Believe you can and you’re halfway there. –Theodore Roosevelt Welcome back to Episode 18! This is the last and final rapid review before the In-Training Exam! Remember to pause the podcast as you go through the review and quiz yourself. Let’s get started with Ob/GYN. OB/GYN Emergencies * The most common cause of maternal mortality during delivery is maternal hemorrhage. Maternal hemorrhage can be caused by uterine atony, genital trauma or retained products. Uterine atony is treated with oxytocin or uterine massage. Genital trauma is treated with pressure or ligation. Retained products require removal of the products to control the hemorrhage. * Vaginal candidiasis is treated with fluconazole or clotrimazole. Bacterial vaginosis is treated with metronidazole, twice daily for 7 days. Lastly, trichomoniasis is treated with a single dose of metronidazole. * PID is typically caused by gonorrhea, chlamydia, or both. It is treated with ceftriaxone 250 mg IM once and doxycycline 100 mg PO BID x 14 days if the patient can tolerate PO. Cervicitis is treated with ceftriaxone 250 mg IM and azithromycin 1g PO. * Fitz-Hugh-Curtis syndrome is a perihepatitis associated with PID. It is a difficult diagnosis to make, but suspect it in sexually active woman with right upper quadrant pain. Pediatric Emergencies * Suspect epiglottitis in those who were incompletely vaccinated. The first priority is airway management, which ideally involves intubation in an operating room. The second priority is antibiotics. Ampicillin-sulbactam or ceftriaxone are often used. * Pertussis has three stages: the catarrhal stage, the paroxysmal stage, and the convalescent stage. Treatment is with a macrolide. * There are five common congenital cyanotic heart defects, which can be remembered by the numbers 1-5. One is for Truncus Arteriosus, in which two vessels join to make one. Two is for Transposition of the Great Vessels in which the two great vessels are switched. Three is for Tricuspid Atresia. Remember three for TRIcuspid. Four is for the four defects of Tetralogy of Fallot. Lastly, five is for the five words of Total Anomalous Pulmonary Vascular Return. * The three common acyanotic heart lesions are atrial septal defects, patent ductus arteriosus, and ventricular septal defects. Symptomatic children with such lesions typically present with congestive heart failure by 6 months of life. * Acrocyanosis is a transient blue discoloration of the hands and feet, which can occur when a newborn is cold. Typically, the pulse oximetry reading is normal. Procedural Emergencies * The emergence reaction from ketamine is the most common adverse effect. The most serious adverse reaction is laryngospasm. The laryngospasm can be treated with bag valve mask ventilation. Ketamine can also be used for analgesia in lieu of opiates at a dose of 0.1-0.3 mg/kg. Renal Emergencies * Hematuria with hearing loss is associated with Alport syndrome. Hematuria and hemoptysis is associated with Goodpasture’s syndrome. * Winter’s formula (pCO2 = 1.5HCO3– + 8 +/-2) is a formula to determine if there is appropriate respiratory compensation in a metabolic acidosis. * MUDPILES mnemonic can be used to remember the causes of an anion gap metabolic acidosis: Methanol, Uremia, DKA, Propylene glycol, Iron or INH, Lactic acidosis, Ethylene glycol, and Salicylates. * The HARDASS mnemonic can be used to remember the causes of a non-anion gap metabolic acidosis: Hyperalimentation, Addison’s disease, RTA, Diarrhea, Acetazolamide, Spironolactone, and Saline infusion.