Usmle Step 2

Front 1

PAGET'S DISEASE PATHOPHYSIOLOGY

Back 1

EXCESSIVE BONE TURNOVER BY OSTEOCLASTS +/- ASSOCIATED WITH PARAMYXOVIRUS INFECTION

Front 2

PAGET'S S/S

Back 2

DEEP BONE PAIN
FREQUENT #
INCREASED CRANIAL DIAMETER (=FRONTAL BOSSING)
DEAFNESS D/T CN VIII COMPRESSION

Front 3

PAGET'S LAB & XRAY FINDINGS

Back 3

INCREASED ALP, URNIARY HYDROXPROLINE
NORMAL Ca, PO4
XRAY - MARKEDLY EXPANDED BONY CORTEX - INCREASED DENSITY, THICKENED TRABECULAE, CHARACTERISTIC "JIGSAW" OR "MOSAIC" BONE PATTERN

Front 4

PAGET'S - Rx

Back 4

NSAIDS, CALCITONIN, ALENDRONATE

Front 5

Paget's - complications

Back 5

#'s, high output cardiac failure, deafness, secondary osteosarcoma

Front 6

heliotrope rash

Back 6

violacious periorbital rash in dermatomyositis

Front 7

Grotton's papules

Back 7

papules on dorsum of hand over bony prominences in dermatomyositis

Front 8

polymyositis lab and EMG findings

Back 8

elevated serum creatine, aldolase, CPK
EMG - fibrillations

Front 9

complications of polymyositis

Back 9

myocarditis, cardiac conduction defects, malignancy

Front 10

Felty's triad

Back 10

hepatosplenomeagly
TCP
RA

Front 11

Lab, synovial fluid and Xray findings in RA

Back 11

rh factor = anti-Fc IgG Ab - elevated in >75% (not specific)
+/- ESR elevated
synovial fluid - turbbid, decreased viscosity, WBC 3000-50000 cells/microL
Xray - juxta-articular dimineralization (early) joint space narrowing and erosions (late)

Front 12

JRA - most common type?

Back 12

pauciarticular - <30% develop iridocyclitis
ANA type - most common - asymmetric involvement of large joints with iridocyclitis
RF type - poor Px - concurrent with AS in HLA-B27+ males

Front 13

Systemic acute febrile JRA

Back 13

least common
characteristic arthritis with daily high spiking fevers
evanescent salmon coloured rash
+/- hepatosplenomegaly and serositis

Front 14

Scleroderma S/S

Back 14

thickening of skin of face +/or distal extremities
CREST
severe form - pulmonary fibrosis, cor pulmonales, ARF, malignant HTN

Front 15

Anticentromere Ab

Back 15

specific for CREST

Front 16

anti-Scl-70 = anti-topoisomerase 1

Back 16

specific for systemic scleroderma

Front 17

treatment for scleroderma

Back 17

glucocorticoids, penicillamine for skin changes, CCB for Raynaud's, ACEI for renal dz/HTN

Front 18

SLE criteria

Back 18

DOPAMINE RASH =
Discoid rash
Oral ulcers
Photosensitivity
Arthritis
Malar rash
Immunologic criteria
Neurologic symptoms (lupus cerebritis, seizures)
Elevated ESR
Renal disease
ANA +
Serositis
Hematologic abnormalities - anemia, leukopenia, TCP

Front 19

Anti-dsDNA, Anti-Sm Ab's

Back 19

highly specific, not sensitive for SLE

Front 20

drug induced SLE antibodies

Back 20

Antihistone Ab

Front 21

Anti-Ro Ab's

Back 21

neonatal SLE

Front 22

Anti-phospholipid Ab's

Back 22

hypercoagulability, thromboembolic disease, recurrent spontaneous abortions

Front 23

Rx for SLE

Back 23

NSAIDs (initial)
Steroids for acute exacerbations
hydroxychloroquine, cyclophosphamide, azithroprine for progressive/refractory cases

Front 24

SLE pathogenesis, epidemiology

Back 24

90% female (esp. African American)
Antibody-mediated cellular attack with deposits of antigen-antibody complexes

Front 25

Drugs inducing SLE

Back 25

hydralazine
pencillamine
procainamide

Front 26

Temporal arteritis pathogenesis

Back 26

subacute granulomatous inflammation of large vessels (includes aorta, ext. carotid - temp. br, vertebral a's)

Front 27

temporal arteritis S/S

Back 27

new h/a uni/bilateral with scalp pain
temporal tenderness
jaw claudication
fever
transient/perm monocular blindness
+/- wt loss, myalgia/arthralgia

Front 28

bx findings in temporal arteritis

Back 28

thrombosis, media necrosis, lymphocyes, plasma cells, giant cells

Front 29

HSP path and epi

Back 29

immune mediated small vessel vasculitis
children 2-11 y/o

Front 30

HSP S/S

Back 30

palpable purpura on buttocks, legs
asym. migartory periarticular swelling
abdominal pain
preceding URTI (75%)

Front 31

Complications of HSP

Back 31

GIB, intussusception, GN - degree of renal involvment determines Px

Front 32

Barlow's maneuver

Back 32

for DDH
pressure on inner aspect of abd thigh, hip add - causes post. dislocation

Front 33

Ortolan's maneuver

Back 33

for DDH
thighs abdocuted from midline with anterior pressure on greater trochanter - +ve = soft click (femoral head reduced into acetabulum)

Front 34

Allis'/Galeazzi's sign

Back 34

for DDH
knees at unequal heights when baby's hips and knees flexed (dislocated side lower)

Front 35

Evaluation of DDH

Back 35

clinical, U/S esp after 10 weeks old (not xray until >4m old)

Front 36

Monteggia's #

Back 36

diaphyseal # of prox ulna with subluxation of radial head

Front 37

Galeazzi's #

Back 37

diaphyseal # of radius with dislocation of distal r/u joint - d/t direct blow to radius
Rx - ORIF radius, cast in supination to reduce r/u jt

Front 38

clavicular #

Back 38

most common #'d long bone in kids
can be associated with brachial plexus injuries

Front 39

greenstick #

Back 39

incomplete # - cortex of only one side of bone
Rx - reduction with casting, repeat Xray 7-10days

Front 40

nursemaid's elbow

Back 40

radial head subluxation secondary to child being pulled or lifted by the the hand
Rx - gentle supination of elb at 90

Front 41

Torus #

Back 41

buckling of cortex of long bone secondary to trauma
- usually distal radius or ulna

Front 42

Salter-Harris # type I

Back 42

physis

Front 43

Salter-Harris # type II

Back 43

metaphysis and physis

Front 44

Salter-Harris # type III

Back 44

epiphysis and physis

Front 45

Salter-Harris # type IV

Back 45

epiphysis, metaphysis, physis

Front 46

Salter-Harris # type V

Back 46

crush injury of physis

Front 47

Rx of Salter-harris #'s

Back 47

Types I, II - conservative
III - V - Sx

Front 48

Rx of DDH

Back 48

Splint with Pavlik harness (maintains hip flexed, abd) if <6m old
6-15m old - spica cast
15-24m old - ORIF

Front 49

DDx of limp in children

Back 49

"STARTSS HOTT"
Septic joint
Tumor
AVN (LCPD)
RA/JRA
TB
SCA
SCFE
HSP
Osteomyelitis
Trauma
Toxic synovitis

Front 50

osteosarcoma

Back 50

2nd most common primary malignancy of bone (MM 1st)
metaphyseal region of distal femur, prox. tibia, prox. humerus - mets to lungs
males, 2nd-3rd decades

Front 51

osteosarcoma vs Ewing's

Back 51

Osteo
metaphyseal region distal femur, prox tibia/humerus
Xray - Codman's triangle, "sunburst" pattern
Ewing's
diaphyseal-metaphyseal regions of pelvis, femur, tibia
multilayered "onion-skinning"

Front 52

Codman's triangle

Back 52

Osteosarcoma Xray finding = periosteal new bone formation at diaphyseal end of bone

Front 53

lesion of Broca's area

Back 53

Broca's aphasia - motor (expressive) - broken speech, normal comprehension

Front 54

lesion of Wernike's area

Back 54

sensory (fluent/receptive)aphasia - poor comprehension

Front 55

lesion to arcuate fasciculus

Back 55

conduction aphasia - poor repitition with good comprehension, fluid speech

Front 56

Lesion to amygdala bilaterally

Back 56

Kluver-Bucy syndrome - hyperorality, hypersexuality, disinhibited behaviours

Front 57

lesion to fronal lobe

Back 57

frontal release signs - personality changes
deficits in concentration, orientation, judgement

Front 58

right parietal lobe lesion

Back 58

spatial neglect syndrome - agnosia of contralateral side of the world

Front 59

Lesion to mamillary bodies bilaterally

Back 59

Wernicke-Korsakoff's encephalopathy - confabulations, anterograde amnesia

Front 60

CN XII lesion

Back 60

tongue deviates towards lesion side

Front 61

CN V lesion

Back 61

jaw deviates towards

Front 62

unilateral cerebellum lesion

Back 62

patient falls towards side of lesion

Front 63

CN X lesion

Back 63

uvula deviates AWAY from lesion side

Front 64

CN XI lesion

Back 64

head turns towards side of lesion

Front 65

R optic nerve defect

Back 65

right hemianopsia

Front 66

optic chiasm lesion

Back 66

bitemporal hemianopsia

Front 67

R optic tract lesion

Back 67

L homonymous hemianopsia

Front 68

R Meyer's loop lesion

Back 68

L upper quadrant anopsia = right temporal lesion

Front 69

R dorsal optic radiation lesion

Back 69

L lower quadrant anopsia = R parietal lesion

Front 70

R visual cortex lesion

Back 70

L hemianopsia with macular sparing

Front 71

anterior cerebral artery distribution

Back 71

medial surface of brain, leg-foot area of motor and sensory cortices

Front 72

middle cerebral artery distribution

Back 72

lateral aspect of brain, Broca's and Wernicke's areas

Front 73

Anterior communicating artery defects

Back 73

most common circle of Willis aneurysm, +/- visual field defects

Front 74

Posterior communicating artery defects

Back 74

CN III palsy
common area of aneurysm

Front 75

Lateral striae arteries distribution

Back 75

internal capsule, caudate, putamen, globus pallidus = "arteries of stroke"

Front 76

stroke of anterior Circle of Willis

Back 76

general sensory and motor dysfunction, aphasia

Front 77

Stroke of posterior Circle of Willis

Back 77

vertigo, ataxia, visual defects, coma

Front 78

Poliomyelitis/Werdnig-Hoffman disease spinal cord lesions

Back 78

LMN lesions only = flaccid paralysis

Front 79

MS spinal cord lesions

Back 79

mostly white matter of cervical region - random and asym lesions

Front 80

ALS

Back 80

combined U/LMN deficits
NO sensory deficits

Front 81

Anterior spinal artery lesion

Back 81

spares dorsal columns

Front 82

Tabes dorsalis

Back 82

impaired propriocetion
locomotor ataxia
d/t tertiary syphilis

Front 83

syringomyelia

Back 83

affects ventral white commissure and ant. horns

Front 84

Vit B12 neuropathy/Friedreich's ataxia

Back 84

affects dorsal columns, lateral corticospinal and spinocerebellar tracts

Front 85

Broca's aphasia

Back 85

disorder of language production with intact comprehension - pts aware
impaired repitition
Associated with arm and face hemiparesis (right), hemisensory loss, apraxia of oral muscles
d/t L superior MCA stroke

Front 86

Wernicke's aphasia

Back 86

disorder of language comprehension
neologisms, paraphasic errors
pts unaware
no hemiparesis, dysarthria
L inf/post MCA embolic stoke
poor Px c/w Broca's

Front 87

Locked in syndrome S/S, causes

Back 87

awake and alert, unable to move except eyes and eyelids
central pontine myelinolysis
brain stem CVA
advanced ALS

Front 88

Persistent vegetative state

Back 88

normal sleep-wake cycles
most common - diffuse cortical injury
hypoxic-ischemic injury

Front 89

5 A's of dementia

Back 89

Aphasia
Amnesia
Agnosia
Apraxia
disturbances in Abstract thought

Front 90

Causes of dementia

Back 90

"DEMENTIAS"
neuroDegenerative diseases
Endocrine
Metabolic
Exogenous
Neoplasm
Trauma
Infection
Affective disorders
Stroke/Structural

Front 91

Peripheral vs central vertigo

Back 91

Peripheral - intermittent, severe, constant nystagmus, always horizonal, unidirectional, associated with hearing loss, no brain stem S/S
Central - constant, less severe, +/- nystagmus (absent, uni/bidirectional, +/- vertical)Rare hearing loss, often brain stem S/S (ataxia, dysarthria, CN abN, motor dysfunctions)

Front 92

Most common causes dysequilibrium

Back 92

BPPV (50%)
Ménière's
Others - hypothyroid, aminoglycoside/furosemide toxicity, stroke, trauma, labyrinthitis, acoustic neuroma

Front 93

Nylen-Barany Maneuver

Back 93

= Dix-Hallpike maneuver
pt sitting to supine quickly turning head to side - +ve if reproduces vertigo +/or nystagmus = BPPV

Front 94

BPPV S/S

Back 94

transient episodic vertigo <1min
nystagmus triggered by changes in head position (classic - turning in bed/getting up in am)
N/V
Symptoms decrease with repetitive testing

Front 95

Meniere's disease S/S
(=endolymphatic hydrops)

Back 95

intermittent peripheral vertigo d/t distention of endolymphatic compartment of inner ear
N/V
ear fullness
hearing loss
tinnitus
episodes resolve hrs-days

Front 96

Causes of Meniere's

Back 96

head trauma
syphilis

Front 97

audiometry findings in Meniere's

Back 97

low-frequency pure-tone hearing loss

Front 98

Treatment of Meniere's

Back 98

low salt diet
acetazolamide
actue attacks - antihistamines, antiemetics, benzo's
surgical decompression if refractory

Front 99

acute h/a causes

Back 99

SAH
hemorrhagic CVA
meningitis
seizure
acutely increased ICP
hypertensive encephalopathy
post-LP
ocular dz (glaucoma, iritis)
new migraine

Front 100

subacute h/a causes

Back 100

temporal arteritis
intracranial tumor
SDH
pseudotumor cerebri
trigeminal/glossopharyngeal neuralgia
post-herptic neuralgia
HTN

Front 101

chronic/episodic h/a causes

Back 101

migraine
cluster h/a
tension h/a
sinusitis
dental dz
neck pain

Front 102

Migraine h/a S/S

Back 102

throbbing h/a >2hrs, <24hrs
N/V
photophobia
noise sensitivity
"Classic" - u/l, visual aura (scintillating scotomas or field cuts)
"common" - b/l, periorbital without associated symp

Front 103

Treatment of migraine h/a

Back 103

ASA/NSAIDS, triptans
prophylaxis - BB, TCA, CCB, valproic acid

Front 104

Cluster h/a description

Back 104

brief, severe, usually u/l periorbital h/a 30min-3hrs
affects same part of head, same time of day (night), same time of year
triggers - EtOH, vasodilators

Front 105

Cluster h/a S/S

Back 105

ipsilateral tearing of eye
conjunctival injection
Horner's syndrome
nasal stuffiness

Front 106

Treatment of cluster h/a

Back 106

acutely - high flow O2 (100% non-rebreather)
ergots
sumatriptan
intranasal lidocaine
corticosteroids

Front 107

Prophylaxis of cluster h/a

Back 107

ergots
CCB
prednisone
lithium
valproic acid
topiramate

Front 108

SAH causes

Back 108

ruptured aneurysm (berry)
AVM
trauma (most common)

Front 109

Berry aneurysms associated with?

Back 109

PcKD
coarctation of aorta

Front 110

CN involvment in SAH

Back 110

CN III palsy with pupil involvement associated with Berry aneurysms

Front 111

Treatment of SAH

Back 111

prevent rebleeding - most likely in 1st 48hrs
prevent vasospasm - nimodipine and IV fluids, maintain elevated BP
antiseizure meds - phenytoin
NO NSAIDs

Front 112

Complications of SAH

Back 112

rebleeding aneurysm>AVM
extension into brain parenchyma (AVM)
vasospasm (in 1/3 of aneurysmal SAH)
obstructive hydrocephalus

Front 113

EDH CT findings

Back 113

lens-shaped CONVEX hyperdensity

Front 114

SDH CT findings

Back 114

cresent-shaped, CONCAVE hyperdensity

Front 115

parenchymal hemorrhage causes

Back 115

HTN - usually in basal ganglia
tumor
amyloid angiopathy (elderly)
vascular malformations (AVM, cavernous hemangiomas)

Front 116

Cushing's triad

Back 116

alterations in BP, HR, and respiratory patterns

Front 117

Parkinson's tetrad

Back 117

resting tremor
bradykinesia
rigidity
postural instability

Front 118

treatment of parkinson's

Back 118

dopamine agoinsts - brompcriptine, levo/carbadopa
MAO-B inhibitors - selegiline (neuroprotective, decreases levodopa need)
COMT inhibitors - entacapone (increase levodopa availability, may decrease motor fluctuations)
(amandatine, antiAch - limited efficacy)

Front 119

astrocytomas

Back 119

Adults
S/S h/a, increased ICP
+/- u/l paralysis CN V-VII, X
slow, protracted course
Rx - resection, XRT

Front 120

GBM

Back 120

most common primary
h/a, increased ICP
rapid progression, poor Px (<1yr)

Front 121

meningiomas

Back 121

women>men
from dura or arachnoid
increased incidence with age

Front 122

acoustic neuroma

Back 122

ipsilateral hearing loss
tinnitus
vertigo
signs of cerebellar dysfunction
Derived from Schwann cells

Front 123

Medulloblastoma

Back 123

children
from 4th vent - increased ICP
highly malignant - can seed subarachnoid space
Rx - Sx + chemo + XRT

Front 124

ependymoma

Back 124

children
from ependyma of ventricle (4th) or spinal cord
hydrocephalus
Rx - Sx + XRT

Front 125

Neurocutaneous syndromes

Back 125

NF 1,2
Tuberous sclerosis

Front 126

NF 1 mutation

Back 126

NFT-1 gene on 17q

Front 127

NF 2 mutation

Back 127

defective gene chrom. 22

Front 128

NF1 diagnostic criteria

Back 128

>=2 of:
1) 6 cafe au lait spots (>5mm kids, 15mm adults)
2) 2 neurofibromas (any type)
3)feckling-axillary/inguinal
4) optic glioma
5) 2 Lisch nodules = pigmented iris hamartomas
6)osseus abnormalities
7) 1st degree relative

Front 129

NF2 diagnostic criteria

Back 129

bilateral acoustic neuromas
1st degree relative
unilateral acoustic neuroma
any 2 of:
neurobfibroma
meningioma
glioma
schwannoma
Other features (not criteria)
seizures, skin nodules, cafe-au-lait spots

Front 130

Tuberous Sclerosis - characterized by:

Back 130

seizures (begin <1y/o)
mental retardation
skin and eye lesions

Front 131

Tuberous sclerosis - presentation

Back 131

infantile spasms
ash-leaf hypopigmented lesions
(trunk and extremities)

Front 132

Skin lesions in tuberous sclerosis

Back 132

sebaceous adenomas (small red nodules over nose and cheeks like acne)
shagreen patch (rough papule in L/S region with orange peel consistency)
Ash-leaf hypopigmented lesions (trunk and extremities)

Front 133

Retinal lesions in tuberous sclerosis

Back 133

mulberry tumors (arise from nerve head)
phakomas (round, flat, grey lesions near disc)

Front 134

Tests and findings in Tuberous sclerosis

Back 134

calcified tubers in periventricular area (rarely transform into malignant asyrocytomas)
Skin lesions with Wood's lamp
ECG for rhabdomyoma (apex of LV in 50% pts)
Renal U/S - renal hamartomas, PcKD
Pulmonary - angiomyolipomas (cause generalized cystic or fibrous changes)

Front 135

Thiamine deficiency

Back 135

Wernicke's encephalopathy
Korsakoff's dementia

Front 136

Wernicke's encephalopathy

Back 136

triad = encephalopathy, ophthalmoplegia (LR palsy,nystagmus, conjugate gaze palsy), ataxia (polyneuropathy, CB and ventricular dysfunction)

Front 137

Korsakoff's dementia

Back 137

Wernicke's (encephalopathy, ophthalmoplegia, ataxia) + amnesia, horizontal nystagmus

Front 138

Way to elicit Wernicke's encephalopathy

Back 138

Large dose glucose administration

Front 139

Cyanocobalamin deficiency

Back 139

= B12 deficiency
Combined system disease or subacute combined degeneration

Front 140

Cyanocobalamin deficiency S/S

Back 140

gradual, progressive onset
symm. P/N
leg stiffness
spasticity
paraplegia
bowel/bladder dysfunction
Dementia

Front 141

Folate deficiency

Back 141

irritability
memory loss
personality changes without CSD of B12

Front 142

Seizure causes in infants

Back 142

perinatal injury
infection
metabolic
congential

Front 143

Childhood (2-10y/o) causes of seizures

Back 143

idiopathic
infection
trauma
fever

Front 144

Adolescent causes of seizures

Back 144

idiopathic
trauma
drug withdrawl
AVM

Front 145

Young adult (18-35y/o) causes of seizures

Back 145

trauma
alcoholism
brain tumor

Front 146

Adult (>35y/o) causes of seizures

Back 146

trauma
stroke
metabolic disorder
alcoholism
brain tumor

Front 147

Lab finding in epileptic seizure

Back 147

elevated prolactin

Front 148

Simple partial seizures

Back 148

motor, sensory, autonomic, or psychic features without LOC
+/- post-ictal focal neuro
deficit resolves 1-2 days
Can evole into generalized
DDx from acute CVA with MRI

Front 149

Complex partial seizures

Back 149

temporal lobe (70-80%)
char by:
impaired LOC
auditory/visual hallucinations
deja vu
automatisms
post-ictal confusion/disorientation, amnesia
Symp can mimic schizophrenia/acute psychosis
Can evolve into generalized

Front 150

Normal EEG in seizure

Back 150

Does NOT r/o epileptic sz disorder

Front 151

First line anti-convulsant in children

Back 151

phenobarbital

Front 152

1st line treatment of idiopathic generalized seizures

Back 152

Valproic acid
Adjuncts - lamotrigine, topiramate

Front 153

treatment of secondary tonic-clonic seizures

Back 153

Same as partial seizures

Front 154

Absence seizures EEG finding

Back 154

3/sec spike-and-wave discharges (classic)

Front 155

Absence seizures treatment

Back 155

ethosuximide - 1st line
Valproic acid, zonisamide

Front 156

West syndrome

Back 156

Infantile spasms
Abnormal interictal EEG (v. high amplitude slow waves)
Arrest of psychomotor devt at age of sz onset

Front 157

West syndrome S/S

Back 157

begins 3-12m
sz - tonic, b/l, symm in clusters of 5-10 individual spasms - occur when drowsy or on awakening
MR in most pts

Front 158

West syndrome Rx

Back 158

ACTH
prednisone
anti-epileptics (clonazepam, valproic acid)

Front 159

Status epilepticus definition

Back 159

prolonged (>30min) or repetitive sz without a return to baseline
20% mortality

Front 160

Status epilepticus causes

Back 160

anticonvulsant withdrawl/non-comliance
anoxic brain injury
EtOH/sedative withdrawl
drug intoxication
metabolic - hyponatremia
trauma
infections

Front 161

Treatment of Status epilepticus

Back 161

ABC's
IV benzo + phenytoin loading dose
If sz continue - intubate + phenobarbital loading dose
glucose, thiamine, naloxone

Front 162

Risk factors for CVA

Back 162

non-modifiable - male, age, genetics, race (African-American, Hispanic, Asian)
Modifiable - HTN, DM, obesity, smoking, hypercholesterolemia, carotid stenosis, heavy EtOH, cocaine, IVDU, AFib

Front 163

CVA most common etiology

Back 163

athlerosclerosis of extracranial vessels (internal and common carotids, basilar, vertebral)

Front 164

Underlying causes of lacunar infarcts

Back 164

athlerosclerosis
HTN
DM

Front 165

cardiac causes of CVA

Back 165

Afib (risk increased 5-6x)
emboli - mural thrombi, diseased/prosthetic valves, paradoxic (venous) in R-to-L shunt (ASD, PFO)

Front 166

MCA stroke S/S

Back 166

aphasia (dominant hemisphere)
neglect (non-dominant)
contralat. hemiparesis, gaze preference, homonymous hemianopsia

Front 167

ACA stroke S/S

Back 167

leg paresis
amnesia
personality changes
foot drop
gait changes
cognitive changes

Front 168

PCA stroke S/S

Back 168

homonymous hemianopsia
memory deficits
dyslexia/alexia

Front 169

Basilar stroke S/S

Back 169

coma
CN palsies
apnea
visual symp
drop attacks
dysphagia

Front 170

lacunar stroke S/S

Back 170

pure motor or sensory
dysrthria-clumsy hand syndrome
ataxic hemiparesis

Front 171

tPA contraindications

Back 171

SBP >185 or DBP >110 despite aggressive antihypertensive Rx
prior ICH
CVA/head trauma in past 3m
recent MI
current anticoagulant Rx with INR >1.7
heparin in last 48hrs with increased PTT
platlets <100000
major Sx in last 14d
GI/GU bleed in past 21d
sz present at CVA onset
glucose <50/>400mg/dL
age <18

Front 172

5 A's of Guillain-Barre

Back 172

Acute inflammatory demyelinating polyradiculopathy
Ascending paralysis
Autonomic neuropathies
Arrhythmias
Albuminocytologic dissociation

Front 173

Findings in Guillain-Barre

Back 173

EMG/nerve conduction studies - diffuse demyelination
CSF - protein >55mg/dL with little/no pleocytosis

Front 174

Myasthenia gravis antibodies

Back 174

postsynaptic ACh receptor Ab (85-90%)
antistriational Ab (85% of pts with thymoma)

Front 175

Labert-Eaton Syndrome antibodies

Back 175

autoantibodies to presynaptic Ca channels

Front 176

Myasthenia Gravis assoicated disorders

Back 176

thymoma
thyrotoxicosis
autoimmune - SLE, RA

Front 177

Myasthenia Gravis S/S

Back 177

fatiguable ptosis/diplopia
dysphagia
proximal muscle weakness
symp worsen throughout day

Front 178

"Myasthenic crisis"

Back 178

respiratory compromise and aspiration (rare)

Front 179

Drug induced myasthenic syndrome cause

Back 179

aminoglycosides

Front 180

Myasthenia Gravis findings

Back 180

edrophonium - dramatic improvement (diagnostic)
Abnormal single fiber EMG +/or decremental response to repetitive nerve stim
ACh Ab (85-90%)
Antistriational Ab (85% of pts with thymoma)

Front 181

Treatment of MG

Back 181

anticholinesterases - neostigmine, pyridostigmine
immunosuppressants - prednisone
Resection of thymoma - can be curative

Front 182

ALS pathogenesis

Back 182

loss of motor neurons in spinal cord, brain stem, and motor cortex

Front 183

ALS S/S

Back 183

asymmetric, slowly progressive weakness of arms, legs, CNs
UMN and LMN signs

Front 184

Diagnostic findings in ALSq

Back 184

Combination of U and LMN signs in >= 3 extremities

Front 185

Findings in ALS

Back 185

EMG/NCS - widespread denervation and fibrillation potentials

Front 186

treatment in ALS

Back 186

supportive
aggressive pulmonary toilet
Riluzole - reduces presynaptic glutamate release, may slow progression

Front 187

Risk factors for carpal tunnel syndrome

Back 187

repetitive use injury
pregnancy
DM
hypothyroid
acromegaly
RA
obesity

Front 188

MS possible pathogenesis

Back 188

T cell mediated autoimmune progression

Front 189

MS classic triad

Back 189

scanning speech
intranuclear ophthalmoplegia
nystagmus

Front 190

Most common presenting complaints in MS

Back 190

limb weakness
optic neuritis
P/N
diplopia
urinary retention
vertigo

Front 191

Exacerbating factors in MS

Back 191

infection
heat
trauma
vigorous activity
(decreasing - pregnancy)

Front 192

MRI findings in MS

Back 192

multiple, asymmetric, often periventricular white matter lesions
Corpus callosum lesions ~pathognomonic
Active lesions enhance with gadolinium

Front 193

CSF findings in MS

Back 193

mononuclear pleocytosis (>5cells/microL) 25%
elevated IgG - 80%
oligoclonal bands (non-specific) albuminocytologic dissociation

Front 194

Treatment for MS

Back 194

Steroids - acute exacerbations
Immunomodulators - ABC
Avonex/Rebif (interferon-β-1a)
Betaseron (interferon-β-1b)
Copaxone (copolymer-1)
Symtomatic Rx for spasticity, pain, fatigue, depression

Front 195

Closed angle glaucoma epidemiology

Back 195

elderly
Asians

Front 196

Causes of closed angle glaucoma

Back 196

acute closure of narrow anterior chamber angle ==>
pupillary dilatation - prolonged time in dark, stress, meds
ant. uveitis
dislocation of lens

Front 197

Closed angle glaucoma S/S

Back 197

extreme pain and blurred vision, ~always u/l
eye hard and red
pupil dilated, non-reactive to light
N/V
increased IOP

Front 198

Treatment of Closed angle glaucoma

Back 198

lower intraocular pressure - acetazolamide
pilocarpine once pressure drops
laser iridotomy - curative

Front 199

open angle glaucoma risk factors

Back 199

>40 y/o
FHx
African-American
DM
myopia

Front 200

Open angle glaucoma pathogenesis

Back 200

intraocular pressure increase d/t diseased trabecular meshwork that obstructs proper drainage of eye ==> gradual pressure increase causing progressive visual loss

Front 201

Open angle glaucoma S/S

Back 201

frequent lens changes in pts >35y/o
mild h/a
visual disturbances
impaired adaption to darkness
visual loss begins peripherally

Front 202

Fundoscopic findings in open angle glaucoma

Back 202

cupping of optic disc

Front 203

Treatment of open angle glaucoma

Back 203

preventative - >40y/o see ophthalmologist q3-5yrs (annual if increased RFs)
topical α-blockers - timolol, betaxolol (decrease aqu. humor producation)
pilocarpine (increases aqu. outflow)
carbonic anhydrase inhibitors if eye drops insufficient control of IOP
laser trabeculoplasty

Front 204

Macular degeneration risk factors

Back 204

Caucasian
female
smokers
FHx

Front 205

Macular degeneration types

Back 205

atrophic - gradual visual loss
exudative - more rapid and severe visual loss

Front 206

macular degeneration S/S

Back 206

painless loss of central vision

Front 207

macular degeneration fundoscopy findings

Back 207

pigmentary or hemorrhagic disturbances of macular region

Front 208

treatment of macular degeneration

Back 208

limited
laser photocoagulation may delay loss of central vision in exudative type

Front 209

CRAO S/S

Back 209

sudden, painlesss, u/l blindness
pupil accomodates
sluggish pupil reaction to direct light

Front 210

CRAO fundoscopy findings

Back 210

cherry-red spot on fovea
arteries +/- bloodless appearance
+/- retinal swelling

Front 211

CRVO S/S

Back 211

rapid painless vision loss
elderly pts

Front 212

fundoscopy findings of CRVO

Back 212

retinal hemorrhages
cotton-wool spots
edema of fundus

Front 213

sequelae of CRVO

Back 213

macular degeneration
glaucoma

Front 214

Treatment of CRAO

Back 214

thrombolysis of ophthalmic artery within 8hrs of symp onset
IV acetazolamide -decrease IOP - increase drainage of aqu. humor

Front 215

sequelae of CRAO

Back 215

untreated - retinal infarction, permanent blindness

Front 216

Treatment of CRVO

Back 216

laser photocoagulation - variable results

Front 217

Estrogen functions (8)

Back 217

follicle growth
endometrial proliferation
myometrial excitability
hepatic synthesis of transport proteins
feedback inhibition of FSH
LH surge
smooth muscle relaxation

Front 218

Progesterone functions (5)

Back 218

endometrial gland secretions
spiral artery development
decreased myometrial excitability
increased body temperature
inhibition of LH, FSH

Front 219

hCG functions (2)

Back 219

maintians corpus luteum for T1 by acting like LH
detect pregnancy (in urine at 8 days)

Front 220

physiologic changes in pregnancy - CVS (4)

Back 220

increased CO (30-50%), HR (10-15bpm), SV
possible S3, syst. murmurs (Normal) (new diast. murmur never normal!)
decreased SVR
decreased BP T1, normalizes by 40 weeks
cardiomeagly on CXR d/t heart displacement upwards

Front 221

physiologic changes in pregnancy - cervix (2)

Back 221

softening and cyanosis ~4wks
bloody show = thick mucus clot

Front 222

physiologic changes in pregnancy - endocrine (3)

Back 222

high estrogen => ↑TBG, bound T3, T4, unchanged active unbound hormone
HPL - acts as insulin antagonist to maintain fetal glucose => prolonged post-prandial hyperglycemia, fasting hyperinsulinemia, triglyceridemia, exaggerated starvation ketone response
↑total and free cortisol

Front 223

physiologic changes in pregnancy - GI (4)

Back 223

N/V (<=70%) resolves by 14-16wks
↑acid reflux d/t ↓LES tone
constipation d/t ↓bowel motility,↑H2O absorption
↑biliary cholesterol

Front 224

physiologic changes in pregnancy - hematologic

Back 224

↑plasma V (50%), RBC mass (30%)=> ↓Hb, hct = 'physiologic anemia'
WBC count ↑s throughout X=10
pregnancy = hypercoagulable state

Front 225

physiologic changes in pregnancy - pulmonary

Back 225

↑tidal V (40%)
↓TLC, RV,ERV
RR same
↑minute vent. => ↑Pa/PAO2, ↓Pa/PACO2 = 'dyspnea of pregnancy'

Front 226

physiologic changes in pregnancy - Renal

Back 226

kidneys dilate
↑GFR (50%)
↑RPF (30%)
↑estrogen/progesterone => ↑RAAS = ↑aldosterone

Front 227

physiologic changes in pregnancy - skin

Back 227

↑estrogen - stigmata like liver disease
↑αMSH, steroids => hyperpigmentation - midline (linea nigra), face (chloasma), perineum

Front 228

physiologic changes in pregnancy - vagina

Back 228

thick acidic secretions
Chadwick's sign = violet colouration from ↑blood flow

Front 229

Nagle's rule = EDD

Back 229

add 9m + 7d to 1st day of LMP

Front 230

Ways to determine GA

Back 230

uterine size
quickening (17-18wks)
fetal heart tones (10wks)
U/S fetal crown-rump length (5-12wks) biparietal diameter (20-30wks)

Front 231

Labs at initial visit for pregnancy

Back 231

CBC, UA + culture, Pap, blood type, Rh + Ab screen, rubella Ab titer, HBsAg, syphilis screen, cervical gonoccocal & chlamydia
PPD
glucose teting
HIV

Front 232

Labs at 15-19wks GA

Back 232

MSAFP or triple screen (=MSAFP, estiol, β-hCG)
amnio if >35y/o

Front 233

Labs at 26-28wks GA

Back 233

glucose loading test
give Rhogam at 28 wks if mom Rh-ve

Front 234

Labs at 32-36wks GA

Back 234

cerval chlamydia + gonorrhea in high risk
GBS screen

Front 235

causes of ↑MSAFP (MoM >2.5)

Back 235

1. open NTD - anencephaly, SB
2. abdominal wall defects - gastroschisis, omphalocele
3. multiple gestation
4. incorrect dates
5. fetal death
6. placental abnormalities - abruption

Front 236

causes of ↓MSAFP (MoM<0.5)

Back 236

need amnio and karyotyping to r/o chromosomal abnormalities
- trisomy 18, 21

Front 237

pattern of triple screen with Down's

Back 237

↓AFP, estriol
↑hCG

Front 238

pattern of triple screen with trisomy 18

Back 238

↓AFP, estriol, hCG

Front 239

Compare complications of amnio with CVS

Back 239

amnio (15-17wks)
fetal maternal hemorrhage 1-2%
fetal loss 0.5%
CVS (10-12wks)
fetal loss 1%
inability to Dx NTD
limb defects if <9wks GA

Front 240

Indications for percutaneous umbilical blood sampling

Back 240

Ax/Rx Rh isoimmunization/erythroblastosis fetalis
karyotyping
fetal infection (CMV, toxo, rubella)
genetic dz
fetal acid-base status

Front 241

Normal labour and deliver stages

Back 241

first
latent - onset to 3-4cm
active - 4cm to 10cm (1.2cm/h primi, 1.5cm/h
multip)increased with CPD
2nd - complete dilatation to delivery
34d - delivery of infant to placenta

Front 242

Factors affecting active phase of labour

Back 242

3P's
power
passenger
pelvis

Front 243

Normal NST

Back 243

FHR monitored by doppler correlated with reported mvts by mom
- acceleration ≥15bpm above baseline for ≥15sec twice in 20min

Front 244

positive contraction stress test

Back 244

repetitive late decels during ≥3 contractions in 10min

Front 245

Biophysical profile

Back 245

"Test the Baby MAN" - give score of 0 or 2 for each
Tone
Breathing
Movement
Amniotic fluid volume
NST
"+ve test" = score 0-2

Front 246

Early decelerations

Back 246

begin and end with contraction
caused by cephalic compression (no fetal distress)

Front 247

Variable decelerations

Back 247

at any time during contraction
Caused by:
umbilical cord compression (change maternal position)

Front 248

Late decelerations

Back 248

begin at peak of contraction and end after contraction has finished
- uteroplacental insufficiency
- fetal hypoxemia
- potentially d/t abruption or hypotension
- if repetitive and severe deliver ASAP

Front 249

Hyperemesis Gravidarum

Back 249

intractable N/V after 14-16wks
poor wt gain/wt loss
more common in G1P0, molar pregnancies
labs - ketonemia, ketonuria, hyponatremia, hypokalemic-hypochloremic m.a.

Front 250

Diagnosis of GDM

Back 250

fasting serum glucose >126mg/dL
random >200mg/dL
abnormal GTT
1hr (50g) >140gm/dL
3hr (75g)with any 2 of -
fasting ≥95,
1h ≥180
2h ≥155
3h ≥140

Front 251

Pregestational DM is associated with?

Back 251

↑risk congenital malformations and maternal/fetal morbidity during labour and delivery

Front 252

Pregnancy induced HTN definition

Back 252

HTN with proteinuria <300mg/dL

Front 253

maternal complications of pregestational DM (8)

Back 253

DKA or HHNK
pre/eclampsia
CPD
Preterm labour
infection
polyhydramnios
PPH
maternal mortality

Front 254

fetal complications of pregestational DM (11)

Back 254

macrosomia
cardiac and renal defects
hypoglycemia from hyperinsulinemia
hypocalcemia
RDS
polycythemia
hyperbilirubinemia
NTD (sacral agenesis)
IUGR
birth injury (sh. dystocia)
perinatal mortality

Front 255

Preeclampsia

Back 255

new-onset HTN
proteinuria
non-dependent edema
>20wks

Front 256

Risk factors for pre/eclampsia

Back 256

nulliparity
black race
extremes of age
multiple gestation
molar pregnancy
renal dz (SLE, DM1)
FHx
chronic HTN

Front 257

Explanation for pre/eclampsia

Back 257

vasospasm causing hemorrhage and organ necrosis

Front 258

Mild preeclampsia S/S

Back 258

BP>140/90 2x 6hrs apart
rapid wt gain
nondependent edema
proteinuria 1-2+, >300mg/24h

Front 259

Severe preeclampsia S/S

Back 259

BP>160/110 2x 6hrs apart
proteinuria >5g/24h 3-4+
cerebral changes - h/a, somnolence
visual changes - blurred, scotoma
hyperactive reflexes, clonus
oliguria (<500ml/24h)
HELLP
oligohydramnios, IUGR
pulmonary edema, cyanosis
RUQ/epigastric pain

Front 260

Severe pre-eclampsia Rx

Back 260

deliver (C/S or induce) ASAP
BP <160/100 - diast 90-100
- IV hydralazine, +/or labetalol
prevent seizures - MgSO4

Front 261

Mg Toxicity S/S, Rx

Back 261

Loss of DTRs
respiratory paralysis
coma
Rx - IV Ca gluconate

Front 262

Complications of preeclampsia

Back 262

prematurity
fetal distress
stillbirth
placental abruption
sz
DIC
ICH
serous retinal detachment
fetal/maternal death

Front 263

Complications of eclampsia

Back 263

ICH
aspiration pneumonia
hypoxic encephalopathy
thromboembolic events
maternal/fetal death

Front 264

Teratogenic effects of - EtOH

Back 264

microcephaly
midfacial hypoplasia
MR
IUGR
cardiac defects

Front 265

Teratogenic effects of - cocaine

Back 265

bowel atresias
IUGR
microcephaly

Front 266

Teratogenic effects of - streptomycin

Back 266

CN VIII damage
ototoxicity

Front 267

Teratogenic effects of - tetracycline

Back 267

teeth discolouration
inhibition of bone growth
small limbs
syndactyly

Front 268

Teratogenic effects of - sulfonamides

Back 268

kernicterus

Front 269

Teratogenic effects of - quinolones

Back 269

cartilage damage

Front 270

Teratogenic effects of - isotretinoin

Back 270

heart and great vessel defects
craniofacial dysmorphisms
deafness

Front 271

Teratogenic effects of - coumadin

Back 271

stippling of epiphyses
IUGR
nasal hypoplasia
MR

Front 272

Teratogenic effects of - ACEI

Back 272

oligohydramnios
fetal renal damage

Front 273

Teratogenic effects of - lithium

Back 273

Ebstein's abnormality (abnormal attachments of tricuspid valve leaflets to annulus of TV)
other cardiac dz

Front 274

Teratogenic effects of - carbamazepine

Back 274

fingernail hypoplasia
IUGR
microcephaly
NTD

Front 275

Teratogenic effects of - phenytoin

Back 275

nail hypoplasia
IUGR
MR
craniofascial dysmorphism
microcephaly

Front 276

Teratogenic effects of - valproic acid

Back 276

NTD
cariofacial and skeletal defects

Front 277

Symmetric IUGR

Back 277

symm - 20%
all U/S parameters ↓
occurs early
caused by fetal problem
- cytogenetic
- infection
- anomalies

Front 278

Asymmetric IUGR

Back 278

80%
↓abdominal circumference, all other U/S parameters N
Late
Placenta mediated
- HTN
- poor nutrition
- maternal smoking

Front 279

Oligohydramnios

Back 279

AFI <5 on U/S
40x ↑perinatal mortality without ROM
Causes
- fetal urinary tract abnormalities (renal agenesis, PcKD, GU obstruction)
- chronic uteroplacental insufficiency (SGA fetuses)
- ROM

Front 280

Complications of oligohydramnios

Back 280

msk abnormalities
- club foot
- facial distortion
pulmonary hypoplasia
fetal hypoxia d/t cord compression
IUGR

Front 281

Polyhydramnios

Back 281

AFI >20 on U/S
usually asymp vs fundal ht >expected
Causes
maternal DM
multiple gestation
isoimmunization
pulmonary abnormalities (cystic lung malformation)
fetal anomalies (duodenal atresia, TEF, anencephaly)
twin-twin transfusion synd

Front 282

Complications of polyhydramnios

Back 282

preterm labour
fetal malpresentation
cord prolapse

Front 283

When to give Rhogam

Back 283

mom is Rh -ve at 28wks
father is Rh +ve
father's Rh status unknown
postpartum if baby Rh+ve

Front 284

Complications of Rhesus isoimmunization

Back 284

hydrops fetalis
fetal hypoxia and acidosis
kernicterus
prematurity
fetal death

Front 285

hydrops fetalis

Back 285

when Hb <7g/dL
↓protein and oncotic pressure
edema
jaundice
high output cardiac failure

Front 286

hydatiform mole - complete

Back 286

46XX
paternally derived (sperm fertilization of empty ovum)

Front 287

hydatiform mole - partial

Back 287

N ovum fertalized by 2 sperm or by haploid sperm that duplicated own chromosome
69XXY
contains fetal tissue

Front 288

Risk factors for GTD

Back 288

extremes of age
diet deficiency - folate, β-carotene
blood group - type A♀ by type O♂

Front 289

Molar pregnancy S/S

Back 289

uterine bleeding (most common)
hyperemesis gravidarum
pre/eclampsia <24wks (preeclampis in T1 is pathognomonic for hydatiform mole)
uterine size >dates
hyperthyroidims
no FHR
enlarged ovaries with b/l theca-lutein cysts
expulsion of grape-like molar clusters into vagina

Front 290

findings of complete hydatiform mole

Back 290

"snow-storm appearance" on U/S
↑↑↑ βhCG (>100000mIU/ml)
no gestational sac/fetus
CXR - +/- lung mets

Front 291

T3 bleeding - most common causes

Back 291

placental abruption
placenta previa

Other causes:
bloody show
ruptured vasa previa
early labour
ruptured uterus
marginal placental separation
genial tract lesions/trauma
placenta accreta

Front 292

Rx of hydatiform mole

Back 292

D&C - "cluster of grapes" tissue
close f/u βhCG
prevent pregnancy x 1yr
malignant - MTX or dactinomycin
residual uterine dz - hysterectomy
chemo/XRT - mets

Front 293

Placental abruption

Back 293

premature separation of normally implanted placenta
1/100

Front 294

Risk factors for placental abruption

Back 294

HRN
trauma
tobacco/cocaine
PHx
rapid decompression of overdistended uterus

Front 295

Symptoms of placental abruption

Back 295

Painful
dark vaginal bleeding that does not stop spontaneously
uternine hypertonicity
fetal distress

Front 296

Dx of placental abruption

Back 296

clinical
U/S 50% sensitivity - look for retroplacental clot
use to r/o previa

Front 297

Complications of abruption

Back 297

hemorrhagic shock
DIC (10%)
recurrence - 5-16%
fetal hypoxia

Front 298

Placenta previa

Back 298

abnormal placental implantation
total - covers os
marginal - extends to margin of os
low-lying - close to os
1/200

Front 299

Risk factors for placenta previa

Back 299

prior C/S
grand multip
advanced maternal age
multiple gestation
PHx

Front 300

Placenta previa S/S

Back 300

painless
bright red bleeding, often stops 1-2hrs +/- contractions
first bleed 29-30wks
no fetal distress

Front 301

Dx placental previa

Back 301

U/S - sensitivity >95%

Front 302

Rx placenta previa

Back 302

No vaginal exams!
tocolytics
Serial U/S
Ax FLM
C/S

Front 303

Complications of placenta previa

Back 303

increased risk of accreta
vasa previa
preterm delivery
PROM
IUGR
congenital anomalies
recurrence 4-8%

Front 304

Primary biliary cirrhosis S/S

Back 304

pruritis
jaundice
heptosplenomegaly
increased ALP, bilirubin, cholesterol
+ve antimitochondrial Ab
xanthalasma

Front 305

Chalazion

Back 305

inflammatory lesion of meibonian tear glands
seen in rosacea, blepharitis

Front 306

hordeolum

Back 306

purulent inflammation of eyelid
usually d/t Staph

Front 307

Serious side-effects of PTU and Rx

Back 307

agranulocytosis
Stop immediately if develops sore throat or fever

Front 308

neonatal gonoccocal conjunctivitis

Back 308

copious purulent eye discharge
swollen eyelids
chemosis
2-3d after birth d/t exposure to genital secretions

Front 309

neonatal chlamydia conjunctivitis

Back 309

scant mucoid discharge (not as purulent as gonococcal)
mild hyperemia
5-14d after birth d/t genital tract exposure

Front 310

risk factors for colonic polyp to become malignant

Back 310

villous adenoma
sessile adenoma
>2.5cm

Front 311

Acute bacterial prostatitis organisms

Back 311

young pts - chlamydia, gonorrhea
elderly - E. coli (most common), G-ve rods
Prostatic manipulations can cause septicemia (contraindicated)
Need urine sample

Front 312

Empiric anaerobic coverage in neutropenic pts is indicated when...?

Back 312

Any evidence of:
necrotizing mucositis
peridontal abscess
perirectal abscess/cellulitis
typhilitis (=necrotizing neutropenic colitis)
intra-abd/pelvic abscess
anaerobic bacteremia

Front 313

Most common organisms in febrile neutropenia

Back 313

gram negatives esp. P. aeroginosa

Front 314

Antibiotics of choice in febrile neutropenia (on spec)

Back 314

cefipime
ceftazidime

Front 315

Malignant otitis externa S/S, cause

Back 315

severe ear pain
ear discharge
radiates to TMJ
worse with chewing
worsens despite topical Abx
granulation tissue in EAM
Most common - P. aeroginosa
rare - staph, aspergillus

Front 316

Preferred Rx for Absence sz

Back 316

1. ethosuximide
2. valporic acid
3. lamotrigmine, clonazepam

Front 317

Drug of choice for partial seizures

Back 317

phenytoin

Front 318

Splenic sequestration

Back 318

vaso-occlusion and pooling of RBCs in spleen
marked decrease Hb, increased retics
P/E - rapidly enlarging spleen +/- hypotensive shock
10-15% mortality
50% recurrence
Rx - splenectomy

Front 319

acute chest syndrome in SCA

Back 319

chest pain
fever
new infiltrate on CXR

Front 320

aplastic crisis in SCA

Back 320

transient arrest of erythropoesis usually d/t infection
parvovirus B19 most common cause

Front 321

recommendations for pneumococcal vaccine

Back 321

1. >65y/o
2. chronic dz - CVS, renal, lung, liver
3. immunosuppressed/DM
4. chronic EtOH, institutionalized

Front 322

Criteria for home O2

Back 322

1. All COPD pts with PaO2 <55mmHg or SaO2 <88% on r/a
2. cor pulmonale, PHTN, Hct>55% when PaO2 <60mmHg
3. exercise or nocturnal hypoxia

Front 323

hereditary spherocytosis

Back 323

AD
chronic extravascular hemolysis (spleen only)
spectrin deficiency (RBC membrane intrinsic defect)
indirect hyperbilirubinemia
increased osmotic fragility

Front 324

defect in decay accelerating factor

Back 324

paroxysmal nocturnal hemoglobinuria

Front 325

Acute GVHD

Back 325

50% of transplants from matched siblings
S/S
Skin maculopapular rash of palms, soles face +/- generalizes
GI - bloody diarrhea
liver - abnormal LFTs, jaundice

Front 326

Acute GVHD pathophysiology

Back 326

recognition of host major and minor HLA antigens by donor T cells leading to cell-mediated response

Front 327

immunoblastic lymphoma

Back 327

EBV induced lymphocytosis in BMT

Front 328

cholesteatoma definition, symptoms

Back 328

epithelial cyst with desquamated keratin (most commonly infected with P. aeroginosa)
located medial to normal TM
congenital or aquired from OM, eustacian tube defects
present with recurrent infections or progressive conductive hearing loss

Front 329

cholesteatoma presentation

Back 329

Most common - drainage and granulation tissue unresponsive to abx
O/E
marginal TM perforation
pus, mucous, granulation
tissue filled ear canal
destroys bone - can extend into cranium
Rx - Sx

Front 330

Serous otitis media

Back 330

d/t prolonged blockage of eustacian tube
conductive hearing loss
dull TM, hypomobile
air bubbles seen in middle ear

Front 331

Chronic otitis media

Back 331

purulent aural discharge
TM thickened with calcific patches and perforation
no exudation of debris or granulation tissue
Complication - tympanic sclerosis (rare hearing loss)

Front 332

medical treatment of gallstones

Back 332

ursodeoxycholic acid
low fat diet

Front 333

progressive and bilateral loss of central vision with preservation of navigational (peripheral) vision

Back 333

macular degeneration

Front 334

Koplik spots

Back 334

pathognomonic of rubeola (measles)
=bluish white lesions (can appear like table salt crystals) on erythematous buccal mucosa opposite 1st and 2nd upper molars (sometimes conjunctivae and vagina also)

Front 335

fever, non-productive cough, coryza, non-purulent conjunctivitis, Koplik spots

Back 335

prodrome of measles (rubeola)

Front 336

Kawasaki's disease S/S

Back 336

<10y/o
fever >5days
mucous membrane changes (injected pharynx, strawberry tongue, fissure lips)
extremity changes (edema, erythema, desquamation)
>=1cervical LN >1.5cm
polymorphous rash

Front 337

scarlet fever S/S

Back 337

sand-paper like erythematous rash +/- desquamation
strawberry tongue
fever
pharyngitis

Front 338

exanthema subetum, 6th disease, rubeola - what virus?
Important complication

Back 338

HHV6 - high fever in infants for 3-4days
Most common cause infantile seizures

Front 339

rubella S/S

Back 339

mild fever
malaise
post. cervical lymphadenopathy
patchy erythema of throat and palate
3 day rash - fine, pink, maculopapular, rapidly migrates from face to trunk

Front 340

Iron toxicity S/S, Cx, Rx

Back 340

corrosive to GI tract
hemorrhagic gastroenteritis
acidosis
hypotension
Cx - intestinal perforation
Rx - defuroximine IV

Front 341

EDTA

Back 341

lead toxicity

Front 342

CHD risk factor equivalents

Back 342

DM
symptomatic CAD
AAA
peripheral arterial disease
multiple risk factors present that confer 10yrs risk of CHD >20%

Front 343

LDL in CHD or equivalent

Back 343

goal LDL <100
lifestyle change at LDL = 100
statins if LDL>130

Front 344

LDL with 2/more risk factor

Back 344

goal LDL <130
lifestyle change at LDL = 130
statins if LDL>160

Front 345

LDL with 0-1 risk factor

Back 345

goal LDL <160
lifestyle changes at/>160
statins at LDL >190

Front 346

SLE features

Back 346

systemic - fever, fatigue, wt loss
mucocutaneous symp - discoid rash, malar rash, alopecia, oral/nasopharyngeal ulcers, photosensitivity
serositis - pericarditis, pleuritis
renal dz
mesangial
focal proliferative
diffuse proliferative - "wire-loop" pattern from immune-complex deposition and GBM thickening (progressive irreversible)
membranous
Neurologic - psychosis, depression, seizures, neuropathy
Non-erosive arthritis
Hematologic
hemolytic anemia, leuko/lymphopenia, TCP

Front 347

Acute renal crisis

Back 347

Cx of systemic sclerosis
malignant HTN - hypertensive encephalopathy, retinopathy, seizures, LV failure

Front 348

SLE - most common cause of death

Back 348

chronic renal failure

Front 349

effect modification

Back 349

effect of the main exposure on outcome is modified by effect of another variable
e.g. risk of estrogens in dvt of thromboembolic dz is modified by smoking

Front 350

Indications for C/S

Back 350

Maternal
prior classical
active genital herpes
cervical ca
Maternal/Fetal
CPD (most common cause)
placenta previa/abruption
failed operative vaginal delivery
Fetal
Malposition
distress
cord compression
erythroblastosis fetalis

Front 351

Post-Partum Hemorrhage causes

Back 351

uterine atony (most common -90%)
genital tract trauma
retained placental tissue

Front 352

Risk factors for uterine atony

Back 352

uterine overdistension - multiple gestation, macrosomia, polyhydramnios
exhausted myometrium (rapid/prolonged labour, oxytocin stim)
Conditions interfering with contractions (anaesthesia, myomas, MgSO4)

Front 353

Dx of uterine atony

Back 353

palpation of soft, enlarged, "boggy" uterus

Front 354

Rx of uterine atony

Back 354

bimanual uterine massage
Oxytocin infusion
methylergonovine (if no HTN)
prostin (PGF2α) if no asthma

Front 355

Risk factors for genital tract trauma

Back 355

precipitous labour
operative vaginal delivery
large baby
inadequate episiotomy repair

Front 356

Risk factors for retained placental tissue

Back 356

placenta accreta/increta/percreta
placental previa
uterine leiomyomas
preterm delivery
previous C/S, D&C

Front 357

Dx of retained placental tissue

Back 357

manual and visual inspection of placenta and uterine cavity for missing cotyledons
+/- U/S of uterus

Front 358

Rx of retained placental tissue

Back 358

manual removal and curettage with suctioning

Front 359

Post-partum infection

Back 359

"7W's"
Womb (most common)
endometritis
Wind
atelectasis, pneumonia
Walk
DVT, PE
Water
UTI
Wound
episiotomy, incision
Weaning
mastitis, breast engorgement/abscess
Wonder drugs
drug fever
Also:
pelvic abscess
septic pelvic thrombophlebitis (consider these if no improvement with 3drugs in 48hrs)

Front 360

Definition of and risk factors for post-partum infection

Back 360

≥38°C for ≥2d of 1st 10 post-partum days (not including 1st 24h)
RF
C/S especially emergent
PROM
prolonged labour
multiple exams
intrauterine manipulations

Front 361

Management of post-partum infections

Back 361

pelic exam to r/o hematoma, lochial block
U/A & culture
blood cultures
admit, broad spect Abx - clinda + gent

Front 362

Sheehan's syndrome

Back 362

pituitary ischemia and necrosis → ant pituitary insufficiency secondary to massive obstetric hemorrhage and shock
primary cause of ant pituitary insufficiency in adult ♀

Front 363

Sheehan's syndrome S/S

Back 363

failure to lactate - most common (d/t ↓prolactin)
weakness
lethargy
cold insensitivity
genital atrophy
menstrual disorders

Front 364

Lactation physiology

Back 364

↑estrogen/progesteron during pregnancy → breast hypertrophy and inhibit prolactin
↓↓hormones with delivery releases prolactin
suckling releases prolactin and oxytocin → myoepithelial cell contraction and milk ejection (=let down reflex)

Front 365

Colostrum

Back 365

protein, fat, secretory IgA → passive immunity and protects against enteric bacteria

Front 366

Breast milk

Back 366

within 1 week
+++ leukocytes → active immunity
protein, fat, lactose, water

Front 367

Benefits of breast feeding

Back 367

active and passive immunity to baby
decreased incidence allergies
mother-child bonding
maternal wt loss

Front 368

Contraindications to breast feeding

Back 368

HIV
active hepatitis
medications - tetracycline, chloramphenicol, warfarin

Front 369

Mastitis

Back 369

cellulitis of periglandular tissue caused by nipple trauma + introduction of S/ aureus from infants nostrils
~2-4wks post-partum
u/l >> b/l
focal breast tenderness
erythema, edema, warmth
+/- purulent nipple d/c
+ve breast milk culture
↑WBC
fever
Rx - continue BF, po abx (penicillin, dicloxacillin, erythromycin)
I&D for abscess

Front 370

teratogenic effects of phenytoin

Back 370

digital hypoplasia
facial abnormalities

Front 371

sulfonamides should be avoided in the last few weeks of pregnancy because...?

Back 371

They competitively inhibit binding of bilirubin to albumin increasing the risk of neonatal hyperbiliruminemia

Front 372

Nitrofurantoin should be avoided in late pregnancy because...?

Back 372

risk of hemolysis d/t deficiency of erythrocyte phosphate dehydrogenase in newborn.

Front 373

menorrhagia

Back 373

>80ml blood loss/cycle or prolonged bleeding (>8d)
Caused by
leiomyomas
adenomyosis
endometrial hyperplasia/polyps
1° bleeding disorders
pregnancy Cx

Front 374

metrorrhagia

Back 374

bleeding between periods
caused by
endometrial polyps
endometrial/cervical ca
pregnancy Cx
exogenous estrogen

Front 375

menometrorrhagia

Back 375

heavy bleeding during and b/t periods
caused by
endometrial polyps
endometrial/cervical ca
pregnancy Cx
exogenous estrogen

Front 376

polymenorrhea

Back 376

frequent menstruation (<21d cycle)
Caused by:
anovulation

Front 377

oligomenorrhea

Back 377

infrequent menstruation (>35d cycle)
Caused by:
pregnancy (most common)
HPGA disruption
systemic dz

Front 378

hypomenorrhea

Back 378

unusually low menstrual volume and duration, regular frequency
Caused by:
hypogonadotropic hypogonadism (common in athletes/anorexics)
OCP's
Asherman's syndrome (=uterin scarring d/t Sx or infection)
outlet obstruction

Front 379

Dysfunctional uterine bleeding

Back 379

dx of exclusion = abnormal menstrual bleeding when no pathologic cause found
Cause - anovulation (90%)

Front 380

post-menopausal bleeding

Back 380

uterine bleeding >1yr after menopause
Cause:
vaginal atrophy
exogenous hormones
cancer

Front 381

w/u for apparent ovulatory disorder

Back 381

transvaginal U/S
sonohysterogram
D&C (gold standard)

Front 382

w/u for apparent anovulatory disorder

Back 382

βhCG, CBC, coags
endocrine - FSH, LH, TSH, prolactin
endometrial bx in all women with post-menopausal or chronic anovulatory bleeding

Front 383

Rx for anovulatory DUB

Back 383

OCPs or cyclic progestin therapy (=medroxyprogesterone 10mg/d x 10d/m)
If profuse
- high dose IV estrogen
- D&C
- endometrial ablation or hysterectomy (last resort)

Front 384

Rx of ovulatory DUB

Back 384

NSAIDs +/- OCP

Front 385

primary amenorrhea

Back 385

absence of menses and lack of secondary sexual characteristics by age 14
or
absence of menses by age 16 with/without secondary sexual characteristics

Front 386

Secondary amenorrhea

Back 386

absence of menses for 3 cycles or for 6 months with prior normal menses

Front 387

Causes of primary amenorrhea

Back 387

anatomic
Mullerian anomalies
vaginal agenesis
imperforate hymen
testicular feminization
Ovarine/uterine dysfunction
Ovarian failure
gonadal dysgenesis (turner's)
steroidogenic enzyme defects
constitutional devt delay
Central Regulatory disorders
hypothalamic dysfunction (Kallman's syndrome, anorexia, excess exercise, wt loss, stress, tumor, infection)
1° pituitary dysfunction (rare)

Front 388

Causes of secondary amenorrhea

Back 388

Anatomic
Asherman's syndrome
cervical stenosis (scarring of os)
Ovarian/uterine dysfunction
ovarian failure
pregnancy
PCOS
Central regulatory disorders
hypothalamic dysfunction (anorexia, exercise, wt loss, stress)
pituitary dysfunction (Sheehan's, panhypopituitism)
hyperprolactinemia

Front 389

Evaluation of secondary amenorrhea

Back 389

βhCG
serum prolactin
TSH
as indicated
- progestin challenge (if serum prolactin normal)
- serum FSH, estradiol
- CT/MRI

Front 390

Elevated prolactin effects

Back 390

inhibits FSH, LH release

Front 391

positive progestin challenge test

Back 391

= withdrawl bleeding after 5d of progesterone
means estrogen is present, outflow tract patent
Therefore anovulatory problem

Front 392

Causes of anovulation

Back 392

hypothalamic dysfunction
PCOS
cushing's syndrome
ovarian/adrenal tumor

Front 393

estrogen-progesteron challenge

Back 393

+ve = bleeding
suggests functional uterus without adequate estrogen stimulation
Causes - problem with follicular or HPA
-ve = asherman's syndrome

Front 394

Fibrocystic change

Back 394

cystic change, nodularity, stomal proliferation, epithelial hyperplasia
Cause
exaggerated stromal response to hormones and growth factors
Seen in ≤50% of postmenopausal women

Front 395

Fibrocystic change S/S

Back 395

cyclic (often premenstrual)
b/l breast pain
tenderness, swelling

Front 396

Dx and Rx of fibrocystic change

Back 396

FNA
↓caffeine, nicotine
Vit. E supplements
hormonal therapy - danazol, progestins, tamoxifen
diuretics for premenstrual mastalgia

Front 397

increased breast cancer risk with fibrocystic change if...?

Back 397

cellular atypia on FNA

Front 398

Fibroadenoma

Back 398

benign, slow growing tumor with epithelial and stromal components
most common lesion in <30y/o

Front 399

Dx and Rx of fibroadenoma

Back 399

round, firm, discrete, nontender, mobile, solitary mass
Rx - Sx excision
recurrence common

Front 400

phyllodes tumor

Back 400

rapidly growing, often large type of fibroadenoma
rarely malignant = cystosarcoma phyllodes

Front 401

Risk factors for breast ca

Back 401

female
older
FHx (1°)
PHx
fibrocystic change with cellular atypia
nulliparity
early menarche
late menopause
1st full term pregnancy >35y/o

Front 402

Breast cancer S/S

Back 402

hard, irregular, immobile, painless breast lump
+/- nipple discharge
skin changes, axillary adenopathy suggest advanced disease

Front 403

breast cancer common site and metastases

Back 403

upper outer quadrant
LN, bones, brain, lung, liver

Front 404

Evaluation of breast cancer

Back 404

palpable mass
mammogram with microcalcifications, hyperdense regions
U/S
FNA if cystic - if cyst doesn't resolve, bloody aspirate or recurs → excise
Bx - direct needle core, stereotactic, open surgical
ER/PR receptors/herzneu amplification

Front 405

Inflammatory breast cancer

Back 405

highly aggressive, rapid growth
invades lymphatics
causes skin inflammation

Front 406

Paget's disease of breast

Back 406

DCIS of nipple
itching, burning
nipple erosion (can be mistaken for infection)
associated with focus of invasive carcinoma

Front 407

bilateral breast cancer

Back 407

more common in young women and lobular type

Front 408

Rx of breast LCIS

Back 408

↑risk invasive in both breasts therefore → close f/u or b/l mastectomy (in high risk)

Front 409

Rx of breast DCIS

Back 409

depends on size
small tumors - local excision + close f/u
larger tumors - wide local excision + XRT or simple mastectomy (no node dissection necessary)

Front 410

Invasive breast cancer

Back 410

ductal more common
staging - size, nodes, mets → bone scan, CBC, Ca, CXR
Localized dz → lumpectomy + axillary node dissection + XRT or modified radical mastectomy
chemo for all premenopausal ♀ with +ve nodes
chemo in postmenopausal ♀ with +ve nodes and -ve hormone receptors

Front 411

Rx for breast cancer with +ve estrogen receptors

Back 411

hormone therapy (tamoxifen)
mets/recurrence with chemo

Front 412

Rx option for herzneu amplification and metastatic dz

Back 412

Herceptin

Front 413

primary dysmenorrhea

Back 413

no obvious organic cause
occurs (usually <20y/o)
may be d/t ++ PGs, leukotrienes, or ψ factors

Front 414

Rx for primary dysmenorrhea

Back 414

NSAIDs
OCP

Front 415

dysmenorrhea

Back 415

marked pain with periods that requires medication and prevents normal activity

Front 416

Secondary dysmenorrhea

Back 416

associated with specific pelvic pathology:
endometriosis (most common)
adenomyosis (=endometrial glands and stoma in myometrium)
myomas
pelvic congestion
PID
ovarian cysts
cervical stenosis
pelvic adhesions

Front 417

Endometriosis

Back 417

endometrial glands and stroma outside the uterus
common sites:
ovaries, cul de sac, uterosacral ligaments
proposed etiologies
endometrial cell implantation via retrograde menstruation
vascular and lymphatic dissemination of endometrial cells
metaplasia in peritoneal cavity
typically in ♀ of reproductive age

Front 418

Risk factors of endometriosis

Back 418

FHx
nulliparity
infertility

Front 419

endometriosis S/S

Back 419

premenstrual pain that resolves at onset of menses
dyschezia
chronic pelvic pain
dysparenuria
abnormal bleeding
infertility
tender nodularity along uterosacral ligament
fixed, retroverted uterus
tender, fixed adnexal masses

Front 420

Evaluation of endometriosis

Back 420

definitive dx by direct visualization laroscopy/laparotomy
rust-coloured to dark brown "powder burns" or raised blue "raspberry lesions"
in severe dz implants surrounded by extensive adhesions
ovarian endometriomas ("chocolate cysts" = cystic collections of thick, dark, old blood)
pain severity ≠ extent of dz

Front 421

Rx of endometriosis

Back 421

medical - OCP, progestin (to suppress ovulation/menses)
- danazol/GnRH agonists (to suppress estrogen production)
Sx
laporoscopic ablation
TAH-BSO with lysis of adhesions for severe, recurrent dz

Front 422

Ectopic pregnancy locations and risk factors

Back 422

locations
ampulla of oviduct 95%
RF
Hx of PID (most common)
prior ectopic
tubal/pelvic Sx
DES exposure in utero
IUD
incidence ~1/100

Front 423

Ectopic pregnancy S/S

Back 423

classic triad
1. amenorrhea
2. light vaginal bleeding
3. lower abd/pelvic pain
tender palpable pelvic/adnexal mass

Front 424

ruptured ectopic S/S

Back 424

sudden, sharp abd pain with
- orthostatic hypotension
- ↑HR
- generalized abd & adnexal tenderness with rebound
- shoulder pain
- shock

Front 425

DDx of ectopic pregnancy

Back 425

spontaneous abortion
ruptured corpus luteum cyst
PID
adnexal torsion
appendicitis
pyelo
pancreatitis
diverticulitis
regional ileitis
UC

Front 426

Evaluation of ectopic pregnancy

Back 426

βhCG quantity(levels <expected) and doubling time (>expected)
serum progestrone <<< normal (<15ng/ml) - nonspecific
U/S
-transabdominal if βhCG ≥5000mIU/ml
- transvaginal if ≥1500
↑βhCG without intrauterine pregnancy on U/S highly suspicious
definitive dx - lap or U/S visualization

Front 427

Rx of ectopic

Back 427

follow closely with serial βhCG & U/S
- expectant for asymp with ↓ing βhCG, fallopian tube pregnancy, no U/S evidency of intra-abd bleeding & <3.5cm ectopic mass
- MTX for early stable, unruptured ectopics
- stabilize & Sx with salpingostomy/ectomy or salpingo-oophorectomy
- Rhogam as appropriate

Front 428

Vaginitis S/S

Back 428

increased vaginal d/c
vulvovaginal pruritis
+/- vulvar edema/erythema

Front 429

Evaluation of vaginitis

Back 429

vaginal pH with nitrazine paper
micro exam with wet prep & KOH
gram stain
chlamydia Ag tests
r/o UTI with U/A, cultures

Front 430

Bacterial vaginosis frequency, S/S, Rx

Back 430

relative frequency 50%
main symp = stale odour
mild vulvar irritation
homogenous, greyish-white d/c
with fishy/stale odour
vaginal pH >4.5
clue cells on saline smear
+ve whiff test with KOH prep
Rx - po metronidazole

Front 431

trichomonas vaginosis frequency, S/S, Rx

Back 431

25% (may coexist with bact)
main symp = d/c
strawberry petechiae in upper vagina/cervix
profuse, malodourous, yellow-greenish frothy d/c
pH >4.5
motile trichomonas on saline smear
-ve KOH prep
Rx po metronidazole
treat partner (STD)
check for other STDs

Front 432

Candidal vaginosis frequency, S/S, Rx

Back 432

25%
main symp = pruritis
erythematous, excoriated vulva/vagina
thick, white, cottage-cheese d/c
normal pH (3.5-4.5)
-ve saline smear
pseudohyphae on KOH prep
Rx topical antifungals (miconazole) or po fluconazole

Front 433

Cervicitis S/S

Back 433

N. gonorrhea, C. trachomatis
yellowish-green, mucopurulent d/c
coinfection common
- 50% pts with gono have chlamydia
CMT in absence of other S/S of PID

Front 434

PID

Back 434

includes endometritis, salpingitis, oophoritis, myometritis, peritonitis
ususally bacterial

Front 435

PID Risk factors

Back 435

young age at 1st intercourse
multiple partners
unprotected sex
frequent intercourse
mucopurulent cervicitis
prior PID
IUD use

Front 436

PID S/S

Back 436

1-3d hx lower abd pain +/- fever, N/V
hx recent menses
purulent cervical/vaginal d/c
u or b/l lower abd, uterine, adnexal and CMT

Front 437

DDx PID

Back 437

ectopic
endometriosis
ovarian tumors
hemorrhagic cysts
adnexal torsion
UTI/pyelo
appendicitis/diverticulitis/
regional ileitis/UC

Front 438

Evaluation of PID

Back 438

minimal dx criteria =
lower abd, adnexal & CMT
supportive
fever >38
↑ESR, CRP
WBC >10000
+ve cervical swab (gono/chl)
pelvic abscess on U/S
Definitive dx = lap with pus in peritoneal cavity

Front 439

Rx of PID

Back 439

inpt IV abx = cefoxitin or cefotetan
+ doxycycline or clindamycin + gentamicin until asymp
then doxycycline po x14d
Outpt abx =
ceftriaxone
+ doxy or ofloxacin
+ clinda or metro x14d
Hospitalize for:
pelvic/tubo-ovarian abscess
peritonitis
non-compliance
N/V preventing po meds
high fever/WBCs
no improvement after 48-72h
teenage/nulliparous

Front 440

Cx of PID

Back 440

TOA - suspect with severe pain, high fever, N/V, adnexal mass
Ectopic pregnancy
infertility
Fitz-hugh-curtis syndrome (5-10% of PID)

Front 441

Toxic Shock syndrome S/S, Rx

Back 441

pre-formed TSST-1 toxin sudden onset fever, diffuse sunburn-like rash, diarrhea, V, pharyngitis, h/a +/or myalgias
can rapidly progress to hypotensive shock
desquamation palms/soles in 1-2wks
menses/tampon use associated in 50%
Rx - antistaph abx (nafcillin, oxacillin) +/-steroids

Front 442

vulvar cancer

Back 442

4th most common gyne ca
after menopause (60s)
squamous cell (90%)
RF DM, obesity, HTN, vulvar dystrophies, HPV 16/18
vulvar pruritis (most common)
erythematous/ulcerated vulvar lesion +/or mass
Rx wide local excision + LN dissection +/- XRT

Front 443

Cervical ca

Back 443

3rd most common gyne ca
RF - early intercourse, multiple partners, immunocompromised, tobacco, STDs, HPV 16/18/31

Front 444

cervical ca S/S

Back 444

meno +/or metrohhagia
post-coital bleeding
pelvic pain
vaginal d/c
cervical d/c +/or ulceration
pelvic mass
fistulas

Front 445

Indications for colposcopy and endocervical curettage

Back 445

dysplasia
squamous intraepithelial neoplasia
2 consecutive ASCUS

Front 446

Rx of cervical ca

Back 446

CIN I = LSIL - most regress spontaneously - Pap + colposcopy q3m
CIN II/III = HSIL - cryosx, laser, or LEEP
Cold knife conization - only for lesions that can't be fully visualized, discrepancy b/t high gr. cytology and bx, adenocarcinoma in situ, +ve ECC, or microinvasive SCC
Invasive ca
early - radical hysterectomy + LN dissection
all stages - XRT, chemo

Front 447

uterine leiomyoma

Back 447

most common benign gyne lesion
more common in blacks, >35y/o
hormonally responsive
increase size with pregnancy
regress after menopause
0.1-0.5% transformation to leiomyosarcoma

Front 448

fibroids S/S

Back 448

asymp
abnormal uterine bleeding
anemia
pelvic pressure
dysmenorrhea
urinary frequency
pain
infertility (uncommon)
firm, nontender, irregularly inlarged "lumpy-bumpy" uterus

Front 449

Evaluation/Rx of fibroids

Back 449

U/S to confirm dx
expectant
hysterectomy/myomectomy
medical - medroxyprogestrone
danazol
GnRH agonists (shrink tumors but growth resumes when meds stopped) can use in perimenopausal
If grows after menopause CANNOT BE FIBROID

Front 450

endometrial ca RF

Back 450

most common gyne ca
strongly associated with high levels unopposed estrogen -
HRT
chronic anovulation
early menarche
late menopause
ovarian granulosa cell tumors
obesity
tamoxifen
DM, HTN, nulliparity, FHx

Front 451

endometrial ca S/S

Back 451

postmenopausal bleeding
menorrhagia
metrorrhagia
lower abd pain and cramping
uterus fixed and immobile if spread to adnexa/peritoneum
Signs of mets
hepatosplenomegaly
general lymphadenopathy
abdominal masses

Front 452

evaluation and Rx of endometrial ca

Back 452

Pap smear (not sensitive)
U/S to r/o fibroids, polyps, endometrial hyperplasia
ECC and EMB - glandular cell hyper/anaplasia with invasion of stroma, myometrium or bvs
Surgical staging
+/- adjuvant XRT
hormone Rx - high dose progestins for stage I
Chemo (doxorubicin + cisplatin) for advanced/recurrent dz

Front 453

ovarian ca RF

Back 453

leading cause gyne ca deaths
most common in post-menopausal and prepubescent
RF
FHx breast, ovarian ca
chronic uninterrupted ovulation
protective - OCPs

Front 454

Catagorization of ovarian ca

Back 454

epithelial cell (most common)
- >20y/o
germ cell eg dysgerminoma
sex cord-stromal eg functional tumors

Front 455

ovarian ca S/S

Back 455

asymp until late
abdominal pain
bloating
pelvic pressure
urinary frequency
early satiety
constipation
vaginal bleeding
systemic symp
palpable solid, fixed, nodular pelvic mass
ascites
pleural effusions

Front 456

Evaluation and Rx of ovarian ca

Back 456

pelvic U/S +/- CT/MRI
CA-125, AFP, LDH, hCG used to monitor progression (not screening)
Surgical staging includes:
TAH-BSO, omentectomy, tumor debulking
XRT for dysgerminomas
Post-Sx chemo (carboplatin + paclitaxel)for epithelial cell (high recurrence, poor px)

Front 457

prevention of ovarian ca

Back 457

strong fhx (≥2 1° relatives)
annual screening with CA-125 + transvaginal U/S
consider prophylactic oophorectomy after childbearing
OCPs may help decrease risk

Front 458

Causes of hirsuitism and virilization

Back 458

PCOS
congenital adrenal hyperplasia
cushing's syndrome
sertoli-leydig cell ovarian tumors
luteoma of pregnancy
adrenal tumors

Front 459

PCOS

Back 459

oligomenorrhea with S/S of increased circulating androgens
characterized by:
b/l polycystic ovaries
chronic anovulation
infertility
affects 15-30y/o

Front 460

PCOS S/S

Back 460

obesity
amenorrhea
hirsuitism
infertility
symptoms d/t excess LH and androgen overproduction
associated with DM, insulin resistance
increased risk endometrial ca

Front 461

Evaluation and Rx of PCOS

Back 461

serum FSH:LH >3
↑serum androstenedione, DHEA
U/s - enlarged ovaries with +++ large subcapsular cysts
Rx
wt loss
infertility - clomiphene citrate or metformin
OCPs for hirsuitism, amenorrhea, acne

Front 462

female infertility most common causes

Back 462

endometriosis > PID

Front 463

Threatened abortion

Back 463

minimal bleeding
+/- abdominal pain
no POC expelled
closed os
normal U/S
Rx
avoid heavy activity, pelvic and bedrest

Front 464

inevitable abortion

Back 464

profuse bleeding
severe cramping
open os
Rx
emergent D&C

Front 465

incomplete abortion

Back 465

some POC expelled
open os
retained fetal tissue on U/S
Rx
emergent D&C

Front 466

missed abortion

Back 466

no uterine bleeding
no POC expelled
closed os
no FHR
retained fetal tissue on U/S
Rx
evacuate uterus
D&C

Front 467

complete abortion

Back 467

minimal bleeding/cramping
all POC expelled
closed os
empty uterus on U/S

Front 468

septic abortion

Back 468

fever/chills
peritoneal signs
often hx recent TA (maternal mortality 10-50%)
↓BP, T
oliguria
resp distress if in shock
↑WBC
Rx
evacuate uterus
D&C
IV Abx

Front 469

intrauterine fetal demise

Back 469

mother may report absence of fetal mvts
uterus SGA
no FHR/mvts on U/S
Rx
induce labour and evacuate uterus to avoid D&C

Front 470

Stress incontinence S/S

Back 470

small amts of urine loss with exertion/straining
no symp supine/asleep
+/- cystocele/urethrocele

Front 471

stress incontinence mechanism

Back 471

mech - change in urethrovesical angle causes intra-abd pressure increases to be transmitted to bladder>urethra

Front 472

stress incontinence RF

Back 472

pelvic relaxation
chronically increased intra-abd pressure
weakened urethral closing mechanisms (eg estrogen deficiency, meds)

Front 473

stress incontinence dx and rx

Back 473

dx
normal U/A, culture, cystometrogram
demonstrable leakage w stress
"+ve Q-tip test" (angle of cotton swab shows >30° change when pt strains)
Rx
kegels
estrogen
pessaries +/or Sx

Front 474

urge incontinence S/S

Back 474

unpredictable large V urine loss
day and night urgency/frequency
exam often normal

Front 475

urge incontinence mechanism

Back 475

involuntary, uninhibited detrusor muscle contractions

Front 476

urge incontinence risk factors

Back 476

UTIs
bladder stones
bladder ca
neurologic dz
DM

Front 477

Dx and Rx of urge incontinence

Back 477

cystometrogram reveals involuntary bladder contractions associated with leakage, normal residual volume and sensation
Rx
anticholingerics (oxybutynin)
βadrenergics (metaproterenol)
behaviour modification
+/or sx denervation

Front 478

Down syndrome

Back 478

most common chrom disorder and cause of congenital MR
MR
flat facial profile
prominent epicanthal folds
simian crease
duodenal atresia
congenital hrt dz (most common septum-primum ASD d/t endocardial cusion defects)
alzeiher's >35y/o
↑risk ALL

Front 479

Edward's syndrome

Back 479

trisomy 18 (1/8000)
severe MR
rocker-bottom feet
low set ears
micrognathia
congenital hrt dz
clenched hands
prominent occiput
death by 1y/o

Front 480

Patau's syndrome

Back 480

trisomy 13 1/6000
severe MR
microphthalmia
microcephaly
cleft lip/palate
abnormal forebrain structures
polydactyly
congenital hrt dz
death by 1y/o

Front 481

Klinefelter's syndrome

Back 481

XXY 1/850
testicular atrophy
eunuchoid body shape
tall, long extremities
gynecomastia
female hair distribution
one of most common causes of hypogonadism in males

Front 482

Turner's syndrome

Back 482

XO 1/3000
short stature
webbed neck
ovarian dysgenesis
coarctation of aorta
most common cause primary amenorrhea

Front 483

Double Y males

Back 483

XYY 1/1000
phenotypically normal
very tall
severe acne
antisocial behaviour in 1-2%

Front 484

phenylketonuria

Back 484

phenylalanine normally converted to tyrosine
in PKU tyrosine becomes essential
↓phenylalanine hydroxlase or tetrahydrobiopterin cofactor
findings
MR
fair skin
eczema
musty body odour

Front 485

Fabry's disease

Back 485

deficient α-galactosidase A → +++ ceramide trihexoside
findings
renal failure
X-linked recessive

Front 486

Krabbe's disease

Back 486

AR
absent galactosylceramide β-galactosidase → +++ galactocerebroside
findings
optic atrophy
spasticity
early death

Front 487

Gaucher's disease

Back 487

AR
↓β-glucocerebrosidase → glucocerebroside +++ in brain, liver, spleen, and bone marrow (gaucher cells with "crinkled paper" enlarged cytoplasm)
Type I - most common
normal life span

Front 488

Niemann-Pick disease

Back 488

AR
↓sphingomyelinase → +++ sphingomyelin and cholesterol in reticuoloendothelial and parenchymal cells
die by 3y/o

Front 489

Tay-Sachs

Back 489

AR
absence of hexosaminidase A → +++ ganglioside
death by 3y/o
cherry-red spot on macula
1/30 Askanasi Jews (1/300 others)

Front 490

Metachromatic leukodystrophy

Back 490

AR
↓ arylsuflatase A → +++ sulfatide in brain, kidney, liver, peripheral nerves

Front 491

Hurler's syndrome

Back 491

AR
↓α-L-iduronidase → corneal clouding, MR

Front 492

Hunter's syndrome

Back 492

X-linked recessive
↓iduronate sulfatase
mild form of Hurler's with no corneal clouding and mild MR

Front 493

X-linked lysosomal storage diseases (2)

Back 493

Fabry's
Hunter's

Front 494

AR lysosomal storage diseases (6)

Back 494

Niemann-Picks
Krabbe's
Gaucher's
Hurler's
Tay-Sachs
metachromic leukodystrophy

Front 495

Fragile X syndrome

Back 495

X linked recessive
affects methylation and expression of FMR1 gene
2nd most common cause genetic MR
CGG repeats
macro-orchidism
long face with large jaw
large everted ears
autism

Front 496

Left to right shunts

Back 496

"3d's"
ASD
VSD
PDA

Front 497

Congenital heart disease classification and intrauterine risk factors

Back 497

presence or absence of cyanosis
RF
maternal EtOH, drugs
exogenous hormones (OCPs)
lithium
congenital infection

Front 498

ASD S/S

Back 498

presents late childhood/early adulthood
large defects can → CHF → cyanosis
easy fatiguability
frequent resp infections
FTT
RV heave
wide and fixed S2
SEM at ULSB (from ↑flow across pulmonary valve)

Front 499

ASD evaluation

Back 499

Echo with colour flow doppler (dx)
flow b/t atria
paradoxic ventricular wall motion
dilated RV
ECG - R axis deviation
CXR - cardiomegaly, increased pulm. vascular markings

Front 500

ASD Rx

Back 500

small defects - Ø
Abx prophylaxis before dental procedures for ostium primum defects
Sx closure in infants with CHF, >2:1 pulm:systemic blood flow ratio
Early correction prevnts Cx
- arrhythmias, RV dysfunction, Eisenmenger's syndrome

Front 501

Eisenmenger's syndrome

Back 501

L→R shunt → pulmonary vascular hyperplasia, irreversible PHTN and shunt reversal

Front 502

VSD S/S

Back 502

most common comgenital heart defect
frequent resp infections
FTT
CHF
pansystolic murmur at LLSB
loud pulmonic S2
Severe defects - systolic thrill, cardiomegaly, crackles

Front 503

VSD evaluation and Rx

Back 503

echo dx
ECG - L/RVH
Rx
CHF with diuretics, ionotropes
small usually Ø
large - early Sx to prevent Cx - Eisenmenger's syndrome
endocarditis and septic emboli prophylaxis (amoxicillin) before dental/pulmonary procedures

Front 504

PDA risk factors and S/S

Back 504

RF
high altitude
maternal T1 rubella
more common in premature & ♀
S/S
slowed growth
recurrent LRTIs
L/E clubbing
symp of CHF
wide pulse pressure
continuous "machinery M" at 2nd LICS
loud S2
bounding peripheral pulses

Front 505

Evaluation and Rx of PDA

Back 505

colour flow doppler showing blood flow from aorta to PA = Dx
echo - LA, LV enlargement
ECG +/- LVH
CXR +/- cardiomegaly
Rx
indomethacin unless needed for survival
if fails or if >6-8m old - Sx closure

Front 506

Coarctation of aorta RF and S/S

Back 506

♂>♀
Turner's syndrome is RF
25% have bicuspid AV
S/S
asymp HTN in childhood
SOBOE
syncope
claudication
epistaxis
h/a
SBP > in U/E, R arm
femoral pulses weak/delayed
late systolic M in L axilla
forceful apical impulse
L/E wasting if advanced

Front 507

Evaluation of coarctation of aorta

Back 507

cardiac cath = Dx
ECG - LVH
echo + colour flow doppler
CXR
- "reverse 3 sign" (d/t pre and post-dilatation of coarct segment)
- "rib notching" (d/t collateral circulation thru intercostal a's

Front 508

Rx of coarctation

Back 508

Sx correction or balloon angioplasty
continue abx prophylaxis after Rx

Front 509

Right to Left shunts

Back 509

"5T's"
Tetrology
Transposition
Truncus arteriosis
Tricuspid atresia
Total anomalous pulmonary venous return

Front 510

Transposition of the Great Vessels

Back 510

pulm and syst circulation are in parallel
- aorta connected to RV
- PA connected to LV
incompatible with life unless PDA or septal defect
RF
Apert's syndrome
Down's
Cri-du-chat
trisomies 13, 18

Front 511

Transposition of GV S/S

Back 511

critical illness and cyanosis typically immediately after birth
tachpnea
progressive resp failure

Front 512

Evaluation and Rx of Transposition of GV

Back 512

eval
Echo
CXR - "egg-shaped silhouette" (narrow heart base and absence of main PA segment)
Rx
keep PDA open with PGE1
Ballon atrial septostomy
Sx - arterial or atrial switch

Front 513

Tetrology of Fallot

Back 513

"PROVe"
Pulmonary stenosis
(=RV outflow obstruction)
RVH
Overriding aorta
VSD

Front 514

Tetrology of Fallot S/S

Back 514

most common cyanotic hrt dz of childhood (transposition is most common of infancy)
early cyanosis from R-to-L shunting
cyanosis, dyspnea, fatiguability
squat for relief during hypoxic episodes (=tet spells)
hypoxemia - FTT, MS changes
SEM at LSB (d/t RV outflow obstruction)
RV lift
single S2
+/- signs of CHF

Front 515

RF and Evaluation of tetrology of fallot

Back 515

Down's
cri-du-chat
trisomies 13, 18
Eval
echo and cath
CXR - "boot-shaped heart" with ↓pulm vascular markings
ECG - RAD, RVH

Front 516

Tetrology of Fallot Rx

Back 516

PGE1 to maintain PDA
cyanotic spells - O2, propranolol, knee-chest position, fluids, morphine
temporary palliation with artificial shunt (balloon atrial septostomy) before Sx

Front 517

HBV vaccination

Back 517

birth, 2m, 6m

Front 518

DTaP vaccination

Back 518

2,4,6, 15-18m, 4-6yrs

Front 519

Hib vaccination

Back 519

2,4,6,12-15m

Front 520

IPV vaccination

Back 520

2,4,6m,4-6yrs

Front 521

PPV vaccination

Back 521

2,4,6,12-15m

Front 522

MMR vaccination

Back 522

12-15m, 4-6yrs

Front 523

varicella vaccination

Back 523

12-15m

Front 524

HAV vaccination

Back 524

2yrs in certain regions and high risk groups

Front 525

influenza vaccination

Back 525

>6m with asthma, CF, DM, HIV, BPD, SCA, chronic heart dz

Front 526

Contraindications and precautions for vaccinations

Back 526

current mod-severe illness
severe allergy to vaccine component or prior dose
encephalopathy within 7d of prior pertussis vaccination
recent admin of Ab-containing blood products for live injected vaccines
Live vaccines in immunocompromised and pregnancy (Exception HIV without immune compromise can have MMR and varicella)
Precautions
progressive neuro disorders
prior rxn to pertussis
Not contraindications
mild illness +/or low gr fever
current abx
prematurity

Front 527

Milestones at 2m

Back 527

GM - lifts head/chest prone
FM - tracks past midline
L - alert to sounds, coos
Social/Cog - recognizes parent, social smile

Front 528

milestones at 4-5m

Back 528

GM - rolls f-to-b(4m), b-to-f(5m)
FM - grasps rattle
L orients to voice, ah-goo
S/C - enjoys looking around, laughs

Front 529

milestones at 6m

Back 529

GM - sits unassisted
FM - transfers objects, raking grasp
L - babbles
S/C - stranger anxiety

Front 530

milestones at 9-10m

Back 530

GM - crawls, pulls to stand
FM - 3-finger pincer grasp
L - mama/dada (non-specific)
S/C - waves bye-bye, pat-a-cake

Front 531

milestones at 12m

Back 531

GM - cruises (11m), walks alone
FM - 2finger pincer grasp
L - mama/dada (specific)
S/C - imitates actions

Front 532

milestones at 15m

Back 532

GM - walks bwds
FM - uses cup
L - 4-6 words
S/C - temper tantrums

Front 533

milestones at 18m

Back 533

GM - runs, kicks ball
FM - builds tower 2-4 blocks
L - names common objects
S/C - copies parent in tasks

Front 534

milestones at 2yrs

Back 534

GM - walks up/down steps with help, jumps
FM - builds tower of 6 blocks
L - 2 word phrases
S/C - follows 2-step commands, removes clothes

Front 535

milestones at 3yrs

Back 535

GM - rides tricycle, climbs stairs alternating (3-4yrs)
FM - copies circle, uses utensils
L - 3 word sentences
S/C - brushes teeth with help, washes/dries hands

Front 536

milestones at 4yrs

Back 536

GM - hops
FM - copies cross
L - counts to 10
S/C - cooperative play

Front 537

Intussusception

Back 537

one portion of bowel telescopes into adjacent segment usually prox to ileocecal valve
most common cause of bowel obstruction <2yrs

Front 538

Intussusception Risk factors

Back 538

Meckel's
intestinal lymphoma (>6y/o)
HSP
parasites
polyps
adenovirus
rotavirus
celiac disease
CF

Front 539

Intussusception S/S

Back 539

abrupt onset colicky abd pain
drawing up of legs and V
young infants - pallor and sweating
palpable "sausage-shaped" RUQ mass
advanced signs - "red, currant jelly stools" lethargy, fever

Front 540

Intussusception eval and Rx

Back 540

AXR, U/S
air contrast barium enema - dx, often curative
Sx reduction/resection if necessary

Front 541

Pyloric stenosis

Back 541

hypertrophy of pyloric sphincter
first born males
1/500 births

Front 542

pyloric stenosis S/S

Back 542

nonbilious emesis progresses to projectile emesis after every feeding from 2wks - 4m old
palpable olive-shaped, mobile, nontender epigastic mass
visible peristaltic waves

Front 543

Pyloric stenosis DDx

Back 543

DDx - duodenal atresia ("double-bubble on Xray)
malrotation
volvulus
meconium ileus
GERD
gastroenteritis
pylorospasm
overfeeding

Front 544

Pyloric stenosis eval and Rx

Back 544

Abd U/S - hypertrophic pylorus - dx
barium studies - "string sign" (narrow pyloric channel) or pyloric beak
Rx acid/base/volume first then Sx - pyloromyotomy

Front 545

B-cell deficiencies

Back 545

most common immunodeficiencies (50%)
present after 6m with recurrent sinopulmonary, GI and GU infections with encapsulated organisms (H. flu, S. pneumo, N. menigitides)

Front 546

T-cell deficiencies

Back 546

present earlier than B (1-3m old)
opportunistic and low grade fungal, viral, and intracellular bacterial infections
+/- secondary B-cell deficiencies

Front 547

phagocyte deficiencies

Back 547

characterized by mucous membrane infections, abscesses, and poor wound healing
catalase +ve (staph aureus) and GN enterics common
Delayed umbilical cord separation may be early sign

Front 548

Complement deficiencies

Back 548

characterized by recurrent bacterial infections with encapsulated organisms

Front 549

Congenital immunodeficiencies

Back 549

present with:
chronic/recurrent infections
unusual or opportunistic organisms
incomplete Rx response
FTT

Front 550

Kawasaki disease

Back 550

"CRASH and burn"
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hands and feet (red, swollen, flaky skin)
AND burn
= fever >40°C for ≥5d

Front 551

Kawasaki disease

Back 551

multisystem acute vasculitis affecting young kids (80% <5y/o) esp. Asian
Acute phase:
Dx = fever + ≥4 of:
fever >40°C for ≥5d
b/l nonexudative painless conjunctivitis
polymorphous rash (primarily truncal)
cervical lymphadenopathy (often u/l, ≥1 LN ≥1.5cm)
Diffuse mucous membrane erythema (strawberry tongue)
erythema of palms/soles
indurative edema of hands and feet, desquamation of fingertips (late)
Subacute phase:
thrombocytosis
↑ESR

Front 552

Rx of Kawasaki's

Back 552

Acute phase
- high dose ASA
- IVIG (to prevent aneurysms)
Untreated pts at risk for coronary artery aneurysms during convalescene
NO steroids - ↑risk aneurysm formation

Front 553

B cell deficiencies include...?

Back 553

X-linked (Bruton's) agammaglobulinemia
common variable immunodeficiency
IgA deficiency (most common of all immunodeficiencies)

Front 554

X-linked (Bruton's) immunodeficiency

Back 554

profound B-cell deficiency in Boys only
can present <6m old
at risk for life-threatening Pseudomonas infections
Dx - quantitative Ig levels and specific Ab responses
Rx - prophylactic abx, IVIG

Front 555

Common variable immunodeficiency

Back 555

Ig levels drop in 2nd-3rd decade of life
↑risk lymphoma, autoimmune dz

Front 556

IgA deficiency

Back 556

most common
usually asyp
recurrent infections

Front 557

T-cell deficiencies include...?

Back 557

Thymic aplasia (DiGeorge)
Ataxia-telangectasia

Front 558

DiGeorge syndrome

Back 558

"CATCH-22"
Congenital heart disease
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcemia
22q deletion
Presents with tetany in 1st days of life
Dx
- absolute lymphocyte count
- mitogen stim response
- delayed hypersensitivity skin testing
Rx
thymus or BMT
IVIG for Ab deficiency

Front 559

Ataxia-telangectasia

Back 559

DNA repair defect
Oculocutaneous telangectasias and progressive CB ataxia
Rx
BMT
IVIG for Ab deficiency
No Rx to limit progression

Front 560

Combined immunodeficiencies includes...?

Back 560

SCID
Wiskott-Aldrich syndrome

Front 561

SCID

Back 561

severe lack of B and T cells
frequent, severe bacterial infections
chronic candidiasis
opportunistic organisms
Rx
BMT or stem cell transplant
IVIG for Ab deficiency
PCP prophylaxis until BMT

Front 562

Wiskott-Aldrich syndrome

Back 562

X-linked
less severe B & T cell dysfunction
eczema
↑IgE, IgA
↓IgM
TCP
Rx
supportive
IVIG and aggressive abx for infection
rarely survive to adulthood

Front 563

Phagocytic immunodeficiencies include...?

Back 563

CGD
Chediak-Higashi syndrome

Front 564

CGD

Back 564

Xlinked or autosomal recessive
deficient superoxide production by PMNs, macrophages
Chronic pulm, GI, GU infections
osteomyelitis
hepatitis
+/- anemia, lymphadenopathy, hypergammaglobulinemia
Dx
Nitroblue tetrazolium test=Dx
absolute neutrophil count
adehsion, chemotaxic, phagocytic, bactericidal assays
Rx
TMP-SMX qd
γ-interferon reduces incidence of serious infections

Front 565

Chediak-Higashi syndrome

Back 565

AR
defect in neutrophil chemotaxis
Oculocutaneous albinism
neuropathy
neutropenia
Dx
absolute neutrophil count
adhesion, chemotactic, phagocytic, and bactericidal assays
Rx
TMP-SMX qd

Front 566

Complement deficiencies includes...?

Back 566

C1 esterase deficiency (hereditary angioneurotic edema)
Terminal complement deficiency (C5-9)

Front 567

C1 esterase deficiency

Back 567

= hereditary angioneurotic edema
AD
recurrent episodes of angioedema lasting 2-72hrs - provoked by trauma/stress
can result in life-threatening a/w edema
Dx
total hemolytic complement (CH50)
Rx
danazol qd
purified C1 esterase and FFP prior to Sx

Front 568

Terminal complement deficiency

Back 568

susceptible to recurrent meningococcal & gonococcal infections
SLE, glomerulonephritis (rare)
Dx
total hemolytic complement (CH50)
Rx
menigococcal vaccine
Abx