05-17-2007, 03:16 AM
fasinopril is best medicine for hypertention due to conn syndrome...
for perioperative control of htn bb is always prefered
ace inhibiter is goood only if uni lat renal artery stenosis in bilateral its contraindicated
in exam dont order tft just order tsh ist its cost efective and best way to know about hypo or hyperthyrodism..
after treatmentof hyperthyroidism f/u with free thyroxine level not tsh...
dont give rai to a preg lady...no pregancy 6 m b4 or after use of rai...cause hypothyrodism....and teratogenic for baby..
if u want prescrive isotrention bcz its best drug for nodular cystic acne do preg test ist...
no pnumovac b4 2 yrs of age its not effective and no imunoglobulin with in 11 month with mmr other vaccination pd is 3-6 m but for mmr its 11 months...
if some body have reaction after gettingimunoglobulin then they r IGA DEFIENCT...
NSALINE IS BEST FOR MVA...WHY BCZ NO LR IN TRUMAA BCZ OF RHABDO ORPOSSIBLE HISTORY OF RENAL PROB SO NS...ONLY
NS IS ALSO GOOOD FOR RENAL FAILURE PT AND NEURO SURGERY PT BCZ LESS K..AND WILL NOT CAUSE HARMFUL EFEFCT...
NO SUCCINYCHOLINE FOR A BURN PT BCZ OF INC CHANCE OF HYPERKALEMIA BCZ THEY HAVE EXTRA POTASSIUM RECEPTERS..
MORPHINE I/V B4 DRESSING CHANGE IN THE BURN PT
NO INHALATIONAL AGENT AND SUCCINYLCHOLINE IF HISTORY OF MELIGNANAT HYPERTHERMIAA....GIVE DENTROLINE..MUSCLE WEAKNESS IS CHEIF SIDE EFFECT OF DENTROLIN ITS IS ALSO BEST FOR NEUROMELIGNANT SYNDROME WHICH IS DUE TO INC CA RELEASED FROM SARCOPLASMIC RETICULAUM AND CAUSE FEVER AND RIGIDITY
IF PT HAS PARKISNISM DONT GIVE REGLON FOR VOMITTING BCZ IT IS HIBITER OF DOPAMINE HE NEEDS DOPAMINE ..
IF CYSTIC BREAT SNODULE DO FNA WITHOUT MAMO IF PT IS LESS THAN 35
IF NONPALPABLE MASS BUT SUSPICIOUS CALFICATIONON MAMO THEN DO NEEDLE DIRECTED BIOPSY..
the dif bet primary and secondry addison diease is primiry start with p and p is for pigmentation so in c pigmentation due to inc acth in primary addison diease and secondry no pigmentaion due to dec acth..
in diabtes kidney will b double in size remmber d for diabetes and d for double.....but in htn its shrinked...see the dif..
TBG WILLL INC IF TOTAL T4 WILL INC BUT FREE T4 WILL B NORMAL...
IF THYROID MASS AND TSH IS NORMAL DO FNA
IF INC TSH DO THYROID SCAN
IF PT HAS AAA AND ANY CARDIAC DIEASE TERAT CARDIAC IST LIKE DO CABG BCZ MOST CC OF DEATH FROM ALL MAJOT VASCULAR DIEASE LEIKE CAROTID ENDARTERCTOMYOR AAA REPAIR IS AMI..SO FIX HEART IST IF NOT URGET...
IF BPIS MORE THAN 180/85 AND PT SAID IT WAS HIGH IN MALLL TOOO TREAT IT BCZ THATS WH THEY GIVE U THIS SENARIO...OTHERWISE RECHECK I MORE TIME....AND THEN EXCERCISE AND DIET IST AND IF FAIL THEN START WITH DIURETIC AND BB..
TOOO SLEEPY MORE LATER ..GOOOD LUCK DOCS.....UR DAY IS COMING ...ALLUR HARD WORK WILL PAID OFFF SO KEEP ON DOING TH EGREAT WORK...GN
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!)most cc of hypothyroidism is hashimotos..
2) most cc of dizziness in elderly is their medciation
3)most cc of impotency is antihypertensive medciation and ssris..
4)tumor marker for melignant melanoma is s-100
5)if family history of ovarian ca is positive then yrly pelvic exam and ultrasound is screening test...
6)no bone scan for melignany melonoma bcz these r lytic bone lesion not osteoblastic...
7)dontjust give ca for steoporosis or jut s vitD both along with alendronate
if pt on alendronate or any of these easophagitis is the most common risk so ask pt that take medcine with galss of water and sit up for 30 minutes after take medciation
9)griseofulvin is beetr absorb if taken with fatty foood..not for kids just liek cipro u cant give pt less tahn 10(cipro)
10)if pt is having meliganncy or some bed ridden condition he or she needs anti coag for life
11) d/c ocp i month b4 surgery and restart i month after
12 )d/c coumadin at least 48 h b4 surgery
13) d/c asp 10 days b4
14)d/c heparin 4 h b4 going to or...half life for heparin is 90 minutes
15) if heparin reversal is reqguired then reverse 100 unit ofheparin with 1 mg of protamine sulfate and thats how u calculate the dose...
16)b4 giving all protein inhibiters plez check all th ept medciation bcz of lots of inter action
17) if ptis on pis..then no rifampine but rifabutin
1if ca is high recheck ist
19)if recheck ca is still high then check pth
20) if pth is low and ca is high then think of sarcoidosis
21)if pt is hypovolemic and has ccf always put central line so u can measure cvp....but remmber ccfis not a contraindication forivfluids if can always give lasix
22)if ca is low always check albuminist
23) never ever pick hypertonic soulutionin exam unless pt is not seizing or na is less than 115...always restrict fluids..
24)in siadh urin eosmolaity will b higher than th e serum..
25)in melig ca is high bcz it s produced by pth like protein which is also produced by granuloma in sarcoidosiss...and for melignancy hypercalcemia steroid will b best forothers ist try ns and lasix then iv palmidronate...
2mallet fx close reduction is goood
29)collls fx close reduction withlong arm cast
30) supracondylar fx in a kid is a surgical emergency ...orif is th e ans and asap...but of nerve palsy risk...
31)smith fx...fx of distal radius withventral displacement due to fall when forearm is supinated and hand is extended...
32)scaphoid fx..risk of avascular necrosis,dont do xray its is neagtive until 2 wks...
33)fall on feet calcanious fx...orif is req
34)dont give flumazenil if mix drug over dose bcz it dec threshold for seizure and dont ever give in tricyclic od...
35)plez read dif bet tricuspid atresia and transposition of great v..both cause cyanosis on ist day...but dif is on t e xtay in vascularity of pul v ..i dont recall rt now bcz its middleof th enite i dont wana put anything which i am not sure about...but its vvvimp...
36)if 6 wks of abx is not able to bring fever down in acut e bec endocarditis....call cardiology asap...
37)any kid wit fever ifless tahn 3 month admit her or him to r/o sepsis
3suction rectal biopsy is best to diag hursprung
diease butist will b kub
39) plez remmber ist test for stess incontinence or heamturia or enuresis will b ua
40)cobble stone aaprence is in crohnand appple core lesion is in colorectal ca
41)central incisor dental carries r due to nocturnal bottle feeding...
42)last but not th eleast just remmber where u c xray ,ultrasound,excercise behaviour therapy,diet ,reassurance,smoking cessation,alcohal abstinence ,nsaid thatis most likely the ans..
if u dont get any ans then go for th elongest choice do thatin ur practice test and u will c
always go forur ist intusion..dont change ur ans its 80-90% correct
relax b4 exam....24 b4 just listen to music..watch movie...dont go out to eat u might get sick eat light dinner sleep early and uwill b fresh when u wil wake up and do som e revisionin th emorning from ur notes only.....so u can have som e memory of what ever is imp.....
dont read any new materail in last 2 wks
practice practice practice ob usmle cd....its worth....it......bye guys and gooodluck....jerry ,gulabooo,hbnorhbs sorry i cant recall ur name atthis time ofnight but best of luck to naz natisha and alll others ...and welcome to new commers just stick to this great site..and pray for waheed and his family...i do...whothought of such great site....for alll of ius..thanks doc.waheed!!!
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Methyldopa (Aldomet) -- Centrally acting antihypertensive agent widely considered the first-line agent for treatment of hypertension during pregnancy.
Studies have revealed no adverse effects on cognitive development up to the age of 7.5 y among children with in utero exposure to methyldopa.
Hydralazine (Apresoline) -- Intravenous form is useful when treating severe hypertension due to preeclampsia/eclampsia.
///////////////////
Lead poisoning case
I. complete physical exam
II. cbc,sma7 blood lead level, lft, glucose,
peripherial blood smear, serrum ferritin
III. <25 environmental intervention
25-44 environmental and oral dimercaprol
44-69 IM or IV edetate disodium
>70 IM or IV dimercaprol
IV. Plan to admit or d/c home
V. console: Inspect home for lead paint
remove child from lead hazard
//////////////Meniere،¯s disease. Triad. ---1-Vertigo 2.Hearing loss 3.Tinnitus
//////////////////////
Sarcoidosis patient gets affection of eye.---uveitis and. Glaucoma
/////////////////////
This case clearly indicated the PD pt presented psychiatic s/s, not depression.. So, the management step by step is (MKSAP, in Neurology, parkinson's dis, Table, 39):
Hallucinations, delusions TX: (step by step):
1). Discontinue non-levodopa drugs, if failed..
2)/. Reduce dose of carbidopa/levodopa (to the minimum theraputic dose), if failed...
3). Clozapine, quetiapine, donepezil, respiridone, olanzapine
For the depression in PD pt:
MKSAP: SSRIs.
Swanson: TCAs
/////////////////
HIV is a major no no for breast feeding, pretty much anything else, except meds like (antipsychotics, lithium), drug abuse, etc, you can encourage breast feeding. even with jaundice, you can usually keep breast feeding. The AAP does not recommed very much not to breast feed.
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PMR : --No muscle tenderness, but muscle ache..
-- Weakness: yes, it is main s/s of PMR
polymyositis -- weakness and muscle pain and tenderness..
FM is almost always dx in a <40yo and ESR=NL. PM and PMR are dx in the same age range, but PM has proximal muscle weakness and muscle bx is=AbNL. PMR= no proximal muscle weakness and muscle bx=NL
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polymyositis has specific weakness which always demonstrated by something like cannot raise from chair or cannot climb stair because of their severe proximal muscle weakness. Polymyositis pt does not complaint pain that much although they have tenderness in PE. the diagnostic for polymyositis is EMG, biopsy and CK etc. Fibromyalgia is a very vague similar to chronic fatigue syndrom. those pt complaint everything but find nothing conclusive (alway negative on labs etc, unless coexist with other dis).
/////////////////////////Which one of the following treatment strategies has been shown to decrease mortality in adult patients with ARDS?
C. Mechanical ventilation that delivers lower tidal volumes and limits plateau pressure.
A patient is found to have prostate cancer metastasis in the spine. Which one of the following is the initial treatment of choice ?
B. Dexamethasone i.v if the presence of spinal cord compression otherwise
E. Leuprolide (or LHRH antagonist, or orchiectomy)
A patient is found to have lactose-intolerance. What food you advise him to take?
D. Yogurt with live activated cultures.
Which one of the following is the mainstay of treatment for pemphigus vulgaris?
B.Prednisone
A mother brought her 5-year boy because of œbed-wetting? She told you that she found on the internet that alarms are more effective than the mediciation. What's the best choice?
C. Data reflect that alarms are most useful when augmented by other behavioral approaches.
////////////////////////
Valproic acid (dapakote)is generally regarded the drug of first choice in primary generalized epilepsy, particularly in patients with more than one seizure type, because of its broad spectrum of activity. Lamotrigine and topiramate also have a broad spectrum of activity and show promise in the management of these patients. Phenytoin, carbamazepine, and phenobarbital are effective in primary generalized tonic-clonic seizures but are ineffective against generalized absence and myoclonic seizures. Felbamate is effective in primary generalized seizures but is relegated to the refractory population because of its potential for toxicity
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BLL <10 mcg/dL: No action is required.
BLL 10-14 mcg/dL: Obtain a confirmatory venous lead level within 1 month. If the BLL is still within this range, patient education about lead exposure is needed, and the BLL test should be repeated in 3 months.
BLL 15-19 mcg/dL: Same as #2, but repeat the BLL in 2 months.
BLL 20-44 mcg/dL: Obtain a confirmatory venous BLL in 1 week. If the BLL is still within this range, assess complete medical, nutritional, and environmental hazards. Environmental evaluation by the local health department is also needed. A 2001 large-scale study reported no improvement in neurologic and behavioral test scores after succimer chelation of children with BLL in this range.
BLL 45-69 mcg/dL: Obtain a confirmatory BLL within 2 days. If still within this range, undergo complete evaluation as in #4. At this level, chelation therapy is recommended. Treatment should be in a lead-free environment. If this is not possible, hospitalization is necessary. Chelation can be started with oral succimer, or, if the patient is hospitalized, calcium disodium edetate (calcium EDTA) can be used. These agents have potential toxicities, and monitoring of the CBC, electrolytes, and LFTs is necessary.
BLL >70 mcg/dL: Hospitalize, obtain a confirmatory venous BLL, and initiate chelation with dimercaprol and calcium EDTA. Because calcium EDTA does not cross the blood-brain barrier, its use as the only agent in this situation is not recommended because of the possibility of lead redistribution from the soft tissues to the CNS. Pretreatment with dimercaprol (which crosses the blood-brain barrier) is recommended.
////////////////The measles (rubeola) vaccine recommended for use in this country is a live attenuated vaccine. It is recommended for use at 15 months of age, but whenever there is likely exposure to natural measles, infants as young as 6 months should be vaccinated and then revaccinated at 15 months to ensure protection. Exposure to measles is not a contraindication to vaccination, and if the vaccination is given within 72 hours of exposure, it may provide protection. Studies indicate that measles vaccine, by protecting against measles, significantly reduces an individual's chances of developing SSPE, a "slow virus" infection of the central nervous system associated with a measles-like virus.
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Eye movement and pupil size, such as miosis in opioid, organophos intox and barbiturate coma, or pontine lesion etc and mydriasis in TCA, amphetamin/cocaine, higher level herniation, brain hemorrhage etc. And that bilaterally dilated and fixed pupils are due to inadequate cerebral perfusion.
nystagmus: Vertical -damage to the brain stem; horizontal more related to drug.
Cushing's triad, which includes bradycardia, hypertension, and a change in respiratory pattern, is seen in head injuries with increased intracranial pressure (ICP).
Head injuries rarely cause hypotension therefore, if it does, other causes of hypotension must be sought.
if pt injested TCA, neither serum or urine give you any good information, because the level does not correlate with symptoms, EKG is key in TCA
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wilson diease-diagnostic test is --Inability to incorporate a copper isotope into ceruloplasmin
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Raloxifene is FDA approved for osteoporosis and is anti estrogenic. Its however not approved for chemoprevention like Tamoxifen, the latter is more superior than raloxifene as a chemopreventor and is FDA approved for chemoprevention.
Tamoxifen complication- hypercalcemic crisis, both predispose to thromboembolic complications.
INDICATIONS FOR CARDIOVERSION///CHF August 19 2003, 1:23 PM
DC VERSION SHOULD BE DONE IN THE PRESENCE OF
1.SYS. BP <90
2.MENTAL STATUS CHANGES
3.CHF
4. CHEST PAIN
////////////////////its LR--- dont give renal pt lactate ringer bcz they r already having hyperkalemia. neverin neurosurgical pts also
////////////////////////
ranson's criteria include
wbc>16000
age>55yrs
ldh>350 units
glucose>200mg/dl
AST>250units/lt.
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AVOID DIGOXIN AND VERAPAMIL in WPW syndrome
////////////////////mn
Polyarteritis nodosa
Fever, abd pain, weight loss, renal disturbances.
Labs: elevated ESR, leukocytosis, anemia, hematuria, proteinuria.
Dx: Biopsy
DO NOT MISS HEPATITIS B!!!!!
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Tourette's associations:
Attention-Deficit/Hyperactivity Disorder (ADHD)
Difficulties with Impulse Control (disinhibition)
Obsessive-Compulsive Disorder (OCD)highest prevalance
Various Learning Disabilities (such as dyslexia)
Various Sleep Disorders
Remember, Tourette's is an Axis I disorder in DSM IV.
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purigo gravidarum
it says that 3rd trimester pruritic rash after jaundice for a couple of weeks...i dunno how jaundice occurs...resolves after delivery.....recurs in future pregnancies...may also recur with OCP use if happened once/////////////////////
cerebellar ataxia
25% after 1to2 months of varicella inf
5% after vaccination
resolves over weeks to months
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prostate ca with bony mets and pain
this is acute conditioin
we have to stop testosterone
bilateral orchiectomy...castrate testo levels achieved in 3 hrs
ketoconazole...in pts who cannot undergo surgery...it blocks cytochrome 450 system and thus stops adrenal and gonadal tetsto..castrate levels achieved in 8 hrs
LHRH...its increases the FSH and LH in the begining by the flare phenomenon and thus is not good for acute setting..castrate levels in 30 days
if there is spinal cord compression due to bone metastasis...give steroids also...it will decrease edema and testosterone
/////////////////////////
In an unconscious pt with an intact brain stem, the fast component of the nystagmus disappears ,so that the eyes deviate toward the irrigated side for 2-3 minutes before returning to their original position.
With impairment of brain stem function,the response becomes peverted and finally disappears.
Ref CMDT
I think if the pt. is UNCONCIOUS the nystagmus disappears and eyes are tonically deviated to the side of applied irrigation for 2/3 min. If in this case nystagmus is present, that means pt. is concious.
//////////////////
long acting biphosphnates,pamidronate or zolendronate r the drug ofchoice for the treatment of hypercalcemia
//////////////////GIVE testosterone TO MAINTAIN ERRECTION.
///////////////
STARRING INTO THE SKY=GENERALISED COMPLEX SZ.TEMP. LOBE EPILEPSY= DEPAKOTE
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aida /needle stick/GIVE POST EXPO PROPX FOR 28DAYS
3 DRUGS
DDI+AZT +ANY NRTI
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CMDT says renal osteodystrophy confirms the diagnosis of CRF
///////////
both DI and polydipsia has low urin osmolarity; however; when you do water deprivation test, the urin osmolarity does not change in DI, but increases in polydipsia.
so for discussion to differentiat causes of DI;
what is the best initial diagnostic test? water deprivation test. it will differentiate btw polydipsia and the other two.
what is the most accurate test:--- vassopressing stimulation test. it wii differentiate btw central vs nephrogenic DI
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Mohs surgery for skin cancer.
///////////
No I/m laoding dose of phenoytin-- erratic absorption/SLOW ABSORPTION
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NSAID/ methotrexate: parenteral steroid is not used for psoriasis,
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viral pericarditis---pericardial tamponade, ---Pulsus Paradoxsus,
///////// LEGS FOR ERYTHEMA NODOSUM, it's associated with Chrohn's disease
//////////////Ceftriaxone displaces bilirubin in albumin thus affecting conjugation.
It is generally avoided in neonates less than 1 month old for fear of exacerbating jaundice!
After 1 month of age, it is safe to use Ceftriaxone already!
///////////////////
PID---IV Cefotetan or IV Cefoxitin plus IV Doxycycline is generally use for inpatient treatment of PID.
IM Ceftriaxone x 1 plus oral Doxycyline x 14 days is the outpatient treatment of PID.
You will shift IV antibiotics to PO antibiotics after patient has been AFEBRILE for at least 24 hours and there are clinical signs of improvement!
order wet mount + Koh ( associated STD infection ), RPR , HIV Eliza, HBAgn, vaccination ( HB vaccine if she does not have the infection)
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Cause of increased erythropoiten - the renal cell carcinoma.
////pt on penicilin and developed autoimmune hemol--do direct coomb test
////SBP_
cefotaxime,if sever
ceftriaxon also we ,treating E-coli, gram +'s,,polys>250 absolute neutrophil count.
//////////Tourette's disorder is a neuropsychiatric disorder characterised clinically by motor and vocal tics, which may be associated to conductual disorders such as obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). Although the neurochemistry of Tourette's disorder is not well known, there are some effective therapies for tics, OCD and ADHD. However, these are not devoid of adverse effects. Tics only require treatment when they interfere with the functioning of the patient. If therapy is needed, monotherapy at the minimal effective dose is desirable, but some patients may require two or more drugs. The most frequently used drugs for tics are antipsychotics (mainly pimozide and haloperidol) and clonidine ..The drugs of choice for OCD in patients with Tourette's disorder are the selective serotonin reuptake inhibitors (SSRIs), although the tricyclic antidepressant clomiplamine, which inhibits both serotonin and noradrenaline uptake, has also been found to be useful. ADHD can be treated with some psychostimulants, mainly methylphenidate, although these drugs must be used with caution. Other potentially useful drugs for the treatment of ADHD in patients with Tourette's disorder are clonidine, guanfacine, selegiline, some tricyclic antidepressants, sertraline, pimozide and clonazepam. Finally, the potential value of some nonpharmacological therapies (hypnotherapy, biofeedback, conductual therapies, electroconvulsive therapy, acupuncture and surgery) is briefly reviewed.
///////
Saw palmetto is utilized throughout the world mainly for its effects on BPH. (B9 prostatic hyper) saw palmetto led to an increase in flow rate in men with BPH....It will increase your urine stream.
///////////////////////
Ipecac, an over-the-counter emetic agent, has been a drug of choice for abuse by patients with eating disorders. Its alkaloid emetine has been associated with serious cardiac toxicity.
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Treatment of spasticity in post stroke patient
Answer is beclofen
///////////////Treatment of influenza. Indications and limitation of AMANTADINE
Answer is
influ. A amantidine within 48-72 hrs
////////////////
male constipation, no other abnormalities, -------Functional causes.
//////////////////////
ileojejunum bypass, diarrhea, what kind of fluid you give?
Total parental nutrition ,BUT normal saline+calcium and magnasium replacement
//////////////////shoulder dystocia.first step tell mom not to pushthen ******* manouver then c- sectionbreaking of clavicle is the last resort
/////////////////
primigravida 28 weeks, rh negative ,husband positive
anti lewis antibody positive what next
1)give anti rhd2)
dont give anti rhd3)
do amniocentesis,
answer,,,, DON™T DO ANYTHING
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During a flu. Season, a pt who did got get flu. Shot and had a flu.s/s for 4 days came in for treatment. You provide for him:
1. amantadine 2. zanamivir 3. only symptomatic support including (Tyleno)
Symptomatic treatment ( amantadine or zanamivir is given within 72 hours of influnza ZANAMIVIR is the best treatment it covers both A and B)
//////////////////// 4 month-old-boy who is diagnosed as having OM without fever yesterday is brought by his mother for his regular vaccination scheduled. At this time, as his PMD, you: 1. give the boy vaccines scheduled 2. Wait after he recovered from his disease 3. others.
Answer is give vaccination ( ever is not a contraindication )
////////////////
Most common parasitic infection in usa
Answer is PINWORM (Entrobius vermicularis)
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A boy (5 may 8 yrs old) was brought by his mother with c/o right hip pain for 3 days. The boy had upper respiratory infection prior this hip pain. After working up, it is dx as septic arthritis.
1. what is the cause ? a. strep. Pneumo. B. staph. A. c. other bacteria (no surgical intervention)
2. what antibiotics ? a. methicillin b. penicillin c. vancomycin d others
3. 2 days after antbx, now there are a few small maculae (2-3 mm in diameter) without itching or redness. What do you do ? a. d/c antx b. continue the treatment c change to another antx. D others
Answers..1) staph aureus 2) methicillin 3) change the antibiotics
Q)23 yrs old women with a vaginal presure symptoms and on pe has a 5 cm cystic mass,use diaphram for contraception, pregnancy test negative
next step
1.u/s
2.observation for 6-8 weeks
3.birth control pills
4.laprotomy
ultrasound
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Cocaine induced HTN - treated with Benzo, Nitroglycerin or Nitroprusside drip and Phentolamine 1 mg IV
No beta blockers like propranolol
////////////////
Q)29 yo M c severe diarrhea
o/e listless but responsive
vitals stable
Na 118,K 2.9, hco3 12,,urine na <10
R
a IV hypetonic saline
b hypotonic
c isotonic
d fluid restriction
e hco3
answer is isotonic solution
//////////////////A 3-month-old child was exposed to an adult with active pulmonary tuberculosis. ..........
Administer a TST, perform a CXR, administer INH, and reevaluate in 3 months.
////////////////////////////
the kid should be given INH prophylaxis even if CXR/PPD are negative. You have to reevaluate in 3 months with a skin test:
. if the test is negative :- to D/C INH
. if the test is positive :- to coninue INH for another 6 months (total 9 months )
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?????????you want give quinolon to a pt. whuch drug of the following should you worn him from:
2- theophyllin
////////////////////
A diabetic man with sexual dysfunction,,comes in for evalutaion of depression,, he is found to be depress..what is the best treatment
a)paroxitine (paxil)
b)fluoxetine (prozac)
c)sertraline (zoloft)
d)citalopram (celexa)
e) bupriopram (wellbutrin)
Answer is E.
wellbutrin and serzone are the only antidepressant that have least effect on sextual function.
///////////////////////
Painless gross and microscopic hematuira: THESE ARE THE STEPS>>>>U/A > IVP > CT..
Q)Painful gross or microscopic hematuira (s/s -> kidney stone):these are the steps >>>> U/A > KUB > IVP > CT ??
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thyroid disorders,
early menopause
or somethign else???
answer is osteoprosis and early menopause AND STRESS FRACTURES
/////////////////////////
paNIC DISORDER---DEPRESSION
/////
Atropine should not be used to treat Mobitz type II block associated with BBB
Hemodynamically unstable pts should be treated initially temporary transvenous pacemaker insertion followed by permanent pacemaker implantation.
///////////////
Infection of which valve is most likely to be associated with the development of heartblock.
Mitral valve
///////////////
Q1) how do u check the progression of multiple sclerosis?
Q2) how to u follow Multiple sclerosis?
Q3) Diagnostic test of Multiple sclerosis
Q4) Effect of pregnancy on multiple sclerosis?
Answers to above question
1) Progression based on clinic
2) F/U depend on clinical course
3) Dx MRI
4) Pregnancy? Pregnancy exacerbate MS symptom.
/////////////////////
person with symptoms of Obstructive sleep apnea...what is the first/next step?
a) sleep study
b)medical workup
c)CPAP treatment
Answer is Medical w/u as below
1.r/o hypothyrid.ent exam
2.polysomnogram
3.treat-weight reduction(doenot work) >>>cpap
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A mother is concern about obese child 3 y. what is the reason child is obese
mother behaviour problem
child neglect
genetic
eating disorder
ANSWER IS MOTHERS behavioral problems excessive eating may lead to childs excessive eating
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drugs which cause exacerbations of psoriasis
lithium
inderal( beta blockers)
anti malarials (chloroquin)
, beta-blockers, aspirin).
....//////////////
Which of the following drugs is the least sedating and anticholinergic, which can be prescribed safely to elderly patients with depression?
a.fluoxetine
b.MAOI
c.Imipramine
d.Sertraline
e.Trazodone
/////////////////////
Amantadine. ----is class of chemotherapy
///////////////
metronidazole taking mother---- not to feed for 24 hours
///////////////
LYME disease /pregnant
amoxicillin or cefta if CNS involved NO tetracycline because she is pregnant
If this patient was not pregnant then tetracycline is doc ten day therapy is usually reserved for isolalated erythema migrans....if systemic or severe symptoms therapy is recommended for 21 days.
any one of the following
tetracycline 250 po qid
doxycycline 100 mg po bid
amoxicillin 500 po tid
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minimum age is 2 years.. both nephritic and sickle cele will nedd vaccine
//////////////////////
45 years old woman with history of DM and mild Hypertension with occational history of seizure for last 6 month came to your office with 6 hours h/o headach right sided partial ptosis,pain in lower half of face and neck rigidity.what would be the cause?
a)Trigeminal neuralgia
b)SAH of Post communicating artery
c)SAH of PICA
d)Brainstem glioma
e)Lacunar stroke
Answer is C..Ipselateral facial pain sensetion,ipselateral horner's syndrom
and involvement of V11 nerve (bells palsy).
/////////////////////
incontinence with no urinary symptoms.side effect of---Phenytoin therapy
////////////// lchen planus-- on biopsy it is hyperkeratosis
////////////////////
ACETAMINPHEN--------acute hepatic necrosis
/////////////////
best test for confirming rupture of membrane -- nitrazine test
//////////////
girl with DM1 now reach puberty,---- increase insulin.
///////////////////
HOW to follow Multiple sclerosis -- f/u with MRI
INITIAL diagnosis made by MRI
/////////
baseball pichter with shoulder injury,xray with compound fracture of clavicle --- open reduction internal fixation
he can play the game after 2-3 months
///////////////
TCA toxicity ---alkalinize urine with Nacho3
/////////////////
histoplasmosis in moist cave and cocci in dry caves,,,
//////////////
Current recommendations are to initiate treatment for HIV-infected patients with CD4 cells < 350/µL
or viral load > 30,000 copies/mL by branched-chain DNA or
55,000 copies/mL by PCR testing.
/////////////////////
complications of meniscus injury ?
tear of medial meniscus is more common than lateral.
Cmplication
Hemarthrosis
Locked knee
Locked knee should be reduced in 24 hrs, because beyond this period, effusion cause loss of elasticity of the meniscus, preventing it to snap back into its normal position.
///////////////////
girl 13 yr left shoulder/scapula is higher 4 cm than right. (no degree info. provided). You recommend:
ref to ortho. surgeon
greater then 2 cm needs referral to ortho.
There are three basic options for the treatment of scoliosis. These include observation, bracing, or surgery. Alternative treatments, although currently popular, have no proven benefit in the current orthopedic scientific literature. Observation is the preferred management choice for curves at low risk of further progression, and where the natural history is favorable. This would include curves less than 20o, or curves under 40o after the child has reached skeletal maturity. Bracing is preferred for curves in which there is documented progression of the curve and where the child has not reached skeletal maturity. These curves are at risk for progression, and the goal of the bracing is to stop this progression. The final option for scoliosis is surgical treatment. This is generally reserved for curves which are out of balance or those in excess of 50o. Curves of this magnitude tend to progress after the onset of skeletal maturity and ultimately cause significant functional compromise.
according to this the patient shoud be followe for 6 months & if any progression is found then suggest a brace !!
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family history of breast cancer cancer is not a contraindication of HRT
//////////////////
Levothyroxine to a pregnant pt --- increased dose
because . Pt. who are pregnant, on HRT, or infection have increases in TBG
///////////////////////
1 wk baby turn blue when feeding but when cry is pinkish??
Answer is choanol atresia
/////////////
pt.need immunoglobulins you give develop severe anaphylaxis.
chronic granulomatous dz,regular allergic reaction,Iga def.
Answer is IGA deficiency Patients with IgA deficiency may develop antibodies to IgA, and can have severe reactions (including anaphylaxis, a potentially life-threatening allergic reaction) to transfusions of blood and blood products. If transfusions are necessary, they should ideally come from another IgA-deficient individual.
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1) THE main DIFFIRENCE between TTP and HUS is lack of Neurological involvement in HUS....otherwise same as both have inc BUN/CRETINE both have INC LDH both ha THROMBOCYTOPENIA both have MICROANGIOPATHIC HEMOLYTIC anemia......both have SHISTOCYTES on periphral bloood smear...v imp for exammmm REMMBER BOTH HAVE NORMAL COAG AND NORMAL OTHER CELL LINES...
2)INC PTT IN CLASSIC HEMOPHILIA AND ITS XLINKED...TREAT WITH FACTOR 8 AND IF IT DOESNT CORRECT PTT THEN IT MEANS THAT PT HAVE ANTIBODIES AGAINST FACTOR 8 WHICH CAN OCCUR IN 10% OF TH E CASES AND TEST THIS WITH MIXING STUDY MEANING WHEN U WILL MIX PTS BLOOOD WITH FFP OR NORMAL BLOOOD NOTHING WILL CORRECT PTT IT WILL STILL INC ...TRETAMENT OF THIS WILL B CYCLOPHOSPHAMDIE ALONG WITH PREDNISONE
3)MOST COMMON CONGENITAL BLEEDING PROB IS WITH VON VILLIBRAND DIASES ITS AUTOSOAML DOMINENT...AND IT WILL INC BLEEDING TIME..INMILD CASES U CAN GIVE PT DESPOPRESSIN ,,,AND IN SEVER CASES CRYO WILL HELP...DONT GIVE DESMO IN SEVER CASES IT WILL MAKE IT WORSE..
4)DESMOPRESSINIS ALSO GOOOD FOR MILD CLASSIC HEMOPHILIA A...
5)IN ITP THERE WILL B MEGAKARYOCYTES ONPERIPHRAL BLOOOD SMEAR BCZ THERE IS INC RATE OF DISTRUCTION OF PLATELETS AND DEC FORMATION OF PLATELETS DUE TO AUTOIMMUNE PHENOMENON, ANTPLATELET IgG ANTOBODIES DESTRY ALL PLATESLETS SO THESE PTS R MORE PRONE TO HAV EMUCOSAL BLEEDING LIKE THEY WILL HAV E MENORHAGIA,OR EPISTAXIS.....FORTREATMENT IST TRY WITH PREDNISONE IT HELPS ALOT BY INC THE PLATELETS itworks by dec the affinity of platelets to activated macrophagesin th e spleen and steroid also dec the binding of autoantobodies toplatelets....tretament always start with low dose of platelets it will inc th eplatelets numb but if u hav eto keep thept on prednisoneor u hav eto inc the dose then do splenectomyis the definate treatmentofitp if they ask u in step 3,,,,but make sure that u give pnumovac and h influenza vac 2 wk prior to splenectomy,other drugs that use when platelets r low and causing bleeding or if pt is going for urgent surgery is ivig..its v expensive so only reserve for life thretening bleeders and its always given slow and never in ppl who have igA defiency bc zthey will die from anaphylaxis...another imp point is that when pt cant go for splenectomy or cantbon prednisone or cant afford 5 k dollerivig give him danazol,or rh gam its helpful tooo...som e tried inflaximab group its helpful but infectionis the side efefct....so watch for that...if u c ccs in exam which most of u willl..... just treta as an out pt with prednisone and call pt in 2 wks and when platelets above 50 taper prednisone and advise for no contact sport..and pt teaching about diease ...v imp...
6)dic is dif from sub acute dic in thatpttis normal and fibrinogenis normal...and remmber in dic treat the underlying cause...
never give aminocaproic acid in dic without heparin bc zit cause severe thrombosis...
7)liver disease have both prolong pt and ptt but fibrinogen level is normal...ff will correct th ebleeding..
the dif bet the vitamin k deficiency and dic is noraml platelets and normal fibrinogen vit k will help....
9)if platelet r 10 k still u can perform splenectomy so never ever give platelets in itp when its in exam..bcz it will b destryed by the antibodies...
10)inmy exam they ask that baby had circumcison and lost lots of bloood on lab hisptt was 100 an his bleedint time was 12....and mom said his uncle has sam e prob he bled in suregry and after surgery...whatu will do u will check factor 8and 9...its dic,its ttp,its itpand blabla...
11)remmber factor x11 deficiney u wont have bleeding just inc ptt they canhave surgery without any prob its also callled hadgman factor deficiency..
12) ifpt is having factor 13 deficiency.u will hav e normal coag but still u will hav e bleeding....so remmebr these clues they will help u to exclude wrong choices in exam...
13)lupus anticoagulant antibodies is v imp subjects so u have to read about it.....its igG or igM antobodies taht produce aprolonged pttby binding to phospholipids,its present in 10% pt of sle and is characterized by recurrent abortion,and thrombosis .there is no bleeding unless second ry factor is presenttaht cause bleeding,the prolonged ptt will failed to correct with mixing study so that is a clue for diag....the russell viper venum isgood and senstive assey and is diag of lupus anticoagulant...antiphpjolipid and lupus anticoagulant will cause the false positive vdrl...u can suspect lupus anticoagulant when inc ptt but no bleeding and vdrl is in and anticardiolipid and natiphospholipid positive...predison is th ebest treatment and give heparin if thrombosis is suspected....
14)autologous bloood can b given to pt for surgery and it can b stored for upto 35 days...it dec the chance of infection and reaction..
15)i pack of rbc pack can raise the hct by 3-4%and prbc is used to raise hct ...not the whole blood that is reserved for sever hypovolemic pt...
16) dont transfuse awake juhuwa witness against his will but for a kid go ahead and transfuse if urgent or in nonurgent situation just tak e court oreder...ifkid belongs to juhuwa witness
17)always remmber when ever kid is in the womb mom will give consent for every thing evenif she is competent and refusing for csection and endangering her baby thats fine u just listen to her an d respect her wish..but as soon as she deliver she has no longer authority if child lif eis in danger....but for non urgent cases we stilll need her consent even if she is in jail or drug addict .....
1febrile bloood transusion reaction pt need leukopooor bloood
19)for graft verses host reaction u need to give iiridiated bloood next time..
20)HIT need that u d/d heparin and coumadin both and start with leupridine...inc risk of thrombosis with the HIT...plez read more from wash manual ....21)...in cases of hemoglobuburia weather its due to rhabdoor bloodo transfusion reaction give vigrous hydration with n/s and mannito or lasix...so hemoglonuria will not damage kidney tubule....bcz atn will cause rf sooon..if will not go aggressive hydration v imp for exam....
21)ist day jaundance is always due to abo imcompatibility
22) if husband is onegative and wife is tooo no prob baby will b normal..(.cam e in my exam..)..case senario was that a gal is pregnantand her rh is negative and her b fd is rh positive and they tell s u in sep setting that this babyis not my b fd but my ex and he is rh negative what u will tell her....
23)delayed transfusion reaction is due to duffy,kell and c,e loci of rh system..they cause delayed reaction after 8 to10 days of transfusion..
.
24)i unit of platelet will inc 5 k of platelets usually we giv e 6 pack..
25)fever chillsl and sever backach eis due to heamolytic reaction,stop transfusion and give ns bolus and lasix..flush th ekid so no damage to tubule and no renal failure other prob is dic....
26)kid if they have dirrhea due to slmonella sheggella or due to e coli they will most like ly have hus so keep that inmind in exam they ask that akid ate hamburger while his father was stilll barb qing...an dkid has now fever and dec inc bun/cretinine .. and thrombocytopenia and in c ldh itS HUS
27)WALDSTROME MACROGLOBUNEMAI IS DUE TOMONOCLONAL IGm paraprotein and in MM ITS DUE TO IgG
THE MAIN DIFIS THAT NO LYTIC BONE LESION IN THE WALDSTROME ...the cause of death in mm is due to infection from streptp pnumoni and h infuenza...
2hairy cell leukia is having pancytopenia,splenomegalyand hairy celll on p blood smear and bm biops
for perioperative control of htn bb is always prefered
ace inhibiter is goood only if uni lat renal artery stenosis in bilateral its contraindicated
in exam dont order tft just order tsh ist its cost efective and best way to know about hypo or hyperthyrodism..
after treatmentof hyperthyroidism f/u with free thyroxine level not tsh...
dont give rai to a preg lady...no pregancy 6 m b4 or after use of rai...cause hypothyrodism....and teratogenic for baby..
if u want prescrive isotrention bcz its best drug for nodular cystic acne do preg test ist...
no pnumovac b4 2 yrs of age its not effective and no imunoglobulin with in 11 month with mmr other vaccination pd is 3-6 m but for mmr its 11 months...
if some body have reaction after gettingimunoglobulin then they r IGA DEFIENCT...
NSALINE IS BEST FOR MVA...WHY BCZ NO LR IN TRUMAA BCZ OF RHABDO ORPOSSIBLE HISTORY OF RENAL PROB SO NS...ONLY
NS IS ALSO GOOOD FOR RENAL FAILURE PT AND NEURO SURGERY PT BCZ LESS K..AND WILL NOT CAUSE HARMFUL EFEFCT...
NO SUCCINYCHOLINE FOR A BURN PT BCZ OF INC CHANCE OF HYPERKALEMIA BCZ THEY HAVE EXTRA POTASSIUM RECEPTERS..
MORPHINE I/V B4 DRESSING CHANGE IN THE BURN PT
NO INHALATIONAL AGENT AND SUCCINYLCHOLINE IF HISTORY OF MELIGNANAT HYPERTHERMIAA....GIVE DENTROLINE..MUSCLE WEAKNESS IS CHEIF SIDE EFFECT OF DENTROLIN ITS IS ALSO BEST FOR NEUROMELIGNANT SYNDROME WHICH IS DUE TO INC CA RELEASED FROM SARCOPLASMIC RETICULAUM AND CAUSE FEVER AND RIGIDITY
IF PT HAS PARKISNISM DONT GIVE REGLON FOR VOMITTING BCZ IT IS HIBITER OF DOPAMINE HE NEEDS DOPAMINE ..
IF CYSTIC BREAT SNODULE DO FNA WITHOUT MAMO IF PT IS LESS THAN 35
IF NONPALPABLE MASS BUT SUSPICIOUS CALFICATIONON MAMO THEN DO NEEDLE DIRECTED BIOPSY..
the dif bet primary and secondry addison diease is primiry start with p and p is for pigmentation so in c pigmentation due to inc acth in primary addison diease and secondry no pigmentaion due to dec acth..
in diabtes kidney will b double in size remmber d for diabetes and d for double.....but in htn its shrinked...see the dif..
TBG WILLL INC IF TOTAL T4 WILL INC BUT FREE T4 WILL B NORMAL...
IF THYROID MASS AND TSH IS NORMAL DO FNA
IF INC TSH DO THYROID SCAN
IF PT HAS AAA AND ANY CARDIAC DIEASE TERAT CARDIAC IST LIKE DO CABG BCZ MOST CC OF DEATH FROM ALL MAJOT VASCULAR DIEASE LEIKE CAROTID ENDARTERCTOMYOR AAA REPAIR IS AMI..SO FIX HEART IST IF NOT URGET...
IF BPIS MORE THAN 180/85 AND PT SAID IT WAS HIGH IN MALLL TOOO TREAT IT BCZ THATS WH THEY GIVE U THIS SENARIO...OTHERWISE RECHECK I MORE TIME....AND THEN EXCERCISE AND DIET IST AND IF FAIL THEN START WITH DIURETIC AND BB..
TOOO SLEEPY MORE LATER ..GOOOD LUCK DOCS.....UR DAY IS COMING ...ALLUR HARD WORK WILL PAID OFFF SO KEEP ON DOING TH EGREAT WORK...GN
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!)most cc of hypothyroidism is hashimotos..
2) most cc of dizziness in elderly is their medciation
3)most cc of impotency is antihypertensive medciation and ssris..
4)tumor marker for melignant melanoma is s-100
5)if family history of ovarian ca is positive then yrly pelvic exam and ultrasound is screening test...
6)no bone scan for melignany melonoma bcz these r lytic bone lesion not osteoblastic...
7)dontjust give ca for steoporosis or jut s vitD both along with alendronate
if pt on alendronate or any of these easophagitis is the most common risk so ask pt that take medcine with galss of water and sit up for 30 minutes after take medciation
9)griseofulvin is beetr absorb if taken with fatty foood..not for kids just liek cipro u cant give pt less tahn 10(cipro)
10)if pt is having meliganncy or some bed ridden condition he or she needs anti coag for life
11) d/c ocp i month b4 surgery and restart i month after
12 )d/c coumadin at least 48 h b4 surgery
13) d/c asp 10 days b4
14)d/c heparin 4 h b4 going to or...half life for heparin is 90 minutes
15) if heparin reversal is reqguired then reverse 100 unit ofheparin with 1 mg of protamine sulfate and thats how u calculate the dose...
16)b4 giving all protein inhibiters plez check all th ept medciation bcz of lots of inter action
17) if ptis on pis..then no rifampine but rifabutin
1if ca is high recheck ist
19)if recheck ca is still high then check pth
20) if pth is low and ca is high then think of sarcoidosis
21)if pt is hypovolemic and has ccf always put central line so u can measure cvp....but remmber ccfis not a contraindication forivfluids if can always give lasix
22)if ca is low always check albuminist
23) never ever pick hypertonic soulutionin exam unless pt is not seizing or na is less than 115...always restrict fluids..
24)in siadh urin eosmolaity will b higher than th e serum..
25)in melig ca is high bcz it s produced by pth like protein which is also produced by granuloma in sarcoidosiss...and for melignancy hypercalcemia steroid will b best forothers ist try ns and lasix then iv palmidronate...
2mallet fx close reduction is goood
29)collls fx close reduction withlong arm cast
30) supracondylar fx in a kid is a surgical emergency ...orif is th e ans and asap...but of nerve palsy risk...
31)smith fx...fx of distal radius withventral displacement due to fall when forearm is supinated and hand is extended...
32)scaphoid fx..risk of avascular necrosis,dont do xray its is neagtive until 2 wks...
33)fall on feet calcanious fx...orif is req
34)dont give flumazenil if mix drug over dose bcz it dec threshold for seizure and dont ever give in tricyclic od...
35)plez read dif bet tricuspid atresia and transposition of great v..both cause cyanosis on ist day...but dif is on t e xtay in vascularity of pul v ..i dont recall rt now bcz its middleof th enite i dont wana put anything which i am not sure about...but its vvvimp...
36)if 6 wks of abx is not able to bring fever down in acut e bec endocarditis....call cardiology asap...
37)any kid wit fever ifless tahn 3 month admit her or him to r/o sepsis
3suction rectal biopsy is best to diag hursprung
diease butist will b kub
39) plez remmber ist test for stess incontinence or heamturia or enuresis will b ua
40)cobble stone aaprence is in crohnand appple core lesion is in colorectal ca
41)central incisor dental carries r due to nocturnal bottle feeding...
42)last but not th eleast just remmber where u c xray ,ultrasound,excercise behaviour therapy,diet ,reassurance,smoking cessation,alcohal abstinence ,nsaid thatis most likely the ans..
if u dont get any ans then go for th elongest choice do thatin ur practice test and u will c
always go forur ist intusion..dont change ur ans its 80-90% correct
relax b4 exam....24 b4 just listen to music..watch movie...dont go out to eat u might get sick eat light dinner sleep early and uwill b fresh when u wil wake up and do som e revisionin th emorning from ur notes only.....so u can have som e memory of what ever is imp.....
dont read any new materail in last 2 wks
practice practice practice ob usmle cd....its worth....it......bye guys and gooodluck....jerry ,gulabooo,hbnorhbs sorry i cant recall ur name atthis time ofnight but best of luck to naz natisha and alll others ...and welcome to new commers just stick to this great site..and pray for waheed and his family...i do...whothought of such great site....for alll of ius..thanks doc.waheed!!!
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Methyldopa (Aldomet) -- Centrally acting antihypertensive agent widely considered the first-line agent for treatment of hypertension during pregnancy.
Studies have revealed no adverse effects on cognitive development up to the age of 7.5 y among children with in utero exposure to methyldopa.
Hydralazine (Apresoline) -- Intravenous form is useful when treating severe hypertension due to preeclampsia/eclampsia.
///////////////////
Lead poisoning case
I. complete physical exam
II. cbc,sma7 blood lead level, lft, glucose,
peripherial blood smear, serrum ferritin
III. <25 environmental intervention
25-44 environmental and oral dimercaprol
44-69 IM or IV edetate disodium
>70 IM or IV dimercaprol
IV. Plan to admit or d/c home
V. console: Inspect home for lead paint
remove child from lead hazard
//////////////Meniere،¯s disease. Triad. ---1-Vertigo 2.Hearing loss 3.Tinnitus
//////////////////////
Sarcoidosis patient gets affection of eye.---uveitis and. Glaucoma
/////////////////////
This case clearly indicated the PD pt presented psychiatic s/s, not depression.. So, the management step by step is (MKSAP, in Neurology, parkinson's dis, Table, 39):
Hallucinations, delusions TX: (step by step):
1). Discontinue non-levodopa drugs, if failed..
2)/. Reduce dose of carbidopa/levodopa (to the minimum theraputic dose), if failed...
3). Clozapine, quetiapine, donepezil, respiridone, olanzapine
For the depression in PD pt:
MKSAP: SSRIs.
Swanson: TCAs
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HIV is a major no no for breast feeding, pretty much anything else, except meds like (antipsychotics, lithium), drug abuse, etc, you can encourage breast feeding. even with jaundice, you can usually keep breast feeding. The AAP does not recommed very much not to breast feed.
//////////////////////
PMR : --No muscle tenderness, but muscle ache..
-- Weakness: yes, it is main s/s of PMR
polymyositis -- weakness and muscle pain and tenderness..
FM is almost always dx in a <40yo and ESR=NL. PM and PMR are dx in the same age range, but PM has proximal muscle weakness and muscle bx is=AbNL. PMR= no proximal muscle weakness and muscle bx=NL
///////////////////////
polymyositis has specific weakness which always demonstrated by something like cannot raise from chair or cannot climb stair because of their severe proximal muscle weakness. Polymyositis pt does not complaint pain that much although they have tenderness in PE. the diagnostic for polymyositis is EMG, biopsy and CK etc. Fibromyalgia is a very vague similar to chronic fatigue syndrom. those pt complaint everything but find nothing conclusive (alway negative on labs etc, unless coexist with other dis).
/////////////////////////Which one of the following treatment strategies has been shown to decrease mortality in adult patients with ARDS?
C. Mechanical ventilation that delivers lower tidal volumes and limits plateau pressure.
A patient is found to have prostate cancer metastasis in the spine. Which one of the following is the initial treatment of choice ?
B. Dexamethasone i.v if the presence of spinal cord compression otherwise
E. Leuprolide (or LHRH antagonist, or orchiectomy)
A patient is found to have lactose-intolerance. What food you advise him to take?
D. Yogurt with live activated cultures.
Which one of the following is the mainstay of treatment for pemphigus vulgaris?
B.Prednisone
A mother brought her 5-year boy because of œbed-wetting? She told you that she found on the internet that alarms are more effective than the mediciation. What's the best choice?
C. Data reflect that alarms are most useful when augmented by other behavioral approaches.
////////////////////////
Valproic acid (dapakote)is generally regarded the drug of first choice in primary generalized epilepsy, particularly in patients with more than one seizure type, because of its broad spectrum of activity. Lamotrigine and topiramate also have a broad spectrum of activity and show promise in the management of these patients. Phenytoin, carbamazepine, and phenobarbital are effective in primary generalized tonic-clonic seizures but are ineffective against generalized absence and myoclonic seizures. Felbamate is effective in primary generalized seizures but is relegated to the refractory population because of its potential for toxicity
///////////
BLL <10 mcg/dL: No action is required.
BLL 10-14 mcg/dL: Obtain a confirmatory venous lead level within 1 month. If the BLL is still within this range, patient education about lead exposure is needed, and the BLL test should be repeated in 3 months.
BLL 15-19 mcg/dL: Same as #2, but repeat the BLL in 2 months.
BLL 20-44 mcg/dL: Obtain a confirmatory venous BLL in 1 week. If the BLL is still within this range, assess complete medical, nutritional, and environmental hazards. Environmental evaluation by the local health department is also needed. A 2001 large-scale study reported no improvement in neurologic and behavioral test scores after succimer chelation of children with BLL in this range.
BLL 45-69 mcg/dL: Obtain a confirmatory BLL within 2 days. If still within this range, undergo complete evaluation as in #4. At this level, chelation therapy is recommended. Treatment should be in a lead-free environment. If this is not possible, hospitalization is necessary. Chelation can be started with oral succimer, or, if the patient is hospitalized, calcium disodium edetate (calcium EDTA) can be used. These agents have potential toxicities, and monitoring of the CBC, electrolytes, and LFTs is necessary.
BLL >70 mcg/dL: Hospitalize, obtain a confirmatory venous BLL, and initiate chelation with dimercaprol and calcium EDTA. Because calcium EDTA does not cross the blood-brain barrier, its use as the only agent in this situation is not recommended because of the possibility of lead redistribution from the soft tissues to the CNS. Pretreatment with dimercaprol (which crosses the blood-brain barrier) is recommended.
////////////////The measles (rubeola) vaccine recommended for use in this country is a live attenuated vaccine. It is recommended for use at 15 months of age, but whenever there is likely exposure to natural measles, infants as young as 6 months should be vaccinated and then revaccinated at 15 months to ensure protection. Exposure to measles is not a contraindication to vaccination, and if the vaccination is given within 72 hours of exposure, it may provide protection. Studies indicate that measles vaccine, by protecting against measles, significantly reduces an individual's chances of developing SSPE, a "slow virus" infection of the central nervous system associated with a measles-like virus.
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Eye movement and pupil size, such as miosis in opioid, organophos intox and barbiturate coma, or pontine lesion etc and mydriasis in TCA, amphetamin/cocaine, higher level herniation, brain hemorrhage etc. And that bilaterally dilated and fixed pupils are due to inadequate cerebral perfusion.
nystagmus: Vertical -damage to the brain stem; horizontal more related to drug.
Cushing's triad, which includes bradycardia, hypertension, and a change in respiratory pattern, is seen in head injuries with increased intracranial pressure (ICP).
Head injuries rarely cause hypotension therefore, if it does, other causes of hypotension must be sought.
if pt injested TCA, neither serum or urine give you any good information, because the level does not correlate with symptoms, EKG is key in TCA
////////////////////////
wilson diease-diagnostic test is --Inability to incorporate a copper isotope into ceruloplasmin
/////////////////
Raloxifene is FDA approved for osteoporosis and is anti estrogenic. Its however not approved for chemoprevention like Tamoxifen, the latter is more superior than raloxifene as a chemopreventor and is FDA approved for chemoprevention.
Tamoxifen complication- hypercalcemic crisis, both predispose to thromboembolic complications.
INDICATIONS FOR CARDIOVERSION///CHF August 19 2003, 1:23 PM
DC VERSION SHOULD BE DONE IN THE PRESENCE OF
1.SYS. BP <90
2.MENTAL STATUS CHANGES
3.CHF
4. CHEST PAIN
////////////////////its LR--- dont give renal pt lactate ringer bcz they r already having hyperkalemia. neverin neurosurgical pts also
////////////////////////
ranson's criteria include
wbc>16000
age>55yrs
ldh>350 units
glucose>200mg/dl
AST>250units/lt.
////////////////////
AVOID DIGOXIN AND VERAPAMIL in WPW syndrome
////////////////////mn
Polyarteritis nodosa
Fever, abd pain, weight loss, renal disturbances.
Labs: elevated ESR, leukocytosis, anemia, hematuria, proteinuria.
Dx: Biopsy
DO NOT MISS HEPATITIS B!!!!!
////////////////////////////////
Tourette's associations:
Attention-Deficit/Hyperactivity Disorder (ADHD)
Difficulties with Impulse Control (disinhibition)
Obsessive-Compulsive Disorder (OCD)highest prevalance
Various Learning Disabilities (such as dyslexia)
Various Sleep Disorders
Remember, Tourette's is an Axis I disorder in DSM IV.
/////////////////
purigo gravidarum
it says that 3rd trimester pruritic rash after jaundice for a couple of weeks...i dunno how jaundice occurs...resolves after delivery.....recurs in future pregnancies...may also recur with OCP use if happened once/////////////////////
cerebellar ataxia
25% after 1to2 months of varicella inf
5% after vaccination
resolves over weeks to months
/////////////////////////
prostate ca with bony mets and pain
this is acute conditioin
we have to stop testosterone
bilateral orchiectomy...castrate testo levels achieved in 3 hrs
ketoconazole...in pts who cannot undergo surgery...it blocks cytochrome 450 system and thus stops adrenal and gonadal tetsto..castrate levels achieved in 8 hrs
LHRH...its increases the FSH and LH in the begining by the flare phenomenon and thus is not good for acute setting..castrate levels in 30 days
if there is spinal cord compression due to bone metastasis...give steroids also...it will decrease edema and testosterone
/////////////////////////
In an unconscious pt with an intact brain stem, the fast component of the nystagmus disappears ,so that the eyes deviate toward the irrigated side for 2-3 minutes before returning to their original position.
With impairment of brain stem function,the response becomes peverted and finally disappears.
Ref CMDT
I think if the pt. is UNCONCIOUS the nystagmus disappears and eyes are tonically deviated to the side of applied irrigation for 2/3 min. If in this case nystagmus is present, that means pt. is concious.
//////////////////
long acting biphosphnates,pamidronate or zolendronate r the drug ofchoice for the treatment of hypercalcemia
//////////////////GIVE testosterone TO MAINTAIN ERRECTION.
///////////////
STARRING INTO THE SKY=GENERALISED COMPLEX SZ.TEMP. LOBE EPILEPSY= DEPAKOTE
//////////////
aida /needle stick/GIVE POST EXPO PROPX FOR 28DAYS
3 DRUGS
DDI+AZT +ANY NRTI
/////////////////////
CMDT says renal osteodystrophy confirms the diagnosis of CRF
///////////
both DI and polydipsia has low urin osmolarity; however; when you do water deprivation test, the urin osmolarity does not change in DI, but increases in polydipsia.
so for discussion to differentiat causes of DI;
what is the best initial diagnostic test? water deprivation test. it will differentiate btw polydipsia and the other two.
what is the most accurate test:--- vassopressing stimulation test. it wii differentiate btw central vs nephrogenic DI
////////
Mohs surgery for skin cancer.
///////////
No I/m laoding dose of phenoytin-- erratic absorption/SLOW ABSORPTION
/////////////////
NSAID/ methotrexate: parenteral steroid is not used for psoriasis,
//////////
viral pericarditis---pericardial tamponade, ---Pulsus Paradoxsus,
///////// LEGS FOR ERYTHEMA NODOSUM, it's associated with Chrohn's disease
//////////////Ceftriaxone displaces bilirubin in albumin thus affecting conjugation.
It is generally avoided in neonates less than 1 month old for fear of exacerbating jaundice!
After 1 month of age, it is safe to use Ceftriaxone already!
///////////////////
PID---IV Cefotetan or IV Cefoxitin plus IV Doxycycline is generally use for inpatient treatment of PID.
IM Ceftriaxone x 1 plus oral Doxycyline x 14 days is the outpatient treatment of PID.
You will shift IV antibiotics to PO antibiotics after patient has been AFEBRILE for at least 24 hours and there are clinical signs of improvement!
order wet mount + Koh ( associated STD infection ), RPR , HIV Eliza, HBAgn, vaccination ( HB vaccine if she does not have the infection)
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Cause of increased erythropoiten - the renal cell carcinoma.
////pt on penicilin and developed autoimmune hemol--do direct coomb test
////SBP_
cefotaxime,if sever
ceftriaxon also we ,treating E-coli, gram +'s,,polys>250 absolute neutrophil count.
//////////Tourette's disorder is a neuropsychiatric disorder characterised clinically by motor and vocal tics, which may be associated to conductual disorders such as obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). Although the neurochemistry of Tourette's disorder is not well known, there are some effective therapies for tics, OCD and ADHD. However, these are not devoid of adverse effects. Tics only require treatment when they interfere with the functioning of the patient. If therapy is needed, monotherapy at the minimal effective dose is desirable, but some patients may require two or more drugs. The most frequently used drugs for tics are antipsychotics (mainly pimozide and haloperidol) and clonidine ..The drugs of choice for OCD in patients with Tourette's disorder are the selective serotonin reuptake inhibitors (SSRIs), although the tricyclic antidepressant clomiplamine, which inhibits both serotonin and noradrenaline uptake, has also been found to be useful. ADHD can be treated with some psychostimulants, mainly methylphenidate, although these drugs must be used with caution. Other potentially useful drugs for the treatment of ADHD in patients with Tourette's disorder are clonidine, guanfacine, selegiline, some tricyclic antidepressants, sertraline, pimozide and clonazepam. Finally, the potential value of some nonpharmacological therapies (hypnotherapy, biofeedback, conductual therapies, electroconvulsive therapy, acupuncture and surgery) is briefly reviewed.
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Saw palmetto is utilized throughout the world mainly for its effects on BPH. (B9 prostatic hyper) saw palmetto led to an increase in flow rate in men with BPH....It will increase your urine stream.
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Ipecac, an over-the-counter emetic agent, has been a drug of choice for abuse by patients with eating disorders. Its alkaloid emetine has been associated with serious cardiac toxicity.
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Treatment of spasticity in post stroke patient
Answer is beclofen
///////////////Treatment of influenza. Indications and limitation of AMANTADINE
Answer is
influ. A amantidine within 48-72 hrs
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male constipation, no other abnormalities, -------Functional causes.
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ileojejunum bypass, diarrhea, what kind of fluid you give?
Total parental nutrition ,BUT normal saline+calcium and magnasium replacement
//////////////////shoulder dystocia.first step tell mom not to pushthen ******* manouver then c- sectionbreaking of clavicle is the last resort
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primigravida 28 weeks, rh negative ,husband positive
anti lewis antibody positive what next
1)give anti rhd2)
dont give anti rhd3)
do amniocentesis,
answer,,,, DON™T DO ANYTHING
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During a flu. Season, a pt who did got get flu. Shot and had a flu.s/s for 4 days came in for treatment. You provide for him:
1. amantadine 2. zanamivir 3. only symptomatic support including (Tyleno)
Symptomatic treatment ( amantadine or zanamivir is given within 72 hours of influnza ZANAMIVIR is the best treatment it covers both A and B)
//////////////////// 4 month-old-boy who is diagnosed as having OM without fever yesterday is brought by his mother for his regular vaccination scheduled. At this time, as his PMD, you: 1. give the boy vaccines scheduled 2. Wait after he recovered from his disease 3. others.
Answer is give vaccination ( ever is not a contraindication )
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Most common parasitic infection in usa
Answer is PINWORM (Entrobius vermicularis)
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A boy (5 may 8 yrs old) was brought by his mother with c/o right hip pain for 3 days. The boy had upper respiratory infection prior this hip pain. After working up, it is dx as septic arthritis.
1. what is the cause ? a. strep. Pneumo. B. staph. A. c. other bacteria (no surgical intervention)
2. what antibiotics ? a. methicillin b. penicillin c. vancomycin d others
3. 2 days after antbx, now there are a few small maculae (2-3 mm in diameter) without itching or redness. What do you do ? a. d/c antx b. continue the treatment c change to another antx. D others
Answers..1) staph aureus 2) methicillin 3) change the antibiotics
Q)23 yrs old women with a vaginal presure symptoms and on pe has a 5 cm cystic mass,use diaphram for contraception, pregnancy test negative
next step
1.u/s
2.observation for 6-8 weeks
3.birth control pills
4.laprotomy
ultrasound
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Cocaine induced HTN - treated with Benzo, Nitroglycerin or Nitroprusside drip and Phentolamine 1 mg IV
No beta blockers like propranolol
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Q)29 yo M c severe diarrhea
o/e listless but responsive
vitals stable
Na 118,K 2.9, hco3 12,,urine na <10
R
a IV hypetonic saline
b hypotonic
c isotonic
d fluid restriction
e hco3
answer is isotonic solution
//////////////////A 3-month-old child was exposed to an adult with active pulmonary tuberculosis. ..........
Administer a TST, perform a CXR, administer INH, and reevaluate in 3 months.
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the kid should be given INH prophylaxis even if CXR/PPD are negative. You have to reevaluate in 3 months with a skin test:
. if the test is negative :- to D/C INH
. if the test is positive :- to coninue INH for another 6 months (total 9 months )
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?????????you want give quinolon to a pt. whuch drug of the following should you worn him from:
2- theophyllin
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A diabetic man with sexual dysfunction,,comes in for evalutaion of depression,, he is found to be depress..what is the best treatment
a)paroxitine (paxil)
b)fluoxetine (prozac)
c)sertraline (zoloft)
d)citalopram (celexa)
e) bupriopram (wellbutrin)
Answer is E.
wellbutrin and serzone are the only antidepressant that have least effect on sextual function.
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Painless gross and microscopic hematuira: THESE ARE THE STEPS>>>>U/A > IVP > CT..
Q)Painful gross or microscopic hematuira (s/s -> kidney stone):these are the steps >>>> U/A > KUB > IVP > CT ??
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thyroid disorders,
early menopause
or somethign else???
answer is osteoprosis and early menopause AND STRESS FRACTURES
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paNIC DISORDER---DEPRESSION
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Atropine should not be used to treat Mobitz type II block associated with BBB
Hemodynamically unstable pts should be treated initially temporary transvenous pacemaker insertion followed by permanent pacemaker implantation.
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Infection of which valve is most likely to be associated with the development of heartblock.
Mitral valve
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Q1) how do u check the progression of multiple sclerosis?
Q2) how to u follow Multiple sclerosis?
Q3) Diagnostic test of Multiple sclerosis
Q4) Effect of pregnancy on multiple sclerosis?
Answers to above question
1) Progression based on clinic
2) F/U depend on clinical course
3) Dx MRI
4) Pregnancy? Pregnancy exacerbate MS symptom.
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person with symptoms of Obstructive sleep apnea...what is the first/next step?
a) sleep study
b)medical workup
c)CPAP treatment
Answer is Medical w/u as below
1.r/o hypothyrid.ent exam
2.polysomnogram
3.treat-weight reduction(doenot work) >>>cpap
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A mother is concern about obese child 3 y. what is the reason child is obese
mother behaviour problem
child neglect
genetic
eating disorder
ANSWER IS MOTHERS behavioral problems excessive eating may lead to childs excessive eating
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drugs which cause exacerbations of psoriasis
lithium
inderal( beta blockers)
anti malarials (chloroquin)
, beta-blockers, aspirin).
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Which of the following drugs is the least sedating and anticholinergic, which can be prescribed safely to elderly patients with depression?
a.fluoxetine
b.MAOI
c.Imipramine
d.Sertraline
e.Trazodone
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Amantadine. ----is class of chemotherapy
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metronidazole taking mother---- not to feed for 24 hours
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LYME disease /pregnant
amoxicillin or cefta if CNS involved NO tetracycline because she is pregnant
If this patient was not pregnant then tetracycline is doc ten day therapy is usually reserved for isolalated erythema migrans....if systemic or severe symptoms therapy is recommended for 21 days.
any one of the following
tetracycline 250 po qid
doxycycline 100 mg po bid
amoxicillin 500 po tid
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minimum age is 2 years.. both nephritic and sickle cele will nedd vaccine
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45 years old woman with history of DM and mild Hypertension with occational history of seizure for last 6 month came to your office with 6 hours h/o headach right sided partial ptosis,pain in lower half of face and neck rigidity.what would be the cause?
a)Trigeminal neuralgia
b)SAH of Post communicating artery
c)SAH of PICA
d)Brainstem glioma
e)Lacunar stroke
Answer is C..Ipselateral facial pain sensetion,ipselateral horner's syndrom
and involvement of V11 nerve (bells palsy).
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incontinence with no urinary symptoms.side effect of---Phenytoin therapy
////////////// lchen planus-- on biopsy it is hyperkeratosis
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ACETAMINPHEN--------acute hepatic necrosis
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best test for confirming rupture of membrane -- nitrazine test
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girl with DM1 now reach puberty,---- increase insulin.
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HOW to follow Multiple sclerosis -- f/u with MRI
INITIAL diagnosis made by MRI
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baseball pichter with shoulder injury,xray with compound fracture of clavicle --- open reduction internal fixation
he can play the game after 2-3 months
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TCA toxicity ---alkalinize urine with Nacho3
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histoplasmosis in moist cave and cocci in dry caves,,,
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Current recommendations are to initiate treatment for HIV-infected patients with CD4 cells < 350/µL
or viral load > 30,000 copies/mL by branched-chain DNA or
55,000 copies/mL by PCR testing.
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complications of meniscus injury ?
tear of medial meniscus is more common than lateral.
Cmplication
Hemarthrosis
Locked knee
Locked knee should be reduced in 24 hrs, because beyond this period, effusion cause loss of elasticity of the meniscus, preventing it to snap back into its normal position.
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girl 13 yr left shoulder/scapula is higher 4 cm than right. (no degree info. provided). You recommend:
ref to ortho. surgeon
greater then 2 cm needs referral to ortho.
There are three basic options for the treatment of scoliosis. These include observation, bracing, or surgery. Alternative treatments, although currently popular, have no proven benefit in the current orthopedic scientific literature. Observation is the preferred management choice for curves at low risk of further progression, and where the natural history is favorable. This would include curves less than 20o, or curves under 40o after the child has reached skeletal maturity. Bracing is preferred for curves in which there is documented progression of the curve and where the child has not reached skeletal maturity. These curves are at risk for progression, and the goal of the bracing is to stop this progression. The final option for scoliosis is surgical treatment. This is generally reserved for curves which are out of balance or those in excess of 50o. Curves of this magnitude tend to progress after the onset of skeletal maturity and ultimately cause significant functional compromise.
according to this the patient shoud be followe for 6 months & if any progression is found then suggest a brace !!
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family history of breast cancer cancer is not a contraindication of HRT
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Levothyroxine to a pregnant pt --- increased dose
because . Pt. who are pregnant, on HRT, or infection have increases in TBG
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1 wk baby turn blue when feeding but when cry is pinkish??
Answer is choanol atresia
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pt.need immunoglobulins you give develop severe anaphylaxis.
chronic granulomatous dz,regular allergic reaction,Iga def.
Answer is IGA deficiency Patients with IgA deficiency may develop antibodies to IgA, and can have severe reactions (including anaphylaxis, a potentially life-threatening allergic reaction) to transfusions of blood and blood products. If transfusions are necessary, they should ideally come from another IgA-deficient individual.
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1) THE main DIFFIRENCE between TTP and HUS is lack of Neurological involvement in HUS....otherwise same as both have inc BUN/CRETINE both have INC LDH both ha THROMBOCYTOPENIA both have MICROANGIOPATHIC HEMOLYTIC anemia......both have SHISTOCYTES on periphral bloood smear...v imp for exammmm REMMBER BOTH HAVE NORMAL COAG AND NORMAL OTHER CELL LINES...
2)INC PTT IN CLASSIC HEMOPHILIA AND ITS XLINKED...TREAT WITH FACTOR 8 AND IF IT DOESNT CORRECT PTT THEN IT MEANS THAT PT HAVE ANTIBODIES AGAINST FACTOR 8 WHICH CAN OCCUR IN 10% OF TH E CASES AND TEST THIS WITH MIXING STUDY MEANING WHEN U WILL MIX PTS BLOOOD WITH FFP OR NORMAL BLOOOD NOTHING WILL CORRECT PTT IT WILL STILL INC ...TRETAMENT OF THIS WILL B CYCLOPHOSPHAMDIE ALONG WITH PREDNISONE
3)MOST COMMON CONGENITAL BLEEDING PROB IS WITH VON VILLIBRAND DIASES ITS AUTOSOAML DOMINENT...AND IT WILL INC BLEEDING TIME..INMILD CASES U CAN GIVE PT DESPOPRESSIN ,,,AND IN SEVER CASES CRYO WILL HELP...DONT GIVE DESMO IN SEVER CASES IT WILL MAKE IT WORSE..
4)DESMOPRESSINIS ALSO GOOOD FOR MILD CLASSIC HEMOPHILIA A...
5)IN ITP THERE WILL B MEGAKARYOCYTES ONPERIPHRAL BLOOOD SMEAR BCZ THERE IS INC RATE OF DISTRUCTION OF PLATELETS AND DEC FORMATION OF PLATELETS DUE TO AUTOIMMUNE PHENOMENON, ANTPLATELET IgG ANTOBODIES DESTRY ALL PLATESLETS SO THESE PTS R MORE PRONE TO HAV EMUCOSAL BLEEDING LIKE THEY WILL HAV E MENORHAGIA,OR EPISTAXIS.....FORTREATMENT IST TRY WITH PREDNISONE IT HELPS ALOT BY INC THE PLATELETS itworks by dec the affinity of platelets to activated macrophagesin th e spleen and steroid also dec the binding of autoantobodies toplatelets....tretament always start with low dose of platelets it will inc th eplatelets numb but if u hav eto keep thept on prednisoneor u hav eto inc the dose then do splenectomyis the definate treatmentofitp if they ask u in step 3,,,,but make sure that u give pnumovac and h influenza vac 2 wk prior to splenectomy,other drugs that use when platelets r low and causing bleeding or if pt is going for urgent surgery is ivig..its v expensive so only reserve for life thretening bleeders and its always given slow and never in ppl who have igA defiency bc zthey will die from anaphylaxis...another imp point is that when pt cant go for splenectomy or cantbon prednisone or cant afford 5 k dollerivig give him danazol,or rh gam its helpful tooo...som e tried inflaximab group its helpful but infectionis the side efefct....so watch for that...if u c ccs in exam which most of u willl..... just treta as an out pt with prednisone and call pt in 2 wks and when platelets above 50 taper prednisone and advise for no contact sport..and pt teaching about diease ...v imp...
6)dic is dif from sub acute dic in thatpttis normal and fibrinogenis normal...and remmber in dic treat the underlying cause...
never give aminocaproic acid in dic without heparin bc zit cause severe thrombosis...
7)liver disease have both prolong pt and ptt but fibrinogen level is normal...ff will correct th ebleeding..
the dif bet the vitamin k deficiency and dic is noraml platelets and normal fibrinogen vit k will help....
9)if platelet r 10 k still u can perform splenectomy so never ever give platelets in itp when its in exam..bcz it will b destryed by the antibodies...
10)inmy exam they ask that baby had circumcison and lost lots of bloood on lab hisptt was 100 an his bleedint time was 12....and mom said his uncle has sam e prob he bled in suregry and after surgery...whatu will do u will check factor 8and 9...its dic,its ttp,its itpand blabla...
11)remmber factor x11 deficiney u wont have bleeding just inc ptt they canhave surgery without any prob its also callled hadgman factor deficiency..
12) ifpt is having factor 13 deficiency.u will hav e normal coag but still u will hav e bleeding....so remmebr these clues they will help u to exclude wrong choices in exam...
13)lupus anticoagulant antibodies is v imp subjects so u have to read about it.....its igG or igM antobodies taht produce aprolonged pttby binding to phospholipids,its present in 10% pt of sle and is characterized by recurrent abortion,and thrombosis .there is no bleeding unless second ry factor is presenttaht cause bleeding,the prolonged ptt will failed to correct with mixing study so that is a clue for diag....the russell viper venum isgood and senstive assey and is diag of lupus anticoagulant...antiphpjolipid and lupus anticoagulant will cause the false positive vdrl...u can suspect lupus anticoagulant when inc ptt but no bleeding and vdrl is in and anticardiolipid and natiphospholipid positive...predison is th ebest treatment and give heparin if thrombosis is suspected....
14)autologous bloood can b given to pt for surgery and it can b stored for upto 35 days...it dec the chance of infection and reaction..
15)i pack of rbc pack can raise the hct by 3-4%and prbc is used to raise hct ...not the whole blood that is reserved for sever hypovolemic pt...
16) dont transfuse awake juhuwa witness against his will but for a kid go ahead and transfuse if urgent or in nonurgent situation just tak e court oreder...ifkid belongs to juhuwa witness
17)always remmber when ever kid is in the womb mom will give consent for every thing evenif she is competent and refusing for csection and endangering her baby thats fine u just listen to her an d respect her wish..but as soon as she deliver she has no longer authority if child lif eis in danger....but for non urgent cases we stilll need her consent even if she is in jail or drug addict .....
1febrile bloood transusion reaction pt need leukopooor bloood
19)for graft verses host reaction u need to give iiridiated bloood next time..
20)HIT need that u d/d heparin and coumadin both and start with leupridine...inc risk of thrombosis with the HIT...plez read more from wash manual ....21)...in cases of hemoglobuburia weather its due to rhabdoor bloodo transfusion reaction give vigrous hydration with n/s and mannito or lasix...so hemoglonuria will not damage kidney tubule....bcz atn will cause rf sooon..if will not go aggressive hydration v imp for exam....
21)ist day jaundance is always due to abo imcompatibility
22) if husband is onegative and wife is tooo no prob baby will b normal..(.cam e in my exam..)..case senario was that a gal is pregnantand her rh is negative and her b fd is rh positive and they tell s u in sep setting that this babyis not my b fd but my ex and he is rh negative what u will tell her....
23)delayed transfusion reaction is due to duffy,kell and c,e loci of rh system..they cause delayed reaction after 8 to10 days of transfusion..
.
24)i unit of platelet will inc 5 k of platelets usually we giv e 6 pack..
25)fever chillsl and sever backach eis due to heamolytic reaction,stop transfusion and give ns bolus and lasix..flush th ekid so no damage to tubule and no renal failure other prob is dic....
26)kid if they have dirrhea due to slmonella sheggella or due to e coli they will most like ly have hus so keep that inmind in exam they ask that akid ate hamburger while his father was stilll barb qing...an dkid has now fever and dec inc bun/cretinine .. and thrombocytopenia and in c ldh itS HUS
27)WALDSTROME MACROGLOBUNEMAI IS DUE TOMONOCLONAL IGm paraprotein and in MM ITS DUE TO IgG
THE MAIN DIFIS THAT NO LYTIC BONE LESION IN THE WALDSTROME ...the cause of death in mm is due to infection from streptp pnumoni and h infuenza...
2hairy cell leukia is having pancytopenia,splenomegalyand hairy celll on p blood smear and bm biops