Women who have gestational diabetes are at a threefold increased risk of developing diabetes later in life.
Maternal complications include hyperglycemia, diabetic ketoacidosis (OKA), increased urinary tract infection (UTI)
risk, increased pregnancy-induced hypertension/preeclampsia, and retinopathy.
Fetal effects include congenital malformations, macrosomia, respiratory distress syndrome, hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia, and
should be screened with a glucose tolerance test postpartum and should undergo annual diabetic screening
screening all women for gestational diabetes between 24 and 28 weeks' gestation with an oral 50-g 1-hour glucose tolerance test (GTT). If the 1-hour glucose challenge is
greater than 135 to 140 mg/dL, then an oral 100-g 3-hour GTT should be performed. The 3-hour GTT requires serum glucose levels be obtained at fasting, 1-, 2-, and 3-hour intervals. The diagnosis of GDM is made based on two or more abnormal results
50-70 women: increased level of female sex hormones, which aid in the urinary excretion of uric acid
30-50 in men
history of taking a thiazide diuretic is also important, as these drugs may induce hyperuricemia by increasing urinary urate reabsorption
increase risk: loop, chemo
weight loss help
In crystal-induced arthritis, the white blood cell count of the joint aspirate is on average 2000 to 60,000/ μL, with less than 90% neutrophils, while a septic joint will
have an average of 100,000 WBC/μL (25,000-250,000 cells) with more than 90% neutrophils.
(1) asymptotic tissue deposition of crystals,
(2) acute gout flares, (3) intercritical segments (occurring after an acute flare, but before the next flare), and (4) chronic gout (symptoms of chronic arthritis and/or tophi).
During an acute attack, the serum uric acid level may be normal or even low
Radiographs may show cystic changes in the joint surface, with punched-out lesions and soft-tissue calcifications.
In patients suspected to have gout, it is important to ask about recent trauma or injury. Following a traumatic event, an increase in the concentration of urate can be seen within the synovial fluid
*chronic monoarticular arthritis or involvement of two to three joints may be caused by fungi or mycobacteria
Bacterial infections of a joint occur most commonly in persons with rheumatoid arthritis. (chronic use of steroids- staph)
septic joint has limited ROM. nearby cellulitis, bursitis, or osteomyelitis will usually maintain the ROM of a joint
decreased net intake, intracellular shifts (eg, alkalosis, excess insulin), and renal losses or extrarenal losses
fatigue, muscle aches, ascending muscular weakness, or
cramps, paralysis or rhabdomyolysis
ST-segment depression, flattened T waves, and prominent U waves
potassium deficits are best corrected by oral potassium replacement
Meds: ACEI, ARB, potassium-sparing diuretics, acidosis, insulin deficiency, and burns
flaccid paralysis, paresthesias, areflexia, ileus
peaked T waves, flattening of P waves, and widening of QRS complexes
tx: IV calcium->glucose and insulin->Kayexalate, loop, dialysis
MCC viral, infectious, allergic, or irritant-> increased
mucous production and airway hyperresponsiveness
Influenza, parainfluenza, adenovirus (Conjunctivitis and adenopathy suggest adenoviral infection), rhinovirus, Mycoplasma pneumoniae, and Chlamydia pneumoniae
cough productive of purulent sputum, fever, malaise, rhinorrhea or nasal congestion, sore throat, wheezing, dyspnea, chest pain, myalgias, or arthralgias
the color of sputum is not diagnostic of the presence of a bacterial infection
patients with abnormal vitals (pulse >100 beats/min, respiration >24 breaths/min, temperature >100.4°F [38.0°C]) need evaluation for pneumonia
bronchodilator therapy such as albuterol and antitussive agents (dextromethorphan and codeine) and follow-up in 2 to 3 weeks
Fever, ear pain, diminished hearing, vertigo, and tinnitus
S pneumoniae, H injluenzae, and M catarrhalis are the most common bacterial pathogens
tx: Amoxicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, or second- and third-generation cephalosporins
Complications: mastoiditis, bacterial meningitis, brain
abscess, and subdural empyema
amoxicillin/clavulanate is recommended if a child has received amoxicillin in the previous 30 days. Tympanostomy tubes are an option if a child has had three episodes of AOM in the past 6 months or four episodes in the past year with at least one episode in the past 6 months.
diabetes mellitus, dyslipidemia, age, hypertension, tobacco abuse, family history of premature CAD, male gender, postmenopausal status, left ventricular hypertrophy,
Aspirin, nitrates, and BETA-adrenergic antagonist (REDUCE first year mortality) have proven benefits for both primary and secondary treatment.
restricting to 1500 mg/ d in patients
ACEis or ARBs should be considered first-line therapy in patients with CHF and reduced left ventricular function. Better outcomes are seen at higher doses, so patients should be maintained at the highest tolerable dose
ACEis and ARBs are contraindicated in pregnancy,
hypotension, hyperkalemia, and bilateral renal artery stenosis, and should be used with caution in patients with renal insufficiency
The administration of P-blockers, especially in high doses, in the setting of acute CHF, can worsen symptoms. should preferentially be started when patients have minimal evidence of fluid retention and few symptoms
Calcium channel blockers, in general, increase mortality in systolic CHF and should be avoided. Nondihydropyridine calcium channel blockers (diltiazem, verapamil) may be useful in heart failure caused by diastolic dysfunction, as they promote increased cardiac output by lowering heart rate, which allows for more ventricular filling time
tests: (CRP) and celiac disease testing (IgA tissue transglutaminase antibody or antiendomysial antibody) are recommended.
family history of ovarian cancer, a CA-125 can be obtained.
Abdominal Pain: Antispasmodics, such as dicyclomine and hyoscyamine; TCA, SSRI, PROBIOTIC, peppermint oil
Constipation-Predominant IBS: Lubiprostone (ACTIVATE Cl channel, increase intestinal secretion), fiber, Linaclotide (increase cGMP, increase motility)
Diarrhea-Predominant IBS: Loperamide, Rifaximin
MORPHINE-ABC (ie, Miosis, Out of it/sedation, Respiratory depression, Pneumonia/aspiration, Hypotension/hypothermia, Infrequency includes constipation, decreased bowel sounds, and urinary retention, Nausea, Emesis/euphoria, Analgesic, Bradycardia, Coma/altered mental status).
Muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise, drug seeking, mydriasis, piloerection, diaphoresis, rhinorrhea, lacrimation, diarrhea, insomnia, elevated blood pressure and pulse
Methadone, Buprenorphine, Naltrexone
<12 hours: insomnia, tremulousness, mild anxiety, gastrointestinal upset, headache, diaphoresis, palpitations, anorexia
12 to 24 hours: visual, auditory, or tactile hallucinations
24 to 48 hours: Generalized tonic- clonic seizures
48 to 72 hours: Delirium Tremens; hallucinations (predominately visual), disorientation, tachycardia, hyper- tension, low-grade fever, agitation, diaphoresis
Naltrexone, Acamprosate (act on GABA and glutamate pathway), Disulfiram (all 3 are FDA approved), Topiramate, Chlordiazepoxide, diazepam, lorazepam, Carbamazepine, valproate, Atenolol, propranolol, Clonidine
Paranoia, depression, somnolence, anxiety, irritability, difficulty to con- centrate, psychomotor retardation, increased appetite
Methylphenidate, amantadine, Propranolol, Desipramine, bupro- pion
gonorrhea and Chlamydia testing of the penile discharge or urine. VDRL or RPR testing for syphilis, and HIV and hepatitis B testing. Empiric treatment for men with a purulent urethral discharge or a positive urine test (positive leukocyte esterase or ≥10 WBCs/hpf. TX: azithromycin, 1 g orally as a single dose, OR doxycycline, 100 mg orally twice a day for 7 days, PLUS ceftriaxone, 125 mg intramuscularly, OR cefixime, 400 mg orally as a single dose.
If same complaint within 3 months, no new partner, repeat tests, culture for Mycoplasma or Ureaplasma and Trichomonas
Treatment should include azithromycin, 500 mg orally once daily for 5 days, or doxycycline, 100 mg orally twice daily for 7 days, plus metronidazole, 2 g orally as a single dose.
hypothyroid ism, chronic renal failure, hypothalamic-pituitary disorders, pituitary adenomas
not associated with breast cancer.
Meds block dopamine or histamine receptors (SSRI, TCA, ACEI, atenolol, verapamil, antipsychotics, H2 receptor antagonists, and opiates)
Estrogen in oral contraceptives can cause galac torrhea by suppressing the hypothalamic secretion of prolactin inhibitory factor and by direct stimulation of the pituitary lactotrophs.
obtain prolactin and TSH level
"mask" areas of the face, which include the central face, eyelids, eyebrows, periorbital area, nose, lips (cutaneous and vermilion), chin, mandible, preauricular and postauricular skin/sulci, temple, and ear