341031440-OnlineMedEd-QuickTables-Preview-pdf

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EPETITIO
R
OR
N
&
RE
N
F
QUICKTABLES
C O G N ITI O
Index:
1.
Cardiology
2.
Pulmonary
3.
Gastroenterology
4.
Nephrology
5.
Hematology Oncology
6.
Infectious Disease
a.
b.
c.
d.
e.
f.
g.
h.
i.
a.
b.
c.
d.
e.
f.
g.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
a.
b.
c.
d.
e.
f.
g.
a.
b.
c.
d.
e.
f.
g.
a.
b.
c.
d.
Coronary Artery Disease
1
Congestive Heart Failure
2
Valve Disease3
Cardiomyopathy4
Pericardial Disease4
Syncope5
Hypertension5
Cholesterol5
ACLS6
Asthma8
Lung Cancer8
Pleural Effusion9
DVT PE9
COPD10
ARDS10
Interstitial Lung Disease
11
Gallbladder Disease12
Esophagitis13
Esophageal Disorders
14
Peptic Ulcer Disease
15
Misc. Gastric Disorders
15
Acute Diarrhea16
Chronic Diarrhea16
Cirrhosis and Ascites
17
Cirrhosis Etiologies18
Malabsorption19
Diverticular Disease19
Colon Cancer20
Gi Bleed21
Acute Pancreatitis22
Inflammatory Bowel Disease
22
Jaundice23
Viral Hepatitis23
Acute Kidney Injury
24
Sodium25
Calcium25-26
Potassium27
Kidney Stones27
Cysts and Cancer
28
Acid Base28
Macrocytic Anemia30
Microcytic Anemia30
Normocytic Anemia31
Leukemia32
Lymphoma32
Plasma Cell Dyscrasia
33
Bleeding, Thrombocytopenia
34
Antibiotics36
HIV36
TB37
Sepsis37
Q u i c k T a b l e s © OnlineMedEd
Index:
e.
f.
g.
h.
i.
j.
k.
l.
Brain Inflammation
38
Lung Infection38
UTI39
Genital Ulcers39
Skin Infections40
Endocarditis41
Antibiotics 41
Surgery41
7.
Endocrinology
8.
Neurology
9.
Rheumatology
a.
b.
c.
d.
e.
f.
g.
a.
b.
c.
d.
e.
f.
g.
h.
i.
a.
b.
c.
d.
e.
f.
Anterior Pituitary42
Posterior Pituitary43
Thyroid Nodules43
Men Syndromes43
Thyroid Disorders44
Adrenals45
Diabetes46
Stroke48
Dizziness48
Seizure49
Tremor50
Headache50
Back Pain51
Dementia52
Coma52
Weakness53
Approach To Joint Pain
54
Lupus55
Rheumatoid Arthritis
55
Other Connective Tissue Dz
56
Monoarticular Athropathies
56
Seronegative Arthropathies
57
10. Dermatology
a.
b.
c.
d.
e.
f.
g.
h.
Blistering Disease58
Papulosquamous Dermatoses
58
Eczematous Dermatoses
59
Hypersensitivity Reactions
59
Hyperpigmentation60
Hypopigmentation61
Skin Infections61
Alopecia62
11. Pediatrics
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
Constipation64
Neonatal Jaundice64
Vomiting65
Seizures65
Gi Bleed66
Allergies66
Peds Rash67
Peds Preventable Trauma
68
Vaccinations68
ENT69
Pediatrics CT70
Upper Airway / Stridor
71
Lower Airway71
Immunodeficiencies
72
Q u i c k T a b l e s © OnlineMedEd
Index:
o.
p.
q.
r.
s.
Ortho Peds73
Pediatric Ophtho74
Urology Peds75
Sickle Cell76
Abuse76
12. Psychiatry
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
Defense Mechanisms
78
Anxiety Disorders79
Impulse Control Disorders
80
Eating Disorders80
Mood Disorders I And II
81
Delusional Disorders82
Personality Disorders
83
Peds Psych84
Dissociative Disorders
85
Addiction85
Drugs of Addiction: Intoxication and Withdrawal
86
Sleep I And II
87
Psych Pharm88-89
Psych Cognition90
Psych Somatoform – DSM-IV
90
13. Gynecology
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
Gynecologic Cancers
92
Gestational Trophoblastic Disease 93
Incontinence93
Adnexal Mass94
Pelvic Anatomy95
Gyn Infections96
Vaginal Bleeding 1: Premenarche
97
Vaginal Bleeding 2: Reproductive Years
97
Vaginal Bleeding 3: Reproductive Age
98
Primary amenorrhea99
Secondary Amenorrhea
100
Infertility101
Menopause101
Virilization102
14. Obstetrics
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
Physiology Of Pregnancy
104
1st Visit Labs And Initial Care
104
Quad Screen105
Third Trimester Labs
105
Medical Disease106
Normal Labor107
Abnormal Labor108
Third Trimester Bleeding
108
L&D Pathology109
Advanced Early Testing
110
Eclampsia110
Multiple Gestation111
Post-Partum Hemorrhage
111
Early Antenatal Testing
112
Isoimmunization112
Perinatal Infections113
OB Operations114
Contraception115
Q u i c k T a b l e s © OnlineMedEd
Index:
15. Surgery: General
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
Pre-op Evaluation116
Post-op Fever116
Chest Pain117
Altered Mental Status
117
Abdominal Distention
118
Wound118
Fistula119
Decreased Urinary Output
119
Obstructive Jaundice120
Esophagus121
Small Bowel121
Pancreas122
Leg Ulcers122
Colorectal123
Breast Cancer124
Pediatrics First Day
125
15. Surgery: Specialty
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
Pediatrics Weeks To Months
126
Surgical Hypertension
126
Endocrine127
CT Surgery128
Pediatrics CT129
Vascular130
Adult Ophtho131
Skin Cancer132
Pediatric Ophtho133
Neurosurgery Bleeds134
Neurosurgery Tumors
134
Urologic Cancer135
Urology Peds136
Urologic Miscellaneous
137
Ortho Injury138-139
Ortho Hand140
Ortho Peds141
15. Surgery: Trauma
a.
b.
c.
d.
e.
f.
g.
h.
Shock142
Head Trauma143
Neck Trauma143
Chest Trauma144
Abdominal Trauma145
Burns146
Bites146
Toxic Ingestion147
16. Preventative Medicine
a.
b.
c.
d.
e.
f.
Biostats148
Prevention
149
Confidence Interval
149
Bias149
Vaccines150
Screening150
Q u i c k T a b l e s © OnlineMedEd
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 with rest, relieved with
nitrates in a hypertensive, diabetic,
dyslipidemic smoker, who is old
Nitrates
Second
Angioplasty
No Clopidogrel needed, 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, 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-toballoon
90 minutes
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 isk F actors
and
CHRONIC Treatment Options
Beta-Blocker
G oals
BP < 140 / < 90, HR < 70
Ace-inhibitor BP < 140 / < 90
Hypertension
<140 / < 90
Diabetes
A1c < 7.0
Smoking
Cessation
Dyslipidemia
LDL < 100, better < 70
HDL > 40, 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, no baseline
abnormality
Left sided / Substernal
Nonpositional
Echo
EKG abnormalities, no CABG
Worse with exertion
Nonpleuritic
Nuclear
Better with rest
Nontender
CABG, Baseline wall defects,
LBB
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
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
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, Asystole
Codes
CPR
CPR
CPR
Epi
Epi, Amio
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
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
chapter
3:
Gastroenterology
Cirrhosis Etiologies
Wilson’s Disease
Primary Biliary Cirrhosis
Path: Copper secretion deficiency, deposits in
eyes, basal ganglia, and liver
Path: Women, Intrahepatic, Microductal
disease
Pt:
Chorea, Kaiser-Fleischer Rings,
Cirrhosis
Pt:
Asymptomatic 40 year old female who
gets cirrhosis
Dx:
Multiple tests available.
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, or may be acute with
AST, ALT in the 1000s
Dx:
Serology = Anti Smooth Muscle,
Anti-LKM
Biopsy = best test
Tx:
Steroids initially
Transplant
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
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”
Pt:
Cirrhosis and Emphysema
Dx:
Biopsy = PAS positive macrophages
Best: genotype
V
Viral Hepatitis (B, 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,
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
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
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, 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
42
GHRH
↓
Q u i c k T a b l e s © OnlineMedEd
↓
↓
↓
↓
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
chapter
9:
Rheumatology
Approach To Joint Pain
Single Joint
Septic
Crystals
Acute
Septic,
Trauma,
Crystal,
Reactive
Isolated
Septic
Crystal
vs
Degenerative
Osteoarthritis
vs
vs
vs
Multiple Joints
Osteoarthritis, Lupus, Rheumatoid
Scleroderma, Myositis, Seronegatives
Chronic
Osteo, Lupus, Rheumatoid, Scleroderma, Myositis,
Seronegatives
Systemic Manifestations
Seronegative (IBD)
Lupus (Face, CNS, Renal, Heart, Lung)
Rheumatoid (Nodules, Serositis)
Reactive (Oral + Genital Ulcer)
Inflammatory
Everything Else
Clear
NonInflammatory
Clear
Yellow, White
Opaque
WBC
<2
<2
>2, <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
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,
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, Cataracts, another cause,
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.
chapter
12: Psychiatry
Psych Pharm
SSRIs
Safe
Fluoxetine
Paroxetine
Sertraline
Citalopram
Anti-Depressants
↓ 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
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)
Phenelzine
Tranylcypromine
Selegiline
HTN Crisis when mixed together, 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, Drug of Choice
Nephrotoxic > 1.5
Bipolar, Acute Mania, Depression
Causes Nephro DI
Augmentation
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 Vision
SJS
Anxiolytics
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”
Benzos
88
Q u i c k T a b l e s © OnlineMedEd
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, use
depot (Haloperidol)
NMS (fever, ↑ CK, rigidity, AMS)
Stop drug
Give Dantrolene
Highest risk of EPS
Gynecomastia,
Sedation, Anti-Ach
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
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,
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
↓ 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
Q u i c k T a b l e s © OnlineMedEd
Psych
Choosing the Right Drug
Compliant Young Adult, Any atypical po
without complications
89
chapter
14: Obstetrics
Advanced Early Testing
Procedure
Week
Goal
Risk of Loss
Extra
Ultrasound
All
Confirm IUP
Fetal Age, Well- 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, 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
Seizing → Eclampsia
110 Q u i c k T a b l e s © OnlineMedEd
chapter
15: Surgery: General
Breast Cancer
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
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, Paclitaxel
Her2neu: Trastuzumab
ER/PR: SERMS (Pre-Menopausal)
ER/PR: Aromatase-I (PostMenopausal)
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
Preventative Medicine
Prevention
Bias
Levels of 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 in 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
Methods to Eliminate Bias
Randomization
Blinding
Standardization
Statistical Controlling
**Bias is addressed in study design.**
Prevent
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