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Phase 1- is it safe?
phase 2 - Does it works?
Phase 3 - Is it as good or better?
Phase 4 - Can it stay?
Confounding bias = Related to both exposure and outcome, but not on the causal pathway.
Strategy to reduce Confounding bias = MMC is RaRe
( M = Multiple studies , M = matching , C= Crossover studies ,
Ra = RAndomization, Re = REstriction )
Positive skew = Mean > Median > Mode ( Direction of arrow is to the direction of the tail of the
positive skew ) - see graph in First aid
Negative skew = Mean < Median < Mode ( Direction of arrow is to the direction of the tail of the
negative skew )
2) If mother is HBsAg positive , administer hepatitis IVIG along with the hepatitis B vaccine
- Phenylketonuria
- Galactosemia
- Hypothyroidism
Rx of Hemangioma :
steroids or pulsed laser if large or interferes with organ function.
Preauricular tags / pits : DO the followings-
Hearing test
Ultrasound of kidneys
Aniridia :
Screen for Wilms tumor with abdominal USG every 3 months until age 8
Rx of Gastroschisis
Surgical correction
Umbilical hernia :
Screen with TSH
May close spontaneously
Undescended testes :
Associated with malignancy if > 1 year of age
No treatment until 1 year of age
(1) Hormone injections ( -hCG or testosterone )
(2) Surgery ( orchiopexy )
Very important concepts of usmle step 1 and step 2 ck ( Neurology ) - source ; FA(step 1)
Effects of strokes
Anterior circulation :
Posterior circulation :
Management
Baseline quantitative -hCG titer
Chest x-ray (rule out lung metastasis)
Suction D&C
effective contraception (oral contraceptive pills)
1) Semen analysis
. If abnormal , repeat the analysis in 6 - 8 weeks.
. No viable sperm:
Artificial insemination by donor .
2) Anovulation
. Hypothyroidism and hyperprolactinemia are causes of anovulation that can be treated.
. Ovulation induction:
Clomiphene citrate is the agent of choice.
Human menopausal gonadotrophin (hMG) is used if
clomiphene fails
3) Tube Abnormalities:
. Hysterosalpingogram (HSG):
No further testing if the HSG shows normal anatomy.
. Laparoscopy :
If the HSG is abnormal to visualize oviducts and attempt reconstruction (tuboplasty).
If tubal damage is severe, IVF should be planned.
Endometriosis :
Treatment
a First-line therapy:
Continuous oral progesterone or OCP .
b Second-line therapy:
Testosterone derivatives (Danocrine or danazol) or GnRH analogs (Lupron or leuprolide)
Tuboovarian Abscess
Treatment :
Acute Salpingo-oophoritis
Treatment
Treatment:
3) Invasive cancer
Ovarian cysts:
Follicular cyst -
Associated with hyperestrogenism, endometrial hyperplasia.
Theca-lutein cyst -
Due to gonadotropin stimulation.
Associated with choriocarcinoma and hydatidiform moles.
Ovarian neoplasms
1) Serous cystadenoma
. Lined with fallopian tubelike epithelium.
2) Mucinous cystadenoma
. Lined by mucus-secreting epithelium .
3) Endometrioma
5) Brenner tumor
6) Fibromas
7) Thecoma
- Histology shows Call-Exner bodies (granulosa cells arranged haphazardly around collections of
eosinophilic fluid, resembling primordial follicles).
2) Serous cystadenocarcinoma
Most common malignant ovarian neoplasm,
Psammoma bodies.
3) Mucinous cystadenocarcinoma
Pseudomyxoma peritoneiintraperitoneal accumulation of mucinous material from ovarian or
appendiceal tumor.
4) Immature teratoma
Aggressive, contains fetal tissue, neuroectoderm.
5) Dysgerminoma
7) Krukenberg tumor
Immunodeficiencies :
B-cell disorders -
Can see Airway and GI infections, Autoimmune disease, Atopy, Anaphylaxis to IgA-containing
products.
T-cell disorders
Deficiency of Th17 cells due to STAT3 mutation > impaired recruitment of neutrophils to sites of
infection.
Increase IgE, decrease IFN-.
FATED : coarse Facies, cold (noninflamed) staphylococcal Abscesses, retained primary Teeth,
increase IgE, eczema.
Defective IL-2R gamma chain (most common, X-linked), adenosine deaminase deficiency
(autosomal recessive).
2) Ataxia-telangiectasia
Defects in ATM gene > failure to repair DNA double strand breaks > cell cycle arrest.
Increase AFP.
Decrease IgA, IgG, and IgE.
Lymphopenia, cerebellar atrophy.
3) Hyper-IgM syndrome
4) Wiskott-Aldrich syndrome
2) Chediak-Higashi syndrome
Defect of NADPH oxidase > decrease reactive oxygen species (eg, superoxide) and
decrease respiratory burst in neutrophils;
Increase susceptibility to Catalase organisms .
( Atleast 2 - 3 Q in exam )
Breast cancer
. Mammography at age 50, then every 12 years, upto age 75.
Cervical cancer
Colon cancer
Prostate Cancer
. No recommendation to screen patients routinely for prostate cancer with either a PSA or a digital
rectal examination.
( But if the patient want to do the these tests , you have to give )
. Recommend against the PSA for men > 75 ( Even if the patient wants )
Osteoporosis
. All women should be screened with bone densitometry at age 65.
. All men about age 65 who were ever smokers should be screened once with an ultrasound.
Diabetes
. Diabetes screening is routine only in those with hypertension
Hypertension
. All patients above age 18 should have their blood pressure checked at every office visit.
Hyperlipidemia
. Men > 35 and women > 45 should be screened for hyperlipidemia.
..................Acyanotic lesions
loud pulmonic S2
Surgical repair if - failure to thrive, pulmonary hypertension, or right-to-left shunt > 2:1
3) Atrioventricular canal
4) Pulmonary stenosis
6) Aortic stenosis
Valve replacement and anticoagulation may be required.
Ductus dependant: Give PGE1 infusion to maintain ductus patent (ensures lower extremity blood
flow)
Surgery repair after stabilization
..................Cyanotic lesions
1) Tetralogy of Fallot
----------------------Crohn disease
---------------------------Ulcerative colitis
-----common in both
( 1 - 2 Q in the Exam )
. Type IV hypersensitivity.
. Lesions occur at site of contact(eg, nickel , poison ivy, neomycin ).
.........Melanocytic nevus
. Common mole.
. melanoma can arise in congenital or atypical moles.
. Intradermal nevi are papular .
. Junctional nevi are flat macules .
.........Psoriasis
..............Rosacea
. Flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts (horn cysts) .
. Looks stuck on.
.............Verrucae
.............Urticaria
............Angiosarcoma
...........Bacillary angiomatosis
...........Cherry hemangioma
...........Cystic hygroma
............Kaposi sarcoma
. Endothelial malignancy most commonly of the skin, but also mouth, GI tract, and respiratory tract.
. Associated with HHV-8 and HIV.
............Pyogenic granuloma
............Strawberry hemangioma
Very high yield topics of Nephrology ( For step 1 and step 2 ck ) Source- FA
. PR3-ANCA/c-ANCA.
. Pauci-immune (no Ig/C3 deposition).
. MPO-ANCA/p-ANCA.
. Pauci-immune (no Ig/C3 deposition).
. LMmesangial proliferation.
. EMmesangial IC deposits.
. IFIgA-based IC deposits in mesangium.
. Severe nephritic syndrome may present with nephrotic syndrome features (nephritic-nephrotic
syndrome) -- if damage to GBM is severe enough to damage charge barrier.
. Often 1 (idiopathic) and may be triggered by recent infection, immunization, immune stimulus.
. may be 2 to lymphoma (eg, cytokine-mediated damage).
. 1 disease has excellent response to corticosteroids.
. Can be 1 (idiopathic) or 2 to other conditions (eg, HIV infection, sickle cell disease, heroin abuse,
massive obesity, interferon treatment, chronic kidney disease due to congenital malformations).
.................Amyloidosis
. LMCongo red stain shows apple-green birefringence under polarized light due to amyloid
deposition in the mesangium.
. Kidney is the most commonly involved organ (systemic amyloidosis).
. Associated with chronic conditions that predispose to amyloid deposition (eg, AL amyloid, AA
amyloid).