CARDIO Qs

Male w/Long QT syndrome has Torsade de Pointes - Likley caused

brief Syncope needing CPR. this.

Long QT sd. Pt having Sudden

Arrhythmia Death Sd - usually has
Torsades or Ventricular Fibrillation
Syncope

Fact: Do Dipyridamole-Thallium Scan

Pt plans to have vascular surgery
(ex: Femoral-anterior tibial artery
bypass surgery). Diagnostic
studies appropriate PRIOR to
surgery?

Uncomplicated Hypertension: A: Perform No Further Evaluation of Uncomplicated HTN is

53yoF fell..came to ER. Found to the Hypertension. Ask pt to frequently found in ER.
have BP 160/100mmHg. She's not FOLLOW-UP with you within a *Can be chronic condition
aware of it. CVS normal. ER month *Can be result from Acutely
doctor calls you, you confirm this painful situation.
is a new problem. What to tell ER
doctor to do? >180/120mmHg =
Hypertensive
Emergencies.worsening
Target Organ Dysfunction -
Needs Emergency Treatment

Treat Venous Ulcers: 1. Compression Therapy +

Pentoxifylline (Trental).

Also: Aspirin.

Leg Claudication Cilostazol (Pletal)

56yo Walks one block - gets
claudication. Relieved by standing Arterial Vascular Disease -
still or sitting. Treatment? Intermittent Claudication.
1. Stop Smoking
2. Do walking program.
**(Lowering LDL not likely to
improve symptoms)
**(Additional Antiplatelet Meds not
likely to improve Sx)
Bilateral Renal Artery Stenosis: Bilateral Renal Artery Stenosis:
70yoM Follow-up for
HTN.Creatinine level Clues:
INCREASED. What's likely cause? 1. Onset Stage 2 HTN
(BP>160/100mmHg) after 50yo.
*HTN associated w/renal
insufficiency (esp. if renal function
WORSENS after admin. Of med that
blocks RAAS
*HTN with repeated Hospital
Admissions for Heart Failure
*Drug-Resistant HTN

If Initial Defibrillation attempt Vasopressin (Pitressin)

Fails Which should be used?
*For Persistent Ventricular
Fibrillation (VF) - in Addition to
Electrical Defibrillation and CPR,
patients should be given
Vasopressor (Epinephrine or
Vasopressin)

Amiodarone (for VF unresponsive

to shock deliver, CPR, & a
Vasopressor)

Lidocaine used if Amiodarone Not

Available.

ORDER
Defibrillator-CPR-Vasopressin >
Amiodarone > Lidocaine

Endocrine Qs
Case: Female taking many meds See if LITHIUM is used.
has Elevated CALCIUM Level.
Calcium 11.2mg (N: 8.4-10.2) PTH Discontinue Lithium. = Lithium
elevated. Elevates CALCIUM (by Increasing
PTH secretion by PTH Gland) (stop
Lithium use for 3mo)

Lithium PTH Gland PTH

CALCIUM

Vit D & Ca supplements can cause

Hypercalcemia, but does NOT
ELEVATE PTH

(Raloxifene or Furosemide+Saline
Infusion = Lowers Calcium levels)

Single Thyroid Nodule. Associated Hoarseness

with Higher incidence of
Malignancy?
Red Flags of possible Thyroid CA:
*Male
*<20yo or >65yo
*Rapid nodule growth
*Local Invasion Sx: Dysphagia, Neck
Pain, Hoarseness)
*Hx: Neck Radiation
*FamHx Thyroid CA
*Hard, Fixed Nodule >4cm
*Cervical Lnadenopathy

Insulin Regimen most closely *Detemir Insulin (Levamir) daily

Mimics normal pattern of plus Rapid-Insulin acting with
Pancreas Insulin Release in Non- meals.
diabetic person.

Diagnostic Test for *Central DXA Scan of the Lumbar Quantitiative CT = accurate,
OSTEOPOROSIS: Spine & Hips but COST & Radiation
Exposure
Risk Factors for Osteoporosis:
1. Asian
2. Low Body Weight BMI
3.Positive FamHx.
4.Postmenopausal Status w/NO
History of hormone replacement.
5. Low Calcium Intake
GI Qs
Case: Spontaneous Bacterial
Peritonitis:
For 2 wks, 62yo M with
documented Cirrhosis & Ascites
has had diffuse abdominal
discomfort, fever, night sweats.
His current meds are Furosemide
(Lasix) and Spironolactone
(Aldactone). Temp 100.4F
Presence of Ascites. You do
Paracentesis, send fluid for
analysis. What finding to
establish the suspected Dx of
Spontaneous Bacterial
Peritonitis?
Case: Gastroenteritis
Nausea, vomiting, Diarrhea
recent (like 36hs ago).
On cruise at food in addition to
oysters (TRAP). Stool sample -
Negative for White cells (CLUE).
What's the likely cause?
Neutrophil Count >300/ml
(Hx: Cirrhosis/ascites
=backgroundalready on
Furosemide etc.)
*Fever.
Do PARACENTESIS in Acute/Chronic
Ascites with Fever or Abdominal
Pain.
Neutrophil >300/mL. = Peritonitis
Rx: Antibiotics immediately
Hepatoma = Blood Ascites
A: Norwalk Virus
(NO WBC = Rule Out Bacterial)
Not Hepatitis A
Gastroenteritis on Cruise ships =
NORWALK Virus = 90% all
Nonbacterial Gastroenteritis.
@Nursing Homes, Cruise Ships,
Summer Camps, Schools.
Case: Celiac Sprue
30yoM previous healthy. 1 yr hx
frequent abdominal pain,
nonbloody diarrhea, 20lb weight
loss. No hx of travel outside the
US, abx use, or consumption of
well water. ROS: has Chronic,
intensely pruritic rash-vesicular
in nature. ROS: rest is negative, is
on NO medications
External Hemorrhoid
Painful Thrombosed External
Hemorrhoid. Treat with?
Metabolic Syndrome:
Pt is in good health BMI
elevated. Labs show:
ALT elevated, AST Elevated. Likely *See in DM, HTN, Insulin
cause of elevated liver enzymes? Resistance.
Cause of Symptoms? Rash = Dermatitis
A: Celiac Sprue Herpetiforms
Autoimmune disorder -
Inflammation of Small Bowel Wall, ddx: Lactose Intolerance,
Blunting of Villi, results in Irritable Bowel Sd, Crohns
Malabsorption.
(significant WEIGHT LOSS is
Sx: Diarrhea, Fatigue, Wt Loss, not part of IBS or Lactose
Abdominal Pain, Borborygmus- Intolerance)
bowel sounds
Crohn's Diarrhea = Bloody
Tx: Stop Gluten in diet.
Lab: Serum IgA tissue
Transglutaminase (TTG) Abx -
sensitive/specific for Celiac Sprue....
Biopsy - Villous Atrophy = Gold for
Diagnosis.
A: Thrombectomy under local
anesthesia
Sx: Sudden Painful, Tender,
Perirectal Lump. (Somatic
Innervationsso pain is INTENSE &
Increases with Edema)
Metabolic Syndrome:
Non-Alcoholic Fatty Liver Diseaes -
MCCO Abnormal liver tests,
Elevated BMI.
Rx: Statin (improves liver enzyme
levels)
82yoM. Chronic Low back pain.
On Warafrin for chronic Atrial
Fibrillation, Tamsulosin (Flomax)
for BPH, Famotidine (Pepcid) for
GERD. Which Analgesic meds will
have least AE?
Lidocaine Patch (Lidoderm)
*Topical Lidocaine produces very
low Serum levels of active drugget
fewer AE.
NOT:
*Hydrocodone - get opiate-type
effect
*Nortriptyline & Duloxetene =
Aggravtes this pt's Arrhythmia &
cause Urine Retention
*Celecoxib = can aggravate his
GERD

Treatments for DM-2 gets Weight Exenatide (Byetta)

loss? *Metformin - helps in obese/over
wt. pts to lose weight
*Incretins (Exenatide) = helps
obese/over wt. pts to lose weight

Other Insulin formulations lead to

wt gain or have no effect on wt.
(Glipizide, Pioglitazone, Detemir,
Lispro)

Skin Qs
Oral Leukoplakia - next step: Biopsy of lesion
Screening for Melanoma - No
Proof it reduces Mortality
Actinic Keratosis is precursor Actinic Keratosis is precursor to
lesion to: Cutaneous Squamous Cell
Carcinoma.
Pigmented skin lesion could be Excision with a 1mm Margin
Melanoma. Its largest dimension
is 0.5cm. First step in Diagnosis by Simple Exision with
Management? clear margins.

(Critical to determine THICKNESS of

lesion for staging)

MSK Qs
Fact: Phenytoin increases Hepatic
Prolonged PHENYTOIN use can metabolism of Vitamin D
accelerate or cause Osteoporosis reduces Intestinal Calcium
Bone Loss Absorption

Others:
*Glucocorticoids-Cortisol
*Cyclosporine
*Phenobarbital
*Heparin

vs: Thiazide diuretic = Reduces Ca

losspreserves bone density.

Raloxifene: Selective Estrogen

Receptor
Modulator...prevent/treats
Osteoporosis in Postmenopausal
women

Lateral Ankle Sprain 2hrs ago Dx:

while playing softball. Pain over Lateral Ankle Sprain
Distal Anterior Talofibular
Ligament, but can bear weight. Tx: Early Range of Motion Exercises
Mild swell, mile black & blue should be initiated to maintain
discoloration, moderate tender flexibility.
over insertion of anterior
talofibular ligament. Malleoli
nontender.

Soccer game. Right foot planted, A: Lachman Detect ACL Tear

ankle locked injury she's Anterior Cruciate Ligament Tear 1. Lachman Test > then
concerned about loss of knee ACL (occur F > M) Anterior Drawer Test
hyperextension. WHICH TEST
likely to be abnomal?
Colonoscopy Screen
30yoF asks if she should get
Colonoscopy, as her father was
diagnosed with colon cancer at
58yo. You recommend she have
her First screening Colonoscopy
at age?
Frozen Shoulder:
40-60yo Pain in Shoulder -
Idiopathic.
Thoracic Vertebral Compression Decrease Activity until pain
Fracture:
72yoM Persistent Interscapular
PAIN with Movement. Xray shows
Thoracic Vertebral Compression
Fracture. What's next?
Start @ 40yo and then every 5
years if normal.
(or 10yrs before earliest age which
the affected relative was
diagnosed) - WHICHEVER Comes
First, - Rescreen every 5 years
Colonoscopy - Preferred Screen (for
Highest risk group Right-Sided
Colon Lesion Sigmoidoscopy
CANNOT detect it)
Sigmoidoscopy can't detect Right
Sided Colon Lesions
Shoulder stiffness, loss of active &
passive shoulder rotation, severe
pain.
*Chronic POSTERIOR Shoulder
Dislocation & Osteoarthritis = see
on Plain XRAY
*Rotator Cuff Tear = Has NORMAL
passive Range of Motion
*Impingement Syndrome: = Does
NOT Affect Passive Range of
Motion... YES PAIN with Elevation
of Shoulder
lessens, and FOLLOW-UP 1 week
Radial Head Fractures.
Playing Tennis, Tripped and fell
lands on OUTSTRETCHED hand
with Elbow in Slight FLEXION at
impact. Pronation & Supination
of Forearm are Painfulas are
attempts to Flex the Elbow.
Tenderness of Radial Head
without Swelling.
MANAGEMENT?
Hammer Toe Treatment.
NEURO Qs
16yo F "Passing Out". In
band..has "Blacked out".
Lightheaded with spots before
her eyes & tunnel vision just
prior to falling. She's pail &
sweaty when episodes occur. NO
seizures ever observed. She
regains consciousness almost
immediately. In ER: Normal vitals, *Neural mediated & Situational
PE, Neuros. Which TESTS likely
yields correct diagnosis?
Posterior Splint & Repeat
Radiograph in 1-2weeks
(5-7days)
Follwed by early mobilization & a
Sling for comfort.
Custom-made Shoes to protect the
hammer toe
A: Tilt Table Testing
Reflex syncope - is strong diagnostic
consideration for episodes of
syncope w/Precipitating factor.
Syncope Categories:
*Carotid Sinus Hypersensitivity
Syncopes
MC & Benign forms: Neural
mediated & Vasovagal - Sudden
Hypotension...+Bradycardia
Pt Lies down quickly for Rapid
Restore central perfusion
80yo white M. heavy medicated
Chronic Schizophrenia. Constant
involuntary Chewing motions &
repetitive movements of his legs.
Likely Diagnosis?
Method to Diagnosing
Psychogenic Nonepileptic
Seizures PNES:
Male with 5year history of
periodic episodes of severe right-
sided headaches. The most
recent episode the headaches
occurred most days during
January & February and lasted
about 1 hour. Most likely
Diagnosis?
RENAL Qs
A: Tardive Dyskinesia
(Sx: Repetitive Movements of the
mouth & legscaused by
Antipsychotic meds: like
Phenothiazines & Haloperidol)
NMS: Neuroleptic Malignant Sd:
Fever, Autonomic Dysfunction,
Movement disorder
Acute Dystonia: Twisting of NECK,
Trunk, LIMBS inton uncomfortable
positions
*vEEG - Video-
ElectroEncephaloGraphy
monitoring
= Gold Standard
(Elevated Postictal Prolactin Levels -
to differentiate Generalized &
Complex Partial Seizures from
PNES)
Cluster Headache. Trigeminal Neuralgia:
*Lasts 20-30seconds
*Mainly a MALE disorder
*Onset: 27-30yo
*Attacks in Cycles & Unilateral
Migraine Headaches:
*More in FEMALE - starts 11-20 or
20-30yo),
*Lasts 4-24hours (lasts longer)
Temporal Arteritis
*>50yo
Calcium Oxalate Stones:
Advice for 50yoF who passed
6Ca-Oxalate stones over past 4
yrs.:
Perinephric Abscess:
48yoF DM2. 2wks ago had
Urinary Frequency, Urgency,
Dysuria. UA showed 25WBC, and
urine culture grew E. Coli. She
was placed on
Trimethoprim/Sulfamethoxazole
(Bactrim, Septra). Improved over
next week, but then developed
Flank Pain, Fever 103.1F, nausea
& vomiting.
Next step at this time?
RESPIRATORY Qs.
Hiccups
Several day history of Hiccups.
Wakes Pt up at nightTreatment?
Asthma. Give
HEME Qs
A: Take Potassium Citrate with
meals (=increases Urine pH & Urine
CITRATE)
*Calcium-Oxalate Stones = MC of
All Renal Calculi.
*Low-Sodium, Restrict Protein,
Fluid intake = Reduces stone
formation
LOW Calcium-diet is shown to be
INEFFECTIVE
Order CT of the Abdomen
Dx: Perinephric Abscess - collection
of pus in tissue surrounding the
kidney.
(Diagnosis considered when pt has
Fever & Persistence of FLANK PAIN)
Pt with DM or Anatomic Urinary
Tract abnormalities have increased
Risk.
Find underlying pathology causing
Hiccups.
Hiccups = caused by Respiratory
Reflex..from Prenic & Vagus Nerves
& Thoracic Sympathetic Chain.
Hiccups lasting only hours = benign
& Self-Limitedmaybe Gastric
Distention.
Short activing Inhaled Beta-Agonist
as needed
African American or White
Femaleshas workup for
Pruritus. Labs show Hematocrit
55.0% (N 36-40) and Hb 18.5g/dL
(N 12-16). Which Additional
Findings would help establish
Diagnosis of Polycythemia Vera?
*P. Vera pt can present with
GOUT & elevated Uric Acid Level
(neither is a criteria for diagnosis)
ENT Qs
Peritonsillar Abscess findings:
RANDOM:
A: Platelet Count >400,000/mm3 Should be expected in
patients with:
Suspect Polycythemia Vera in *Portal Vein Thrombosis
*Hb >16g/dL or Hct >47% in *Splenomegaly
African-Americans or White *With or without
Females Thrombocytosis &
Leukocytosis
White Males
*Hb >18g/DL, and Hct> 52%. Major Criteria:
*Increased RBC MASS
*Normal O2 Saturation
*SPLENOMEGALY
Minor Criteria
*Elevated B12
*Elevated Leukocyte Alkaline
Phosphatase LAP
*Platelet >400,000/mm3
1. Sore Throat Key:
2. Fever Peritonsillar Abscess is
3. Difficulty OPENING mouth. RARELY found in Pts who
(Trismus = universally present) don't have at least 3-day
History of progressive sore
(Voice Changes, Otalgia, throat.
Odynophagia = may/may not be
present)
*Otalgia -ear pain common
w/Peritonisillar Abscess, Otitis
Media, others)
Hospice Any TERMINAL patient with life
expectancy <6months is eligible

Medicare require pt to seek only

PALLIATIVE treatment (not curative)
(= relieving pain or alleviating a
problem without dealing with the
underlying cause.)

To determine if CHILD is 1. Prolonged Capillary Refill Time

DEHYDRATED: (Slow)
2. Abnormal Skin Turgor
3. Abnormal Respiratory Pattern

*Skin Recoil time increases

LINEARLY with the INCREASED
DEHYDRATION
Dehydration Recoil TIME
TREATMENTS:
Hx: Vacation/Long Distance
Travel. Swollen lower extremity. Rx:
Homan sign positive. US show Enoxaparin (Lovenox) 1mg/kg
noncompressible vein in
popliteal fossa. What's true:
Q: COPD-increasing Dyspnea.
No JVD. Decreased breath
sounds, scattered rhonchi, Heart
sounds distant. +1 lower leg
edema. Cardiomegaly, not
pleural effusion. BNP (B-
Natriuretic Peptide) is 850
(N<100). Which is Initial
Management?
Morphine Tolerance = Pt
becomes tolerant (no longer
effectiveneeds higher dose)
Pseudoaddiction = Inadequate
narcotic dosing that mimics
addiction bc of unrelieved pain
Physical Dependence = Seen
with abrupt Narcotic
Withdrawal
Head Lice Treatment:
(DVT deep vein thrombosis)
Subcutaneous BID
= LMWH Low Molec. Weight
Heparin.
INR to maintain: 2.0-3.0
for 3-6months.
2.5-3.5 (if Pt has Mechanical
Heart Valves)
Rx: Start LOOP Diuretic
Furosemide (Lasix) 40mg IV
(BNP senses Left Ventricle
Function. - End-Diastole-
Pressure-correlates to Dyspnea
& CHF.)
BNP <100 (Means Dyspnea is
NOT due to CHF)
BNP >400 (Means CHF is 95%
likely)
BNP 100-400 (=need further
investigate)
First-Lines
1. Permethrin
2. Malathion (triple action with
Isopropyl Alcohol & Terpineol)
Drugs Inhibits Platelet Function Aspirin = interferes with platelet
for the LIFE of the Platelet? aggregation for the Life of the
Platelet.
(How: Permanently Acetylating
the Platelet enzyme
Cyclooxygenase = Inhibits PG
synthesis.)
CARDIO Qs
Pregnant F. BP 140/100. Dx: Preeclampsia Goal:
UA 2+protein, 2+pitting Control Symptoms & Deliver
edema legs. Next 1. Admit Pt to hospital infant
Management step? 2. Treat w/Parenteral
Magnesium Sulfate
3. Plan Prompt DELIVERY of
Baby(vagina or cesarean section)

Sx: Epigastric Pain & Headache =

means her Preeclampsia is
SEVERE
*Indicates advanced process &
convulsions will happen.

Breastfeeding a full-term OK to breastfeed if mom has:

healthy infant is *Hep B, C
contraindicated when *Smokes (should stop)
mom has: Herpes *CMV (unless resent onset or
Simplex Virus Lesions on infant is LOW birthweight)
Breast
Mom with Herpes Simplex
Lesion on breast = no breastfeed
to infant of INFECTED BREAST.
*Mom TB
*Mom use Radioactive Isotopes
*Mom uses Chemotherapy
*Mom Use Recreation drugs

ENDO Qs
Hirsutism Tx: *Spironolactone (Aldactone)
34yoF History Bilateral
Tubal Ligation consults bc *Antiandrogen (Spironolactone),
Excessive Body & Facial along with Oral Contraceptives -
Hair. No other signs of for Hirsutism in Premenopause
Virilization & Regular Women.
Menses. Which is
Treatment for her *Prednisone = minimal helpful in
Hirsutism? reducing hirsutismby
suppresses Adrenal Androgens.
Has AE.
*Leuprolide = Expensive + AE
*Metformin = Tx: PCOS

25yoF concered about *Spironolactone During LUTEAL

recurrent Psychological & PHASE
Physical Symptoms that = (in Randomized, Controlled
occur during LUTEAL Trials found that LUTEAL Phase-
Phase of her Menstrual Spironolactone IMPROVED
Cycle & Resolve by the psychological/physical symptoms
end of Menstruation. She of Premenstrual Sd over 2-6
wants to Manage the Sx, months.
but doesn't want
additional Estrogen or
Progesterone. Which
Management strategies?
CARDIO Qs
Still's Murmur = Systole murmur.
Heard @lower precordium - low-short
tonedoes not radiate to axilla or
back. Decrease with inspiration
(Worsens with Inspiration or Diastole)
YOU NEED TO KNOW/LEARN
Physiologic Peripheral Pulmonic Stenosis Mitral Stenosis =
PPPS murmur = physio changes in Diastole murmur
newborns pulmonary vessels.
= Systole murmur Loudest in Axillae
bilaterally (usually disappears by 9mo age) Eisenmenger sd.: SOB,
Cyanosis, Organomegaly
(seen from Hx & Exam)

GI Qs
36hr old male - Jaundice extending to Continue Breastfeeding, Evaluate Risk
Abdomen. Is breastfeeding well. Next Factors, Initiate PHOTOTHERAPY if at risk
Step Management?
Dx: Hyperbilirubinemia newborn

MSK Qs
Teen. Lower Thigh Pain. Felt when Slipped Capital Femoral Epiphysis
jumping while play basketball, and
walking. Can bear full weight without *Classic Cx: Teen Male, Recent Growth
limp. Internal rotation of hip is limited Spurt. Pain with ACTIVITY - MC Sx.
on Right. Diagnosis?
Vs (nighttime pain = Malignancy)

Key: Limited Internal Rotation of Hip - esp

with hip in 90degree flexion.

Meralgia Paresthetica = Pain in Thigh Legg-Calve-Perthes disease (Avascular or

due Entraped Lateral Femoral Aseptic Necrosis @ Femoral Head)
Cutaneous Nerve (tight clothing) = likely in ages 4-8yo

Juvenile Rheumatoid Arthritis - associated

with other Sx: Stiffness, Fever, Pain in a least
one OTHER Joint. (Pain not necessarily with
activity)

Vaccines
Varicella Vaccine All Kids with normal immune status
2 Doses of Varicella Vaccine (not for immunocompromised kids)
recommended for:
Infants & Children, Adolescents - 400 IU (of Vitamin D)
Daily Vitamin D intake should be:
(New evidence supports a potential role for
vitamin D in maintaining innate immunity
and preventing diseases such as diabetes
mellitus and cancer)
Patient-Based Systems Qs
Advance Provision of Drugs &
Instructions for Emergency
Contraception to Sex active
women. Advance provision of
Emergency Contraception
Population-Based Care
Recommended for Routine
Prenatal Care?
A: Decreases time from
unprotected sex to use of
Emergency Contraception
Advance Provision benefits bc it
Increases spead & frequency of
EC use
A: HIV Screening
*Recommended as part of
Prenatal care = Routine
*Cystic Fibrosis Carrier Testing -
Recommended, but NOT
ROUTINE Testing
*Hep C & Parvovirus Antibodies
= NOT Routine Prenatal
Screening
Psychiatric - Behavioral
Sleep problems in children
most likely to occur during
Second half of night?
34yo M. Hx & findings of
DSM-IV for Bipolar disorder.
Which Treatment Options
most affective for Long-term
management?
A: NIGHTMARES
Nightmares occur in second half of
night - when REM-rapid eye
movement most prominent.
Parasomnias: Sleepwalking, Sleep
Terrors, confusional arousal =
disorders of arousal from NON-
REM (NREM) sleep - More
Common in CHILDREN bc kids
spend more time in deep NREM
sleep. These occur within 1-2 hrs
of sleep onset
A: Lithium - DOC Neuroleptic(Antipsychotic) drugs =
effective in ACUTE MANIA
ECT: Electroconvulsive Therapy - (not for long term use-AE)
Tx: Severe Depression &/or Mania
Bipolar disorder (Reserved for pt Bipolar-DEPRESSION
who can't wait for mood-stabilizing =Rx: TCA, SSRI, MAO-I (but if
drugs to take effect) long-term use = get Episodes of
MANIA)
BIPOLAR
Rx: Lithium DOC Anticonvulsions: Carbamazepine,
Valproic Acid, Benzos.combo
w/Lithiumin pt w/Episodes of
Mania and/or Depression.
Mom of 3yo M, concerned he
doesn't like being held,
doesn't interacti with other
kids, rarely smiles. Which
feature most helpful to
distinguish Asperger's from
Autism?
A: Normal Language Development
Both Asperger & Autism = Kids
have difficulties with Social
Interactions
(More severe in AUTISM)
AUTISM: Serious Communication
Skills- SPEECH/CANNOT Carry
Conversation
Both have
*Repetitive Motor Mannerisms
*Restricted Interests
*Preoccupation with parts of
Objects.

ASPERGER: CAN
Communicate/SPEECH OK.

Independent Function prognosis in

ASPERGER better than Autism

Case: A: Methylphenidate (Ritalin) 4. Pt with Anhedonia, Persistent

85yo M w-Terminal Dysphoria, Disturbed Self-Image,
Pancreatic Cancer expected Goal: Hopelessness, Poor Sense of Self-
to survive for another 2 Preparatory Grief vs. Depression in Worth, Rumination about Death
weeks. His pain is controlled Dying Patient & Suicide, or active desire for
with morphine. He now early death = DEPRESSION (is
developed a disturbed self- 1. Treat unresolved Physical problem)
image, hopelessness, Symptoms if present.
anhedonia, told family 2. If Pt stays in Distress - then
members that he has thought Evaulate MOOD.
about suicide. Psychomotor
retardation is also noted. 3. If Pt Waxes & Wanes with Time
Daughter feels he is & if Self-Esteem is Normal = likely
Depressed. Son feels he is Preparatory Grief.
more in Grieving Process. Pt may have Fleeting Thoughts of
Which is Most Appropriate for Suicide & Likely Express worry
Managing his problem? about separation from loved ones
= Responds to COUNSELING

++++++++++++++++++
Patients who expected to live only
a few days...use Psychostimulants:
METHYLPHENIDATE

If pt expected to survive longer =

SSRI
Case: COPD Recognition by the patient that the
Consistent with Obsessive- Obsessions or Compulsions are
Compulsive Disorder in Excessive or Unreasonable
Adults:
DSM-IV - Pt at some point
RECOGNIZES the
obsessions/compulsions are
excessive or unreasonable.
Also Pt experiences DISTRESS bc of
the impulses.

Which of the PATIENTS should Look at AGE
be advised to take ASPIRIN,
81mg daily, for Primary Men 45-79yo - ASPIRIN
Prevention of Stroke? (benefit from reduce MI>> GI
hemorrhage risk)
72yo female with no chronic
medical conditions Women 55-79yo - ASPIRIN
Benefit of Reducing Ischemic
Strokes >>outweighs harm of GI
Hemorrhage
F <55yo = Against Aspirin use for
Stroke Prevention
M<45yo = Against Aspirin use for
MI prevention
ASPIRIN reduces risk of MI in Men,
Ischemic Stroke in Female

current insufficient evidence to

assess benefits/harms of ASPIRIN
for CVS prevention in M/F 80yo+

Depression in Elderly, Insomnia: 1. Mirtazapine (Remeron)

75yoMloss interested in usual
activites. Loss weight. Can't sleep. (Trazodone for Insomnia, but NOT
Meds for his depression? primary antidepressant bc causes
SEDATION & Orthostatic
Hypotension @therapeutic doses).

(Bupropion (Wellbutrin) = will

aggrevate his Insomnia.)
TCA -Amitriptyline,Nortriptyline
(Pamelor) = can work but not 1st
line bc AE & Cardiotoxic

Mirtazapine: SNRI...Apeptite &

Weight Gain. Good for Pt with
Insomnia & Weight loss

TREATMENTS
Serotonin Syndrome: Dextromethorphan
= commonly in Cough & Cold
Pt taking Fluoxetine (Prozac) Meds. Associated w/Serotonin Sd
40mg BID develops Shivering,
tremors, diarrhea after taking SSRI: Fluoxetineassociated
an OTC cough & cold w/Serotonin Sd.
medication. On exam: Pupils
dilated, HR 110bpm. Which
med combos with Fluoxetine
caused sx?
Malaria:
Treat MRSA:
Rash.
3yo toilet-trained F. Mom
noticed Red-Rash on Perineum
for last 5 days. Rash is pruritic,
spreading. Nystatin cream used
but no improvement.
Examination shows beef red
rash surrounding the vulva &
anus. Etiological Agent?
Clostridium Difficile is NOT
KILLED by alcohol based hand
disinfectants.
Bordatella Pertussis. Why use
antibiotics?
Malaria clues: Smear:
*Recent TRAVEL (missionary trip to Normochromic,
Asia) Normocytic Anemia
*Delerium with Plasmodium
*unarousable COMA following Falciparum
general Convulsion, Fever Trophozoites &
*Lack of Focal neurologic signs in Schizonts involves RBC
presence of a Diffuse, Symmetric = Cerebral Malaria
Encephalopathy.
Rx: IV Quinidine
"Urine Dark red&positive for Hb Gluconate
Anemia)
*Clindamycin
*Doxycycline
*Minocycline
*Trimethoprim/Sulfamethoxazole
A: Group A Streptococus Pyogenes
GAS at Perineum similar to GAS
Pharyngitis. (How: Auto-
inoculations from mouth-hand-to
perineum. Or by GI tract)
Pt 1 to 11yo.
Sx: Itching, Beefy-Redness around
ANUS and/or Vulva. Will not clear
with meds used for Candida
infections
Staph Aureus, Pseudomonas,
Klebsiella - can be killed by Alcohol
products
To REDUCE Risk of Transmission to
others.
*Azithromycin 3-5days
*Clarithromycin for 7days.