CARDIOLOGY: 1. Stable angina chest discom o!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 do CA-G .. /nstable angina 'n*!edictable at !est o! ab!'*tl0 &o!sening *atte!n o angina" *!olonged d'!ation 12.34" d( c 5CG 1st 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$7!in8metal Angina chest *ain at !est" S) ele,ation 1note the + ca'ses o S) ele,ation a!e 9I 1in e!io! 1LDA4 is II" III A6:; late!al 1ci!c'm le( a4is I" A6L" 6<" 6=; ante!io! is 61>6?4" 7e!ica!ditis 1di 'se" meaning e,e!0 lead has it4" and 6a!iant Angina4 &ith negati,e ma!#e!s. )!eat &ith Ca>channel bloc#e!s 1Cabs4 o! nit!ates. ?. Ac'te 9I chest discom o!t" c!'shing *ain &itho't &a!ning 1 emales and diabetics get at0*ical chest *ain" &hich is abdm *ain" atig'e" nec# *ain o! &ea#ness4" *!olonged d'!ation 1ho'!s4" 5CG ma0 be abno!mal 1st ele,ation o! de*!ession4" inc!eased ma!#e!s" t( c 9O@A" AC5I" he*a!in" bb" t7AAs i B1. h!s a te! onset o *ain" com*lications incl'de 9R" 6SD" ca!diac !'*t'!e and ,ent!ic'la! ane'!0sm. <. CAD !is# acto!s: smo#ing" C)@" amil0 h$o *!emat'!e CAD 1B<< in male" B=< in emale4" male 2?<" emale 2<<" CDL B?3" LDL 2133. 1I CDL 2=3" s'bt!act one4. 2. !is# acto!s: diet i 21=3" d!'gs i 21D3; . o! mo!e !is# acto!s: diet i 21+3" d!'gs i 21=3" *t has CCD: diet i 2133" d!'gs i 21+3. =. Ca'ses o high o't*'t hea!t ail'!e se,e!e anemia" th0!oto(icosis" ac'te be!ibe!i" *agetAs d8" la!ge A6 ist'la E. Ac'te 7'lmona!0 edema t( 1st '*!ight *osition and O." .nd loo*s" nit!ates" mo!*hine" and +!d int'bate i se,e!e. F. COC9 t( 1st a,oid deh0d!ation" .nd st!en'o's acti,it0 *!ohibited" +!d --" ?th CabAs" <th s'!gical m0ectom0. -est d( is histo!0 1sc!een amil04 and *h0sical" then 5cho. D. Rest!icti,e C9 G6D" edema and ascites" d( c echo" t( 1st di'!etics$ dec!ease salt 13. 90oca!ditis histo!0 o! /RI 1co(sac#ie4 then e,e!" d0s*nea" C7" edema" tach0 11. Ac'te 7e!ica!ditis *ositional C7" t( c @SAIDS 1.. 7e!ica!dial e 'sion *e!ica!dial !iction !'b" t( c *e!ica!diocentesis 1+. )am*onade bec#s t!iad 1G6D" m' led hea!t so'nds" *'ls's *a!ado(ic's c h0*otension4" t( c *e!ica!diocentesis 1?. Const!icti,e *e!ica!ditis *e!ica!dial #noc#" #'ssma'l b!eathing" CHR sho&s *e!ica!dial calci ication" t( c di'!etics 1<. Ac'te R: 75CCS 1*ol0a!th!titis" e!0thema ma!ginat'm" ca!ditis" cho!ea" s'bI nod'les4 in #ids <>1<0o d'e to g!o'* A st!e*. )( is Ab(" bed !est" salic0lates" sedati,es o! cho!ea" ste!oids o! ca!ditis. 1=. 9it!al stenosis most associated c RCD" LA enla!gement J hoa!seness" d0s*hagia" and A. ib" diastolic !'mble at L6 a*e(" t( c di'!etics" co'madin o! a. ib" endoca!ditis *!o*h0la(is" balloon ,'l,o*last0 1E. 9it!al !eg'!ge a$& ma! ans" RCD" m0(omato's change" high>*itched holos0stolic m'!m'! at le t ste!nal bo!de!" t( c di'!etics" dilato!s" endoca!ditis *!o*h0la(is" mit!al ,al,e !es*acement$!e*ai! 1F. Ao!tic !eg'!ge congenital" ma! ans" t!a'ma" ao!titis" high>*itched dec!escendo diastolic m'!m'! at le t ste!nal bo!de! and$o! a*e( and &ide *!ess'!e" t( c ,al,e di'!etics" dilato!s" endoca!ditis *!o*h0la(is" ,al,e !e*lacement 1last4 1D. Ao!tic stenosis calci ic in elde!l0" b'c's*id in congenital" angina" d0s*nea" s0nco*e" mid>late s0stolic m'!m'! at base !adiating to ca!otids" t( c !e*lacement 11st ste*4 .3. 5ndoca!ditis i dental *!oced'!e gi,e amo(icillin 1clindam0cin i alle!gic4" i GI$G/ *!oced'!e gi,e amo(icillin c gentam0cin 1,anco &ith gentam0cin in alle!gic4 .1. 6SD memb!ano's se*t'm" ha!sh s0stolic m'!m'! at L ste!nal bo!de!" s*ontaneo's clos'!e in +3><3K" t( o! small ,sd obse!,e" o! la!ge ,sd and signi icant sh'nt" s'!gical !e*ai! and endoca!ditis *!o*h0la(is. ... ASD &ide" i(ed s*litting S." t( i small obse!,e" i la!ge s'!ge!0 .+. 7DA machine!0 m'!m'!" &ide s0stemic *'lse *!ess'!e" t( c indomethacin then s'!ge!0

.?. Ao!tic Coa!ctation /5 C)@ c L5 h0*otension" !ib notching" L5 cla'dication" CA" d( &ith 9RA o! cont!ast ao!tog!a*h0" t( is s'!ge!0 1best at ?>F0o4. .<. )et!alog0 o :allot 7RO6e 17'lm C)@" R6C" O,e!!iding ao!ta" 6SD4" #id sL'ats to inc!ease s0stemic !esistance" th's dec!eased R to L sh'nt" c0anosis in #id 210o" CHR c boot sha*ed hea!t" con i!m d( &ith cath" t( is s'!ge!0" endo *!o*h0la(is .=. )!ans*osition o g!eat ,essels 9CC o c0anosis in .?h!s o bi!th" t( c s'!ge!0 .E. Initial )(As: CC: J thia8" bb" acei" a!b" aldo ant; 7ost>9I J bb" acei" aldo ant; D9 J acei" bb" thia8" a!b; !ec'!!ent st!o#es J thia8" acei .F. C0*e!aldoste!onism h0*o#alemic met al#alosis" 7RA !atio" ca*to*!il>s'**!ession test" high aldo le,el" .?h! '!ina!0 aldo" salt loading test .D. 7heoch!omoc0toma .?h! '!ine collection o! 69A" 9RI to ,is'ali8e ad!enal t'mo!s" 9I-G i chemist!ies *ositi,e b0 C)$9RI a!e negati,e. +3. Renal a!te!0 stenosis !enal /$S c Do**le!" ca*to*!il scanning" C)$9RA" high !enin" AC5I cont!aindicated i -$L +1. /!gent , 5me!gent C)@ /!gent is %'st one high !eading 1gi,e nit!o*!'sside o! lobetolol" &ait til -7 goes do&n and d$c home4. 5me!gent is &hen the!e a!e signs o end>o!gan damage 1m'st admit and do &o!#'*4. +.. 7AD cla'dication" !est *ain" 'lce!ation at medial an#le" d( c an#le>b!achial inde( be o!e$a te! e(e!cise" angiog!a*h0" 9CC is athe!oscle!osis" t( c meds 1*ento(0 0lline" cilasta8ol" cabAs4" angio*last0$stenting" a,oid const!icting d!'gs 1bb4 ++. )em*o!al A!te!itis > 2<<0o *t c CA" scal* tende!ness" ,is'al s$s" ne(t ste* is lo&>dose ste!oids 1be o!e tem*o!al a bio*s0 o! getting 5SR4. +?. 7ol0e!te!itis C)@" abdominal *ain" n'mbness in legs" s#in indings" cns s$s" d( c bio*s0" t( &ith ste!oids. +<. A6 :ist'la th!ill$b!'it o,e! ist'la 1b'88ing so'nd4" d( c angiog!a*h0" t( c s'!gical e(cision" i congenital do conse!,ati,e management instead. +=. 6a!icose ,eins *ain" *igmentation" s'*e! icial 'lce!" t( c elastic stoc#ings +E. S'*e! icial th!ombo*hlebitis *ain" e!0thema" embolism is !a!e" t( c &a!m com*!ession" limb ele,ation and @SAIDS. +F. Dee* ,ein th!ombo*hlebitis *ain" s&elling" e,e!" M Comans sign" 75 is !is#" so m'st do *leth0smog!a*h0 o! Do**le!" t( c he*a!in$&a! a!in" ilte! i !ec'!!ent. +D. Dissecting ao!tic ane'!0sm sha!* C7 !adiating to bac#" d( c C)" )55 o! 9RI" t( 1st dec!ease -7 1nit!o*!'sside4" .nd > I ascending ao!ta 1'* to ao!tic a!ch4 do s'!ge!0" i descending ao!ta 'se meds ?3. Abdominal ao!tic ane'!0sm b!'it" d( &ith /$S" see abdominal notes ?1. Ane'!0sm o tho!acic ao!ta 1nondissecting4 ma0 com*!ess ad%acent st!'ct'!es ca'sing C7" d0s*hagia" hoa!seness" d( c ao!tog!a*h0" Athe!oscle!osis is 9CC" also d'e to c0stic medial nec!osis. )( c s'!gical g!a t !e*lacement. SNI@: ?.. CS6 t0*e 1 at mo'th" t0*e . in genitalia. Rec'!!ent e!0thema nodos'm is cha!acte!istic. D( c )8an#" t( c ac0clo,i! ?+. Ce!*es 8oste! 1shingles4 de!matomal" !eacti,ated at do!sal ne!,e !oot" t( c ac0clo,i! ??. 6a!icella 1chic#en*o(4 lesions in all stages o de,elo*ment" t( c benad!0l. In 1st )9" ca'ses mic!oce*hal0" cho!io!etinitis" I/GR and cata!acts. )!eat neonates &ith 6OIG i mom cont!acted ,a!icella &ithin < da0s o deli,e!0. ?<. Im*etigo hone0>c!'sted lesions. S a'!e's and ->hemol0tic st!e*. )( c m'ci*!ocin ?=. R'bella + da0s o ce!,ical$s'bocci*ital$*osta'!ic'la! node enla!gement" *!e,ention best c imm'ni8ation be o!e 1st )9 to *!e,ent t!iad: ,is'al 1cata!acts4" hea!ing loss" hea!t 17DA4 de ects. ?E. 9easles 1R'beola4 loo#s li#e s*illed !ed *aint o,e! 0o'! head 1!ash s*!ead beind ea!s and o,e! o!ehead to nec# to t!'n# and e(t!emities4" *!e,ent c imm'ni8ation ?F. Roseola +>< da0s o e,e!" and )C5@ !ash a te! 1ne,e! togethe!4. @o t( ?D. 5!0thema in ectios'm <th d8 sla**ed chee# a**ea!ance" *a!,o -1D" ca'ses a*lastic

c!isis in sic#le cell *atients" no t( <3. Roc#0 9o'ntain S*otted :e,e! e,e!" !ash on &!ists then *alms and soles" d( c &eil> eli( test" t( c tet!ac0cline 1chlo!am*henicol i *!egnant4 <1. L0me d8 e!0thema ch!onic'm mig!ans c cent!al clea!ing" t( is do(0c0cline 1amo(icillin i *!egnant and child!en BD0o4. <.. Scabies b'!!o&s in hands" a(illae" genitalia" highl0 contagio's" t( c *e!meth!in to the &hole amil0. <+. Alle!gic contact de!matitis t0*e ? 1cell>mediated4 h0*e!sensiti,it0 li#e *oison i,0 <?. 7so!iasis a )>cell mediated e*ide!mal h0*e!*!oli e!ation" scaling *laL'es on #nees" elbo&s" a$& cl'bbing o inge!s" &o!sened b0 antimala!ial d!'gs" lithi'm" bbAs" t( c ste!oids" calci*ot!iene. <<. Sebo!!heic De!matitis on scal* is dand!' " on #ids is c!adle ca*. )( c #etocona8ole 1*t on ch!onic a8oles need to ha,e L:)s monito!ed4 I gene!ali8ed" !$o histioc0tosis H; i se,e!e" !$o AIDS. <=. -'llo's 7em*higoid 2=30o" la!ge tense bliste!s" > ni#ols#0" IgG$C+ at de!mal>e*ide!mal %'nction" t( c *!ednisone" tet!ac0cline" a8athio*!ine 1!emembe! -CD5 -'llo's *em*higoid" C+ at De!mal 5*ide!mal %'nction4 <E. 7em*hig's 6'lga!is ?3>=30o" m'lti*le laccid b'llae" M ni#ols#0" bio*s0 sho&s acathol0sis" antibodies to e*ide!mal Ag" t( is *!ednisone" l'ids" tet!ac0cline <F. De!matitis he!*eti o!mis itch0 *a*'lo,esic'la! e!'*tion 's'all0 on shins" > ni#ols#0" a$& celiac s*!'e" t( c gl'ten> !ee diet and da*sone 1!$o G=7D i!st4 <D. :actitial De!matitis no !ash in non!eachable a!eas 1midbac#" b'tte! l0 sign4 =3. Acne 6'lga!is common acne. )( c 1st ben8o0l *e!o(ide" .nd to*ical$o!al Ab(" +!d )o*ical !etinoids" ?th Iso!etinoin 1!$o *!egnanc0 i!st4 =1. Ce!edita!0 angioedema AD" C1 este!ase inhibito! de icienc0" s'bI$m'cosal edema =.. 7ilonidal c0st s&elling" tende! sac!al mass" t( c antibiotics" IPD =+. 5*ide!moid c0st contains #e!atin" as0m*tomatic" i in ected 1IPD" ab(4" i not e(cise =?. Ca*illa!0 Cemangioma st!a&be!!0 ne,'s" !eddish>*'!*le hemangioma" t( c *'lse d0e lase! the!a*0 =<. Ca,e!no's Cemangioma *'!*lish ,asc'la! anomal0" t( c !eass'!ance" com*!ession ==. Sebo!!heic #e!atosis benign s#in t'mo! in elde!l0" b!o&n lat mac'le that a**ea!s Qst'c#> on. Obse!,e 'nless e!'*tion is m'lti*le then do sha,e e(cision and c'!ettage" c!0othe!a*0 =E. 7o!t>&ine stain a$& st'!ge>&ebe! s0nd!ome" b!ain calc ications" sei8'!es =F. Actinic Ne!atosis *!ec'!so! to SCC" s'n ind'ced #0*e!#e!atotic coa!se lesions that a!e ha!d to !emo,e. )( c c!0os'!ge!0" <:Y" e(cision =D. SL'amo's cell ca gene!all0 !om the lo&e! li* do&n. /lce! that &onAt heal. )( c s'!ge!0 o! !adiation E3. -asal cell ca gene!all0 !om '**e! li* '*. 7ea!l0 nod'le c !olled bo!de!. S'!gical !emo,al has high c'!e !ate. E1. 9elanoma A-CD 1as0mmet!0" bo!de!s i!!eg'la!" colo! ,a!iation" diamete! 2=mm4" 9C is s'*e! icial s*!eading t0*e" d( c total e(cision" lo,es to metastasi8e E.. -ehcetAs s0nd!ome a*tho's 'lce!s" genital 'lce!s and ',eitis" t( c d$c ab(" chlo!amb'cil E+. De!matom0ositis di ic'lt0 !ising !om chai!" *!o(imal &ea#ness" gott!ons sign 1*'!*le *a*'les on #nees and #n'c#les4" d( c m'cle bio*s0" t( c *!ednisone E?. Lo g!en S0nd!ome e,e!" e!0thema nodos'm 1L5 nod'les4" and sa!coidosis. E<. Am0loidosis mac!oglossia" &a(0 *a*'les on ace" congo !ed stain on bio*s0 E=. Scle!ode!ma !a0na'ds" d0s*hagia" mas#li#e ace" tight s#in" d( c s#in b(" t( s0m*tomaticall0 o! c D>7enicillamine" a$& CR5S) s0nd!ome EE. )'be!o's scle!osis !etinal *hacomas" sei8'!es" 9R" sebaceo's adenomas" ash>lea h0*o*igmented mac'les" t( c sei8'!e cont!ol. EF. 7o!*h0!ia C'tanea )a!da no abdm *ain" b't M !ed '!ine and ,esicles on bac# o hand a te! ha,ing alcohol" d!'gs" est!ogens" a$& Ce* C" t( c 1st sto* 5tOC then *hlebotom0 ED. Ac'te Inte!mittend 7o!*h0!ia abdm *ain" &ea#ness in sho'lde!s$a!ms" change in beha,io!. -loc#s *o!*hobilinogen deaminase" high ALA in the stool. F3. Acathosis @ig!ans blac# a(illa!0$nec# *atches" a$& 7COS" D9" obesit0 and abdm adenoca!cinoma. @e(t ste* is get asting gl'cose to !'le o't ins'lin !esisitance. F1. ))7 e,e!" th!omboc0to*enia 1ca'sing *etechia$*'!*'!a4" 9ACA" !enal *!oblems 1hemat'!ia4

and C@S s0m*toms 1de*!ession" CA" *s0chosis4. )( c *lama*he!esis F.. DIC all labs messed '* 1-)" 7)" 7))" ib!inogen" ib!in s*lit *!od'cts4 ca'sing c'taneo's hemo!!hage and ecch0mosis. )( 1st t!eat *!ima!0 ca'se" .nd he*a!in 5@DOCRI@5: F+. )h0!oid nod'le 1st do )SC" then do :@A 1*!e e!!ed4 o! scan to see i its hot o! cold 1cold is malignant" i hot" obse!,e do not bio*s04. 9C benign is ollic'la! adenoma" 9C malignant is *a*illa!0 1*sammoma bodies4" m'st as h$o !adiation" &o!se i *t is male" 2?3 o! 0o'ng" distant mets. I !es'lts t'!n o't that itAs a c0st" as*i!ate it and ollo&>'*" i cance!" s'!ge!0 c !adioiodine 1i *a*illa!0 o! ollic'la!4. F?. Goite! high o! lo& iodine '*ta#e" lithi'm$amiodo!one 'se" amilial" t( c le,oth0!o(ine. Do not d$c d!'g" %'st contin'e the d!'g and add le,oth0!o(ine. F<. De I'e!,ains 1s'bac'te4 th0!oiditis *ain 'l th0!oid" t( is @SAIDS F=. Sic# 5'th0!oid S0nd lo& )?$)+" no!mal )SC. @o s$s" %'st a goite!. )( > nothing FE. RiedelAs t!acheal com*!ession d'e to scle!osing ib!osis 1!a!e4 FF. CashimotoAs antimic!osomal ab" t( c le,oth0!o(ine FD. Congenital h0*oth0!oidism 1c!etinism4 %a'ndice" letha!g0" 'mbilical he!nia" lo& )?" high )SC" t( c s0nth!oid 1le,oth!0o(ine4 D3. Ad'lt h0*oth0!oidism atig'e" m0(edema" cold intole!ant" &t gain" e0eb!o& thinning" high tsh" lo& )?" 9CC is hashimotos" b't also d$t *!io! g!a,es t(" sheehanAs" amiodo!one" lithi'm" t( c s0nth!oid D1. G!a,es lo& tsh" high )?" tach0" *al*itations" &eight loss" o*thalmo*ath0" smooth goite!" A. ib" t( c --As 1t!emo! and tach04" 7)/" methima8ole" !adioacti,e iodine o! s'btotal th0!oidectom0. In *!egnanc0" 7)/ can be 'sed" as &ell as s'!ge!0 i a**!o*!iate. 7t B.<0o get s'!ge!0" *t 2?30o get !adioacti,e iodine. D.. )o(ic @od'le high RIA/" no e0e s$s" nod'la! goite!" on scan the!e is O@5 a!ea o inc!eased '*ta#e" &he!eas the !est its dec!eased 1in to(ic m'ltinod'la! goite! 1*l'mme!s disease4" the!e a!e se,e!al a!eas o inc!eased '*ta#e and in G!a,es the enti!e gland has inc!eased '*ta#e4 D+. )h0!oid sto!m ,e!0 high e,e!" deli!i'm" n$," abdm *ain" high t?" lo& tsh" t( c s'**o!ti,e ca!e i!st 1dec!ease tem*" a!!h0thmia" -74" --" gl'coco!ticoids D?. )0*e 1 D9 *ol0'!ia$d0*sia$*hagia" islet cell ab" CLA DR+$?" lo& C>*e*tide" t( c ins'lin. I ha,ing s'!ge!0" gi,e 13 'nits ins'lin in A9" and then 3.1/$#g$h! in 'sion. D<. )0*e . D9 *ol0'!ia$d0*sia. :asting gl'cose 21.=" !andom 2.33 on . ,isits. )( i!st &ith diet$&eight changes 1dec!ease calo!ies and ca!bs4" o!al agents" ins'lin. C-A1c to monito! gl'cose o,e! .>+ months. :o! !etinal neo,asc'la!i8ation" gi,e laste! *hotocoag'lation the!a*0. :o! ne*h!o*ath0" chec# o! mic!oalb'min'!ia 11st sign4 and gi,e AC5I. :o! ne'!o*ath0" gi,e oot ca!e and analgesia. D=. DNA letha!g0" n$," *ol0'!ia" abdm *ain" con 'sion" #'ssma'l b!eathing" !'it0 b!eath" gl'cose ?33>=33" anion ga* met acidosis. )( Isotonic l'ids &ith ins'lin" !e*lace NM i needed 1*!e,ent ce!eb!al edema4. DE. C0*e!osmola! coma deh0d!ation" letha!g0" con 'sion" coma" high gl'cose &itho't #etones" t( c l'ids" ins'lin and elect!ol0te !e*lacement. DF. Lactic Acidosis coma" con 'sion" h0*e!,entilation" no #etones" anion ga* met acidosis" !a!e a$& met o!min" t( etiolog0 1sta!,ation4. DD. 7t &ith high blood gl'cose in the mo!ningR Get ?A9 blood gl'cose. I its high 1Da&n e ect4" then inc!ease mo!ning @7C" i its lo& 1Samogi e ect4 then dec!ease night>time @7C. 133. Ins'linoma letha!g0" di*lo*ia" CA" gl'cose B?3" high *!oins'lin" high c>*e*tide 1lo& c> *e*tide i e(ogeno's ins'lin 'sed4. )( c s'!ge!0" i eme!genc0 then i!st gi,e <3mL o <3K de(t!ose I6. 131. 7!ima!0 C0*e!*a!ath0!oidism #idne0 stones" osteitis ib!osa c0stica" m'scle &ea#ness" high calci'm" lo& *hos*hate" high 7)C" a$& 95@. )( c s'!ge!0 i adenoma" b't i *t has se,e!e h0*e!calcemia" 1st t( c saline" then '!osemide" calcitonin and$o! *amid!onate. 13.. C0*o*a!ath0!oidism lo& calci'm 1ch,oste#As sign" t!o'ssea'As sign" tetan04" high *hos*hate" no!mal !enal 'nction. )( c ,itamin D and calci'm 13+. Diabetes Insi*id's &ate! loss" *ol0'!ia" noct'!ia" thi!st" c!a,ing o! ice" lo& '!ine osm 1B.<34" high se!'m osm. D( Gi,e ,aso*!essin" i co!!ected its cent!al" i still getting &o!se its

ne*h!ogenic 1can 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 1DDA674" i ne*h!ogenic gi,e di'!etic 1thia8ides" amilo!ide4. 13?. SIADC lo& @a" lo& se!'m osm" high '!ine osm" a$& small cell ca$mo!*hine$ chlo!*!o*!amide$o(0tocin" t( c 1st l'id !est!iction" .nd demecloc0cline o! h0*e!tonic saline i @a is !eall0 lo&. Do not t!eat too !a*idl0 to a,oid cent!al *ontine m0elinosis. 13<. Ac!omegal0 enla!ging hands" eet" coa!se eat'!es" dee* ,oice" la!ge tong'e" hat$&edding !ing doesnAt it an0mo!e 1hat donAt it an0mo!e can be 7agetAs4" d'e to high GC" d( &ith gl'cose s'**!ession test" then IG:>1" then 9RI to con i!m adenoma" t( c s'!ge!0 1t!ans*henoidal4" o! !adiation$meds 1b!omoc!i*tine" oct!eotide4 i s'!ge!0 doesnAt &o!#. 13=. Ac'te ad!enoco!tical ins' icienc0 shoc#" e,e!" abdm *ain" lo& s'ga!" d( c cos0nt!o*in testing" t( c h0d!oco!tisone sodi'm s'ccinate. 13E. Ch!onic ad!enoco!tical ins' icienc0 1Addisons4 9CC is /S is a'toimm'ne" 9CC in &o!ld is )-. Letha!g0" s#in *igmentation" h0*otension" lo& @a" high NM" lo& co!tisol" high AC)C is *!ima!0" no!mal$lo& AC)C is seconda!0. D( c AC)C stim'lation test 1co!tisol sho'ld inc!ease" b't !emains lo& in Addisons4. )( c h0d!oco!tisone 1gl'coco!ticoid4 and l'd!oco!tisone 1mine!alco!ticoid4 13F. C'shingAs s0nd!ome obesit0" *'!*le st!iae" C)@" hi!s'tism" b' alo h'm*" &a#ness" osteo*o!osis" d( c 1st .?h! '!ine !ee co!tisol" then DH9 s'**!ession test 1i s'**!essed that means its *it'ita!0 ca'sed 1C'shing disease4" i not its ad!enal o! ecto*ic AC)C li#e small cell ca o! ca!cinoid4. )( i iat!ogenic 'se smallest e ecti,e ste!oid dose *ossible" i c'shing disease do s'!ge!0$!adiation o *it'ita!0 adenoma. 13D. Ad!enogenital s0nd!ome hi!s'tism" ameno!!hea" high '!ina!0 1E>OC" 9CC is .1>OC de icienc0 in #ids" 9CC in ad'lts is 7COS o! ad!enal disease. )( is s'!ge!0 i ambig'o's genitalia in gi!ls4" then est!ogen s*i!onolactone" me o!min 1i 7COS4" gl'co$mine!aloco!ticoid i CAC. 113. ConnAs s0nd high aldo" lo& NM" high @a" Cigh -7" lo& !enin" t( is ad!enalectom0 c s*i!onoloactone *!eo*. 111. Seconda!0 C0*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 antagonist d!'gs 1halo*e!idol" metaclo*!amide4 and !$o h0*oth0!oidism" i *!olactin le,el 2133" then do 9RI o b!ain. )( i C@S s$s 1bitem*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" C)@" CA" 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 1then --4 ollo&ed b0 s'!ge!0. 11?. 7COS and 7!emat'!e o,a!ian ail'!e see obg0n notes 11<. Cemoch!omatosis AR" he*atomegal0" b!on8e s#in" ca!diomegal0" D9" d( c li,e! bio*s0" t( c *hlebotom0 1st" then de e!o(amine 1i needed4. 11=. Gestational D9 meas'!ed at .=>.F&#s" gl'cose chec#ed 1 ho'! a te! <3g load" i abno!mal" chec# + ho'!s a te! 133g load 1 asting sho'ld be BD<" 1h! B1F3" .h! B1<<" +h! B1?34. )( c diabetic diet and ins'lin i needed. 11E. Ca!cinoid s0nd!ome dia!!hea" l'shing" b!onchos*asm" lo& b*" R hea!t ,al,e lesions" d( c '!ina!0 <CIAA" t( c s'!ge!0. 9C is at a**endi(" b't i s0m*tomatic" 9C is at small bo&el. GI: 11F. /**e! GI bleed hematemisis" d( c 5GD" t( 1in o!de!4 I bleeding 'lce!: 77I" t!ans 'se" '!gent endosco*0 &hen *ossible" e*ine*h!ine into ,essel" s'!ge!0 i needed. I eso*hageal ,a!ices: Oct!eotide" banding$scle!othe!a*0" 5) int'bation" )I7S 1 o! eso*hageal ,a!ices" *!e,ent ne(t bleed &ith --As4 11D. Lo&e! GI bleed 9CC o -R-7R is di,e!tic'losis" then angiod0s*lasia. D( c colonosco*0 i bleeding sto*s" blood scan i bleeding contin'es and i M" angiog!a*h0. )( !e*lace blood" ,aso*!essin at site. 1.3. &hat is the c'to bet&een '**e! and lo&e! GI bleedingR Ligament o )!iet8. 1.1. C!ohnAs all gi t!act 1's'all0 !ectal s*a!ing4" ist'la" s#i**ed lesions" all la0e!s o bo&el

1t!ansm'!al4" ist'la" abscess" noncaseating g!an'loma" gallstones" calci'm o(alate #idne0 stones" e(t!aintestinal mani estations" d( c colonosco*0 and bio*s0. )( 'sing in li(imab 1m'st do 77D be o!e sta!ting it4" s'l asala8ine" met!onida8ole" *!ednisone. 1... /le!ati,e Colitis !ect'm mainl0 1'nless bac#&ashing *!esent4" contin'o's" %'st m'cosa$s'bm'cosa" c!0*t abscesses" to(ic megacolon" small$ !eL'ent blood0 dia!!hea c tenesm's. )( c a8'l idine" s'l asala8ine 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 1 !ee ai! on AHR4 1.?. 7e*tic /lce! D'odenal dec!eases c ood" Gast!ic inc!eases &ith ood" gastic is mo!e a$& cance!" d'odenal is mo!e a$& C.*0lo!i. D( 1st c C.*0lo!i testing" then endosco*0 &ith bio*s0 to !$o cance!. Ris#s o! @SAIDS: 2E3" h$o *!io! 7/D" onl0 a,ailable t( is miso*!ostol. C.*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 !$o cance!. )( &ith amo(" cla!ith!o and om*!a8ole. :ollo&>'* &ith '!ea b!eath tests a te! 1 month o t(. Com*lications: hemo!!hage 19C4" *e! o!ation do AHR to see !ee ai! in a *t c *e!itoneal s$s and t( c ab( and la*a!atom0. A te! s'!ge!0 1ant!eceom0" ,agotom0" bill!oth I and II4" &atch o't o! D'm*ing S0nd!ome 1&ea#ness" n$, a te! eating4" A e!ent loo* s0nd!ome 1bilio's ,omiting !elie,es abdm *ain a te! meal4" I!on$-1. de icienc0. 1.<. O5 s0nd!ome se,e!e" non>healing 'lce!s. Get gast!ic le,els and !$o ca 195@4. 1.=. O!o*ha!0ngeal d0s*hagia s&allo&ing im*ai!ed d$t lac# o ne'!om'sc'la! cont!ol !om *!io! C6A$7a!#insons$Al8heime!s. D( c ba!i'm s&allo&. )( 'nde!l0ing d8. 1.E. Achalasia a*e!istalsis" incom*lete L5S !ela(ation c high L5S *!ess'!e" d0s*hagia o! solids and liL'ids" no !eg'!ge" d( c ba!i'm 1dilated distal .$+!d4 then manomet!0 1bi!d bea#4" then endosco*0 to !$o cance!. )( c *ne'matic dilatation" then boto(" then s'!gical @issenAs 'ndo*lication. 1.F. Chagas Disease achalasia" ca!diomegal0" he*atomegal0 in a so'th Ame!ican. 1.D. G5RD hea!tb'!n" C7" e*igast!ic *ain" olde! g'0" 9CC o noct'!nal co'gh. D( c .?h! *C" '**e! GI endosco*0 to !$o ba!!ettAs o! 'lce!s. I 0o' s's*ect it" t!eat it &itho't doing an0 diagnostics. )( c li est0le changes" 77I" C. bloc#e!s. I *t still has s0m*toms then do .?h! *C. I *t sa0s d!'gs 'sed to &o!# b't donAt &o!# an0mo!e" do 5GD to !'le o't cance!. 1+3. Oen#e!As Di,e!tic'l'm a motilit0 diso!de!" ca'sing halitosis" d( c ba!i'm" t( c S(. 1+1. 5so*hagitis *ain 'l s&allo&ing 1od0no*hagia4" Candida so sta!t c l'cana8ole. 1+.. Di 'se 5so*hageal S*asm 1@'tc!ac#e!4 C* d'e to st!ong inte!mittent cont!actions. D( c ba!i'm 1co!#sc!e& *atte!n4 i!st" then manomet!0 1sho&s non*e!istaltic 'ncoo!dinated cont!actions4" t( c calci'm channel bloc#e!s o! nit!ates. 1++. Scle!ode!ma 5so*hag's 0o'nge! g'0 &ith G5RD s0m*toms" !a0na'ds" hea!tb'!n" d0s*hagia o! solids and liL'ids" d( c manomet!0 1lo& L5S *!ess'!e 1'nli#e achalasia &hich is high4" absent cont!actions in the smooth m'scle eso*hag's" no!mal *e!istalsis in the st!iaghted m'scle" no!mal /5S4. )( c same things as G5RD. 1+?. Schat8#i Ring 0o'ng *t &ith e*isodic di ic'lt0 1not *ain4 s&allo&ing. D( c ba!i'm" t( c *ne'matic dilatation o L5S 1+<. 7l'mme! ,inson s0nd h0*o*ha!0ngeal &eb c i!on de icienc0. Ris# o SCC. 9iddle>aged emale c d0s*hagia immediatel0 a te! meals. D( c ba!i'm" t( c s'!ge!0. 1+=. -a!ettAs 5so*hag's <0!s o d0s*hagia" &eight loss" no !e l'(" s$s ,isible on 5GD so do bio*s0. I bio*s0 sho&s no d0s*lasia then !e*eat in .><0!s" i b( sho&s lo& d0s*lasia" !e*eat in +>= months" i b( sho&s high g!ade d0s*lasia !esection 1+E. 5so*hageal CA *!og!essi,e d0s*hagia o! solids and e,ent'all0 liL'ids" &t loss" C7" h0*e!calcemia 1SCC4" d( c ba!i'm" then com i!m c 5GD and bio*s0. )( c s'!ge!0" chemothe!a*0 1cis*latin" <>:/4 and !adiation. 1+F. Gast!o*a!esis dela0ed gast!ic em*t0ing ca'sing n$," bloating and '**e! abdm discom o!t" common in D9" t( c metoclo*!amide 1+D. Shen 0o' s's*ect GI *e! o!ation" 'se gast!og!a in 1not ba!i'm4" &hen 0o' s's*ect as*i!ation" 'se ba!i'm 1not gast!og!a in4. 1?3. Dia!!hea see ID notes 1?1. I!!itable -o&el S0nd!ome alte!nating consti*ation$dia!!hea" *ain !elie,ed c de acation. )( c inc!eased ibe! in diet.

1?.. Di,e!tic'losis d$t lo& ibe!$high at diet. LLI *ain" e,e!" tende!ness. D( c colonosco*0. )( c inc!eased ibe!. 1?+. Di,e!tic'litis *e!itonitis" e,e! d'e to mic!o$mac!o>*e! o!ations" do C) scan. )( c @7O" I6: and ab( 1ci*!o$met!o o! ce o(itine o! am*icillin$s'lbactam4 1??. 7se'domemb!ano's Colitis C.di icile o,e!*o*'lation d'e to *!io! 'se o Ab( &ee#s ago" d( c C.di in stool. Colonosco*0 sho&s 0ello& adhe!ent *laL'es on m'cosa. )(: d$c d!'g" sta!t met!onida8ole" i still M" ,ancom0cin. 1?<. Colo!ectal CA .nd 9CCOD d$t cance!" !ectal bleeding" change in -9" &eight loss" sometimes as0m*tomatic 1 o'nd incidentall0 on colonosco*04. D(: :O-) 0ea!l0 a te! age <3" le(ible sigmoidosco*0 e,e!0 ? 0ea!s" colonosco*0 at <3 then <+ then e,e!0 < 0ea!s" b't sta!t 13 0ea!s ea!lie! than the age o &hich amil0 !elati,e &as diagnosed &ith it. )( s'!gical !esection o *!ima!0 t'mo!. 1?=. Ch!onic Li,e! Disease ca'ses incl'de a'toimm'ne he*atitis" hemoch!omatosis" ch!onic alcohol 'se" att0 li,e! d8 1non>alcoholic stateohe*atitis4" &ilsons d8" ,i!al 1C-6" CC64" s$s incl'de atig'e" inc!eased abdm gi!th" %a'ndice" s*ide! angiomas" *alma! e!0thema" CS9" g0necomastia" testic'la! at!o*h0" labs c high AS)$AL)$7)$I@R" th!omboc0to*enia" h0*onat!emia" h0*oalb'minemia. 1?E. A'toimm'ne he*atitis .3>?30o emale c MA@A" Manti>smooth m'scle Ab" e,e!0thing else no!mal. )( c ste!oids. 1?F. SilsonAs 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! 1not !ee4" high '!ine co**e!. C) sho&s h0*dense !egions in the basal ganglia. Con i!m d( c li,e! bio*s0. )( c D>*enicillamine. 1?D. 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. 1<3. S*ontaneo's bacte!ial *e!itonitis > 2.<3*ol0s in + bedside c'lt'!es" t( c ce ota(ime 1<1. 5nce*halo*ath0 t( c *!otein !est!iction and lact'lose. 1<.. CA6 shell ish" ecal>o!al" d( c M anti>CA6 Ig9 1IgG sho&s *!e,io's in (n4 1<+. C-6 CbsAg is ea!liest ma!#e!" 2=months is ch!onic" i ,accinated T MCbsAb" >CbcAb" i e(*osed in the *ast T MCbsAb" MCbcAb. Sindo& *e!iod has anti>C-c Ig9 onl0. 7!e,ent &ith ,accine M C-IG. )!eat c Inte! e!on al*ha and lami,'dine. Gi,e ,accine at 3>.mo" ?>=mo" 1+>1F months. I mom has MCbsAg" gi,e bab0 ,accine M C-IG &ithin 1. ho'!s o bi!th. 1<?. CC6 d( c anti>CC6 Ab$IgG$Ig9 and CC6 R@A b0 7CR. )( In >a c !iba,i!in 1<<. D!'g>ind'ced )0lenol" isonia8id" halothane" ca!bon tet!achlo!ide" tet!ac0cline. D( c ,e!0 high AS)$AL) le,els. )( D$C med 1<=. Ac'te att0 li,e! o *!egnanc0 de,elo*s in +!d )9. )( immediate s'!ge!0 1<E. 7!ima!0 -ilia!0 Ci!!hosis antimitochond!ial Ab in se!'m" *!'!itis" atig'e" he*atomegal0" high al# *hos" dest!'ction o int!ahe*atic and e(t!ahe*atic d'cts. )( c '!sodeo(0cholic acid" cholest0!amine. 1<F. 7!ima!0 Scle!osing Cholangitis 0o'ng man c I-D 1/C4" dest!'ction on e(t!ahe*atic d'cts onl0 1sho&s beading e ect d$t ib!osis4. 1<D. Gallstones emale" at" ?3" e!tile" R/I o! e*igast!ic *ain" &o!sened c ood" !adiates to midsca*'la! a!ea. D( c /$S" then CIDA scan i negati,e. )( c la* chole. 5RC7 i *t still has s0m*toms a te! 1stone is in C-D4. 1=3. 9esente!ic Ischemia se,e!e abdm *ain$tende!ness &ith *a'cit0 o clinical indings. 7t &ill 's'all0 ha,e e(tensi,e ischemic histo!0 19I" D9" etc4" d( c angiog!a*h0" t( &ith *!om*t la*a!otom0 to !eestablish a!te!ial lo& 1=1. Ac'te 7anc!eatitis 9CC is gallstones" then alcohol. 5*igast!ic *ain !adiating to midbac#" alle,iated c sitting '*" %a'ndice sometimes e,e!. Cigh am0lase$li*ase. D( c C). )( c @7O" @G)" analgesia" and then begin to conside! 5RC7 and s'!ge!0 i *e! o!ated" bleeding" abscess" *se'doc0st o! *e!itonitis. 1=.. 7ac!eatic 7se'doc0st ,s Abscess &o!sening o *ain" n$," e,e! high S-C and *ositi,e blood c'lt'!e a te! initial im*!o,ement. D( c C). )( c Ab(" then s'!gical d!ainage o abscess. 7se'doc0st is gene!all0 as0m*tomatic. 1=+. 7anc!eatic CA ,ag'e abdm *ain 1doesnAt ha,e to !adiate to the bac# an0mo!e4"

ano!e(ia and &eight loss &ith %a'ndice" n$,. D( c C). I negati,e do 5RC7. Chec# CA 1D>D. )(: I onl0 at *anc!eatic head c no s*!ead" t!0 !esection. I not" do Shi**le 1*anc!eaticod'odenectom04 *!oced'!e. 1=?. 9alabso!*tion Steato!!hea 1d( c S'dan stain 1st test4. )hen d( c D>(0lose" i abno!mal" s'ggests small bo&el disease. @o!mal ,al'e s'ggests oc's on *anc!eatic d8: C) o abdm" se!'m am0lase" AS)$AL). I o,e!g!o&th conside!ed" note !es*onse to malabso!*tion to Ab(. Celiac s*!'e *anel: antiendom0sial$antigliadin Ab" tiss'e t!ansgl'taminase" total se!'m IgA" antigliadin Ab IgA and IgG; at least + bio*s0 s*ecimens !om distal d'oden'm is gold standa!d. 1=<. Shi**leAs malabso!*tion" a!th!algia and C@S s0m*toms 1dementia4. D( c small bo&el bio*s0 1sho&s oam0 mac!o*hages on 7AS stain4. )( c )97>S9H 75DS GI: @A95 AG5 6O9I)/S :I@DI@GS 70lo!ic Stenosis 3>.mo @onbilio's" *!o%ectile 92:" oli,e>sha*ed mass" lo& N Intestinal At!esia 3>1&# -ilio's" *!o%ectile Do'ble b'bble sign" a$& Do&ns )5 :ist'la 3>.&# :ood !eg'!gitation Res* *!oblems c eeding" as* *ne'mo" d( ,ia cant *ass @G) Ci!schs*!'ng 3>10! :ec'lent Distention" obsti*ation" no ganglia on bio*s0 Anal At!esia 3>1&# Late" ec'lent Seen on initial e(am in n'!se!0 Choanal At!esia 3>1&# > C0anosis c eeding" !elie,ed c c!0ing" CCARG5 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( c ba!i'm enema @ec 5nte!ocolitis 3>.mo -ilio's 7!emies" e,e!" !ectal bleeding" ai! in bo&el &all" t( c @7O$I6: 9econi'm Ile's 3>.&# :ec'lent" Late C0stic :ib!osis 9idg't 6ol,ol's 3>.0& -ilio's D$t mal!otation" s'dden *ain$n$,. d( c '**e! Gi" t( c S( 9ec#elAs Di,e!tic'l'm 3>.0& 6a!ies GI 'lce!$bleed" d( c 9ec#els 1)echneti'm4 scan" t( c S( St!ang'lated Ce!nia An0 -ilio's -o&el loo*s in ing'inal canal O@COLOGY: 1==. )'mo! ma!#e!s -hcg testic'la! cance!" cho!ioca!cinoma" mole; A:7 he*atocell'la! ca!cinoma testic'la! ca; C5A GI cance!s; 7SA *!ostate ca; CA>1.< O,a!ian ca; CA 1D>D colo!ectal$GI$*anc!eatic cance! 1=E. Sigmoidosco*0 > 2<30o e,e!0 +><0!s; :O-) > 2<3 ann'all0; DR5 > 2?3 ann'all0; 7SA > 2<3 ann'all0 in no!mal !is#" 2?3 ann'all0 in high !is#; 7a* smea! onset o se('al acti,it0 o! 1F0o ann'all0 o! + consec'ti,e 0ea!s then ho&e,e! o ten; 7el,ic e(am 1F>?30o e,e!0 1>+0!" 2?3 ann'all0; 5ndomet!ial bio*s0 meno*a'se$high !is# ann'all0; Sel b!east e(am > 2.3 monthl0; Clinical b!east e(am .3>?3 e,e!0 + 0ea!s" 2?3 ann'all0; 9ammog!am ?3>?D e,e!0 1>. 0!s" 2<3 ann'all0. 1=F. Cance!o's Occ'*ation Ca8a!ds a!omatic amines c bladde! ca" a!senic c l'ng$s#in$li,e! ca" asbestos c mesothelioma 1b!onchogenic 9C4" ben8ene c le'#emia" m'sta!d gas c l'ng$la!0n($sin's cance!" ,in0l chlo!ide c li,e! cance! 1=D. Codg#inAs e,e!" night s&eats" chills" &eight loss 1li#e )-4" and *ainless ce!,ical adeno*ath0. D( c C) chest$abdm and then l0m*angiog!a*h0 and then bio*s0 1 o! t!eatment *'!*oses4. Reed>ste!nbe!g cells. )( I no - s$s 1 e,e!" &t loss" s&eats4 gi,e !adiation alone. I s$s gi,e chemothe!a*0 19O77 o! A-6D4 1E3. @on>Codg#inAs ,a!iable nodes" monoclonal -$)>cell *!oli e!ation" d( c C) chest$abdm$*el,is then othe! st' li#e -9 b(" 75) scan" galli'm scan. )( c !adiation and chemo 1CCO74 c Rit'(imab 1CD.3 Ab4. 1E1. Ac'te L0m*hoc0tic Le'#emia #ids" blasts" t( c int!athecal chemo 19)H4 1E.. Ac'te 90elogeno's Le'#emia 9+ ca'ses DIC" Ae'! !ods" blasts" add All>t!ans !etinoic acid 16it A4 to t(. 1E+. C9L high S-Cs" high 79@s" s*lenomegal0" L/I *ain" 'llness and ea!l0 satiet0" dec!eased LA7" d( c *hili ch!omosome 1tD;.. o b!c:abl4 in -9" t( c Imatinib 1Glee,ac4. 1E?. CLL elde!l0" high S-Cs" high l0m*hoc0tes" s*lenomegal0" d( c sm'dge cells" no t( i no l0m*hoc0tosis" i M l0m*hoc0tosis gi,e l'da!abine o! chlo!amb'cil.

1E<. Cai!0 Cell Le'#emia CD13M and )RA7M 1ta!t!ate>!esistant acid *hos*hatase4" t( c clad!ibine 1E=. 90cosis 'ngoidis c'taneo's )>cell l0m*homa 1loo# at 1st aid *ict'!e4" lion>li#e acies" t( c 7/6A chemothe!a*0. I a ecting *e!i*he!al blood" its Se8a!0 s0nd!ome. 1EE. 9'lti*le 90eloma high calci'm" high OA:" high '!ic acid. -est initial test is H !a0 i bone *ain o! elect!o*ho!esis i high *!otein. 9ost acc'!ate test is 213K *lasma cells. )(: BE30o get stem cell t!ans*lant" 2E30o get 9ei*helen o! )halidomide 1EF. A*lastic Anemia lo& !bc$&bc$*latelet" d!'gs 1chlo!am*henicol4" *a!,o>-1D 1sic#le cell4" t(: B<30o get -9)" 2<30o get c0clos*o!ine M anti>th0moc0te glob'lin 1ED. I *t has nec# M *el,ic mass a te! chemo the mass gets smalle!" &heat test chec#s content o the l0m*h nodeR 75) scan. So in a n'tshell" a l0m*homa gets e(cisional bio*s0 o the node" then 75) scan" and chemo i the0 ha,e - s0m*toms. 1F3. Ad,e!se e ects o chemo: 6inc!istine$blastine *e!i*he!al ne'!o*ath0" c0clo*hos*hamide hemo!!hagic c0stitis" -'s'l an$-leom0cin I!!e,e!sible 7'lmona!0 :ib!osis 1thatAs &h0 Lance A!mst!ong !e 'sed it4" C0s*latin !enal d8" ototo(icit0" anemia. O,e!all 9C ad,e!se e ect &ith chemo d!'gs is ste!ilit0. 1F1. L'ng cance! ch!onic co'gh 19C s$s4" &t loss" smo#e!" hemo*t0sis. D(: 1st CHR" then bio*s0. )(: Small cell get chemo onl0" @on>small cell chemo c !adiation. Co!ne!As s0nd!ome 'nilate!al *tosis" meiosis" anhid!osis d'e to com*!ession o i*silate!al s'*e!io! ce!,ical ganglion b0 l'ng t'mo!" *a!tic'la!l0 SCC. S6C s0nd!ome obst!'ction o S6C ca'ses acial s&elling$*letho!a" d0s*nea" co'gh" G6D. 7ancoast s0nd!ome t'mo! o the s'*e!io! s'lc's ca'ses b!achial *le('s s$s. Small cell ca'ses C'shings s0nd!ome 1AC)C4 and SIADC" SCC ca'ses h0*e!calcemia 17)C>li#e *e*tide4 1F.. Solita!0 nod'le 1st ste* get old (>!a0. I *!esent and same si8e" its benign 1send home4" i inc!ease in si8e its *!obabl0 cance!. I it &asnAt the!e" assess !is# 1high is smo#e! and 2+<" lo& !is# is nonsmo#e! and B+<4. I lo& !is# ollo& '* late!" i high !is# do bio*s0. 1F+. -!east Cance! bio*s0 e,e!0one c *al*able mass 2+< e(ce*t i -$L" l'm*0 and s$s onl0 occ'! c menses. I B+< its *!obabl0 ib!oadenoma 1!'bbe!0 mo,eable mass" obse!,e *t4. A te! b(" get mammog!am i 2+<0o. I mammo &as al!ead0 done" get :@A. I a te! bio*s0" mass goes a&a0" send *t home. )(: tamo(i en" mastectom0" !adiation" a(illa!0 dissection" chemothe!a*0 1c *latin'm4 i M nodes. 1F?. 7!ostate cance! s$s o -7C c hemat'!ia" high 7SA 1onl0 to sc!een$monito!" not o! d(4" i!!eg'la!$bogg0" bac# *ain. )( c s'!ge!0. I Mmets" then do o!chiectom0" le'*!olide" l'tamide" D5S" b't no chemo. Onl0 do )/R7 and !adiation o mets is local 1bone4. 1F<. Colon cance! R sided bleeds 1blood0 stools4" L sided obst!'cts 1consti*ation4" &t loss. D( c colonosco*0. )( c s'!ge!0 and <>:/ and then $' C5A le,els. I mets 19C is li,e!4 to li,e! do s'!ge!0" b't an0&he!e else do chemo. 1F=. 7anc!eatic cance! ?3>F30o male smo#e! c %a'ndice" &t loss and ,ag'e abdm *ain. 9a0 ha,e mig!ato!0 th!ombo*lebitis 1)!o'ssea'As s0nd!ome4 o! *al*able" nontende! gallbladde! 1Co'!,oisie!As sign4. D( c C)" then :@A. )( c &hi**les. C59A)OLOGY: 1FE. 9ic!oc0tic 19C6 BF34: I!on de icienc0" )halassemia" Anemia o Ch!onic D8" Side!oblastic Anemia 1lead *oising" isonia8id" alcohol>ind'ced4 1FF. @o!moc0tic 19C6 F3>1334: Chec# Retic'loc0te co'nt1sho'ld be B.K c anemia" othe!&ise ma!!o& isnAt !es*onding *!o*e!l04: B.K is ac'te blood loss 1B<>Eda0s4" ea!l0 i!on de icienc0" a*lastic anemia" ea!l0 AOCD" !enal disease. 2+K is d'e to eithe! Int!insic R-C de ect 19AD: 9emb!ane de ects 1S*he!oc0tosis" 7@C4" Abno!mal hemoglobins 1Sic#le cell4" De icient en80mes 1G=7D" *0!',ate #inase de icienc044 o! 5(t!insic R-C de ect 1A'toimm'ne hemol0tic anemia" 9ACA" blood loss 21 &ee#4 1FD. 9ac!oc0tic 19C6 21334: -1. de " olate de " 90elod0s*lastic s0nd!ome" d!'g>ind'ced" he*atic d0s 'nction 1d$t alcohol4" !etic'loc0tosis. 1D3. Red Cell 9o!*hologies: Ro'lea'( 1m0eloma4" -'!! cells 1'!emia4" )ea! d!o*s and n'cleated

!ed cells 1m0elo ib!osis4" h0*och!omic$mic!oc0tic 1i!on de 4" ta!get cells 1CAL): Cemoglobino*athies" As*lenia" Li,e! d8 1obst!'cti,e %a'ndice4" )halassemia4" O,al mac!oc0tes 1-1.$:olate de 4" baso*hilic sti**ling 1Lead" -1. de 4" s*he!oc0tes 1CS4" Schistoc0tes 19ACA" AICA" DIC4" bite cells and Cein8 bodies1G=7D4" Co&ell>Goll0 bodes 1As*lenia li#e SCD4. 1D1. I!on de icienc0 lo& 9C6" high )I-C" lo& e!!itin" lo& i!on 1B=34" high RDS 1&h0R -eca'se some 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 1&eb" lo& i!on" glossitis4" co& mil# be o!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 1be o!e 0o' gi,e i!onU4" .nd t!ans 'sion 1i needed ast4 o! o!al i!on s'**lements o! =>1. months. 1D.. Anemia o Ch!onic D8 1ho& does this &o!#R )he bod0 #no&s diseases 1RA" )-" SL5" cance!4 lo,e i!on" so it &ill hide i!on a&a0 in sto!es 1high e!!itin4 b't #ee* it o't o the se!'m 1lo& se!'m i!on and high )I-C44 i anemia is a$& ch!onic !enal d8" loo# o! -'!! cells. 1D+. )halassemia no!mal i!on 1so donAt gi,e i!on4" ta!get cells" n'cleated !bc" (>!a0 sho&s c!e&>c't a**ea!ance o s#'ll" d( c Cb elect!o*ho!esis" no t( o! t!aits. )hal ma%o! gets t!ans 'sion 1st and de o!o(amine to *!e,ent i!on o,e!load" s*elenectom0 1no& gi,e *ne'mo,a(" *enicillin *!o*h0la(is" olate s'**lement4. 1D?. Lead 7oisoning *ica #ids &ho ha,e A-CD 1Anemia$Ata(ia$Abdm *ain" -aso*hillic sti**ling$-eha,io!al changes" Consti*ation" D!o*s 1 oot$&!ist4$Death4" high !ee e!0th!oc0te *!oto*o!*h0!in. D( c blood 7b le,el and (>!a0 1*b ,isible in bones4. )( c 5D)A o! dime!ca*!ol. 1D<. -1. De icienc0 9CC is *e!nicio's anemia 1anti I:$*a!ietal Ab4" also d$t gast!ectom0" te!minal ile's !esection" ,egeta!ian" ch!onic *anc!eatitis and di*h0lloboth!i'm lat'm in ection. Loo# o! C@S s$s 1s0mmet!ic *a!ethesia in eet$ inge!s" dist'!bed *!o*!ioce*tion and ,ib!ato!0 sense" i!!itabilit0" somnolence" abno!mal taste$smell" cent!al scotomas" *ositi,e babins#i4 and achlo!h0d!ia 1no stomach acid sec!etion so *C in stomach is high4. Chec# se!'m -1.. Schilling test 1ne,e! 'sed in !eal &o!ld4. C0*e!segmented 79@. Cigh meth0lmalonic acid le,el. )( c cobalamin. :olate ma0 &o!sen the C@S s$s. 1D=. :olate 's'all0 d$t dieta!0 lac# 1g!een ,egetables" li,e!" #idne0" 0east" m'sh!ooms4" alcoholism" *!egnanc0" celiac s*!'e" *hen0toin" bact!im" 9)H" <>:/" OC7s. )( c olate s'**lements. 1DE. A'toimm'ne Cemol0tic Anemia Ab$com*lement binds to R-C mmb. )&o t0*es Ig9 1aggl'tination at colde! tem* li#e 90co*lasma4 and IgG 1&a!m aggl'tination li#e SL5" *enicillin" meth0ldo*a4. D( c di!ect CoombAs *ositi,e. I hemol0sis is mild" obse!,e" i hemol0sis is se,e!e" gi,e gl'coco!ticoids. I !ec'!!ent" do s*lenectom0. 1DF. 7a!o(0smal @oct'!nal Cb'!ia C0*o,entilate at night" so acidosis ca'ses R-C b'!st d$t lo& DA:" the!e o!e com*lement comes !ight o 1CD <<$<D4. 9a0 die in 13 0!s d$t th!ombosis. -est test is S'ga! &ate! test o! Cams test 1Acidic so'nds li#e Cacidic" Cacidics donAt li#e Cam4. s$s incl'de Cb'!ia in the mo!ning time 1not at night" that &o'ld be a *!ostate *!oblem4" inc!ease !is# o A9L. Gi,e ste!oids. 1DD. G=7D De icienc0 9CC is in ection 1the0 's'all0 &ont sa0 G!ee#" *!imaL'ine" a,a beans" Da*sone4. Cemol0sis" %a'ndice abdm$bac# *ain 1>+ da0s a te! e(*os'!e. Cein8 bodes" bite cells. -est t( c a,oiding o ending agents. .33. S*he!oc0tosis inc!eased osmotic !agilit0" AD" lo& s*ect!in" s*lenomegal0. D( c osmotic !agilit0 test" t( c s*lenectom0 1de e! 'ntil =0o4" *ne'mo ,accine and olate .31. Sic#le Cell Disease A !ican descent" AR" s$s 2=mo d$t Cb:" i t!ait onl0 gets /)I" best initial test is smea!" most acc'!ate test is Cb elect!o*ho!esis" o! c!isis 1st gi,e l'ids$*ain management" i e,e! 1d$t a'tos*lenectom04 gi,e Ab( 1Ce t!ia(one4" i e0e$C@S$chest$7!ia*ism gi,e e(change t!ans 'sion" to *!e,ent ne(t a*lastic c!isis gi,e olate" to *!e,ent ne(t ,aso>occl'ssi,e *ain c!isis 1the0 &ill %'st sa0 Qc!isis4 gi,e h0d!o(0'!ea" i Cct d!o*s s's*ect A*lastic anemia d$t 7a!,o,i!'s. Gi,e *!o*h0lactic *enicillin" 7n'mococcal$Caemo*hil's in l'en8a ,accine V childhood. .3.. A*lastic Anemia lo& !bc$&bc$*latelets" chlo!am*henicol" *a!,o,i!'s" ben8ene" ac'te le'#emia" AO)$8ido,'dine. )( c 1st sto* d!'g" then gi,e antith0moc0te glob'lin .3+. 90elo*hthisic anemia 190elo ib!osis4 malignant in,asion o -9" anisoc0tosis 1aniso T an0 si8e4" *oi#iloc0tosis 1sha*e4" tea!d!o*>sha*ed R-C" d( c -9 bio*s0 sho&ing no cells 1d!0 ta*4. .3?. )!ans 'sions: Shole blood 1*oisoning" ))74" 7ac#ed R-C 1*ost>s'!ge!0$t!a'ma t!ans 'sion o! instead o &hole blood4" &ashed R-C 1IgA de icienc04" 7latelets 1213"3334" g!an'loc0tes 1*ost

chemo4" ::7 1bleeding diathesis li#e DIC" &a! a!in *oisoning" li,e! ail'!e4" c!0o*!eci*itate 1,SD and DIC4. 9CC o t!ans 'sion !(n is lab e!!o!. I it occ'!s" 1st ste* is sto* t!ans 'sion. .3<. 7latelet *!oblems T s#in" g'ms" nose" gingi,al 1ALL S/75R:ICIAL4" GI" C@S and ,aginal bleeding; :acto! *!oblems bleeding into %oin and m'scles 1D5574" GI" C@S. .3=. ,on Silleb!an D8 high 7))" no!mal 7)" high -)" no!mal *lt$!bc co'nt" AD 1loo# o! amil0 histo!04 1a *latelet t0*e o bleeding c a no!mal *latelet co'nt4. -est initial test is bleeding time" then !istocetin le,el. -est t( c desmo*!essin 1DDA674 .3E. Cemo*hilia A$- !eall0 high 77)" no!mal 7)" no!mal -)$*lt$R-C" loo#ing o! dela0ed hema!th!osis in males onl0 1A is acto! F" - is acto! D4. .3F. DIC high 7)$7))$-)" lo& *lt" lo& R-C" lo& acto! F. .3D. Li,e! ail'!e high 7)" no!mal$high 7))" no!mal -)" no!mal$lo& *lt$R-C" %a'ndince" no!mal acto! F" do not gi,e ,itamin N 1ine ecti,e4" gi,e ::7As. .13. Ce*a!in high 7))" th!omboc0to*enia. )( c d$c d!'g .11. Sa! a!in high 7)" ,it N antagonist 1."E"D"134" t( c ::7 1 ast4 o! ,it N 1slo&4" s#in nec!osis .1.. I)7 lo& *latelets" high -)" h$o /RI" ne(t ste* is ste!oids 1%'st t!eat it4" a'to>*latelet Ab" i *latelets all BE333 gi,e I6IG o! RhoGam. .1+. ))7 high -)" lo& *lt" lo& R-C" hemol0sis" C@S" !enal" e,e!" th!omboc0to*enia 1*etechia" *'!*'!a4. )( c *lasma*he!esis .1?. C/S li#e ))7 b't no !enal ail'!e o! C@S s$s" h$o in ection" 5. coli 31<CE. .1<. Sc'!,0 all st'dies no!mal. :inge!nal$g'm$bone$*e!i ollic'la! hemo!!hage" *oo! diet 1onl0 eats hot dogs and soda o! tea and toast4. )( c ,itamin C. .1=. @e't!o*enia 79@ B..3 ( 13WD. D( c bone ma!!o& as*i!ate$b(. )(: 1st dete!mine the ca'se" .nd Ab(" +!d ste!oids" ?th G9>CS:. .1E. 7ol0c0themia R'b!a 6e!a ? CAs 1C0*e!,olemia" C0*e!,iscosit0 1th!ombosis is 9CCOD4" C0*e!'!icemia" Cistaminemia 1itch all o,e! a te! a hot sho&e!44. )( c *hlebotom0. WWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWW ID: .1F. )o(ic Shoc# S0nd!ome *!e o!med to(in" *!olonged tam*on *lacement" h0*otension" e,e!" deL'amated !ash 1*eeling o *alms$soles4" S.a'!eas .1D. Con%'ncti,itis 1st .? ho'!s is chemical" .>< da0s is @eisse!ia" ?M is Chlam0dia. I the0 sa0 *ain 'l con%'ncti,itis" thatAs ,i!al 1CS64 so t!eat c ac0clo,i!. ..3. 5(te!nal Otitis *ain" d!ainage" itch0 s&imme!As ea!" 7se'domonas. ..1. Otitis 9edia ?3K s.*ne'mo" +3K h.in l'en8a" +3K m.cata!!halis" d(: 1st ste* is *ne'matic otosco*0 sho&ing immobilit0 o t0m*anic mmb" .nd ste* is t0m*anocentesis" t( c amo(icillin. .... Sin'sitis same K as abo,e. Yello& g!een d$c" sin's tende!ness" best initial ste* em*i!ic ab( 1amo( M decongestant4" then H>!a0" then Sin's bio*s0 1most acc'!ate4 ..+. 9eningitis 3>1mo G-S" 5.coli" Liste!ia" .mo>.0o S.*ne'mo" .>1F0o @eisse!ia" 1FM > S.*ne'mo; Ne!nigs$-!'d8ins#i sign" letha!g0" e,e!" b'lging ontanelle" *hoto*hobia" n'chal !igidit0" n$," d( c L7 1bacte!ia: lo& gl'cose" high *!tn" 79@As; ,i!al: no!mal gl'cose" slightl0 high *!tn" lo& S-C" l0m*hoc0tes4. I bacte!ial" gi,e ce t!ai(one" ,anco o! ste!oids. Gi,e am*icillin 1liste!ia4 i imm'nocom*!omised. I neisse!ia s's*ected 1.>1F0o c !ash4 ne(t ste* is !es*i!ato!0 isolation and t( him and amil0 membe!s c !i am*in. I 2133 l0m*hoc0tes: C!0*tococc's 1!$o CI6" best initial test is India in#" most acc'!ate test is c!0*t ag" t( c Am* -4" 6i!al 1no s*eci ic test4" )1*'lm s$s" high CS: *!otein" gi,e RI75 M ste!oids4" L0me D8 1se!olog0" h$o bite" ta!get !ash" do(0c0cline" o! i C@S s$s li#e c!anial ne!,e E e ects" gi,e Ce t!ia(one4" R9S: 1se!olog0" !ash on &!ists$an#es mo,ing cent!all0" h$o cam*ing o! hi#ing" t( c Do(0c0cline" chlo!am*henicol i *!egnant4. )he 9C seL'ela is hea!ing loss. ..?. 5nce*halitis loo# o! ac'te eb!ile con 'sion 1i the0 sa0 con 'sion" its ence*halitis not meningitis4" 9CC is he!*es 1blood in cs 4" best initial test is C) 1tem*o!al lo*e4" i negati,e do 7CR 1most acc'!ate4. )( c ac0clo,i!" then osca!net i !esistant. ..<. -!ain Abscess loo# o! ocal ne'!ologic indings c !ing$cont!ast enhancing lesions. I CI6 1>4" do bio*s0" i CI6 M" sta!t s'l adia8ine>*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!.

@e(t ste* is C)" then s'!gical d!ainage c ab(. ..E. )etan's !ict's sa!donic's 1 acial snee!4" tonic m'scle s*asms 1%a&" t!ism's4" clost!idi'm tetani" 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 1DA)4 and *enicillin o! e!0th!om0cin. ..D. C!o'* a#a ac'te la!0ngot!acheitis ba!#ing co'gh in a 1>.0o. 7a!ain l'en8a ,i!'s. :!ontal nec# (>!a0 sho&s stee*le sign. )( c !acemic e*ine*h!ine. .+3. 5*iglottitis .><0o #id 'nimm'ni8ed 1C.in l'en8a4 c !a*id *!og!ession o high e,e!" d!ooling and !es*i!ato!0 dist!ess c no co'ghing. H !a0 sho&s th'mb sign. Do not e(amine th!oat o! i!!itate the #id 1&o!sen ai!&a0 obst!'ction4. )( c ai!&a0 assessment" then ce*halos*o!ins. .+1. -!onchiolitis 3>1Fmonth old #id in the all$&inte! gets e(*i!ato!0 &hee8ing d'e to RS6. )( c !iba,i!in. 1In a n'tshell" 3>.0o c &hee8ing is b!onchiolitis" 1>.0o c ba!#ing co'gh is c!o'*" .><0o c d!ooling is e*iglottitis4 .+.. 7e!t'ssis &hoo*ing ins*i!ato!0 &hee8e. .++. L'ng abscess e,e! o! &ee#s" bad teeth" alcoholic" as*i!ation" st!o#e *t" int'bated *t" ne(t ste* is CHR" best &a0 to *!e,ent it is to !emo,e all teeth" ho& do 0o' di e!entiate !om )-R )he smell 1,e!0 bad in abscess4" most acc'!ate test is bio*s0" t( c clindam0cin .+?. -!onchitis mild co'gh c s*'t'm" negati,e CHR" t( c a8ith!o" le,aL'in o! do(0 .+<. 7ha!0ngitis so!e th!oat" e('des" l0m*h nodes" no co'gh" no hoa!seness" best test is !a*id st!e* test" t( c *enicillin .+=. In l'en8a ahces" *ains" ti!ed" co'gh" CA" no e,e!. -est t( is oseltami,i! o! 8anami,i! 1note the I,i! 1 o! In l'en8e4" not O,i! li#e ac0clo,i!$ amc0clo,i! o! CS6 o! A,i! li#e !itona,i!$nel ina,i! o! AIDS4 .+E. 7ne'monia o't*t t( is same as b!onchitis 1a8ith!o" le,aL'in" do(04" in*atient t( incl'de ce t!ia(one. In 0o'ng health0 *t" thin# m0co*lasma 1get se!ologies4 o! i in*t" thin# S.*ne'mo. I C@S and GI s0m*toms" *ic# Legionella. I AIDS c CDB.33 *ic# 7C7 1)97>S9H t(4. I e(*osed to shee* *lacenta" *ic# Co(iella b'!netti. I loba! *ne'monia 1s.*ne'mo is 9C4 then stain and c'lt'!e ne(t. Shen do 0o' gi,e ste!oidsR 7O. BE<" A>a g!adient B+<. Shen do 0o' admit and gi,e *ne'mo,a(R C0*o(ia" 2=<" s*lenectom0" h0*otensi,e c high *'lse" como!bidities" con 'sion" lo& @a 1SIADC4. .+F. )- homeless" alcoholic" immig!ant" CI6" health ca!e &o!#e!" *!isone!" e,e!" co'gh" s*'t'm" &t loss" night s&eats" i!st thing to do is CHR 1@O) 77D &hen do 0o' choose 77D i!stR Sc!eens as0m*tomatic *tsU4" .nd ste* is A:7 and then gi,e RI75 c isolation o! . months" then isonia8id and !i am*in o! anothe! ? months 1= months total4. Ad,e!se e ects a!e Isonia8id is ne'!oto(ic 1less c -=4" Ri am*in c !ed '!ine" *0!i8inimide c high '!ic acid 1do not t!eat it" it &ill *ass4 and ethamb'tol &ith e0e *!oblems. .+D. 77D 7ositi,e i : 2<mm in CI6" ste!oid 'se!s" close contacts; 213mm in immig!ants" health ca!e &o!#e!s 1meU4" 21< in *t c no !is# acts. I 77D is *ositi,e" *!oceed to CHR" i 1>4 ta#e I@C o! D months" i M get s*'t'm A:-. I 77D is negati,e" !e*eat it in 1>. &ee#s to !'le o't alse negati,es. I *t had 77D in the *ast that &as M" donAt do 77D again 1it &ill al&a0s be *ositi,e4" go !ight to CHR. .?3. 5ndoca!ditis e,e! and a m'!m'! is #e0" h$o I6DA is s.a'!eas at t!ic's*id ,al,e" X1 d( is blood c'lt'!e 1not 5CCO4" X. d( is 5CCO 1))5 t0*e" not )554. :o! dental *!oced'!es 1m'st be dental *!oced'!e c blood" cant be dental illings4 gi,e amo(icillin o! clinda i alle!gic" o! GI$G/ 1st!e* bo,is4 *!oced'!e gi,e amo( M genta" o! ,anco M genta i alle!gic. St!ongest indication o! s'!ge!0 is !'*t'!ed ,al,e. So" 1st ste* is blood c'lt'!e" .nd ste* is sta!t ab( &hile &aiting o! !es'lts. .?1. )h!'sh o!al candida" !emo,able &hite mo'th *atches 1Candida CA@ come o " hai!0 le'#o*la#ia cant4. )( c n0statin mo'th !inse. .?.. L0me Disease *!oblems in %oints" C@S 1b$l bells *als04" hea!t 1+ deg!ee A6 bloc#4. I its %'st a tic# bite and no s$s" do nothing. I itAs a bite c l0me !ash gi,e amo( 1*!egnant o! #ids4 o! do(0 1not se!olog04. I *t has b$l bells *als0 get se!olog0. I a, bloc# c cns s$s 1e(ce*t bells *als04 gi,e ce t!ia(one ne(t. .?+. CI6 1st 5LISA" .nd &este!n blot 1in #ids" 1st is 7CR4. 7e!i*he!al ne'!o*ath0 c sta,'dine$didanosine" anemia c 8ido,'dine" !ash c tm*$sm( 1sta!t da*sone4" ne*h!olithiasis c indina,i!. 9C o,e!all ad,e!se e ect is inc!ease li*ids and gl'cose le,els. 7!o*h0la(is: B.33 o! 7C7 1tm*$sm(4" B<3 9IA 1a8ith!om0cin4. Shat i *t inds o't she has CI6 d'!ing *!egnanc0R Contin'e all

meds e(ce*t e a,i!en8. Shen do 0o' onl0 contin'e c AO)R I she has high CD co'nt" gi,e it in end o *!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 e a,i!en8. 9'st 0o' sta!t t( i *t got s*lashed in e0esR Yes. NissingR @o. .??. I *t is st'c# c C-6 needle" no& has MC-sAg" &hat do 0o' doR I ,accinated" do nothing. I not ,accinated" gi,e I6IG M ,accine. I *t got st'c# c CC6 needle do nothing. .?<. Co& can 0o' tell '!eth!itis !om c0stitisR /!eth!itis has discha!ge. :o! both conditions" 1st ste* is s&ab" then stain" then D@A *!obe then t(. :o! '!eth!itis t( GC 1Ce t!ia(one4" o! ce!,icitis" t( o! Chlam0dia 1A8ith!o o! Do(04 .?=. Genital 'lce!s and M L0m*h co'ld be s0*hilis" LG6 o! chanc!oid .?E. S0*hilis *ainless genital 'lce!" s#in !ash 1lata4" C@S$ao!titis. 1st ste* is Da!# ield mic!osco*0 1not !*!$,d!l4. DOC is *enicillin. I alle!gic gi,e do(0c0line. I alle!gic and *!egnant" desensiti8e c *enicillin. I *t gets immediate alle!gic !(n to *enicllin" gi,e as*i!in. .?F. LG6 *ainless 'lce! c *ain 'l nodes. 1st ste* is se!olog0 1Chlam0dia is c'lt'!e negati,e4" t( c do(0c0cline .?D. Chanc!oid *ain 'l 'lce!" 1st ste* is c'lt'!e" t( c a8ith!om0cin .<3. Genital ,esicles" ne(t ste* is ac0clo,i! 1not )8an# beca'se 0o' al!ead0 ha,e d(4" i !esistant gi,e osca!net. Shen do 0o' choose 7CRR CS6 in the b!ain. .<1. I the0 sho& o! desc!ibe a ,esicle 1b't donAt sa0 ,esicle4" then do )8an# test .<.. I the0 desc!ibe o! sho& &a!ts" ne(t ste* is !emo,e 1no tests needed4. .<+. Se*tic A!th!itis 1st ste* is a!th!ocentesis 12<3"333 &bc4. I 0o' s's*ect gono!!hea 1loo# o! tenos0no,itis" !ash o! mig!ato!0 *ol0a!th!itis4" ne(t ste* is c'lt'!e *ha!0n(" !ect'm" ce!,i(" etc. .<?. Osteom0elitis 1st ste* is (!a0 1*e!iosteal ele,ation4" .nd is 9RI" +!d is bio*s0. Shen do 0o' choose bone scanR I 0o' cant do 9RI 1metal" *acema#e!" hea!ing t'bes" etc4. A te! b( 0o' can ma#e d(: S.a'!ea's 1na cillin4" 9RSA 1,anco" line8olid4" 5.coli 1L'inolones o! bones4 and then $' 5SR. Shen do 0o' choose c'lt'!e o! sin's d!ainageR @e,e!U RC5/9A)OLOGY: .<<. Osteoa!th!itis sti " not !ed" not hot. DI7 1Cebe!dens node4" 7I7 1-o'cha!ds4" &o!se in 79 1not in A9 li#e RA4. H>!a0 sho&s osteo*h0tes and %oint na!!o&ing. )( c &eight loss 1st" then @SAIDS. .<=. Rhe'matoid A!th!itis !ed" hot" s&ollen" e,e!" s'bI nod'les" MR:" *e!ica!ditis" *le'!al e 'sion" ',eitis" long mo!ning sti ness" s&an nec#" 7I7$9C7 1not DI74. H!a0 sho&s *ann's. )( c @SAIDS 11st i mild4" methot!e(ate 11st i se,e!e4" .nd is )@: 1in li(imab !$o )- 1st4" then ste!oids. .<E. Go't *odag!a" to*hi 1s'bI '!ic acid de*osits c *'nched>o't bone lesions4" 1>4 bi!e !igent c!0stals" a$& alcohol$as*i!in$CC)O 'se. )(: Ac'te: 1st c @SAIDS 1Indomethacin4" then colchicines" then ste!oids 11st i !enal d84. Ch!onic: I o,e!sec!eto! gi,e allo*'!inol 1allo o! **l &ho ma#e a lot4" 'nde!sec!eto!s get *!o*enecid. .<F. 7se'dogo't calci'm !homboid sha*ed c!0stals" M bi!e !ingence" chond!ocalcinosis" a$& ? CAs 1hemoch!omatosis" h0*e!*a!ath0!oidism" h0*o*hos*hatemia" h0*omagnesemia4. 9C V #nees$elbo&s. .<D. 7so!iasis scal0 s#in lesions" inge! cl'bbing" R: negati,e. )( c @SAIDS" 9)H .=3. An#0losing s*ond0litis CLA>-.E 1not diagnostic4" amil0 h(" bac# *ain" bent o,e! 1bamboo s*ine4" &o!se c !est 1#e04" bette! c e(e!cise" d( c 1st Sac!al H>!a0 1sac!oiliitis4. )( c e(e!cise and @SAIDS .=1. Reite!s S0nd CLA>-.E" canAt see 1con%'ncti,itis4" *ee 1',ieitis4" climb a t!ee 1a!th!itis4. )( c @SAIDS" e0e d!o*s" S)D t!eatment. .=.. -ehcetAs s0nd!ome .3>?30o c *ain 'l o!al$genital 'lce!s and a!th!itis. )( c ste!oids. .=+. Na&asa#iAs 1:55L 90 Con%'ncti,a :e,e! 2<da0s" 5dema" 5!0thema" L0m*hadeno*ath0" 90ositis" Con%'ncti,itis4. @e(t ste* is 5cho 1!$o co!ona!0 ane'!0sms4. )( c As*i!in M I6IG .=?. )a#a0as' a!te!itis Chinese +3><30o emale c *'lselessness on 1 side. D( c angiog!am o ao!tic a!ch 1co!ona!ies to !$o st!o#e4. )( c ste!oids" c0clo*hos*hamide .=<. Segene!s nasal 1sin'sitis4" l'ng 1hemo*t0sis" d0s*nea4" #idne0 1hemat'!ia4" c>A@CA" t( c

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$*el,ic *ain$sti ness" ele,ated 5SR" no!mal bio*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 .=D. De!matom0ositis same as abo,e" b't c !ash 1heliot!o*e !ash a!o'nd e0elid4. .E3. 7agetAs disease > 2?30o male c *e,ic$s#'ll damage" hats donAt it an0mo!e" dea ness" *a!a*legia" bone *ain" ,e!0 high al# *hos" no!mal calci'm$*hos" inc!eased !is# o osteosa!coma. H> !a0 sho&s thic#ened bones. )( c @SAIDS" bis*ho*honates 15tid!onate4 and calcitonin. .E1. Ce!niated dis# most at L?>< 1&ea# big toe4" and L<>S1 1!ed'ced Achilles !e le(4" *ositi,e st!aight leg test. .E.. Ca!*al )'nnels median ne!,e com*!ession 1th'mb" *ointe!" middle inge!4" )innels sign 1ta**ing &!ist ca'ses n'mbing4" 7halens sign 1 le(ing &!ist4" t( c !est" s*lint" &o!#*lace modi ications" then @SAIDS. .E+. Osgood>Shlatte! in lammation 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 *inning 2<0o. .E<. Legg>Cal,e>7e!thes non>obese #id c a lim* 1d$t a,asc'la! nec!osis V hi*4. )( c obse!,ation and *ain !elie " .nd is b!acing" +!d is s'!ge!0. .E=. Osteo*o!osis !is#s incl'de ea!l0 meno*a'se" alcohol" Ca'casian" thin bod0" tobacco. D( c D5HA 2>..< 1>1 to >..< is osteo*enia4. )( 1st &eight>bea!ing e(e!cise" .nd li est0le 1smo#ing" alcohol cessation4" +!d calci'm$,it D" bis*hos*honates" etc. .EE. 7atella! tendonitis an @-95 + test L'estion" a#a %'m*e!As #nee" *atella! tende!ness d'e to o,e!'se and %'m*ing s*o!ts !es'lting in L'ad!ice*s cont!action. )( c !est" nsaids" L'ad!ice*s st!etching. .EF. Osteosa!coma 13>.<0o c #nee *ain" mass" lim*ing" high al# *hos. H>!a0 c s'nb'!st a**ea!ance. )( c s'!ge!0 and chemothe!a*0 .ED. Osteoid Osteoma bone *ain &o!se at night and !elie,ed c @SAIDS. )( c nsaids .F3. Osteochond!oma bone *ain" (!a0 sho&s *ed'nc'lated meta*h0seal t'mo! at distal em'!. )( c s'!ge!0. .F1. 5&ing sa!coma e,e!" *el,ic$ em'! bone *ain" s&elling" (!a0 sho&s onion s#inning. )( c !adiation" chemo" s'!ge!0. .F.. Re le( S0m*athetic D0st!o*h0 b'!ning *ain" s#in changes 1colo!$tem*4" edema in a *t &ho had *!io! in%'!0 to that a!ea. )( c *ain management 1ha!d to do4. .F+. @'!semaids 5lbo& !om *'lling 0o'! childs a!m" he de,elo*s se,e!e *ain at elbo& and &ill not 'se that a!m. )( c *'shing bac# the head o the !adi's &hile the a!m is s'*inated and le(ed. Nid &ill eel m'ch bette! immediatel0. @5/ROLOGY: .F?. 9ig!aine CA E3K 'nilate!al" th!obbing" a'!a" *hoto*hobia" amil0 histo!0" *ossible !is# o st!o#e" &o!se c OC7s$5tOC$chocolate. )( c @SAIDS" t!i*tans 1cont!aindicated in hea!t disease4" e!gots. 7!e,ent c -- 1st" cabAs .nd" sodi'm ,al*!oate$SSRI$)CAs. .F<. Cl'ste! headache same time e,e!0 month$0ea!" males mostl0" tea!ing" !edness" *ain" !hino!!hea" eels li#e an ice>*ic# is sho,ed in 0o'! e0e 1old L'estion4. )( c 133K o(0gen 1st" ste!oids .nd. .F=. )em*o!al A!te!itis 2<30o c 'nilate!al tem*o!al CA" scal* tende!ness" ,ision changes" high 5SR. 1st ste* is gi,e ste!oids" .nd ste* tem*o!al a!te!0 bio*s0. .FE. 7se'dot'mo! Ce!eb!i a#a -enign Int!ac!anial C)@ inc!eased IC7" CA" ,is'al changes" obese emale" *a*illedema" no ocal C@S indings" a$& ,itamin A to(icit0. D( c 9RI 1st then L7 .nd" t( c a8eta8olamide. .FF. )!igeminal @e'!algia *ain &hene,e! 0o' to'ch 0o'! ace V <th c!anial ne!,e dist!ib'tion. )( c ca!bama8a*ine. De initi,e t!eatment &ith s'!gical !hi8otom0.

.FD. 5ssential )!emo! at !est and motion. )( c *!o*!anolol. 1)!emo! at !est onl0 is 7a!#insonAs o! h0*e!th0!oidism" t!emo! c motion onl0 is ce!ebella! d0s 'nction4 .D3. @0stagm's$6e!tigo i M ocal de ecits" the *!oblem is cent!al 1,e!tical n0stagm's4: ce!ebell'm 1C)$9RI4" 9. G!a,is 19RI4" St!o#e 19RI$C)4" *hen0toin &itho't an hea!ing loss o! tinnit's. I no ocal de ecits" the *!oblem is *e!i*he!al 1in the ea!s4" so *t &ill ha,e hea!ing loss and tinnit's. I *t onl0 has ,e!tigo" its benign *ositional ,e!tigo. I *t has hea!ing loss and tinnit's &ith it: 9inie!eAs disease 1ch!onic disease4" Aco'stic @e'!oma 1loo# o! ata(ia4" Lab0!inthitis 1ac'te ,i!al in (n4 .D1. 5*ile*s0 1as *e! Na*lan on &hat is im*o!tant4: do not t!eat 1st time sei8'!es 'nless the!e is a amil0 histo!0" 55G is *ositi,e o! *t has stat's e*ile*tic's. .D.. 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 1lastU4. )(: 1st -en8o 1lo!a8e*am I64" .nd 7hen0toin" +!d -a!bit'!ate" ?th Anesthesia 1s'ccin0lcholine$*!o*o ol these &ill %'st sto* the sha#ing" &ont sto* the sei8'!e4. .D+. Absence sei8'!es #id sta!es into s*ace" doing *oo!l0 in school" e0e blin#ing" li* smac#ing" 55G c +$sec s*i#e and &a,e *atte!n. )( c ethos'(imide. .D?. )IA ocal" ab!'*t onset lasting less than 1 ho'!" s0m*toms !esol,e a te! 1 da0. Ris# o st!o#e in da0s to &ee#s. Amo!osis 'ga( 1c'!tain o,e! an e0e d'e to !etinal d0s 'nction4 needs Do**le! /$S o ca!otids o! 9RA. Gi,e he*a!in ac'tel0 1i no cont!aindications4" then long te!m as*i!in. I stenosis 2E3K" ama'!osis 'ga($)IA o! small" non>disabling st!o#e do C5A 1ca!otid enda!te!ectom04 and gi,e as*i!in. I stenosis BE3K" se,e!el0 disabling st!o#e" o! )IA$st!o#e in e,ol'tion gi,e dail0 as*i!in alone. .D<. C6A 1st test is C) &itho't cont!ast 1altho'gh" i ischemic" it &ill sho& negati,e4" .nd is 9RI. Ce*a!in is not gi,en 'ntil hemo!!hagic st!o#e is !'led o't. I ischemic" gi,e t7AAs i less than + ho'!s o onset. I hemo!!hagic" cont!ol -7 and IC7. .D=. Ischemic St!o#e Locations: 9CA cont!alate!al hemi*legia" hemiano*sia" -!ocaA s 1non l'ent" babbling4$Se!nic#eAs 1 l'ent b't doesnAt ma#e sense4 a*hasia. ACA cont!alate!al leg *a!al0sis" s*hincte! incontinence 1the0 cant #ic# 0o'" so the0 *ee on 0o'4; 7oste!io! co!tical blindness" hemiano*sia; 6e!teb!obasila! ata(ia" ho!i8ontal ga8e" n0stagm's; Ce!ebella! ata(ia and di88iness; As o! hemo!!hagic" !emembe! that in the thalam's its onl0 senso!0 loss" in the *ontine$inte!nal ca*s'le$*'tamen its onl0 moto! loss. .DE. 9'lti*le Scle!osis insidio's onset o C@S s$s in a &oman aged .3>?3 &ith e(ace!bations and !emissions o n'mbness" *a!asthesia" &ea#ness" o*tic ne'!itis" gait dist'!bance" incontinence and emotional$mental stat's changes. Loo# o! classic b$l inte!n'clea! o*thalmo*legia 1lesion V 9L: so 0o' cannot add'ct in ho!i8ontal ga8e4 and scanning s*eech. -abins#i ma0 be *ositi,e. 5nti!el0 C@S 19.g!a,is and G>-a!!e a!e enti!el0 7@S4. 1st ste* is 9RI" .nd test is L7 1oligoclonal bands4. )( ac'te e(ace!bation c ste!oids. 7!e,ent ne(t attac# c A-C 1A,one( 1In >-4" -etase!on 1In > -4 and Co*a(one 1Glati!ame! acetate44. I st'c# in 1 *osition all da0" gi,e baclo en o! )i8anidine. I incontinent gi,e o(0b'tinin o! bethanacol. .DF. G'illain>-a!!e S0nd!ome h$o /RI o GI in ection 1cam*0lobacte! %e%'ni4 o! imm'ni8ation 1 &ee# be o!e de,elo*s onset o s0mmet!ic" assending *!og!essi,e &ea#ness o! *a!al0sis and loss o D)Rs. 1st ste* is 7:)s 19CCOD is !es*i!ato!0 d0s 'nction d'e to *a!al0sis" so monito! the *tAs @I: 1negati,e ins*i!ato!0 o!ce4 and i it #ee*s dec!easing" conside! int'bation4. 9ost acc'!ate test is 59G. Shen do 0o' choose L7R Last 1sho&s ele,ated CS: *!otein4. )( c I6IG o! *lasma*he!esis 1not ste!oidsU4. .DD. 90asthenia G!a,is Ab against Ach !ece*to!s in &omen .3>?30o. Loo# o! *tosis" di*lo*ia" di ic'lt0 s&allo&ing and &ea#ness c !e*etition 1at the end o the0 da0 the0 a!e e(ha'sted4. -est initial test is Ach Ab 1@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 1b!eathing *!oblems4 c D$C anitchone!gics and gi,e I6IG and 7lasma*he!esis 1@O) ste!oids4. )( o! ch!onic disease: B=3 gets th0mectom0 1do CHR" Chest C)4" 2=3 gets neostigmine and ste!oids" then a8athio*ine$c0clos*o!ine$tac!olim's. Shat ab( is cont!aindicatedR Aminogl0cosides. +33. 5aton>Lambe!t Ab against *!es0na*tic calci'm channels ca'sing limb &ea#ness that gets st!onge! c !e*etiti,e stim'lation 1o**osite o g!a,is4"no loss o D)Rs o! e(t!aoc'la! mani estations" a$& small cell l'ng cance!" t( c g'anidine. 1cabAs a!e cont!aindicated4. +31. @e'!os0*hilis te!tia!0 t!e*onema *allid'm disease. )!eat c high dose *enicillin. A te! gi,ing

*enicillin" *t ma0 de,elo* h0*otension" e,e!" CA" chills and tach0ca!dia &ithin .? ho'!s o t!eatment d'e to t!e*onemal *!od'cts 1Ga!isch>Ce!(heime! !eaction" this is not a *enicillin !eaction4. )( c as*i!in. +3.. 90otonic D0st!o*h0 .3>+30o g'0 g!abs something and cant let go 1im*ai!ed !ela(ation4 d$t m'tations in chlo!ide channel. )( c *hen0toin. +3+. D'chenne 9'sc'la! D0st!o*h0 HLR" bo0s +>E ha,e m'scle &ea#ness" ,e!0 high CN" cal *se'doh0*e!t!o*h0" Go&e!As sign 1#id climbs his legs to stand" loo# at it in google ,ideos its so sad4. Nid is in &heelchai! b0 teenage! and dead b0 .3. D( c m'scle bio*s0. +3?. 9itochond!ial 90o*ath0 a#a Le,e!As he!edita!0 o*tic at!o*h0 e,e!0 mom gi,es to all o,e!s*!ing 1no male t!ansmission4. Loo# o! !agged !ed ibe!s on bio*s0. +3<. -ot'lism in ant ingests hone0 and de,elo*s lo**0 bab0 s0nd!ome. 1st ste* is int'bate i needed" .nd ste* is antito(in. S*ontaneo's !eco,e!0 in 1 &ee#. +3=. Am0ot!o*hic late!al Scle!osis a#a Lo' Geh!igAs d8 <<0o male '**e! 1s*asticit0" h0*e!!e le(ia" babins#i4 and lo&e! moto! ne'!on 1 ascic'lations" at!o*h0" laccidit04 *!oblem. Onl0 moto! *!oblems" no senso!0$se('al$bo&el *!oblems. )( c Ril'8ole. +3E. C'ntingtonAs Disease AD 1 athe! had it" 0o' ha,e it at a 0o'nge! age4 c CAG !e*eats" cho!ea" *e!sonalit0 change" *s0chiat!ic s0nd!omes" *!og!essi,e dementia. D( c C)$9RI sho&ing ca'date n'cle's and ce!eb!al co!te( at!o*h0" ca'sing dec!eased Ach and GA-A 1th's ca'sing inc!eased do*amine4. )( c anti*s0chotics 1halo*e!idol4 Shen 0o' see a mo,ement diso!de!" dementia and emotional *!oblems" thin# o C'ntingtonAs. Shen 0o' see dementia and emotional *!oblems 1no cho!ea4" *ic# 7ic#As disease. +3F. 7a!#insonAs =30o c e(t!a*0!amidal mo,ement diso!de! 1*ill>!olling !esting t!emo!" cog&heel !igidit0" sh' ling gait" b!ad0#inesia" mas#ed acies4. Ca'sed b0 loss o do*amine!gic ne'!ons in s'bstantia nig!a. )(: 9ild s$s 1can still ta#e ca!e o themsel,es4: B=30o c Anticholine!gic 1cabe!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 1*!ima*e(ole" !o*ini!ole" *e!golide4" +!d CO9)>inhibito!s 1)alco*one4" ?th 9AOI 1selegiline4. Some anti*s0chotics 1halo*e!idol" !is*e!idone" 97)74 can ca'se *a!#inson>li#e s0m*toms" t( c anticholine!gics 1ben8t!o*ine$ t!ihe(0l*henid0l$ cabe!geline4. Yo'ng g'0 c 7a!#insonism" b't not on meds" thin# o SilsonAs disease. +3D. Al8heime!As *!og!essi,e dementia 1memo!0" lang'age" ,is'os*atial" mood" hall'cinations" *e!sonalit0$beha,io!4 in mid>late li e. a$& Do&nAs s0nd!ome 1am0loid *!ec'!so! *!otein4. D( c 9RI sho&ing co!tical at!o*h0" senile *laL'es" ne'!o ib!illa!0 tangles. )( c done*e8il" !i,astigmine and galantamine to inc!ease Ach %'st in b!ain. +13. 7ic#As ea!l0 aged 1?34 *e!sonalit0 change" dementia. C)$9RI sho&s !ontetem*o!al at!o*h0" a!g0!o*hilic ne'!onal 17ic#4 bodies in !ontal and tem*o!al lobe" s*a!ing s'*e!io! tem*o!al g0!'s 1gene!all0 no memo!0 *!oblems4. +11. 9'lti>in a!ct Dementia ste*&ise dementia in a *t c bad medical histo!0 1C)@" D9" etc.4. )he0 &ill desc!ibe the *t as *!og!essi,el0 getting &o!se" little>b0>little. D( c 75)$S75C) scan sho&ing m'lti ocal dec!eases in ce!eb!al blood lo&. )( c as*i!in +1.. @o!mal 7!ess'!e C0d!oce*hal's > Q&et" &ac#0" &obbl0 1incontinent" dementia" ata(ia4. D( c C) scan" t( c ,ent!ic'lo*e!itoneal sh'nt. +1+. C!e't8 eldt>Ga#ob > 0o'ng g'0 c !a*idl0 *!og!essi,e dementia" m0oclon's d'e to abno!mal iso o!m o *!ion *!otein. D( c bio*s0 1nothing else4. @o t!eatment. +1?. @a!cole*s0 da0time slee* attac#s c cata*le(0" h0nogogic 1going to slee*4$h0*no*om*ic 1&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<. Obst!'cti,e slee* a*nea o,e!&eight" C)@" a!!h0thmia" gas*ing o! ai!. D( c *ol0s0mnog!a*h0. )( c C7A7. +1=. Cent!al slee* a*nea old" non>obese *t c loss o !es*i!ato!0 d!i,e. )( c a8eta8olamide. +1E. 5*id'!al Cematoma > M head t!a'ma" M CA" M LOC" l'cid inte!,als a te! b!ie LOC ollo&ed b0 inc!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 Cematoma > Mhead t!a'ma" M CA" M LOC" b!idging ,eins in%'!ed" can be ac'te 1C) sho&ing conca,e o! c!escent>sha*ed hematoma4" da0s 19RI4" o! g!ad'al dete!io!ation 19RI4. )( c

same as abo,e. +1D. S'ba!achnoid Cemo!!hage > MCA" M LOC" no head t!a'ma" s*ontaneo's" s'dden onset o meningitis 1sti nec#" *hoto*hobia" #e!nigAs" b!'d8ins#i4" &o!st CA o m0 li e" a$& *ol0c0stic #idne0 disease" CS: c blood. -est initial test is Cead C)" most acc'!ate test is L7. )( s'**o!ti,el0 1bed !est" analgesia4 +.3. Conc'ssion M head t!a'ma" M LOC" no ocal C@S de ecits. )( go home. +.1. Cont'sion M head t!a'ma" M LOC" blood$b!'ise on head. )( go home. +... @e'!ole*tic malignant s0nd!ome high tem*e!at'!e" m'sc'la! !igidit0" con 'sion" high C7N" high NM" no s&eating" t( c I6 dant!olene o! b!omoc!i*tine. +.+. 9alignant h0*e!the!mia high tem*e!at'!e" con 'sion" high C7N" high NM" no s&eating" h$o anesthesia 1halothane4. )( c I6 dant!olene +.?. Ceat St!o#e high tem*e!at'!e" con 'sion" no s&eating" no!mal C7N" no!mal N. )( c anning them 1donAt o,e!cool them4 and &ate!. +.<. Closed>angle Gla'coma s'dden e0e *ain" n$," ,ision loss. )( c s'!gical i!idectom0 +.=. O*en>angle Gla'coma *!og!essi,e *e!i*he!al ,ision loss" disc c'**ing" no *ain. )!eat &ith bb 1timolol4" aceta8olamide" e0e d!o*s and *!ostaglandins 1latano*!ost4. G!o&th$De,elo*ment$ 7!e,entati,e 9edicine: +.E. Gestational Age 'nd's at *'bic s0m*h0sis V F &#s" abo,e s0m*h0sis V 1?&#s" 'mbilic's V .3&#s" (i*hoid V +F&#s. +.F. @aegeleAs !'le ass'ming .F da0 c0cle" s'bt!act th!ee months" add E da0s 1i mo!e than .F da0s" add the !emaining da0s to the E4 +.D. In ant si8e gains bac# bi!th &eight b0 . &ee#s o age" do'ble &eight b0 = months" t!i*les &eight b0 1 0ea!. ++3. Lactation est!ogen ma#es mamma!0 d'ct tiss'e g!o&" *!ogeste!one stim'lates al,eola! glands. 7ost*o!t'm" the0 both d!o*" *!olactin inc!eases 1inhibiting o,'lation4 and o(0tocin" ,ia ni**le stim'lation" allo&s mil# letdo&n. Cont!aindicated &ith CI6" C96 o! ce!tain meds. ++1. @e&bo!n ca!e: QCa*'t s'ccedane'm is a hematoma ac!oss the s't'!e line" ca*halohematoma is a hemotoma that does not c!oss the s't'!e line. 9ongolian s*ot is a bl'ish discolo!ation at the sac!'m" al&a0s benign 1do not ass'me ab'se4. Chec# o! !ed e0e !e le( 1!$o !etinoblastoma and congenital cata!acts4" O!olani$-a!lo& mane',e! 1!$o DDC4" abdm masses 1AR7ND" SilmAs t'mo!" ne'!oblastoma" 'mbilical he!nia 1!$o h0*oth0!oidism44 ++.. De,elo*ment: 1 month head lag$social smile; + months li ts head" = months !olls o,e!$sits '* alone$st!ange! an(iet0" D months c!a&ls$ta#es ste*s i hands held" 1. months &al#s i 0o' hold one hand" s*ea#s th!ee &o!ds; 1< months &al#s alone$se*a!ation an(iet0" t&o> bloc# to&e!; .0o si( c'be to&e!$*oison>*!oo home. +++. At ? 0ea!s old" m'st get ob%ecti,e hea!ing and ,is'al e(am. ++?. 7'be!t0: :emales seL'ence 1est!ogen4: o,a!0 g!o&th" b!eat b'd" g!o&th s*'!t" then *'bic hai!. 9ale seL'ence 1testoste!one4: testic'la! g!o&th" g!o&th s*'!t" then *'bic hai!. ++<. Shen to #ee* child>*h0sician con identialit0R D!'gs" 5tOC" OC7" S)D *!e,ention. ++=. OC7 -a!!ie! 9ethod 1condoms hel* *!e,ent S)Ds" dia*h!agms might be anno0ing to *!e*a!e" th's inhibiting 'se4" ho!monal cont!ace*ti,es 1combined est$*!og 1sa e" e ecti,e4" mini*ill 1mo!e *!egnanc0$bleeding4" o! in%ectable and im*lanted *!ogestins4" ,aginal s*e!micides" I/D" s'!gical ste!ili8ation. ++E. X1 st!esso! is death o a s*o'se" X . is di,o!ce. ++F. @o!mal Aging: ca!diac 1dec!eased CO4" m'sc'los#eletal 1dec!eased bone mass4" *'lmona!0 1dec!eased st!ength and com*liance4" imm'nit0 1th0m's in,ol'tion4" senses 1dec!eased ,is'al" a'dito!0" tactile and taste4" endoc!ine 1dec!eased ins'lin>sec!eting cells" gl'cose intole!ance4" mental 1dec!eased memo!0" lea!ning abilit0 and calc'lation s*eed4. ++D. 5(ce*tions to in o!med consent: eme!genc0" imcom*etent *t" mino!s. +?3. In l'en8a > 2<30o" high !is# 1CO7D" ca!dio,asc'la!" !enal4" &omen &ho SILL become *!egnant in &inte!" ho'sehold contacts o high>!is# *t 1to *!otect the high>!is# *t4. 7ne'mococcal > 2=<" como!bidities. +?1. :o!m'las: YA T )!'e 7ositi,e; - T :alse *ositi,e; C T :alse negati,e; D T )!'e @egati,eZ

1*ositi,es al&a0s on to*4 Sensiti,it0 T )7$)7M:@; S*eci icit0 T )@$)@M:7; 776 T )7$)7M:7; @76 T )@$)@M:@; Att!ib'table !is# 1att!ib T s'bt!act4 T 1a$aMb4 1c$cMd4; Relati,e !is# 1onl0 o! *!o*ecti,e st'dies li#e coho!t st'd04T 1a$aMb4 $ 1c$cMd4; Odds !atio 1onl0 o! !et!os*ecti,e st'dies li#e case>cont!ol4 T ad$bc; attac# !ate 1ho& man0 **l get attac#ed c d84 T aMc$bMd. +?.. 7o&e! T !e%ecting the n'll &hen its alse 1a good thing" li#e sa0ing 6iag!a does not t!eat consti*ation" &hich it doesnAt do4. Co&e,e!" sometimes :DA ma0 not al&a0s ma#e the !ight choice and end '* a**!o,ing something that doesnAt &o!#" o! not a**!o,ing something that &o!#s. )0*e 1 e!!o! !e%ecting the n'll &hen itAs t!'e 1sa0ing 6iag!a does not t!eat e!ectile d0s 'nction4. )0*e . e!!o! T acce*tance o the n'll h0*othesis &hen it is alse 1sa0ing 6iag!a t!eats consti*ation4. Gene!all0" the onl0 &a0 to inc!ease *o&e! is to inc!ease the sam*le si8e. +?+. 9ean T a,e!age; 9edian T middle X" 9ode T 9C X. +??. Con idence Inte!,al T Ymean M$> O sco!e ( standa!d e!!o! o meanZ" &he!e O is the standa!d sco!e 1I con idence inte!,al is D<K" O is ." i CI is DDK" O is ..<4 and standa!d e!!o! o mean is 1S $ sL'a!e !oot o @4" &he!e S is the standa!d de,iation and @ is the sam*le si8e. :o! e(am*le" old )I said the mean &as =EK" standa!d de,iation &as FK in a sam*le si8e o 1=" calc'late a D<K CI: 1=E M$> . 1F $ sL'a!e !oot o 1=4 T 1=E M$> . 1F$?44 T =? M$> ?. )he ans&e! &as =+>E1. +?<. Shen the0 gi,e 0o' a cha!t &ith di e!ent con idence inte!,als" %'st loo# o! the one that has 1 &ithin the !ange 1ie. 3.FD>..+" not 1.1.>...< o! 3.<=>3.D+4. )hat one is @O) statisticall0 signi icant" meaning the !is# is the same. I 1 is not &ithin the !ange" is is statisticall0 signi icant. I it &as o,e! 1 11.1.>...< 'sed abo,e4" the!e is an inc!eased !is#. I it &as 'nde! 1 13.<=>3.D+ 'sed abo,e4" the!e is a dec!eased !is#. +?=. Shen gi,en statistical scales and as#ed o! the statistical test: @ominal is catego!ical 1ho& man0 0o' can s*lit into g!o'*s" li#e gende!s" ethnicities" etc4" Inte!,al is a meas'!ement 1height" &t" -7" etc.4. 7ea!son co!!elation T . inte!,als; Chi>sL'a!e T . nominals; t>test T 1 nominal M 1 inte!,al. :o! e(am*le" i 0o' &ant to ind o't i men do bette! than &omen on ste* .. 9en ,s &omen is nominal" Ste* . is an inte!,al" the!e o!e one o each ma#es it a t>test. +?E. I gi,en the ollo&ing data: A te! s'!ge!0: D3K s'!,i,e 10ea!" E<K s'!,i,e .0ea!s" <3K s'!,i,e +0ea!s" ?3K s'!,i,e ?3K" and as#ed: &hat is the li e e(*ectanc0 a te! s'!ge!0R Al&a0s *ic# closest to <3K" so the ans&e! &o'ld be + 0ea!s. I as#ed" i a *t s'!,i,es . 0ea!s" &hat is the chance o s'!,i,ing + 0ea!sR Al&a0s *'t the X ending on to*" X sta!ting on bottom" so it &ill be <3$E<" o! =EK. +?F. Coho!t st'd0 1thin# Coho!t to Go :o!th4 a *!os*ecti,e st'd0 &he!e *eo*le a!e ollo&ed o! a *e!iod o time. Ad,antages a!e that incidence 1X o ne& cases4 can be dete!mined" the!e is an acc'!ate !elati,e !is# 1!emembe! RR &ith coho!t4" and less cont!ol g!o'* bias. Disad,antages a!e that it ta#es too long" e(*ensi,e" the sam*le si8e can get too la!ge" and 0o' might !'n into an ethical *!oblem. +?D. Case>cont!ol st'd0 a !et!os*ecti,e st'd0 &he!e 0o' sta!t &ith an o'tcome and then chec# bac#&a!ds to e,al'ate the !is# o! ca'se. Ad,antages a!e that itAs chea* and eas0" small sam*le si8e and minimal ethical !is# is in,ol,ed. Disad,antages a!e that incidence 1ne& cases4 a!e not dete!mined" RR is %'st a**!o(imated 1not e(act" %'st ta#ing odds" !emembe! OR c case>cont!ol4 and that the!e is some cont!ol g!o'* bias. Na*lan sa0s" i 0o' ha,e no idea &hich t0*e o st'd0 it is" *ic# this one. +<3. Con o'nding bias &hen hidden acto!s a ect the !es'lts. :o! e(am*le" an e(*e!imente! meas'!es the X o asht!a0s o&ned and incidence o l'ng cance! and inds that *eo*le c l'ng cance! ha,e mo!e asht!a0s. Ce o! she then concl'des that asht!a0s ca'se l'ng cance!. Smo#ing is the con o'nding bias he!e" beca'se it inc!eases both asht!a0s and l'ng cance!. So ho& can 0o' *!e,ent thisR Do m'lti*le st'dies. +<1. Lead>time bias &hen 0o' con 'se the acts that ea!l0 sc!eening &ill inc!ease li e e(*ectanc0. Loo# o! alse estimates o s'!,i,al !ates. :o! e(am*le" i I diagnosed 0o' &ith cance! at 1F and 0o' li,ed 'ntil +3" 0o' &ill thin# I t!eated 0o' o! .. 0ea!s. Co&e,e! i I didnAt diagnose 0o' 'ntil .< and didnAt t!eat 0o' a te!" and then 0o' li,ed 'ntil +3" 0o' &ill thin# that 0o' onl0 s'!,i,ed < 0ea!s. )he di e!ence is not that m0 d!'g t!eats 0o' bette!" b't that I am diagnosing 0o' ea!lie!" th's getting a good lead on time. )he sol'tion he!e is to meas'!e the Qbac#>end s'!,i,al 1ie. Getting the age +3 as the age that the0 both die at" &hethe! the0 &e!e t!eated o! not4. +<.. Recall bias s'b%ects canAt !emembe! e,ents in the *ast. Sol'tion is to ma#e them con i!m in o!mation &ith othe! so'!ces.

+<+. Late>loo# bias s'b%ects die be o!e the end o the s'!,e0" so 0o'! in o!mation gets disto!ted. :o! e(am*le" a s'!,e0 inds that AIDS *ts onl0 get mild s0m*toms. )his is &!ong beca'se the0 die be o!e the !eall0 bad s0m*toms occ'!. Sol'tion he!e is to st!ati 0 the disease b0 se,e!it0. +<?. 5(*e!imente!$Inte!,ie&e! bias a#a 70gmalion e ect > &hen the e(*e!imente!s e(*ectations a!e inad,e!tentl0 comm'nicated to s'b%ects" &ho then *!od'ce the desi!ed e ect. Sol'tion is to ma#e the st'd0 a do'ble>blind one. +<<. Selection bias a#a sam*ling bias &hen the sam*le selected is not a !e*!esentati,e o the *o*'lation. :o! e(am*le" ta#ing the *eo*le !om a health cl'b and doing a s'!,e0 on the l'ngs in the gene!al *o*'lation. Anothe! ca'se is &hen a st'd0 'ses hos*ital !eco!ds to estimate *o*'lation *!e,alence 1-e!#sonAs bias4. :o! e(am*le" a docto! sa0s all the *eo*le in @Y a!e sic# beca'se all da0 he &o!#s &ith sic# *atients in @Y. +<=. 9eas'!ement bias a#a Ca&tho!ne e ect &hen being obse!,ed ma#es 0o' change ho& 0o' ans&e! to L'estions. Also" &hen the &a0 the in o!mation is *!esented ma#es 0o' ans&e! in a ce!tain &a0. :o! e(am*le" as#ing a *t Q0o' donAt li#e 0o'! docto!" do 0o'R )he *t is li#el0 to sa0 no beca'se o the &a0 the L'estion &as *!esented. In the la& &o!ld" its te!med Qleading. 7!e,ent this b0 ha,ing a cont!ol$*lacebo g!o'*. WWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWW O-: +<E. @'mbe!s to note: Co& man0 &ee#s in each t!imeste!R 1+; &hat is so s*ecial abo't +E &ee#sR L'ngs a!e m't'!e b$c lethicin$s*hingom0elin !atio is .:1; &hat is the !is# o ha,ing Do&nAs i mom is +<R 1$+<3; !is# V ?3R 1$133; !is# V ?<R 1$<3" so 0o' absol'tel0 m'st !ecommend amniocentesis. 7!egnanc0 &eight gain is abo't .< *o'nds 1< in i!st .3 &ee#s" 1 *d e,e!0 &ee# a te!4. /te!ine height: F &ee#s V iliac" 1? &ee#s V *'bic s0m*hisis" .3 &ee#s V 'mbilic's" +F &ee#s V (i*hoid *!ocess. +<F. Dates to note: =>F&#s is *!enatal &o!#'*. 1<>1F &ee#s is t!i*le sc!een. 1F &ee#s is 'lt!aso'nd. .= &ee#s is gl'cose challenge test o! D9. +< &ee#s is G-S c'lt'!e. +<D. Diagnostics: /lt!aso'nd 1nonin,asi,e" no ad,e!se e ects" done at 1F>.3 &ee#s4" Cho!ionic ,ill's sam*ling 1QC6S" in,asi,e" done at D>1. &ee#s" best o! ea!l0 gestation so mom has the chance to choose an abo!tion" ma0 be atal" $' c t!i*le sc!een a te!4" Amniocentesis 1done at 1<>.3 &ee#s o! genetic *'!*oses o! high !is# *atients" done at .? &ee#s o! Rh isoimm'ni8ation" done at +? &ee#s o! gestation age" *!egnanc0 loss abo't 3.<K4 +=3. Diabetes &o!#'*: Done at .?>.F &ee#s in no!mal *t. Done c *!enatal &o!#'* 1=>F &ee#s4 i *t is obese o! has h$o mac!osomic bab0" h$o D9 o! amil0 h$o D9. )he *t &ill come to 0o'! o ice asting o! 1 ho'!" he! blood s'ga! sho'ld be 21?3. I B1?3" get he! asting gl'cose 1sho'ld be BD34 and *!oceed to a + ho'! 133g gl'cose tole!ance test: 1h! B1F3" .h! B1<<" +h! B1?3. +=1. 5mb!0olog0: See# 1 im*lantation" &ee# . . la0e!s o!med 1e*iblast and h0*oblast4 and b>hCG is *!od'ced b0 s0nc0tiot!o*hoblast" &ee# + + la0e!s o!med" &ee# ? ma%o! o!gans o!med. @ote that &ee#s +>F a!e the *e!iod o g!eatest te!atogenicit0. +=.. )e!atogens: In ections 1)ORCC4" Radiation 12.3 !ads4" Chemothe!a*0 1In i!st )9" cant gi,e 9)H" Ad!inom0cin4" 5n,i!onmental 1smo#ing ca'ses I/GR" alcohol ca'ses mic!oce*hal0" lat *hilt!'m" thin '**e! li*4" Rec!eational d!'gs 1cocaine ca'ses *lacental ab!'*tion and int!a,ent!ic'la! hemo!!hage" ma!i%'ana ca'ses *!emat'!it04" 9edications 1D5S 1,aginal$ce!,ical cell CA4" Dilantin 1gingi,al h0*e!*lasia" n0stagm's" c!anio acial d0smo!*hism4" Sa! a!in 1Sti**led e*i*h0sis4" Iso!etinoin 1dea ness" C@S4" Lithi'm 1ebstein anomal04" St!e*tom0cin 1C@ F4" )et!ac0cline 1blac# teeth4" )halidomide 1small limbs4" 6al*!oic acid 1s*ina bi ida44. +=+. ->hCG + *'!*oses: maintains co!*'s l'te'm 1&hich #ee*s ma#ing *!ogeste!one4 'ntil *lacenta ta#es o,e! at Dth &ee#" !eg'lates ste!oid *!od'ction" stim'lates testoste!one *!od'ction in etal male testes. Le,els ma0 be too high 1inco!!ect dates 19C4" t&ins" h0datidi o!m mole" cho!ioca!cinoma" eb!0onal CA4 o! too lo& 1inco!!ect dates 19C4" ecto*ic" th!eatened$missed abo!tions4. I le,els a!e high o! lo&" ne(t ste* is to !echec# the dates. +=?. C'man 7lacental lactogen 1C7L4 chemicall0 simila! to GC and *!olactin" th's antagoni8ing ins'lin &hich &ill cont!ib'te to gestational diabetes i too high. +=<. 5st!ogens: 5st!adiol 1non*!egnant !e*!od'cti,e 0ea!s" made !om g!an'lose cell !om

testoste!one ,ia a!omatase4" est!iol 1*!egnanc0" made !om DC5A ,ia s'l atase in the *lacenta4" est!one 1meno*a'se" made !om ad!enal ad!ostenedione in adi*ose4. +==. Changes in *!egnanc0: S#in 1st!iae g!a,ida!'m 1st!etch ma!#s4" chad&ic#As sign 1bl'ish ce!,i(4" linea nig!a" chloasma. @ote the onl0 cance! that inc!eases c *!egnanc0 is melanoma4" C6S 1dec!eased -7 in 1st )9" highest CO in L late!al dec'bit's *osition" s0stolic e%ection m'!m'! is no!mal" diastolic m'!m'! is abno!mal4" GI 1*!ogeste!one ca'ses inc!eased sali,ation" g'm h0*e!*lasia" G5RD$as*i!ations" dec!eased gast!ic motilit0" consti*ation4" *'lmona!0 1gene!all0" most inc!ease e(ce*t tidal ,ol'me ca'sing !es* al#alosis4" !enal 1inc!eased G:R" dec!eased -/@$C!" dec!eased '!ic acid" gl0cos'!ia is no!mal" *!otein'!ia is not4" *it'ita!0 1si8e inc!eases" cont!ib'ting to *ossible SheehanAs s0nd!ome4" th0!oid 1inc!ease in )-G and total )+$)?" not !ee )+$)? th's not ca'sing s$s o h0*e!th0!oidism" blood 1inc!ease R-C$S-C" no!mal *latelets. @ote lo& *latelets c C5LL7 s0nd!ome d$t *!eeclam*sia" 9CC o anemia is i!on de icienc0" then olate de icienc04. +=E. 7!enatal &o!#'*: done at =>F &ee#s. Chec# C-C" /A 1!$o as0m*tomatic bacte!'!ia &he!e 21333 5.Coli &ill be o'nd" t!eat c am*illin o! nit!o '!antoin i alle!gic4" R'bella 1&o!st at 1st )94" R7R" C-6" Rh blood t0*ing" sic#le cell *!e* 1i 1M4" *!oceed to Cb elect!o*ho!esis4. I *t is a teenage!" do Chlam0dia and gono!!hea c'lt'!es. +=F. )!i*le Sc!een A:7" hCG" est!iol 1c'!!ent0 inhibin>A ma#es o! L'ad sc!een4. I A:7 is lo&" thin# o Do&nAs$5d&a!ds s0nd. I A:7 is high thin# o @)Ds" gast!ocele" om*halocele. Again" i A:7 is high$lo&" ne(t ste* is to get ,aginal '$s to chec# dates. I dates a!e co!!ect and /$S is non> e(*lanato!0 1did not sho& n'chal old thic#ening o Do&nAs4" get amniocentesis o! #a!0ot0*e" amniotic l'id>A:7 and acet0lcholineste!ase acti,it0 1both high in @)D4. Do&nAs s0nd!ome high hCG" lo& A:7" lo& est!iol. 5d&a!ds s0nd!ome all + a!e lo&. +=D. 9om sa0s she doesnAt eel the bab0 mo,e an0mo!e. @e(t ste* is /$S. I it sho&s etal ca!diac acti,it0" get non>st!ess test. I it doesnAt sho& etal ca!diac acti,it0" this is etal demise and the ne(t ste* is DP5 A) 1.>1=&# 1not DPC 1B1.&#4" not C$S" ind'ce labo! B1=&#4 ollo&ed b0 ce!,i($*lacental c'lt'!e" a'to*so0" #a!0ot0*ing and total bod0 (>!a0 1!$o osteochond!o*lasia4. @on> st!ess test 1done in high !is#" o! i *t sa0s she doesnAt eel the bab0 mo,e an0mo!e4: !eacti,e is good 1. accele!ations in .3 min'tes4" non!eacti,e is bad 1B. accel$.3 min'tes4 +E3. @onst!ess test 1@S)4: i !eacti,e bab0 is o# 1monito!4. I non>!eacti,e" bab0 ma0 be slee*ing o! in dange!" so do ,ib!oaco'stic stim'lation 16AS4 and !e*eat @S). I @S) is no& !eacti,e" bab0 &as slee*ing and is no& o# 1monito!4. I still non>!eacti,e" get a -io*h0sical *!o ile 1-774 c /$S. I -77 is F>13" bab0 is o# 1!e*eat in ? da0s4; i -77 is =>?" do a st!ess test 1chec# o! decele!ations4. I -77 is 3>." deli,e! immediatel0. +E1. -77 meas'!es < com*onents 1each &o!th .4: @S)" amniotic l'id ,ol'me 1no!mal is <> 1<"B< is oligoh0d!amnios" 21< is *ol0h0d!amnios4" etal g!oss bod0 mo,ements" etal e(t!emit0 tone" etal b!eathing mo,ements. +E.. St!ess test chec#s o! decele!ations. Go in o!de! 1head" then co!d" then *lacenta4. 5a!l0 decele!ation means head com*!ession" 6a!iable decele!ation means co!d com*!ession" Late decele!ation means 'te!o>*lacental ins' icienc0. )!eatment o! decele!ations in a st!ess test: 1st D$C o(0tocin" .nd Gi,e o(0gen and l'ids" +nd *osition he! to L late!al dec'bit's *osition" ?th get scal* *C 1no!mal E..< E.?" i BE.. go !ight to C>s(n4. +E+. G!o'* - St!e* 1G-S4 not a disease o! *athogen to the mothe!" b't i t!ansmitted to the ne&bo!n d'!ing deli,e!0 can ca'se *ne'monia" se*sis o! meningitis. 7!o*h0la(is c I6 *enicillin G 1i alle!gic" gi,e clinda" e!0th!o o ce a8olin4 is gi,en o! MG-S c'lt'!e V +E &ee#s" h$o *!e,io's child c in ection" *!ete!m gestation 1e,en i c'lt'!e negati,e4" 7RO9 21F ho'!s 1m'st gi,e eno'gh time o! *enicillin to !each et's4" o! mate!nal e,e!. +E?. )o(o*lasma gondii cat eces" !a& goat mil#" 'nde!coo#ed meat. So!st in .$+!d )9. In neonate it can ca'se sei8'!es" in et's loo# o! int!ac!anial calci ications. )( c *0!imethamine> s'l adia8ine. +E<. 6a!icella #id c Q8ig8ag lesions 1d'e to ne!,e dist!ib'tion4" cata!acts" cho!io!etinitis. So!st i mom has the *!'!itic ,esicles < da0s ante*a!t'm>. da0s *ost*a!t'm. 7!e,ent c 6OIG D= ho'!s *!io! to bi!th. )( c ac0clo,i!. +E=. R'bella &o!st in 1st )9. 7!e,ent + months be o!e concei,ing. Loo# o! t!iad: dea ness" cata!acts and 7DA. Sometimes Qbl'e>be!!0 m' in !ash. @o t!eatment. +EE. C96 loo# o! ce!eb!al calci ications" dea ness and mic!o*hthalmia. -lood sho&s

int!an'clea! incl'sions. )( c ganciclo,i!" o! osca!net i !esistant. +EF. S0*hilis D( c da!# ield mic!osco*0 1!*!$,d!l ma0 be negati,e 'ntil seconda!0 disease4. Child &ill ha,e C'tchinsonAs teeth" sabe! shins" saddle nose and Fth c!anial ne!,e dea ness. )( c 7enicillin" i alle!gic then desensiti8e *enicillin. +ED. CS6 i ,esic'la! lesions a!e *!esent in ,'l,a! a!ea at time o deli,e!0" do C$S. I lesions a!e onl0 on legs" none o ,'l,a$labia" co,e! &ith to&el and *!oceed c ,aginal deli,e!0 1ne,e! done in !eal &o!ld4. I histo!0 o lesions o c'lt'!e 1 &ee# be o!e deli,e!0" do C$S. +F3. Ce*atitis - &o!st in +!d )9. I mom has MC-sAg" ne(t ste* is to get L:)As 1i high" she has acti,e disease" i no!mal she ma0 %'st be a ca!!ie!4. /*on deli,e!0" gi,e bab0 ,accine and CbIG &ithin 1. ho'!s o bi!th. Gi,e mom In >a c lami,'dine. +F1. CI6 5LISA then &este!n blot. I 1M4" get ,i!al load and CD>? co'nt. I ,i!al load 21333 o! CD B<33" gi,e all the d!'gs e(ce*t e a,i!en8. I CD2<33" onl0 gi,e AO) th!o'gho't *!egnanc0 1sta!ting at 1? &ee#s4 and = &ee#s *ost*a!t'm. A te! = &ee#s" d( CI6 c 7CR 1cant 'se 5LISA 0et4. 9om m'st a,oid b!east eeding. +F.. ? big ca'ses o 1st )9 bleeding: Incom*lete$Com*lete abo!tion" )h!eatened abo!tion" 5cto*ic *!egnanc0" 9ole. /se A*t test to ma#e s'!e blood is !om et's" not !om mom. +F+. 1st )9 bleeding: 1st ste* is s*ec'l'm e(am. I ce!,ical os is o*en" *t had an incom*lete$com*lete 1de*ending ho& m'ch *!od'cts o conce*tion *assed4" ne(t ste* is DPC. I ce!,ical os is closed" ne(t ste* is ,aginal /$S c hCG. I ,aginal /$S sho&s an int!a'te!ine *!egnanc0" *t had a th!eatened abo!tion" ne(t ste* is bed !est. I ,aginal /$S sho&s no int!a'te!ine sac and hCG 21<33" *t has an ecto*ic *!egnanc0 and the ne(t ste* sal*ingostom0 o! 9)H t!eatment ollo&ed b0 se!ial hCG le,els 'ntil 8e!o. I ,aginal /$S sho&s a sno&sto!m a**ea!ance" *t has a mole and the ne(t ste* is DPC ollo&ed b0 se!ial hCG le,els to 8e!o 1also *'t *t on OC7As to *!e,ent bi!th" &hich &o'ld inc!ease hCG and not be able to allo& 0o' to monito! hCG a**!o*!iatel04. +F?. 5cto*ic ameno!!hea" ,aginal bleeding" abdm *ain" hCG21<33" no I/7 on ,aginal /$S. I 'nstable c *e!itonitis" do la*a!asco*ic sal*ingectom0. I stable and does not &ant s'!ge!0" gi,e methot!e(ate and ollo&>'* hCG le,els 'ntil 8e!o. +F<. 9ole *!eeclam*sia be o!e +!d)9" ,e!0 high hCG" in 1st )9 0o' &ill see e(*'lsion o g!a*es and a 'te!ine si8e thatAs too big o! gestation age. 6aginal /$S sho&s sno&>sto!m a**ea!ance. Com*lete 1?=HH" all !om dad4 ha,e no etal tiss'e" incom*lete does. )( c DPC and $' hCG &hile *t is on OC7As. I hCG still doesnAt all" *t has cho!ioca!cinoma and needs 9)H and actinom0cin. +F=. +!d )9 bleeding: 1st ste* is 'lt!aso'nd 1absol'tel0 not *el,ic e(am4. 7ossible choices a!e *lacenta *!e,ia" ,asa *!e,ia" ab!'*tion *lacenta" 'te!ine !'*t'!e. +FE. 7lacenta *!e,ia *ainless bleeding c 'lt!aso'nd sho&ing *lacental im*lantation o,e! the lo&e! 'te!ine segment. 7t ma0 sa0 she &o#e '* in a *ool o blood. )!eatment: I *!ete!m gestation" *t is stable and bleeding sto*s: 1st admit" then bed!est" get ,ital signs$labs" t!ans 'se i needed and *'t on ste!oids 1 o! l'ng mat'!it04 c magnesi'm s'l ate. I *t is 2+E &ee#s" do C>section 1&hethe! she is still bleeding o! not4. +FF. 6asa *!e,ia loo# o! t!iad: !'*t'!e o memb!anes 1g'sh o l'id4" b!ight !ed *ainless ,aginal bleeding and etal b!ad0ca!dia. @e(t ste* is C>section. +FD. Ab!'*tio *lacenta *ain 'l ,aginal bleeding 1i 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 &ill ha,e ac'te abdm 1!oc# ha!d4 c *!o o'nd h0*otension" ne(t ste* is immediate C>section. +D3. /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 i she doesnAt. +D1. Rh Isoimm'ni8ation mom is Rh1>4" dad is Rh 1M4" second bab0 is a ected c e!0th!oblastosis etalis. 7!e,ent c RhoGA9 at .F &ee#s and E. ho'!s o deli,e!0" DPC o! C6S. I mom al!ead0 has Rh antibodies" RhoGA9 is 'seless 1onl0 o! *!e,ention4 and so the ne(t ste* is to get Rh tite!s. I 21:F" do amniotic l'id s*ect!o*hotomet!0 to assess se,e!it0 o hemol0sis. +D.. 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 1mate!nal e,e!" 'te!ine tende!ness" 7RO9" c'lt'!e$g!am stain amniotic

l'id" t!eat c am*icillin &hile a&aiting !es'lts and i 1M4" deli,e!4. 9anagement: i in ection *!esent" deli,e!. I no in ection *!esent and et's is B.? &ee#s" o'tcome is dismal 1ind'ce labo! c bed!est at home4. I bab0 is .?>+< &ee#s c no e,e!" hos*itali8e" I9 betamethasone" C(" Ab(. I bab0 is 2+= &ee#s" *!om*t ,aginal deli,e!0. +D+. 7!ete!m Labo! m'st ha,e ce!,ical change 2.cm 1i none" *t has alse 1-!a(ton>hic#s4 cont!actions and send he! home4. 9C !is# acto! is *!e,io's *!ete!m labo!. D( c etal ib!onectin 1i M" tocol0tics and ste!oids" i 1>4" send home4. 9anagement: 1st L late!al dec'bit's *osition" bed !east" O. and I6:. .nd Sta!t tocol0tics 1'seless 2?cm dilatation" !$o cont!aindications i!st4" get ce!,ical$'!ine c'lt'!e be o!e gi,ing I6 7en G 1 o! G-S4" I9 betamethasone and send home. +D?. )ocol0tics 1st 9g S'l ate 1calci'm bloc#e! that ma0 ca'se !es* de*!ession" loss o D)Rs and *'lmona!0 edema. I so" gi,e I6 calci'm gl'conate4. .nd Ritod!ine$)e!b'taline 1->ad!ene!gic agonists that ma0 ca'se h0*otension and tach0ca!dia so donAt gi,e in *t c hea!t disease o! D94. +!d @i edi*ine 1calci'm bloc#e! that ma0 ca'se h0*otention4. ?th 9iso*!ostol 1*!ostaglandin inhibito! that ma0 ca'se in 'te!o d'ct's a!te!ios's clos'!e" so donAt gi,e i gestation age 2+. &ee#s4. Some cont!aindications to tocol0tics incl'de 1conditions &he!e 0o' ma0 need to deli,e!4 ab!'*tion *lacenta" RO9" cho!ioamnionitis" etal demise" late decele!ations" eclam*sia" se,e!e eclam*sia and ce!,ical dilatation 2?cm. +D<. 7ost>date *!egnanc0 12?3&#4: com*lications incl'de inc!eased *e!inatal mo!talit0" mac!osomia" need o! c>section" d0smat'!it0 s0nd!ome 1mothe!As s'**o!t !'ns o't4. 1st ste* is to chec# dates 1i dates still 'ns'!e" contin'e c conse!,ati,e t!eatment and bi&ee#l0 @S)s4" .nd ste* is ind'ction o labo!. I ce!,i( is a,o!able 1so t4" begin agg!essi,e t( c o(0tocin and a!ti icial RO9. I ce!,i( is 'n a,o!able 1ha!d4" gi,e *!ostaglandins c o(0tocin and &ait o! s*ontaneo's deli,e!0. +D=. )!ansient C)@ 'ns'stained high -7 &itho't *!otein'!ia o! edema. @o t(. +DE. Ch!onic C)@ high -7 be o!e .3 &ee#s gestation. )( c meth0do*a" h0d!ala8ine. +DF. 9ild *!eeclam*sia mild C)@ 11?3$D34" *etal edema" .M *!otein'!ia a te! .? &ee#s gestation. 9anagement: B+= &# conse!,ati,e 1no meds4. 2+= &# deli,e! +DD. Se,e!e *!eeclam*sia s'stained -7 21=3$113" 2+M *!otein'!ia" edema" e*igast!ic *ain" CA" bl'!!ed ,ision" th!omboc0to*enia 1!$o C5LL7 s0nd4. )(: *!om*t ,aginal deli,e!0 c o(0tocin" 9gSO? 1to *!e,ent con,'lsions4 and I6 h0d!ala8ine$lobetolol. ?33. 5clam*sia C)@" *!otein'!a" edema" sei8'!es. )(: 1st A-CAs" .nd 9gSO? to sto* sei8'!e 1do not deli,e! 1st" 0o' can ne,e! attem*t deli,e!0 i *t is sei8ing4" +!d agg!essi,e *!om*t ,aginal deli,e!0 c o(0tocin and h0d!ala8ine to dec!ease -7. ?31. C5LL7 s0nd!ome hemol0sis 1schistoc0tes4" ele,ated L:)s" lo& *latelets. @o C@S o! !enal *!oblems 1!$o ))74" no h$o /RI$GI in ection 1!$o C/S4. )( c ste!oids and *!om*t deli,e!0. ?3.. @e,e! !ecommend te!mination o *!egnanc0" 'nless: 1 *'lmona!0 C)@ in mom" . 9a! anAs s0nd!ome c an ao!tic ane'!0sm 2?cm" + 5isenmenge!s s0nd!ome 1*'lm C)@ c bidi!ectional sh'nt" ? *e!i*a!t'm ca!diom0o*ath0. ?3+. I the0 as# abo't !he'matic hea!t disease in the conte(t o *!egnanc0" #no& abo't mit!al ,al,e stenosis management 1di'!etics 1st" ,asodilato!s" then balloon ,'l,o*last04. 9anagement o ca!diac disease in *!egnanc0 is bed !est" dec!eased *h0sical acti,it0" dec!ease &eight" co!!ect anemia" analgesics" ,ac''m deli,e!0. ?3?. 9anagement o h0*e!th0!oid disease in *!egnanc0 is to sta0 on 7)/ to *!e,ent th0!oid sto!m" b't &a!n mom that bab0 might be mentall0 !eta!ded o! ha,e I/GR. ?3<. D9 in *!egnanc0 a$& etal @)D 1most common etal anomal04" h0*ogl0cemia 1d$t mate!nal ins'lin" t( c I6 gl'cose4" h0*ocalcemia 1 ail'!e o 7)C s0nthesis a te! bi!th4" *ol0c0themia 1d$t inc!eased e!0th!o*oietin !om int!a'te!ine h0*o(ia4" !es*i!ato!0 dist!ess 1to chec# l'ng mat'!it0" *hos*hatid0lgl0ce!ol is a bette! choice than L:C !atio4" h0*e!bili!'binemia. ?3=. 7!olonged latent *hase ce!,ical dilatation B+cm 12.3h!s in *!imi*a!a" 21?!hs in m'lti*a!a4. 9CC is analgesia" so t( is bed!est and sedations. ?3E. 7!olonged acti,e *hase ce!,ical dilatation 2+cm" b't slo&$no !ate 1B1..cm$h! in *!imi*a!a" B1.<cm$h! in m'lti*a!a4. Ca'ses incl'de the + 7As 1*assenge! 1mac!osomia4" *el,is 1ce*halo*el,ic dis*!o*o!tion4 o! *o&e! ins' icienc04. )(: I cont!actions a!e h0*otonic 1B.3396/ in .h!s4" gi,e o(0tocin. I cont!actions a!e h0*e!tonic" gi,e mo!*hine and conside! C>section. ?3F. 7!olonged .nd stage ail'!e to deli,e! head 11h! in *!imi" .h!s in m'lti4. Ca'ses a!e the same as abo,e 1+ 7As4. I head is engaged" ,ac''m deli,e!. I head is not engaged" do C>

section. ?3D. 7!olonged +!d stage ail'!e to deli,e! *lacenta &ithin +3 min'tes. Ca'ses incl'de *lacenta acc!eta 1A o! A" acc!eta adhe!es to 'te!ine &all" 9CC is *lacenta *!e,ia4" *lacenta inc!eta 1In o! In" inc!eta goes into 'te!ine &all4" *lacenta *e!c!eta 1in,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: 2<33 in ,aginal deli,e!0" 21333 in C>section. 9CC is 'te!ine aton0 1t(: 1st massage 'te!'s" .nd *itocin" +!d 7G5" ?th methe!gin" <th h0ste!ectom04" then lace!ations" !etained *lacenta 1t( c sedation" then e(>la* o! b$l 'te!ine and h0*ogast!ic a!te!0 ligation and h0ste!ectom04" DIC" 'te!ine in,e!sion 1 !om *'lling4. ?11. 7!ola*sed 'mbilical co!d eme!genc0 d$t co!d com*!ession. Do not hold the co!d o! attem*t to !einse!t it into the 'te!'s. 1st ste* is *lace *t in #nee>chest *osition" .nd ele,atate the *!esenting co!d 1a,oid *al*ating4" +!d eme!genc0 c>section. ?1.. Sho'lde! D0stocia 9CC is mac!osomia 1D94. 1st ste* is 9cRobe!tAs mane',e! 1mate!nal thigh le(ion c s'*!a*'bic 1not 'ndal4 *!ess'!e4. .nd C>section. ?1+. 7ost*a!t'm :e,e! Da0 3 is atelectasis 1d$t anesthesia4" Da0 1>. is /)I" Da0 .>+ is 5ndomet!itis 1this is &hat the0 &ill as#" ca'ses incl'de C>sections" *!olonged 7RO9" *!olonged labo!. )( c am*icillin" gentam0cin" met!onida8ole4. Da0 ?>< is &o'nd in ection" Da0 <>= is *el,i( abscess$se*tic th!ombo*hlebitis 1the0 &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 is no!mal to ha,e discha!ge 1 i!st !ed" then &hite lochia4 '* to 13 da0s *ost*a!t'm. I the!e is a bad smell" 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**le t!a'ma. )!eat c o!al clo(acillin and contin'ed b!east eeding !om that b!east. I the same s0m*toms occ'!" b't the &oman &as not lactating" thin# o cance!. ?1<. I &oman does not &ant to b!east eed" tell he! to &ea! tight> itted b!as c ice>*ac#s and analgesia. I that is not eno'gh" gi,e b!omoc!i*tine o! est!ogens. ?1=. In a *!egnant emale c anti*hos*holi*id s0nd!ome and !ec'!!ent abo!tions" t( c as*i!in 1othe!&ise" a,oid as*i!in in *!egnanc04. ?1E. Cholestasis c *!egnanc0 %a'ndice" itchiness" inc!ease L:)As" t( c deli,e! bab0. Ac'te :att0 li,e! o 7!egnanc0 is mo!e se!io's beca'se it can *!og!ess to he*atic coma. )( A:L7 c l'ids" I6 gl'cose and ::7s. ?1F. Amniotic :l'id 5mbolism > *ost*a!t'm emale c d0s*nea" tach0*nea" chest *ain" h0*otension and$o! DIC. GY@: ?1D. Ce!,ical D0s*lasia i!stl0" note the &o!d d0s*lasia 1its not cance!" its *!ecance! that has not 0et in,aded the basement memb!ane o! a ected l0m*hatics4 as0m*tomatic o! lesions on ce!,i(. 9CC is C76 1=$1F 1=M11 a!e benign4. Ris# acto!s a!e ea!l0 aged inte!co'!se" smo#ing" m'lti*le *a!tne!s and imm'nos'**!ession. Sc!eening c 7a* smea! 1sho&s d0s*lasia at t!ans o!mation 8one4. Sta!t *a* smea!s ann'all0 at 1F0o o! age o se('al acti,it0 onset o! + consec'ti,e 0ea!s" and then e,e!0 + 0ea!s the!ea te!. I *t has !is# acto!s" *a* smea! ann'all0. In o!de!: 1st 7a*" .nd col*osco*0 1abno!mal indings incl'de mosaicism and &hite e*itheli'm; col*osco*0 tells 0o' &he!e the disease is" so i a *t comes to 0o' &ith a lesion on he! ce!,i(" 0o' can s#i* *a* smea! and s#i* this *hase beca'se 0o' al!ead0 #no& &he!e the lesion is and go !ight to stage +4" +!d 5ctoce!,ical bio*s0 and 5ndoce!,ical c'!ettage 15CC sho'ld not be done on *!egnant *ts4" ?th Cone bio*s0 and t!eat &ith c!0othe!a*0 1mild CI@4 o! L557 1loo* elect!odiathe!m0 e(cision *!oced'!e o! mode!ate CI@4. Remembe!" its not cance!" do not choose chemo" s'!ge!0 o! !adiation o! d0s*lasia. ?.3. ASC/S 7a* smea! ma0 sho& at0*ical sL'amo's cells o 'ndete!mined signi icance" &hich is basicall0 the ste* !ight be o!e C76 1so 0o' &o'ld not 0et ind #oiloc0tosis4. )he ne(t ste* &o'ld be C76$D@A testing. I the smea! !et'!ns c C76 = o! 11" *!oceed &ith col*osco*0 and bio*s0$5CC. I the smea! !et'!ns 1>4 C76 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 ,aginal bleeding. D( c ce!,ical bio*s0 1st 1donAt *ic# *a* o! col*osco*04. Onl0 a *el,ic e(am and I67 can be 'sed to stage ce!,ical cance!. )(: Stage Ia1 1B+mm in,asion4 do )AC 1total abdominal

h0ste!ectom04. Stage Ia. 1+><mm in,asion4 do modi ied !adical h0ste!ectom0. Stage Ib 12<mm4 o! IIa 1'**e! .$+ ,agina4 do !adical h0ste!ectom0" *a!a>ao!tic l0m*hadenectom0 and !adiation. All *atients &ith ce!,ical cance! sho'ld be ollo&ed>'* c *a* smea!s e,e!0 +months o! . 0ea!s a te! t(" then e,e!0 = months the!ea te!. 9C site o metastasis is li,e!. 9CCOD is '!emia d$t '!ete!al obst!'ction. ?... Ce!,ical cance! in *!egnanc0 col*osco*0 and bio*s0" b't no 5CC. I CI@ 1no in,asion4" *a* e,e!0 +mo then !e*eat col*osco*0 and *a* . months *ost*a!t'm. I mic!oin,asion 1+><mm4" do cone bio*s0 1!$o !an# in,asion4 and i 1M4" t( c L557 and c!0othe!a*0 . months late!. I in,asi,e cance!" 1st *'nch bio*s0" .nd i B.?&# gi,e !adiation c !adical h0ste!ectom0; i 2.?&#s do C$S at +E&#s then h0ste!ectom0. ?.+. /te!ine$5ndomet!ial Cance! *ostmeno*a'sal bleeding. D( c endomet!ial bio*s0. I it comes bac# negati,e" *t is ass'med to ha,e bled !om at!o*h0 and is t!eated c CR) 1est!ogen A@D *!ogeste!one" not est!ogen alone4. I it sho&s cance!" do )AC$S-O. I *!ognosis is *oo! 1nodes a ected" metastasis *ast the ce!,i( into the 'te!'s and be0ond4 gi,e !adiation and chemothe!a*0 as &ell. ?.?. Leiom0oma 'te!ine s'bm'cosal ib!oids ca'se menometo!!hagia" *ain" in e!tilit0" ,isce!al obst!'ction 1ca'sing '!ina!0 !etention and consti*ation4. )!eat c le'*!olide 1GnRC anolog the!a*04" then m0omectom0 1i *t &ants e!tilit04 o! h0ste!ectom0 1i *t is anemic o! does not &ant to be e!tile an0mo!e4. Leiom0omas a!e ass0met!ical and b'm*0. ?.<. Adenom0osis endomet!ial glands and st!oma located in the m0omet!i'm. 5nla!ged" s0mmet!ical" tende! 'te!'s in the absence o *!egnanc0. Onl0 de initi,e d( is histological sam*ling con i!mation. )( c h0ste!ectom0. ?.=. O,a!ian Cance! loo# o! adne(al mass" abdm *ain and ascites in a *ostmeno*a'sal &oman. 7!e,ent c OC7s. Sc!een c biman'al *el,ic e(ams. D( 1gene!all0 ha!d to d(4 c /$S i!st" then CA>1.<. In #ids" s's*ect ge!m cell t'mo!s 1te!atoma" cho!ioca!cinoma4" in ad'lts s's*ect e*ithelial t'mo! 1m'cino's" se!io's" clea! cell4. )( c deb'l#ing 1)AC" -SO" omentectom04 and chemothe!a*0 1ca!bo*latin and ta(ol4. ?.E. 6'l,a! cance! ,'l,a! itching in a =<0o. D( c bio*s0. )( c s'!ge!0. ?.F. Ge!m Cell )'mo!s )e!atoma$De!matoid c0st 1s#in" hai!" teeth and *el,ic calci ications on H> !a04" Se!toli>le0di cell t'mo! 1high testoste!one ca'sing ,i!ili8ation4" G!an'lose>theca cell t'mo! 1high est!ogen ca'sing emini8ation and *!ecocio's *'be!t04" 9eigAs s0nd!ome 1o,a!ian ib!oma" asicets and R h0d!otho!a(4" N!'#enbe!g t'mo! 1stomach cance! c metastasis to o,a!ies4. ?.D. Gestational )!o*hoblastic @eo*lasia s$s: ,e!0 high hCG" la!ge 'te!'s" *!egnanc0 c bleed" no etal hea!t tones" high -7 in 1st )9" h0*e!emesis" h0*e!th0!oidism 1m'st to )SC in a *t c G)@4" sno&sto!m '$s. Can be benign 1mole4 o! malignant 1cho!ioca!cinoma4. Com*lete mole is an em*t0 egg e!tili8ed c single H>s*e!m 1?=HH so s*e!m d'*licated4" no et's" 'te!'s illed c g!a*e>li#e ,esicles 1same 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 1ca'sing =DHHH4" 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 !$o 95)S. I *oo! *!ognosis 1hCG 2?3"333" b!ain$li,e! mets" 2= months o DPC4 do !adiation and chemothe!a*0 19AC: 9)H" Adenom0cin" C0toto(in4. I good *!ognosis" gi,e 9)H onl0 and $' hCG e,e!0 &ee# o! +months &hile on OC7s. ?+3. /te!ine *!ola*se loss o 'te!ine s'**o!t d'e to ca!dinal ligament d0s 'nction. 9CC is childbi!th. -est t( is ,aginal h0ste!ectom0 c ant$*ost !e*ai! 10es" i!stU4" b't i *t !e 'ses s'!ge!0" do Negel e(e!cises" est!ogen CR) and *essa!ies. ?+1. St!ess Incontinence &ea# *el,ic loo! ca'ses 0o' to '!inate &hene,e! 0o' snee8e$co'gh" none at night. D( c I>ti* test. )( c Negel e(e!cises" then s'!ge!0 19a!shall>9a!cheli>N!an8 *!oced'!e4. ?+.. /!ge Incontinence in,ol'nta!0 det!'so! cont!actions ca'sing s*'!ts o '!ine to all at an0 time. D( c c0stomet!ic st'dies. )( c anticholine!gics 1Dit!o*an4 ?++. O,e! lo& Incontinence dene!,ated bladde! 1D9" 9S" C6A4 ca'ses bladde! to #ee* illing '*" th's high !esid'al ,ol'me e,en a te! '!ination. )( c choline!gics 1bethanecol4. ?+?. 5ndomet!iosis d0meno!!hea" d0s*a!e'nia" in e!tilit0" 'te!osac!al ligament nod'la!it0in the c'l>de>sac" chocolate c0sts. D( c la*a!osco*0. )(: 1st OC7" .nd Dana8ol and Le'*!olide 1best t(" b't not 1st beca'se o side>e ects4" +!d s'!gical !esection" ?th *!egnanc0 1ho&e,e! ha!d" d$t

in e!tilit04" <th )AC$S-O. I endomet!iosis is *!esent" and *t has no s$s" do nothing. ?+<. Chanc!oid *ain 'l chanc!e 1C. d'c!e0i 0o' c!0 c d'c!e0i4 c !agged" !olled edges. )( c A8ith!om0cin ?+=. LG6 *ainless 'lce! that heals and then o!ms *ain 'l nodes. )( c e!0th!om0cin. ?+E. G!an'loma ing'inale *ainless" bee 0>!ed 'lce!. D( c Dono,an>bodies on smea!. )( c A8ith!om0cin. ?+F. Chlam0dia 9C bacte!ial S)D" can be as0m*tomatic o! mild m'co*'!'lent ce!,ical discha!ge c o! &$o ce!,ical motion tende!ness 1C9)4" 1M4 C($Ab test" 1>4 stain. )( c a8ith!om0cin 11 dose4 o! o!al do(0c0cline 1E da0s4. ?+D. 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 c m'co*'!'lent d$c c C9) on biman'al e(am. D( c chocolate aga!" G!am 1>4 di*lococci on stain. )( 1 o! GC and Chlam0dia4 Ce t!ia(one M Do(0c0cline. ??3. 7ID lo&e! abdominal *ain" adne(al tende!ness" C9) and e,e! 1 &ee# a te! menses in a se('all0 acti,e emale. Ce!,icitis 1onl0 ,aginal D$C" no *ain t( G$C4" Sal*ingo>oo*ho!itis 1b$l lo&e! abdo$*el,ic *ain c C6A tende!ness t( G$C4" )'bo>o,a!ian abscess 1*t &ill loo# se*tic" se,e!e *ain" n$," d0sche8ia" e,e! t( c Am*icillin" Gentam0cin and :lag0l. I !'*t'!ed" e(>la* is done4. )( o! G$C in these cases a!e: o't*atient: ce t!ia(one M do(0c0cline" in*atient: clindam0cin M gentam0cin ??1. Ga!dne!ella 6aginosis ish0 odo! on &hi test" *C =" cl'e cells" t( c met!onida8ole 1clindam0cin i *!egnant in 1st )94 ??.. )!ichomonas ,aginalis !oth0" g!een smell0 discha!ge c st!a&be!!0 ce!,i(" *C <. )( c met!onida8ole o! *t and *a!tne! 1i *t *!egnant" t( c ,aginal betadine4. ??+. Candida 0east in ection itch0" b'!ning" d0s*a!e'nia" cottage>cheese discha!ge" that stic#s to the ,aginal &all" *se'doh0*hae" *C ?" t( c n0statin o! Am* -. ???. Cont!ace*tion: !emembe! e ects o est!ogen 1inc!eases -7" cholelithiasis" L:)s" CDL" a!t$,eno's th!ombosis and dec!eases LDL4 and *!ogeste!one 1a ects mood" inc!ease &eight" acne" inc!ease LDL" dec!ease CDL4. Absol'te CI: *!egnanc0 1ca'ses 6AC)5RL4" li,e! d8" ,asc'la! d8 1D6)" SL5" C6A4 and ho!monall0>de*endent cance!s li#e b!east4. -ene its incl'de dec!eased !is# o o,a!ian$endomet!ial cance!" dec!eased d0smeno!!hea$D/-$7ID$ecto*ics. ??<. I/D *'t it in 1 &ee# a te! menses and $' in 1 &ee#. Does not a ect !is# o S)Ds. Absol'te cont!aindications incl'de *!egnanc0" *el,ic cance!" sal*ingitis" ste!oid 'se 1*t on C!ohns" asthma4" h$o 7ID. Inc!eased !is# o ecto*ics and 7ID &hen *laced. ??=. Abno!mal ,aginal bleeding: 7!e>mena!chal 1B1.0o > o!eign bod0" t!a'ma" sa!coma bot0!oides" *!ecocio's *'be!t04" !e*!od'cti,e 11+><.0o > *!egnanc0" ib!oids$adenom0osis" D/-4" *ostmeno*a'sal 12<.0o > endomet!ial cance!4. A neonate c ,aginal bleeding is no!mal d'e to mate!nal est!ogen" th's !eass'!e mom. ??E. 7!ecocio's 7'be!t0 no!mall0: b!east de,elo*ment V D0o" *'bic$a(illa!0 hai! V 130o" g!o&th V 110o" mena!che V 1.0o. 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*lete isose('al *!ecocio's *'be!t0" ne(t ste* is t( c constant GnRC stim'lation 1to dec!ease est!ogen4. I *t has bone lesions and ca J[>a'>lait s*ots" *t has 9cC'ne>Alb!ight S0nd!ome. I *t has high est!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$t 'no**osed est!ogen" so no sec!eto!0 *hase 1d$t lac# o *!ogeste!one4 c 'nstable endomet!ial thic#ening. 7t &ill ha,e h$o i!!eg'la!" 'n*!edictable menst!'al bleeding &itho't c!am*s. @e(t ste* is endomet!ial bio*s0 to !$o cance!. )( c @SAIDS i she desi!es child!en" c0clic *!ogestin the!a*0 o! dail0 combined OC7s i she doesnAt desi!e child!en o! has meno!!hagia. ??D. 7!ima!0 Ameno!!hea 1st ste* is *!egnanc0 test 1&hethe! she sa0s she is se('all0 acti,e o! doesnAt4" .nd ste* is *h0sical e(am: 1M4 b!easts and 1M4 'te!'s >2 chec# *!olactin" i no!mal !$o im*o! e!ate h0men 1c0clic menst!'l *ain c b'lging h0men" *!edis*osition to endomet!iosis" t( c s'!ge!04 and t( c *!ogeste!one. 1M4 b!easts and 1>4 'te!'s >2 get #a!0ot0*e" i ?= HY" *t has And!ogen Insensiti,it0 S0nd!ome 1)estic'la! :emini8ation" no *'bic hai!" ne(t ste* is !emo,e testes !om abdm4" i ?=HH" *t has Ro#itan#0>Ca'sen s0nd!ome 1she &ill ha,e *'bic hai!4. 1>4 b!east and 1M4 'te!'s >2 gonadal d0sgenisis" so ne(t ste* is get #a!0ot0*e to !$o )'!ne!s s0nd!ome 1?<HO"

&ebbed nec#" a! s*aced ni**les" st!ea# o,a!ies" *!emat'!e o,a!ian ail'!e" needs est!ogen4. ?<3. Seconda!0 Ameno!!hea 1st ste* is !$o *!egnanc0" .nd !$o *!olactinoma 1i *!olactin le,el is high" ne(t ste* is 9RI o head. I abno!mal" *t has *it'ita!0 t'mo!" i no!mal" *t has d!'g>ind'ced *!olactinoma4 and h0*oth0!oidism" +!d *!ogeste!one challenge test. I *t bleeds a te! . &ee#s 1est!ogen is adeL'ate4" chec# LC. I ele,ated *t has 7COS" i no!mal$lo& chec# )SC$*!olactin again. I *t does not bleed a te! . &ee#s 1inadeL'ate est!ogen4 chec# :SC" i high *t has *!emat'!e o,a!ian ail'!e 1ne(t ste* is #a!0ot0*e to !$o )'!ne!s ,s O,a!ian ail'!e d'e to congenital ad!enal h0*e!*lasia4" i no!mal$lo& *t has c!anio*ha!0ngioma" ne(t ste* is 9RI. I 9RI is ins' icient" *t has Ahse!mannAs s0nd!ome 1sca!!ing d'e to *!io! DPC$DP5. )( b0 s'!gicall0 !emo,ing sca!!ed tiss'e then gi,ing high>dose est!ogen o! 1 month to !egene!ate lining4. Again" i LC$:SC a!e high" ne(t ste* is #a!0ot0*e. I HO" *t has t'!ne!s" i HH *t has o,a!ian ail'!e 1no& !$o a'toimm'ne d8 ,e!s's CAC4. I LC$:SC a!e no!mal o! lo&" ne(t ste* is 9RI o head. I abno!mal *t has *it'ita!0 t'mo!$dest!'ction o! h0*othalamic d8 1ma0 be a$& NallmanAs s0nd!ome 1anosmia" ameno!!hea4" ano!e(ia" e(e!cise" t( c est!ogen4. I no!mal" *t has Ashe!manAs s0nd!ome. ?<1. -!east mass in a emale B+<0o :ib!oc0stic D8 1b$l" tende! es* &ith menses" m'lti*le" t( c !eass'!ance and $' late!4" :ib!oadenoma 1*ainless" !'bbe!0" mobile" t( c obse!,e b't t!0 not to sta!e too long4" 9astitis$Abscess 1lactating" *ain 'l" !ed" t( c clocacillin" i still the!e" IPD4" :at @ec!osis 1h$o t!a'ma" t( c obse!,ation4. A,oid mammog!am in &omen B+<0o 1tiss'e too dense4 and i s's*icio's o cance! go !ight to bio*s0. ?<.. -!east mass in a emale 2+<0o :ib!oc0stic D8 1same as abo,e" b't this time 0o' m'st as*i!ate it and do a mammog!am. I mass !esol,es" obse!,e. I :@A sho&s blood o! i c0st !ec'!s L'ic#l0" do bio*s04" :ib!oadenoma 1mobile" get mammog!am. I *t is lo& !is#" obse!,e" i high !is# get bio*s04. I *t is *ostmeno*a'sal and has a mass" go !ight to bio*s0. ?<+. I blood0 discha!ge !om the ni**le >2 int!ad'ctal *a*illoma. @e(t ste* is galactog!am>g'ided e(cision. ?<?. 7ol0c0stic O,a!ian S0nd emale" hi!s'tism" ameno!!hea" in e!tilit0 19CC o in e!tilit0 in &omen B+30o c abno!mal menses" &hile 7ID is 9CC i no!mal menses4 and ins'lin !esistance 1D94. @e(t ste* is /$S to sho& m'lti*le c0sts" then LC and :SC 1!ation sho'ld be .:14" then testoste!one and DC5A le,els. /no**osed est!ogen &ill inc!ease !is# o endomet!ial cance!. )( c OC7As" c0clic *!ogestins" 9et o!min" S*i!onolactone and clomi*hene i she &ants #ids. ?<<. Congenital Ad!enal C0e!*lasia o,e!*!od'ction o ad!ogens ca'sing ,i!li8ation and ameno!!hea. Yo'ng gi!ls get clito!omegal0. D3K is .1>OC de icienc0 1salt>&asting" high N" lo& -7" high '!ina!0 1.>h0d!o(0*!ogeste!one4. )( c ste!oids M I6: 1to *!e,ent death4. 9'st do #a!0ot0*e to ig'!e o't gende!. ?<=. Re,ie& o hi!s'tism 1e(cessi,e se('al hai!4 ,e!s's ,i!ili8ation 1e(cess and!ogen" th's acne" balding" dee* ,oice" clito!omegal0" ameno!!hea4: Ci!s'tism c high testoste!one" no!mal DC5AS" C) sho&s enla!ged o,a!ies is 7COS. 6i!ili8ation c no!mal testoste!one" high DC5AS" C) sho&s enla!ged ad!enals is Ad!enal )'mo! 1CAC" t( c DH9 s'**!ession4. 6i!ili8ation c high testoste!one" no!mal DC5AS" C) sho&s enla!ged o,a!ies is o,a!ian t'mo! 1t( c OC7s" GnRC analogs and s'!ge!04. Ci!s'tism c no!mal testoste!one" no!mal DC5A" no!mal C) is amilial hi!s'tism 1a$& <> al*ha !ed'ctase de ienc0" t( c s*i!onolactone" l'tamide4. ?<E. 9eno*a'se high LC$:SC" lo& est!ogen$*!ogeste!one. Cot lashes" osteo*o!osis" at!o*hic ,aginitis" abno!mal li*i *!o ile" athe!oscle!osis$CAD. )( c CR) o! B<0ea!s and then calci'm" e(e!cise" and l'b!icants o! se('al acti,it0. CR) inc!eases !is# o CAD" in,asi,e b!east cance!" memo!0 loss" st!o#e" 75. Dec!eased osteo*o!osis and colon cance!. Cont!aindicated in b!east and endomet!ial cance! 1m'st do endomet!ial bio*s0 be o!e gi,ing it4" ac'te li,e! d8" acti,e th!ombosis" ,aginal bleeding. I cont!aindicated" gi,e S5R9S 1)amo(i en" Ralo(i en" &hich still inc!ease !is# o endomet!ial cance!4. ?<F. In e!tilit0: 1st ste* is semen anal0sis 1t( c s*e!m in%ection4" .nd ste* is o,'lation anal0sis 1basal bod0 tem*e!at'!e" endomet!ial bio*s0" se!'m est!ogen le,el to !$o ano,'lation. )( c clomi*hene4" +!d ste* is C0te!osal*ingog!am o! t'bal bloc#age" ?th ste* is la*a!osco*0. CO@G5@I)AL A@O9ALI5S$75RI@A)AL 95DICI@5: ?<D. Do&nAs S0nd t!isom0 .1" 1$E33 bi!ths 11$+<3 i 2+<0o4" 9R" endoca!dial c'shing

de ect$ASD$6SD" d'odenal at!esia" simian c!ease" Al8heime!s V ?30o" e*icanthal olds. 7!enatal d(: high hCG" lo& A:7" lo& est!iol" inc!eased mate!nal age" amniocentesis" '$s sho&s thic#ened n'chal olds" C6S V D>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$6SD ?=1. 7ata'As S0nd t!isom0 1+ 17 o! 7: cle t li7" cle t 7alate4" holo*!osence*hal0" !enal and oc'la! mal o!mations. ?=.. C!i d' Chat S0nd Ch!om <* deletion" cat>li#e c!0" 9R so t( c s*ecial schooling ?=+. )'!ne!s S0nd Gonadal d0sgenesis ?<HO" 1$.333 ne&bo!n gi!ls" sho!t &ebbed nec#" ho!seshoe #idne0" coa!ctation o ao!ta" *!ima!0 ameno!!hea. 5st!ogen !e*lacement ?=?. Nline elte!s S0nd semini e!o's t'b'le d0sgenesis ?EHHY" h0*ogonadism" g0necomastia" tall stat'!e" in e!tilit0" gi,e testoste!one !e*lacement sta!ting at 1.0o. ?=<. :!agile H S0nd mac!o>o!chidism" 9R ?==. Achond!o*lasia AD" sho!t limbs" h0d!oce*hal's 1m'st monito! closel04 ?=E. He!ode!ma 7igmentosa s'nlight sensiti,it0 !om 1st e(*os'!e" con%'nctitis leading to blindness" d( c s#in bio*s0 and t( c st!ict s'n a,oidance 1the0 &ill sa0 #id onl0 comes o't at night4. ?=F. :etal Alcohol S0nd 9R" lat *hilt!'m" thin '**e! li*" &o!st in 1st )9 ?=D. )obacco in *!egnanc0 I/GR ?E3. Cocaine in *!egnanc0 C@S damage" *lacental ab!'*tion ?E1. :etal Sa! a!in s0nd e*i*h0seal sti**ling" C@S mal o!mations" 9R ?E.. )halidomide *hocomelia 1absence o long bones in e(t!emities4 ?E+. S0*hilis t!e*onema *allid'm" sn' les" *alm$sole !ash" anemia" he*atos*lenomegal0" *e!iostitis" C'tchinsonAs teeth" sabi! shings" saddle nose" t( c *enicillin ?E?. )o(o*lasmosis ooc0tes !om cat litte! and meat" h0d!oce*hal's" cho!io!etinitis" scatte!ed C@S calci ications" t(: 1st a,oidance" .nd *0!imethamine" +!d sh'nt o! h0d!oce*hal's ?E<. R'bella bl'ebe!!0 m' in !ash" 7DA" dea ness" cata!acts ?E=. C96 dea ness" *e!,ent!ic'la! C@S calci ications" mic!oce*hal0 ?EE. Ce!*es aL'i!ed at bi!th 1*!e,ent c C>s(n4" sei8'!es 1tem*o!al lobe4" ence*halitis" ,esicles" o,e!&helming se*sis" he*atitis" t( c ac0clo,i! ?EF. CI6 all meds 1e(ce*t e a,i!en84 i CD B<33" AO) onl0 i CD2<33 in .nd$+!d )9 and = &ee#s *ost*a!t'm. D( in #id c 7CR 1not 5LISA4. ?ED. C0*os*adias *ee on 0o'! eet 1,ent!al '!eth!al o*ening4" hooded *!e*'ce" cho!dee 1,ent!al c'!,ing o *enis4" t( c 1st a,oid ci!c'mcision to sa,e o!es#in o! !econst!'ction" .nd s'!ge!0 at 10o ?F3. Om*halocele$Gast!ocele absence o ante!io! &all 1gast!ocele has no sac" om*halocele does4. )(: 1st co,e! c *lastic &!a*" .nd s'!ge!0 &ithin .? ho'!s. ?F1. 7oste!io! '!eth!al ,al,es ca'se o /)I in 0o'ng bo0s" a$& *otte!s s0nd" d( c 6C/G ?F.. /ndescended testicle c!0*to!chidism" !a!el0 descent a te! 10o" m'st di e!entiate !om !et!actable testis" t(: i testes is *al*able &ait o! descent and do o!chie*le(0 a te! 1 0ea!. I testes a!e not *al*able conside! hCG t!ial i b$l. .nd O!chiectom0 o! at!o*hied testis d'e to !is# o malignanc0 and in e!tilit0 o! othe! testis. ?F+. Congenital Ad!enal C0*e!*lasia ad!enogenital s0nd!ome" no ste!oidogenisis d'e to .1>OC de icienc0" ambig'o's genitalia" clito!omegal0" salt>&asting" h0*e!#alemia. )(: 1st l'ids o! lo& -7" .nd t!eat h0*e!#alemia 1calci'm" al#alini8ation" ins'lin$gl'cose" #a0e(alate4. ?F?. Choanal at!esia !es*i!ato!0 dist!ess$c0anosis !elie,ed b0 c!0ing" a$& CCARG5 s0nd 1Colobama o e0e" Cea!t de ect" At!esia o choanae" Reta!dation" Genital h0*o*lsia" 5a! anomalies4. )( c !es*i!ato!0 s'**o!t. ?F<. La!0ngomalacia le(ible la!0n( colla*ses ca'sing obst!'ction on ins*i!ation. D( c l'o!osco*0 o! di!ect la!0ngosco*0. Ai!&a0 s'**o!t i needed" othe!&ise sel >limited. ?F=. Dia*h!agmatic Ce!nia eithe! at o!amen o -ochdale# 1le t sided 1b$c R side has li,e!4" se,e!e ne&bo!n !es*i!ato!0 dist!ess" sca*hoid abdm" mediastinal shi t" *'lmona!0 h0*o*lasia4 o! at o!amen o 9o!gagni 1*!esents late! c bo&el obst!'ction4. )( c 1st agg!essi,e !esc'citation" .nd e(t!aco!*o!eal memb!ane o(0genation 15C9O4" +!d s'!ge!0. ?FE. )et!alog0 o :allot 7RO6e 1*'lm C)@ d'e to R6 o't lo& obst!'ction" R6C" O,e!!iding ao!ta" 6SD4" 9C c0anotic CCD" *!esents 210o" tet s*ells" boot>sha*ed hea!t ?FF. )!ans*osition o g!eat ,essels c0anosis in 1st .?h!s" ao!ta !om R6" *'lm a!te!0 !om L6" egg on a st!ing hea!t" t( c balloon at!ial se*tostom0" then a!te!ial s&itch

?FD. )otal anomalo's *'lm ,eno's !et'!n *'lmona!0 ,eins d!ain into s0stemic ,eno's ci!c'lation 1*a!tial o! total4" sno&man hea!t. 1st medications" .nd s'!ge!0 ?D3. )!'nc's a!te!iosis single g!eat a!te!0 is o!igin o ao!ta and *'lm a!te! and co!ona!0 a!te!0" listen o! t!'ncal ,al,e clic#. )(: 1st t!eat CC:" .nd s'!ge!0 ?D1. 6SD 9C CCD" holos0stolic m'!m'! at 1>.months" t( c s'bac'te bacte!ial endoca!ditis *!o*h0la(is ?D.. ASD *'lmona!0 e%ection m'!m'! *l's &ide" i(ed s*lit S." no S-5 *!o*h0la(is" 's'all0 *!esents a te! in anc0 ?D+. Coa!ctation o ao!ta C)@ in /5" lo& -7 in L5" *oo! emo!al *'sles" )'!ne!s s0nd" !ib notching on CHR" t( c balloon angio*last0 ?D?. 7DA *!emat'!e babies" congenital !'bella" contin'o's machine!0 m'!m'! c &ide *'lse *!ess'!e. ?D<. C0*o*lastic le t hea!t 'nde!de,elo*ed L6 and ao!ta" ,asc'la! colla*se in 1st &ee# o li e" d'ct's de*endent" t(: 1st *!ostaglandin 5" .nd @o!&ood o! t!ans*lant ?D=. C0d!oce*hal's comm'nicating 1obst!'ction o a!achnoid ,illi4 o! noncomm'nicating 1AL'ed'ct o S0l,i's stenosis" Chia!i mal o!mation at ce!ebella! tonsils o! Dand0>&al#e! c0st o ?th ,ent!icle4. -ab0 c !a*id inc!ease in head ci!c'm e!ence" s*lit s't'!es" b'lging ante!io! ontanelle" setting>s'n sign 1o e0es4" =th ne!,e *alse" *a*illedema" d( c C) scan 1do not do L7 in !is# o he!niation4. )(: 1st h0*e!,entilate and ele,ate head" .nd mannitol" +!d ,ent!ic'lo*e!itoneal sh'nt ?DE. Congenital cata!acts !'bella" C96" to(o" galactosemia" t( c s'!ge!0 !ight a&a0 to *!e,ent *e!manent ,is'al im*ai!ment. ?DF. Congenital gla'coma tea!ing" co!neal clo'ding" *hoto*hobia" st'!ge>&ebe! s0nd 1 acial *o!t>&ine stain" sei8'!es" C@S calci ications4" ne'!o ib!omatosis" !'bella" t( c s'!ge!0. ?DD. Congenital dea ness Al*o!ts 1ne*h!itis c dea ness4" C96" !'bella" mate!nal d!'gs. <33. Osteogenesis Im*e! ecta b!ittle bones ca'se m'lti*le !act'!es in a #id" bl'e scle!a" osteo*o!osis" amil0 histo!0" t0*e I collagen diso!de!" teeth de o!mities. <31. De,elo*mental D0s*lasia o the Ci* s'bloa(ation o emo!al head !om the acetab'l'm" ca'sing as0mmet!ic thigh c!eases" clic#ing so'nd" M O!tolani sign 1hi* !ed'cibilit04" M -a!lo& sign 1hi* dislocatabilit04" d( c 'lt!aso'nd. )( c ha!ness" then closed !ed'ction" then o*en !ed'ction 12=mo age4 i closed !ed'ction ailed. <3.. )ali*'s 5L'ino,a!'s toes ace mediall0" o!e oot add'ction. )( c mani*'lati,e casting" then s'!ge!0 i needed. <3+. )!anseso*hageal :ist'la d( c ail'!e to *ass nasal cathete! to stomach" AHR sho&s ai!> distended *!o(imal eso*hag's. )(: 1st @G)" .nd s'!ge!0 <3?. D'odenal at!esia bilio's *!o%ectile emesis" a$& Do&ns s0nd!ome" abdominal distention" do'ble b'bble on AHR 1ai!>distended stomach and *!o(imal d'oden'm4. )(: 1st co!!ect l'ids$elect!ol0tes" .nd s'!ge!0 <3<. 70lo!ic stenosis nonbilio's *!o%ectile emesis" oli,e>sha*ed R/I mass" deh0d!ation c h0*ochlo!emic al#alosis. )(:1st l'id$elect!ol0te co!!ection" .nd *0lo!om0otom0 <3=. 9ec#elAs Di,e!tic'l'm .0o c *ainless !ectal bleeding and abdm *ain. D( c techneti'm> labeled n'clea! scan 19ec#elAs scan4" t(: 1st co!!ect li e>th!eatening anemia" .nd s'!gical e(cision. <3E. Ci!schs*!'ngAs Disease congenital megacolon ca'sing obst!'ction" absense o A'e!bachAs and 9essne!As *le('s" ail'!e to *ass meconi'm in 1st &ee#" d( c 1st ba!i'm enema 1sho&s t!ansitional 8one4 !ectal bio*s0 1aganglionosis4. )(: 1st l'id$elect!ol0te co!!ection" .nd Ab( i ente!ocolitis s's*ected" +!d s'!gical e(cision o ganglionic segment. <3F. C0aline memb!ane Disease RSD" s'! actant ins' icienc0" ea!l0 onset 1ho'!s a te! bi!th4 bab0 has tach0*nea" g!'nting" nasal la!ing and !et!actions. 5a!l0 *!oblems incl'de b!eathing di ic'lt0" metabolic dist'!bances and in ection. Late *!oblems incl'de b!onco*'lmona!0 d0s*lasia. Ris# acto!s incl'de *!emat'!it0" mate!nal D9 and m'lti*le *!egnancies. D(: 1st CHR 1sho&s ine !etic'la! g!an'la!it0 in b$l l'ngs4" .nd L:S !atio 1sho'ld be 2.:14 and *hos*hat!id0lgl0ce!ol. )(: 7!e,ention is the best t( 1*!e,ent *!emat'!it0" gi,e mate!nal ste!oids ?F>E. ho'!s ante*a!t'm i B++ &ee#s to &omen &ho do not ha,e to(emia" D9 o! !enal disease4" .nd co!!ection o h0*o(ia" acidosis" h0*e!ca*nea" h0*otension" h0*othe!mia and anemia. +!d neonatal s'! actant 1,ia 5))4 at deli,e!0 b't a,oid 'neccessa!0 *'lmona!0 ba!ot!a'mas o! o(0gen to(icit0.

<3D. Chlam0dia con%'ncti,itis ?>E da0s a te! bi!th" staccato co'gh" t( c e!0th!om0cin. <13. Gono!!hea con%'ncti,itis +>< da0s a te! bi!th" disseminated in (n" chocolate aga!" )ha0e!> ma!tin media" t( c *a!ente!al ab(. <11. G-S ea!l0 onset 1B+da0s old4 has !es* dist!ess" *ne'monia" meningitis; late onset 1Eda0s> +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. 7SYCCIA)RY <1.. I 0o' see a L'estion abo't the best ne(t test and one o the ans&e!s is Qmini>mental e(am" *ic# that one. <1+. A'tism sta!ts b0 +0o. Im*ai!ed social inte!actions 1'na&a!e o s'!!o'ndings4" im*ai!ed ,e!bal$non,e!bal comm'nication 1i ,e!bal is o#a0" d( is As*e!ge!As s0nd!ome4" and !est!icti,e acti,ities and inte!est 1head banging" st!ange mo,ements4. Lin#ed to congenital !'bella. )( c 1st st!'ct'!ed class!oom t!aining" beha,io!al modi ications" amil0 s'**o!t" .nd halo!*e!idol" !is*e!idone" SSRIAs. I child has no!mal de,elo*ment and then dete!io!ates into this condition o! &o!se" that is RettAs s0nd!ome. <1?. Lea!ning diso!de! im*ai!ment in !eading 1F3K4" math" lang'age" &!itten e(*!ession &ith no mental !eta!dation o! li est0le anomalies. )( c ed'cational inte!,ention. <1<. ADCD d( BE0o. -o0 is h0*e!acti,e" im*'lsi,e and has a sho!t memo!0 s*an" b't is not c!'el. )(: 1st indi,id'al$ amil0 the!a*0 and beha,io!al modi ications" .nd meth0l*henidate 1Ritalin4 o! de(t!oam*hetamine" both o &hich ma0 ca'se insomnia" abdm *ain" CA" ano!e(ia" e(ace!bations o tics" &eight loss o! g!o&th s'**!ession. )( c 1st atimo(itine 1b't m'st be gi,en e,e!0da0" so i mom sa0s #id onl0 has s$s 9onda0 th!' :!ida0" then 0o' cannot gi,e this" gi,e t( X.4" .nd 9eth0l*henidate o! am*hetamine. <1=. Cond'ct Diso!de! ,iolates societ0 no!ms" *ediat!ic o!m o antisocial diso!de!. Loo# o! i!e setting 1i onl0 this" d( is *0!omania4" c!'elt0 to animals" l0ing" stealing" ighting. 9'st ha,e this diso!de! in o!de! to ma#e diagnosis o antisocial d$o as ad'lt. )(: 1st e,al'ate s'icide$,iolence *otential" .nd containment b0 *a!ents" schools" legal s0stem o! hos*ital" +!d t( agg!ession c SSRI o! halo*e!idol" ?th indi,id'al$g!o'*$ amil0 the!a*0. <1E. O**ositional De iant Diso!de! negati,e" hostile and de iant beha,io! to&a!ds a'tho!it0 ig'!e. @ote the di e!ent bet&een this and cond'ct d$o is that he!e" the #id is %'st bad to ad'lts beha,es &ith *ee!s and is not a c!'el" l0ing c!iminal. )( c indi,id'al$ amil0 the!a*0 <1F. Se*a!ation an(iet0 Diso!de! loo# o! a #id &ho !e 'ses to go to school o! slee* alone o! a&a0 !om home b0 claiming sic#ness" stomachache" CA o! tem*e! tant!'ms. 9'st be 2=months old 1might as# abo't Fmo bab0 &ho c!ies &hen he sees g!andma o! 1st time T se*a!ation an(iet0" b't i #id &as 'nde! =mo" its no!mal4 School !e 'sal is a *s0chiat!ic eme!genc0 and needs *!om*t e,al'ation and t!eatment in,ol,ing *a!ents" school and *ee!s. <1D. )o'!etteAs Diso!de! 1onl0 13>+3K c'!se4" loo# o! males c moto! tics 1blin#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 ADCD and OCD. )(: 1st Calo*e!idol 1im*!o,es F3K b't &atch o! 57S" mental d'lling and ta!di,e d0s#inesia4. .nd 7imo8ide o! Clonidine <.3. 5nco*!esis 2?0o c *assage o eces into ina**!o*!iate *laces 1clothing" loo!4. !$o Ci!schs*!'ngs disease. )( c beha,io!al techniL'es" indi,id'al the!a*0. <.1. 5n'!esis > 2<0o c ina**!o*!iate ,oiding o '!ine. )(: 1st beha,io!al techniL'es 1bell" b'88e!" bed time l'id !est!iction4" .nd Imi*!amine 1last !eso!t4. <... Dementia ,s Dele!i'm: Dele!i'm 1!a*id onset" l'ct'ating conscio'sness" o ten !e,e!sible" *e!ce*t'al dist'!bances" incohe!ent s*eech4. Dementia 1insidio's onset" clea! conscio'sness 1'ntil late in co'!se4" i!!e,e!sible4. <.+. Al8heime!As ,s 6asc'la! 19'lti>In a!ct4 Dementia: Al8heime!s dementia 1&omen" olde!" ch!om .1" linea!$*!og!essi,e" no ocal de ecits 1#e04" s'**o!ti,e t(4. 6asc'la! dementia 1men" 0o'nge! than al8heime!s" C)@" ste*&ise$*atch0 *atte!n" 1M4 ocal de icits 1#e04" t( 'nde!l0ing condition4. <.?. Alcohol into(ication incl'des sl'!!ed s*eech" ata(ia" disinhibition" im*ai!ed %'dgement"

coma and blac#o'ts. Sithd!a&al incl'des t!emo!" agitation" i!!itabilit0" n$," e,e!" sei8'!es" deli!i'm t!emens 1onset o deli!i'm" ,i,id a'dito!0$tactile$,is'al hall'cinations" *a!anoid del'sions .>+ da0s *ost cessation o long>te!m hea,0 'se4. )( into(ication s'**o!ti,el0. )( &ithd!a&al c ,ital sign$elect!ol0tes$9g$thiamine$,it -1.$ olate$gl'cose monito!ing. .nd C0d!ation c thiamine be o!e gl'cose 1*!e,ent Se!nic#e4" +!d ben8odia8e*ine 1chlo!dia8e*o(ide4. )( de*endence c con !ontation o denial and !ehab 1AA4. S*eci ic managements: Alcohol hall'cinations 1chlo!dia8e*o(ide" I6:" halo*e!idol4" Se!nic#eAs ence*halo*ath0 1s'dden ata(ia" con 'sion" n0stagm's" late!al !ect's *als0 !om thiamine de icienc0. )( c thiamine4 No!sa#o As s0nd!ome 1se,e!e ante!og!ade$!et!og!ade amnesia" con ab'lations and *ol0ne'!itis !om thiamine de ienc04. <.<. O*ioids into(ication incl'des e'*ho!ia" analgesia" h0*oacti,it0" ano!e(ia" d!o&siness" n$," consti*ation" *in>*oint *'*ils" h0*otension and b!ad0ca!dia. O,e!dose incl'des C@S$!es*i!ato!0 de*!ession" *in*oint *'*ils" *'lm edema" sei8'!e" coma and death. Sithd!a&al incl'des 1not deadl04 !hino!!hea" 0a&ning" dia!!hea" s&eating" dilated *'*ils" tach0ca!dia and C)@. )( o,e!dose c nalo(one. )( de*endence c abstinence th!o'gh methadoes tit!ation. <.=. Stim'lants am*hetamines$cocaine" !a*id de*endence o tole!ance" I6DA !is#s" *a!anoid *s0chosis. Into(ication incl'des e'*ho!ia" ale!tness" inc!eased ene!g0" an(iet0" tal#ati,eness" m0d!iasis" tactile hall'cinations 1c!a&ling b'gs4" C)@ and tach0ca!dia. Sithd!a&al incl'des 1non> deadl04 atig'e" h0*e!somnia" an(iet0" d0s*ho!ia" s'icidal ideation" c!a,ing. )( into(ication s0m*tomaticall0 1antia!!h0thmic" ben8o o! agitation" halo*e!idol4. )( &ithd!a&al s'**o!ti,el0 1obse!,e o! s'icidalit04. )( de*endence c !ehab. <.E. Sedati,es ben8o$ba!bs into(ication ca'ses sl'!!ed s*eech" d!o&siness" im*ai!ed attention" disinhibition. 1:l'met!a8e*am is the date>!a*e d!'g4. O,e!dose c ba!bs o! s'icide" 1not so m'ch ben8o b$c o high the!a*e'tic inde(" 'nless ta#en &ith anothe! d!'g o! alcohol4. -oth ca'se !es* de*!ession" coma" death. Sithd!a&al ca'ses an(iet0 and insomnia. Se,e!e &ithd!a&al is a medical eme!genc0 1n$," a'tonomic h0*e!acti,it0" *hoto*hobia" t!emo!" h0*e!the!mia" dele!i'm" sei8'!es" death4 most se,e!e c sho!t>acting d!'gs. O,e!dose ben8o c l'ma8enil 1does not !e,e!se !es* de*!ession4" ba!bs c cha!coal" gast!ic la,age. )( ba!bit'!ate &ithd!a&al c *entoba!bital challenge test to get dail0 dose" and ta*e! o . )( ben8o &ithd!a&al c long>acting ben8o 1dia8e*am" clona8e*am4 and g!ad'all0 &ithd!a&. <.F. @icotine acet0lcholine 1nicotinic4 agonist. Sithd!a&al ca'ses i!!itabilit0" &t gain" and di ic'lt0 c concent!ation. )(: 1st obtain s*eci ic date to sto*" .nd ed'cate$co'nsel. <.D. 7C7 *a!anoia" assa'lti,eness" im*'lsi,eness" ,e!tical and$o! ho!i8ontal n0stagm's 1dead gi,e>a&a04" dia*ho!esis" !es* de*!ession" sei8'!es" no!mal si8e *'*ils. )( s0m*tomaticall0 <+3. Call'cinogens LSD" 5cstac0 s0m*athomimetic e ects 1m0d!iasis" tach0ca!dia" s&eating" dia!!hea" '!ination4" *anic !eactions" ill'sions" *a!anoia. Late! on" *t ma0 not be 'sing d!'g an0mo!e and !ee(*e!ience into(ication 1 lashbac#4. <+1. Canna binoids 9a!i%'ana$)CC into(ication has e'*ho!ia" bad %'dgement" slo&ed !eactions" d!0 mo'th" con%'ncti,al in%ection 1dead gi,e>a&a04. Ch!onic 'se ca'ses amoti,ational s0nd!ome and memo!0 im*ai!ment. <+.. Call'cination is a dist'!bed senso!0 *e!ce*tion 1,is'al" tactile" a'dito!04. Del'sion is a i(ed" alse belie 1e,en i *eo*le *!o,e to 0o' othe!&ise4. 7s0chosis is inabilit0 to %'dge bo'nda!0 bet&een !eal and 'n!eal. <++. Schi8o*h!enia *!esence o 2. s$s o the ollo&ing o! 2=months: del'sions" hall'cinations 1gene!all0 a'dito!0" lin# ,is'al c alcohol &ithd!a&al4" diso!gani8ed s*eech$beha,io!" negati,e s$s 1 lat a ect" no s*eech" no moti,ation" anhedonia4. -ette! *!ognosis 1@-95 + L'estion4 i ac'te" late onset" good social$occ'*ation h(" *ositi,e s$s" medication com*liance" ma!!ied" emale gende!. S0m*toms d'e to alte!ed do*amine acti,it0 1ne&e! anti*s0chotics a ect se!otonin also4. @egati,e s$s ha,e enla!gement o ce!eb!al ,ent!icles and h0*oacti,e !ontal lobe. )(: 1st assess i *t needs hos*itali8ation 1*!otect sel $othe!s4" .nd Anti*s0chotics 1Ris*e!idone4" +!d 7s0chosocial t(. Y)imeline: B1month T b!ie t *s0chotic d$o" 1>=months T schi8o*h!eni o!m" 2=mo T schi8o*h!eniaZ <+?. Del'sional 17a!anoid4 Diso!de! *e!sistent" nonbi8a!!e" &ell>s0stemati8ed del'sion. 5!otomanic 1on is lo,ed b0 a amo's othe!" @-95 + )I4" g!andiose 1one *ossesses g!eat talent4" %ealo's 1con,iction that lo,e! is 'n aith 'l4" *e!sec'to!0 1one is cons*i!ed against" 9C4" somatic 1one

has a *h0sical abno!malit0 li#e odo!4. )(: 1st hos*itali8ation o! inabilit0 to cont!ol s'icidal$homicidal im*'lses o! dange! a$& del'sions" .nd *s0chothe!a*0" +!d anti*s0chotics$antide*!essants. <+<. Schi8o*h!eni o!m schi8o*h!enia B=months. Good *!ognosis c ac'te onset" con 'sion" diso!ientation" 'll a ect" t( c anti*s0chotics o! at least = months. <+=. -!ie 7s0chotic Diso!de! s'dden onset o *s0chotic s$s c emotional t'!moil and con 'sion" o ten ollo&ing ob,io's st!esso!" d'!ation B1month. S'icide !is#" th's t( 1st hos*itili8ation as needed" .nd anti*s0chotics$antian(iet0 agent" +!d *s0chothe!a*0 <+E. Schi8oa ecti,e schi8o*h!enia c de*!ession o! mania o! at least . &ee#s. <+F. Sha!ed 7s0chotic diso!de! s'bmissi,e" de*endent isolated !elationshi* &ith *e!son c established del'sion. S'icide$homicide *acts. )(: 1st se*a!ate the . *eo*le" .nd anti*s0chotics. <+D. 9ania 21&# o ele,ated" e(*ansi,e" i!!itable mood c g!andiosit0" no slee*" tal#ati,eness" im*'lsiti,it0 1sho**ing s*!ees" gambling" *!omisc'it04 " !acing tho'ghts" dist!actibilit0" agitation. C0*omania is less se,e!e and lasts 2?da0s. <?3. 9a%o! de*!ession diso!de! 19DD4 . o SIG5CA7S in 2.&#s slee* changes 1dela0ed slee* onset" dec!eased R59. @ote the di e!ence: An(iet0 has inc!eased R59 latenc0" de*!ession and na!cole*s0 ha,e dec!eased R59 latenc04" inte!est loss" g'ilt" ene!g0 loss" concent!ation dec!eased" a**etite 1'* o! do&n4" *s0chomoto! 1!eta!dation o! agitation4" s'icidalit0. Dec!eased se!otone!gic acti,it0 a$& ,iolence and s'icide. )(: Cos*itali8e i s'icide !is#" .nd Antide*!essant 1SSRI 1st4 o! =>1. months 1not that it ta#es ?>=&#s to sta!t e ects4" +!d 5C) 1!a*id !es*onse in *!egnanc0" elde!l0" medicall0 ill4" ?th *s0chothe!a*0" <th anti*sc0hotic M antide*!essant o! *s0chotic *ts" <th 7hotothe!a*0 i de*!ession is seasonal" =th t!eat como!bid *s0cho*atholog0 1an(iet0" s'bstance ab'se" *e!sonalit0 d$o" ADCD4. <?1. De*!ession ,s -e!ea,ement De*!ession 1mood *e!,asi,e$'n!emitting" constant lo& sel > esteem$&o!thlessness" s'icidal" s'stained *s0chotic s$s" no im*!o,ement c t!eatment" social &ithd!a&al4. -e!ea,ement 1mood l'ct'ates" sel >!e*!oach !ega!ding deceased" not s'icidal" t!ansient ,is'al$a'dito!0 hall'cinations o! deceased" s$s im*!o,e c time and 's'all0 gone b0 = months" o ten &elcomes social s'**o!t4. It is no!mal to ha,e an ill'sion o! hall'cination abo't the deceased" b't a no!mal g!ie,ing *e!son #no&s that it is an ill'sion o! hall'cination" &hile an 9DD *t thin#s its !eal. Othe! cl'es to 9DD that a!e not no!mal a!e eeling o &o!thlessness" s'icidalit0 and *s0chomoto! !eta!dation. <?.. -i*ola! Diso!de!s: )0*e I is 'll>blo&n mania c 9DD. )0*e II is h0*omania c 9DD. )(: 1st assess !is# o s'icide" assa'lti,eness" dange!o's *oo! %'dgement. .nd :o! ac'te mania gi,e mood stabili8e! 1lithi'm4. :o! de*!ession modd stabili8e! c o! &$o antide*!essant i necessa!0. <?+. C0cloth0mia n'me!o's h0*omanic e*isodes c de*!essi,e e*isodes o! 2.0!s. 1C0clo is a *s0cho" &hile d0sth0mia is %'st de*!ession o! 2.0!s4. <??. 7anic Diso!de! min'tes to ho'!s o 'ne(*ected" s'dden intense an(iet0" d0s*nea" *a!asthesia" C7" ea! o d0ing. A$& ago!a*hobia 1 ea! o *laces &he!e esca*e is di ic'lt s'ch as b!idges" *'blic t!ans*o!tation" la!ge c!o&ds" t!a,eling4. )(: 1st I ac'te" eme!gent case" gi,e !eass'!ance and ben8o 1al*!a8olam" clona8e*am4. .nd R$o 9I" 75" C6A" h0*ogl0cemia" +!d Antide*!essants 1SSRI is t( o choice o! long>te!m management4" ?th Cogniti,e>beha,io!al the!a*0 1C-)4 o! ago!a*hobia. <?<. Obsessi,e>Com*'lsi,e Diso!de! !ec'!!ent int!'si,e images" im*'lses" tho'ghts 1obsessions4 and !it'alistic beha,io!s 1com*'lsions4 that *!od'ce an(iet0 and a ect &a0 o li e. A$& )o'!ette s0nd!ome. Abno!malit0 is se!otonin s0stem. )( c SSRIs 1 l',o(amine4" b't i 0o' onl0 see )CAAs *ic# clomi*!amine. <?=. S*eci ic 7hobia i!!ational" e(cessi,e ea! and a,oidance o a s*eci ic ob%ect o! sit'ation. )(: S0stemic desensiti8ation. <?E. Social 7hobia ea! o emba!!assment" sc!'tin0 o othe!s 1*'blic s*ea#ing" eating in *'blic" *'blic bath!ooms4. )(: 1st C-)" .nd -- 1*!o*!anolol4 o! stage !ight" +!d Antide*!essants 1not )CAs4 and high>*otenc0 ben8odia8e*ines. <?F. 7ostt!a'matic St!ess Diso!de! 21 month" m'st ha,e +: !ee(*e!iencing 1 lashbac#s4" emotional n'mbing 1a,oidance4" a'tonomic a!o'sal 1insomnia" i!!itabilit04. )(: 1st hos*itali8e o! ac'te s'icide" ,iolence !is#. .nd C-)" +!d Antide*!essants. <?D. Ac'te St!ess Diso!de! > B1month o the same + s0m*toms. )( c *s0chothe!a*0. <<3. Gene!ali8ed An(iet0 Diso!de! 'n!ealistic" *e!sistent an(iet0 o! 2=months. 9'scle tension"

!estlessness" *oo! concent!ation" atig'abilit0" i!!itabilit0" loss o slee*. )(: 1st *s0chothe!a*0" .nd Antide*!essants 1-'s*i!one4. <<1. Somato!o !m Diso!de!s 'nli#e actitio's diso!de! and malinge!ing" the s0m*toms a!e not intentionall0 *!od'ced b't a!e st!ongl0 lin#ed to *s0chological acto!s. 5(am*les incl'de somati8ation diso!de! 1m'lti*le somatic com*laints" t( c !eg'la!l0 sched'led ,isits c 79D4" con,e!sion diso!de! 1ne'!ologic s$s4" *ain diso!de! 1*ain in absence o adeL'ate *h0sical indings" t( c *s0chothe!a*04" h0*ochond!iasis 1 ea! o s*eci ic disease" t( c !eg'la! medical ,isits4" and bod0 d0smo!*hic diso!de! 1*!eocc'*ation c de ect in a**ea!ance" t( c *s0chothe!a*0 and SSRIAs a te! 0o' assess s'icide !is#4. <<.. :actitio's diso!de! Q9'ncha'sen s0nd!ome. Intentional *!od'ction o s$s o! 'nconscio's *s0chological !easons 1need to ass'me sic# !ole4 's'all0 in someone in medical occ'*tion o! c histo!0 o illness. I s$s *!od'ced b0 *a!ent" this is 9'ncha'senAs b0 *!o(0. )( c *s0chiat!ic cons'lt" con !ontation ma0 be hel 'l. <<+. 9alinge!ing intentional *!od'ction o s0m*toms o! a !ecogni8ed gain 1mone0" d!'gs" a,oid &o!#$milita!0$*!ison4. <<?. Dissociati,e Identit0 diso!de! m'lti*le *e!sonalities" &hich ta#e o,e! li e and *t ma0 o! ma0 not be a&a!e o each othe!. )( c intensi,e *s0chothe!a*0. <<<. Amnestic Diso!de! . t0*es: *s0chogenic 'g'e 1s'dden" 'ne(*ected t!a,el c amnesia o old identit0 and ass'm*tion o ne& identit0 that lasts ho'!s to months" *t is 'na&a!e o loss4 and *s0chogenic amnesia 1s'dden inabilit0 to !ecall im*o!tant *e!sonal in o!mation o a t!a'matic o! st!ess 'l e,ent" b't a&a!e o loss4. Reco,e!0 's'all0 !et'!ns s*ontaneo'sl0. I not" t!0 h0nosis" amoba!bital o! *s0chothe!a*0. <<=. De*e!sonali8ation diso!de! !ec'!!ent eeling o detachment !om oneAs bod0 o! sel 1 eel li#e 0o'A!e in an o'tside &o!ld4. <<E. Ano!e(ia @e!,osa m'st ha,e +: ameno!!hea" minimal no!mal bod0 &eight" ea! o gaining &eight. )(: 1st hos*itali8e o! deh0d!ation" sta!,ation" h0*otension" elect!ol0te" h0*othe!mia" s'icide !is#. .nd t!eatment cont!act o! &t gain" +!d C-). <<F. -'limia @e!,osa binge eating" no!mal &eight" o,e!conce!ned c &t$diet$e(e!cise" sel > ind'ced ,omiting" la(ati,es$di'!etics" a$& #le*tomania. )(: 1st hos*itali8e o! 5CG 1h0*o#alemia> ind'ced a!!h0thmia is 9CCOD4" elect!ol0tes" am0lase" L:)s" eso*hageal$gast!ic !'*t'!e" s'icide !is#. .nd *s0chothe!a*0" n't!itional co'nseling" SSRI o! binging 1do not gi,e b'*!o*!ion o! !is# o sei8'!es4. <<D. Old" classic /S9L5 )I: 9om inds he! son ha,ing se( c anothe! bo0" is this no!mal o! homose('alit0R @o!mal 1'nless the0 sa0 he en%o0s it4. Anothe! )I is a man" &ho #no&s he is a man and li#es &omen" d!esses '* li#e a &oman and acts li#e a &oman" &hat is his se('al o!ientationR Cete!ose('al 1b$c he li#es &omen4. <=3. 7!o%ection att!ib'ting 0o'! o&n &ishes to someone else. A$& *a!anoid *e!sonalit0 d$o 1* o! * *a!anoia c *!o%ection4 <=1. Denial i the0 den0 ha,ing a disease" ne(t ste* is do nothingU 1beca'se it 's'all0 does not inte! e!e c t!eatment" b't i it does" ne(t ste* is con !ont the *t4. <=.. S*litting all is good o! bad. a$& bo!de!line d$o. I the0 onl0 sa0 all is good" its ideali8ation. I the0 onl0 sa0 all is bad" its de,al'ation. S*litting m'st ha,e both. <=+. Reg!ession loo# o! h$o bed&etting in a #id 2<0o 1B<0o is no!mal4. <=?. Reaction o!mation ,s /ndoing !(n o!mation is a tho'ght" 'ndoing is an action. -oth a!e classicall0 a$& obsessi,e com*'lsi,e d$o" &he!e !(n o!mation is the obsession" and 'ndoing is the com*'lstion. <=<. Reaction o!mation ,s s'blimation s'blimation does something good o! man#ind. <==. 7!ima!0 insomnia dist'!bance in initiating" maintaining o! eeling !ested a te! slee*. )(: 1st h0geine t!eatment: !eg'la!i8e slee* ho'!s" 'se o bed onl0 o! se($slee*" i not aslee* in +3 min'tes then lea,e bed and !et'!n onl0 &hen d!o&s0" no na**ing" !eg'la! e(e!cise b't not immediatel0 *!io! to bedtime" !ed'ce$eliminate alcohol$ca eine$smo#ing" !ela(ation e(e!cise. .nd sedati,e>h0*notics 1ben8o" 8ol*idem4 o! sho!t>te!m !elie <=E. @a!cole*s0 da0time d!o&siness" i!!esistible slee* attac#s c h0*nagogic$h0m*o*om*ic hall'cinations" slee* *a!al0sis" cata*le(0 1loss o m'scle cont!ol c st!ong emotions4. )( c sho!t da0time na*s" .nd stim'lants o! slee* attac#s and )CAs o! cata*le(0.

<=F. Slee* a*nea obst!'cti,e t0*e d$t occl'sion o '**e! ai!&a0 d'!ing slee* in an obese *t. Cent!al t0*e is d$t !ed'ced noct'!nal !es* d!i,e4. D( c *ol0somnog!a*h0. )(:1st &t !ed'ction" .nd C7A7 o! obst!'cti,e t0*e" Aceta8olamide o! *!ot!i*t0line o! cent!al t0*e. <=D. Restless Legs S0nd agoni8ing" dee* c!ee*ing sensations in leg$a!m m'scles !elie,ed b0 mo,ing o! massage. 7t has t!o'ble alling aslee* at night beca'se o it. )( c ben8odia8e*am. <E3. Inte!mittent 5(*losi,e disc!eet e*isodes o loss cont!ol o agg!essi,e im*'lses" b't othe!&ise not agg!essi,e. )( c ben8o 1ca'ses disinhibition4 and C-). <E1. Nle*tomania ail'!e to !esist stealing 'nnecessa!0 and 'nneeded things. a$& -'limia. <E.. 70!omania delibe!ate i!e setting and ascination c i!e" 's'all0 in #ids. 9a#e s'!e the g'0 is not getting *aid to do it and that it is com*letel0 o! sel >satis action. <E+. )!ichotillomania !ec'!!ent *'lling o't o oneAs o&n hai!. )( c *s0chothe!a*0" SSRI. <E?. Ad%'stment Diso!de! e(cessi,e emotional$beha,io!al !es*onses that occ'! &ithin + months o a st!esso! that is &ithin !ange o no!mal e(*e!ience 1'nli#e 7)SD4" s'ch as school *!oblems" ma!ital disco!d" %ob loss o! illness. Does not *e!sist a te! = months o st!esso!. Lac#s s' icient e,idence to ma#e o! othe! diagnosis 19DD4. )(:1st e,al'ate s'icide !is#. .nd *s0chot(" antian(iet0" antide*!essants" +!d st!ess !ed'ction. <E<. 7e!sonalit0 Diso!de!s > Cl'ste! A 1Sei!d: 7a!anoid" Schi8oid 1*t &ants to be alone4" Schi8ot0*al 1*ec'lia! ideations$a**ea!ance$beha,io! magical thin#ing44" Cl'ste! - 1Sild: Antisocial 1e(*loitati,e" dest!'cti,e" im*'lsi,e beha,io! c no !emo!se. Childhood h$o cond'ct d$o essential o! d(. )( c SSRI4" -o!de!line 1instabilit0 o sel >image" identit0" !elationshi*s and mood. Does c!a80 things and still eels em*t0 inside. h$o child ab'se. )( c *schot( 1long>te!m4" SSRI o! mood stabilit0 and im*'lsiti,it0" halo*e!idol o! *s0chosis. A,oid ben8o4" Cist!ionic 1attention see#ing" hits on the docto!" needs *!aise and !eass'!ance4" @a!cissistic 1g!andiose" mad i h'miliated" lac# o em*ath04. Cl'ste! C 1So!!ied: Obsessi,e>com*'lsi,e 1t( c l',o(amine4" De*endent" A,oidant 1does not &ant to be alone 1'nli#e schi8oid4" b't ea!s !e%ection4 <E=. Anti*s0chotics 1@e'!ole*tics4: Lo&>doses 1thio!ida8ine" chlo!*!oma8ein4" high>doses$long> acting 1halo*e!idol" l'*hena8ine. Cighest !is# o 57S" @9S4" at0*ical 1clo8a*ine" !is*e!idone" olan8a*ine" L'etia*ine" 8i*!asidone4. )0*icals bloc# do*amine 1D.4 !ece*to!s" th's 'sed o! *ositi,e s0m*toms onl0 and ha,e man0 side>e ects" &hile At0*icals bloc# se!otonin 1<>C)4" D. and D?" th's can be 'sed o! *ositi,e and negati,e s0m*toms and ha,e e,e! side>e ects. Ad,e!se>e ects: Co'!s>Da0s: D0stonia 1s*asms4" )o!ticollis and oc'log0!ic c!isis 1e0es sta0 loo#ing '*4. )( c ben8t!o*ine" di*henh0d!amine o! t!ihe(0l*henidate. See#s: A#athisia 1!estlessness4. )( c lo&e!ing d!'g>dose" ben8o" --" o! s&itch to at0*ical 1best4. 9onths: )a!di,e d0s#inesia 1li*>smac#ing4. )( c s&itching to at0*ical. @e'!ole*tic malignant s0nd!ome: 9C c high>*otenc0 d!'gs" inc!eased !is# i 'sed c lithi'm" e,e!" !igidit0" a'tonomic instabilit0" ,e!0 high C7N le,els" high NM" t( c I6 dant!olene o! b!omoc!i*tine. Clo8a*ine ca'ses ag!an'loc0tosis 1m'st do &ee#l0 C-C i ta#ing4" thio!ida8ine ca'ses !etinal *igment de*osits" chlo!*!oma8ine ca'ses %a'ndice and *hotosensiti,it0. <EE. @e&e! At0*icals Ad,e!se 5 ects: Ris*e!idone 1less sedati,e" b't inc!eases *!olactin" inc!ase !is# o mo,ement d$o4" Olan8e*ine 1lo,e to as# abo't. &eight gain 19C4" !is# o D94" Oi*!asidone 1*!olonged I)4" I'etia*ine 1!is# o mo,ement d$o4 <EF. Antide*!essants: bloc# @5" <>C)" Do*amine. 9AOIs 1bad b$c o )0!amine ood !eaction 1cheese" !ed &ine" chocolates" sa'sages4. 9'st sto* 9AOI at least . &ee#s be o!e sta!ting )CAs o! SSRI. )( o choice o! at0*ical de*!ession 1inc!eased slee*$&eight$a**etite o! Leaden *a!al0sis44. )CAs 1best ones a!e no!t!0*tilline and desi*!amine" &o!st is amit!i*t0lline. Ca'ses h0*otension" anti> choline!gic s$s" cond'ction de ect 19CCOD" 9C is sin's tach0" b't /S9L5 lo,es &idened IRS" t( c bica!b4" se('al *!oblems" changes in &t" sedation4. SSRI 11st choice o! 9DD 1 l'o(etine" se!t!aline" *e!o(itine" citalo*!am" escitalo*!am4" An(iet0 1 l'o(etine" se!t!aline" *e!o(itine4 and OCD 1 l',o(amine onl04. Ca'ses headache 19C4" GI '*set" sedation" agitation" se('al d0s 'nction 1&o!st s$s4" &eight gain4. Othe!s incl'de 6enla a(ine 19DD" an(iet04" D'lo(etine 19DD" *ain d$o4" -'*!o*ion 19DD" smo#ing cessation4" 9i!ta8i*ine 1&eight good 1good o! ano!e(ia4" sedation4" )!a8odone 1*!ia*ism4. In a n'tshell" al&a0s ans&e! SSRI 'nless: 1> *t c 9DD and ne'!ole*tic 1s*inal4 *ain" gi,e d'lo(etine; . *t c 9DD and has se('al changes$&eight gain" gi,e b'*!o*ion 1not b's*i!one o! GAD4. <ED. 9ood stabili8e!s De*!essed *t 1lithi'm o! lamot!igine4 o! 9i(ed$9anic 1Lithi'm" ,al*!oic acid" anti*s0chotics4. 5ithe! &a0" lithi'm is 1st line. It ca'ses t!emo!s" GI '*set" h0*oth0!oidism"

ne*h!oto(ic" te!atogenic" acne" &t gain" le'#oc0tosis" ata(ia" and sei8'!es. 9'st get &ee#l0 blood le,els and m'st get )SC" -/@$C!" hCG be o!e sta!ting it. I !enal disease" *ic# ,al*!oic acid" i ,e!0 ac'te mania *ic# halo*e!idol" othe!&ise al&a0s go &ith lithi'm i!st. @e,e! discontin'e lithi'm ab!'*tl0 and le,els 2+.3 is a medical eme!genc0 that needs I6 saline o! hemodial0sis. <F3. 5lect!ocon,'lsi,e the!a*0 inc!eases se!otonin o! conditions li#e 9DD" mania and schi8o*h!enia. @o absol'te cont!aindications. Onl0 !elati,e CI is high int!ac!anial *!ess'!e 1b!ain t'mo!s4. Sho gets itR S'icidal *t 1t( o choice4" those &ho donAt !es*ond to meds" *!egnanc0" h$o bene it c 5C)" medication com*lications. 9C ad,e!se e ect is memo!0 loss. <F1. -en8odia8e*ines all &o!# on C7?<3 e(ams O)L 1O(a8e*am" )ema8e*am" Lo!a8e*am4" so !emembe! O)L o! O'tside )he Li,e!. <F.. S'icide i *t mentions it" ne(t ste* is to as# mo!e L'estions 1attem*t" ideations4" then admit. Ris#s: h$o attem*t 1best indicato! o e,ent'al s'ccess4" ho*elessness" *s0chiat!ic$*h0sical illness" d!'g ab'se" elde!l0" social isolation 1li,ing alone is &o!se than single" the0 a!e not the same thingU4" lo& %ob satis action. 9C method in males a!e g'ns" emales a!e g'ns. 9C attem*t in males a!e g'ns" emales a!e *ills. 7/L9O@ARY: <F+. Shen to int'bateR *O.B<3" *CO.2<3" *CBE.+ V !oom ai!. Remembe! i *t becomes atig'ed" this is a bad sign" donAt ass'me heAs %'st ti!ed" int'bate him. <F?. Common cold !hinitis" snee8ing" headache" malaise and co'gh 1no e,e!4. Rhino,i!'s is 9CC 1also adeno,i!'s" RS6" in l'en8e4. )(: #ee* &ell h0d!ated" @SAIDS o! e,e!" &a!m salt &ate! ga!gles o! *ha!0ngitis 1 e,e!" d!0$so!e th!oat4 and la!0ngitis" *se'doe*hed!ine$*hen0le*h!ine o! nasal congestion" a,oid as*i!in in child!en <F<. 7ha!0ngitis 1st!e* th!oat4 altho'gh ,i!'ses can be a common ca'se" !$o bacte!ial in ection 1g!o'* A st!e*" a#a st!e* *0ogenes4 c !a*id st!e* test. Cl'es to st!e* th!oat incl'de ce!,ical l0m*hadeno*ath0" e,e!" *ha!0ngeal and tonsilla! e('dates and the absence o co'gh. )( c *enicillin$e!0th!om0cin is gi,en to *!e,ent com*lications 1*e!itonsilla!$!et!o*ha!0ngeal abscess" meningitis" endoca!ditis" ac'te R: and glome!'lone*h!itis4. I ,i!al etiolog0" s'**o!ti,e ca!e onl0. <F=. 7e!itonsilla! abscess d0s*hagia" e,e!" *ain and t!ism's 1ha!d to o*en mo'th4. /,'la dis*laced b0 s&elling" t( c s'!gical d!ainage and antibiotics. <FE. )h!'sh candidal in ection that has !emo,able &hite *atches in the mo'th 1!ememebe!" candida CA@ come o " hai!0 le'#o*la#ia cant4. )( c n0statin" l'cona8ole. <FF. Sin'sitis acial *ain$*!ess'!e" e,e!" g!eenish *'!'lent !hinitis. I s's*ected" go ahead and begin t( c amo0cillin" then get (>!a0" then C)>scan o sin's. Onl0 ma(illa!0 and ethmoid sin'ses a!e *!esent in child!en. 5thmoid sin'sitis is mo!e !eL'ent in child!en. Ca,e!no's sin's th!ombosis is a com*lication that incl'des acial edema" meningitis and o*thalmo*legia. <FD. Alle!gic !hinitis snee8ing" itch0$&ate! e0es" nose bloc#ed and$o! !'nn0. )( c co!ticoste!oids and c!omol0n sodi'm" antihistamines" decongestants" alle!g0 shots. <D3. @asal *ol0*s s&ollen m'cosa$s'bm'cosa *ol0*oid tiss'e ca'sing obst!'ction o nasal ca,it0. A$& alle!gic !hinitis" c0stic ib!osis and as*i!in intole!ance. <D1. C!o'* 1la!0ngot!acheob!onchitis4 an ac'te ,i!al illness in 0o'ng #ids &ho get cold s$s at onset" then ba!#ing co'gh" slight e,e! and ins*i!ato!0$e(*i!ato!0 st!ido!. H>!a0 sho&s stee*le sign. )( c h'midi ied ai! then !acemic e*ine*h!ine. <D.. 5*iglottitis #id c d!ooling" high e,e!" !es* obst!'ction" d0s*nea" d0s*hagia" ins*i!ato!0 st!ido!" late!al (>!a0 sho&s th'mb sign. Do not i!!itate the #id o! mane',e! e*iglottis as that &o'ld &o!sen obst!'ction. 9CC is C. in l'en8a t0*e -. )( c ce*halos*o!ins and int'bation i needed. <D+. 7e!t'ssis + stages: cata!!hal 1co!08a o! 1>.&#4" *a!o(0smal 1&hoo*ing co'gh" .>?&#4" con,alescent stage &ee#s late!. )( c e!0th!om0cin in cata!!hal stage" othe!&ise s'**o!ti,e ca!e. <D?. Ac'te -!onchitis la!ge ai!&a0 in lammation" *!od'cti,e co'gh" e,e!" mild d0s*nea" CHR is clea! 1i the!e &as an in ilt!ate" then its *ne'monia4. )( c ab(" h0d!ation" e(*ecto!ants" b!onchodilato!s. <D<. -!onchiolitis small ai!&a0 in lammation" tach0*nea" &hee8ing" e,e!" co'gh in a child B.0o. Ca'sed b0 RS6. )( c !iba,i!in and o(0gen. <D=. 7'lmona!0 @od'le 1st ste* is get old (!a0. .nd ste* I lesion &as *!esent and is the same

si8e" its benign 1hama!toma" discha!ge home4. I the lesion &as the!e and has gotten bigge!" ass'me cance!. Co&e,e!" i the lesion &as not in the old>(!a0" then classi 0 his !is#. I he is lo& !is# 1B?30o" nonsmo#e!4 then its *!obabl0 benign 1hama!toma" CHR e,e!0 +mo o! .0!s4. I he is high> !is# 12<3" smo#e!4" ass'me cance! 1do o*en>l'ng bio*s04. <DE. 7ne'monia )0*ical 1B.da0s *!od!ome" e,e! 213." 2?30o" one lobe in,ol,ed4 is d$t st!e* *ne'mo 1g!am M di*lococci" t( c le,aL'in" *!e,ent c ,accine in 2=<0o and *t c como!bidities" t( c +!d gene!ation ce*halos*o!ins4. At0*ical 12+da0s" CA" aches" d!0 co'gh" B?30o" m'lti*le lobes" di 'se4 in a 0o'ng" othe!&ise health0 ad'lt c at0*ical *ne'monia is 90co*lasma$C. In l'en8a$Chlam0dia and t( c A8ith!om0cin. College st'dent c d!0 co'gh" thin# o 90co*lasma 1cold aggl'tinins4 o! Chlam0dia. An elde!l0 *t c CO7D li#el0 has bacte!ial *ne'monia" o! i in the &inte!" *ossible in l'en8a. An AIDS *t c lo& CD? and s'bac'te illness has 7C7 1t( c bact!im 1i alle!gic" gi,e da*sone4 o! *!o*h0la( &hen CDB.334. A *t &hose mentation is alte!ed 1*osto* !om anesthesia" demented" into(icated4 o! &ho ha,e s&allo&ing d0s 'nction 1C6A4 has as*i!ation *ne'monia. An alcoholic &ill li#el0 ha,e Nlebsiella. I 0o' see C@S 1headache4" GI 1dia!!hea4 and *ne'monia" its Legionella so gi,e e!0th!om0cin 11st test is '!ine legionella Ag test" most acc'!ate test is di!ect l'o!escent antibod0 !om s*'t'm4. I c0stic ib!osis o! hos*itali8ed o! a long time" thin# *se'domonas 1tho'gh S.a'!e's is still a big one he!e4 and t( c *i*e!acillin$ta8obactam o! ce ta8idime. I *t is a a!me! 1cattle" shee*" goats4 o! ,ete!ina!ian" thin# o Co(iella b'!netti 1t( c do(0c0line4 o! chlam0dia *sitacci 1bi!d>e(*os'!e" t( c do(0c0cline4. 17ediat!ic Shee8ing: B10o is RS6" .><0o is C!o'* 1ba!#ing4 o! e*iglottitis 1d!ooling4" 2=0o is Asthma4 <DF. In l'en8a e,e!" chills" co'gh" so!e th!oat c *ositi,e th!oat$nasal s&abs in the &inte!>time. :o! *!o*h0la(is" gi,e Amantidine 1in l'en8a A onl04 o! ,accine 12<30o o! high>!is# *t4. I disco,e!ed B.da0s" gi,e Oseltami,i!. I 2.da0s" !est$ l'ids$s0m*tomatic t( c analgesics$anti*0!etics. <DD. 7ne'mococcal ,accine e,e!0one 2=<0o" an0one 12.0o4 c CO7D$D9$alcoholism$ imm'nocom*!omised 1CI6$AIDS" cance!" ste!oid>'se" chemothe!a*04$*ost>s*lenecom0. =33. In l'en8a ,accine child!en =>.+months" 2=< 1D!. :ishe! sa0s 2<30o4 c ch!onic medical conditions" !esidents o n'!sing homes" health ca!e &o!#e!s c *t contact" child!en 1.>1F4 c ch!onic as*i!in 'se 1Na&asa#iAs4" ca!egi,e!s o #ids B=mo. =31. )- caseating g!an'lomas" t!ansmission b0 ae!oli8ed d!o*lets 1o,e!c!o&ded a!eas" *oo! ,entilation" health>ca!e &o!#e!s" imm'nocom*!omised" homeless4" e,e!" *!od'cti,e co'gh" night s&eats" chills" &t loss. I s0m*tomatic" ne(t ste* is CHR then A:-. I as0m*tomatic" ne(t ste* is 77D 1!e e! to ID notes o! 9anto'( !eaction ma!gins4" then CHR then A:-. )( c RI75 'ntil c'lt'!e sensiti,e. =3.. Cisto*lasma Ohio$9ississi*i !i,e! bi!d$bat d!o**ings in soil g!o& s*o!es" &hich a!e inhaled. I mild" no t(. I mo!e ill gi,e #etocona8ole o! am*hote!icin -. I disseminated 1AIDS *t4 then 1st ste* is blood$bone ma!!o& c'lt'!e" .nd Am*ho -. =3+. Coccidiom0cosis l'li#e s$s" a!th!algia" e!0thema nodos'm$m'lti o!me !ash. I mild" no t(. I se,e!e" gi,e Am*ho -. =3?. C!0*tococc's AIDS o! ste!oid>'se *t gets in ected c enca*s'lated 0east o'nd in soil$*igeon d!o**ings in @Y a!ea ca'sing s$s in the l'ngs and C@S 1meningitis4. )( c Am*ho - M l'c0tosine o! se,e!e disease. =3<. L'ng Abscess *'!'lent$*'t!id s*'t'm" co'gh" chest *ain" e,e!" *t c *oo! dentition and as*i!aton" CHR sho&s ca,ities and ai!> l'id le,el. )( c I6 *enicillin G. =3=. A>a g!adient: 1<3 11..< ( 7CO.4 7aO.. 1@L T <>1<" high c all h0*o(emia ca'ses e(ce*t h0*o,entilation and high altit'de4 =3E. Obst!'cti,e lo& :561" lo& :6C" lo& :561$:6C" lo& DLCO in em*h0sema" no!mal DLCO in Ch!onic b!onchitis$Asthma. :561 dete!mines se,e!it0 o disease 1=3>E3K is no!mal>mode!ate CO7D" B<3K is se,e!e CO7D4. Dec!eased l'ng lo&. =3F. Rest!icti,e :561" :6C both dec!eased" b't :561$:6C is no!mal. )LC is !ed'ced. Dec!eased l'ng ,ol'me. =3D. CO7D &hat a!e the onl0 things that dec!ease mo!talit0R Come O. 1&hen 7aO. B=3mmCg4 and smo#ing cessation. I t( is not s' icient c b!onchodilato!s" gi,e theo*h0lline 1dec!eased clea!ance i also gi,en c e!0th!o" ci*!o" cimetidine4. )( 1st Anticholine!gics 1i*!at!o*i'm b!omide 9DI4" .nd Alb'te!ol" +!d )heo*h0lline. Shat is the best *!edicto! o s'!,i,alR :561. 6acccinesR In l'en8a ann'all0 and *ne'mococc's e,e!0 < 0ea!s.

=13. Ch!onic -!onchitis bl'e bloate!s 1d'e to c0anosis4" *!od'cti,e co'gh" !ec'!!ent *'lm in ections. =11. 5m*h0sema *in# *' e!" *!og!essi,e d0s*nea" lo& DLCO" less co'gh" cache(ic" ba!!el chest" sits in t!i*od *osition" h0*e!!esonant l'ngs" distant hea!t so'nds" CHR sho&s h'ge l'ngs c b'llae". I in a 0o'ng *t c no smo#ing histo!0" *ic# al*ha>1>antit!i*s0n 1AA)4 de icienc0" t( c *'!i ied h'man AA). =1.. Asthma o! attac#s: 1st gi,e o(0gen" .nd *ee# lo&" +!d Alb'te!ol" ?th Ste!oids o! 1? da0s 1no ab(4. Shat i *t has attac# seconda!0 to --sR Gi,e anticholine!gics 1i*!at!o*i'm b!omide4. :o! e(e!cise>ind'ced asthma" gi,e c!omol0n and alb'te!ol be o!e e(e!cising. Ch!onic t(: dail0 inhaled ste!oids" alb'te!ol as needed 1othe! d!'gs de*end on t0*e o asthma4. :o! ac'te e,al'ation get A-G 1!es* al#alosis" i it gets no!mal thatAs bad4" 7'lse o(" CHR. :o! ch!onic e,al'ation" get 7:)s" methacoline challenge" b!onchodilato! 1test !e,e!sibilit04. )( o choice o! noct'!nal co'gh is long acting ->agonist 1Salmete!ol4. =1+. -!onchiectasis c'* 'ls o *'!'lent$malodo!o's *!od'cti,e co'gh" &t loss" hemo*t0sis" cl'bbing" a$& c0stic ib!osis and #a!tegene!As s0nd!ome 1immotile cilia4. D( c CHR 1st then C) 1best" b't not 1st4. :o! ac'te management" t( o! *se'domonas 1tica!$*i*e!cillin" L'inolones" ce ta8idine4. :o! ch!onic t(" gi,e b!onchodilato!s" *ost'!al d!ainage" !otate ab( 1*!e,ent !esistance4" s'!ge!0 and ,accines. =1?. 7'lmona!0 :ib!osis inte!stitial in lammation" e(e!tional d0s*nea 19C s$s4" c!ac#les" cl'bbing" co! *'lmonale. D(: 1st CHR 1sho&s g!o'nd>glass a**ea!ance4" .nd C)" +!d L'ng bio*s0 1gold standa!d4. )( c ste!oids o! =months" then t!ans*lant i needed and $' 7:)s. =1<. Alle!gic -!oncho*'lmona!0 As*e!gillosis 1A-7A4: m'st ha,e = o the ollo&ing E: h$o asthma" *e!i*he!al eosino*hilia" *'lm in ilt!ates" M s#in test to As*e!gill's" high se!'m Ig5" MIg5$IgG o! As*e!gill's" cent!al b!onchiectasis. )( c *!ednisone. =1=. Atelectasis 9CC o *osto* e,e! a te! 1>. da0s. )(: 1st incenti,e s*i!omet!0" .nd Dee* b!eathing e(e!cises" +!d o't o bed" ?th chest *h0sical the!a*0" <th C7A7" =th -!onchosco*0 1i atelectasis is se,e!e and s*ontaneo's>d'e to m'c's *l'g4. =1E. Cemotho!a( blood in *le'!al s*ace. D0s*nea c massi,e shoc#. )(: i ,e!0 small" obse!,e. All othe!s need a chest t'be. Some need tho!acotom0 1bleeding 2.33mL$h!4 =1F. Asbestosis e(*os'!e to !emoal sides" *i*e maintenance" etc. )a#es 2.3 0ea!s to de,elo* mesothelioma" b't m'ch less to de,elo* b!onchogenic CA 1es* i smo#ing4. D( c l'ng bio*s0 sho&ing e!!'gino's bodies 1not CHR o! C)4. @o t(. =1D. Silicosis inc!eased !is# o )- 1m'st do ann'al 77D4. /**e! lob nod'les c eggshell hila! node calci ication. =.3. Ca*lan S0nd !he'matoid nod'les in l'ng *e!i*he!0 c coal>&o!#e!s *ne'moconiosis. =.1. Sa!coidosis blac#s" emales" bio*s0 sho&s non>caseating g!an'lomas 1most acc'!ate4" e,e!" d0s*nea" s#in 1e!0thema nodos'm4$e0e 1i!itis4$C@S 1ne!,e *als04$ca!diac 1a!!h0thmia4 s$s. CHR sho&s b$l enla!ged hila! adeno*ath0" d( c bio*s0" ele,ated AC5" high calci'm. )( c ste!oids. =... Ac'te Res* Dist!ess S0nd 1ARDS4 ac'te l'ng damage !om inc!eased *'lmona!0 1al,eola!4 *e!meabilit0. 7t c d0s*nea" tach0*nea" tach0ca!dia" no im*!o,ement c o(0gen" a!te!ial h0*o(emia 17aO.$:iO. !atio B+334" h0*e!ca*nea" CHR sho&s b$l &hited o't l'ngs. C$o in ection" as*i!ation" nea!>d!o&ning" d!'gs" shoc#" b'!ns" and *anc!eatitis. )( c 7557. =.+. 7'lmona!0 5mbolism ,eno's stasis$th!ombosis" h0*e!coag'lable state 1*!egnanc0" SL5" cance!" *!tn C$S de " OC7" antith!ombin III de " :acto! 6 leidin4. S'dden onset o d0s*nea" *le'!itic C7" hemo*t0sis" s0nco*e" s*lit S. so'nd. Clea! CHR. 5NG sho&s sin's tach0ca!dia o! S1I+)+. A-G sho&s !es* al#alosis c h0*o(ia and inc!eased A>a g!adient. 9ostl0 !om dee* leg ,ein th!ombi 1abo,e #nee is not *ossible" m'st be belo& #nee4. D( c s*i!al C) o! 6$I scan 1es* i *!egnant4. De initi,e d( c *'lmona!0 angiog!a*h0. )( c 1st anticoag'lation c he*a!in1L9S>he*a!in i *!egnant4 c O. i stable" .nd th!ombol0tics 1t7A4 i 'nstable" +!d embolectom0 1i se,e!e li#e a saddle embolism4" ?th ilte! 1i !ec'!!ent o! i anticoag'lation is cont!aindicated4. =.?. 7'lmona!0 C)@ C7" d0s*nea" letha!g0" sho!tened S. s*lit c lo'de! 7." &ea# *e!i*he!al *'lses$coldhands. )( c o(0gen and ,asodilato!s. =.<. Good*ast'!es !enal c *'lm so *t c hemo*t0sis and hemat'!ia" anti>G-9 Abs" t(:1st *!ednisone" .nd c0clo*hos*hamide" +!d *lasma*ha!esis. =.=. Segene!s /**e! ai!&a0" *'lmona!0" !enal so *t c sin'sitis" hemo*t0sis" hemat'!ia" c>

A@CA. )(: 1st c0clo*hos*hamide" .nd *!ednisone. =.E. 7le'!al 5 'sion once 0o' see it on CHR" ne(t ste* is ta* 1tho!aentesis4 to see i it is t!ans'dati,e 1CC:" 75" ne*h!otic s0nd!om" atelectasis4 o! e('date 1*a!a*ne'monic" cance!" 75" ch0lotho!a(" eso*hageal !'*t'!e" !he'matoid a!th!itis4. :o! it to be e('dates: 7le'!al l'id to se!'m *!otein !atio 2 3.<" 7le'!al l'id to se!'m lactate deh0d!ogenase 1LDC4 !atio 2 3.=" 7le'!al l'id LDC mo!e than .$+ o the '**e! limits o no!mal se!'m ,al'e. Shat i the0 donAt gi,e 0o' the se!'m le,elsR )hen e('dates is &hen *le'!al l'id choleste!ol 2?< mg$dL and *le'!al l'id *!otein 2 ..D. I 0o' thin# it is malignanc0 1old g'0" &t loss" smo#e!" etc4 then loo# o! LDC 21333" gl'cose +3><3" and l0m*hoc0tes <3>E3K. Co&e,e!" i 0o' &o!!0 abo't *a!a*ne'monic e 'sion" loo# o! LDC 21333" gl'cose 2+3" *C BE.." ne(t ste* is chest t'be d!ainage. =.F. L'ng Cance! no a,ailable sc!eening test. SL'amo's cell 1cent!al ca,itation" a$& h0*e!calcemia d$t 7)C>li#e *e*tide" d( c b!onchosco*04" Small cell 1cent!al ca,itation" a$& SIADC" 5aton>Lambo!t and C'shings s0nd!ome" d( c b!onchosco*04" Adenoca!cinoma 1*e!i*he!al lesion" 9C is b!onchoal,eola! CA" inc!eased h0al'!onidase le,els" d( c :@A then tho!acotom0 c *le'!al b(4. Shen is it 'n!esectableR Coa!seness" 95)S" &t loss 213K" C@S s$s" S6C s0nd!ome 1G6D c acial discolo!ation d$t SCC4 o! t'mo! at the t!achea$eso*h$*e!ica!di'm. :o! small>cell Ca" t( c chemothe!a*0 1671=>eto*oside and *latin'm4. :o! non>small cell Ca gi,e !adiation and chemo 1CA7 C0clo*hos*hamide" Ad!iam0cin" 7latin'm4. R5@AL$/ROLOGY: =.D. 7!ostatitis d0s'!ia" chills" e,e!" lo& bac# *ain" *e!ineal *ain" !eL'enc0" *!ostate ma0 eel bogg0 and la!ge b't is al&a0s tende!. 5.coli. )( c le,aL'in and h0d!ate. =+3. 5*idid0mitis tende! 1!elie,ed c sc!otal ele,ation" o**osite o to!sion4" enla!ged testicle" e,e!" sc!otal thic#ening. Ca'sed b0 neisse!ia" e.coli" chlam0dia. )( c ab( 1tet!ac0cline" le,aL'in4" nsaids" sc!otal s'**o!t. =+1. O!chitis e,e!" inc!ease testic'la! si8e" sc!otal *ain$e!0thema" a$& m'm*s and )-. )( c same as abo,e. =+.. /!eth!itis '!eth!al d$c" d0s'!ia. @e(t ste* is c'lt'!e$g!am stain 1!$o S)D4. )( c ab(. =++. )estic'la! to!sion 9CC o sc!otal s&elling in #ids" ca'sing se,e!e *ain 1es*eciall0 &hen sc!ot'm is li ted" o**osite o e*idid0mitis4" abdm *ain 1sometimes this is thei! onl0 s$s" so m'st chec# sc!ot'm4" ,omiting. /!ologic eme!genc0 o! blood s'**l0 m'st be !egained &ithin = h!s to *!e,ent loss o testicle. =+?. C!0*to!chidism no s$s. D( c C). )(: O!chio*e(0 at age 1 to *!e,ent cance!. =+<. An0 testic'la! mass needs to ha,e cance! !'led o't" so e(cise and bio*s0 it. =+=. -enign 7!ostatic C0*e!t!o*h0 enla!gement o *!ostat gland ca'sing obst!'ction 1hesitanc0" d!ibbling" &ea#$lo& st!eam4" '!genc0" noct'!ia and !eL'enc0. D(: 1st DR5" .nd /$S. )(: 1st a> bloc#e! 1te!a8osin" !emembe! tams'losin 1 loma(4 has the least ad,e!se e ects4" .!d <>a>!ed'ctase inhibito!s 1 inaste!ide4" +th S'!ge!0 1)/R74. Co&e,e!" i *t is in 5R in *ain" 1st ole0 1i it &ont *ass" do s'*!a*'bic ta*4" .nd )/R7 1s#i* meds4. =+E. C0*os*adia meat's belo& *enis ti*" so 0o' *ee on 0o'! eet. 7t ma0 ha,e cho!dee 1,ent!al *enile c'!,e ca'sing *enis to c'!,e D3deg!ees4. )(:1st obse!,e 'ntil 10o 1do not ci!c'mcise4" .nd s'!ge!0 =+F. C0d!ocele l'id a!o'nd the testis d'e to *atent *!ocess's ,aginalis. D( c M t!ansill'mination. )( c obse!,ation. =+D. 6a!icocele *am*ini o!m *le('s ,ein dilation d'e to ine icient *am*ini o!m ,al,es. Disa**ea!s in s'*ine *osition 1no ,eno's *ooling4. D( c 1>4 t!ansill'mination. )( c s'!ge!0. =?3. C0stitis bladde! in ection ca'sing d0s'!ia" !eL'enc0" noct'!ia" '!genc0. D( c /A$/c($/!ine di*. 9CC is 5.coli. )(:1st ab(" .nd I67" c0stosco*0 1i !ec'!!ent4. =?1. /)I '!genc0" d0s'!ia" lo& balc# *ain" lo& e,e!. D( c midst!eam '!ine C( to sho& high nit!ates and le'#oc0tes. )( c )97$S9H" amo(icillin" nit!o '!antoin" le,aL'in. An0 #id B=0o c /)I needs 6C/G 19CC is ,esic'!ete!al !e l'( and *oste!io! '!th!al ,al,es4. =?.. @e*h!olithiasis se,e!e lan# *ain !adiating to the g!oin c hemat'!ia. D(: 1st H!a0 1'!ic acid stones not ,isibile4" .nd C) scan abdo$*e,is &itho't cont!ast. )(: 1st C0d!ation c analgesia" .nd 1!emembe!" '!ete! is Fmm &ide" so a small stone 1B<mm4 &ill *ass c s'**o!ti,e meas'!es" b't

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 i lo&e! G/ t!act. =?+. An0time 0o' s's*ect '!eth!al in%'!0 1high !iding *!ostate o! blood at '!eth!al meat's4" ne(t ste* is !et!og!ade '!eth!og!am 1not ole0U4. =??. Se gi,e c0clos*o!ine o! g!a t !e%ection" b't c0clos*o!ine itsel is ne*h!oto(ic. Co& do 0o' di e!entiate !enal g!a t !e%ection !om c0clos*o!ine to(icit0R 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!a t !e%ection 1ho&e,e! t!0 *e!c'taneo's needle bio*s0 i!st in !is# o &o!sening #idne04. =?<. Incontinence disc'ssed in G0n notes. :'nctional$O,e! lo& 1ne!,e d0s 'nction" D9$9S" high ,oiding !esid'al ,ol'me" t( c sel >cathete!i8ation i *t cannot em*t0 o! anticholine!gics i *t cannot sto!e4" St!ess 1&ea# *el,ic loo!" agg!e,ated b0 co'ghing$snee8ing$la'ghing" t( c #egel e(e!cises" then s'!gical 99N *!oced'!e4" /!ge 1det!'so! h0*e!!e le(ia ca'sing s*ontaneo's cont!actions" t( c anticholine!gics4. =?=. C0d!one*h!osis #idne0$'!ete! damage !om '!ete! obst!'ction 1in men" thin# -7C4 ca'sing lan#$bac# *ain and olig'!ia. D( c 'lt!aso'nd. )( c 1st ole0 cathete! to !elie,e distal obst!'ction" .nd c0stosco*0 and ablation o stones. =?E. 70elone*h!itis ascending in ection into #idne0 ca'sing e,e!$chills" n$," lan# *ain and ano!e(ia. I *t is not se!io'sl0 ill" t( c ab(. I *t has se,e!e n$, and a**ea!s ill 1deh0d!ation" h0*otension4 gi,e I6 h0d!ation and ab( o! . &ee#s. =?F. Glome!'lone*h!itis hemat'!ia" *!otein'!ia" C)@" edema. I ac'te" gi,e bed !est" anti>C)@. Ca'ses incl'de CI6" C-6" *ostst!e*tococcal" SL5" Good*ast'!es" Segene!s" RA" 7ol0a!ete!itis nodoa" *enicillamine" h0d!ali8ine" allo*'!inol and !i am*in. I !a*id *!og!ession gi,e ste!oids" c0toto(ics" *lasma*ha!esis. =?D. -e!ge!As Disease IgA ne*h!o*ath0" g!oss hemat'!ia a te! ,i!al /RI. D( c bio*s0 1imm'ne de*osits o IgA in glome!'li4. @o t(. 1DonAt con 'se c -'e!ge!As disease" &hich is a *!oblem o the inge!s in smo#e!s4. =<3. Diabetic @e*h!o*ath0 mic!o,asc'la! glome!'la! damage 1thic#ened G-94 and Nimmelsteil> Silson lesions 1nod'la! de*osits in glome!'li4. -est t( is *!e,ention. =<1. Ac'te Renal :ail'!e !ales" G6D" h0*onat!emia. Ca'ses incl'de *!e!enal" !enal and *ost!enal. See belo&. =<.. 7!e!enal :ail'!e h0*o,olemia 1deh0d!ation4 -/@$C! 21<:1" )( c I6:. Ca'ses incl'de se*sis" CC: 1t( c di'!etic4" Li,e! :ail'!e 1Ce*ato!enal S0nd" &hich has no t(4 =<+. Renal :ail'!e 9CC is A)@ 1m'dd0>b!o&n casts4 d'e to: I6 cont!ast 1a,oid in D9" !enal d8" asthma" shell ish alle!g04" Rhabdo$90oglobin'!ia 1high C7N" t( c I6: and di'!etics4" SL5" Ch!onic @SAID 'se 1*a*illa!0 nec!osis4" aminogl0cosides" c0clos*o!ine" Good*ast'!es 1anti>G-9 Ab" linea! on b(" t( c ste!oids and c0clo*hos*hamide4" Segene!s 1t( c c0clo*hos*hamide4. A)@ 's'all0 !esol,es in = &ee#s so %'st t!0 to #ee* them ali,e 1dial0sis4 'ntil then. .nd 9CC is AI@ 1ac'te inte!stitial ne*h!itis loo# o! &bc casts and eosino*hilia. d$t d!'gs 1->lactam4" calci'm c!0stals" o(alate 1anti !ee8e4" chemot( 1'!ic acid4" t( c d$c st!esso!4. +!d 9CC is Glome!'lone*h!itis 1R-C casts" d( c bio*s0 immediatel04 and ?th 9CC is ,asc'litis 1C/SB ))7" 9'lti*le Choleste!ol 5mboli S0nd!ome 1s$* ca!diac cath *t gets bl'e eet" C)@ and eosino*hilia4. =<?. 7ost!enal :ail'!e An'!ia 1no '!ine o't*'t &ith 2.<cc !esid'al ,ol'me4. D( c !enal '$s 1sho&s h0d!one*h!osis4. 9CC is -7C 1then b$l !enal stones4. )( c cathete!i8ation" then )/R7. =<<. 9inimal Change Disease #ids" glome!'l's loo#s no!mal" b't ma0 ha,e 'sion o *odo0ctes. D( c .?h! '!ine *!otein 1no need o! bio*s04. )( c ste!oids. =<=. 9emb!ano's Glome!'lone*h!itis elde!l0 Ca'casian c am0loidosis. @o need to do bio*s0 o! diagnosis. =<E. :ocal Segmental Glome!'lone*h!itis h$o I6DA" <3K get 5SRD" d( c bio*s0 =<F. 9emb!ano*!oli e!ati,e Glome!'lone*h!itis a$& he*atitis C 1gi,e !iba,i!in4 and endoca!ditis" d( c bio*s0. =<D. Shen do 0o' choose dial0sisR Acidosis BE..<" /!emic ence*ho*ath0 11st gi,e DDA67" then dial0sis4" Inc!eased NM and c!eatinine" *e!ica!ditis" hea!t ail'!e. ==3. 7ol0c0stic Nidne0 Disease amil0 histo!0" C)@" hemat'!ia" *al*able lan# mass" D( c C) o abdo 1sho&s m'lti*le c0sts4.

==1. Ch!onic Renal :ail'!e a8otemia 1high -/@$C!4" metabolic acidosis" high N" h0*e!,olemia 1C)@" CC:" edema4" lo& calci'm$high *hos*hate. )( c dial0sis 1st" then &ate!>sol'ble ,itamins 1lost in dial0sis4" calci'm" 57O and anti>C)@ meds. ==.. C0*onat!emia: + t0*es: C0*o,olemic C0*onat!emia 1t( c saline4" C0*e!,olemic C0*onat!emia 1*t c ca!diom0o*ath0 and edema" t( c co!!ecting 'nde!l0ing ca'se4" and 5',olemic C0*onat!emia 1C0*oth0!oidism 1t( c th0!o(ine4" SIADC 1high '!ine osmola!it0" t( c l'id !est!iction4" 7s0chogenic *ol0di*sia 1lo& '!ine osmola!it0" t( c l'id !est!iction44. ==+. @e,e! gi,e I6 7otassi'm 'nless: 1> NMB..F" . *t on digo(in" + a!!h0thmia. ==?. Onl0 . conditions in Anion>ga* acidosis 19/D7IL5S4 &he!e 0o' do @O) gi,e bica!b: DNA and Lactic acidosis. ==<. 6omiting ,s ConnAs S0nd in ,omiting 1lose N and Cl" th's Cl is lo&4 0o' t!eat c saline. In ConnAs s0nd 1lose N" not Cl" th's Cl is no!mal4 t( c S*i!onolactone and AC5I. ===. Renal A!te!0 Stenosis high !ennin C)@. 1st test is ca*to*!il imaging" .nd test is Angiog!am. )( c angio*last0. Re*o!t Ab'se