# Flashcards
<60 Hr and hemodynamic instability
>100 HR and unstable
Pacing
Sync cardioversion
Management of vtach
Stable - amio
Unstable - scv
No pulse- unsync
Management of afib
New (<48hours or unstable - scv
Others - anticoag, bb and ccb (verapamil and diltiazem
Management of wpw
Acute - procainamids
Long term- catheter ablation
Unstable - scv
Management of heart blocks
1st and 2nd degree type 1 nothing
2nd degree type 2 - pace
TCA toxicity
- pathophysiology
- ekg changes
- treatment
Blocks na
Long qrs
NAHCO3
What electrolyte imbalances causes long qt
Low ca k mg
Management of Hyperkalemia
(+EKG changes
Calcium gluconate
Long qrs
Hypothermia ekg changes
J wave or Osborne wave
How does smoking affect ekg (+treatment)
Multi focal atrial tachycardium- >=3 different looking waves
Tx: veeapamil, diltiazem
Causes of ATN
Causes of AIN
Aminoglycosides, heavy metals. (Lead) , rhabdo , ethylene glycol , radioconstrast dye, irate ( tumor lysis syndrome)
Ain- NSAIDs and antibiotics (penicillin ) diuretics
Differentiate lichen sclerosis from lichen simplex chronicus (+ vulva cancer
Sclerosis - fibrosis and thinning of the epidermis of the vulva of a post menopausal women; vulva- paper thin; ** increased risk of vulvar squamous carcinoma
Vulva cancer - HPV related or non HOV related ; HPV: 40s, non HPV: May be due to lichen sclerosis in someone in 70s
Chronicus - hyperplasia of the vulvar epithelium due to chronic scratching creating leathery thick vulva skin
Vaginal carcinoma
- adeno or squamous
- risk factor
Squamous lead from VAIN dysplasia due to HPV
DES daughters at risk for clear cell adenocarcinoma
DES MOMS and daughters at risk of
Moms- breast cancer
Daygters - adenosis—» clear cell adenocarcinoma of vagina; abnormality of uterus and fallopian tubes therefore increasing miscarriages
Positive histochemical staining for rhabdomyosarcoma/ sarcoma botryoides
Desmin and myogenin
Cervical cancer
- risk factor
- squamous or adenocarcinoma
- age
- presentation
- MCCOD
HPV related in both squamous and adeno
- vaginal bleeding especially postcoital bleeding and vaginal discharge in 40-50
- MCCOD- invades the bladder and blocks the ureter leading to hydronephrosis and postre al failure (obstructive nephropathy
Acute vs chronic endometritis
- pathophysiology and presentations
Acute- bacterial infection of the endometrium due to retained POC; fever, AUB, pelvic pain
Chronic - inflammation due to PID, IUD retained POC , Tb ; same symptoms; inc plasma which is abnormal and lymphocytes which are normally found
What medication predisposed to endometrial polyps
Tamoxifen
Endometriosis
- presentation
- MC affected organ
- complication
Dysmenorrhea, pelvic pain , uterine ligament affected pelvic pain , Douglas affected (pain with defecation, bladder will afffected ( dysuria) bowel serosa (abdominal pain and adhesions, fallopian tuve (ectopic bc of scarring
- most common : ovaries (increased risk of endometriod ovarian cancer )
- endometrial Endometriod cancer
Endometrial carcinoma
- presentation (+age)
Endometriod (arising form endometrial hyperplasia; 40s; Looks like normal endometrial )
Sporadic (not formed from a dysplasia ; serous papilloma which the papillary can become calcified therefore psamomma bodies; 70s
Differentiate fibroids from Leimyosarcoma
Fibroids - white whirled multiple in reproductive age
Sarcoma - single /hemorrhagic / necrotic center in post menopausal; fibroids don’t increase the risk of them
Female surface epithelial tumors
- presentation (+age)
- metastasis where
- tumor marker
Most common ovaries tumors
- benign (30-40); malignant 60-70
- types : serous/ mutinous cystadenoma, serous/ mucinous cyst adenocarcinoma (malig so older ); benign Endometriod (associated with endometriosis and endometrial Endometriod cancer) and malignant brenner bladder like epithelium
Late onset of symptoms - pain and fullness , urinary frequency increase
Likes. To spread to the omentum
Ca125
Brca 1 increase risk of
Breast cancer , serous carcinoma of ovary and fallopian (prophylatically salpingo oophorectomy)
Female germ cell tumor
- presentation
** 15-30 yo reproductive age **
Teratoma (subset is struma ovarii which is primarily thyroid tissue ) - benign but can be malignant if has immature tissue (neural or has a skin with squamous cancer - most common
Dysgerminoma **most commo malignant **; LDH
Endodermal sinus ** most common malignant in children **; afpSchiller Duvall bodies which looks glomerular
Chorioxarcinoma - malignant proliferation. Of trophoblast and not villi; loves to go to blood like placenta does; Bhcg
Female sex stromal tumor
Granulosa - theca - **malignant **; estrogen- kid (precocious), reproductive age (menorrhagia or metorrhagia; postmeno (endometrial hyperplasia with uterine bleeding
Serotoli- leydig -**androgens ** so virilization and hirsutism; reinke crystals
Fibroma- benign tumor of fibroblast ; presents as meiggs syndrome - ascites, pleural effusion
Metastatic tumor with metas to bilateral ovaries -
Intestinal gastric adenocarcinoma (krunkenberg) lobular breast cancer and colon cancer
Choriocarcinoma can arise from
Normal pregnancy , mole, spontaneous abortion, spontaneous germ cell tumor (responds well to chemo)
Complication of lymphogranuloma venereum
Heals with fibrosis which can affect perianally therefore rectal stricture
-chlamydia L1-l3
Complications of orchiditis
Infertility , testicular atrophy, increased risk of germinal cell carcinoma (seminoma)
Causes of orchitis
Mumps- teen
Chlam/ gnorrhea 1 young adult (increased risk of sterility
Pseudomonas or ecoli- old
Autoimmune or Hutus
Variocele is associated with
Left sided RCC (if it blocks the renal vein , the left spermatic vein which drains into it is affected
Male germ cell tumors
- presentation
- risk factors
- diagnosis
RF: cryptoorchidism, klinefelter
**ALL are malignant **; don’t biopsy bc can seed
Dysgerminoma (seminoma ) - most common;** bhcg**; responds well to
Treatment
Embryonal - hemorrhagic with necrosis , glands maybe; chemotherapy can change it to mature ; spreads early to blood ; **afp or bhcg **
Yolk sac - _**most common in kids **; afp; Schiller
Chorio- bhcg so hyperthyroidism and gynecomastia possibly because alpha subunit of HCg can bind Lh fsh and tsh; spreads to blood like placenta
Teratoma- malignant unlike in females ; afp or bhcg
Male sex cord
Mainly benign
- think leydig- precocious puberty or gynecomastia (adult ) ; reinke crystals
Testicular tumor in older male
- presentation
Lymphoma
- >60 and is bilateral ; similar to diffuse large B cell lymphoma
Acute vs chronic prostatis
-presentation
Acute - acute inflammation due to bacteria such as gonorrhea or chlamydia in young or pseudomonas/ ecoli in old ——-fever/chills, dysuria, tender boggy prostate on DRE; prostatic secretions show wbc and cx reveals bacteria
Chronic - chronic inflammation —-dysuria with pelvic or low back pain ; prostatic secretions show wbc and cx are negative
BPH vs prostate cancer
- location
- PSA
- complications
- treatment
BPH- hyperplasia of prostate glands and stroma periurethral zone therefore urethra can become obstructed leading to hydronephrosis , hypertrophy of bladder and infection; urinary symptoms
- since hyperplasia of glands which produce psa ; psa is slightly elevated (5-10 compared to 0-4 )
- Tx: alpha 1 antagonist ( terazosin) good if BP is high , tamsulosin alpha1 a in nórmotensive patients; long term is 5 alpha reductase bc takes months to become effective
Cancer - aligning proliferation of glands; involves peripheral posterior region of the prostate therefore no urinary symptoms until later ; PSA >10 increase bounded PSA ; Gleason based on architecture and not atypia
Acute intermittent porphyria
- MOI
- pathophysiology
- presentation
- treatment
Porphobilinogen deaminase deficiency (AD)
Neuropsych symptoms, abdominal pain and red urine
Tx: ALAS inhibitor (IV glucose , IV heme , IV hematoma)
porphyria cutanea tarda
- MOI
- pathophysiology
- presentation
- treatment
Uroporphyringen decarvoxylase deficiency (sporadic)
- :skin issues, hyperhidrosis (sweating) and red urine
- Tx: phlebotomy and test for Hep C
Tumor marker for ovarian cancer
Ca- 125
Contraindicated for use of Hrt/estrogen containing contraceptives
H/o venous theomembolism disease- mi, pe, h/ o of breast cancer, hepatic adenoma, h/o migraine with aura, female whose 35 and older who smokes , severe HTN
Contraindications of use of mirena
History of breast cancer
Sti<6 months
Candiadiasis management
Oral azole
Management of urge incontinence
Muscarinic antag - oxybutinin, fenacin (darfenacin, solifenacin) tolterodine, trospium
B3 agonist - Mirabegron
Management of overflow incontinence
Muscarinic agonist - bethanechol, carbachol
Acetylcholisterase inhibitor1 neostimine
If symptomatic (bladder distended and tender- Catherization
Management of stress incontinence
Kegels (midurethral sling is kegels doesn’t work)
Management of POP
Kegels and pessaries
