Uword

Question Main
Id
Division
Sub Division
Notes
2141
Medicine
Cardiovascular System
In Sinus bradychardia use atropine, if hypotensive go EPI. IF still bad go for

Transcutaneous Pacing
2145
Medicine
Pulmonary & Critical Care
PE cause Hypotension, JVD and WAIT FOR IT RBBB
2156
Medicine
In RV MI (II, III and AVf) avoid nitrate BB ,, give IV fluid to prevent hyotension
2166
Medicine
Gastrointestinal & Nutrition
Retained gastric content over 3 hours will produce a splash upon stethoscope
auscultation when move patient aka "succussion splash".. Happening in Gastric Outlet
Obstruction
2169
Medicine
Renal, Urinary Systems &

Electrolytes
Hyperclcemia is FIRST TREATED with IV SALINE .. CAN ALSO GIVE CALCITONIN,,

FOR LONG TERM BISPHOSPHONATES
2171
Medicine
Endocrine, Diabetes &

Metabolism
DKA: Stupourous patient, rapid breathing, hx of weight loss, polydispia, polyuria
2174
Medicine

Metabolism
Cosyntropin stimulation test is like ACTH stimulation test to check etiology of adrenal
insuffisciency
2174
Medicine

Metabolism
In Adrenal Insuffiscienct: First line DO COSYNTROPIN STIMULATION TEST (NOT 24h

Urine collection cortisol)
2179
Medicine

Metabolism
Radioactive iodine is definitive treatment for Graves and not Surgery (unless pregnant or
have severe ophtalmopathy which are contraindications)
2180
Medicine

Electrolytes
Chronic NSAID use can cause SIADH
2184
Medicine

Metabolism
In DKA: Give normal saline to restore IntraVascular volume Correct hyperglycemia with
regular insulin, and correct electrolyte imbalance (Potassium) Treat precipitatingg cause
(infection..) After recovery add 5% dextrose to fluids given to avoid hypoglycemia
2186
Medicine

Electrolytes
In non ketotic hyperglycemia coma first GIVE NORMAL SALINE
2189
Medicine

Metabolism
In DKA follow up based on pH and anaion gap to assess improvement
2190
Medicine

Metabolism
Diabetic nephropathy: 1st control BP (more importnt than sugar level especially if
controlled HbA1C)
2195
Medicine
Ear, Nose & Throat (ENT)
Deviation of uvula unilateral lymphadenopaty: peritonsillar abscess (not epiglotittis)...

drain it now
2199
Medicine
If have achalasia symptoms: Even after Barium done ==> Do endoscopy to rule out
MALIGNANCY (In elderly ..)
2210
Medicine
A single negative occult blood test does not exclude colon CA
2212
Medicine
In esophageal motility disorders DO: BARIUM, THEN MANOMETRY.. (THINK ABOUT

BIRD's PEAK APPEARRANCE THAT WE LIKE TO SEE FIRST) IF MECHANICAL START
endoscopy UNLESS HAVE A HX OF Sx, Caustic injury or PRIOR RADIATION BE SAFE
AND DO BARIUM FIRST
2218
Medicine
In ascites of cirrhosis ==> restrict water and Na+==> give sipronolactone ==> furosemide
==> if still not enough: do parascentesis (2-4 L/day as long as renal are OK! )
2229
Medicine

Electrolytes
If get a lot of blood in urinalysis (RBC) but on microscopical analysis no RBC are seen
suspect the false positive of myoglobin which might indicate rhabdomyolisis which can
occur following massive seizure maybe due to alcoholic withdrawal LOL
2230
Medicine

Electrolytes
HSP or IgA nephropathy occurs post-URI (few days later not weeks (post-strep) ) ==>
diagnosis is IgA nephropathy if no rash and systemic symptoms etc.. (instead of HSP,
which is more common in kids)
2238
Medicine
Male Reproductive System
Non inflamatoory chronic prostatis exists !!!!!!
2239
Medicine
Infectious Diseases
EPIDIDMYTIS IN YOUNG = STD = chalmydia, Gonorhea IN elderly: Gram (-) rods
2242
Medicine

Electrolytes
Sulfonamide and allergic interstitial nephritis BIG SHIT
2248
Medicine
Hematology & Oncology
AIHA can cause splenomegaly
2249
Medicine
MGUS is multiple myeloma withotu RENAL, ANEMIA, HYPERCALCEMIA (and lytic bone
lesions logically).. but it has the risk to become MM: so do xray
2264
Medicine
Infectious Diseases
Toxoplasma : AIDS patient with multiple ring enhanced lesion on CT. Give sulfadiazine
and pyrimethamine (which are both diagnostic and therapeutic (SD) )
2265
Medicine
Infectious Diseases
When diagnose syphilis with dark field microscopy (VDRL and FT-ABS are serologies
used for advance stages not chancres) suspect HIV and screen with ELISA since the
patient is exposed to all the dirt that could potentially get you HIV
2268
Medicine
Infectious Diseases
MAC prophylaxis with AZYSTHROMYCIN Starts with CD4<50 .. It does nonspecific

symptoms with lung involvment and no findings on CXR also have SPLENOMEGLAY
and elevated ALP
2270
Medicine
Infectious Diseases
CMV: is Mono without lymphadenopathy and sore throat, of course - monospot or

heterophile antibody. Present with atypical looking Lymphocytes
2276
Medicine
Nervous System
IF AIDS and have EBV in CSF with PERIVENTRICULAR RING ENHANCED LESION =
OF COURSE LYYMPHOMA .. Even if TOXO serology (+) coz MANY MANY PPLE ARE
(+) for this (but only immunocompromised get it ) in addition to that patient is TAKING
TMP-SMX
2277
Medicine
Infectious Diseases
Progressive multifocal leukoencephalopathy (JC vrius) is suspected in AIDS with focal

neurological signs and multiple enhancing lesions with no mass on CT
2289
Medicine
Nervous System
Tick borne ascending paralysis (in colorado hiking trip) causes no autonomic
dysffunction like in Guillain Barre symdrome and presents with no fever or other
complaints
2298
Medicine
Hypertrophic osteoarthropathy can occur in lung CA patients.. also have clubbing
2305
Medicine
OA can present with crepitus due to cartilage erosion and incongruous join surfaces, it
Rheumatology/Orthopedics
has 10min morning stiffness if more than 30 min its inflmatorry.. INITIALLY GIVE
& Sports
ACETAMINOPHEN
2310
Medicine
2314
Medicine
Birefringent crystals: Bseudogout not gout Calcium pyrrophosphate crystals
& Sports
2315
Medicine
SLE: BLack 20-40 women Fatigue Fever, Weight loss Oral ulcers (not just Behcet)
Hematological abnormalites Proteinuria Rash Arthritis (MCP, PIP like RA but no bone
& Sports
erosion on Xray)
2317
Medicine
Rheumatology/Orthopedics Erythema nodosum and sx suggestive of sarcoid, or African American lady.. Do CXR to
& Sports
look for cause
2341
Medicine
Diverticulosis is most common bleeding LOWE GI BLEEDING in elederly
2342
Medicine
When suspect pancreatitis ==> Do GB U/S to narrow ur differential or get the cause
since stones are most common cause of pancreatitis (if not alcoholic)
2375
Medicine
Ophthalmology
Progressive and central bilateral vision loss in elderly >50= Age related macular
degeneration
2380
Medicine
Stop PAP SMEAR after 65.. Do DEXA scan for osteoporosis above 65 instead
& Sports
2384
Medicine
Infectious Diseases
Hep B exposure algorithm: -Documented vaccine: Reassure (HBsAb positive) -Unknown

status or not immune: HBIG (immunoglobulin) and Vaccine series
2581
Medicine
IBD Has a bimodal distribution: 20's and 60's ==> In Both forms you see Neutrophilic
cryptitis.. (Bimodal since there BiForm of the disease)
2582
Medicine
Ulcerative colitis: (increased colorectal cancer risk) Start colonoscopy 8 year afer
diagnosis or a bit longer if not extensive. Repeat every 1-2 years
2597
Medicine
Waldenstrom: IgM spike Hyperviscosity Multiple myeloma: IgG and IgA (rarely
hyperviscosity) MGUS are rarely symptomatik Heavy chain diseaseL IgA excess
2599
Medicine
In breast Ca mets to bones: go for bisphosphonate (zoledronic acid, etidronate sodium

and pamidronate THE DRONATES), if >12 sever hyperCa2+ use calcitonin with
bisphosphonate But radiation is always better for alleviating pain
2615
Medicine
AdenoCa of lungs is most common in smoker and non smoker (think of it in non
smoker).. ususlay peripheral Large cell carcinoma also is peripheral but gives u large
breast with galactorhhea
2616
Medicine
Infectious Diseases
Febrile neutropeniia: always cover first pseudomonas (cefepime, mero, tazosin)
2623
Medicine
Chemotherapy malaise nausea vomiting is treated with Sertonin Antogonist rather than
Dopamine antagonists
2624
Medicine
Trousseau's syndrome: Hypercoagualibility and thrombophlebitis at unusual sites (arm,

chest.. ) ==> Indicative of possible visceral malignancy as pancreatic, stomach, lung or
prostate CA
2633
Medicine

Electrolytes
Sypmtomatik Hypercalcemia (>12 usually) require IV HYDRATION.. Bisphosphonate are

long term managemetn of HYPERCALCEMIA of MALIGNANCY
2636
Medicine
SIADH treatment: 1-Fluid restriction.. If fail 2-Hypertonic saline and increase salt intake..
If fail 3-Demeclocycline (rarely needed)
2641
Medicine
Tumor lysis: HIGH K, PO4, URIC Acid LOW: Calcium
Atheroembolism aka cholesterol embolism is a complication of any kind of

catheterisation.. can cause cutaneous findings (blue toe syndrome..) cerebral, intestinal
ischemia, acute kidney injury .. Treatment: Supportie + give Statin and reduce risk
factors..
2642
Medicine
Social Sciences
(Ethics/Legal/Professional)
Before the tests are out revieling bad news: Ask the patient how he wld like to be
approaches as it is important to have a good strategy and plan to deliver the news
according to patient's wish. In case of delivering bad news, first start with open ended
discussion asking the patient to tell you what he thinks of his current situation, in order
not to shock him if hes not expecting bad news
2646
Medicine
Progesterone analogues: (and steroids) increase apetite weight gain in cachexic

cancerous patients.. USE FOR PALLIATIVE (less side effects than steroids so prefer it)
THINK WOMAN LOVE TO EAT COZ OF THEIR HIGH PROGESTERONE
2659
Medicine
Torsades: If Stable Give Mg, If not Defibrillate
2661
Medicine
Psychiatric/Behavioral &
Substance Abuse
Treat alcohol withdawal (Delirium tremens: Fever, hallucination, tremor, agitation) with
benzo
2664
Medicine
Poisoning & Environmental Phenyton toxicity: Horizontal nystagmus Cerebellar ataxia Confusion (like CAN of
Exposure
Wernike in alcoholics)
2671
Medicine
Nervous System
In ER settings ALWAYS!!! CT without contrast (FOR BRAIN ONLY).. also for urine
stones dont use contrast !
2672
Medicine
Nervous System
HTN bleeds into Basal Ganglia, Pons and Cerebellum and Lobes (less commonly)..
Basal gglia sx: Contralateral Hemiparesis and Hemisensory loss, Homonymous
Hemianospia and Gaze palsy
2673
Medicine
Nervous System
CN III opens eye, CN VII closes it.. The level of pons determine Upper face paralysis
and Bell's palsy
2686
Medicine
Hypertrophic cardiomyopathy = give Beta blockers
2687
Medicine
Hypertrophic cardiomyopathy is Autosomal Dominant
2695
Medicine
MVP Is the most common MR in DEVELOPING COUNTRIES and is DUE TO

MYXOMATOUS DEGENERATION OF MITRAL VALVE LEAFLETS AND CHORDAE
2698
Medicine
Aortic stenosis in patient belo 70 with no rheumatic disease = Biscupid valve
2711
Medicine
In hypertrophic cardiomyopathy the mitral valve leaflet motion is abnormal.. SAM

(systolic anterior motion of mitral valve) SAM and Septal hypertrophy cause the sound of
murmur
2713
Medicine
MYXOMAS are MOST COMMON HEART TUMORS.. can cause embolic events or
rupture chorda tendina..
2717
Medicine
US is best for diagnosis and f/u of AAA use CT w contrast if not clear image for ex
2722
Medicine
Variant angina is like angina bbut Prinzmetal (see ST elevation during episode, not
depression.. ) it is similar to raynaud's phenomena
2723
Medicine
PRinzmetal angina (findings only during episodes) are treated with CCB
2731
Medicine
Post MI aneurysm causes pesrsitent ST elevation on ECG FUN FACT
2732
Medicine
ACEi reduce remodeling of heart post stress (mainly MI's)
2741
Medicine
CHF and lung infection in young patient ==> VIRAL INFECTION
2742
Medicine
SLE and STEROIDS can accelerate coronnary atherosclerosis
2743
Medicine
Pulmonary edema = give furosemide (even post MI.. and cz decompensated Heart
failure dnt give Beta blockers)
2744
Medicine
Reversible causes of PAC's: Alcohol, Tobacco.. Do holter if get symptoms of arrythmias

like Syncope or Palpitations
2750
Medicine
Dermatology
Scabies: pruritic rash on flexor surfaces of the wrist, lateral surfaces of the fingers and
finger webs.. excoriations with small crusted red papules scattered around affected
areas. Dx by skin scrapngs and excoriated lesions. Tx: topical permethrin 5% cream or
oral Ivermectin (more preferred in adults)
2762
Medicine
Dermatology
Basal cell Ca is slow growing (6months...) unlike SCC.. and can appear below the nose,
in neck.... (not only up)
2771
Medicine
Dermatology
-Tetracycline: Photoxicity (exaggerated sunburn) -Erythromycin (marcolide) : GI upset

and cholestatic jaundice -Steven Johnson: TMP-SMX. penicillin, sulfa drugs NSAIDs,
Anticonvulsant, allopurinol
2774
Medicine
Dermatology
In Celiac, Treat Dermatitis Herpetiform with Gluten restrication and Dapsone (coz like
leprosy lesions )
2817
Medicine

Electrolytes
In endemic areas (Russia one of them) think TB if B symptoms --> Addisionian

presentation maybe --> Hypoaldosterone
2821
Medicine

Electrolytes
Postictal lactic acidosis is common after tonic clonic episode. and resolve on its own
2836
Medicine
Presbycusis: Start at 60's, bilateral seunsorineural loss with high frequency sounds
2839
Medicine
Serous otitis media is definec as the presence of a midlle ear effusion without signs of
active infection. Have a Dull Tympanic Membrane that is HIV lymphadenopathy, or
obstructing Lymphoma... Get conductive hearing loss
2842
Medicine
Nasal polyps can get worse with NSAID use
2844
Medicine
Oral leukplakia: White patches or plaques over the oral mucosa and cannot be scraped
off. Tobacco and Alcohol are risk factors: Like SCC and can progress to SCC.. butt SCC
present with erosive ulcerative lesion with surrounding erythema (white and red and
ugly) with possible lymphadenopathy HSV gingivostomatitis: multiple vesicularlesions
with erythematous and inflamatory base and erythematous border in oral cavity and
perioral. without white plaques
2845
Medicine
Infectious Diseases
Epiglotitis can happen in adults..
2850
Medicine
Ophthalmology
Cataract = progressive thickening of lens ==> Blurred vision
2852
Medicine
Ophthalmology
Open angle glaucoma: More common in Blacks and is characterised by loss of

peripheral vision
2856
2860
Medicine
Medicine
Ophthalmology
Optic neuritis: female 20-45 (usually seeni n MS) change in color perception, loss of
afferent pupillary, central scotoma (bigger blind spot)
Ophthalmology
Herpes simplex keratitis (common cause of blindness) Photophobia, pain, blurred vision,
tearing and redness. Recurrence: associated with sun exposure (outdoor occupation),
fever, immunodeficiency You see Corneal Vesicles and Dentritic Ulcers.. treat with
Acyclovir
2863
Medicine
Ophthalmology
Vitreous hemorrhage is a very common complication of diabetic retinopathy, where

fundus is barely seen on exam and if seen its details are obscured.. It presents acutely
(also patient sees floater like detachment; usually associated with metabolic stuff,
trauma, vascular disease or myopia )
2868
Medicine
Tartrate resistant acid phosphatase (TRAP) seen in hairy cell leukemia
2869
Medicine
Heterophile antibodies can be negative in early disease.. se leukocytosis and variant

atypical lymphocytes on smear. A - test will not exclude disease.. Repea test
2869
Medicine
CAN HAVE MONO WITH NEGATIVE TESTS
2872
Medicine
Meglaoblastic anemia can cause anisocytosis, poikilocytosis.. Basophilic stippling is not

super sensitive can also happen here.. usually see it in lead poisoning, alcoholism,
thalassemia..
2886
Medicine
Leukocyte alkaline phosphatase HIGH = Leukemoid reaction LOW in CML.. can be high
with secondary infection so need a BCR ABL
2887
Medicine
CLL IS DIAGNOSED WITH FLOW CYTOMETRY JAK2 in myelodysplasia specially

polycythemia like my patient with SAGHIR EL ZABER
2888
Medicine
CLL has a poor prognosis in thrombocytopenia Anemia is the second worst prognosis Its
a B cell disease (but not plasma like multiple myeloma) It has smudge cells
(lymphocytes that break down easily)
2889
Medicine
MULTIPLE MYELOMA: ELDERLY Anemia Renal Failure Hypercalcemia Diagnosis ==>

Serum immunoelectrphoresis
2894
Medicine
BCR/ABL is 9 22 chromosome translocation treated with Wyrosine Kinase inhibitors

(inhibits abnormal BCR/ABL gene) AN AWSEOME TREATMENT FOR CML
2895
Medicine
Hepaticolenticular degeneration = Wilson's disease affecrting liver basal ganglia with

greenish brown deposits around cornea
2903
Medicine
U/S is better than HIDA. But HIDA is better in suspected Cholecystitis (especially
acaluculous)
2905
Medicine
Hep A A vesrion to cigarettes and recent trip where sista has same disease
2911
Medicine
Alcoholic hepatitis: No evidence of cirrhosis like gynecomastia, ascites, spider angioma

but do have jaundice. AST/ALT >2 but absolute value less than 500 Also have high
gamma GT which is also present in liver cells and Ferritin (as an acute phase reactant)
If values >25x upper limit it is toxic induced (acetaminophen), ischemic or viral
2919
Medicine
Alpha 1 antitrypsin deficiency stain with PAS (like PAN ancinar)
2923
Medicine
Gilbert is milder thand criggler 2 exacerbated with fasting low fat diet and hemolysis,
stress fatigue, sport fever Unconugated <3 in crigler 2 <20
2930
Medicine
Incidental Gallstones on Imaging with no concern or symptoms: Leave them alone
2936
Medicine
Cirhhotic patient shld undergo screening endocscopies to R/O esophageal varices, also
screen for HCC every 6 months
2938
Medicine
Nervous System
Wilson's: young pple present with liver disease (with Mallory bodies can also be
suggestive of alcoholic liver damge) and neuropsychiatric disease (tremor, rigidity,
depression, paranoisa, catatonia) and Kayser Fleischer rings in eye see decrease
serum ceruloplasmin and increased urinary copper
2940
Medicine
EMPHYSEMATOUS CHOLECYSTITIS haapen in eledrely diabetics males as their GB

get infected wwith gas forming bacteria
2946
Medicine
Acalculous cholecystitis: (no stones) -Burns -Trauma -TPN, Prolonged fasting

-Mechanical ventilation
2950
Medicine
Primary biliary sclerosis is associated with AMA, and also can cause xanthomatous
lesions in eyelids or skin and tendon.. First line is Ursodeoxycholic acid as it relieves
symptoms and lengthens transplant free survival time
2953
Medicine
HepaticEncephalopathy: Supportive care.. first fix electrolytes etc..
2961
Medicine
Infectious Diseases
Hepc B with cirhosis and fucked up use ENTECAVIR or TENOFIVIR HepC RiBAVIRIN,
IFN
2966
Medicine
Alcohol is assiociated with chronic pancreatitis which is by itself associated with

pancreatic cancer. On the other hand smoking is directly associated with pancreatic CA.
2970
Medicine
Infectious Diseases
Eginoccocus = Egg shell calcified cyst I KNOW THAT JUST A NOTICE TO REMEMBER
Infectious Diseases
INH induced toxicity (AST ALT<100) is self resolving no need to worry about it (10-20%),
unless cirrhosis symptoms happen (in 2.5% of pple). If symptoms of "viral hepatitis"
appear stop it and switch to second line treatment. (No need for liver bx since etiology is
known). Continue on full regiment even when symptoms are out. Give steroids if disease
beome fulminant.
2981
Medicine
2984
Medicine
Infectious Diseases
Follow up on Hep B clearance with ALT and HBeAg until there is viral clearance
2994
Medicine
Infectious Diseases
Mucormycosis: Debridement + Amphotericin B (Naim Shraif who ddnt have it)
2998
Medicine
Infectious Diseases
Histoplasma: Southeastern US and central.. Acute pneumonia Blastomycosis: in

southcentral and north central.. Lungs, skin, bones, joints and prostate
(immunocompromised patients).. Primary pulmonary infection is flu like
2999
Medicine
Infectious Diseases
Blastomycosis is a fungal infection endemic to Central USA. It causes mild respiratory

illness but dessiminated infection (even in immunocompetent pple) may cause
cutaneous disease with WELL CIRCUMSCRIBED VERRUCEOUS NODULE AND
PLAQUES THAT PROGRESS TO MICROABSCESSES
3011
Medicine
Infectious Diseases
HUMAN BITE GIVE AUGMENTIN
3012
Medicine
Infectious Diseases
In suspected Infective Endocarditis draw blood cultures
3013
Medicine
Infectious Diseases
Right sided endocarditis is treated empirically with VANCO coz u know US and MRSA..
3014
Medicine
Infectious Diseases
Strep sanguinis is part of Strep viridans ,, involved in IE
3016
Medicine
Hypersensitivity pneumonitis also occurs from exposure to birds not only in a farmer.
Remove exposure and all is good
3020
Medicine
ARDSL PaO2/FiO2<300 and bilateral alveolar infiltrate: Impaired gas exchange,

decreased lung compliance (stiff lungs) and Increased pulmonary arterial pressure
(pulmonary HTN)
3021
Medicine
Bronchogenic is most common lung CA in Asbestos exposure
3029
Medicine
when suspect lung Ca on xray with previous xray positive, do a CT then Biopsy
3033
Medicine
Nocturnal polysomnography is done to diagnose Obstructive sleep apnea
3044
Medicine
Nervous System
Pseudotumor cerebri occurs in young obese female who take OCPS or excess VitA and
can cause blindness Have to reduce weight and give acetazolamide and if necessary do
optic nerve sheath fenestration or do shunting
3049
Medicine
Wegner can present with skin manifestation too like subcutaneous nodules, palpable
purpura pr pyoderman gangrenosum like lesions.. Trest with cytotoxic agents and
cyclophosphamide
3054
Medicine
Legionaire (clues: recent travel, moist AC, aerosols, droplets, abdominal pain,
pneumonia, confusion, ataxia) ==> Macrolides or Fluoroquinolones
3059
Medicine
Polymyositis: Progressive 40-50 women with proximal muscle (hip, shoulder) weakness.
It is usually Drug induces (statins, antipsychotics, and alcohol..). Elevated ESR ans
Rheumatology/Orthopedics Creatine Kinase make the diagnosis (25% anti-JO) ==> Treat with STEROIDS give IVIG
& Sports
if life threatening Inclusion body myositis: same as up but >50 and male, with
eosinophilia on bx In all EMG: spontaneous muscle stimulation with descreased
amplitude
3067
Medicine
Pernicious anemia In EASTERN EUROPE: Causes vit B12 deficiency with Atrophic
glossitis.. Vitiligo Thyroid disease Neurological abnormalities (ataxia, loss of position
sense..)
3068
Medicine
Infectious Diseases
Nosocomial UTI may cause Enteroccocci endocarditis
3072
Medicine
Nervous System
Central cord syndrome occurs with Hyperextension injuries ==> Like synringomyelia
(whichis central) affects mainly upper extremities but mototr first
3080
Medicine
Dermatology
celluitis: Group A strep is most common cause
3099
Medicine

Metabolism
Respiratory Alkalosis will Increase Calcium affinity to Albumin ==> Decrease free
Calcium ==> Hypocalcemia signs (AWSEOME)
3101
Medicine

Metabolism
In bone mets it not tumor itself that directly break the bone but instead release factors
that activate osteoclast (like in breat tumor, which also can cause PTHrP secretion)
3105
Medicine
Infectious Diseases
Trimethorpim sulfamethoxazole is gevien in transplant patients to prevent PCP.. shld

also be vaccinated for influenca, pneumococcus and Hep B
Bright red firm friable exophytic nodules in an HIV infected patient are most likely due to
bacillary angiomatosis Molluscum contagiosum is umbilicated lesions non pruritic Herpes
lesions are painful and vesicular Kaposi: On trunk, face and extremities, papules that
become plaques or nodules and start from light brown to pink to dark violet
3107
Medicine
Infectious Diseases
3126
Medicine
Poisoning & Environmental

TCA OD severity is assessed with QRS widening extent.
Exposure
3131
Medicine
Infectious Diseases
associate EBV with autoimmune hemolytic anemia and thrombocytopenia due to cross
reactivity of EBV induced antibodies against red blood cells and platelets. (IgM
cold-agglutin antibodies aka anti-i-antibodies) Diphterium also present with sore throat
but with pseudomembrane formation, and can cause dilated cardiomyopathy
3131
Medicine
Infectious Diseases
mononucleosis: Not splenic infarct but splenic rupture, can also hemolytic anemia and
thrombocytopenia for 2-3 weeks
3134
Medicine
Poisoning & Environmental In organophosphate poisoning remove patient's clothes since they soacked with the
Exposure
poison
Medicine
Neuroleptic maligant syndrome is a side effect of antipsychotic: Fever, Muscle rigidity,

Poisoning & Environmental Autonomic instabilty and mental status change (high creatine kinase, leukocytosis and
Exposure
electrolytes abnormalitites are also seen).. a bit like parkinosim induced antipsychotic
but with fever
3138
Medicine
Uses of NaHCO3 -Hyperkalemia: reduces it -Aspirin OD: Alkalanize urine and increase
excretion -TCA OD (inhibit fast sodium channels in Purkinje and myocardium) so
Poisoning & Environmental Increase QRS and Hypotension and possibly Vtach and Vfib (coz slow normal cndction
Exposure
and will then rely on ectopic beats) ==> Here the use og NaHCO3 will first increase Na+
which will decrease TCA binding on Na+ channels, and then Bicarb will alkalanise
medium which decrease drug affinity for the channels
3139
Medicine
Poisoning & Environmental Typical Antipsychotics like Risperidone, Fluphenazine can cause Hypothermia so AVOID
Exposure
Long cold Exposures
3151
Medicine
HyperPTH can predispose to pseudogout other stuff too..
& Sports
3157
Medicine
Spinal stenosis is also called Spinal canal narrowing
& Sports
3161
Medicine
Poisoning & Environmental BOTH CAUSE HIGH ANION GAP ACIDOSIS To recognise difference: Methanol Affect
Exposure
EYES Ethylene Glycol Affect Kidneys (coz we know it also cause Stones)
3164
Medicine
Visual sx in giant cell arteritis shld be treated with steroids.
& Sports
3167
Medicine
Ankylosing spondylitis is diagnosed with XR not HLA B27 coz not specific
& Sports
3171
Medicine
Parvo B19 can cause Rheumatoid like arthritis with MCP PIP involvement but morning
Rheumatology/Orthopedics stifness less than 30 min and onset of disease is acute. Must resolve within 2 months..
& Sports
dnt have slapped cheeks in adults. anyways cant diagnose RA if less than 6 weeks sx
Psoriasi affects DIP (like Dactylitis "D" which means sausage digit)
3173
Medicine
COMMON SIDE EFFECT of Hydroxychloroquine: Retinopathy
& Sports
3177
Medicine
In symptomatik sarcoid give steroids (steroid sounds like sarcoid TEKRAM)
& Sports
3202
Medicine
Fibromyalgia: SPORT and TCA's
& Sports
3203
Medicine
Carpal tunnel: -Pregnancy: Flui accumulation *3rd trimester most of time) -Hypothyroid:
Mucopolysacchardie deposition with perineum and endoneurium of median nerve DA
& Sports
FUCK!!
3208
Medicine
Polymyositis increase risks of many cancers
& Sports
3209
Medicine
Rheumatology/Orthopedics Diagnose polymyositis with MUSCLE BX.. It presenest with muscle weakness, often with
& Sports
pain too, and difficulty climbing stairs or rising from a seated position
3230
Medicine

Metabolism
Hyperaldosteronism may not have primary hypokalemia but are to have so if with
diuretic for ex
3231
Medicine

Metabolism
In hyperaldosteronism managed non surgically give Spironolactone or Eplerenone
3247
Medicine
Infectious Diseases
Ehrlichia some new shit But dont wry same treatment as Lyme,, Do leukocytosis,
thrombocytopenia, elevated liver enzymes malaise, fever, confusion and very rarely
rash. IN SOUT CENTER US, AND SOUTH EAST not like lyme in NYC
3249
Medicine
Infectious Diseases
Cryptosporidium (can also be other parasites. cystoIsospora or Giardia.. ): Traveler's

non bloody watery diarrhea for more than 2 weeks Entameba's diarrhea is bloody and is
endemic in all areas except europe and north america
3254
Medicine
Infectious Diseases
Cryptococcal meningo encephelatis in AIDS with CD4<100.. Give Amphotericin and

flucytosine then fluconazole.. MA MNENZAH IN SIDA with MENIGOENCEPHALITIS
3256
Medicine
Infectious Diseases
Primary Syphillis: Benzathine single dose IM (Penicillin G) If allergic give DOXYCYCLINE

Unless Pregnant desensitive
3257
Medicine
Infectious Diseases
Pregnant women with lyme = Amoxicillin not doxy
3259
Medicine
Infectious Diseases
Sub saharan (ethiopia) Amazon , Asia are Chlroquine resistant malaria so give
Mefloquine, atovaquone-proguanil or doxycycline for prophylaxis
3266
Medicine
Infectious Diseases
Measle Temperature >40 compared to ~ 38 in rubella.. and spread of rash is slower..

and no joint involvement like in Rubella
Trichinellosis: In China, Thailand, Latin america.. Cause GI sx within 1 week of
undercood meat ingestion: Abdominal pain, nausea, vomiting and Diarhhea Up to 4
week stage II Myositis, Periorbital edema and Eosinophilia (Triad, coz TRIchinellosis)..
can also get fever and subungual splinter hemorrhages
3135
3267
Medicine
Infectious Diseases
3303
Medicine
Preplatellar syndrome is like ME.. Anserine bursitis: shaarply localised pain over the
anteromedial part of the tibia just below the joint line of the knee. Valgus test is (-) so
& Sports
MCL is ruled out : Causes are overuse, abnormal gait..
3317
Medicine
Polymyalgia rheumatica has HIGH ESR CRPand can be associated with temporal
arteritis.. Treat with STEROIDS (sometimes no arteritis ) It is bilateral,, worse in
& Sports
morning.. proximal arms thigh hip.. can have normocytic anemia
3320
Medicine
Infectious Diseases
3322
Medicine
Systemic sclerosis (scleroderma substype) presents with GERD, Right heat Faulure,
pulonary and renal arteries and esophagus as well. ANA and Anti Topoisomerase I
& Sports
antiibodies are likely to be +
3327
Medicine
Nervous System
If extraocular muscles are involved in eye infection think or orbital cellulitis that can give
Cavernous sinus thrombosis which is right behind it
3330
Medicine
Ophthalmology
3 Kind of diabetic neuropathyL -Background or simpleL microaneurysms, hemorhages,

retinal edema -Pre proliferative: cotton wool spot -Proliferative or malignant:
Neovascularisation
3422
Medicine
Infectious Diseases
Treat zoster recurrence post stress with Valacyclovir and to present pain can give TCA's
3425
Medicine
Infectious Diseases
LeprosyL Asian with hypopigmented patch of skin affecting sensation of area too.
Diagnose with skin BX showing acid-fast bacilli
Disseminated Gonococcus: Fever, poly arthralgia and pustular rash (not dessiminated
rash all over body like in SSS)
3429
Medicine
Ophthalmology
Ocular tonometry measure intraocular pressur when we have emergency suspecting

acute cosed angle glaucoma.. Can be precipitated by Decongestant, Antiemetic and
Anticholinergic drugs in patient with predisposed anatomy. Get headache nausea,
diminished vision and halos around lights and mid dilated non reactive pupil, redness
and corneal opacification
3433
Medicine
In ARDS have to increase PEEP
3446
Medicine
Nervous System
MS suspected Do MRi (Ms and Mr MS and MRI)
3453
Medicine
INCIDENTAL NODULE in LUNGS found ALGORITHM !! Check for previous Xrays.

Stable over 2-3 yrs in non risk young patient==> let go Changing mass or no previous
Xray==> CT CT benign ==> follow up later with CT's Suspicious CT==> Bx or Pet CT
HIGHLY SUSPICIOUS==> Surgical Excision
3467
Medicine
Acute episode of diverticulitis is best diagnosed with CT
3474
Medicine
Bronchiectasis: Dilated bronchi with thickened wall on CT .. Hemoptysis is a potential

complication (often severe and require bronchial artery embolization).. See it in COPD
3475
Medicine
Infectious Diseases
In pyelonephritis or UTI sx do Imaging if sx do not resolve in 2-3 days of therapy.. or if

have hx of nephrolithiasis, complicated pyelonephritis or unusual findings (gross
hematuria, suspicion for obstruction... )
3481
Medicine

Electrolytes
When have BPH and symptoms and DRE done, do Urinalysis to look for infection
3483
Medicine

Metabolism
Hypothyroid can cause elevated AST ALT, HyperLipidemia and Hyponatremia (the fuck)
3484
Medicine

Metabolism
Before any FNA of thyroid, do TSH level and US
3488
Medicine

Metabolism
RAI is likely to cause Hypothyroidism But ususally cause Hypothyroid when whole gland
will absorb the radioactive Iodine like in GRAVES In toxic adenoma the radioactive
Iodine will mainly be uptaken by this single mass..
3490
Medicine

Metabolism
Osteolmalavia (vit D deficiency): defective mineralisation of organic bone matrix.. can

happen in celiac
3495
Medicine

Metabolism
Sick euthyroid syndrome aka "low T3 syndrome" occurs with acute, severe illness. Get a
fall in total and free T3, with normal T4 and TSH levels
3497
Medicine

Metabolism
HASHIMOTO INCREASe LYMPHOMA OF THYROID RISK (MANTE2)
3513
Medicine
Nervous System
Primidone is an anticonvulsant usd for essential tremor but can precipitate acute
intermittent porphyria (abdomincal pain, confusion, headache and hallucinations,
dizziness)
3516
Medicine
Paget: HYDOXYPROLINE IN URINE
& Sports
3518
Medicine

Metabolism
Paget's labs: ALL GOOD WITH HIGH ALP TREAT ONLY IF SYMPTOMATIK
3526
Medicine
In limb embolisation dont forget to do an ECHO..
3583
Medicine
Infectious Diseases
As already said Early HIV = EBC symptoms (dnt forget possible GI symptoms, night
sweats, lymphadenopathy.. )
3589
Medicine
Peptic ulcers are most commonly complication is Hemorrhage, and other less frequent
complications are perforation, penetration and obstruction.
3605
Medicine
Lactose intolereanc eis easly diagnosed with a POSITIVE HYDROGEN BREATH TEST
(bacteria metabolism of carbs not being absorbed)
3606
Medicine
INR goal 2-3 for DVT 2.5-3.5 for idiopathic venous thromboembolism
3610
Medicine
Macrovascular traumatic hemolysis is microcytic
3613
Medicine
Infectious Diseases
Post BMT Pneumonitis and colitis: CMV Only diarrhea no lungs: Cryptosporidum Skin
rash, and less commonly intestine, liver, lung: GVHD (always get rash) Can get PCP
pneumonia in early stage but very rare coz have good prophylaxis Cryptosporidium=
Diarrhea NOT LIKE CRYPTOCOCCUS (IN HEAD)
3617
Medicine
Social Sciences
Respect patient's opinion about not wanting life saving treatment, but first discuss issue..
DONT JUST SAY YEA ITS UR LIFE MOFO
3619
Medicine
Nervous System
TCA, Beta blocker; migraine prophylaxis During episodes give ANTIEMETICS:

Chlorpromazine, prochlorperazine, metoclopramide..
3622
Medicine
Nervous System
Non traumatic subarachnoid hemorrhage is most commonly due to saccular or berry

aneurysm rupture. we see bleeding in cisterns.. if CT - , do LP
3634
Medicine

Metabolism
Acromegaly get huge hearts then cardiomyopathy
3635
Medicine
Constrictive pericarditis (calcification.. ) in Africa India china.. THINK TB
3637
Medicine
Nervous System
Pseudotumor cerebi aka idiopathic intracranial HTN in young obese women taking too
much isotretinoin or tetracycline --> Treat with Acetazolamide +/- furosemide
3643
Medicine
Nervous System
Acute MS exacerbation = Steroids but if u want to decrease episode frequency give beta
interferom or glatiramer, cyclophosphamide,IVIG, or plasmapheresis
3644
Medicine
Nervous System
MS CSF: Normal pressure, Oligoclonal bands (with normal overall protein level.
3644
Medicine
Nervous System
MS: (also have autonomous dysregulation) ==> See Oligoclonal bands and All the rest is
normal in CSF (normal proteins) Guillain Barre: Get elevated protein with
Albumino-cytologic dissociation
3674
Medicine
Infectious Diseases
Check Question for different rashes Cutaneous larva migrans: common in travel to
tropics including SE USA characterised with pruritic speriginous lesions on skin which
elongate ate rate of several mm/day as larvae migrate in epidermis and usually seen in
lower extremitites and can also involve upper extremity.. associated with sand contact
(soil contaminated with dog or cat feces containing infective larvae) Brown reclus spider
cause papul with erythema flwd w ulceration
3680
Medicine
in mets to epidura from prostate Ca for ex. give steroids to alleviate the swelling and sx.
Imaging Do MRI not bone Scan
3690
Medicine
Nervous System
Malignant hyperthermia: is uncontrolled accumulation of Ca2+ is cells (due to

uncontrolled efflux from sarcoplasmic reticulum) ==> Susceptible patients gets the event
after halothane and succynylcholine ==> Treat with dantrolene: BLOCKS Ca2+
ryanodine receptors
3691
Medicine
Nervous System
Heat stroke is managed with ICE cooled bath no chillin cold bath
3693
Medicine

Electrolytes
In UTIs: Leukocyte esterase= pyuria.. Nitrites:conversion of nitrate to nitrite with

enterobacteriacea (E.coli.. SO BOTH ARE POSITIVE IN UTI
3697
Medicine
In Afiv with rapid ventricular response need rate control with Betablockers or CCB..
Cardioversion is indicated if hemodinamycally unstable
3698
Medicine
Vfib and Vtack = DEfibrillate then give antiarrythmic if Dfib fails
3699
Medicine
Afib Hemodinamically stable: Digoxin Non Stable: DC cardioversion (also in Vfib and
Vtach)
3704
Medicine
Acute erosive gastritis is seen in NSAIDs or Aspirin OD's
3717
Medicine
Also treat before diagnosing if high suspicion of problem. THINK CLINICALLY
3725
Medicine
Nervous System
GLIOBLASTOMA OF BRAIN HAS A BUTTERFLY APPEARANCE
3727
Medicine
Nervous System
Mysthemia crisis can cause fever and respiratory distress ==> Give steroids and IVIG,
but Intubate if desaturating and weak effort of respiration
3728
Medicine
Nervous System
HTN brain ischemia: Basal gglia, pons, cerebellar NEVER CORTEX
3738
Medicine
Nervous System
NON DOMINANT BROCA: AFFECT EMOTIONS RELATED TO SPEECH NOT SPEECH

ITSELF
3750
Medicine
Substance Abuse
If there is somatization 3abber the patients as it can help him,, dont send him the psych
3763
Medicine
VTach: -Cardioversion: iIF hemodynamically unstable -IV Amiodarone: IF Stable
3771
Medicine
Nervous System
Riluzole In ALS Plasmapheresis in Guillain Barre
3775
Medicine
Germ c tumors are the only ones that produce both Bhcg and AFP.. usually AFP is in
HCC and endodermal sinudoid (yolk sac )tumor and and Bhcg is choriocarcinoma a
3781
Medicine

Metabolism
Diabetic neuropathy is assessed with Monofilament testing which assess pressure

sensation (altered in this disease)
3789
Medicine
Infectious Diseases
Echinococcus (Big round cyst and smaller cysts inside of it) occur in Mexico with Sheep
contact (DAYM SHEEP)
3790
Medicine
Zinc deficiency results from TPN or malabsorption: Sx: Alopecia, skin lesions, abnormal
taste and impaired wound healing
3797
Medicine

Metabolism
Diabetic gastroparesis is treated with prokinetic agents like METOCLOPRAMIDE,

ERYTHROMYCIN, CISAPRIDE
3800
Medicine

Metabolism
TCA's are drug of choice for diabetic neuropathy pain so are NSAID's (but avoid in renal
dysfunction)
3808
Medicine
Infectious Diseases
NEUROCYSTICERCOSIS: PArasite in BRAIN, Like name implies it cause several Cyst is

brain it is caused by TANEIA SOLIUM
3819
Medicine
Infectious Diseases
cyst in liver after travel in endemic area: entameba histolytica ==> Treat with
Metronidazole ==> IF fail go fo drainage
3820
Medicine
ACEi ARB Spirono BBlocker and ASPIRIN (if due to CAD) IMPROVE CHF survival but
Digoxin and Furosemide DO NOT although are good for symptoms
3823
Medicine
Start statin in a high risk patient with bad lipids level.. not exercecice only
3829
Medicine
PVCs post MI are common or cardiac pathologies.. they indicate worse prognosis, but
treating them with antiarrythmic will even worsen prognosis. So observe, or can give
Beta Blockers.
3837
Medicine
Nervous System
In myasthemia DTR are preserved unlike Eaton Lambert (Ab's against voltage gated
calcium channesls in presynaptic nerve terminal)
3847
Medicine
For prostate CA, aftr orchioectomy, go for radiation not hormonal (u already went too far
by removing balls u wont go back to stupid meds go for the big shit the radiations)
3852
Medicine
Nervous System
Diagnose MS with MRI
3859
Medicine
In PE, if very likeley go do CT ANGIO (=with IV contrast)... If not likely Do dimer.. Leg
doppler if DVT
3878
Medicine

Metabolism
Hypothyroid causes myopathies with elevaed Creatine Kinase
3887
Medicine
Foul smelling stool from a recent trip = Giardia = Metronidazole
3894
Medicine
Young person with renal stenosis = fibromsucular dysplasis ==> treat with stent Use
ACEi in old people with renal stenosis (probably due to atherosclerosis) since they are
not candidate for stent
3898
Medicine
SLE Nephropathy is Imune mediated involving also C3 thereby it lowers in the serum Ig
Rheumatology/Orthopedics E medicated reaction is in allergic interstitial nephritis like methicillin induced interstitial
& Sports
nephrtis Goodpasture = Cytotoxic antibodies Non immune nephropathy in toxins, HTN,
DM
3902
Medicine

Metabolism
ACEi decrease the progression of diabetic nephropathy (NEVER FORGET THAT)
3916
Medicine
Trazodone causes boner
3920
Medicine
Peripheral CCB vasodilate veins ==> EdeMa
3930
Medicine
In alcoholism think FOLATE deficiency not B12
3934
Medicine
Biostatistics & Epidemiology
p value= N N is the probability that the results of the experiment are random (so the
lower p the better)
3938
Medicine
Infectious Diseases
In AIDS PCP TMP-SMX is alway better if we add steroids if paO2 <70 and A-a gradient
>35
3939
Medicine

Electrolytes
Never forget Berry aneurysm and ADPKD
3943
Medicine
Elderly with bone pain, renal failure, HyperCa2+ = Multiple myeloma (50% of these
devellop renal insuffisciency) by obstructing collecting and distal tubules with
paraproteins (Bence Jones proteins)
3949
Medicine

Electrolytes
Cystinuria is familial and causes recurretn stones. Hard radiopaque hexagonal crystals
with positive Urinary Cyanide Nitroprusside Test
3952
Medicine

Metabolism
HTN Hypothyroid: Increase SVR Hyperthyroid: Decrease SVR +Increase heart

contractility ==> Increase BP Overall Hypeparathyroid: Contractility increase and arterial
effect Hyperthyroid can cause mild Hypercalcemia due to increase bone turnover
3956
Medicine
Aortic dissection algorithm
3958
Medicine
Hypovolemia BUN/Cr is elevates >20 Na+ excretion should also be low, unless using
diuretic BE CAREFUL SO CHOOSE FIRST ONE IN DISEASED OLD FUCKER USING
DIURETICS
3959
Medicine
Nervous System
IF ONLY MUSCLE PROBLEM POST STROKE THINK BASAL GGLIA (LACUNAR

STROKE) NOT CORTICAL STROKE (PRESENT WITH SPEECH PROBLEMS TOO..
etc.) NOTE: Slurred speech is only muscular not related to cortex
3962
Medicine
Vasovagal syncope: -triggered by: Stress, pain, prolonged standing (in OR doing
nothing).. Get vagal induced bradychardia with a dizziness prodrome and black out for
seconds to minutes. Wake up full oriented Do tilt table stress which is super stressful
and will provoque episode
3965
Medicine

Electrolytes
In goodpasture ==> go for plasmapheresis to remove antibodies
3966
Medicine

Electrolytes
In carcinomas we see Membranous nephropathy But in HODGKIN: See Minimal change

disease (as it is a minimal cancer)
3973
Medicine
niacin side effects are prostaglandin induced like NSAIDS in asthma
3977
Medicine
Malignant HTN (emergency; doesnt depend on values but on damage): severe HTN
(>180/120) with retinal hemorrhafes, exudates or papilledema.. HtN encephalopathy is
associated with cerebral edema
3978
Medicine
EPO side effects: -HTN -Headache -Flu like symptoms -Red cell aplasia
3979
Medicine
If get uremic carditis encephelitis.. DIALYSIS (BUN>60)
3980
Medicine
Allergy & Immunology
Check Immunosupressant side effects
3986
Medicine

Electrolytes
Diabetes NEphropathy early on is due to GLOMERULAR HYPERINFILTRATION and

ACEi Will decrease Glomerular P, decreasing Ifurther GLOMERULAR DAMAGE (D"J"G
Diabetes)
3997
Medicine

Electrolytes
Suspect amyloidosis in RA (predisposes to that) With Hepatomegaly and enlarged

kidneys ==> See amyloid deposits with apple-green birefringence under polarized light
after congo red stain -Crescent shape in RPG (remember Hezbolla) -Linear
immunoglobunin deposit in Goodpasture's -Granular deposits: In immune complex
mediated glomerulonephritis like Lupus and Post strep
3997
Medicine

Electrolytes
RA predisposes to amyloidosis.. Suspect amyloidosis also if hav hepatomegaly and

enlarged kidneys
4000
Medicine
Rheumatology/Orthopedics After strenuous movement: Even if leg raise test is positiv ebut no other neurological
& Sports
symptoms ==> Use NSAIDs Early mobilization and Muscle relaxant
4004
Medicine

Electrolytes
Long term analsegic can cause tubulointerstitial nephritis and hematuria due to papillary
necrosis,
4007
Medicine

Electrolytes
Analsegic abuse: Papillary necrosis or Tubulointerstitial nephritis.. Get polyuria and

sterile pyuris (WBC casts)
4011
Medicine
Dermatology
Herpetic withlow is a common viral infection of the hand. It is causedby either type 1 or 2
HSV and is self limiting. Dentisits who come in contact with infected orotracheal
secretions get it
4015
Medicine
Ophthalmology
Fperign body in eye: Initially pen ligh examination id negative go for FLUORESCEIN
EXAMINATION
4021
Medicine
Ophthalmology
Sympathetic ohptalmia aka "spread eye injury": immune mediated inflammation of one
eye after penetrating injury to other eye. It is due to uncovering of hidden antigens which
means that you have antigen that are not being attacked in the eye du to some natural
barriers but breaking these barriers will induce an immune response and anterior
uveitis...
4027
Medicine

Electrolytes
Uric acid stones: Alkalanise them to make them soluble: Give K+ citrate (citrate also
prevents stone formation) SAME TREATMENT AS CYSTEIBNE SOTONES
4034
Medicine

Electrolytes
EVEN IF HYPOTENSiVE DNT USE CRYSTALLOIDS KEEP THEM FOR BURN AND
HYPOPROTEINEMIA
4036
Medicine
Steroids= Demarginalisation: Increase WBC and PMN's but decrease basophils

esonipholis..
4040
Medicine
COPD exacerbation, besides med management give NON INVASIVE Positive-pressure

ventilation
4042
Medicine
In cocaine OD give benzos not beta blocker.. can also give CCB, Aspirin, Nitroglycerine
4049
Medicine
Nervous System
in NF type I can have optic gliomas or accoustic neuromas (we diagnose accoustic
neuroma with MRI and gadolinium)
4065
Medicine
ASpirin mediated respiratory disease in Hay fever in not IgE mediated but from
prostaglandin and leukotrienes.
4068
Medicine
in PVB in MI shld nt be treated since it wldnt change the prognosis (PVB are associated
with worse prognosis) and increase the risk of asystole
4071
Medicine
Infectious Diseases
Intubated patients: Think Pseudomonas ==> Cefemin, piperacillin-tazobactam,

meropenem
4074
Medicine
Crypt Abscess = UC Non caseating granuloma = Crohn
4075
Medicine
Post Hemothorax (good medium for infection) empyema is common also post
pneumonia empyema.. Remove empyema if localised, complex with thick rim and is not
draindable .. present with fever
4076
Medicine
Dermatology
Roacutan is mainly used in non inflamatory huge acne if its inflamatorry go for topical
antibiotics first
4080
Medicine
Do Hep A vaccine when u go to developing countries
4083
Medicine
Vertebral compression fracture can happen in osteoporotic people and present with
acute pain following minimal trauma (bending, coughing, lifting..) ... GET POINT
& Sports
TENDERNESS, BUT NEURO WISE SUPER NORMAL
4085
Medicine
Angiodysplasia: common recurrent or occult painless lower abdominal bleeding in

patients age>60. They cause lower GI bleeding in patient with AORTIC STENOSIS
(HEYDE'S SYNDROME( AND ESRD. NO COLONO FINDINGS UNLIKE
DIIVERTICULOSIS (WHICH IS MOST COMMON CAUSE)
4087
Medicine
Pleural effusion of unknown etiology ==> Thoracocentesis
4089
Medicine
Nervous System
Status epilepticus (>5min) can lead to CORTICAL NECROSIS Due to overexitation, and
may lead to irreversible damage
4099
Medicine
Ophthalmology
CMV retintis is painless with fundoscopic hemorrhages and fluffy granular lesions
around retinal vessels.. HSV and VZV pain with keratitis, uveitis, peripheral pale lesions
and central retinal necrosis
4106
Medicine
In ZE syndrome pancreatic enzymes are inactivated by excess acid
4108
Medicine
Inferior wall MI is due to RCA:LCX, 5:1.. if RCA can get AV block bcoz it supllies the AV
node, and can get a Mobitz II
4112
Medicine
Vit K deficiency occurs 7-10 days after inadequate dietary intake (post op), liver
disease.. prolonged PT followed by prolonged PTT
4118
Medicine
Excessive alcohol factor is a BIG Risk factor for Aspiration, also GERD, Seizures and
Achalasia can do so
4123
Medicine
Dermatomyositis can be a PARANEOPLASTIC FINDING affecting muscle fibers (Unlikw

Lambert eaton affecting presynpatic membrane calcium channels),, with symetrical
& Sports
muscle weakness and erythematous rash over dorsum of fingers or upper eyelids
4127
Medicine
Beta blockers are best initial treatment of STABLE ANGINA (use CCB or nitrate if BB
contraindicated or not enough)
4128
Medicine

Metabolism
In Men II can screen with RET genetic testing if have + family history
4131
Medicine
COPD with PaO2<55 mmHg or SaO2<89 : Start on O2 OR Pulmonary HTN (cor

pulmonale) OR HCT>55% (polycythemia) OR patient who become hypoxic at night (like
my patient)
4147
Medicine
Phenytoin = folate
4151
Medicine
Dermatology
GVHD: T cell of donor against host HLA. ALWAYS involve SKIN also can involve
intestine, liver.. (mentionned in another question)
4154
Medicine

Metabolism
Since OCP increase binding of thryoid hormone, if on HRT for thyroid u shld increase
doe
4161
Medicine

Metabolism
Post pelvic fracture we might have neurogenic penile dysfunction .. Venous dysfunction
is usually post tunica albuginea disruption
4165
Medicine
Once diagnose gastric AdenoCA do CT for staging
4168
Medicine
Infectious Diseases
Post ulcer osteomylitis in diabetes is through contiguous spread Direct inoculation

osteomylitis is post trauma
4169
Medicine
Infectious Diseases
With acute pyelnephritis always start IV Antibiotics like Ceftriaxone.. when start to have
response switch to PO like Fluoroquinolone or Trimetoprim sulfamethoxazole
4170
Medicine
Nervous System
MOST COMMON LOCATION OF ULNAR ENTRAPMNT IS ELBOW (medial epicondyle)
4177
Medicine
Primary pulmonary HTN can be seen in middle aged patients, with exertional
breathlenssness. Lungs are clear on auscultation. CXR show enlargement of pulmonary
arteries and enlargement of right ventricle UNLIKE Pulmonary fibrosis which is
associated with auscultation findings (crackles..) and lung Xray abnormalities
4178
Medicine
Biostatistics & Epidemiology Beautiful table about bias in epidemio
4181
Medicine

Electrolytes
Simple renal cysts are almost always benign AND REAUSSURE PATIENT TELL HIM TO
GO WATCH TV. Malignancy fear include Multilocular mass, Irregular walls, Thickened
septae and Constrast enhancement (COOL FACT CONTRAST IN KIDNEY
MALIGNANCY unlike CYST)
4188
Medicine
Zenker which occurs in >60's ususally males with neck mass (possible) is mainly due to
upper sphincter dysfunction and eosophageal dysmolity (motor issues) and is diagnosed
with Barium esophgram or Eosophageal mannometry since it is motor in nature.
4190
Medicine
Remember from pharmaco TBL that late stage CHF comes with Hyponatremia
4191
Medicine
IF U GIVE SILDENAFIL AND ALPHA BLOCKER TOGETHER GIVE THEM 4h APART TO

PREVENT HYPOSTENSION
4202
Medicine
Ophthalmology
When pigmentation is stated think of neurofibromatosis, and associated eye mass is

Optic Glioma
4203
Medicine
Nervous System
Thalamic stroke cause sensory problem
4210
Medicine
Aspergilloma is a mobile lesion
4216
Medicine

Electrolytes
Hypocalcemia can occur after major surgery and in patients requiring extensive
transfusions.. Will have hyperactive DTRs
4218
Medicine
Nervous System
Most common Mutation in Neurofibromatosis II (on chromosome 22) is NONSENSE DA

FUCKKKK
4226
Medicine
Diffuse esophageal spasm occur in young ladies with intermittent episodes of chest pain
and dysphagia
4228
Medicine

Metabolism
Check table for diabetic neuropathy symptoms
4243
Medicine
CHF: (LV) Decrease CO, Incresed SVR, and logically since decrease CO we get
Increase LVEDV
4257
Medicine
Infectious Diseases
Rusty nail (cloue) = Pseudomonas
4259
Medicine
Prevent Alchol in Gout coz its metabolite lactate compete with uric acid exrection
& Sports
4261
Medicine

Metabolism
Paget = Disorganised bone remodeling
4265
Medicine
Infectious Diseases
Meningococcus: Rash, strong myalgia..
4266
Medicine

Electrolytes
In Nephrotic get Hypercoagulable state
4267
Medicine
Dermatology
Antihistamine in mild drug allergy keep steroid and epi for more systemic symptoms
(anaphylaxis)
4284
Medicine
Infectious Diseases
Give Oseltamivir and Zenamivir for flu only in fucked up elderly no for healthy patient
who require symptomatik treament
4288
Medicine

Electrolytes
Only give Iv ca2+ gluconate if ECG changes otherwise look for etiology and abort it
4298
Medicine
Clopidogrel: Given to prevent MI after a NSTEMI for at least 12 months.. and following
PCI (30days if bare metal stents) (1yr: drug eluting stents) or if aspirin not tolerated
Otherwise only give: Aspirin BB ACEi Statins
4307
Medicine

Metabolism
Untreated Hyperthroid are at risk of for Tachyarrythmias and Rapid BONE LOSS from
increased osteoclastic activity in bone cells
4316
Medicine
Heparin induced thrombocytopenia -Type I: More common 1-4 days after heparin
Platelet > 100 000 Management: Continue heparin but slowlier and observe -Type II:
Much less common 5-10 days, or less than 1 days if previous hep was given this month
Incerased risk of thrombosis (venous, arterial).. Necrotic lesions at hep site injection
STOP HEP GIVE OTHER ANTICOAGULATIONS Due to Ab agaisnt Heparin platelet
factor 4
4321
Medicine
Nonalcoholic fatty liver occurs in Diabetes cause of insulin resistance causing lipolysis
everywhere and uptake of the fatty acids by the liver and triglceride production
4322
Medicine
Nervous System
Parkinson TRAP Mnemonic: Tremor, Rigisity, Akinesia, Postural instability and Shuffling
gait (equivalent to hypokinetic gait)
4326
Medicine
Hypovolemic shock: </ RA P, PCWP, CO, Mixed venous oxygen saturation, /> SVR
Cardiogenic shock: </ CO and Mixed venous oxygen saturation, /> Ra P, PCWP, SVR
Septic shock: </ RA P, PCWP, SVR and /> Mixed venous oxygen saturation, CO(1/~ to
extraction) -CO, MVO2sat and SVR (inversely proportional)=> GD if vasodilation but will
get less extraction coz no P (hypotension, sepsis.. -RA P and PCWP (proportional,
increase if heart problem, decrease if blood loss from circulation)
4327
Medicine
Infectious Diseases
crystal induced nephropathy is a well known side effects of indinavir
4328
Medicine
Achalasia: High Esophageal sphincter tone Scleroderma: Low Esophageal sphincter

tone But in botch get lower or absent lower peristaltic activity
4329
Medicine
splenomegaly is rarely seen in bone marrow Aplasia,, but do happen in bone marrow
infiltration
4336
Medicine

Metabolism
Give statin in diabetes above 40 regardless of levels also in CAD
4337
Medicine

Electrolytes
In acute ill patient with renall failure, liver failure or sepsis STOP METFORMIN coz it can
cause LACTIC ACIDOSIS
4339
Medicine
TTP: Anemia (hemolysis) + thrombocytopenia + Neuro (unlike HUS) + Kidney : Lethal if

untreated ==> Plasmapheresis (assess improvement with normalization of platelets and
LDH coz Renal and Smear may still be abnormal few weeks post recovery)
4344
Medicine
Young ladis with OCP can cause PE .. present with tachypnea tachycardia pleuritic pain
and hemoptysis
4345
Medicine
In tamponade since preqssure equalises in all chambers so naturally LV will be smaller

and lower LV preload and Deacrease stroke volume and CO that may cause pulmo or
neuro sx
4347
Medicine

Metabolism
Prussian blue positive for Hemosiderin which we see in RBC hemolysis..
4352
Medicine
Non tender firm solitary lymph nodes in neck are suggestive of head and neck scc
metastasis to lymph node, especially in smokers
4357
Medicine
B9 B12 deficiency will both increase HOMOCYSTEINE, and B12 will also increae
methylmalonic acid
4361
Medicine

Electrolytes
In suspected renal calculi (lower abd pain radiating to groin ie.) US or cT of abdomen
and pelvis is cool.. US in pregnant ladies
4366
Medicine
Nervous System
Metoclopramide is a prokinetic agent that can cause drug induced extapyramidal

symptoms
4368
Medicine
Rheumatology/Orthopedics Cord compression: Do MRI Tumor red flag in back: Xray and ESR and if bad results do
& Sports
MRI to still r/o other ortho causes
4369
Medicine
Lumbar Disc Herniation: Back pain +/- radiation down to one leg (usually recall an
inciting event) Sitting and and flexion makes it worse. Lumbar spinal stenosis: We have
& Sports
radiation with neurological signs (tingling..) relieved by flexion.
4371
Medicine
Rheumatology/Orthopedics Osteomylistis Fever and WBC unreliable (ca be normal) rely only on ESR (Staph causes
& Sports
it especially in drug injectors)
4371
Medicine
Osteomylitis can happen without fever or leukocytosis, we rely on ESR (hx of injection
drug use, or other infection before that like UTI) and pain.. ==> Confirm with MRI
& Sports
STRAIGHT LEG RAISE TEST + = HERNIATED DISC
4373
Medicine
Infectious Diseases
Immunocompromised with visceral and cutaneous angioma like blood vessels growth:
Bacillary angiomatosis caused by BARTONELLA QUINTANA.. give antibiotics to regress
lesions
4376
Medicine
Meniere diseaseL Vertigo, ear fullness, tinnitus and hearing loss ==> Start with lifesyle
modification: Low Salt Diet..
4381
Medicine
Nervous System
Pronator drift is an Upper motor neuron thing
4382
Medicine

Metabolism
PROXIMAL MUSCLE WEAKNESS WITH OR WITHOUT ATROPHY: SUSPECT HYPO

OR HYPERThyroid especially when have weight changes, mood changes, energy
changes... etc.
4383
Medicine
ITP: platelets are destroyed by IgG, it is a diagnosis of exclusion. Give steroids with low
count (<30K)
4384
Medicine
Increase level of homocysteine can predispose to vascular damage.. (atheros..) give B6
4387
Medicine
Lung consolidation: -Dullness to percussion -Increased breath sound (better heard)
4397
Medicine
Nervous System
Vasovagal syncope (neucardiogenic) due to high vagal tone can be preceded with
nausea, diaphoresism bradychardia and pallor due to Stress, urination or Prolonged
Standing IN OR or OUT OR
4398
Medicine
Tricuspid endocarditis: can cause emboli that go to lungs and causes symptoms of
cough, chest pain..
4402
Medicine
In Packed RBC there iscitrate which chelates Calcium and Mg and can lowers their
levels in host
4403
Medicine
Dermatology
Cherry angioma are small, red, cutaneous papules common in aging adults. They do not
regress spontaneously, but they are benign and generally do notrequire treatment
4410
Medicine
Dermatology
Aktinic keratosis: Sun exposure-> lesions are erythematous papules with central scale
and sand paper texture.. ==> can become squamous cell carcinoma
4412
Medicine
SLE HYPERCOAGULABILITY = HIGH PTT ( WEIRD BUT TRUE )
4414
Medicine

Electrolytes
To prevent Acyclovir crystalline nephropathy give agressive IV HYDRATION
4415
Medicine

Metabolism
Radioactive iodine fuck up exophtamous so avoid it
4416
Medicine
Non white child bearing women can get SLE: Get autoimmune pancytopenia (not alway
all).. and in late stage the renal disease they get is FGS
4417
Medicine
Infectious Diseases
Branching: Nocardia, Actinomyce Acid Fast: Mycobacterium, Nocardia
4419
Medicine

Electrolytes
Asthma meds think of steroids or albuterol: anywayz both will produce Hypokalemia and
muscle weakness
4428
Medicine

Electrolytes
Never use Succinylcholine with Hyperkalemia like BURN or CRUSH injuries, TUMOR
lysis or Demylinating like Guillain Barre
4431
Medicine
HERPES ZOSTER IS REACTIVATED WITH ILLNESS or SEVERED STRESS LIKE CA..

CLOVIRS WIL SHORTEN COURSE AND DECREASE CHANCES OF POST HEPETIC
NEURALGIA
4435
Medicine

Electrolytes
DIURETICS MUST BE USED WITH CARE TO PREVENT RENAL DAMAGE
4436
Medicine
Hyposthenuria: inabilty to concentrate urine in sickle cell disease and sickle trait (sciling
in vasa rectae of inner medulla imparing counturcurrent exchange and free water
reabsoption)
4443
Medicine
Nervous System
Steroids induced myopathy is similar to polymyalgia rheumatica (of giant cell arteritis)
but with normal ESR but in both CK is normal In statin induced myopathy it is like
Hypothyroid one with normal ESR and high CK Steroids myopathy both are normal
4446
Medicine
Headache, nause, diziness in a person who works in an enclosed space.. CO poisoning

especially if high HCT to compensate Pvera: get high RBC and others..
4447
Medicine
Osler Weber Rendu syndrome is a hereditary telegenctasisa (Autosomal Dominant) with

Widespread AVM's causing telegenctasia, epistaxis, (AVM's everywhere) and AVM's in
lungs causing pulmonary HTN and eventually high HCT (like polycythemia).
4449
Medicine
Rheumatology/Orthopedics Gout can happen in myeloproliferative disorders.. since we have increase catabolism
& Sports
turnover
4450
Medicine
Vagal maneuvers which are helpful in SVT like putting cold stuff on face will work by
increasing vagal tone and decreasing AV conductivity
4451
Medicine
Not all that wheezes is asthma ,, if patient has Uncontrolled HTN for so long think of
heart failure and pulmo edema.. Tx: O2 and ventilation, Agressive diuresis (furosemide)
and possible vasodilators..
4454
Medicine
In patient taking digoxin follow up on its level coz it can cause vomiting, diarrhea, vision
changes and arrythmias
4459
Medicine
AVM can cause increase preload and AVM can happen with trauma, fistula or CA
4460
Medicine
Giant cell arteritis can cause Aortic aneurysm as complication
& Sports
4461
Medicine
Nervous System
Coerneal abrasion can happen due to V1 dysfunction of Trigerminal that supllies eye
4465
Medicine
Nervous System
Guillain barre is an ascending paralysis with elevated protein on CSF ONLYYY
4466
Medicine
MM patients can get recurrent infection due to inffective antibodies.. Also get bone pain
4468
Medicine
Sickle cell usually do normocytic anemia due to hemolysis.. but can get folate deficiency
with increase cell turnover and increased folate consumption.. Suplement folate to all
sickle cell patients
4469
Medicine
If have Afib with no other cardiopulmonary disease==> No treatment since there is super
low risk of embolisation (CHADS score of 0)
4471
Medicine
Nervous System
Consider in DDx of dementia (old memory preserved) Hypothyroid
4476
Medicine
Infectious Diseases
Chronic liver disease vaccine workup: Hep A Hep B Tdap (then every 10 yrs Td)
Pneumoccocal vaccine (start always with fancy PPSV23 then sequential PCV13 and
redo PPSV23 at 65) Influenza anually
4488
Medicine
Infectious Diseases
women with PID which are high risks for infections are encouraged to go for HIV,
syphillis, Hep B, Hep C (if use drugs or got transfusions before 1992)
4488
Medicine
Infectious Diseases
Screen for syphilis in youngs with STF (RPR test)
4492
Medicine
UC patient should regularly screened yearly for Colon CA 8-10 year after diagnosis. We
dont screen for uveitis, erythema nodosum, spondyloarthropathy or sclerosing
cholangitis
4502
Medicine

Electrolytes
NEVER SCREEN FOR BLADDER CA
4513
Medicine
Nervous System
Brain abscess resulting from sinusitus usually is due to anaerobes like Strep Viridans..
(think like tooth abscess becoming brain abscess)
4517
Medicine
Infectious Diseases
S. aureus post viral pneumonia, causes acute necrotizing pneumonia with secondary
pneumatoceles, and necrotizing pulmonary bronchopneumonia with multiple nodular
infiltrates that cavitates and cause small abscesses
4519
Medicine
DONT forget postnasal drip in cHronic Cough.. also Asthma and GERD can do so
4520
Medicine
COPD patient can present with Pneumothorax if having catastrophic respiraatoy findings
and is usully due to dilated alveolar blebs that rupture into pleural space
4522
Medicine
antipsychotic causing Neuroleptic Malignant Syndrome presents wiith fever , muscle

rigidity and autonomic instability and mental status change ==> give DANTROLENE CZ
Exposure
SERUM CK IS HIGH SO U NEED TO RELAX MUSCLES
4523
Medicine
If acute dyspnea and dysphagia think upper obstruction
4532
Medicine
AAA screning: any 65-75 male actual or former smoker (at least one screening in a
lifetime)
4536
Medicine
In PEEP increase intrathoracic pressure so decreasure RA filling, so be careful with

heart disease
4564
Medicine
Degenerative joint disease = Osteoarthritis
& Sports
4565
Medicine
Rheumatology/Orthopedics Avascular necrosis (disruption of bone vasculature): Due to chronic steroid use and
& Sports
Excessive Alcohol.. Progressive anterior hip pain with limitation of range of motion
4566
Medicine
In afebrile acute bronchitis with no complications can just OBSERV And Follow up
4567
Medicine

Electrolytes
IN DISEASED ELEDERLY WHO ARE ON ACEi OR NSAIDs, HAVE A DECREASED

GLOMEULAR FILTRATION, and + they dont feel thirst.. beware
4574
Medicine
When RA affects the spine it affects the CERVICAL PORTION
& Sports
4576
Medicine
Rheumatology/Orthopedics In Ankylosing spondylitis can get ENTHESITIS which is pain at site of tendon and
& Sports
ligament attachment to bone.. Heel, tibial tuberosity, iliac crest
4578
Medicine
Rheumatology/Orthopedics Ankylosing spondyltis for long time (~2decades) cause decreased bone mineral density
& Sports
and Increased risk of bone fracture even with minimal trauma.
4583
Medicine
Baker cyst = inflamed synovium
& Sports
4585
Medicine
Polycystic Kidney do not have Proteinuria or Edema Secondary amyloidosis can occur
sexondary to chronic infection or diseases like IBD or RA.. Leading to enlarged LV,
& Sports
palpable kidney and hepatomegaly
4590
Medicine
Disseminated gonoccocal triad: Polyarthralgia Tenosynovitis Vesiculopapular rash
& Sports
4594
Medicine
In CHF get efferent renal eterioles constriction as a response of ATII as a result get a
high glomerular pressure
4603
Medicine
acute pancreatitis is a burn and causes fluid loss as any other inflamation with increased
vascular permeability in addition to release of pancreatic enzyme which cause further
vasodilation Mnemonic: since we give H2O to those patients, think that the also loose
water (other thand coz of burns) due to increase vascular permeability (LOL)
4613
Medicine
PE: Sudden, Chest pain, Tachycardia, Tachypnea (dyspnea) with Hemorrhagic (as Dr.
Sfeir once told us), Exudative pleural effusion (With no consolidation on CXR) (25% of
time it is a transudate coz no infarct happened)
4615
Medicine

Electrolytes
Disc herniation with autonomic dysfunction will cause urinary overflow incontinence and
loss of anal sphincter.. not retention
4617
Medicine
Asthma treatment: Inhaled albuterol PRN ==> Inhaled steroid ==> LABA ==> Oral
prednisone
4626
Medicine
Any liver disease wether hep C or not .. give hep A and hep B vaccines (if not given) If
anti HAV is positive cant tell if coz of immunity or infection.. check symptoms
4633
Medicine
Spleen kill bacterias via PHAGOCYTOSIS by dentritis cells in white pulp.. SPleen eats
these mofos
4634
Medicine
Infectious Diseases
Post splenectomty wait 2 weeks before or after Sx
4639
Medicine
Hemochromatosis cause PAncreas liver heart (sick sinus sindrome (conduction

problem) or dilated cardiomyopathy) testicles atrophy (loss of libido too) and bronze skin
4641
Medicine
Nervous System
MS acute episodes must be treated with steroids
4645
Medicine
COPD Increase TOTAL LUNG CAPACITY and DECREASES VITAL CAPACITY.. LIMITS
EXPIRATORY AIRFLOW
4646
Medicine
Weight loss is supper effective in HTN
4647
Medicine
Put IVC filter if reccurent DVT with therapeutic INR on warfarin, or if contraindication to
anticoagulant (but if fail to get therapeutic INR, change meds)
4649
Medicine
Warfarin reduces the risk of thromboembolityc events cause despite antiarrythmic u can
still have these emboli showering that were previously formed
4653
Medicine
Social Sciences
BRAIN DEAD EQUAL DEAD.. NO NEED LEGAL STUFF ARE NEEDED TO EXTUBATE
4659
Medicine
Paget is due to osteoclast dysfunction
& Sports
4663
Medicine
Chloride is exchanged with Bicarb if metabolic alkalosis compensation is needed
4665
Medicine
In COPD diaphragm flattens increasing the work of breathing
4668
Medicine
Endocarditis presentation
4676
Medicine
QT syndrome:congenital prolonged or shortened QT associated with deafness (+mild

chance of developing Afib) Afib with no cardiac or pulmo disease, think of DM,
Hyperthyroid, Obesity, Alcohol abuse, and stimulant abuse
4679
Medicine
In MI, can hear S4 like in hypertrophic cardiomyopathy because we have stiffness of the
Ventricles due to ischemia.
4685
Medicine
Dermatology
Firm, Flesh colored, domed shape, umbilicated apules are typical of MOLLUSCUM
CONTAGIOSUM due to Celluar immunodeficiency, Steroid use, Chemo, HIV
4693
Medicine
Dermatology
Hepes zoster may reappear after immunosupressant therapy (TNF alpha inhibitor:
infliximab) in a dermatomal fashion starting with erythematous papules then to vesicles,
bullaes the crusting a week later
4700
Medicine
Nervous System
confusion, ataxia, ophtalmoplegia (CAN) in malnourished alcoholics (homeless) :

Wernicke's ==> Treat with Thiamine before giving anything else even if malnourished
(Thiamine before Dextrose or worsen Wernicke's)
4706
Medicine
Acute ASTHMA COCKTAIL with low respiratory drive and muscles and respiratoy failure
INTUBATION VENTILATION SABA ANTICHOLINERGIC STEROIDS
4707
Medicine
Diastolic dysfunction is due to impaired ventricles relaxation which will diminish their
compliance and will cause left atria dilation and Afib.. upon lying will have backflow to
lungs and dyspnea ==> Treat with Diuretics and antihypertensives
4709
Medicine
IN HEMODYNAMICALY SVT: VAGAL MANEUVERS, ADENOSINE, CCB UNSTABLE: DC

CARDIOVERSION
4714
Medicine
Infectious Diseases
Infective endocarditis can cause splenic abscess causing pleuritic chest pain
4716
Medicine
Malignancy and Respiratory sx ==> Hypercoagulable state: PE's ==> Right heart failure
(RV dilation)
4718
Medicine
In COPD if u give too much O2 u will supress the drive for respiration (normally it is
dependant on CO2 but in COPD it becomes dependant on low O2) .. So lower
respiration and CO2 will accumulate and BAM seiures... etc (WEIRD SHIT)
4722
Medicine
high PTH cause HTN (WTF)
4725
Medicine
Only in Vtach Pulseless Electrical Activity DEFIBRILLATE, otherwise CPR
4726
Medicine

Metabolism
Grave's ophtalmopathy presents with impaired gaze and diploplia, with increase
retroorbital tissue (ct, muscularm adipose tissue and lymphocityc infiltrate).. risk factor
for ophtalmopathy is old (50 is old here) female smoker
4728
Medicine
With age baroreceptors get tired causing orthostatic decrease in BP
4730
Medicine
like my patient on 5 south: she stopped smokin but is still COPDer. On exacerbation we
gave her O2, bronchodilators, AB's and systemic steroids
4738
Medicine
Smoking and AAA is MAX association
4740
Medicine
In MI, if get water in lungs and regurg murmur it is due to papillary muscle ischemia or
rupture..
4742
Medicine
never use Beta Blocker with Asthma !!!
4747
Medicine
SAAG >1.1: Portal HTN <1.1:TB, Peritoneal CA, Pancreatic ascitis, Nephrotic syndrome
Bloody: Trauma, TB, CA Milky: Chylous or Pancreatic. Turbid: infectious PMNs: <250:
No peritonitis >250: Peritonitis Protein: <2.5; Cirhosis or Nephrotic (because loss or
inability to produce proteins) >2.5: Everything else In liver early stage we have ascites
due to venous pressure in Portal HTN, in cirhosis it cz low albumin
4749
Medicine

Electrolytes
Urinary outflow obstruction presents with flank pain, low volume voids with occasiona
High volume voids, and can cause renal dysfunction if bilateral
4750
Medicine

Electrolytes
In diabetic nephropathy you get Glomerular basement membrane changes, with

progressive GFR deecline. Pathologic hallmark is nodular glomerulosclerosis nodular or
diffuse
4751
Medicine

Electrolytes
Hematuria: Initial: Urethral Terminal: Bladder or Prostate Toral: Kidney or Ureter In

Kidney bleeding dont see clots
In acute pneumonia with consolidation patients can have persitent blood flow to areas
with impaired ventilation.. Positioning of patient with affected lung can worsen shunt (il
left consolidation shld not position him on his left side but on right to draw away blood
from poorly ventilated area)
Medicine
Pulsus paradoxus (drop in BP of >10 on inspiration) in pericardial fluid (Tamponade or

pericardial fluid by the same rationale we get variation in QRS; inspiration restricts LV
volume so lower BP), Asthma, COPD (coz inspiration will drop intrathoracic pressure by
much more than normally, so most of blood will be located in chest as in the lungs and
less to systemic circulation and BAM lower BP
4807
Medicine

Electrolytes
Interstitial cystitis (paiful bladder syndrome): idiopathic, chronic with Bladder Pain
worsened by filling and relieved by urination (a bit like IBS). Also get Dyspareunia and
Frequency Treat with Behavioral modification Amitryptilline and Analsegic for
exacerbations (Like fibromyalgia, IBS etc..)
4860
Medicine
ITP should make you suspicious for HIV and Hep C
4860
Medicine
Low Platelets with no know cause or no clues: Test For Hep C and HIV which commonly
cause ITP
4866
Medicine

Electrolytes
In metabolic alkalosis give normal saline infusion
4867
Medicine
Infectious Diseases
post flu pneumonia is Staph pneumonia (superimposed)
4902
Medicine
Otosclerosis is a common cause of conductin hearing loss in 20s and 30s
4909
Medicine
S4 comes just before S1 can even confuse it with S1 and think there is a murmur.. it
occurs from longstanding HTN causing LV hypertrophy MVP: mid systolic click and a late
systolic murmur heard best over the cardia apex
4770
4771
Medicine
4913
Medicine
Nervous System
Essential tremor: Bilateral action tremor of the hands, without leg involvement. No other
neuro signs, can present with head tremor without dystonia Parkinson: Resting tremor
and decrease with voluntary movements, involve legs and hands, and less commonly
facial involvement Cerebellar: with ataxia, dysmetria or gait disorder. Increases with
movement (finger to nose test) Physiologic: not vsible, increased with stimulants. Worse
with movements and can involve face and extr
4914
Medicine
Nervous System
Essential Tremor: Give Beta Blocker (caffeine not very much associated with the tremor)
4920
Medicine
PSVT: Dont see P waves Give Adenosine If sinus Tachycardia, see P waves So it most
likely Anxiety
4922
Medicine
Dependat effect = seen when increase rate QRS widening in IC : coz they have not time
to dissociate from the channels and will cause this widening (in normal rythm they have
time to dissociate before furthur rythms) PR prolongation in CCB: coz they cause
prolongation of the refractoy period of the AV node
4927
Medicine
Wathever is the case when someone is obtunded intubate even they talk about varice
bleeding.. Before u put a scope intubate
4934
Medicine
Drugs that cause esophagitis: Aspirin, NSAIDs, Alendronate, Tetracycline, KCl Fe

Quinidine
4938
Medicine
Infectious Diseases
Histosplasma in Central and South US diagnosed in urine, bone marrow if affecting it, or
antigen but less sensitive and takes more time. Treated with amphotericin in AIDS or
itraconazole (usually in immunocompetant pple)
4938
Medicine
Infectious Diseases
Histoplasma is diagnosed through urine testing
4939
Medicine
Infectious Diseases
Trest H(I)stoplasma with (I)troconazole
4940
Medicine
Salvage therapy is complementary post surgery, unlike Adjuvant is used if surgery fails
8331
Medicine

Electrolytes
Trimethoprim cause Hyperkalemia (blocks epithelial sodium channel in collecting

tubule).. and inhibitis with Cr filtration giving HIGH Cr but with no change in GFR
8819
Medicine
THINK of coarctation if epistaxis, headaches, LVH with ST and T waves changes and
QRS increased voltage in left heart, HTN
8822
Medicine
Substance Abuse
Delayed (wake up late like chris who is always delayed)or Advanced (sleep early like ME
i am advanced) sleep phase syndrome are independant of socoal stress or job etc.. if
depends on activity etc. it is poor sleep hygiene
8823
Medicine
Substance Abuse
Advanced sleep phase disorder: like Chris canot wake up well in morning Delay sleep
phase syndrome: Cannot sleep early like Chris too
8866
Medicine
Infectious Diseases
Quinolones can cause tendinopathies with Achilles most common (on average 8 days
after the drug started, but can start as soon as 1 day).. Patient shld stop the drug avoid
exercice..
8876
Medicine

Metabolism
Wilson and hemochromatosis can lower blood calcium!!! but with normal to low PTH
(NOT HIGH LIKE EXPECTED)
8880
Medicine
Infectious Diseases
HACEK Endocarditis like other endocarditis come fom oral infection
8894
Medicine
Best screening test for thalassemia in preconception is CBC (THUG LIFE!!)
8905
Medicine
Sometimes asthma can presents first time in ADulthood How to tell Asthma from COPD:
Diffusion capacity (DLCO): Reduced in COPD, Normal in Asthma
8918
Medicine

Metabolism
Risperidone causes hyperprolactinemia but doesnt affect rest of axis like thyroid..
8925
Medicine
Ophthalmology
Viral conjuctivitis or pink eye is self limited and just need cooling and moisting
8929
Medicine

Electrolytes
Cystoscopy: Gross hematuria with no glomerular disease Microscopic hematuria with no

glomerular disease or infection and increase risk of CA Recurrent UTIs Obstructive
symptoms Irritative symptoms without UTI Abnormal imaging or urine cytology
8959
Medicine
Infectious Diseases
If candida eosophagitis u see oral thrush.. otherwise viral
9885
Medicine
Infectious Diseases
Cryptoccocal (no MRI findings) is chilling meningitis in AIDS unlike HSV (see temporal
involvement in MRI) JC (white matter patchy area suggesting demylination on MRI) or
Toxo who presents with ring lesion
10145
Medicine
Poisoning & Environmental Cyanide block oxidative phosphorylation and promote anaerobic metabolism causing
Exposure
LACTIC ACIDOSIS, by binding to ferrous in cytochrome oxidase a3 in mitochondrial ETC
10146
Medicine
smoke inhalation victims can get cyanide toxicity and shld be treated empirically with
HYDROXOCOBALAMIN or SODIUM THIOSULFATE or with nitrites to induce
Exposure
METHEMOGLOBINEMIA
10179
Medicine
CCB can cause peripheral edema
10287
Medicine

Electrolytes
Hematuria suggest GLOMERULAR DIASEASE IF have PROTEINURIA, DYSMORPHIC

RBC and RBC casts (usually microscopic hematuria unlike non glomerular)
10434
Medicine
Rheumatology/Orthopedics Pyoderma gangrenosum: Purulent base painful ulcer with violaceous borders,
& Sports
Associated with IBD
10485
Medicine
Dermatology
HPV CAN DO PLANTAR WARTS (FOOT) IN YOUNG AUDLTS OR

IMMUNOCOMPROMISED
10553
Medicine
Dermatology
Autoimune alopecia areata: round loss Pressure induced alopecia: is post op..
Trichotillomania: is due to hair plucking but dont get regular loss pattern Tinea capitis:
Scaly, erythematous, with residual black dot. Possible painful lymphadenopathy. In
Blacks. (Human to Human, or formite transmission) Diagnosed with KOH .. treated with
Griseofulvin
10763
Medicine
Nitroprusside for long time = CN toxicity: lactic acidosis, seizure, coma, alterend mental
status ==> treat with amyl nititre.. or glutathione
10764
Medicine
Constrictive pericarditis: Important cause of Right heart failure with progressive edema,
ascites, elvated JVD and pericardial knock (middiastolyc sound) and pericardial
calcification on CXR
10767
Medicine
Scleroderma crisis: Acute renal failure,, proteinuria malignant HTN microangiopathic

hemolytic anemia: thrombocytopenia and fragmented RBCs
10904
Medicine
Infectious Diseases
In TNF antagonis beware of live vaccines like MMR, Varicella, yellow fever, and
intranasal influenza. Meningococcal shld be give at 11 and regiven at 16 if high risk of
first year college give back above 21 if high risk
2330
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
In lower abd pain: Do HCG before any workup
2345
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Palpable breast mass: If below 30 do only US if above do Mammo (+/- US).. if cyst do
needle aspiration (not obliged) if suspicius for malignancy or complex cyst (solid mass)
do image guided core biopsy
2362
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Fat necrosis has similar radiographics than breast cancer, including skin or nipple
retraction and calcifications on mammography. Biopsy will reveal fat globules and foamy
histiocytes in fat necrosis. DONT TREAT
2372
Obstetrics
Pregnancy, Childbirth &
&
Puerperium
Gynecology
Post tonic clonic seizure can have Erb duchenne like presentation due to posterior
shlder dislocation
2389
Obstetrics
&
Puerperium
Gynecology
All ladies with abscence of menses for more than 1 month should be evaluatd for
pregnancy wathever are the season
2391
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Endometrial biopsy is indicated for evaluating abnormal uterine bleeding in: Women >45
and all postmenopausal women Women age <45 with persistent symptoms or risk
factors fo endo CA like (obesity, diabetes, unopposed estrogen exposure, PCOS, early
menarche/late menopause) Prolonged amenorhhea with anovulation
2392
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Combined OCP reduce BREAST, OVARIAN and ENDORMETRIAL CA but increase BP
2393
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Copper intrauterine device can be used within 3-5 days of unprotected intercourse and
is effective fro precoital or postcotal with 99% efficacy. OCP are less effective (good for
emergencies)
2394
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Primary dysmenorrhea is normal crampylower abdominal/back pain during menses

which is due to prostaglandin release and is normal. Endometriosis triad: Pain (peaks
before menses), Dyspareunia, infertility Fibroids: Heavy menses with clots, constipation,
urinary frequency, pelvic mass/heaviness, enlarged uterus on exam Adenomyosis:
Dysmenorhhea, pelvic pain, menorrhagia, bulky globular & tender uterus Pelvic
congestion: Dull pelvic ache that worsens with standing + Dyspareu
2398
Obstetrics
&
Electrolytes
Gynecology
Stress incontinence: Do Kegel exercicie to strenghten base of pelvis, and do

urethropexy by adjusting angle of urethra It can be diagnosed by a cotton swab insertion
intro urethral orifice showing an angle of >30degree upon increase in intrabdominal
pressure Oxybutinin is given in urge incontinenece (detrusor hyperactivity; sudden urge
to urinate not related to increase intaabdominal pressure)
2404
Obstetrics
&
Metabolism
Gynecology
Oral glucose tolerance testing shld be performed in all pregnant ladies at 24-28 weeks
of gestation to screen for gestational diabetes
2405
Obstetrics
&
Gynecology
Amniotic flui embolism syndrome typically present with rapid onset respiratoy failure,
severe hypotension and DIC, during labor or immediate postpartum period. Clinical dx
and Supportive management.. Bad condition with poor outcomes
2406
Obstetrics
&
Gynecology
Bilateral lower leg edema is normal in pregnancy.. Always be suspicious for DVT but if
no signs just send patient home
2407
Obstetrics
&
Puerperium
Gynecology
Placental abruption: (bleed in 80% of cases) Abdominal pain Uterine tenderness Uterine
contractions with increased tone Recurrent late or variable decelrations with
bradychardia and does not improve with resucitation measures
2408
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Raloxifene: Antagonist in breast and vagina (good) Bone tisue agonist also good BUT
BUT not so fast, it INCREASES RISK of thromboembolism
2409
Obstetrics
&
Puerperium
Gynecology
Asthma drugs like inhaled beclamethasone or albuterol are safe during pregnancy
2410
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Tamoxifen Antagnist on breast tissues Agonist on endometrium (increase risk of CA)

Decrease risk of osteporosis
2411
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Transvaginal US is better than Transabdominal US for ectopic diagnosis, and should be

performed when BHCG are between 1500-6500 (coz below 1500 not visible.. a doubling
bHCG every 2 days is normal pregnancy if rise is slower suspect abnormal pregnancy..
2412
Obstetrics
&
Puerperium
Gynecology
Breech presentation before 37weeks is normal, and these convert to vertex by 37 week
usually. External cephalic version is indicated after 37 weeks if still breech--> IF fail-->
Csection must be planned
2413
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
PCOS patient have unbalanced estrogen (no progesterone) resulting in endometrial

hyperplasia and potential endometrial CA
2415
Obstetrics
&
Puerperium
Gynecology
Pregnancy luteomas and thea lteum are most common causes of hyperandrogenism in
pregnancy. Luteomas:Solid masses on US + virilization. DONT MANAGE Theca Luteum:
Cysts and unlikely will cause virilization If underlying cause is molar pregnancy do D&C
2416
Obstetrics
&
Infectious Diseases
Gynecology
PID: inpatient: If high fever, failure to respond to PO antibiotics, inability to take PO due
to nausea, vomiting, pregnancy, and people with noncompliance risk GIVE cephalo +
doxy
2418
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
In women with AUB do endometrial biopsy. If hyperplasia with no atypia give Progestin
(no mixed OCP to Obese >35 women to avoid DVTs.. ) If have atypia do Hysterectomy
2419
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
PMS: mood swing, irritability, fatigue, bloating and breast tenderness. Sx occur in the
1-2 weeks prior to menses and resolves with onset of menstrual flow. Dx is confirmed by
menstrual diary Tx: first line is SSRI (intermitently of continuously throughout cycle)
2420
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Vaginismus (pain and tightness upon intercourse): Tx with relaxation techniques, Kegel
exercices (relax vaginal muscles) and insertion of objects gradually increasing in size to
encourage desensitization
2423
Obstetrics
&
Metabolism
Gynecology
Grave's in pregnancy: TSH antibodies cross placenta. So baby will have it Affected
infant: Irritable, tachucardic, does not gain weight --> Give beta blocker and
Methimazole until symptoms subside
2523
Obstetrics
&
Puerperium
Gynecology
Placenta previa: Risk factor: Prior placenta previa, Csection or uterine surgery,
multiparity and advanced age Painless 3rd trimester bleed with uterine contraction Dx:
transabdominal US followed by transvaginal (dont do digital exam) The lack of
abdominal pain r/o placental abruption (ischemic pain.. )
2525
Obstetrics
&
Puerperium
Gynecology
In previa, hen bleeding and mom's vitals cannot be controlled do immediate Csection
even if <34, and may discover accreta during surgery which can be the cause so must
do hysterectomy. Reason can be uterine atony, DIC or placental abruption.. Give
steroids and wait if situation stabilises
2527
Obstetrics
&
Puerperium
Gynecology
Painful 3rd trimester vaginal bleed with hypertonic uterus is mostl likely abruption risk
factor: HTN, smoking, cocaine..
2528
Obstetrics
&
Puerperium
Gynecology
Placental abruption: Risk factor: HTN, trauma, cocaine, cigs Presentation: Sudden
vaginal bleeding, Abdominal/back pain, high frequency low intensity contractions,
Hypertonic tender uterus US to r/o previa: but if mentionned recent US was normal go
immediatly for management If stable >34 NVD trial Unstable or bad fetal heart rate:
Csection
2530
Obstetrics
&
Puerperium
Gynecology
Placental abruption: risk factors: Maternal HTN, preeclampsia, eclampsia, abdominal

trauma, prior abruption, cocaine, tobacco Presentation: Sudden onset vaginal bleeding,
abdominal or back pain, high frequency, low inensity contractions, hypertonic tender
uterus Dx: by clinical presentation, US to r/o previa. Tx: Unstable or low fetal heart
rate--> Csection Stable: >34 NVD trial
2531
Obstetrics
&
Puerperium
Gynecology
Symptomatically uterine rupture can be discerned from placental abruption in that baby's
position (station) will change and may feel abdominally his organs passing through the
rupture Risk of Placenta accreta is also increased with previous Csection (when uterus is
next to scar)and can also cause bleeding..
2532
Obstetrics
&
Puerperium
Gynecology
Uterine rupture: Risk factors: Uterine scars or abdominal trauma Sx: Sudden onset
abdominal pain, fetal heart rate abnormalities, and recession of babie's position when in
active labor.
2533
Obstetrics
&
Puerperium
Gynecology
Antepartum bleed: Normal: Intermittent pain with contraction, cmall amount of

blood-tinged mucus Placental abruption: Sudden-onset vaginal bleeding, abdominal
pain, hypertonic/tender uterus Placenta previa: Painless vaginal bleed, low lying
placenta Uterine rupture: Sudden-onset vaginal bleeding, constant abdominal pain,
cessation of contraction, palpable fetal parts, fetal deterioration Vasa previa: Painless
vaginal bleed occuring on ROM, fetal deterioration (bradycardia.. )
2535
Obstetrics
&
Puerperium
Gynecology
If pregnant bleeds a lot, and hemodynamically unstable give her IV fluids first if still bad
go for Csection not NVD as it can be previa..
2536
Obstetrics
&
Puerperium
Gynecology
Incomplete abortion: Bleeding, partial passage of tissue (open cervix). If

hemodynamically stable Tx: expectant, misoprostol or D&C
2541
Obstetrics
&
Puerperium
Gynecology
Spontaneous abortion (mscarriage) can be managed with expectant management,

prostaglandin (not oxytocin coz nt enough oxytocin receptors early in pregnancy) or
surgery D&C which is manadatory if hemodynamically unstable.. If abortion become
septic take blood and endometrial cultures and start on broad spectrum
2542
Obstetrics
&
Puerperium
Gynecology
Check For complete incomplete threatened abortion pictures..
2543
Obstetrics
&
Puerperium
Gynecology
After any procedure or incident there is possibility of feto maternal blood mixing. so give
give Rhogam within 72 hrs in unsensitized Rh negative women.
2544
Obstetrics
&
Puerperium
Gynecology
The only difference between inevitable and complete abortion is that in complete
abortion the cervix has closed.
2545
Obstetrics
&
Puerperium
Gynecology
Septic bortion: retain products of conceptions it can be also missed, incomplete or

inevitable abortion (rare).. Fever, chills, lower abd pain, bloody or purulent vaginal
discharge, Boggy, tender uterus with dilated cervix. See on US retained product of
conception, increased vascularity, echogenic material in the cavity, thick endometrial
strie.. Give IV antibiotic (and cultures of blood and endometrium) + D&C and
hysterectomy if fully complicated.. Bad complications
2546
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Endometriosis (also endometrioma in ovary) is a common cause of: infertility and

chronic pelvic pain. Dx by laparo then Bx
2549
Obstetrics
&
Puerperium
Gynecology
In Fetal demise shld induce mother into laber. Fibrinogen and platelets are in the low
normal range indication begining of DIC
2552
Obstetrics
&
Substance Abuse
Gynecology
Pseudocyesis Women presents with sx and signs of pregnancy (amenorrhea, breast

and abdominal enlargment, morning sickness, weight gin, sensation of fetal movement
and reported positive urine pregnancy test per the patient) In clinic no pregnancy It is
seen in women with strong desire to become pregnany. Depression caused by this
condition will cause hormonal changes similar than those in pregnnacy Form of
conversion disorder (psych evaluation)
2561
Obstetrics
&
Puerperium
Gynecology
If have Hypermagnesemia while treating severe preeclampsia with delayed DTR stop it
and give calcium gluconate
2567
Obstetrics
&
Puerperium
Gynecology
Elevated AFP is seen in: neural tube defects, gastroschisis, omphalocele, and multiple
gestation (in this case look for do not adequate estimate of date revieling multiple
gestation).. Do US to evaluate anatomy etc.
2568
Obstetrics
&
Puerperium
Gynecology
If abnormal quad screen do US to check natomy. then amnio if 16-20 or chorionic if

10-13
2572
Obstetrics
&
Nervous System
Gynecology
Fetalhydantoin syndrome (Phenytoin use) Small body size, microcephaly, digital and nail
hypoplasia, midfacial hypoplasia, hirsutism and cleft palate and rib anomalies
2607
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Paget of breast: eczematous rash near nipple that does not improve with topical
treatment (usually have underlying AdenoCa)
2608
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
In HER2 (+) Ca, which require Trastazumab aka Herceptin (adjuvant or for metastatic
disease) It causes CARDIOTOXICITY, particularly if low EF so do echo before
administration of drug
2611
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
In fibrocystic disease, aspirate cyst (shld show clear fluid and mass deisspearance
otherwise do bx) then observe for 4 to 6 weeks
2612
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
In breast CA. FISH immunohistochemical staining will detect or not oncogene HER2
which is responsive to trastuzumab and anthracycline chemo
2613
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Screening for ovarian cancer with CA125 and pelvic US is not recommended unless
have some genetic predisposition such as BRCA
2804
Obstetrics
&
Puerperium
Gynecology
In pregnancy: High progesterone stimulates respiratory centers in brain to cause

increase tidal volume, increased minute ventilation, increased PaO2, so get a
physiological compensated respiratory alkalosis
2925
Obstetrics
&
Gynecology
Pruritis, high bile acids, high liver enzymes = intrahepatic cholestasis of pregnancy. Dx of
exclusion. Jaundice is uncommon (if there, need futher workup..)
3106
Obstetrics
&
Puerperium
Gynecology
Vaccines in pregnancy Routine: Tdap, inactivated influenza Special circumstances:

HepB, HepA, Pneumococcus (2n,3rd trimester), Hflu, Meningococcus (in addition to high
risk if 19-21 livingin dorms), Rhogam Not recommended: HPV, MMR (but not a big deal
if was given by mistake, dont treat), Varicella. Live influenza (in the last 3 avoid 4 weeks
before pregnancy)
3110
Obstetrics
&
Puerperium
Gynecology
IF low or absent fetal movement felt by mom fo Non Stress test..
3111
Obstetrics
&
Puerperium
Gynecology
Non stress test shld be perfrormed at least weekly in the third trimester especially if
there is maternal comorbidities as HTN.. Normal: >2 acceleration Abnormal: <2
accelerations or recurrent variable or late deceleration
3112
Obstetrics
&
Puerperium
Gynecology
Late term pregnancies are at risk for uteroplacental insufisciency: Antenal surveillance
should begin at 41 weeks gestation to detect fetal compromise suggested by abnormal
heart rat patterns, decreased fetal activity and oligohydramnios
3116
Obstetrics
&
Puerperium
Gynecology
Arrest of labor: no cervical change for >4hrs despite contractions OR no cervical

changes for >6hrs with inadequate cotraction Here give Oxytocin otherwise observe..
3118
Obstetrics
&
Puerperium
Gynecology
Women with breech presentation >37 shld try externla cephalic version. Avoid ECV if
Oligohydramnios, Placental abnormalities (previa, abrupto), Hyperextended fetal head,
Fetal or uterine anomaly, Multiple gestation
3120
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Check table differentiating fibroids, adenomyosis...
3269
Obstetrics
&
Puerperium
Gynecology
Preterm labor <34 weeks shld receive TOCOLYTICS (ccb, bb) MgSO4 for
neuroprotection and STEROIDS for lung maturity
3271
Obstetrics
&
Puerperium
Gynecology
False labor (in last 4-8 weeks of pregnancy) Irregular contractions are felt in lower
abdomen, occur at a stable interval (in true labor become more frequent). These are
relieved by sedation unlike real labor GO HOME BITCH
3273
Obstetrics
&
Puerperium
Gynecology
In severe congenital anomaly (renal agenesis.. ), and PROM. Labor shld be allowed to
proceed even if very early in gestation since baby is not gna live anyway
3274
Obstetrics
&
Puerperium
Gynecology
L/S < 2 = lung immaturity. Before 34 weeks ROM shld be treated with steroids
3275
Obstetrics
&
Puerperium
Gynecology
Fetal distress (late deceleration etc. ) : C section urgently, even if premature
3277
Obstetrics
&
Puerperium
Gynecology
GBS: Screening: 25-37 weeks Indication for prophylaxis with penicillin Prior birth to an
infant with early ONSET GBS GBS bacteuria of UTI at any time during pregnancy
Unknown status with 1 of the following: <37 weeks, intrapartum fever or ROM for >18 hrs
3278
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Ultrasound dating with fetal crown-rump measurement in the first trimester is the most
accurate way to determine estimated gestational age. It should not be changes if have
contradictin values in 2nd and 3rd trimester. In other words early in pregnancy standard
for giving an estimated age are more accurate since all babies will almost be alike..
3279
Obstetrics
&
Puerperium
Gynecology
Cause of intrauterine growth restriction: Vascular diseases, HTN(asymemetric fetal

growth restriction), aneuploidy, intrauterine infection and substance abuse (cocaine)
3280
Obstetrics
&
Puerperium
Gynecology
Symmetric growth restriction is caused by Fetal anomalies Abnormal fetal karyotype

Early maternal infection Asymetric (usually appear late in pregnancy) Vascular disease
HTN DM Smoking
3281
Obstetrics
&
Puerperium
Gynecology
Oligohydramnios is a common complication of late term and postterm pregnancies (if

low amniotic fluid shld induce) THINK of it as in the baby is getting bigger so is taking
place of amniotic fluid Long term pregnancies risk Fetal: Oligo, meconium aspiration,
stillbirth, macrosomia, convulsion MOM: Csection, infection, post partum hemorrhage,
perineal trauma
3337
Obstetrics
&
Puerperium
Gynecology
In pospartum settings: Low grade fever, Leukocytosis and vaginal discharge are normal
findings. Initially bloody discharge, then serous and finally white to yellow in color days
following delivery..
3338
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
When breast is congested in a lactating women that is not breastfeeding, do not

frequently empty breast as it would induce more prolactin and milk production..and dont
give estrogen as it will increase risk of thromboembolism DO weartight fitting bra, avoid
nipple stimulation and use ice packs and analsegics.. This will also supress milk
production
3339
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Lactation is not a reliable Contraception method so give these women Progestin only
since combined OCP may decrease milk production
3340
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
LAcating women have prolactin which will inhibit GnRh hich will decrease FSH and LAH
==> anovulation and amenorrhea.
3359
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Do PAP smear starting 21 OCP side effects: those that improve with continued use:
nausea, bloating, breast tenderness those who are unrelated to course: Breakthrough
bleeding (most common, and usually when estrogen is low.. ) HTN, increased risk for
cervical cancer, Venous thromboembolism, amenorhhea.. NOT weight gain
3365
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Structural abnormalities in uterus or fallopian tubes are assessed by a

hysterosalpingogram: Risk factor for tubal disease: PID
3367
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
in PCOS give Clomiphene citrate to induce ovulation metformin also is good to be given
3368
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Premature ovarian failure: Amenorrhea (3 month of duration), hypoestrogenism, High

GnRH in women <40 Important to diagnose to prevent osteoporosis cause: follicular
atresia or low initial number of primodial follicles, mumps, oophoritis, irradiation or
chemo. Some autoimmuneAssociated with Hashimoto, Addison, Type I DM, Pernicious
anemia If desire pregnancy do InVitro with donor oocyte
3370
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
In ovulatory phase unlike other stages, mucus is thin, pH 6.5 or higher (more basic than
usually) and demonstrate "ferning" on microcope smear
3371
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
In hypogonadotripic hypogonadism (severe exercice, severe stress, eating disorder.. )

as amenorrhea cause give GnRH pulsatile therapy to induce ovulation and fertility
3480
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Mittelschmerz phenomena occurs in midcycle (with no other problems cycle normal nor
fever..) The pain results from ovulation itself (unilitareal at side of ovulation)
3639
Obstetrics
&
Infectious Diseases
Gynecology
Gonococcal cervicitis: Mucopurulent discharge and Friable cervix with easy bleeding Dx:
Nucleic acid amplification testing Treatment: #3d Cephalo + Azithro or Doxy (to cover for
chlamydia too)
3656
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Nystatin for oral candidiasis. In vaginal (pseudohyphae on wet mount..) give

Fluconazole. (parteners dnt need to be treeated)
3676
Obstetrics
&
Infectious Diseases
Gynecology
Toxo triad: chorioretinitis, hydrocephalus, intracranial calcifications
3678
Obstetrics
&
Infectious Diseases
Gynecology
HIV: prenatally start mom with 3 HAART drugs and prophylaxis AB's when <200CD4,
and avoid amniocentesis (test HIV load avery 3 months) Intrapartum management,
avoid artificial ROM, fetal scalp electrode or any kind of instrumentation IF mom not on
HAART give zidovudine, and if viral load above 1000 do Csection too After birth give
infant Zidovudine for>6weeks plus serial HIV PCR testing
3679
Obstetrics
&
Infectious Diseases
Gynecology
Trichonomas (flagellated) vaginitis: vaginal, malodorous (fishy), thin, frothy and yellow
green discharge (pH>4.5) Candida: significant vulvar inflamation and thic vaginal
sichage (normal pH) odorless (cottage cheese like)
3682
Obstetrics
&
Infectious Diseases
Gynecology
Trchonomas: thin vaginal discharge, erythematous vaginal mucosa, motile pear shaped
organisms on wet-mount Tx: Metronidazole
3707
Obstetrics
&
Infectious Diseases
Gynecology
Gardenella = profuse gray malodorous (fishy odor accentuated with KOH) discharge
with pH 5 to 6.5. See clue cells (epithelial cell coateed with bacteria) on wet mount prep.
Itching and burning are not usual. Give metronidazole
3745
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Vaginal cancer sx: Malodorous, bloody vaginal discharge. Irregular mass, plaque or
ulcer on vagina SCC: >60, HPv (16,18), cigarette use (same risk factor as Cervical CA)
and involve upper third of posterior vaginal wall. Dx by Bx Clear cell adenoCa: <20, in
utero DES exposure, involve upper third of ANTERIOR vaginal wall. Dx by BX
3748
Obstetrics
Social Sciences
&
Gynecology
A pregnant women takes whatever decision she wants even if she puts her fetus is
danger, as long as she is competent
3757
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Ggenital warts (condyloma acuminata) HPV presents as clusters of pink skin colored
lesionswith a smooth teardrop appearance on genitalia. Patients are asymptomatik, but
pruritis pain and bleeding are all possible. Acetic acid will turn them white If smal
Trichloroacetic acid or podophylin will remove them. If large excision or fulguration
(electric current) is applied. Regardless of treatment there is high recurrence rate
3814
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Menopause Increased FSH, LH with FSH/LH >1
3862
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Endometriosis: Chronic pelvic pain, dyspareunia, infertility, sometimes bowel/bladder

problems. Tx: NSAIDs, OCP, Progestins, GnRH agonists. If complicated, or refractory to
treatment do sx
3869
Obstetrics
&
Puerperium
Gynecology
Most cases or recurrent variable decelration is managed with O2 and change in

maternal position. It is abrupt and less than 30 sec from nadir of contraction (what i
wrote in other note is wrong)
3914
Obstetrics
&
Gynecology
If have HTN while taking OCP, stop the meds as it can reduce the BP. And dont give
OCP to HTN women
3953
Obstetrics
&
Puerperium
Gynecology
Anorexia complications: Osteoporosis, high cholestrol and carotene, cardiac arrythmia

(prolonged QT interval), euthyroid sick syndrome, Hyothalamic axis fucked up and
androgen deficinecy, hyponatremia due to excess water and other electrolyte
abnormalitites due to purging. Women with current or previous anorexiaare at risk for
miscarriage, IUGR, hypermemesis gravidarum, premature birth, Csection and
postpartum depression
4122
Obstetrics
Rheumatology/Orthopedics Osteoporosis risk factors: Advanced age, Menopause Thin body, Malnutrition Cigarette
&
& Sports
Alchol in enxcess Steroids Family history Asian, Caucasian
Gynecology
4124
Obstetrics
&
Metabolism
Gynecology
In pregnancy Free T4 increase and TSH decrease therefore, since there is an increase
in thyroid globulin binding protein. (Dont forget that also TSH is affected)
4135
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
HCG (by syncitiotrophoblast) preserves corpus luterum until the placenta produces
progesterone itself
4136
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Menopause (similar sx as hyperthyroid) Irregular, absent menses Heat intolerance

flushing insomnia, night sweats Shld check serum TSH and FSH levels
4146
Obstetrics
&
Puerperium
Gynecology
One side effect of epidural is Hypotension (10%) due to blood redistribution to Lower
extremities (venous pooling) from symathetik blockage down there==> can result in
decreased placental perfusion and fetal acidosis so give IV prior to anesthesiato expand
intravascular volume and positioning to left to improve venous return, and can resort to
vasopressor if need to Leakage of CSF is when by mistake puncture dura, so patient will
have postural headache (LP) not hypotension
4148
Obstetrics
&
Electrolytes
Gynecology
BUN and Cr decrease in pregnancy as there is an increase renal plasma flow and
glomerular filtration rate
4149
Obstetrics
&
Metabolism
Gynecology
In obese menopausal women u have conversion of androgen to estrogen in fat !! mider

menopausal sx
4156
Obstetrics
&
Infectious Diseases
Gynecology
Pregnant with syphyllis: Give penicillin, if allergic desensitize If untreates: stillbirth,

neonatal death, mental retardation
4162
Obstetrics
&
Gynecology
ABO incompatibility causes less severe hemolytic disease of newborn (most are
asymptomatik with mild anemia and neonata jaundice successfully treated with
phototherapy) than Rh(D)
4174
Obstetrics
&
Puerperium
Gynecology
Newborn care: Removal of airway secretions Drying the infant and keep it wrm
Erythromycin in eye, Vit K supplementation
4193
Obstetrics
&
Gynecology
Rhogam (anti-D antibodies) must be low in a women even after delivery of Rh(+) if high
it is due to inadequate Rhogam infusion after delivery.. Kleihaue Betke test is done to
determine the ammount of fetal blood in moms circulation to know how much rhogam
we shld give her
4194
Obstetrics
&
Gynecology
Infertile couple: After Hx taking take semen analysis (easy cheap r/o male factor)
4220
Obstetrics
&
Metabolism
Gynecology
Seconday amenorrhea is abscence of menses for >3cycles or >6 months in women who
menstruated previously Workup: BetaHCG, followed by PROLACTIN, TSH and FSH (for
premature ovarioan failure)
4221
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
TRH stimulates prolactin production .. (so hypothyroid --> Hyperprolactin)
4223
Obstetrics
&
Puerperium
Gynecology
(2n 3rd trimester)Hyperinsulinemia due to hyperglycemia cause -Increase metabolic

demand-> Hypoxemia-> Erythropoiesis-> Polycythemia -Organomegaly: Heart, liver..
-Macrosomia: Shoulder dystocia -Neonatal hypoglycemia In first trimester you get
Congenital heart disease, neural tube defects, small left colon syndrome or even
spontaneous abortion
4225
Obstetrics
&
Electrolytes
Gynecology
EPidural anesthesia in labor impairs bladder function causing urinary retention and
overflow incontinence. Put short term indwelling catheter
4242
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
If young lady presents with a lump ask her to return after menses to check if it has
regressed
4245
Obstetrics
&
Puerperium
Gynecology
Sheehan syndrome: Failure to lactate, hypothroid.. due to ischemic injury to puituitary

pospartum..
4272
Obstetrics
&
Infectious Diseases
Gynecology
Give Hep A and B vaccines in pregnancy if potential risk that mom infected..
4283
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Athletes with extreme exercicing will have rreduce GnRH, FSH, LH and hence reduced
estrogen producing amenorrhea associated with infertility, vaginal atrophy, breast
atrophy and osteopenia
4294
Obstetrics
&
Electrolytes
Gynecology
Renal colic in pregnancy is done with ultrasound not CT (low dose CT may be done if
2nd,3rd trimester)
4472
Obstetrics
&
Infectious Diseases
Gynecology
UTI in pregnancy: GIVE: NITROFURANTOIN, AMOXICILLIN, AUGMENTIN,

CEPHALEXIN AVOID Tetreacycyline, fluoroquinolone or TSM-SMX
4496
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Aromatase deficiency: prevents the conversion of androgens to estrogens. Virilization of

the XX kid so affected girl have normal internal genitalia with ambiguous external
genitalia, and low estrogen leading to high FSH (as feedback)
4528
Obstetrics
&
Puerperium
Gynecology
Anti D shld be given at 28-32 weeks and after delivery --> To prevent antibody formation
4529
Obstetrics
&
Puerperium
Gynecology
TO do tests in pregnancy All: cervical cytology (nway doin it), Rh and antibody screen,
CGC(for Hb MCV..), Rubella Varicella immunity checking, Urine culture, Syphyllis HepB
Chlamydia HIV tests, Flu vaccines before season, Offer Cystic fibrosis genetic screen..
Patients at risk: Thyroid function (family hx or if have diabetes type I..), TB, Toxo, Hgb
electrophoresis (for sickle cell), Lead level if at risk, Gonorhhea (<24, new partners, hx
of STDs)
4530
Obstetrics
&
Puerperium
Gynecology
Routine screen in pregnancy Syphillis, HepB, HIV. Gonorhhea, Chlamydia if <25 or at

risk. Hep C if at risk
4543
Obstetrics
&
Metabolism
Gynecology
Physiologic galactorrhea: Bilateral, milky or yellow, brown, gray or green.

Hyperprolactinemia is most common cause. Order prolactin, TSH, possibly MRI If
unilateral bloody (gross or occult) nipple discharge, palpable abnormalities or skin
changes evaluate for malignancy
4636
Obstetrics
Rheumatology/Orthopedics Estrogen depolymerize ground substance which cause interstitial edema in thands and
&
& Sports
face.. Can cause Carpal Tunnel that you treat with steroids
Gynecology
4666
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Bilateral breast tenderness and swelling during breatfeeding (onset 24-72 hrs post
partum peaks 3-5 days after delivery) is BREAST ENGORGMENT AND RESOLVES
SPONTANEOUSLY.. (unlike mastitis which is unilateral and presents with fever' plugged
cyst do dont fever)
4715
Obstetrics
&
Gynecology
Some women with previous sore throat when children may have rheumatic fever that is
silent.. It becomes apparent during pregnancy with mitral stenosis (LA enlargement and
possible Afibs), dyspneic with pulmonary edema
4734
Obstetrics
&
Gynecology
Rubella is teratogenic in first trimester. Triad of cataract, PDA, sensorineural hearing

loss. IUGR and purpura also. PRotect by maternal vaccination prior to conception
4735
Obstetrics
&
Puerperium
Gynecology
Osteogenesis imperfecta: Autosomal dominant disease (mutation in type I collagen). In

severe type II babies die in utero due to multiple fractures. They have limb deformities,
growth retardation, multiple fractures and blue sclera
4745
Obstetrics
&
Puerperium
Gynecology
Stillbirth management: 2nd trimester: D&C, induce labor or spontaneous NVD 3rd
trimester: Induce labor +/- cervical ripening agents, spontaneous NVD, Csection if has a
hx (even if has a hx shld consult cz less risk with NVD)
4756
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Most common cause of decreased fertility in women in their 4th decade who are still
having their cycle is AGE RELATED DECREASED OVARIAN RESERVE
4757
Obstetrics
&
Puerperium
Gynecology
In unknown GBS status with PROM, give penicillin prophylaxis (if >18hrs). If >34 weeks
delivery is recommended Give steroids if <32 (btw 32-34 grey zone)
4758
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
In pregnant lady with high grade squamous intraepithelial lesion on Pap smear -->
Colposcopy--> if (-) repeat cytology and colposcopy after delivery Cervical biopsy and
loop electrosurgery are not encouraged during surgery unless there is urgent need in
cases of lesions suggestive of invasive cancer
4759
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
For pregnancy to be seen on US BHCG shld be 1500-2000. If <1000 both BHCG and
transvaginal US shld be repeated in 2 3 days
4766
Obstetrics
&
Infectious Diseases
Gynecology
Asymptomatik chamydia infection is treated with single dose azithro or 7 day course of
doxy.
4768
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
PCOS= anovulation
4769
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
First year or 2 year irregular menses are anovulatory
4773
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
With endometriosis, if no improvemetn with NSAIDS +/- OCPs go for LAPARO
4775
Obstetrics
&
Puerperium
Gynecology
To confirm intrauterine fetal demise A REAL TIME US TO DEMONSTRATE ABSCENCE

OF FETAL MOVEMENT AND CARDIAC ACTIVITY
4776
Obstetrics
&
Puerperium
Gynecology
All cases of stillbirth shld have an AUTOPSY of placenta and fetus shld be done
4777
Obstetrics
&
Gynecology
Prengnancy HTN before 20 weeks is primary HTN, if after 20 weeks Gestational HTN, if
with Proteinuria Preeclampsia, If also have a grand mal seizure: Eclampsia Chronic
primary with superimposed preeclampsia is presented with new onset proteinuria or
worsening of existing proteinuria at >20 weeks, sudden worsening of HTN and sign or
signs of end organ damage
4778
Obstetrics
&
Gynecology
HTN complications --> placental abruption, superimposed preeclampsia,

Oligohydramnios, IUGR, preterm and Csection DM: Macrosomia Placenta previa risk
factors: Csection (previous), multiparity, multiple gestations, advanced age. Uterine
atony (due to polyhramnia or multiple gestation)can cause pospartum hemorrhage and
perdisposes to excessive uterine distention
4779
Obstetrics
&
Puerperium
Gynecology
Severe preeclampsia: SBP >160 or DBP >110..
4780
Obstetrics
&
Puerperium
Gynecology
Tx of preeclampsia: Hydralazine or Labetalol for BP and MgSO4 to prevent eclamptic

seizures
4781
Obstetrics
&
Puerperium
Gynecology
HELLP syndrome occurs in severe preeclampsia with RUQ pain (due to liver
enlargement and distention of hepatic capsule), Hemolytic anemia, Elevated Liver
enzymes and Low Platelets
4782
Obstetrics
&
Puerperium
Gynecology
Pulmonary edema (respiratory distress) is alife threatening complication of severe

preeclampsia. Caused increased SVR, capillary permeability and pulmonary capillary
hydrostatic pressure and decrease albumin..
4784
Obstetrics
&
Puerperium
Gynecology
In preeclampsia: transfuse platelets if <20K
4789
Obstetrics
&
Puerperium
Gynecology
Hyperemesis gravidarum, characterised by severe, persistent nausea and vomiting and

>5% loss of pregnancy weight. Women dehydrated and malnourished without another
explanation for their symptoms. Multifetal pregnancy or molar pregnancy are at an
increase risk for this condtion.. So do US
4790
Obstetrics
&
Puerperium
Gynecology
Molar pregnancy: abnormal fertilization of trophoblastic tissue. See abnormal plaacenta,

ssociated with bilateral ovarian enlargement seonday to hyperstimulationa and ovarian
cyst formation (theca luthein cysts). Causes: Complete moles: 2 sperm fertilize an ovum
lacking genetic material--> Placental trophoblastic tissue with noo fetal tissue Partial
moles: 2 sperm fertilize a haploid ovum--> abnormal placenta and fetal tissu ewith a
triploid karyotype (69XXY,XXX,XYY)
4793
Obstetrics
&
Metabolism
Gynecology
First line treatment of gestational diabetes: -Diet + Exercice -If not enough FBS>95, 1hr
level<140 or a 2hr level <120, Give insulin or PO meds
4794
Obstetrics
&
Metabolism
Gynecology
Uncontrolled mother hyperglycemia can cause cogenital malformations, macrosomia,

neonatal hypoglycemia and polycythemia..
4796
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
If patient has HELLP syndrome (life threatening) immediate delivery is warranted if >34
weeks or with deteriorating maternal or fetal status. Vaginal delivery is preferred if
mother is alreay in labor, fetus is vertex and otherwise stable..
4797
Obstetrics
&
Puerperium
Gynecology
Chorioamnionitis: MAternal fever with >1 of the following: Uterine tenderness, maternal
or fetal tachycardia, malodorous amniotic flui or purulent vaginal discharge. Prolonged
eupture of membranes is an important risk factor Placental abruption, presents with
bleeding, uterine tenderness abnormal contractions too but no fever or leukocytosis
Give antiobiotics and deliver (u might give oxytocin)
4799
Obstetrics
&
Puerperium
Gynecology
Endometritis: Fever, intrauterine tenderness in postpartum period and is often

associated with foul smelling locha. Risk factor: PROM, prolonged labor, tools used in
NVD, Csection
4800
Obstetrics
&
Puerperium
Gynecology
Post partum endometritis is usually a polymicrobial infection composed of gram (+) and
gram (-) aerobicand anaerobic mainly.. Treat with clinda and genta (big coverage.. )
(gentle clitoris)
4802
Obstetrics
&
Puerperium
Gynecology
Pelvic ultrasound is needed to diagnose missed abortion
Obstetrics
&
Puerperium
Gynecology
Threatened abortion = any hemorrhage before 20 weeks of gestation with a live fetus
and closed cervix Inevitable: dilated cervix, bleed.. US: ruptured or collapsed gestational
sac with absence of fetal cardiac motion Incomplete: evacuation of some fetal tissue
while some stay in uterine cavity. Vaginal discharge of blood and tissue like material,
abdominal cramps and cervical dilation. See on transvaginal US retained products of
conception
4804
4805
Obstetrics
&
Puerperium
Gynecology
In threatened abortion, once fetal safty is assessed patient can go home and f/u a week
later. She shld bed rest not have sex (to clear patient's mind but no proof of harm
otherwise)
4806
Obstetrics
&
Infectious Diseases
Gynecology
Mother with Herpes (primary or secondary) shld deliver by Csection painfu vesicles on
an erythematous base Pregnant women with a hx of genital HSV shld receive
prophylactic acyclovir or valacyclovir (at 36 weeks) reducing the risk of requiring
Csection (therapy or prophylaxis at time of delivery will not reduce noanatal HSV)
4809
Obstetrics
&
Puerperium
Gynecology
Uterine atony occurs when uterus gets huge due to huge baby, polyhydraminia, twins..
and results in bleeding.. Treat with oxytocin
4810
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Liche sclerosus: Affect posmenoposal women Vulvar pruritis and discomfort with
porcelian white atrophy. Punch bx shld r/o vulvar SCC Treat with high dose steroid
4892
Obstetrics
&
Puerperium
Gynecology
Contraindication to breastfeeding: Untreated TB, HIV, illict drugs and alcohol,

Galactosemia in child. HepB, C are not contraindications.
4915
Obstetrics
&
Puerperium
Gynecology
Cervical insuficiency risk factore, trauma, gynecological procedurelike cervical LEEP or

cone bx, DES exposure or multiple gestation. Previous hx of preterm birth or 2nd
trimester pregnancy loss are also risk factors for incompetent cervix
4916
Obstetrics
&
Puerperium
Gynecology
Transvaginal ultrasound is the gold dtandard for evaluating the cervix for cervical
incompetence in pregnancy. Cervical length below 10th percentile for gest age is
considered short.
8868
Obstetrics
&
Puerperium
Gynecology
Black are at increased risk for fetal macosomia and its complication as fetal dystocia.
Erb duchenne.. They usually recover arm function spontaneously within few months
(CHILLIN..)
8877
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Atypical squamous cells of undetermined significance on cytology workup women 21-24:

repeat in 1 year women >25: HPV DNA test. If (+) do colposcopy if (-) repeat PAP Smear
in 3 years
8888
Obstetrics
&
Metabolism
Gynecology
Patient with hypothryoid shld increase their levothyroxine dose during pregnancy
especially during the first trimester, because of an increase in Throid binding globulin
levels.
8892
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Obesity is a big cause of amenorhhea although normal FSH and LH. Estrogen can be
produced but not progesterone.. DONO WHY
8903
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Needle aspiration is contraindicated in postmenopausal women with adnexal mass, it

has poor sensitivity in detecting malignancy, and if cystic 25% of chance of recurrence
after aspiration, if malignant ull spill it So followig ultrasound do CA125 level, if high
suspect cancer, if normal a mass <10cm can be followed conservartly
8910
Obstetrics
&
Gynecology
If suspect appendicitis in pregnancy do US.. If dnt see appendix do MRI
8917
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
HPV vaccine to 9-26 age cateoory (except pregnant women) Pap smear: start at 21, If
immunocompromised (HIV, SLE, organ transplant or on steroids, IBD drugs..) Start at
onset of sexual activity twice a year
8939
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Ovarian torsion will cause nausea and vomiting unlike ruptured cyst, althought a cyst will
enlarge the ovary increasing its chance for torsion. Go for Laparoscopic surgery
8941
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
Ruptured ovarian cyst: Acute unilateral pelvic pain and maybe nausea vomiting after
severe exercice or sex. US: show free fluid near ovarian cyst Tx: supportive care
(analsegia..) or surgery if needed
8948
Obstetrics
Female Reproductive
&
System & Breast
Gynecology
If suspect any ovarian, uterine pathology go for ultrasound which has higher sensitivity
than CT and is safer (no radiation exposure) Do Bx for suspected hyperplasia or Ca:
Women >45 with abnormal or postmenopausal bleed
8962
Obstetrics
&
Puerperium
Gynecology
Early deceleration occur at peak of contraction, late nadir is at end of contraction (both
are more than 30 s see wide deceleration). In variable it is not dependant on contraction
and is less than 30s so see a peak on monitoring: It is due to cord compression or
prolapse or oligohydramnios
9984
Obstetrics
&
Puerperium
Gynecology
Decreased fetal movement management: Non stress test, then contraction stress test (if
no contraindication to labor: placenta previa, hx of extensive uterine surgery) (especially
if NST negative) or a biophysical profile (if (-) NST) If small fetus (<10thpercentile) Do
umbilical artery flow velocimetry (not related to decreased baby activity)
9985
Obstetrics
&
Puerperium
Gynecology
When a contraction stress test turns out well repeat in one week
10441
Obstetrics
&
Puerperium
Gynecology
Cell free fetal DNA testin is noninvasive highly sensitive and specific in screening for
aneuploidy startin >10 weeks of gestation. Abnormal results are confirmed by chorionic
villus sampling at 10-12 weeks or amniocentesis at 15-20 weeks
2134
Pediatrics
SCID: viral, fungal (T) and bacterial (B) infections Complement deficiency: S.pneumo,
Hflu, Neisseria.. (encapsulated) Thymic hypoplasia (Di Georges): viral, fungal CGD:
catalase positive organisms (Aspergillus, Staph.. ) B cell deficiency: (first present after 6
month of age); encapsulated organisms (Hflu, Spneumo..) and lack of IgA predisposes
to Giardia
2196
Pediatrics
Infectious Diseases
Epiglotittis: abrupt onset of fever, sore throat, dysphagia and drooling. Airway
obstruction is the most concerning potential complication of epiglotittis and requires
nasotracheal intubation Keeping airway hyperextended provide some relief as it
maximises the airway diameter
2226
Pediatrics

Electrolytes
Chronic constipation will cause rectal distention which will compress the bladder and
prevent good voiding then stasis of urine and infection
2234
Pediatrics

Electrolytes
Transient proteinuria (caused by exerice, fever, seixure, stressor volume depletion) is a

common cause of proteinuria when patient is upright (fall down when recumbent)
(resolve on its own) Should be reevaluated with a repeat dipstick on two separate
occasions to r/o persistent proteinuria which require further evaluation for underlying
renal disease AKA ORTHOSTATIC PROTEINURIA
2253
Pediatrics
In SCC with stroke of any occlusion go for EXCHANGE TRANSFUSION. NOT HEPARIN
NOT TPA.. Suspect stroke even if CT (-)
2279
Pediatrics
Nervous System
Abscence seizure: Ethosuximide or Valproate
2280
Pediatrics
Nervous System
Complex partial seizure: brief episodes of loss of consciousness, failure to respond to

various timuli during the episode, staring spells, automatisms and post ictal confusion
NORMAL EEG Unlike Abscence seizures (which also have no post ictal confusion)
2353
Pediatrics
Substance Abuse
Anorexia= Hospitalisation
2373
Pediatrics
Hydrocele: wait 12 months for them to resolve, if dont go for Sx
2378
Pediatrics
In caustic ingestion.. Secure airway, breathing, circulation if compromised

Decontaminate: remove contaminated clothing and visible chemicals; irrigate exposed
Exposure
skin CXR if respiratory sx endoscopy within 24 hrs
2388
Pediatrics
Female Reproductive
System & Breast
Primary amenorrhea: FSH measurment shld be ordered if no breast development

Pituitary MRI if FSH decreased Karyotype if FSH increased
Pediatrics
Female Reproductive
System & Breast
ACute abnormal uterine bleeding therapy: High dose IV estrogen High dose Progestin
High dose OCP Tranexamic acid (stabilise fibrin matrix) D&C if persists longer than
24-36 hrs Transfuse if hemodynamically unstable or sx of anemia are strong, otherwise
Iron supplementation later on will do the job
2390
2395
Pediatrics
Female Reproductive
System & Breast
Primary dysmenorrhea: Pelvis cramping during the first few days of menses in the
context of normal physical exam with no adnexal pain or enlargmenets. It caused by
prostaglanding release from endometrial sloughing during menses. Endometriosis: also
common in asdolesents but presents with tenderness along uterosacral ligaments,
nodularity on cul de cac, adnexal enlargement due to endometrioma AnD precedes
menses by few days. THEY ALSO HAVE DYSPAREUNIA
2424
Pediatrics
Infectious Diseases
CROUP (whooping cough) can exacerbate with airway compromise.. Give EPI before
thinking of intubation (very invasive) (PEDIATRICS)
2432
Pediatrics
Laryngomalacia: Inspiratory stridor that worsens in supine position and crying or feeding
and peaks at 4-8 months. Dx by flexible laryngoscope, showing collapse of supraglottic
structures during inspiration.. It self resolves by 18 months of age so REassure of
Supreglottoplasty if severe (cyanotic etc..)
2435
Pediatrics
If suspected Diaphragmatic herniation do Endotracheal intubation and put NG to

decompress
2439
Pediatrics
Nervous System
Friedrik's ataxia: Autosomal recessive, Trinucleotide repeat.. they are in wheelchair at

25 die at 35.. -Necrosis, degeneration of cardiac muscle fibers (T wave inversion due to
myyocarditis not INFARCT) -And have ataxia of course T wave inversion: MI,
Myocarditis, old pericarditis, myocardial contusion and DIGOCXIN Toxicity
2441
Pediatrics
Nervous System
Fragile X = CGG repeats: Low IQ, Language disability, short attention span, autism,
large head, prominent jaw, large low set of ears and BIG testes
2443
Pediatrics
Nervous System
Cerebral palsy: MAin risk factor is prematurity
2444
Pediatrics
Nervous System
Fetal alcohol Syndrome: -Small palpebral fissure -Smooth Philtrum -Thin vermilion
border
2450
Pediatrics
Rheumatology/Orthopedics HOW TO CONFIRM SLE: ANTI SMITH AB's and ANTI DOUBLE STRANDED DNA
& Sports
ANTBODIES
2451
Pediatrics
Sudden onset respiratory distress in a toddler with focal findings on exam is consistent
with foreign body aspiration. CXR not very helpful since radioluscent object wont
appear.. IMMEDIATE BRONCHOSCOPY TO REMOVE OBJECT
2456
Pediatrics
NEC: Premature baby Increase gastric residual volune, vomiting, abdominal distention
Xray: pneumatosis intestinalis (intramural) and portal venous air
2463
Pediatrics
Intusception is usually due to Peyer's patch enlargement due to viral infection (+ROTA
vaccine) leading to the condition. IF recurrent; think of Mecke;s diverticulum
2464
Pediatrics
Milk or Soy protein Enterocolitis is suspected in a well apearing neonate with PAINLESS
BLOODY STOOLS. Bleeding shld stop within 2 weeks of eliminating dietary dairy and
soy products Lactose intolerance: crampy abdominal pain, bloating flatulence,
NONBLOODY WATERY DIARRhea.. rare in child
2465
Pediatrics
Malrotation with midgut volvulus: bilious vomiting and abdominal distentsion. ITs an
Emergency.. Can pass stool.. (whats already there) Dx: Upper GI contrast study
Hirschsprung and meconium ileus, present with failure to pass meconium in the first 2
days of life and dilated loop on Xray.. Do contrast Enema..
2466
Pediatrics
In neonatal ileus do Xray to r/o pneumoperitoneum then go for Contrast enema.. (to
determine level of obstruction..)
2468
Pediatrics
Edward's: micrognatia microcephaly overlapping finger, absent palmar crease VSD Most
commonly
2469
Pediatrics
Nervous System
Infant botulinism can still happen even if had not eaten honey: Bulbar palsies
constipation hypotonia
Substance Abuse
ADHD differs from conduct in that conduct disorder violate major societal norms or
others right's with agression, property distruction, theft.. ADHD: Inattention, impulsivity
and hyperactivity .. results in impaired family and peers relationships ODD:
angry/irritable mood and defiant toward authority. They are hostile, and defiantly brek
rules..
2470
Pediatrics
2472
Pediatrics
Nervous System
Cephalhematoma: subperiosteal hemorrhage, presents few hrs after birth as scalp

swelling limited to one cranial bone. Do not reuire treatments and resolve within 2 weeks
to3 months dependin on size Caput is diffuse sometimes echymotic swelling of scalp. It
involves portion of head presenting during vertex delivery. MAY EXTEND MIDLINE AND
CROSS SUTURE LINES (unlike cephal)
2474
Pediatrics
Suspect NEC in Newborn with feeding intolerance, Abd distentsion and bloody stools.
Risk factors: Prematurity, Hypotension and Congenital heart disease. on Xray:
Pneumatosis intestinalis
2479
Pediatrics
Exculusively breastfed infant shld take vitD supplementations Iron shld be given IF
Prematurity, Mom's Fe deficiency, Introduction of cow's mild before age of 1yr (until age
of 1) Normal babies have good stores of Fe and start having deficiencies at 4-6 months
2480
Pediatrics
VitA deficiency: 2-3 yr old boy with impaired darkness adaptation, photophobia, dry scaly
skin (also in excess), xerosis (abnormally dry; like inexcess too) conjuctiva, xerosis
cornea, keratomalacia (softening and necrosis of cornea), Bitot (like a silver spot on
sclera) spot and follicular hyperkeratosis of the shoulders, buttocks and extensor
surfaces
2485
Pediatrics

Puerperium
In newborn clavicular fracture observe
2486
Pediatrics
Exlusivebreatfeeding, increased skin pigmentation and lack of sun exposure are risk
factores for vitD deficiency rickets. findings: -Craniotabes -rachitic rosary -genu varum
& Sports
-Xray: cupping and fraying of metaphysis of the long bones
2489
Pediatrics
General Principles
Cri du chat microcephaly, hypotonia, short stature and cat like cry 5p deletion (spell 5
transversally it is cr THUG LIFE!)
2504
Pediatrics
Substance Abuse
Methyphenidate given for ADHD is astimulant causing decrease in appettite
2513
Pediatrics

Electrolytes
Enuresis: Bedwetting alarm, Desmopressin and Imipramine in last resort Do urinalysis if

symptomatik..
2656
Pediatrics
Onchocerciasis "River blindness" Ocular lesion and dermatitis .. Treat with Ivermectin
(like strongyloides) Battery ingestion Esophagus: endoscopic removal If beyond wait
since it will be excreted
2669
Pediatrics
Nervous System
Neurofibromatosis type 1: Cafe au lait spots Macrocephaly Feeding problems Short

stature Learning disabilities May later develop fibromas, neurofibromas or different
tumors Nf2: cataracts and bilateral accoustic neuromas
2691
Pediatrics
HCM:maneuvers that increase preload or afterload (squatting, leg raise, hand grip)
increase LV cavity size and decrease outflow obstructio, decrease murmur intensity.
Decreasing LV capacity by decreasing preload (Valsalva, abrupt standing, amyl nitrate
administration) do the complete opposite
2712
Pediatrics
GIve prophylaxis penicilin to rheumatic fever patients ..
2756
Pediatrics
Dermatology
Contact cell dermatitis presents with erythema, edema, pruritis, tiny veiscles and weepy
crusted lesions 24-48 hrs after contact allergen (in woods etc.. ) It is type VI
hypersensitivity
2758
Pediatrics
Dermatology
Atopic dermatitis in infant: pruritis, scaly erythematous lesions on face, chest and
extensor surfaces o the extremities. Flexural involvement is common in children and
adults. Topical emmolient is first line treatment
2763
Pediatrics
Nervous System
Sturge Wekber: Port wine stain around eye (unilateral along trigerminal districution) and
radiographic evidence of intra cranial calcifications that resemble a tramline
2773
Pediatrics
Celiac can cause dermatitis hepetiformis. It is associated with DMI
2778
Pediatrics
Dermatology
SSSS fever by generalised erythema and superficial flaccid blisters with positive Nikolsky
sign.. Scaling and Desquamation follow. Affects children <10 yrs, Immunocompomised
and Kidney patients
2783
Pediatrics
Infectious Diseases
Rubella low grade fever, tender lymphadenopathy, amculopapaular rash that spreads
from up to down.
2831
Pediatrics
Cholesteatomas are either Congenital or Aquired dues to chronic middle ear disease..
New onset hearing loss with ear effusion despite antibiotics. Granulation tissue and skin
debirs are seen within retraction pockets of the tympanic membranes on otoscopy
Ophthalmology
Trachoma (by chlamidya, major cause of blindness worldwilde) is charcterized by

foLLICULAR COnjuctiVITIS and PANNUS (neavascularization) also get fet concurrent
nasopharyngeal infection with nasal discharge.. Treat with Tetracycline or Oral
azithrimycin. Dx by Giemsa stain of conjuctival scraping
2857
Pediatrics
2867
Pediatrics
ALL: Contain cytoplasmic aggregates of PAS material (no peroxidase activity). TdT is
positive in 95% (expressed by preB and preT lymphoblast) Presentation: (2-10yrs)
present with Infection, half come with lymphadenopathy and splenomegaly, varying
anemia, neutropenia and thrombocytopenia. More than 25% of lymphoblast in BM is
diagnostic
2896
Pediatrics
Reye syndrome: Microvesicular fatty infiltration & hepatic mitochondrial dysfunction
2945
Pediatrics
Biliary cysts can be acquired or congenital and can elvate bilirubin
3005
Pediatrics
Infectious Diseases
Staph aureus is most common cause of osteomylitis in both infants and children
3009
Pediatrics
Infectious Diseases
In mumos (bilateral parotitis), can get testes involvment and in rarer cases get pancreas
involvement
3077
Pediatrics
Infectious Diseases
Measle: High grade fever and rash for the last 9 days. Brick-red, maculopapular rash on
face and subsequent spread to trunk and extremities. Before that cough, eye tearing,
runny nose, sneezing and intermittent nasal obstruction. Also Get Leukopenia and
Thrombocytopenia Vitamin A helps the GI adn respiratory tracts' epithelium to
regenerate. Plus it Enhances immunity ..
3078
Pediatrics
Pyloric stenosis do not present at birth but at 3-5 weeks for hypertophy to happen
3079
Pediatrics
Treat kawasaki(non purulent conjuctivitis.. ) with Aspirin + IVIG
3122
Pediatrics
Dermatology
Erythema toxicum neonatorum: Asymptomatik, scattered erythematous macules,

papules & pustules thoughout body.. NO treatment Neonatal HSV: Vesicular clusters on
skin, eyes, mucous membranes, CNS infection, Fulmnant disseminated multiorgan
disease (GIVE ACYCLOVIR) Neonatal varicellaL Fever: different stages of lesions and
can beocome fulminant disseminated disease (acyclovir) SSS: Fever, irritabilitym diffuse
erythma, blistering, exofoliation, +Nikolsky (oxa, nafcillin, Van
3123
Pediatrics
Nervous System
Phenylketonuria: buildup of toxic phenyalaline and its bad metabolites. -Intellectual

diability -fair complexion eczema -musty odor urine and body odor. TREAT WITH LOW
PHENYLALANINE DIET
3192
Pediatrics
Nervous System
G6PD: 3-4 months of age kid with HYPOGLYCEMIA (may produce seizure), LACTIC
ACIDOSIS, HYPERURECIMIA, HYPERLIPIDEMIA. Doll Like face (fat cheeks), thin
extremities, short statures and Protuberant Abdomen coz of HEPATOMEGALY and
Enlarged KIDNEYS
3193
Pediatrics
Nervous System
Galactosemia (galactose 1 phosphate uridyl transferase deficiency) occur in newborn or

young infant with failure to thrive, bilateral cataracts, jaundice and hypoglycemia Tx:
Eliminate galactose from diet
3196
Pediatrics
Hyper IgM syndrome is caused by a CD40 defect ligand and is charachterized by high
IgM levels, low or absent IgG and IgA and normal Lymphocyte population.. PRESENTS
WITH RECURRENT SEVER SINOPULMONARY INFECTIONS.
3197
Pediatrics
Immunodeficiency: -Common variable immunodeficiency or aquired

hypogammaglobulinemia is similar to Bruton's agammaglobulinemia but less severe and
presents at later age (15-35 of age) IgG, A, M, E are decreased.. but normal B cells
-Burton's X linked: asymptomatik 6-9 months; recurrent pyogenic infections (S.pneumo,
H.flu).. DEcreased IgG,A,M,E with also low B cells(CD19), poor response to vaccine
3198
Pediatrics
Chronic granulomatous disease Recurrent lymphadenitis Hepatic abscesses

Osteomylitis at multiple sites Catalase positive organisms infection (S.aureus,
Aspergillus, Serratia, Burkholderia) Nitrozolin blue test is abnormal
3200
Pediatrics
Aquired aplastic anemia is suspected when thrombocytopnia (rashes) and anemia

following Drug intake, viruses or toxins of viruses
3235
Pediatrics
Social Sciences
If parents dont want to give chemo to their child Obtain a court order for chemo
3236
Pediatrics
If no significant harm is likely to result from witholding therapy, parental wishes regarding
the medical care of a child should be honored and the discussion documented in the
chart
3282
Pediatrics
Hereditary spherocytosis in kids: Persistent jaundice Hemolytic anemia Splenomegaly

Positive family history Spherocytes on peripheral blood smear RBC fragility test on
acidified glycerol lysis and eosin-5-maleimide binding test confirms the diagnosis
3284
Pediatrics
ALL: Presence of >25% of lymphoblast on bone marrow give Dx 2-5 yrs Male>Female
Nonspecific sytemic sx Bone pain Lymphadenopathy Hepatosplenomegaly Pallor (from
anemia) Petechia (from thrombocytopenia)
3286
Pediatrics
Infectious Diseases
Bacterial rhinosinusitis cause maily by Hflu and Strep pneumo (equal in prevalence) and
less likely Moraxella catarhalis (~10%)
3288
Pediatrics
Infectious Diseases
Croup (parainfluenza): (<3yrs) Hoarsness, barking cough, varying degree of respiratory

ddistress Whooping cough is due to Pertussis
3375
Pediatrics
Substance Abuse
Tourette (ticks and swearing ..) is treated with antipsychotic 2nd generation
3396
Pediatrics
Nervous System
Shaken baby syndrome: shearing of dural veins + vitreoretinal traction
3403
Pediatrics
Slipped capital femoral epiphysis is treated with SURGICAL PINNING OF SLIPPED

EPIPHYSIS WHERE IT LIES In order to lessen the risk of avascular necrosis of femoral
& Sports
head and chondrolysis
3416
Pediatrics
In radial head subluxation when a baby is being dragged or being turned while playing
(like I used to do) Before extrnally cating hand.. shld Hyperpronate the forearm or flex
& Sports
elbow and suppinate forearm
3418
Pediatrics
General Principles
In child, if peripheral line is not acessible go for INTRAOSSEOUS LINE IN EMERGENCY

CASES (easier than central line insertion)
3438
Pediatrics
Miscellaneous
(Multisystem)
HUS is a clinical syndrome of hemolytic anemia, Thrombocytopenia and acute renal

failure. Caused by Shiga toxin mediated endothelial cell damage. After infection of Ecoli
O157:H7 or Shigella Tx: supportive, 50% of these will require dialysis
3440
Pediatrics
ITP shld be suspected in children who develop isolated thrombocytopenia and petechia
after a viral infection. They resolve spontaneously within 6 months so shld observe
regrdless of platelet count. If bleeding shld recieve IVIG and steroids.. IF refractory do
Splenectomy
3443
Pediatrics
Infectious Diseases
Group A step rheumatic fever: -sore throat -fever -pericarditis -erythema marginatum
-arthritis -chorea -subcutaneous nodules
3457
Pediatrics
Infectious Diseases
In subcutaneous emphysema always Order CXR to r/o Pneumothorax
3458
Pediatrics
Infectious Diseases
Pertussis = whooP cough 3 phases: catarrhal: Mild cough rhinitis, paroxysmal: very bad
cough and postussive emesis Convalescent: sx resolve gradually Treated with
MARCOLIDE (azitro, erythro, clarithro) Dx: PCR or Culture.. have lymphocyte
predominant leukocytosis
3459
Pediatrics
In severe asthma unresponsive to meds whith fatigue, altered mental status, CO2
retention, worsening hypoxemia and poor aire movement
3538
Pediatrics
Systic fibrosis diagnosis: Sweat chloride testing by quantitative pilocarpine iontophoresis
3539
Pediatrics
Down syndrome get endocardial cushion fusion defucts resulting in AV septal defect
3544
Pediatrics
Miscellaneous
(Multisystem)
Duchenne (no dystrophin, 3-5 yrs die at 25 from respiratorhy failure, mental retardation,
cardiomyopathy) vs becker (less dystrophin, 5-15, die at 45 from heart failure, normal
intelectually have cardiomyopathy) Both are Xlincked recessive Myotonic dystrophy:
Autosomal dominant (CTG repeat in DMPK gene on 19q13.3).. onset 12-30, facial
weakness, hand grip myotonia, dysphagia, arrythmias, cataracts, balding, testis atropy
and die from respiratory failure
3545
Pediatrics
Di georges Conotruncal cardiac defects (truncus arteriosus) Abnormal facies Thymic

a(hypo)plasia Cleft palate Hypoalcemia
3546
Pediatrics
Innocent cardiac murmur (normal blood flow sound) grade I or II and decrease with
standing. Mid systolic in timing OBSERVE, REASSURE
3550
Pediatrics
Nervous System
Tuberous sclerosis have hypopigmented macules (not cafe au lait)
3552
Pediatrics
Suspect Wilm'sTumor (most common pediatric renal malignancy) when have a FIRM,
SMOOTH, UNILATERAL ABDOMINAL MASS AND HEMATURIA Associated with WAGR,
Beckwith-Wideman, Denys-Drash Syndrome Tx: Sx, Chemo +/- Radio
3553
Pediatrics
Bronchiolitis <2 yrs if age RSV is most common cause Nasal congestion discharge and
cough, wheezing, crackles and respiratory distress.. Tx: supportive care Prophylaxis with
Palivizumab for: Preterm infant<29 weeks Chronic lung disease of prematurity
Hemodinamically significant Congenital heart disease Complications: Apnea, Respiratory
failure can also cause OM do not cause bacterial superinfection which rarely happen at
low Temperatures.. EBV=> Nasoph CA or Lymphom
3554
Pediatrics
Miscellaneous
(Multisystem)
Henosh Schenlein purpura is common in children < 15 Palpable purpura, Hematuria,

Abdominal pain, Arthralgia, Scrotal Swelling At INCREASE RISK FOR
INTUSSUSCEPTION
3555
Pediatrics
Growing pain occurs betwn 2-12 yrs in LE and occur at night
& Sports
3612
Pediatrics
Infectious Diseases
Nocturnalpeianal pruritis = Enterobius vermicularis (highly contagious).. the pinworm

lives in cecum and appendix. At night female migrate out to rectum lay eggs in perianal
region causing pruritis. Also get abdominal pain, nausea, vomiting and vulvovaginitis.
Scotch tape test detect the eggs. Tx: Albendazole and pyrantel pamoate (this one
mainly for pregnant) Chagas is treated with Benzindazole Ivermectin for strongyloides,
which present with urticaria, abd pain and resp.
3624
Pediatrics
Social Sciences
If mom wants treatmnt dad no.. its enough to give treatmnt; we need only one consent
3636
Pediatrics
Infectious Diseases
Lyme disease: Give amoxi not doxy to kids <8yrs
3640
Pediatrics
Infectious Diseases
Sepsis in Sickle cell is most commonly due to PNEUMOCOCCAL, then think of other
ENCAPSULATED
3642
Pediatrics
Infectious Diseases
Impetigo Bullous (Staph) More fucked up and treat with PO Antibiotics (chepalexin,
dicloxacillin or clinda) vs Non Bullous (Staph and/or Strep) Chillin painful non itchy honey
crusty lesions and treat WITH Topical AB like MUPIROCIN ORDER ASO if have systemic
complications
3660
Pediatrics
Ophthalmology
Erythromycin ointment at birth is effective against gonococcal conjuctivitis not chlamydial

Maternal prenatal testing and treatment is the only effective strategy for prevention of
this condition
3661
Pediatrics
Nervous System
Myotonic muscular dystrophy: Age of onset 12-30 Facial weakness, hand grop,
myotonia (delayed relaxation), dysphagia Arrythmias, cataract, Balding, Testicular
atrophy
3662
Pediatrics

Metabolism
Infant with hypothyroid appear normal at birth but gradually develop apathy, weakness,
hypotonia, large tongue, sluggish movement, abdominal bloating and *umbilical hernia*.
Screening newborn with phenylketonuria, galactosemia and hypothyroid is manadatory
3663
Pediatrics
Infectious Diseases
Congenital rubella: Sensorineural hearing loss, cardiac anomalies (PDA), cataract,

glaucoma.. Children rubella: low grade fever, conjuctivitis, coryza, cervical
lymphadenopathy, Forschheimer spots. Cephalocaudal spread of blanching
erythematous maculopapular rash Tx: supportive
3665
Pediatrics
Retinoblastoma consists of bilateral retinoblastoma and pineal gland tumor Pineal tumor:
Parinaud syndrome: limitation of upward gaze, bilateral ptosis and bilateral lid
retraction.. headaches vomiting due to obstructive hydrocephalus
3667
Pediatrics
Nervous System
MEdulloblastoma arise IN VERMIS OF MEDULLA (TRUNCAL ATAXIA)
3669
Pediatrics
Miscellaneous
(Multisystem)
Duchenne: most common dystrophy presents at 2-5 age, w bilat calf pseudohypertrophy
and Gower sign (pull himself up; cannot stand like normal dudes) (X linked recessive
transmission so uncle might have it) -Dx Gold standard: Genetic testing show deletion of
dystrophin gene on Xp21 (muscle bx is good bas cv genetic of course better)
3670
Pediatrics
Infectious Diseases
HIV infection in infant: Failure to thrive Lymphadenopathy thrush Mom Iv user Even if
mom (-) still suspect since it takes 3 month to be (+) Dx with PCR
3671
Pediatrics
Infectious Diseases
Group B and Ecoli are the most common causes of neonatal sepsis.. Prevention is with
maternal testing and treatment with intrapartum IV penicillin
3672
Pediatrics
Nervous System
CGD: nitro blue Wiskot aldrich: eczema, thrombocytopenia, excess bleeding from
circumcision, bloody stools, low Ig A,M,E and low T and reccurent encapsulated vaccine
Migraine in kids give advil or panadol and triptans if the 2 first fail
3685
Pediatrics
Clubfoot: Stretch and manipulate foot, then apply casts, malleable splints or taping. Do
surgery if conservative management fails (if surgery is needed do it between 3 and 6
& Sports
months)
3686
Pediatrics
Miscellaneous
(Multisystem)
Marfan: Mutation of fibrillin- 1 gene
3692
Pediatrics

Electrolytes
Children < 2 yrs with a first UTI shld be treated. Then Renal and bladder US shld be
ordered to evaluate for abnormalities leading to UTI's Voiding cystourethrogram is not
indicated for first febrile UTI, unless abnormality is seen on US
3694
Pediatrics

Electrolytes
Vesicoureteral reflux is the most common cause of chronic or recurrent pyelonephritis.

(see parenchymal scarring, HTN and renal insufficiency) Dx by voiding
cystourethrogram Posterior urethral valves (is a congenital membrane obstructing flow
at level of urethra) it is most common cause of chronal renal insufciency in BOYSS
3711
Pediatrics
Ophthalmology
Strabismus after 4 months is abnormal can cause amblyopia.. Diagnosed by Asymetric

corneal reflection and deviations on cover test. Tx: Cover unaffected eye (to sensitize
brain to bad eye and not let the brain trash it away)
3713
Pediatrics
Acute Splenic sequestration can worsen the anemia by increasing extravascular

hemolysis
3721
Pediatrics

Metabolism
Hypothyroidism in kids (thyroid dysgenesis) Decreased activity, hoarse cry, jaundice ..

majority are asymptomatik If find thyroid TSH antibody its hyperthyroid jitterness,
tachycardia, weight loss poor feeding
3760
Pediatrics
Substance Abuse
Tourette and OCD, ADHD are highly associated (increase the risk of these)
3770
Pediatrics
Rheumatology/Orthopedics Osteogenesis imperfecta (mutation in type 1 collagen) -Blue sclera -Recurrent fractures,
& Sports
Joint laxity, Short stature, Scoliosis -Theeth loss early in age -Hearing loss
3773
Pediatrics
Female Reproductive
System & Breast
Normal vaginal discharge and bleeding are normal up to 3 months of age
3774
Pediatrics
Anemia of prematurity (IT FKIN EXISTS) in premature and low birth weight babies due
to low RBC production, shortened RBC lifespan and blood loss. Give Fe, transfuse and
EPO if needed and of course follow up on Hgb with CBC
3783
Pediatrics

Metabolism
Pubertal gynecomastia occur in 2/3 of adolescent it can be unilateral, bilateral or painful.

Reassure
3785
Pediatrics
DActylitis(pain and symetric swelling of hand and feet, sometimes get fever) is the
earliest manifestation of vaso occlusive disease in sickle cell, usually appear between 6
months to 2 year
3786
Pediatrics
Hydoxyurea prevents sickle cell painful episodes, by incresing fetal hemoglobin
3787
Pediatrics
Sickle cell trait present mainly with Hematuria (not the full blown disease)
3788
Pediatrics
Infectious Diseases
Tetanus in newborn occurs in unimmunized mothers, following and umbilical stump

infection. Child is with poor suckling with rigidity spasms ..
3791
Pediatrics
Infectious Diseases
Nocturnla valvular itching = Pinworm --> Scotch test.. GIVE MEBENDAZOLE
3817
Pediatrics
Nervous System
Lesh Nyhan (due to HYPOXANTHINE GUANINE PHOSPHORIBSYL TRANSFERASE

defincency HPRT) -Self induced mutilation -Neuro failure (mental retardation, dystonia,
choreathosis, spasticity) -Gouty arthritis, tophus formation (only cause of gout in a child)
3818
Pediatrics
Diamond blackfan syndrome is a macrocytic pure red aplasia (like diamond is pure
carbon here it is pure RBC) WITH ASSOCIATED CONGENITAL ANOMALIES (short
stature, webbed neck, cleft lip, shielded chest and triphalyngeal thumbs)
Pediatrics
Iron posoning: -Abdominal pain -Vomiting (hematemesis) -Diarrhea (GI sx..)

Poisoning & Environmental -Hypotensive shock, Anion gap Metabolic acidosis -Radiopage pills on Xray -Within 2
Exposure
days: Hepatic necrosis -Within 2-8 weeks: Pyloric stenosis Tx: Deferoxamine, Whole
bowel irrigation, Supportive respiratory and circulatory care
3830
Pediatrics
Infectious Diseases
Bacteria in Cystic Fbrosis: (-) rods: Pseudomonas aeruginosa, Burkholderia capacia

complex (khayyo la pseudomonas) and Stenotrophomonas maltophilia (couseino) (-)
coccobacilli: nontypable Hflu (+) cocci in clusters: STAPH AUREUS Staph is more
common in children (<20) and Pseudomonas in older (>20)
3835
Pediatrics
Beckwith wideman: macrosomia, macroglossia, umbilical hernia/omphalocele,

hemihyperplasia and hypoglycemia.. Check for Wilms tumor or hepatoblastoma
3836
Pediatrics
Rheumatology/Orthopedics Lyme arthritis is most common late manifestation of disease.. Hx of travel to

& Sports
northeastern or upper midwestern US
3838
Pediatrics
In sickle cell: Acute severe anemia with low or absent reticulocytes is consistent with an
aplastic crisis
3849
Pediatrics
TE fistula: newborn chokes and coughs during first feeding.. NG or OG tube fail and xray
will show so
3854
Pediatrics
Hep B vaccine prevents hepatocellular carcinoma especially in endemic regions in Asia

and Africa
3871
Pediatrics
Miscellaneous
(Multisystem)
McCune Albright 3 P's: Precocious puberty Pigmentation(cafe au lait) Polyostotis fibrous

dysplasia resulting in several fracture
3896
Pediatrics
after Gi infection if u gt kiney problems think of HUS (microangiopathic hemolytic anemia)
3900
Pediatrics
Infectious Diseases
Lyme prophylaxis in endemic region trip: Permethrin-treated pants and long sleeved
shirts, to apply insect repellant to skin and check entire body for ticks
3906
Pediatrics
Infectious Diseases
If someone gets pertussi in the house give Macrolide prophylaxis to all households
regardless of age, vaccines or sx
3910
Pediatrics
Prolonged QT (usually these patients have hearing loss), present with syncope, V
arrythmias, sudden cardiac death. Should avoid electrolytes derangements so avoid
CCB. Tx with BetaBlockers and Pacemaker TO PREVENT ARREST
3924
Pediatrics
Rib notching is seen in coarctation (even in young)
3926
Pediatrics
Growth failure, recurretn respiratory infection shld raise suspicion for Cystic Fibrosis.
Pancreatic enzyme deficienxcy causes steatorrhea and fat soluble vitamin
malabsorption, resulting in poor weight gain
3967
Pediatrics

Electrolytes
Sickle cell trait can present with painless Hematuria (renal papillary necrosis), UTI, renal
medullary cancer
3969
Pediatrics
Infectious Diseases
Scarlet fever: fever, toxicity, pharyngitis, sand paper like rash, curcumoral (perioral)
pallor and strawberry. Caused by Group A step's erythrogneuc exotoxins START
PENICILIN V
3972
Pediatrics
Acute Otitis media is common in children, especially with cigarette smoke exposure,
recent or concurrent URI, day care attendance and formula intake. Spneumo, Hflu and
Moraxella Give amoxi to prevent mastoditis
3974
Pediatrics
Miscellaneous
(Multisystem)
Kartegeners syndrome: recurrent sinusitis bronchiectasis dextrocardia
3827
Friedrich ataxia: (most common type of spinocerebellar ataxia) -Ataxia,

dysarthria(mototr speech disorder) -Skeletal (scoliosis, feet deformities "hammer toes")
-Cardiomyopathy (concentric hypertrophic cardiomyopathy) --> Which kill them and
respiratory complication are deadly too
3985
Pediatrics
Miscellaneous
(Multisystem)
3990
Pediatrics
VSD: HARSH HOLOSYSTOLIC MURMUR HEARD AT LEFT LOWER STERNAL

BORDER (APEX like the tip of the V). IF HEAR IT SHLD DO ECHO to r/o other defects
and assess size.. MOST WILL CLOSE SPONTANEOUSLY
3991
Pediatrics
Tricuspid atresia --> Hypoplastic RV + decreased pulmonary marking du to decrease

blood to them--> Left axis deviation
4005
Pediatrics

Electrolytes
Diaper children shld undergo stragiht catherization to obtain obtain sterile urine for urine
culture, to avoid contamination from stool or skin flora
4018
Pediatrics

Electrolytes
Minimal change disease is most common nephrotic in child<10 (edema (periorbital in

morning, legs and genitals later in the day), proteinuria.. ).. Give steroids directly dont do
anything else
4030
Pediatrics
Infectious Diseases
In cystic fibrosis patients with severe airway infection dont kid go FOR IV VANCO OH
YEA
4038
Pediatrics
Rheumatology/Orthopedics Asceptic necrosis of femoral head is common complication of sickle cell, by occluding
& Sports
end arteries supplying femoral head.. and eventually fucking bone cartillage
4041
Pediatrics
Substance Abuse
4064
Pediatrics
Spondylolisthesis: Dvlpmntal disorder with forward slipping of vertebra; usually L5 over

S1.. In preadolescent with back pain, neurologic dysfunction (urinary incontinence),
& Sports
palpable "step off" at lumbosacral area in severe cases (can feel the slipping)
4090
Pediatrics
ODD Patient are non compliant and hostile If child is non compliant but friendly maybe
he has some hearing deficits and doesnt understand shit
Cocaine abuse: wight loss, behavioral cahnges and erythema of th turbinates and nasal
septum
4104
Pediatrics
Dermatology
Eczema hepeticum is a form of primary herpes simplex virus infection associated with
atopic dermatitis; superimposed on healing atopic lesion after HSV exposure. Numerous
umbilicated vesicles over the area of atopic dematitis are typical, with fever adenopathy.
Tx with acyclor shld be immediate cz it can be life threatening
4117
Pediatrics
Internal carotid dissection: potential stroke in children Due to trauma to soft palate with a
foreign body 9pencil penetrating).. Stroke sx do not happen directly (up to 24hts after
traumatic episode).. Dx by MRI/MRA
4142
Pediatrics
Female Reproductive
System & Breast
In TURNER, due to ovarian dysgenesis and poor ovarian function FSH is High by
negative feedback not active
4155
Pediatrics
Nervous System
Postictal paralysis (Todd paralysis)may follow generalised as well focal seizures. NOT
UNDERSTOOD. Restoration of motor function improves within 24 hrs. Todd paralysis
indicate structural abnormality causing the seizure
4183
Pediatrics
Meconium ileus is obstruction at ileus and these people are at increased risk of chronic
rhinosinusitis
4186
Pediatrics
Infectious Diseases
Chikenpox (varcella) exposure algorithm: Immunity YES: OBSERVE NO:

IMMUNOCOMPROMISED: VZIG within 10 days of exposure (DONT GIVE VACCINE
COZ IT'S LIVE)(dont give to pregnant women too) IMMUNOCOMPETENT: JUST
VACCINE
4187
Pediatrics
Prolonged PT: Problem in vit K factors 1972 CS can happen in cystic fibrosos due to
poor absorption
4217
Pediatrics
Female Reproductive
System & Breast
In Androgen insensitivity syndrome do bilateral gonadectomy after completion of puberty

(attainment of adult height) todecrease risk of gonadal malignancy Unlike here gonads
in Turner shld be removed before puberty coz they have a higher risk of malignancy
4230
Pediatrics
Female Reproductive
System & Breast
Granulosa cell tumor produce Estrogen Sertoli-leydig produce androgen Dysgerminoma

and mature teratoma(dermoid cysts) are neutral. and serous cystadenoma are also
neutral hormonally
4239
Pediatrics

Metabolism
If congenital hyperplasia occur at 7yr old think of nonclassic congenital adrenal

hyperplasia (unlike Leydig cell tumors which present with unilateral testicular
enlargment, it has no testis enlargement and in both LH and FSH are low despite GnRH
infusion; due to feedback inhibition)
4244
Pediatrics
Female Reproductive
System & Breast
Induced by estrogen Neonate get: Breast Hypertrophy Swollen labia Physiological

leukorrhea (whitish vaginal discharge) Uterine withdrawal bleeding
4249
Pediatrics
Hemearthrosis is hemosiderin deposition leading to synovitis and fibrosis within thejoint..

Prophylactic treatment with factor concentrate will reduce the risk of hemearthropathy
4258
Pediatrics
In DTaP if child had unstable neurological encephalopathy within a week of

administration.. remove the pertussis part of it in further vaccination.. but if got fever and
febrile seizure no prob regie vaccine later on
4271
Pediatrics
Nervous System
When diagnose guillain barre by CSF studies do respiratory workup to rule out
respiratory failure
4279
Pediatrics

Electrolytes
HSP IgA mediated vascultitis: get mesangial deposition og IgA in kidneys
4302
Pediatrics
Riboflavin deficiency: Malnourished patient wih Angular cheilitis, Stomatitis, Glossitis,

Normocytic-normochromic anemia and Sebrrheic dermatitis
4313
Pediatrics
Dermatology
Sunscreen protection (factor 15-30) shld be applied 30 min prior t sun exposure to allow
time for devellopment of a protective film
4317
Pediatrics
Infectious Diseases
CAt bite = pasteurella multicoda = Augmentin
4342
Pediatrics
sickle: black with hematuria, episodes of pain (abdominal..), high retic count.. dnt forget
to give vaccines and BID penicilin prophylaxis until age of 5
Infectious Diseases
Unilateral cevical adenitis can be caused by: Staph, Strep (these 2 are acute and
associated with cellulitis or suppuration), Anaerobic bacteria (the 3 of them treat with
clinda), Non TB mycobacteria (macrolide +/- Rifampin), TB (3 or 4 anti TB druugs),
Bartonella (requires no treement)
4353
Pediatrics
4438
Pediatrics
Fanconi anemia: Diagnosed dy age 16 -Aplastic anemia and progressive marrow failure
-Short stature, microcephaly, abnormal thumbs, and hypogonadism -hypopigmented/
hyperpigmented areas, cafe au lait spots -Strabismus, low set ears, middle ear
abnormalities (ie, hemorrhage, incomplete development, chronic infections, deafness..)
4439
Pediatrics
Sickle cell can cause childhood stroke
4479
Pediatrics
In preterm babies give vaccines normally according to age but dont give HepB unless
>2kg
4495
Pediatrics
Chronic ganulomatous: inability to oxidise pathogens within phagocytes. Patients

experience reccurent infections starting early in life. Pneumonia and suppurative adenitis
are most common
4497
Pediatrics
Vascular ring: Presents before age of 1.. Persistent stridor that improve with neck
extension, associated with cardiac abnormalities
4531
Pediatrics
Ophthalmology
Visual screeing shld occur at well visit baby starting age 3 .. Lead levels shld be asked if
pre 1978 house, occupational exposure from parents (pottery.. ) and recent
immigration.. Not needed if no symptoms or risk factors
4533
Pediatrics
Leg calve perthes is Bone necrosis (avscular)
& Sports
4548
Pediatrics

Electrolytes
4584
Pediatrics
Rheumatic fever do not happen if take antibiotics.. Serum sickness like reaction is most
commonly caused by beta lactam and sulfa drugs. Sx 1-2 weeks after exposure: Fever,
& Sports
urticarial rash, arhtralgia, lymphadenopathy Resolve with withdrawing agent
4638
Pediatrics
4642
Pediatrics
Rheumatology/Orthopedics Painful, Lytic bone lesion overlying swellin and hypercalcemia in a child SHLD SUSPECT
& Sports
LANGERHANS CELL HISTIOCYTOSIS OR OTHER NEOPLASTIC PROCESS
4661
Pediatrics
In congenital heart disease causing distress at birth give PgE1 to maintain PDA
Dermatology
Tinea corporis is seen in hot, humid climates. Pruritic, erythematous, scaly and have a
red ring with central clearing. Exposure to animals, people and public places are risk
factors, IT IS MOST COMMON IN PREADOLESCENT Dx: Skin scraping and KOH exam
Tx: Antifunfal (Terbinafine..)
4704
Pediatrics
Posterior urethral valve cause urinary tract obstruction, oligohydramnia, hypoplastic

lungs, flattened facies, clubfeet.. (most common cause)
patient with anaphylaxis Hx shld carry epi pen all the time
4705
Pediatrics
Large VSD: Failure to thrive, easy fatiguability and heart failure Pansystolic murmur
loudest at left lower sternal border and a diastolic rumble at apex due to increased flow
across mitral valve When Eisenmenger occur: Cyanosis, dyspnea secondary to shunting
Tx diuretics, trancath surgical closure ideally before Eisenmengr syndrome
4761
Pediatrics
Acquired torticollis is common in kids: Cause: URI, minor trauma, cervical lymphadenitis,
retropharyngeal abscess Do Xray of neck to make sure no spine fracture or any
dislocation..
4762
Pediatrics
Xlinked agammaglobulinemia or Bruton's agammaglobulinemia : Give them IVIG and

live normally Biochem: Defect in Bruton's tyrosine kinase (signaling molecule expressed
in B cells at all stages of development) Sx: Sinusitis, URI, OM, pneumonia btw 6 -18
months.. Absent tonsils and lymphoid tissue Nl CD3, Low CD19 (Bcells)
4767
Pediatrics
Female Reproductive
System & Breast
First year of menses, axis is not well secreting so get irregular periods
4818
Pediatrics
Do phototherapy for bilirubin >20 and Exchange transfusion if >25 Neonates shld be
breastfed 8-12 x / day every 2-3 hrs for >10-20 mins
4819
Pediatrics
In neonates, POLYCYTHEMIA is Hct >65% Risk factors: -Delayed cord clamping

-Maternal HTN -Maternal DM Sx: Respratory distress, hypoglycemia and neurological
manifestations
4822
Pediatrics
General Principles
By 1 year of age wight shld triple and height shld increase by 50%
4825
Pediatrics
Hydrea increases fetal Hgb
4826
Pediatrics
Pericardial effusion can occur within day or months after cardiac surgery and is referred
to as postpericardiotomy syndrome. Life threatening flui accumulation characterised by
distant heart sounds, hypotension and distended jugular veins and requires drainage
4828
Pediatrics

Electrolytes
Renal Tubular Acidosis: Hydrogen excretion or Bicarb reabsorption defect. Presents with
failure to thrive with normal anion gap metabolic acidosis. Give bicarb replacement
4829
Pediatrics
Enlarged thymus shadowing (above right silhouette of heart) make us suspect

malignancy or pneumonia
4831
Pediatrics
Respiratory distress syndrome= surfactant deficiency Risk factors: Prematurity, Maternal

Diabetes
4832
Pediatrics
Rheumatology/Orthopedics Osteogenesi imperfecta: Blue sclera, hearing loss, recurrent fractures, opalescent teeth
& Sports
HAVE NORMAL INTELLIGENCE
4834
Pediatrics
Kawasaki: Vasculitis with fever >5 days, nonexudative conjuctivitis, extremiry changes,
cervical lymhphadenopathy (unilateral usually), oral mucosal changes and
& Sports
polymorphous rash
4836
Pediatrics
Rheumatology/Orthopedics Rheumatic fever: Jones criteria: Joints (polyarthritis), Carditis, Nodules (subcutaneous),
& Sports
eryhtema marginatum, Syndenham 2 major is enough to Dx
4837
Pediatrics
Poisoning & Environmental Children with initial abnormal lead valure (on capillary fingerstick specimen) (have false
Exposure
positive) shld undergo venous draw Tx 5-44 observe and repeat 45-69: DMSA >70 EDTA
4838
Pediatrics
4840
Pediatrics
Rheumatology/Orthopedics AtlanTOAXIAL INSTABILITY SHLD BE SUSPECTED IN ANY PATIENT WITH DOWN

& Sports
SYNDROME WHO PRESENT WITH UPPER MOTOR FINDINGS
4841
Pediatrics
Nervous System
FEbrile seizure with no severe post ictal state is no worrissome about brain problems..
REASSURE and DISCHARGE
4843
Pediatrics
Infectious Diseases
Acute unilateral cevical lymphadenitis in children is infectious usually byt STAPH

AUREUS
4847
Pediatrics
Wiskot aldrich X linked disorder: TRIAD (like peaks of the W) Thrombocytopenia with
small platelets Eczema Recurrent bactrial infections
4849
Pediatrics
Osgood Schlatter is a traction apophysitis of tibial tuercle. Anterior soft tissue swelling ..
& Sports
4850
Pediatrics
Infectious Diseases
Most common predisposing factor for acute bacterial sinusitis is a viral URI (not allergic
rhinitis)
4851
Pediatrics
Intussuception: Target sign on Ultrasound Tx with air or water soluble contrast enema
4852
Pediatrics
Infectious Diseases
Congenital syphyllis: Hepatosplenomegaly Cutaneous lesions Jaundice Anemia

Rhinorrhea Methaphyseal dystrophy and periostitis may be seen on radiograph
Pediatrics
Colic is common and begins in the first weeks of life with excessive cryring for >3 hrs a
day (usually at night) >3 days/week for >3 weeks in an otherwise healthy infant.
Soothing and feeding techniques shld be reviewed and parents shld be emotionally
supported and reassured
4857
Pediatrics
Transient synovitis is the most common cause of hip pain in chuldren and treated with
Rheumatology/Orthopedics rest and ibuprofen. No fever no leukocytosis. Do Bilat Hip Xray to r/o Legg Calve Perthes
& Sports
Disease Do arthrosyntecis for septic hip etc.. if FEVER, HIGH WBC EST SCRP and
inability to bear weight (at least 3 of these)
4865
Pediatrics
Nervous System
Congenital heart disease and recurrent sinusitis are important predisposing factores for
BRAIN ABSCESSES (that present with fever, headache and focal neurlogical deficits and
seizures..)
4868
Pediatrics
Human milk: -Low vit D -low Ca and PO4 but great absorption so no prob -Many IgA's
-Less relfux and colic than Cow's milk
4870
Pediatrics
Female Reproductive
System & Breast
In vaginal foreign body: Remove it with calcium alginate swab or irigation with warmed
fluid after topical anesthesia is applied.. No need for CT
4871
Pediatrics
Nervous System
A child presenting with Hydrocephalus gor for CT or MRI
4856
Most common cause of painless Hematochezia in kids is Meckels ! (maroon colored

stools..)
4872
Pediatrics
Breath holding spells: Cyanotis, crying followed by breath holding in forced expiration,
apnea, cyanosis, limpness and LOC Pallid: Minor trauma followed by loss of
counsciousness, breath holding, pallor and diaphoresis Associated with Fe deficiency
anemia so ORDER CBC and Serum Ferritin
4875
Pediatrics
Thalassemia minor: RDW is normal, RBC normal or elevated.. MCV/RBC<13 see Target
and Teardrop cells
4889
Pediatrics

Puerperium
Small for gestational age babies (<10th percentile) are at risk for all hypo's Hypoxia,
Hypoglycemia, Hypothermia, Hypocalcemia AND Polycythemia
4890
Pediatrics
jujenal atresia = triple bubble sign
4891
Pediatrics
Infectious Diseases
Retropharyngeal abscess shld be suspected in children who present with fever,

dysphagia, inability to extend neck, myffled voice and lateral x ray showing a widened
prevertebral space.
4893
Pediatrics
Substance Abuse
Heroin withdrawal in neonate: presents in few days of life IRRITABILITY, HIGH

PITCHED CRY, POOR SLEEP, TREMORS, SEIZURES, SWEATING, SNEEZING,
TACHYPNEA, POOR FEEDING, VOMITING and DIARRHEA
4898
Pediatrics
Substance Abuse
Imaginary friends is normal between age 2 and 6
4912
Pediatrics
In PDA get high pressure aorta with and low pressure pulmonary rtery thus exaggerated
pulses
4923
Pediatrics
Nervous System
Epidural hematoma is a surgical emergency
4924
Pediatrics
Substance Abuse
Toddlers are curious about genital NOT A BIG DEAL CHILLOUT PARENTS THEYRE
NOT GAY (have masturbatory movements etc.. )
4925
Pediatrics
Moderate to severe dehydration in children shld be treated with IV bolus Isotonic
Physiological gastroesophageal refulux is common in childs coz of their short

esophagus, incomplete closure of lower esophageal sphincter and greater time spent in
supine position REASSURE PARENTS and shld hold baby upright after feed In GERD
Unlike this disease u get failure to thrive, irritability and sandifer syndrome Tx with
thickened feeds, antacids can do esophageal pH probe monitoring and upper
endoscopy Milk allergy: Regurg and vomiting, Eczema and Bloody stoolds
4926
Pediatrics
7726
Pediatrics
General Principles
Dry, flaky, peeling skin of the hands and feet is exprected in neonates as the skin
adjusts to dry extrauterine environment Pink stain or brick dust in neonatal diapers
represent uric acid crystals. They are seen during the first week as the mother's milk is
coming in. Or months later in the morning void when infant begins to sleep through the
night
8784
Pediatrics
Ophthalmology
Most common cause of ORBITAL CELLULITIS (ophtalmoplegia, proptosis and diploplia,

pain with eye movement): BACTERIAL SINUSITIS Do surgery if have subperiosteal
abscess
8791
Pediatrics
Esophageal coins in asymptomatik patients can be observed up to 24 hrs of ingestion If

symptomatik or time of ingestion unknown, the coin shld be removed by flexible
endoscopy
8820
Pediatrics
In low APGAR, with bad respiratory and cardiac do PEEP if RR<60 do Chest
compression
8871
Pediatrics

Metabolism
In Anorexia with chrinic starvation and acute refeeding.. U get a surge of Insulin when
reeat which can Fuckin lower ur Phosphorous Postassium Mg Thiamine (B1) and
increase water and sodium retention.
8923
Pediatrics
Substance Abuse
PANDAS: pediatric autoimmune neuropsychiatric disorder associated with strep ==>

Subtype of OCD Like other OCDs treat with SSRIs and Psychotherapy
8951
Pediatrics
Rota vaccine is contraindicated in patients with a hx of intussusception due to risk of this

side effect
8952
Pediatrics
Cystic fibrosis patients have OBSTRUCTIVE AZOOSPERMIA from congenital bilateral

abscence of vas deferens. Insipissated mucus acummulation will not allow vas deferens
to develop ==> INFERTILITY
8955
Pediatrics
Constipation is a common problem in toddlers due to transition to solid food and cow's
milk, toilet training and school entry. Complications include anal fissure, encoprsis,
enuresis Start on PO laxatives
8956
Pediatrics
Cryptorchidism: Increased risk of torsion, infertility and increase detection of testes

cancer Sx will decrease risk of torsion and improve fertility but sperm count and quality
remain substandard so still have Subfertility risk
9566
Pediatrics
Female Reproductive
System & Breast
Turner Pelvic US will show: Infantile Uterus and Strek Ovaries
9849
Pediatrics
Infectious Diseases
Herpangina = Coxaki A (3-10yrs) Posterior Oropharyngeal vesicles/ulcerations, fever,

pharyngitis. Tx is supportive (hydration adn pain control) In Herpetic gingivostomatitis
(6mo-5 yrs) also have fever and pharyngitis but ANTERIOR cluster of small vesicles TX
with ACYCLOVIR (Anterior:Acyclovir A's)
10742
Pediatrics
Dermatology
Burns sparing the flexors areas are suggestive of abuse since u hold them from
there..or baby can easily keep them out of water ..
2354
Psychiatry
Substance Abuse
Unlike patient with anorexisa, bulemia patients have a normal body weight and not
amenorheic
2357
Psychiatry
Substance Abuse
Dont use lithium in kidney patients
2494
Psychiatry
Substance Abuse
1- start SSRI for 4-6 weeks, if fail increase to max dose, if fail change to other SSRI, if
fail go for Other class
2496
Psychiatry
Substance Abuse
Panic attack give Benzo Treat with SSRI and CBT
2503
Psychiatry
Substance Abuse
In depression try SSRI if doesnt work try antoher SSRI if still not working after 2 trials of
same family switch to another family
2506
Psychiatry
Substance Abuse
OCD first line is SSRI or Clomipramine
2510
Psychiatry
Substance Abuse
Bipolar I: manic episodes without depression episodes Bipolar II: Hypomanic episodes
(less severe, less impairement and no psychotic symptoms) and a hisotry of one or
more depressive disorders
2521
Psychiatry
Substance Abuse
Somatic symptom disorder: 1 or more somatic complaints that are stressul and result in
negative feelings related to these for more than 6 months.. It can happen in Sick people
(khaldieh) or Healthy one
3144
Psychiatry
Substance Abuse
Delusions follow logical thinking
3185
Psychiatry
Substance Abuse
Risk of bipolar in General Population 1% If first degree relative has it it becomes 5-10%
3382
Psychiatry
Substance Abuse
Primary treatment of Adjustment disorder (cant adapt to Girlfriend that cheated) is

Psychodynamic Psychotherapy.. SSRI can be given if depression is happening too (but
not main treatment)
3385
Psychiatry
Substance Abuse
Kelptomania does not respond well to meds but responds to CBT
3535
Psychiatry
Substance Abuse
Passive agressive is a defense in which indivuduals expresses his agression toward

another person with repeated passive failures to meet the other person's needs
Displacement: I break up with my girlfriend. I crash my TV (bfesh khel2e be shi tene)
Distortion: I take heroin I got hep C. I blame the CDC for inadequate control Acting out:
Most direct. Someone insults me I punch him in the nose Introjection: Is when u agree
with an authoritie's opinion..U learn it
3751
Psychiatry
Substance Abuse
Be very sensitive with Body dysmorphic patients like ask them to come back regularly
3762
Psychiatry
Substance Abuse
Benzo cessation abruptly can lead to seizure
3798
Psychiatry
Substance Abuse
Reaction formation is the transformation of an unwanted thought or feeling into its

opposite .. Helping syrian refuges althougth i hate that they are competing with job
demands
3843
Psychiatry
Substance Abuse
Continue antidepressant for 6 months after patient starting to response
3845
Psychiatry
Substance Abuse
In hypochondriatic patients, ask about emotional stressors
4043
Psychiatry
Substance Abuse
For bipolar with at least 2 manic episodes shld countinues Li forever.. Unless not
tolerated
4063
Psychiatry
Substance Abuse
OCD is assiciated w serotonin problem thus the efficiency of SSRI
4067
Psychiatry
Substance Abuse
If patient not compliant to antipsychotics prescribe long acting injectable form
4141
Psychiatry
Substance Abuse
SSRI is first line treatment for Generalised Anxiety Disorder then Benzos and Buspirone
follow
4285
Psychiatry
Substance Abuse
Panic disorder is associated with: -Agoraphobia -Depression -Bipolar -Substance abuse

-Higher rate of suicide and ideations
4848
Psychiatry
Substance Abuse
Antipsychotics (doamone antagonists) will naturally cause weight gain and increase
prolactin thus fucking up the periods
4883
Psychiatry
Substance Abuse
Adjustment disorder require clear impairement in social and occupational functioning..

otherwise normal reaction to event if there is stress
4885
Psychiatry
Substance Abuse
Beware of metabolic syndrome in patients taking 2nd generation antipsychotics

(olanzapine, clozapine..)
4897
Psychiatry
Substance Abuse
DElusional disorder occur with no other psychotic behaviours for at least 1 month Brief
psychotic symptoms is psychosis for less than 1 month
4905
Psychiatry
Substance Abuse
Specific phobia is treated with Behavioral therapy (expose the patient to the stimulus in
controlled environment)
8875
Psychiatry
Substance Abuse
Hoarding disorder: The urge to keep things (magazines, valueless stuff.. ) despite their
accumulations at home or WTVER.. Do CBT + give SSRI
8915
Psychiatry
Substance Abuse
Survivors of rape are at high risk of -PTSD -Depression -Suicide
8938
Psychiatry
Substance Abuse
CBT focuses on negative thoughts and avoidance behaviour focusing distress

Psychodynamic therapy focuses on unconscious conflicts (in higher functional pple)
Interpersonal psychotherapy is to dela with grief, bad relationships, conflicts..
Biofeedback; patients are thaught tocontrol their response to various stimuli, like
learning to control their heart rate increase to stressful stimuli..
9841
Psychiatry
Substance Abuse
Introjection: People believe I'm fat so I start believing Projection: I think I'm fat so I
believe people think I'm fat Access to guns is the greatest is the greatest risk to
complete homocide
2143
Surgery
Acute mesenteric ischemia: severe acute onset poorly localized abdominal pain out of
proportion to physical exam initially, then with rebound tenderness and guarding, with
nausea and vomiting, bloody stool. Cause blots emboli from Afib..
2144
2245
Surgery
Surgery
Paget of bone is typically asymptomatik, have isolate elevated ALP. If symptomatik

present with pain associated with fractures or with arthritis resulting from bone deformity.
& Sports
Can result in hearing loss
Acalculous cholecystitis: Occurs in critically ill patients. It presents like its calculous
counterpart, but assessment is difficult due to underlying illness. Imaging: Gallbladder
wall thickening and distention and perichlecystic fluid. Tx: ABs + percutaneous
chelecytostomy (do cholecystectomy when patient gets better) Ileus, u get hypoactive
bowel sounds + distention of both small and large bowel. Small bowel obstruction u get
distention of only small+ hyper sound intially
2322
Surgery
Indication for OR in small bowel obstruction: Hemodynamic instability, fail to improve

after conservative management (NPO, NG, IV fluids electrolyte correction) , devellop
signs of strangulation (fever, tahycardia leukocytosis and acidosis) even if peritoneal
signs are absent (meaning that necrosis has not occured but go to OR to reverse
ischemia )
2327
Surgery
Most common injury in blunt trauma is spleen, and fluid accumulation in splenorenal
area (even if peritoneal signs)
2337
Surgery
Post Heart surgery (within 14 days), can have mediastinitis: fever, Chest pain,
leukocytosis and mediastinal widening on CXR. Tx: Drainage, Surgical debridement and
Antibiotics 10-50% mortality even with treatment
2371
Surgery
Bowel ischemia and infarction are possible early complications of AAAR
2476
Surgery
Umbilical hernia is common in black infants. The usually close spontaneously before age
of 5. Surgery is not required
2590
Surgery
Mediastinal mass ddx: 4 T's Thymoma Teratoma (and other germ cell tumors)
-Seminoma: High BHCG -Non seminoma: High BHCG (not in all) and AFP Thyroid
Terrible lymphoma
2666
Surgery
Limb ischemia: acute arterial occlusion 5P's (pain, pallor, pulseness, parasthesia and
paralysis). Immediate anticoagulation and referral for emergency vacular surgery
evaluation is the right thing to do
2734
Surgery
Aortic dissection can cause spinal cord ischemia, and cause LE weakness. Or renal
ischemia... Can extend to pleural cavity and cause hemothorax (similar to pleural
effusion on CXR). Often see Widened mediastinum on CXR (not always) Confirm Dx
with CT angio or TEE
2735
Surgery
Aortic dissection: Sudden chest pain, tearing radiating to the back. HTN is the cause. In
Abdominal aneurysm Atherosclerosis
2788
Surgery
V/Q mismatch (elevated A-a gradient): get compensatory tachypnea and respiratoty
alkalosis PE, Atelectasis, pleural effusion, pulmonary edema (so the 3 PE's and
atelactasis).. On the other hand alveolar hypoventilation we have normal A-a gradient
<15 (PAO2-PaO2= FiO2(Patm-PH2O)-(PaCO2/R)-PaO2=0.21(760-47)-PaCO2/8-PaO2=
150-PaCO2/8-PaO2 And get respiratory acidosis COPD, sleep apnea, scoliosis, NM
disease (myasthemia.., Narcotics, Central etiology..)
2812
Surgery
In lactic acidosis from septic shock giv Isotonic IV saline +/- Vasopressor therapy and
ABs to correct underlying infection.. Give bicarb only if pH<7.2
2822
Surgery
Bowel ischemia: occurs in atherosclerotic patients (Afib, PVD, DM etc.. ) Acute

abdominal pain out of proportion to examination findings and resulting in lactic acidosis
hence metabolic acidosis (Peptic ulcer perforation wont cause lactic acidosis)
2846
Surgery
Infectious Diseases
Retropharyngeal abscess can spread infection to mediastinum and cause acute

necrotizing mediastinitis
2847
Surgery
Infectious Diseases
Retropharyngeal abscess: sore throat, fever, difficulty swallowing (dysphagia),

odynophagia, pain ith certain neck movement (extension particularly). Initiate treatment
immediately (ABs + drainage) in order to prevent mediastinal involvement
2922
Surgery
In esophageal varice Establish vascular access with 2 large IV bore before Enoscopic
sclerotherapy or band ligation..
Chlecystectomy is indicated with symptomatik gallstones who are medically stable

enough to undergo surgery (post pancreatitis due to gallstones) If pancreatitis is not
getting better wth meds etc. Do ERCP.. or if chronic pancreatitis do ERCP to evaluate for
possible ampullary CA..
2933
Surgery
2973
Surgery
Post cholecystectomy pain: Functional pain (chillin, dx of exclusion) Common bile stones
(r/o by ERCP) Elevated biliary sphincter pressure, specific for spincter of Oddi
dysfunction--> RUQ pain and elevation of liver enzymes which resolve after the attack-->
Tx with ERCP sphincterotomy Nitrate, CCB or analsegic are useless
2978
Surgery
Acute cholangitis treatment is supportive and broad coverage ABs. If dont respond
should undergo biliary drainage by ERCP, if fails place a large bore T tube.. At some
point after treatment shld do cholecystectomy
2983
Surgery
Post op cholestasis can happen after prolonged surgery characterized by hypotension,

extensive blood loss into tissues and massive blood replacement.
3064
Surgery
When there is full blown presentation of appendicitis dont do CT and go for surgery
directly. IF suspicious presentation go for CT
3179
Surgery
Paralytic ileus: Absent vowel sounds with gaseous distention of both the small and large
intestine. Classically happens post abdominal surgery, but can also happen in cases of
retroperitoneal hemorrhages associated with vertebral fractures.
3181
Surgery
Psoas abscess: hematogenous spread of bacteria from skin.. (Staph aureus), bone or
bowel. There is pain but no guarding rebound tenderness but have psoas signs..
Confirm with CT
3182
Surgery
Complicated diverticulitis with abscess formation can be dranied by percutaneous CT

guided drainage. If it fails, surgical drainage can be done
3213
Surgery
General Principles
GCS score: Eye opeing (4) Verbal response (5) Motor response (6)
3220
Surgery
In rib fracture, give pain meds to restore good ventilation and prevent atelectasis,
pneumonia
3221
Surgery
General Principles
Any penetrating wound below the 4th intercostal space (nipples level) is in the
abdomen--> Laparotomy if unstable
3222
Surgery
General Principles
Hypotension not responsive to fluid following trauma is suggestive of ongoin blood loss.
So exploratory Laparotomy coz other sites would be obvious on exam
3227
Surgery
General Principles
Cervical spine injuries require stabilisation of the cervical spine. Orotracheal intubation
with rapid sequence intubation is preferred for establishing an airway in an apneic
patient with a cervical spine injury.
3302
Surgery
Rheumatology/Orthopedics Fat embolism occurs after long bones fractures, and presents with dyspnea, confusion
& Sports
and petechia in upper part of body
3325
Surgery
Do tetanus vaccine every 10 years If clean minor wound Give vaccine if last was >10
years and dont give Immunoglobulin If dirty severe wound Give vaccine if last booster
was given >5 yrs. IF MORE THAN 3 TOIXOID DOSES OVERALL IN LIFE DONT GIVE
IMMUNOGLOBULIN OTHERWISE GIVE IT
3348
Surgery

Electrolytes
Posterior urethral injury: Blood at meatus,scrotal hematoma, inability to void, Pelvic

fracture (the cause), High riding prostate (which does not happen with anterior injury)
and often palpable distended bladder
3349
Surgery

Electrolytes
In suspected urethral injury do Rtrograde urethrograsm. Not foley as it can predispose

to abscess formation and wprsens urethral damage
3352
Surgery
Penile fracture: Do retrograde urethrogram first to assess urethra then do penile surgery
3358
Surgery
General Principles
Blunt abdominal trauma often causes splenic injury which can present with delayed
onset of hypotension, LUQ + Left shoulder pain. CT with IV contrast is needed. If
Hemodynamically unstable do Hemodyalisis
3395
Surgery
Poisoning & Environmental In circumferential full thickness burns in extremitites or chest, do escharatomy to prevent
Exposure
vascular compromise or respiratory difficulty..
3398
Surgery
Circumferential full thickness burn with eschar causing edema and vascular constriction
and decreased pulses: Escharotomy.. If no relief do Fasciotomy (Escharotomy is more
Exposure
superficial than fasciotomy)
3413
Surgery
Midshaft humerus fracture: Think radial nerve injury
& Sports
3415
Surgery
Rheumatology/Orthopedics Non displaced saphoid fracture (fall on outstretched hand with <2 mm displacement and
& Sports
no angulation)--> Wrist immobilization for 6-10 weeks
3420
Surgery
General Principles
Penetrating abdominal trauma with unstable hemodynamically patients. --> Laparotomy

to correction the source of perforation causing sepsis
3427
Surgery
Torus palatinus: Fleshy immobile mass on the midline hard palate. No therapy needed
unless symptomatik interfering with speech or eating
3428
Surgery
Post rhinoplasty whislting inspiration suspect nasal septum perfortion likely resulting in
septal hematoma
3455
Surgery
Venous insufficiency (venous HTN): Valve incompetence. Ulcer seen on medial leg
supperior to medial malleolus + Edema, stsis dermatitis (brown discoloration)
3456
Surgery
Dermatology
Marjolin ulcer (SCC ulcers of skin) that grows on a wound that fails to heal after a
prolonged period.
3463
Surgery
Compartment syndrome: Pain out of proportion to injury, pain on passive stretch, rapidly
increasing and tense swelling and early parasthesia. Pallor and loss of pulse are
& Sports
uncommon.. Do fasciotomy
3464
Surgery
General Principles
Coaglusa negative Staph (epiderdemis.. ) are the most frequent cause of nosocomial
bloodstream infection in patient with intravascular devices. Get fever, leukocytosis,
hypotension and blood culture growth ..
3500
Surgery
Nasopharyngeal CA is common in Mediterranean and Far Eastern descent. Associated

with EBV
3505
Surgery
General Principles
If u have tension pneumothorax before even giving IV fluid top atient to needle
thoracostomy
Surgery
Suprachondylar fracture of humerus (must common ortho pediatric injury): Fall on

Rheumatology/Orthopedics outstretched hand Complications: Median nerve, Brachial artery, Compartment
& Sports
syndrome leading to Volkmann ischemic contracture (fork like hand and arm.. you
know), cubitus varus deformity (outward bluge of lateral epicondyle.. you know too)
3557
Surgery
Clavicular fracture: Most commonly, middle third of the clavicle. It occurs during athletic
events and follows a fall on a n outstreched arm or a direct blow to the shoulder. These
Rheumatology/Orthopedics patients present with pain and immobility of the affected arm. The contralateral hand is
& Sports
classically used to support the weight of the affected arm. The shoulder of the affected
side is displaced inferiorly and posteriorly. First of all a careful Neurovascular exam
should be done before tx
3562
Surgery
Clinical signs of scaphoid fracture following an injury, with possible fracture, shld get
thumb immobilization in a spica cast even if Xray is negative. Repeat xrayin a week or
& Sports
10 days
3564
Surgery
Rheumatology/Orthopedics In a patient with hip fracture emergent surgery must be done but it can wait up to three
& Sports
days to assess good cardiac and respiratory activity in suspected patients.
3566
Surgery
Stress fracture: Most commonly affect the anterior part of the middle third of the tibia in
people involved in jumping sports (dancing etc.. ) and posteromedial part of the distal
& Sports
third of the tibia in Runners. X rays are often normal.
3569
Surgery
Rheumatology/Orthopedics In knee soft tissue injury (tendons etc.. ) MRI is best way to investigate further. In MCL
& Sports
tears, bracing and early ambulation is the preferred treatment (not sx)
3572
Surgery
Medial lemniscus tear: injury during forceful torsion of the knee with the foot planted. Get
popping sound and severe pain during injury. McMurray's sign (flexion of knee with
Rheumatology/Orthopedics internal and external rotation followed by extension) is positive with popping. Knee
& Sports
effusion is notdirect; it takes hours or days following injury as it is not directly perfused,
unlike ligament injuries. MCL injury will be diagnosed vith Valgus stress test (extension
and adduction then outward of leg
3578
Surgery
General Principles
In amputated injury: wrap amputated part in saline-moistened gauze, seal in a plastic

bag and place the bag on ice --> GO TO ER then OR
3784
Surgery

Electrolytes
In traumatic spinal cord injuries place urinary catheer to assess for urinay retention and
prevent acute bladder distention and damage
3851
Surgery
Duodenela hematoma: (occurs in children ususally following abdominal trauma) Treated

conservately with NG suction and TPN
3556
3877
Surgery
Bowel ischemia is a side effect of aortoiliac vessel surgery (7%). Due to loss of collateral
circulation, manipulation of vessels with surgical instruments, prolonged aortic clamping
and impaired blood flow through inferior mesenteric artery. Affect the distal left colon.
Dull pain over ischemic bowel and hematochezia. Colonoscopy shows a discrete
segment of cyanotic and ulcerated bowel. CT will show thickening of bowel wall.
4025
Surgery
Venous valve incompetene is most common cause of lower extremity edema. It worsens
throughout the day and resolves overnight..
Dumping syndrome (common (50%) postgastrectomy complication): Rapidemptying of

hypertonic gastric content in duodenum--> Fluid will shift from intravascular space to SI,
release of intestinal vasoactive polypeptides and stimulation of autonomic reflexes.. Sx
diminish with time, and dietary modifications (avoid simple carbohydrate) will control sx.
If dont Give OCTREOTIDE and if still intractable go for Surgery
Pulmonary contusion can occur after MVC. Sx occur in the first 24 hrs with patchy
alveolar infiltrate on CXR. Presentation: Tachypnea, tachycardia and hypoxia, chest wall
bruising and decreased breath sound in onvolved area. Fat embolism: Tachypnea,
tachycardia, petechiae but HYPOTENSION and can get mental changes and
thrombocytopenia
4062
4145
Surgery
Surgery
4204
Surgery
Nervous System
Anterior spinal cord infarction is a potential complication of thoracic aortic aneursym

surgery and typially presents wtih spinal shock (Sx: abrupt onset flaccid paralysis and
loss of Pain and Temperature sensation below the level of spinal injury). Upper motor
neuron signs (spasticity and hyperreflexia) will develop over days to week. Posterir
spinal cord is preserved so Vibration and Proprioception are preserved
4207
Surgery
General Principles
In blood loss first (when only 15% is lost or 750 mL ) vitals change is tachycardia a
vasoconstriction to maintain BP.. then BP will drop
4212
Surgery
General Principles
Abdominal aortic aneurysm rupture: Hypotensive and on CT enlarged aortic silhouette ..

60s smoker.. IMMEDIATE SURGERY
4229
Surgery
Diaphragmatic rupture usually happen in left side (coz right protected by liver). Patients
have resppiratory distress and can have mediastinal shift to opposite side. IF smaller
ruptures can have delayed presentation with nausea and vomiting. CXR: Might see
elevation og hemiiphragm or NG in chest If bowel in chest go for surgery
4241
Surgery
Peripheral artery aneurysm: Pulsatile mass that can compress adjacent structures
(nerves, veins) and can result in thrombosis and ischemia. Popliteal and Femoral
aneurysms are most common peripheral aneurysms and aree associated with
Abdominal aneurysm.
4250
Surgery
Persistent symptoms in patients with probable meniscal injury should be further

evaluated by MRI. Surgery is often necessary to correct problem If acute Tx with rest
& Sports
and NSAIDs
4251
Surgery
Appendicitis > 5 days have high incidence of perforation and abscess formation (often
contained abscess). Ifstable treat with IV fluids, ABs and bowel rest then appendectomy
(6-8 weeks later)
4254
Surgery

Metabolism
Causes of hypoparathyroid: Post surgical, autoimmune and non autoimmune

parathyroid destruction or defective calcium sensing receptor on the glands
4292
Surgery
General Principles
Splenic trauma after blunt injury depends on hemodynamic state of patient. If improve
with fluids do CT. If dont SURGERY
4293
Surgery
Nervous System
Femoral nerve: Innervates the muscles of anterior thigh compartment (knee extension
and hip flexion)+sensation to Anterior thigh and medial leg (via saphenous branch) Tibial
nerve: posterior compartment of thigh muscles (flexion of knee and digits, platar flexion
of foot)+sensation to leg (except medial part) and plantar foot Obturator: medial thigh
compartment (adductors)+sensation there Peroneal: anterior and lateral leg
muscles+sensation to anterolateral leg+dorsum foot
4364
Surgery
Complete small bowel obstruction usually presnts with nausea, vomiting, abdominal
bloating and dilated loopd of bowel on xray (hypertympany). Previous surgery is most
common cause.
4462
Surgery
General Principles
When see air under the diaphragm it means somewhere the bowel have perforated.
Immediately open the patient
4485
Surgery
Stress (hairline) fractures of metatarsals are common in athletes, military. 2nd

Rheumatology/Orthopedics metatarsal in most commonly involved. Whenever its 2nd,3rd or 4th no need for cast or
& Sports
splinting since they are already splinted by surrounding metatarsals.. SO REST AND
ANALSEGICS
4486
Surgery
Gastric outlet obstruction: (mechanical) postprandial pain and vomiting with early satiety.
nausea, nonbilious vomiting and weight loss. Due to malignancy, peptic ulcer, Crohns,
strictures (pyloric stenosis), 2ary to caustic agent ingestion and gastric bezoars
4493
Surgery
DVT is treated with Heparin followed by warfarin for several months.
4494
Surgery
ABI >1.30 suggestive of calcified and uncompressible vessels; additional vascular

stidues shld be considered. Whenever have sx suggestive of peripheral vascular
disease do ABI
4498
Surgery
General Principles
In suspected peritoneal bleeding do FAST examination. If equivocal or not diagnostic do

DPL (diagnostic peritoneal lavage) and assess need for surgery or not
4500
Surgery
General Principles
In trauma causing peritoneal fluid, not response to IV fluid even in the absence of seen
organ injury, since its not reliable for organ injury -->OPEN
4501
Surgery
Retroperitoneal hematoma (within 12 hrs of precedures): local vascular complication of

cardiac cath due to vessel puncture.. and presents with sudden hemodynamic instability
and ipsilateral flank or back pain. Do non contrast CT of abdomen and pelvis or US. Tx:
Supportive, bed rest, monitoring, IV fluids +/- blood transfusion Other compliction:
arterial dissection, acute thrombosis, pseudoaneurysm, AV fistula formation
4507
Surgery
Leg emboli P's Pain, Pulselessness, pallor, parasthesia and paralysis
4526
Surgery
Infectious Diseases
Blood transfusion reaction table
4527
Surgery
Aortic rupture: High energy, blund, rapid deceleration trauma to chest. If contained
rupture patient will make it to ER. See widened mediastinum and left sided hemothorax,
deviating mediastinum to the right
4537
Surgery
In distal clavicle fracture need to correct surgically unlike middle portion which is more
common. Pulmonary contusion: Severe blunt chest trauma injuring pulmo parenchyma.
Dyspnea, tachypnea, hypoxemia worsened by Intravascular expansion and patchy
irregular alveolar infiltrates on CXR
4538
Surgery
Tension pneumothorax: Tachypnes, tachycardia, distented neck veins, tracheal

deviation IN blunt or penetrating trauma. If unstable hemodynacmically Immediated
needle thoracostomy is done prior to intubation (since positive ventilation first with
intubation will exacerbate condition)
4540
Surgery
Hypovolemic/hemorrhagic shock: Hypotension, tachycardia, flat neck veins, confusion

and cold extremeties despite fluid rescucitation in a trauma setting
4541
Surgery
High PCWP and right atrial pressure (preload) is indicative of cardiogenic shock. In
hypovolemic and cardiogenic shock we have increased SVR so increased O2 extraction
from tissues therefore lower Mixed venous oxygen saturation (unlike septic shock)
4542
Surgery

Metabolism
Intraductal papilloma: (benign breast disease) Intermittent bloody discharge from one
nipple. Cannot feel mass as it is small soft and directly beneath nipple
Infectious Diseases
Acute parotitis: painful swelling of the parotid gland that is aggravated by chewing. High
fever and tender swollen erythematous parotid gland are common. This post op
complication can be prevented with adequate fluid hydration and oral hygiene. Due to
Staph
4544
Surgery
4546
Surgery
Tronchateruc bursitis (bursa surrounding the insertioon of the gluteus medius onto the
femur's great trochanter): Excessive frictional forces secondary to overuse, trauma, joint
crystals or infection are possible. Middle aged adult, with superficial unilateral hip pain
& Sports
that is exacerbated by external pressure to the upper lateral thigh (as whn lying on the
affected side in bed) suggest trochateric bursitis.
4550
Surgery
Dermatology
In severe burns the major cause of morbidity is hypovolemic shock. If have adequate
ressucitation, bacterial infection such as bronchopneumonia or burn wound infection can
lead to sepsis and septic shock also another morbidity cause
4551
Surgery
Positive pressure mechanical ventilation increases intrathoracic pressure (dont be

mistaken its not like normal respiration where intrathoracic pressure decrease and on
the contrary increase preload) , which decreases venous return therefore preload. In
hypovolemic patient this will exacerbate the condition. So replace intravascular volume
first.
4552
Surgery
Nervous System
Transtentorial herniation herniation of the parahippocampal uncus occur during

significant head trauma and leads to ipsilateral hemiparesis, Ipsilateral mydrasis and
strabismus, contralateral hemianospia and altered mentation
4555
Surgery
Blunt trauma to the upper abdomen can cause a pancreatic contusion, crush injury,
laceration or transection. Can be missed on CT during the first 6hrs If untreated can
later be complicated by a retroperitoneal abscess or pseudocyst
4556
Surgery
In pericardial tamponade, u get a normal cardiac silhouette. It is a clinical Dx
4557
Surgery
General Principles
If an injury is causing pain in one or both shlder it is a subdiaphragmatic peritoneal

injury. So in case of bladder it could only be the dome (only peritoneal component of
bladder)
4558
Surgery
Pancreatic adenoCA: Risk factors: Smoking, hereditary or nonheriditary pancreatitis,

Obesity and lack of ecercice Presentation: Weight loss, anorexia, fatigue, abdominal or
back pain, jaundice (not all the time), Recent onset atypical DM, unexplained migratory
superficial thrombophlebitis, Hepatomegaly & ascites with mets (possibly) Increased
ALKP and direct bilirubin (due to obstruction) Elevated CA 19-9 (not screening tool), US
(if jaundiced) CT (if not) of abdomen..
4561
Surgery
In flail chest: Positive pressure mechanical ventilation will make chest move normally
4597
Surgery
In burn victims, injury to Upper airway or smoke inhalation injury to lungs is suspected
with burns on the face, singing of the eyebrows, oropharynx inflammation/blistering or
carbon deposits, carbonaceous sputum, stridor and carboxyhemoglobin >10% (or
closed space burn).. If suspecting so even if no respiratory sx right now--> INTUBATE
4599
Surgery
Nervous System
Parotid surgery involving the deep lobe of the parotid gland carries a significant risk of
facial nerve palsy resulting in facial droop
4600
Surgery
Upper abdominal surgery will cause respiratory complications so best thing to do to

increase Functional Residual Capacity is to elevate bead head..
4601
Surgery
Acute GI perforation (air under diaphragm) require emergent laparotomy. If patient is on

Warfarin reverse immediately with FFP before surgery
4604
Surgery
Nervous System
Foregul abduction and external rotation of arm (blockshot style): can cause anterior
shoulder dislocation (acute shoulder pain) and injure axillary (natation dos
"arriere""axillary") nerve: Paralysis of deltoid (adduction) teres minor (external rotation)
and loss of sensation over lateral upper arm
4606
Surgery
rate of carbondioxide produed to rate of oxygen depends on nutritional state (RQ) If 1

then u are eating carbs If proteins 0.8 and fat 0.7 (THE BEST)
4607
Surgery

Electrolytes
In post op: Acute pre renal failure from hypovolemia: Oligouria, azotemia, elevated
BUN/Cr>20:1 Give IV fluid
4608
Surgery
Reperfusion of a limb following arterio-occlusive ischemia for longer than 4-6 hours can
lead to intracellular and interstitial edema. Compartment syndrome may occur when
edema causes pressure within a muscular fascial compartment to rise above 30 mm Hg,
leading to further ischemic injury
Post op Morphine and Opiates, increase sympathetik tone from spllanchic irritation..
decrease GI motility causing Ileus: nausea, vomiting, abdominal distention, failure to
pass flatus or stool and hypoactive bowel sound (vs hyperactive in mechanical
obstruction)
4609
Surgery
4640
Surgery
Acute pain and swelling of the midline sacrococcygeal skin an dsubcutaneous tissues
are most commonly due to pilonidal disease. The acute presentation involves infection
of a dermal sinus tract originating over the coccyx. Bowen's disease is squamous cell
carcinoma in situ if the skin. It typically presents as a thn erythematous plaquw with well
defined irregular borders and an overlying scale or curst
4655
Surgery
Fenofibrate contribute to gallstone formation. Acute cholecystitis: surgery within 72 hrs

of onset
4695
Surgery
Atelectasis (common post op complication): Results from shallow breathing and weak
cough due to pain. It happens day 2-3 followong abdominal or thoracoabdominal
surgery--> Hypoxia which will stimulate respirations and cause alkalosis (lower PCO2)
4696
4698
Surgery
Surgery
Blunt deceleration (fall from 5th floor for eg), blunt aortic truma must be r/o. Widening of
mediastinum is the most sensitive finding
Nervous System
In spinal cord injury (3-4%) will develop post traumatic syringomyelia. (Whiplash injury)
Sx develop months to years later--> Enlargement of central canal of spinal cord due to
CDF retention--> Impaired Strength, Pain and Temperature of upper extremities. MRI
will confirm Dx
4930
Surgery
In blunt abdominal trauma (hypoactive boel, abdominal pain distention and ecchymosis)
do FAST (also assess pericardial effusion) to assess for intraperitoneal hemorrhage
(ususally splerenal or hepaticorenal space) especially if unstable. If equivocal do Deep
peritoneal lavage. If positive do laparo. If negative and stable do abdominal CT
4931
Surgery
Atelectasis: (postop complication: airway obstruction from retained airway secretions,

decreased lung compliance, pain and med interfering with deep breathing; that why
epidural is preferred) ABG: Hypoxemia, hypocapnea, Alkalosis (coz tachypneic)
4933
Surgery
Motor neuroma: mechanical induced degenerative neuropathy commonly seen in

Rheumatology/Orthopedics runners, thigh high heeled shoes and walking on hard surface. Presentation: pain
& Sports
between 3rd and 4th toes reproducle with palpation. Tx: Conservative with bilateral shoe
inserts to reduce pressure. Surgery if conservative treatment fails.
4936
Surgery
In TB patients, first step ISOLATE patient
4937
Surgery
In hemoptysis Establish airway (intubate) and ventilate.. Patient shld be placed in lateral
position (opposite side to divert the blood from that lung). If persistent bleed do
Bronchoscopy to indentify site of bleed and attempt intervention
8882
Surgery

Metabolism
Hypocalcemia: QT prolongation May be due to Parathyoid gland injury during thyroid sx
Infectious Diseases
Prostethic joint infection: Pseudomonas and Staph and anaerobes: Early after prosthesis
was installed (within 3 months)--> Wound drainage, erythema, swelling often with
fever--> remove impant, debridement.. Delayed onset prosthetic joint infection
(subacute): Staph epidemidis (more than 3 months)--> persistent joint pain, implant
loosening or sinus tract formation--> Implant removal recommended
9111
Surgery

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Question Main

In Sinus bradychardia use atropine, if hypotensive go EPI. IF still bad go for

Pulmonary & Critical Care

PE cause Hypotension, JVD and WAIT FOR IT RBBB

Gastrointestinal & Nutrition

Renal, Urinary Systems &

Hyperclcemia is FIRST TREATED with IV SALINE .. CAN ALSO GIVE CALCITONIN,,

Endocrine, Diabetes &

DKA: Stupourous patient, rapid breathing, hx of weight loss, polydispia, polyuria

Endocrine, Diabetes &

Endocrine, Diabetes &

In Adrenal Insuffiscienct: First line DO COSYNTROPIN STIMULATION TEST (NOT 24h

Endocrine, Diabetes &

Renal, Urinary Systems &

Chronic NSAID use can cause SIADH

Endocrine, Diabetes &

Renal, Urinary Systems &

In non ketotic hyperglycemia coma first GIVE NORMAL SALINE

Endocrine, Diabetes &

In DKA follow up based on pH and anaion gap to assess improvement

Endocrine, Diabetes &

Ear, Nose & Throat (ENT)

Deviation of uvula unilateral lymphadenopaty: peritonsillar abscess (not epiglotittis)...

Gastrointestinal & Nutrition

Gastrointestinal & Nutrition

A single negative occult blood test does not exclude colon CA

Gastrointestinal & Nutrition

In esophageal motility disorders DO: BARIUM, THEN MANOMETRY.. (THINK ABOUT

Gastrointestinal & Nutrition

Renal, Urinary Systems &

Renal, Urinary Systems &

Male Reproductive System

Non inflamatoory chronic prostatis exists !!!!!!

EPIDIDMYTIS IN YOUNG = STD = chalmydia, Gonorhea IN elderly: Gram (-) rods

Renal, Urinary Systems &

Sulfonamide and allergic interstitial nephritis BIG SHIT

Hematology & Oncology

AIHA can cause splenomegaly

Hematology & Oncology

MAC prophylaxis with AZYSTHROMYCIN Starts with CD4<50 .. It does nonspecific

CMV: is Mono without lymphadenopathy and sore throat, of course - monospot or

Progressive multifocal leukoencephalopathy (JC vrius) is suspected in AIDS with focal

Pulmonary & Critical Care

Hypertrophic osteoarthropathy can occur in lung CA patients.. also have clubbing

Gastrointestinal & Nutrition

Diverticulosis is most common bleeding LOWE GI BLEEDING in elederly

Gastrointestinal & Nutrition

Hep B exposure algorithm: -Documented vaccine: Reassure (HBsAb positive) -Unknown

Gastrointestinal & Nutrition

Gastrointestinal & Nutrition

Hematology & Oncology

Hematology & Oncology

In breast Ca mets to bones: go for bisphosphonate (zoledronic acid, etidronate sodium

Pulmonary & Critical Care

Febrile neutropeniia: always cover first pseudomonas (cefepime, mero, tazosin)

Hematology & Oncology

Hematology & Oncology

Trousseau's syndrome: Hypercoagualibility and thrombophlebitis at unusual sites (arm,

Renal, Urinary Systems &

Sypmtomatik Hypercalcemia (>12 usually) require IV HYDRATION.. Bisphosphonate are

Pulmonary & Critical Care

Hematology & Oncology

Tumor lysis: HIGH K, PO4, URIC Acid LOW: Calcium

Atheroembolism aka cholesterol embolism is a complication of any kind of