Cardio: ** Depressed CO + elevated PCWP+elevated SVR=> left ventricular failure.

Cardio shock Hypovolemia shock=> decreased PCWP + decreased CO Pulmon shock => normal or lower PCWP, ** ST elevation in II, III, and aVF =>acute inferior wall myocardial infarction. occlusion of either the right coronary artery or the left circumflex artery. Left anterior descending artery occlusion causes anterior wall myocardial infarction. # Pericarditis will have diffuse ST elevation in all leads # Atrial fibrillation is a common complication of hyperthyroidism. Tx: beta-blocker like propranolol. # early complications of an acute anterior wall Ml: Papillary muscle dysfunction=> Sudden onset of shortness of breath (SOB), bibasilar rales, an apical pansystolic murmur (PSM) radiating to the axilla(mitral regurgitation ). Ventricular septal rupture has similar features but the murmur is heard at the left sternal border and would not radiate to the axilla. Pericardial tamponade-- not have any murmurs # late complication of an acute anterior wall MI: Left ventricular aneurysm=>Precordia double apical beat, additional S3 or S4 and sometimes a murmur of mitral regurgitation is present due to papillary muscle dysfunction. Chest x-ray usually shows a characteristic prominence of the left border of the heart. The EKG shows persistent ST elevation. # Free-wall rupture is an early mechanical complication of Ml. It does not produce a murmur and it presents with cardiogenic shock. # Rupture of chordae tendinae is not a complication of Ml and it usually occurs secondary to trauma or infective endocarditis # sick sinus node syndrome -- the best treatment is placement of a permanent pacemaker. sick sinus syndrome refers to a clinical syndrome in which sinus node dysfunction produces symptomatic bradyarrhythmias, including sinus bradycardia, sinoatrial block and sinus arrest either singly or in combination. Symptoms may range from syncope, dizziness, confusion, and congestive heart failure. # malignant HPN  high blood pressure (>/= 200/140 mmHg) + papilledema. The pathologic change responsible for end-organ damage in malignant hypertension is fibrinoid necrosis of small arterioles. # Amiodarone is a class 3 anti-arrhythmic agent, which has now been shown to be very effective in terminating both atrial and ventricular arrhythmias. However, administration of this drug has been known to cause lipoid accumulation in lung parenchyma lead to fibrosis. In a patient with compromised lung function, use of amiodarone can potentiate the lung injury and its use should be with held. # Atrial fibrillation due to macro re entry circuits-- characterized by irregular undulation base line, No discrete P wave and QRS irregularly spaced. Tx: hemodynamically unstabl-- electrical cardioversion Stable w acute process -- either cardioversion or rate control Stable w chronic process -- rate control along with anticoagulation Electrical cardioversion should not be performed without 3-4 weeks of anticoagulation in chronic atrial fibrillation (>48hours), as the risk of embolization is high. Cardioversion can be either electrical or chemical. chemical cardioversion the best drugs would be class III agents (amiodarone, sotalol, ibutilide etc.) For rate control -- either IV diltiazem or beta-blockers (IV metoprolol). Digoxin is a good agent for patients with heart failure (systolic dysfunction) # recurrent VT, first thing to do after stabilizing the patient is to search for underlying cause, eg: Measure serum electrolytes if pt use digoxin, furosemide ïƒ decreased K # third degree AV block-- atria and ventricles beat independently. Tx: permanent pacemaker # Electromechanical dissociation is typical for pulmonary thromboembolism and pericardial tamponade. # Increased automaticity is a frequent cause of arrhythmia in patients with glycoside intoxication. # Reentrant ventricular arrhythmia (ventricular fibrillation) is the most common cause of death in acute myocardial infarction. # exertional angina + hypertension -- ST depression. best initial treatment-- beta-block, Calcium antagonists if beta-blockers are contraindicated or poorly tolerated. # vasovagal syncope= neurocardiogenic syncope=> prodrome (lightheadedness, weakness, and blurred vision), provocation by an emotional situation, and rapid recovery of consciousness. frequently recurrent. Diag: upright tilt table testing # The most common cause of aortic dissection is systemic HTN. – sudden excruciating chest pain radiates to back. an early diastolic decrescendo murmur at the right or left sternal border. Chest xray -- a widened superior mediastinum. normal EKG. Diag: Transesophageal echocardiography

# Renal artery stenosis is a common cause of resistant hypertension in a patient with advanced atherosclerosis. # diagnosis and follow-up of abdominal aortic aneurysms is an abdominal ultrasound # The primary mechanism responsible for the effect of nitroglycerin in patients with anginal pain is dilation of veins (capacitance vessels). Increased venous capacitance and venous pooling of the blood lead to significant decrease in ventricular preload and decrease in heart size. As the result of these changes, oxygen requirement of the heart greatly reduces. # aortic stenosis and hypertrophic cardiomyopathy produce a midsystolic (ejection systolic murmurs) murmur; For aortic stenosis -- murmur at right second intercostal space, radiates to the carotids, Valsalva maneuver attenuates murmur For HCM-- murmur at the lower left sternal border and it does not radiate to carotids, Valsalva maneuver accentuates murmur # Myxomatous valvular degeneration is the most frequent cause of mitral valve prolapse # Elderly patients are particularly sensitive to fluid loss, and even mild hypovolemia may predispose them to orthostatic syncope, especially upon getting up in the morning. BUN/creatinine ratio is a useful indicator of dehydration. # Aortic regurgitation-- high-pitched, blowing, early diastolic decrescendo murmur heard best in the left third intercostal space. collapsing (water-hammer) pulse Pulmonary regurgitation-- early diastolic, decrescendo, high-pitched, blowing, best heard along the left sternal border The murmur of mitral stenosis is a mid-diastolic rumble and it is best heard at the apex. The murmur of tricuspid stenosis is a mid-diastolic rumble and is best heard along the left lower sternal border. The murmur of the aortic stenosis is ejection systolic and best heard at right 2nd intercostal space. The murmur of tricuspid regurgiation is pansystolic #Elevated liver enzymes and myopathy are well-known side effects of statins, the popular lipidlowering drugs. They inhibit HMG-CoA reductase, a rate-limiting enzyme in the synthesis of cholesterol that converts HMG-CoA to mevalonate. It is important to know that mevalonate is used not only for the synthesis of cholesterol, but also for the production of several other products including dolichol and CoQ10. Reduced CoQ10 production has been implicated in the pathogenesis of statin-induced myopathy # right ventricular infarctionïƒ Decreased compliance of right ventricleïƒ right ventricle dilatedïƒ tricuspid regurgitation(pansystolic murmur at the left lower sternal border) , Diastolic dysfunction of R ventricleïƒ R heart failure(jugular venous distension, KussmaulDs sign, hepatomegaly, and hypotension in the presence of clear lung fields) # The hallmark finding mitral stenosis is elevated left atrioventricular pressure gradient that ultimately leads to left atrial enlargement. # evaluate aortic stenosis – Echocardiography # Aspirin, beta-blockers, ACE inhibitors and spiranolactone improve survival in patients with heart failure, while digoxin and loop diuretics does not provide any survival benefit. # It is better to keep Bp < 130/80 mmHg to slow end-organ damage in patients with diabetes and chronic renal failure. # Amiodarone is an excellent drug for stable ventricular tachycardia and maintaining normal sinus rhythm following a ventricular arrhythmia # Torsades de pointes—caused by 1st – Quinidine, then procainamide, tricyclics and disopyramide. EKG -- varying QRS morphology with prolonged QT Torsades can caused by hypokalemia, hypomagnesemia and hypocalcemia, acute ischemia and bradycardia. mitral valve prolapse, amyloidosis and acute myocarditis. Tx: magnesium # Jervell-Lange-Nielson syndrome=> congenital QT prolongation syndromes + congenital deafness. autosomal recessive. Cause torsades de pointesïƒ syncopal episodes and sudden death. Tx: betablocker like propranolol. # Restrictive cardiomyopathy is characterized by severe diastolic dysfunction due to a stiff ventricular wall. Chest x-ray shows only mild enlargement of the cardiac silhouette. Echocardiography usually shows a symmetrically thickened ventricle wall, normal or slightly reduced left ventricle size and normal or near normal systolic function. # Dilated cardiomyopathy is characterized by impaired systolic function of left and right ventricle leading to progressive cardiac enlargement. Chest x-ray shows marked or moderate enlargement of cardiac silhouette. Echocardiography shows systolic dysfunction and left ventricular dilatation with normal thickness of the ventricular wall. # Hypertrophic cardiomyopathy is characterized by asymmetric left ventricular hypertrophy. In HCM, a harsh systolic murmur best heard at the left sternal border is also present. Chest x-ray

shows mild enlargement of cardiac silhouette. Echocardiography shows vigorous systolic function, asymmetric septal hypertrophy and in some cases systolic anterior motion of the mitral valve. Due to the hypertrophy of the left ventricular wall, there is diastolic dysfunction. # Dipyridamole and adenosine are coronary vasodilators. Infusion of these substances in patients without coronary artery disease, increases coronary blood flow three to five times above the baseline levels. However, in patients with coronary artery disease, the diseased vessels distal to the obstruction are already maximally dilated, and their ability to increase myocardial perfusion is limited; therefore, redistribution of coronary blood flow to non-diseased areas occurs, and the perfusion of diseased segments diminishes. This phenomenon demonstrated by dipyridamole is called coronary steal and is used to diagnose ischemic heart disease. Dipyridamole can be used during myocardial perfusion scanning to reveal the areas of restricted myocardial perfusion. # prevention of recurrent attacks of rheumatic fever with antibiotic prophylaxis may slow down the progression of mitral stenosis in adolescents. # The drugs that slow the AV conduction (digoxin and verapamil) are contraindicated in patients with atrial fibrillation and Wolff-Parkinson-White syndrome because they can increase the conduction of impulses through the accessory pathway, thus leading to malignant arrhythmias and hypotension. # Procainamide or disopyramide are for Atrial fibrillation in the context of WPW syndrome. # chemical cardioversion for atrial flutter is ibutilide Either calcium channel blockers (verapamil or diltiazem) or beta-blockers can be used for rate control in acute/chronic atrial flutter Atrial flutter with unstable hemodynamics is best treated with cardioversion # ST segment depression, T wave inversion and first degree AV block can occur at therapeutic levels of digoxin. Atrial tachycardia along with variable degree of AV block is the most important EKG finding of digitalis toxicity # In a post-MI hypertensive patient, beta-blockers and ACE inhibitors are preferred over diuretics and calcium channel blockers. Beta blockers decrease myocardial oxygen demand by reducing heart rate and contractility. ACE inhibitors improve prognosis in post-MI patients with subnormal EF by decreasing ventricular remodeling, # Any patient who presents with sudden onset of chest pain, SOB, and has evidence of hypoxia and the new onset right bundle branch block should be considered as having a pulmonary embolism # Marfan’s syndrome-- aneurysms of the ascending aorta In aldut, Atherosclerosis-- aneurysm of the descending aorta In yang, of blunt injuries to the chest-- aneurysm of the descending aorta CT scans or angiograms are diagnostic # high risk to develop infective endocarditis include: 1. All prosthetic heart valves. 2. Any history of previous bacterial endocarditis. 3. Complex cyanotic congenital heart disease and surgicallyconstructed systemic pulmonary shunts. Patients with artificial pacemakers and defibrillators do not require prophylaxis for infective endocarditis. # Absolute indications for dialysis 1. Fluid overload not responsive to medical treatment. 2. Hyperkalemia not responsive to medical management. 3. Uremic pericarditis. 4. Refractory metabolic acidosis. Contraindications: 1. Debilitating chronic disease. 2. Severe irreversible dementia. # isolated systolic hypertension—1st low-dose thiazide diuretic # Antihypertensive management should be the first step in patients with aortic dissection with hypertension, then Transesophageal echocardiogram # a difference of more than 30 mmHg in the blood pressure readings between two arms-- aortic dissection # Cutaneous flushing and intensive generalized pruritis are well-known side effects of high-dose niacin therapy caused by drug-induced release of histamine and prostaglandins=> peripheral vasodilatation. can be reduced by low-dose aspirin # Age-dependant idiopathic sclerocalcific changes are the most frequent cause of isolated aortic stenosis in elderly patients. Cause Exertional syncope. # In a patient with an Ml who develops a cold leg, one has to get an ECHO to rule out a thrombus in the left ventricle. # A detailed medical history and physical examination is the most effective way to screen a low risk population for the presence of underlying cardiac disease.

The QRS is usually wide. elevated or decreased blood pressure. The best treatment w no hemodynamic compromise ïƒ either lidocaine or amiodarone.# alcoholism-. cardiomegaly -. dilated pupils. Peaked T ïƒ ST elevationïƒ inversion Tïƒ Q waves # Nitrates are contraindicated when a patient is continuously or intermittently taking sildenafil. Streptokinase do not need co-administration of heparin because it may produce allergy. Unstable ïƒ cardioversion # Carotid massage is useful for supraventricular tachycardia # Dressler’s syndrome. Ml. . an idioventricular rhythm. # The earliest EKG finding in acute Ml is peaked (hyperacute) T waves. Also increased LDL cholesterol & triglycerides. Thiazide diuretics are the initial antihypertensive of choice in patients with osteoporosis. Dobutamine stress echo is indicated in patients who can’t do sufficient exercise. pulsus paradoxus. dilated cardiomyopathy—heart failure. aspirin. and ST depression of greater than 1 mm at rest. a history of HTN. EKG shows an early P wave. Features of cocaine intoxication are cocaine bugs. megacolon or mega-esophagus. large Q wave infarct. # Mitral valve prolapse is the most common cause for isolated mitral regurgitation in North America. with tissue plasminogen activator. followed by the inversion of T waves. and elevated transaminases. # Mobitztype 2 block is characterized by a fixed PR interval with an occasional dropped beat in a 2:1. sex and symptoms. and no prior history of angina pectoris. or sudden death when a patient has an acute coronary syndrome. requires co-administration of heparin and aspirin for additional benefit.>cardiomyopathy. beta-blocker. and pulseless electrical activity in a patient with a recent acute Ml should make you think of free ventricular wall ruptureïƒ acute cardiac tamponade Free wall rupture usually occurs in the first week after Ml. It is recommended not to use nitrates within 24 hours of the last dose of sildenafil. tachycardia or bradycardia. conduction abnormalities ** Decreased tolerance to glucose is a well-known side effect of thiazide diuretic therapyïƒ hyperglycemia. Wolff-Parkinson-White syndrome. # Treatment with IV heparin.thrombocytopenia. hyponatremia.3:1. The reason for the dangerous interaction between nitrates and sildenafil is that both induce nitric oxide mediated vasodilatation. is a degenerative process and it may lead to severe mitral regurgitation. and nitroglycerin is indicated unstable angina and non-Q wave infarcts # thrombolytic therapy indicate 1) MI w ST elevation greater than 1 mm in two contiguous leads after sublingual nitroglycerin administration to rule out coronary vasospasm. Tobacco and alcohol are reversible risk factors for the development of atrial premature beats. Risk factors include advanced age. # Think of cocaine intoxication in a young patient presenting with chest pain/myocardial infarction or stroke.4:1 pattern. progressive increase in PR interval until a ventricular beat is dropped # Stress testing with imaging is indicated when the patient has complete left bundle branch block. # Norepinephrine is a powerful vasoconstrictor and can lead to decreased blood supply to both the lower and upper extremity cause Bluish discoloration and cool fingers # septic shock both right atrial pressures and pulmonary capillary wedge pressure are low. macrocytosis. # Mitral annulus calcification due to aging occurs in elderly. Thiazide diuretics decrease urinary calcium excretion # Chaga’s disease caused by Trypanosoma cruzi. is a late complication of acute Ml that usually develops between the second and tenth weeks post Ml.systolic anterior motion of mitral valve leaflet that causes mitral regurgitation. Tx: permanent pacemaker # Type I Mobitz or Wenckebach AV block is characterized by a narrow QRS. # ventricular tachycardia – widen QRS. decreased appetite. followed by ST elevation. followed by the appearance of Q waves. # Sepsis is the most common cause adult ARDS # hypertrophic obstructive cardiomyopathy -. # An atrial premature beat results from the premature activation of the atria that originates from a site other than the SA node. Coronary angiogram is indicated in patients who have abnormal stress testing exercise EKG testing should be the initial test of choice for stable angina when there is an intermediate pretest probability of coronary heart disease that is based on patient’s age. agitation. and sweating. hypokalemia and hypercalcemia # Presence of hypotension. an autoimmune pericarditis. 2) new left bundle branch block # Thrombolytic therapy. In such settings nitrates may cause syncope.

like enalapril. Contraindications to thrombolytics include active bleeding. early ST segment resolution. # In all ST elevation Ml. They have also replaced LDH for the retrospective diagnosis of Ml. These are usually 2nd line drugs for the general population. and beta-blockers have been shown to reduce mortality in the setting of acute Ml. They begin to rise 4-6 hours after an Ml. tender hepatomegaly etc. severe bradycardia and heart block greater than first degree.# Papillary muscle rupture -. # Generally. it is given under special circumstances like the finding of residual thrombus. # ACE inhibitors. dyspnea. # Constrictive pericarditis-. and electrical alternans. hypotension. # Alpha-blockers(Doxazosin) are preferred in patients with BPH and an unfavorable metabolic profile (dyslipidemia. ascites. It’s high specificity and rapid return to the baseline makes it the biomarker of choice for the diagnosis of a recurrent Ml. pedal edema. It begins to rise within 4-6 hours after Ml and returns to baseline within 48-72 hours. and autonomic symptoms of MVP. They are more specific than all the other biomarkers of cardiac injury being used for the diagnosis of Ml. In type II block -. Non-selective beta-blockers are contraindicated in asthmatics especially if they are steroid dependent or on continuous albuterol. drug allergy or systolic BP greater than 175 mmHg. Percutaneous Transluminal Coronary [PTCA]. # Acute transmural infarct => Q-waves + ST elevation # The diagnosis of ventricular septal rupture (The diagnosis of ventricular septal rupture can be made if there is evidence of left to right shunting on Swan-Ganz catheter readings )can be made if there is evidence of left to right shunting on Swan-Ganz catheter readings # Aspirin. # The first line medication for HTN in the general population is either a thiazide diuretic or betablocker. Electrical alternans is characterized by alternating amplitudes of QRS complexes # Mobitz type I heart block is characterized by a narrow QRS. are the 1st line drugs for diabetics with hypertension. # CK-MB fraction has a high specificity for an acute Ml (slightly lower than cardiac troponins). Concurrent administration of glycoprotein llb/llla inhibitors has shown promising results with improved coronary reperfusion. and remain elevated for 10 days. and reduction of the incidence of recurrent ischemia and infarction.dropped QRS complex with normal PR interval. Caused by coronary vasospasm # situational syncope related to micturition caused by autonomic dysregulation # The EKG findings in pericardial tamponade include sinus tachycardia. The role of GP llb/llla inhibitors in primary PCI(PTCA) is not certain. Other absolute contraindications to their use include asthma. palpitations. positive Kussmaul's sign. or Balloon Angioplasty) with or without stenting must be performed as soon as possible. lead to acute mitral regurgitation and a pansystolic murmur # Premature atrial beats never require any treatment and are completely benign # Digoxin is particularly used in patients with heart failure (systolic dysfunction) and atrial fibrillation/flutter. we can say that prophylaxis is recommended for high-risk conditions and is optional for moderate risk conditions. glucose intolerance). papillary muscle dysfunction or infarction as the next most common cause #Beta blockers are used to treat chest pain. progressive increase in PR interval until a ventricular beat is dropped. muscle wasting etc) and /or signs and symptoms of venous overload like elevated JVP. PCI is the reperfusion therapy of choice as it has a better outcome than thrombolysis. reperfusion therapy with thrombolytics or PTCA(Percutaneous Coronary Interventions (previously called Angioplasty.decreased cardiac output (fatigue. they are contraindicated in the presence of pulmonary edema. Cardiac enzymes are usually negative. Sharp 'x' and y descent on central venous tracing is characteristic of constrictive pericarditis as is the presence of pericardial knock.occurs in the first week after an acute Ml. At some centers it is used routinely while at others. It increases the AV nodal refractoriness and thereby slows the ventricular rate in atrial fibrillation and flutter. . low voltage QRS complexes.atria and ventricles beat independently # Even though IV beta-blockers improve mortality in acute Ml.. They have now become the primary biochemical tests used for the diagnosis of acute Ml. # Cardiac troponins T and cardiac troponins I are proteins that control the interaction of actin and myosin. # Mitral valve prolapse is the most common cause of mitral regurgitation in USA. ACE inhibitors. Tuberculosis is the most common cause of constrictive pericarditis # Calcium channel blockers are the drugs of choice for Variant anginaïƒ rest chest pain w transient ST elevation during the episode of chest pain which usually returns to baseline as the pain resolves. In third degree AV block -. history of a hemorrhagic stroke anytime or a cerebrovascular accident within the last year.

# Screening should be done in all first-degree relatives of the patients of hypertrophic cardiomyopathy and the most effective way of screening these people is echocardiography. severe tricuspid regurgitation. Tx: Controlling the rhythm or rate # Hyperkalemia and pregnancy are contraindications to the use of ACE inhibitors # Beta-blockers can worsen severe peripheral vascular disease while helping for blood pressure. Complex cyanotic congenital heart disease and surgically constructed systemic pulmonary shunts. prophylaxis is optional in high-risk patients and not recommended in moderate-risk patients For genitourinary tract procedures like prostatic surgery. ostium primum ASD.> IV adenosine push # Prolonged. Hypertrophic cardiomyopathy. uterine D&C. prophylaxis is not recommended For gastrointestinal procedures like sclerotherapy of varices.Conditions put a patient at high risk to develop infective endocarditis include: 1. For dental procedures which are unlikely to cause bleeding. Any history of previous bacterial endocarditis.HR of >140/min. which put a patient at moderate risk to develop infective endocarditis includes: 1. gastrointestinal surgery involving mucosa. For endotracheal intubation. valvular stenosis and regurgitation). # Water hammer or collapsing pulse and pistol shot femoral pulses are diagnostic clues to aortic regurgitation Tapping apex beat and malar flush are important physical findings of mitral stenosis. right ventricular infarction and cardiac tamponade. Tx: unstableïƒ cardioversion. prophylaxis is optional in high-risk patients and not recommended in moderate-risk patients. antibiotic prophylaxis is recommended both in high-risk and moderate-risk patients. antibiotic prophylaxis is recommended both in high-risk and moderate-risk patients. bicuspid aortic valve and coarctation). therapeutic abortion. VSD. Midsystolic soft murmurs (grade l-ll/IV) in an asymptomatic young patient are usually benign and need no further work-up. 2. tachysystolic atrial fibrillation causes significant left ventricular (LV) dilation and a depressed ejection fraction. MVP with regurgitation and/or myxomatous leaflets. and spironolactone. prophylaxis is not recommended. 4. 3. 2. # supraventricular tachycardia-. prophylaxis is recommended only when an infection is present. Pulsus paradoxus is defined as greater than 10-mmHg fall of the systolic blood pressure during inspiration # Pulsus paradoxus and hypotension point toward the diagnosis of pericardial tamponade . Conditions. Acquired valvular heart disease (such as rheumatic heart disease. All prosthetic heart valves. Stableïƒ vagal maneuvers initially. # Hyponatremia is a bad prognostic factor in patients with heart failure. For urethral catheterization. If these fail -. For dental procedures with bleeding. # Hyperkalemia present in this patient may be due to the combination of enalapril. prophylaxis is optional in the high-risk patient. cystoscopy and urethral dilatation. For endoscopy and TEE. a moderate-risk cardiac condition and now the decision about the need and choice of antibiotic regimen will depend on the type of procedure. For respiratory procedures like rigid bronchoscopy and operations involving mucosa. antibiotic prophylaxis is recommended in high-risk patients and optional in moderate risk patients. sterilization or insertion or removal of IUD. Furosemide causes hypokalemia. For cesarian section. # Jugular venous distention (JVD) and RBBB indicate right heart strain # Think of PE in a postoperative patient with JVD and new onset RBBB # Hypertrophic cardiomyopathy has an autosomal dominant mode of inheritance. that is also called pericardial knock and the inspiratory increase in the jugular venous pressure (KussmaulDs sign). esophageal stricture dilatation and ERCP in the presence of obstruction. digoxin. Congenital cardiac malformations not falling into the high or negligible risk categories (such as PDA. are important physical findings of constrictive pericarditis. For flexible bronchoscopy. biliary tract surgery. loss of P waves and narrow QRS complex. regular. KussmaulDs sign is also present in right sided heart failure. antibiotic prophylaxis is recommended both in high-risk and moderate-risk patients. It indicates the presence of severe heart failure and a high level of neurohumoral activation # The early third heart sound. 3. Detailed history and examination is the screening method used for young athletes # Diastolic and continuous murmurs as well as loud systolic murmurs revealed on cardiac auscultation should always be investigated using transthoracic Doppler echocardiography. For vaginal delivery and vaginal hysterectomy. prophylaxis is not recommended.

# Isolated premature ventricular arrhythmias generally do not require any medical treatment. On the other hand moderation of alcohol intake to 1-2 drinks per days also has been shown to have a cardioprotective effect ïƒ decrease blood pressure # Thrombolytic therapy is indicated when the chest pain is suggestive of Ml and there is ST segment elevation greater than 1 mm in two contiguous leads after sublingual nitroglycerin administration to rule out coronary vasospasm. Thrombolytic therapy is not indicated for an Ml with ST segment depression and it is also not indicated for unstable angina. They are also metabolically neutral. The diagnosis is made by echocardiogram. as well as sequel of humoral or cellular immune responses to persistent viral infection. Leg elevation increases the left ventricular volume and thus decreases the gradient and the associated murmur. observation is usually the treatment of choice # Transmural infarcts-. # Lidocaine increased risk of asystole # Valsalva maneuver and standing after squatting are two maneuvers that decrease left ventricle volume thus increasing the gradient and intensifying the associated systolic murmur.V atropine is the drug of first choice in patients with symptomatic bradycardia (Choice B). Phenylephrine also decreases the murmur by increasing systemic arterial pressure. # A history of recent upper respiratory tract infection followed by sudden onset of cardiac failure in an otherwise healthy patient is suggestive of dilated cardiomyopathy. Sodium nitroprusside or inotropes like dopamine or dobutamine are used to stabilize this condition before emergent surgery can take place. handgrip increases the systemic arterial resistance and thus decreases the gradient and associated systolic murmur. ACEi and digitalis be avoided in HCM especially when an outflow gradient is present. as in valvular aortic stenosis or untreated hypertension Eccentric hypertrophy of the heart is seen following chronic volume overload. ECG will reveal 'non specific1 ST elevations and there may be a pericardial effusion. Concentric hypertrophy of the heart is seen following chronic pressure overload. or many times no changes) should be hospitalized and treated with aspirin. T wave inversion. # Whenever a patient of chronic aortic regurgitation develops symptoms of LV dysfunction. # Dressier syndrome typically occurs two-to-four weeks after an Ml and presents with a low-grade fever. If the patient has severe bradycardia with hypotension then epinephrine is the drug of choice Adenosine is used for supraventricular tachycardia # If average alcohol intake is greater than 2 drinks/day. Tx: Always treat isolated systolic hypertension. which typically shows dilated ventricles with diffuse hypokinesia resulting in low ejection fraction (systolic dysfunction). he should undergo aortic valve replacement after his congestive symptoms are relieved by intense medical treatment with digoxin.ST segment elevation followed by the development of Q waves and elevation of cardiac enzymes # Subendocardial infarcts are characterized by ST segment depressions that are not followed by the development of Q waves and elevation of cardiac enzymes. Transcutaneous pacing is the next step after atropine. and vasodilators (ACE inhibitors). . an angiography can be performed non-emergently. Once the patient is free of chest pain. most likely secondary to acute viral myocarditis(Coxsackie B infection). malaise and pleuritic chest pain.5-2 times compared to the general population and the risk increases substantially if the average alcohol intake is greater than 5 drinks/day. # All patients with unstable angina(either ST depression. and IV nitroglycerin. hypertrophic cardiomyopathyïƒ Beta-blockers are usually the first line of medication. #I. not affecting plasma lipid profile. Acute aortic regurgitation is an emergency and requires emergent surgery. diuretics. NSAIDs are the agents of choice. Viral myocarditis can cause dilated cardiomyopathy by direct viral damage. as seen in valvular regurgitation # Isolated systolic hypertension (ISH) is important cause of hypertension in elderly patients caused by decreased elasticity of the arterial wall. IV heparin. – Hydrochlorothiazide # Diuretics. # Infective endocarditis prophylaxis and repeated regular follow-ups are recommended for all patients of aortic stenosis even if they are asymptomatic.# A pansystolic murmur at the left sternal border is usually seen in tricuspid regurgitation # Calcium channel blockers have good peripheral vasodilating properties that can help to diminish the symptoms of intermittent claudication. Another indication for thrombolytic therapy is a new or presumably new left bundle branch block. nitrates. risk of development of hypertension increases by 1. # Chronic oral contraceptive use is a common cause of secondary hypertension caused by an estrogen-mediated increase in the synthesis of angiotensinogen in the liver # Coxsackie-B virus is a common cause of acute pericarditis.

# Mitral valve prolapse-. sensorineural hearing loss and tinnitus. # Beta-blockers are preferred over the digoxin or calcium channel blockers in patients with coronary artery disease. Thus any patient who has atrial fibrillation and heart failure will benefit from digoxin. referred earache. The mainstay of treatment is early and aggressive antibiotic . CTscan of the head and the face is confirmatory 7 nasal polyps are recurrent episodes of rhinitis. It also has a beneficial effect in patients of systolic dysfunction due to its positive inotropic effect. Diastolic dysfunction is present in HCM. drooling. and ST depression of greater than 1 mm at rest. and trismus -.recurrent episodes of rotational vertigo. # Treatment with IV heparin.-. an idioventricular rhythm. dark. and VI are present. puffy eyelids 5 Otitis externa is always painful and tender. These effects are explained by niacin-induced peripheral vasodilatation. headache.systolic click. ptosis. The mechanism involved in this reaction is believed to be drug-induced release of histamine and prostaglandins. it should be considered over before beta-blockers or calcium channel blockers. hypertrophied ventricle wall.dysfunction of the CN III. neck pain. swollen tonsils. Supernormal ejection fraction is present in hypertrophic cardiomyopathy as is dynamic outflow obstruction. Wolff-Parkinson-White syndrome. can be reduced by low-dose aspirin # In a patient with an Ml who develops a cold leg. a loop diuretic can cause ototoxicity—hearing loss. chronic nasal obstruction. IV. # Dobutamine stress echo is indicated in patients who canDt do sufficient exercise. mydriasis (CN III dysfunction). PTCA with stent placement has been shown to have better outcomes than thrombolytic therapy in acute ST elevation Ml. aspirin. CT is the definitive procedure for diagnosis. # exercise EKG testing should be the initial test of choice for stable angina # Presence of complete RBBB (or) ST depression at rest of less than 1 mm are not contraindications to perform stress testing. dysphagia. nasopharyngeal mass. angina. Even if the patient has no contraindications forthrombolytic therapy and a catheterization laboratory is available in the hospital. # Severe systolic dysfunction and increased left ventricle size are features of dilated cardiomyopathy. Caused by auditory tube dysfunction arising from HIV lymphadenopathy or obstructing lymphomas 10 Peritonsillar abscess presents with unilateral sore throat. For streptokinase. one has to get an ECHO to rule out a thrombus in the left ventricle. # in hypertrophic cardiomyopathy it is the systolic anterior motion of mitral valve leaflet that causes mitral regurgitation Coronary angiogram is indicated in patients who have abnormal stress testing # Aortic stenosis may present with syncope. and diplopia secondary to erosion into cranial cavity and pressure on optic chiasm.Streptococcus pyogenes 1 Furosemide.pale bluish mucosa. or within 30 min of the hospital. V. The click occurs earlier with standing and Valsalva maneuver and it disappears with squatting and handgrip #Cutaneous flushing and intensive generalized pruritis are well-known side effects of high-dose niacin therapy (high dose is required to treat lipid abnormalities). 9 Serous otitis media—aids pt with hearing difficulty. co-administration of heparin is not required. # ejection fraction (EF) normal = 55-65% # Digoxin slows the ventricular response rate in atrial fibrillation by slowing down AV conduction and thus increasing the diastolic filling. Lateral gaze palsy (CN VI dysfunction). Calcium channel blockers are not the best drugs for patients with heart failure due to their negative inotropic effect. and IV nitroglycerin is indicated in cases of unstable angina and non-Q wave infarcts # Manage a patient with ST segment elevation Ml with immediate angiography and PTCA when thrombolytic are contraindicated. altered taste sensation. dull tympanic membrane which is sluggish to air insufflation and presence of air fluid levels in the middle ear. diminished sense of smell and persistent postnasal drip 8 Manner -. Tissue plasminogen activator is slightly more effective than streptokinase but it has a slightly more risk of intracranial bleeding. due to the stiff. pain without tenderness suggests middle rather than an external infection 6 Juvenile angiofibroma-.triad of nasal obstruction. tinnitus and dysequilibrium 2 Cavernous Sinus Thrombosis is the most common. # IV dobutamine is used when a patient is in cardiogenic shock. or dyspnea (SAD) on exertion ENT 4 allergic rhinitis -.Thrombolytic therapy with tissue plasminogen activator requires co-administration of heparin and aspirin for greater benefit. late complication of infection of the central face or para nasal sinuses. conductive hearing loss. Stress testing with imaging is indicated when the patient has complete left bundle branch block. and recurrent epistaxis. absent corneal reflex (CN V dysfunction).

Treatment consists of Iv antibiotics and needle aspiration of the abscess. restriction of extra ocular movements. followed by fever and periorbital edemea. It is due to the auditory tube dysfunction arising from HIV lymphadenopathy or obstructing lymphomas. characterized by a reddish-blue hue over promontory and oval window niche areas. and drooling of saliva. Myopia or shortsightedness -. nasopharyngeal mass. Usually patients notice inability to focus objects at normal reading distance and complain of having to hold books at arms length to read. concentration and depression.Streptococcus pyogenes is the most commonly associated organism-. Failure to obtain pus is an indication for surgical incision and more formal exploration Retropharyngeal abscess also presents with neck pain. secondary to rich vascular supply associated with immature and audiometry shows conductive hearing loss and loss of stapedial reflex. pooling of saliva.high frequency hearing loss in both ears associated with difficulty in speech discrimination 16 Petrous apicitis presents with a triad of retro orbital pain. Juvenile angiofibroma can be managed with medical or surgical therapy depending on the stage of tumor. cervical adenopathy.light rays are focused in front of the retina.repeated infections or progressive conductive hearing loss. They present with pulsatile tinnitus and hearing loss 15 Presbyacusis-. It is inherited in an autosomal dominant pattern with incomplete penetrance. It is corrected with convex lenses In Hyperopia light rays fall behind the retina.not usually associated with hearing loss or tinnitus.It can cause disruption of sleep. Tympanic membrane appears thickened with calcific patches and perforation 9 Otosclerosis is an osseous dyscrasia limited to the temporal bone.follows a viral infection or mumps. foul smelling discharge. – cause Staphylococcus aureus. and dysphagia. Tonsils are normal 11 Presbyopia is the loss of accommodative capacity that occurs with ageing. Benign positional vertigo-. altered taste sensation. and recurrent epistaxis in a young male is highly suggestive of juvenile angiofibroma. It causes symptomatic hearing loss + tinnitus tinnitus by third decade of life. associated with prominent cervical lymphadenitis and deviation of uvula. 14 Glomus tumor arises in the middle ear or in the jugular bulb.unilateral sore throat. These patients have posterior pharyngeal edema. Tricyclic anti¬depressants have been found to be effective for this condition. Acute labyrinthitis-. trismus. leukemia. Treatment consists of oral sodium fiuoride 10 peritonsillar abscess -. drainage and granulation tissue that are unresponsive to antibiotic treatment. examination there is a grayish-red mass in the posterior nasopharynx. proptosis. neck pain. 4 Juvenile angiofibroma is a vascular tumor -. Vancomycin can cause nephrotoxicity and the red man syndrome (due to histamine release from mast cells) 13 Tinnitus can sometimes occur in patients taking aspirin.Nasal examination shows an erythematous mucosa. fever. diminished sense of smell and persistent postnasal drip 6 meniere’s syndrom-.the most common benign tumor of nasopharynx The triad of nasal obstruction. lateral rectus palsy.clear nasal discharge and nasal mucosa is pale or bluish. Anticoagulants and corticosteroids may also be used as adjunctive therapy. and Hemophilus influenza 18 Malignant otitis externa is an infection of external ear -. chronic nasal obstruction. 8 Chronic otitis media usually presents with purulent aural discharge. It presents with hearing difficulty. and even in patients who are depressed -. sensorineural hearing loss and tinnitus. granulations in ear canal and involvement of cranial nerves VII. sore throat.administration. 17 Orbital cellulitis is manifested by abrupt onset of fever. Patients present with severe headache. characterized by marginal tympanic membrane perforation or sometimes it may present as ear canal filled with mucous. Allergic rhinitis-. 3 Viral rhinitis-. dull tympanic membrane which is sluggish to air insufflation and presence of air fluid levels in the middle ear. 5 Typical symptoms of nasal polyps are recurrent episodes of rhinitis. and otorrhea. malnutrition. referred earache. IX-XII. vertigo 7 Serous otitis media is the most common middle ear pathology in acquired immuno deficiency syndrome. 10% of patients demonstrate a Schwartz sign. quinine. X-rays should be done in all cases of suspected malignant otitis externa to look for the degree of damage to the body tissues X-rays should be done in all cases of suspected malignant otitis externa to look for the degree of damage to the body tissues 19 Cholesteatoma is an epithelial cyst that contains desquamated keratin-. It is corrected using concave lenses 12 quinine is being used for treating cramps in dialysis patients. and a muffled voice. and other debilitating diseases. and dysphagia. nuchal rigidity. ear ache. Cholesteatomas destroy . tonsils are swollen-. deep otalgia.recurrent episodes of rotational vertigo. Otoscopic examination --usually normal. pus and granulation tissue. and swollen red eyelids. Streptococcus pneumoniae.caused by pseudomonas aeruginosa and occurs in patients who suffer from coexisting diseases such as diabetes mellitus.

and tenderness over mastoid area( behind ear ). incisional biopsy or exfoliative cytologic examination should always be done. It is associated with mycoplasma or viral respiratory Infection 35 Diabetic Retinopathy -. popping noise while swallowing or yawning. It presents as thickening and calcification of the tympanic membrane. -> emergent ophthalmologist referral emergent ophthalmologist referral 22 Acute angle closure glaucoma is characterized by sudden onset of symptoms such as blurred vision. pain behind the ear. It demonstrates fluid filled middle ear and demineralization of mastoid trabeculae. It presents as thickening and calcification of the tympanic membrane. aspirin is contraindicated as it may lead to severe bronchospasm (aspirin triad or SamterDs triad).bones and therefore. Intravenous antibiotics are the immediate treatment of choice 32 Treatment of choice for streptococcal pharyngitis is single injection of IM Benzathine penicillin G 33 IV crystalline penicillin G is used in cases of bacterial meningitis. venous dilation and tortuosity. 29 Lichen planus is characterized by polygonal. Examination reveals erythema. exudates and papilledema – g 4 31 Mastoiditis is the most common complication of the otitis media. nausea and vomiting. Fundoscopy may reveal swollen optic disc and central scotoma.Argon Laser photocoagulation 36 Retinal detachment . 28 Hairy leukoplakia is a white. Otoscopy reveals retraction and decreased mobility of the tympanic membrane. and retinal edema. It is caused by Epstein Barr Virus (EBV).proliferative retinopathy consisting newly formed vessels -> leading cause of blindness in USA. Symptoms follow the onset of upper respiratory tract infection or allergic rhinitis . Hearing loss is rare Tympanic sclerosis is common sequelae of chronic otitis media. any bony structure in or around the middle ear and mastoid cavity can be eroded –CT. They will also have pupillary abnormalities pallor of the optic disc. flame shaped hemorrhages.aural fullness.found in AIDS patient on the lateral aspect of tongue. 24 Central retinal artery occlusion is also characterized by sudden painless loss of vision in one eye. Tx ->A single intramuscular dose of ceftriaxone 41 Neonatal chlamydial conjunctivitis presents with mild hyperemia with scant mucoid eye discharge not purulent. alcohol. Influenzae and Group A Streptococcus are the most common causes of epiglottitis 40 Gonococcal conjunctivitis . painless. papular eruption covered by fine scales. risk of transformation into squamous cell carcinoma.pallor of the optic disc. unilateral loss of vision. Examination reveals a red eye with hazy cornea and a fixed dilated pupil 23 Optic neuritis also presents with sudden unilateral loss of vision but is associated with severe pain. occurs 2-3 days after birth. Therapy consists of surgical removal Therapy consists of surgical removal 20 Tympanic sclerosis is common sequelae of chronic otitis media. cupping of optic disc 38 Cigarette smoking increases the risk of macular degeneration 39 H. It occurs about 5-14 days after birth . exudates. CT imaging may be used to confirm the clinical diagnosis. treated with auto insufflations and oral and nasal decongestants 27 Leukoplakia -. severe eye pain. granular appearance ->hard to remove caused by chronic irritation to the oral mucosa due to smoking.whitish patch or plaque. retinal hemorrhages and cotton wool spots. painless lesion .micro aneurysms. cherry red fovea and boxcar segmentation of blood in the retinal veins. disk swelling.copious purulent eye discharge with swollen eyelids and chemosis. protruded auricle. cherry red fovea and boxcar segmentation of blood in the retinal veins. malignant retinopathy-. 30 Keith-Wagener classification -.stages of hypertensive retinopathy Slight AV nicking – grade 1 Copper wiring. AV depression with humping ends –g 2 G2g Silver wiring. 25 In patients with asthma and nasal polyps. intermittent ear pain. edema. and hearing loss. exudates –g3 333 Flame shaped hemorrhages. pre proliferative retinopathy with cotton wool spots. Hallmark of eustachian tube dysfunction is a middle ear effusion. These lesions when involving oral mucosa have higher incidence of malignant transformation. or ill-fitting dentures and Vitamin A and B deficiencies and syphilis. violaceous.retina hanging in the vitreous. Hearing loss is rare 21 Central Retinal Vein Occlusion (CRVO) presents with sudden..gradual loss of peripheral vision resulting in tunnel vision. and fever. endocarditis. 26 Eustachian tube dysfunction is a common cause of conductive hearing loss in children. and neurosyphilis 34 Bullous myringitis presents with painful vesicles on the tympanic membrane. Tx. 37 Open angle glaucoma-. hemorrhages.

sulfonamide containing diuretics. Discontinuing the offending drug is the treatment of drug-induced interstitial nephritis Clinical features include fever. decreased libido and ejaculatory problems. Caused by apillar ischemia. Typical presentation includes nephritic range proteinuria. It acts on the epithelial components of the prostate gland and produces . calculus formation within the ductal system of salivary gland is most common in submandibular gland followed by sublingual and parotid gland. and normal sized kidneys 5 HIV + hepatitis B -> membranous glomerulonephritis 6 Cardiovascular disease is the most common cause of death in dialysis patients and in renal transplant patients 7 interstitial nephritis are caused by drugs such as cephalosporins. Both hematuria and hemoptysis are seen in cases of GoodpastureDs syndrome and WegenerD s granulomatosis. Flu like syndrome d. Worsening of hypertension or induced hypertension – Tx: fluid removal (by dialysis) and use of anti¬hypertensive drugs (beta blockers and vasodilators are preferred). GenitaUrine ============ 1 Membranoproliferative glomerulonephritis. rash and arthralgias. post-streptococcal glomerulonephritis 3 anti-GMB antibody – good pasture ‘ syndrom. x-ray of the involved salivary gland is diagnostic. In WegenerDs granulomatosis 12 hepatitis B infection-.> painless episode hematuria. and allopurinol. 16 All patients with chronic renal failure and hematocrit < 30% (or hemoglobin <10g/dl_) are candidates for recombinant erythropoietin therapy after iron deficiency has been ruled out. A detailed metabolic evaluation is not needed when a patient presents with their first renal stone 18 Finasteride acts on epithelium.Cellmediated injury 4 collapsing focal and segmental glomerulosclerosis is the most common form of glomerulopathy associated with HIV. WBC casts may be present in the urine 8 sickle cell trait in a young black male . red cell aplasia 17 recurrent renal stones need 24hr urine is collected to find any underlying metabolic disorder. idiopathic crescentic glomerulonephritis. azotemia. resulting in impotence. alpha-1 blockers act on smooth muscles of prostate and bladder base 19 Finasteride is 5-alpha reductase inhibitor and it inhibits the conversion of testosterone to dihydrotestosterone. penicillins. sulfonamides. type 2 -. Treatment consists of dilation and incision of the involved duetto remove the calculus. results from papillary ischemia induced by analgesic-mediated vasoconstriction of medullary blood vessels (vasa recta).-. hematuria. phenytoin. Papillar necrosis can occur with massive hematuria 9 analgesic nephropathy – headache + painless hematuria.membranous glomerulonephritis. sterile pyuria and eosinophiluria. Rifampin. caused by IgG antibodies (termed C3 nephritic factor) directed against C3 convertase of the alternative complement pathway. cavitary lung lesions. A history of silver nitrate eye drops instillation is usually present 43 Sialolithiasis presents as post-prandial pain and swelling. ->Papillary necrosis 10 several years of analgesic abuse induce pailess hematuria characterized by chronic tubuiointerstitial damage 11 Any patient with recurrent sinusitis. but HBsAg carriers-membranoproliferative glomerulonephritis 13 Child or adolescent presenting with priapism suspect sickle cell disease and leukemia 14 Fluoxetine does lead to sexual dysfunction. These antibodies reacting with C3 convertase lead to persistent complement activation and kidney damage 2 immune complex-mediated glomerulopathies that include SLE. NSAIDDs. 15 Priapism with Trazadone. pulmonary hemorrhages and glomerulonephritis will most likely have WegenerDs glomerulonephritis.42 Chemical conjunctivitis is the most common cause of conjunctivitis occurring within the first 24 hours after birth. Headaches c. Erythropoietin is also indicated in all the hemodialysis patients who have symptoms attributed in part to anemia most common side effects of erythropoietin therapy are: a. b. Other features are peripheral eosinophilia.Dense intramembranous deposits that stain for C3.

encephalopathy. removal of K+ from the body can be achieved with dialysis. chills and white blood cells in the urine. 33 nephrotic syndrome.proteinuria in excess of 3. and thereby increasing the excretion of K+. headache. hypoalbuminemia and edema. and hypercoagulable state 34 In hyperkalemia. when there is bleeding tendency. Kayexalate or sodium polystyrene sulfonate is a cation-exchange resin. BPH w collagen predominance respond neither to finasteride nor to alpha-1 blockers 19 epididymitis characterized by fever. Most of these patients have evidence of Hepatitis C. Urinalysis . peripheral neuropathy. hepatosplenomegaly. AD. non-specific systemic symptoms. cation exchange resins or diuretics. Electron microscopy --thinned and thickened capillary loops with splitting of GBM 27 In a patient with flank pain. or when a patient is having hypothermia 21 Indications for dialysis includes uremic symptoms such as pericarditis. trachomatis or N. diabetic nephropathy =>Thickening of the glomerular basement membrane is the first change that can be quantitated -> mesangial expansion -> Nodular sclerosis 24 acyclovir. and irritative voiding symptoms usually w UTI. helps to confirm the diagnosis 32 cryoglobulinemia includes palpable purpura. 28 medullary cystic kidney. . and hypocomplementemia. Bruit or venous hum may be heard at the costovertebral angle. however they do not remove potassium from the body. Terazosin and Doxazosin are all selective alpha-1 blockers recommended for the treatment of BPH. It creates intraglomerular hypertension leading to progressive glomerular damage and renal function loss. 2. Microcytic hypochromic anemia may be due to loss of transferring. hyperkalemia not amenable to standard therapy. They produce side effects like orthostatic hypotension. hypertriglyceridemia. Accelerated atherogenesis may occur due to increased levels of LDL. Prazosin. 3 immunoglobulins may be lost in urine resulting in hypogammaglobulinemia. fevers. painful enlargement of testes. 29 Alpha-blockers are used for the treatment of benign prostatic hyperplasia. arthralgias. dizziness. impaired amino acid transport by the brush borders of renal tubular and intestinal epithelial cells.20 (acidosis 22 All patients with irritative or obstructive voiding symptoms should have their urinalysis and serum creatinine done. and fluid overload unresponsive to diuresis. detects elevated cystine level. -ïƒ adults with recurrent UTI or renal stones ( x-ray shows nephrocalcinosis and contrast filled cysts demonstrated by IVP.5g/day. think pyelonephritis.= > Crystalluria with renal tubular obstruction & acute renal failure 25 Fibromuscular dysplasia can present with diastolic hypertension in children. coagulopathy. 4 cholecalciferol-binding protein may be lost in urine with resulting deficiency of vitamin D and hypocalcemia. Angiogram will reveal "string of beads" sign 26 Alport’s syndrome -recurrent episodes of hematuria with proteinuria sensorineural deafness and family history of renal failure. in younger patients is usually caused by sexually transmitted organisms such as C. glomerulonephritis(proteinuria and hematuria) along with high titers of rheumatoid factor. 35 Sodium bicarbonate. retrograde ejaculation and rhinitis 30 Tamsulosin is a new drug and it blocks only alpha-1 receptors that are present in prostate and bladder base used for the treatment of benign prostatic hyperplasia 31 Cystinuria is an inherited disease causing recurrent renal stone formation. insulin plus glucose drip and beta agonist decrease the extra cellular concentration of potassium by driving the potassium into the cell. Urine and blood cultures should be obtained prior to obtaining antibiotics. and pH less than 7. In older men it is usually non-sexually transmitted and is caused by gram-negative rods 20 Peritoneal dialysis is an alternative to hemodialysis when vascular access is not possible. Urinary cyanide nitroprusside test. whereas the juvenile form also known as nephronophthisis is autosomal recessive. gonorrhea. Hypocalcemia may result in secondary hyperparathyroidism ***Patients with nephrotic syndrome are at increased risk for developing hypercholesterolemia. is not associated with renal failure or hypertension.selective alpha-blocker. Phenoxybenzamine is a non.improvement of symptoms as well as reduction in the size of the gland. which acts in Gl tract by promoting the exchange of Na+ for K+. when there is hemodynamic instability.Nephrotoxicity. ureter and bladder done 23 Glomerular hyperfiltration is believed to be the earliest renal abnormality present in patients with diabetes mellitus.hexagonal crystals. Patients with elevated serum creatinine levels should have ultrasound of kidney.

and use of low purine diet with/without allopurinol if hyperuricosuria is present.g. 2. Within 5-10 years of diabetes mellitus. glomerulosclerosis is characterized by progressive loss of glomerular capillary surface area with glomerular and peritubular fibrosis. urological imaging with CT scan or ultrasound must be performed to exclude obstruction. alkali nization of urine to pH > 6. or some other complication 54 Calcium gluconate is the treatment of choice for hyperkalemic patients with significant EKG abnormalities 55 Kayexalate is a cation exchange resin used in case of chronic hyperkalemia 56 The duration of diabetes should be longer (10-15 years) to cause nephropathy.Microalbuminuria. lupus nephritis or poststreptococcal glomerulonephritis).. Oral erythromycin is used to treat nonbacterial prostatitis. Linear immunoglobulin deposits on immunofluorescence microscopy are typical for antiglomerular basement membrane disease (e. 52 hematuria with irritative or voiding symptoms. whereas. suprapubic discomfort along with urinary findings of bacteriuria and pyuria establish the diagnosis of acute cystitis. Oral trimethoprim-sulfamethoxazole is the preferred empiric treatment for acute uncomplicated cystitis 41 Uric acid stones are radiolucent. glomerular hypertrophy. This is because unabsorbed fatty acids chelates calcium and thus oxalic acid is free for absorption 38 Calcium phosphate stones are common in primary hyperparathyroidism and renal tubular acidosis (RTA) 39 Struvite stones are formed when urine is alkaline because of infection with urease producing bacteria like Proteus 40 dysuria. renal. and hepatomegaly Crescent formation revealed on light microscopy is characteristic for rapidly progressive glomerulonephritis 45.Glomerular hyperperfusion and renal hypertrophy with increase in glomerular filtration rate. increased urinary frequency and urgency ). urinary frequency. Treatment of uric acid stones includes hydration. GoodpastureDs syndrome) 46 Granular immunoglobulin deposits revealed on immunofluorescence microscopy -. and mesangial volume expansion with glomerular filtration rate returning to normal. 51 Analgesic abuse nephropathy is primarily a tubulointerstitial disease characterized by focal glomerulosclerosis. however. First five years of diabetes mellitus . Oral trimethoprim-sulfamethoxazole is used to treat chronic bacterial prostatitis 49 Hypertensive nephrosclerosis-. Physical examination is unremarkable and urinalysis is normal 37 chronic diarrhea may develop renal stones composed of calcium oxalate. suprapubic pain should alarm the physician for the possibility of bladder cancer 53 a patient with acute pyelonephritis does not respond to 72 hr treatment with appropriate antibiotics. nonbacterial prostatitis ->bladder cancer must be ruled out by urinary cytology and cystoscopy.5 with oral sodium bicarbonate or sodium citrate is indicated.Arteriosclerotic lesions of afferent and efferent renal arterioles and glomerular capillary tufts -> Nephrosclerosis is characterized by hypertrophy and intimal medial fibrosis of renal arterioles.36 prostatodynia are afebrile and have irritative voiding symptoms urinary hesitancy and interruption of flow. 47 The two initial tests. they are seen on USG and CT scan. most common with membranous glomerulonephritis 44 amyloidosis are renal amyloid deposits that show apple-green birefringence under polarized light after staining with Congo red.usually present during immune complex glomerulonephritis (e. enlarged kidneys w proteinuria. 50 diabetes mellitus 1.g.. perirenal abscess. 3. which later progresses to overt nephropathy. are serum creatinine and urinalysis. Fat malabsorption result in increased absorption of oxalic acid. 48 Transient proteinuria is a common cause of isolated proteinuria and can occur during stress or any febrile illness 49 When an old patient comes with irritative voiding symptoms and cultures are negative.Glomerular basement membrane thickening. alkalinization of urine. Hypercalcemia is usually not caused by HTN related renal failure . The kidneys are generally small and microscopic hematuria and proteinuria occurs due to glomerular lesions. Within first year of diabetes mellitus . as it may be caused by Mycoplasma or Ureaplasma. 42 Hydrochlorothiazide decreases urinary calcium excretion and is used in management of recurrent hypercalciuric renal stones 43 Renal vein thrombosis is an important complication of nephrotic syndrome. history of rheumatoid arthritis (that predisposes to amyloidosis). which are recommended in all the patients with possible benign prostatic hyperplasia.

Instead. and in all prepubertal non-sexually active females with UTI. 72 Dietary calcium restriction is no longer recommended in patients with renal calculi. Hence. usually follows surgical or interventional manipulation of the arterial tree. especially in patients with renal failure. it starts in the center of prostrate.platelet dysfunction. in all male children with UTI. Other complications of nephrotic syndrome include: protein malnutrition. Renal failure. which manifests as venous or arterial thrombosis and even pulmonary embolism. Decreased dietary protein and oxalate 2. and sensation of incomplete voiding. 68resence of urinary eosinophils (remember the positive Hansel stain) often indicates either allergic interstitial nephritis or cholesterol embolization **69 Muddy brown granular cast.Acute tubular necrosis RBC casts . 62 Acute tubular necrosis-. 4) Fatty casts are seen in conditions causing nephrotic syndrome. systemic eosinophilia. increased susceptibility to infection. waxy cast. livedo reticularis. Imaging studies are performed to find any underlying structural abnormality predisposing to UTI. 64 Imaging studies should be performed in all children under the age of 10 years with UTI. etc. pyelonephritis. and vitamin D deficiency. Renal vein thrombosis is the most frequent manifestation. ***Dietary recommendations for patients with renal calculi are: 1. is generally seen in chronic renal disease. Decreased sodium intake 3. urgency. they are seen in chronic renal failure (CRF). and urinary tract cancer 59 BPH -weak urinary stream.Interstitial nephritis and pyelonephritis Fatty casts . mainly calcium stones. 61 nafcillin cause acute allergic interstitial nephritis -> a Type 4 hypersensitivity reaction. which is shiny and translucent.Muddy brown granular casts are characteristic 63 The nephrotic syndrome is a hypercoagulable condition. . ironresistant microcytic hypochromic anemia. They may be seen in asymptomatic individuals and in patients with pre-renal azotemia. renal failure. frequency. eosinophiluria (positive Hansel stain). Also. and hypercalcemia has multiple myeloma until proven otherwise 58 Papillary necrosis and chronic tubulointerstitial nephritis is the most common pathology seen in analgesic nephropathy.Chronic renal failure 70 WegenerDs granulomatosis is treated with a combination of cyclophosphamide and steroids 71 A high protein diet is associated with increased predisposition for stone formation. treatment with alpha-blockers is usually the first choice 60 uremic coagulopathy -. 3) Hyaline casts are composed almost entirely of protein and they pass unchanged along the urinary tract. and low complement level should make you think of cholesterol embolism 67 1)WBC casts are definite evidence that urinary WBCs originate in the kidney and are seen in cases of interstitial nephritis. atherosclerotic vascular disease. and peripheral eosinophilia in an azotemic patient is highly suggestive of allergic interstitial nephritis. 5) Broad casts arise in the dilated tubules of enlarged nephrons that have undergone compensatory hypertrophy in response to reduced renal mass. patients with an established diagnosis of nephrolithiasis should restrict protein in their diet. Patients with chronic analgesic abuse are more likely to develop premature aging. 2)RBC casts are indicative of glomerular disease or vasculitis. thus. Increased fluid intake 4 Increased dietary calcium 73 Mega doses of Vitamin C lead to increased formation of oxalate stones. as it is associated with an enhanced tendency to stone formation. petechial rash.Glomerulonephritis WBC casts . cryoprecipitate. and conjugated estrogens has been used to correct the coagulopathy in uremic patients. Voiding cystoureterogram is usually done for this purpose but it is performed only after the acute illness is over 65 Struvite stones almost always occur in the presence of alkaline urine that is persistently infected with urease producing bacteria **66 Cholesterol embolization. The most common one in this age group is vesico-ureteral reflux.Nephrotic syndrome Broad and waxy casts . desmopressin (DDAVP). these patients should be encouraged to include calcium in their diet.57 Any elderly patient with bone pain. The triad of fever.

…) 4 increase in serum levels of both insulin and C-peptide is diagnostic of insulinoma. BUN/creatinine ratio > 20 Hemto & onco =========== **1 Surgical resection is the preferred management of solitary brain metastasis. HIT II usually occurs within 4 to 10 days after . ïƒ an occult tumor (pancreatic carcinoma.5 mg/dl In general. Multiple brain metastases are best treated with palliative whole brain radiation. gum hypertrophy.reatment of choice for fibromuscular dysplasia is percutaneous angioplasty with stent placement. Esophageal carcinoma 4. and often has poorly defined borders. In older patients. Oropharyngeal cancer 3. the reasons for which are still not known 7 solitary pulmonary nodule" defined as a 2cm or less coin-shaped lesion.**74 In young patients. the cause is usually an atheromatous plaque. Major toxicity of mycophenolate is bone marrow suppression. CT scan of the abdomen is most sensitive and specific for diagnosing the renal cell carcinoma ** 80 Cyclosporine and tacrolimus have the same mechanism of action. leukopenia. Prostate cancer 2 Thymoma is associated with pure red cell aplasia 3 Migratory thrombophlebitis. Open Sore that bleeds. 5. prostate cancer. Idiopathic hypercalciuria (hypercalciuria with normal serum calcium and in absence of metabolic disease . 79 Varicoceles typically fail to empty when the patient is recumbent. or crusts and remains open for three or more weeks. which is white.surgical removal. oozes. that is pearly or translucent and is often pink. hypertension. cancer usually remains local and almost never spreads. There are two types of heparin-induced thrombocytopenia (HIT). A Scar-like Area. 2. A Pink Growth with a slightly elevated rolled border and a crusted indentation in the center. Major toxicity of azathioprine is dose related diarrhea. excision with 1-2 mm of clear margins 1. red. and hepatotoxicity. Tx . yellow or waxy. hypophosphatemia. hypomagnesemia. renal artery stenosis is caused by fibromuscular dysplasia. However. 5 basal cell carcinoma: Basal cell carcinoma is the most common form of skin cancer in the US. known as Trousseau's syndrome. ACE inhibitors are likely to worsen renal failure when serum creatinine levels are greater than 3-3. hirsutism. A Shiny Bump or nodule.always raise suspicion for a renal cell carcinoma w Increased erythropoietin by kidney mass can produce polycythemia and thrombocytosis. hyperkalemia. 81 DM--Autonomic neuropathy may lead to a denervated bladder. marginally high values for hematocrit and serum electrolytes. A Reddish Patch or irritated area 3. Major side effects of cyclosporine include nephrotoxicity. It also occurs in patients with HIV and IV drug abuse 84 Rifampin causes red to orange discoloration of body fluids 85 classic signs of dehydration (dry mucosa. Popcorn" calcification is a hamartoma while "bulls eye" is a granuloma 8 warfarin therapy alone may increase the risk of venous limb gangrene in patients with deep vein thrombosis 9 Thrombocytopenia is a well-recognized serious complication of heparin therapy. > 4 mg/kg in both males and females. Tacrolimus has similar toxicity except for hirsutism and gum hypertrophy. lung carcinoma. 4. 2 not reported (almost never metastasize) to have metastasized to brain 1. 75 Factors that improve the prognosis in a patient with chronic renal failure are protein restriction and use of ACE inhibitors.e. including microscopic shaving (Mohs1 surgery) i. or white. and tremor.most common form of hypercalciuria Treatment for a first uncomplicated calcium stone is hydration and observation. . membranous nephropathy is the most common nephropathy associated with carcinoma **76 The most common cause of nephrotic syndrome in patients with HodgkinDs lymphoma is minimal change disease 77 Leucocyte esterase in urine is indicative of significant pyuria whereas nitrites signify the presence of Enterobacteriaceae 78 hypercalciuria (24 hour urinary calcium excretion > 300 mg in males and >250 mg in females. Non-melanomatous skin cancer 2. resulting in overflow incontinence due to detrusor weakness 82 Alcoholism is the most frequent cause of rhabdomyolysis 83 Focal segmental glomerulosclerosis (FSGS) is the most common cause of nephrotic syndrome in African American adults. 6 The incidence of stomach cancer has dramatically declined universally.

If the patient does not show improvement -> hemodialysis against a calcium-free dialysate 11 Leukocyte depletion techniques. and juvenile nasopharyngeal angiofibromas. 17 Tumor burden. These include desmoid tumors. HIT II is an autoimmune disorder characterized by the formation of antibodies against the heparin-platelet factor 4 complex. we should biopsy it to confirm diagnosis. The first manifestation of such a tumor may be a palpable cervical lymph node. Once the diagnosis of metastatic cord compression is confirmed => radiotherapy 22 Helicobacter pylori infection => gastric mucosa-associated lymphoid tissue (MALT) lymphoma. clarithromycin. 21 acute cord compression with cauda equina. 24. Then do MRI.B Lymphocyte..vomiting. occurs within the first two days after heparin therapy. sebaceous or epidermoid cysts. lipomas. Patients with positive FOBT test should be followed up with colonoscopy 19 hairy cell leukemia. thyroid Ca. 20 Presence of partial ptosis. Over expression of Her-2/new oncogene is related to worse prognosis 18 Fecal occult blood testing (FOBT) is the most commonly used screening test for colon cancer.heparin treatment has started. The first step in a patient with HIT should be immediate cessation of all exposure to heparin including LMW heparin since it may cross react with the heparin-induced antibodies and may induce heparin-dependent IgG antibody formation. and prednisone) or CHOP-Bleomycin 23 Folate deficiency is the most common cause of megaloblastic anemia in chronic alcoholics. limping 13 Ewings sarcoma --onion skinning 14 Giant cell tumor has characteristic "soap bubble appearance" on the radiograph 15 Acute vasoocclusive crisis is an important complication of sickle cell anemia and may cause stroke. 10 hypercalcemic crisis -. vincristine. since these patients remain at risk for thrombosis. cessation of heparin alone is often not sufficient.Any patient who has long history of scar. decrease the probability of febrile. is considered the single most important prognostic consideration in treating patient with breast cancer ER + and PR + are good prognostic features.Codman’s triangle and sunburst appearance are the two classic radiologic features.pain. The other type.autosomal recessive 26 Gardner's syndrome is autosomal dominant where colonic polyps are seen with prominent extraintestinal lesions. Adriamycin. Pylori. and nodular gingival hyperplasia. Tx: eradication of H. The mechanism is non-immune and is possibly due to a direct affect of heparin on platelet activation. Symptom. 30 The patient has squamous cell carcinoma of mucosa of head and neck.g mechanical heart valve): danaparoid and a direct thrombin inhibitor such as lepirudin orargatroban. and amoxicillin if fail to respond to eradication of H. and nail loss (onycholysis). Tx normal saline followed by furosemide to maintain urine output at 200cc/hr. TX – Cladribine. Therapeutic regimens usually include CHOP (cyclophosphamide. ->swelling and limitation of motion. or in most case. However. painless. 27 Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by intestinal hamartomatous polyps in association with mucocutaneous melanocytic macules 28 Multiple hamartoma syndrome (Cowden syndrome) is association of Gl-tract hamartomas with breast Ca. and anuria as well as somnolence and coma. There are two recommended alternatives to heparin in patients who developed HIT and requires ongoing anticoagulation (e.Turcot's syndrome =brain tumors (primarily medulloblastomas and gliomas) and FAP (Familial Adenomatous polyposis) or HNPCC (Hereditary nonpolyposis colorectal cancer). supernumerary teeth. and miosis (HornerDs syndrome) in a known smoker should alert you to think of lung cancer until proven otherwise. nonhemolytic transfusion reaction 12 osteosarcoma -. osteomas (especially of the mandible). After the primary tumor/s is detected. pylori w omeprazole. based on TNM staging. gastric polyps. SR: neurological and kidney damage. bone marrow may become fibrotic. These are very common in people who smoke and drink a lot of alcohol. most likely secondary to metastasis of prostrate cancer. bleeding ulcer should be considered for carcinoma most likely squamous cell. hyperpigmentation. and laryngoscopy) to detect primary tumor. Management : Intravenous dexamethasone. 29 Cronkhite-Canada syndrome is association of juvenile-type polyps and ectodermal abnormalities like alopecia. The best test for such patients is panendoscopy (triple endoscopy= esophagoscopy. priapism or intractable pain -> Tx: Exchange transfusion 16 Hydroxyurea is a cytotoxic agent and is used in a patient of sickle cell anemia when his life is disrupted by frequent painful episodes. tumors. and develops a non-healing. tartrate resistant acid phosphatase (TRAP) stain. oliguria. CT scan may be . HIT I. bronchoscopy. Diag: Punch biopsy 25 . Simple chest x-ray should be the first test in patients with suspected lung cancer. like cell washing.

35 hereditary spherocytosis --autosomal dominant. most common in the armpits and other body folds associated with being overweight. sebaceous or epidermoid cysts. Open dissection of the lymph node at this stage is always discouraged because it makes the task of surgeon difficult later as it obscures the surgical approach to the cancer 31 Acanthosis nigricans -. And various tumors like gastric carcinoma ** Acanthosis nigricans might be a manifestation of occult gastrointestinal malignancy 32 patients with ulcerative colitis who have pancolitis should begin colonoscopy after eight years of disease Four biopsies should be obtained every 10cm from the cecum to the rectum. dizziness. splenomegaly. and low erythropoetin level. supernumerary teeth. Polycythemia Vera . 37 Hypercalcemia results in increased gastrin release 38 Glucagonoma is characterized by hyperglycemia. thick areas on the skin. normal oxygen saturation.intra-vascular Hemolysis w low serum haptoglobin and elevated serum LDH. as isolated thrombocytopenia may be a presenting feature of SLE especially if the patient is a young female. the bone marrow examination must be performed to rule out primary hematological disorder. LAP score is decreased. Patient must also be screened for SLE by antinuclear antibody testing. ESR will be very low 41 intra vascular hemolytic anemia -. defect spectrin. Increases the risk endometrial cancer and uterine sarcoma. spherocytosis and polychromatophilia. The sudden elevation in the total leukocyte count and marked increase (to the left) of granulocyte precursors suggests a serious infection with or without an underlying leukemic state. However. There is an elevated leukocyte alkaline phosphatase. all patients should be prescribed folic acid supplementation Usually splenectomy should be delayed four to five years to prevent post splenectomy sepsis.remarkable increase in RBC mass and total blood volume Symptoms such as headache.-> may develop cholelithiasis and present with cholecystitis & Chronic leg ulcers. lymphadenopathy or atypical lymphocytosis. All patients prior to splenectomy should receive vaccinations against encapsulated organisms such as Haemophilus. an increased LAP score may be encountered in CML because of subsequent secondary infections. 34 Whenever a person is having chronic ITP. Colonoscopy should be repeated every one to three years 33 Paroxysmal nocturnal hemoglobinuria (PNH ) -. causes the anemia of chronic disease. and splenomegaly. and juvenile nasopharyngeal angiofibromas 44 low leukocyte alkaline phosphatase with leukocytosis is classic for chronic myelogenous leukemia. osteomas (especially of the mandible). 45 Elevated Leukocyte Alkaline Phosphatase -. Usually the MCV is normal but the mean corpuscular hemoglobin concentration is elevated. and decreased haptoglobin **42 Iron deficiency is the most common cause of anemia in elderly patients.repeated later to have a close look at its extent. it reduces the risk of recurrence of the original cancer and also reduces the risk of developing new cancer in the other breast. In CML. If a patient. increased LDH levels. The Leukocyte Alkaline Phosphatase (LAP) test is of diagnostic importance in distinguishing between CML and a leukemoid reaction. hepatitis viruses and toxoplasma should be considered. shows abnormal findings like hepatosplenomegaly. Both thrombosis and bleeding can occur due to elevated platelet count and impaired platelet function Reversible moderate hypertension frequently occurs as a result of expanded blood volume. she does not need to be screened for HIV by ELISA or EBV by Monospot test. Inflammatory joint disease. gastric polyps. Pneumococci. They also have granulocytosis and thrombocytosis on peripheral blood smear. The patient presented in this vignette does not have any such abnormality. and anemia. Chronic myeloid leukemia (CML) and a leukemoid reaction are indistinguishable on a peripheral blood film. with diagnosis of chronic ITP. These include desmoid tumors. 40 Polycythemia Vera (PCV)-. and not degenerative joint disease. A urinary erythropoetin assay reveals the absence of measurable erythropoetin in the urine. the presence of Philadelphia chromosome is more diagnostic for CML and should be obtained in suspected cases. So. 43 Gardner syndrome refers to an association between colonic polyps and the presence of prominent extra-intestinal lesions. therefore. lipomas. and meningococci 36 Tamoxifen is an anti-estrogen drug used to treat breast cancer. HIV. episodes of aplastic crisis caused by parvovirus infection. Bone marrow is virtually always hypercellular. and paresthesias are frequently related to hyperviscosity.Leukemoid Reaction.dark.elevated reticulocyte count. weight loss. Flow cytometry confirms the diagnosis of PNH by showing absence of CD59. secondary causes of autoimmune thrombocytopenia like infection with CMV. 39 leukocyte alkaline phosphatase score is high in leukemoid reactions and usually low in chronic myeloid leukemia A leukemoid reaction is a marked increase in leucocytes by a severe infection or inflammation. pancytopenia. dermatitis.

fracture risk) and perhaps improve survival in patients with multiple myeloma or breast cancer. 63 IV fluids and furosemide are the treatment of hypercalcemic crisis. necrolytic migratory erythema and diarrhea. On the other hand if the patient has significant renal failure and less neurologic symptoms it is considered HUS. both conditions are very serious and require emergent plasmapheresis. lymphocytosis. in all women with metastatic breast cancer and radiographic lytic bone disease who are receiving either hormone therapy or chemotherapy. microangiopathic hemolytic anemia.Fluctuating neurological signs 4. it is considered TTP. elevated serum iron level and increased TIBS caused by vitamin B6 deficiency (alcoholism. do yearly rectal exam PSA-> n = 1-4pg/dl Men age > 50. renal failure. Glucagonoma is usually malignant and metastasis to the liver may occur 61 After the diagnosis of a solid testicular mass has been made. 66 hereditary Nonpolyposis Colorectal Cancer HNPCC ïƒ Lynch syndrome (known as the Amsterdam Criteria I): . they are relatively nontoxic and are more potent than intravenous saline. is contraindicated because of the risk of spillage of cancer cells.often asymptomatic. FNAC. particularly P. presence of thrombocytopenia is a poor prognostic factor 55 Elderly patient with anemia.Severe thrombocytopenia 2. Gram negatives. There is increasing evidence that bisphosphonates may prevent skeletal complications (reduce bone pain. Empiric treatment with ceftazidime/cefepime is the first step 51 Bite cells on peripheral smear is also characteristic of G-6-P-D deficiency. and hypercalcemic should make you think of multiple myeloma 56 Radiation therapy would be most appropriate for management of progressive pain in a patient with prostate cancer metastatic to bone after androgen ablation (orchiectomy).Microangiopathic hemolytic anemia (RBC fragments) 3. However. which can potentially spread through lymphatics and blood vessels 62 The bisphosphonates are the drugs of choice for mild to moderate hypercalcemia. For staging of prostate cancer do the bone scan to see the bone metastasis. a transrectal ultrasonogram is usually the next best step. and some lymph nodes.Renal failure 5. Smudge cells are highly characteristic.Increased size of the spleen. Lymph node biopsy not bone marrow biopsy confirms the diagnosis. 54 chronic lymhpocytic leukemia (CLL) -. Various visual problems 49 Aminoglycosides are contraindicated in patients receiving cisplatin chemotherapy because of the potential for significant nephrotoxicity 50 Febrile neutropenia is a medical emergency.-> X-linked 52 Sickle cells -.46 Supplementation with folic acid is recommended in all cases of sickle cell anemia to prevent the occurrence of aplastic crisis. followed by needle biopsy and then staging. may develop hypogammaglobulinemia.. weight loss should make you think about glucagonoma. 65 Screening Prostate cancer Men age 40-50.sickle cells or Howell Jolly bodies 53 Thrombotic thrombocytopenic purpura (TTP) is a serious disorder. drugs). aeruginosa infection. Hydroxyurea is used in sickle cell anemia when painful episodes occur very frequently 47 Acute lymphoblastic leukemia-.periodic acid schiff positive staining in diagnosis 48 Waldenstrom macroglobulinemia – Excess IgM in the blood causes hyperviscosity-. which presents with the following classical pentad: 1 .Fever Hemolytic uremic syndrome (HUS) and TTP come under a spectrum of diseases. If the patient has more neurologic symptoms and less of renal failure. fever. **57 Recognize HUS in a child who has recently recovered from a diarrheal illness and presents with acute renal failure.soap-bubble appearance in the epiphysis 60 Hyperglycemia. (a painless hard mass in testicle + suggestive ultrasound). intravenous pamidronate is recommended. thrombocytopenia and characteristic peripheral smear finding of schistocytes **58 Sideroblastic anemia usually manifests as microcytic/hypochromic anemia. liver. the initial management is removal of the testis and its associated cord. do yearly digital rectal plus PSA (Prostate Specific Antigen) If either the rectal examination is suggestive or PSA is greater than 4 ng/dl (n= 0-4) or the age specific normal values. or transscrotal biopsy. Tx : pyridoxine 59 giant cell tumor of bone -. The bisphosphonates are the drugs of choice for mild to moderate hypercalcemia ïƒ pamidronate 64 bone marrow iron stain is the most definite way to diagnose an iron deficiency.

g. hyperpigmentation. trimethoprim) 72 Antiphospholipid antibody syndrome is characterized by recurrent arterial or venous thrombosis or recurrent fetal losses in the presence of antiphospholipid antibodies. Increased serum iron. Acute promyelocytic leukemia (M3) has a lot of promyelocytes. which may be hyergranular. 69 polycythemia vera ïƒ increased RBC mass. 79 cystic fibrosis. VII. Biopsy shows malignant cells that invade the epidermis and have abundant pale staining cytoplasm surrounding a hyperchromatic nucleus. which falsely elevates APTT. ïƒ large cells. Subsequently such patient is anticoagulated with warfarin Women with fetal losses due to Antiphospholipid antibody syndrome are managed during pregnancy with heparin and aspirin. Can ïƒ myelofibrosis (teardrop shaped RBCs) Tx: phlebotomy to keep HCT < 45%. Liver biopsy confirms the diagnosis. microgranular or hypogranular. it may also elevate in cancers of GIT and lungs Seminoma: PLAP . enlarged spleen. as APTT is not reliable in such cases. surrounded by halo-like area. AFP is not specific.decreased MCV and MCH. autosomal recessive disorder.M5ïƒ gingival hyperplasia. There is a red. one of whom must be a first degree relative of the other two 2. arthropathy. 70 cancer-associated anorexia: Tx :Megestrol acetate **71 The most common cause of folic acid deficiency is nutritional due to poor diet and/or alcoholism. and hypogonadism. mild granulocytosis.hyperphosphatemia. The first is responsible for false-positive syphilis serology.g. CD11c marker is relatively specific for hairy cell leukemia. oozing. intestinal iron absorption is abnormally increased leading to iron deposition in the tissue. diabetes (bronze diabetes). 75 Familial Colonic Polyposis is autosomal dominant disease caused by mutations in the adenomatous polyposis coli (APC) gene. crusted lesion..Clinically it presents with hepatomegaly. phenytoin) or antagonize its physiologic effects (e.. hypocalcemia. Usually the total body vitamin B12 stores are available for three to four years 83 PagetDs disease presents as a persistent dermatitis of the nipple. before the age of 20 76 AFP is never produced in seminoma. The third is anticardiolipin antibody. and low erythropoetin level. bone marrow ïƒ fibrotic. require a proctocolectomy. and arthropathy. heart. restrictive heart failure. pancreas. and pituitary. damages the organs especially liver. tartrate resistant acid phosphatase (TRAP) stain. The second is lupus anticoagulant.1. Hypertension. Alpha-naphthyl esterase positive 81 acute myeloblasts leukemia with maturation (M2) myeloblast predominate on the peripheral blood film. with prominent nucleoli.3s. The first logical step in the diagnosis of this disease is serum iron studies. ferritin. Involvement of two or more generations 3. At least one case diagnosed before age 50 4. IX. aPTT n= 21-32s 73 microcytic hypochromic anemia.Placental Alkaline phosphate Embryonal Carcinoma: AFP + beta-hCG (50%) Choriocarcinoma: beta-HCG 77 tumor lysis syndrome -. arterial or venous thrombosis or fetal losses due to Antiphospholipid antibody syndrome. Antiphospholipid antibody syndrome is either primary or may be associated with other autoimmune disorders like SLE. Normal MCHC MCV n=80-100 MCH n= MCHC n= 74 Hairy cell leukemia is a type of B-Lymphocytic derived chronic leukemia. invading the epidermis . which is often unresponsive to topical steroid and antibiotics. hepatomegaly. methotrexate. these drugs can impair the absorption of folic acid (e.ïƒ exocrine deficiency of the pancreatic ïƒ Fat malabsorptionïƒ vitK defici 80 acute monocytic. Acute thrombosis is treated with heparin and factor antiX-a activity is measured. and transferrin saturation correlates with hemochromatosis. It usually indicates embryonal cell carcinoma. hyperkalemia. Warfarin is not used due to its teratogenicity PT n= 8. At least three relatives with colorectal cancer. plethoric face and splenomegaly.. Antiphospholipid antibodies are of three types. he or she must be started on anticoagulant therapy.2-10. and hyperuricemia 78 Vitamin K is an important cofactor in post translational modification of several coagulation factors: factors II. Folic acid deficiency can be caused by some drugs. and X as well as proteins C and S. 100% risk of cancer. DIC is also some times seen with this type 82 Strict vegetarian diet can cause B12 deficiency. Familial adenomatous polyposis has been excluded 67 Lynch syndrome II – high risk endometrial carcinoma 68 hemochromatosis ïƒ diagnosed diabetes.

93 Tamoxifen reduces the risk of breast cancer in patients who are at an increased risk of developing breast cancer. present as a solitary nodule. Early menarche. along with anti-androgen therapy. The best approach wait for 4-6wk mass goes away and does not come back.000 to 30. First line Tx CML. evidence of erythema nodosum. and alcohol ingestion are all associated with slight increased risk of breast cancer 91 When ITP fails to respond to high-dose prednisolone therapy (2 weeks after diagnosis). and loss of storage sites due to hepatocellular disease are the three major causes of vitamin-K deficiency. however. SR ïƒ mild nausea. M component (IgA.84 Palliative radiation. major defect is of membrane glycoprotein lb. or is resistant to treatment. there is no evidence that tamoxifen is beneficial for women who do not have an increased risk of developing breast cancer. an acutely sick person can become vitamin-K deficient in 710 days. The decision to take tamoxifen is an individual one since risks associated with tamoxifen ( endometric ca.Giant platelets. This defective platelet membrane lacks the receptor site for vWF so the platelets canDt adhere to vascular subendothelium. consists of columnar cells growing along the septa 98 fibrocystic disease. itchy rash. 97 Adenocarcinoma of lung has the least association with smoking. best treated with reassurance and regular followup 96 Cryptorchidism -.autosomal recessive. loop diuretics may be added as well. Platelets from these patients do not aggregate in the presence of normal vWF and ristocetin Mild thrombocytopenia. Chronic treatment may involve administration of lithium or demeclocycline.ïƒ a tyrosine kinase inhibitor. or IgG. If the mass recurs. 86 Myasthenia Gravis-. is the treatment of choice for metastatic prostate cancer. Platelet aggregation studies with ADP Abnormal 104 he bleeding time (BT) is a measure of the interaction of platelets with the blood vessel wall .diagnosis is confirmed by EMG and acetylcholine receptor antibody test. especially in patients younger than age 60 87 Bernard-Soulier syndrome-. Adenocarcinoma of lung is usually a peripheral lesion and usually not associated with hypercalcemia. ïƒ splenectomy.000/mm3 90 The most significant risk factor for breast carcinoma is increased age. or IgM) <3000mg/dl. leg aches/cramps. or it doesn’t go awayïƒ a biopsy is indicated 99 Ondansetron. deficient glycoproteins llb-llla complex so fibrinogen will not cross-connect. usually located peripherally. 102 Splenomegaly is associated with extra-vascular hemolysis while decreased levels of serum haptoglobin are caused by intra-vascular hemolysis 103 Glazmann’s Thrombasthenia-. Anti-androgen therapy consists of Leuprolide (LHRH analogue). diarrhea. a history of CHF. which inhibit ADH action 95 Monoclonal gammopathy of undetermined significance (MGUS)-. Recurrence of the tumor after surgical resection is common. Epinephrine. and temporary reduction in the production of blood cells by the bone marrow. collagen and thrombin fail to induce aggregation. if 3 month premature. localized mass with bony erosion on the back of the nose.Treatment is delayed until 12 month of age to give the testicle a chance to come down on its own. then treated with danazol or cytotoxic agents like cyclophosphamide 92 Hypercalcemia is usually associated with Squamous Cell Carcinoma of Lungs (Remember sCa++mous) not Oat Cell Carcinoma. When fails to respond to glucocorticoids and splenectomy. A 30-day store of vitamin K is stored in a normal liver. 88 GlazmannDs Thrombasthenia is a qualitative platelet defect with normal platelet count but prolonged bleeding time and abnormal aggregation test with ADP 89 Platelet transfusion is indicated only if the patient is actively bleeding and the platelet count is less than 20. Flutamide is considered inferior to LHRH analogues 85 Inadequate dietary intake. ) 94 Water restriction is the first step in managing hyponatremia in patients with syndrome of inappropriate antidiuretic hormone secretion If the serum sodium is below 120 or if the patient is seizing. emergency treatment is administration of 3% sodium chloride solution to raise the serum sodium to 125 If the patient has evidence of fluid overloading. intestinal malabsorption. Sarcoidosis does cause hypercalcemia but usually patients have bilateral hilar adenopathy.the absence of symptoms. it is important to look for evidence of thymoma. child has increased risk of testicular carcinoma even if it is fixed by surgery. Aspiration of the cyst got a clear fluid. wait until they are 15 month. nulliparity. In some cases. a 5-HT3 receptor antagonist is the drug of choice for chemotherapy-induced emesis 100 angiofibroma—epistaxis. After the diagnosis is confirmed. swelling of the face and around the eyes. conjugated estrogens. Cladribine is the drug of choice for hairy cell leukemia 101 CML—crisis phase: visual blurring and altered mental status. no treatment is necessary 101 imatinib (Gleevec).

hypokalemia resulting in leg cramps. Abdominal pain is the most common symptom. Treatment ïƒ supportive care with fluids and electrolyte replacement # Ultrasound can be used to assess gallstone pancreatitis and common bile duct obstruction. and persistent hyperglycemia # Esophagoscopy is indicated when GERD fails to respond to empiric treatment or when patient has features of complicated disease. anemia. distal lower esophageal sphincter is normal with failure to relax # Multiple myeloma ïƒ The combination of back pain. thiazides. VIPomas cause diarrhea. AIDS patientïƒ think about didanosine. 2. should have secretin stimulation test done -. edema. chronic cough. Patient with history of seizures or bipolar disorderïƒ valproic acid. Excretion of more than 7g of fat per day (normal is less than 6 g) is diagnostic of malabsorption. # Toxic megacolon from ulcerative colitisïƒ Tx: IV corticosteroids # Crohn’s diseaseïƒ skip lesions. followed by gallstones. Later stages characterized with dementia .supranuclear ophthalmoplegia and myoclonus. diuretics ïƒ furosemide. 1. and a decrease acid in the stomach. Barium swallow will reveal a large dilated esophagus with a bird’s beak tapering at the distal end. # The common drugs (important for USMLE) cause pancreatitis are: 1. Patient on antibioticsïƒ metronidazole. 4. necrosis or liquefaction. PAS-positive materials in lamina propria with villous atrophy # Clostridium difficle diarrheaïƒ Dx: Cytotoxin essay in the stool. So the hemolysis is more at night and hemosiderinuria is common in the first morning urine. Diagnosis made by manometry-> absence of peristaltic contractions in the upper esophagus. 5-ASA. # CTscan is the best test for the diagnosis of diverticulitis in acute setting. # Glucagonoma presents with narcotizing dermatitis. pentamidine. Patient with inflammatory bowel diseaseïƒ sulphasalazine. Thrombosis of major venous structures especially the hepatic vein is the common cause of death in these patients. Decay Activating Factor (DAF) is diminished in PNH. It is also performed when atypical symptoms are present # Achalasiaïƒ dysphagia to both solids and liquids. Test specific to PNH are sugar-water test and the acidified-hemolysis (Ham) test. # Esophageal pH monitoring is done when empirical therapy fails to control symptoms of GERD and endoscopy is negative. CT scan is diagnostic for pancreatitis--will show diffuse or focal parenchymal changes. A red cell membrane defect causes increased binding of complement to the red cell leading to increased intravascular hemolysis. These cells are more susceptible to lysis in an acidic environment. weight loss. tetracycline # The most common cause of pancreatitis is alcohol. Tx: oral/IV metronidazole # All patients suspected of having Zollinger-Ellison syndrome and having a nondiagnostic fasting serum gastrin levels. 5. # quantitative estimation of stool fat is the gold standard for diagnosis of steatorrhea. increase aPTT GIT ============================================================== = # Whipple’s disease ïƒ multi systemic illness. # D-xylose test is a test for carbohydrate malabsorption . 107 Heparin-lnduced Thrombocytopenia. and elevated ESR. there is mild acidosis.Serum gastrin concentrations do not rise in patients with other causes of hypergastrinemia as secretin stimulates the release of gastrin by gastrinoma cells whereas normal gastric G cells are inhibited by secretin. This is not diagnostic of achalasia because a tumor or stricture of the esophagus may also look very similar. Measurement of gastric pH on a single specimen is important to exclude secondary hypergastrinemia due to achlorhydria. the best procedure is to perform anastomosis between the jejunum and the pancreatic duct. # VIPomas are cancerous tumors that affect cells in the pancreas that produce vasoactive intestinal peptide (VIP). Diagnosis ïƒ serum amylase and lipase. Intermittent low-grade fever. 3. Patient on immunosuppressive agents ïƒ azathioprine. hypercalcemia # Giardia lamblia ïƒ trophozoites adhere to the mucosal surface by adhesive disks and produce a malabsorption.105 Spironolactone is the diuretic of choice for managements of ascites 106 Paroxysmal Nocturnal Hemoglobinuria (PNH). renal dysfunction. Due to relative hypoventilation at night. Linear ulcers with a cobblestone pattern # In chronic pancreatitis when the duct is dilated and the patient has pain. Extra intestinal manifestations include migratory polyarthropathy. and myocardial or valvular involvement leading to congestive failure or valvular regurgitation. anemia. x-ray shows a dilated esophagus with an air fluid level. pigmentation and lymphadenopathy. L-asparaginase.

and anorexia. # Celiac disease is a malabosorbtion syndrome associated with skin condition called dermatitis herpetiformisïƒ chronic. # Polyps can be classified as follows 1. Hepatic enzymes could be elevated in Crohn’ disease. and pruritic vesicular skin disease. These two watershed areas are most vulnerable to ischemia during systemic hypotension. Even though carcinoids are most commonly found on the appendix. vitamin Bl. Treatment includes antispasmodics. Hyperplastic polyps: These are the most common non-neoplastic polyps in the colon and arise from a hyperplastic mucosal proliferation.# Abdominal CTscan is the next diagnostic test when abdominal ultrasound does not explain cholestatic jaundice. or neurologic abnormalities (like confusion or lethargy). increased urination. Manometric studies demonstrate high amplitude peristaltic contractions. # Neuromas and marfanoid status are characteristic for MEN2B ** Treatment of both acute and chronic anal fissures starts with dietary modification (high-fiber diet and large amount of fluids) along with a stool softener and local anesthetics. # Hypotension. # Chronic pancreatitis alone does not cause elevation of alkaline phosphatase. pylori negative # The major risk factors of squamous cell cancer of esophagus are smoking. # An empiric trial of antisecretory therapy. it is associated with emotional factors and functional gastrointestinal disorders. ** Scleroderma is a collagen vascular disorderïƒ loss of distal peristalsis of the esophagus. # Painless obstructive jaundice is more likely to be due to malignancy. (1) The splenic flexure supplied by narrow terminal branches of the superior mesenteric artery. weakness. Adenocarcinoma of the head of pancreas causes obstruction of extra hepatic bile duct leading to elevation of direct bilirubin and marked icterus. Adenoma: This is the most common type of polyp found in colon. dull back pain. making the diagnosis difficult. like H2 blocker or proton pump inhibitor. # The first sign of colorectal cancer in individuals of less than 40 years of age is rectal bleeding. and (2) the recto-sigmoid junction supplied by narrow terminal branches of the inferior mesenteric artery. These polyps are potentially premalignant. azotemia. Hamartomatous polyp: This includes juvenile polyp (a non-malignant lesion. however <1% of such polyps become malignant. # Increased intragastric pressure during vomiting could cause tears in the mucosa of the cardia and sometimes of the distal esophagus. No further work¬up is needed. characterized by granular IgA deposits in the upper dermis. when they present with carcinoid syndrome. In contrast to achalasia. 3. hyponatremia. # Presence of 5-HIAA in the urine is indicative of a carcinoid tumor. Presence of pruritic papulovesicular rash in association with symptoms of malabosorbtion is highly suggestive of dermatitis herpetiformis # Diffuse esophageal spasmïƒ intermittent episodes of chest pain and dysphagia. # HIDA scan is used for the diagnosis of acute cholecystitis # Hypercalcemia may manifest as severe constipation. less than 5 % of patients have positive occult stool blood tests.called Mallory-Weiss tears. There is astronomical elevation of alkaline phosphatase. Most of the polyps are asymptomatic. the lower esophageal sphincter does not relax (high tone). Since the esophageal spasms occur in episodes. Self-limiting illness in HIV-infected patients with a more preserved CD4 count. The modified acid-fast stain showing oocysts. # Cryptosporidium parvum is a major cause of chronic diarrhea in HIV-infected patients with a CD4 count less than 180 cells/mm3. # There are two watershed zones in the colon. There is fibrosis and complete atrophy of the esophageal smooth muscle. and oliguria with normal urinalysis in a patient with severe liver disease are suggestive of hepato-renal syndrome. or a prokinetic agent for one month is recommended in young patients without alarm symptoms who are H. No treatment is available. 2. intensely burning. leading to reflux esophagitis and a stricture. they are usually located in the small bowel # Ulcerative colitis nearly always involves the rectal mucosa and it usually produces bloody diarrhea. Noninvasive tests for H. . generally removed due to the risk of bleeding) and Peutz Jeghers Polyp (generally non-malignant). Measures are taken to withhold all possible precipitating factors and initial management includes careful volume load. pylori should be the first step in the management of patients with dyspepsia under 45 years of age who do not have alarm symptoms. It may be associated with weight loss. dietary modulation and psychiatric counseling ** In achalasia. Barium swallow may reveal a Dcorkscrew’ esophagus. the lower esophageal sphincter usually has a normal relaxation response. manometric findings may be intermittent. anorexia. # Dyspepsia is defined as pain or discomfort centered in the upper abdomen. dietary deficiency of beta carotene. The lower esophageal sphincter becomes incompetent (low tone) with time. alcohol.

Blood intermixed with stool is not considered in this category. sepsis. # Zollinger-Ellison syndromeïƒ increased production of stomach acid inactivates pancreatic enzymes ïƒ impaired fat absorption # Fulminant colitis is a serious complication of ulcerative colitis and plain radiography shows distended colon. Crypt abscess following cryptitis may also be seen in UC. Crypt abscess are characteristic of CD. That’s the reason that these syndromes are common in the setting of hepatic metastasis.5 cm. and exerting gastric cytoprotective effects. most probably due to cancer. sessile adenoma. D-xylose absorption is abnormal both in bacterial overgrowth and WhippleDs disease. thus impairing D-xylose absorption. . # Esophageal cancer may mimic achalasia. and disseminated intravascular coagulation are its major drawbacks. Proctosigmoidoscopy with biopsy establishes the diagnosis of ulcerative colitis and it can be performed in acute settings. plus ribavirin. In bacterial overgrowth there will be both impaired fat absorption due to bacterial de-conjugation of bile salts as well as decreased excretion of xylose due to bacterial consumption of the simple sugar. Focal involvement of lower esophageal sphincter by malignancy is difficult to differentiate from achalasia on manometric and radiographic studies. # A CT scan is a standard diagnostic tool employed in patients with newly diagnosed gastric cancer to evaluate the extent of the disease. # Bacterial overgrowth is a malabsorption syndrome. which can be associated with a history of abdominal surgery. # Migratory thrombophlebitis and atypical venous thromboses are suggestive of chronic DIC. and diarrhea indicates that this patient has carcinoid syndrome. Physical examination may reveal abdominal distention with identifiable succussion spiash due to palpable soft. WhippleDs disease damages small intestinal mucosa. # Hepatitis B virus immune globulin plus lamivudine treatment is the most effective treatment to prevent recurrent HBV infection after liver transplantation. In most of the patients. fluid-filled loops of bowel. and upper esophageal webs associated with iron-deficiency anemia. # Plummer-Vinson syndrome is characterized by atrophic glossitis. they are not pathognomonic of CD. Isolated tumors without metastasis do not produce carcinoid syndrome. Peritoneo-jugular shunt is designed for treatment of ascites only. # The initial evaluation of the patient with upper Gl bleeding involves an assessment of hemodynamic stability and the necessity for fluid resuscitation. # Worsening postprandial pain that leads to avoidance of food is characteristic of chronic occlusion of visceral arteries (abdominal angina). Tryptophan is the precursor of serotonin and use for synthesis of niacin.Cancer is seen more commonly in sessile polyps. Rapid weight loss and inability of esophagoscope to pass through the lower esophageal sphincter point towards the diagnosis of esophageal cancer. Endoscopy is the procedure of choice for the diagnosis and treatment of active upper Gl bleeding and also for the prevention of re bleeding. Somatostatin or octreotide can thus be used when endoscopy is unsuccessful. stomatitis. 5hydroxy tryptophan is degraded in the liver to functionally inactive 5HIAA. Slow tapping of ascitic fluid balanced with infusion of albumin per liter tapped. or as an adjunctive before endoscopy. # Office-based anoscopy/proctoscopy is the first procedure to be done in patients less than 50 years old who present with minimal bright red blood per rectum and do not have any risk factors for colon cancer. surgery is the treatment of choice # Laxative abuse is characterized by high frequency watery and nocturnal diarrhea and characteristic dark brown discoloration of the colon with lymph follicles shining through as pale patches confirms the diagnosis. # Side-to-side porto-caval shunt will improve the ascites but may worsen the encephalopathy. # D-xyloseïƒ Its absorption requires an intact mucosa only. remember hyperplastic polyps do not require further work-up. is the final conservative measure for the treatment of acsites secondary to cirrhosis that has to be attempted before surgery. is used to treat chronic HCV infection and may be used to prevent recurrent HCV infection after liver transplantation. and size >2. Peritonitis. inhibiting gastric acid secretion. Somatostatin or its long-acting analogue octreotide acts by reducing splanchnic blood flow. # Interferon. Also. Elevated serotonin and its metabolites 5-hydroxy indole acetiic acid (5-HIAA) are present in the blood and urine of most patients with this syndrome. # The classic triad of flushing. So Carcinoid syndromeïƒ Niacin deficiency. contraindicated. # Non-caseating granulomas are pathognomonic of Crohn’s disease. Usually these webs don’t regress and require dilatation. Carcinoid syndrome is associated with carcinod tumors with hepatic metastasis. however. or unavailable. These tumors secrete serotonin and various other products. # Zenker’s diverticulumïƒ Barium esophagogram is for confirmation. valvular heart disease. The risk of malignancy: villous > tubulovillous > tubular *** The risk factors for a polyp progressing into malignancy are villous adenoma.

fasting. CT scan has higher sensitivity for suspected pancreatic cancer. most commonly seen in hospitalized in the following conditions and severely ill patients. accompanied by abdominal cramps. most often the bleeding originates from the cecum or ascending must rule out Ml before further Gl work-up. initial peri umbilical pain is a referred pain and visceral in nature. Pregnancy is a risk factor of gallstone disease due to gallbladder hypomotility and stasis thus leading to formation of sludge # Acute acalculous cholecystitis is an acute inflammation of the gallbladder in the absence of gallstones. Lactase is a brush border enzyme that hydrolyses lactose. ERCP is most useful for patients in whom chronic pancreatitis is a strong suspicion or in cases where CT or USG fails to reveal a mass lesion within the pancreas. The second is vascular ectasia or angiodysplasia. which shows blunting of villi with infiltration of chronic inflammatory cells including lymphocytes. PAS staining of small intestinal biopsiesïƒ PAS-positive material in the lamina propria and villous atrophy. # Pain that radiates to the arms is strongly suggestive of Ml. Lactose intolerance manifests as osmotic diarrhea after ingestion of dairy products. Chronic hemolysis 2. 3. plasma cells and eosinophils. you should obtain EKG/serum enzymes immediately. Increasing age. 80% of gallstones are radiolucent so an abdominal x-ray is not a sensitive tool for diagnosis of gall stone disease. octreotide or prolonged TPN. Even though these ectasias can present throughout the colon. Prolonged TPN. Angiodysplasia typically presents in an elderly patient with painless bleeding. If you have a high index of suspicion for Ml. # Hemorrhage is the most common complication of peptic ulcer disease. Clofibrate therapy. Obesity or rapid weight loss 3. Female sex hormones and oral contraceptive pills (OCP). # Asymptomatic diverticulosis needs only dietary modifications # Metronidazole is the drug of choice for pseudomembrane colitis. Prolonged fasting 4. Lactose intolerance is characterized by a positive hydrogen breath test. # Diagnosis of Tropical sprue is made by small intestinal mucosal biopsy. # In acute appendicitis. The other well recognized association is renal failure. Severe trauma 2. Mechanical ventilation. old age. However. MRI is the investigation of choice in patients in whom ERCP is not possible due to pancreatic duct obstruction. Lactase deficiency is characterized by a positive Clinitest of stool for reducing substances. 6. Hypomotility of gall bladder as in pregnancy. positive Clinitest of stool for reducing substances and increased stool osmotic gap. # The most common cause of lower Gl bleed in elderly is diverticulosis. 1 Extensive burns 1. bloating and flatulence. Chronic biliary tract infection or parasites 3. Oral vancomycin is effective for the treatment of pseudomembrane colitis but it is used as an alternative to metronidazole when there is intolerance to the latter # Diagnosis of Whipple’s disease can be confirmed with upper gastrointestinal endoscopy with biopsy of the small intestine. # Angiodysplasia is seen as a cherry red fern-like pattern of blood vessels that appear to radiate from a central feeding vessel # . #Risk factors for pigment gallstone are: 1. Cholesterol and mixed stones together comprise 80% of all gallstones Gallstones are common in Fat Fertile Female of Forty. 4. Malabsorption of bile acids as in ileal disease or resection. There has been a well-defined association of aortic stenosis and angiodysplasia. 5. # Abdominal ultra sonogram is the initial investigation of choice in patients with jaundice. or pancreatic cancer. Hepto # Various predisposing factors for cholesterol gallstones are: 1. fibrosis.# An elevated level of serum bilirubin and alkaline phosphatase is suggestive of compression of the intrapancreatic portion of the bile duct by edema. More common in western population than the Asian population 2. however pain shifts to right lower quadrant with involvement of parietal peritoneum and become somatic in nature. .

#Gallstone disease is common in Fat. # Acute fatty liver of pregnancy is a complication of the third trimester of pregnancy. GGT. It generally presents with right upper quadrant abdominal pain with fever. Cholangitis leading to fever and right upper quadrant abdominal pain. have been used in cases of severe primary biliary cirrhosis with very severe symptoms not controlled by other drugs and when liver transplantation is not an option. but it does not improve the survival rates. The medical control of bleeding >vasoconstrictors like octreotide and somatostatin. The initial investigation of choice is an ultrasonogram. and abnormal liver function tests. C. which shows signs of acute cholecystitis and no gallstones. and attacks of recurrent pancreatitis.. initial investigation of choice is an ultrasonogram followed by CT scan or magnetic resonance imaging (MRI) as needed. characterized by tender congestive hepatomegaly . which is a chronic progressive cholestatic liver disease commonly presenting with fatigue. It is important to have a high degree of suspicion in high-risk patients in order to correctly identify this problem. positive anti mitochondrial antibodies. Treatment options include cholestyramine with or without phenobarbital or ursodeoxycholate. OCP also predisposes to gall stones. characterized by intense pruritus & markedly elevated serum bile acid levels. 2.Involved pathophysiology is localized or generalized ischemia. associated with gall bladder carcinom # Choledochal cysts are congenital abnormalities of the biliary tree characterized by dilatation of the intra and/or extra hepatic biliary ducts. Portal hypertension leading to hematemesis and melena. # Intrahepatic cholestasis of pregnancy is a functional disorder of bile formation. The second step control the bleeding itself. and other immunosuppressant drugs. association of pre-eclampsia. IgM anti HBcAg is present in the window period (when both HBsAg and Anti HBsAg are undetectable) HbeAgïƒ active viral replication. major types of gallstones: Cholesterol stones. # Primary sclerosing cholangitis associated w ulcerative colitis # Abdominal ultrasound is the best initial investigation for gallbladder pathology. and Female of Forty. but re bleeding is very common # Acute onset of severe epigastric pain radiating to the back associated with leucocytosis in an alcoholic is highly suggestive of acute pancreatitis # Anti HBcAg and HBsAg is the best screening of the acute hepatitis. can degenerate into cholangiocarcinoma. CT scan and HIDA scans are more sensitive and specific for the diagnosis. # Caroli’s syndrome is a rare congenital disorder characterized by intrahepatic dilatation of biliary tree and is associated with adult polycystic kidney disease. mild elevation of amino transferase. leucocytosis. Ursodeoxycholic acid is the most commonly used drug for primary biliary cirrhosis (PBC )as it relieves symptoms and improves the transplant free survival time. Mixed stones. high degree of infectivity. Risk w Cholangiocarcinoma. Cholestyramine can be used to control the severe pruritus and hypercholesterolemia in patients with PBC. # The first step in the treatment of acute variceal bleeding is to get vascular access with two large bore intravenous needles followed by fluid resuscitation. Tx : ursodeoxycholic acid to decrease the complication from stone and surgical treatment in patients with recurrent or refractory cholangitis. It is a second choice. # chronic cholecystitis generally show a small fibrosed gall bladder on the ultrasonogram. intense pruritus. characterized by microvesicular fat deposition in the hepatocytes. aminotransferase. d. methotrexate. # Primary biliary cirrhosis. Pigment stones composed of chiefly calcium bilirubinate (20 %). # Normal physiological changes in liver enzymes in pregnancy include mild elevation of alkaline phosphatase due to placental secretion but normal bilirubin. Intermittent abdominal pain due to bile stasis or intermittent passage of stone. Steroids. Variable elevation in bilirubin. and jaundice. jaundice. # porcelain gall bladderïƒ X-ray: gall bladder appears large and dilated outlined by a line of calcium (calcium salt deposits into the wall of a chronically inflamed gall bladder). Symptom ïƒ a. 3. Renal complaints due to APKD. It can lead to complications like gangrene. perforation. and emphysematous cholecystitis. Patients generally complain of bloating and dyspepsia after eating fatty foods with occasional right upper abdominal pain. Anti HBeAg ïƒ cessation of active viral replication and low infectivity. but it is indicated in patients with progressive primary biliary cirrhosis with severe liver damage or cirrhosis. It resolves on its own and has no hepatic sequelae. HIDA scan is a very specific tool for confirmation of suspected acute cholecystitis. infection. however. Three 1. Fertile. In children it causes abdominal pain. b. # Persistently elevated hematocrit with organomegalyïƒ Polycythemia rubra Vera which is risk of hepatic vein occlusion (Budd Chiari syndrome). Liver transplantation is the only ultimate cure of progressive PBC. mainly used to control severe symptoms. biliary stasis. and GGT. alkaline phosphatase.ïƒ Perform an endoscopic band ligation of varices. or external compression of the cystic duct. characterized by markedly elevated alkaline phosphatase and cholesterol levels.

Therefore all the uncomplicated pseudopancreatic cysts smaller than 5cm should be observed for 6 weeks before any therapeutic intervention is done. # Panlobular emphysema and cirrhosis in non-alcoholic. necrosis. spider nevi and palmar erythema. Bilirubin Tests to assess the structural integrity and cellular damagïƒ Transaminases. Hepatic venogram or a liver biopsy is the diagnostic test Constrictive pericarditis could also cause tender congestive hepatomegaly and would be characterized by a pericardial knock and elevated jugular venous pressure. Gall stones. Liver transplantation is indicated in deteriorating PSC. # In the evaluation of tender congestive hepatomegaly. Many second line anti tubercular drugs can be used in patients who develop significant hepatotoxicity with the first line drugs. and cysts but is relatively insensitive for gallstones. It is often associated with ulcerative colitis w jaundice. #Hepatitis B and C can both be transmitted by blood transfusions Persons who received blood transfusions before 1992 should be screened for Hepatitis C and those with blood transfusions before 1986 should also be screened for hepatitis B. However. in this case antiviral treatment can lead to liver injury. A number of other autoantibodies (ANA. Tests to assess the functions of liverïƒ PT. Albumin.with ascites. detectable HCV RNA and histologic evidence of chronic hepatitis of at least moderate grade are candidates for antiviral therapy with interferon and ribavirin. it returns to normal despite continued use of isoniazid in most of the patients. then the next best step in the diagnosis would be to do a hepatic venogram or a liver biopsy. testicular atrophy. do not need to be treated. Atypical perinuclear antineutrophil cytoplasmic antibodies (P-ANCA). debris. and rheumatoid factor) may also be present. # Pseudopancreatic cysts are collections of amylase rich fluid. Alkaline phosphatase A marked increase in the transaminase is indicative of active ongoing tissue destruction. Gamma glutaryl transferase. # Endoscopic retrograde cholangiopancreatography is the investigation of choice for patients with recurrent pancreatitis with no obvious cause. non-smoker young adults are highly suggestive of alpha-1 antitrypsin deficiency. but they have uncertain clinical significance. # Gallstones and alcoholism are the two most common causes of acute pancreatitis. Octreotide is used medical management of acute variceal bleeding # Hyperestronism in cirrhosis leads to gynecomastia. Serious complications and should be treated with either percutaneous drainage or a gastrostomy # Chronic hepatitis C who show persistently normal liver enzymes on multiple occasions have minimal histological abnormalities. A progressive decrease in transaminase levels can represent either recovery from liver injury or that there is very little tissue left from destruction. Diag: ERCP Cholangiography shows characteristic beading due to strictures and dilation of intra and extra-hepatic ducts. # Cigarette smoking is the most consistent reversible risk factor for pancreatic cancer. May have Hypergammaglobulinemia. # PT is considered the single most important test to assess the function of liver as almost all of the clotting factors except factor VIII are synthesized in the liver. #Primary sclerosing cholangitis is caused by inflammatory destruction of both the intrahepatic and extrahepatic biliary channels. Acute pancreatitis is a clinical diagnosis (history and biochemical) and . Cholesterol. can resolve on their own over 6 weeks. Endoscopic interventions should be used as the first line to control the acute variceal bleed. Increased serum IgM. RUQ abdominal pain and very high alkaline phosphatase with mild elevation of transaminases. #Newborns of mothers with active hepatitis B should be passively immunized at birth with hepatitis B immunoglobulin followed by active immunization with recombinant HBV vaccine. pruritus. Not risk factorsïƒ Alcohol. and tissue in the lesser sac of peritoneum (or bursa omentalis minor). # Rotors syndrome causes predominantly conjugated hyperbilirubinemia # Non-selective B blockers are used in primary and secondary prevention (recurrent bleeds )of variceal bleeding in cirrhotic patients who have portal hypertension with varices. thyroperoxidase. # Most of the first line anti tubercular drugs are hepatotoxic except for streptomycin. Anti SMA. Glucocorticoids would have been indicated in the case of severe miliary tuberculosis # About 10% of patients on isoniazid develop a mild elevation of aminotransferases within first few weeks of the treatment. Ultrasonogram (USG) of the abdomen would provide the best information on the presence/ absence of gallstones. Risk hepatocellular carcinoma. Treatment is directed toward the relief of obstruction and treatment of the infectious complications. the first step is to rule out right-sided heart failure and constrictive pericarditis. decrease bodily hair. Coffee intake # interferon + lamivudine treat hepatitis B # All chronic hepatitis C patients with elevated ALT. anticardiolipin. CT scan is better than USG to identify pancreatic edema. The hepatocytes contain granules w PAS positive and diastase resistant.

# Indications for screening for HCV are: 1 IV drug users 2. 5. # OCP can cause an increase in liver enzyme but it does not cause the liver cell necrosis # Tuberculous hepatitisïƒ granulomas on biopsy # Cholestasis  CPZ. # Acute cholecystitis usually presents with acute onset of fever and right upper quadrant abdominal pain radiating to the right scapula. Acetaminophen GranulomatousAllopurinol. Autoimmune diseases like SjDDnDs syndrome and thyroiditis. Biopsy confirms the diagnosis by finding mildly atypical to normal hepatocytes with glycogen deposits. Idiopathic thrombocytopenic purpura. Lichen planus. however it is very costly and has high recurrence rates. Treatment with alpha interferon or lamivudine is unlikely to be effective in patients with normal serum ALT # Hepatitis E ïƒ no chronic carrier state. # HIDA scan is a very sensitive diagnosis of acute calculous or acalculous cholecystitis. diabetes mellitus. # chronic hepatitis Bïƒ persistence of HBsAg in the serum for more than six months # Liver biopsy is the most reliable way to distinguish chronic active from chronic persistent hepatitis. Persons with chronic elevation of ALT levels. complications of chronic hepatitis C. 7.usually does not require CT abdomen to diagnose. # Hepatic adenoma is a benign tumor seen in middle age females taking oral contraceptive pills. but not for acute pancreatitis. Nitrofurantoin.glomerulonephritis 2. Anabolic steroids Fatty liver Tetracycline. and necrosis. 6. Valproate. CT abdomen is indicated in patients with a white count of >20. Phenytoin. polymorphonuclear cellular infiltrates. 3. Hemodialysis patients 4. Isoniazid.-. Patients who received blood transfusions from a donor who later on became seropositive for HCV. # Orthotopic liver transplantation remains the only effective mode of treatment of fulminant hepatic failure. Health care workers after a needle stick injury or mucosal exposure to HCV positive blood. 4. ERCP is a very good diagnostic and therapeutic intervention for common bile duct (CBD) stones and chronic pancreatitis # Ursodeoxycholic acid (UDCA) is the medical treatment of small radiolucent gallstones in patients with normal functioning gall bladder who are poor surgical candidates. # Chronic hepatitis C is associated with number of extra hepatic complications like: 1. asymptomatic ones are managed by imaging surveillance.000 and when the suspicion for necrotizing pancreatitis/infection is very high. Intra-tumor hemorrhage is the major complication. hyperlipidemia. Anti-retrovirals Hepatitis. # Patients with cirrhosis should have an endoscopy to screen for varices # The degree of elevation of serum ALT is important in deciding the treatment since it is one of the most important predictors of response to both interferon and lamivudine. # Autoimmune hepatitis is characterized by presence of anti smooth muscle antibodies and hypergammaglobulinemia. whereas the smaller. has a very high rate of progression to fulminant hepatitis in pregnant women. 3. 5. # Non-alcoholic hepatic steatosisïƒ biopsy shows steatosis. Porphyria cutanea tarda. 7. # Endoscopic cholangiopancreatography can lead to iatrogenic biliary enteric fistula causing gas in the biliary tree. Erythromycin. B cell lymphomas. Alpha methyldopa Toxic or fulminant liver failureCarbon tetrachloride. # Celiac plexus nerve block can be used to relieve pain in chronic pancreatitis patients with non-dilated ducts. generally after a meal and associated with leukocytosis. Superficial and big adenomas can be resected. total parental nutrition and bypass surgery for obesity. # Risk factors for non alcoholic hepatic steatosis are obesity. Phenylbutazone # Isoniazid causes idiosyncratic liver injury with histology similar to viral hepatitis. # pain management with chronic pancreatitisïƒ endoscopic retrograde cholangiopancreatography with removal of the stone and stent insertion. Cryoglobulinemia. Persons who received blood transfusions or organ transplantation before July 1992. The triad . Liver transplantation is contraindicated if cerebral edema has already ensued. Children born to HCV positive mothers. Membranous glomerulonephritis is an important one. Plasmacytomas. 6. Halothane.

the AST and ALT levels are only mildly elevated # Transjugular intrahepatic portosystemic shunt (TIPS) 1. Pruritus is generally the first symptom and is very severe. 3. # Hepatocellular carcinoma is characterized by minimal elevations of alkaline phosphatase and marked elevation of AFP. decrease in serum albumin levels # Benign intrahepatic cholestasis can develop after a major surgery in which hypotension. having normal liver function tests and no dilatation of biliary tree. especially at night. and biliary drainage with an endoscopic retrograde cholangiopancreatography. which converts the absorbable ammonia into nonabsorbable ammonium ion (ammonia trap). alkaline phosphatase levels can be markedly elevated. Refractory cirrhotic hydrothorax. fever. 2. 4. # : Halothane hepatotoxicity can be of two types: Type 1 is mild elevation of liver enzymes without jaundice and Type 2 is characterized by acute liver failure. # Balloon degeneration with polymorphic cellular infiltratesïƒ acute alcoholic hepatitis # Panlobular mononuclear infiltration with hepatic cell necrosisïƒ acute viral hepatitis. most commonly due to acetaminophen toxicity. 2. liver synthesizes all the clotting factors except factor VIII. treated with empirical cefotaxime or an ampicillin with an aminoglycoside # Presence of bilirubin in urine is indicative of conjugated hyperbilirubinemia. # Acute bleeding in patients with liver failure is best treated with fresh frozen plasma. hypoglycemia and metabolic acidosis. Oral neomycin a nonabsorbable antibacterial agent kills the colonic bacteria producing ammonia. sphincter of Oddi dysfunction. Acute liver failure will have elevated prothrombin time. markedly elevated serum aminotransferases. and leukocytosis is highly suggestive of acute cholecystitis. USG is the investigation of choice. Syptem: jaundice by second or third postoperative day. Fulminant hepatic failure is defined as acute liver failure with hepatic encephalopathy. ammonia levels. PMN cellular infiltration. During acute attack all the dietary protein should be withheld. 3. # Acute liver failure is defined as development of liver failure within 8 weeks of onset of hepatocellular injury. 1.ïƒ Impaction of a gallstone in the cystic duct. # Emphysematous cholecystitis is a common acute complication in elderly diabetic males due to infection of the gallbladder with gas forming bacteria. PT prolongation. # Inflammatory destruction of small intrahepatic biliary ductsïƒ primary biliary cirrhosis # Reye’s syndrome or acute fatty liver with encephalopathy(hepatic mitochondrial injury) can lead to fulminant hepatic failure in children. # Alcoholism is the most common cause of cirrhosis in United States # Post cholecystectomy pain occurs most commonly because of a common bile duct stone. broad-spectrum antibiotics. X-ray showing air fluid levels in the gallbladder and the ultrasonogram showing the curvilinear gas shadows in the gallbladder. lactulose. Recurrent variceal bleed not controlled by other minimal invasive means. It is characterized by . extensive blood loss into tissues and massive blood replacement are notable. treatment consists of administration of glucose with FFP and mannitol to decrease the cerebral edema. # Spironolactone is the diuretic of choice in the treatment of cirrhotic ascites. # spontaneous bacterial peritonitis (SBP) in cirrhotic patients with fever and ascites. # The development of a palpable mass in epigastrium 4 weeks after the onset of acute pancreatitis is highly suggestive of Pseudocyst formation. # Portal necrosis including piecemeal necrosis and/or bridging fibrosisïƒ chronic hepatitis. and necrosis in the peri-sinusoidal space # HCV RNA is the single most sensitive serological marker to screen for HCV infection.of sudden onset right upper abdominal pain. Later on patient should be started on low protein diet of 20 g/day. # Primary biliary cirrhosis usually presents in middle age and 90 percent of patients are females. then sphincter of Oddi dysfunction and CBD stone can be ruled out # Choreiform movements copper deposition in basal ganglia # Hypertriglyceridemia > 1000mg/dl can cause acute pancreatitis. Refractory ascites (defined as diuretic resistant or diuretic refractory ascites). # The treatment of acute cholangitis is to give supportive care. and neomycin are used for the treatment of acute hepatic encephalopathy. Bacterial action on lactulose results in acidification of the colon contents. # hallmark of alcoholic hepatitis is hepatic cell injury evidenced by the presence of ballooning degeneration. # Protein free diet. it is characterized by extensive fatty vacuolization of the liver. or functional causes. Patients waiting for liver transplantation and needing portocaval shunts. # Females are more susceptible than males to liver injury from alcohol. # ERCP with sphincterotomy is the treatment of choice for sphincter of oddi dysfunction. Give oral or rectal lactulose.

alcoholism. If only AST is elevated then ALT should be checked to rule out extrahepatic causes of AST elevation. S. elective abortion. # Hydatid cysts in the liver are due to infection with Echinococcus granulosus. 2. # Streptococci viridians species (S.markedly elevated serum cholesterol levels. and is associated with colon cancer. and minimally elevated aminotransferases. The next step is to perform esophagoscopy with cytology. # Gallbladder carcinoma is a rare tumor found in patients with chronic choledocholithiasis and usually diagnosed intra or post operatively after a cholecystectomy. cirrhosis and arthralgia. Inf # Acyclovir --prophylaxis or treatment of herpes simplex infection in transplant patients. diabetes. carcinoma. associated with SjDDnDs disease. X_rayïƒ diffuse patchy infiltrates. The vaccine might take at least one month for the immunity to become effective. alkaline phosphatase. . epidermidis is cause of prosthetic valve endocarditis. however. RA. drug use The next step in the evaluation should be to repeat the liver function tests after stopping the drugs and alcohol. biopsy and culture to find out the specific etiology. Treatment is with oral metronidazole. 3. hepatic failure. and intravenous drug use. mutans . Liver biopsy ïƒ granulomatous destruction of bile ducts in portal triad. or Cytomegalovirus (CMV). # Principles of conservative treatment for acute pancreatitis are as follows: 1. # Trimethoprim -sulfamethoxazole is used for prophylaxis of Toxoplasmosis. So traveling in a monthïƒ serum immune globulin # ERCP is a good evaluation tool in case of suspected chronic pancreatitis to look for abnormalities of the pancreatic and biliary ducts. If fail to respond to 3-5 days. Bovis is a normal inhabitant of the Gl tract. the first step is to rule out alcohol. because ALT is more specific for liver injury than AST. # Hemochromatosis is an autosomal recessive disorder characterized by increased skin pigmentation. IgM. CTïƒ well-defined cyst will egg shell calcifications # Cysticercosisïƒ secondary to infection with tenia solium and generally results in cysts in the brain or in muscle. 4. Jaundice and osteopenia occur in later stages of disease. high-resolution chest CTïƒ ground glass attenuation and innumerable small nodules. The presence of anti mitochondrial antibodies. 3. No oral alimentation. Ganciclovir --prophylaxis or treatment of cytomegalovirus infection in transplant patients. Give analgesics for pain. parenchymal opacification # VDRL is a useful screening test and FTA-ABS is a confirmatory test for syphilis. # S. and CREST syndrome. #HAV vaccine or serum immune globulin should be given to all non-immunized travelers to endemic region. Accumulation of ammonia in blood. Ursodeoxycholic acid decreases the pruritus and slows the rate of progression. # The presence of cirrhosis in a young patient with choreiform movements and the finding of a Kayser Fleischer ring (yellow brown pigmentation of the cornea) are highly suggestive of Wilson’s disease # Amebic abscess is characterized by an Danchovy paste’ collection in the liver. Most of the patientsïƒ asymptomatic and generally diagnosed on screening for some other problem. Production of false neurotransmitters. while sulfadiazine and pyrimethamine is for treatment # Esophagitis occurs with HIV CD4 counts less than 50/microL caused by Candida. Recent studies have shown that nasogastric suction must be considered elective rather than mandatory. CMV pneumonitis is not seen in immediate post transplant period.most commonly) are the most commonly causes endocarditis following dental procedures. Oral Trimethoprimsulfamethoxazole is effective in preventing Pneumocystis carinii in transplant patients. #The pathogenic factors involved in the development of hepaticencephalopathy are: 1. 4. Tx: first started on fluconazole directed against candidiasis. 2. Herpes simplex virus (HSV). about 2 weeks after. The definitive treatment is liver transplant # In the evaluation of asymptomatic elevation of aminotransferases. Nasogastric suction to decrease gastrin release from the stomach and prevent gastric contents from entering the duodenum. Increased sensitivity of the CHS to inhibitory neurotransmitters like GABA. Intravenous fluids to maintain intravascular volume. Zinc deficiency. Colonoscopy should be performed when this organism is isolated from blood cultures # All the allogenic bone marrow recipients are at risk for CMV pneumonitis. Group B streptococcal endocarditis include diabetes mellitus.

# Diarrhea due to Vibrio parahemolyticus -. Tx: quinine-clindamycin and atovaquone-azithromycin. # Whenever a health care worker is exposed to HIV.crusted. S. IV pentamidine is an alternative when patients cannot tolerate trimethoprimsulfamethoxazole. they are S. malaise. the use of adjunctive corticosteroids has decreased mortality. sanguis. # Rocky Mountain spotted feverïƒ Ehrlichiosis. mutans. Lung is the most frequently involved organ and it may produce suppurative. If the x-rays are negative three-phase technetium bone scan should be considered. cavity. maybe surrounded by micro abscesses # In case of suspected osteomyelitis. amoxicillin/clavulanate and fluoroquinolones.# Intermittent catheterization is an effective measure to reduce the risk of UTI in patients with neurogenic bladder. Four types of S. aureus (e. include fever. S. Tx: Trimethoprimsulfamethoxazole. splenectomized. It may cause nodules. hemolytic anemia associated with jaundice. baseline HIV testing should be performed immediately and postexposure prophylaxis with combination of two or three anti retroviral drugs should be started without any delay. which is the only effective drug against this fungus. Salmonella is a frequent cause of osteomyelitis in patients of sickle cell anemia. # Intravenous ceftriaxone or cefotaxime are indicated for early disseminated and late Lyme disease. # In a HIV patient. Infections that do not improve after forty-eight hours of antibiotic therapy require the addition of antimicrobial therapy to treat methiciHin-resistantS. # Nocardia is a gram-positive filamentous branching rod with weak acid fast staining. mutans is the most commonly involved organism in dental caries. vancomycin) and Pseudomonas aeruginosa (Ticarcillin).amoxicillin. granulomatous or mixed disease. vermicularis infection( nao cong in child ). or diffuse pulmonary infiltrates. In diabetics. blood cultures and x-rays should be taken and the patient should be started on intravenous antibiotics. Staphylococcus aureus is the most common organism responsible for osteomyelitis. Epidermidis is the most frequent cause of infective endocarditis with prosthetic valves. S. is Streptococci viridians. S. The average duration of antibiotic therapy during uncomplicated pyelonephritis is two weeks #Albendazole or mebendazole is the first line of treatment for E. Gram-negative rods like Klebsiella or Pseudomonas cause osteomyelitis when patients have a history of urinary tract infection (UTI) or urinary instrumentation. # Intravenous cefotetan. or the combination of clindamycin and a fluoroquinolone is the appropriate empirical treatment for limb-threatening infections. In pregnant and lactating women and in children-.ingestion of seafood # Pseudomonas aeruginosa is the most frequent cause for malignant otitis externa # The patients with uncomplicated pyelonephritis can be usually switched to an oral antibiotic after 48-72 hours of parenteral therapy. and Streptococcus saiivarius. # In both infants and children. lung abscess. . Needle biopsy can be done to identify the organism if the blood cultures are negative. clindamycin. or non-limb-threatening. bilateral interstitial pneumonia(fluffy infiltrates) is most likley due to Pneumocystis carinii infection occurs with CD4 counts less than 200/microL. Saprophyticus usually causes urinary tract infections. Epidermidis is a frequent cause of osteomyelitis associated with prosthetic devices. #Strep viridans is the most frequent cause of infective Subacute endocarditis with damaged heart valves. mitis. Prednisolone is used in combination w trimethoprim-sulfamethoxazole when Pa02 is less than 70 mmHg # IV cefuroxime is used to treat bacterial pneumonias. infections can be treated with oral antibiotics like cephalosporin.. reticulonodular. Inhaled pentamidine is used for prophylaxis. viridans cause IE. whereas mild. heaped up and warty with violaceous hue w sharp border . # The organism most likely responsible for endocarditis in native valves. # Prophylaxis against Mycobacterium Avium Complex (MAC) in HIV-infected patients is indicated when CD4 cell count falls below 50/micro-L Azithromycin or clarithromycin # Blastomycosis is big-based budding yeast. Staph. # Babesiosis is a tick borne illnessïƒ Long island. For moderate to severe Pneumocystis carinii in individuals with AIDS. headache. Labs show leukopenia and thrombocytopenia. Staph. nausea or vomiting.g. Bacterial pneumonia in HIV-infected patients usually occurs with CD4 counts above 200. # Gonorrhea is a common infection and is characterized by cervicitis and urethral discharge and pharyngeal inflammation cause by oral sex # Mucormycosis(Rhizopus infection) requires aggressive surgical debridement plus early systemic chemotherapy with amphotericin B. Pyrantel palmate is an alternative. following dental procedures. Staph aureus is major cause of acute infective endocarditis in IV drug abusers. ampicillin/sulbactam. onset is abrupt and patient is usually productive of sputum with chest pain and high fever. Skin .

bizarre behavior and gustatory hallucinations. # Hematological abnormalities seen in infectious mononucleosis include autoimmune hemolytic anemia. nonpainful. # Heterophil antibody test is sensitive and specific for diagnosis of IM. # Granuloma inguinale (Gl) caused by Donovania granuiomatis. Roth spots and OslerDs nodes. In the early part of the disorder. # Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae and primarily affects the peripheral nerves and skin. a combination of an aminoglycoside with anti-pseudomonal penicillin is the preferred therapy. IV aqueous crystalline penicillin is the treatment of choice and IM procaine penicillin is a good alternative. (DIC) and thrombotic thrombocytopenic purpura / hemolytic uremic syndrome (TTP/HUS). non-tender. # Cervicofacial actinomycosis classically presents as slowly progressive. Initial treatment with IV amphotericin B decreases the fungal load and lifelong treatment with itraconazole prevents relapse. disseminated intravascular coagulation.intracellular inclusions Esophagitis caused by CMV. ** Immunocomplex disease is primarily responsible for glomerulonephritis. blanching. It is most commonly seen in areas where sheep are raised—Echinococcosis # Urethral cultures have higher yield than synovial or blood culture in cases of suspected gonococcal purulent arthritis. a fluoroquinolone like ciprofloxacin may be used as an alternative to aminoglycosides # Treatment of disseminated Histoplasmosis in HIV patients is IV amphotericin B followed by lifelong treatment with itraconazole. Hydatid cysts can be found in almost any part of the body but liver (MC) is involved in two-thirds of patients and the lungs are involved in 25 percent of patients. For patients with neurosyphilis. erythematous lesions on the palms and soles) lesions result from septic embolism. meat and eggs and symptoms usually begin within one to six hours after ingestion. which is insensate. shallow and superficial w A biopsy -. CSF tested by PCR for herpes simplex virus DNA is now the diagnostic test of choice. With progressive peripheral nerve damage. # Pig farmers are at high risk for neurocysticercosis #The majority of human infections with E.affects temporal area. thrombocytopenia. fistulae. #The herpes simplex virus (HSV) esophagitis ulcers are usually multiple. the ulcer and lymphadenopathy of granuloma inguinale present at the same time. tx: iv Ganciclovir # Skin induration of greater than 5 mm with PPD testing in HIV patients requires prophylaxis with isoniazid for 9 months. * infectious mononucleosis cause autoimmune hemolytic anemia # Abrupt onset of nausea and vomiting is mot likely due to intake preformed toxin. which evolves into multiple abscesses. whereas the ulcers seen in CMV infection tend to be large. # Untreated Lymphogranuloma venereum caused by Chlamydia trachomatis may progress to a severe and chronic disease causing ulceration. The infection can spread from the soft tissues to the bone. Janeway(macular. granulosus are asymptomatic. EBV specific antibody test is used in patients with high suspicion for IM and have negative heterophil antibody test. Moreover. the ulcer of Granuloma inguinale has irregular borders and is characterized by a beefy red granular base. well circumscribed and have a "volcano" (small and deep) like appearance. and draining sinus tracts with sulfur granules. # Whenever there is a severe acute exacerbation of pulmonary infection in a patient with cystic fibrosis. salad. # arterial insufficiency and peripheral neuropathy account for the susceptibility of diabetic patients to foot ulcer. ceftazidime or cefepime and aminoglycoside. it may present as a hypopigmented patch. proctocolitis. rectovaginal fistulas and elephantiasis. in onset and fever is present along with impaired mental status. The treatment of actinomycosis is high dose penicillin or erythromycin for 6-12 weeks. rectal stricture. # Herpes simplex virus (HSV) encephalitis-.# Empiric antibiotic therapy with either ceftazidime or cefepime should be started in febrile neutropenic patients. diagnosis is made by demonstration of acid-fast bacilli in skin biopsies # Drug of choice for early syphilis is benzathine penicillin G and a single IM injection is required. For those patients who are allergic to penicillin. Staphylococcus aureus toxin is present in foods like dairy. In adult patients. toxin of Bacillus cereus is present in rice. Such contiguous spread is . IV acyclovir should be started without delay. doxycycline or tetracycline is given for 14 days. muscle atrophy is common causing crippling deformities of the hands. indurated mass. # Ciprofloxacin is contraindicated in children as it may cause cartilage destruction and growth retardation. which appear yellow.

a gram-negative bacillus. Tx: podophyllin # Ganciclovir prophylaxis is given when CD4 count is less than 50/cu. # Salmonella species are the most common organisms (upto 70% of cases) causing osteomyelitis in patients with sickle cell disease. Plain x-ray films are usually normal in first two to 3 weeks of acute osteomyelitis # Pseudomonas aeruginosa is a frequent cause of osteomyelitis in adults with nail puncture wound. malaise and headaches. vesicular. # H. Pneumocystis carinii may cause nodular and papular cutaneous lesions of external auditory meatus in immunocompromised HIV patients Bacillary angiomatosis is caused by Bartonella species. Treatment is with oral or parenteral quinolones and aggressive surgical debridement. The color from light brown to pink to dark violet. Cutaneous lesions are round reddish papules or nodules. CT scan shows pulmonary nodules with halo sign or lesions with air crescent. Aspergillus is ubiquitous in its geographic distribution. Hematuria in bacterial endocarditis is usually the result of glomerular injury caused by deposition of immune complexes. #Histoplasmosis – Missouri. weight loss and pleuritic chest pain. Chestx-ray may show cavitary lesion. # Streptococcus bovis endocarditis is associated with colorectal cancer and colonoscopy is advisable in such patients. edematous tender skin lesion with raised borders. ** Streptococcus pneumoniae is the most common pathogen causing pneumonia in nursing home patients. A bone scan is extremely sensitive. # IV amphotericin-B plus oral flucytosine is the initial treatment of choice for central nervous system cryptococcal infection(positive India ink staining) in AIDS patients. verrucous and papilliform skin lesions present around the anus. systemic symptoms along with leukopenia and thrombocytopenia. Colonoscopy and biopsy of the ulcers is reserved for those with persistent diarrhea and negative stool examination. proptosis and diplopia are important features. Involved turbinates usually become necrotic. Primary pulmonary infection has non. involvement of the eye with chemosis. henselae. MRI is usually performed for suspected osteomyelitis of the spine and some times foot. erythematous and popular.occurs in immunocompromised. The characteristic finding of erysipelas is a sharply demarcated. and is recommended for diagnosis early in the disease course. # Mucor mycosis of the nose and maxillary sinus caused by Rhizopus. xray are consistent with interstitial pneumonitis # Coccidioidomycosis is endemic in Arizona. erythematous. # Kaposi sarcoma -. Influenza and Moraxella catarrhalis are the common causes of bacterial sinusitis. # History of rheumatic fever.beta-hemolytic streptococci. Staph aureus accounts for less than 25% of cases. # Ehrlichiosis-.specific features like fever. CT scan is not very sensitive in detecting osteomyelitis. papules that later on become plaques or nodules. Tx: Doxycycline # Tick bite is not treated prophylactically even in high-risk patients. doxycycline (oral or intravenous) for adults and children # Three phase technetium scan is the test of choice for acute osteomyelitis. Central and South USA. nasal congestion. most frequently caused by group A. ova and parasites. hepatosplenomegaly and and serum CMV IgG is positive or there is a positive biopsy for CMV. oral fluconazole is started with the discontinuation of amphotericin and flucytosine. # Cat-scratch disease is an infectious disease caused by B. Amoxicillin prophylaxis is given in pregnant patients who have history of tick bite and have anxiety about acquiring disease.the most likely pathogenic mechanism of contiguous osteomyelitis in patients with arterial insufficiency (mostly diabetic patients). New Mexico. . Cutaneous findings like erythema multiforme and erythema nodosum as well as arthralgias are immunologically mediated. Texas. In general population. Usually there is no rash. fatigue. Tx: Five days of azithromycin # Stool examination should be done first in all HIV-infected patients with diarrhea for bacterial culture. # Erysipelas is a specific type of cellulitis in which there is inflammation of the superficial epidermis producing prominent swelling.tick bite. Poorly controlled DM is a predisposing factor for this disease. face and the extremities. presence of murmur and hematuria suggest the diagnosis of infective endocarditis. Low-grade fever. # Aspergillosis-. transmitted by a cat scratch or bite. bloody nasal discharge. Staphylococci aureus is the most common organism causing osteomyelitis # the treatment of RMSF needs to be initiated on clinical suspicion. vascular and are associated with fever. mucous membrane ulcers.trunk. # Condylomata acuminata caused by are skin colored or pink. dry cough.

A detailed history and physical examination. 4. features like subungual splinter hemorrhages. Hepatitis A and B vaccine if seronegative. Carinii is indicated in HIV-positive patients whose CD4 count is less than 200/cmm. # All of the patients who are diagnosed with HIV infection should have the following evaluations: 1. # The cutaneous lesions of Kaposi sarcoma are asymptomatic. 4. # The three most frequent causes of community-acquired meningitis are Pneumococcus. 12. solium eggs. periorbital edema and chemosis. There is no necrosis of skin or underlying structures.papule at the site of inoculation and followed by ulceration and lymphadenopathy. Trimethoprim-sulphamethoxazole prophylaxis against P. A plasma HIV RNA titer. An anti-Toxoplasma antibody titer. conjunctival and retinal hemorrhages.sandy beach and sand boxes contact. The following studies are indicated before starting anti retroviral treatment: 1. 5. A pneumococcal polysaccharide vaccine. A CD4 T lymphocyte count. 11. Hepatitis A and B serology. complete blood chemistry. Proteus produce a urease which makes the urine alkaline. # Orchitis is one of the most frequent complication of mumps. and lipid profile. nausea. 9. 3. A CBC. A VDRL test for syphilis. 10. arranged linearly on areas such as legs. treated with antifungal creams such as tolnaftate. Tx: Steroids # ELISA is the preferred test to screen for HIV infection. # Cutaneous larva migrans or creeping eruption-. 6. # Amoxicillin-clavulanate --prophylaxis infections caused by human bite. 2. tenderness. and ulcerate subsequently) and bilaterally symmetrical maculopapular rash involving the entire trunk and extremities are characteristic of second stage of syphilis. It is followed by. redness and fissuring in swimmers is typical of athlete’s foot. A complete history and physical examination. vomiting and diarrhea. serpiginous. Listeria monocytogenes is a frequent cause of meningitis in patients older than 55. 13. Hemophilus influenzae and Meningococcus. elliptical. A PPD skin test. 2. # Sporotrichosis-. also known as pork tapeworm. 3. Western blot is a confirmatory test for HIV infection # Cysticercosis is a parasitic disease caused by the larval stage of Tenia solium. erythematous papule followed by characteristic severely pruritic elevated. 8. # Proteus is the most likely cause of urinary tract infection in patients with alkaline urine. Thus. which are shed by infected animals and not from ingestion of infected pork. HIV counseling. serum transaminases. The most prominent clinical manifestation includes neurocysticercosis (NCC). A routine chemistry and hematology. empiric antibiotic regimen—vancomycin+ ceftriaxone+ ampicillin # Itch. Ixodes . Extend help and information to those who might have been infecteded by the subject. # Mitral regurgitation is the most common valvular abnormality observed in patients with infective endocarditis not related to IV drug abuse. but can be larger) fluid-filled cysts in the brain parenchyma. Remember the rash is present on palms and soles. A Mini Mental Status Examination. As larvae enter skeletal muscles. Serological tests are positive in secondary syphilis. which is characterized by multiple small (<1 cm usually. A CD4 T lymphocyte count. It is classically seen in gardeners. face. reddish brown lesions # Lyme disease-. such as abdominal pain. people who do not eat pork can also have NCC # Condyloma Lata(exophytic formations which develop abundantly on the anogenital region or upper thighs.The infectious spirochetes (Borrelia burgdorferi) are transmitted to humans through bites of the tick.# Trichinosis has two phases. oral cavity and genitalia. They are initially papules and later develop into plaques or nodules and their color changes from light brown to violet. swelling and weakness occur. unless the CD4 count is less than 200/cmm. Two plasma HIV RNA levels. muscle pain. Humans develop NCC from ingestion ofT. The initial phase is manifested by gastrointestinal complaints. 7.

# hemochromatosis are vulnerable to listeria monocytogenes infections. Iron overload is also a risk factor for infection with Yersinia enterocolitica and septicemia from Vibrio vulnificus both of which are iron-loving bacteria. # The presence of gram-negative bacilli in sputum of an intubated intensive care unit (ICU) patient with fever and leukocytosis is highly suggestive of nosocomial pseudomonas infection. Pseudomonas aeruginosa is a common cause of gram-negative nosocomial pneumonia #Any HIV-positive patient with bloody diarrhea and normal stool examination should have a colonoscopy and biopsy done to look for CMV colitis. CMV colitis is characterized by bloody diarrhea with abdominal pain, multiple ulcers and mucosal erosions on colonoscopy; biopsy shows characteristic cytomegalic cells with inclusion bodies-- large cells with eosinophilic intranuclear and basophilic intracytoplasmic inclusions (OwlDs eye effect). # infective endocarditis in iv drug abuse. Tx: vancomycin and gentamycin # Pneumococcal vaccine is recommended in all HIV infected patients whose CD4 count is above 200 cells/mi cro-L. ** Steroids have been shown to decrease the mortality in patients with severe PCP infection. Indication of steroid use in PCP includes: 1. PaO2<70mmHg. 2 . A-a gradient > 35; # For chemoprophylaxis of malaria, chloroquine is the drug of choice. However, Southeast Asian countries like India, Pakistan and Bangladesh -- chloroquine resistant malaria is present in these areas. mefloquine should be given instead of chloroquine # Blood smear with atypical lymphocytes should make you rank Cytomegalovirus (CMV) higher on the list in a patient with mononucleosis Iike symptoms. #Nocardiosis is diagnosed by the presence of crooked, branching, beaded, gram-positive, and weakly acid-fast positive filaments on microscopy. The combination of sulfamethoxazole and trimethoprim is the treatment of choice-- pulmonary nocardiosis ïƒ nodule with cavity # Glucocorticoids are indicated in a case of infectious mononucleosis complicated by upper airway obstruction, autoimmune hemolytic anemia, and thrombocytopenia. # Facial nerve palsy and classical Erythema migrans (EM) indicate Lyme disease, Lyme disease may cause palsy of any cranial nerve with facial nerve palsy being the most common. OBJ&GYN # a positive PPD >10 mm. all patients with positive PPD should undergo a chest x-ray. If the lesion is present and the patient is asymptomatic, she should start INH and pyridoxine as prophylaxis. If the chest x-ray is negative, no workup is necessary. If the patient is symptomatic she should be treated with combination drugs # hyperthyroidism is very well tolerated by pregnant women. Graves disease is the most common cause of hyperthyroidism in pregnancy # Sudden onset atrial fibrillation in pregnant women should alert the physician to look for hyperthyroidism. Diagnosis is best made with serum TSH and free T4 ieveis. However, the best screening test would be TSH oniy. # selective mutism in a child who is verbal and talkative at home, but does not speak in select places such as school and other social events. Social phobia in childhood may occur due to learning and communication disorders # Testicular feminization syndrome present with amenorrhea, developed breasts, absent pubic and axillary hair, absent internal reproductive organs, and a 46 XY karyotype. defect or absence of androgen receptors resulting in androgen resistance of peripheral tissues. The Mullerian Inhibiting Factor (MIF) is produced by the gonads, so the uterus, tubes and vagina are absent. Breasts develop because of peripheral production of estrogen # Placenta previa presents commonly with bright red and painless vaginal bleeding in the third trimester. Diagïƒ ultrasonography # Vasa previaïƒ fetal blood vessels traverse the fetal membranes across the lower segment of the uterus between the fetus and the internal cervical os. a painless antepartum hemorrhage, associated with rapid deterioration of the fetal heart tracing. # Abruptio placenta-ïƒ Painful third trimester vaginal bleeding with normal ultrasound # Alpha-Feto-protein (AFP) is produced by the yolk sac and fetal liver. Increased levels are seen in the presence of neural tube defects, abdominal wall defects (Gastroschisis, Omphalocele), as well as false positive causes such as fetal demise, multiple gestation, and inaccurate gestational age. However, the most common cause of abnormal AFP is a gestational age error. In the case of an increase in MSAFP levels, the physician should first perform an ultrasonography to rule out the false positive causes, and to detect the presence of any anomaly that may be seen by ultrasound. Amniocentesis has to be ordered afterwards for confirmation by measuring amniotic levels of AFP and Acetylcholinesterase (AChE). AChE is a protein that is increased only in neural tube defects. Low levels of MSAFP are frequently associated with chromosomal anomalies, especially Down’s

syndrome Triple test: A combination of a decreased MSAFP, increased beta-hCG and decreased UE3 levels is typical of Down’s syndrome. in trisomy 18, all three parameters are decreased # pelvic inflammatory diseaseïƒ hospitalization is usually needed especially for women who are severly infected (i.e. with temperature > 39 C, nausea and vomiting or signs of ileus), adolescents, nulliparous (such as in this case), women with low socioeconomic status and women who fail to respond to oral antibiotic therapy. ; in hospitalized patients, used regimens include Cefoxitin/Doxycycline, Cefotetan/Doxycycline and Clindamycin/gentamycin. In non-hospitalized patients, Cefoxitin/probenecid or Ceftriaxone/Doxycycline are used. The patient's partner should also be treated. # Ovulatory abnormalities may initially be screened for by basal body temperature and midluteal level of progesterone; the former assesses the duration of the luteal function and the latter the level of the luteal function. #Diabetes screening is performed between 24 and 28-weeks of gestation. The screening test is the 1-hour 50 g oral glucose tolerance test(>140 mg/dL). Confirmation is done by the 3-hour 150 g OGTT. # In mild peeclampsiaïƒ bed rest, salt-reduced diet, and close observation. Hypertensive therapy is used in patients with BP >160/110 mmHg, and patients with CNS symptoms regardless of the BP. # Pregnancy leuteoma usually appears as bilateral, multinodular, solid masses on both ovaries. It is characterized by replacement of the normal ovarian parenchyma by solid proliferation of luteinized stromal cells under the influence of human chorionic gonadotropin (HCG). It is a benign self-limited condition and requires no treatment. # Radiation levels used for diagnostic exams are not assocaited with teratogenicity. Doses inferior to 5 cGy are not associated with fetal abnormalities Termination of pregnancy should be considered and even mandated when the mother is exposed to doses between 5 and 10 cGy. # Beta-2 agonists may worsen the edema by decresaed water clearance, tachycardia and increased myocardial workload. It increase gluconeogenesis in the liver and muscle resulting in hyperglycemia, which increases insulin requirements in diabetic patients. The mean arterial pressure do not change with beta-agonist treatment, since the rise in systolic pressure is compensated by decrease in diastolic pressure. # Abdominal circumference is the most effective parameter for estimation of fetal weight in cases of suspected IUGR. IUGR may be symmetrical and asymmetrical. In symmetrical growth restriction, the insult to the fetus begins before 28 weeks gestation and growth of both the head and the body is deficient. It is usually caused by congenital infections, congenital anomalies and vascular diseases of the mother. Asymmetrical IUGR is a result of a late exposition to the insult past 28 weeks and is characterized by a normal or almost normal head size and a reduced height and weight. 3 Grave's disease and migraine headaches improve in pregnancy. Beta-blockers should be avoided as they may decrease placental blood flow and cause growth retardation. # In a patient with primary amenorrhoea and no breastsïƒ Estrogen is low. Need to measure FSH, if it is decreased, GnRH stimulation test is the next step; if it is increased, karyotype is the next step. If karyotype is normal, diagnosis of ovarian agenesis or dysgenesis is established. Measurement of LH has no diagnostic value. # BUN, serum creatinine, and hematocrit are often decreased in pregnant patients, and it is due to a dilutional affect. # Combination of thrombocytopenia, microangiopathic hemolytic anemia and increased liver enzymes in a patient with preeclampsia is defined as HELLP syndrome. # the first step in the workup of male infertility is the sperm count. If the sperm count is abnormal, an endocrine evaluation is carried out; it includes (1) thyroid function tests, since like in the female, increase in TSH inhibits GnRH production and consequently decreases FSH production; (2) testosterone levels to indicate the presence or not of hypogonadism; (3) gonadotropin levels to determine whether the hypogonadism is central or testicular; and (4) prolactin levels. # Prolactin is responsible for milk synthesis whereas oxytocin for contraction of the gland’s ducts and acini and thus excretion of milk. # for lactation suppressionïƒ Tight fitting bra and ice packs # Premature rupture of membranesïƒ When the patient is not in labor, and whether the pregnancy is at term or not, the hand of the examiner should not be inserted into the vagina because of the increased risk of infection, and the examination should be performed with a sterile speculum. # phenytoin and other hydantoins in uteroïƒ Neuroblastomas. # cocaine abuse & Folate deficiency can cause Abruptio placenta. Once the diagnosis is made, a large-bore IV line, as well as a Foley catheter must be placed. Blood products should always be available. Patients with placental abruption in labor have to be managed aggressively to insure a rapid vaginal delivery, since this will remove the inciting cause of DIC and hemorrhage # Ritodrine is beta 2 agonist and is contraindicated in hypertension. # benign edema of pregnancyïƒ Cramps and mild leg edema

# the earliest sign of magnesium sulfate toxicityïƒ depressed deep tendon reflexes. The second sign of toxicity is respiratory depression, then coma, the cardiac arrest and death. The treatment of MgS04 toxicity is to immediately stop the infusion then to administer calcium gluconate # Danazol is an androgen derivative that has a gonadotropin inhibitory effect. It is indicated in endometriosis, fibroids and fibrocystic breast disease #A defect in the luteal phase refers to a relatively low progesterone secretion by the corpus luteum. Progesterone is important for embryo implantation and maintenance of pregnancy, so a defect in its secretion may cause infertility even if ovulation takes place. The defect may affect the level or duration of production of progesterone. Luteal phase defect is suggested by short cycles, history of spontaneous abortion, abnormal basal body temperature (BBT) or low levels of midluteal progesterone. The diagnosis is confirmed by endometrial biopsy, which demonstrates a lag in endometrial maturation of 2 days or more as compared with normal states. Luteal phase defect is treated with progesterone vaginal suppositories. Clomiphene citrate or human menopausal gonadotropin (hMG) may be used if progesterone suppositories give no results; they increase serum FSH level and thus correct follicular maturation and oocyte expulsion # Labor progresses through four stages: 1 The first stage extends from the onset of labor until full dilation of the cervix, and includes two phases: a latent phase, during which dilation progresses at a slow rate until reaching 2-3cm, followed by an active phase, during which the dilation is more rapid. The length of the latent phase is highly variable but is considered prolonged when it exceeds 20 hours in the primiparous and 14 hours in the multiparous. The progression of the active phase is evaluated by the rate of cervical dilation. At this phase, the cervix normally dilates at a rate of at least 1cm/hr in the primiparous and 1.2cm/hr in the multiparous. 2 The second stage of labor extends from complete dilation of the cervix to delivery of the baby. It usually lasts 30 min to 3 hours in the primiparous, and 5 to 30 minutes in the multiparous. 3 The third stage of labor starts with the delivery of the baby, and ends with the delivery of the placenta. 4 The fourth stage extends from delivery of the placenta until 6 hours postpartum. The mother should be closely observed during this stage because of the risk of postpartum hemorrhage. Prolonged latent phase can be caused by hypertonic uterine contractions( Tx: rest with morphine sulphate), hypotonic contractions(treated with a diluted infusion of oxytocin), or premature or excessive use of anesthesia or sedation. Anesthesia may reduce uterine activity if administered in the latent phase # Prolactin production is inhibited by dopamine and stimulated by serotonin and TRH. Hypothyroidism may result in amenorrhea and galactorrhea # trichotillomania in patients with uncontrollable urges to pull out their hair, resulting in alopecic patches. # Syphilisïƒ by the spirochete Treponema Pallidum. 1.The chancre-- primary stage: painless, indurated ulceration with a punched-out base and rolled edges w painless inguinal adenopathies. heals spontaneously in 3 to 9 weeks. Serologic testing is not reliable at this stage and includes a high rate of false-negatives, so diagnosis in the first stage is made via spirochete identification on dark field microscopy 2.The Condylomata Lata z(anogenital region or upper thigh)--second stage: malaise, headaches, anorexia and a generalized maculopapular rash and/or moist papules on the skin or mucous membranes. 3. Tertiary syphilis-- gummas of the skin and bones, aortitis, meningovascular disease, paresis and tabes dorsalis. Gummas are nodular formations that ulcerate and become necrotic, leaving large defects in the structure # The ulcer in chancroid is very painful, has a gray base and is foul smelling. inguinal nodes are painful with subsequent bubo formation and suppuration # The ulcer of granuloma inguinale starts as a nodule or papule, rapidly ulcerates. painless, irregular borders and a beefy red granular base. # Metronidazole for Trichomonas vaginitis(thin, bubbly and grayish vaginal discharge accompanied with erythema and swelling of the vulva and vaginal mucosa. strawberry cervix) to both the patient and the partner. Clotrimazole cream is preferably used in pregnancy because of the risk of teratogenicity of metronidazole # Midplevis contraction which is indicated by prominent ischial spines is an important cause of arrest disorder of dilation. Tx: C-section. # Anesthesia may cause a decrease in the strength of uterine contractions if it is administered in the latent phase. # Asymmetrical IUGR is a result of a late exposition to the insult past 28-weeks and is characterized by a normal or almost normal head size and a reduced abdominal circumference. It is usually caused by maternal factors such as hypertension, preeclampsia and chronic renal disease.

Pulmonary edema or cyanosis 4. Metformin can be used as an alternative to oral contraceptive pills for restoring ovulatory menses in polycystic ovarian syndrome patients who refuse or are contraindicated to use oral contraceptive pills. # For gross lesions. In conjugation with clomiphene citrate. however. scotoma or blurred vision 3. and the most abundant androgen is androstenedione. biopsy is needed and Pap smear is no longer appropriate # Conization is indicated in any situation wherein the results of the tests (i. however. severe itch and vaginal soreness. It helps prevent type 2 diabetes mellitus. The symptoms occur within three months of the onset of the stressor and rarely last beyond six months of the termination of the stressor. with the presence of marked distress. They are estrogen-dependant tumors. helps correct hirsutism to some extent. into estrone. may progress to vulvar cancer ïƒ routine biopsies. Tx: topical steroids. Altered consciousness. The patient tries to avoid places. acne. estrogens are mainly formed through the conversion of androgens by the action of the enzyme aromatase present in granulosa cells. relieved by menses and often with a history of sexual problems.# Polycystic ovarian syndrome(irregular periods.e. Significant thrombocytopenia 6. 4. 3. or when the result of endocervical curettage is abnormal. Oliguria (< 500ml_/24hr) 2. # Lichen sclerosis is characterized by epithelial thinning. Pap smear suggests carcinoma in situ. Helps losing weight by causing anorexia (most of the patients with polycystic ovarian syndrome are obese). vulva is red and appears dry with scaly patches. it is not FDA approved to be used for this purpose. or biopsy indicates severe dysplasia or microinvasion. Epigastric or right upper quadrant pain 5. endocervical curettage. The major sources of androgens in the female are the adrenal glands and the ovaries. Altered liver function test . Peripheral fat tissue also contains the enzyme aromatase. It has modest effect in suppressing androgen production and. During childbearing years. which converts androstenedione therein. thus. # Eclampsia results from cerebral vasospasm and the resultant cerebral hypoxemia # Severe preeclampsia: BP >=160/110 and /or have one or more of ïƒ 1. hirsutism) is an risk factor for type-2 diabetes mellitus in women # The benefits of metformin use in polycystic ovarian syndrome are as follows: 1. # Pelvic congestion presents as a dull ill-defined pelvic ache usually worse premenstrually. 5. # The high incidence of UTI in females is primarily due to the shorter length of the urethra in females. inflammation and dryness of the skin. 2. # Polycystic ovarian diseaseïƒ amenorrhea. it helps to induce ovulation in infertile polycystic ovarian syndrome patients with anovulation. # The diagnosis of major depression requires presence of symptoms for at least six months. biopsy) are equivocal or unsatisfactory. headache. # The major source of estrogen in menopausal women is from the peripheral conversion of adrenal androgens by fat tissue. ultrasound reveals a normal endometrial stripe. ACTH stimulation testïƒ exaggerated increased DHEA because of increased sensitivity of the adrenal gland to ACTH. heavy menses. # The increase in blood pressure that appears before 20-weeks gestation is either chronic hypertension or hydatiform mole. androgen excess and a LH to FSH ratio greater than 2:1. Pap smear. and 2 others 12-hours later. hirsutism. # Before 37-weeks of gestation. fetuses in breech presentation need no intervention as they may convert to vertex automatically # Pseudocyesis( jia yu) is a rare condition in which a woman presents nearly all symptoms and signs of pregnancy. people or activities that remind him/her of the trauma. # In posttraumatic stress disorder (PTSD). increase in size with oral contraceptive pills (OCPs) or pregnancy. Microangiopathic hemolysis 7. infertility and obesity. the traumatic event is persistently re-experienced in the form of recurrent nightmares and flashbacks of the event. and therefore. # Presence of dysmenorrhea. # adjustment disorder is the development of emotional or behavioral symptoms in response to an identifiable stressor. and enlarge uterus is almost diagnostic of either adenomyosis or fibroid uterus. and often regress after menopause. # emergency contraception is a combination of ethinyl estradiol (estrogen) and norgestrol (progestin): 2 tablets taken within 72-hours of intercourse.

Addison's disease. antibodies to ABO antigens belong to the IgM that do not cross the placenta. # Pap smear – dysplasia. pyrimethamine and sulfadiazine is preferred in second and third trimester.8. # Mittelschmerz is mid cycle abdominal pain and typically presents in young females. # chorioamnionitisïƒ Tx Ampicillin and gentamicin. In the primigravida. Labor #Toxoplasmosis should be suspected in any patient with mononucleosis syndrome. IUGR. nausea. 2/Complete breech-. Like disulfiram. # Urethropexy is indicated in stress incontinence(pelvic floor weakness) # follicular cells secrete estrogen & inhibin (inhibition of FSH only ). one or both of the hips are not flexed in way that the foot or knee lies below the buttocks.2 cm/hr. For this reason.both thighs and knees are flexed. # Penicillin desensitization is considered to be the treatment of choice for the pregnant patients with syphilis and having penicillin allergy # In false labor. It consists of pushing back the baby into the uterine cavity followed by a cesarea section. the presenting parts are the feet and the buttocks. cervical dilatation in the active phase progresses at a speed of 1. During the first two trimesters.fetal legs stretched in front of the fetal trunk. # One of the side effects of epidural anesthesia is urinary retention caused by bladder denervation. # all oral antidiabetic medications & ACE inhibitors are contraindicated in pregnancy. Infection is demonstrated by detection of IgM to Toxoplasma. the next step is ultrasonography. spiramycin is the agent of choice as pyrimethamine is contraindicated in the first trimester. or oligohydramnios # Premature ovarian failure refers to a failure of estrogen production by the ovaries that occur in women less than 35 years. Omphalocel) and false positive. If maternal serum Alpha-Feto-Protein levels are found to be abnormal in a pregnant patient.Anti-D antibodies that are responsible for Rh alloimmunization belong to the IgG class and cross the placenta easily. As for long acting drugs. Elective termination of pregnancy is an option in first trimester of pregnancy # Zavanelli maneuver is used as a last resort in case of shoulder dystocia. the presence of fetal infection may require elective termination of pregnancy. Diagnosis is confirmed by increased FSH serum levels. Koilocytes and hyperplasia. decreased HDL. abdominal wall defects (Gastroschisis. and high risk of heart disease due to lack of effect of estrogen on cholesterol balance. the most widely used agent is methyldopa. interruption of pregnancy is no longer possible and pyrimethamine and sulfadiazine should be administered to reduce the severity of fetal disease as well as to decrease the risk of transmission. osteoporosis. Use insulin only. # All patients with pseudocyesis need psychiatric evaluation # Active phase arrest ïƒ dilation fails to progress in the active phase >= two hours. In pregnant lady with Toxoplasmosis (recognize contact with cats). # There are three types of breech presentation: 1/Frank breech-. If the mother chooses to continue gestation. If it reveals an inflammatory atypia. 3/Footling or incomplete breech. used for urge incontinence. repeat after 4 to 6 months. Testosterone is produced by stromal cells of ovary # Menopause results in increased LDL. short acting drugs that can be used safely in pregnancy are hydralazine and labetolol. associated with Hashimoto's thyroiditis. are genital lesions caused by human papilloma virus (HPV) serotypes 6 and 11. vomiting and hypotension. Condylomas present as exophytic lesions with a raised papillomatous or spiked surface and may grow into large and cauliflower-like formations. This incontinence is only transient and lasts until the effect of the anesthetic wears off and the bladder regains normal function. Elevated serum creatinine level 9. # Metronidazole is associated with disulfiram like reactions. causing accumulation of Acetaldehyde in the blood stream and consequently symptoms such as flushing. all patients who take metronidazole should abstain from drinking alcohol. # ABO antigens are strongly antigenic. it inhibits aldehyde dehydrogenase in the metabolic pathway of alcohol. type I diabetes mellitus and pernicious anemia. and also due to altered vascular endothelium reactivity due to decreased estrogen. or condylomata acuminata. next do Colposcopy ( ying duao jing ). Spiramycin for first trimester. If negativeïƒ do conization # Vulvar papillomatosis. Infertility in premature ovarian failure is treated with egg donation. progressive cervical changes are absent and all such patients need reassurance # Magnesium sulfate is the drug of choice for tocolytic therapy . Biopsy ïƒ inflammation. # Alpha-Feto-Protein (AFP)ïƒ Increased levels are seen in the presence of neural tube defects. frank or complete breech can be virginal delivery. In the third trimester. Tx: intermittent catheterization # Oxybutynin has antocholinergic properties. Low levels of MSAFP are frequently associated with chromosomal anomalies. For hypertension.

first rule out hypothyroidism by measuring serum TSH. It can. Giemsa or Wright’s stain-. be used to treat HTN in combination with methyl-dopa. the circulating levels of thyroid stimulating immunoglobulin (TSI) remains as high as 500 times the normal value . cervical cultures. The alpha subunit is common to hCG. # Preeclampsia caused by uteroplacental ischemia # A significant granulocytic leukocytosis may be seen in immediate postpartum period # Hypotension is a common side effect of epidural anesthesia. painless ulcer w irregular borders and a beefy-red granular base. decreased libido and irritability. Psychological symptoms may include anxiety. treated with cyclic progestins. The cause of hypotension is blood redistribution to the lower extremities and venous pooling caused by sympathetic fiber block that results in vasodilatation of the lower extremity vessels # The ulcer of lymphogranuloma venereum is also painless but is shallow and associated with nonspecific systemic symptoms. encapsulated. magnesium sulfate # Estroge used for atrophic vaginitis. preventing premature epiphyseal plate fusion. #Human Chorionic Gonadotropin (hCG) is a hormone secreted by the syncytiotrophoblast and is composed of two subunits: alpha and beta. Thiazides and calcium channel blockers should not be used in pregnancy # Prolactin production is inhibited by dopamine and stimulated by serotonin and TRH. # Septic abortion is managed with cervical and blood sampling.caused by the bacterium Donovania granulomatis. it is ineffective as a monotherapy and does not prevent proteinuria or diabetic nephropathy. Moreover. obese. distributed symmetrically but are frequently localized and discreet. whereas. A menstrual diary for at least 3 cycles is a useful aid for confirming the diagnosis # Levothyroxine does not cross the placenta. however. and it has also been shown to be very effective in preventing proteinuria and diabetic nephropathy. antibiotics. Patients often present for vulvar pruritus. Treatment consists of local application of 1% corticosteroid ointment three times a day for 6 weeks. Tx: tetracycline for 10-21d. diabetic or with chronic hypertension.V. IV antibiotics and gentle suction curettage. the inguinal adenopathy is inflammatory and does not appear at the same time as the ulcer.reddish. On examination. These should include repeated practice with insertion (dilation) training. the inguinal adenopathy is inflammatory and does not appear at the same time as the ulcer. difficulty concentrating. should be treated with GnRH agonist therapy in order to inhibit secretion of estrogens. In many women with Grave's disease. # Treatment for vaginismusïƒ relaxation. # Granuloma inguinale-. hCG is responsible for maintenance of progesterone secretion by preservation of the corpus luteum until the placenta starts producing progesterone on its own # Management of dysfunctional uterine bleedingïƒ If the patient is older than 35 years. has a gray base and is foul smelling. It is believed to be caused by the increase in lumbar lordosis and the relaxation of the ligaments supporting the joints of the pelvic girdle. Endometrial ablation or hysterectomy are indicated only if hormonal therapy fails. do Endometrial biopsy. # Preeclampsia rarely presents before the 20 weeks of pregnancy # premenstrual syndromeïƒ Symptoms usually disappear near menses and symptom free until her next ovulation. inguinal nodes are painful with subsequent bubo formation and suppuration. Hyperplastic dystrophy cannot be distinguished clinically from cancer of the vulva and biopsy is therefore required every time the diagnosis is suspected. In the case of amenorrhea-hyperprolactinemia. They may be multiple. the beta subunit is specific to hCG. TSH. steroids. mood swings. LH. Labetalol as an alpha and beta blocker has become the drug of choice to control HTN in pregnancy. and FSH. I. # Idiopathic precocious pubertyïƒ presence of similar cases in the family and a normal sequence of secondary sexual characteristics apparition. shallow and associated with nonspecific systemic symptoms. Testosterone cream and progesterone cream are effective for 2nd line treatment of lichen sclerosus # Hypertrophic dystrophy of the vulva may be seen in women of reproductive age but occurs most commonly in postmenopausal women. lesions are thickened and hyperkeratotic with evidence of chronic rubbing and scratching. # Although hydralazine is indicated to control HTN in pregnancy. and individual and partner involvement in a series of at-home exercises. inguinal lymphadenopathy. If biopsy is negative for hyperplasia or carcinoma. # The ulcer of lymphogranuloma venereum --painless . # Low back pain is a very common complaint in the third trimester of pregnancy.. bipolar staining bacteria found within monocytes. # ulcer in chancroid is very painful.# premature labor (28 weeks) ïƒ Bed rest. Kegel exercises (to relax the vaginal muscles).

# Detrusor instability.V. deep dyspareunia. 100 micrograms are administered as an I. even after surgery. multiple congenital anomalies. it is advisable to proceed with ultrasonography. FSH elevation. In GnRH stimulation test. ectopic pregnancy). the probability of a benign disease is very high. in which the increase in female steroid hormones and the resultant apparition of secondary sexual characteristics occurs without activation of the hypothalamic-pituitary axis. # Etiologies of precocious puberty in females can be subdivided into (1)true isosexual precocious puberty. # BehDDs disease is a rare multisystem disorder with an autoimmune etiology and manifests with recurrent ulceration in the mouth and genital area associated with uveitis. These antibodies cross the placenta and can cause thyrotoxicosis in the fetus and the neonate. and often associated with a history of sexual problems. If the mass decreases in size after the menstrual period. whereas genital ones are more destructive. ultimately leading to a completely scared and fenestrated vulva # Anticoagulants are not used for superficial thrombophlebitis unless the disease is rapidly progressing or it extends the deep vein system. # Stress incontinence -. greater than LH elevation # Mild PID is often treated as an outpatient with single dose IM/IV ceftriaxone and PO doxycycline or azithromycin severe PID includes cefotetan (2 g IV every 12 hours) or cefoxitin (2 g IV every 6 hours) plus doxycycline (100 mg PO or IV every 12 hours). bladder irritation from a neoplasm. and within 72 hours after any procedure or incident (e. and often associated with a history of sexual problems. and a fixed retroverted uterus. # Classic endometriosis is associated with premenstrual and postmenstrual pain. # Pelvic congestion presents as a dull ill-defined pelvic ache. This will prevent clot extension into the deep vein system. # RhoGAM is indicated in previously unsensitized(antibody titers <1:6 ) negative women at 28 weeks gestation. usually worse premenstrually. Diabetic neuropathy causes overflow incontinence . presence of oligohydraminos is an indication for delivery #In cases of post-term pregnancy (42-43 weeks). # In cases of intrauterine growth retardation. bolus: A significant release of LH indicates an activation of the pituitary gland. tender pelvic nodes. exogenous estrogen exposure. microangiopathic hemolytic anemia and thrombocytopenia occurs in hemolytic uremic syndrome. it is an antagonist. advanced hypothyroidism and McCune-Albright syndrome. amenorrhea. true isosexual precocious puberty.increased risk of developing clear cell adenocarcinoma of the vagina and cervix. # DiethylstiIbestroI-. # A young woman who presents with a breast lump can be asked to return after her menstrual period for reexamination if no obvious signs of malignancy are present. # Pelvic congestion presents as a dull ill-defined pelvic ache. delivery is mandated.Kegel exercises should be advised in all patients to restore pelvic floor strength. If the pregnancy is more than 42 weeks. and (2) pseudoisosexual precocious puberty.g. abortion. fine needle aspiration biopsy and/or excisional biopsy. the most beneficial treatment is restoration of urethrovesical angle by urethropexy. Mammography is usually not helpful in interpreting the mass because the density of breast tissue is high in young women. whereas in bone tissue. It increases the risk of thrombo-embolism. the cervix is favorable and fetal head is into the pelvis labor should be induced. mostly from ovarian tumors. If the pregnancy is more than 43 weeks. Local heat. short stature and bilateral streaked ovaries. and interstitial cystitis result in urge incontinence.for several months. # Ligation and division of the saphenous vein at saphenofemoral junction is indicated when thrombophlebitis is extensive or is in close proximity to the saphenofemoral junction. usually worse premenstrually. and delivery # Raloxifene is a mixed agonist/antagonist of estrogen receptors. bed rest and NSAIDs are the mainstay of treatment of superficial thrombophlebitis. delivery has to be accomplished. it is an agonist and may be used to treat osteoporosis. but also adrenal tumors. therefore. Oral lesions are aphthalike. # Triad of renal failure. which is secondary to activation of the hypothalamic-pituitary-ovarian axis. # Turner syndrome is characterized by primary ovarian failure. In breast tissue and vaginal tissue. Otherwise. as well as cervical anomalies and uterine malformations. Tx : NSAIDs. Long-term oxybutin therapy is used for motor urge incontinence. the non-stress test and biophysical profile should be performed twice weekly and if there is oligohydramnios or if spontaneous decelerations are noted. Anti staphylococcal antibiotics are indicated when there is an evidence of septic phlebitis. # Primary dysmenorrhea caused by higher level of prostaglandins. relieved by menses. oral cntraceptive pills inhibit ovulation and are also effective. # Long-term bethanechol and alpha-blockers are used for overflow incontinence. relieved by menses.

lasting at least 15 seconds each. MSAFP is routinely performed during the second trimester.#Savage's syndrome. Once the bleeding is stopped. # Pick diseaseïƒ Personality and language changes are often more prominent than other cognitive symptoms. early amniocentesis can be performed before 15 weeks’ gestation when CVS cannot be performed. urinary frequency. screen for neural tube and abdominal wall defects # Tubo-ovarian abcesses are usually managed with triple antibiotic therapy(gentamycin plus clindamycin plus ampicillin). triphasic. this latter should be balanced with medroxyprogesterone if the uterus is still present. Diagnostic features are a rapidly progressive dementia. and to ensure cardiovascular stability. if in 20 minutes. The most common cause of dysfunctional uterine bleeding (DUB) in adolescent women is anovulation. # Creutzfeldt-Jakob disease is caused by a slow virus (prion). XX karyotype. endometrial biopsy is not required in these patients. # Diagnosis of luteal phase defect is confirmed by endometrial biopsy. ( 10-12 w). GnRH agonists have an inhibitory action on the secretion of FSH and LH when given continuously and thus. Patients have a normal pubertal development and typically present with primary amenorrhea. Premarin(estrogen) cream twice daily may be used. ** Antiphospholipid antibodies (such as Lupus anticoagulant and anticardiolipin antibodies).sharp. secondary to a receptor defect. Hydration has a negative feedback on the secretion of ADH as well as oxytocin # Chorionic villus sampling is the best test for detection of fetal chromosomal abnormalities in the first trimester of pregnancy. thus resulting in improvement of peptic ulcer in pregnancy. hirsutism. It is carried out by recording fetal heart rate while the mother is resting on her left lateral side. best next step -. nocturia or even stress incontinence. or ovarian resistance syndrome. Amniocentesis is done between 16th and 18th week of gestation. dyspareunia. or partial vaginal agenesis and presence of a rudimentary uterus. Ovaries are visualized on ultrasound and chromosomal study reveals a 46. which are protective of the gastric mucosal barrier. Patients present with primary amenorrhea and absent secondary sexual characteristics # Mayer-Rokitansky-KDDr-Hauser syndromeïƒ congenital condition secondary to mullerian agenesis.The most common cause of non reactive . Once cardiovascular stability is achieved. and characterized by either a complete vaginal agenesis and absent uterus. which are present in some patients of SLE. Danazol is used when patients cannot tolerate or fail to respond to birth control pills. epithelium is pale with erythematous patches and visible vessels. predispose to recurrent mid trimester fetal loss. with multiple sclerosis have a significant decrease in the incidence of relapses during the 3rd trimester. Treatment is achieved either by reconstructive surgery or serial dilation of the perineal body by the patient. So. They are also considered as second line agents. anytime in both high risk and low risk pregnancies. basal epithelial cells instead of superficial cells)is treated with estrogen. These antibodies are also associated with thromboembolic disease. add 10 mg of medroxyprogesterone for the last 10 to 15 days of treatment. myoclonus and classic EEG findings-. tocolytics are indicated. 2 accelerations of fetal heart rate of at least 15 beats per minute above the baseline. # Pregnancy is associated with increased prostaglandins. deepening of the voice) and cost. 2) when there is a decrease in fetal movements. followed by an increase in the postpartum period. the vulva is diffusely erythematous. which demonstrates a lag in endometrial maturation of 2 days or more as compared with normal states. the test is said to be non-reactive (bad). D&C should be performed. then allow 5-7 days for withdrawal bleeding. These antibodies cause placental infarction leading to fetal growth restriction or death. If less than 2 accelerations are noted in 20 min. urgency. NST is usually performed in 1)high risk pregnancies starting at 32-34 weeks’ gestation. # Bed rest and hydration are the first step in stopping uterine contractions in early stages of preterm labor and if these measures fail.non-stress test (NST). If the patient is not willing to use oral hormones. Drainage(ultrasound guided aspiration) is indicated if there is no response to antibiotic therapy after 24 to 48-hours. A test is considered reactive (good). It is an androgen derivative that causes a pseudomenopause state. is a congenital condition characterized by a failure of the ovaries to respond to FSH and LH. # Atrophic vaginitis(vulvar irritation and a mild clear or yellow vaginal discharge. # Heavy unremitting endometrial hemorrhage through the menarche and perimenopuase requires high dose conjugated estrogens to suppress bleeding. All this in order is to mimic the menstrual cycle. produce a temporary castration. advise the patient to: take 25 mg of oral conjugated estrogen daily for 25 days. synchronous discharges # In the presence of decreased fetal movements. It is used as a second line agent because of its side effects (acne. # Oral contraceptive pills are first line agents in the treatment of endometriosis in young women desiring future fertility. fetal compromise should be suspected.

collard greens. and breads). # Clomiphene citrate is an antiestrogen that acts by competitively blocking estrogen receptors of the hypothalamus. # Premenopausal women with simple or complex hyperplasia without atypia usually respond to therapy with cyclic progestins. the former assesses the duration of the luteal function and the latter the level of the luteal function.NST is sleeping baby. repeat the next day. so vibroacoustic stimulation to wake the baby up. and in the postpartum to suppress milk production. If the score is <4. # Pelvic thrombophlebitis is a diagnosis of exclusion. you can give cyclic progestins. The ovulatory factor involves defects in the hypothalamo-pituitary-ovarian axis and related infertility may be due to impairment of follicular maturation. If acceleration (>15 bpmfor>15 sec) is noted after exposure to the stimulus. 2/fetal movements (3 per 10 min). # Total abdominal hysterectomy is the treatment of choice for uterine rupture. emotional stress. # diagnosis of ectopic pregnancy is entirely made by rapid beta HCG and tranasvaginal ultrasonogram # Danazol is an androgen derivative that has a gonadotropin inhibitory effect. Ovulatory abnormalities may initially be screened by basal body temperature and midluteal level of progesterone. A total score of 8-10 is considered normal. moreover. green leafy vegetables (such as broccoli. abdominal-pelvic bloating. steroid use. Need repeat biopsy after 3-6 months of treatment If a premenopausal woman is diagnosed with complex hyperplasia with atypia and does not want to preserve fertility. Laparoscopy is the procedure of choice for diagnosis and treatment of such conditions. It includes the NST in addition to four parameters assessed by ultrasonography: 1/ Fetal tone. # Tzanck smear-. and spinach) are good sources of calcium. If the score is 6 without oligohydramnios. 4/amniotic fluid index (5-20). Wright’s stain is a combination of eosin and methylene blue. the fetus should be delivered. fibroids and fibrocystic breast disease # Bromocriptine is a dopamine analogue that suppresses prolactin secretion. or endometrial development. If fetal lungs have not yet reached their maturity. smoking. in the absence of oligohydramnios. a vegetarian diet is not a risk factor for osteoporosis. If this latter gives non-reassuring results. Debridement and closure of the site of rupture can be considered in women with low parity or who desire more children. and reassuring. Dark.Identification of a multinucleated giant cell is characteristic of herpes genitalis. the test is considered positive. Danazol and Medroxyprogesterone. and tubo-uterine factor. biopsy should be repeated after 3-6 months. If the score is 4 without oligohydramnios and fetal lungs are mature. menopause. family history of osteoporosis. Rapid response will be noted. Each of these five variables is given a score of two when present. 3/fetal breathing (30 per 10 min). the patient may benefit from foods fortified with calcium (such as orange juice. should only be repeated once or twice weekly until term for high risk pregnancies. So. inhibiting thus the negative feedback estrogen has on GnRH production and consequently increasing FSH and LH secretion. Mild forms of endometriosis usually respond to medical treatment with agents such as GnRH agonists. When it is clinically suspected heparin should be instituted. total hysterectomy is the treatment of choice. ovulation. ovulatory factor. and a score of zero when absent or abnormal. Major complications include ovarian hyperstimulation syndrome (OHSS) and multiple gestation. Along with hMG and hCG it is indicated in cases of chronic anovulation associated with PCOD and mild hypothalamic insufficiency secondary to obesity. intensive exercise. delivery is usually indicated. # The risk factors for osteoporoses include: Thin body habitus. even though the response rates are lower. breast discomfort and abnormal uterine bleeding. It is useful to demonstrate Donovan bodies for diagnosis of granuloma inguinale # The causes of female infertility fall into one of the four following categories: peritoneal factor. contraction stress test should be ordered. hot flashes. If she wants to preserve fertility. and Asian or Caucasian race. . It is used for treatment of prolactin secreting microadenomas. alcohol intake. If the NST is abnormal BPP is the next step. and psychological disorders. cervical factor. malnutrition. for ovulation induction in patients with amenorrheahyperprolactinemia. Side effects include ovarian enlargement. delivery should be considered. It should be suspected in any postpartum patient with persistent spiking fever for 7-10 days despite adequate antibiotic therapy. It is indicated in endometriosis. The peritoneal factor is the most common and includes endometriosis and peritoneal adhesions. and improving ovulation. cereals. if it gives suspicious results. steroids injection should be administered and BPP assessed within 24 hours. In the presence of oligohydramnios (AFI <5) delivery is to be considered since it can result in umbilical cord compression and therefore fetal compromise Contraction stress test is indicated when the BPP score is 6.

and the patient should be monitored every 4-6 weeks for dose adjustments. hyponatremia and seizures *** Estrogen replacement therapy increases the requirement for L-thyroxine in patients receiving estrogen replacement therapy. Abnormal development of the olfactory bulbs and tracts result in the hyposmia or anosmia (decreased sense of smell). Because of such limitations. In pregnancy. smoking. and present with amenorrhea. If the patient has an adequate estrogen production and a history of intrauterine instrumentation. an enlarged and generally symmetrical soft uterus.5. The usual method serving this purpose is the progestin challenge test. When adding potassium hydroxide. cervical ectopy created by oral contraceptives may preferentially predispose to colonization with C trachomatis. weight gain. and an increased volume of the distribution of thyroid hormones. The subsequent step should be the determination of the patient's estrogen status. thyroid hormone requirements will be increased. then hyperprolactinemia. decrease in fetal heart rate by 15 beats/sec from baseline for at least 15 seconds. Fetal cord compression presents with variable decelerations # Kallmann's syndrome consists of a congenital absence of GnRH secretion associated with anosmia and a normal karyotype. to a sinusoidal pattern # Bacterial vaginosis caused by Gardnerella vaginalis manifests with a profuse ivory to gray malodorous discharge with a pH of 5 to 6. Patients with PCOD are not at risk for ovarian carcinoma # Patients with polycystic ovarian disease are at risk of developing type II diabetes # Hypertension and diabetes are risk factors for endometrial cancer. oral contraceptive pills. clinical methods such as assessment of cervical mucus. A ruptured fetal vessel presents typically as an antepartum hemorrhage with fetal heart deterioration. # The most common cause of mucopurulent cervicitis is Chlamydia trachomatis. # Endometritis caused by mostly Anaerobes. ovarian rupture. and endometrial thickness. If estrogen production is inadequate. section. Clue cells are characteristic epithelial cells diffusely coated with the organism. internal reproductive organs are present. Identifying "clue cells" on a wet-mount makes the diagnosis. ampicillin or first generation cephalosporin. # Late childbirth and pauciparity are risk factors for breast cancer Risk factors of cervical cancer include young age at first coitus (<20). Symptoms and signs include abdominal pain. OHSS may be complicated with ovarian torsion. nausea. If pregnancyïƒ intravaginal cream or metronidazole cream # Lichen sclerosisïƒ tx: 'superpotent topical corticosteroids' such as clobetasol or halobetasol. pregnancy. # Candida vaginitis is not considered a sexually transmitted disease and occurs in presence of risk factors such as diabetes mellitus. hypotension and pleural effusion. # CA-125 levels are used in ovarian carcinoma for follow-up after treatment. patients have hypogonadotropic hypogonadism. occuring at the same time as the uterine contraction. #Adenomyosis defined as the presence of endometrial glands in the uterinemuscle occurs most frequently in women above 40 and typically presents with severe dysmenorrhea and menorrhagia. young age at marriage and at first pregnancy. and low socioeconomic status. Itching and burning are not usual. and hypothyroidism. progressing from tachycardia. FSH levels should be ordered to determine the gonadal or central origin of the disorder. Tx: oral metronidazole. multiple sexual partners. . # ovarian hyperstimulation syndrome -. pregnancy and immunosuppressive therapy. high parity. abdominal distension. then Asherman's syndrome should be suspected. Besides that. The potential causes may include induction of liver enzymes. to bradycardia. are more and more employed. # The first step in a patient with secondary amenorrhea is to rule out common situations. increased level of TBG. Patients with no such history are virtually all anovulatory or oligo-ovulatory. thrombophlebitis and . Ovaries are enlarged on Ultrasound and serum electrolytes and hematocrit are elevated. vaginal epithelial cell maturation. diarrhea. this method is progressively abandoned.risk endometrial cancer Patients are treated with combined oral contraceptive pills or cyclic progestins. anosmia and absent secondary sexual characteristics. #Vasa previa or fetal vessel rupture necessitates immediate C. also. # Excessive use of oxytocin may cause water retention. # Asymptomatic bacteriuria increases the risk of cystitis and pyelonephritis in pregnancy Treatment : a 7 to 10-day course of nitrofurantoin.# PCOD is characterized by an unbalanced estrogen secretion that may result in endometrial hyperplasia. the discharge gives a characteristic amine or "fishy" odor. that is. however. as it relies on the patient's compliance and may not result in withdrawal bleeding. although. despite the presence of adequate endogenous estrogen. # Early decelerations are due to fetal head compression. vomiting. Tx: clindamycin with either aminoglycoside or ampicillin.It develops in 5 to 7 days after hMG or hCG administration and refers to an acute increase in vascular permeability of enlarged ovaries.

OCP are steroid compounds. 11-alpha-hydroxylase deficiency. With tamoxifen therapy. Inhaled steroids are ok in pregnancy. But in Gonococcal infections empiric treatment of Chlamydia is recommended since is it difficult to identify Chlamydia on smears. increasing the risk of endometrial carcinoma. clear and thin # All patients with primary amenorrhea and high FSH levels need to have a karyotype determination # Labor should be induced immediately in patients with intrauterine fetal demise who develop coagulations abnormalities. the overall mortality is decreased from breast cancer. but also in preventing development of carcinoma in the opposite breast. cerebrovascular disease. Ml. because the excess of T3 and T4 is bound to the excess of TBG. patients usually develop hot flashes and vaginal dryness. this risk is small (1. and positive cases should be treated with penicillin G during labor # hyperemesis gravidarumïƒ 1st HCG measurement. Normal TSH **In Chlamydial infection. Then screen gestational diabetes # The major cause of death in eclampsia is hemorrhagic stroke. not only in preventing recurrences. across the midline and across suture line # Craniopharyngiomas derived from epithelial remnants of Rathke’s pouch. sometimes ecchymotic. however. # Lithium is associated with the congenital anomalies. This increase. gallblader disease and benign hepatic tumors. cause bi-temporal hemianopia by pressing optic chiasma. When a woman is treated with isotretinoin. classically Ebstein's anomaly.renal insufficiency. # Clotrimazole cream is an effective treatment for Candidal vaginitis. There may also give signs and symptoms of Diabetes Insipidus. # Benign glycosuria is a very common finding in pregnant women because of decreased renal thresholdïƒ 1st step Obtain fasting urine sample rule out other causes. Cput succedaneum is a diffuse. possibly by the TSH action of hCG. however. X-ray: calcified lesion above the sell # Arthrocentesis and empiric treatment with IV nafcillin are the most appropriate measures for the management of suspected septic arthritis in a child. empiric treatment of gonorrhea is not recommended. may worsen diabetes they do not precipitate diabetes in a nondiabetic patient. swelling of the scalp.Staphylococcus aureus. presents few hours after birth limited to the surface of one cranial bone. does not result in clinical symptoms. # Diabetes screening is also mandated in all pregnant women between 24 and 28 weeks gestation. cause sodium and water retentionïƒ worsening of hypertension. # Mastitis-. and partners need not be treated. Tamoxifen has a great adjuvant role. . production of total T3 and T4 is increased (but not serum free T4 and T3). **High estrogen levels accompanying pregnancy result in an increase in thyroid binding globulin (TBG). cervical mucus is profuse. Because of its antiestrogenic effects. # In the ovulatory phase. Treatment is supportive. salt wasting. OCPs expose to other complications such as thromboembolism. 2nd Ultrasound # Treatment for overflow incontinence(detrusor hypotonia) include cholinergic agents and intermittent self-catheterization. which results in androgen and mineralocorticoid excess # Cephalohematoma is a subperiostal hemorrhage. It acts as an agonist on the endometrium. # Tamoxifen-. Tx: penicillinase-resistant antibiotic such as oral dicloxacillin # Missed abortion involves a dead fetus that is still retained in the uterus # Delivery is definitive treatment of HELLP syndrome in women beyond 34 weeks gestation Pedia: #21-hydroxylase deficiency is the most common form of CAH.1%) and is seen only in postmenopausal women. she should be under strict contraception. Symptoms generally resolve in 1 to 2 weeks. but may be more severe and persist longer if pregnancy is successful. It presents with virilism(ambiguous genitalia at birth). Tx: Single dose Azithromycin plus single dose IM Ceftriaxone # Screening cultures for group B streptococcus should be performed at 36-37 weeks gestation. Diagnosis is suggested by increased levels of 17-alpha-hydroxyprogesterone and confirmed with ACTH stimulation test. and increased 17-alpha-hydroxyprogesterone levels.mixed agonist-antagonist action on estrogen receptors. Its agonist effect on bone tissue protects from osteoporosis. # Laparoscopy is the gold standard of diagnosis of endometriosis # OCPs have been shown to decrease the risk of ovarian and endometrial carcinoma.

usually disappear by the first few years of life. a highly malignant tumor. if untreated. It is a flat vascular lesion and usually disappears in early childhood. visceromegaly and omphalocele. Clinical features include mental retardation. Diagnosis is made by clinical findings in the presence of calcifications on US or CT scan. peripheral neuropathy. # WAGR syndrome consists of Wilms’ tumor. It arises from neural crest cells which secondarily populate sympathetic ganglia and adrenal medulla. increased risk of neoplasms such as Wilms1 tumor. influenza in patients with splenectomy or functional asplenia. peripheral motor sensory neuropathy and seizures. and neck. Treatment mainly involves administration of high doses of Vit B6. paralysis. back pain. deletion in chromosome 11. # Denys-Drash syndromeïƒ male pseudohermaphrodism and early onset renal failure characterized by mesangial sclerosis with increased risk of Wilms’ tumor # Von-Gierkesïƒ deficiency of glucose-6-phosphatase. Anencephaly and neural tube defects.# Always consider antibiotic prophylaxis and vaccination against Pneumococci and H. Duodenal atresia and small left colon. malleable splints. It is an autosomal recessive disease caused by cystathionine synthase deficiency. Transposition of great vessels. prominent eyes. 2. ear creases and hyperplasia of the pancreas. # Iron supplementation in the form of iron-fortified milk formula or medicinal iron. well-demarcated. and thromboembolic events # Clubfoot is initially managed with stretching and manipulation of the foot. Electron microscopy shows diffuse effacement of foot processes of podocytes. #Galactosemiaïƒ # The first step in the management of an infant with suspected congenital diaphragmatic hernia is the placement of an orogastric tube. leads almost invariably to death because of liver and brain metastases. # Mongolian spot ïƒ a flat. In the typical clinical scenario. and gray-pigmented lesion over the sacral area. # DiGeorge syndrome results from microdeletion of 22q11 # strabismus -. followed by serial plaster casts. and is preferably performed between 3 and 6 months. Hypoglycemia caused by failure to release glucose from the liver into the circulation. Surgical treatment is indicated if conservative management gives unsatisfactory results. hypoglycemia and hyperinsulinemia. . and gonadoblastoma. eyelids. Caudal regression syndrome. or taping. # A leukocoria is a retinoblastoma until proven otherwise. # Salmon patch is a flat salmon-colored lesion commonly seen over glabellas.most common cause of amblyopia. and a palpable "step-off" at the lumbosacral area present if the disease is severe. It results from inactivation of the Rb suppressor gene # Metanephros is at the origin of Wilms’ tumor # Neuroblastoma is the third most common cancer in the pediatric population (after leukemia and CNS tumors). # The common congenital problems in an infant of diabetic mother are: 1. genitourinary anomaly and mental retardation. The most common cause of bacteremia or sepsis in sickle cell disease is Pneumococcus. deafness. # Spondylolisthesis is a developmental disorder characterized by a forward slip of vertebrae (usually L5 over S1) that usually manifests in preadolescent children. They may also develop kidney and heart failure. prominent occiput. Restriction of methionine along with supplementation of cysteine is used for patients not responsive to Vitamin B6 therapy. Classic clinical features include angiokeratomas. macroglossia. # Krabbe's is a sphingolipidosis due to a deficiency in beta-galactosidase. neurologic dysfunction (urinary incontinence). # Beckwith-Wiedemann syndromeïƒ macrosomia. Tx: Continuous covering of the normal eye # Presence of inflamed tympanic membrane and diminished movement of the membrane with insufflation are the hallmarks of otitis media. 4. #Fabry's disease is also a sphingolipidosis --deficiency of alpha-galactosidase. microcephaly. Aniridia. and asymptomatic corneal dystrophy. hepatoblastoma. blindness. should be started at 6 weeks in all premature and low birth weight babies # Marfan’s features + mental retardation + thromboembolic events + downward dislocation of the lens = Homocystinuria. # Diffuse thickening of glomerular basement membrane and subepithelial spikes are characteristic for membranous glomerulonephritis # Minimal change disease Light microscopy and immunofluorescence does not usually reveal any change in kidney architecture. total absence of myelin. 3.

represents as delayed relaxation of the affected muscles after contraction. x-ray: fine reticular granularity of the lung parenchyma. a workup for sickle cell anemia should be done in these patients. It is the earliest manifestation of vaso-occlusion in sickle cell anemia.# Group B streptococcus is the most common cause of neonatal sepsis. -. inability to release the handshake. spiteful and argumentative. bowel or bladder control. Argon laser therapy is successful in removing the skin lesions. symmetrically involving the hands and feet. may also be hemianopia. associated with multiple endocrinopathies(testicular atrophy. occurs in children ages 6 months to 2 years. cataract. have normal cognitive and language development. leading to precocious puberty. # Sturge-Weber-. especially in the distal muscles of the hands. reveal gyriform intracranial calcifications that resemble a tramline. does not develop endocarditis. intravenously during labor and delivery. Dactylitis presents with the acute onset of pain and swelling. play and motor skills. Listeria is the third # myotonic muscular dystrophy—AD. # Urinalysis is a fundamental test that should be performed in all urologic patients. # Granulosa cell tumors produce excessive amounts of estrogen. Muscle abnormalities begin in childhood and continue slowly into adulthood and include weakness and progressive muscle wasting. # Hand-foot syndrome. treatment :echanical ventilation and surfactant. social skills. # ASD is the only congenital heart disorder. repetitive and stereotyped patterns of behavior. which occurs more commonly in males. or dactylitis. It is characterized by a period of normal development for at least two years. It is part of the normal vaginal flora of women and is transmitted to infants during their passage through the birth canal. It may also involve an estrogen-secreting tumor. disobedient. # Retinal hemorrhage is considered to be an extremely ominous sign of preeclampsia # McCune-Albright syndromeïƒ precocious puberty. Treatment is aimed at controlling seizures and reducing intraocular pressure. prolactin or GH-secreting pituitary adenomas and adrenal hypercortisolism. obeys 2-step command: 2 years Gross motor development: Holds head: 3 months Rolls back to front and front to back: 4 months Sits well unsupported: 6 months Walks alone: 12 months Walks up and down stairs without help: 24 months Fine motor development: Raking grasp: 6 months . # Asperger disorder is characterized by a qualitative impairment in social interaction and restricted. # Pyloric stenosis is a surgical condition. and can present with precocious puberty in younger children and postmenopausal bleeding in elderly patients. # Language development: Social smile: 2 months Babbles: 6 months 2 words. and ipsilateral glaucoma. deliberately annoy others. # Oppositional defiant disorder is a childhood behavioral disorder.Hyaline membrane disease. such as hyperthyroidism. # Childhood disintegrative disorder is a rare pervasive developmental disorder. Caused by defect in the G-protein cAMP-kinase # Peutz-Jeghers syndrome is characterized by gastrointestinal tract polyposis and mucocutaneous pigmentation.mental retardation. and often blame others for their mistakes. and anterior compartment of the lower legs. Hence. diabetes mellitus. intellectual impairment and dysmorphic facies. frontal baldness. Associated with other endocrine disorders. and hypothyroidism). # Voiding after intercourse has been shown to decrease the risk of UTI in sexually-active females.defiant and hostile behavior. posterior forearm muscles. neurologic abnormalities. # The incidence of vertical transmission of HIV can be reduced from 25% to 8% by administrating ZDV to pregnant women and their offspring. Skull X-rays. seizures. surgery should be undertaken only after the infant has been resuscitated and electrolytes replaced. This is followed by a loss of previously acquired skills in at least two of the following areas: expressive or receptive language. easily annoyed. Escherichia coli—2nd. immunologic deficiencies. cafe au lait spots and multiple bone defects (polyostotic fibrous dysplasia—fractures). # ARDS-. visual impairment and a characteristic port-wine stain over the territory of the trigeminal nerve. Patients are usually normal at birth. and orally to the neonate for the first 6 weeks of life. hemisensory disturbance. obeys 1-step command: 1 year 2-3 word phrases. Myotonia-. hemiparesis. ZDV is administered orally during pregnancy after the first trimester.

Maintaining the patency of the ductus arteriosus is important for survival. and red blood cell precursors in the bone marrow are decreased. Parinaud's sign (paralysis of vertical gaze).brachial palsy. It is characterized by a cystic structure with presence of calcifications # In the pediatric population. and subsequently with behavioral arrest accompanied by involuntary automatism. # Erb-Duchenne palsy -. 3. Normal WBC and platelet counts. single and loud S2. Erythropoietin is not routinely used. It consists of hand paralysis and ipsilateral Horner’s syndrome (ptosis and miosis). # Meningitis may be complicated by regression of developmental milestones. a normal S1. # Pinealoma develops in the dorsal aspect of the midbrain. 2. Peripheral smear shows normocytic and normochromic anemia. No other abnormal forms are seen. and symptoms usually include visual field defects and endocrine syndrome. fifth and sixth cervical nerves. and Collier's sign (retraction of the eyelid). # erythema toxicumïƒ eosinophils in the skin lesions Milia are small pearly white cysts ** Transposition of great vessels is the most common cyanotic heart disease which presents with cyanosis in the first 24 hours of life. # Craniopharyngiomas arise in the sella turcica. 4. Postexposure prophylaxis with VZIG is preferred and indicated in susceptible high-risk persons exposed to varicella within 96 hours (preferably 72 hours) of exposure. Normal total bilirubin level.usually crosses the midline and diagnosis is made by urinary metabolites of catecholamine. there is a postictal confusion or aphasia. associated with Beckwith-Wiedemann and DenysDrash syndromes. # Increased gastric residues in a preterm neonate is highly suspicious for necrotizing enterocolitis. Symptoms consist of endocrine syndrome. autonomic or psychic symptoms without alteration in consciousness. # The 24-hour esophageal pH monitoring is the gold standard for the diagnosis of . and is secondary to injury to seventh and eighth cervical nerves and first thoracic nerve. absent Moro reflex and intact grasp reflex of the affected arm. If the child age is less than 1 year think of neuroblastoma-. Postexposure prophylaxis for chicken pox is provided with VZIG (Varicella Zoster Immune globulin) or acyclovir. with a characteristic positionïƒ adduction and internal rotation of the arm with pronation of the forearm. subcostal retractions. # Thyroid dysgenesis is the most common cause of congenital hypothyroidism in United States. sensory. Treatment: The treatment involves iron supplementation. intracranial hypertension. # A simple-partial seizure causes either motor. # Diagnosis of anemia of prematurity: 1. Surgical treatment is definitive. The reticulocyte count is low. # Complex-partial seizures present with an aura.Throws object: 12 months Builds tower of 2 blocks: 15 months Builds tower of 6 blocks/turn pages of books: 24 months Social development: Recognizes parents: 2 months Recognizes strangers (stranger anxiety): 6 months Imitates action/comes when called: 12 months Plays with other children: 18 months Parallel play: 24 months # Klumpke paralysis—Klumpke’s paralysis is a brachial palsy that occurs in newborns following excessive traction on the arm. and benign astrocytomas are the most common histologic type in both group. or risk factors for coronary artery disease should get a screening test for total cholesterol level. infratentorial tumors are more common than supratentonal tumors. but does effectively reduce disease severity. does not cross the midline. # Midgut volvulus usually presents in a child less than one month with bilious vomiting. abdominal distension and bloodstained stools. periodic hemoglobin checking and blood transfusion if needed. It is commonly seen in infants of diabetic mothers and in males w tachypnea. # Children with a parental history of elevated total cholesterol levels (>240 mg/dL). one has to think of Wilms tumor. # Iodine deficiency or endemic goiter is the most common cause of congenital hypothyroidism worldwide but essentially not seen in the United States. # Vitamin A reduce morbidity and mortality of measles # Immnunoprophylaxis with VZIG may not prevent infection. # In a young child of 2-5 years age with a localized abdominal mass and hematuria. and no murmur.

hostile. Prolonged PTT. aggravated by feeding and relieved by cryingïƒ choanal atresia. low-set malformed ears. normal fibrinogen level and low serum factor VIII activity .aggression. rocker-bottom feet. scalp defects. Tx: ceftriaxone.more than 60% of the femoral head slips off of the metaphysic Mild SCFE may be treated conservatively by regular use of crutches to keep weight off the affected hip. temper outbursts. presents with cleft lip. and hyperactive.approximately 30-60% of the femoral head slips off of the metaphysis Severe . It involves occlusion of end arteries supplying the femoral head. # an upper respiratory tract infection and later develops a rash after exposure to ampicillin or amoxicillin ïƒ infectious mononucleosis caused by Epstein-Barr virus ** Aseptic necrosis of the femoral head is a common complication of sickle cell disease. bone necrosis. Definitive treatment consists of repairing the obstruction with surgery or endoscopy # Edwards' syndrome--closed fists with the index finger overlapping the 3rd digit and the 5th digit overlapping the 4th. ocular hypotelorism. EKG demonstrates right atrium dilation and right ventricle hypertrophy. # Parainfluenza virus is the most common agent responsible for croup in children. or Patau's syndrome. Staphylococcus aureus and anaerobes are common causes of chronic sinusitis #Streptococcus pneumonia is the most common cause of acute sinusitis in childhood. and will often be droolingïƒ Tx: Endotracheal intubation with a set up for tracheostomy # Nebulized Racemic epinephrine and oral dexamethasone are the management options for Croup # The infantile form of botulism is different from the adult form: Infantïƒ the Clostridium botulinum gains entry through the food. Diagnosis is made by the failure to pass a catheter through the nose 3-4 cm into the oropharynx. alcoholism. Most cases (90%) are associated with ventricular septal defect. the child assumes a position with his head tilted to the left side and his back arched # Tricuspid atresia is a cyanotic congenital heart disease characterized clinically by cyanosis that appears early in life and left axis deviation. small abnormal skull. # Surgery used for primary coarctation. Infant w this disease ïƒ posturing of Sandifer’s syndrome -during the vomiting episodes. treatment is balloon angioplasty.approximately 30% of the femoral head slips off of the metaphysis. Gonococcal conjunctivitis is the most destructive to the eye. # Moderate to severe degree of slipped capital femoral epiphysis requires surgery. prominent occiput.gastroesophageal reflux disease. visceral and genital anomalies. # Ebstein’s anomalyïƒ extreme cardiomegaly with marked right atrial enlargement. property destruction. in tetralogy of Fallot. and defiant behavior towards adults. cardiac malformations. which causes release of factor VIII from the endothelial cells. Recoarctation can present years later with upper extremity hypertension and diminished lower extremity pulses. Both tetralogy of Fallot and tricuspid atresia have normal heart size and decreased vascular marking on chest x-ray. normal prothrombin time. and eventually collapse of the periarticular bone and cartilage. # hemophilia--factor VIII assay is diagnostic. micrognathia. and 30% are associated with transpositioned great arteries. range of external rotation is normal. cardiac and renal malformations # Trisomy 13. CT scan with intranasal contrast. microcephaly. have stridor and highgrade fever. and deliberate annoyance # Conduct disorder-. They appear very toxic. theft. and Gaucher's disease . # Neonatal chlamydial conjunctivitis is treated with systemic erythromycin because of the risk of pneumonia. Moderate . narrow hips with limited abduction.The standard treatment for hemophilia is to replace the factor VIII. mild hemophilia may be treated with desmopressin (DDAVP). The first step in management consists of placing an oral airway and lavage feeding. and deceitfulness # Silver nitrate is administered to all neonates at birth to prevent Gonococcal conjunctivitis. it presents as a hyperacute and highly purulent conjunctivitis that appears 2 to 5 days after birth and may result in corneal perforation and permanent loss of vision if left untreated. SCFE has three degrees of severity: Mild . However. resulting in displacement. limitation on internal rotation. ** cyanosis. flexed fingers with Polydactyly. failure of the growth plate between the femoral neck and femoral head. # Oppositional defiant disorder usually presents in adolescence with negativistic. followed by Haemophilus influenzae and Moraxella catarrhalis. especially in . microphthalmia. It may cause mild conjunctival irritation and tearing that resolve generally within 24 hours. bulbous nose. impulsivity. cerebral malformation. short sternum. # Epiglottitis is seen in children 3-7 years of age. excessive talking for more than 6 months & than one setting (school and home). Same as otittis media # Attention deficit hyperactivity disorder--short attention span. non-traumatic causes of avascular necrosis of the femoral head include chronic corticosteroid therapy. which shows a narrowing at the level of the pterygoid plate. normal bleeding time. hypoplastic or absent ribs. Arguments. SLE.

Legionella # Gram-positive rods D Listeria. cherry-red spot in retina and neurologic symptoms ** The growth of axillary hair results from androgen secretion by the adrenal glands (adrenarche). no specific treatment is required.deficiency of Hexosaminidase. aberrant production or attachment of dynein arms-. # Kawasaki disease or mucocutaneous lymph node syndrome is one of the most common causes of generalized vasculitis in children. Aspirin is useful for fever and arthritis. which rupture giving a thick adherent crust with characteristic golden yellow appearance # Surgery is advised in umbilical hernia if the hernia persists to the age of 3-4 years. # Iron poisoning --Tx Deferoxamine. immobilization may be required using a figure-of-eight strap # Milk protein intolerance may present with vomiting and bloody diarrhea. then repeated 6 to 8 weeks later. # Asperger syndrome-. Pseudomonas. echocardiography performed within 7 days of the disease onset. on x-ray-dextrocardia (the apex of the heart is in the right chest). There is no covering of the intestines and umbilicus is normal. hypoglycemia. pathological fractures. protruding abdomen. # GM2 gangliosidoses include Tay-Sachs and Sandhoff's -. The diagnosis made by lymphoid follicles on the conjunctiva. impaired cilial function # Acute severe exacerbation in patients with cystic fibrosis caused by **pseudomonas aeruginosa. causes symptoms. Hemophilus. is used IV in moderate to severe intoxications # Gastroschisis is diagnosed at birth by protrusion of bright red intestines to the right side of the umbilicus. Erlenmeyer flask deformity of the distal femur. Legionella The common organisms cause pneumonia in cystic fibrosis are: Hemophilus. #Kartagener’s syndrome -.Galactose-1-phosphate uridyl transferase deficiency: jaundice. and a rapidly progressive neurodegenerative. caused by Chlamydia trachomatis is the most common cause of blindness in the world. It is a surgical emergency. Bacillus Gram-negative rods D Pseudomonas. Autosomal recessive. and regression of developmental milestones.honey and produces the toxin in the intestinal tract Adultïƒ the toxin ingested produces the symptoms # Werdnig Hoffmann's diseaseïƒ Degeneration of the anterior horn and cranial nerve motor nuclei # Gaucher’s disease-. becomes strangulated. hepatomegaly. vomiting.deficient activity of the lysosomal enzyme acid beta-glucosidase. # GM1 gangliosidosis results from the deficient beta-galactosidase-. Impetigo is a superficial skin infection with multiple vesiculopustules on the exposed areas of face and extremities. and bronchiectasis. # Clavicular fracture-. renal function returns to normal in 1 . Hematuria may persist for up to 6 months. the sac is covered with peritoneum without overlying skin. Klebsiella. Influenza vaccination is recommended in patients with Kawasaki's disease taking life long aspirin therapy # Bedwetting is a normal phenomenon until the age of 5. is generally benign and has no clinical significance. recurrent sinusitis. # Pyloric stenosis presents with non-bilious vomiting in a 4 to 8-week-old child. ** Remember. failure to thrive. Gram-positive rods D Listeria. or if it enlarges progressively after the age of 1 to 2 years. # An omphalocele is a herniation or protrusion of abdominal contents into the base of the umbilical cord. Stools may show RBCs and eosinophils # Galactosemia-.Generally. Klebsiella.C3 and CH50 levels are low resolve in 8 to 12 weeks. jaundice and hypoglycemia for galactosemia. Tx: hospitalized with intravenous immune globulin (IVIG) and high-dose aspirin. Premature adrenarche. Hemophilus.2 weeks . increased risk for Escherichia coli neonatal sepsis. and thickening of the calvarium. and abdominal ultrasound confirms the diagnosis. aminoaciduria. exceeds 2 cm in diameter.situs inversus. or mental retardation. # Topical mupirocin or oral erythromycin is the treatment of choice for local impetigo. lymphadenopathy. Bacillus Gram-negative rods D Pseudomonas. poor weight gain. convulsions. hepatic cirrhosis. failure to thrive. Immediate surgical repair # Acute post streptococcal glomerulonephritis-. # Positive anti-Smith antibodies and/or anti-double stranded DNA antibodies is specific and confirmatory for the diagnosis of systemic lupus erythematosus. cherry red macula.language development is normal. and characteristic Gaucher cells with their wrinkled paper appearance in bone marrow # Niemann-picks-. hepatosplenomegaly. Rarely. scarring and limbal follicles.deficient sphingomyelinase. and H. S. an iron chelator. bilateral cataract. or the isolated appearance of axillary hair before the age of six years. Staphylococcus. IVIG has been shown to reduce the incidence of coronary artery aneurysms and other complications. aureus. bone pain. enlargement of the sella turcica.hepatosplenomegaly along with skeletal abnormalities including anterior beaking of the vertebrae. # Trachoma.

dysarthria). also associated with necrosis and degeneration of cardiac muscle fibers leading to myocarditis. or glaucoma are also frequently found in the neonatal period. cardiac defects (atrial or ventricular septal defect. diabetes. severely impaired hearing X-linked ALD is a genetically determined disorder associated with the accumulation of saturated very long chain fatty acids and a progressive dysfunction of the adrenal cortex and nervous system white matter. disturbances of vision. prematurity. The serum immunoglobulins and antibody deficiencies in CVID may be as profound as in XLA but with normal numbers of circulating immunoglobulin-bearing B-lymphocytes # Wiskott-Aldrich syndrome-. which may be complicated by Volkmann’s ischemic contracture. # X-linked agammaglobulinemia (XLA) is characterized by four findings: 1 . and redundant skin fold of the neck. # Hyper-IgM syndrome (HIM) is characterized by high levels of IgM with deficiency of IgG. Intravenous antibiotics are required along with surgical drainage # Displaced anterior fat pad is a radiographic sign of supracondylar fracture. resulting in an abnormality of a tocopherol transfer protein. type 2 diabetes later in life # Laryngomalacia or congenital flaccid larynx is the most common cause of chronic inspiratory noise in infants. presents with intestinal obstruction and red currant jelly stools containing blood and mucus. and pigmentary degeneration of the retina(impaired vision) # treatment of Bordetella pertussis infection is erythromycin for 14 days. IgA and poor specific antibody responses to immunizations. recurrent bacterial infections in the first 5 years of life. presenting with low IgG levels. like scoliosis and hammer toes. cataract.Absent isohemagglutinins or poor response to vaccines. Need hold the child in an upright position for half an hour after feeding. and hence. epicanthal folds. . neurologic features including mental retardation. Severe weakness and hypotonia. # Turner's syndrome with 46 XY ( usually 45XO )karyotype is associated with a higher incidence of gonadoblastoma. frequent falling. choreoathetosis and spasticity. gait ataxia. up-slanting palpebral fissures.# Meckel's diverticulum usually presents at 2 years of age with painless rectal bleeding. high IgA and IgE # Fetal alcohol syndrome is characterized by midfacial abnormalities (short palpebral fissures. and skeletal deformities. 3. # Septic joint is a true surgical emergency in pediatric orthopedics and needs immediate surgical drainage as delay of even 4-6 hours can lead to avascular necrosis of the femoral head. epicanthal folds. long philtrum. seizures. the most common cause of intestinal obstruction in the first two years of life. Symptoms are generally first noted between the ages of 4 and 8 years. # neonatal adrenoleukodystrophy-. posterior columns. # Friedreich ataxia-. thin upper lip). persistence of arterial canal). growth retardation and mental retardation. The most common initial manifestations are hyperactivity. and to never feed the child when he is lying down. and recurrent infections with encapsulated germs in a young boy.gait abnormalities.eczema.Enlarged liver and impaired liver function.finding of an epiglottis rolling in from side to side is diagnostic. 2. and dysarthria. skeletal (scoliosis. If you see a boy with gout. an excessive number of trinucleotide repeat sequences. myocardial fibrosis and hypertrophic cardiomyopathy. IgM and IgA levels. #Common variable immunodeficiency (CVID) is a heterogeneous syndrome. laryngoscopy-. Gout is usually seen in patients of above 50 years of age. multiple joint anomalies. # Intussusception. Neurological manifestations result from degeneration of spinal tracts (spinocerebellar tracts. ataxia. sausage-like mass palpable # Obesity is a risk factor for uterine cancer. # lithium—Ebstein’s anomaly # Self-mutilation in the presence of dystonia is characteristic of Lesch-Nyhan syndrome. and strabismus # Refsum disease-. prophylactic bilateral gonadectomy is indicated. # Zellweger's syndrome is a disorder due to a defect in peroxisomes. virtually all infants the symptoms disappear by two years of age.deficiency in hypoxanthine-guanine phosphoribosyl transferase (HRPT). 4. thrombocytopenia. hypoplastic supraorbital ridges.Serum IgG. pigmentary degeneration of the retina. sensorineural hearing loss. The most common causes of deaths are cardiomyopathy and respiratory complications Remember the combination of neurologic (ataxia. dystonia.autosomal recessive. pyramidal tract).Less than 2% CD19+ B cells in the peripheral circulation. HIM presents with recurrent sinopulmonary infections and Pneumocystis carinii pneumonia. suspect this. It is an Xlinked recessive disorder-. neonatal seizures. Features of diagnostic importance are the typical facial appearances of high forehead. wide-open sutures and eye abnormalities such as a cloudy cornea. Infants with Zellweger's syndrome rarely live more than a few months. poor handwriting. feet deformities) and cardiac (concentric hypertrophic cardiomyopathy) manifestations of the disease. low IgM. IgM and IgA values at least 2 SD (standard deviation) below the normal for age.

hepatomegaly. HUS and TTP. kidneys.deficiency phenylalanine hydroxylase ïƒ accumulation of phenylalanine in body fluids. blonde with fair skin and blue eyes. and iron-fortified cereal should be added at the age of 4-6 months. and occurs in rapid progression (3 days) from face to trunk. # Deficiency of branching enzyme -.Von-Gierkes: hepatomegaly w hypoglycemic seizures. Lab findings include hyperammonemia. and routine care should be provided to the infant. progressing to lethargy. # Infection by respiratory syncytial virus may increase the risk of asthma in later life. When phagocytes extract this rigid precipitate. is common in patients with sickle cell anemia. Hepatomegaly. and brain.posterior cervical lymphadenopathy. Leukopenia # American Academy of Pediatrics advises against the use of cow's milk in the first year of life. which are generally removed by functional spleen. # Pompes1 disease -. otherwise known as hand-foot syndrome. or any CNS complication within 7 days of administration of the vaccine is a contraindication for further administration of DTaP ** Mammary gland enlargement and non-purulent vaginal discharge are common findings in newborn infants. short stature. and a positive osmotic fragility test points towards hereditary spherocytosis. they form the characteristic Bite cells # Helmet cells are fragmented RBC. # 3 years. # Classic phenylketonuria -.deficiency of glycogen debranching enzyme. agitation. hyperuricemia. and irrational behavior. ALT. # Maternal HIV infection is an absolute contraindication to breast-feeding. # Howell Jolly bodies are characteristic findings seen in the peripheral smear (PS) of patients with functional asplenia due to sickle cell disease. common see in G6PD deficiency and thalassemia. 6 years. Howell-Jolly bodies are the nuclear remnant within the RBC.copies a diamond # Tx: ITP when pt < 30000/mm3 w corticosteroids # supracondylar fractures of humer ïƒ Brachial artery injury # Rib notching. Infants should receive breast milk or iron fortified formulas for the first year of life. hypoglycemia. but blood lactate and uric acid concentrations are usually normal. and moderate to severe elevations in AST. 5 years.diagnosis as well as the follow-up is CT scan of the head # the highest morbidity and mortality after HUS is the kidneys damage.aggregates of denatured hemoglobin. # The cerebral lesions in Sturge-Weber syndrome are histologically similar to the facial lesions. elevation of liver transaminases level and fasting ketosis are prominent. not Muscle biopsy # Painless gross hematuria is the most common presentation of sickle cell trait # Frequent UTI is found to occur in pregnant individuals with sickle cell trait. an encephalopathy. # Glucose-6-phosphatase deficiency-. hyperlipidemia growth retardation. ** The adverse reactions to the DTaP vaccine are usually attributed to the pertussis component of the vaccine. The rash is fine. is specific for coarctation. If An immediate anaphylactic reaction. acute.# A positive Coombs' test points towards autoimmune hemolytic anemia. pink.copies a cross and circle. unpleasant odor of phenylacetic acid(musty or . chronic diarrhea and hepatosplenomegaly may be the presenting symptoms of AIDS in infants. vomiting. lymphadenopathy. painful episodes. symmetrically. normal or slightly elevated bilirubin and alkaline phosphatase. and lactate dehydrogenase. but kidneys are not enlarged. caused by the dilatation of the collateral chest wall vessels. hypertrophic cardiomyopathy # Type III glycogen storage disease -. # Reye's syndrome – After treated with salicylates for a viral infection. No work-up is necessary. maculopapular.copies a triangle. So Administer the diphtheria and tetanus toxoids. giving it the name of 3-day measles. and convulsions. macroglossia. 4 years. Treatment for Reye's syndrome is supportive. ** DNA studies are used to confirm the diagnosis of Duchenne muscular dystrophy. suggestive of traumatic hemolysis. floppy baby. Splenomegaly may be present. Tissue histopathology demonstrates microvesicular steatosis of the liver. The hallmarks of the disease are hypoglycemia. seen in DIC. fat cheeks. as it tends to increase Hb F levels.copies a square and rectangle. and a protuberant abdomen.deficiency acid maltase. # measles (rubeola)— # Rubella-. hypoglycemia. # Hydroxyurea is indicated in patients with frequent. whereas the spleen and heart are normal.type IV glycogen storage disease or amylopectinosis. relatively thin extremities. It presents as painful swelling of feet and hands. and hyperlipidemia. restlessness. stupor. They represent benign and transitory events that are explained by target-organ response to transplacental^ acquired maternal hormones (estrogens). # Persistent oral thrush. prolonged prothrombin time. Dactylitis. kidneys enlarged. thus their presence in peripheral smear suggests splenectomy or functional asplenia # Heinz bodies -. lactic acidosis. avoid the pertussis component.

a darkening of the urine to almost a black color on standing. asynchronous. hydrocephalus. high-voltage.paralysis of vertical gaze. Oral theophylline ->control of nocturnal symptoms of asthma # Parinaud's syndrome-. and extremities. galactosemia). may have a seborrheic or eczematoid rash. genetic disorders (e. A plasma phenylalanine level above 20mg/dl_. 4. and metabolic acidosis. Medulloblastoma arises from the cerebellar vermis # Nodular swellings in the irises of patients with neurofibromatosis are hamartomas Neurofibromatosis—AD. generalized language disability. It is a cause of "floppy baby" syndrome along with infant botulism . mutation in the FMR1 gene Fetal hydantoin syndromeis ïƒ hypoplastic nails. A normal plasma tyrosine level. mucocutaneous lesions. hepatomegaly and persistent rhinitis # Fragile X syndrome ïƒ profound to normal IQ with learning disabilities. It is four times more potent than beclomethasone. trunk. osteitis and osteochondritis.g. # Recurrent self-limiting episodes of vomiting and nausea in children. in the absence of any apparent cause. short attention span. Renal biopsy is commonly used in adult patients presenting with nephrotic syndrome # Tuberous sclerosis (TSC) --.mousy). developmental delay. cleft palate. hyperactivity. mast cell stabilizers are the agents of choice-.Inhaled sodium cromolyn Fluticasone ïƒ severe chronic asthma not controlled with steroids like beclomethasone or triamcinolone. 2. Increased urinary levels of metabolites of phenylalanine (phenylpyruvic and ohydroxyphenylacetic acids). autism. large head. cortical tubers on head CT. The causes of cataract include familial. congenital syphilis-> intermittent fever. 1-5 years caused by lifted or pulled by the hand or arm # For pertussis prevention. lymphadenopathy. Turner's syndrome). slow-wave activity. known as infantile spasms. and vitamin K deficiency #Werdnig-Hoffman syndrome is an autosomal recessive disorder that involves degeneration of the anterior horn cells and cranial nerve motor nuclei. metabolic conditions (e. increased number of CGG trinucleotide repeats. large low set ears and macroorchidism. or symptoms.x-ray: pneumatosis intestinalis # Lateral epicondylitis. risk for optic gliomas(pale optic discs and decreased visual acuity # Always give a trial of epinephrine in cases of croup before intubation # congenital toxoplasmosis. may be associated with pupillary disturbances and eyelid retraction (Collier’s sign).often presents during the first year of life with clusters of brief symmetrical contractions of the neck." is caused by repetitive contraction of the extensor muscles at their origin on the lateral epicondyle. and pain is felt with passive wrist flexion and resisted wrist extension. # Alcaptonuria-. Congenital rubella-> sensorineural deafness. failure to thrive. immunizations. The criteria for diagnosis of classic PKU are: 1. regardless of age. 3. Tenderness is elicited over the lateral epicondyle. and intracranial calcifications. hypopigmented lesions (ASH leaf spots).chorioretinitis. cystic fibrosis must be ruled out. Oral corticosteroids ïƒ when inhalation corticosteroids do not provide adequate control of asthma symptoms. all close contacts should be given erythromycin for 14 days. # Empiric steroid therapy is indicated in young patients presenting with nephrotic syndrome. treatment consists of anti-emetics and reassurance of the parents **A white reflex (also called cat's-eye reflex) means that the patient has leukocoria. A normal concentration of the cofactortetrahydrobiopterin.deficiency of homogentisic acid oxidase.radial head subluxation. suggest the diagnosis of cyclical vomiting.g. and cardiac defects. # In a young child who presents with recurrent upper respiratory tract infections and bilateral nasal polyps. Down's syndrome. congenital infections. and long-term/high-dose glucocorticoid use. diabetes mellitus. bilateral. The most common cause of leukocoria is congenital cataract. # Nursemaid's elbow-. or white pupils. cataracts. It results from lesion of the rostral midbrain at the level of the superior colliculus and CN III. and the most dreaded cause is retinoblastoma. ochronosis and arthritis # Neonatal necrotizing enterocolitis-. which consists of chaotic. in early infancy with vomiting. prominent jaw. most commonly caused by germinomas and pinealomas # In 90% of cases. or "Tennis elbow. risk renal angiomyolipomas and cardiac rhabdomyosarcomas The best drug for infantile spasms is intramuscular ACTH # asthma accompanied by other allergic disorders like allergic rhinitis and eczema. EEGïƒ hypsarrhythmia.

# Bruton’s agammaglobulinemia (XLA) is anX-linked recessive disorder with defect in the gene product tyrosine kinase in B cells. splenomegaly. Corticosteroids are used if the patient do not respond to NSAIDs. myotonia. hypergammaglobulinemia.mutation fibrillin-1 gene.Delayed separation of the umbilical cord. abdominal bloating. # Ventricular septal defects are common in patients with Edward ‘s syndrome # Conotruncal abnormalities (Truncus arteriosus. and Aspergillus sp. # Wolf-Hirschhorn syndrome-. Most common clinical findings are lymphadenopathy. testicular atrophy. Infections with encapsulated bacteria (like S. Liver enzymes need to be monitored. leukocytosis. hypogonadism. progressive pancytopenia and macrocytosis. obesity. blue sclera. pneumoniae) are typical ** osteogenesis imperfecta-. # transient hypogammaglobulinemia of infancy-. hypotonia. S. bone marrow transplantation is experimental but curative. and aortic root dilatation. B. The mainstay of treatment is NSAIDs. microphthalmia. ptosis. # Common variable immunodeficiency (CVID) also known as "acquired" hypogammaglobulinemia-normal numbers of circulating immunoglobulin-bearing B-lymphocytes.also called congenital hypoplastic anemia. such as S. Diagnosis is made with voiding cystourethrogram (VCUG) followed by renal imaging. aureus. sluggish movement. dolichocephaly. The treatment uncomplicated sinusitis --amoxicillin 45-50 mg/kg/day. cepacia. mental retardation and dysmorphic craniofacial features. . hearing loss.microangiopathic hemolytic anemia. recurrent bacterial infections. joint laxity. or cytochrome C reduction. chronic diarrhea. lymphadenopathy.deletion in the long arm of chromosome 15. Skeletal manifestations include arachnodactyly and hypermobility of joints # Still’s disease-.juvenile rheumatoid arthritis. short stature. # Chronic granulomatous disease (CGD) is a defect of phagocytic cells with dysfunction of the NADPH oxidase enzyme complex. hepatomegaly. and scoliosis. or in the presence of myocarditis or anterior uveitis. and umbilical hernia. # The current recommendations by the American Association of Pediatrics suggest that for children <6 years of age. and urogenital tracts infection.low levels of IgG and normal levels of IgA with variable levels of IgM.Mutations in type 1 collagen. strabismus. # Impaired leukocyte adhesion-. gastrointestinal. # Prader-Willi syndrome-. autosomal dominant. short stature. and necrotic periodontal infections # opsonization defect --asplenia. renal dysfunction and fever. horseshoe kidneys and absent thumbs # Diamond-Blackfan anemia -. flow cytometry. hypoplasia of the eye socket. Diagnosis is made by nitroblue tetrazolium (NBT) slide test. an intrinsic defect of erythroid progenitor cells which results in increased apoptosis (programmed cell death). genomic imprinting. underweight. neurologic disturbances. # arteriovenous malformation is the most common of the subarachnoid hemorrhage in children. and dermatitis. ectopia lentis.abdominal ultrasound to establish the diagnosis # TTP-. high-grade fever. # Marfan syndrome-. diamond-shaped eyes. joint is swollen and erythematous but has a normal range of motion. marked reduction in the number of B cells in the peripheral circulation. hepatosplenomegaly. # Selective IgA deficiency-. anemia of chronic disease. The history of seizures and migraine-like headaches is characteristic. Greek helmet facies with ocular hypertelorism.respiratory. and baldness. webbed neck. # Unilateral flank mass in a child more than 3 years is most likely due to WilmDs tumor arises from the metanephros. most common cause is thyroid dysgenesis # Fanconi's anemia is an autosomal recessive.Deletion of chromosome 4p. Treatment includes prevention of infection with daily trimethoprim-sulfamethoxazole and gamma-interferon three times a week. gingivitis. short stature. short stature. shielded chest and triphalangeal thumbs. large tongue. prominent glabella and frontal bossing. including DiGeorge and velocardiofacial syndromes. marcescens. the diagnosis of acute bacterial sinusitis be based on clinical criteria rather than radiographic criteria. fleeting maculopapular rashes. multiple recurrent fractures. # Congenital hypothyroidismïƒ hypotonia. # pyloric stenosis-. # Upper gastrointestinal endoscopy is the diagnostic study of choice when a patient presents with acute alkali ingestion # Acute UTI in children is most commonly due to vesicoureteral reflux. cleft lip.# Myotonic congenital myopathy is an autosomal dominant disorder characterized by muscle weakness and atrophy most predominant in distal muscles of the upper and lower extremities. microcephaly. Associated deformities include cafe-au-lait spots. pleuroperi carditis and myocarditis. Tetralogy of Fallot. microcephaly. macrocytic pure red aplasia associated with several congenital anomalies including short stature. leading to recurrent and uncontrolled infections with catalasepositive organisms. interrupted aortic arch) are associated with CATCH D22 syndromes. thrombocytosis and elevated ESR.

# Antibiotics like penicillin or metronidazole are used for the treatment of wound botulism. unless there is some secondary infection like pneumonia or UTI. The second line medication is imipramine. monocytogenes . this should not delay the antibiotic administration.cystic expansion of the fourth ventricle Chiari malformation is a condition in which the structures of the posterior fossa protrude through the foramen magnum. spreading subsequently down the body. meningitides. partial oculocutaneous albinism.#Chak-Higashi syndrome is characterized by decreased degranulation. The rash is erythematous. # The drug of choice for persistent nocturnal enuresis is DDAVP. enlarged testicles and penis.Postictal paralysis followed by generalized as well as focal seizures. with other features such as distinctive facial appearance. This is caused by maternal estrogens. H. N. aureus).congenital pure red cell aplasia # A CT scan of the head is a very rapid and accurate means to confirm increased intracranial pressure and should be performed before an LP if signs of increased ICP are present. pancytopenia. frequent bacterial infections (usually S. it causes non-communicating hydrocephalus. # Guillain-Barr’yndrome-. Along with Dandy-Walker anomaly. influenzae age 18 and aboveïƒ S. # Heroin withdrawal usually presents within the first 48 hours of life. S. hepatosplenomegaly. there maybe manifestations of palpable purpura. eosinophilia and coarse facial features. lungs and joints. hematuria and abdominal pain. throat is erythematous with gray-white exudates. # Dandy-Walker anomaly -. Diagnosis is made by neutropenia. # posterior vermis syndrome (Truncal dystaxia)—medulloblastomas # Chlamydia is the most common causative agent of infectious neonatal conjunctivitis. Tx: Penicillin V is the drug of choice. scrotal swelling. tender lymphadenopathy. # Todd’s paralysis-. as they may cause lysis of intestinal C. L. with tremors and hyperirritability as the most prominent symptoms. # Rubella is characterized by low-grade fever. # scarlet fever-. Sudden loss of consciousness with following disorientation and slow gain of consciousness. Supportive care is the mainstay of treatment in cases of infant botulism # Girl infants less than 3 months of age sometimes develop vaginal spotting or bleeding. restoration of motor function within 24 hours ** severe tricyclic antidepressant intoxication -. meningitides. sandpaper-like rashes. # Diamond-Blackfan anemia (DBA)-. and peaks at 12-15 months. and consequently release of their neurotoxin. markedly elevated serum IgE. significant growth acceleration. It is a multisystem disorder with clinical characteristics of mild coagulopathy. botulinum. # Stranger anxiety starts anywhere between 6-8 months. pneumoniae 60-70 percent of cases # pediatric Migraine—tx: acetaminophen orNSAIDs . hypotension. pneumoniae. and QRS complex prolongation on ECG. Recurrent staphylococcal infections involving the skin. an excess of sex steroidsïƒ severe cystic acne. Tx: Sodium bicarbonate #21-hydroxylase deficiency—late on set in boy. and the detection of giant lysosomes in neutrophils. however.seizure.Group A streptococcus that produce erythrogenic exotoxins. These children are susceptible to intussusception. which crosses the placenta and enters the fetal blood stream before birth. and coarse pubic and axillary hair # Chronic pyelonephritis is characterized by focal parenchymal scarring and blunting of calices on IVP. chemotaxis and granulopoiesis. Chlamydial pneumonia can also develop in infected infants. one month through two yearsïƒ S. # In Henoch-Schin purpura (HSP). peripheral and cranial neuropathy. demyelinization of the peripheral nerves # Guthrie test is a qualitative (coloration) test --detect the presence of metabolic products of phenylalanine in the urine.involves mainly motor nerves. pneumoniae. group B streptococcus age 2 through 18 yearsïƒ N. # meningitidis Newbornsïƒ Group B streptococcus. recurrent staphylococcal infections (skin and respiratory tract). and progressive lymphoproliferative syndrome. and treatment includes prevention of infection with daily trimethoprim-sulfamethoxazole and daily ascorbic acid # Hyper-lgE (JobDs) syndrome is characterized by chronic pruritic dermatitis. maculopapular and classically begins on the face. S. dental abnormalities and bone fractures are essential for the diagnosis. They should not be employed to treat infant botulism. but sensory and autonomic nerves may also be affected. lymphadenopathy (sub-occipital and posterior auricular) and rash. pneumoniae.

gastrointestinal disturbances (nausea. cyanosis. Eosinophils and lymphocytes are decreased. and cyanosis with minimal chest findings. cataract formation. Oral itraconazole reduces steroid requirement in patients with acute bronchopulmonary aspergillosis and improves pulmonary function but the mainstay of treatment is oral prednisolone. # multifocal atrial tachycardia associated with the exacerbation of chronic obstructive pulmonary disease (COPD). Nebulised albuterol is used for acute exacerbation of asthma. immediate skin hypersensitivity reaction to aspergillus antigen. the next step is to obtain a V/Q scan. ** Suspect cystic fibrosis in patients with bronchiectasis and symptoms suggestive of intestinal malabsorption due to pancreatic insufficiency. **Glucocorticoids cause neutrophilia by increasing the bone marrow release and mobilizing the marginated neutrophil pool. The mechanisms responsible for the toxicity may include phosphodiesterase inhibition. decreased growth in children. Bilateral diffuse interstitial infiltrates beginning in the peri hilar region is a characteristic finding on chest xray # Aspergillosis can also be seen in immunocompromised patients. vomiting). adenosine antagonism. When a pulmonary embolus occurs. # High doses of inhaled corticosteroids can lead to increased systemic absorption and can produce adrenal suppression. in septic. Carinii pneumonia is characterized by dyspnea. There is better alveolar ventilation and less fatigue of respiratory muscles by using NIPPV.35 or PaC02 >45mmHg or respiratory rate >25 per min. the next step is to perform a mediastinal bronchoscopy and obtain tissue for biopsy. beta agonists also have the tendency to lower the potassium levels. insomnia). which is a hypersensitivity reaction to inhaled aspergillus antigens. However. It should be tried before intubation and mechanical ventilation. association with erythema nodosum. Inhaled beclomethasone is the first-line treatment for persistent asthma. fleeting pulmonary infiltrates. Serum Ca and ACE levels are elevated. and a nonproductive cough. it may occlude one or few branches of the pulmonary artery and present on an x-ray as a cone shaped area of opacification representing an area of atelectasis or infraction. NIPPV is recommended in a patient of respiratory distress with a pH<7. fever. Physical examination would show tachypnea. Steroids are the treatment of choice in symptomatic patients. one can exclude the diagnosis of PE. theophylline and beta agonists may actually worsen the arrhythmia. which is associated with the exacerbation of chronic obstructive pulmonary disease (COPD). Once mediastinal adenopathy is seen on a chest x-ray. these systemic effects are dose-dependent and occur in patients who are on high-dose inhaled steroids for prolonged period of time. failure to pass meconium at birth. which is characterized by bilious vomiting. as 3rd or 4th line agent. Oral prednisolone is the treatment of choice for the treatment of acute bronchopulmonary aspergillosis. Systemic steroids are the first line therapy of the acute exacerbation of COPD. # Theophylline toxicity usually manifests as CNS stimulation (headache. # Acute bronchopulmonary aspergillosis is characterized by: worsening asthma.# Cystic fibrosis may presents with meconium ileus. # P. and precipitating antibodies against aspergillus in serum. The most common presentation of a patient with a pulmonary embolism will be a normal chest x-ray. Beta-2 agonists like albuterol are used as second-line drugs Aminophylline or oral Theophylline is used after beta-2 agonists and anticholinergic agents. or dysrhythmic patients. NIPPV is contraindicated # The patient has multifocal atrial tachycardia. interference with bone metabolism and purpura. . # Anticholinergic drugs (Ipratropium bromide) are the first line medications in COPD. which have further arrhythmic effects. however. ciprofloxacin and erythromycin decreases Theophylline clearanceïƒ serum theophylline increased. diaphoresis. and stimulation of epinephrine release. However. When the x-ray is normal and suspicion is still high. and cardiac toxicity (arrhythmia). # The diagnosis of pulmonary embolism based on a chest x-ray is virtually impossible. # Indicators of a severe asthma attack include normal to increased Pco2 values. tachycardia. peripheral eosinophilia. # Candida is an extremely rare organism to cause pneumonia in any patient. This sign is seen in only a few patients. Monod's sign). Two modalities that can decrease mortality in patients with COPD are home oxygen therapy and smoking cessation. altered sensorium. Resp # Noninvasive positive pressure ventilation is an excellent option for patients with COPD exacerbation. and ground glass appearance on abdominal X-rays. Biopsy typically shows non-caseating granulomas. and silent lungs. the chest x-ray typically shows a solid mass surrounded by a radiolucent crescent (crescent sign. AFP and HCG are used to monitor response to therapy # Rigid bronchoscopy is indicated in patients with massive hemoptysis as it allows rapid visualization of the bleeding site and to control bleeding through cauterization or other means# Sarcoid can present in a black female with bilateral hilar adenopathy. # Adverse effects of low-dose inhaled corticosteroids are limited to topical problems like dysphonia and thrush. hypotensive. # Anterior mediastinal mass along with elevated AFP and HCG indicates Nonseminomatous tumor. If the V/Q scan is of low probability with a normal x-ray. increased serum IgE. theophylline and beta agonists worsen the arrhythmia. speech difficulty.

More importantly. # All patients with suspected bacterial pneumonia should have a chest x-ray done as the first step. Inflammatory mediators are released as a result of local or distant tissue injury. and hyper-responsiveness of the bronchial mucosa. Beta-2 agonists and oral theophylline are very useful to control symptoms but do not make any difference in the long term out come of the disease. The most effective treatment is avoidance of offending antigens or haptens. Accumulation of protein rich fluid in alveoli as a result of diffuse alveolar damage makes the lungs stiff and they become less distensible or compliant. productive cough. Taking a careful history is critical for the diagnosis. Farmer’s lung and bird breeder’s lung are two typical examples. Legionella usually cannot be seen under ordinary gram staining. Chest X-ray shows multiple pleural plaques bilaterally. A point mutation in a gene coding for the coagulation factor Vïƒ Factor V becomes resistant to inactivation by protein C # corticosteroids are the most important intervention in patients with moderate persistent asthma. Clinical features include fever. they lack the systemic toxicity of oral corticosteroids. Alveolar-arterial P02 difference is widened in cases of ARDS and hypoxemia occurs as a result. # Alveolar proteinosis is characterized by accumulation of phospholipid rich material in the alveoli probably due to impaired clearance. free water is also dragged into the alveoli. dyspnea and non-productive cough. in a fresh postoperative patient. # Factor V Leiden is the most common inherited disorder causing hypercoagulability and predisposition to thromboses. especially DVT of lower extremities. Patients have antibodies to the offending antigen in their serum and this disease is mediated thru a type III hypersensitivity reaction. They are usually associated with contamination of water sources like air conditioners. Chest-X ray shows bilateral alveolar infiIterates and pulmonary function tests shows restrictive lung disease. especially after trauma.# the three major complications of too high a PEEP: Alveolar damage. Inhaled corticosteroids reduce the inflammation. malaise. a mass on the periphery of the lung * Pleural involvement is a hallmark of asbestos exposure # Extrinsic allergic alveolitis or hypersensitivity pneumonitis results from exposure to organic dusts like fungal spores. Corticosteroids are of no benefit in this disease. and antibiotics should be administered as soon as possible without waiting for sputum gram stain or cultures. the patient may require warfarin (Coumadin) for a few months. and fever with chills. It is usually less than 15 mmHg in ARDS while it is greater than 18 mmHg in cardiogenic pulmonary edema. Patients usually complain of fatigue. **Pulmonary capillary wedge pressure is normal in ARDS and it is the most important differentiating point between ARDS and cardiogenic pulmonary edema. AIDS. It occurs largely due to ventilation-perfusion mismatch. Lung biopsy will confirm the diagnosis by showing PAS positive material. Patients usually are chronic alcoholics and smokers. hyponatremia and hematuria. It may cause diffuse bleeding) . Tension pneumothorax and Ventricular failure. non-bloody diarrhea and abdominal pain. Chest x-ray usually . # Both mesothelioma and bronchogenic carcinomas are associated with the asbestos exposure( plumber ) but bronchogenic carcinoma is far more common and occurs more frequently after asbestos exposure. Total lung bronchoalveolar lavage is effective treatment of this disorder. Use of prophylactic inhaled corticosteroids is beneficial in the long term out come of chronic persistent asthma. if the patient has contraindications to the use of fibrinolytic therapy( eg. Other risk factors include cancer. A pulmonary embolectomy can be performed either surgically or percutaneously. malaise. hypotension. # When an acute pulmonary embolus occurs with hemodynamic compromise. Alveolar capillary permeability increases and protein is released into alveoli increasing osmotic pressure in alveoli and as a result. confusion. Pulmonary hypertension is very common in ARDS and it occurs as a result of hypoxemic vasoconstriction of pulmonary vasculature. tachycardia. hyponatremia and diarrhea are almost classic for Legionella. the best treatment is fibrinolytic therapy. decreased breath sounds with dullness on percussion. chest pain. Labs may reveal proteinuria. # Remember pneumonia. But. Its cause is unknown and it presents with dyspnea and dry cough. an embolectomy is the treatment of choice. Chest-X ray reveals diffuse ill-defined patchy infiltrates. Cigarette smoking acts synergistically with asbestos exposure in increasing the risk for bronchogenic carcinoma. thermophilic actinomycetes etc. Sputum analysis will reveal neutrophils. Both pleural mesothelioma and peritoneal mesothelioma can occur after asbestos exposure. Even after an embolectomy. ** Chronic dry cough is a very common side effect of the therapy with ACE inhibitors like enalapnl. # ARDS results from diffuse inflammatory injury to the alveoli of lungs. Pulmonary function tests may show a restrictive pattern. Neutrophils recruited to the lungs become activated and release proteases and free oxygen radicals which damage alveolar endothelial and epithelial cells. Legionella is a gram-negative bacteria known to cause community acquired and hospital acquired pneumonia. Chest-X ray shows interstitial infiltrates. transplantation and long term steroid therapy. Physical exam may show tachypnea.

arthralgias. cyanosis and clubbing.5 is required in prosthetic heart valves. difficult to oxygenate the patient) # Postoperative atelectasis is a major cause of fever. When pleural effusion is suspected or diagnosed. Hemoptysis with fever are most probably due to septic pulmonary emboli. anorexia. # A chest x-ray is normal in almost all asthmatic patients. All patients with suspected COPD should have pulmonary function tests done as soon as possible. The cardiac examination usually reveals involvement of the tricuspid valve. Patient with signs of pulmonary hypertension or hematocrit > 55% should be started on home oxygen when the Pa02 < 60 mmHg. PE. chest x-ray findings are delayed for a long period of time until the significant air trapping occurs. #Right-sided valvular lesions are common in carcinoid syndrome owing to degradation of serotonin metabolites by the lung. The agent reduces the viscosity and prevents airway plugging. anti neutrophil cytoplasmic antibodies confirms this diagnosis. PEEP increases the intrathoracic pressure which results in a decrease in preload and thus a decrease in cardiac output. # Histoplasma capsulatum is a common and usually asymptomatic infection(asymptomatic pulmonary nodule) in endemic areas like Mississippi and Ohio River valleys and Central America. Chest x-ray reveals infiltrates. Diagnostic thoracentesis is the preliminary investigation of choice in the management of pleural effusion. (transudative fluid would rule out malignant effusion). # Pulmonary Function Tests (PFTs) are the most useful tool to determine if a patient can benefit from the lung resection surgery.x-ray usually shows peribronchial pneumonia pattern. its major drawback is a decrease in cardiac output. The treatment is steroids. then the patient does not require a bronchoscopy.0 to 3. present with fatigue. Almost always a biopsy is done to rule out sarcoid. weight loss. except when they have acute exacerbations where you can see hyperinflation. x-ray shows a diffuse bilateral reticulonodular patternïƒ bilateral interstitial involvement. masses. If a diagnostic thoracentesis shows exudative pleural fluid. If the pleural fluid cytology is positive for lung cancer.0 to 4. Bronchoscopy will be the next step if the pleural fluid cytology is non-diagnostic and the patient has lung mass. and management starts with determining whether the fluid is transudate or exudate. nodules. Amphoric breath sounds on lung examination # All COPD patients with Pa02 < 55 mmHg or Sa02 < 88% are candidates for long-term home oxygen treatment. Erythromycin is the treatment of choice. the first step is to determine the cause of pleural effusion. regardless of the chest x-ray findings. and cavities. CO should be monitored with a Swan-Ganz catheter. # In a postoperative patient who presents with dyspnea and tachypnea. # When PEEP is increased. It is usually caused by carcinoid tumors with hepatic metastasis. # The most common cause of superior vena cava obstruction(venous congestion of his face and arms. It is also known as cryptogenic fibrosing alveolitis. Vegetations over the tricuspid valve can embolise to remote organs. Carcinoid syndrome refers to a classic triad of flushing. # Infective Endocarditis in IV drug abusers is usually right-sided and mostly caused by staph aureus. # Idiopathic pulmonary fibrosis is a diagnosis of exclusion.shows patchy interstitial inflammation and unilateral lower lobe involvement. # TMP+SMX is the drug of choice for Pneumocystis carinii pneumonia. further diagnostic investigations are indicated. # Mycoplasma pneumonia -. which may progress to areas of consolidation over a few days. Patients who are maintained on PEEP. The cytoplasmic pattern (C-ANCA) is highly specific for WegenerDs granulomatosis. some physicians may elect to use inotropic agents or more fluids.smelling productive cough. valvular heart disease and diarrhea. Predicted postoperative FEV1 is very helpful for this purpose. A bronchodilator response test is used to demonstrate reversibility of airway obstruction. # N-acetylcysteine is used to treat patients who have very viscous secretions. angioplasty with stenting is the standard of care) ïƒ bronchogenic cancer. A higher INR of 3. which intensifies with inspiration. # Wegener’s granulomatosisïƒ vasculitis of the small vessels and necrotizing granulomatous lesions affecting both upper and lower respiratory tract and glomerulonephritis. is most probably due to tricuspid regurgitation. Ampicillin and gentamycin is almost never used for pneumonia # In patients with fever and cough after upper Gl endoscopy suspect anaerobic lung infection. .0. It helps to differentiate between COPD and asthma. Clindamycin and ampicillin plus metronidazole are the commonly used agents ** Undiagnosed pleural effusion is best evaluated with thoracentesis. and slightly increase the central venous pressure. Even in COPD patients. # Lung abscess ïƒ X-rays : thickened wall cavities with air fluid levels w fever and foul. except in patients with clearcut evidence of congestive heart failure. # Therapeutic INR for most clinical indications of warfarin is 2. one has to exclude Ml. The holosystolic murmur. pneumonia and ARDS(bilateral fluffy infiltrates on a chest x-ray w hypoxemia persists. To counteract the effects of PEEP on cardiac output. It can be derived from preoperative value and the fractional function of the lung tissue to be resected.

or rheumatoid arthritis # Klebsiella is a capsulated gramnegative bacillus. Bronchiectasis 2. and debris and hyphae may coalesce and form a fungus ball. #Restrictive lung disease is characterized by an equal decrease in FEV1 and FVC and. b. ring shadows and peribronchial thickening (tram track appearance).tests can help you most in differentiating asthma from emphysema ïƒ .Pa02 (Normal gradient is 5-15). # The most serious complication of bronchiectasis is hemoptysis. Then endoscopy. Pleural fluid a.3 indicates pleural inflammation. pH of 7. and normal DLCO. Atelectasis 2. thus. which lies free in the cavity and moves around with position change. # The most common cause of pulmonary complications in patients with systemic sclerosis is interstitial fibrosis.Intra cardiac shunt (Right-Left) due to VSD. especially alcoholics. Anaerobic pneumonia. The chest x-ray may demonstrate central or target calcification.Intraalveolar filling (pulmonary edema) 3. and can cause pneumonia in subjects with debilitating conditions. hyperinflation of the chest. mild flattening of the diaphragm. # Histoplasmosisïƒ Calcified nodes in the lung. is characterized by reduced FEV1 and rapid decline FEV1 FEV1/FVC is decreased. # Emphysemaïƒ Pink puffers.21* # Shunt should be suspected if there is no response to 100% 02. PH < 7. FEV1 measurement with and without a bronchodilator # In ARDS. a normal ratio of FEV1/FVC. Patients with COPD are generally smokers with a history of 1 pack per day for at least 20 years.64. ASD etc. 4.2 requires a chest tube aspiration to prevent empyema. Pleural fluid pH< 7. # Aspergillosis is an opportunistic infection. A solitary nodule may be seen sometimes. decreased DLCO (due to destruction of alveoli). if no pneumothorax is seen. characterized by coarse fragmented septae. Pleural fluid LDH/serum LDH ratio > 0. # obstructive ventilatory defects (such as asthma and COPD). the one treatment that can improve oxygenation is the addition of PEEP. a low DLCO can be seen in both emphysema and interstitial fibrosis. protein/serum protein ratio > 0. # Dysphagiaïƒ first step: barium. # Coccidioidomycosisïƒ Cutaneous findings like erythema multiforme and erythema nodosum as well as arthralgias. restrictive ventilatory defects (such as interstitial fibrosis and chest wall deformities).5. Pleural fluid LDH more than two-thirds of the upper limit of normal serum LDH Normal pleural fluid pH is approximately 7. # bronchiectasisïƒ CXR: increased vascular markings. two main types of COPD are emphysema and chronic bronchitis. spleen. save for observation # Presence of bilateral hilar lymphadenopathy and non-caseating granulomas is diagnostic for sarcoidosis.and moderate oxygen desaturation. Friedler’s pneumonia generally affects the upper lobe and is characterized by current jelly-like sputum. The chest x-ray may demonstrate a crescent radiolucency next to a rounded mass.35 is consistent with transudative pleural effusion. # A-a gradient = PA02. Lung abscess 3. the first thing one wants to rule out is a pneumothorax. and liver may occur. # Pleural fluid ïƒ Glucose level < 60 mg/dL favors the diagnosis of parapneumonic effusion. # Beta agonists and mast cell stabilizers both play an important role in the management of exercise-induced asthma. followed by EKG and V/Q scan. # 24-hour pHïƒ employed in patients with chest pain or chronic cough when esophagoscopy is negative. Shunt can result from any of the following causes: 1. prominent bronchovascular marking.ïƒ do CXR first.6 c. PA02 = FiO2(760-47)-PaCO2/0. the patient can be observed. tuberculosis. # When an individual with asthma presents with subcutaneous emphysema. # Patients with suspected pulmonary embolism should have a chest-x ray and arterial blood gases. mediastinum. in general. it is also best to keep the patient on the dry side and avoid fluid overload # Any patient with fever. DLco is normal in asthma. Then motility #Alcohol precipitate cluster .8 =0. # Chronic bronchitisïƒ chronic productive cough. Hyphae are typically seen.Vascular shunt within the lungs # COPD. Cavitary lesions may form because of destruction of the underlying pulmonary parenchyma. decreased vascular markings. High resolution CTscan of the lung is the diagnostic modality of choice for bronchiectasis # pulmonary embolismïƒ right axis deviation on ECG # transudation ( shen chu yie ) coused by increased hydrostatic pressure or hypoalbuminemia # Exudate is formed as the result of local factors like inflammation. night sweats and copious foul smelling sputum has any one of these three condition: 1. grows as mucoid colonies. Subcutaneous emphysema does not require any formal treatment.

# Pt >60y w meningitis. especially when CD4 count is less than 200. CAP can be caused by a host of bacteria and viruses. Newer antipneumococcal quinolones. ** Proximal (above knee veins> iliac. Other important features include history of brownish plugs in the sputum and high IgE levels. empiric Tx: ampicillin(listeria G+ rod)+vancomycin+ceftriaxone. For out¬patient therapy. in many cases. it is not possible to isolate the causative organism. and it presents with exertional breathlessness. # Tx: central sleep apnea ïƒ acetazolamide. Tx : substitute medium chain TG for longchain TG. # Any person from Wisconsin. hot water # Multiple air_fluid level in the small intestineïƒ intestine obstruction. # The most typical findings of a pulmonary embolism on arterial blood gas sampling are hypoxemia and hypocarbia. Pyrimethamine and sulfadiazine for treating Toxoplasmosis. # Disordered thought associations and affective flattening is main point to diag schizophrenia # First line empiric Tx hospitalized pt w pneumococcusïƒ fluoroquinolone (levofloxacin) or betalactam + macorlide # cryptococcal ïƒ India ink.Elevated IgE 3. #Tx necrotizing enterocolitis w perferationïƒ surgery. # Diabetic Cardiomyopathy cause left ventricular hypertrophy and diastolic dysfunction which ejection fraction is normal.) deep vein thrombosis of lower extremities is the most frequent source of pulmonary embolism # Acute bronchopulmonary aspergillosis (ABPA) is characterized by transient recurrent pulmonary infiltrates. Mississippi river belt or Ohio River Belt presenting with chronic respiratory symptoms should be suspected of having Blastomycosisïƒ triad of lung(lobe cavitation). are the drugs of first choice for in-patient treatment of community-acquired pneumonia. Indirect inguinal hernia ïƒ feel hernia on the tip of finger. Lungs will be clear to auscultation. A-a gradient & D-dimers usually increased. most of the time.Central bronchiectasis 5. femoral and popliteal. Sometime bronchiectasis is also present in this disorder. #Polymyalgia Rheumaticïƒ # bronchoalveolar lavage is > 90% effective in diagnosing Pneumocystis carini pneumonia in HIV positive patients. Fetishismïƒ use certain inanimate objects to accomplish sex arousal # Gabapetin use for treating DM neuropathy. but antigen assay in CSF more sensitivity and specificity. # steroid indicated when Po2<70mmHg #Obstructive sleep apnea Tx: weight loss & nasal continuous positive pressure ventilation. progesterone. asthma and immediate wheal and flare reaction to Aspergillus fumigatus and presence of antibodies in the serum against Aspergillus fumigatus. # Frotteurismïƒ rubbing genital against women. # Direct inguinal herniasïƒ lateral aspect of Dr’s finger placed on external inguinal ring. treatment is empirical. # Corticosteroid lead to more difficult glucose control in DM # Esophgeal spasm precipitated by cold.headache. # Steatorrhea in newborn caused by bile acid deficiency.Hypereosinophilia 4. Chest x-ray would show enlargement of the pulmonary arteries with rapid tapering of the distal vessels (pruning) and enlargement of the right ventricle. either azithromycin or doxycycline can be used. The best treatment for a patent with a confirmed hamartoma is observation. First step Tx: nasogastric tube # Trimethoprim/Sulfamethoxazole for prophylaxis Toxoplasmosis. and is due to immune complex . # In Parapneumonic effusions. peripheral eosinophilia. Hence. if Glucose of less than 60mg/dL is an indication for tube thoracostomy. like levofloxacin or gatifloxacin.Positive Aspergillus Skin test # community-acquired pneumonia (CAP). Tx: Amphotericin B + flucytosine # ALLERGIC BRONCHO PULMONARY ASPERGILLOSIS--1 . # screen gestation DM start at 24-28 w #Tx neurocystocercosisïƒ albendezole & dexamethasone #Tx systolic hypertesionïƒ Ca channel block. and. # Hamartomas are the most common benign lung masses and contain abundant cartilage. skin(sharply demarcated papules) and bone lesions(a lytic lesion) # Patients with DVT in whom anticoagulation is contraindicated require placement of inferior vena cava filter for the prevention of pulmonary embolism.Asthma like symptoms 2. reanastomosis after 6 weeks. # A pulmonary angiogram is the gold standard to diagnose a pulmonary embolism. # Large a waveïƒ tricuspid regurgitation. # Haloperidol cause dystonia # hill sign & de musset signïƒ aortic regurgitation. neuropathic pain. #Primary pulmonary hypertension can be seen in middle-aged patients.

sympathetic chain and lower brachial plexus. Cl. # Osler-Weber-Rundu syndromïƒ Multiple angiondysplasias on mucuous membrances. # HIV w CD4 < 50 ïƒ CMV infection # Roughly. a CT scan of the chest followed by bronchoscopy is indicated to ensure that the bronchus is not blocked and there is no lung abscess. # Adrenal insufficiencyïƒ decreased Na. Glucocorticoids are used to treat this disorder. every 3mEq/L increaded Na represent 1L water deficit. Venography is considered to be the gold standard for the diagnosis of DVT.deposition. Lymphoreticular malignancies are common in such patients. hyperpigmentation on skin. skin is the most frequent site. Peak T. antigen is the first diagnostic step. arrhythmia. pelvic exam. order venous ultrasonography to reveal DVT or CT angiogram. If the test is positive.25 D3 ( calcitriol ).)and it can be corrected by reducing the ventilatory rate. # Coronary artery pypass use for 3 vessels disease or left main coronary disease. . #Sildenafil contraindicate w nitrates since it cause severe hypotension # Symptom of high Kïƒ muscles cramping. lower lobe pneumonia ) # Suspected deep vein thrombosis (DVT) ïƒ do compression ultrasonography first. ACIH increased. # Excessive alcohol intake can lead to aspiration pneumonia(. Other lung Caïƒ Tx: surgery. TCAs toxicityïƒ prolongation QRS interval # For small cell lung Cancer. High K. do not need fludrocortisone. serum precipitins against Aspergillus fumigatus and IgE level are checked. For secondary. Foul-smelling sputum and the right. If using black tar heroinïƒ Clostridium spp. # Serum-ascites albumin gradient >1:1 caused by portal hypertention. Impedence plethysmography is the study of choice for recurrent DVT. ascending paralysis. but not initial step. . ABPA is excluded if IgE levels are less than 1000ng/ml or if serum precipitins against Aspergillus fumigatus are absent. # Beta-2 transferrinïƒ CSF marker # Most frenquent cause skin infection in injecting drug is staphylo. # Amyloid nephropathy w increased size of kidney associated w injecting drug abuse Heroin nephropathy ïƒ small kidney w hypertention. # If ventilation/perfusion scan is inconclusive in patients undergoing diagnostic work-up for pulmonary thromboembolism. widen QRS. The next step is chest x-ray. <1:1 by non portal hypertensive etiology. and beta-hCG. #An enlarged left atrium in mitral stenosis can cause a persistent cough and elevation of the left main stem bronchus. lower lobe pneumonia # Suspect choriocarcinoma in any postpartum women who presents with shortness of breath and hemoptysis. primary Tx is Chemotherapy. Percutaneous-transluminal-coronary angioplasty w stent insertion use for 2 vessels disease. Neutrophils ïƒ impaired chemotaxis # Wiskott-Aldrich syndrome—X-link. weakness. Pulmonary angiography is an invasive procedure and should be employed only if venous ultrasonography or CT angiogram is negative. hypotension. systolic murmur increased w standing ( aortic stenosis murmur decreaded w standing ) # Excessive alcohol intake can lead to aspiration pneumonia_ïƒ . and agitation in a patient on mechanical ventilation in IPPV(Intermittent Positive Pressure Ventilation) mode is suggestive of barotrauma. # low Kïƒ flattened T & prominent U. # Pancoast tumorïƒ grow in the apex of the lung (superior sulcus) and tend to invade the upper chest wall. # Fluvoxamineïƒ Tx obesive-compulsive disorder. low glucose. # When pneumonia fails to heal after two weeks of appropriate antibiotics. loss P. It is used only when the noninvasive testing is not possible or the results obtained by noninvasive testing are equivocal. # A sudden drop in oxygen saturation. skin testing with A. # Hypertrophic obstructive cardiomyopathyïƒ brisk upstroke carotid pulse. ribs. # Increased ventilatory rate in patients on mechanical ventilation leads to auto PEEP(condition starts to deteriorate. # Risperidone cause increased prolactin ïƒ amenorrhea # Thrombolytic Tx for ST elevated MI or new onset left bundle branch block. Chest-x ray should be the next step. IgE and IgA levels are high while IgM levels are low. restlessness. Tx primary adrenal insufficiencyïƒ prednison + fludrocortisone. # Job Syndrome is characterized by recurrent bacterial infections and markedly elevated IgE levels. # Granulomatous disease like sarcoidosis and lymphoma cause high Ca via increased 1. Foul-smelling sputum and the right.

ABG and EKG results rule out other differential diagnoses then you should begin treatment with heparin without waiting for a V/Q scan to confirm your diagnosis.# Rheumatoid arthritis can cause keratoconjunctivitis( dry eye. peripheral eosinophilia. # diffuse bilateral interstitial infiltrates are typical of Pneumocystitis carinii pneumonia (PCP). kidney. and peripheral edema. Investigation of choice is Nocturnal Polysomnography. and possibly by the activation of the arachidonic acid pathway. Aspirin sensitivity syndrome is believed to be a pseudo-allergic reaction. # Ziprasidoneïƒ Wt neutral. accelerated and chronic silicosis. hypokalemia should be ruled out. any patient receiving beta-2 agonists and complains of muscle weakness. Up to 75% of the patients with CSS have evidence of peripheral neuropathy. pottery working. advanced dementia. A CSS-like syndrome has been noted in patients who have been successfully treated for chronic steroid dependent asthma with the leukotriene receptor antagonists. Its cause is unknown and it presents with dyspnea and dry cough. asthma and prominent peripheral blood eosinophilia. # Loeffler’s syndrome # Acute bronchopulmonary aspergillosis (ABPA) is characterized by eosinophilic pulmonary infiltrates. polyp formation) in susceptible individuals. lungs. The treatment with glucocorticoids and sometimes with immunosuppressants. and other neurologic disorders are predisposed to aspiration pneumonia due to impaired epiglottic function.allergic granulomatosis is a multisystem vasculitic disorder of unknown etiologythat affects the skin. emphysema presenting in the 3-rd decade or any emphysematous changes in the lower lobes should strongly raise the suspicion of alpha-1 antitrypsin deficiency. nervous system. underground mining abrasive working etc. tachycardia. # Erythema multiforme( target shaped skin lesions) is one of the extra pulmonary manifestations of mycoplasma pneumonia. diagnosis can be made by serum alpha-1 anti-trypsin levels. It is characterized by allergic rhinitis. Treatment includes avoidance of NSAIDs and the use of leukotriene receptor antagonists # All beta-2 agonists reduce serum potassium levels because they drive potassium into cells. It is usually done the day after an inconclusive Polysomnography # The most common locations of post aspiration lung abscess in recumbent position are apical segment of right lower lobe and posterior segment of right upper lobe. gastrointestinal tract and heart. photophobia) Tx: artificial tears. # Salbutamol at bedtime would be a good treatment for mild nocturnal asthma. Beta 2 agonists also produce fine resting tremor of fingers. High resolution CT scan should be considered only after the assessment of alpha-1 anti-trypsin levels. Upper lobe consolidation and/or cavitation is the typical X-ray finding. foreign-body sensation. and chest X ray. # Churg Strauss syndrome (CSS)-. # Patients with impaired consciousness. clubbing. Chest X-ray shows bilateral alveolar infiltrates and pulmonary function tests shows restrictive . # Alveolar proteinosis is characterized by accumulation of phospholipid rich material in the alveoli probably due to impaired clearance. PCP occurs with CD4 counts less than 200/microL # Tuberculosis occurs early in the course of HIV when the CD 4 counts are greater than 200/microL. # Silicosis is a type of pneumoconiosis caused by exposure to crystalline silica. remember that leukotreine antagnoists cause CSS. # Acute exacerbation of COPD is treated with a combination of inhaled/nebulized bronchodilators (ipratropium and albuterol nebulization )and systemic steroids # Hypertrophic osteoarthropathy is associated with chronic proliferative periostitis of the long bones. eg. High-risk professions include glass making. asthma. Multiple Sleep Latency Test is used only when the diagnosis is not clear after nocturnal polysomnography. # Echocardiography is best initial test for CHF. There are three patterns of this disease that include acute. # Any emphysema in a non-smoker. It results from aspirin-induced prostaglandin/leukotriene misbalance that triggers characteristic reactions (bronchoconstriction. associated with squamous cell carcinomas and adenocarcinoma of the lungs. Glucocorticoids are used to treat this disorder. Spiral CT will be the answer instead of V/Q scan if the baseline chest-x ray is abnormal. which is due to immune complex deposition (type III hypersensitivity). # Ipuprofen can cause epistaxis # Obstructive sleep apnea is a common condition among obese population w Habitual nighttime snoring Daytime somnolence and Hypertension. Destroyed lung. an immediate wheal and flare reaction to Aspergillus fumigatus (type 1 hypersensitivity) and the presence of antibodies in the serum against Aspergillus fumigatus. MUGA ( multigated acquisition ) is accurate test. Sometime bronchiectasis is also present in this disorder. # If you suspect a pulmonary embolism clinically. Small nodules with predominance in the upper lung lobes are important radiographic findings in cases of chronic silicosis. and synovitis. ** Aspirin is a cyclooxygenase (COX-1 and COX-2) inhibitor. # A non-productive caused by ACE inhibitors: an accumulation of kinins.

Joint stiffness lasts for more than 30 minutes.pain and swelling associated with vasomotor instability. Stellate ganglion block is also very effective. They are very expensive and are not indicated as first line of treatment. A radiographic finding of pleural plaques is the hallmark of asbestos exposure. # Total knee replacement is indicated in patients with severe restriction of walking and nocturnal and rest pain # Hydroxychloroquine-. Erosive joint disease in rheumatoid arthritis is a clear-cut indication for the use of diseases modifying anti-rheumatic drugs # rotator cuff tear -. MRI is gold standard for the diagnosis of avascular necrosis of hip. and thickened subchondral bone. infliximab and azathioprine. ceftriaxone # Chlamydia causes Reiter’s syndrome characterized by urethritis. Technetium 99 scinti scanning is the most effective method to assess bone metastasis.shoulder pain aggravated by movements like pushing.narrowing of joint space. Bronchoalveolar lavage is effective treatment of this disorder. Physical therapy is done to restore function. Bilateral irregular opacities of reticulonodular or reticular pattern most prominent in lower lung lobes. they are usually given in low doses at nighttime.neurogenic claudication radiates back to the buttocks. Methotrexate is the initial drug. Prednisone is indicated in resistant cases. # Lumbar spinal stenosis-. # diseases modifying anti-rheumatic drugs(slow down the progression of bony erosions and cartilage loss) -. Tx. leflunomide. hydroxychloroquine. plumbing. Leflunomide used when contraindications to methotrexate( caused pulmonary fibrosis ). conjunctivitis. Usual w urinary retention or overflow incontinence. limitation of mid arc abduction and external rotation that does not improve after lidocaine injection. Exertional dyspnea is the usual clinical presentation. #Prepatellar bursitis presents with pain and swelling over the anterior aspect of knee. Other disorders produced by asbestos exposure are pleural disease and mesothelioma. etanercept.pain over the medial tibial plateau just below the joint line. mucocutaneous lesions. Etanercept and infliximab are the new generation TNF inhibitors. it becomes better with sitting or leaning forward due to flexion of the lumbar spine or hips and gets worsened by extension of the lumbar spine. cement and insulation. ESR is always elevated. # Asbestosis is a type of pneumoconiosis caused by inhalation of asbestos fibers and is characterized by slowly progressive pulmonary fibrosis. history of trauma.lung disease.asymmetric migratory polyarthralgia followed by monoarticular arthritis. To relieve the pain. working with textiles.methotrexate. discolored limb with atrophy. # Narrowing of joint space and juxta articular erosions ïƒ rheumatoid arthritis--an erosive arthritis. # Neisseria gonorrhea -. Lung biopsy will confirm the diagnosis by showing PAS positive material. #Punched out erosion with a rim of cortical bone ïƒ gouty arthritis.Sausage-shaped digits. There is no effective treatment of this disorder. pulling and positioning the arm above the shoulder. non-narcotic analgesics like acetaminophen can be given during the daytime.osteopenia. impotence and intermittent claudication # Progressive low back pain not relieved by rest and worse at night suggests vertebral body metastasis. # Reflex sympathetic dystrophy-. High-risk professions include shipbuilding.cause serious eye disease including macular degeneration. Eye examinations at 6 months to 1 year intervals should be performed # osteoarthritis-. Wide gait (walking like a drunken sailor) and positive Romberg sign are specific but not sensitive for lumbar spinal stenosis.MRI or arthrography. multiple necrotic pustules over palm and soles.compression of lumbosacral nerve roots by infection or tumor. Selective serotonin reuptake inhibitors (SSRIs) are added when disease is refractory to the above medicine. # fibromyalgia—Tx: either amitriptyline or cyclobenzaprine are the initial drugs. saddle anesthesia around the anus or perineum and decreased tone of anal sphincter. # Marginal bony erosions and irregular joint destruction ïƒ psoriatic arthritis-. highly effective w refractory disease with methotrexate. Definitive diagnosis-. Symmetrical synovitis of the Metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints. Examination shows cystic swelling over the patella with variable signs of inflammation. # Leriche syndrome caused by atherosclerotic vascular disease. bone scan shows increased uptake. X-ray -. sharpened articular margins. osteophyte formation. asymmetric oligoarticular arthritis # arthritis. spaghetti legs #Herniated disc syndrome – Pain worsened with sitting and lumbar flexion #The cauda equina syndrome -. Corticosteroids are of no benefit in this disorder. Lung function tests show a restrictive pattern. urethritis and uveitis characterizes Reiter’s syndrome # Corticosteroid-induced avascular necrosis of the femoral head usually presents as progressive hip or groin pain without restriction of motion range and normal radiograph on early stages. Rheu #Anserine bursitis-. Examination shows bilateral end-inspiratory crackles. excessive muscular tenderness in 9 or more tenderpoints. and arthritis. sulfasalazine. . upper or lower legs.

and loss of normal axillary pouch. It does not affect the bones. increasing creatine kinase and aldolase & ESR. # Rotator cuff tear or rotator cuff tendinitis presents with severe pain and weakness of the shoulder abduction. and physical therapy.proximal muscle weakness w difficulty climbing the stairs or rising from the chair. bilateral nodular lung infiltrates. and facial nerve palsy. Dermatomyositis—Polymyositis + Skin w Heliotrope rash around the eyes associated with periorbital edema. No joint redness & swelling. anterior uveitis. which is absent at rest but present on overhead activity.Diag: muscle biopsy. (Periorbital edema with a purplish suffusion is called the heliotrope rash) . mild eosinophilia. arthralgias and previous history of rheumatic fever or rheumatic heart disease. Treatment is conservative with NSAIDs. Confirm diag: temporal artery biopsy # Subacromial bursitis characterized by shoulder pain. # Heerfordt-Waldenstrom syndrome is another rare from of acute sarcoidosis consists of fever. may elevated platelet counts. ** Cessation of alcohol and staying on a low purine diet are important measures in the prevention of future attacks in patients with acute gouty arthritis. or the joints. The treatment involves NSAIDs. erythema marginatum and subcutaneous nodules. hypercalcemia) # Thoracic outlet syndrome refers to compression of the neurovascular structures supplying the upper extremity. headache. parotid enlargement. associated with giant cell arteritis. Systemic steroids ïƒ symptomatic sarcoidosis (anterior uveitis. seen over the age of 50. and antinuclear antibodies. which are red scaly patches over the metacarpophalangeal joints. noncaseating granulomas. scleroderma does. # sarcoidosis-. knees and feet are the most frequently involved.# Polymyositis-. Lung involvement is very rare in this acute form. Neer’s impingement sign (pain on passive internal rotation and forward flexion at shoulder) is present.point tenderness over lateral epicondyle of the humerus and exacerbation of pain by extension of wrist against resistance.stiffness of glenohumeral joint. weakness and muscle atrophy. Suprascapular neuropathy is characterized by weakness on abduction and external rotation # Anti-Scl-70 antibodies are positive in scleroderma . Hands. Rotator cuff tendinitis can be distinguished from rotator cuff tear by injecting lidocaine that will result in improvement in range of motion in cases of rotator cuff tendinitis but no effect in range of motion in cases of rotator cuff tear. # CREST-. restricted both on active and passive movement in all cardinal movements. wrists.acute form of sarcoidosis w triad of arthritis (of ankles. Tx : low-dose prednisolone # Giant cell arteritis-.carditis.>50y. Paresthesias aggravated at night.Asymptomatic sarcoidosis does not require treatment. In CREST syndrome hardening of the skin is limited to the face and hands whereas in the diffuse form of scleroderma it extends to involve the trunk and proximalextremities. wrists or elbows). polyarthritis(migratory).do not develop interstitial lung disease or renal failure. # Lofgren’s syndrome -. Diag: Anti-B19 IgM. # Tennis elbow is epicondylitis-. corticosteroids injection into the joint space. # Frozen shoulder-. # Polymyalgia rheumatica—pain & stiffness of the shoulder and pelvic girdle(muscles of the neck. and Gottron's papules. # cervical spondylosis-. Movements of shoulder like positioning the arm above the shoulder aggravate pain. lower back. Arthroscopy establishes the diagnosis by showing decreased joint space volume. may be present in large tears.Osteophytes # kidney damage in SLE patients is immune complex-mediated. Diagnosis of rheumatic fever is made when two major criteria or one major and two minor criteria. physical therapy and activity modification # Rupture of long head of biceps commonly occurs in bicipital groove and would lead to a bulging muscle mass in the middle arm. immunosuppressive agents such as methotrexate may be effective. knees. Tx: high dose glucocorticoids immediately once clinical diagnosis made. Range of active shoulder movements are limited by pain. mediastinal. Tx: prednisone. and hilar lymphadenopathy. false positive rheumatoid factor. shoulders. ESR highly increased . # Adult Parvovirus infection – symmetrical joint pain w morning stiffness < 15 min. Ultrasonogram or MRI generally confirms the diagnosis. # Baker’s cyst is a complication of rheumatoid arthritis # major criteria of rheumatic fever -. pain caused by the swelling of blood vessels in the muscles. cannot tolerate corticosteroid. visual problems and polymyalgia rheumatica. Range of motion is limited only on active movement but is normal on passive flexion. peri carinal. erythema nodosum and bilateral hilar adenopathy. with inability to actively maintain 90 degree of passive abduction. This is a result of peri capsulitis. however. elevated arm stress tes used for screening purposes. Anti-B19 IgG antibodies appear a few days after Anti-B19 IgM antibody persist for life. Minor criteria include fever. # Suprascapular nerve supplies supraspinatus and infraspinatus muscles. hips and thighs). no muscles weakness. no rash. A positive drop arm sign. chorea.

calcium pyrophosphate crystals with positive birefringence # Coffin lid shaped crystals represent struvite crystals seen in nephrolithiasis. Sarcoidosis often presents with EN as an initial symptom.# Pseudogout is characterized by acute onset of pain and swelling of large joints. It has very low sensitivity and specificity. Carpal compression test-more sensitive than Tinel’s and Phalen’s signs but not episodic. oral contraceptive pills shouldn’t be used as it can aggravate renal disease. Histologically.Diffuse proliferative glomerulonephritis is the severest form # Epicondylitis about the origin of flexors of forearm is also called golfer’s elbow. tuberculosis. Anti phospholipid antibodies are of three types. increased risk of thrombosis. # Mixed Connective Tissue Disease-. and RaynaudDs phenomenon w history of smoking. It results in significant extensor weakness leading to loss of digital extension. focal proliferative. # renal injury in patients of SLE is immune mediated glomerular injury that can be divided into six sub-groups.back pain with morning stiffness. hyperparathyroidism. Initial evaluation should include a Complete blood count. This causes a tingling sensation along the median nerve distribution.flexion of both wrists to 90 degrees with the dorsal aspect of hands held in opposition for 60 seconds leads to pain or paresthesia along the median nerve--positive This test has a good specificity but lower sensitivity.-.Always consider thyroid abnormalities and fibromyalgia in a patient with diffuse muscle aches and excessive fatigue with non-restorative sleep # Phalen’s sign -. presence of symptoms for more than three months. The third is anticardiolipin antibody. Bone remodeling is constant. # Buerger’s Disease-. asymmetrical joints pain. Remaining five are as follows: Mesangial. membranous and sclerosing. It is more commonly associated with aging. polymyositis and systemic sclerosis are present simultaneously w positive anti-RNP. which falsely elevates APTT. segmental inflammatory process of small and medium sized arteries (thromboangiitis obliterans) characterized by occlusive disease of the arteries. CT scan is next. ESR. A small number . # Regular exercise has been shown to halt the progression of ankylosing spondylitis. Thyroid function tests (TFTs) and enzymes (CK)-. Both osteoclasts and osteoblasts are involved in the process and by itself is not a cause of pain. Sulfasalazine is effective for symptom control # SLE—migratory. plain X-ray of the sacroiliac joint is the next step. # For fibromyalgia. improves with exercise. rhomboid shaped. Berger’s Disease= IgA nephropathy # Oral contraceptive pills use in SLE is considered safe if the patient is in remission. hemochromatosis. Tinel’s sign is elicited by tapping over the median nerve. .If X-ray are negative or equivocal. Also. reduced range of forward flexion of the lumber spine on Schober testing and reduced chest expansion. sarcoidosis. associated with recent streptococcal infections. the pain is reproduced by simultaneously extending the wrist and fingers while the long finger is passively flexed by the examiner and also by resisted forearm supination. initial step . The second is lupus anticoagulant. this is a panniculitis involving inflammation of septa in the subcutaneous fat tissue. diffuse proliferative. hypophosphatemia and hypothyroidism. It is a compression neuropathy of radial nerve in radial tunnel characterized by tenderness over mobile muscle mass distal to the radial head.Chest X-ray # ankylosing spondylitis-. hypomagnesemia. # Radial tunnel syndrome can be confused with lateral epicondylitis as both the conditions can coexist. migratory superficial thrombophlebitis. Barriers method is used instead. point tenderness over the medial epicondyle # Interosseous nerve is most commonly entrapped at the proximal edge of the supinator. inflammatory bowel disease. exacerbated by flexion at wrist against resistance.SLE. insidious to reddish painful. # Paget’s disease is characterized by excessive bone resorption and repair. The first is responsible for false-positive syphilis serology. evidence of sacroiliitis is essential for the diagnosis. Its features are normal serum calcium and an elevated alkaline phosphatase. trauma. Antiphospholipid antibody syndrome is either primary or may be associated with other autoimmune disorders like SLE. • Nerve conduction studies very useful in diagnosing the carpal tunnel syndrome # erythema nodosum(EN)-. Type I is normal. # Anti phospholipid antibody syndrome is characterized by recurrent arterial or venous thrombosis or recurrent fetal losses in the presence of anti phospholipid antibodies. So. # Prophylactic allopurinol is the most effective method to prevent gout in patients at risk for tumor lysis syndrome. subcutaneous. # Rupture of long head of biceps commonly occurs in bicipital groove and would lead to a bulging muscle mass in the middle arm. nodules that usually develop in a pretibial location. In patients with active nephritis.

# Reactive arthritis is a form of seronegative spondyloarthropathy w Enthesopathy(pain and sausage digits) is quite specific for it. Rheumatoid factor and ANA are usually negative. Schirmertest measures the quantity of tears secreted # Reiter’s syndrome—onset of arthritis after infection with Chlamydia.back pain without significant neurologic deficit. Hence accordingly a uricosuric agent or a xanthine oxidase inhibitor is added to the patientDs medication. migratory and asymmetrical. seronegative spondyloarthropathy and such patients have negative rheumatoid factor. pain over the lateral side of wrist. a SLE renal biopsy is needed. #In patients with frequent attacks of acute gouty arthritis not controlled by colchicine. eosinophilia. Lip biopsy is the only specific diagnostic. and elevated ESR. and tenderness in one or both ears. diagnosis can be made by positive Finkelstein maneuver (passive stretching of the thumb tendons over the radial styloid in thumb flexion aggravates pain). # disk herniation-. and genitourinary. . pain. # Erosion of bone and cartilage is the hallmark feature of rheumatoid arthritis w symmetrical and non-migratory SLE-. history of asthma followed by fever and marked eosinophilia. malignancy. and positive P-ANCA in a young patient are highly suggestive of inflammatory bowel disease. # Flexor carpi radialis tenosynovitis is characterized by pain with wrist motion like active wrist flexion or passive wrist dorsiflexion. Corticosteroids are the mainstay of treatment. eyes. the lungs are usually spared. the pathogenesis is autoimmune. Shigella. leukopenia. # Absent ankle reflex can be seen in elderly patients as part of the normal aging process. # scaphoid fracture-.chronic dysfunction of the exocrine glands. dental caries due to salivary insufficiency. # Anti-DsDNA antibodies are primarily involved in the pathogenesis of lupus nephritis. multiple systems. Tx: High-dose steroids # Churg Strauss syndrome is a multisystem vasculitis-.tendonitis of abductor pollicis longus and extensor pollicis brevis as they pass beneath the retinacular pulley. redness. joints and/or eyes. However. severe when lifts the infant from the crib. Salmonella. dryness of mouth.affects skin. and NSAIDs. or venules. # When kidney is involved.necrotizing inflammation of small. nervous. integumentary. infectious mononucleosis and Parvovirus infection should not be present. gastrointestinal. lungs.Nonerosive arthritis. cardiac. musculoskeletal. Treatment is best with local injection of long-acting steroids.a variant of rheumatoid arthritis.( blue-reddish skin discoloration) # Erythema nodosum. or narrowed results in mottled discoloring on large areas of the legs or arms. Renal failure is the most common cause of dealth. muscle relaxants. # De Quervain’s tenosynovitis-. arthralgias. To make the diagnosis of adult still’s disease. and other mucosal areas. # polychondritis—recurrent inflammation of cartilaginous structures and other internal organs. # Thoracic aortic aneurysm is a serious complication of giant cell arteritis # The single most common cause of asymptomatic isolated elevation of alkaline phosphatase in an elderly patient is Paget’s disease. capillaries. gastrointestinal tract and heart. The goal is to maintain serum uric acid levels to less than 6 mg/dL Uricosuric agent is indicated for cases of under secretion of uric acid.blood vessels are constricted. This evaluates whether hyperuricemia is due to over production or under secretion of uric acid. conditions like systemic lupus erythematosus (SLE). tissue sample showing a blood vessel with eosinophils around it Tx: glucocorticoids # Polyarteritis nodosa-. Bed rest and physical therapy has not been shown to be helpful. # Muscle biopsy is the best diagnostic study for polymyositis. conservative approach is preferred for a period of 4-6 weeks. Xanthine for over production. throat.history of trauma and point tenderness over the snuffbox. The treatment of choice for reactive arthritis or ReiterDs syndrome is with NSAIDs # HCV infection is associated with 80% cases of mixed essential cryoglobulinemia. A value of less than 800 mg/day suggests under secretion. Yersinia and Campylobacter.present as a new lytic lesion and a sudden increase in alkaline phosphatase. A value of more than 800 mg/day suggests over production.of patients will develop osteosarcoma or sarcomatous changes over 10 years -. nervous system. the nose. Presence of rheumatoid nodules in SLE is associated with active disease. kidney.and medium-sized arteries without glomerulonephritis or vasculitis in arterioles. diarrhea. rheumatoid arthritis. usually IV methylprednisolone is used # atheromatous embolism—painful cyanotic toe w intact pulses # livedo reticularis-. This includes early mobilization. a 24-hour uric acid levels in urine is determined. including renal. biopsy shows lymphoid foci in accessory salivary glands. swelling. # Sjogren’s syndrome-. high spiking fevers w evanescent salmon colored maculopapular or macular rash that involves trunk and extremities. # Adult still’s disease-. arthritis or arthralgias and significant leukocytosis.

Maculopapular or purpuric lesions) Surgery # CT scan diagnosis intraabdominal abscess. Arthralgia is migratory. Tx: surgery. eye lesions. . # In an unstable patient with suspected intraabdominal bleeding the best diagnostic intervention is diagnostic peritoneal lavage. notably penicillin based medicinesïƒ The classic clinical manifestations consist of fever. Corticosteroids offer relief from most of the symptoms but do not protect from progression to dementia or blindness.Ultrasonogram used in emergency room by trauma team is actually the best option. an irregular or no menstrual cycle. acneiform nodules and papulopustular lesions. like indomethacin. normal or low FSH levels. alcohol. #Acetaminophen is the initial therapy to relieve pain in patients of osteoarthritis. like celecoxib. are the most commonly found organisms in nosocomial infections. Surgical site infectionsïƒ second.swelling. are indicated for the treatment of osteoarthritis when patient is at risk for upper Gl bleed and has failed to respond to analgesics # Bladder carcinoma is a recognized complication of long-term use of cyclophosphamide. anterior uveitis. CT scan of abdomen is a better option in stable patient but not in unstable patient. # Dupuytren’s contracture occurs due to fibrosis of palmar fascia-. associated with cigarette smoking. including anterior uveitis and posterior uveitis. arthralgia. Nosocomial pneumonia is the third most common cause of nosocomial infections. retinal vascularization. # Ganglion cyst presents as small nodule that is mobile and tender to touch and is usually located over the metacarpophalangeal joint. infertility. ruptured. So USG or DPL are the procedures of choice to diagnose intra abdominal bleeding in an unstable trauma patient. lymphadenopathy.thickening and contracture of the fibrous bands on the palmar surfaces of the hand and fingers. Lower extremities: 27% total Rule of Palm ïƒ The size of the patient’s hand is roughly equal to 1 % of the body surface area. Skin and joint manifestation are thought to be immunemediated caused by immune-complex formation from gonococcemia. Atelectasis is the most common cause of fever in the first postoperative day. Rash is pustular or vesiculopustular and is usually present on trunk and extensor surfaces of the distal extremities and it may become hemorrhagic.recurrent oral ulcers. Serum sickness can also be caused by several drugs.recurrent genital ulcers. Distal interphalangeal (DIP) joint involvement # Behcet’s syndrome-. erythema nodosum The international criteria for diagnosis includes: Recurrent oral ulcers plus two of the following features . hands and ankles may occur. fluffy periostitis. androgen excessïƒ hirsutism. are indicated. diabetes mellitus. tenosynovitis and polyarthralgia.clear vesicles on red bases and later on develop into macules or papules. Women are at more likely to develop disseminated gonococcal infection especially during menses and pregnancy. asymmetrical and oligo-articular. recurrent genital ulcers. and a positive pathergy test. Exploratory laparotomy would have been the first step in trauma patient with signs of abdominal irritation or penetrating injuries to abdomen. NB3 Polycystic ovarian diseaseïƒ LH increased. epilepsy and tuberculosis. initially present with infertility w obesity and insulin resistance. A urinary tract infection is the most common type of nosocomial infection.# Typical skin lesion of Reiter’s syndrome is Keratoderma blennorrhagicum found on palms and soles -. coli and S. # a gangrenous. # Disseminated gonococcal infection is a syndrome of rash. Tenosynovitis of multiple tendons at wrist.. skin lesions including erythema nodosum. an irregular or no menstrual cycle Premature Ovarian Failureïƒ FSH increased > 40. # Body surface involved in burn injury is calculated with the help of Rule of Nines: For adults: Each arm: 9 % Each lower extremity: 18 % (9 % anterior and 9% posterior) Anterior torso: 18% Posterior torso: 18% Face: 9% Perineum: 1% For children: Head: 18% (9 % anterior and posterior each). pencil cup deformity of fingers. Cyclooxygenase-2 (COX-2) inhibitors. Other skin lesions are circinate balanitis -. retrocecal appendixïƒ Right hemicolectomy with ileotransverse anastomosis # E.painless shallow ulcers present on the glans penis or urethral meatus. and bilateral asymmetrical fusiform soft tissue # Trigger finger presents with pain on flexion of the involved digit followed by inability to extend. aureus. If analgesics. fail to control pain NSAIDs. and skin eruption(urticaria. # Psoriatic arthritis --pitting nails and onychodystrophy. like acetaminophen.

# Dumping syndrome is a common postgastrectomy complication. # Retrograde cystogram with post void films is used for diagnosis of bladder injury # Retrograde urethrogram should be the first step in management of suspected posterior urethral injury(inability to void. The symptoms usually diminish overtime and dietary changes are helpful to control the symptoms. Torus fracture is an impaction injury in which the cortex of long bone buckles with no loss of cortical continuity. flexion and abduction. if necessary. high riding prostrate) Immediate surgical repair is done in case of anterior urethral injury. Mallory Weiss tear is an incomplete esophageal tear. pulmonary toilet and antibiotic have all been used in patients with inhalation injury.# Major determinant for decision of surgical v/s non-surgical management of splenic rupture are : 1. while the opposite cortex and periosteum is intact. blood at urethral meatus and scrotal hematoma. Vital signs and hemodynamic stability. Reconstructive surgery is reserved for intractable cases. It occurs between the ages of 10-16yrs. # After blunt trauma to the chest. AP and lateral films of the pelvis show widening of the joint space and collapse of the femoral head # Duodenal injuries are best diagnosed with CT scan of the abdomen with oral contrast or an upper Gl study with gastrograffin. Stabilization and delayed primary closure is the optimal therapyïƒ Dressing of the wound and plaster cast. # Osgood Schlatter disease involves tibial tuberosity resulting in tenderness over it. # Hemothorax is most commonly managed by a tube thoracotomy in lower part of chest. # The recommended treatment in isolated diaphyseal humeral fracture is closed reduction followed by hanging cast or a coaptation splint # Hypoventilation is a frequent occurrence after abdominal hernia repair and early physiotherapy and respiratory exercises are mandatory. # Boerhaave’s syndrome is esophageal perforation due to severe vomiting and it produces pneumomediastinum. Open reduction and internal fixation is required if initial X ray shows fracture displacement. # Early manifestations of carbon monoxide poisoning ïƒ headache and respiratory distress followed by acute confusion and agitation. The patient may have abnormal limb length. Arthroscopy or MRI to confirm diagnosis. Physeal fracture is a fracture across the growth plate of bone. # History of a traumatic event and presence of crunching are compatible with fracture of metatarsal. A barium swallow will be diagnostic. Surgery is seldom necessary. It is indicated when there is more than 1500 ml of blood recovered on inserting the chest tube or when there is more than 600 ml of blood loss over 6 hours after inserting the chest tube. Beta agonists along with steroids. specific for meniscal injury. # Central cord syndrome may result from hyperextension injuries and is characterized by weakness that is more pronounced in the upper extremities than in the lower extremities. pain with wrist movement. Treatment with long arm cast. Surgery is best done via the abdomen in acute conditions and via the chest in chronic cases # Open fractures should not be closed primarily because of the associated increased risk of infection and subsequent osteomyelitis. Pain is absent or mild. treated with 100% oxygen via a facemask. Rest and NSAIDs are used as an initial conservative therapy for acute meniscal injury. Gait is antalgic and range of motion of the hip is limited on internal rotation. the posterior urethral injury should have a supra pubic catheterization and delayed repair. Change in hematocrit overtime. 3. Radiography shows displaced femoral epiphysis. All diaphragmatic ruptures require treatment. . octreotide should be tried. In resistant cases. Radiography shows irregularities of the tubercle contour # Legg-calve-perthes disease occurs between the ages of 2-12 year old with the mean age of 7 years. followed by barium. Surgery (arthroscopic or open) is often necessary to correct the problem. # Scaphoid fracturesïƒ a fall on an outstretched hand. # Beck's triad of hyotension. complete perforation is not a feature. one should suspect a diaphragmatic perforation. elevated JVP. tenderness in the anatomical snuffbox. # Bolus 50% dextrose and thiamine is indicated in any unconscious patient as an emergency measure # Intravenous morphine in emergency setting is indicated for acute pulmonary edema.2. usually seen in patients with recurrent vomiting. and muffled heart sounds confirms the diagnosis of pericardial tamponade. However. # Slipped capital femoral epiphysis typically occurs in an obese adolescent and presents with a painful limp. Diagnosis is best done with a bronchoscopy. endotracheal intubation. # Green stick fracture is an incomplete fracture in which one cortex is broken. Need for blood transfusion. # Inhalation injury is common in burns patients and may take several days to manifest. # McMurray sign ïƒ popping sound on passive flexion/extension of the joint. Radiologically evident fractures may not be visible for up to two weeks. Plastic deformation is an injury exclusively of children in which bones simply bend without any break in either cortex. so you wont see pneumomediastinum. if an x-ray shows a deviated mediastinum with a mass in the left lower chest.

use of acetazolamide or mannitol. # Glasgow coma scale is used to assess the severity of head injury but it does not indicate the presence or absence of increased intracranial pressure. # Acalculous cholecystitis occurs in critically ill patients and imaging studies show diagnostic findings of thickening of the gall bladder wall and presence of pericholecystic fluid. The treatment is cholecystectomy. Early range of motion and strengthening are recommended. antibiotics and bowel rest. Ortolani’s maneuver: to see if the dislocated hip is reducible. and have localized right lower quadrant findings.Papilledema. Antibiotics should cover enteric gram-negative organisms and anaerobes. 2. # When clavicle injuries occur and a bruit is present. # Uric acid stones. # Clinical signs of increased intracranial pressure (ICP) include:1.Craniotomy is indicated in acute subdural hematoma with midline shift of structures on CT scan but is associated with grave prognosis. have to be evaluated by either CT of the abdomen or intravenous pyelography. In emergency room an orotracheal intubation with pulse oxymetry monitoring is the best option.# Barlow’s maneuver: Used to determine if a hip is dislocatable. # Necrotized surgical infection is characterized by intensive pain in the wound. Restoring circulation in emergency is best done by rapid infusion of isotonic fluids rather than packed red blood cells # Cystic lesion involving the pancreas on CT scan in the setting of acute pancreatitis with systemic toxicity must be considered an abscess and should be treated with external drainage # Protamine is antagonist of heparin. Hepatic encephalopathy is the main risk after this procedure. anisocoria or non-reactivity of one or both pupils. Proximal and middle third clavicle injuries can be treated with closed reduction with figure of eight brace or sling for one-to-two weeks. an arterial injury must be ruled out with an angiogram. decreased sensitivity at the edges of the wound. The symptoms usually develop in the first 24 hours and a patchy alveolar infiltrate on chest x-ray is typical. # In cases of bleeding esophageal varices need for 5 or more units of blood transfusion in a period of 24 hours is considered an indication for surgery and transjugular intrahepatic portosystemic shunt is the best choice in emergency. USG is the most sensitive investigation for the diagnosis of Developmental dysplasia of the hip(uneven gluteal folds. # Transient submandibular gland swelling may occur during feeding due to partial obstruction of its duct and further evaluation is required if swelling is persistent or recurrent. hyperventilation and if needed. subluxatable and dislocatable proximal femur and acetabulum. Warfarin treated patients should be given fresh frozen plasma instead of vitamin K(Vitamin K therapy and cessation of warfarin will have effect in 1 or 2 days)when emergency surgical procedure is to be performed. usually caused by mixed gram-positive and gram-negative flora. # An airway is needed in all unconscious patients. Distal third clavicle injuries are usually unstable and may require open reduction and internal fixation. # An exploratory laparotomy is needed in all the patients with blunt trauma to abdomen with signs of peritoneal irritation. Unexplained acidosis.Flaccidity or decerebrate or decorticate motor posturing. # Acute blood loss in excess of 1500 ml requires blood transfusion. or progressive neurological deterioration not attributable to other causes 3. may indicate blood transfusion. A second/third generation cephalosporin or a fluoroquinolone plus metronidazole are usually used. CT scan of abdomen to diagnose intra abdominal bleed should only be done in stable patient and not in unstable patient. with painless limp and pain if present is mild . cloudy-gray discharge. # Patients who present more than five days after the onset of symptoms of appendicitis.) for infants less than 6 months of age. characterized by avascular necrosis of head of femur. bilaterally dilated pupils. Early surgical exploration is essential. Crystalloid resuscitation is adequate for blood loss that is less than 25% of the patient’s blood volume. in anemic patients. should be treated with IV hydration.(semi lenticular hematoma) Treatment is centered on prevention of intracranial hypertension by head elevation. In the field the best option would be a needle cricothyroidectomy. which are radiolucent. examination the hip can be easily displaced posteriorly and can be brought back to normal position with a click sound. # Mesenteric thrombosisïƒ Severe abdominal pain out of proportion to the physical findings along with bloody diarrhea # Intermittent claudication is best treated with aspirin and an exercise program. # Absent bowel sounds with gaseous distention of both small and large bowels indicate paralytic ileus. if the patient had required less than 5 units of blood transfusionïƒ Continue the pharmacotherapy and leave the tube for another 24 hrs # Legg Calve Perthes disease is serious but self-limiting disease in children of 4-10 years. and sometimes crepitus. # Treatment of acute subdural hematoma is essentially conservative if no midline shift is present on CTscan. # pain on passive extension of fingers is the most sensitive marker of compartment syndrome # Pulmonary contusion is not uncommon after high-speed car accidents.

Any gunshot wound below the 4th intercostal space (level of nipple) is considered to involve the abdomen. # Unless strangulation or perforation is suspected. further support this diagnosis. urinary and fecal incontinence. variable sensory loss. which may contain occult blood. Pneumomediastinum associated with mediastinitis would need surgical drainage of the mediastinum. CT scan is the single best study to evaluate solid organ damage. # Any gunshot wound of the abdomen requires exploratory laparotomy. The intensive abdominal pain out of proportion to the physical findings and the diarrhea. It is commonly seen in elderly secondary to forced hyperextension type of injury to the neck. Zone 3(upperzone) extends from angle of mandible to base of skull All gun shot injury in middle zone of neck should be surgically explored. excessive Gl absorption of oxalate. # Increased oxalate can also occur in people who drink large amounts of tea. atrophy of thigh. limitation of internal rotation and abduction at the hip joint. # The presence of deep Q waves without ST/T wave change indicates old transmural infarction # Monteggia(isolated fracture of proximal third of ulna. . # Pseudomembranous colitis usually develops 2-3wks after the onset of the antibiotic treatment # bowel ischemia and infarction as an early complication of operation on the abdominal aorta. Hyperoxaluria occurs in patients with small bowel resection. # Central cord syndrome is characterized by burning pain and paralysis in upper extremities with relative sparing of lower extremities. # hyperextension of the kneeïƒ Anterior cruciate ligament injury. # CT. Children less than 5 years of age generally do not need treatment. associated with disruption of distal radio ulnar joint )fractures in adults are treated with open reduction and internal fixation. # Cauda equine syndrome is characterized by paraplegia. coffee. The increased intestinal fat binds dietary calcium. chocolate and ethylene glycol overdose. # Brown Sard syndrome is acute hemisection of cord and is characterized by ipsilateral motor and proprioception loss and contra lateral pain loss below the level of lesion. Expanding or large neck hematomas need surgical intervention # CT scan of a diffuse axonal injury shows numerous minute punctuate hemorrhages with blurring of grey-white interface caused by traumatic deceleration injury and results in vegetative state # Mesenteric thrombosis (arterial or venous) or non-occlusive ischemia can lead to massive fluid sequestration in the bowels Hypovolemic shock( cvp = 0 ) and hemoconcentration usually ensue. with contrast. will visualize both kidney and spleen. bowel obstruction is treated conservatively with fluids. In communicating hydrocele. stab wound injury to middle zone in asymptomatic patient can be safely observed. the upper limit can’t be reached and it is treated surgically # Zone 1 (lower zone) extends from clavicle to cricoid cartilage. which is then unavailable to bind oxalate as usual.and may be referred to knee or thigh. Therefore. beer. # Pneumomediastinum associated with tension pneumothorax usually responds to chest tube drainage and it does not usually require surgical decompression. In stable patients with abdominal trauma.Gunshot wound in lower zone (zone 1) and not upper zone (zone 3) needs esophagogram and bronchoscopy. # Intestinal obstruction with metabolic acidosis and shock indicates serious disease and it requires laparotomy. inflammatory bowel disease and other malabsorptive states. Children above 5 year of age or those with severe disease may require abduction bracing or surgical corrections. # Slipped capitis femoral epiphysis is seen in adolescent obese boys and antalgic gait is characteristic. with anterior dislocation of radial head )& Galeazzi (isolated radial shaft fracture. Lachman's test is a very sensitive physical test for acute anterior cruciate ligament tear # McMurray's test is used for diagnosis of meniscus injury # Cardiac contusion can be associated with various arrhythmias and is best monitored by continuous ECG monitoring. The poor neurologic condition in this patient is probably due to brain hypoperfusion as a consequence of shock. The extreme elevation of CK suggesting massive ischemia is characteristic. nasogastric suction and enemas. Zone 2(middle zone) extends from cricoid cartilage to angle of mandible. Closed reduction and casting are optimal for treatment of Monteggia fracture in children # Anterior cord syndrome is commonly associated with burst fracture of the vertebra and is characterized by total loss of motor function below the level of lesion with loss of pain and temperature on both sides below the lesion with intact proprioception. increased oxalate absorption in large bowel (unabsorbed bile salts may aid this) occurs and precipitates in the kidney # Non-communicating hydrocele disappears spontaneously by 12 months of age and it is therefore managed expectantly.

red. # Amount of fluid required in the first 24 hours = 4 ml / kg / % of body surface area involved in the burns. # Superficial and erythematous burns while painful do not require any special wound care. Half of this is given in the first 8 hours and half in the next 16 hours. tachycardia. and the ulcers are deep and located usually in the distal parts of the leg where the blood supply is least. Expectant therapy is a rule for all patients with uncomplicated basilar skull fracture.#Bladder rupture can be classified into the following types: Type 1: Bladder contusion. Mafenide sulphate is only used if deep penetration is required in case of wound with eschar. # basilar skull fracture are rhinorrhea. Third-degree burns or full thickness burnnessïƒ The epidermis and dermis is completely destroyed and no dermal appendages remain. The best diagnostic test is serum creatine kinase levels. Spontaneous healing may occur depending on the dermal involvement and viability of dermal appendages. It heals without scaring. The pulses are weak or absent. and occasional cramps at night. # Clear fluid discharge from nose after a facial or head injury is suggestive of cerebrospinal fluid rhinorrhea secondary to fracture of base of skull. gross hematuria. and intravenous mannitol and diuretics. An example would be flame burn.3 weeks with nasogastric tube and parenteral nutrition. head elevation. lacrimal system. Second-degree burns or partial thicknessïƒ It involves the entire epidermis and various layers of the dermis. waxy and charred appearance. Diagnosis can be confirmed by presence of fat droplets in urine or presence of intra-arterial fat globules on fundoscopy. Sunburn is a classical example. tachypnea. The best initial treatment for rhabdomyolysis is osmotic diuretics and bicarbonate (to alkalinize the urine) to prevent renal failure # emoral artery aneurysmïƒ A pulsatile groin mass below the inguinal ligament is characteristic # First-degree burns or superficial burnsïƒ The injury is confined to the epidermis with minimal skin damage. They are not painful and have leathery. Early excision therapy is indicated for extensive partialthickness and full-thickness burns. edematous and blistered. The skin is painful. Craniotomy may be required for patients with leak that continue for more than 2 weeks # Crush injuries are associated with rhabdomyolysis. ecchymosis behind the ears and otorrhea. aching. Associated injuries of . They can be further classified as superficial and deep depending on the depth of dermal involvement. which is responsible for the discoloration. Suprapubic pain and high riding prostrate # Isolated duodenal hematoma is treated conservatively with nasogastric tube and parenteral nutrition. as spontaneous healing does not occur. Mafenide sulfate is associated with severe pain and acidosis. Type 3: Intraperitoneal rupture is less common but is commonly seen in patients with full bladder at accident due to rupture of dome of bladder Type 4: Combined intra and extra peritoneal rupture: it accounts for 10% of bladder injury. Surgery in needed only if there are other associated injuries or if the hematoma does not resolve within 2 . It is manifested as myoglobinemia. There is no swelling with arterial insufficiency. myoglobinuria and eventual renal failure w Hyperkalemia. Even though the peripheral pulses are present. it allows for early skin grafting and lesser complications. # Anaphylactic shock should be promptly treated with subcutaneous epinephrine. Ulceration occurs from the prolonged venous hypertension. #The most common symptoms from varicose veins are fatigue. Topical or oral analgesics agents can be prescribed. medial canthal tendons. The edema associated with varicose veins is due to incompetent perforators. Nasoethmoidal fractures may be associated with injuries to ethmoidal roof. The skin is mildly erythematous and pain is the chief complaint. Type 2: Extra peritoneal rupture is more common than intra peritoneal rupture and usually occurs at lateral border or base. raccoon eyes (black eyes). Also. as they do not heal spontaneously. swelling. and fever. petechial rash. The symptoms are generally worsened by standing or after prolonged periods of sitting. a femoral arteriogram to rule out femoral vessel injury is required # Patients with increased ICP should be treated with hyperventilation. tiredness in the leg. cribriform plate and vasculature of nose. Debridement and skin grafting is required. The hypertension in the varicose veins leads to a leakage of red cells in the surrounding tissues. and is usually located on the medial aspect of the leg and is superficial. subconjuctival hemorrhage. In patients who develop deep vein thrombosis (DVT). # Arterial insufficiency usually presents with symptoms of claudication and worsened by leg elevation. The swelling and aching rapidly decrease after leg elevation and rest. but hair loss and muscle atrophy may be visible. Hyperventilation works by causing vasoconstriction and decreasing the intracranial pressure by decreasing the cerebral blood volume # Fat embolismïƒ characterized by severe respiratory distress. follow-up studies reveal ulcers and incompetent veins # gun shot injury in anteromedial portion of the upper thigh. The topical anti bacterial agent most commonly used is silver sulphadiazine.

it is not suitable as an initial means in a hemodynamically unstable patient. anosmia. Ulcers from arterial insufficiency (peripheral vascular disease) are usually located on the lateral aspect of the foot and are well circumscribed. # Abdominal rigidity and muscle cramps are seen with black widow spider bite. # Slipped femoral capitisïƒ Loss of abduction and internal rotation. Posterior urethral injury is associated with pelvic fractures and presents with blood at meatus. # Pelvic X ray should be routinely done in all patients with trauma to screen for pelvic injury. artery and nerve is to stabilize the bone followed by repair of vasculature followed by the nerve repair. and many have delayed manifestation. neuropathic ulcers from diabetes should be suspected. Venous hypertension may be due to vein varicosities and incompetent perforators. # Brown recluse spider bite causes deep necrotic ulcer at the bite site. Moreover. However. Local excision is the treatment of choice and skin grafting should be considered in severe cases. # Muffled heart sounds are common in severe hypovolemia and do not necessarily indicate pericardial fluid. if there is a whistling noise during respirationïƒ nasal septal perforation # The usual sequence of management of injury to bone. which is exacerbated by contraction of quadriceps muscle. most commonly due to blunt trauma to the perineum (straddle injuries). external rotation of thigh when hip is flexed. jugular venous distension and decreased breath sounds. # Osgood Schlatter disease is an epiphysitis of the tibial tubercle and is characterized by pain over tibial tubercle. # Torus palatinus is a benign bony mass located on the hard palate. TT: Yes if last dose >10 years ago TIG: No TT: Yes if last dose > 5 years ago. # History of Tetanus immunization Clean wounds Dirty looking wounds < 3 doses of tetanus toxoid in past. Associated w EbsteinBarr virus infection # Gentle traction to attempt alignment of the fragments of a fractured long bone is important to prevent further vascular and neurological damage and it should be attempted immediately. # Stress fracture or March fracture or insufficiency fracture is commonly seen in young active adults involved in vigorous and excessive exercises. This is almost exclusively seen in young men and women of less than 19 years age whose growth centers are still active. # Anterior urethral injury due to injury to urethra anterior to the perineal membrane. Bones most commonly involved in stress fractures are metatarsal. TIG: No # Mediastinitis needs thoracotomy for debridement. # The characteristic finding of tear of patellar tendon is proximal displacement of patella. # Posterior urethra consists of the prostatic urethra and membranous urethra. epiphoria or telecanthus. Whenever a patient is in decompensated hemorrhagic shock most probably from ruptured abdominal organ bleeding. . shortness of breath. # tension pneumothoraxïƒ hypotension. analgesics and sedatives should be done in all the patients with severe head trauma as indicated by Glasgow coma scale. navicular. CT scan of pelvis is an excellent method to access the pelvic fracture. TT:Yes TIG: No TT:Yes TIG: Yes More than or equal to 3 doses of tetanus toxoid in past. No medical or surgical therapy is required.these structures can give rise to cerebrospinal fluid rhinorrhea. # Intubation with mechanical ventilation and administration of intravenous fluids. scrotal hematoma and inability to void in spite of sensation to void. # Most of the fractures of shaft of femur can be managed with closed intramedullary fixation of fracture. # Ulcers on the medial aspect of the leg indurated with irregular margins are generally from venous disease. and antibiotic therapy # Garden classification for femoral neck fracture is as follows: Type 1: Valgus impaction of femoral head commonly seen with stress fractures. neck of femur and tibia. The individual is a smoker and his peripheral pulses may be absent. # Volkmann’s ischemic contracture is the final sequel of compartment syndrome in which the dead muscle has been replaced with fibrous tissue # After rhinoplasty. Tx: external screws # ulcers on the soles of the foot. drainage. next step is diagnostic peritoneal lavage or abdominal ultrasound once the resuscitative efforts are begun. high riding prostrate. epistaxis. The typical patient is a 13 -14 year old boy or 11-12 year old girl who has had recent rapid growth spurt. cardiac tamponade is unlikely without distention of the neck veins. # Nasopharyngeal cancer usually presents initially as a painless neck mass. treated with calcium gluconate and muscle relaxants.

# Complications after central line placementïƒ pneumothorax. Either a CT( stable) scan or ECHO(unstable) will be diagnostic. # Ludwig’s angina is infection of the submaxillary and sublingual glands. Careful observation for recurrence of the mass is the standard follow-up. # Aortic rupture should be ruled out in all the chest trauma patients with hypotension. Pain increases on contraction of quadriceps muscle. hemothorax. peptic ulcer disease (PUD). as in young women. aortic injury must be suspected. # When blunt chest trauma occurs with a widened mediastinum on chest x-ray. In such a case. Mammogram is not useful for young women. ultrasound would be indicated. Type 4: Complete fracture with displacement > 50%. Treatment is intravenous penicillin with coverage for anaerobes. # breastïƒ coarse calcifications are more characteristic of benign lesions. pain and swelling around the tibial tubercle. Type3 &4ïƒ Primary arthroplasty. # Breast mass that produces non-bloody aspirate and disappears completely on aspiration does not need any further evaluation other than observation # Cysts that disappear completely. # Compartment syndromeïƒ Nerve palsy is not very common # Patient with cirrhosis may have upper Gl bleeding due to: erosive gastritis. CT and diagnostic peritoneal lavage may be indicated. and hypotension after a stressful event (e. # Angiography would not be informative after the barium enema because the colon is already filled with contrast. the content of which is non-bloody as well as possess a characteristic diffuse nodularity. Type 1 or stress fractures can be managed with toe touch weightbearing until there is radiological evidence of complete healing. Tx: Immediate surgical intervention # Intravenous pyelography is the best investigation to look for stones or tumors # Careful observation with follow-up in patients with mild curve (< 20 degree). hypoglycemia. abdominal pain. Prior to use of any newly placed central lines. Scoliosis tends to progress till the skeletal growth is achieved so careful follow-up to assess the rate of progression of . sepsis and tamponade. Fat necrosis is not a premalignant lesion. If it is negative US. # Upright abdominal x-ray is the first diagnostic test when intestinal perforation is suspected. The source of the infection is from an infected tooth.. If the normal breast tissue is dense. surgical procedure) in a patient who is steroiddependent(preoperative steroid use) # Neutralization of gastric pH should be considered for severely ill patients to prevent gastric stress erosions. Treatment is symptomatic with rest. # Nonunion and avascular necrosis are common complications seen in scaphoid fracture. Labeled erythrocyte scintigraphy could be helpful to define the site of bleeding # Osgood Schlatter diseaseïƒ caused by overuse. whereas microcalcifications are more characteristic of malignancy. Radiologic confirmation of the position of the catheter is a standard step in protocols after insertion of central lines. vomiting.3 and 4 are called unstable fractures and need open reduction and internal fixation or a primary arthroplasty as soon as the patient is stabilized. but it should always be preceded by a retrograde urethrogram to rule out a urethral injury which is very common with penile fracture. # Thus compression fracture of vertebra should always be ruled out in patients with calcaneus fracture secondary to fall from a height # acute adrenal insufficiencyïƒ Acute onset of nausea. Radiographs may show characteristic fragmentation on lateral view of upper tibia. Surgery is rarely necessary for MCL tear. # Diverticulosis is the most common cause of bleeding in an elderly patient. # Surgical exploration is the treatment of choice for fracture of penis. are most likely due to fibrocystic disease. type 2. Mammogram would be indicated if the mass didn’t disappear completely or if its content was bloody. No treatment is needed. since their breast tissue is dense. a mass may not be seen on mammogram. Fat necrosis shows coarse calcification on mammography and biopsy reveals fat globules. NSAIDs and brief casting. and Mallory-Weiss tears. Ultrasound is useful also for evaluation of cystic lesions. varices. Internal fixation can be used for type 2 or 3 fracture in young patients.g. # MRI is choice for ligamentous injuries of the knee with an accuracy rate of 95%. but this cyst is already drained. Screening for aortic trauma can best be done with a chest x-ray. # Galactogram guided resection is the treatment of choice for intraductal papilloma which presents with serous or bloody nipple discharge. A cardinal rule for the prevention of myocardial perforation is radiologic confirmation that the catheter tip is proximal to the cardiac silhouette. Chronic constipation is the single most predisposing factor to develop diverticulosis. the chest x-ray must be reviewed to ensure the absence of pneumothorax. Confirmatory test is angiography or spiral CT scan. hemothorax and good positioning of the catheter tip.Type 2: Complete but non-displaced femoral neck fractures Type 3: Complete fracture with displacement < 50 %.

The intimal flap may progress to complete obstruction of the vessel or may lead to emboli and stroke. #herniated lumbar discïƒ diag:MRI. ESR is normal and serum alkaline phosphatase is elevated. Bracing is needed if the initial curve at diagnosis is more than 30 degree or it shows more than 5 degrees of progression in follow-up studies of mild scoliosis.ïƒ metastasize to liver. The angiograms will evaluate the aortic arch and its branches. For patients with curve between 20-30 degrees. # HIV-infected patients are at high risk for the development of tuberculosis. rare in organs that drain via the portal system. Angiograms are usually done for penetrating injury. waiting for a more propitious time in which to attempt hemostasis. malaise. in which 20-some years may elapse between primary tumor and metastatic manifestations.scoliosis is needed. Recurrent or persistent locking needs arthroscopic assessment and treatment. # Colles fracture is the most common fracture of distal radius characterized by dorsal displacement and dorsal angulation giving a dinner fork deformity. # Saphenous vein cut down or percutaneous femoral vein catheterization are alternatives to have an intravenous access in trauma patients with collapsed veins. primary closure of esophagus. there is an intimal flap. #Osteogenic sarcoma usually presents with painful swelling around the knee. X-ray shows osteolytic lesion with onionskin appearance Giant cell tumor or Osteoclastoma is a tumor of adults and it involves the epiphysis of the distal femur or proximal tibia. Radiology characteristically shows a soap-bubble appearance. Thus. # Clavicle fractured is not commonly associated with neurovascular damage. exploration is mandatory. If perforation is present. Surgery is generally needed for curves more than 40 degrees at initial diagnosis. Tx: bed rest #squamous cell carcinoma of the lower lip. #suggests a skin cancerïƒ The edge of the lesion offers the best information for the pathologist. the abdomen also has to be closed immediately albeit temporarily in the most expeditious manner. Tx: closed reduction and casting # Galeazzi fracture is isolated fracture anywhere along the length of radius with associated injury to the distal radio ulnar joint. once coagulation function and body temperature have improved. Despite the patient being neurologically intact. treated with figure of eight bandage. which may cause collapse of the vertebral bodies and intervertebral disk. # Internal fixation with sliding #screw and plate and early mobilization is the treatment of choice for intertrochanteric fractures. # Pain relief should be the prime objective in management of rib fracture in elderly. # After an abdominal aortic aneurysm repair. diarrhea with blood in the stools should raise the suspicion of ischemic colitis. and weight loss are marked. they favor the lungs as the metastatic site. If the CTscan is inconclusive a sigmoidoscopy/colonoscopy is recommended. # Retrograde cystogram with post void film is the investigation of choice for patients with suspected bladder trauma. #Sarcomas metastasize via the blood stream. the pulse pressure is the first physiological change. Basal cell carcinoma favors the upper part of the face . debridement and drainage are indicated if the percutaneous drainage fails. # Glasgow coma scale: Points # iatrogenic esophageal perforation. to prevent a stroke. Contrast study would best demonstrate it. # Angiograms are done following neck trauma to rule out carotid artery injury. #When hemorrhage occurs. Laparotomy. # Technetium pertechnetate scintigraphy is the best diagnostic test for Meckel's diverticulum. Only melanoma would have this weird timetable. primary repair of the esophagus should be done immediately. # Once an esophageal perforation has been diagnosed. when hypothermia complicates the picture. Diag: Full thickness biopsy of the edge of the lesion # the appropriate course of action when coagulopathy develops in Surgery is to empirically provide fresh frozen plasma and platelet packs. and drainage of mediastinum must be attempted within 6 hours to prevent the development of mediastinitis. # Percutaneous drainage is the standard treatment approach for pelvic abscess. # Medial meniscus injuryïƒ Initial treatment in acute injury is conservative with immobilization and bracing. Ewing’s sarcoma is another frequent tumor of adolescent population (usually <10yr age group). However. #There are two malignant tumors of the eye for which enucleation would be done: retinoblastoma and melanoma. the choice between observation and bracing should be made based on the presence of rotational deformity and positive family history in which case a more aggressive approach is recommended. X-ray shows osteolytic lesion with periosteal reaction Systemic manifestations are rare. The bleeding surfaces have to be packed. Local findings are similar to those of osteogenic sarcoma but systemic features like fever. In the above patient.

and the underlying chest wall. lung. #mitral valve prolapseïƒ Mitral valve annuloplasty. but since the capacity of the vascular tree is also increased under these circumstances. grows to huge size over many years. or bones. filling it up with additional volume is also helpful #Follicular cancers(Tx: Total thyroidectomy plus postoperative radioactive iodine) can metastasize by way of the blood stream to the liver. whereas technical problems with the biliary and vascular anastomosis are the most common cause of early functional deterioration. dorsally angulated fracture of the distal radius. the nodes. the tumor becomes the most effective iodine trapper in the body. Stone >3cmïƒ Open surgical removal # A rough guideline to quantify water loss is that every 3 mEq/L that the serum sodium concentration is above normal. however. Tx: Closed reduction and long arm cast #A newly developed white pupil in a child raises the possibility of retinoblastoma #the diagnosis of the pheochromocytoma can best be confirmed by MRI of the adrenals #Intraoperative myocardial infarction is mostly seen in elderly men. Endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiogram (PTC) would be the next step if the CT scan were negative. Air goes to the top. #Morton's neuromaïƒ #prostatic metastases to bone are blastic rather than lytic. and appropriate biopsies would be done to confirm the diagnosis. mitral valve replacement iwhen repair of the native valve cannot be done. Insertion of a chest tube at the base #In all other solid organ transplants. #Examination of the animal's brain for signs of rabies will determine whether the painful and risky process of rabies passive and active immunization is required. #Rubber band ligation internal hemorrhoids #anal fissureïƒ Tx: Forceful dilatation under anesthesia.#The most sensitive test to detect early bone metastasis is the radionuclide scan. thin-walled gallbladder without stones. #Any gunshot wound below the nipples involves the abdomen # Urinary stones Stone >3mm ïƒ Extracorporeal shock wave lithotripsy. and blood goes to the bottom. #The diagnostic study of choice to confirm the presence of gallstones is a sonogram. #most penetrating wounds of the chest that produce hemothorax require no surgery #Colles fractureïƒ dorsally displaced. and the most common triggering event is prolonged hypotension. brain. also known as reflex sympathetic dystrophy    . deterioration of function 10 days out would suggest an acute rejection episode. CT has a good chance of showing it in a noninvasive manner. antigenic reactions are less common. For hemothorax. represents about 1 L of water deficit. #A high spinal anesthetic can produce vasomotor shock by inducing widespread vasodilation. the expected mortality is 50%-90% #Obstructive jaundice is evident by the high alkaline phosphatase and the dilated biliary ducts. In the case of the liver. Malignancy is suggested by the dilated. dinner fork. the tumor cannot compete successfully with normal thyroid tissue for the capture of iodine. # Cystosarcoma phyllodes occurs in young women. Lung and brease to bone is lytic. it can be traced with and ablated by radioactive iodine. or botulinum toxin injections #Pelvic fractures ïƒ External fixation #causalgia. Because the tumor has rudimentary functional capability. however. # The treatment of breast cancer in a pregnant woman should be the same as that in a nonpregnant woman. #antireflux operationïƒ laparoscopic Nissen fundoplication #Heller myotomy is used for achalasia. and no radiation therapy during the pregnancy. and yet spares the skin. # Plantar fasciitisïƒ #A chest tube high in the pleural space is for a pneumothorax. except for two restrictions: no chemotherapy during the first trimester. Vasoconstrictors are the appropriate therapy. After removal of the entire gland. If there is a cancer of the head of the pancreas. lateral sphincterotomy. Transhiatal total esophagectomy is the most commonly used operation for esophageal cancer.

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