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EPETITIOR OR N & RE N F QUICKTABLES C O G N ITI O d. d. c. b.Index: 1. c. f. c. g. e. Antibiotics 36 HIV 36 TB 37 Sepsis 37 Q u i c k T a b l e s © OnlineMedEd . o. b. c. f. Thrombocytopenia 34 6. m. Acute Kidney Injury 24 Sodium 25 Calcium 25-26 Potassium 27 Kidney Stones 27 Cysts and Cancer 28 Acid Base 28 5. Pulmonary a. e. p. Coronary Artery Disease 1 Congestive Heart Failure 2 Valve Disease 3 Cardiomyopathy 4 Pericardial Disease 4 Syncope 5 Hypertension 5 Cholesterol 5 ACLS 6 2. c. n. b. l. d. i. e. g. f. e. b. i. Gallbladder Disease 12 Esophagitis 13 Esophageal Disorders 14 Peptic Ulcer Disease 15 Misc. g. h. f. k. Infectious Disease a. Asthma 8 Lung Cancer 8 Pleural Effusion 9 DVT PE 9 COPD 10 ARDS 10 Interstitial Lung Disease 11 3. j. g. c. Hematology Oncology a. d. g. Macrocytic Anemia 30 Microcytic Anemia 30 Normocytic Anemia 31 Leukemia 32 Lymphoma 32 Plasma Cell Dyscrasia 33 Bleeding. Gastroenterology a. q. d. e. f. d. Gastric Disorders 15 Acute Diarrhea 16 Chronic Diarrhea 16 Cirrhosis and Ascites 17 Cirrhosis Etiologies 18 Malabsorption 19 Diverticular Disease 19 Colon Cancer 20 Gi Bleed 21 Acute Pancreatitis 22 Inflammatory Bowel Disease 22 Jaundice 23 Viral Hepatitis 23 4. b. Nephrology a. Cardiology a. h. b. g. k. h. Constipation 64 Neonatal Jaundice 64 Vomiting 65 Seizures 65 Gi Bleed 66 Allergies 66 Peds Rash 67 Peds Preventable Trauma 68 Vaccinations 68 ENT 69 Pediatrics CT 70 Upper Airway / Stridor 71 Lower Airway 71 Immunodeficiencies 72 Q u i c k T a b l e s © OnlineMedEd . m. Stroke 48 Dizziness 48 Seizure 49 Tremor 50 Headache 50 Back Pain 51 Dementia 52 Coma 52 Weakness 53 9. e. c. d. h. b. n. e. d. g. f. d. b. l. d. Anterior Pituitary 42 Posterior Pituitary 43 Thyroid Nodules 43 Men Syndromes 43 Thyroid Disorders 44 Adrenals 45 Diabetes 46 8. c.Index: e. b. Neurology a. Pediatrics a. l. c. Endocrinology a. e. h. j. i. i. i. b. j. g. g. b. c. h. f. Approach To Joint Pain 54 Lupus 55 Rheumatoid Arthritis 55 Other Connective Tissue Dz 56 Monoarticular Athropathies 56 Seronegative Arthropathies 57 10. f. e. Rheumatology a. Blistering Disease 58 Papulosquamous Dermatoses 58 Eczematous Dermatoses 59 Hypersensitivity Reactions 59 Hyperpigmentation 60 Hypopigmentation 61 Skin Infections 61 Alopecia 62 11. e. Dermatology a. d. f. c. Brain Inflammation 38 Lung Infection 38 UTI 39 Genital Ulcers 39 Skin Infections 40 Endocarditis 41 Antibiotics 41 Surgery 41 7. f. k. g. f. j. f. k. c. Gynecology a. h. s. f. m. d. Psychiatry a. o. Gynecologic Cancers 92 Gestational Trophoblastic Disease 93 Incontinence 93 Adnexal Mass 94 Pelvic Anatomy 95 Gyn Infections 96 Vaginal Bleeding 1: Premenarche 97 Vaginal Bleeding 2: Reproductive Years 97 Vaginal Bleeding 3: Reproductive Age 98 Primary amenorrhea 99 Secondary Amenorrhea 100 Infertility 101 Menopause 101 Virilization 102 14. o. e. l. b. p. c. Defense Mechanisms 78 Anxiety Disorders 79 Impulse Control Disorders 80 Eating Disorders 80 Mood Disorders I And II 81 Delusional Disorders 82 Personality Disorders 83 Peds Psych 84 Dissociative Disorders 85 Addiction 85 Drugs of Addiction: Intoxication and Withdrawal 86 Sleep I And II 87 Psych Pharm 88-89 Psych Cognition 90 Psych Somatoform – DSM-IV 90 13. e. r. Obstetrics a. l. j. g. i. h. q. Ortho Peds 73 Pediatric Ophtho 74 Urology Peds 75 Sickle Cell 76 Abuse 76 12. n. b. c. i. m. k. l.Index: o. j. m. d. n. p. g. n. i. Physiology Of Pregnancy 104 1st Visit Labs And Initial Care 104 Quad Screen 105 Third Trimester Labs 105 Medical Disease 106 Normal Labor 107 Abnormal Labor 108 Third Trimester Bleeding 108 L&D Pathology 109 Advanced Early Testing 110 Eclampsia 110 Multiple Gestation 111 Post-Partum Hemorrhage 111 Early Antenatal Testing 112 Isoimmunization 112 Perinatal Infections 113 OB Operations 114 Contraception 115 Q u i c k T a b l e s © OnlineMedEd . k. r. h. d. e. b. f. q. g. p. d. i. n. b. Pediatrics Weeks To Months 126 Surgical Hypertension 126 Endocrine 127 CT Surgery 128 Pediatrics CT 129 Vascular 130 Adult Ophtho 131 Skin Cancer 132 Pediatric Ophtho 133 Neurosurgery Bleeds 134 Neurosurgery Tumors 134 Urologic Cancer 135 Urology Peds 136 Urologic Miscellaneous 137 Ortho Injury 138-139 Ortho Hand 140 Ortho Peds 141 15. Preventative Medicine a. f. j. Surgery: General a. Biostats 148 Prevention 149 Confidence Interval 149 Bias 149 Vaccines 150 Screening 150 Q u i c k T a b l e s © OnlineMedEd . j. q. c. d. g. h. Surgery: Trauma a. b. p. e. f. k. i. Surgery: Specialty a. Pre-op Evaluation 116 Post-op Fever 116 Chest Pain 117 Altered Mental Status 117 Abdominal Distention 118 Wound 118 Fistula 119 Decreased Urinary Output 119 Obstructive Jaundice 120 Esophagus 121 Small Bowel 121 Pancreas 122 Leg Ulcers 122 Colorectal 123 Breast Cancer 124 Pediatrics First Day 125 15. m. h. e. n. l. l. k. o. o. c. h. g. g. d. c. d. Shock 142 Head Trauma 143 Neck Trauma 143 Chest Trauma 144 Abdominal Trauma 145 Burns 146 Bites 146 Toxic Ingestion 147 16. b. f. m. c. e. e.Index: 15. b. f. Coronary Artery Disease Myocardial Infarction Path: ACUTE Treatment Options Occlusion of a coronary vessel ASA FIRST drug to give Pt: Chest pain that is worse with exertion. better > 60 Age Woman > 55 Man > 45 Story Prasugrel = Clopidogrel Physical Aspirin Anti-Platelet Clopidogrel Anti-Platelet Statins LDL < 100 (prefer < 70) Stress Testing Imaging EKG Test of choice. Baseline wall defects. only in single-vessel disease Drug-Eluting Stent Clopidogrel x 1 year. dyslipidemic smoker. of any kind. only in single-vessel disease CABG Left Mainstem equivalent or multi-vessel disease tPA No PCI is available within 60 minutes transport time Door-toballoon 90 minutes Tx: Morphine. nitrates. who is old Nitrates Second Angioplasty No Clopidogrel needed. HR < 70 Ace-inhibitor BP < 140 / < 90 Hypertension <140 / < 90 Diabetes A1c < 7. no contraindication to exercise with feet Pharm Any reason why they can’t get on a treadmill. better with rest. only in single-vessel disease Dx: ST segment changes = STEMI Biomarker Elevation = NSTEMI Stress Test = CAD Coronary Angiogram = best test Bare-Metal Stent Clopidogrel x 1 month. Dobutamine and Adenosine essentially identical Testing Stable Unstable Angina Angina nstemi stemi Pain Exercise @ rest @ rest @ rest Relief Rest + Nitrates Ø Ø Ø Trops Ø Ø ↑ ↑ ST ∆s Ø Ø Ø ↑ Complications of MI RV Failure Right Sided ECG No Nitrates Aneurysm Diagnosed by Echo Arrhythmia Vtach / Vfib – ventricular ectopy from dying cells Brady / Blocks – AV nodal dysfunction Q u i c k T a b l e s © OnlineMedEd 1 Cardio Cardiology . better < 70 HDL > 40. Heparin (BASH) Coronary Angiography with Stent (single vessel disease) CABG (multi-vessel disease) tPA if no transport available (60 minutes) R isk F actors and CHRONIC Treatment Options Beta-Blocker G oals BP < 140 / < 90. Ace-inhibitor. Statin. Oxygen. Aspirin (MONA) Beta-Blocker. diabetic. no CABG Worse with exertion Nonpleuritic Nuclear Better with rest Nontender CABG. no baseline abnormality Left sided / Substernal Nonpositional Echo EKG abnormalities. relieved with nitrates in a hypertensive. LBB Exercise Test of choice.0 Smoking Cessation Dyslipidemia LDL < 100. Infection. Amio Epi Afib with RVR Path: Underlying stressor Ischemia. Amio Shock: Shock Afib Path: PIRATES mnemonic Ischemia. Apixaban Score 2 + Coumadin or -axabans 6 Q u i c k T a b l e s © OnlineMedEd Vfib Vtach Torsades SVT Sbrady Stach 1 ° Block 2 ° Type 1 2 ° Type 2 3 ° Block Afib Aflutter Idioventricular Asystole . Asystole Codes CPR CPR CPR Epi Epi. Structural heart Pt: Palpitations.chapter 1: Cardiology ACLS Rhythm Vfib Vtach Torsades SVT 1° Block 2° Type 1 2° Type 2 3° Block Rhythms to treatment Drug Electricity Amio Shock Amio Shock Mag Shock Adenosine Shock Atropine Pace Atropine Pace Pace Pace No pulse Shock delivered Anything All codes VT/VF Codes PEA. Asymptomatic Dx: ECG Tx: Rate control = Rhythm Control (AFFIRM) Rhythm: Cardioversion after TTE. CCB Rate: Anticoagulate with CHADS2 C CHF H HTN A Age > 75 D Diabetes S Stroke S Stroke Score 0 – Aspirin Score 1 – Rivaroxaban. one month of anticoagulation Rate: BB. Infection. TEE. Asymptomatic Dx: ECG Tx: NO HEART FAILURE: BB or CCB HEART FAILURE: Dig. Structural heart Pt: Palpitations. Cirrhosis Pt: Asymptomatic 40 year old female who gets cirrhosis Dx: Multiple tests available. ALT in the 1000s Dx: Serology = Anti Smooth Muscle. transplant Etiology Advanced Organizer “VW HAPPENS” Pt: Cirrhosis and Emphysema Dx: Biopsy = PAS positive macrophages Best: genotype V Viral Hepatitis (B. Genotype PiMM normal. extrahepatic disease. and liver Path: Women. men Dx: Serology = p-ANCA ERCP = Beads on a string Biopsy = Onion Skinning Fibrosis Tx: Cholestyramine symptomatic relief Stents maybe. may also have ulcerative colitis. and cirrhosis without evidence of another disease causing cirrhosis Dx: Ultrasound 1st Biopsy best Tx: Weight loss. make transplant harder Transplant . Anti-LKM Biopsy = best test Tx: Steroids initially Transplant Hemochromatosis Path: No “off” signal for iron absorption Pt: Bronze Diabetes = Diabetes. Dyslipidemia. or may be acute with AST. ♂: Amenorrhea. Obesity. basal ganglia. but may/will recur 18 Q u i c k T a b l e s © OnlineMedEd P Primary Biliary Cirrhosis E Ethanol N Non-Alcoholic Steatohepatitis S Something else… fulminant diseases Autoimmune Hepatitis Afla-toxin Acetaminophen Budd-Chiari Shock Liver Portal Vein Thrombosis .chapter 3: Gastroenterology Cirrhosis Etiologies Wilson’s Disease Primary Biliary Cirrhosis Path: Copper secretion deficiency. C) W Wilson’s Disease Tx: Protease (emphysema) Transplant (liver) H Hemochromatosis A Alpha-1 Antitrypsin P Primary Sclerosing Cholangitis Primary Sclerosing Cholangitis Path: Autoimmune disease in men. ♀ Dx: Iron Tests First Test: Ferritin – very elevated Best: Biopsy showing elevated iron Tx: Deferoxamine (Desferal) or phlebotomy Transplant will result in recurrence Alpha-1 Antitrypsin Deficiency Path: Elastase goes unchecked because Antitrypsin is trapped in liver. Microductal disease Pt: Chorea. deposits in eyes. and Hyperpigmentation. PiZZ worst form NASH/NAFL Path: Fatty liver from Fatty People Pt: Diabetes. NEVER: Serum Copper Option: Ceruloplasmin low Option: Urine Copper high 1st: Slit Lamp looking for eye findings Best: Biopsy Dx: Serology = AMA Biopsy shows disease Tx: Transplant Tx: Penicillamine → Transplant Free: Picture of an eye + question about cirrhosis Autoimmune Hepatitis Path: Women with autoimmune disease Pt: May be insidious. Cirrhosis. Kaiser-Fleischer Rings. diabetes control. Intrahepatic. macroductal disease Pt: Biliary stasis and cirrhosis. Macroadenomas. test is positive (abnormal) if the GH does not change Wait Carpal tunnel is more associated with RA than Acromegaly… don’t be tricked 42 GHRH ↓ Q u i c k T a b l e s © OnlineMedEd ↓ ↓ ↓ ↓ Cushing’s Syndrome See Adrenal ACUTE Pan Hypopituitarism Path: Infection. Rads Pt: TSH: Lethargy. Dx: Medication list 1st: TSH Then: Prolactin Levels Best: MRI Tx: Bromocriptine or Cabergoline Surgery f/u: Surgery is NOT first line therapy for prolactinomas. Deposition.chapter 7: Endocrinology Anterior Pituitary 3 Levels of Feedback and Endocrine Reg of the Ant Pituitary Hypothalamus GnRH TRH CRH Portal Circulation Pituitary Systemic Circulation Target Organ Metabolic Effect ↓ ↓ FSH/LH TSH ACTH GH Ovaries Estrogen Progesterone Ovulation Thyroid T3 T4 Metabolism Adrenals Cortisol Liver ILGF Stress Growth ↓ Prolactinoma Path: Autonomously secreting prolactin Most common pituitary lesion Pt: Women: Galactorrhea. Surgery. bloody delivery Apoplexy: Tumor outgrows blood supply and dies. Coma ACTH: Hypotension. necrosis CHRONIC Pan Hypopituitarism Path: Autoimmune. Infarction. Tachycardia GH/LH/FSH: Irrelevant Dx: Clinical Hormone (Cortisol and T4) Tx: Replace end hormones f/u: Sheehan’s: Pregnancy. Vision Changes. CARPAL TUNNEL Big hands Dx: Growth Hormone ILGF-1 Glucose Suppression Test MRI Tx: Surgery first Octreotide or Cabergoline (adjunct) f/u: Glucose Suppression Test = give glucose. No Vision Change Men: Decreased libido. Microadenomas. Amenorrhea. changes in menstruation ↓ Growth Dx: Insulin Stimulation Test ˗˗ Growth Hormone fails to rise MRI Tx: Reverse underlying cause Replace hormones as needed Empty Sella Syndrome Path: Normal variant Pt: Asymptomatic Dx: MRI Tx: Reassurance . it is for all other secreting pituitary tumors and macroadenomas Acromegaly Path: Growth hormone = things that can grow Child = Long bones (Gigantism) Adult = visceral organs Pt: Cardiomegaly → DIA heart failure Diabetes Wide-spaced teeth Hat/ring/shoe size increases Coarse features. Cancer GH / FSH / LH sacrificed so that TSH and ACTH can persist Pt: ↓ Libido. Gynecomastia. CNS. Crystal. Rheumatoid Scleroderma. <50 >50 Polys <25% <25% ≥ 50% ≥ 75% - - - + None Osteoarthritis Everything Else Infection Normal Appearance Gram/Cx Dz Inflammatory Sepsis Antibody Interpretation Antinuclear Antibodies Sensitive Lupus Anti-Histone Antibodies Specific Drug-Induced Lupus Anti-ds-DNA Antibodies Specific Lupus + Renal Involvement Anti-Smooth Muscle Ab Autoimmune Hepatitis Anti-Mitochondrial Antibodies Primary Biliary Cirrhosis Anti-Centromere Antibodies Scleroderma (CREST) Anti-Ro+La Antibodies Sjogren’s Anti-CCP Antibodies Rheumatoid Arthritis Anti-RF Antibodies Rheumatoid Arthritis Anti-Jo Antibodies Polymyositis Anti-Topoisomerase Antibodies Systemic Scleroderma 54 Q u i c k T a b l e s © OnlineMedEd . Reactive Isolated Septic Crystal vs Degenerative Osteoarthritis vs vs vs Multiple Joints Osteoarthritis. Myositis. Lung) Rheumatoid (Nodules. Heart. Trauma. Lupus. Renal. White Opaque WBC <2 <2 >2. Lupus. Myositis. Rheumatoid. Seronegatives Systemic Manifestations Seronegative (IBD) Lupus (Face. Serositis) Reactive (Oral + Genital Ulcer) Inflammatory Everything Else Clear NonInflammatory Clear Yellow. Scleroderma. Seronegatives Chronic Osteo.chapter 9: Rheumatology Approach To Joint Pain Single Joint Septic Crystals Acute Septic. chapter 11: Pediatrics Pediatric Ophtho Type Chemical Time 24 hrs Purulent Non-purulent Gonorrhea Day 2-5 Purulent Chlamydia Day 7-12 Retinoblastoma Pt: Newborn screen in the neonatal unit with an abnormal light reflex Dx: Red reflex (normal) = Pure White Retina “white thing in the BACK of the eye” Tx: Surgery Radiation Therapy (NEVER) f/u: Osteosarcoma Amblyopia Path: Cortical Blindness Bilateral. . leads to cortical blindness Dx: Tx: Strabismus Path: “Lazy eye” Pt: Baby with one eye that focuses while the other does not Almost ALWAYS a photograph question Dx: Light reflects at different points on both eyes Tx: If present at birth ˗˗ Patch the good eye ˗˗ Surgery if all else fails Glasses if developed after birth 74 Tx Caused by ppx can turn to blindness Muco-purulent Path: Rb gene mutation Problems Bilateral Q u i c k T a b l e s © OnlineMedEd This is a duplicate from surgery. Cataracts. Topical Erythro then IV ceftriaxone Silver Nitrate Ppx Unilateral Oral + Topical Erythro Can turn into pneumonia Silver Nitrate PPx Congenital Cataracts Path: Present at birth → TORCH infections Not present at birth → Galactose Deficiency Pt: White cloudy lesions in front of their eye “white thing in FRONT of the eye” Dx: Clinical Tx: Surgical Removal Retinopathy of Prematurity Path: Premature baby. oxygen toxicity Pt: Suspect in any premature neonate especially if any of the “other 3” are present None Dx: Ophtho Exam = growths of retina None Fix the problem that could lead to cortical blindness Tx: Laser Ablation f/u: The “other three” Necrotizing Enterocolitis Bronchopulmonary Dysplasia Intraventricular Hemorrhage Pt: Strabismus. another cause. sedation. AD See Anti-Depressants. ↑ Risk of Seizures Diastolic HTN Weight Gain Sedation. Drug of Choice Nephrotoxic > 1. Depression Causes Nephro DI Augmentation Narrow TI Valproate First Line if Li contraindicated Bipolar. Ø useful in acute attack β-Blockers Performance Anxiety Bradycardia.5 Bipolar. Priapism TCAs Amitriptyline Nortriptyline Imipramine Desipramine Used for enuresis Seconds as neuropathic pain Can be Lethal (Convulsions. SJS AV Block Lamotrigine Second Line Stabilizer Newer anticonvulsant Blurred Vision SJS Anxiolytics Abort panic attack Treats EtOH withdrawal Addictive Withdrawal Seizure SSRIs First-Line long term treatment for chronic anxiety: OCD. Constipation) Phenelzine Tranylcypromine Selegiline HTN Crisis when mixed together. Seizures Teratogen (Spina bifida) Thrombocytopenia Agranulocytosis Pancreatitis Carbamazepine Second Line Stabilizer Trigeminal Neuralgia Teratogen (Cleft palate) Rash. myoclonus. altered mental status GI. Uretention. Insomnia Atypicals Bupropion Venlafaxine Mirtazapine Trazodone Minimal Sex SE. Coma. PTSD.chapter 12: Psychiatry Psych Pharm SSRIs Safe Fluoxetine Paroxetine Sertraline Citalopram Anti-Depressants ↓ Libido Serotonin Syndrome = fever. lack of washout or eating of tyramine (red wine/ cheese) Orthostatic HoTN + Weight Gain Most Dangerous MAO-Is Rarely used Lithium Mood Stabilizers Teratogen First-Line. Acute Mania. Asthma Bupropion Backup to SSRI Avoid in bulimia (causes seizures) Haloperidol Diphenhydramine Lorazepam Depot form Enhances Sedation Anxiolytics Called a “B52” Benzos 88 Q u i c k T a b l e s © OnlineMedEd . Cardiac) → Wide QRS → EKG! Has Anti-Ach properties (dry mouth. torticollis. ↑ CK Dantrolene. use depot (Haloperidol) NMS (fever. sxs initially worsen ↓ SE profile Combative ER patient Haloperidol + Benzo + Diphenhydramine The “B52” Sedating Noncompliant Psychotic Haloperidol depot q 1wk Old Psychotic Atypical or High-Potency Typical ↓ Sedation Hospitalized and off their meds Atypical. ↑ Dose q Day until maxed.and + sxs Currently “first line” for psychosis EPS. AMS) Stop drug Give Dantrolene Highest risk of EPS Gynecomastia. Anti-Ach Less potent but also has less side effects Both D2C and 5-HT1 so work on . most dangerous Fever. ICU NMS Q u i c k T a b l e s © OnlineMedEd Psych Choosing the Right Drug Compliant Young Adult.Psychiatry Psych Pharm Antipsychotics Typicals Haloperidol Fluphenazine Thioridazine Chlorpromazine Are more potent so have better effect but also more side effects D2 only so good for + sxs only For noncompliance. Gynecomastia. then try another Everything else has failed Clozapine Best. rigidity. Any atypical po without complications 89 . order CPK. ↑ CK. and oculogyric crisis Anti-Cholinergic Dyskinesia Parkinsonism Anti-Cholinergic Tardive Dyskinesia Irreversible hyper-sensitization of dopamine-R = suppressible oral-facial movements Stop Drug. AMS. Rigidity. Sedation. hand ringing. Anti-Ach (small risk) QTc prolongation DM and Weight Gain The best antipsychotic The most selective for D2C and 5HT1 (+ and -) Drug of last resort Agranulocytosis Requiring CBC q week Atypicals Risperidone Quetiapine Olanzapine Aripiprazole Ziprasidone Clozapine Unique to itself Akathisia Extrapyramidal Side Effects A Feeling of Restlessness ↓ Dose Acute Dystonia Involuntary muscle contractions. Sedation. Karyotypes.None Being 1st Tri = + 1 wk 2nd Tri = + 2 wk 3rd Tri = + 3 wk Transcranial Doppler > 20 weeks Fetal Anemia No risk NO ACCESS Amniocentesis > 16 weeks AFP. LFT. Well. Vision Δs → Vasospasm Labs: CBC. ?? Abortion 1/100 Elective abortion still possible in 1st tri PUBS > 20 weeks Fetal Anemia 1/30 Access for transfusion Eclampsia Disease BP Timing U/A Sxs Treatment Chronic HTN > 140 / > 90 Sustained BEFORE 20 weeks Ø Ø α-methyldopa Hydralazine Labetalol Transient HTN > 140 / > 90 Sustained AFTER 20 weeks Ø Ø α-Methyldopa. Genetic Material 1 / 200 > 16 weeks: Genetic > 24 weeks: Anemia > 36 weeks: L:S Chorionic Villus Sampling 10-12 weeks Genetic Screens. Metoprolol Returns to normal 12 weeks after Mild PreE > 140 / > 90 Sustained AFTER 20 weeks > 300mg/dL Ø > 36: Mg + deliver < 36 Develop Severe PreE > 160 / > 110 Sustained AFTER 20 weeks > 5g/dL + Mag + Deliver (C/S) Eclampsia ---- ----- ---- Seizing Mag + Deliver (C/S) HELLP Hemolysis Elevated Liver Enzymes Low Platelets Mag + Deliver (C/S) Path: ?? Vasoconstriction Alarm Sxs: Hemoconcentration. Hydralazine. Edema → 3rd Spacing Epigastric / RUQ Abdominal Pain → Glisson’s Capsule Stretch Headache.chapter 14: Obstetrics Advanced Early Testing Procedure Week Goal Risk of Loss Extra Ultrasound All Confirm IUP Fetal Age. U/A ˗˗ Proteinuria → Eclampsia ˗˗ HELLP → HELLP Syndrome Seizing → Eclampsia 110 Q u i c k T a b l e s © OnlineMedEd . ↑ Endo Ca Raloxifene: Worse. Irreversible. every 2 years ACS: 40q1.Obesity. Early Menarche. Late Menopause. start at 40. Nulliparity. HRT Genes – BRCA ½. every 1 year All: Mammogram → Core Needle Biopsy BRCA: MRI Diagnostic Dilemma: The Young Woman < 30 gets a different set of rules Then Then Then OR OR OR < 30 = Reassurance x 2-3 cycles < 30 + persists = Ultrasound < 30 + cyst on ultrasound = FNA < 30 + cyst resolves = reassurance Mammogram and Core Needle Biopsy if… > 30 Ultrasound shows mass Aspirate is bloody Cyst recurs after aspiration 124 Q u i c k T a b l e s © OnlineMedEd Pick the treatment Local Surgical Therapy Disease: Lumpectomy + Radiation OR Mastectomy Sentinel Lymph Node Biopsy and then Axillary Lymph Node Dissection if + Spread Systemic Therapy Disease: Chemo: Doxorubicin. ↓ Endo Ca Trastuzumab: Heart Failure. EARLY Doxorubicin: Heart Failure. LATE Daunorubicin: The other Doxorubicin ALND: Sentinel Lymph Node First . ↑ DVT. Radiation Pt: Asymptomatic Screen Breast Lump.chapter 15: Surgery: General Breast Cancer Breast Cancer Path: Estrogen . Breast Mass Dx: Mammogram Core Needle Biopsy Tx: Lumpectomy + radiation = Mastectomy Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection if positive Chemo ˗˗ Her 2 Neu + ˗˗ Trastuzumab ˗˗ ER/PR + ˗˗ Tamoxifen (pre-menopausal) ˗˗ Anastrozole (post-menopausal) ˗˗ All ˗˗ Doxorubicin or Daunorubicin (anthracycline) based regimen Breast Cancer Screen USPTF: 50q2. start at 50. Reversible. Paclitaxel Her2neu: Trastuzumab ER/PR: SERMS (Pre-Menopausal) ER/PR: Aromatase-I (PostMenopausal) Know Your Treatments Tamoxifen: Better. ↓ DVT. why correlation doesn’t = causation Methods to Eliminate Bias Randomization Blinding Standardization Statistical Controlling **Bias is addressed in study design. can’t get meaningful comparisons. skews outcome Publication Null/negative results less likely to be published. skews available data Confounding 3rd variable that has a noncasual relationship with exposure AND outcome. hypertension meds Tertiary Prevent complications of dz Surgery.Preventative Medicine Prevention Bias Levels of Prevention Primary Prevent onset of dz Vaccines. artificially ↑ survival time Length Time Deadly dz is found less often. skews outcome Information Pts know something that affects their actions. diet/exercise Secondary Prevent progression of dz Screening. but no effect on outcome. can’t get meaningful comparisons. is meaningless. rehab All medicine falls under 1 of these 3. Confidence Interval Associations Null CI includes 1 Effect Size Furthest from 1 Power Narrowest range Bias in Studies/Screens Lead Time Pt of diagnosis changes. skews outcome Measurement Using different tools to measure same thing.** Prevent Q u i c k T a b l e s © OnlineMedEd 149 . artificially makes screening ↑ Overdiagnosis Diagnosis is ↑ but has Ø effect on mortality. bias that assumes finding dz means it’s less dangerous. Artificially ↑ survival stats Selection Pt group isn’t chosen at random.