Step 2ck cram notes

8/13/2019 Step 2ck cram notes

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CARDIOLOGY:1. Stable angina chest discomo!t" can be elt in bac#$a!ms$%a&$abdm" occ'!s c st!ess$emotion"!elie c !est" d( c st!ess test. )( c nit!ates" bb" Cabs" he*a!in" as*i!in" i + ,essels o! L main doCA-G. /nstable angina 'n*!edictable at !est o! ab!'*tl0 &o!sening *atte!n o angina" *!olongedd'!ation 234" d( c 5CG st de*!ession$t in,e!sion4 o! cath sho&s CAD" b't negati,e ca!diac

ma!#e!s" t( c nit!ates" cabs" bb" he*a!in+. 6a!iant$7!in8metal Angina chest *ain at !est" S) ele,ation note the + ca'ses o S) ele,ationa!e 9I ine!io! LDA4 is II" III A6; late!al ci!c'mle( a4is I" A6L" 6


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?. Ao!tic Coa!ctation /5 )@ c L5 h0*otension" !ib notching" L5 cla'dication" A" d( &ith 9RAo! cont!ast ao!tog!a*h0" t( is s'!ge!0 best at ?>F0o4.b!achial inde( beo!e$ate!e(e!cise" angiog!a*h0" 9CC is athe!oscle!osis" t( c meds *ento(00lline" cilasta8ol" cabs4"angio*last0$stenting" a,oid const!icting d!'gs bb4++. )em*o!al A!te!itis > 2


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c!isis in sic#le cell *atients" no t(


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ne*h!ogenic can be d'e to demec0clone o! lithi'm4" i no change in '!ine osm its *!ima!0*ol0di*sia. )( i cent!al gi,e ,aso*!essin DDA674" i ne*h!ogenic gi,e di'!etic thia8ides"amilo!ide4.13?. SIAD lo& @a" lo& se!'m osm" high '!ine osm" a$& small cell ca$mo!*hine$chlo!*!o*!amide$o(0tocin" t( c 1st l'id !est!iction" nd demecloc0cline o! h0*e!tonic saline i @a is!eall0 lo&. Do not t!eat too !a*idl0 to a,oid cent!al *ontine m0elinosis.

13O" 9CC is 1>Odeicienc0 in #ids" 9CC in ad'lts is 7COS o! ad!enal disease. )( is s'!ge!0 i ambig'o's genitalia ingi!ls4" then est!ogen s*i!onolactone" meo!min i 7COS4" gl'co$mine!aloco!ticoid i CA.113. Conns s0nd high aldo" lo& NM" high @a" igh -7" lo& !enin" t( is ad!enalectom0 cs*i!onoloactone *!eo*.111. Seconda!0 0*e!aldoste!onism 9CC is !enal a!te!0 stenosis high @a" lo& N" high!ennin" !enal b!'it. D( c aldo:!enin !ation" then C) Abdm.11. 7!olactinoma mil#0 d$c !om b!east" i *!olactin le,el 3>133 then !$o do*amine antagonistd!'gs halo*e!idol" metaclo*!amide4 and !$o h0*oth0!oidism" i *!olactin le,el 2133" then do 9RI ob!ain. )( i C@S s$s bitem*o!al hemiano*sia4 do s'!ge!0" i not gi,e b!omoc!i*tine.11+. 7heoch!omoc0toma s'dden e*isodes o l'shing" )@" A" s&eating" eeling o doom" a$&95@ II$III" d( c '!ina!0 69A o! catecholamines" then i M do C) o abdomen and t( c gi,e

*heno(0ben8amine then --4 ollo&ed b0 s'!ge!0.11?. 7COS and 7!emat'!e o,a!ian ail'!e see obg0n notes11


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t!ansm'!al4" ist'la" abscess" noncaseating g!an'loma" gallstones" calci'm o(alate #idne0 stones"e(t!aintestinal maniestations" d( c colonosco*0 and bio*s0. )( 'sing inli(imab m'st do 77Dbeo!e sta!ting it4" s'lasala8ine" met!onida8ole" *!ednisone.1. /le!ati,e Colitis !ect'm mainl0 'nless bac#&ashing *!esent4" contin'o's" %'stm'cosa$s'bm'cosa" c!0*t abscesses" to(ic megacolon" small$!e'ent blood0 dia!!hea c tenesm's.)( c a8'lidine" s'lasala8ine

1+. )o(ic 9egacolon eme!genc0" a$& /C" t(: @7O" @G)" I6" D$C meds" Ab(" s'!ge!0 onl0 i M*e!o!ation !ee ai! on AHR41?. 7e*tic /lce! D'odenal dec!eases c ood" Gast!ic inc!eases &ith ood" gastic is mo!e a$&cance!" d'odenal is mo!e a$& .*0lo!i. D( 1st c .*0lo!i testing" then endosco*0 &ith bio*s0 to !$ocance!. Ris#s o! @SAIDS: 2E3" h$o *!io! 7/D" onl0 a,ailable t( is miso*!ostol. .*0lo!i: b!eath test"gast!ic bio*s0" '!ease. D( o! 7/D: 1st /**e! GI endosco*0" then bio*s0 o! gast!ic 'lce!s to !$ocance!. )( &ith amo(" cla!ith!o and om*!a8ole. ollo&>'* &ith '!ea b!eath tests ate! 1 month o t(.Com*lications: hemo!!hage 9C4" *e!o!ation do AHR to see !ee ai! in a *t c *e!itoneal s$s andt( c ab( and la*a!atom0. Ate! s'!ge!0 ant!eceom0" ,agotom0" bill!oth I and II4" &atch o't o!D'm*ing S0nd!ome &ea#ness" n$, ate! eating4" Ae!ent loo* s0nd!ome bilio's ,omiting !elie,esabdm *ain ate! meal4" I!on$-1 deicienc0.1


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1?. Di,e!tic'losis d$t lo& ibe!$high at diet. LL *ain" e,e!" tende!ness. D( c colonosco*0. )( cinc!eased ibe!.1?+. Di,e!tic'litis *e!itonitis" e,e! d'e to mic!o$mac!o>*e!o!ations" do C) scan. )( c @7O" I6and ab( ci*!o$met!o o! ceo(itine o! am*icillin$s'lbactam41??. 7se'domemb!ano's Colitis C.diicile o,e!*o*'lation d'e to *!io! 'se o Ab( &ee#s ago" d(c C.di in stool. Colonosco*0 sho&s 0ello& adhe!ent *la'es on m'cosa. )(: d$c d!'g" sta!t

met!onida8ole" i still M" ,ancom0cin.1?smooth m'scle Ab" e,e!0thing elseno!mal. )( c ste!oids.1?F. ilsons disease 0o'ng g'0 &ith *a!#insonism d'e to he*atilentic'la! degene!ation"#a0se!>leische! !ing" hemol0tic anemia" d( c lo& se!'m ce!'lo*lasmin" lo& total co**e! not !ee4"high '!ine co**e!. C) sho&s h0*dense !egions in the basal ganglia. Coni!m d( c li,e! bio*s0. )( cD>*enicillamine.1?. Ascites /$S" C) and then *a!acentesis. )( c @a$l'id !est!iction" di'!etics" then '!osemide"then la!ge>,ol'me *a!acentesis" then )I7S.1A6 Ig9 IgG sho&s *!e,io's in(n41=mo" 1+>1Fmonths. I mom has MbsAg" gi,e bab0 ,accine M -IG &ithin 1 ho'!s o bi!th.1


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ano!e(ia and &eight loss &ith %a'ndice" n$,. D( c C). I negati,e do 5RC7. Chec# CA 1>. )(: Ionl0 at *anc!eatic head c no s*!ead" t!0 !esection. I not" do hi**le *anc!eaticod'odenectom04*!oced'!e.1=?. 9alabso!*tion Steato!!hea d( c S'dan stain 1st test4. )hen d( c D>(0lose" i abno!mal"s'ggests small bo&el disease. @o!mal ,al'e s'ggests oc's on *anc!eatic d8: C) o abdm" se!'mam0lase" AS)$AL). I o,e!g!o&th conside!ed" note !es*onse to malabso!*tion to Ab(. Celiac s*!'e

*anel: antiendom0sial$antigliadin Ab" tiss'e t!ansgl'taminase" total se!'m IgA" antigliadin Ab IgAand IgG; at least + bio*s0 s*ecimens !om distal d'oden'm is gold standa!d.1=1 -ilio's" *!o%ectile Do'ble b'bble sign" a$& Do&ns)5 ist'la 3> ood !eg'!gitation Res* *!oblems c eeding" as* *ne'mo" d( ,ia cant *ass @G)i!schs*!'ng 3>10! ec'lent Distention" obsti*ation" no ganglia on bio*s0Anal At!esia 3>1 Late" ec'lent Seen on initial e(am in n'!se!0Choanal At!esia 3>1 > C0anosis c eeding" !elie,ed c c!0ing" CARG5 s0nd" cant *ass @G)Int'ss'sse*tion ?mo 0o -ilio's C'!!ant %ell0 stool" *al*able abdm mass" #id d!a&s '* legs" d( cba!i'm enema@ec 5nte!ocolitis 3>mo -ilio's 7!emies" e,e!" !ectal bleeding" ai! in bo&el &all" t( c @7O$I69econi'm Ile's 3> ec'lent" Late C0stic ib!osis9idg't 6ol,ol's 3>0& -ilio's D$t mal!otation" s'dden *ain$n$,. d( c '**e! Gi" t( c S(9ec#els Di,e!tic'l'm 3>0& 6a!ies GI 'lce!$bleed" d( c 9ec#els )echneti'm4 scan" t( c S(St!ang'lated e!nia An0 -ilio's -o&el loo*s in ing'inal canal

O@COLOGY:

1==. )'mo! ma!#e!s -hcg testic'la! cance!" cho!ioca!cinoma" mole; A7 he*atocell'la!ca!cinoma testic'la! ca; C5A GI cance!s; 7SA *!ostate ca; CA>1< O,a!ian ca; CA 1> colo!ectal$GI$*anc!eatic cance!1=E. Sigmoidosco*0 > 2 2 2 23 monthl0;Clinical b!east e(am 3>?3 e,e!0 + 0ea!s" 2?3 ann'all0; 9ammog!am ?3>? e,e!0 1> 0!s"2cell *!olie!ation" d( c C)

chest$abdm$*el,is then othe! st' li#e -9 b(" 75) scan" galli'm scan. )( c !adiation and chemoCO74 c Rit'(imab CD3 Ab4.1E1. Ac'te L0m*hoc0tic Le'#emia #ids" blasts" t( c int!athecal chemo 9)H41E. Ac'te 90elogeno's Le'#emia 9+ ca'ses DIC" Ae'! !ods" blasts" add All>t!ans !etinoic acid6it A4 to t(.1E+. C9L high -Cs" high 79@s" s*lenomegal0" L/ *ain" 'llness and ea!l0 satiet0"dec!eased LA7" d( c *hili ch!omosome t; o b!c:abl4 in -9" t( c Imatinib Glee,ac4.1E?. CLL elde!l0" high -Cs" high l0m*hoc0tes" s*lenomegal0" d( c sm'dge cells" no t( i nol0m*hoc0tosis" i M l0m*hoc0tosis gi,e l'da!abine o! chlo!amb'cil.


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!ed cells m0eloib!osis4" h0*och!omic$mic!oc0tic i!on de4" ta!get cells AL): emoglobino*athies"As*lenia" Li,e! d8 obst!'cti,e %a'ndice4" )halassemia4" O,al mac!oc0tes -1$olate de4"baso*hilic sti**ling Lead" -1 de4" s*he!oc0tes S4" Schistoc0tes 9AA" AIA" DIC4" bite cellsand ein8 bodiesG=7D4" o&ell>oll0 bodes As*lenia li#e SCD4.11. I!on deicienc0 lo& 9C6" high )I-C" lo& e!!itin" lo& i!on B=34" high RD &h0 -eca'sesome a!e no!moc0tic and some a!e mic!oc0tic so the !ange o &idth &ill be high4" *ica #id &ho eats

sand and ice" *l'mme!>,inson &eb" lo& i!on" glossitis4" co& mil# beo!e age 1" e(cl'si,e b!east>eeding" *!egnanc0. )( 1st is to ind the so'!ce o i!on loss and i( that beo!e 0o' gi,e i!onU4"nd t!ans'sion i needed ast4 o! o!al i!on s'**lements o! =>1 months.1. Anemia o Ch!onic D8 ho& does this &o!# )he bod0 #no&s diseases RA" )-" SL5"cance!4 lo,e i!on" so it &ill hide i!on a&a0 in sto!es high e!!itin4 b't #ee* it o't o the se!'m lo&se!'m i!on and high )I-C44 i anemia is a$& ch!onic !enal d8" loo# o! -'!! cells.1+. )halassemia no!mal i!on so dont gi,e i!on4" ta!get cells" n'cleated !bc" (>!a0 sho&sc!e&>c't a**ea!ance o s#'ll" d( c b elect!o*ho!esis" no t( o! t!aits. )hal ma%o! gets t!ans'sion1st and deo!o(amine to *!e,ent i!on o,e!load" s*elenectom0 no& gi,e *ne'mo,a(" *enicillin*!o*h0la(is" olate s'**lement4.1?. Lead 7oisoning *ica #ids &ho ha,e A-CD Anemia$Ata(ia$Abdm *ain" -aso*hillicsti**ling$-eha,io!al changes" Consti*ation" D!o*s oot$&!ist4$Death4" high !ee e!0th!oc0te*!oto*o!*h0!in. D( c blood 7b le,el and (>!a0 *b ,isible in bones4. )( c 5D)A o! dime!ca*!ol.1occl'ssi,e *ain c!isisthe0 &ill %'st sa0 Qc!isis4 gi,e h0d!o(0'!ea" i ct d!o*s s's*ect A*lastic anemia d$t7a!,o,i!'s. Gi,e *!o*h0lactic *enicillin" 7n'mococcal$aemo*hil's inl'en8a ,accine V childhood.3. A*lastic Anemia lo& !bc$&bc$*latelets" chlo!am*henicol" *a!,o,i!'s" ben8ene" ac'tele'#emia" A)$8ido,'dine. )( c 1st sto* d!'g" then gi,e antith0moc0te glob'lin3+. 90elo*hthisic anemia 90eloib!osis4 malignant in,asion o -9" anisoc0tosis aniso T an0si8e4" *oi#iloc0tosis sha*e4" tea!d!o*>sha*ed R-C" d( c -9 bio*s0 sho&ing no cells d!0 ta*4.3?. )!ans'sions: hole blood *oisoning" ))74" 7ac#ed R-C *ost>s'!ge!0$t!a'ma t!ans'sion o!instead o &hole blood4" &ashed R-C IgA deicienc04" 7latelets 213"3334" g!an'loc0tes *ost


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chemo4" 7 bleeding diathesis li#e DIC" &a!a!in *oisoning" li,e! ail'!e4" c!0o*!eci*itate ,D andDIC4. 9CC o t!ans'sion !(n is lab e!!o!. I it occ'!s" 1st ste* is sto* t!ans'sion.31mo G-S" 5.coli" Liste!ia" mo>0o S.*ne'mo" >1F0o @eisse!ia"1FM > S.*ne'mo; Ne!nigs$-!'d8ins#i sign" letha!g0" e,e!" b'lging ontanelle" *hoto*hobia" n'chal!igidit0" n$," d( c L7 bacte!ia: lo& gl'cose" high *!tn" 79@s; ,i!al: no!mal gl'cose" slightl0 high*!tn" lo& -C" l0m*hoc0tes4. I bacte!ial" gi,e cet!ai(one" ,anco o! ste!oids. Gi,e am*icillinliste!ia4 i imm'nocom*!omised. I neisse!ia s's*ected >1F0o c !ash4 ne(t ste* is !es*i!ato!0isolation and t( him and amil0 membe!s c !iam*in. I 2133 l0m*hoc0tes: C!0*tococc's !$o I6"best initial test is India in#" most acc'!ate test is c!0*t ag" t( c Am* -4" 6i!al no s*eciic test4" )-*'lm s$s" high CS *!otein" gi,e RI75 M ste!oids4" L0me D8 se!olog0" h$o bite" ta!get !ash"

do(0c0cline" o! i C@S s$s li#e c!anial ne!,e E eects" gi,e Cet!ia(one4" R9S se!olog0" !ash on&!ists$an#es mo,ing cent!all0" h$o cam*ing o! hi#ing" t( c Do(0c0cline" chlo!am*henicol i *!egnant4.)he 9C se'ela is hea!ing loss.?. 5nce*halitis loo# o! ac'te eb!ile con'sion i the0 sa0 con'sion" its ence*halitis notmeningitis4" 9CC is he!*es blood in cs4" best initial test is C) tem*o!al lo*e4" i negati,e do 7CRmost acc'!ate4. )( c ac0clo,i!" then osca!net i !esistant.*0!imethamine t( o! )o(o and !e*eat C).=. S*inal Abscess local se,e!e bac# *ain that becomes !adic'la! *ain" then &ea#ness c e,e!.


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@e(t ste* is C)" then s'!gical d!ainage c ab(.E. )etan's !ict's sa!donic's acial snee!4" tonic m'scle s*asms %a&" t!ism's4" clost!idi'mtetani" t( c tetan's IG and *enicillin G.F. Di*the!ia g!a0 *ha!0ngeal *seodommb c so!e th!oat" t( c di*hthe!ia antito(in DA)4 and*enicillin o! e!0th!om0cin.. C!o'* a#a ac'te la!0ngot!acheitis ba!#ing co'gh in a 1>0o. 7a!ainl'en8a ,i!'s.

!ontal nec# (>!a0 sho&s stee*le sign. )( c !acemic e*ine*h!ine.+3. 5*iglottitis >0o c &hee8ing is b!onchiolitis" 1>0o c ba!#ing co'gh is c!o'*" >S9H t(4. I e(*osed to shee**lacenta" *ic# Co(iella b'!netti. I loba! *ne'monia s.*ne'mo is 9C4 then stain and c'lt'!e ne(t.hen do 0o' gi,e ste!oids 7O BE


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meds e(ce*t ea,i!en8. hen do 0o' onl0 contin'e c A) I she has high CD co'nt" gi,e it in endo *!egnanc0 and to ne&bo!n o! = &ee#s. I *t gets st'c# c needs" sta!t n'cleosides and 1 7I o! n'cleosides c ea,i!en8. 9'st 0o' sta!t t( i *t got s*lashed in e0es Yes. Nissing @o.??. I *t is st'c# c -6 needle" no& has M-sAg" &hat do 0o' do I ,accinated" do nothing. I not,accinated" gi,e I6IG M ,accine. I *t got st'c# c C6 needle do nothing.?


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c0clo*hos*hamide==. ib!om0algia 0o'ng emale &ith *ain all o,e!" m'lti*le *oints o tende!ness" i!!eg'la! slee**atte!n" an(iet0" e(ams all no!mal. )( c antide*!essant" @SAIDS=E. 7ol0m0algia Rhe'matic old emale c *ecto!al$*el,ic *ain$stiness" ele,ated 5SR" no!malbio*s0" a$& tem*o!al a!te!itis. )( c ste!oids.=F. 7ol0m0ositis ?3>=30o emale c *!o(imal m'scle &ea#ness" ele,ated 5SR$C7N" abno!mal

m'scle bio*s0" d( c 1st m'scle bio*s0" then 59G. )( c ste!oids=. De!matom0ositis same as abo,e" b't c !ash heliot!o*e !ash a!o'nd e0elid4.E3. 7agets disease > 2?30o male c *e,ic$s#'ll damage" hats dont it an0mo!e" deaness"*a!a*legia" bone *ain" ,e!0 high al# *hos" no!mal calci'm$*hos" inc!eased !is# o osteosa!coma. H>!a0 sho&s thic#ened bones. )( c @SAIDS" bis*ho*honates 5tid!onate4 and calcitonin.E1. e!niated dis# most at L?>< &ea# big toe4" and LS1 !ed'ced Achilles !ele(4" *ositi,est!aight leg test.E. Ca!*al )'nnels median ne!,e com*!ession th'mb" *ointe!" middle inge!4" )innels signta**ing &!ist ca'ses n'mbing4" 7halens sign le(ing &!ist4" t( c !est" s*lint" &o!#*lacemodiications" then @SAIDS.E+. Osgood>Shlatte! inlammation o tibial t'be!cle in bo0s. )( c !est and immobili8ation.E?. Sli**ed Ca*ital emo!al 5*i*h0sis Obese #id c *ain'l lim*. D( c (!a0. )( c s'!gical *inning27e!thes non>obese #id c a lim* d$t a,asc'la! nec!osis V hi*4. )( cobse!,ation and *ain !elie" nd is b!acing" +!d is s'!ge!0.E=. Osteo*o!osis !is#s incl'de ea!l0 meno*a'se" alcohol" Ca'casian" thin bod0" tobacco. D( cD5HA 2>.< >1 to >.< is osteo*enia4. )( 1st &eight>bea!ing e(e!cise" nd liest0le smo#ing" alcoholcessation4" +!d calci'm$,it D" bis*hos*honates" etc.EE. 7atella! tendonitis an @-95 + test 'estion" a#a %'m*e!s #nee" *atella! tende!nessd'e to o,e!'se and %'m*ing s*o!ts !es'lting in 'ad!ice*s cont!action. )( c !est" nsaids" 'ad!ice*sst!etching.EF. Osteosa!coma 13>


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F. 5ssential )!emo! at !est and motion. )( c *!o*!anolol. )!emo! at !est onl0 is7a!#insons o! h0*e!th0!oidism" t!emo! c motion onl0 is ce!ebella! d0s'nction43. @0stagm's$6e!tigo i M ocal deecits" the *!oblem is cent!al ,e!tical n0stagm's4:ce!ebell'm C)$9RI4" 9. G!a,is 9RI4" St!o#e 9RI$C)4" *hen0toin &itho't an hea!ing loss o!tinnit's. I no ocal deecits" the *!oblem is *e!i*he!al in the ea!s4" so *t &ill ha,e hea!ing loss andtinnit's. I *t onl0 has ,e!tigo" its benign *ositional ,e!tigo. I *t has hea!ing loss and tinnit's &ith it:

9inie!es disease ch!onic disease4" Aco'stic @e'!oma loo# o! ata(ia4" Lab0!inthitis ac'te ,i!alin(n41. 5*ile*s0 as *e! Na*lan on &hat is im*o!tant4: do not t!eat 1st time sei8'!es 'nless the!e is aamil0 histo!0" 55G is *ositi,e o! *t has stat's e*ile*tic's.. Stat's 5*ile*tic's D(: 1st sodi'm" nd gl'cose" +!d calci'm" ?th h0*o(ia" to(icolog0" C)>head" 55G lastU4. )(: 1st -en8o lo!a8e*am I64" nd 7hen0toin" +!d -a!bit'!ate" ?th Anesthesias'ccin0lcholine$*!o*ool these &ill %'st sto* the sha#ing" &ont sto* the sei8'!e4.+. Absence sei8'!es #id sta!es into s*ace" doing *oo!l0 in school" e0e blin#ing" li* smac#ing"55G c +$sec s*i#e and &a,e *atte!n. )( c ethos'(imide.?. )IA ocal" ab!'*t onset lasting less than 1 ho'!" s0m*toms !esol,e ate! 1 da0. Ris# ost!o#e in da0s to &ee#s. Amo!osis 'ga( c'!tain o,e! an e0e d'e to !etinal d0s'nction4 needsDo**le! /$S o ca!otids o! 9RA. Gi,e he*a!in ac'tel0 i no cont!aindications4" then long te!mas*i!in. I stenosis 2E3K" ama'!osis 'ga($)IA o! small" non>disabling st!o#e do C5A ca!otidenda!te!ectom04 and gi,e as*i!in. I stenosis BE3K" se,e!el0 disabling st!o#e" o! )IA$st!o#e ine,ol'tion gi,e dail0 as*i!in alone.-4" -etase!on In>-4 and Co*a(one Glati!ame! acetate44. I st'c# in 1 *osition all da0" gi,e bacloen o! )i8anidine. Iincontinent gi,e o(0b'tinin o! bethanacol.F. G'illain>-a!!e S0nd!ome h$o /RI o GI inection cam*0lobacte! %e%'ni4 o! imm'ni8ation 1&ee# beo!e de,elo*s onset o s0mmet!ic" assending *!og!essi,e &ea#ness o! *a!al0sis and loss oD)Rs. 1st ste* is 7)s 9CCOD is !es*i!ato!0 d0s'nction d'e to *a!al0sis" so monito! the *ts@I negati,e ins*i!ato!0 o!ce4 and i it #ee*s dec!easing" conside! int'bation4. 9ost acc'!ate test is59G. hen do 0o' choose L7 Last sho&s ele,ated CS *!otein4. )( c I6IG o! *lasma*he!esisnot ste!oidsU4.. 90asthenia G!a,is Ab against Ach !ece*to!s in &omen 3>?30o. Loo# o! *tosis" di*lo*ia"diic'lt0 s&allo&ing and &ea#ness c !e*etition at the end o the0 da0 the0 a!e e(ha'sted4. -est

initial test is Ach Ab @O) ed!o*honi'm test" &hich is nd o! i the0 al!ead0 mention the Ach Ab4.9ost acc'!ate test is 59G. )( 90asthenia c!isis b!eathing *!oblems4 c D$C anitchone!gics and gi,eI6IG and 7lasma*he!esis @O) ste!oids4. )( o! ch!onic disease: B=3 gets th0mectom0 do CHR"Chest C)4" 2=3 gets neostigmine and ste!oids" then a8athio*ine$c0clos*o!ine$tac!olim's. hat ab(is cont!aindicated Aminogl0cosides.+33. 5aton>Lambe!t Ab against *!es0na*tic calci'm channels ca'sing limb &ea#ness that getsst!onge! c !e*etiti,e stim'lation o**osite o g!a,is4"no loss o D)Rs o! e(t!aoc'la! maniestations"a$& small cell l'ng cance!" t( c g'anidine. cabs a!e cont!aindicated4.+31. @e'!os0*hilis te!tia!0 t!e*onema *allid'm disease. )!eat c high dose *enicillin. Ate! gi,ing


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*enicillin" *t ma0 de,elo* h0*otension" e,e!" A" chills and tach0ca!dia &ithin ? ho'!s o t!eatmentd'e to t!e*onemal *!od'cts a!isch>e!(heime! !eaction" this is not a *enicillin !eaction4. )( cas*i!in.+3. 90otonic D0st!o*h0 3>+30o g'0 g!abs something and cant let go im*ai!ed !ela(ation4 d$tm'tations in chlo!ide channel. )( c *hen0toin.+3+. D'chenne 9'sc'la! D0st!o*h0 HLR" bo0s +>E ha,e m'scle &ea#ness" ,e!0 high CN" cal

*se'doh0*e!t!o*h0" Go&e!s sign #id climbs his legs to stand" loo# at it in google ,ideos its sosad4. Nid is in &heelchai! b0 teenage! and dead b0 3. D( c m'scle bio*s0.+3?. 9itochond!ial 90o*ath0 a#a Le,e!s he!edita!0 o*tic at!o*h0 e,e!0 mom gi,es to allo,e!s*!ing no male t!ansmission4. Loo# o! !agged !ed ibe!s on bio*s0.+3!olling !esting t!emo!"cog&heel !igidit0" sh'ling gait" b!ad0#inesia" mas#ed acies4. Ca'sed b0 loss o do*amine!gicne'!ons in s'bstantia nig!a. )(: 9ild s$s can still ta#e ca!e o themsel,es4: B=30o c Anticholine!giccabe!geline$ben8t!o*ine$t!ihe(0l*henid0l4" 2=30o c Amantidine. I Se,e!e s$s: 1st Le,o$Ca!bido*a"nd is DA agonist *!ima*e(ole" !o*ini!ole" *e!golide4" +!d CO9)>inhibito!s )alco*one4" ?th 9AOIselegiline4. Some anti*s0chotics halo*e!idol" !is*e!idone" 97)74 can ca'se *a!#inson>li#es0m*toms" t( c anticholine!gics ben8t!o*ine$ t!ihe(0l*henid0l$ cabe!geline4. Yo'ng g'0 c7a!#insonism" b't not on meds" thin# o ilsons disease.+3. Al8heime!s *!og!essi,e dementia memo!0" lang'age" ,is'os*atial" mood"hall'cinations" *e!sonalit0$beha,io!4 in mid>late lie. a$& Do&ns s0nd!ome am0loid *!ec'!so!*!otein4. D( c 9RI sho&ing co!tical at!o*h0" senile *la'es" ne'!oib!illa!0 tangles. )( c done*e8il"

!i,astigmine and galantamine to inc!ease Ach %'st in b!ain.+13. 7ic#s ea!l0 aged ?34 *e!sonalit0 change" dementia. C)$9RI sho&s !ontetem*o!alat!o*h0" a!g0!o*hilic ne'!onal 7ic#4 bodies in !ontal and tem*o!al lobe" s*a!ing s'*e!io! tem*o!alg0!'s gene!all0 no memo!0 *!oblems4.+11. 9'lti>ina!ct Dementia ste*&ise dementia in a *t c bad medical histo!0 )@" D9" etc.4.)he0 &ill desc!ibe the *t as *!og!essi,el0 getting &o!se" little>b0>little. D( c 75)$S75C) scansho&ing m'ltiocal dec!eases in ce!eb!al blood lo&. )( c as*i!in+1. @o!mal 7!ess'!e 0d!oce*hal's > Q&et" &ac#0" &obbl0incontinent" dementia" ata(ia4.D( c C) scan" t( c ,ent!ic'lo*e!itoneal sh'nt.+1+. C!e't8eldt>a#ob > 0o'ng g'0 c !a*idl0 *!og!essi,e dementia" m0oclon's d'e to abno!malisoo!m o *!ion *!otein. D( c bio*s0 nothing else4. @o t!eatment.+1?. @a!cole*s0 da0time slee* attac#s c cata*le(0" h0nogogic going to slee*4$h0*no*om*ic&a#ing '*4 hall'cinations" slee* *a!al0sis. Ra*id onset o R59 slee*. )( c am*hetamines o!

slee*iness" clomi*!amine o! cata*le(0.+1 M head t!a'ma" M A" M LOC" l'cid inte!,als ate! b!ie LOC ollo&ed b0inc!easing obt'ndation" middle meningeal a!te!0. D( c C) &itho't cont!ast sho&ing con,e(hematoma. )( c 1st h0*e!,entilate and ele,ate head" nd e,ac'ate" +!d mannitol+1F. S'bd'!al ematoma > Mhead t!a'ma" M A" M LOC" b!idging ,eins in%'!ed" can be ac'te C)sho&ing conca,e o! c!escent>sha*ed hematoma4" da0s 9RI4" o! g!ad'al dete!io!ation 9RI4. )( c


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int!an'clea! incl'sions. )( c ganciclo,i!" o! osca!net i !esistant.+EF. S0*hilis D( c da!#ield mic!osco*0 !*!$,d!l ma0 be negati,e 'ntil seconda!0 disease4. Child&ill ha,e 'tchinsons teeth" sabe! shins" saddle nose and Fth c!anial ne!,e deaness. )( c7enicillin" i alle!gic then desensiti8e *enicillin.+E. S6 i ,esic'la! lesions a!e *!esent in ,'l,a! a!ea at time o deli,e!0" do C$S. I lesions a!eonl0 on legs" none o ,'l,a$labia" co,e! &ith to&el and *!oceed c ,aginal deli,e!0 ne,e! done in !eal

&o!ld4. I histo!0 o lesions o c'lt'!e 1 &ee# beo!e deli,e!0" do C$S.+F3. e*atitis - &o!st in +!d )9. I mom has M-sAg" ne(t ste* is to get L)s i high" shehas acti,e disease" i no!mal she ma0 %'st be a ca!!ie!4. /*on deli,e!0" gi,e bab0 ,accine and bIG&ithin 1 ho'!s o bi!th. Gi,e mom In>a c lami,'dine.+F1. I6 5LISA then &este!n blot. I M4" get ,i!al load and CD>? co'nt. I ,i!al load 21333 o! CDBsto!ma**ea!ance. Com*lete ?=HH" all !om dad4 ha,e no etal tiss'e" incom*lete does. )( c DPC and $'hCG &hile *t is on OC7s. I hCG still doesnt all" *t has cho!ioca!cinoma and needs 9)Hand actinom0cin.

+F=. +!d )9 bleeding: 1st ste* is 'lt!aso'nd absol'tel0 not *el,ic e(am4. 7ossible choices a!e*lacenta *!e,ia" ,asa *!e,ia" ab!'*tion *lacenta" 'te!ine !'*t'!e.+FE. 7lacenta *!e,ia *ainless bleeding c 'lt!aso'nd sho&ing *lacental im*lantation o,e! thelo&e! 'te!ine segment. 7t ma0 sa0 she &o#e '* in a *ool o blood. )!eatment: I *!ete!m gestation"*t is stable and bleeding sto*s: 1st admit" then bed!est" get ,ital signs$labs" t!ans'se i needed and*'t on ste!oids o! l'ng mat'!it04 c magnesi'm s'late. I *t is 2+E &ee#s" do C>section &hethe!she is still bleeding o! not4.+FF. 6asa *!e,ia loo# o! t!iad: !'*t'!e o memb!anes g'sh o l'id4" b!ight !ed *ainless ,aginalbleeding and etal b!ad0ca!dia. @e(t ste* is C>section.+F. Ab!'*tio *lacenta *ain'l ,aginal bleeding i bleeding sto*s" it ma0 be collecting in!et!o*e!iteal a!ea4" 'te!ine tende!ness and inc!eased 'te!ine tone &ith h0*e!acti,e cont!action*atte!n. 9a0 e,en ca'se DIC. I mild to mode!ate" gi,e l'ids and deli,e! ,aginall0. I se,e!e" *t &illha,e ac'te abdm !oc# ha!d4 c *!oo'nd h0*otension" ne(t ste* is immediate C>section.

+3. /te!ine !'*t'!e s'dden abdm *ain c *!o'se ,aginal bleeding and abno!mal etal hea!t !ate.)!eat c immediate C>section and then 'te!ine !e*ai! i mom &ants #ids in 't'!e" o! h0ste!ectom0 ishe doesnt.+1. Rh Isoimm'ni8ation mom is Rh>4" dad is Rh M4" second bab0 is aected c e!0th!oblastosisetalis. 7!e,ent c RhoGA9 at F &ee#s and E ho'!s o deli,e!0" DPC o! C6S. I mom al!ead0 hasRh antibodies" RhoGA9 is 'seless onl0 o! *!e,ention4 and so the ne(t ste* is to get Rh tite!s. I21:F" do amniotic l'id s*ect!o*hotomet!0 to assess se,e!it0 o hemol0sis.+. 7!emat'!e !'*t'!e o memb!anes s'dden g'sh o l'id. @e(t ste* is e!n test" nit!a8ine test.Ris# o cho!ioamnionitis mate!nal e,e!" 'te!ine tende!ness" 7RO9" c'lt'!e$g!am stain amniotic


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section.?3. 7!olonged +!d stage ail'!e to deli,e! *lacenta &ithin +3 min'tes. Ca'ses incl'de *lacentaacc!eta A o! A" acc!eta adhe!es to 'te!ine &all" 9CC is *lacenta *!e,ia4" *lacenta inc!eta In o! In"inc!eta goes into 'te!ine &all4" *lacenta *e!c!eta in,ades 'te!ine &all4. )( c 1st man'al *lacental!emo,al" nd c'!ettage in the OR and +!d h0ste!ectom0.?13. 7!olonged ?th stage: 7ost*a!t'm hemo!!hage: 2la* o! b$l 'te!ine andh0*ogast!ic a!te!0 ligation and h0ste!ectom04" DIC" 'te!ine in,e!sion !om *'lling4.?11. 7!ola*sed 'mbilical co!d eme!genc0 d$t co!d com*!ession. Do not hold the co!d o! attem*tto !einse!t it into the 'te!'s. 1st ste* is *lace *t in #nee>chest *osition" nd ele,atate the *!esentingco!d a,oid *al*ating4" +!d eme!genc0 c>section.?1. Sho'lde! D0stocia 9CC is mac!osomia D94. 1st ste* is 9cRobe!ts mane',e!mate!nal thigh le(ion c s'*!a*'bic not 'ndal4 *!ess'!e4. nd C>section.?1+. 7ost*a!t'm e,e! Da0 3 is atelectasis d$t anesthesia4" Da0 1> is /)I" Da0 >+ is5ndomet!itis this is &hat the0 &ill as#" ca'ses incl'de C>sections" *!olonged 7RO9" *!olongedlabo!. )( c am*icillin" gentam0cin" met!onida8ole4. Da0 ?>< is &o'nd inection" Da0 = is *el,i(abscess$se*tic th!ombo*hlebitis the0 &ill sa0" *t still s*i#es e,e! des*ite antibiotics. 1st ste* is C)scan" i the!e is an abscess d!ain it" i the!e is no abscess" *t has th!ombo*hlebitis" t( c he*a!in4. It isno!mal to ha,e discha!ge i!st !ed" then &hite lochia4 '* to 13 da0s *ost*a!t'm. I the!e is a badsmell" e,e! o! tende!ness" s's*ect endomet!itis.?1?. 9astitits e,e!" 'nilate!al b!east tende!ness" e!0thema and edema d'e to lactational ni**let!a'ma. )!eat c o!al clo(acillin and contin'ed b!east eeding !om that b!east. I the same s0m*tomsocc'!" b't the &oman &as not lactating" thin# o cance!.?1 *ost*a!t'm emale c d0s*nea" tach0*nea" chest *ain" h0*otensionand$o! DIC.

GY@:

?1. Ce!,ical D0s*lasia i!stl0" note the &o!d d0s*lasia its not cance!" its *!ecance! that has not0et in,aded the basement memb!ane o! aected l0m*hatics4 as0m*tomatic o! lesions on ce!,i(.9CC is 76 1=$1F =M11 a!e benign4. Ris# acto!s a!e ea!l0 aged inte!co'!se" smo#ing" m'lti*le*a!tne!s and imm'nos'**!ession. Sc!eening c 7a* smea! sho&s d0s*lasia at t!anso!mation8one4. Sta!t *a* smea!s ann'all0 at 1F0o o! age o se('al acti,it0 onset o! + consec'ti,e 0ea!s" andthen e,e!0 + 0ea!s the!eate!. I *t has !is# acto!s" *a* smea! ann'all0. In o!de!: 1st 7a*" ndcol*osco*0 abno!mal indings incl'de mosaicism and &hite e*itheli'm; col*osco*0 tells 0o' &he!ethe disease is" so i a *t comes to 0o' &ith a lesion on he! ce!,i(" 0o' can s#i* *a* smea! and s#i*this *hase beca'se 0o' al!ead0 #no& &he!e the lesion is and go !ight to stage +4" +!d 5ctoce!,icalbio*s0 and 5ndoce!,ical c'!ettage 5CC sho'ld not be done on *!egnant *ts4" ?th Cone bio*s0 and

t!eat &ith c!0othe!a*0 mild CI@4 o! L557 loo* elect!odiathe!m0 e(cision *!oced'!e o! mode!ateCI@4. Remembe!" its not cance!" do not choose chemo" s'!ge!0 o! !adiation o! d0s*lasia.?3. ASC/S 7a* smea! ma0 sho& at0*ical s'amo's cells o 'ndete!mined signiicance" &hichis basicall0 the ste* !ight beo!e 76 so 0o' &o'ld not 0et ind #oiloc0tosis4. )he ne(t ste* &o'ldbe 76$D@A testing. I the smea! !et'!ns c 76 = o! 11" *!oceed &ith col*osco*0 and bio*s0$5CC.I the smea! !et'!ns >4 76 11$1=" then %'st !e*eat *a* smea! in 1 0ea!.?1. In,asi,e Ce!,ical cance! no& it has *enet!ated the -9. Loo# o! *ostcoital ,aginalbleeding. D( c ce!,ical bio*s0 1st dont *ic# *a* o! col*osco*04. Onl0 a *el,ic e(am and I67can be 'sed to stage ce!,ical cance!. )(: Stage Ia1 B+mm in,asion4 do )A total abdominal


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h0ste!ectom04. Stage Ia +>'* c *a* smea!s e,e!0 +months o! 0ea!s ate! t("then e,e!0 = months the!eate!. 9C site o metastasis is li,e!. 9CCOD is '!emia d$t '!ete!alobst!'ction.?. Ce!,ical cance! in *!egnanc0 col*osco*0 and bio*s0" b't no 5CC. I CI@ no in,asion4" *a*

e,e!0 +mo then !e*eat col*osco*0 and *a* months *ost*a!t'm. I mic!oin,asion +>le0di cell t'mo! high testoste!one ca'sing ,i!ili8ation4" G!an'lose>theca cell t'mo! highest!ogen ca'sing emini8ation and *!ecocio's *'be!t04" 9eigs s0nd!ome o,a!ian ib!oma"asicets and R h0d!otho!a(4" N!'#enbe!g t'mo! stomach cance! c metastasis to o,a!ies4.?. Gestational )!o*hoblastic @eo*lasia s$s: ,e!0 high hCG" la!ge 'te!'s" *!egnanc0 c bleed"

no etal hea!t tones" high -7 in 1st )9" h0*e!emesis" h0*e!th0!oidism m'st to )S in a *t c G)@4"sno&sto!m '$s. Can be benign mole4 o! malignant cho!ioca!cinoma4. Com*lete mole is an em*t0egg e!tili8ed c single H>s*e!m ?=HH so s*e!m d'*licated4" no et's" 'te!'s illed c g!a*e>li#e,esicles same desc!i*tion as sa!coma bot0!oides in 0o'ng gi!ls4. Incom*lete mole is a no!mal egg c s*e!m ca'sing =HHH4" M et's$co!d" b't et's dies. o! eithe! mole" t!eatment is DPC" $' hCG"sta!t OC7s. I cho!ioca!cinoma" 1st ste* is C) head$chest$abdo$*el,is to !$o 95)S. I *oo! *!ognosishCG 2?3"333" b!ain$li,e! mets" 2= months o DPC4 do !adiation and chemothe!a*0 9AC: 9)H"Adenom0cin" C0toto(in4. I good *!ognosis" gi,e 9)H onl0 and $' hCG e,e!0 &ee# o! +months&hile on OC7s.?+3. /te!ine *!ola*se loss o 'te!ine s'**o!t d'e to ca!dinal ligament d0s'nction. 9CC ischildbi!th. -est t( is ,aginal h0ste!ectom0 c ant$*ost !e*ai! 0es" i!stU4" b't i *t !e'ses s'!ge!0" doNegel e(e!cises" est!ogen R) and *essa!ies.?+1. St!ess Incontinence &ea# *el,ic loo! ca'ses 0o' to '!inate &hene,e! 0o' snee8e$co'gh"

none at night. D( c >ti* test. )( c Negel e(e!cises" then s'!ge!0 9a!shall>9a!cheli>N!an8*!oced'!e4.?+. /!ge Incontinence in,ol'nta!0 det!'so! cont!actions ca'sing s*'!ts o '!ine to all at an0time. D( c c0stomet!ic st'dies. )( c anticholine!gics Dit!o*an4?++. O,e!lo& Incontinence dene!,ated bladde! D9" 9S" C6A4 ca'ses bladde! to #ee* illing'*" th's high !esid'al ,ol'me e,en ate! '!ination. )( c choline!gics bethanecol4.?+?. 5ndomet!iosis d0meno!!hea" d0s*a!e'nia" ine!tilit0" 'te!osac!al ligament nod'la!it0in thec'l>de>sac" chocolate c0sts. D( c la*a!osco*0. )(: 1st OC7" nd Dana8ol and Le'*!olide best t("b't not 1st beca'se o side>eects4" +!d s'!gical !esection" ?th *!egnanc0 ho&e,e! ha!d" d$t


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ine!tilit04" 4 stain. )( c a8ith!om0cin 1dose4 o! o!al do(0c0cline E da0s4.?+. Gono!!hea Lo&e! G/ ca'ses d$c" itching" b'!ning" d0s'!ia; /**e! G/ ca'ses abdo$*el,ic*ain. Disseminated &hen the!e is de!matitis" *ol0a!th!itis o! tenos0no,itis. 7t has ,'l,o,aginitis cm'co*'!'lent d$c c C9) on biman'al e(am. D( c chocolate aga!" G!am >4 di*lococci on stain. )(o! GC and Chlam0dia4 Cet!ia(one M Do(0c0cline.??3. 7ID lo&e! abdominal *ain" adne(al tende!ness" C9) and e,e! 1 &ee# ate! menses in ase('all0 acti,e emale. Ce!,icitis onl0 ,aginal D$C" no *ain t( G$C4" Sal*ingo>oo*ho!itis b$llo&e! abdo$*el,ic *ain c C6A tende!ness t( G$C4" )'bo>o,a!ian abscess *t &ill loo# se*tic"se,e!e *ain" n$," d0sche8ia" e,e! t( c Am*icillin" Gentam0cin and lag0l. I !'*t'!ed" e(>la* isdone4. )( o! G$C in these cases a!e: o't*atient: cet!ia(one M do(0c0cline" in*atient: clindam0cin Mgentam0cin??1. Ga!dne!ella 6aginosis ish0 odo! on &hi test" * =" cl'e cells" t( c met!onida8oleclindam0cin i *!egnant in 1st )94??. )!ichomonas ,aginalis !oth0" g!een smell0 discha!ge c st!a&be!!0 ce!,i(" * *!egnanc0" ib!oids$adenom0osis" D/-4"*ostmeno*a'sal 2 endomet!ial cance!4. A neonate c ,aginal bleeding is no!mal d'e tomate!nal est!ogen" th's !eass'!e mom.??E. 7!ecocio's 7'be!t0 no!mall0: b!east de,elo*ment V 0o" *'bic$a(illa!0 hai! V 130o"g!o&th V 110o" mena!che V 10o. I onl0 1 stage occ'!s ea!l0" this is Incom*lete isose('al*!ecocio's *'be!t0" ne(t ste* is C) b!ain$abdo$*el,is. I all stages occ'! ea!l0" this is com*leteisose('al *!ecocio's *'be!t0" ne(t ste* is t( c constant GnR stim'lation to dec!ease est!ogen4. I*t has bone lesions and caJ[>a'>lait s*ots" *t has 9cC'ne>Alb!ight S0nd!ome. I *t has highest!ogen c a *el,ic mass" the0 ha,e a g!an'lose>theca cell t'mo!" t( c s'!ge!0.??F. D0s'nctional /te!ine -leeding 9CC is ano,'lation d$t 'no**osed est!ogen" so nosec!eto!0 *hase d$t lac# o *!ogeste!one4 c 'nstable endomet!ial thic#ening. 7t &ill ha,e h$oi!!eg'la!" 'n*!edictable menst!'al bleeding &itho't c!am*s. @e(t ste* is endomet!ial bio*s0 to !$o

cance!. )( c @SAIDS i she desi!es child!en" c0clic *!ogestin the!a*0 o! dail0 combined OC7s i shedoesnt desi!e child!en o! has meno!!hagia.??. 7!ima!0 Ameno!!hea 1st ste* is *!egnanc0 test &hethe! she sa0s she is se('all0 acti,e o!doesnt4" nd ste* is *h0sical e(am: M4 b!easts and M4 'te!'s >2 chec# *!olactin" i no!mal !$oim*o!e!ate h0men c0clic menst!'l *ain c b'lging h0men" *!edis*osition to endomet!iosis" t( cs'!ge!04 and t( c *!ogeste!one. M4 b!easts and >4 'te!'s >2 get #a!0ot0*e" i ?= HY" *t hasAnd!ogen Insensiti,it0 S0nd!ome )estic'la! emini8ation" no *'bic hai!" ne(t ste* is !emo,e testes!om abdm4" i ?=HH" *t has Ro#itan#0>a'sen s0nd!ome she &ill ha,e *'bic hai!4. >4 b!east andM4 'te!'s >2 gonadal d0sgenisis" so ne(t ste* is get #a!0ot0*e to !$o )'!ne!s s0nd!ome ?


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&ebbed nec#" a! s*aced ni**les" st!ea# o,a!ies" *!emat'!e o,a!ian ail'!e" needs est!ogen4.?


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deect$ASD$6SD" d'odenal at!esia" simian c!ease" Al8heime!s V ?30o" e*icanthal olds. 7!enatald(: high hCG" lo& A7" lo& est!iol" inc!eased mate!nal age" amniocentesis" '$s sho&s thic#enedn'chal olds" C6S V >1. @eonatal: 1st ste* is echo" then genetic co'nseling.?=3. 5d&a!ds S0nd t!isom0 1F" I/GR" !oc#e!>bottom eet" clenched hands" 7DA$6SD?=1. 7ata's S0nd t!isom0 1+ 7 o! 7: clet li7" clet 7alate4" holo*!osence*hal0" !enal andoc'la! malo!mations.

?=. C!i d' Chat S0nd Ch!om


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ma!tin media" t( c *a!ente!al ab(.+mo4 has meningitis" osteom0elitis" se*tic a!th!itis and occ'lt bacte!emia. 7!e,ent c c'lt'!e at ++E and *enicillin at bi!th. @eonates gi,en ab( i eb!ile.

7SYCIA)RY

+3K c'!se4" loo# o! males c moto! tics blin#ing" g!'nting"th!oat clea!ing" g!imacing" ba!#ing" sh!'gging4 that a!e e(ace!bated b0 st!ess and !emit c acti,it0 o!slee*. Lin#ed to ADD and OCD. )(: 1st alo*e!idol im*!o,es F3K b't &atch o! 57S" mentald'lling and ta!di,e d0s#inesia4. nd 7imo8ide o! Clonidine 2


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coma and blac#o'ts. ithd!a&al incl'des t!emo!" agitation" i!!itabilit0" n$," e,e!" sei8'!es" deli!i'mt!emens onset o deli!i'm" ,i,id a'dito!0$tactile$,is'al hall'cinations" *a!anoid del'sions >+ da0s*ost cessation o long>te!m hea,0 'se4. )( into(ication s'**o!ti,el0. )( &ithd!a&al c ,italsign$elect!ol0tes$9g$thiamine$,it -1$olate$gl'cose monito!ing. nd 0d!ation c thiamine beo!egl'cose *!e,ent e!nic#e4" +!d ben8odia8e*ine chlo!dia8e*o(ide4. )( de*endence c con!ontationo denial and !ehab AA4. S*eciic managements: Alcohol hall'cinations chlo!dia8e*o(ide" I6"

halo*e!idol4" e!nic#es ence*halo*ath0 s'dden ata(ia" con'sion" n0stagm's" late!al !ect's*als0 !om thiamine deicienc0. )( c thiamine4 No!sa#os s0nd!ome se,e!eante!og!ade$!et!og!ade amnesia" conab'lations and *ol0ne'!itis !om thiamine deienc04.acting ben8o dia8e*am"clona8e*am4 and g!ad'all0 &ithd!a&.a&a04. Ch!onic 'se ca'ses amoti,ational s0nd!ome andmemo!0 im*ai!ment.s0stemati8ed del'sion.5!otomanic on is lo,ed b0 a amo's othe!" @-95 + )4" g!andiose one *ossesses g!eat talent4"%ealo's con,iction that lo,e! is 'naith'l4" *e!sec'to!0 one is cons*i!ed against" 9C4" somatic one


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has a *h0sical abno!malit0 li#e odo!4. )(: 1st hos*itali8ation o! inabilit0 to cont!ol s'icidal$homicidalim*'lses o! dange! a$& del'sions" nd *s0chothe!a*0" +!d anti*s0chotics$antide*!essants.


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satisaction.com*'lsi,e t( c l',o(amine4" De*endent" A,oidant does not &ant to bealone 'nli#e schi8oid4" b't ea!s !e%ection4eects. Ad,e!se>eects:o'!s>Da0s: D0stonia s*asms4" )o!ticollis and oc'log0!ic c!isis e0es sta0 loo#ing '*4. )( cben8t!o*ine" di*henh0d!amine o! t!ihe(0l*henidate. ee#s: A#athisia !estlessness4. )( c lo&e!ingd!'g>dose" ben8o" --" o! s&itch to at0*ical best4. 9onths: )a!di,e d0s#inesia li*>smac#ing4. )( c

s&itching to at0*ical. @e'!ole*tic malignant s0nd!ome: 9C c high>*otenc0 d!'gs" inc!eased !is# i'sed c lithi'm" e,e!" !igidit0" a'tonomic instabilit0" ,e!0 high C7N le,els" high NM" t( c I6 dant!oleneo! b!omoc!i*tine. Clo8a*ine ca'ses ag!an'loc0tosis m'st do &ee#l0 C-C i ta#ing4" thio!ida8ineca'ses !etinal *igment de*osits" chlo!*!oma8ine ca'ses %a'ndice and *hotosensiti,it0.


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si8e" its benign hama!toma" discha!ge home4. I the lesion &as the!e and has gotten bigge!"ass'me cance!. o&e,e!" i the lesion &as not in the old>(!a0" then classi0 his !is#. I he is lo& !is#B?30o" nonsmo#e!4 then its *!obabl0 benign hama!toma" CHR e,e!0 +mo o! 0!s4. I he is high>!is# 2+months" 2=< D!. ishe! sa0s 2a g!adient: 1


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la!ge! stones ma0 com*letel0 obst!'ct4 e(t!aco!*o!eal lithot!i*s0 i '**e! G/ t!act" o! '!ete!osco*0 ilo&e! G/ t!act.=?+. An0time 0o' s's*ect '!eth!al in%'!0 high !iding *!ostate o! blood at '!eth!al meat's4" ne(t ste*is !et!og!ade '!eth!og!am not ole0U4.=??. e gi,e c0clos*o!ine o! g!at !e%ection" b't c0clos*o!ine itsel is ne*h!oto(ic. o& do 0o'die!entiate !enal g!at !e%ection !om c0clos*o!ine to(icit0 Do *e!c'taneo's needle bio*s0. Also" i

sit'ation occ'!s" t!0ing inc!easing c0clos*o!ine: i #idne0 'nction &o!sens" its ne*h!o(icit0. I #idne0'nction im*!o,es" its g!at !e%ection ho&e,e! t!0 *e!c'taneo's needle bio*s0 i!st in !is# o&o!sening #idne04.=?


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Step 2ck cram notes

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