Pt treated at community health centrePt with essential hypertension >>>> 1st line treatment >. Thiazide diuretics

Pt on amiodarone experiencing hypothyroidism >> next step ? >> check TSH levels Do Not Stop Amiodarone

Amiodarone induced thyroid problems:- Thyroid functions are monitored every 6 month on pt on amiodarone - Amiodarone causes thyroid dysfuncion due to its high iodine content .- Hypothyroidism ( 85% ) is more common than thyrotoxicosis - Thyrotoxicosis; two mechanism by which amio. Causes hyperthyrotoxicosis

1. Type 1 thyrotoxicosis : (activation of graves disease) Rx: high dose Thioamides (methimazole / propylthiouracil ) >> Perchlorate for further

2. Type 2 thyrotoxicosis : ( destructive thyroiditis )Rx: Steroids

- Hypothyroidism: 1. it is not necessary to discontinue amiodarone if a pt becomes hypothyroid2. pt of amiodarone induced hypothyroidism require a higher dose of levothyroxine since it inhibits conversion

of T4 to T3 3. Rx: Levothyroxine

Pt with mildly suppressed TSH but normal T4 and T3, no symptoms , normal heart rhythms , normal bone density >> not intensively investigated because no treatment is necessary and high chances of normalization of TSH >> repeat TSH after 6-8 weeks is generally performed. SUBCLINICAL THYROITOXICOSIS:

- Suppressed TSH with normal T4 and T3 levels - Most common causes include levothyroxine , nodular thyroid disease , graves disease and thyroiditis - If induced by Levothyroxine >>> Reduce the dose of LEVO - If etiology cannot be determined , no symptoms , normal heart rhythms , normal bone density >>>

>>>>> Repeating TSH after 6-8 weeks is generally performed

Pt with abdominal aortic aneurysm , single most important factor with greatest likelihood of slowing AAA progression >> smoking cessation INDICATION FOR SURGERY IN AAA :

1. Diameter > 5 cm 2. Presence of symptoms \3. Rapid rate of growth

Symptomatic hyperthyroid pt with tachycardia >>> give B-Blocker ( propranol / atenolol ) [ symptoms can be quickly controlled with it

Diabetes Mellitis is a single most important in determining the future CVS events in a women .

pt hypertensive and Diabetic with using metformin undergoing CT scan ,, what best next step? >>> Metformin and Nsaids should be discontinued ( IMP : why NOT copious fluid intake oral , the role and efficacy of oral rehydration is unclear , Pt who are at risk of developing ARF should be given NaHCO3 or Normal saline infusion before and after therapy )

METFORMIN IMPORTANT CONTRAINDICATION : 1. Renal failure ( creatinine 1.5 or more in males , 1.4 or more in females ) 2. Decrease creatinine clearance ( below 50 ml/ min)3. Congestive heart failure 4. Significant liver disease 5. Alcohol abuse

>>> Furthermore metformin should also be discontinued in any situation where s decrease in creatinine is expected Eg before administration of contrast for radologic procedure , Sick admitted patient

Pt with dementia and urinary incontinence + enlarge prostate >>>>> Overflow Incontinence due to bladder outflow obstruction Dementia associated with urinary incontinence is a multifactorial disorder that may not be etiologically related to demecntia itself.therefore careful assessment of an individual patient and revealing predisposing urinary tract and non-urinary tract conditions may be treatable Not necessary Normal pressure hydrocephalus other factors should also be considered . Not Atony caused by Alzheimer and multi-infarct dementia( thought to damage cortical and subcortical inhibitory structures ) however several studies have proved that even severely demented pt mat stay continent.

Lactose intolerant pt what should be given for Calcium >>. Fermented milk and Yogurt with live cultures containing beta-galactosidase which is well tolerated in these pts

pt with TSH levels 8 (or between 5-9)and free T4 normal+ Asymptomatic + Normal menstrual cycle + normal Lipids and taking no medications , which parameter is useful for guiding her therapy ? >>>. SUBCLINICAL HYPOTHYROIDISM >> SUBCLINICAL HYPOTHYROIDISM:

- Defned as mild elevation in TSh levels ( 5-10 ) accompanied by normal free t4 levels. - Treatment is warranted in presence of

1. Antithyroid peroxidase antibodies 2. Abnormal lipid profile 3. Symptoms of hypothyroidism 4. Ovulatory / menstrual dysfunction

- When antithyroid bodies are present with elevated TSh , there are high chances for a pt to become overtly hypothyroid

- A pt of TSh > 10 is also generally treated with levothyroxine

Pt eith esophagus / stomach diseases what sort of endoscopy is recommended ? >>>>>>> Endoscopy is preferred than Wireless video EndoscopyWireless Video Endoscopy :

- effective tool to diagnose some small bowel disease inc. haemorhage, tumor ulceration inflammatory conditions - Images are excellent and more magnified than endoscopy- Limited view of esophagus , stomach and cecum ( so Endoscopy is clearly preferred )- Complications are rare , retention of capsule occurs in 1% of people.

Pt with current c/o urinary frequency and still BP is high , past h/o COPD , hypertensive, hypercholesterolemic, taking many drugs inc Ipratropium inhaler too , O/e smoothly enlarged prostate >>> what to do ?>> add an A-blockers (e.g prazosin) Not stop Ipratropium because it will improve prostate symptoms but will not be any benefit to hypertension and COPD management of this pt.>> Joint national Committee seventh reports states that alpha blocker are indicated for the management of pt with both hypertension and BPH unless the pt has Congetive Heart Failure or develops persistent dizziness .Alpha blockers are also useful in diabetic because they increase insulin sensitivity , decrease LDL and increase HDL

pt with hair loss in groups on/e the hairs have split ends and oil visible on the strands ??? Traumatic alopecia :

- Damage by some Chemical Reaction, traction , hair eating (trichotilomania )- Produce a lesion on the hair strand or shaft itself . The hairs have split ends there should be toxic or chemical

reaction causing the hairloss.This can be by application of certain substances over the scalp or hairs NOT lithium because it produces Thining of the hairs and widespread hairloss, without damaging hair itself NOT allaergic reaction it will damage

Pt on OCPS and depressive >>> give SSRIs NO NEED to discontinue OCPs

Pt with past history of papillary thyroid cancer now with TSH > 5 what to do next ?>> Thyroid cancer in remission >>> the dose of levothyroxine is (increased ) adjusted to suppress the TSH below normal range usually between 0.1- 0.3 units >> for pt with metastasis complete suppression is required Important to remember the Side Effects of Levothyroxine >> Boneloss and Atrial fibrillation

Pt to be started on Clozapine >. Weekly monitor WBC for agranuloctosis during first 6 months of therapy then bimonthly And then monthly The majority of cases of agranulocytosis occurs in first three months

Pt with Diabetic background retinopathy >>>> a tight Glucose Control is paramount to prevent or stop the progression of Diabetic retinopathy . Intensive Insulin Therapy can prevent more than

50% of the cases and retard the progression of the disease. And a good control of hypertention with ACE inhibitors

Toxicology screen:The best evidence of a long term recreational drug use is to obtain from a >>>>>>>>> Thorough HISTORY and TOXICOLOGY SCREEN .Some of the widely accepted indications for toxicology screen are :

1. History of alcohol or other drug2. Evidence of drug use on physical exam. E.g. Septal perforation 3. Signs of intoxication and withdrawal 4. Altered mental status

>>> IMP : it is important to seek pt permission before testing so as to not jeopardize his trust

Drug addict pt. STABLE : what to do for this planning ?Drug Rehabilitation Program are the preferred means of initiating recoverer’s from drug addiction while Group Therapy Programs (eg alcohol anonymous ) are the preferred means of maintaining drug and alcohol abstinence. Inpatient hospitalization is for those who experiences Withdrawal symptoms or who poses a danger to himself or others

Pt with nevus increasing in size asymmetric, color variegation , > 5mm in diameter >>> suspected Melanoma >>>>>>>>> EXCITIONAL biopsy is the next step in pt with suspected malignant melanoma Interferon alfa 2b is used as an adjuvant therapy in pt with high risk of developing metastatic disease.

The most effective method of detecting alcohol abuse or dependence >>>> CAGE questionnaireStepwise approach to Alcoholic patient :

1. Ask about current and past alcohol use and family history of alcohol problem 2. Ask about type quantity and frequency of alcohol use ( distinguish b/w moderate and heavy user)3. Standard questionare CAGE 4. More specific qs related to 1 and 3

If a pt tell you he is alcoholic next step ? >>> ask about type quantity and frequency of alcohol use

A pt diagnosed tuberculosis 3 years back and didn’t take the complete course of therapy now comes with fatique and wt loss coming with labs that shows isolated elevations of ALP , ALT AST normal , bilirubin normal , albumin normal , PT normal likely cause ?? >>>>> >>>>> Infiltrative disease of liver ( lymphoma and tuberculosis ) , in this case Tuberculosis

NOT alcoholic disease coz normal AST and ALT , no cirrhotic stigmataNOT Viral disease coz it would cause elevation of ALT and AST too with or W/O jaundiceNOT CBD stone coz prominent inc of ALP with some hyperbilirubinemia with or W/O Abdominal pain NOT pancreatic head CN it never causes isolated elevation of ALP

Most effective strategy to decrease the pt risk for development of acute coronary artery disease ?? >>> Decrease LDL cholesterol ( 1st prime ) and blood pressure control ( CAD and DM BP less than 130/80) Imp: other measures like exercise , stop smoking diabetes control and HDL are beneficial but not as critical as above two.

Pt coming with purulent and abundanr uretheral D/C after having sexual intercourse 2-7 days >>>> Gonococcal Urethritis >>> RX ceftriaxone

Pt coming with watery or mucoid uretheral D/C after having sexual intercourse 5-10 days >>>>> Non gonococcal urethritis >>>Rx : Azithromycin single dose 1st line Doxycyline – 7 days 2nd line The same pt comes after 10- 15 days again complaining the same , No new exposure and he is medicine compliant >>>> NGU not by Chlamydia >> give Metronidazole single dose 2 gm followed by 7 days of Erythromycin 500 mg q 6 hr ( therapy is directed

against Trichomonas and resistant NGU pathogens ) Alternate : Erythromycin monotherapy High dose

800 mg x 6 times a daySickle cell disease : In Children the most common initial symptom of sickle cell disease is dactylitis develops in 40 % Splenic sequestration is second most common and occurs in about 20 % of pt.

Pt Sexually active with c/o rash that is maculopapaular with cervical adenopathy , gives past history of sorethroat and fever for which he started an antibiotic >>>>>> Ampicillin induced Rash: immune mediated rash (circulating immune complex Ig G and Ig M directed aganist penicillin derivatives )

- The pt was probably suffering from Infectious mononucleosis . ampicillin induced rash is commonly seen in 80%- Especially when IM by EBV- Rx: D/C antibiotic and observe

Exposure to TB pt : do PPD >>>> if –ve >>>> repeat after 10 weeks after the last exposure.

Syndromes of children :

Turner’s syndrome 45xo : the recurrence risk does not increase after having an infant with turners syndrome The risk of 45xo does not increase with increase maternal age.

Perimaenupause :- Perimenupause is the time extending from two to eight years preceding menopause until one year following the

last menstrual period - This state is associated with normal ovulatory cycles interspersed with an ovulatory cycles that vary in length- Because the hormone levels are inconsistent during perimenoapause and estrogen is frequently unopposed , menses

become irregular and heavy breakthrough bleeding may be reported - Endometrial hyperplasia can develop during lengthy intervals of anovulation - HI YIELD: if pt complains of an episode of heavy dysfunctional bleeding or of six or more months of

irregular menses then endometrial suveilance in the form of Vaginal Ultrasound ( to ensure thickness is <4mm ) or Endometrial Biopsy is indicated. ( very very high Yield)

Child with sudden behavioral problems with unstable economic background / parents have a history of drug abuse >>>>>> always maintain a high index of suspicion of Physical / Sexual Abuse

BEST CONTRACEPTIVE: Implantable and injectable contraceptives , including implantable levonorgestrel and depot medroxiprogesterone acetate , have the lowest rate of pregnancies among nonpermanent methods of contraception.

Emergency Contraception :Levonorgestrel: Maximal efficacy first 12 hours ,,, good efficacy 48 hours ,,Can be used upto 120 hours after intercourseIf presented after 120 hours >>>> copper intrauterine device

Chances of infertility in women of Cystic Fibrosis are 20 % because of secondary amenorrhea caused by malnutrition and also due to thick and tenacious cervical mucous while in males are 95 % , Spermatogenesis is normal but sperm transport is impaired because of impaired development of wolfian duct.

Young women with ASCUS ( atypical squamous cells of unknown origin ) >> Next step : >>>> HPV DNA testing

Pt with wt loss and non specific symptoms , itchy dry rash on face and axilla >>>> >>> AIDS suspicion >>> obtain sexual history and I/V drug use history for AIDS

Cervical cancer screening should be started three years after initiation of sexual intercourse or at the age of 18.

Lesbian women have a lower risk of acquiring HPV infection and a lower chance of developing CIN and invasive cervical carcinoma

Women with pre-eclampsia in previous pregnancy asking for chances in new pregnancy ?? >>>> More likely to develop preeclampsia in subsequent pregnancy A history of preeclampsia in the first pregnancy increases the possibility of a second episode in the following pregnancy. The risk is at least 7 times higher , but it can be higher as 15 if the previous preeclampsia presented before 33 weeks of pregnancy .

Pt vaccinated 10 days back with influenza vaccine and acquired influenza why ?? >>> It takes about two weeks to mount an adequate immunologic response against the influenzas virus

Treatment of the influenza must be started earlier :Within 30- 36 hours when using zanamavir and oseltamavir Within 48 hours when using rimantidine and amantidine If greater then that only symptomatic therapy with acetaminophen

Old age women with multiple co morbidites and on gynae exam demonstrate protrusion of the posterior vaginal wall that is most prominent with bearing down while in the lithitomy positionRECTOCELE :

- Is a relative common condtion in older women and is characterized by the displacement of the rectum through posterior vaginal wall defect

- The condition is typically caused by damage to the recto vaginal septum incurred during vaginal childbirth - Exaberated by periodic increases in intraabdominal pressure ( laughing and coughing ) and the effect of the gravity - RX:- If Aymptomatic : pelvic exercises , regular use of intra vaginal Estrogen and avoidance of activities with

increased abdominal pressure - If Symptomatic : surgical repair Posterior colporraphy is the most appropriate recommendation however

correction of the condition does not always provide symptomatic relief.- Women with symptomatic rectocele who are poor surgical candidates / who donot wish to undergo surgery may be

treated with Pessaries which are structures designed to support the vaginal wall - Pessaries should only be used in conjunction with vaginal estrogen ( without this these can cause chronic

discharge and bleeding secondary to injury of the vaginal tissues .

Boy with Acute otitis media presentation, no prior history of antibiotic use in previous month , amoxicillin is prescribed after 3-4 days condition remains the same next step ?? This boy has Treatment failure so Drug resistant S. Pneumonia ( DRSP) infection + No history of previous AB use >>>> treat for DRSP high doses of Amox/ Clavulanate or certain 2nd / 3rd gen Cephalosporin

If Treatment failure Drug resistant S. Pneumonia ( DRSP) infection + History of previous AB use >>>> treat with high doses of Amox/ Clavulanate or certain 2nd / 3rd gen Cephalosporin . IM ceftriaxone is even more effective against DRSP Moreover Immediate tympanocentesis allows culture and sensitivity. Tympanostomy and tubing is generally reservcd for chronic otitis media with effusion persisting for more than 3 months or recurent AOM ( greater than 6 episodes in 6 months ) which is not prevented by prophylactic antibiotic ( half of normal dose amoxicillin or sulfisoxazole ). It might be considered in AOM if the bulging earache fever vomiting and or diarhoea were unusually severe of persistent

PAP smear result LSIL , Satisfactory colposcopy prove CIN 1 >>>> expectant management repear pap in 6 months If colposcopy was not satisfactory >>> Excision

NORPLANT: - Consist of 6 capsules of levonorgestrel which are placed subdermally generally in the upper arm .- it offers contraception for about five years - the most common complication is menorhagia (prolong vaginal bleed during each menstrual period) 28 %- second imp. complications include vaginal spotting 17% , others incl. rash , MI ,PE, thromboemboilism,

TTP , stroke and breast cancer

Most frequent finding in a pt with Marfans syndrome esp in child >>> > Dural Ectasia The risk of Aortic dissection is high in pt with MFS. For this reason corrective surgery is recommended when the aortic root reaches 45mm. About 80% of the pts will have mitral insufficiency which can lead to CHF . These pt will benefit from mitral valve replacement.

Calcium and Vit D supplementation should be given to all post-menopausal women to protect bones.

All pregnant are screened for Gestational diabetes between 24- 28 th month of pregnancy by 50g glucose tolerance test Values =/ > 140 >>>>>>> is followed by 100 gm oral glucose tolerance test for 3 hours

The recommended fasting blood glucose levels in pregnant diabetic pt should range between 60-90mg / dl and post –prandial should be less than 120 mg/dlNPH in combination with lispro insulin is generally indicated if diet and exercise are unable to control (fisrt add NPH at bedtime still not controlled then add lispro postprandial Glargine is long acting and is not preferred

See routine vaccination mtb 2 pg 354 Anogenital warts : RX : three major treatment modalities

1. Chemical destruction by trichloracetic acid ( PREFERED INITIALLY ). Trichloracetic acid destroys the lesion by protein coagulation

2. immunotherapy : systemic or topical interferon 3. surgical excision : when medical therpy is ineffective ablative and surgical options are considered.

Know the primary and secondary amenorrhea workup :

Male not sexually active currently coming with the uncircumcised penis , multiple dome shaped skin color papules , the papules are located in sulcus and the corona of the glans penis and are arranged circumferentialy >>>>>>>>>> pearly penile papule are considered normal variant

Pearly penile papule :- are considered a normal variant- are not spread by sexual contact or activity - no malignant potential - asymptomatic and are more common in uncircumsized - typically appear as on multiple rows of small circumferentially around the corona or sulcus of the glanspenis - RX : No treatment necessary

OCP contraindication:Absolute:

1- History of thrrombolemboic state or stroke 2- Active liver disease 3- History of estrogen dependent tumor 4- Pregnancy 5- Abnormal uterine bleeding 6- Heavy smokers who are older that 357- Hypertriglycedemia

Relative:1- Migraine headache 2- Poorly controlled hypertension 3- Anticonvulsant drug therepy

Exercise induced amenorrhea is due to decrease in the pulsatile secretion of LH , which leads to decline in estrogen production . It can lead to osteopenia , osteoporosis , breast and vaginal atrophy . mild hyper cholesterolemia and infertility. Girl asking for oral OCP what to do ? Prescribe her ORAL OCP and advise her to use Barrier methods to prevent risk for STDs

Carrier of girdia lamblia ( positive cyst on stool and parasite test ) what next step ? >>>>> Asymptomatic carriers of giardia lamblia are not usually treated , No need to isolate too except in specific instances such as in outbreak control For prevention of household transmission by toddlers to pregnant women pts with hypogamaglobulinemia or cystic fibrosis

Primary nocturnal enuresis : - First line management for children less than seven years of age is reassurance the patient’s parents - Among the different modalities alarms are most effective in inducing remission and preventing relapses. The

success rate is higher if this method is combined with complex behavioral intervention ( limiting child fluid intake before bedtime )

- Although Desmopressin has fast induction it is less effective in preventing relapses

MMR ( measles mumps and rubella vaccine ) (EXTREMELY HIGH YIELD )MMR vaccine is ContraIndicated in

1. Current moderate or severe febrile illness 2. Anaphylaxis to neomycin or gelatin 3. Severe immunodeficiency 4. Thrombocytopenia after first dose of mmr 5. Recent administration of immunoglobulin6. Pregnancy

Follwing are NOT contraindication for mmr 1. TB or +ve ppd 2. Breast feeding 3. Immunodeficient family member 4. Asymptomatic HIV infected pts without severe immunosupression 5. Anaphylaxis to eggs

High grade squamous intra epithelial lesion >>>>> LEEP is the treatment of choice

Male doctor ask adolescent girl for examination, girls don’t want you to se her body >>Age appropriate self consciousness

Screening for diabetes melitis : is indicated in everyone above 45 and should be repeated every three years in the absence of other risk factors , the recommended screening test is FBS

Radiograph of pagets disease skull

Pt with PSA ( prostate specific antigen ) levels > 4 ng/ml should be referred to urologist for a biopsy. Pt with a history of colorectal cancer in first generation relative should start having screening colonoscopy at 40 years of age and screening should be repeated every 10 years . seec MTB

Be sure how to recognize the radiograph of pagets disease : thickened bones with homogenous density Pt may also present as elevated alkaline phosphatase with normal calcium and no sign of hepatobiliary pathology

Hearing loss is a common complication in pt with pagets disease and is thought to be secondary to compression of the auditory nerve or inv of cochlea or cochlear capsule .Treatment with calcitonin or bisphosphonate can slow the progression of hearing loss but is unlikely to reverse hearing loss that has already occurred.

All the pt with breast lump after the age of 35 >>>>>>> evaluated with mammography NOT FNAC , U/s

The intervention that have proved to offer more benefit for OSTEOPOROSIS are :1. Smoking cessation (if the pt smokes one pack or more of cig a day2. Raloxifene3. Calcium and Vit D 4. D/C of medication such as heparin or glucocoticoids ( HRT is extremely effective in osteoporosis preventioin but widespread use is not advisable because of the risk of malignancy or cardiovascular disease. )

Female circumcision :- practiced in Africa - is a partial or total cutting away of the ezternal female genitalia in the preparation for womenhood and marriage- the procedure is oftern performed in an unclean setting without anesthetic by those with little understanding

IN PATIENT Post exposure prophylaxis when exposed to an HIV pt >>>>> 2 NRTI or 2 NRTI + 1 PI should be started immediately And continue for 4 weeks Ziduvudine + lamivudine OR ziduvudine + lanivudine + indinavir .Know who to give Prophylaxis of neiseria meningitis : Oral rifampin (600 mg q 12 hour upto four doses ) or Cipro single 500mg oral or ceftriaxone I/M single

Elderly pt with no symptoms Urine Dr shows WBC < 20 wbc /hpf and urine culture show > 100000 colonies / ml >>>> Asymptomatic bacteruria >>>> antibiotic treatment no needed now repeat culture after 2 months Asymptomatic bacteruria:

- Elderly pt are more likely to have aymptmatic bacteruria than frank UTI - Antibiotic therapy is usually not recommended if urine WBC is less than 20 wbc/ hpf or if pt is asymptomatic - Most of the pt resolve w//o treatment , some may develop urosepsis so pt should be instructed to report any

symptoms - Repeat urine culture in 2 months

DKA pt developing fever facial swelling maxillary pain and tenderness nasal DC opthalmoplegia and headache >>>> Rhinocerebral Mucormycosis >>> confirmed by biopsy of infected tissue RX : surgical debridement and IV amphotericin

Bleeding is the most common complication of cervical conization ( cone biopsy)

HIV testing : donot test pateients HIV statis W/O obtaining formal consent.

Pt with HIV status +ve , with Isolated thrombocytopenia >>> Primary HIV associated thrombocytopenia ( PHAT )Primary HIV associated thrombocytopenia ( PHAT ) :

- Thrombocytopenia has been known to occur ar all stages of HIV infection ( whether during asymptomatic or end stage AIDS

- PHAT effects 40 % of HIV +ve pt at some points - PHAt is highly similar to ITP - Most require therapy - RX: the main stay of therapy is Zidovudine ( AZT), which is also known to reduce the occurrence of opportunistic

infections such as kaposi’s sarcoma - Add AZT at a minimum dose of 600mg / dl in a multiretroviral regimen ( if the thrombocytopenia does not resolve

dosage can be increased to 1000- 1500mg/day - Other options :

1- Corticosteroids : the conditions returns when stoped also can increase risk of kaposi’s sarcoma and opportunistic infection

2- Dapsone 3- Splenectomy for Persistent PHAT or dependence on repeated infusions of intravenous immunoglobulin

In HIV pt treated, HAART should decrease the viral load < 5000 copies / mL within 1 months < 500 copies / mL within 2-4 months (8-16 weeks)

<50 copies / mL within 6 months.

Know how to recognize meningitis : be sure how to differentiate between cryptococal and virus Cyryptococcal meningitis :

- CSF findings in pts with cryptococcal meningitis are :1- Markedly elevated opening pressure > 200 on the initial spinal tap 2- Low wbc < 50 with mononuclear predominance ( lymphocytes 3- Elevated protein and low glucose 4- Positive india ink preparation

- RX : IV amphotericin and flucytosine ( 10-14 days ) >> >>> followed by oral flucozole - Some pt with cryptococcal meningitis may present with increased intracranial poessure that manifests as severe

headache , altered sensorium and blurred vision , the opening pressure may be markedly elevated >>>> Serial lumbar puncture for relief >>> some may require lumber drain or ventriculostomies.

Mother blood glucose only moderately controlled during pregnancy >>>> Neonate hypertrophic cardiomyopathy and CHF Neonate hypertrophic cardiomyopathy in diabetic mother: Fetal hypertopic cardiomyopathy and CHF results from excess glycogen deposition within the myocardium resulting in the hypertrophy of of the fetal heart musculature. The interventricular septum is most commonly effected resulting in outflow obstruction Rx: observation and conservative management ( the defect will often correct spontaneously in the infant fallowing birth as it will no longer be exposed to the maternal hyperglycemia )

Aids pt with CVP catheter begin to have significant pain and sensitivity of light in one eye , on fundoscopy lesions are large glistening soft white lesion s with indistinct borders >>>>> Endogenous Candida Endopthalmitis :

-