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history to rule out “central vertigo”
- diplopia
- dysarthria
- paresthesia/ numbness
- ataxia gait/ imbalance
- focal weakness
What is the physical maneuver to confirm peripheral vertigo?
Dix-Hallpike maneuver
risk factors of AOM?
- daycare, nursery contact
- expose to second-handed smoking
- bottle-feeding/ shorter duration of breastfeeding, soother, pacifier
- crowded living condition
- any type of feeding in a supine/flat position
- enlarged tonsils + adenoids, anatomic anomaly (e.g. cleft palate
?? male, white ethinicity, family hx, first nation or Inuit
Indications of ENT referral for tympanostomy
- persistent effusion ( >3 months)
- (bilateral) hearing loss
- speech delay/ language problems
- recurrent episodes of AOM (> 3 episodes in 6 mo, > 4 episodes in 12 mo)
- atelectasis/ retraction of the tympanic membrane
&- cleft palate/ craniofacial malformations
diagnosis criteria of panic attack
4 of 13 - peak in 10 minutes
STUDENTS Fear the 3Cs S sweating T trembling U unsteadiness, dizziness D DEREALIZATION E excess HR, palpitation N nausea T tingling S SOB
Fear of death/going crazy
3Cs
choking
chest pain +/- agoraphobia
chills
DM microvasculopathy and macrovasculopathy
micro
- nephropathy
- retinopathy
- neuropathy
Macro-
- CVD
- CVA
- PAD
screening methods for DM microvascular diseases
- Urine test for albumin-to-creatinine ratio (ACR)
- neurological exam/ ankle reflex test/ monofilament testing/ vibration testing/ propioception testing
- optometrist/ ophthalmology referral for eye exam
- foot exam/ referral to podiatrist
lifestyle that can cause primary hypothalamic-pituitary dysfunction and subsequent anovulation
- excessive stress
- excessive exercise
- excessive dieting/ an eating disorder
What hormonal diseases/conditions could be responsible for anovulatory cycles?
- polycystic ovarian syndrome (PCOS)
- thyroid disorder
- Cushing’s syndrome/ congenital adrenal hyperplasia
- prolactinemia/ hyperprolactinemia
Clinical manifestations of cirrhosis
∙ Encephalopathy ∙ Xanthelasma ∙ Icterus ∙ Jaundice ∙ Fetor hapticus ∙ Spider angioma ∙ Gynecomastia ∙ Muscle wasting ∙ Bruising ∙ Testicular atrophy ∙ Ankle edema ∙ Palmar erythema ∙ Asterixis ∙ Dupuytren‘s contracture ∙ Leuconycia ∙ Clubbing
Ten adverse effects of SSRIs
CV
- prolonged QT interval
- hyponatremia
GI
- dyspepsia, nausea, loss of appetite
- gastrointestinal bleeding
- xerostomia
Neuro-psychi - suicidal thought - insomnia - seizure - somnolence - tremor - asthenia (lack of energy) - falls and fractures (elderly, first 6 weeks) GU - impotence
Serotonin syndrome - symptoms
Fever > 38.5
Confusion/ delirium
sustained clonus/ rigidity
rhabdomyolysis
hyperreflexia diaphoresis agitation/ restlessness inducible clonus side-to-side eye movements (ocular clonus)
nervousness insomnia tremor nausea/diarrhea dilated pupils
diagnosis of serotonin syndrome
[Hunter’s criteria ]
Requires one of the following features or groups of features:
- spontaneous clonus;
- inducible clonus with agitation or diaphoresis;
- ocular clonus with agitation or diaphoresis;
- tremor and hyperreflexia;
- hypertonia;
- temperature above 100.4°F (38°C) with ocular or inducible clonus
Management of serotonin syndrome
- withdrawal of the offending serotonergic drugs
- provision of supportive care
[ antidote ] - Cyproheptadine, a serotonin 2A antagonist, is usually recommended and is the most widely used antidote
- Benzodiazepines may be used for control of agitation and tremor
Five classes of medications for dyslipidemia
Statins Nicontinics (niacin) Fibrates (eg fenofibrate) Resins (eg cholestyramine) Ezitimibe (ezetrol)
Inclusion criteria of polymyalgia rheumatica
- Age > 50 y/o
- duration > 2 weeks (some guideline say 1 month)
- abrupt onset
- morning stiffness > 45min
- bilateral shoulder +/- pelvic girdle pain
- elevated ESR/CRP
Exclusion criteria of polymyalgia rheumatica
Malignancy infection Giant cell arteritis inflammatory or non-inflammatory conditions drug induced
what condition can combine with polymyalgia rheumatica
giant cell arteritis
treatment of polymyalgia rheumatica
prednisone 15-20mg daily while monitoring ESR
Treatment for scabies
Apply Permethrin 5 % cream from neck down to sole for 8-14 hours, repeat 7 days later if necessary
Lice treatment
Pyrethrins (>2mo) or Permethrin apply to dry air + scalp, let sit for 10 min, rinse with cool water and avoid body exposure, repeat in 7d
Epidemiology: Which parameters depend on disease prevalence?
Positive and negative predictive value (not specificity or sensitivity)
Panic attack symptoms and diagnosis criteria
4 out of 13 peak in 10 minutes
- STUDENTS Fear the 3Cs -
sweating tremor unsteadiness/ dizziness derealization excess HR, PALPITATION nausea tingling sob
Fear : death, going crazy
Choking
Chest pain
Chills
Four types of antidepressants
∙ Selective serotonin reuptake inhibitors
∙ Selective norepinephrine reuptake inhibitor
∙ Benzodiazepine
∙ Tricyclinic antidepressant
∙ Monoamine oxidase inhibitor
Neonate with jaundice, 10 questions to ask mother
∙ Complications during pregnancy ∙ Gestational diabetes ∙ Blood type (for ABO or Rh incompatibility) ∙ Breast feeding or formula ∙ Intake ∙ Birth trauma (cephalohematoma) ∙ Group B Strep status ∙ Infections ∙ Premature? ∙ Medications ∙ When jaundice started (before or after 24 hours)
Complications of phototherapy
∙ Dehydration ∙ Hyperthermia ∙ Erythematous rash ∙ Loose bowel movements ∙ Retinal degeneration
Non-infections complications of strep throat (GAS)
∙ Acute rheumatic fever
∙ acute glomerulonephritis
- pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)
(The disorders whose symptoms get worse include obsessive compulsive disorder (OCD) and tic disorders such as Tourette’s syndrome)
** Scarlet fever needs penicillin to treat
Treatment of strep throat
penicillin V or amoxicillin for 10 days
Noninfectious causes of macroscopic hematuria in a child
recurrent: IgA nephropathy, benign familial hematuria, Alport’s syndrome Acute poststreptococcal glomerulonephritis Systemic lupus erythematosus Henoch-Schonlein purpura Goodpasture’s disease
Acute pyelonephritis Acute interstitial nephritis Tuberculosis Hematologic (sickle cell disease, coagulopathies von Willebrand’s disease, renal vein thrombosis, thrombocytopenia)
Urinary tract Bacterial or viral (adenovirus) infection–related
Nephrolithiasis and hypercalciuria Structural anomalies, congenital anomalies, polycystic kidney disease Trauma Tumors Exercise Medications
Causes of asymptomatic isolated
microscopic hematuria in children
Common Undetermined Benign familial Idiopathic hypercalciuria IgA nephropathy Sickle cell trait or anemia Transplant
Less common Alport nephritis Post-infectious glomerulonephritis Trauma Exercise Nephrolithiasis Henoch-Schonlein purpura
clinical presentation of Hydatidiform mole (molar pregnancy)
classic signs of complete mole
- Vaginal bleeding
- Hyperemesis
- Hyperthyroidism
other symptoms:
Excessive uterine size
Hypertension of pregnancy
Most important risk factor of Hydatidiform Mole
mother’s age
clinical features of Bacterial Vaginosis
[most common cause of vaginal discharge, 50% asymptomatic]
- transparent/grey thin vaginal discharge
- fish odor
- NO vulva/ vaginal irritation
diagnostic test of bacterial vaginosis
Whiff test ++
saline wet mount shows >20% clue cells
treatment of bacterial vaginosis
Treat only symptomatic
Increase PROM during pregnancy, avoid vaginal route
Metronidazole 500mg BID for 7 days
OR metronidazole 0.75% cream 5g intravaginally for 5 d
pathogen of chicken pox
varicella zoster virus (VZV)
what are the complications of chickenpox
- secondary bacterial infection (most common): e.g. pneumonia, pharyngitis, AOM, gastroenteritis
- cerebral ataxia
- encephalitis
- fetal varicella syndrome (for pregnant women)
prevention/prophylaxis of chickenpox
For immunocompromised persons, pregnant women and exposed infants
- varicella-zoster immune globulin, which must be given within 96 hours of exposure to be effective
- A one-week course of high-dose acyclovir started early can prevent chickenpox
Generalized rash over trunk and limbs, along the Langer lines, 2 weeks after a herald patch on trunk
can associated with flu-like symptoms
the most likely diagnosis and ddx
Pityriasis rosea
DDx: secondary syphilis seborrheic dermatitis nummular eczema pityriasis lichenoides chronica tinea corporis viral exanthems lichen planus drug eruption
treatment of pityriasis rosea
self-limited course within a few months
oral antihistamine or topical steroid for symptoms mgt
phototherapy for severe cases
DDx with rosacea
- Acne vulgaris
- photodermatitis
- seborrheic dermatitis
- systemic lupus erythematosus
- carcinoid syndrome
management of rosacea
- avoid triggers
- use mild cleansing agents
- use photoprotection
- topical metronidazole or azelaic acid or brimonidine; for papulopustular rosacea, can try topical ivermectin
- ocular rosacea: lid hygiene + artificial tears +/- topical cyclosporine
- severe phymatous: oral doxycycline or tetracycline
what is the best predictor of response to Naloxone? and what is the dosage?
Respiratory rate < 12 /min
Naloxone 0.4mg IV or 2mg intranasal q4min
Universal Antidotes in altered mental status
- Dextrose: 50mL of D50W or Glucagon 1mg IM
- Oxygen: 100% O2 in carbon monoxide poisoning
- Naloxone (Narcan):
- – 2mg initially up to 10mg
- – 0.1mg initially doubled every 2 minutes up to 10mg
- Thiamine
- – given 100mg IV/IM/PO with 25g dextrose (50mL of D50W) to prevent Wernicke’s encephalopathy
Antidotes to prevent Wernicke’s encephalopathy
Given 100mg IV/IM/PO with 25g dextrose (50mL of D50W)
a/e of isotretinoin
Severe birth defects Miscarriage, Stillbirth Photosensitivity Dry skin, severely chapped lips depression, suicidal burning, redness, itching, or other signs of eye inflammation IBD Pruritis Dry mucous membranes nosebleeds Bone or joint pain
STEMI management
depends on duration from onset of symptoms
= or < 12 hours: Reperfusion goals
1) Door-to-balloon inflation (PCI) goal of 90 min
2) Door-to-needle (fibrinolysis) goal of 30 min
Absolute contraindication of fibrinolysis for STEMI
Absolute contraindication:
- intracranial hemorrhage
- cerebral lesion
- malignancy
- head/facial trauma < 3 mo
- ischemic stroke < 3 mo
- active bleeding (excluding menses)
- aortic dissection
- intracranial/ intraspinal surgery < 2 mo
- severe uncontrolled HTN
relative contraindications of fibrinolysis for STEMI
relative contraindication
- hx poorly controlled HTN
