UWreaders-help urself posted by amith - fjaan - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: UWreaders-help urself posted by amith - fjaan (/showthread.php?tid=140246) |
UWreaders-help urself posted by amith - fjaan - ArchivalUser - 11-21-2006 USMLE Forum Step 1 Step 2 CK Step 2 CS Matching & Residency Step 3 * Step 2 CK * Archives * * To all UW readers - let us help ourself .. #123398 amith - 10/02/06 05:06 Guys we all know it would be very vital to revise UW and no matter we did it once or twice still we miss a subtle detail what may be a detail crucial for exam. This thread is only for UW.......we can post any info that you all think is important for differentiatiing 2 close d/d or important NSIMX...or be it InitialSIMX..........so that a day or two before exam we can just can all revise..................to remind you this is thread only for UW and info only from UW....and no discussions(any doubts can be postd in another title if yu may need. Report Abuse * cardio: nsimx in pt with cocaine induced ischemia #499558 dolly123 - 10/11/06 11:40 benzodiazepine ( diazepam) nitrates aspirin increases coronary perfusion, allays anxiety and pain, decreases chances of the emb formation BETA BLOCKERS SHOULD NOT BE GIVEN Report Abuse * cardio: nsimx in pt with stable angina #499501 dolly123 - 10/11/06 11:19 pt is already on adequate meds, and getsanginal episodes well controlled by SL nitroglycerine. nsimx in inv? exercise stress testing if this is c/i for any reason then do pharmacologic stress testing. the purpose of stress testing is for risk stratification Report Abuse * cardio: nsimx in bradycardia due to sick sinus syn #499446 dolly123 - 10/11/06 11:06 pt gets a single lead ventricular pacemaker atropine / isoproterenol will always be one of the choices here but is not the right answer since it is temp mangement, and most pts are usually stable needing a more definitive treatment Report Abuse * cardio: abdominal dissection next diagnostic step #497710 dolly123 - 10/10/06 12:51 c/f tearing pain radiating to back ie acute dissection dx---> transesophageal echo (TEE) ----> also CT if pt has chronic presentation and is hemodynamically stable ------> MRI Report Abuse * Re:To all UW readers - let us help ourself .. #497673 amith - 10/10/06 12:40 Post natal jaundice : Criteria for extensive evaluation * Jaundice 24-36hrs * Dir.Bil >2mg/dl anytime * Ser.Bil rate of inc at 5mg/dl/day * Full term Ser.Bil >12mg/dl * Preterm Ser.Bil>10-14mg/dl Physiological Jaundice starts 2-3 d------>peaks 2-4 day---->normal 5-7day Report Abuse * cardio: nsimx in hyperthyroidism induced Afib #497487 dolly123 - 10/10/06 11:14 PROPRANOLOL digoxin is not a good choice because the rpid ventricular response in hyperthy induced afib is resistant to cardiac glycosides Report Abuse * CARDIO: cold leg nsimx and follow thru #497473 dolly123 - 10/10/06 11:10 cold leg in post MI case is likely a thrombus from the LV ( Arterial embolus ) to localize: angiogram to treat : embolectomy if proximal endoarterial thrombolysis is distal another important test to be done:ECHO this is to localize site of embolus origin in ventricle Report Abuse * cardio: unstable angina #497457 dolly123 - 10/10/06 11:05 tt is heparin, beta blocker, nitroglycerin aspirin remember: THROMBOLYTIC THERAPY WITH tPA IS NOT INDICATED IN UNSTABLE ANGINA Report Abuse * Re:To all UW readers - let us help ourself .. #497470 him_vadodaria - 10/10/06 11:09 cong .h. dis. 1)down ---ASD endocardial cusion type 2)turner---coarctation of aorta --a. stenosis ---pul.ste( noonan syndrom) 3)marfan ---aortic and pulmonary artery dilatation ---M.R ,AR. 4)holt oram syndrom --familial asd 5)rubella --PDA (most comm) --PUL.STE. --VSD(Acco C.P.D.T. and GHAI) Report Abuse * Re:To all UW readers - let us help ourself .. #497448 him_vadodaria - 10/10/06 10:59 hocm c/o--most comm.-dyspnoea --sudden death may be frist menifest --systolic murmur (due to m.r.) -hallmark ---doubble and triple apex beat diag echo --best rx beta block.,ccb. avoid digitalis diuretices nitrates beta agonist Report Abuse * Re:To all UW readers - let us help ourself .. #497425 him_vadodaria - 10/10/06 10:51 ekg changes of the 1)hypokelamia -st depression -inverted t wawe -prominant U wawe -prolong p-r interval 2)hyperkelamia early......... peaked t wawe increse t wawe amplitude later -prolong p-r interval and qrs duration -loss of p wawe -av conduction delay -sine wawe pattern Report Abuse * cardio: nsimx in pulsatile abdominal mass #497412 dolly123 - 10/10/06 10:46 dx is abdominal aortic aneurym diagnostic test of choice-----> USG CT is less sensitvei,MRI and is not cost effective Report Abuse * Re:To all UW readers - let us help ourself .. #497409 him_vadodaria - 10/10/06 10:45 st segment changes elevated with convexity upwards -acute m.i -priz. angina -l.v. anuresum with concavity upwards -acute pericarditis st segment depression 1)with oblique plane-angina pectoris 2)with mirror image mark-digitalis 3)with convexity upwards-strain pattren of ventricular hypertrophy Report Abuse * Re:To all UW readers - let us help ourself .. #497395 him_vadodaria - 10/10/06 10:38 cause of s4 sound -hocm -hypertention -a.s. -acute m.r. -is.heart.dis absent s4 a. fib ventriculaer aneurysum Report Abuse * Re:To all UW readers - let us help ourself .. #497289 kr - 10/10/06 09:40 beta blocker overdose(poisoning) rx:1-cardiac monitoring,resp support. 2-if there is bradycardia or AVblock 1st give atropine..if that fails give isoprterenol.if both fail..next give GLUCAGONE. 3-if all drug therapy fails -temporary pacemaker. Report Abuse * cardio: more on SVT #497082 dolly123 - 10/10/06 00:34 if patient is hemodyanmically UNSTABLE: try electrical cardioversion immediately if hemodyanmically stable: do as above in previous post on SVT Report Abuse * cardio: nsimx in supraventricular tahcycardia #497078 dolly123 - 10/10/06 00:31 first try------------------> carotid sinus massage to convert the rythm if it does not work -----> give IV adnosine push most imp : learn to recognise supraventricular tachy on ECG Report Abuse * CARDIO: HOCM screening #497047 dolly123 - 10/10/06 00:20 in a young athlete if u want to screen for hypertrophic cardio myopathy what is the best measure? ans: detailed persona, family history and exam keyword: screen for hocm not diagnose. in that case probably EKG and ECHO although they have high false + and are useful only in conjunction with the family/personal history Report Abuse * NSIMx in aortic regurgition #496895 dolly123 - 10/09/06 22:57 c/f of AR are: high pitched blowing diastolic decrescendo murmur in 3rd ICS The defintive tt is surgical replacement of the valve The nsimx in chronic AR --->digoxin, ACE I , Diuretics (DAD) acute AR ---> sodium nitroprusside, dobutamine, dopamine in both of above cases the meds tt is to stabilze the pt prior to surgery Report Abuse * Re:To all UW readers - let us help ourself .. #496695 amith - 10/09/06 20:47 Given a case of seizure NSIMX Pt with fit or h/o of fit some time ago --------------------------->O/E Look for any focal neuro deficits/consciousness------------>CBC/Electrolytes/EKG/CXR/Urine toxicology screen -------------------->lorazapam given empirically for fit----------------->CT without contrast/CT with contrast for SOL to rule out IC Hem or tumor(depending upon clinical clues)------------------------>Dilantin if seizure doesnt stop still(Mx along side invst cause)---------------->LP only if CT rules out raised ICT and/or febrile patient (with neck rigidity..clinical clues of meningitis)--------------------->EEG last after stabilizing acute seizures activity but gold standard for documentng epilepsy type. Mx further depends upon results and diagnosis Report Abuse * Re:To all UW readers - let us help ourself .. #494234 amith - 10/08/06 06:38 Aspirin Toxicity in adults and children adults - acute stage - respiratory alkalosis only later stages - primary repiratory alkalosis with primary metabolic acidosis(not compensated) children- acute stages - primary metabolic acidosis with compensatory respiratory alkalosis.........compensatn depends on the timing but usually is very quick in hrs... Report Abuse * Re:To all UW readers - let us help ourself .. #494225 amith - 10/08/06 06:16 Pt with metabolic acidosis and non anionic gap acidosis(an example here is pt with diarheaa with DM nephropathy) 2 causes of NonAnionic Gap Met.Acidosis in our case: *bicarbonate losses by gi loss in diarhhea *defective Nh4+ synthesis in renal syn secondary to DM nephropathy Nsimx ---->calculate urine anionic gap UAG by formula... urine (Na+K) - urine Cl ---->Nrm UAG IS FROM 0 TO (-50)------->If positive-(low c--->low nh4 excretn)-it can either type 1 RTA or type 4RTA---------->IF NEG >cl --->more NH4+ excreted--->renal causes rules out and so it is blammed on GI losses Note: Bicarbonate gap is used in mixed acid base disorder Osmolar gap is used in inc anionic gap metabolic acidosis Urine Ph is used in differentiating types of RTA Report Abuse * Re:To all UW readers - let us help ourself .. #493504 amith - 10/07/06 16:46 Acute pyelonephritis and recurrent...with bacteruria/pyuria/costovertebral tenderness or flank pain n the puzzle behind SIMX - theme: Acute febrile illness with costovertebral tenderness and findings of pyuria and bacteriuria on urinalysis suggest the diagnosis of acute pyelonephritis.------------------------------------------ -------->(Oral or parenteral antibiotics can be used to treat acute pyelonephritis depending upon the disease severity) When disease is severe or the patient cannot take the antibiotics orally, IV ampicillin plus gentamycin is an appropriate choice as an empiric therapy for acute uncomplicated pyelonephritis / Those patients who can take the drugs orally, who are compliant or who are not suffering from severe diseases can be started on oral ciprofloxacin as an empiric therapy.------------------------------------------------------------------------------------>When a patient with acute pyelonephritis does not respond to 72 hr treatment with appropriate antibiotics, urological imaging with CT scan or ultrasound must be performed to exclude obstruction, renal, perirenal abscess, or some other complication In mild recurrent pyelo who on cipro already doesnt respond-----------> may also indicate the presence of obstruction, abscess, or other complications of acute pyelonephritis---->same workup Report Abuse * Re:To all UW readers - let us help ourself .. #493165 amith - 10/07/06 13:06 Mx of calcium oxalate urolithiasis Increase fluid intake (>3 L/dL) -------->Normal or increased calcium diet (recommended daily allowance is 1000 mg/dL)----->Dietary sodium restriction (<100 mEq/dL)---> Oxalate restriction (i.e., dark roughage, chocolate, and vitamin C)--->Decrease dietary proteins (i.e., beef, fish, eggs, and poultry Mx of recurrent hypercalciuric renal stones is increased fluid intake, sodium restriction, and a thiazide diuretic. Calcium restriction is not advised. Mx of a first uncomplicated calcium stone is hydration and observation. Report Abuse * Re:To all UW readers - let us help ourself .. #492895 amith - 10/07/06 09:12 Acute tubular necrosis The hallmark finding of acute tubular necrosis is "muddy brown granular casts" consisting of renal tubular epithelial cells; The serum BUN and Cr ratio is less than 20:1. The other findings that support the diagnosis of acute tubular necrosis are: Urine osmolality of 300-350 mOsm/L (but never <300) Urine Na of >20 mEq/L FEÂÂÂÂNa ÂÂ>1% Casts can be classified as follows: WBC casts ---------> Interstitial nephritis, pyelonephritis, etc. RBC casts ---------> Indicative of glomerular disease or vasculitis. Hyaline casts ------> asymptomatic individuals and pre-renal azotemia. Fatty casts ---------> nephrotic syndrome. Broad casts --------> chronic renal failure (CRF). Waxy cast----------> chronic renal disease. Report Abuse * Re:To all UW readers - let us help ourself .. #490901 ben - 10/06/06 13:19 Acute Pancreatitis Def Inflammation d/t autodigestion by proteolytic enzymes Causes 1. Alcohol (MC in US) “ AST 2x > ALT 2. Gallstones 3. Drugs (Furosemide,Thiazides/IBD Azathioprine/Valproic Acid/Didanosine, Pentimidine/Metro,Tetracylines) 4. ERCP Clinically - Midepigastric Pain Radiating to Back, Fever, Nausea/Vomt. Worse after Food Dx: 1. Amylase , Lipase levels (Very High)-- Initial to establish acute Pancreatitis 2. US “To r/o Stones as cause 3. CT scan when pancreatitis is severe - Development of complications: Necrosis, Pseudocysts, Abcess) (w/ incr severity elevated WBC/Glucose/LDH/AST/ BUN/Hypoxia/↓ Ca Rx: In Acute Pancreatitis d/t any cause - *Bed Rest, NPO, Ab™s, IV Fluids (Conservative Mx) Once resolved and cause was Stones (seen by US) - ERCP then later elective Cholecystectomy Complications that can develop (best seen w/ CT scan) - *Phlegmon-inflamed pancreas “(48hrs of onset) “ Conservative Mx - Necrosis (Turner & Cullens sign)“ 2 wks from onset “ Surgical Debridment - Pseudocyts (occurs 2- 4 wks after acute or chronic pancreatitis) -> If less 5 cm & ASx = Observe -> If less 5 cm Sx = Drain -> If > 5cm & > 1mo there is danger of rupture = CT guided Surgical Removal - Abscess “ 4-6 wks from onset = CT guided Aspiration Chronic Pancreatitis Def Chronic inflammation of pancreas Causes 1. Alcohol (70%) 2. Idiotpathic (30%) 3. In Children ---Think CF Clinically - Midepigastric Pain, Diarrhae-steatorrhea & Malabsorption, Diabetes Dx: 1. X ray = Shows Calcifications (not sensitive so do #2 initially if you susp cancer) 2. CT scan = If you suspect Pancreatic Cancer (Old, rapid weight loss, dilated CBD) Labs - Low trypsin, nl or mild AST/ALT Rx: 1. Replace Pancreatic Enzymes 2. Medium Chain Triglycerides in diet 3. Decr Fat intake 4. Supplements/Vitamins/Anagesics Report Abuse * Re:To all UW readers - let us help ourself .. #490435 sc98 - 10/06/06 10:46 NSIM-Pleural effusion- CXR,thn thoraco centesis,if malig cells + ->CT if cytology non dx with lung mass thn bronchoscopy Report Abuse * neuro:nsimx in tonic clonic seizure #490387 dolly123 - 10/06/06 10:34 pt with no hh/o seizures is seen having t-c seizures there is disorientatin but no focal neuro s/s all intial workuo done, incl met screenn, tox screen, glucose given etcetc next step? do CT without contrast to rule out intracrebral hge 2nd step: load pt on dilantin (phenytoin) to suppress further seizire activity However best test to demonstrate epileptiform activity is EEG Report Abuse * Re:To all UW readers - let us help ourself .. #490361 amith - 10/06/06 10:26 NSIMx - Virilisation symtoms ass with genital abnormalities in women Phase 1) To start with suspect tumor in either adrenal or ovary-----measure testosterone n DHEAS--------->if inc test with nrm DHEA IT IS OVARIAN tumor-------->if inc DHEA with normal Testosterone, it is adrenal origin. Phase 2) After localising to adrenal measure 17 alpha hydroxy prog for late onset CAH that would explain further the clitoromegaly along with virilisation Note : LH N FSH r used in cases of PCOD Report Abuse * Re:To all UW readers - let us help ourself .. #489525 amith - 10/05/06 20:58 NSIMx of Thyroid nodule -------> check clinically state---->if hyper/hypo symp+------------------>TSH,T3 N T4---->lab status comes out to be hyperthyroidism ---->do Radionucleotide scan----if hot nodule it shud be benign----/if cold ---->do FNAC(then mostly work up for malinancy) If clinically euthyroid--------->TSH only-->LAB shows euthyroid----->FNAC to look for benign cond or malignancy. Report Abuse * Re:To all UW readers - let us help ourself .. #489162 amith - 10/05/06 18:23 Primary hyperparathyroidism- Mx is Surgery IN symptomatic/Medical Surveillance(in surgicaly unfit ) If asymptomatic --------Surgery if a) ser.ca >1mg/dl of upper nrm limit of calcium + urinary ca exc >50mg/24hr b) Urine ca>400mg/day c)pregnancy d)follow up is difficult e) cortical bone densiy 2sd f) <50 years Report Abuse * Re:To all UW readers - let us help ourself .. #488975 amith - 10/05/06 17:18 Mx of Hyponatremia from SIADH. Mild (asymptomatic with sodium 120-130 meq/L) = Fluid restriction Moderate (asymptomatic with sodium 110-120 meq/L) = Loop diuretic + normal saline Severe (symptomatic) = hypertonic saline Report Abuse * neuro: acoustic neuroma #488774 dolly123 - 10/05/06 15:51 in a yong pt with gradually dev tinnitus. decreased hearing, and cafe au lait spots think of NF type II best test: MRI with gladolinium enhancement Report Abuse * Re:To all UW readers - let us help ourself .. #488713 amith - 10/05/06 15:37 Addisons NSIMx Cosynntropin test----->diagnosis of Addisons made -----------further if yu want to diff primary from secondary do Plasma ACTH level----------->if >50picograms it is primary----<50 is secondary Report Abuse * Neuro: diagnosis of alzheimers #488677 dolly123 - 10/05/06 15:21 The only definitive way to diagnose Alzheimers is by post mortem brain autopsy!!! Brain autopsy shows: neurofibrillary tangles neuronal loss gliosis hirano bodies senile neuritic plaques beta amyloid in the walls of the intracerebral arteries other tests commonly done are: CT = cortical atrophy,widenening of sulci etc..these are not definitve. Report Abuse * neuro: mgx of myasthenia gravis #488525 dolly123 - 10/05/06 14:27 3 tt options: 1. anticholinesterase : pyridostigmine/neostigmine 2. immuno suppressive : azathiprine /prednisolone/cyclosporine 3. thymectomey Report Abuse * neuro: SHY DRAGGER SYNDROME #488496 dolly123 - 10/05/06 14:17 how to diagnose: history suggestive of PD with h/o fall, dry mounth, dry skin and erectile dysfunction the importance is that PD drugs dont work here and the treatment is : volume xpansion, salt supplementation, alpha adrenergic agonists and tight garments in lower body Report Abuse * neuro: pseudotumor cerebri #488480 dolly123 - 10/05/06 14:12 pt presentation: young....obese.....female.....preseneof 6th nerve palsy sign: double vision etc on exam: papilledema on csf: n except increased opening prs >200 tt: weight reduction------->acetazolamide-------> optic nerve fenestration to prevent blindness long term effect if not ttd: blindness!! Report Abuse * NEURO: cerebral hge vs cerebral infarction #488472 dolly123 - 10/05/06 14:08 in a ct the hge is a HYPERdense area, wherea the infarction is a HYPOdense area Report Abuse * neuro: cerebellar hge #488468 dolly123 - 10/05/06 14:07 pt presentation: ataxia.......vomiting......occipital heaache....gaze paralysis...facial weakness IMPORTANT TO REMEBER: THERE IS NO HEMIPARESIS HEMIPARESIS IS SEEN ONLY IN CEREBRAL HGE Report Abuse * sorry guys #488464 dolly123 - 10/05/06 14:04 the two d/d ones i posted were meant to look like tables but it got formatted when i posted it Report Abuse * neuro: d/d between tick borne and GBS #488460 dolly123 - 10/05/06 14:02 progress fever sensation csf Tick few hrs --- N N GBS few weeks + decreassed/abN proteins high>100 also GBS has a preceding history in most cases, (GIT infection), tick borne does not Report Abuse * neuro: syringomyelia #488442 dolly123 - 10/05/06 13:52 'cape' distribution of neurological defects UL weakness and areflexia dissociated anaesthesia( ie pain and temp gone with vib/position sense preserved) etio: cord cavitation most frequent site: lower cervical/upper thoracic spine Report Abuse * Neuro: diabetic neuropathy #488430 dolly123 - 10/05/06 13:49 best test ot diagnose: EMG and nerve conduction studies Report Abuse * neuro:d/d between absence and complex partial #488424 dolly123 - 10/05/06 13:48 loss of conciousness automatism postictal stg EEGchange Absence + (sec) + ---- + Complex PArtial +(min) + + - ? (not sure) EEG changes in the absence seizures can be increased or challenged by hypeerventilation Absence seizures also have typical EEG changes (wave and spike ch) Atypical absence seizures: last longer and have lower voltage EEG changes Report Abuse * neuro: tonic clonic seizure #488409 dolly123 - 10/05/06 13:41 aura stiffness unconciousness seizure post ictal stage tt: supportive if seizures are over, diazepam. Report Abuse * neuro: cauda equina syndrome #488404 dolly123 - 10/05/06 13:37 pt presents with : 1. complete motor loss of LE b/l 2. complete sensory loss of L/E b/l 3. loss of rectal tone and perneal sensation 4. inability to pass urine tt: emergency surgery for spinal cord decompression if this is a repeat scenario in a pt think of spinal metastases...often seen in a prostate cancer old pt Report Abuse * neuro: tt protocol for status epilepticus #488391 dolly123 - 10/05/06 13:30 ABC---> DIAZEPAM/LORAZEPAM---->PHENYTOIN---->PHENOBARB---> MIDAZOLAM, AND INTUBATE (every arrow implies failure of the previous tt, however ABC is a must in all seizing pts ) Report Abuse * neuro: tt protocol for parkinsons #488386 dolly123 - 10/05/06 13:27 if resting tremors and no /minimal functional impairment---> check pt's age if < 70 give benztropine (anticholinergic) if >70 give amantadine if more bradykinesia nd functional imp give, carbidopa and levodopa if thereis response fluctuation in carbi/levo give Rapinerole or selegeline best drug to decrease progress of disease is selegeline Report Abuse * Neuro: trigeminal neuralgia #488375 dolly123 - 10/05/06 13:22 best drug for tt = carbamazepine this has to be routinely followed up bec of risk of aplastic anemia if there is b/l trig neuralgia in history think of multiple schlerosis Report Abuse * Re:To all UW readers - let us help ourself .. #487887 sc98 - 10/05/06 10:38 nocturnal dysnea -asthma -gerd -lv dysfn -obs sleep apnea Report Abuse * Re:To all UW readers - let us help ourself .. #487859 sc98 - 10/05/06 10:22 lets try to keep this thread alive Report Abuse * Re:To all UW readers - let us help ourself .. #485328 amith - 10/04/06 10:59 NSIMX IN Diabetic ulcer UW Grade 1) superficial ulcer 2) deep 3)- deep with cellulitis or abscess 4)- local gangrene 5-extensive gangrene grade 1 n 2------->wound care+debridement grade 3------------>short period of hosp/debridement/ulcer material culture/bone biopsy/iv antio bio grade 4 and 5------->Urgent hospital with exploratn for amputation Report Abuse * Re:To all UW readers - let us help ourself .. #484888 amith - 10/04/06 08:15 In acute respiratiry decompensation A-a Gradient is the best predictor--->calculate it-using formula(PAO2 - Pao2) where PAO2 is 0.21(760-47) - PaCO2/0.8 this shud be (5 - 15 nrml)---->diffusion defects looked for by V/Q mismatch Report Abuse * Re:To all UW readers - let us help ourself .. #484761 amith - 10/04/06 05:47 Community acquired Pneumonia trt When clinial n CXR shows CAP with difficulty in isolating organisms....trt is empirical most of the time A) first step decide on hosopitalisatn based on PSI pneumonia severity index. ----->if HIGH RISK AND IP----->BEST IS NEW GEN QUINOLONES(LEVO/GATIFLOXACIN) B)if OP-AND LESS RISK--> AZITHRO OR DOXY C) icu setup ---->RISK OF MRSA-->VANCOMYICN D) Alcoholic/recent stroke/sedation for endoscopy.---->Clindamycin(High Yield) Report Abuse * surgery #484441 airmax - 10/03/06 23:48 i had copy pasted this on my comp.... smne had posted it on the forum... don rmbr his/her name but thanks dislocation. 1.Hip is shortened and internally rotated==post dislocation. ap/lat xray emergency reduction(risk of avasc necrosis 2.Hip is shortened and externally rotated====ant dislocation. ap/lat xray reduction. 3.Pt fell on shoulder. Arm adducted and Forearm externally rotated==*ant dislocation of the shoulder joint. *x ray *reduction. 4. Pt had a violent seizure. Arm adducted Forearm internally rotated==ap/lateral Xrays/axillary view reduction.. look for axillary nerve injury in first(ant) and vascular injury in second.(post) DO distal neurovascular testing in all fractures. URETHRAL /bladder injuryINJURY. Urethal injury: Triad: Blood in meatus, No void and Distended bladder.test,,retrograde urethrogram - post: associated with blunt trauma. prostate is displaced up - high ridging prostate. tx..suprapubic catheter now....2.surgery later. - Ant: associated with pelvis fracture. also scrotal hematoma.more of straddle injury - in which the patient falls on the crossbar of a bike or the top of a fence . tx...immediate surgery. bladder injury - Type 1: contusion Type 2: Extraperotineal injury EP - MC with pelvic # - generally bladder not full - more on base or lateral bladder injury 3: Intraperitoenal injury. when bladder is full - dome is stretched - dome injury 4: Both Dx: Retrograde cystogram with postvoiding films! Don;t forget the postvoiding films!!!. summary.. Anterior- blood at meatus + scrotal hematoma Ix: retrograde urethrogram Treament- immediate repair Posterior- blood at meatus + scrotal hematoma+ high riding prostate Ix: retrograde urethrogram Treament- suprapubic cather, delayed repair after 6 months For both folate cather can't pass bladder injury====+/- blood at meatus.....foleys can be passed but blood in catheter as soon as foleys is passed+ suprapubic pain + and ass #of pelvis present LACERATED WOUND MX it is a lacerated wound - No Closing - just dressing - first let the inflammation subside, rule out infection - as the patient was able to walk - you can fix it later. Leggs calv pertheis Mx . less 5 - no Rx usually resolves spont 2. greater 5 or severe Sx- - casting and crutches spindolysisthesis. Spondylolisthesis is a condition that is seen when one spinal segment 'slips' away from another. Spondylolisthesis is most commonly seen with degenerative (aging) changes of the spine, but there may be other causes superior saggital sinus thrombosis. HEADACHE, fever, altered sensorium, paraplegia, seizures, hemiparesis and focal deficit.6th cranial N.effect..Lat rectal palsy Dequrivein tenosynovitis, SIGN... tenderness localised to radial styloid palpable thickening of tendon sheath leaading to limitation of movement TESTS pain aggravated by 1. adduction of thumb over palm 2. forcing ulnar deviation 3. radial deviation against resistance TREAT early stage....1. rest in slab 2. analgesics 3.ultrasonic radiation 4. local infiltration of hydrocortisone chronic case.....slitting n excision of tendon sheath Compartment syndrome compartment synd is when the interstitial pressure is elevated in a closed osseofascial compartment resulting in microvascular compromise n thus may cause irreversible damage 2 the contents of the space. causes.... decrease in compartment size... closure of fascial defects, tight dressing increase in compartment.... bleedin, vascular injury increase cappilary permeability... burns , trauma, seizures,venous obstruction muscle hypertrophy infiltrated effusion nephrotic synd pathophysio..... ext or int constrictions leads to increase in arterial spasm.....causes musle ischemia..... leads to increase in cappilary permeability.....causes increase in intramuscular oedema...thus increase in im pressure....further arterial compromise........leads to muscle necrosis....replaced by collagen......contractures HALLMARKS....6 P'S pain pallor paraesthesia paralysis pulselessness + passive stretch test treatment.. record ICP, if + clinical findingsdo fasciotomy if doubtful clinically but ICP more than 30 mm hg do fasciotomy osteogenic sacroma/ewing sarcoma OS 1.10-20 2.distal femur n proximal tibia 3. codsman triangle...periosteal elevation due to tumor sunburst pattern...lytic lesion 4.excision n local irradiation ES 1.<15 2.diaphesis.. 3.onion skinning 4.chemo **ewing..more aggressive with systemic symtoms OS..metaphysis...ES=diaphysis.. os also associated with retinoblastoma.. hemoatofenous osteomylitis ist test----XRay. specific....bone scan confirmatory/gold.....cultures tx..oxa/cloxa/dicloxa..(cillin SEPTIC HIP 1.child...staph 2.young...gonococcus 3.oleder...ataph 4.sicle cell...salmonella. 5.due to nail puncture....psedomonas. for children .first arhtrocentesis then hospitalized and tx with antibiotics with 10--21 days . herniated disc/quada equina 1.herniated=sensory deficit on level of spinal nerve compress Cauda=saddle anesthesia, acute urinary retention,dec anal tone 2.spine XRAY 3.spinal MRI 4.herniated= anti inflamatory, if nrve root compression-laminectomy cauda= emergency surgical decompresion. herniated disk can lead to cauda equina if advanced, it is just like differentiating MI from LVF, MI can have many manifestations, LVF being a serious manifestation of MI though it might have many other causes also. myocardial contusion/pulm contusion guess for cardiac contusion is just the same as MI ... but the problem will be less compliant venrticular wall as compared to the less SV in MI .. so we will have less CO with high SVR with High PCWP with less SVO2 do ekg...enzymes...early onset of sx<24 hrs. mi-->lv wall necrosis-->lv failure to contract-->decrease in stroke vol-->dec in cardiac output-->this dec perfusion to peripheries--->this causes increase in SVR---->inc in afterload lvf also causes---->pooling of blood in lv----->backward failure---->inc blood in pulmn veins--->pulmn congestion--->pulmn edema-----> inc in pulmn htn---->inc pcwp---->inc jvd and rt heart In Pul contusion does it affect Hemodynamics .. well it depends on the extent .. if affect a whole lung .. wich will also cos the lung to be edematous & stiff & permitting less blood to pass in Pul cap. which will caz the CO to go down , the PCWP down , the SVO2 down & the PVR increased ... this is my logic ..any correction is fraily welcome (white out lung...pulm infiltrate...characerstic)..after 24 hrs) tension pneumothorax caused by any lthorax injury that acts as a one way valve and allowsair inside but no exit--->air enters lung but cannot exit--->incrsd pressure in intrapleural space----->compresses the affected lung, the heart and mediastinum to contralateral side---->collapsed lung causes hypoxia,,compression of thin walls of rt atrium causes dec venous return and becoz the heart is compressed it becomes kind of stiff ---> leading to pooling of blood backwards..in the venous sys----> this causes inc in JVP---->the decreased venous return and the non compliant compressed heart also cause decrsd CO---->leading to hypotension----> shock CO poisioning . What could you so on P/E (external signs) --soot inside mouth, chery red color 2. Initial Tests / Confirmatory Test --I=ABG / --C=Bronchoscopy --determines extend 3. What lab do you need to determine extend of damage and need for support --Via ABG (incr carboxyhb levels)--dteremines actual extend & need for resp support Report Abuse * Re:To all UW readers - let us help ourself .. #483553 amith - 10/03/06 19:10 Parapneumonic effusion In recurrent cases of effusion decision on placing tube thorocostomy--- ------------>is pleural fluid ph <7.2 ------------>Glucose<60mg/dl Report Abuse * Re:To all UW readers - let us help ourself .. #483484 amith - 10/03/06 18:39 Post OP diagnosis usinmg time scale------if nothing works out then follow this! Immediete post op or Day 1 -------> Atelectasis Day 3 to 7----------------------------> Pneumonia Day 5 to 7----------------------------> PE Report Abuse * NEURO: Hypertensive Stroke #482938 dolly123 - 10/03/06 15:27 Most common cause of htn is stroke Most common type of htn sroke is the lacunar stroke due to thrombotic thickening of the small vessels 4 common presentations: 1. Pure motor hemiparesis due to a u/l motor deficit inv the face/arm/ and to a lesser extent theleg. There is also mild dysarthria ( clumsiness) But no sensory /visual/cortical dysfunction Stroke in the posterior limb of the internal capsule 2. Pure sensory stroke: u/l sensory loss/numbness and paresthesias, hemisensory deficit involving the face/leg/armtrunk This is due to a stroke in the ventroposterolateral (vpl) nucles of the thalamus 3. Ataxic-hemiparesis in arm, and to a greater extent in the leg, with same side arm-leg incordination. Stroke in posterior limb of internal capsule 4. Dysarthria: clumsy hand syndrome: stroke at the basis pontis Report Abuse * Re:To all UW readers - let us help ourself .. #481953 amith - 10/03/06 10:14 DVT --------MX IDEAS UW Test of choice for suspected deep vein thrombosis (DVT) is compression ultrasonography. Impedence plethysmography is the study of choice for recurrent DVT. Venography ---------> gold standard n used only when the noninvasive testing is not possible or the results obtained by noninvasive testing are equivocal. Only when the diagnosis of DVT is made by diagnostic testing,----------> anticoagulation therapy is started to prevent thrombus propagation and pulmonary embolism. Report Abuse * some quick facts regardin ards #481885 airmax - 10/03/06 09:38 normal cardiac output normal pulmonary capillary wedge pressure increased pulmonary artery pressure decreased PaO2 and normal or increased PaCo2 decreased pulmonary compliance decreased alveolar-arterial PaO2 the last two are due to the pulmonary odema which is present due to increased permiablitiy criteria for diagnosis of ARDS 1. pulm capillary wedge pressure < 18 mm of Hg 2. PaO2 to FiO2 ratio of <= 200 mm of Hg 3. Diffuse, B/L infiltrates on CXR Rx - treat underlying disorder. If conditioning worsening then put him on IPPV or PEEP. common complication in IPPV or PEEP - barotrauma (suspect when there is drop in O2 in patient on PPV) Report Abuse * Re:To all UW readers - let us help ourself .. #481848 fjaan - 10/03/06 08:38 blastomycosis: blasts SKIN,LUNG AND BONE Report Abuse * Rx of MS #481393 airmax - 10/02/06 21:51 drdepa00 - 09/12/06 17:52 Tx of MS 1-Relapsing Remitting ds--3 disease modifying agents--INF-B1a,INF-B1b and Glatiramer acetate (B=Beta) 2-Secondary progessive disease--INF-B1b and Mitoxantrone (Mitoxantrone give only to pts with normal EF) If pts with above two cant tolerate INF orglatiramer acetate then considerMethotrexate,cyclophosphamide,IV Immunoglobulin or azathioprine If pt has MS + Pain/spasticity--Baclofen If pt has Ms+ Fatigue--Amantadine or Fluoxetine If pt has MS+ Urinary Incontinency--Oxybutynine If pt has Ms+ Urinary Retention--Bethanecole If pt has Erectile Dysfunction--Sildenafil acetate Report Abuse * Re:To all UW readers - let us help ourself .. #481117 pinkee - 10/02/06 19:24 a decrease in MSAFP and estriol and increase in BhCG is typical of down's syndrome. all of the above parameters are decreased in edward's syndrome. condylomata acuminata also known as vulvar papillomatosis -- caused by HPV Report Abuse * Re:To all UW readers - let us help ourself .. #480414 amith - 10/02/06 13:54 Few more to add ...to the above mentioned forgot to mention that this is only in hemodynamically compromised...or unstable....and not to mention even after embolectomy pt shud be warfinarised for a few months Report Abuse * Re:To all UW readers - let us help ourself .. #480399 amith - 10/02/06 13:50 PE thrombolysis Fibrinolysis is the best trt for acute PE clot lysis---(But if h/o trauma/surgery.Fibrinolysis in NOT INDICATED)----->embolectomy Report Abuse * Re:To all UW readers - let us help ourself .. #480384 amith - 10/02/06 13:46 COPD/ASTHMA DIFFERENTIATION A bronchodilator response test (administration of a beta2-agonist) measuring forced expiratory volume (FEV1) before and after ----------------> Significant improvement in FEV1 after bronchodilator administration (15% or greater) indicates reversibility of obstruction, and this finding is more consistent with asthma.....n not so in copd Report Abuse * Re:To all UW readers - let us help ourself .. #480130 airmax - 10/02/06 12:46 prostatodynia - pt hav irritative voiding symp. physical exam as well as urinalysis is normal. expressed prostatic secr hav normal WBC nd culture is negative for bacteria. Usually no past hist of UTI but voiding abn may be present in the past... hey if nybdy knws its Rx then pls post it Report Abuse * Re:To all UW readers - let us help ourself .. #480118 airmax - 10/02/06 12:40 hey guys can we post such relevant information according to topic or subject .... it willl help keep things in order Report Abuse * Re:To all UW readers - let us help ourself .. #480113 airmax - 10/02/06 12:39 criteria for hospitalization in PID pregnancy , failure to respond to out patient treatment , suspected non compliance to Rx , nulligravida, severe illness (indlucding nausea, vomiting or high fever) , suspected tubo-ovarian or pelvic abscess , failure to rule out surgical emergencies.. Rx cefotetan or cefoxitin IV plus Doxcy PO Report Abuse * NEURO: multiple schlerosis #479937 dolly123 - 10/02/06 11:55 best test to diagnose: MRI Report Abuse * NEURO: D/D OF ds based on neuroimaging #479854 dolly123 - 10/02/06 11:27 Huntington's Chorea : atrophy of the caudate nucleus Alzheimers ds: atrpohy of cerebral cortex Wilson's ds : atrophy of lenticular disease Pick's ds : atrophy of frontal /temporal lobes Report Abuse * NEURO: d/d between TIA and RIND #479845 dolly123 - 10/02/06 11:21 TIA : reversible ischemic episode lasting <24hours RIND (revrsible ischemicneurologic deficit) the local s/s resolve iin 24hrs to one week Report Abuse * NEURO: d/d between TIA and RIND #479843 dolly123 - 10/02/06 11:20 TIA : reversible ischemic episode lasting <24hours RIND (revrsible ischemicneurologic deficit) the local s/s resolve iin 24hrs to Report Abuse * d/d between SHY DRAGGER AND RILEY DAY SYND #479818 dolly123 - 10/02/06 11:08 SHY DRAGGER: older PD type pt orthostatic hypotension impotence incontinence RILEY - DAY SYNDROME autosomal ds in askenzai jew CHILDREN SEVERE orthostaic hypotension gross dysfunction of the sutonomic nervous system Report Abuse * variant creutzfeldt jacob ds #479813 dolly123 - 10/02/06 11:01 age of onset: 25-30 slower disease progression sensory abnormality common EEG abnormal but no high voltage complexes Report Abuse * CREUTZ FELDT JACOB DS : clincal features etc #479810 dolly123 - 10/02/06 10:59 50-7- yrs of age reapidly progressive dementia myoclonus CSF normal HIGH voltage EEG complexes NO SPECIFIC TT Report Abuse * tt of pesudotumor cerebri #479741 dolly123 - 10/02/06 10:05 1. Weight reduction 2. Acetazolamide 3. Surgery: shunting or optic nerve fenestration Report Abuse * d/d of paralysis of infectious origin .. BOTULISM #479732 dolly123 - 10/02/06 09:56 DESCENDING PARALYSIS !! Report Abuse * d/d of paralysis of infectious origin GBS #479730 dolly123 - 10/02/06 09:55 ASCENDING P'lysis....... SLOW ASCENT in days to weeks annormal csf abnormal sensation h/o FEVER + Report Abuse * d/d of paralysis of infectious origin TICK BORNE #479728 dolly123 - 10/02/06 09:54 TICK BORNE ASCENDING P'lysis....... FAST ASCENT in hrs to days Normal CSF NORMAL sensation NO fever Report Abuse * best test for diabetic polyneuropathy #479708 dolly123 - 10/02/06 09:43 Electromyography and conduction studies Report Abuse * cluster headache prophylaxis #479706 dolly123 - 10/02/06 09:39 VERAPAMIL given asap after onset of ACUTE attack (other options: propanolol,methysergide, indomathacin , lithium, Lithium for prophylaxis of CHRONIC FORM OF CLUSTER HEADACHE Report Abuse * cluster headache acute #479701 dolly123 - 10/02/06 09:33 best tt: 100% O2 best med: nasal or subcutaneous SUMATRIPTAN Report Abuse * Re:To all UW readers - let us help ourself .. #479702 amith - 10/02/06 09:34 UW ARRYTHMIAS APPROACH Anytime if the patient is hemodynamically unstable [ means BP is low or patient not responding to the verbal commands treatment of choice is electrical cardioversion. 2. If the patient is hemodynamically stable, then you have to think whether it is an acute process? or a chronic process?. a. If it is an acute [ < 48 hrs] process i. initial approach is usually rate control. ii. Electrical or pharmacologic cardioversion may be necessary 1. if rate control cannot be achieved and 2. the patient is experiencing ongoing ischemia or 3. hemodynamic instability. iii. 4-6 wks warfarin anticoagulation b. If it is a chronic [ > 48 hrs] process i. initial approach is usually rate control ii. 4-6 wks warfarin anticoagulation iii. Electrical or pharmacologic cardioversion TREATMENT Rate control by 1. I.V beta blockers like I.V metoprolol & I.V esmolol 2. I.V calcium channel blockers like I.V verapamil or I.V diltiazem 3. I.V digoxin 4. Quinidine---for SVT ( supraventricular tachycardias ) Cardioversion 1. electrical 2. chemical like I.V ibutilide Report Abuse * spinal cord compression #479698 dolly123 - 10/02/06 09:29 Best treatment: URGENT surgical decompression as it affects prognosis Report Abuse * Re:To all UW readers - let us help ourself .. #479700 amith - 10/02/06 09:32 ISOIMMUNISATION fetus is at risk when 1.mother is ag -ve 2. father is ag +ve 3.atypical ag test is +ve 4.abs associated withhemolytic ds of newborn are +ve 5.>1:8ab titre fetus is at risk is fetus anemic what is to be done ? 1.Amniocentesis for af bil. Bil plotted on liley graph 2. PUBS if fetal hematocrit is <25 anemic... nl is 40 is it the time to intervene? i.e is the anemia severe enough ? on liley graph zone1: no or mild anemia repeat amniocentesis zone2: moderate repeat amniocentesis zone3: high risk intervention required intervention if fetus<34wks --------------- intra uterine transfusion if fetus>34wks --------------- deliver Prevention 1. routinely to all rh-ve mothers at 28wks 2.within 72 hrs of cvs,amniocentesis,d&c to a rh-ve mother 3.within 72 hrs of delivery of rh+ve baby to a rh-ve mother 300micro gm of rhogam neutralises 15ml of fetal rbc i.e 30ml of fetal blood TO REMEMBER 1.ABO incompatibility decreases risk of maternal isoimmunisation 2). Duffy ------------------>Dies 3) kell kills,lewis --------->lives 4.atypical abs test(att)------ INDIRECT COOMBS TEST 5.kleihauer-betke test----fetal cells in maternal blood both qualitative &quantitative Report Abuse * cataplexy #479696 dolly123 - 10/02/06 09:28 the basic pathophysio underlying cataplexy is DISTURBED REM SLEEP REGULATION Not a true syncope d/d is through associated features: no lossof conciousness loss of muscular tone assc with some emotion coexistent with narcolepsy in 75% cases (daytime somnolece and hypnogogic hallucinations) Report Abuse * Re:To all UW readers - let us help ourself .. #479693 amith - 10/02/06 09:25 Pulmonary embolism guys please dont get confused with this thread byfar this is the best discussion we ve had for PE MXN NSIMX----->I would take usmle20 and depa's conclusion as a review..... www.usmleforum.com/forum/message.php?id=118928 Report Abuse * with ref to benign essential tremor #479691 dolly123 - 10/02/06 09:20 the drug PRIMIDONE mentioned before has S/e of acute intermmittent porphyria..to elaborate on its clinical presentation , the c/f of AIP will be 1.abdominal pain 2.psych 3.neurological abnormalities Report Abuse * SAH and hyponattremia #479690 dolly123 - 10/02/06 09:16 In a case of subarachmoid hge, the associated electrolyte imbalance os hyponatremia Thsi is cerebral salt wasting syndrome, due to SIADH and increased vasopressin secretion Report Abuse * status epilepticus #479689 dolly123 - 10/02/06 09:13 if routine antiepileptic mx does not break seizure, INTUBATION is the tt of choice workup is done after the control of seizure Report Abuse * Re:To all UW readers - let us help ourself .. #479687 amith - 10/02/06 09:12 The previous post was from Ben/star earlier discussion based on UW thx n from my collections Report Abuse * Re:To all UW readers - let us help ourself .. #479686 amith - 10/02/06 09:11 Ca/Ph/PTH --------------CONUNDRUMS 1. Osteoprorosis --nl PTH/Ca & Ph-- Dec osteoclast--->dec resorption, Bone loss but mineraliztion is normal 2. Pagets --Nl PTH/Ca & PhInc ALP--defect in skeletal meneralization/incr bone turnover-incr resop & formation(Inc osteoclast And Inc Osteoblast---> thick sclerotic bone.) 3. Osteomalacia --Vit D ineffective (not deficient)/low Ca & Ph/high PTH/ nl 1,25 Vit levels (aka calcitrol) --Defect in mineralization/looser zoenes - pseudofractures/Blurring of Spine on X ray 4. Type II Vit D dependent Rickets --Mutation of Vit D receptor thus nl Vit D levels (calcitrol) other Values same as osteomalacia --defcet in mineraliztion of bone and cartilage (growth plate) 5. X linked Hypophophatemic Rickets --isolated decr Ph / everything else normal/may nl to low Calcitrol 6. Milk Alki Syndrome --incr Ca/decr PTH, alkalosis & renal failure 7. Osteogenis Imperfecta Type I --Defect in Collagen Type I 8. Primary Hyperparathyroidsm --incr PTH & Ca / decr Ph --MCC = parathyroid adenoma 9. Secondary Hyperparathyroidsm --incr PTH/ low Ca & Ph --exp . Vit D def and Renal failure (incr PTH & Ph and decr Ca--?) 10. Pseudohypoparathyroidism --incr PTH and Ph and decr Ca 11. CRF-- dec ca,incr phosphorous,inc PTH Report Abuse * Re:To all UW readers - let us help ourself .. #479683 hope00 - 10/02/06 09:10 cmplication of supracondyl # of humerus? Volkman contraction Report Abuse * Re:To all UW readers - let us help ourself .. #479680 hope00 - 10/02/06 09:06 indication to use asprin in kids 1.kawasaki disease 2.juvenil rhematoid arthritis Report Abuse * Re:To all UW readers - let us help ourself .. #479678 hope00 - 10/02/06 09:00 pnemothorax---hypotension, Inc jvp and dec air entary in affected side Report Abuse * Re:To all UW readers - let us help ourself .. #479675 hope00 - 10/02/06 08:57 pt with MVA in shock with normal chest and plevic Xray.abd exam little tenderness do abd US or DPL befor laparatomy. but if abd exam with signs of peritpneal irritation eg rebound tendernss go for laparatomy immediately. Report Abuse * Re:To all UW readers - let us help ourself .. #479672 upsups - 10/02/06 08:53 Benign Essential tremor.. DOC Propanolol or Primidone anti convulsant which can precipitate acute intermittent porphyria Report Abuse * tt of trigeminal neuralgia #479670 dolly123 - 10/02/06 08:52 CARBAMAZEPINE is tt of choice follow the CBC count due to the risk of the aplastic anemia with prolonged anemia ailure of medical tt , other tt are: surgical gangliolysis suboccipital craniectomy for decompression of the trig nerve. Carbamazepine is also used for tt of atypical bipolar depression Report Abuse * Re:To all UW readers - let us help ourself .. #479669 hope00 - 10/02/06 08:49 cardiac temponad-Beck's triad--muffled heart sounds,hypotension,inc JVP Report Abuse * Re:To all UW readers - let us help ourself .. #479668 amith - 10/02/06 08:48 Respiratory - Bronchiectasis Steps in Mx First localisatn of anatomical lesion ---High resoluion CT(Tram track app/ring shadows/peribronchial thickening/also to rule out obstructive lesions) ---->Sputum examinatn n AFB. Please title the topic otherwise readers will not understand what u intend to say...thx Report Abuse * Re:To all UW readers - let us help ourself .. #479667 nida - 10/02/06 08:48 * Patient with stable angina and hypertension, a beta-blocker is the DOC. * Depressed CO combined with elevated PCWP, indicator of left ventricular failure. * Statin-induced myopathy is due to reduced CoQ10 production. * PTCA with stent placement has better outcomes than thyrombolytic therapy in patietns with acute ST elevation MI. * I.V. adenosin is the DOC for paroxysmal SVT. * Renal artery stenosis (RAS) is a common cause of resistant hypertension in patients with atherosclerosis. Continuous periumblical area murmur is the characteristic of RAS Report Abuse * D/D of intracerebral hge #479666 dolly123 - 10/02/06 08:48 PUTAMEN hge : hemiparesis, hemisensory loss, homonymous hemianopsia, stupor , coma CEREBELLARhge: ataxia, vomiting,occipital headache, gaze palsy, faical weakness. NO HEMIPARESIS..if left unttd then there is stupor or coma due to brainstem comprssion PONTINE HGEudden dramatic onset of severe headache, no focal neuro signs, no HTN risk and ususally due to saccularaneurysm and vascular malformation Report Abuse * Re:To all UW readers - let us help ourself .. #479664 hope00 - 10/02/06 08:46 when you need home O2 therapy in COPD? when Po2<55 or O2 sat <88% Report Abuse * Re:To all UW readers - let us help ourself .. #479661 hope00 - 10/02/06 08:44 How diagnosis malabsorption? 24hrs stool for fat,if >7g it is malabsorption Report Abuse * other bugs in gbs #479656 dolly123 - 10/02/06 08:37 HERPES VIRUS MYCOPLASMA HEMOPHILUS INFLUENZA RECENT HIV RECENT IMMUNIZATION GBS also seen in pts with lymphoma, SLE and sarcoidosis other bugs as distractors: ecoli O157:H7 in HUS salmonella, shigella, campy, yersinia, chlamydia in REACTIVE ARTHRITIS Report Abuse * Re:To all UW readers - let us help ourself .. #479659 hope00 - 10/02/06 08:41 Which condtion need blood transfusion? loss 1500cc of blood Report Abuse * INFECTIVE AGENT IN GB syndrome #479653 dolly123 - 10/02/06 08:33 Guillain Barre syndrom e is preceded by an resp or GIT infection frequent bug responsible/involved: CAMPYLOBACTER JEJUNI Report Abuse * PD features #479650 dolly123 - 10/02/06 08:28 In addition to tremors, cogwheel rigidity, bradykinesia, retropulsion, also look for 1.subtle dementia, 2.depression and 3. MICROGRAPHIA Report Abuse * sudden painless loss of vision NSMx #479648 dolly123 - 10/02/06 08:26 NSMx is duplex ultrasound of carotids is done with painless loss of vision lasting few seconds. amaurosis fugax. the usg detects the presence of emboli at the carotid bifurcation CT?MRI is indicated only if there is associated h/o of stroke or any focal neurological s/s Report Abuse * Drugs for resting and other tremors #479643 dolly123 - 10/02/06 08:17 Propanolol : for benign essential tremors Benztropine: anticholinergic improves resting tremor and rigidity, with minimal or no effect on bradykinesia they are most useful in under 70s, with a disturbing element of resting tremor and minimal bradykinesia They are also used in advanced disease in thosewhere tremors do not improve with l-dopa they are discourage in the elderly due to their anticholinergic side effects Report Abuse * Re:To all UW readers - let us help ourself .. #479614 amith - 10/02/06 05:12 Psych Mania - - mania which may be ass with acute agiattion - -- immediete Simx----Haloperidol Mania --- Abrubt onset of symptoms witout agiatation---- Valproate best alaternatively Lithium(takes 4 to 10 days to act) After Antiphyscotic trt - Dytonia duration of occurence 4hr to 4 days Parkinsons -- 4d to 4m Tardive dyskinesia - 4m to 4yr Report Abuse * Re:To all UW readers - let us help ourself .. #501877 amith - 10/12/06 10:06 Stable and unstable angina -Differentiation Both conditions wud have more or less same presentation clinically....so what do u do first..------------>start the treatment protocol of asa, ntg, o2 , morphine..........>..mesnwhile take an ekg............>if ur ekg shows st elev ..----->u got ur diagnosis.--------->mi-------------->tx wth thrombolysis etc If ekg shows no ST elev ------->.then it cud be either unstable angina / NSTEMI/ cud also be an evolving mi which is slowly evolving so what do u do./.u send cardiac enzymes-------------->dont wait for results------->.mean while take serial ekgs------->and start tx------->for UA/NSTEMI(tx for both is Aspirin, NTG, betablockers, heparin, o2, morphine).---->a) if the serial ekg shows evolved MI wth st elev then add TPI------/------or b) on otherhand if cardiac enzymes r raised with ST elevation -->STEMI---->Rx Aspirin, NTG, betablockers, heparin, o2, morphine + STK/tPA/PTCA if in window period-----/--c) If cardiac enzymed raised with ST depression as seen previously----confirm diagnosis of NSTEMI -------d) If ST dep and T inv with no rise in cardiac enzymes---->confirm Unstable angina Reference: for the above protocol Diagnosis..... EKG.........................cardiac enzy................treatment USA........normal/T inv/ST dep.......not raised......Aspirin, NTG, beta, heparin, o2, morphine Nstemi....normal/T inv/ST dep........raised...........same as above STEMI....ST elevation/new LBBB.....raised...... ...same + STK/tPA/PTCA if in window period Courtesy: ajeet ,cg, airmax and ben Report Abuse * heme/onc: metastatic bone pain #506637 dolly123 - 10/14/06 08:53 CA PRostate: nsimx IV dexamethasone Report Abuse * * heme/onc: metastatic bone pain #506640 dolly123 - 10/14/06 08:55 then MRI or CT myelogram to confirm site/diagnosis of the pain as due to anterior cord compression then radiotherapy Report Abuse * Re:To all UW readers - let us help ourself .. #506655 amith - 10/14/06 09:16 Time scale- Simple guesses *Generalised Anxiety Disorder - too many things to worry - min 6mn duratn *PTSD - Flashbacks and nightmares(important words) - >4 weeks *Acute Stress Disorder - <4 weeks Similar symptoms as PTSD *Adjustment disorder - diff it with major depression /some signs of depression but within 3 mnths to 6 months but def <6months Vs Major depressn which shud have a min of 6 months *Brief psychotic disorder - psychotic symptoms <1 months *Schizophrenia - have symptms for 6 months to establish diagnosis *Schizophreniform - >1month but <6 month *Schizoaffective - schizo+mood symptoms but schizo symptoms of delusion n hallucinatn should be present exclusively for 2 weeks in absence of mood symtoms *Delusional disorder - Nonbizzare delusion at least for 1 month without functional impairment Report Abuse * heme/onc: metastatic bone pain #506659 dolly123 - 10/14/06 09:24 CA prostate: ina stage 4 pt with bone pain not responding to NSAID, start with short acting morphine to achieve control, once done switch to long acting opiates. Fentanyl patches referred to in the Q take 8-12 hrs to start acting..not a good choice Report Abuse * heme/onc: basal cell CA ( > sun exposure) #506662 dolly123 - 10/14/06 09:28 nsimx : full thickness biopsy after diagnosis: excision with 1-2 mm of clear margins then watch pt diligently over time for new sites of recurrence Report Abuse * Re:To all UW readers - let us help ourself .. #507804 amith - 10/15/06 09:09 NSIMx of mild preeclampsia- -- - - - a) Pt at term and fetal lung maturity is fine ----->induce labour for delivery if no other risks b) Pt is remote from term and fetal lung not matured----->wait until 34 weeks--->bed rest/salt restrictn and close obs to manage HT+dexamethasone ----->as soon as lung maturity is accomplished with dexa------->delivery to be carried out in anycase within 34 weeks NSIMx of severe preeclampsia Bed rest/salt rest/dexa and ANTI HT to everyone irrespective to stabilise the pt a) if pt stabilised------->decison for delivery depends on gestation age....same as in mild preeclampsia with lil changes 1) if pt at term - deliver 2) pt is remote -->wait for lung maturity till 34 weeks.....but not later even if not matured b) if pt does not respond to initial therapy and is not stabilisd irrespective of factor immediete deliver Report Abuse * hemeonc: ITP nsimx #509520 dolly123 - 10/16/06 13:54 dx: thrombocytopeni with no cause or thrombocytopenia with ab to IIc/IIIb or Ib/IX tt: steroids for 2 wks no response---> splenectomy no reposnce---> anticancer drugs: cyclophosphamide/danazol if bleeding crises / before surgery: IV Ig infusion and platelet tranfusion Report Abuse * heme onc: post orchiectomy prostatic met s pain #509567 dolly123 - 10/16/06 14:01 nsimx: for areas of bony metastasis in post orchiectomy pt ? Radiation therapy, since pt has already had surgical androgen ablatioin..if that were not the case we do that first with appropriate drugs these are: flutamide and cyproterone acetate.. please confirm? Report Abuse * Re:To all UW readers - let us help ourself .. #511213 hope00 - 10/17/06 10:10 -------- Report Abuse * Re:To all UW readers - let us help ourself .. #511218 amith - 10/17/06 10:12 ITP---dec plat all others normal TTP---dec plat ,hemolytic anemia,nuerologic symptoms, inc ur/cr HUS--same as TTP but high inc in ur/cr little neurologic sypmtoms DIC---dec plat ,inc PT,inc PTT,inc bleeding time, inc FDP CLL---sumdge cells ,thrombocytosis,splenomegaly,anemia CML-----low LAP,phelidepha ch + thx to hope Report Abuse * heme/onc: solid testicular tumor ...nsimx #511434 dolly123 - 10/17/06 11:25 After the diagnosis of a solid testicular mass has been made, (a painless hard mass in testicle + suggestive ultrasound), the initial management is removal of the testis and its associated cord, orchiectomy. Depending on the cell type of the cancer present other therapies, i.e. additional surgery, radiation therapy, or possibly chemotherapy may be indicated REMEMBER!!! FNAC, or transscrotal biopsy, is contraindicated because of the risk of spillage of cancer cells, which can potentially spread through lymphatics and blood vessels Report Abuse * Re:To all UW readers - let us help ourself .. #511552 amith - 10/17/06 12:07 Asthma Mx Protocol 4 types 1) Mild Intermittent - symtoms<=twice a week/nocturnal symp occur <= twice a month Rx Inh short acting beta 2 agonist/flares with inh steroids if needed ...Note:daily medicatn not needed 2) Mild persistent - symptoms >twice a week/noc sym occur >twice a month Rx Low dose inh steroids/flares with short acting b2agonist...............long term control only req daily trt 3) Moderate persistent - daily symptoms +exacerbatn >=twice a week Rx Low doseInhaled corticosteroids + long acting beta agonist or medium dose inhaled steroids 4) Severe persistent - High dose Inhaled steroids + long acting beta agonist/also leukotriene antagonist and systemic steroids if needed Report Abuse * Re:To all UW readers - let us help ourself .. #511571 amith - 10/17/06 12:14 *Also add continuous symptoms with freq exacerbatn in severe persistent *3 n 4 requires daily trt *Exercise induced asthma best trt by inhaled b2agonist Report Abuse * Re:To all UW readers - let us help ourself .. #521546 amith - 10/21/06 19:23 Tuboovarian abscess trt Admit the pt------>Triple antibiotic regimen -----Gentamycin + Ampicillin +clindamycin --------------->if no response within 24 to 48 hrs --->drainage Report Abuse * Re:To all UW readers - let us help ourself .. #522416 amith - 10/22/06 13:10 Burns - HY 1) Rules - second degree and third degree b urns are only counted for these formula n calculatns of fluid replacement 2) Rule of nine in adults Head ----------9 peds - Head - 18 Left hand --- 9 both legs ---- 27 Right hand --- 9 all the rest same Left leg ------ 18 Right leg ------18 trunk ----------36 3) Parkland Formula - Body weight x% of burns(only upto 50) x 4(4 - 6 in babies)+ (additionally 2000ml D5W to compensate as pt on NPO and NG tube in place) This is the amount of RL to be given in first 24 hrs. Given as : Half dose within first 8 hrs and second half within next 16hrs 4) Colloids not given in first day due to loss in edema fluid so given in 2nd day in 16hrs 5) Empirically for anyone coming with burns >20% BSA start with 1000ml/h initially in adults and 20ml/kg/hr in kids 6) Third degree burns differ in adults n children ------leathery gray in adults/deep bright red in children 7) Give TT prophylaxis/antibio silver sulphadiazine(mafenide acetate restricted use only in deep burns not anywhere else) Report Abuse * Re:To all UW readers - let us help ourself .. #516254 amith - 10/19/06 06:49 Precocious puberty Its divided into 2 groups and deals w/ normal developmental factors that shuld be seen at a certain age. If these devlop are seen to early its called precocious puberty. Its includes -Breast develpment-->nl develp at 9-10 years -Pubic & Hair--> nl at 10-11 -Growth--> nl at 11-12 -Menarche-->nl at 12-13 Its divided into 2 groups a. Incomplete --Involves only one change on the list --D/t transient elevations of FSH/LH or end organ damage --Mx Conservative b. Complete --Involves all changes on the list --Also has 2 types --> GNRH dependent --> GNRH indepdent GNRH dependant ------->also called as true isosexual precocious puberty is secondary to activation by hypothalamic-pituitary axis - ex pituitary tumors.etc GNRH independant -------->also called as pseudoisosexual precocious puberty is secondary to end organ causes withouit activatn of the Hypotha pit axis - ex ovarian tumors, adrenal tumors, exogenous estrogen exposure,advanced hypothyroidism and Macune Albright syndrome To differentiate this we do a test called GNRH stimulation test(most important test) - 100micrograms are administred as IV bolus -----> a gud reponse of LH release-->true isosexual puberty However we do other nonspecific test to detect the underlying problem like MRI/Serial bone age/Visual testing so on.... 1) Adrenarche n thelarche <6year |