OnlineMedEd-QuickTables-Preview.pdf

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QU I C K TA B L E S © O NLINEMEDED

1. CARDIOLOGY

a. Coronary Artery Disease b. Congestive Heart Failure

c. Valve Disease d. Cardiomyopathy e. Pericardial Disease f. Syncope g. Hypertension h. Cholesterol i. ACLS 2. PULMONARY a. Asthma b. Lung Cancer c. Pleural Effusion d. DVT PE e. COPD f. ARDS

g. Interstitial Lung Disease

3. GASTROENTEROLOGY a. Gallbladder Disease b. Esophagitis

c. Esophageal Disorders d. Peptic Ulcer Disease e. Misc. Gastric Disorders f. Acute Diarrhea

g. Chronic Diarrhea h. Cirrhosis and Ascites i. Cirrhosis Etiologies j. Malabsorption k. Diverticular Disease l. Colon Cancer m. Gi Bleed n. Acute Pancreatitis

o.

Inammatory Bowel Disease

p. Jaundice

q. Viral Hepatitis

4. NEPHROLOGY

a. Acute Kidney Injury b. Sodium

c. Calcium d. Potassium e. Kidney Stones f. Cysts and Cancer g. Acid Base

5. HEMATOLOGY O NCOLOGY a. Macrocytic Anemia b. Microcytic Anemia

c. Normocytic Anemia d. Leukemia

e. Lymphoma

f. Plasma Cell Dyscrasia

g. Bleeding, Thrombocytopenia 6. I NFECTIOUS DISEASE a. Antibiotics b. HIV c. TB d. Sepsis

Index:

1 2 3 4 4 5 5 5 6 8 8 9 9 10 10 11 12 13 14 15 15 16 16 17 18 19 19 20 21 22 22 23 23 24 25 25-26 27 27 28 28 30 30 31 32 32 33 34 36 36 37 37

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Q U I C K TA B L E S © O NLINEMEDED

Index:

e.

Brain Inammation

f. Lung Infection g. UTI h. Genital Ulcers i. Skin Infections j. Endocarditis k. Antibiotics l. Surgery 7. E NDOCRINOLOGY a. Anterior Pituitary b. Posterior Pituitary c. Thyroid Nodules d. Men Syndromes e. Thyroid Disorders f. Adrenals g. Diabetes 8. NEUROLOGY a. Stroke b. Dizziness c. Seizure d. Tremor e. Headache f. Back Pain g. Dementia h. Coma i. Weakness 9. R HEUMATOLOGY

a. Approach To Joint Pain b. Lupus

c. Rheumatoid Arthritis

d. Other Connective Tissue Dz e. Monoarticular Athropathies f. Seronegative Arthropathies 10. DERMATOLOGY a. Blistering Disease b. Papulosquamous Dermatoses c. Eczematous Dermatoses d. Hypersensitivity Reactions e. Hyperpigmentation f. Hypopigmentation g. Skin Infections h. Alopecia 11. PEDIATRICS a. Constipation b. Neonatal Jaundice c. Vomiting d. Seizures e. Gi Bleed f. Allergies g. Peds Rash

h. Peds Preventable Trauma i. Vaccinations

j. ENT

k. Pediatrics CT

l. Upper Airway / Stridor m. Lower Airway n.

Immunodeciencies

38 38 39 39 40 41 41 41 42 43 43 43 44 45 46 48 48 49 50 50 51 52 52 53 54 55 55 56 56 57 58 58 59 59 60 61 61 62 64 64 65 65 66 66 67 68 68 69 70 71 71 72

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QU I C K TA B L E S © O NLINEMEDED o. Ortho Peds p. Pediatric Ophtho q. Urology Peds r. Sickle Cell s. Abuse 12. PSYCHIATRY a. Defense Mechanisms b. Anxiety Disorders

c. Impulse Control Disorders d. Eating Disorders

e. Mood Disorders I And II f. Delusional Disorders g. Personality Disorders h. Peds Psych

i. Dissociative Disorders j. Addiction

k. Drugs of Addiction: Intoxication and Withdrawal l. Sleep I And II

m. Psych Pharm n. Psych Cognition

o. Psych Somatoform – DSM-IV

13. GYNECOLOGY

a. Gynecologic Cancers

b. Gestational Trophoblastic Disease c. Incontinence

d. Adnexal Mass e. Pelvic Anatomy f. Gyn Infections

g. Vaginal Bleeding 1: Premenarche

h. Vaginal Bleeding 2: Reproductive Years i. Vaginal Bleeding 3: Reproductive Age j. Primary amenorrhea k. Secondary Amenorrhea l. Infertility m. Menopause n. Virilization 14. OBSTETRICS a. Physiology Of Pregnancy b. 1st_{Visit Labs And Initial Care}

c. Quad Screen

d. Third Trimester Labs e. Medical Disease f. Normal Labor g. Abnormal Labor

h. Third Trimester Bleeding i. L&D Pathology

j. Advanced Early Testing k. Eclampsia

l. Multiple Gestation

m. Post-Partum Hemorrhage n. Early Antenatal Testing o. Isoimmunization p. Perinatal Infections q. OB Operations r. Contraception

Index:

73 74 75 76 76 78 79 80 80 81 82 83 84 85 85 86 87 88-89 90 90 92 93 93 94 95 96 97 97 98 99 100 101 101 102 104 104 105 105 106 107 108 108 109 110 110 111 111 112 112 113 114 115

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Q U I C K TA B L E S © O NLINEMEDED

15. SURGERY: GENERAL a. Pre-op Evaluation b. Post-op Fever

c. Chest Pain

d. Altered Mental Status e. Abdominal Distention f. Wound

g. Fistula

h. Decreased Urinary Output i. Obstructive Jaundice j. Esophagus k. Small Bowel l. Pancreas m. Leg Ulcers n. Colorectal o. Breast Cancer

p. Pediatrics First Day

15. SURGERY: SPECIALTY

a. Pediatrics Weeks To Months b. Surgical Hypertension c. Endocrine d. CT Surgery e. Pediatrics CT f. Vascular g. Adult Ophtho h. Skin Cancer i. Pediatric Ophtho j. Neurosurgery Bleeds k. Neurosurgery Tumors l. Urologic Cancer m. Urology Peds n. Urologic Miscellaneous o. Ortho Injury p. Ortho Hand q. Ortho Peds 15. SURGERY: TRAUMA a. Shock b. Head Trauma c. Neck Trauma d. Chest Trauma e. Abdominal Trauma f. Burns g. Bites h. Toxic Ingestion 16. PREVENTATIVE MEDICINE a. Biostats b. Prevention c.

Condence Interval

d. Bias e. Vaccines f. Screening

Index:

116 116 117 117 118 118 119 119 120 121 121 122 122 123 124 125 126 126 127 128 129 130 131 132 133 134 134 135 136 137 138-139 140 141 142 143 143 144 145 146 146 147 148 149 149 149 150 150

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C A R D I O CARDIOLOGY Q U I C K TA B L E S © O NLINEMEDED 1

Coronary Artery Disease

ACUTE TREATMENT OPTIONS

ASA FIRST drug to give Nitrates Second

Angioplasty No Clopidogrel needed, only in single-vessel disease

Bare-Metal Stent

Clopidogrel x 1 month, only in single-vessel disease

Drug-Eluting Stent

Clopidogrel x 1 year, only in single-vessel disease CABG Left Mainstem equivalent or

multi-vessel disease

tPA No PCI is available within 60 minutes transport time

Door-to- balloon

90 minutes

Prasugrel = Clopidogrel

CHRONIC TREATMENT OPTIONS

Beta-Blocker BP < 140 / < 90, HR < 70 Ace-inhibitor BP < 140 / < 90 Aspirin Anti-Platelet Clopidogrel Anti-Platelet Statins LDL < 100 (prefer < 70) STRESS TESTING Imaging

EKG Test of choice, no baseline abnormality

Echo EKG abnormalities, no CABG Nuclear CABG, Baseline wall defects,

LBB Testing

Exercise Test of choice, no

contraindication to exercise with feet

Pharm Any reason why they can’t get on a treadmill, of any kind. Dobutamine and Adenosine essentially identical

COMPLICATIONS OF MI

RV Failure Right Sided ECG No Nitrates

Aneurysm Diagnosed by Echo

Arrhythmia

Vtach / Vb – ventricular ectopy

from dying cells

Brady / Blocks – AV nodal dysfunction

MYOCARDIAL INFARCTION

Path: Occlusion of a coronary vessel

Pt: Chest pain that is worse with exertion, better with rest, relieved with

nitrates in a hypertensive, diabetic, dyslipidemic smoker, who is old Dx: ST segment changes = STEMI

Biomarker Elevation = NSTEMI Stress Test = CAD

Coronary Angiogram = best test Tx: Morphine, Oxygen, nitrates, Aspirin

(MONA)

Beta-Blocker, Ace-inhibitor, Statin, Heparin (BASH)

Coronary Angiography with Stent (single vessel disease) CABG (multi-vessel disease) tPA if no transport available (60

minutes) R IS K FACTORS AN D GOALS Hypertension <140 / < 90 Diabetes A1c < 7.0 Smoking Cessation Dyslipidemia LDL < 100, better < 70 HDL > 40, better > 60 Age Woman > 55 Man > 45 STORY PHYSICAL

Left sided / Substernal Nonpositional Worse with exertion Nonpleuritic Better with rest Nontender

STABLE

ANGINA

UNSTABLE

ANGINA

NSTEMI STEMI

Pain Exercise @ rest @ rest @ rest Relief Rest +

Nitrates

Ø Ø Ø

Trops Ø Ø

↑

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CHAPTER 1 : C_ARDIOLOGY QU I C K TA B L E S © O NLINEMEDED 6

Vb

Vtach Torsades SVT Sbrady Stach 1 ° Block 2 ° Type 1 2 ° Type 2 3 ° Block

Ab

Autter

Idioventricular Asystole R HYTHMS TO TREATMENT

Rhythm Drug Electricity

Vb

Amio Shock

Vtach Amio Shock

Torsades Mag Shock

SVT Adenosine Shock

1° Block Atropine Pace

2° Type 1 Atropine Pace

2° Type2 Pace 3° Block Pace CODES No pulse CPR Shock delivered CPR Anything CPR

All codes Epi

VT/VF Codes Epi, Amio PEA, Asystole Epi

AFIB WITH RVR

Path: Underlying stressor

Ischemia, Infection, Structural heart Pt: Palpitations, Asymptomatic

Dx: ECG

Tx: NO HEART FAILURE: BB or CCB HEART FAILURE: Dig, Amio Shock: Shock

AFIB

Path: PIRATES mnemonic

Ischemia, Infection, Structural heart Pt: Palpitations, Asymptomatic

Dx: ECG

Tx: Rate control = Rhythm Control (AFFIRM)

Rhythm: Cardioversion after TTE, TEE, one month of anticoagulation

Rate: BB, CCB

Rate: Anticoagulate with CHADS2 C CHF H HTN A Age > 75 D Diabetes S Stroke S Stroke Score 0 – Aspirin

Score 1 – Rivaroxaban, Apixaban Score 2 + Coumadin or -axabans

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CHAPTER 3 : G_{ASTROENTEROLOGY}

18

Cirrhosis Etiologies

PRIMARY BILIARY CIRRHOSIS

Path: Women, Intrahepatic, Microductal disease

Pt: Asymptomatic 40 year old female who gets cirrhosis

Dx: Serology = AMA Biopsy shows disease Tx: Transplant

AUTOIMMUNE HEPATITIS

Path: Women with autoimmune disease

Pt: May be insidious, or may be acute with AST, ALT in the 1000s

Dx: Serology = Anti Smooth Muscle, Anti-LKM

Biopsy = best test Tx: Steroids initially

Transplant

NASH/NAFL

Path: Fatty liver from Fatty People

Pt: Diabetes, Dyslipidemia, Obesity, and cirrhosis without evidence of another disease causing cirrhosis

Dx: Ultrasound 1st

Biopsy best

Tx: Weight loss, diabetes control, transplant

ETIOLOGY ADVANCED ORGANIZER

“VW HAPPENS” V Viral Hepatitis (B, C) W Wilson’s Disease

H Hemochromatosis A Alpha-1 Antitrypsin

P Primary Sclerosing Cholangitis P Primary Biliary Cirrhosis

E Ethanol

N Non-Alcoholic Steatohepatitis

S Something else… fulminant diseases Autoimmune Hepatitis

Aa-toxin

Acetaminophen Budd-Chiari Shock Liver

Portal Vein Thrombosis

WILSON’S DISEASE

Path:

Copper secretion deciency, deposits in

eyes, basal ganglia, and liver Pt: Chorea, Kaiser-Fleischer Rings,

Cirrhosis

Dx: Multiple tests available. NEVER: Serum Copper

Option: Ceruloplasmin low Option: Urine Copper high

1st

_{: Slit Lamp looking for eye ndings}

Best: Biopsy

Tx:

Penicillamine → Transplant

Free: Picture of an eye + question about cirrhosis

HEMOCHROMATOSIS

Path: No “off” signal for iron absorption Pt: Bronze Diabetes = Diabetes, Cirrhosis,

and Hyperpigmentation.

♂: Amenorrhea, ♀

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.

Genotype PiMM normal, PiZZ worst form

Pt: Cirrhosis and Emphysema

Dx: Biopsy = PAS positive macrophages Best: genotype

Tx: Protease (emphysema) Transplant (liver)

PRIMARY SCLEROSING CHOLANGITIS

Path: Autoimmune disease in men,

extrahepatic disease, macroductal disease

Pt: Biliary stasis and cirrhosis, may also have ulcerative colitis, men

Dx: Serology = p-ANCA ERCP = Beads on a string

Biopsy = Onion Skinning Fibrosis Tx: Cholestyramine symptomatic relief

Stents maybe, make transplant harder Transplant , but may/will recur

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CHAPTER 7 : E_NDOCRINOLOGY QU I C K TA B L E S © O NLINEMEDED 42

Anterior Pituitary

CUSHING’S SYNDROME See Adrenal ACUTE PAN HYPOPITUITARISM

Path: Infection, Infarction, Surgery, Rads Pt: TSH: Lethargy, Coma

ACTH: Hypotension, Tachycardia GH/LH/FSH: Irrelevant

Dx: Clinical

Hormone (Cortisol and T4) Tx: Replace end hormones

f/u: Sheehan’s: Pregnancy, bloody delivery Apoplexy: Tumor outgrows blood

supply and dies, necrosis

CHRONIC PAN HYPOPITUITARISM

Path: Autoimmune, Deposition, Cancer

GH / FSH / LH sacriced so that TSH

and ACTH can persist

Pt:

↓ Libido, 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

3 LEVELS OF FEEDBACK AND ENDOCRINE R EG OF THE ANT PITUITARY

Hypothalamus Portal Circulation GnRH

↓

TRH

↓

CRH

↓

GHRH

↓

Pituitary Systemic Circulation FSH/LH

↓

TSH

↓

ACTH

↓

GH

↓

Target Organ Metabolic Effect Ovaries Estrogen Progesterone Ovulation Thyroid T3 T4 Metabolism Adrenals Cortisol Stress Liver ILGF Growth PROLACTINOMA

Path: Autonomously secreting prolactin Most common pituitary lesion

Pt: Women: Galactorrhea, Amenorrhea, Microadenomas, No Vision Change Men: Decreased libido, Gynecomastia,

Macroadenomas, Vision Changes, Dx: Medication list

1st_{: TSH}

Then: Prolactin Levels Best: MRI

Tx: Bromocriptine or Cabergoline Surgery

f/u:

Surgery is NOT rst line therapy for

prolactinomas; 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, CARPAL TUNNEL Big hands

Dx: Growth Hormone ILGF-1

Glucose Suppression Test MRI

Tx:

Surgery rst

Octreotide or Cabergoline (adjunct) f/u: Glucose Suppression Test = give

glucose, test is positive (abnormal) if the GH does not change

Wait Carpal tunnel is more associated with RA than Acromegaly… don’t be tricked

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CHAPTER 9 : R _HEUMATOLOGY

54

Approach To Joint Pain

SINGLE JOINT VS MULTIPLE JOINTS

Septic Crystals

Osteoarthritis, Lupus, Rheumatoid

Scleroderma, Myositis, Seronegatives

ACUTE VS CHRONIC

Septic, Trauma, Crystal, Reactive

Osteo, Lupus, Rheumatoid, Scleroderma, Myositis, Seronegatives

ISOLATED VS SYSTEMIC MANIFESTATIONS

Septic Crystal

Seronegative (IBD)

Lupus (Face, CNS, Renal, Heart, Lung) Rheumatoid (Nodules, Serositis)

Reactive (Oral + Genital Ulcer)

DEGENERATIVE VS INFLAMMATORY

Osteoarthritis Everything Else

NORMAL

NON

-INFLAMMATORY

INFLAMMATORY SEPSIS

Appearance Clear Clear Yellow, White Opaque

WBC <2 <2 >2, <50 >50

Polys <25% <25%

≥

50%

≥

75%

Gram/Cx - - - +

Dz None Osteoarthritis Everything Else Infection

ANTIBODY INTERPRETATION

Antinuclear Antibodies Sensitive Lupus

Anti-Histone Antibodies

Specic Drug-Induced Lupus

Anti-ds-DNA Antibodies

Specic 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

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CHAPTER 11: P_EDIATRICS

74

Pediatric Ophtho

CONGENITAL CATARACTS

Path:

Present at birth → TORCH infections

Not present at birth → Galactose

Deciency

Pt: White cloudy lesions in front of their eye “white thing in FRONT of the eye” Dx: Clinical

Tx: Surgical Removal

R ETINOPATHY OF PREMATURITY

Path: Premature baby, oxygen toxicity Pt: Suspect in any premature neonate

especially if any of the “other 3” are present

Dx: Ophtho Exam = growths of retina Tx: Laser Ablation

f/u: The “other three”

Necrotizing Enterocolitis Bronchopulmonary Dysplasia Intraventricular Hemorrhage This is a duplicate from surgery.

TYPE TIME PURULENT PROBLEMS TX

Chemical 24 hrs Non-purulent Bilateral Caused by ppx

Gonorrhea Day 2-5 Purulent

Bilateral, can turn to blindness Topical Erythro then IV ceftriaxone Silver Nitrate Ppx Chlamydia Day 7-12 Muco-purulent

Unilateral Can turn into

pneumonia

Oral + Topical Erythro Silver Nitrate PPx

R ETINOBLASTOMA

Path: Rb gene mutation

Pt: Newborn screen in the neonatal unit

with an abnormal light reex

Dx:

Red reex (normal) = Pure White Retina

“white thing in the BACK of the eye” Tx: Surgery

Radiation Therapy (NEVER) f/u: Osteosarcoma

AMBLYOPIA

Path: Cortical Blindness

Pt: Strabismus, Cataracts, another cause, leads to cortical blindness

Dx: None Tx: None

Fix the problem that could lead to cortical blindness

STRABISMUS

Path: “Lazy eye”

Pt: Baby with one eye that focuses while the other does not

Almost ALWAYS a photograph question Dx:

Light reects 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

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CHAPTER 1 2: P_SYCHIATRY QU I C K TA B L E S © O NLINEMEDED 88

Psych Pharm

ANTI-DEPRESSANTS SSRIs Safe Fluoxetine Paroxetine Sertraline Citalopram ↓ Libido

Serotonin Syndrome = fever, myoclonus, altered mental status GI, Insomnia

Atypicals Bupropion

Venlafaxine Mirtazapine Trazodone

Minimal Sex SE

, ↑ Risk of

Seizures Diastolic HTN Weight Gain Sedation, Priapism TCAs Most Dangerous Amitriptyline Nortriptyline Imipramine Desipramine

Used for enuresis

Seconds asneuropathic pain

Can beLethal(Convulsions,Coma, C

ardiac) → Wide QRS → EKG!

Has Anti-Ach properties (dry mouth, sedation, Uretention, Constipation) MAO-Is Rarely used Phenelzine Tranylcypromine Selegiline

HTN Crisiswhen mixed together, lack of washout or eating of tyramine (red wine/ cheese)

Orthostatic HoTN + Weight Gain

MOOD STABILIZERS

Lithium First-Line, Drug of Choice

Bipolar, Acute Mania, Depression Augmentation

Teratogen

Nephrotoxic > 1.5 Causes Nephro DI Narrow TI

Valproate First Lineif Li contraindicated Bipolar, Seizures Teratogen

(Spina bida)

Thrombocytopenia Agranulocytosis Pancreatitis Carbamazepine Second Line Stabilizer

Trigeminal Neuralgia

Teratogen (Cleft palate) Rash, SJS AV Block Lamotrigine Second Line Stabilizer

Newer anticonvulsant

Blurred Vision SJS

ANXIOLYTICS

Benzos Abort panic attack Treats EtOH withdrawal

Addictive

Withdrawal Seizure SSRIs First-Line long term treatment for

chronic anxiety: OCD, PTSD, AD

See Anti-Depressants. Ø useful in acute attack

β-Blockers

Performance Anxiety Bradycardia, Asthma

Bupropion Backup to SSRI Avoid inbulimia (causes seizures) Haloperidol Diphenhydramine Lorazepam Depot form Enhances Sedation Anxiolytics Called a “B52”

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PSYCHIATRY Q U I C K TA B L E S © O NLINEMEDED 89 P S Y C H ANTIPSYCHOTICS Typicals Haloperidol Fluphenazine Thioridazine Chlorpromazine

Aremore potent so have better effect but also more side effects

D2 onlyso good for + sxs only For noncompliance, use

depot (Haloperidol)

NMS (fever, ↑ CK, rigidity, AMS)

Stop drug

Give Dantrolene Highest risk of EPS

Gynecomastia, Sedation, Anti-Ach Atypicals Risperidone Quetiapine Olanzapine Aripiprazole Ziprasidone

Less potent but also has less side effects

BothD2_C and5-HT₁ so work on - and + sxs

Currently “rst line” for

psychosis

EPS, Gynecomastia, Sedation, Anti-Ach (small risk)

QTc prolongation

DM andWeight Gain Clozapine

Unique to itself The best antipsychotic The most selective for D2_C

and 5HT₁(+ and -) Drug oflast resort

Agranulocytosis

Requiring CBC q week

EXTRAPYRAMIDAL SIDE EFFECTS

Akathisia A Feeling of Restlessness

↓ Dose

Acute Dystonia Involuntary muscle contractions, hand ringing, torticollis, and oculogyric crisis

Anti-Cholinergic

Dyskinesia Parkinsonism Anti-Cholinergic

Tardive D yskinesia Irreversiblehyper-sensitization of dopamine-R = suppressible oral-facial movements

Stop Drug, sxsinitially worsen

CHOOSING THE R IGHT DRUG

Compliant Young Adult, without complications

Any atypical po

↓ SE prole

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, then try another

Everything else has failed

Clozapine Best, most dangerous

Fever, Rigidity, AMS,

↑ CK

Dantrolene, order CPK, ICU NMS

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CHAPTER 1 4: O_BSTETRICS

110

Advanced Early Testing

PROCEDURE WEEK GOAL R ISK OF LOSS EXTRA

Ultrasound All

Conrm IUP

Fetal Age, Well-Being None 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, Genetic

Material 1 / 200 > 16 weeks: Genetic > 24 weeks: Anemia > 36 weeks: L:S Chorionic Villus Sampling 10-12 weeks Genetic Screens, Karyotypes, ?? 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,

Hydralazine, 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, Edema

→ 3

rd_Spacing

Epigastric / RUQ Abdominal Pain

→ Glisson’s Capsule Stretch

Headache, Vision Δs

→ Vasospasm

Labs: CBC, LFT, U/A

˗ Proteinuria → Eclampsia

˗ HELLP → HELLP Syndrome

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Breast Cancer

PICK THE TREATMENT Local Disease: Surgical Therapy Lumpectomy + Radiation OR Mastectomy

Sentinel Lymph Node Biopsy and then Axillary Lymph Node Dissection if +

Spread Disease:

Systemic Therapy

Chemo: Doxorubicin, Paclitaxel Her2neu: Trastuzumab

ER/PR: SERMS (Pre-Menopausal) ER/PR: Aromatase-I

(Post-Menopausal)

K NOW YOUR TREATMENTS

Tamoxifen:

Better, ↑ DVT, ↑ Endo Ca

Raloxifene:

Worse, ↓ DVT, ↓ Endo Ca

Trastuzumab: Heart Failure, Reversible, EARLY

Doxorubicin: Heart Failure, Irreversible, LATE

Daunorubicin: The other Doxorubicin ALND: Sentinel Lymph Node First

BREAST CANCER

Path: Estrogen - Obesity, Nulliparity, Early Menarche, Late Menopause, HRT Genes – BRCA ½, Radiation

Pt: Asymptomatic Screen Breast Lump, 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, every 2 years ACS: 40q1, start at 40, 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

< 30 = Reassurance x 2-3 cycles < 30 + persists = Ultrasound < 30 + cyst on ultrasound = FNA < 30 + cyst resolves = reassurance

OR OR OR

Mammogram and Core Needle Biopsy if…

> 30

Ultrasound shows mass Aspirate is bloody

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Prevention

LEVELS OF PREVENTION

Primary Preventonset of dz

Vaccines, diet/exercise Secondary Preventprogression of dz

Screening, hypertension meds Tertiary Preventcomplications of dz

Surgery, rehab

All medicine falls under 1 of these 3.

Condence Interval

ASSOCIATIONS Null CI includes 1 Effect Size Furthest from 1 Power Narrowest range

Bias

BIAS IN STUDIES/SCREENS

Lead Time Pt of diagnosis changes, but no

effect on outcome, articially

↑ survival time

Length Time Deadly dz is found less often,

bias that assumes nding dz

means it’s less dangerous,

articially makes screening ↑

Overdiagnosis

Diagnosis is ↑ but has Ø effect

on mortality, is meaningless.

Articially ↑ survival stats

Selection Pt group isn’t chosen at

random, can’t get meaningful comparisons, skews outcome Measurement Using different tools to

measure same thing, can’t get meaningful comparisons, skews outcome

Information Pts know something that affects their actions, 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, why correlation doesn’t = causation

METHODS TO ELIMINATE BIAS

Randomization Blinding

Standardization Statistical Controlling **Bias is addressed in study design.**