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CanadaQbank Questions

Foreign Body ingestion sx of esophageal obstruction, MCC is coin, observe up to


24 hrs. If single coin, with no sx use foley catheter or bougienage technique. If
longer than 24 hrs use endoscopy removal.
Clostridium gas gangrene due to clostridium perfringens. Medical emgerncy, due
to rapid myonecrosis and sepsis. Txt with abs, surgery/radical debriment, and
hyperbaric o2 (slows growth but should not delay surgical debriment)
HCTZ side effecs - hyperGLUC hyperglycemia, hyperlipids, hyperuricemia,
hypercalcemia. Increases excretion of h20 by inhibiting rabs of Na, Cl. Leads to
secondary loss of K+, and HCO3-. May cause metabolic alkalosis.
Assesment of fetal length: 1st trimester crown- rump. 2nd trimester biparietal
diameter.
Acute Mnt Sickness headache, plus anorexia, nausea, vomiting, insomnia,
dizziness, fatigue. Can then lead to cerebral edema. ataxia and alt consiocuness.
Give supplemental O2, descend 500-1000m. If not possible give dexamethasone
and/or acetazolamide to decrease sx.
C. Diff- stop antibiotic, dont start treatment until stool is posistive for toxins A and
B. Initally tx oral metronidazole. Avoid loperamide it can slow down transit times
and worsen toxin-mediated diarrhea
Pulmonary Embolism (PE) Tpa main treatment window up to 5 hours in
hemostable patient. If untable first give IV fluids 0.5 1 L, if that doesnt work to
stabilize then give vasopressor like Noreepi.
PID most asymptomatic common sx: fever, lower ab pain, cervical/vaginal
discharge. Uncommon n/v, dysuria, aub. Chronic constant pelvic pain,
dyspareunia, palpable mass.
Back pain- best treatments for idiopathic nsaids, tramadol, acetaminophen,
multidisciplaniary rehab, acupuncture.
Hep B preg- HBIG should be admin as soon as possible to patients with known
exposure to hep B. Hep B vaccine can be used in pregnancy at any time since its
killed. So when exposed give both vaccine and hbig.
Pap smear - AGUS nuclear atypia but lack features of adenocarcinoma. AGUST
occurs in 20 75% of all smears. All women with AGUS should have a colposcopy. If
older than 35 colposcopy plus endocervical sampling. Repeat pap at 6 and 12
months for atypical squamuous cells of undet significance or low grade squamous
lesions. HPV testing and follow up papsmear is used in squamous cells of
undetermined significance. Loop electrosurgical excision and cold knife conisation
of cervix, used for definitive diagnosis but should not be done before colposcopy.
Only done after colposcopy depending on subclass of AGUS.
Ambiguous genitalia girls after age 16 with amenorrhea suspect something.
Phenotypically female with no uterus, breast and primary amenorrhea is mulerian

agenesis and androgen insensitivity. To confirm Dx check serum testosterone,


dihydrotest, and karyotype. If patient has male levels of testo then dx androgen
insensitivity and confirm with karyotype (46xy). If pt has normal female levels of
testo then Muleria agenesis, and confirmed with 46 xx.
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FSH level to check for amonrrhea when uterus present and pregnancy test
negative. High fsh means turner, low fsh means kallman confirm kallman
(hypogonadotropic hypogonadism, failure to start puberty, infertility, alt
sense or absent smell, GnRH neurons fail to migrate into hypothalamus)
with brain MRI

PCOS characterized by mild obesity, irregular menses, or amenorrhea + signs of


androgen excess (hirsutism, acne). Dx by pregnancy testing, hormone level
measurement (serum estradiol, prolactin, and TSH) and imaging to exclude tumor.
Dx confirmed by U/s showing > 10 follicles per ovary (string of pearls). If follicles
present measure testosterone and DHEAS. LF/FSH ratio is 1:1 in premenopause but
in PCOS its > 2:1.
Vaginal discharge Trichomoniasis: yellow-green, bad smell discharge, dysuria,
tender vulva, petechial on vagina and cervix
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Candidiasis: white cottage cheese, itchy, swollen, burning, dysuria,


dyspareunia.
BV grey, thin, diffuse discharge. Most asymptomatic, fishy odour,
absence of irritation.

Preeclampsia eleated bp, proteinuria after 20 weeks gest. Patient first needs 24
hour urine quantitative measurement for protein, bp monitor, and lab eval of hb,
hct, plate count, serum transaminase, Cr, albumin, LDH, uric acid. Definative tx is
delivery.
Anemia if mircocytic with normal RDW its a thalassemia. In hemorrhage RDW is
high with normal MCV. In b12 and folate high rdw and high mcv. In mixed iron def
and b12 high rdw and mcv can be high low or normal.
Placenta Previa common finding in 2nd trimester, but few carry to term. In absence
of bleeding repeat ultrasound in 3rd trimester. Decision regarding delivery shoud not
be made until ultrasound performed at 36 weeks. Digital exams no done on women
with placenta previa, might make bleeding worse. In patients with hx of c-section
who have previa at site of previous incision a color flow Doppler should be done to
evaluate for placenta accrete. MRI is helpful to confirm dx.
Post Op fever 5 Ws wind (pneumonia/atelectasis), water ( UTI), Wound
infections, walking ( can help reduce dvt and pe), wonder drugs especially
anesthesia. Occur on post op days 1,3,5,7, and anytime respectively. Wind at 1,
water at 3 etc..
Post meningitis MCC of meningitis in 5 year olds include Pneumococcus
pneumonia, meningococcal men, H influenza. bacterial menigntis especially at risk
if not properly immunized. Sensorineural hearing loss is found in 20-30% of H.
influenza meningitis survivors. Audiologic assesments in pateints 4 to 6 weeks after

antibiotic tx clears infection. Other complications: hydrocephalus, cortical blindness,


epilepsy, beh changes, motor coordination, and intellectual disability.
10 year risk of coronary artery disease Framingham risk score age, smoking
status, SBP, total serum cholesterol, and HDL.
Rheumatic fever nonsuppurative, acute inflamm complication of GAStrep
infection. Causes arhtirtis, cariditis, subcute nodules, erythema marginatum,
chorea. Dx based on jones criteria, hx and exam, lab testing. Rh fever can be
prevented in strep pharyngitis if penicillin is given before 9 days after onset.
Myopathies initially test is cpk.
Otitis externa athletes, swimmers susceptible to skin infections. pH of external ear
is acidic. Water exposure increases pH leads to more bacteria growth. MC by p.
aeruginosa and s. aureus. Swimming pool folliculitis is due to p. aeruginosa.
Mastitis- MCC S.aurues. develops 1-4 weeks after delivery, infected area is red and
painful. Releases large numbers of bacteria in milk, may infect nursing child. Can
present similar to inflammatory breast cancer.
Antimicrobial prophylaxis recommended for patientsa t high to moderate risk of IE
before procedures (dental). Single dose shortly before (1h) is effective. If allergic to
penicillin give clindamycin or macrolides. For patients with prostprosthetict valves,
previous ie, CHD unrepaired, repaired with residual defects or completely repaired
during first 6 mo after surgery if prosthetic material or device used.
Conns overproduction of aldosterone leads to fluid retention, inc bp, weakness
and maybe paralysis. Leads to potassium excretion
Ulcerative colitis large intestine becomes inflamed and ulcerated, leads to flare
ups, bloddy diarrhea, ab cramps, fever. Narcotic antidiarrheal medications are not
indicated, since it decrease motility and makes toxic megacolon worse.
Cyclosporine is used in severe UC that is refractory to sterois. Azathioprine is used
in steroid dependent or resistance ases. Mesalazine is initial therapy for UC.
Volvulus bilious vomiting +/- ab distention, initial sign of intestinal obstruction in
new borns. Nasogastric tube should be placed immediately to decompress the
stomach. Ab films dilated bowel loops, air fluid levels suggest surgical obstruction.
Contrast dye may be needed.
Angina patient with previous MI and now unstable angina admit for cadiac
monitoring even without ekg changes. May progress to MI. May need therapy
adjustment inpatient. May need cardiac catheterization if sx cannot be controlled
with max medical therapy. Beta blocker max therapy when bpm is 55-60 resting.
HIV patient with latent TB give isoniazid for 9 months. Rifampin is not used in
patients with HIV because of increased rates of resistance and drug interactions
with antiretrovirals. Combination drug therapy is used to tx active tb.
CAP first do CXR to establish dx, complications. Sputum samples only good 50% of
time in cap, and only half of those have the pathogen. 2 sets of blood cultures

needed for hospitalized patients not for outpatient. Initial tx of CAP is empiric, and
macrolides and fluoroquinolones or doxy are used (not so much fluoroquinolones.)
Amoxi/clavulanate and b-lactams are alternatives.
Gastroenteritis pediatrics first dietary changes to rest gi tract and oral hydration.
Stool culture and sens after 7 days of diarrhea or if bloody stools. Parasite/ova if hx
of travel. No oral antidiarrheals, no antibiotics if its viral.
Pneumothorax if small and hemodynstable without parenchymal disease then it
will resolve spontaneously, breathing 100% o2 helps. Simple aspiration and defer
hospitalization in primary spontaneous if patient is stable. CT of lung in complicated
cases, or lung disease.
Postpartum Hemorrhage MCC is uterine atony. Less frequent include lacerations,
hematomas, and uterine rupture. These occur immediate after birth. Delayed
hemorrhage, occurring beyond the first 24 hrs is due to retained placental
fragments. Placenta accrete mcc of bleeding needing hysterectomy.
EKG changes due to occlusion circumflex occlusion changes in I and AVL, and
maybe V5,V6. LAD occlusion changes in V1 to V6. Right coronary occlusion changes
in II, III, AVF.
Remember to add K+ to IV fluid when treating DKA or hyperosmolar due to shift
of K+ from extracell back into the cells after insulin is given.
Bacterial vaginosis mcc of acute vaginitis, more than 50% of cases. Due to shift in
normal flora. Mixed vaginal flora is second mcc of discharge.
Labial adhesion of vagina in peds affects 3 mo to 6 year olds. Harmless resolves
once puberty starts. If they are severe or interfere with urination need tx. Tx
options: estrogen cream applied bid for 2-8 weeks. Side effects self limited.
Surgery is last resort. Antibiotic cream bust me applied to labial edges to stop them
from sticking together while they heal.
Sensitivity and specifity Sensitivity = a/(a+c) = dz&tst+ / all dz+. Spec = (neg,neg
/ (all with no dz).
Preeclampsia patiants with pre eclampsia require magnesium sulfate as soon as
dx is made, then deliver at 34 weeks or when deterioration of maternal or fetal
status or fetal lung maturity occurs. Always deliver if they have a seizure and severe
hypertension.
Genital wards hpv Imiquimod, podophyllin and podofilox are not recommended
during pregnancy. For tx during preg use cryotherapy with liquid nitrogen and not a
cryoprobe. Alternative is trichloroacetic acid
Sensitivity snout rule out measure of true positives. High sensitivity means if
you are negative you probably dont have the disease.
Specifity ability to correctly ID patients who do not have the disease. True negative
rate. Spin - rule in.

Thiazolidinedions like pioglitazione associated with fluid retention, bad in CHF.


Atrial flutter 300 bmp, atrial rhythm is regular, p waves flutter waves (sawtooth,
in II, III, AVF). Tx involves rate control with CCB, or b-blockers. Conversion of rate
with type 1 antiarrhythmic agent such as quinidine or procainamide.
Risk reduction ARR probability of a minus probability of b. i.e prob of survival
with txa and with placebob. NNT is average number of patients who need to be
treated to prevent one additional bad outcome (e.g. the number of patients that
need to be treated for one to benefit compared with a control in a clinical trial). It is
defined as the inverse of the absolute risk reduction. It was described in 1988.[1]
The ideal NNT is 1, where everyone improves with treatment and no one improves
with control. The higher the NNT, the less effective is the treatment. NNT best
scenario is 1.0 everyone gets cured with pill and no1 gets cured without it.
Prolonged Qt interval can be seen in hypocalcemia, hypokalemia,
hypomagnesemia. Also type 1A antiarrhythmics (quinidine, procainamide). Or
severe cns abnormalities like subarachonoid hemorrhage. Torsades the point is
associated with prolonged qt interval from these electrolyte disorders.
Pseudoparkinson Chlorpromazine used to tx pos sx of schizophrenia. As a side
effect can induce psuedoparkinson. Levodopa (dopa decarboxylase inhibitor
(COMTi)), bromocriptine (dopa agonist), pergolide (dopamine receptor agonist),
selegeline (MAO-b inhi) can all be used to treat parkinsons. Parkinson is due to
death of dopa generating cell sin substantia nigra.
Antidotes N-acetylcystine for acetaminophen. Naloxone for reversal of opoid OD.
Flumazenil for BZDs. Glucagon for CCB, B-blockers, insulin. Ca2+gluconate for
magnesium sulfate toxicity.
Atopic dermatitis after topical steroids and other conventional remedies dont
work use tacrolimus immunomodulator.
Smoking withdrawal may take 8-12 weeks to get accustomed to new life. Sx
include irritability, insomnia, impaired concentration, disturbed sleep/drowsy,
headaches, increased app ->weight gain.
Drug induced interstitial nephritis sudden impairment of renal function due to
immune mediate rxn to drug. Sn/Sx arthralgias, macular exanthemas, fever, mild
proteinuria, sterile pyuria, eosinophilia.
Meperidine demorol can accumulate in elderly and cause seizures. Also watch
out for serotonin syndrome with meperedine with SSRIs or MAOis.
Normal pressure hydrocephalus triad wet, wobbly, wacky urinary incont, gait
ataxia, mental disturbance/dementia. Caused by abnormal accumulation of csf in
ventricular system. Assessed by absence of papilledema on ophthalmoscopy exam.
Gold std dx is via removal of csf large volume lumbar puncture.
Bupropion side effect seizures, increased in eating disorders. Never give
bupropion if they have seizure disorder, stroke, brain tumor, closed hear injury or
eating disorder or if they use sedatives/alcohol.

PE In patients with high clinical probability of PE do CTa. Normal D-dimer rules out
PE only in low or moderate clinical probability patients.
Oligohydramnios - Potter syndrome typical appearance due to dramatically
decreased amniotic fluid or absent fluid, secondary to renal agenesis. Causes fetus
to become compressed in uterus. Leads to potter facies and lower extreme
deformaties like clubbed foot / bowing of legs.
Neuroleptic malignant syndrome Hypermetabolic rxn to antipsychotics especially
dopamine receptor antagonists (thiothixene). Occurs early in tx after an inc in
dosage. Signs/sx lead pipe rigidity, hyperpyrexia, tachycardia, htn, ams, confusion,
and diaphoresis. Can lead to MI, aspiration, resp failure, acidosis, rhabdo.
Weight changes with psych drugs - Bupropion antidepressant least likely to cause
weight gain, may induce some weight loss. Among SSRIs paroxetine will cause most
weight gain and fluoxetine least. Mirtazapine causes more weight gain than SSRIs.
Heart failure vasopressin worsens heart failure by causing vasoconstriction of a.
and v., causes fluid retention and worse hyponatremia.
Ginseng can cause hypoglycemia and has anticoag properties must be stopped
before surgery.
OCD, ADHD, Tourettes in children all 3 commonly seen together. If one found
screen for the other 2 .
Shaken baby syndrome retinal hemorrhages, broken bones/ribs, mioght be
sleeping well/calm due to brain injury/swelling, sometimes from subdural
hemorrhages.
Aortic regurg diastolic decrescendo murmur best heart in left 3 rd intercoastal. Also
wide pulse pressure in valvuar lesions.
Spontaneous bacterial peritonitis sbp PMN > 250 is diagnostic. Protein > 1g is
evidence against sbp.
Lead poisoning peripheral neuropathy may occur after chronic exposure seen as
extensor muscle weakenss with minimal sensory loss. First sign usually painless
wrist drop.
Meningococcal caused by n. meningitides. Sx include high fever, severe headache,
dyspnea, stiff neck/back, painful joins and vomiting. Tx with penicillin or ceftriaxone.
Spreads to close contact through saliva or nose/throat secretions. Close contacts
shold be given prophylaxis either rifampin or ceftriaxone.
Chlamydia infection MC reported std. maybe asypm or mucopurulent discharge
endocervical, urethral syndrome (like uti, with abacterial pyuria), pelvic pain,
dyspareunia, post coital bleeding. Cannot be ID on saline wet mount or gram stain.
NAAT Is best. Doxy is drug of choice (100 mg PO BID 7 days). Can also do
azithromycin 1g PO single dose.

Gonorrhea negative intracellular diplococcic. Tx with single dose 125 mg IM


ceftriaxone/cefixime, cipro.
Malignant hyperthermia inherited myopathy abnormal skeletal muscle
sarcoplasmic reticulum, causes increase in intracellular Ca2+ levels leads to
sustained muscular contraction and hypermetabolic state. Triggered by inhalational
anesthetics (halothane) or by succinylcholine.
Conductive hearing loss is due to reduced conduction/transmission of vibrations to
inner ear. Usually due to problem with outer or middle ear. Usually from blockage by
earwax, stiffening of ossicles or from middle ear infection or surgery and fluid
accumulation. IE. Cholesteatoma (noncancerous tumorin middle ear caused by
infection), OM, and OM with effusion, obstruction, and perforated eardrum.
Restless leg syndrome neurologic movement disorder of the limbs sx are relieved
by movement. MC its primary. Secondary can develop from different causes- mcc is
Iron def and peripheraly neuropathy. Pregnancy is another cause.
S1Q3T3 think PE. McGinn-White sign, indicates acute Right heart strain. Only seen
in 20% of PEs, but can also be in other causes of acute cor pulmonale such as
pneumothorax and bronchospasm. If you think its a PE, do V/Q scan or CTA.
Osteoporosis screening for all men and women start at 65.
Slipped capital femoral epiphysis seen in young kids during growth spurtassocitated with physical activity, obesity and more in males. Femoral head is
displaced posteriorly thorugh the growth plate. Pain on physical activity most
ommonly in upper thigh, or referred lower thigh/knee pain. Hallmark is limited
internal rotation of hip especially when hip is flexed to 90 degres.
Indication of primary closure of mammalian bite woudns if on face or scalp, within
6 hours, simple and appropriate for single layer closure, no devitalized tissue. Lack
of underyling fracture, and no systemic immunocompromising conditions.
Acute otitis media MCC in children is s.pneumonia. Risk factors for aom include
bottle feeding, passive smoking, prematurity, down syndrome and hx of recurrent
OM. H.influenza is common cause of AOM if not vaccinated. P.aeruginosa is common
in chornic suppurative otitis especially in kids with CF. S.pyovenes is #4 most
common cause of AOM.
Lithium excreted via kidney, no need to monitor liver. Need EKG because it can
cause flattening or T wave inversion, or sinus node dysfx. Elevation of wbc is
possible on lithium. Hypothyroid is seen 2ndaary to lithium. Renal fx must be
checked every 3 months.
Sarcoidosis do a slit limp exam to rule out uveitis, pulm function testing, serum
calcium level, and ekg. Also check serum angiotensin converting enzyme and
anergy skin testing.
Rosacea skin condition in women 30-60 y.o. Central facial erythema and
telangiectasis may progress to sterile pustules. Presents with central facial
erythema and flushing. Can be triggered by food, environment, chemical, emotional

triggers. Ocular problems occur in half of patients. Mgmt includes avoid factors and
use sunscreen. Oral metronidazole, doxy and tetracycline can also be used. Low
dose clonidine and beta blockers can be added to help with flushing.
HIV screening newborn recommended that pregnant women receive anti-retroviral
therapy and infants with positive screening should ge zidovudine asap. Early hiv
infection is if present w.in 48 hours after birth and associated with rapid progression
to sxtomatic AIDS. Preferred screening is HIV DNA PCR. Sensitivity and specifitiy is
highest and increase with time the highest being after 6 monmths. Test 48 hours
after birth, then after 1 month then again after another 4 months.
Drug Side effects psychiatry antipsychotic meds parkinsonism tremor,
increased muscle tone, bradykinesia or akinesia, postural instability, loss of
spontaneity, micrographia.
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Akathisia motor restlessness, urge to move, inability to sit still


Dystonia sustained contraction of muscles, twisting postures, neck and
arm most affected.
Tardive dyskinesia hyperkinesia, involutanary body movements, muscles
of face, mouth, tongue.

Death Rattle terminal respiratory secretions sound produced by someone near


death when fluids accumulate in upper chest. Anticholinergic medications like
glycopyrrolate can be used to dry secretions in terminally ill patients.
Hyperoxia tool to evaluate cyanotic neonate arterial blood taken with child
breathing room air and 100% o2. The change in PaO2 with the admin of oxygen if
paO2 is less than 150 with 100% suggests a cardiac lesion. Then if pao2 less than
50 on 100% means cardiac disorder, in which there is restricted pulmonary blood
flow or a separate venous arterial circulation, but if its 50 150 there is no
restriction of pulmonary blood flow, and theres complete mixing of O2 and deo2
blood.
Ovarian cysts Most ovarian cysts dx in early pregnancy are physiological cysts
corpus luteum cysts. Normal finding, corpus luteum supports the lining of the womb
and in the pregnancy itself. Does it by producing progesterone, once pregnancy is
past 1st trimester, the CL is not needed and resolves spontanousely. Most are
asymptomatic. If it ruptures, twists or bleeds into the middle of the cyst there wil be
lower ab pain on the same side as the cyst.
Parkinsons idiopathic, slowly progressive, degenerative. Resting tremor, muscular
rigidity, slow and decreased movement, mask like face expression, postural
instability. Dx is clinical. Tx is with levodopa + carbidopa. Resting tremor of the
hand is usually first sx; Pill rolling tremor. Dementia can occur. Hypokineisa and
impaired control of distal musculature causes micrographia.
Restless leg syndrome neuro disorder, irresistible urge to move ones body to stop
uncomfortable or odd sensations. Mgmt involves identyfing causes of sx. Tx is to
reduce sx and severity and night time awakenings. Stretching leg muscles can bring
temporary relief, exercising every day and avoiding heavy meals before bed help.

But cardio and weight training before bed time is bad. Iron and vitamin deficiency
can cause RLS, check all RLS patients for iron def. if cant manage sx with warm
baths, reducing stress, etc .. then use gapapentin or low dose pramipexole.
Drug induced esophagitis in elderly tetracyclines mc is doxy causes esophigits
decreased peristaltic clearance in old people can lead to pill retention and leads to
esophageal in jury due to prolonged contact. Aspirin and nsaids can also da mage
the esophagus. Others include KCl, quinidine, iron, alendronate.
Renal cyst simple renal cysts are found incidentally in older people, and in many
autopsies. No further evaluation needed if its a simple thin walled, homogenous,
fluid filled cyst. If its complex need renal CT with contrast. MRI is better to find
benign lesions and can be helpful if the CT results are not good enough.
Ophthalmology - Amaurosis fugax transient loss of vision inone or both eyes.
Patients present after it has resolved and neuro and opth exam is normal. Scotoma
is an area of depression vision in the visual field, surrounded by area of normal
vision (blind spot). Strabismus where visual axes of the eyes are not parallel and
the eyes appear to be looking in different directions. Esotropia cross eye a form
of strabismus. Nyctalopia night blindness, due to impaired function of specialized
cells in retina.
Fetal dev division of embryonic discs before day 4 di-di. Days 4-8 diamniotic,
monochorionic. Days 8-12 mo-mo. Division after day 12 conjoined.
Acardiac twins happens in monochorionic with delayed cardiac function in one
twin, with arterial anastomosis leading to reversed arterial perfusion and absence of
development of the heart tube TRAP twin reversed arterial perfusion. So the
heart of one twin does not develop.
Pheochromocytoma catecholamine secreting tumor of chromaffin cells in the
adrenals. Causes persistent or paroxysmal hypertension. The triad of sx is episodic
headache, diaphoresis, tachycardia. Dx is by measuring catecholamine products in
blood or urine. CT or MRI to localize tumors. Tx includes removal of tumor if
possible. Drug Tx for control of bp includes a-block, +/- b-block. Labs will show
hyperglycemia, hypercalcemia, erythrocytosis.
Menieres disease inner ear disorder that produces vertigo, fluctuating
sensorineural hearing loss, tinnitus. Sudden attacks of vertigo that last up to 24
hours, with n/v. no dx test. Treat vertigo and n/v with anticholinergics or bzds.
Vestibular system can be ablated with topical gentamicin or surgery in severe
cases. Thought to result from accumulation of excessive fluid in inner ear. Fluid
pressure stretches the mmembranes that divides the compartments of the inner
ear. As the membranes stretch, hearing decreases and tinnitus worsens. If they are
too stretched they will rupture leads to mixing of fluids (Na in one and K+ in the
other) and this mixture brings about the vertigo.
G6PD hemolytic anemia presents with decreased hb and increased retic count. For
g6pd recent treatment with tmp-smx, pyridium (both cause oxidative stress). Rapid

fluorescent blood spot test, the test detects the generation of nadph from nadp and
if it is positive (failes to fluoresce under uv light) then patient has g6pd.
Diabetes diagnosis sx of diabetes plus a casual glucose level of 11.1 ; fasting
plasma level of 7 ; or a 2 hour postprandial level of 11.1 after 75 gram glucose load
or hba1c >6.5%.
Risks for preterm delivery 3-4x more likely in a woman with prior preterm delivery.
Multiple gestation also makes it more likely. Known risk factors include 2,3 rd
trimester bleeding. Chronic conditions like DM, HTN. Being under or overweight,
gaining too little or too much. Cigg, alcohol, illicit drugs.
Diabetes treatments biguanides and thiazolidinediones are insulin sensitizers that
decrease hepatic glucose production andincrease insulin sensitivity. Sulfonylureas
and meglitinides stimulate pancreatic insulin secretion. DPP-4 inhibitors prevent
GLP-1 breakdown and slow the breakdown of some sugars. GLP-1 mimetics
stimulate insulin secretion, supress glucagon secretion, promote beta cell
production. Amylin analogs act with insulin to delay gastric emptying, inhibit
glucagon release.
Patietal lobe lesion parietal lobe has 2 areas sensation and perception and the
other is integrating sensory input with the visual system. Damage to the left parietal
lobe can lead to gerstmanns syndrome: right-left confusion, agraphia, acalculia.
Can produce disorders aphasia, and inability to perceive objects normally (agnosia).
Damage to the right parietal lobe leads to neglect of the body contralateral. Can
also cause difficulty making things (constructional apraxia), denial of deficits
(anosagnosia) and drawing ability.
Heat exhaustion and heat stroke evidence of CNS dysfx means heatstroke, even if
other sx are not severe. Heastroke is medical emerg. Heastroke is defined as temp
higher than 41.1 (106) associated with neuro dysfx. However, sometimes patient is
allowed to cooldown, measured temp might be lower than 41. Similar some pateints
may retain the ability to sweat in heatstroke.

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