Uworld Step 3 Notes

USMLE WORLD STEP 3 NOTES By GEBBILS Risk of Limb Anomalies in Chorionic Villi Sampling – is greatest at Less Than 9 weeks of Gestation Children diagnosed with Infant Botulism – will be hospitalized for 1-3 months and will have a full recovery Vasovagal Syncope – is a NeuroCardiogenic Event of Passing Out Spontaneous Bacterial Peritonitis – is treated with Antibiotics and if there is presence of Encephalopathy, then Lactulose is to be added End Stage Liver Disease – survival is calculated using INR, Bilirubin and Creatinine Values Acute Variceal Bleeding – should be managed with Endoscopy where Sclerotherapy or Banding Can be used Variceal Prevention – can be Managed with Non Selective Beta Blockers Patients with Horner Syndrome – (Miosis, Anhydrosis, Ptosis) must have MRA to detect Carotid Dissection Hepatic Adenomas – are usually managed by Discontinuation of OCPs, if patients are on it. Non Secretory Pituitary Tumors – are Managed Surgically by Transphenoidal Removal (Tumors that are Gonadotropin (LH/FSH) Secreting) Carpal Tunnel Syndrome – is Associated with Hypothyroidism, DM, Direct Trauma and ESRD. (Not Osteoporosis) Acute Fecal Impaction – is managed by Disimpaction First and then Stool Softeners. Patients with Sarcoidosis – must have a Biopsy of Parotid Gland, Lacrimal Gland and Palpable Superficial Lymph Nodes Screening for Cushing’s Disease – must be done with Dexamethasone Suppression Test Chlamydia Pneumonia – presents between 2-19 weeks after birth, with Staccato Cough, Conjunctivitis and Otitis. Hypertensive Patients with Hyperuricemia – will Benefit from ARBs Clopidogrel – is a Better Agent for Patients who had a Stroke while being on Aspirin. PSA Elevation – might be Transient (due to Rectal Exam) and the Levels might need to be rechecked. Infant with Down Syndrome – must be Evaluated with Echocardiography if there are Cardiac Symptoms Diabetic Mothers – might have Fetal Hypertrophic Cardiomyopathy, due to Glycogen Deposition, and will have Hypertrophic Interventricular Septum Painless Testicular Mass – must be evaluated with Scrotal Ultrasound and only then if suspicious to have a CT Scan.

Fibrinolytic Therapy for Strokes – must be initiated within 3-4.5 hours All patient with CVA – must have Echocardiogram to evaluate for Thrombus Formation Anaphylaxis – is treated with Epinephrine 0.5 mg IntraMuscularly Dashboard Injury – affects Posterior Cruciate Ligament Hyperkalemia with EKG Changes – must be managed with Calcium Gluconate or Calcium Chloride Patients with Ankylosing Spondylitis – are managed with Repeat X-Ray in 3 months to evaluate for Progression of the Disease Patients with Sickle Cell Splenomegaly – must have CBC and IV Hydration Psoriatic Lesions are Worsened – with Beta Blockers, NSAIDs, Anti-Malarial Drugs, ACE Inhibitors and Lithium. Thus Medication must be Stopped Heparin Induced Thrombocytopenia – is managed with D/C of Heparin and Argatroban (Thrombin Inhibitor) must be initiated. 21 Alpha Hydroxylase Deficiency – will have Elevated Levels of 17-Alpha Hydroxyprogesterone Patellar Tendon Rupture – will present with Swelling of Anterior Part of the Knee and Inability to maintain Passive Extension of the Knee against gravity Most Common Complication of Tick Bites – is a Local Infection, if the Tick is not Engorged with

Blood, there is no Risk of Lyme Disease Swallowing Evaluation – must be done in All Stroke Patients Patients with Stroke – must be started on Lovenox, to reduce the Risks of PE and DVTs Acute Hepatitis – is treated with Supportive Measures Adults with Acute Hepatitis – only 1-10% will go on to Develop Chronic Hepatitis Elevated Troponin – is indicative of a Worse Prognosis, as it shows the embolus is large enough to place more strain on the Heart Warfarin – must be started after Heparin, in the patients with PE Patients with Hip Fractures – who have a lot of Comorbidities, need to be adequately controlled for pain and Surgery is not indicated. Lumbar Spinal Stenosis – presents in patients in their 60s, where the pain disappears upon sitting down, but increases with spine extension and decreases with flexion Lumbar Spinal Stenosis – must be evaluated with MRI Primary HIV Associated Thrombocytopenia – must be treated with Zidovudine, which reduces the risk of Opportunistic Infections Rash in patients with Infectious Mono – treated with Amoxicillin is due to Circulating Immune Complexes Isotretinoin – used for Sever Acne, has been associated with Hypertriglyceridemaa and causes Pancreatitis, it’s also Teratogenic Achilles’ Tendon Rupture – will present with Plantar Flexion, when the Calf is Squeezed (Thompson Test) Esophageal Rupture – is Best evaluated with Esophagogram with Water Soluble Contrast

Ecthyma Gangrenosum – is treated with IV Antibiotics and Not Surgical Debridement Progestin Releasing IUD’s – such as Mirena are Widely Used in Patients with Sickle Cell Disease, especially those who have had strokes in the past. ARDS – is best managed with Low Tidal Volume GSB + Mothers – babies, who did not received an adequate Prophylaxis (within 4 hours of delivery) are to be Observed for 48 hours Hypertension in Scleroderma Patients – is to be controlled with Captopril (ACE Inhibitor) Acute Cholecystitis Patients – must get RUQ Sono and Abx to be Started Hepatic Hydrothorax – in patients with Hepatic Failure where the Ascitic Fluid leaks and causes Pleural Effusion. It must be Treated with Diuretics and Sodium Restriction Refeeding in Anorexia Patients – must be treated with Potassium Replacement and can present with Edema, Heart Failure and Delirium Advanced Osteonecrosis – must be treated with Total Hip Replacement Flexible Kyphosis – is easily correctable by Voluntary Extension, it is a Common Finding, it must be treated with Bracing and Exercises Levonorgestrel (Mirena) – is the best Emergency Contraception Breast Milk Jaundice – presents after 7 days of Breastfeeding and the management is to Stop Breastfeeding and Start Formula Feed, and then Resume Breast Feeding in 1 week. Piglitazone – can cause Pulmonary Edema Sudden Onset of Hyperglycemia – in patients receiving TPN is caused by Sepsis High Dose Nicotine Patch – is helpful in patients in the early stages of Smoking Cessation Asymptomatic Bradycardia – in patients with recent MI, should be treated with Atropine Retinal Hemorrhage – is the most Ominous Sign of Preeclampsia Rotator Cuff Tendonitis – presents with Lateral Shoulder Pain, and aggravated by Abduction and External Rotation Patients with Benign Essential Tremor – will have a normal life expectancy Patients with Cocaine Induced Ischemia – must have Angiography to check for any Thrombus Patients with Brain Death – will not have a Cough Reflex with Suctioning, but it’s possible to have Babinski Reflex present Patients with Infected Catheters – must have it removed and placed on Vancomycin and be treated for Gram Negative Sepsis such as Cefepime

If patient with Staph Aureus – is suspected to have Osteomyelitis and must have MRI to confirm that Toxic Megacolon – in patients with Ulcerative Colitis and must have Abd X-Ray imaging done, and Glucocorticoids are to be started in the Acute Attack Patients with PCP – if have a A-a gradient more than 35, must be started on Steroids Patients with SLE – will have MI due to Atherosclerosis

Patients with Hyperreflexia – will not have any unusual symptoms Diabetic Patients with Neuropathy – must have a Tuning Fork Test to identify for Vibratory Sense Loss. Patients may be treated with TCA such as Duloxetine, not SSRIs Hepatic Cysts – are the most common manifestation of Adult Polycystic Kidney Disease Patients with Initial Onset of Depression – must be treated for at least 6 months with SSRIs Any patient with RA – if develop Fevers, must have Joint Aspiration to test for Infection Scrotal Trauma – must be evaluated with Surgical Exploration Lyme Arthritis – must be evaluated with Aspiration of Synovial Fluid and ELISA antibodies in it. Patients with TB – who have a new Pleural Effusion must have Thoracocentesis Rupture of Chorda Tendinae – must be suspected in healthy adults with new onset of Pulmonary Edema Toxic Shock Syndrome – will present with Exotoxin Wide Spread (X for Tox) In Diabetic Ketoacidosis – the Blood Glucose will be more than 250. If patient presents with Confusion, Ketonuria then it’s most likely Alcoholic Ketoacidosis Secondary Hypertension – due to Renal Artery Stenosis is evaluated with MR Angiography of the Renal Vessels Sarcoidosis – must be Evaluated with Chest X-Ray for Hilar Nodes Enlargement, and confirmed with Lung Biopsy New Onset of CHF – must be evaluated with Echo and Stress Test Right Blood Glucose Control – will prevent conditions such as Retinopathy Medial Medullary Syndrome – is associated with Contralateral Spastic Hemiplegia, Contralateral Vibratory and Proprioception Loss and Tongue Deviation to the Injured Side. Bright Red Blood Per Rectum – must be evaluated with Colonoscopy, where Radionuclide and Angiography are Reserved when it cannot be visualized. APACHE Score – is now used to assess the serverity of Acute Pancreatitis Myelomeningocele – will also present with Bladder Dysfunction VQ Scan – does not completely rule out Acute PE in patients highly suspected to have one Patients with Pheochromocytoma – if being prepared for surgery, then Alpha Blockers must be started 10-14 days prior Diagnostic Work up in Multiple Myeloma – includes Serum Protein Electrophoresis, Skeletal Survey and Bone Marrow Biopsy Hashimoto’s Thyroiditis – is confirmed with high titers of Antimicrosomal (anti-TPO) antibody is diagnostic. Majority of Patients with Hypothyroidism – will also present with Hypercholesterolemia History of Egg Allergy – has to be known before administering Influenza Vaccine Febrile Reaction during Transfusion – can be prevented by Washing the Cells, where Leukocytes are removed from Blood

H.Pylori Treatment – is Proton Pump Inhibitor, Clarithromycin and Amoxicillin (or Metronidazole if Penicillin Allergic) for 2 weeks If H. Pylori – is resistant to Triple Therapy, then try Quadruple Therapy which is Proton Pump Inhibitor and Bismuth, Tetracycline and Metronidazole Retrograde Ejaculation (Dry Ejaculate) – occurs in up to 70% of patients after TURP. Schistosomiasis – is diagnosed with Urine or Stool Microscopy and not Cystoscopy Cluster Headaches – typically present with Lacrimation, Retroorbital Pain, Conjunctival Injection, Rhinorrhea and usually last 30 or more minutes

Verapamil – is the Drug of Choice for Prevention of Cluster Headaches Patients with Acne – Topical Retinoid, Benzoyl Peroxide and Erythromycin Patients with Symptomatic Rectoceles – who are poor surgical candidates, are to be fitted with Pessaries and Estrogen Cream. Patients treated with Thrombolytics for Ischemic Strokes – are not to be placed on Anti-Platelet Meds or Heparin, instead the Blood Pressure Control is Labetalol or Nitroprusside Children with Sickle Cell Disease – will have Dactylitis and also Splenic Sequestration Patients Post Cholecystectomy – who present with Diarrhea are to be Treated with Cholestyramine Non Gonococchal Urethritis – in men, may be due to Trichomonas and to be treated with Metronidazole Dermatomyositis – which presents as a scaly rash over the knuckles should suspect Malignancy in these patients Pyelephlebitis – is the most common complication of Ruptured Appendicitis Condyloma Acuminata – is not a contraindication for Vaginal Delivery Supraglottic Edema – should be suspected in the patients exposed to Smoke Inhalation Women under 30 with a Breast Mass – must have an Ultrasound initially and only then a Biopsy Treatment for TB – is usually at least 9 months with INH Renal Parenchymal Disease – should be suspected in young patients with Secondary Hypertension Patients who are Kidney Donors – are at Slightly Increased Risk of Gestational Complications, otherwise the risks for other conditions are the same as general population Patients with Mallory-Weis – who are not actively bleeding, can be observed. Hiatal Hernia is the known complication in these patients Massive PEs – can cause Pulmonary Hypertension and can lead to Right Ventricular Dysfunction and Acute Tricuspid Regurgitation Limited Sigmoidoscopy – is the Study of Choice in Patients with C.Diff Colitis Meniere’s Disease – presents with Triad of Periodic Vertigo, Unilateral Hearing Loss and Tinnitus

Septate Uterus – doesn’t interfere with inability to conceive, but must be Surgically Corrected to Avoid the Risk of Miscarriages Acute Gout – is Diagnosed with Arthrocentesis by Demonstrating Negatively Birefringent Crystals, Serum Uric Acid can be Normal in the Acute Attack, Treatment is Indomethacin Implantable Levonorgestrel and Depot – are the Most Effective and have the Lowest Rate of Pregnancies among Non Permanent Types of Sterilization Acute Pericarditis – can occur days after MI and must be treated with High Dose Aspirin Infant Botulism – will present with Absent Gag Reflex and may result in Aspiration Lichen Planus – is associated with Hepatitis C Sildenafil and Alpha Blockers – such as Terazosin must be given 4 hours apart to reduce the Risk of Hypotension HIV Prophylaxis – consists of Two Nucleoside Reverse Transcriptase Inhibitors for 4 weeks (If HIV Viral Load is High, then add Protease Inhibitor) Patients with Sulfonylurea Overdose – must be given Octreotide which decreases Insulin Secretion Fat Embolism – can be prevented by Early Immobilization and Operative Fixation Imipenem – is contraindicated in Patients with Seizure Disorders IgA Nephropathy – presents with Gross Hematuria, following Acute URI, where in Postrstreptococcal Glomerulonephrosis Gross Hematuria is Uncommon Absent Cremasteric Reflex – is Highly Suspicious for Torsion Group A Strep – GAS is the causative Agent for Necrotizing Fasciitis and Rapidly Spreading Cellulitis Necrotizing Fasciitis – is treated with IV Penicillin, Clindamycin and Surgical Debridement Diverticular Bleeding – is most commonly caused by Erosion of the Artery Asymptomatic Patients with BV – who are Pregnant are not to be treated, as it doesn’t show

improval in prevention of PTL Patients with High Pretest Probability for C.Diff – are to be Repeated the Rapid C. Diff, even if the Initial is Negative Patients with Recurrent C.Diff – after 1 relapse must be still treated with Flagyl TB in Pregnancy – is treated with Isoniazid, Rifampin and Ethambutol (Pyrazinimide is thought to be not safe) Hyperflexion of the Wrist – must be done in the Patient suspected to have Carpal Tunnel as it Compresses the Median Nerve, and to be Confirmed with Nerve Conduction Studies Epidural Hematoma or Transverse Myelopathy – the First Step is MRI!!!! Sputum Study – is the Test to Confirm the Presence of TB, where PPD just shows the Exposure to TB in the Past St. John’s Wart – is used in the Treatment for Depression (SE is GI Distress) Kava – is used for Anxiety and Insomnia. (Side Effect is Hepatotoxicity) Garlic – is used for Hypercholesterolemia (SE is Bleeding and Platelet Dysfunction, which is also seen in Gingko Biloba)

Saw Palmetto – is used in Benign Prostatic Hyperplasia (SE is Hypertension) Congenital Toxoplasmosis – can present as Microcephaly and is usually due to Undercooked Lamb Meat Conusmption during Pregnancy Adults who cannot tolerate Rifampin – for Meningitis Prophylaxis must receive Ciprofloxacin Chronic Alcoholics – who are treated with IV Fluids and Thiamine, if present with Muscle Weakness the Next day that is due to Hypopshophatemia CML – is to be treated with Tyrosine Kinase Inhibitor such as Infliximab Multiple Sclerosis – is diagnosed with MRI, and then once confirmed to be started on Methylprednisolone. Once stabilized then Start Interferon and Repeat MRI in 3 months In ARDS – after Sepsis, Pulmonary Wedge Pressure is less than 18 mmHg and presents with diffuse bilateral infiltrates on Chest X-Ray Acute Otitis Media – usually presents with Mucosal Response of Mastoid Air Cells. In End Stage Renal Disease – Anemia is usually due to deficiency of Erythropoietin Mitral Stenosis – usually presents with Rumbling Diastolic Murmur, and can result in Hemoptysis, can have Prominent Pulmonary Arteries Amiodarone - causes a decrease in conversion of T4 to T3 and thus causing an increase in T4 and Decrease in T3 Levels. Restless Leg Syndrome – can be an indicator of Iron Deficiency Anemia Licorice – can aggravate Hypertension in Patients In patients with AAA – the greatest effect of reducing the risk is Smoking Cessation Diagnosis of Diabetes – can be made when HgbA1C is more than 6.5, Fasting Blood Glucose is over 126 or a Random Glucose of more than 200 with Symptoms of Hyperglycemia Women on OCPs – if want to get pregnant, must stop OCPs and start Folic Acid Supplementation 1 month prior to conception Patients with Barret’s Esophagus – must have an annual surveillance with Endoscopy. Peripheral Edema – is a Known Side Effect of Calcium Channel Blocker, where ACE Inhibitors cause Angioedema Benzodiazepines – are the first line of Management in Patients with Status Epilepticus, who were stabilized initially Femoral Nerve Injury – presents with the loss of Knee Jerk Reflex, Inability to Extend the Knee, Sensory Loss of Anterior and Medial Aspects of the Thigh, Medial Aspect of the Shin and Arch of the Foot Obturator Nerve Injury – presents with Inability to Adduct the Thigh Common Peroneal Nerve Injury – will present with Foot Drop and Weakness in Foot Dorsiflexion and Eversion Patients with DKA – who are getting better, must have Subcutaneous Insulin started and have IV Insulin going for at least 2 hours before discontinuation of IV Insulin

X-Ray of the Spine – is the first step in patients with Spondyloarthropathy Patients with Reiter’s Syndrome – must have Antibiotics, Exercise and Methotrexate for Treatment Fluphenazine – is the treatment of Choice for Facial Tics, in patients with Tourette’s Syndrome Varenicicline – is a partial Agonist of Nicotinic Acetylcholine Receptor and is used in Smoking Cessation Therapy. Side Effect is Major Depression Bacterial Conjunctivitis – is treated with Erythromycin Drops, the patient can go to school after 24 hours of Antibiotic Therapy Corticosteroids – must be initiated in the setting of Complicated Infectious Mononucleosis G6PD – usually presents with Jaundice within the First 24 hours of Birth Lithium – has a known Interaction with Thiazide Diuretics, which decrease its Excretion Clonidine – is the Drug of Choice in Patients with Opioid Withdrawal Hypertension Ineffective Erythropoiesis – is a known manifestation in patients with B12 Deficiency TB Treatment – in Infants and Children with TB Meningitis, Miliary TB and TB Osteomyelitis consists of 12 months!!! Cimetidine – can cause a Decreased Tubular Secretion of Creatinine Cutaneous Cryptococcus – is Diagnosed with Skin Lesion Biopsy Hypertension Control – is the most Effective in prevention of Stroke Schmidt’s Syndrome – is Addison’s disease that presents with Type I Diabetes Alloantibodies – is the issue in patients with previous blood transfusions that will make it difficult to match the blood. IV Heparin – must be started once DVT is diagnosed clinically and by history, such as cold leg with no pulse Acute Pancreatitis – can be caused by Thiazide and Furosemide Tretinoin – is an excellent choice for treating hyperpigmentation in smokers Patients taking SSRIs – if present with Sexual Dysfunction, must have the medication either decreased or switched to another (Mirtazapine or Bupropion) Patients with PMS – if were started on Fluoxetine and see no Relief, then must be switched to Alprazolam PMS patients – have a high predisposition to Psychiatric Conditions and Depression Patients with Snoring – must be advised to stop drinking Alcohol before bedtime Hyperactive DTRs – are present in patients with Hypocalcemia, especially who underwent a major surgery, with Blood Transfusion Methimazole – is contraindicated for use in the First Trimester as it causes Scalp Defects, but once in 2nd or 3rd Trimester may be switched back from PTU, as PTU carries a Risk of Liver Failure All Post-Menopausal – must be taking Calcium and Vitamin D Supplements Neonatal Polycythemia – is defined as Hct more than 65%, and the sample from Heel Prick must be rechecked with Peripheral Venous Sample

Peptil Ulcer Perforation – must be managed with Laparotomy with Surgical Repair of Perforation Pituitary Enlargement – after Bilateral Adrenalectomy, is called Nelson’s Syndrome and is due to the Loss of Negative Feedback Mechanism. Obsession – in Obsessive Compulsive Syndrome, is the Recurrent Thought or Image that cause Severe Distress. Such as Mother always getting ideas wanting to kill her children. Patients with Papillary Thyroid Cancer – must have a Near Total Thyroidectomy Risk of B-Cell Lymphona – is 5% for Sjogren’s Syndrome Patients Familial Adenomatous Polyposis – once diagnosed on Colonoscopy, then the patient must have an Endoscopy to rule out Gastric and Duodenal Involvement Slipped Capital Femoral Epiphysis – must be managed with Internal Fixation and the Screw Placement. There is a strong associated with Obesity in these Children Patients with Hyperlipidemia – must be started on Statins, and if that doesn’t improve Hypertrglyceridimea, then must be started on Gemfibrozil

Splenic Vein Thrombosis – must be suspected in patients with Recurrent Chronic Pancreatitis and Isolated Gastric Varices Co-Oximetry – is used to Diagnose Carbon Monoxide Poisoning Stress – increases Insulin Resistance, and may be Responsible for Hyperglycemia in a Patient with Recent Acute Attack of Gout, and not Steroids that were given to the patient to treat Tinea Pedis – is treated with Topical Antifungal Cream Lobular Carcinoma in Situ – is a Non Malignant Lesion and the Treatment is Excisional Biopsy Patients with Undescended Testes – are to be referred for surgery at 6 Months of Age Dandruff – is a Seborrheic Dermatitis and the Treatment is Selenium Shampoo Peristalsic Waves – can be seen in the patients with Pyloric Stenosis Left Ventricular Dysfunction – must be treated with ACE Inhibitor (Most Important) and Beta Blockers Autoimmune Hepatitis – must be tested for Presence for Anti-Smooth Muscle Antibodies and Antinuclear Antibodies Indinavir – has been found to cause Crystal-Induced Nephropathy Prolactinomas – are to be treated with Oral Dopaminergic Receptor Agonists, Surgery is rarely done for Prolactinomas Elevated Ferritin Levels – are found in Acute Setting of Dermatomyositis and Inflammatory Muscular Conditions, where CPK Levels will be Elevated Radiation – is the treatment of choice for Patients with Metastatic Prostate Cancer with Bony Lesions Patients treated with Pernicious Anemia – treated with Vitamin B12, will have low levels of Potassium, due to Rapid Uptake of Potassium by newly formed cells. Acute Pharyngitis treated with Abx – is to prevent development of Rheumatic Fever

Patients that are High Risk for Colon Cancer – must be offered colonoscopy at the age of 40 or 10 years before the diagnosis in the relative, whichever comes first Bacterial Rhinosinusitis – that is lasting more than 10 days, must be treated with Abx and no need for testing Benzodiazepines – must be discontinued in elderly patients with frequent falls Cardiac Tamponade – will show as Diastolic Collapse of Both Right Atrium and Ventricle during Filling In Acute Asthma Exacerbation – add Oral Corticosteroids In Carpal Tunnel Syndrome – Forced and Prolonged Flexion of the Wrist will reproduce the symptoms Patient desiring Herbal Medication – must sign the written agreement but still be told to follow up Patients with TB – that is Resistant to INH, must be treated with Rifampin for 6 months External Otitis – must be initially treated with Cerumen Wire Look or Cotton Swab to Clean out the Ear Canal Patients with Grave’s Disease – must be treated with Radioactive Iodine Ablation and Corticosteroids Patients with Clear Evidence of Pain – must be given the Rx but must sign the agreement that they will seek further treatment with another specialist. Patients with Pseudotumor Cerebri – must have an Opthalmic Examination to evaluate for Papiledema Prolonged Therapy with Amiodarone – can cause Pulmonary Fibrosis A Newborn – must be fed every 2-3 hours Dialectical Behavior Therapy – is a successfully way of treating a Borderline Personality Disorder Foreign Objects – that have made their way to the stomach, will pass on its own in 90% of the time Constipation in Children – should be treated with Dietary Modifications and if that doesn’t work, then Magnesium Hydroxide FEV – remains the single most important factor in prognosis for COPD patients Autoimmune Metaplastic Atrophic Gastritis – presents with Pernicious Anemia and Absent Rugae

in the Fundus If Exposed to the Bats – administer Rabies Immunoglobuline and Rabies Vaccine Urethral Diverticulum – must be suspected in women with Post Voidal Dribbling, Dysuria and Dyspareunia and it’s Diagnosed by Transvaginal Ultrasound Patients with Prostate Cancer – c/o Musculoskeletal Pain and Elevated PSA, must have a Radioisotope Bone Scan IV Drug Abusers – commonly have Right Sided Endocarditis, where Rheumatic Fever damages the Left Side Cystoscopy – is the Gold Standard in Diagnosing Bladder Malignancy, when the patients presents with Painless Hematuria Patients with Porcelain Gallbladder – must have an Elective Cholecystectomy, as it increases the Risk of Malignancy Staph Aureus – is the most common Isolated Organism from the Cornea

Infant born to Hep B+ mother – must have a Serology Repeat at 9 months of age IV Pentamidine – is associated with multiple Electrolyte Abnormalities such as Hyperglycemia, Hypo and Hyperkalemia, Hypoglycemia and Hypocalcemia Superior Vena Cava Syndrome – must be evaluated in patients with CT of the Head and Neck, who are complaining of Dyspnea, Neck Pain and Swelling and Venous Dilatation of Cervical and Upper Extremities RBC Cholinesterase – the Test to Confirm Organophosphate Poisoning Displaced Clavicular Structures – must have Open Reduction and Internal Fixation, where Non Displaced, are managed with Conservative Therapy Rubella – presents with Rash that starts on the Face and Spreads Downward, patient will have Fever, Posterior Cervical and Auricular Lymphadenopathy Rocky Mountain Fever – starts in the Lower Extremities and spreads upward Renal Stones – less than 5 mm will pass on its own, more than 5 but less than 10, will need Extracorporeal Lithotripsy, and more than 10mm will need Stone Removal Viral Arthritis – should be suspected in a patient with a recent URI and now symptoms with less than 6 weeks in duration, the treatment is supportive Dose of Levothyroxine – must be Increased as soon as you find out that the patient is pregnant Patients with Back Pain – if less than 6 weeks, ESR must be drawn and if the symptoms persist more than 12 weeks then MRI must be ordered Patients with Lupus and Renal Involvement – must have a Renal Biopsy to evaluate the severity of the Disease. Serum Complement and Anti-dsDNA – must be monitored in Patients with SLE for Disease Activity Compartment Syndrome – must be suspected in patients with Pain on Passive Movement Tenosynovitis – which is a pain along the tendons and ankle joints is characteristic of Gonococcal Arthritis Plasma 25-Hydroxyvitamin D – must be measured to Assess for Vitamin Deficiency in patients who underwent Gastric Bypass Lidocaine – is the Drug of Choice for TCA Induced Arrhythmia, and Sodium Bicarbonate is given for Cardiac Effects of TCA Overdose Atrial Fibrillation – with High Ventricular Rate must be managed with Diltiazem Ischemic Stroke – in patients with DVTs, there needs to ben Echocardiogram done to evaluate further Dog Bite Injuries – are not to be closed and must be left open to drain, as to not get infected Dumping Syndrome – is to be treated with High Protein, Low Carbohydrates and Smaller and More Frequent Meals Failure To Thrive – babies are to have a Diet Modification Painless Testicular Mass – suspected for Malignancy, must be evaluated with Ultrasound Levothyroxine – must be taken on an empty stomach, as medications such as Iron and Calcium can impair its absorption

Anterior Uveitis – is the most common Eye Involvement in Sarcoidosis In Pregnancy – Hyperthyroidism is treated with PTU in the 1st trimester and then to be switched to Methimazole in 2nd and 3rd Patients with Cerebral Palsy – must undergo evaluation with MRI for abnormalities Patients requesting to use Chinese Herbs – must be told not to use it, because of the lack of evidence Hepatitis – is the most Common Side Effect of Isoniazid Before considering Peritoneal Dialysis – a patient must have a Total Colonoscopy, to rule out Diverticulosis Any Sharp Object in the Esophagus – must be removed with Endoscopy Thiazide Diuretics – have been known to cause Photosensitive Rash In Subacute Thyroiditis – there is a Decreased Radioactive Iodine Uptake and Thyrotoxicosis, the treatment is NSAIDs and Beta Blockers Corticosteroids – given for less than 3 weeks, do not need to be tapered Pancreatic Cyst – is best evaluated with Ultrasound and Cyst Aspiration Lactating women with Trichomonas – are to be treated with 2g Metronidazole and must discontinue Breastfeeding for 24 hours Tension Headaches – are usually Non Throbbing and Bilateral Cluster Headaches – are usually Unilateral and Localize in Periorbital Region When switching from SSRI to MOAI – you must wait a Month, to avoid Serotonin Syndrome Clavicular Fracture – the patients can return to activity in 4-6 weeks Local Anesthetics – are not useful in managing cellulitis, due to the irregular borders and shape Akathisia – which presents as inability to sit still, which is a common side effect of anti-psychotic medications, can be treated with Beta Blockers Lactose Breath Test – is the diagnostic test for Lactose Intolerance, the patient must fast for 8 hours before the test HIV+ Women – who find out that they’re pregnant, must continue HAART Therapy, if they found out in the early 1st trimester, then they can stop and continue in the 2nd trimester. Batteries lodged in Esophagus – must be removed endoscopically, those that passed into the stomach, you can watch for spontaneous passage Upright Table Tilt Test – must be done to evaluate for Vasovagal Syncope Genetic Testing Information – is prohibited by Law, when an Employer asks for it Nephrolithiasis in Pregnancy – must first be evaluated with Abdominal Ultrasound Urethral Catheterization – must be used in any case of retention, once Urethral Injury is excluded Aortic Valve – is heard best at 2nd and 3rd Intercostal Space on the Right Sternal Border Pulmonic Valve – is heard best at 2nd and 3rd Intercostal Space on the Left Tricuspid Valve – is best heard in between 5th and 6th Space at the Left Sternal Border

Mitral Valve – is best heard between 5th and 6th Intercostal Space in the Left Mid Clavicular Line PPD+ Patients who were treeated with INH – do not need to be treated again if they still test + for PPD When Diagnosed with Serious Hereditary Disease – the patient if refuses to tell the family, then has to sign a Refusal Form and it must be placed in the chart In Normocytic/Normochromic Anemia – Reticulocyte Count must be obtained to determine the cause Medical Board – must be notified of Physician Misconduct Abdominal Ultrasound – is the Test of Choice for Abdominal or Subphrenic Abscess Confirmation of H.Pylori Cure – is the Fecal Antigen Test 4 weeks after completion of the Therapy DVT – that developed as a complication of a Hospital Stay must be treated with Coumadin for at least 3 months, but no more than 6 months Patello-Femoral Syndrome – most common cause of knee pain in patients younger than 45, present with anterior knee pain upon climbing the stairs