OnlineMedEd QuickTables Preview

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QUICKTABLES

& R

E C OGNITIO

N

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Q uick T ables © OnlineMeded

1. C

ardiology

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. P

ulmonary a. Asthma b. Lung Cancer c. Pleural Effusion d. DVT PE e. COPD f. ARDS

g. Interstitial Lung Disease

3. g

astroenterology

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. Inflammatory Bowel Disease

p. Jaundice

q. Viral Hepatitis

4. n

ePhrology

a. Acute Kidney Injury

b. Sodium

c. Calcium

d. Potassium

e. Kidney Stones

f. Cysts and Cancer

g. Acid Base

5. h

ematology

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

d

isease

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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Index:

e. Brain Inflammation 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. n

eurology 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. d

ermatology a. Blistering Disease b. Papulosquamous Dermatoses c. Eczematous Dermatoses d. Hypersensitivity Reactions e. Hyperpigmentation f. Hypopigmentation g. Skin Infections h. Alopecia

11. P

ediatriCs 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. Immunodeficiencies 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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Q uick T ables © OnlineMeded o. Ortho Peds p. Pediatric Ophtho q. Urology Peds r. Sickle Cell s. Abuse

12. P

syChiatry 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. g

yneCology

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. o

bstetriCs 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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15. s

urgery

: g

eneral

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. s

urgery

: s

PeCialty

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. s

urgery

: t

rauma a. Shock b. Head Trauma c. Neck Trauma d. Chest Trauma e. Abdominal Trauma f. Burns g. Bites h. Toxic Ingestion

16. P

reventative

m

ediCine a. Biostats b. Prevention c. Confidence 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

ardio

Cardiology

Q uiCk T ables © onlineMeded 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

COmpliCATiOnsOf 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

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)

risk fACTOrsAnd 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: Cardiology Q uiCk T ables © onlineMeded 6 Vfib Vtach Torsades SVT Sbrady Stach 1 ° Block 2 ° Type 1 2 ° Type 2 3 ° Block Afib Aflutter Idioventricular Asystole rHyTHmsTOTrEATmEnT

Rhythm Drug Electricity

Vfib Amio Shock

Vtach Amio Shock

Torsades Mag Shock

SVT Adenosine Shock

1° Block Atropine Pace 2° Type 1 Atropine Pace

2° Type 2 Pace 3° Block Pace COdEs No pulse CPR Shock delivered CPR Anything CPR

All codes Epi

VT/VF Codes Epi, Amio PEA, Asystole Epi

AfibwiTH 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: GastroenteroloGy

Q uick t ables © onlineMeded

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 Afla-toxin

Acetaminophen Budd-Chiari Shock Liver

Portal Vein Thrombosis

wilsOn’s disEAsE

Path: Copper secretion deficiency, 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 findings}

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: Endocrinology Q uick T ablEs © onlinEMEdEd 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 sacrificed 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 lEvElsOf fEEdbACkAnd EndOCrinE rEgOfTHE AnT piTUiTAry

Hypothalamus

Portal Circulation GnRH

↓

TRH

↓

CRH

↓

GHRH

↓

Pituitary

Systemic Circulation FSH/LH

↓

TSH

↓

ACTH

↓

GH

↓

Target Organ

Metabolic Effect Estrogen Ovaries 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 first 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 first

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: Rheumatology

Q uick t ables © onlinemeded

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 _i nOn-

nflAmmATOry 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 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

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chapter 11: Pediatrics

Q uick t ables © OnlineMeded

74

Pediatric Ophtho

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

rETinOpATHyOf 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

rETinOblAsTOmA

Path: Rb gene mutation

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

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 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

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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 as neuropathic pain Can be Lethal (Convulsions, Coma,

Cardiac) → Wide QRS → EKG!

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

HTN Crisis when 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 Line if Li contraindicated

Bipolar, Seizures Teratogen (Spina bifida) Thrombocytopenia Agranulocytosis Pancreatitis Carbamazepine Second Line Stabilizer

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

Newer anticonvulsant Blurred VisionSJS

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 in bulimia (causes seizures) Haloperidol Diphenhydramine Lorazepam Depot form Enhances Sedation Anxiolytics Called a “B52”

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Psychiatry Q uick t ables © OnlineMeded 89 P sych 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, 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

Both D2C and 5-HT1 so

work on - and + sxs Currently “first line” for

psychosis

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

DM and Weight Gain Clozapine

Unique to itself The best antipsychotic The most selective for D2C

and 5HT1 (+ and -)

Drug of last 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 Dyskinesia Irreversible hyper-sensitization of dopamine-R = suppressible

oral-facial movements

Stop Drug, sxs initially worsen

CHOOsingTHE rigHT drUg

Compliant Young Adult,

without complications Any atypical po ↓ 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, 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 14: Obstetrics

110

Advanced Early Testing

prOCEdUrE wEEk gOAl riskOf lOss

E

xTrA

Ultrasound All Confirm 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 → 3rd_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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chapter 15: Surgery: general

124

Breast Cancer

piCkTHETrEATmEnT

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)

knOw 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 Cyst recurs after aspiration

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Prevention

lEvElsOf prEvEnTiOn

Primary Prevent onset of dz Vaccines, diet/exercise Secondary Prevent progression of dz

Screening, hypertension meds Tertiary Prevent complications of dz

Surgery, 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

biAsin sTUdiEs/sCrEEns

Lead Time Pt of diagnosis changes, but no effect on outcome, artificially ↑ survival time

Length Time Deadly dz is found less often, bias that assumes finding dz means it’s less dangerous, artificially makes screening ↑ Overdiagnosis Diagnosis is ↑ but has Ø effect

on mortality, is meaningless. Artificially ↑ 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

mETHOdsTO EliminATE biAs

Randomization Blinding

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