green color, thin and frothy. Also vaginal pruritis, dysurea and dyspareunia. Petechial pathes on the cervix show "strawbery cervic". Dx by microscopic obervation of flagellad organism in wet mount preparation. Tx is either one dose 2000mg or 250mg 3X a day for 7 days, for both partners. Metronidazole is teratogenic avoid using in 1st trimester.
Tricuspid Atresia:
Is a cyanotic congenital heart disease characterized by cyanosis early in life and left axis deviation. Most cases, 90% , are asso with VSD. DDX is TOF.
Tricuspid Regurgitation
A pansystolic murmur at the left sternal border Tricuspid Stenosis:
A mid diastolic rumble, best heard along the left lower sternal border Tricyclic Antidepressant drug tox:
Is the mcc of hospitalization and death due to excessive ingestion of prescription drugs. Pt with TCA overdose presents with anticholinergic, CV and neurological symptoms. CV se is proonged QRS and AV block. Also dry mouth dilated pupils, decreased bowel sounds, urinary retention, constipation, tachycardia, flushed skin and hyperthermia. Its been realized that QRS interval more reliably predicts the level of toxicity than the serum or urine drug levels.
Trigeminal Neuralgia - 2
At surgery or autopsy, intracranial arterial and, less often, venous loops
compressing the trigeminal nerve root where it enters the brain stem have been found, suggesting that the tic is a compressive neuropathy. Paroxysmal lightning pain on the face, tx is carbamazepine.
Trimeta-Sulfa Toxicity
In African-Americans it cann cause acute hemolysis, back pain due to G6PD
deficiency. NOTE:vigniette says that "G6PD I snormal", Don’t fall for that because in these pts it is normal but the cuase is still G6PD def. This also happens with Primaquine.
Torus Palatinus:
Is a benign bony mass on the hard palate. No medical or surgery is required. Cause is unknown. Tx is reassurance.
Tropical Sprue
Blunting of the villi and hx of travel is DDX with CELIAC disease. A common presentation is the triad of sore tongue, diarrhea, and weight loss. All features of a malabsorption syndrome may develop. Steatorrhea is common, and D-xylose absorption is abnormal in > 90% of cases. Folic acid and vitamin B12 deficiencies lead to megaloblastic anemia. shortening of the villi and lengthening of the crypts, with changes in the surface epithelium and an inflammatory cell infiltrate of lymphocytes, plasma cells, and eosinophils. The best treatment is tetracycline TTP
presents with Pentad of 1-severe thrombocytopenia, 2-Microangiopathic hemolytic anemia (RBC fragments), 3-Neurological signs, 4-Renall failure, 5-Fever. LDH is elevated, PT & pTT are normal. HUS is like TTP w/o neuro signs. Both need Emergent Plasmaphoresis. DDX:I T P, a dx of exclusion, pt presents with isolated decreased in platelet count. Hb and WBC are normal, Pt & Ptt are normal. DDX3:DIC, RBC fragments, PT,PTT and BT are elevated. Renal failure is not a feature.
Tuberous Sclerosis:
Initial presentation is seizures. The cutaneous anomaly is called adenoma sebacum, which appears b/e 5-10 yrears of age. TS occurs in first year of life with clusters of brief symmetrical contractions of the neck , trunk and extremities known s ‘infantile soasms, demonstrating EEG patterns. There is also hyperpigmented lesions (Ash leaf) and cortical tubers on head CT. The DOC is IM ACTH.
Tubo-varian abscess
Is seen in 10% of pt w PID. Admit the pt, Broad spectrum antibiotics should be started immediately AFTER taking cultures. Gentamycin+Clindamycin+Ampicillin. In absence of obvious response w/i 48 hours , drainage should be considered. If there is doubt re Dx we do Laparoscopy. If hay rupture we need to do exploratory
Laparotomy.
Tumor Lysis Synd - 2
Is characterized by Hypreuricemia. Seen in pt undergoing chemotherapy, with high nucleic acid turn over such as Leukemia dn Lymphoma. Prophylactic Allopurinol is the most effective method to prevent gout in these pts. Hysration is also good but alone is not enough, it should be used with Allopurinol.****Tumors which have high cell turn over are frequently ass with TLS, like Burkitts, ALL and AML. There is Hyperphosphatemia, Hypercalcemia, HyperKalemia and Hyperuricemia. The reason is both K and PO4 are intracel so they increase, PO4 causes HypoCa and Degradation of cellular protein causes increased Uric acid.
Turcot synd
It refers to an asso b/w brain tumors (primarily medulablastoma and gliomas) and FAP ( Familial Adenomatous Polyposis) or HNPCC (Hereditary Non Polyposis Colorectal Cancer. Its autosomal recessive and occurs mostly in teens. DDX1: Gardner, An auto Dominant, colonic polyps are seen with extraintestinal lesions, like Desmoid tumors, sebacious or epidermal cysts, lipomas, osteomas (mandible) gastric polyps and nasopharyngeal angiomas. DDX2: Peutz-Jeghers, an auto dominant dis, intestinal hamatomatous polyps with cutanous melanocytic macules. DDX4:Multiple Hamartoma synd, asso of GIT hamartomas and breast cancer, thyroid cancer and gingiva hyperplasia.
Turner synd
Since all ova are lost by atresia before menarchi, pts have streaked ovaries. There are no estrogen production, as there are no functinal filicular cells in streak ovaries. Absence of follicular cells results in absence of estrogen and inhibin from the ovaries as a result of loss of feedback inhibition of estrogen on LH & FSH causing their elevation. Inhibin only causes feedback inhibition of FSH, so in the absence of inhibin, serum FSH are more than LH, which is pathognomonic for Primary
Ovarian Failure. **** Variation are possible, as in one X and one Y Ch. In this case the pt needs a bilateral gonadectomy due to increase risk for
gonadoblastoma.*****Cxr shows rib notching due to coarcation of the aorta. Ulcerative colitis - 3
Toxic Megacolon is a complication of UC. Its an emergency and prompt admin of IV steriods, nasogastric decompression& fluid management is required. Pt presents with diarrhea and bloddy stools, Dx is established clinically and colonoscopy. As it progresses, the rectum looses its elasticity and lumen collapses. Once tx is sarted some pt remit but some go on and manifest wieght lost and fever, when this acute colitis symptoms are associated with radiologic evidence of coloninc dialatation its called toxic megacolon.****Pts with UC that have pancolitis, should begin
surveilance colonoscopy after eight years of diease. Ulcerative Esophagtis
with Odynophagia, shallow superficial ulceration and intracellular incluisons are dx of CMV (tx is gancyclovir). If ulcers are caused by HSV(tx is Acyclovir) they are multiple, well circumscribed and look like Volcanos.
Ulnar Nerve entrapment
Decreased sensation to 4 & 5 digits, and weak grip. The mc site is the elbow, in medial epicondyl groove.
Umbilical cord compression
is asso with Variable deceleration. Fetal sleep presents with decreased logn term variability. Fetal Head compression is asso with EARLY deceleration.
Uteroplacential insufficiency presents with LATE deceleration. Intrauterine infection presents with tachycardia.
Umbilical Hernia
Is due to imperfect closure or weakness of the umbilical ring. Commonin low weight and Black infants. Its covered with skin and is easily reduced. > most disappear by one year. Surey is advised if hernia persists to the age of 3-4, exceeds 2cm in
diameter, causes symptoms, becomes strangulated or progresily enlarges after 1-2 years.
Urethral injury, posterior - 2
Hallmark of Urethral injury is triad of 1-Blood at urethral meatus. 2-Inability to void, 3-Distended bladder. We have two types of UI: 1-Anterior, urethral inury anterior to perineal membrane. AUI are mc due to blaunt trauma to perinuem (saddle injuries). An immediate surgert is tx. 2-Posterior urethra, consists of prostate urethra and membaneous urethra. PUI are mc asso with pelvic fracture and high riding prostate. Initial mgmnt is retrograde urethrogram and then suprapubic catheterization. Remember Urethrogram with post void film is for Bladder injuries.
Urethritis
A/01/03. Tx for uncomlicated infections, Tetracycline, Azithromycin. For Pregnant women Erythromycin.
Uric acid stones
Are visualized via CT of abdomen, or IV pyelography.*****Needle shape crystals on urine analysis indicate urc acid stones. Uric acid stones which are radiolucent have to be evaluated with either CT of abdomen ar IVP. The stone can cause Ileus, possibly due to vagal reaction due to ureteral colic. The result will be absent bowel sounds, constipation, signs of obstruction, no gas passing. Ileus will be over once ureterolithiasis is tx. Stones <o.6 pass spontaneously with hydration and analgesics. Don’t do colonoscopy in case of ileus due to perforax. Also no barium enema or sigmoidoscopy since there is no pathology in left side.
Presents with intense abdominal pain asso w vaginal bleeding, ranging from
spotting to massive hemorrhage.****Risk in transverse line is 0.5% and in Vertical its 5.0%. If pt does not want any more children, total hysterectomy is the Tx of xhoice. If she wants more kids then Debridment and closure is
indicated.****difficult to ddx from abrupta placenta. UR is preceeded by agitation, rapid breathing, tachycardia.
UTI in females - 3
The mcc in order are: 1-Shorter urethra compare tomen, 2-Contraceptives, 3-wt periuretral envoronment, 4-close proximity to anus.*****E.Coli is the mcc but it dos not produce uease so it doesn’t alter the normal Acidic pH of urine. Proteus is a urease producing bacteria and a frequent cause of UTI. Protease makes the urine Alkaline. ****In a female that there is no response to trimetasulfa and yellow/green mucopurulent endocervical dischage and edematous friable cervix, suspect
C.Trochomatis. Dx is cervical culture. Asingle doze of Azithromycin for both