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Prego’s, Hoo-ha’s and Beans (oh my!)
Board Review for Ob/Gyn and Renal Tracie Shea, MD January 17, 2008
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What is Chadwick’s sign and when does it develop?
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Chadwick’s sign is a bluish discoloration of the cervix
Chadwick’s sign is a bluish discoloration of the cervix. It is a sign of pregnancy that develops at 6-8 weeks.
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What is the normal pCO2 in pregnancy?
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30 mmHg Decreases due to the increases in minute volume.
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Physiologic Changes of Pregnancy
Pulmonary RR and VT Cardiovascular CO and HR BP Renal BUN and Cr GFR Heme Volume, WBC, D-dimer Hgb and platelet
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Name one physiologic parameter that decreases in pregnancy
Name one physiologic parameter that decreases in pregnancy? (hint: on previous slide)
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FRC BP BUN and Cr Hgb Platelets
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What immunization is contraindicated in pregnancy?
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Any live immunizations.
MMR Smallpox
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What is the most common cause of spontaneous abortions?
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Chromosomal abnormalities Then:
Autoimmune disease Drugs Maternal illness Increased maternal age Conception early in post partum period
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What are the general landmarks for gestational height?
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12 weeks – Pubic Symphysis
20 weeks – Umbilicus 36 weeks – Costal Margin
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What is the discriminatory zone for transabdominal ultrasound?
And at what week should a gestational sac be visualized?
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ß-HCG > 6500 mIU 6 weeks
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Endovaginal ultrasound?
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ß- HCG >1500 mIU 5 weeks
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Name a risk factor for ectopic pregnancy that is not PID or previous ectopic?
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IUD Pelvic surgery Infertility treatments
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What is the mechanism of methotrexate?
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Inhibits the formation of nucleosides
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What are the contraindications for methotrexate use?
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ß- HCG > 5,000 Evidence of rupture Active renal or liver disease Inability to provide/obtain adequate follow up
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What is the criteria for hyperemesis gravidarum?
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Ketonemia Electrolyte disturbance Loss of >5% of pre-pregnancy weight
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Ultrasound findings of a molar pregnancy?
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Snowstorm appearance
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What is the difference between a complete and partial molar pregnancy?
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Complete mole- 46 XX- both paternal in origin, no fetal tissue.
Partial mole- 69 XXY- may have viable fetus ß-HCG higher than expected
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What is the most sensitive indicator for placental abruption?
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Fetal distress Not ultrasound or vaginal bleeding
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What are the indications for Rh immunoprophylaxis?
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Any Rh-negative mother who is/may be carrying a Rh-positive baby and are exposed to any event, which puts them at risk for developing isoimmunization.
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What are the dosings for Rho-GAM and when does it need to be administered?
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50 mcg IM < 12 weeks gestation
Must be administered within 72 hours of the event.
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What is the leading cause of maternal death in preeclampsia?
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Intracranial hemorrhage
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What is the treatment for preterm labor?
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MgSO4 – 6g IV then 2g/hour Terbutaline 0.25 – 5 mg SQ Steroids if pt < 34 weeks
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Signs of amniotic fluid vs. vaginal fluid?
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“pooling” of fluid in vaginal vault
“ferning” on glass slide pH (nitrazine paper turns blue)
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Define mild preeclampsia
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BP > 140/90 with proteinuria
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Define sever preeclampsia
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BP > 160/90 Or ANY symptom: oliguria, cerebral or visual disturbances, pulmonary edema, epigastric RUQ pain, impaired LFTs, thrombocytopenia, fetal growth restriction.
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Treatment for preeclampsia
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MgSO4 4g IV then 1-2 g per hour
Benzos for seizures Hydralazine 5mg IV or labetalol 20-40mg IV for BP Delivery of fetus
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What is a normal fetal heart rate?
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bpm
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Name the 5 measurements of the APGAR score?
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Appearance (color) Pulse Grimace (reflex) Activity (tone) Respiration
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Define HELPP syndrome
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Hemolysis Elevated liver enzymes Low platelets Address coag deficits
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How many weeks following the last menses do ectopic pregnancies most commonly present?
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5-8 weeks
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What is the next approach if a nuchal cord is unable to be reduced?
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The cord should be cut prior to delivery
and the child quickly delivered.
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What is the treatment for mastitis?
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Dicloxacillin 500 mg qid x 1 week
1st generation cephalosporin I&D if necessary
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POINT TALLY!!!
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What is the treatment for a bartholin’s abscess?
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I & D Place Word catheter GC/Chlamydia cultures F/u Ob/Gyn
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For what length of time should a ward catheter be placed for a Bartholin Abscess?
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4-6 weeks
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What is the 2nd line treatment for GC?
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Cefixime 400mg PO 1st line- Ceftriaxone 125mg IM
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What is the 2nd line treatment for Chlamydia?
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Doxycycline 100mg PO BID x 7d
1st line- Azithromycin 1 gm PO
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What are the indications for hospitalization for PID?
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Cannot exclude surgical abdomen
Pregnancy Failed outpatient treatment Severe illness (N/V/high fever) Tubo-ovarian abscess Inadequate follow-up.
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What is the inflammation of the liver capsule resulting in adhesions secondary to PID?
What is it commonly caused by?
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Fitz-Hugh-Curtis Syndrome
N. gonorrhea
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What should we always consider in older women with tubo-ovarian abscess?
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Always consider malignancy or diverticular disease.
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Name some predisposing factors for adnexal (ovarian) torsion.
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Cyst Hyperstimulation Tumor Pregnancy PID Pelvic surgery
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What is the gold standard for diagnosing ovarian torsion?
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Laparoscopy U/S lacks sensitivity and normal blood flow does NOT r/o torsion
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Most ovarian tumors are derived from what tissue?
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Epithelial
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Name some causes of dysfunctional uterine bleeding.
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Anovulatory states Polycystic ovarian disease Weight gain or loss Eating disorders Hypothyroidism Fibroids (leiomyomata) Exogenous gonadal steroids IUD Cervicitis Coagulopathies Endometrial hyperplasia/malignancy
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POINT TALLY!!!
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In which of the causes of acute renal failure (prerenal, renal or postrenal) is the microscopic urinalysis abnormal?
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Renal
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Prerenal vs. Renal (ATN)
Urine sodium > 40 mEq/L Dilute urine
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Renal (ATN)
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Prerenal vs. Renal Urine/plasma creatinine ratio < 20
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Prerenal vs. Renal PreRenal Renal < 20 > 40 > 40 < 20
Urine Sodium Urine/plasma Cr PreRenal < 20 > 40 Renal > 40 < 20
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What are the indications for emergency dialysis?
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A – acidosis (pronounced)
E – electrolyte imbalance (esp. hyper K) I – intoxication (methanol, ethylene glycol) O – overload (fluid) U - uremia
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What is the most common cause of renal azotemia?
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Acute Tubular Necrosis
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What is the most immediate life-threatening complication of acute renal failure (ARF)?
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Hyperkalemia
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What is the most sensitive test for detecting rhabdomyolysis?
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Serum creatnine kinase (CK)
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What are the most important electrolyte abnormality occuring in association with rhabdomyolysis?
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Hyperkalemia and hypocalcemia
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Which type of kidney stone occurs in association with chronic UTI’s due to urea-splitting organisms?
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Struvite Stones
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Name 2 diseases that produce uric acid stones.
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Myeloproliferative disease or leukemia
Gout
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What type of renal stones are radiolucent?
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Uric acid and xanthine stones
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What is the most common cause of infection of vascular access in hemodialysis patients?
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Staphylococcal
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Most UTI’s are caused by which organism?
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E. coli
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What is the definitive diagnosis of UTI based on?
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Isolating 105 colony-forming units on bacterial culture.
Associated with > 10 WBC per hpf
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What is the most common cause of nongonococcal urethritis?
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Chlamydia
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If a gram stain from a painless penile ulcer reveals Donovan bodies it is indicative of what disease?
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Granuloma inguinale
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What is the treatment for granuloma inguinale?
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Bactrim or doxycycline for a minimum of 3 weeks.
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What are the predominant causative organisms of Fournier’s Gangrene?
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Bacteroides fragilis E. coli
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Which of the following urologic conditions requires emergency treatment?
Phimosis Paraphimosis Peyronie’s disease
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Paraphimosis
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Phimosis- inability to retract foreskin
Paraphimosis- inability to replace retracted foreskin back over the glans Peyronie’s- penile fibromatosis
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POINT TALLY!!!
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What is the initial treatment of choice for both reversible and irreversible priapism?
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Sub Q terbutaline Along with hydration, oxygen, pain control. Also can try alpha-agonists, aspiration of corpus cavernosum, HBO Rarely requires surgery; urology should be consulted
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What are the most common ages for testicular torsion to occur?
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First few days of life Between years
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What are the “classic” exam findings for testicular torsion?
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Swollen, firm, high-riding testicle with a transverse lie.
NO cremasteric reflex
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A positive Tzank smear confirms the diagnosis of what?
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Herpes simplex Although this is no longer done. Diagnosis is usually clinical or with PCR testing.
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What is the organism most likely to cause prostatitis?
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E. coli Followed by GC/Chlamydia Klebsiella Enterobacter Proteus
Pseudomonas
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Name the systemic diseases that are associated with orchitis?
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Syphillis Mumps Viral illness Bacterial spread of epididymitis
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What are the presenting signs/symptoms of polycystic kidney disease?
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Pain Hematuria Nocturia (due to concentrating deficit) HTN (renal insufficiency) UTI’s and pyelonephritis Family history
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What is the major cause of staghorn calculi?
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Urea splitting organism (struvite stones)
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What imaging modality should be used to diagnose polycystic kidney disease?
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Ultrasound
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What is the most common testicular tumor?
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Seminomas
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What organism must be considered in patients with recent or indwelling foley catheters with UTIs?
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Pseudomonas
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What is the leading cause of perinephric abscess?
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Pyelonephritis
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What causes painful penile ulcers?
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Herpes Haemophilus ducreyi
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What is the treatment for H. ducreyi?
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Single dose: Azithromycin Ceftriaxone
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What is Prehn’s sign and what does it distinguish?
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Elevation of painful testicle decreases pain
Seen in epididymitis
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What are some causes of nontraumatic hematuria?
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GU tumors Vigorous exercise Renal disease/infection Bleeding disorders Dyes
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What is the triad of HUS?
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Hemolytic anemia Thrombocytopenia Renal insufficiency
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Do we treat HUS or TTP with plasma exchange, FFP or Steroids?
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TTP Treat HUS with supportive care.
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POINT TALLY!!!
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The End
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