1. Non stress test: 
- Used to evaluate decreased fetal movement; used to evaluate all high-risk pregnancies starting at 32-34 weeks gestation.
- Normal: 2 or more accelerations (HR increases >15 beats/min above baseline for >15 seconds) in 20 minutes.
- If less than 2, considered abnormal - most common cause is fetal sleep cycle; wake fetus with vibroacoustic stimulation and then try again.
2. HTN in pregnancy: 
- Chronic: >140/90 anytime before 20 weeks of conception
- Gestational: new onset HTN at 20 weeks, without evidence of proteinuria or end organ damage
- Pre-eclampsia: new onset HTN at 20 weeks + proteinuria OR signs of end organ damage
- Eclampsia: Pre-eclampsia + seizures
- Chronic HTN + preeclampsia: chronic HTN + worsening HTN/proteinuria/end organ damage beginning at 20 weeks
- Risk factor for IUGR, placetal abruption (other risk factors: DM, smoking, cocaine use, prior abruption)
3. Diagnosing acromegaly: 
- GH => IGF-1; the levels of GH fluctuate in a diurnal pattern but IGF-1 levels are consistent elevated and is thus the preferred initial test to evaluate. IGF-1 levels do tend to decrease with age.
- If IGF-1 is positive, then confirmatory test - oral glucose suppression. Most people suppress GH to <1 ug/dL after 75g glucose load, but those with acromegaly do not.
- If both are positive, should get MRI brain; if no pituitary tumor found, look for ectopic GH-secreting tumor.
4. Esophageal rupture: 
- Most common cause is instrumentation
- Mallory-weiss is an incomplete mucosal tear at GE junction; not a true perforation (ie will not cause mediastinal air)
- Boerhaave syndrome is a complete tear, and typically occurs a few cm above GE junction.
5. Febrile seizures: 
- Typically occur in kids 6 mos - 6 years, at T>38, in association with viral illness (flu, adeno, HHV6) or bacterial infection
- Can be simple (nonfocal - tonic clonic/atonic, one episode) or complex (focal, one ep > 15' or multiple episodes > 30')
- Treat if seizures last > 5 minutes
- If the patient returns to neurologic baseline afterwards, and is otherwise healthy and with a normal exam, there is no indication for more invasive testing or imaging and no indication for further treatment.
- These do not cause brain injury, and these kids go on to develop normally. The recurrence rate is around 30%, and the risk of future development of epilepsy is low (<5%)
6. Bowel ischemia complicates up to 7% of aorto-iliac vascular surgery, and most commonly occurs in distal L colon. Presents with dull pain and hematochezia. Scope shows discrete segment of cyanotic and ulcerated bowel.
- Radiation proctitis, on the other hand, is typically associated with diarrhea, tenesmus, incontinence, with possible development of strictures and fistulae.
7. Malignant otitis externa: 
- If untreated can cause skull osteomyelitis and CN damage (i.e. of 7th nerve)
- Will see granulation tissue in ear canal
- Must treat with systemic antibiotics - topical are ineffective
- Contrast with Ramsey Hunt syndrome, which is a zoster infection of CN 7 (can also cause palsy) - will see vesicles in ear canal.
8. Niacin 
- Flushing related to prostaglandin induced vasodilation - treat with aspirin.
9. Respiratory distress in neonate: 
- Choanal atresia - can be bony (90%) or membranous (10%), presents with cyanosis with feeding; treat with OG tube and definitive surgical/endoscopic repair; may occur alone or with CHARGE syndrome (coloboma, heart defects, atresia of choanae, renal abnormalities, growth impairment, ear abnormalities/deafness)
- Laryngomalaica: inspiratory stridor worse with exacerbation/distress. Rarely cyanosis.
- TOF: cyanosis triggered by stress.
- TEF: typically with have coughing, respiratory distress, and lung sounds in addition to cyanosis
- Transient tachypnea of neonate: tachypnea, nasal flaring, costal retractions, grunting immediately after birth
- Vocal cord paralysis - presents identically to laryngomalacia (stridor, tachypnea, rarely cyanosis) and can only be distinguished by direct visualization.
10. Repeated episodes of thrombosis (ie thrombophlebitis) - think genetic hypercoagulability in younger person, GI/GU cancer in older (gastric, ovarian, pancreatic - pan scan)