MTB p. 536, UW3136

• serum osmolality = 2xNa⁺ + BUN/2.8 + glucose/18

MTB p. 542

• formic acid/formaldehyde
• oxalic acid
• inhibit alcohol dehydrogenase w/ fomepizole

• diltiazem or digoxin
• SVT will get worse with these medications b/c they block the normal AV node and force conduction into the abnormal pathway.
• tx current WPW with procainamide or amiodarone

MTB p. 556

• none
• all staph species produce penicillinase
• use penicillinase resistant abx - oxacillin, cloxacillin, dicloxacillin, and nafcillin.

MTB p. 4

• cefoxitin and cefotetan: deplete prothrombin and ↑ risk of bleeding.
• ceftriaxone: inadequate biliary metabolism.

MTB p. 6

• vancomycin
• linezolid
• daptomycin
• tigecycline
• ceftaroline
• minor skin infxn of skin: TMP/SMX, Clindamycin, Doxycycline, Linezolid.

MTB p. 7

• exclusively for gram (-) bacilli including Pseudomas
• only drug in the class of monobactams
• aminoglycosides also excellent for gram (-); no anaerobes (requires O₂ to work).

MTB p. 6

• ceftriaxone + vancomycin + steroids
• add ampicillin if immunocompromised for Listeria
• steroids are only proven to ↓ mortality in S. pneumoniae.
• Listeria is resistant to all cephalosporins (tx if elderly, neonates, steroid use, AIDS/HIV, imunocompromised, etOH, pregnant).

MTB p. 11

• foscarnet
• acyclovir is IV
• famciclovir and valacyclovir are oral meds; ineffective for encephalitis.

MTB p. 13

• chronic hepatitis B: persistence of surface Ag > 6 mos.
• tx with one of the following: entecavir, adefovir, lamivudine, telbivudine, interferon, or tenofovir.
• Interferon AE: arthralgia/myalgia, leukopenia/thrombocytopenia, depression, flu-like sx.
• hepatitis C: interferon & ribavirin + telaprevir/boceprevir (for both acute and chronic).
• no acute tx for hepatitis B

MTB p. 21

• 1° and 2°: single IM injection of penicillin; allx → oral doxycycline; pregnant → desensitize to penicillin.
• 3°: IV penicillin; allx → desensitize to penicillin.

MTB p. 25

• ampicillin & gentamicin until culture results are known.
• ceftriaxone, ertapenem
• ciprofloxacin for outpt

MTB p. 28

• endocarditis
• empiric thx: vancomycin and gentamycin

MTB p. 30

• Waterhouse-Friedrichsen syndrome
• sudden vasomotor collapse and skin rash due to adrenal hemorrhage

UW 3442

• ventricular tachycardia
• 2° to ischemia
• tx ischemia → angioplasty

MTB p. 559

• goal #1: ↓ HR < 100 with β blocker, CCB (verapamil/diltiazem), digoxin.
• goal #2: anticoagulation w/ warfarin, dabigatran (direct thrombin inhibitor), or rivaroxaban (factor Xa inhibitor).

• #1: vagal maneuvers
• #2: adenosine
• #3: β blocker, CCB (verapamil/diltiazem), digoxin
• note: SVT alternating w/ VT = WPW; diltiazem/digoxin can precipitate WPW; tx WPW with procainamide or amiodarone.

• ventricular remodeling → dilatation of left ventrical w/ thinning of ventricular walls → CHF
• occurs in the weeks to months following an MI.
• ACE inhibitors have been shown to limit ventricular remodeling; should be initiated within 24 hrs of MI.

UW 2732

• small cell lung cancer
• pancreatic cancer
• neuroendocrine
• bronchial carcinoids

UW2173

• can occur with ectopic ACTH production
• ↑ aldosterone → ↑ principal cell basolateral Na/K ATPase w/ subsequent loss of K⁺ via apical channels; however, when K⁺ is ↓, protons are used by the ATPase instead → loss of H⁺ and alkalosis.

[image]

UW 2173

• ovarian teratoma which produces thyroid hormones → thyrotoxicosis
• extremely rare
• if you see pt w/ thyrotoxicosis w/ ↓ radioactive iodine uptake it is more likely that is a thyroiditis; also subacute granulomatous thyroiditis, levothyroxine overdose, iodine-induced thyrotoxicosis.

UW 2191

• hyperglycemia
• ↑ LDL
• ↑ plasma TG
• gout 2° uric acid retention
• hypercalcemia, hyponatremia, hypokalemia
• Furosemide: hypokalemia and hypomagnesemia → ventricular tachycardia; also can potentiate effects of digoxin → VT.

UW 4171, 2164

• trait: HbA 50-60%, HbS 35-45%, HbF < 2%
• disease: HbA 0%, HbS 85-95%, HbF 5-15%
• Ssx sickle cell trait: microscopic or gross hematuria (sickling in the renal medulla), isosthenuria (impairment in concentrating ability) which can present as nocturia & polyuria.

UW3787

• mothers presenting with prolonged or preterm premature rupture of the membranes (< 37 weeks)
• fever
• AND one of the following: tachycardia (> 100 bpm), fetal tachycardia (> 160 bpm), maternal leukocytosis (> 15,000), uterine tenderness, or foul-smelling amniotic fluid.
• abx: ampicillin & gentamicin

UW4134

• aka fatty liver with encephalopathy
• seen exclusively in children < 15, and is preceded by an URI w/ influenza or varicella.
• tx w/ salicylates ↑ the likelihood of developing Reye syndrome.
• SSx: N&V, excitability, delerium, combativeness, hypoglycemia, liver failure.
• ASA is contraindicated in children except in tx of Kawasaki disease.

UW2896

• indistinguishable on a peripheral blood film.
• leukocyte alkaline phosphatase score plays a role in distinguishing btw the two.
• ↑ LAP → leukemoid rxn
• ↓ LAP → CML with blast crisis

UW2886

• CNS lymphoma
• MRI → weakly ring-enhancing mass that is usually solitary and periventricular.

UW2276

• pentamidine
• remember: prednisolone is used with TMP/SMX when a pts PaO₂ < 70.

UW2273

• i.e. pseudotumor cerebri
• OCPs, corticosteroids, vitamin A
• acute/subacute/chronic HA associated with blurry vision or visual loss, papilledema, pulsatilse tinnitus, abducens nerve palsy, and N&V.

UW 3162

• WBC 10k-50k → crystal-induced arthritis
• 50k-150k → septic arthritis
• Staphylococcus aureus is the most common cause of prosthetic joint septic arthritis; via hematogenous spread.

UW4589

• MI, myocarditis, old pericarditis, myocardial contusion, and digoxin toxicity.

UW2439

• propranalol
• akathisia is a common side effect of antiΨ

UW4895

• a functional defect in bowel motility in the absence of a physical obstruction.
• Ssx: N&V, abdominal distension, failure to pass flatus or stool, hypoactive bowel sounds (mechanical obstruction actually → hyperactive "tinkling" bowel sounds).
• abdominal surgery is the most common cause.

UW4609

• β-blocker or cardiac acting CCB (verapamil/diltiazem)
• HOCM has an autosomal dominant inheritance pattern.

UW2686

• βhCG
• if pt is not pregnant amenorrhea 2° to OCP usage → ↑ estrogen dose often solves problem.

UW2389

• primary biliary cirrhosis
• antimitochindrial Ab
• ursodeoxycholic acid is the drug of choice for PBC
• methotrexate and colchicine have also been shown to be of moderate benefit.
• steroids are ineffective

UW2950

• grade 2/6 or less
• also diastolic murmurs are considered innocent

MKSAP p. 35

• heparin → release of platelet factor 4 → formation of heparin-PF4 complexes → IgG against complexes → activation of platelets, endothelial cell activation, and abnormal generation of intravascular thrombin → vascular thrombosis in 50% of pts affected by HIT.

UW4616

• hypercalcemia
• constipation
• abdominal pain
• weight loss
• polyuria/polydypsia

UW3083

• weakness
• fatigue
• weight loss
• anorexia
• depression
• ↑ pigmentation
• hypotension
• hyponatremia, hyperkalemia, anemia, and eosinophilia may be present.

UW2174

• MGUS: < 3 g/dl M protein on serum protein electrophoresis; < 10% plasma cells in BM.
• MM: ≥ 3 g/dl M protein; ≥ 10% plasma cells BM; anemia, hypercalcemia, lytic bone lesions, renal insufficiency.

UW2249

• age > 50
• pain and stiffness in neck, shoulders, and pelvic girdle
• ↑ ESR
• morning stiffness lasting over 1 hour
• no pain with active ROM
• no signs of joint inflammation
• tx: low dose prednisone

UW3317

• hypothyroidism
• test with TSH
• hyperthyroidism also → myopathy
• acute thyrotoxic myopathy (more severe distal or proximal muscle weakness)
• chronic thyrotoxic myopathy (proximal muscle weakness weeks to months after onset of hyperthyroidism).

UW3878, 4382

• aka Prinzmetal angina
• greatest risk factor is smoking
• typically occurs in young females (40s)
• episodes typically occur at night
• transient ST segment elevation
• CCB (diltiazem) or nitrates

UW2723

1. radiolucent stone disease (uric acid)
2. calcium stones < 1-3 mm
3. non-stone causes (obstruction by clot or tumor)

• uric acid stones seen w/ low urine pH
• tx: hydration, alkalinization of urine, ↓ purine diet, possible allopurinol use.
• alkalinize urine w/ potassium bicarbonate or potassium citrate.

• postural ↓ in BP by 20 systolic or 10 diastolic

UW4728

1. vomiting (volume depletion)
2. diuretics (volume depletion)
3. excess mineralocorticoids (volume depletion)

• metabolic alkalosis respiratory compensation formula
• PaCO₂ = (0.9 x HCO₃^-) + 16 ± 2

UW2806

• Premature adrenarche (isolated appearance of axillary hair before the age of 6) is from secretion of androgen from the adrenal glands; no clinical significance.
• Premature thelarche (breast development) from secretion of estrogen and progesterone from ovaries.
• Premature pubarche (pubic hair before the age of 8) is alarming and associated with CNS disorder in 50% of cases.

UW3867

• useful for differentiating heart disease from liver disease as a cause of lower extremity edema.
• (+) in individuals with heart disease
• (-) liver disease related edema

UW4133

• neutropenia = absolute neutrophil count < 1500/μl
• it is a medical emergency
• empiric thx with broad-spectrum abx that covers Pseudomonas.
• monothx: ceftazidine, cefepime, imipenem, or meropenem.

UW2992

• it is a degenerative process of the vertebrae
• #1 osteophyte formation on the joint factes, #2 hypertrophy of the ligamentum flavum.
• pain radiates to the thigh and buttocks; walking and lumbar extension aggravates the pain; sitting and flexion relieves pain
• this is in contrast to disc herniation → pain worsened with flexion and sitting.

UW4369

1. viral infxn (EBV, Hep C, HIV)
2. Chemothx
3. myelodysplasia
4. etOH
5. congenital (fanconi syndrome)
6. vitamin B₁₂ or folate deficiency

• ---

  SLE
• medications (heparin)
• ITP, DIC, TTP/HUS
• antiphospholipid syndrome
• OTHER: transfusion (dilutional) and splenic sequestration.

UW4860

• Most common congenital cause of aplastic anemia.
• autosomal recessive or X-linked disorder involving DNA repair genes → chromosomal breaks.
• SSx:
• Bone Marrow: aplastic anemia and progressive bone marrow failure.
• Appearance: short stature, microcephaly, abnormal thumbs, and hypogonadism.
• Skin: Hypopigmented/hyperpigmented areas, cafe au lait spots, large freckles.
• Eyes/Ears: strabismus, low-set ears, middle ear abnormalities (e.g. hemorrhage, incomplete development, chronic infections, deafness); can present with pounding in ears from possible conduction defects or chronic hemorrhage.
• tx: hematopoietic stem cell replacement.

UW4438

• between 24 and 34 weeks
• Lecithin/Sphingomyelin ratio < 2

UW3274

• aortic stenosis or end-stage renal disease
• it is a common cause of recurrent, painless GI bleeding in patients age > 60 years.

UW4085 

• ethylene glycol is converted to oxalic acid (binds Ca²⁺ and deposits in kidneys) and glycolic acid (nephrotoxic, renal tubule injury).
• look for ethanol-like intoxication, flank pain, hematuria, anion gap metabolic acidosis.
• tx: fomepizole or etOH

UW4511

• regular eye exam

UW3173

• Renal parenchymal disease (↑ creatinine, abnormal UA w/ proteinuria or RBC casts); this is in contrast to renovascular disease.
• Cushing disease
• hypothyroidism
• primary hyperparathyroidism

UW4722

• worsening HTN
• HA
• flu-like symptoms
• red cell aplasia

UW3978

• renal vein thrombosis
• nephrotic syndrome → loss of antithrombin III
• SSx: suden onset abdominal pain, fever, and hematuria.
• most common cause of RVT is membranous glomerulonephritis.

UW2243

• diabetes insipidus vs. psychogenic polydipsia
• both present with polyuria & polydispsia → ↓ urine osmolarity.
• then, if pt fails to concentrate urine, → AVP/desmopressin test for central vs. nephrogenic DI.

UW3729

• benzodiazepine
• also: ASA, nitroglycerin, and CCBs
• No β-blockers; contraindicated!!! Can cause unopposed α adrenergic stimulation and worsen coronary vasoconstriction.

UW4042

• stomatitis
• nausea, abdominal pain
• anemia (folate deficiency → macrocytic anemia)
• hepatotoxicity
• interstitial lung disease
• myelosuppression
• fever

UW4573

• #1 - Na⁺ and H₂O restriction
• #2 - Spironolactone
• #3 - Loop Diuretic (≤ 1 L/day)
• #4 abdominal paracentesis (2-4 L/day)
• over diuresis/fluid removal → hepatorenal syndrome; monitor renal fxn closely!

UW2218

• pyridoxine deficiency
• causes microcytic anemia → sideroblastic anemia 2° to ↓ protoporphyrin synthesis (glycine & B₆ required by ALA synthase).

UW4037

• babesiosis (No rash)
• tx: quinine-clindamycin or atovaquone-azithromycin
• Babesia enters RBCs → lysis
• Ehrlichiosis (No rash): fever, malaise, HA, N&V, leukopenia and thrombocytopenia.

UW3104

• cephalohematmoa: subperiosteal hematoma; does not cross suture lines and presents several hrs after delivery. Can cause neonatal jaundice; resorbs after 2 wks - 3 mos.
• caput succedaneum (edema): diffuse soft tissue swelling; sometimes ecchymotic.

UW2472

• fall in systolic pressure of > 10 mmHg during inspiration.
• cardiac tamponade, asthma, COPD, and tension pneumothorax.

UW4771

• intestinal disorders that predispose the pt to fat malabsorption.
• normally, in the GI, Ca²⁺ binds oxalate and prevents it's absoprtion.
• however, with ↑ fat, Ca²⁺ is bound to it, leaving oxalate free for absorption.

UW3435

• single temp > 38.3° C or sustained temp > 38° C for > 1 hour in a neutropenic pt.
• in a neutropenic pt fever may be the only sign of infectino.
• mild (< 1500 cells/μl), moderate (<1000), severe (<500).
• must hospitalize and administer abx if moderate or severe.

UW2616

• primary hyperPTH: 24 hr urine calcium > 200 mg or urine calcium/creatinine clearance ratio > 0.02.
• familial hypocalciuric hypercalcemia: < 100 mg or urine calcium/creatinine clearance ratio <0.01
• both have ↑ PTH

UW2176, 2165

• TRH stimulate prolactin production
• serotonin also stimulates prolactin production
• prolactin production is inhibited by dopamine

UW4221

• mild (forgetfulness, unstable gate) - fluid restriction or oral salt tablets.
• moderate (confusion, lethargy) - hypertonic saline to ↑ sodium > 120 mEq/L.
• severe (seizures, inability to communicate, or coma) - hypertonic saline until symptom resolution.

UW2181

• progesterone analogs (megestrol acetate and medroxyprogesterone acetate).

UW2646

• aka Langerhans cell granulomatosis, histiocytosis X
• proliferative disorder of dendritic cells from the monocyte lineage.
• cells are functionally immature and do not stimulate T lymphocytes via antigen presentation.
• Birbeck granules (tennis rackets) are characteristic.
• can cause solitary lytic bone lesions in children and young adults; benign, can spontaneously resolve, tx conservatively.

UW4642

• Histoplasmosis: cough, fever, malaise. CXR → hilar adenopathy; chronic histoplasmosis and disseminated histoplasmosis is more common in HIV pts.
• Blastomycosis: infection in immunocompromised host is uncommon.
• Coccidiomycosis: Southwesern US, Cental & South America. Fever, fatigue, dry cough, weight loss, pleuritic chest pain. Cutaneous findings such as erythema multiforme/nodosum, as well as arthralgias.
• Aspergillosis: CXR → cavitary lesion; CT → pulmonary nodule with halo sign or lesion with air crescent. Occurs in immunocompromised pts (fever, cough =, dyspnea).

UW2997

• ethosuximide
• valproic acid
• lamotrigine

UW2279

• often associated w/ Hep C, and can be triggered by etOH or estrogen.
• painless blister, facial hypertrichosis, and hyperpigmentation.
• uroporphyrinogen decarboxylase deficiency
• also Acute intermittent porphyria (porphobilinogen deaminase def; upstream from above). Painful abdomen, redwine colored urine (clear at first), polyneuropathy, psychological disturbances, precipitated by drugs.

UW4314

• newly dx diabetes, arthropathy (eg, knee/shoulder pain), and hepatomegaly
• HHC pts are vulnerable to Listeria monocytogenes, Yersinia enterocolitica, Vibrio vulnificus.

UW2880, 3160

• cyanosis within the first 24 hours
• single loud S2; because of the transposition the aorta is now located in front of the pulmonary artery → loud singular S2 (drowns out soft pulmonary valve S2).

UW4260

• aspirin-exacerbated respiratory disease (AERD)
• commonly associated with nasal polyps
• AERD associated with the following symptoms: asthma, chronic rhinosinusitis w/ nasal polyps, and bronchospasm or nasal congestion following the ingestion of ASA or NSAIDs.

UW2842

• polycystic kidney disease
• hematuria may also be present
• Adrenal masses (1° hyperaldosteronism, pheochromocytoma, Cushing) are almost never palpable.

UW4680

• Corrected Ca²⁺ = measured total Ca²⁺ + 0.8 (4.0 g/dL - measured sreum albumin)
• basically for every 1 g/dL ↓ in albumin below 4 g/dL, there is decrease in total serum Ca²⁺ by 0.8.
• Start correcting when albumin dips below 4.

UW3100

• mild to moderate - preferred: atypical antiψ
• aripiprizole, olanzapine, quetiapine, risperidone, ziprasidone; or as an alternative: lithium or valproic acid.
• severe episodes - mood stabilizer + antiΨ
• mood stabilizer: lithium, valproate, or lamotrigine.

UW2495

• HA, nausea, dyspnea, malaise, AMS, dizziness
• severe: seizure, coma, syncope, heart failure, or arrhytmias.
• pulse oximeter is unreliable in this situation; cannot differentiate carboxyHb from oxyHb.

UW3223

• VTE
• cardiovascular events/stroke
• ↑ TG
• cholestasis or cholecystitis
• DM
• HTN

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  Benefit/protective against
• ovarian cysts/cancer
• endometrial cancer
• benign breast disease
• dysmenorrhea

UW2392

• focal parenchymal scarring
• blunting of calices
• hydronephrosis → dilation of the collecting system (different from above).

UW3694

• develops as a result of excessive fluid production by inflamed synovium.
• as fluid volume expands, excess fluid accumulates in the popliteal bursa → fills popliteal fossa.
• caused by inflammatory conditions: RA, osteoarthritis, and cartilage tears.

UW4583

1. No ovarian mass: abdominal CT to rule out adrenal mass.
2. Bilateral cyst: Theca Lutein cyst (rule out ↑ βhCG states).
3. Bilateral solid: mostly pregnancy luteoma (benign condition, no tx necessary).
4. Unilateral solid: laparotomy or laparoscopic bx to rule out malignancy.

UW2415

• low dose ASA
• low molecular weight heparin

UW2256

• malnourished pts predisposed to hypomagnesemia (eg, alcoholics)
• TCA
• moxifloxacin and fluconazole
• familal long QT syndrome
• tx: initiate magnesium sulfate

UW2659

• associated with burst fxr of vertebra
• total loss of motor fxn below level of lesion
• loss of pain and temperature on both sides below lesion
• intact proprioception
• central cord syndrome: burning pain and paralysis in upper extremities w/ relative sparing of lower extremities. Common in elderly w/ forced hyperextension type injury to neck.
• syringomyelia:damage to crossing fibers of pain & temp, upper extremity motor fibers (medial location of w/in corticospinal tract); preserved vibration and proprioception.

UW3300, 4698

• mitral valve prolapse
• by far the most common cause of MR in developed countries.
• rheumatic fever can cause MR, but mitral stenosis is more common.

UW2695

• emesis → volume contraction → ↑ aldosterone → K⁺ and H⁺ loss.
• metabolic acidosis can be divided into chloride-sensitive and chloride resistant.
• chloride-sensitive: urine Cl^- < 20 mEq/day (aldo → Na⁺ retention and Cl^-; think NaCl).

UW2819

• low leukocyte alkaline phosphatase + leukocytosis
• note: elevated leuk Alk Phos is characteristic of Leukemoid Rxn.

UW2885

• gonnococcal infection only
• only prenatal maternal testing and tx are effective against neonatal chlamydial infections; screen all pregnant women for chlamydia at first prenatal visit; repeat screening during 3rd trimester age < 25.
• chlamydial conjunctivitis presents at age 5-10 days
• chlamydial pneumonia presents at age 4-12 weeks
• both are tx with oral erythromycin for 14 days, despite risk of hypertrophic pyloric stenosis.

UW3660

• RDW
• RDW > 20% → Fe deficiency anemia
• reticulocyte count is ↓ as well; it is an indicator of ↓ bone marrow erythropoiesis
• RDW normal in thalassemia

UW4876

• pseudo-allergic rxn
• bronchoconstriction and polyp formation
• aspirin sensitivity syndrome; it is not a true allergy, and due to a shift/imbalance of prostaglandins/leukotrienes.
• COX1/2 inhibition → arachidonate shuttling into 5-lipoxygenase pathway → ↑ leukotrienes.
• tx: leukotriene inhibitors (montelukast or zafirlukast)

UW4065

• skin: maculopapular rash involving palms, soles, and face.
• intestine: blood (+) diarrhea
• liver: abnormal liver fxn and jaundice

UW4151

• PBC: eyelids
• hypertriglyceridemia: yellow-red papules on arms and shoulders (eruptive xanthomas); consider checking lipid panel if pt has above SSx with acute pancreatitis (TG > 1000).

UW2965

• CMV

UW3613

• often resolves spontaneously
• drainage if persists > 6 weeks, > 5 cm, or becomes infected.
• major complication: erodes into blood vessel → severe hemorrhage into pseudocyst.
• not a true cyst (no epithelial lining, just a thick fibrous capsule); inflammatory fluid contains amylase, lipase, and enterokinase.
• commonly associated with chronic pancreatitis, but can occur with acute pancreatitis, pancreatic trauma, and pancreatic neoplasm.

UW2897

• angioplasty with stent placement
• can be unilateral
• FYI: b/l renal artery stenosis → ACEi is contraindicated.

UW3894

• fever ≥ 5 days + 4 of the following:

1. Δs in peripheral extremities (initial reddening or edema of palms & soles → desquamation of finger/toe tips).
2. polymorphous, non-vesicular rash
3. oropharyngeal Δs (erythema, fissuring, crusting of lips; strawberry tongue; diffuse mucosal injection of oropharynx).
4. bilateral conjunctival injection (painless, nonexudative)
5. acute nonpurulent cervical lymphadenopathy w/ lymph node diameter > 1.5 cm, usually unilateral.

emedicine

• requires radiographic evidence of colonic distension + 3 of the following
• fever > 38° C
• HR > 120
• nø leukocytosis
• anemia AND 1 of the following
• volume depletion, AMS, electrolyet disturbance, or hypotension.

UW2205

• surgical resection of mass + whole brain irradiation
• multiple brain mets → palliative whole brain irradiation.

UW4072

• PPI, clarithromycin, amoxicillin
• tx for H. pylori
• if abx thx fails → chemothx

UW2596

• aka vasomotor rhinitis
• predominant nasal congestion/stuffiness, postnasal drip, and no specific identifiable triggers.
• tx: intranasal antihistamine spray or intranasal glucocorticoids.
• allergic rhinitis: more prominent eye symptoms (watery, itchy), sneezing, and triggers.

UW4201

• palpable purpura
• glomeulonephritis
• arthralgias
• hepatosplenomegaly
• peripheral neuropathy
• hypocomplementemia (in Henoch-Schonlein purpura complement is normal)
• most patients have Hepatitis C.

UW2232 

• young pt with HTN, muscle weakness, and numbness.
• hypokalemia → weakness & numbness

UW3929

• ↑ BUN → platelet dysfunction
• prolonged bleeding time; normal PT & PTT
• tx: DDAVP
• transfused platelets quickly become inactive

UW3951

• hyperkalemia refractory to tx
• volume overload or pulmonary edema not responding to diuretics
• refactory metabolic acidosis
• uremic pericarditis
• uremic encephalopathy or neuropathy
• coagulopathy due to renal failure

UW2224