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Neeraj S Notes Step3 PDF
Neeraj S Notes Step3 PDF
1. Case of back pain with normal thorough physical & Neurological examination
excluding systemic and visceral disease Rx Supportive care and NSAIDs like
Acetominophen
2. Rx Acute Prostatitis: Cotrim or Cipro(Fluoroquinolones)
3. Low grade squamos intraepithelial lesions (LGSIL) or CIN I lesions usually
revert to normal except 10-15% which may progress. One may perform colposcopy
immediately or after 4-5 months.
4. Livedo reticularis: Seen in cholesterol emboli syndromepurplish web of
discoloration over skin
5. GERD Rx first non-pharmacological measures like elevating head, avoid
eating before bed/Caffeine/Chocolates Fails H2 blockers Severe Ds not
responding Proton Pump inhibitors
6. New born with FH of CF might have meconium plug syndrome involving
jejunum Ba Enema has a therapeutic as well as diagnostic value DDx Ileal
atresia
7. OCPs reduced GnRH Reduced ovulation Reduced disruption of ovarian
germinal capsule Reduced risk of ovarian CA(Nulliparity,HRT and ovulation
inducing drugs increase the risk)
8. Parapneumonic effusion Rx antibiotics and tube thoracostomy Empyema?
Decortication
9. Hot tap water burns: Usually first degree burns presenting as erythematous
swollen skin Run cold water over the area or hold a cool compress over it Apply
aloe vera cream and use aspirin/Ibuprofen for pain Adv for setting water
temperature <120-130F
10. Olfactory dysfunction: Caused by Brain tumors,Sinusitis,Rhinitis,Nasal
poly/Neoplasm,Hypothyroidsm and depression PE Neuro to assess odor
perception with alcohol R/o Neoplasm with CT
11. Acute renal failure due to Pre-Renal cause usually associated with
hypovolemia Is associated with Sodium avid state as Kidney tries to retain water.
The urine Na+ will < 25mmol/L
12. H/o encephalopathy is contraindication to TIPS.
13. Pseudogout associated with calcium deposits in meniscus.It has close
association withhemachromatosis, Hypothyroidism, Hyperparathyroidism, and
Hypomagnesemia. Pseudogout + Pigmented skin + Raised liver enzymes/FH liver
failure Hemochromatosis
14. DM + HTN Drug of choice ACE inhibitors
15. Patient with known PID develops tenderness and guarding s/o peritonitis
?Ruptured TO abscess Immediate Surgery
16. Hemodynamic subsets of Shock
CO PAWP SVR
Cardiogenic shock Low High High
Hypovolemic Low low High
Septic High-Normal-Low High low
Extracardiac Low Normal or High High
Obstructive Shock
17. Surgical resection of Choledochal cyst is essential to prevent frequent
recurrent cholangitis and malignant degeneration.
104. Predictor of Restrictive lung disease on PFT: Decresed FEV1 but FEV1/FVC is
normal (>80%) and there is disproportionate decrease in DLco(Diffusion capacity of
CO) as compared with TLC.(Proportional decrease s/o extra-throacic restrictions like
Kyphoscoliosis)
105. Lymes ds transmission requires about 24-28hrs attachment of Tick to the
body.
106. Discitis in Immunosuppressed might be due to many organism Start broad
spectrum antibiotic first Take tissue from disc under fluoro guidance to ascertain
organism Blood culture though taken but has low yield
107. Eosinophilic pneumonia: Ac hypersensitivity reactionHypoxemic resp failure
+ Diffuse pulmonary opacities +>25% eosinophils on bronchoalveolar lavage +
eosinophilic infiltrates on lung biopsy Tx Methyprednisolone
108. Threatened abortions There is no proven role of bed rest in prognosis!
But do not forget to perform blood grouping in every case of any bleeding in
pregnancy (RhoGam?)
109. Rheumatoid ds might be associated with anemia of chronic ds
110. Asthma Prolonged expiration and increased TLCVentilator setting will
require sufficient time to exhale air and no overload over preexisting expanded
lungs Choose low tidal volume +slow respiratory rate(to allow time to expire) +
High flow rate on inspiration.
111. Tx Vitiligo: Topical steroid & Phototherapy
112. Milk line: along axilla and inguinal region Site for accessory nipple
113. Epidural catheter: To infuse drugs into epidural space for anesthesia +
analgesiaPatient receiving narcotics thru epidural catheter should not have IV
narcoticsIf patient controlled analgesia (via electronically controlled infusion
pump activated by patientas per the need) with IV morphine is required first
discontinue Hydromorphone in epidural mix.
The herald
patch of pityriasis rosea is then followed by the appearance of multiple smaller oval
pink patches on the child's trunk, arms, and legs. These can be mildly itchy and can
linger for several weeks or months, but the child will otherwise have no symptoms
and pityriasis rosea is thought to be harmless. It is not known what causes pityriasis
rosea, but it may be cause by a virus or a reaction to a previous viral infection. No
treatment is usually required, except perhaps to control the itching if it is
bothersome.
appearance
148. Fruit juices which have sorbitol like pear/prune may relieve constipation.
149. Iron deficiency anemiaFeSo4 for 2-3 months +Iron rich diet with meat
150. Bloody diarrhea+Hypotension in an elderly?Ischemic colitisSigmoidoscopy
shows green mucosa with isolated depigmented patches.
151. DKA on insulin+Fluid+K Suddenly develops headache?Edema cerebral
Rx Mannintol
152. Type-I:Distal RTA (dRTA)failure of acid secretion by the alpha intercalated
cells of the cortical collecting duct of the distal nephronfailure to acidify the urine
to a pH of less than 5.3 even if the blood is too acidicclinical features of
DrtaNormal anion gap metabolic acidosis/acidemia,Hypokalemia,Urinary stone
formation,Nephrocalcinosis (deposition of calcium in the substance of the
kidney),Bone demineralisation (causing rickets in children and osteomalacia in
adults) . Type-II: Proximal RTA (pRTA) is caused by a failure of the proximal tubular
cells to reabsorb filtered bicarbonate from the urine, leading to urinary
bicarbonate wasting and subsequent acidemia. The distal intercalated cells function
normally, so the acidemia is less severe than dRTA and the urine can acidify to a pH
of less than 5.3. pRTA also has several causes, and may occasionally be present as a
solitary defect, but is usually associated with a more generalised dysfunction of the
proximal tubular cells called Fanconi's syndrome where there is also phosphaturia,
glycosuria, aminoaciduria, uricosuria and tubular proteinuria. The principal feature
of Fanconi's syndrome is bone demineralization (osteomalacia or rickets)
due to phosphate wasting Rx NaHco3
153. MiliariaHeat rashes due to prolonged bed restTurn frequently+Cooler
temperature
154. Low Cardiac outout(CO)+Normal pulmonary artery wedge
pressure(PAWP)+High systemic vascular resistance(SVR) S/o extracardiac
obstructive shockTemponade/Tension pneumo/Pulmonary TE
The lesion begins as a soft, red papule. Within 1 to 2 days, it becomes pustular,
eroded, and ulcerated. The ulcer is usually 1 to 2 cm in diameter, painful, and
covered by a yellowish or gray exudates; it bleeds easily when scraped. The edges of
the ulcer are ragged and undermined. Chancroid does not have a vesicular stage. In
males the ulcer is typically located on the distal penis, but may occasionally occur in
the urethra and anal orifice. In females, the lesions tend to be localized to the vulva
but can also occur in the vaginal, perianal area, and cervix. Painful inguinal
lymphadenopathy and over-riding erythema is associated with chancroid in nearly
half of all cases in males, less often in female cases. The lymph nodes become
fluctuant, can spontaneously rupture, and drain pus.Tx Azithromycin single dose
166. Fracture in cervical spine involving transverse foraminaVertebral artery
trauma? Dissection/ThrombosisAngiography
167. AFPEmbryonal /Yolk sac tumourHCG by both seminoma &
nonseminomaRP nodes involvement s/o stage 2Supradiaphragmatic nodes s/o
satge 3Stage 1 seminoma requires orchidectomy + RT
168. Roseola/Sixth Ds/Exanthema subitum:mild illness that mainly affects children
that will go away on its own. Roseola is caused by viruses of the herpes type6 or
169.
A 12-lead electrocardiogram obtained at a body temperature of
32C.(Hypothermia) Note J wave of Osborn, which have an extra deflection a
the end of the QRS complex.
170. Monitored bed units:To regularly assess cardiac & respirstory systemsE.g
Postop orthopedic patient with intathecal morphine still have pain and requires more
IV morphineNeeds respiratory monitoring
171. Insulin like growth factor(IGF)-1 elevated at multiple occasionsconfirms
diagnosis of acromegaly.
172. Insulin dependent DM scheduled for operative procedureReduce the insulin
dose to 1/3-1/2 on the day of procedure as he/she is kept NPORegularly monitor
glucose levels and adjust it with insulin/Dextrose.
Typically in Candidal nappy rash, there is erythema in the perineal region, with
satellite lesions which may coalesce. There is often an appearance of scale. In the
images to the left from the same baby, satellite lesions are seen. Note that there are
some lesions close to the umbilicus and extending around the flank. Swabs were
positive for Candida(Pseudohyphae and spores).Treatment primarily involves the use
of a topical agent such as nystatin or miconazole
Mantoux / PPD tuberculosis skin test results showing a raised bump measuring 5 mm
or greater is interpreted as a positive result in the following:
1. persons with weakened immune systems, such as those with HIV/AIDS
2. persons who have been exposed to persons with active TB/Healthcare staff
3. persons with fibrotic changes on chest x-rays/scans that are consistent with an
old TB infection
Mantoux / PPD tuberculosis skin test results showing a raised bump measuring 10 mm
or greater is interpreted as a positive result in the following:
1. persons recently (<5 years) arriving to the U.S. from a foreign country
2. persons who use injectable drugs but HIV -ive
3. persons who live or work in high-risk environments, such as cities and
crowded areas
4. persons who work in laboratories, especially Mycobacteriology
5. Children under the age of 4
6. Children and adolescents exposed to adults in high-risk environments
All other persons with test sites showing a raised bump of 15 mm or greater are
considered to have a positive test result.
369. Most important risk factor contributing in Prinzmetal angina(pain at rest not
responding to sublingual NG)Tobacco
Good luck!