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by anya84, Apr. 2015

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1237 Cards in this Set

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	ASD	wide fixed s2 split also RBBB pulm eject syst murmur possible (left to right shunt) MC in F. hole in septum btw atria echo or cath to dx can cause disrhythmia and paradox emboli
	subclavian steal	difference in arms >15-20 flow reversal in vertebral artery stenosis in subclavians dx w duplex of carotids and subclavs
	amiodarone	PFT, LFT, thyroid class III for AF w/o obstruction inhibits metabolism of warfarin and digoxin (ups levels) prolongs QT (so does procainamide) txs ventric and atrial arrythmias
	ABI	for PAD increase aspirin or add cilostazol nml = 1
	Leriche syndrome	thigh and butt claudicat w ED
	lipid screening	35M 45F earlier if risk facts - DM, fam hx, tobacco, HTN every 5 years of risk under 7.5
	no PCI w/in 90 min (of first medical contact, and 12 hrs w/ing symptom onset)	do thrombolytic therapy asp, hep, altleptase over 1mm ST elevat in 2 contig limb leads or over 2mm precordial
	IABPs	increase coronary artery perfusion
	thrombolytics absolute contraindicats	intracran hemorrage/neoplasm cerebrovasc lesion, ischemisa stroke or head/face trauma 3 mo aort dissect, active bleed, menses
	adenosine dypiramidole persantine	inotropes work like dobutamine but can provoke bronchospasm in COPD/asthma
	MVP	assoc w marfan, ehler danlos soft SYSTOLIC murmur w midsyst click presents like panic attack, palpitats, atypical CP beta blocks or repair OPPOSITE maneuvers
	valsalva and standing	decrease venous return and ventricle size WORSEN MVP and HOCM
	squat and handshake	increase afterload and LV chamber LESSEN MVP and HOCM and AS!!
	cardiogenic shock	tx w inotropes to increase contractility and CO
	AS	crescendo decrescendo radiating to carotids delayed carotid upstroke R 2nd intercostal angina dizzyness syncope HF HANDGRIP DECREASES MURMUR bc ups afterload and downs pressure gradient asympt - do echo sympt or getting CABG or LVEF <50 - replace
	DVT tx	hospital, LWMHep, warf 2-3 INR
	INR 3-4	mechanical valve
	tamponade	elevates pressures in all chambers
	HOCM	harsh cresec decresc systolic LLSB + apex MC present = dyspnea asymmetrical hypertrophy of LV obstruct btw valve leaflet & septum blocks blood thick ventric spetum, SAM (syst ant mot) of mitral valve beta blocks, if don't work - myomectomy implant defib if high risk valsalva and standing WORSEN NOT diuretic syncope - TTE + holter "continuous EKG" to eval for arrythmia
	stress test	measures ischemia use in stable outpt w CP if positive --> angio unclear story = stress test
	beta blockers, ACE, and aspirin lower mortality	in chronic angina ACE better for lower EF and valve regurg dz
	constrictive pericardit	presents w RH fail edema ascites HSM JVD calcifications on CXR - best init test pericardial knock before S3 decreased elasticity fibrotic, caused by TB kussmal tx w diuretics and surgical removal of pericardium
	restrictive cardiomyopathy	thickened walls pulmonary and systemic congestion possible S3 nonspecific ST changes, ankle edema, tender hepatomegaly if caused by amyloid - speckling pattern amyloid, sarcoid, scleroderma, irrevers reversible w hemochromatis
	verapamil	good for rate control, AF tx
	stage I HTN	btw 140/90-159/99 diet exercise thiazide is no comorbs add ACE of betablocker
	mitral stenos	middiastolic rumble, tapping apex beat heard on expirat, diast murmur after opening snap LAD in 70% low pitch rumbling if asympt:annual f/u squat and leg raise INC bc UP venous pressure dysphagia/hoarseness dt LA enlargement balloon valvulotomy if area >1.5cm and pulm artery pressure >50mmHg arrythmias, esp AF common - do EKG hemoptys and pulm HTN, stroke pulm congest + LV fail = SOB/dyspn on exert
	valve eval	TTE best initial - less invasive angio most accurate TEE for vegetations
	MC intracardiac tumor	atrial myxoma middiast rumble near apex like MS low grade fever emboli w CNS sympts
	RV dysfx	result of inferior wall MI - II III aVF UP RA pressure, DOWN RV and wedge press low CO dt low volume in LV (cardio shock) tx w IV fluids nml SVR - syst ven resist
	CHF	LV pump fail tx w O2 morph nitrates furosemide (to down preload) if SOB - add dobutamine to UP contractility and down pulm edema, then hydralazine if pulm edema
	fibromuscular dysplasia	non-atherosclerotic renal art or internal carotid stenos HTN+hypokalemia low serum K - metabolic alk tx w angioplasty
	IV nitro	for HTN emergency and ischemic heart dz
	AAA dx	w US unless obese - CT
	ACEi vs ARB	ACE - cough + hyperkalemia ARB only hyperkal aldosterone excretes potassium hydralazine = arterial vasodilat, down afterload - use w nitrates to avoid steal
	LDL >100	give STATIN (check LFTs) to decrease mortality, try to be under 70 liver dysfx MC than rhabdo antioxidant effect on endothelial lining statin+fibrate = myositis statins also raise LFTs and cause rhabdo = ren fail
	asthma and cocaine or prinzmetal	cant give betablocks, give NON HR-increasing CCBS - verapamil diltiazem
	L main artery occulsion	CABG also 3 vessels + decreased LVEF or 2 vessel + DM or equiv - 70% of prox LAD and PCA
	PCI	1 or 2 vessels NOT including LAD cholest emboli and ren fail = complicats
	beta blocks good for	preop pts w cardiac risk facts
	HTN+hypokalemia (muscle weakness)	hyperaldosteronism
	HTN+hyperglyc and hypercortisol	cushing's
	captopril renal scan	for renal artery stenosis abdominal bruit only check for 2ndary causes if under 25 over 55 otherwise - essential HTN, add 2nd med
	thiazides for healthy pts	raynaud/migraine - CCB stroke - thiazide, ACE DM- thia, ACE, beta, CCB avoid beta in COPD kidni - ACE/ARB post MI - beta, ACE, spironolact
	Afib in stable pt	tx w beta blocks - lower mortality in CHF also CCBs - dilt verap and digox only defibrillate unstable - hypotens, AMS
	digox tox seein in	hypokal --> arrythmia or pts w ren fail check lytes before giving digox scooped ST segs digox level doesn't tell b/c intracell
	mitral regurg	holo/pansystolic at apex radiat to axilla surgery if sympt - dyspnea, orhtopnea, PND or asympt but EV<60, AF, pulm HTN repair better than replace same sympts as CFH
	MCC of diastolic heart dysfx	chronic HTN - concentric hyperthropy tx w betablocks, decrease BP and HR = better ventric fillin ACE/ARB prevent remodeling aldost antags decrease fibrosis
	RCA occlusion	RV/inferior infarct ST elevat + Twave inversion in II III avF hemdyn unstable - give IV fluids JVD hypotens clear lungs
	decrease mortality in CHF	ACE betablock aldoserone antagonsits - spironolactone = aldactone
	displaced PMI to axilla	cardiomyopathy LVH LV dysfx
	JVD up on inhalat	kussmaul constrictive pericardit
	>10mm decrease in BP on inhalat	pulsus paradoxus tamponade
	ST elevat in V2-V4	anterior leads STEMI = worst prognos aspirin then angio to decrease mortality ant wall of LV ACE best for ant wall infarcts
	PR interval > 200	1st degree block
	ST depression in V2-V4	posterior wall MI low mortality
	check reinfarction with	CKMB
	door to PCI door to thromoblysis	90min 30min
	ST depression	give heparin only use thrombolytics clot is formING (in the process) so dissolve it also use in ST elevat w/in 12 hours or new onset LBBB clot already formed in ST elevat, still forming in depress
	GpIIa/IIIb	prevents restenosis after PCI give to angio pts getting stents beta blocks good too, but not time sensitive
	VT/Vfib	cardiovert dx rupture w echo increase in O2 from RA to RV = septal rupture
	3rd degree AV block	bradycardia cannon A waves no A waves in sinus brady
	tamponade/wall rupture	sudden pulseless JVD clear lungs
	RV infarct	inf wall MI II III avF clear lungs, tachy tx w fluids to up prelad
	Vfib	loss of pulse
	valve rupture	papillary muscle 2-7 days post MI new murmur, rales, congestion
	septal rupture	new murmur increased O2 sat entering RV
	ACE decreases CHF mortality by	by lowering preload
	pulmonary congestion	LV fail - backup into lungs
	chronic AR can cause CHF	L side fail burdens HR = R side fail
	RV fail	backs up into body JVD congested liver peripheral edema can be result of L side fail. R side loses pumping power, blood backs into veins = edema
	diastolic LV fail	impaired ventric relaxation stiff, can't fill in diastole nml EF congestion LVH on EKG, prominent LV on CXR MCC=chronic HTN
	systolic LV fail	inadequate contracile fx DOWN EF hypotension can't pump well enough during systole
	no prophylaxis for acquired valve dz	yes for prosthetic valves to avoid endocardit also h/o endocardit, congenital cyanotic dz, valvuloplasty, transplanted heart
	RV infarct	hypotens TR JVD clear lung EKG ST elevat in V4R (R sided leads) AV block RA 10 mmHg, PCWP 8 (nml) Rx w fluid AVOID preload reduxn
	LV infarct	pulm congest S3 S4 MR ST elevat in std leads INC PCWP Rx fluid DECREASE preload and afterload
	pulm edema	can be caused by arrythmias and CHF MC = AF - do EKG pink bloody frothy sputum arrythmia+CP+SOB+CNS: cardiovert dyspnea orthopnea fatigue rales end insp crackles S3 periph edema tx w inotrope dobutamine dec afterload (work against which heart has to pump) if hypotensive give dopamine
	do stress test post MI	5-7 days: submax 2wks: max
	internal mammary	better than saphenous in CABG
	constrictive pericardit	R side fail JVD perishp edema clear lungs early diast sound - pericardial knock calcificats on CXR, kussmal (JVD up on insp) S3 and all 4 chambers equal on cath
	best test for pheochromo	free plasma fractionated metanephrines
	best way to lower BP	weight loss not smoke cessat or diet
	manage stable angina	medical - decs mortality but if recurrent - can do angio for sympts only
	pre HTN	120-139/80-89 diet and exercise
	high risk pt LDL goal	under 100 lifestyle greater or equal to 100 meds greater or equal to 100
	moderate risk pts w 2 risk facts LDL goal	under 130 lifestyle greater or equal to 130 meds greater or equal to 160
	low risk pt w 0-1 factors LDL goal	under 160 lifestyle greater or equal to 160 meds greater or equal to 190
	prolonged CPR	relative contraindicat to thrombolytics
	endocardit dx/tx	blood cult, TTE, TEE viridans: ceftriax/amp/penicill fungal: amphotercin + valve replace staph epi/MRSA: vanc enterococc: amp/gent s. aureus: oxacill/nafcill/cefazolin + rifampin for prosthetic valve resistant: aminoglycos EMPIRIC: vanc/gent
	TEE vs TTE	TEE good for valves TTE for CHF - best init MUGA most accurate for CHF
	nml BNP and nml wedge	excludes CHF in acute dyspnea not CHF
	best initial therapy for acute pulm edema	furosemide do EKG to r/o arrythmia
	high/low thyroid can cause	CHF
	dyspnea sudden onset clear lungs	PE
	dyspnea sudden wheezing, up exp phase	asthma
	dyspnea slower progress, fever, sputum, unilat ronchi	pna
	dyspnea decreased unilat breath sounds , trach deviat	pneumothorax needle into 2nd intercostal space in mid-clavicular line decompresses and increases venous return
	dysp numbness caffeine anxiety	panic attack
	dysp gradual pallor	anemia
	dysp dull percuss at base	pleural effusion mcc of MALIG pleural eff = breast CA
	dysp smoking, barrel chest	COPD
	dysp palpitats, syncope	arrythmia
	dysp anesthetic, brown blood, O2 not helping, cyanosis	methhemoglobinemia
	dysp burning car wood stove suicide	CO2 poison
	papillary muscle rupture	murmur and MR
	sinus brady can occur after inferior wall MI	give atropine first to all hypotensive bradycards even w heart block faster than thraseven pacing
	synch cardiovert unsynch	Afib Vfib or pulseless Vtach
	thallium test	if pt cant exercise, has EKG abl/unclear, or is on digox
	stress echo	use w abl/unclear EKG
	valsalva and standing	DEC afterload and venous return DEC normal murmurs handgrip INCreases
	neurocardiogenic	vasovagal MCC of fainting prodrome, emot situat, rapid recover, no confusion dx w tilt table test if cant w phys exam alone
	somatomedin C	insulin like growth factor up in acromegaly confirm w oral gluc - fails to supress GH
	pericardit tx	NSAIDS colchicine for recurrent prednisone is NSAIDS didn't work
	beck's traid	muffled hear sounds, JVD, hypotens seen in RV fail but if puls paradox - only tamponade
	inhalation	increases venous return so R side lesions increase w inhalation so L side murmurs inc w EXhalation
	regurigitation responds best to	vasodilation ACE ARB hydralazine replace if dilates too much - end syst diam 55 aort diameter 40 mitral
	stenosis and fibrosis	surgery for stenos ballon for fibrosed MS replace/remove calcified AS
	biphasic wave in V1V2	mitral stenosis CXR = LA hypertrophy L main stem bronchus elevated straightening of heart border 2nd bubble behind heart tx w diuretics and Na depletion
	handgrip and AS	increases afterload SOFTENS/improves AS!!! valsalva and standings also soften it MC presentat - ANGINA cresc decresc peaks midsyst in diamond shape S wave in V1 R wave in V5 asympt = ACE "you handgrip the ASS that is SOFT"
	papillary muscle rupture + HTN	mitral regurg leaflets separate heart dilates as in MI and endocardit pansystolic to axila WORSE with handgrip, squat, and leg raise all left side lesions INC with exhalation EXCEPT HOCM and MVP
	ACE/ARB best for	regurg digox and diuretics for symptoms only, not longevity replace when LVESD over 40
	stenotic lesions need	replacement
	aortic regurg	marfan, cystic medial calcinos, syphilis, ank spond, reiter synd elraged LV closer to chest = awareness of heart beat wide pulse pressure, water hammer, nailbed pulse, hill = BP in legs > arms, demusset = head bob early midiastolic decrescendo at LLSB worse w handgrip better with valsalva and stand replace before LV syst diameter 55mm
	reflex syncope	post tussive or most micturit (orthostatic hypo MC d/t anti HTN)
	bradycardia alternating with atrial flutter	sick sinus syndrome tx w ventic pacemaker
	dilated cardiomyopathy	can't contract syst dysfx low EF
	hypertrophic cardiomyopathy	can't relax diast dysfx preserved EF
	all cardiomyopathies	initial and accurate = echo tx all w diuretics
	S4	stiff, noncompliant
	mitral stenos unaffected by	hand grip amyl nitrate = arteriolar vasodilat ACEi
	amyl nitrate	is like ACE/ARB SOFtens MR/AR worsens HOCM/MVP
	restrictive cardiomyopathy	can't contract OR relax
	pericardit on EKG	ST elevation in all leads PR seg depression
	pulsus paradoxus	specific for tamponade BP down by 10 on inhalation EKG: electric alternans CXR: globular heart NO diuretics!!!
	cilostazol	for PAD ABI initial angio accurate CXR shows wide mediast - hazy aortic knob pain btw scapulae BP difference btw arms tx w beta blocks and nitroprusside, then surgery
	screen every smoker male	for AAA at 65
	bad heart stuff in preggo	worst - peripartum cardiomyopathy eisenmenger: L->R shunt = pulm HTN = R->L shunt
	variant angina assoc w	raynaud = arterial vasospasm (can be caused by beta blockers) transient ischemia, ST elevat
	ST depression	unstable plaque partially blocks blood flow
	diastolic dysfx	impaired filling but normal capacity to empty tx w beta blocks and CCBs prevent hypertrophy w ACE remodeling w spironolact - aldost antag
	avoid beta blocks in	COPD/asthma brochocostrict and wheezing beta blocks decrease O2 demand and prevent arrythmia
	ACE survival benefit	more for pts w EF < 40
	SVT	1st - maneuvers like valsalva, carotid but don't massage murmurs/stenosis 2nd - adenosine, verapamil but if unstable - cardiovert
	multifocal atrial tachy	assoc w chronic lung dz hypoxia - give O2
	WPW	preexcitation synd shortened PR int (<.12) broad QRS (>.12) slorred QRS upslope = delta wave digox and dilt CONTRAINDIC bc block AV node = SVT or VT init tx - procainamide/amiodarone definitive - ablat
	femoral pseudoaneurysm	complicat of cath pulsatile mass w femoral bruit US groin true aneurysm assoc w conn tiss disorder
	don't dc amiodarone if	txing arrythmia
	acute asthma exacebat check	ABG/PFT/peak exp mild - hypox + resp alk severe - hypox + resp acid nml CXR DLCO INC
	stable asthma	most accurate - PFTs 20% FEV1 down with methacholine FEV1 DOOOOWN FVC DOWN
	zariflukast	leukotriene best for atopic hepatotoxic assoc w churg strauss
	asthma reversibility	12% inc of FEV1 w albuterol
	asthma tx for mild intermit	SABA - albut/pirbut/levalbut under 2 days/wk under 2 night/mo
	asthma mild persist	over 2 days/wk or 2 nights/mo add low dose inhaled corticosteroid beclometh budenosine fluticasone
	asthma moderate persist	daily or over 1 night/week add LABA salmetrol formetol or INC inhaled corticos
	asthma severe persist	continuous INC inhaled coritco
	cromolyn	for exercise mast cell mediator inhibit
	theophylline	phosphodiesterase inhibitor INC CAMP heart and neurotoxic
	anticholinergics	ipratrop better for COPD don't forget flu and pneumococc vaccine
	COPD/asthma exacerbation	decreased peak exp flow A-a gradient INCreases give O2 albut (bronchodilat) steroids
	respiratory rate and normalization of ABG	RR = severity of asthma INC PCO2 = resp acid = impending respi fail
	COPD findings	down FEV1/FVC, UP TLC no reversability with albuterol or response to methachol DLCO DOWN in emphysema INC hematocrit on CBC from hypox Afib or MAT RA and RV hypertrophy on EKG pulm HTN on echo erythrocytos and 2nd heart sound
	COPD dx/tx	init: CXR - INC AP diameter, air trap, flat diaphragm PFTs: accurate if PO2 UNDER 55 or pulse ox 88% --> O2! in case of pulm HTN, inc Hct, cardiomyopathy: PO2 under 60 and 90% sat mortality improves w smoke cessat
	COPD bugs	s pneum, h influ, moraxella so macrolides, cephalos, amoxi, quinolones give flu and pneumococc vaccine
	ABPAspergill	fungal allergy in asthmatics up IgE brown speck sputum tx w prednisone
	bronchiectasis	mcc of it is CF also TB, pna chronic dilation of large bronchi remodeling dx w CXR - train tracks most accurate = CT tx w chest physiotherapy, rotate abx, surg resect
	CF dx/tx	INC sweat chloride - above 60 Cl pilocarpine and Ach INC sweat routine abx - do sputum cultures rhDNAase - breaks DNA that clogs up airways h influ, p aureug, s auerus, burkh cepacia bronchodilatros and lung transplant nasal polyps
	gross hemoptysis	rigid bronchoscopy/embolization put pt bad lung down
	rapid shallow breathing	ratio of RR(breath/min)/TV if ratio below 100, can wean off ventilator
	idiopathic pulm fibrosis	restrictive DOWN DLCO diffuse linear opacities biopsy dx
	p53 and Rb	tumor supressors
	RAS telomerase	protooncogene UPs cancer cells' immortality
	malignant cells resist meds with	MDR1 p glycoprot MRP ABCB1 ABCC2
	hoarseness	recurrent laryngeal lung metastas
	benign pulm nodule	popcorn coarse diffuse central laminar cocentric calcificat
	small cell lung ca synds	eaton lambert SIADH = hyponatremia, high urine Na (dt sodium wasting from dec aldost dt inc water retent from ADH) ectopic ACTH - cushing muscle weakness dry mouth ptosis
	silicosis increases risk of	TB - do annual PPD
	leukotrienes vs NSAIDS	leuks are bronchoconstrictors NSAIDS inhibit cycloxigenase and INC leukotrienes DEC prostocyclins and protsglandins
	ARDS	mcc of ARDS = sepsis diffuse bilateral alveolar infiltrates nml or low PCWP - 8 nml wedge press 18 alveoli fill w fluid PO2/FiO2 < 300 < 200 moderate <100 severe 6ml/kg low tidal ventilat - noncardiogenic PEEP keeps alveoli open plateau press <30
	PE	nonspecific ST and T wave changes hemodyn stable = low weight or unfractionated heparin unstable (BP<100) = thrombolytics if thrombilysis c/i = embolectomy
	thoracentesis	midaxillary line just above rib to avoid intercost VAN 2 intercostal spaces below level of fluid by percussion for pleural effusion: dyspnea + pleuritic CP CXR: obliteration of costophrenic angle
	lung CA tx	small cell - chemo others - resect
	aldosterone	keeps sodium excretes potassium ("yelda" keeps anNA, tosses Kaz)
	squam cell carci and renal cell carci and breast	breast most commoly causes hyperCA by making PTHrP systemically or by bone mets PTH-like peptide hypercalcemia can cause seizures - imipenem
	ventilator pna	acenitobacter bamanii specific tx w antipseud beta lactam - cephalo, penicill+clav PLUS another antipseud: carbapenem, aminoglyc (genta, tobra), fluoro (cipro, levo) PLUS MRSA: vanc, linezolid
	atypical pna	infexn in interstitial space empty alveoli noncukturable, dry cough bilat interstit infiltrates or clean CXR mycoplasma virus coxiella PCP chlamydia
	CXR	first but not most accurate for ID
	empyema	LDH > 60% of serum protein > 50% of serum WBC > 1000 and pH < 7.2 = infexn tap and insert tube
	exudative pleural effusion	infexn vascular permeability damaged/leaky
	transudative pleural effusion	INC PCWD DEC intravasc oncotic pressure
	PCP dx/tx	need bronchoschopy/BAL nml LDH = not PCP interstitial infiltrates TMP-SMX steroids if severe - improve mortality if PO2 under 70 or A-a under 35 if can't use sulfa - clinda and primaquine or pentamidine prophylax if CD4<200 if mild - atorvaquone
	outpt tx - mild, no abx hx	macrolide doxy moxi comorb or 3mo abx: levoflox (fluoro)
	inpt tx	resp fluoro: levo of moxiflox or ceftriax and azithro
	CURB65=admit	confusion uremia resp distress (hypox) BP low (hypotens) over 65
	hospital pna = after 48 hrs	more gram neg gram neg bacilli - antepseudomonal cephalo, penicill, carbapenems if using pepera/ticarcillin, add beta lactamase inhibitor like calvulan or tazobactam
	mc side off of TMPSMX	rash BM supress anemia and bite cells in G6PD dapsone c/i in G6PD
	DLCO	nml or up in asthma DOWN in COPD and restrictive
	don't use LMW heaprin with	ren fail GFR < 10
	COPD chronic VQ mismatch	hypoxic vasoconstriction --> pulm HTN
	bilateral hilar LAD	carcinoma lymphoma TB sarcoid cervical lymph node biosy dxs noncaseating granulomas
	pulsus paradoxus in asthma	is bad - intubate
	tidal vols for COPD, asthma, ARDS	COPD: 5-7 ml/kg asthma: below 8 ARDS: 6 ml/kg
	langerans cells	aka birbeck granules eosino granulomatos = histiocytosis X
	mesothilioma	NOT mc in asbestos, which causes bronchogenic carcinoma adreno and squamous IS
	restrictive pulm dz	UP FEV1/FVC DOWN TLC, DLCO, RV up cancer chances 75x
	mcc of brain tumor	mets from lung
	pulm nodules eval	below 1 cm - serial scans over 1cm - resect
	PE eval	CT unless ren fail = VQ scan (PE can present w hemoptysis and pleuritic CP) PE is a wedge shaped infarction on CT (PE can cause pulm infarction)
	b agonists like albuterol worsen	tachycardia
	most accurate TB dx	pleural biopsy
	positive PPD	even if BCG, 9 months of isoniazid don't give pyrazinamide ot sterptomycin to preggos
	pulmonary fibrosis	dysp on exert fine crackles loud P2 clubbing fibrosis is irreversible inflammatory infiltrats w WBCs txable w prednisone
	interstitial dz dx	start w CXR biopsy most accurate pulm HTN or ventric hypertrophy on echo honeycombing FEV1/FVC RATIO normal but individually and TLC and RV DOWN DLco down
	most likely to respond to steroids	berylliosis as well as other granulomas
	decreases mortality in ARDS	low tidal vol 6ml/kg
	hypoxia dt damaged parenchyma in COPD or pulm fibros	DEC alveoli --> capillary diffusion YES A-a gradient
	hypoxia dt high altitude	down fraction of inspired O2 NO gradient
	hypoxia dt shunt	pna, atalectas, pulm infarct, ARDS O2 will not help YES A-a gradient
	hypoxia dt VQ mismatch	PE, COPD, atalectas, pulm edema, pna YES A-a grad O2 will help (nml A-a is under 15)
	AMS, petichiae, refractory hypoxemia	fat embolus
	sitting	DECs preload improves pulmonary congestion
	tension pneumo	sudden hemodynamic instab in ventitaled pts on PEEP distended neck, JV pulsation, absent breath sounds
	oral prednisone	has many side effectsdo not use in mild asthma use oral/IV steroids in acute asthma
	sarcoid dx	most accurate - lymph node biopsy
	PE eval	init: CXR - clean EKG - sinus tach, RV hypertroph or RA deviat ABG - resp alk - up pH down pCOx most accurate: angio - but can be fatal VQ first in pregnancy d-dimer sensitive but not specific - neg=no clot so good way to exclude low pretest probability, pos=means nothing
	PE tx	heaprin warf INR 2-3 h/o HIT - argotroban or lepirudin
	hypoxemia = vasoconstriction -->	pulm HTN wide split of S2 loud P2 R heart fail - JVD + edema polycythemia from hypoxia
	allergic rhinit refract to meds	10 day oral steroids
	best prognostic factor for COPD	FEV1 O2 tx goal is 90-92%
	pancoast tumor	superior sulcus/apex of lung = compression of cervical sympathetic plexus horner syndrome ulnar nerve sympts
	bloody pleural effusion	do cytology to look for malignant cells
	pulm lesions with doubling times in under 30 days	infectious, malignant stippled asymmetric calfificat FDG uptake
	primary pulm HTN tx	IV vasodilators NO, prostacyclin, adenosine
	bronchopulm dysplasia in kids	tx w furosemide seen in preemies
	mc cyanotic heart defect after infancy	ToF overriding aorta, pulm stenos, RVH, VSD chrom 22 blue lips and limbs, holosyst murmur, squatting boot heart, DEC pulm vasc markings surgery
	3 holosyst murmurs	MR TR VSD VSDs common in trisomies 21, 18, 13
	transposition of great vessels	aorta from right ventricle, pulm artery from LV no oxygenat of blood w/o PDA give prostoglandin E1 to kEEp it open early and severe cyanosis, egg on a string CXR mc cyanotic dz of neonates increased pulmonary vascular markings cyanosis in first 24 hrs of life
	pulsus alternans	LV systolic dysfx
	pulsus bigeminus	HOCM
	pulsus bisferiens	aort regurg - double pulse dt blood backflow
	puslsus parvus et tardus	aort stenos
	pulsus paradoxus	cardiac tamponade tension pneumo
	hypoplastic left heart	LV hypoplasia, mitra valve atresia, aort valve lesions absent pulses w single s2, inc RV impulse, gray cyanosis CXR - globular heart w pulm edema echo more accurate 3 surgeries
	truncus arteriosus	single trunk off both ventricles sever dyspnea, early/frequent respi infexns single s2 CXR - cardiomegaly w inc pulm markings pulm HTN worst sequela - do surgery to prevent
	total anomalous pulm ven return	mc to show up soon after birth cyanos --> HF blood mixes pulm veins drain back into venous system supracardiac shadow above enlarged heart on CXR, pulm edema and figure 8 snowman echo most accurate surgery
	mc congenital heart lesion	VSD holosyst murmur and FTT can reverse LR shunt to RL = eisenmenger dyspnea and respi distress high pitched holosyst murmur loud pulmonic S2 inc vascular marks cath definitive
	ASD	more common in women hole in septum btw atria fixed wide split of S2 inc vascular markings and cardiomegaly on CXR most close spontaneously dysrythmias and possible paradoxical emboli from DVTs later in life (go to brain thru hole instead of lungs)
	PDA	failure to close spontan in 1st 12 hrs usually should w rising PO2 machinery murmur - spills into diastole - L intercost space, wide pulse press, bounding pulses respi infects and infect endocardit echo best initial and cath most accurate indomethcin (NSAID) closes ductal ligation can tx assoc w mom rubella (also deafness and cataracts)
	tricuspid and pulmonary lesions radiate to	back
	aortic lesions radiate to	neck
	long QT syndrome	hearing loss syncope nml vitals and exam fam h/o sudden cardiac death
	coarctation of aorta	assoc w turner CHF and respi distress in early life different pressures btw upper and lower limbs reduced pulses in legs HTN in arms rib notching and 3 sign on CXR cath most accurate resection
	marfan presents w AR murmur	aoirt root dilatat diast decrescendo at sternal border
	immobilization causes	hyperCAlc by inc bone resorpt also raise CA from milk alkali, paget, addison, neoplasm, excess vit A/D, sarcoid, Z-E
	DKA	more common in type I DM met acid with UP anion gap measure of severity is bicarb acidosis shifts K out of cells insulin shifts K into cells like glucose. in-cell-in so hyperkalemia in BLOOD but low TOTAL body dt urine spillage tx w saline and insulin paradoxical hyperkalemia b/c body reserves actually depleted, but come out dt extracellular shift
	health for DM	pneumovacc and flu yearly eye statins if LDL over 100 ACE/ARB if BP 130/80 or microalb aspirin foot exam DM=CAD equivalent risk for MI, CHF
	gastroparesis	bowel immobility no stretch = no motility bloat constipat early satiety tx w metoclopramide erythromycin ups motility develops after about of decade of DM
	diabet neuropathy	pregabalin/gabapentin, TCA
	primary adrenal insuffic	hyperpigmentation, fatigue, abdominal pain, faint, dehydrat, nausea can happen if studdenly dc steroids hypONa, hypOgluc, hypOtens hyperK also caused by TB tx w corticos - prednisone and mineralos - fudrocort
	trousseau synd	migratory thrombophlebitis wax/wane palpable corn inflammat mcc=panc cancer = gnawing pain and distended GB + intra and extrahepatic biliary tract dilation
	cushing ups DVT risk	INC factor VIII and vonWF, DEC fibronolysis
	low morning cortisol and high ACTH	adrenal insuffic no increase of cortisol with coyntrop test
	MC CAH	21 hydroxy defic excess 17 hydrox = virilizat, androgen excess adult onset means partial defect
	autoimmune hyperthyroid	can be caused by DM give propranalol to prevent arrythmia thyroid ablation definitive however RAI can cause hypothyroid
	benign adrenal nodule	is less than 4 cm smooth and round hypodense on CT
	Barter synd	ion transport defect in ascending loop of henle down K, NaCl, Mg hyperCAlciURIA and met ALK similar effects = furosemide, ethacryn acid, bumetadine excessive prostoglandins and aldosterone so treat with spironolactone and NSAIDs
	Grave's scan will show	diffuse increase of radio uptake hot nodule will take up a lot, but rest of gland won't
	metformin	don't give to renal pts - will cause met acid but is otherwise first line blocks GNG safest, no hypOglyc
	DM dx	most sensitive - oral gluc tolerance - best in preggos two fasting over 125 or one over 200 + polydipsia/uria/phagia
	exercising muscle	doesn't need insulin
	sulfonylurea	ups insulin from panc obesity
	gliptins	up insulin, down glucagon
	glitazone/thizolidenidone	not in CHF - fluid overload
	nateglinide repaglinide	like sulfonylurea minus the sulfa
	incretins - exenatide	up insulin, down glucagon lowers gastric motility to promote satiety and help w weight loss
	alpha glucosidase inhibitors - acarbose/miglitol	block glucose absorpt in bowel diarrhea and GI pain
	amylin pramlintide	lowers gestric emptying to decrease appetite
	long acting oral antiglyc	glargine more stable than NPH, add insulin if uncontrolled with orals
	short acting oral antiglyc	lispro, aspart - take before meals
	PTH-like peptide	ups CA, downs phosphate squam cell lung and renal cell carci
	1st line cushing's test	iatrogenic MC, then endogenous 24 hr urine cortisol and creat cortisol will be up in all of them then check ACTH only adrenal will be LOW ACTH pituitaty and ectopic will be HIGH ACTH tell those apart by dexamethasone YES in pit NO in ectopic
	cushing SYND ectopic hyper cortisol	up glucocorticoids adrenal gland or carcinoid indep of ACTH no suppression do chest CT to look for cancer paraneoplastic synd of small cell lung carci
	cushing DZ	ant pituitary increases ACTH dexamethasone supresses do MRI pituitary
	weight gain and osteoporosis in cushing's	hyperglycemia from glucocorts UPS insulin UPS weight gain cortisol demineralizes bone also buffalo, stria, heart, DM, HTN from hypercortisol
	in the morning cortisol increases	FFA and sugar = "morning energy" UPS Na, downs K aldosterone deceases K in distal tubule so cortisol = hyperGLYC, LIPID, leukocytos, hypOkalemia, metabolic ALKalos surgically remove source
	Addison's	hypOadrenalism, opposite of cushings hypONa, hyper K autoimmune weightloss, hyperpigment, AMS, fatigue, hypotens, vomit met ACID and UP BUN (prerenal) eosinophilia
	cosyntropin test	synthetic ACTH rise of cortisol means crappy pituitary no rise means dead gland tx w hydrocortisone - fludo
	adrenal fail	rise of ACTH due to lack of feedback inhibition
	Conn's	primary hyperaldosteronism UP Na, hypOK, alkalosis HTN with low renin from solitary adenoma (laparoscopy) or bilateral hyperplasia check renin/aldost - chemistry before imaging low renin high aldost salt should shut off aldosterone but fails tx w epleronone/spironolactone = aldost antags
	pheo	medulla failure to shut down MBIG scan tx w alpha blocker phenoxybenzamine 24 urine catechols metanephrine can also tx w beta blocks and CCBs finally remove
	low calcium	easy depolarization = excitability/seizures long QT - arrythmia - VT tx by replacing Ca and vit D hypoMg and renfail and low alb = hypOCa DOWN Mg, Ca, PTH UP phosphate
	alk phos found in	bone liver GI placenta if up, check GGT - if up - liver US
	adrenal insufficiency	down steroids - cortisol (gluco) and aldosterone (mineralo) hypotension, down Na, up K in HIV pts, caused by TB or CMV
	prolactin cosecreted with GH	up GH = surgery! if can't resect, do dopamine (cabergoline) and somatostatin agonists but up prolactin, do meds FIRST before surgery dopamine like bromocriptine lowers both GH and prolactin
	squam vs small cell carci hormones	squam - ups Ca via PTHrP small cell - ectopic ACTH (cushing)
	facticious insulin	no C peptide but YES C peptide in sulfonyluria
	insulinoma	rare beta cell panc tumor hypogycemia while fasting UP insulin and C peptide resect
	carcinoid synd	flush diarrhea wheeze dx w 5HIAA cutaneous telangiactasias, bronchospasm, tricuspid regurg possible means liver mets niacin defic dt being used up in extra serotonin and tryptophan production niacin defic = pellagra w dermatit diarrhea dementia tx w octreotide
	give to hyperthyroid pts even before scan	beta blocks
	adrenal nodule	benign vs mailg and fx vs nonfx low dose dexamethasone rules out cushings urine cathechols/metaneph = pheo serum aldost/renin = aldosteronoma
	primary hypothyroidism can cause	hyperproloactin = DOWN GnRH = 2ndary amenorrhea and galactorrhea also HTN d/t TPR hypercholest dt DEC renal LDL excret fatigue, cold intol, constipat, weight gain, dry skin, bradycard
	glucagonoma	panc alpha cell tumor DM, weight loss, diarrhea, thromboembolism, necrotic ertyhema, anemia
	primary polydipsia	aka psychogenic - compulsive water drinking lowers urine osm corrected with water deprivat cDI and nDI also have low urine osm cDI responds to vasopressin
	hot nodule	makes lots of TH and shuts off TSH so nonnodular portion of gland has dec colloid production and dec RAI uptake converserly, a COLD nodule, has the rest of the nonnodular gland picking up RAI
	seminoma	MC germ cell tumor of balls curable w no hormone sympts make beta HCG but not AFP (nonseminoma does)
	lyedig	androgens converted to estrogen by aromatization precocious puperty in younger men feminization in older large cells w eosino cytoplasm bland nuclei with crystal reine inclusion
	symptomatic hypercalcemis	over 12, or severe over 15 tx w IV saline, IV calcitonin, bisphosphonates
	tangier dz	alpha lipoprotein defic w low HDL polynerupathy, LAD, HSMeg yellow/orange tonsil hyperplasia
	unique to graves hyperthyroid	eyes and skin (tx w steroid) - periorbital edema, pretebial myxedema UP radio iodine TSH-R antibodies low TSH w elevated T3 and elevated thyroid stimulating immunoglobulin
	hyperCA	short QT neurons can't fire - away from AP constipation and lethargy ineffective ADH = volume loss - dehydration - renal insuffic resolve prerenal azotemia with hydration together with PTH dissolve bone and lower phosphate dissolving bone ups AK
	sarcoid granuloma tx	prednisone
	hyperthyroid tx	methimazole better and PTU can do surgery in preggos and allergics, obstructive goiter, malignancy radioablat is definitive
	radiactive iodine uptake before FNA	for cold, malignant nodule
	solitary nodule	get TSH first! low TSH = hyperthyroid = hot nodule - takes up iodine = NONmalignant - leave alone cold nodule = nml or LOW TSH - FNA after RAI
	euthyroid sick syndrome	nml or up TSH low T3 T4
	water deprivations test tells apart	psychogenic polydipsia and DI psychogenic better w water deprivat DI = no change neurosurgery can damage pituitary stalk
	nephro vs central DI	desmopressin CENTRAL responds with INC urinary osm
	poor healing diabetic ulcers	dt microvascular dz and hypoxia tx w hyperbaric O2
	vit D defic	hypocalcemia irritable, delerium, tetany
	hypercalc	groan bones psych depression, psychomot retard, constipat, muscle weak, renal dysfx short QT
	MEN1	menin gene aut dom werner PPP pit adenoma, parathyroid hyperplasia, panc tumor screen panc peptides annually
	MENIIa	ret aut dom sipple PMP parathyroid hyperplasia, medullary thyroid ca, pheochromo screen pheo w urine metanephrines
	MENIIb	ret aut dom MMMP med thyroid carci, marfanoid, mucosal neuromas (ganglioneuromatos), pheochromo
	hypovolemia	causes raise of aldost to try to raise blood vol by conserving Na aldost lowers K by upping its urine excretion so in dehydration, check electrolytes and hypOkalemia (hyperKal-uria) K in pee not in blood
	DM assoc w celiac	screen w tissue transglutaminase Iga abs
	metabolic sydrome	up TG down HDL hyperglyc high CRP high fibrinogen
	pit adenoma	mc - up prolactin can also down LH or hyperthyroid - up TSH
	congentical hypothyroid dt	thyroid dysgenesis
	adrenoleukodystrophy	x linked peroxisomal membrane protein defect inc of very long chain FAs neuro - weakness, spasticity, dementia, blindness, quadripleg prim adrenal insuffic - hypoNa, hyperK, postural hypotens, no response to cosyntropin
	21 hydroxy CAH	mc 17 hydrogeprogest and DHEA UP hyponatremia and hyperkalemia
	diGeorge dx	PCR of 22q11 to confirm
	LH and FSH in turners	UP
	moms of potential CAH kids	give desamethasone at 6 weeks of prego at 10 wks confirm with CVS continue steroids for girls, not boys
	SCID	adenosine deaminase defic no thymic shadow die by 1 year w/o BM transplant
	acuye laryngotracheobronchit	viral croup insp stridor and bark cough paramyxovirus racemic epinephrine steeple sign, but CXR is wrong test
	if can't comply w oral abx for strep	can do penicill G IM
	asthma dx in kids	clinical
	congenital diaphragmatic hernia	tx w nasogastic suction and itubation guts in chest
	apnea of prematurity	over 20 sec of no response - ventilate theophylline/caffeine to stimulate
	what to do to hypoactive infant	dry and warm to stimulate, then check HR and breathing
	MC pneum in kids	mycoplasma - macrolide azithro often occurs w erythema multiforme
	choanal atresia dx	CT confirms catheter in nose initial
	insp striod W/O cough	laryngomalacia
	common variable immunodefic	VERY low IgG low IgA and IgM poor vaccinat response recurrent sinopulm infexns and GI w giardia normal B cell levels infexns later in life
	bruton's X agammaglob	B cell precursors fail to mature no germinal centers in lymph nodes ALL Iggs defic sinopulm and GI infects since 1st year of life (after 6 mo)
	first reflexes to disappear in babies	rooting and palmar grasp
	truncus arteriosus	increased pulm vasculature
	transposit of great vessels	nml pulm vasculature
	JONES	joints carditis subcut nodules erythema MARGINATUM sydeham chorea
	tetralogy of fallot	concave mail pulm art segment dark lung fields small boot heart down pulm blood flow down vascular markings Right axis deviat on EKG RVH, VSD, overriding aorta, pulm stenos harsh systolic murur over ULSB R-L shunt bc of VSD eventual cyanosis in milder cases
	ebstein anomaly	downward displacement of tricuspid RA enlargement tricusp regurg cardiomegaly down pulm blood flow assoc w arrythmias - SVT WPW AF
	erythema marginatum	erythematous serpiginous macular lesions w pale centers, nonpruritic, trunk and limbs
	confirm recent strep	anti DNAse B titer antistreptolysin O antihyaluronidase GAS beta helolytic in past 2-4 wks needed to confirm dx of rheumatic fever can happen after strep throat or scarlet fever penicillin
	innocent murmur	soft (mid)systolic vibratory 2/6 age 3-7
	VSD	harsh holosystolic at LLB w thrill dyspnea, poor feeding and growth, sweating
	congenital long QT and deafness and arrythmias	Jervell lang nielsen synd
	hypoplastic left hear	hypoplasia of LA, LV, aorta atresia/stenos of aortic mitral orifices precordial hyperactivity lound 2nd sound weak pulse
	TAPVR	mixing syst venous and oxygenated venous blood = severe cyanosis up pulm vasculature dt pulm overcirculat RVH and R axis deviat
	kawasaki	aspirin and ivig! over 5 days of fever bilat nonexudat conjunctivit dry lips, stawberry tongue mucositis cervical LAD rash - polymorphic extremity changes - limb swelling
	coxakie	sick mom and sick baby with hypotens/hypoperfus met acid distant heart sounds loud apical murmur cardiomegaly abl EKG and pulm edema
	coarctation rib notching	posterior
	MCC of HTN in kids	renovasc
	aort stenos in kids	dt bicuspid valve (which can also cause AR) systolic eject murmur w click and soft early diast - cresc decresc radiat to carotids peaks in midsyst LVH
	hypoplastic left ventricle	severe HF no murmurs no Q waves
	painless serosangionous breast dicharge with no mass or tumor cells	intraductal papilloma
	anti histone autoabs	drug induced SLE arthralgia myalgia fatigue pericarditis pleuritis (possible crackles)
	congenital toxo	chorioretitnit, hydroceph, intracran calcificats First Trimester – death Second Trimester – Hydrocephalus, Intracranial calcifications, Chorioretinitis fever, IUGR, microcephaly, seizure, hearing loss, blindness, maculopapular rash, jaundice, hepatosplenomegaly, anemia, and lymphadenopathy
	congenital CMV (HHSV5)	PeriVVVentric calcifications IUGR, developmental delay, microcephaly, sensorineural hearing loss, retinitis, jaundice, hepatosplenomegaly, thrombocytopenia, hypotonia, lethargy, poor suck
	congenital rubella	Blueberry Muffin” rash due to extramedullary hematopoiesis Cataracts “Salt and Pepper” retinopathy Radiolucent bone disease (long bones) IUGR, glaucoma, hearing loss, pulmonic stenosis, patent ductus arteriosus, lymphadenopathy, jaundice, MR, hepatosplenomegaly, thrombocytopenia, interstitial pneumonitis, diabetes mellitus
	mc child leukemia	ALL Bcells
	meningit bugs	Newborns - GBS, E coli, Listeria Infants and Children - S. pneumoniae, Neisseria meningitidis, H influenzae type b Adolescents- N. meningitidis, S.pneumoniae Older Adults: S pneumoniae, N.meningitidis, Listeria
	calcium gluconate	for preggos with MgSulfate overdose (decreased DTRs/hyporeflexia, then respi depress dt CNS depression) hypocalcemia hyperkalemia - no effect on K but caridoprotective - reduces the excitability of cardiomyocytes thus lowering the likelihood of developing cardiac arrhythmias
	post circ bleeding	von willie or hemophilia down factor VIII - hemoph up PTT
	dorsal column (posterior)	vibration, proprioception, and touch localization
	transferance is what patient places onto you	countertrasferance is what therapist feels from patient
	EPS management	dystonia/parkinsonism - anticholinergic antiparkinson NMS - muscle relaxants, DA agonists akathisia - benzos, propranolol tardive diskinesia - increase neuroleptic
	P value BELOW .05	not random, can reject null hypothesis but if OVER .05, does NOT mean we accept it, we just "fail to reject" meaning - not enough evidence
	case control study	identifies ppl w dz and compares to comparable group without dz
	cohort vs restrospective cohort	alike in many ways but differ by specific charecteristic cohort - summarized by attributable/relative risk retrospective - odds ratio
	CLL	B cell disease thrombocyto bad prognosis 8-10 survival years smudge cells = fragile, partially disintegrade CD20 cell surface antigen
	intestinal lymphom	abd pain, wight loss, n/v, distention, occult blood diffuse infiltrate by apical lymphos
	whipple dz	multisystem disorder chronic malabsorptive diarrhea, weight loss, migratory nondeforming arthritis, arthraligas, LAD, low fever, endocardit, CNS dysfx PAS positive macrophages in lamina propria w non acid fast gram pos bacilli (acid schiff) tx w abx - ceftriax and TMP/SMX
	dx acoustic neuroma	MRI w gadolinium
	pyloric stenosis imaging	abd US
	neonate w bilious vomiting	stop feeds, NG tube decompress, IV fluids abd xray double bubble = duod atresia dilated loops of bowel =mec ileus/hirshprung upper GI w ligament of trietz on R side / corkscrew duodenum = MALrotat (in neonate under 1 month) ichemia from midgut volvulus - bloody stools, bowel perf, abd distend, peritonit
	dilated loops of bowel	do contrast enema microcolon = meconium ileus rectosigmoid transition zone = hirschprung
	pseudodementia	can show up w depression tx w SSRIs unlike in Azlheimers where pts don't care/realize, these pts are distressed by their cog imairment
	CP	nonprogressive motor dysfx prematurity leading risk factor uncoordinated/limited voluntary mvmts resistance to passive mvmt vision, hearing, speech
	optic glioma	slowly progressive unilat vision loss seen in NF optic disk may be nml, swollen, atrophic
	pigment retinitis	bilateral vision loss
	retinal hamartoma	found in tuberous sclerosis
	acute limb ichcemia	from ARTERIAL embolus (cold) not warm like dVt look for LV thrombus w echo
	validity/accuracy	how well a test measures what it is supposed to measure - as compared gold standard
	reliability	similar results on repeat measurements
	interstitial cystitis	idiopathic painful bladder chronic bladder pain worse w filling better w voiding pyspareunia, urinary frequency and urgency amitryptiline analgesics avoid triggers
	cross-section study	exposure and outcome measured simultanously, not seperated by time period
	diarrhea in HIV	bloody w normal stool - do colonoscopy w biopsy to look for CMV - ulcers and erosions and cells w inl bodies nonbloody - MAC bloody w trophozites in stool - e hystolitica plus flak shaped colonic ulcers on colonoscopy profuse watery nonbloody over 2 weeks - cryptosporidiosis
	SIADH tx	mild - fluid restrict severe - hypertonic saline
	neonatal chlamidial conjunctivit	5/14 days of life eye swelling chemosis mucopurulent bllod stained eye discharge oral erythromycin topical won't help (yes for gonococcal=ceftriaxone) only way to prevent is to dx and tx mom while preggo
	nosocomial UTI	enterococci - can cause endocardit
	transient monocular vision loss	amaurosis fugax = stroke warking can be dt emboli from up BP do carotid US in young women - fibromuscular dysplasia - dxed w abd angio or US
	aldost/renin ratio over 20	primary hyperaldost HTN and hypokalemia adrenal vein sampling differentiates btw the 2 causes - adrenal hyperplasia and adrenoma
	raising cutoff level for diagnostic test	harder to obtain positive test ALL NEGS UP, ALL POSs DOWN UP false negs = down true positives DECrease = DOWN sensitivity UP true negatives = down false positives = UP specificity
	precision	measure of random error tighter confidence inter val and bigger sample size increase precision
	thymoma	often found on chest CT of mysathenia gravis pts fatigable muscle weakness bulbar muscles of oropharynx and jaw = funny voice extraocular muscles = lid lag CPK and TSH normal
	hazard ratio	event occurring in tx vs non-tx group under 1 = tx group had fewer events over 1 = tx group had higher event rate
	mesenteric angio	symptoms of a narrowed or blocked blood vessel in the intestines find the source of bleeding in tGI cause of ongoing abdominal pain and weight loss look at blood vessel damage after an abdominal injury Angiodysplasia (assoc s AS and ESRD, painless rectal pleeding in old) of the colon Blood vessel rupture from injury Blood clots Cirrhosis Tumors
	live attentuated vaccines	MMR, varicella, nasal influenza, yellow fever avoid in HIV CD4 under 200 or pts on immunospupressants meningococc is not live and needed for all adolescents. first give at 11-12, then at 16 to boost if still in college
	arm drop	rotator cuff tear supraspinatus muscle
	PPV and NPV	"all the pos" and "all the neg" TP/TP+FP and TN/TN+FN
	seminoma	elevated betaHCG, NORMAL AFP
	anterior mediastinal mass	thymoma teratoma (germ cell tumor) - UP AFP and bHCG thyroid terrible lymphome
	pyoderma gangrenosum	purulent with violaceous borders expanding ulcer assoc w IBD in contrast erythema nodosum - nodules/plaques w/o ulceration and resolve w/o scarring
	seizure not contraindication for	vaccination. but anaphylaxis and neuro/encephalopathy
	rheumatic fever	give penicillin to prevent reoccurence and limit progression of rheumatic heart dz
	posterior urethral valves	mcc of chronic renal insuffic/ren fail in kids can cause urinary reflux dt distal urinary obstruction, but only in boys reflux causes recurrent pyelo - parenchymal scar, HTN, renal insuffic - dx w voiding cystourethrogram
	basal cell carci	mc skin cancer in US open bleeding oozing sore reddish irritated patch = superfic pearly traslucent with pink = nodular remove with wide margins mohs surgery on face
	bilirubin in urine	anticholinesterase toxicity cholinergic toxicity up ACh = bradycardia, miosis, salivation tx w atropine and pralidoxime DUMBBELSS = diarrhea, urination, miosis, bronchospasm, bradycard, excitat of skeletal muscle, lacrimation, sweating, salivation CHOLINE MAKES YOU LEAK
	PACs benign but	smoking and alcohol are reversible risk factors
	circulating lymphocytes reduced in	SCID and HIV SCID=adenosine deaminase defic
	splenectomy causes defects in	antibody mediated opsonization and phagoctyosis risk of sepsis for up to 30 years give vaccines - antipnemococc, heamophiliss, meningococc penicillin prophylax for 3-5 yrs following splenectomy splenectomy results in THROMBOCYTOSIS
	actinic/solar keratosis tx	fluorouracil cream
	PNH and acute intermit porphyria	both present w dark pee and abd pain but AIP is porphyrins, not hemoglobinuria, so heme is nml PNH - hemolysis, anemia, pancytopenia, hypercoagulable thrombosis flow cytometry cd55 cd59
	schistocytes	microangiopathic hemolytic anemias DIC HUS TTP or RBC destruct by valves down haptoglobin, LDH, bilirubin MCV may be a up a bit dt extra erythropoesis
	cerebral septic emboli	suddenly drops the usually high retuculocytes and drops Hct PCR/DNA most accurate
	signs of increased cardiac filling pressures	test for HPV + = colposcopy - = repeat in 6 mo low/high displasia on pap = colpo/biopsy cervical CA = postcoital bleed. hysterect
	cryoprecipitate	gallstone obstructing CYTIC duct sudden RUQ pain w n/v leukocytos and fever alk phos NML in contrast to COMMON BILE duct obstruction or carcinoma - which result in jaundice and very high alk phos
	endometrial hyperplasia	with atypia - hysterectomy WITHOUT atypia - progestin therapy ablation is CONTRAINDICATED
	lithium therapy	long term if 2 manic episodes, lifetime if more
	cushing reflex	bradycardia, hypotens hypoglycemia, pulm edema tx w glucagon, calcium, insulin, dextrose
	5% dextrose	for asymptomatic hypovolemic hyperNA free water supplementat for EUVOLEMIC
	diabetic retinopathy	proliferative=neovascularitzat - tx w laser photocoagulation nonprolif = vein dilation, microaneourysms, retinal homorrages, edema, hard exudates w cotton wool spots poor night vision curtain falling and sudden loss of vision w floaters = vitreous bleed floaters with resolution of vitreous bleeds
	closed angle glaucoma	ACUTE sudden onset of blurred vision, severe eye pain, n/v red eye with fixed dilated nonresponsive pupil and hazy cornea blurry vision w halos iris against trabecular network block nml outflow of aqueous humor increased intraocular pressure - dx w tonometry tx w mannitol, acetazolamide, timolol, pilocarp AVOID atropine - dilates and makes worse conjuct erythema w corneal opacificat ginioscopy = gold standard, tonometry also dxs
	orbital cellulitis	pain w eye mvmt, propoptosis, opthalmoplegia, diplopia bacterial sinusitis predisposes
	prerenal failure	BUN/creat over 20 oliguria/anuria and azotemia (nitrogen - urea/creat) often dt hypovolemia
	nonselective beta blockers and aspirin promote	responds to reistocetin if add fnx plasma factor 8 antigen
	intramembranous deposits staining for C3 with nephrotic proteinuria	membranoproliferative type 2 GN persistent activation of complement pathway
	BPH evaluation	starts w urinalysis for UTI and hematuria PSA if life expectancy over 10 yrs biopsy guided by rectal US if PSA over 4
	osteomalacia	defective mineralization of organic bone matrix dt vit D defic = dec intest Ca and P absorpt =secondary hyper PTH hypo phosph and Ca elevated AlkPhos low plasma 25OH vit D assoc w type 2 RTA, lupus and Sjorgen
	clavicular fracture	require neurovasc exam to r/o brachail plexus or subclavian artery injury
	immune complex mediated kidney damage	in SLE or post-strep GN low C3 serum level dt complement activation
	acetaminophen tox	HAV, HBV, HPV age9-26, Influ annually, meningococc 11-18, PCV13 once, PPSV23 8 wks later EVERY 5, Tdap once, repeat Tdap for preggos, Td every 10 years following
	dipyridamole	in myocard perfusion scans reveals areas of lower perfusion - redistribution of coronary flow to non-diseased areas = coronary steal
	bernard soulier	cardiac tamponade - nml cardiac silouette on CXR
	tinea corporis	circular dry scaly hypopigmented patch elevated at border with central clearing ringworm KOH shows hyphea topical clotrimazole
	postviral sinovitis	ship pain resolves in a week post URI or rubella vaccine
	rubella	begins on face spreads down body maculopapular post occip LAD prodrome of low grade fever "rub-me on the head"
	measles	koplik spots starts at head goes down trunk "rub me head"
	parvo B19	erythema infectiosum malar rash on cheek
	roseola infantum	HSV6 starts on trunk spreads to extremities after high fevers exanthem subitum
	infant chlamidya	staccato cough eye infxn hyperinflated groundglass lungs on cxr
	staph scalded skin	epidermal lysis and sloughing rash fever exfoliation mucosa spared + nikolsky oxacillin nafcillin tx exfoliative toxin B from infectious nidus cleaves desmoglein1
	preggos w listeria	feel flu neonates - amnioninis w brown fluid sepsis w granulomatosis infantiseptica
	brain abscess in meningit	affects PTT - (coag factors) not PT
	entameba histolytica	colicky abd pain bloody diarrhea tenesmus mebendazole tx do US to r/o liver abscess mc in men no eosinophilia serology detects antibods - serum antibods confirm abscess CT can't tell amebic from pyogenic abscess
	clostridium botulinim and tetani and listeria char	gram + rod
	ecoli and h influ char	gram NEG rod h influ is ox + cocobacill, grows on chocolate
	s agalacticae	GBS mcc neonatal meningit gram + coccus s pneum also gram POS is the mc overall
	impetigo	crusty staph or strep topical muciprocin
	nisseria char	gram NEG cocci mc meningit in teens up protein down glucose on CSF
	cat bite tx	amox clavulan for p multocida and s aureus
	CFbest for osteomyelit dx	MRI - if have metal - nuclear triphasic scan
	gonorrhea	if gram stain + tx 3rd gen cephalo if allerg to beta lactams - skin test and macrolides if gram stain NEG - do nucl acid amplification
	s aureus pnemonia	seen in IVDUs, CF, chronic glanulom dz salmon sputum necrosis - abscess and cavitary lesions vanc linezolid tx
	zoster	risk up with age, immunospupress, skin trauma shingles reactivates in dorsal root ganglion no crossing of midline
	herpes encephalit	neuro sympts and olfactory hallucinat 10s-100s lymphos and RBCs elevated protein nml gluc on CSF acyclovir
	bacterial meningit CSF	1000s lymphos and neutros up protein down glucose + stain CSF count is initial dx for all meningit
	TB meningit CSF	for torsades and digitalis tox for preeclampsia lowers Ca influx and decs early afterdepolarizat
	cryptococc lyme rickettsia CSF	up protein down gluc no stain 10-100s leuks
	thick walled cavitary lesion	lung abscess fever cough fould sputum CP weight loss night swear anemia clinda
	white plaques in mouth in HIV	candida easily rubbed off leukoplakia not rubbed off - dt EBV/HIV
	immunocompetent pt w ring enhancing lesion	brain abscess frontal lobe sinusitis oral flora - alpha hemolytic strep and mixed anaerobes
	zidovudine	hepatotox myopathy up transaminases HA GI
	needlestick HIV	immed test, then 6wk, 12wk, 6mo prophylax w emtricitabine, tenofovir, raltegamir
	peritonsillar abscess	cold smudge cells starts w asympt leukocytos - no tx later flutarabine chlorambucil for palliation
	nml iron	stridor and drool
	COPD exacerbat bugs	spneum and mor catarell - tx w amox/clavu
	glanzman thrombastenia	botulism has papillary dilation
	empiric meningit tx	3rd gen cephalo (ceftriax) for gram +/- vanco for penicill resist spneum ampicillin for listeria steroids
	complicated pyelo	hosp + IV genta, ceftriax, fluoroquinolone
	gram pos cocci in clusters	staph
	gram pos diplococci	gonorrhea
	bell's palsy occurs post	EBV, lyme, herpes oral glucocorts and eye lubricants
	tinea capitis	thrombocyto, neuro sympts, fever renfail, microangio hemoplytic anemia schistocytes up creatitine nml PT/PTT tx w plasmaphares
	atropic gastritis	RR 40-60, HR 120-160 apgar, suction, cord, warm, rub appearance pulse grimace activity resp
	red eyes in neonate	1 day - chemical 2-7 - gonorrhea 7-12 - chlamydia 21+ - herpes all babies get eye drops at birth - erythro or tetracycline and silver nitrate
	transient polysythemia and spelomegaly in newborn	nml so is tachypnea unless over 4 hrs = sepsis get blood/urine and LP if neuro signs hiperbili dt hbF removal by spleen
	microcephaly, short palpebral fissures, maxillary hypoplasia, micrognathia, thin upper lip	etoh baby
	hydrocephalus, microcephaly, CNS defect	retinoic acid baby
	narrow bifrontal diamater, high forhead, epicantal folds, low nasal bridge, midfacial hypoplasia, small mouth w long philtrum, cleft lip and meningomyelocele	valproate baby
	glycogen storage dz type 2	opiate - respi distress in newborn
	low birth weight, hypogonadism, almond eyes, hypotonia	prader willi - FISH: 15q11-13
	adams test	forward bend to easy test for scoliosis, but gold standard is XRay
	mc complicat of very low birth weight baby	intracranial hemorrage
	legg calve perthes	avasc necrosis in kid 4-12 pain in hip/groin//thigh/knee and limp wide articular space and opacity of femoral head self healing
	fair blond blue babay w vomit, photosensitivity, rash	PKU, also musty smell
	newborn skull fract	depressed=surgery, linear =mc, basilar=fatal
	capUt saccUdaneum	crosses sUtUre lines, but cephalohematoma does not
	brachial plexus injury - dystocia, erb, klumpke	mc fract dt dystocia=clavicle erb = waiter = c5-c6 = can't abduct shoulder or rotate or supinate arm klumpke = claw = paralyzed hand = c7-c8-t1 immobilize the arms to tx for erb and klumpke
	WAGR	wilms, aniridia, GU abl (cryptorch), retardat HTN + abd mass, constipat, abd pain, n/v chrom 11 delet US init, CT best tx w nephrectomy w chemo/rad wilm's = mc kid nephroblastoma does not take up on MBIG scan can met to lungs
	bartter synd	aut recess hypOkal, hypOchlor up renin/aldost
	mom DM can cause in baby	heart - VSD, transposit, dextrocardia CNS - open neural tube kidney skeleton hyperviscosity dt polycythemia
	cyanosis w feeding	bilateral choanal atresia part of CHARGE coboloma, heart defects, atresia, retardat, GU abl, ear abl
	worst complication of juvenile RA	uveitis RF = poor prognos ANA = better prognos
	osgood schlatter	traction apophysitis of tibial tubercle anterior soft tissue swelling, lifting of tubercle from shaft, irregularity or fragmentation of tubercle common cause of knee pain in teen athletes
	poorly formed bulky stools w low weight gain	steatorrhea dt low bile acids replace long chain TGs w medium chain b/c med don't need bile acids
	VEAL CHOP fetal tracings	variable decel - cord compress early decel - head accelerat = OK! late decels = placental insuffic/fetal hypoxia
	varicella vaccine done at	12-15 months
	duchenne musc dyst	xlinked mutuat in gene for plasma memb protein dystrophin dx w Ck serum increase and PCR DNA
	air fluid levels on CXR	diaphragmatic hernia - bowels in thorax
	omphalocele vs gastroschisis	omphalocelel has sac and is assoc w edwards trisomy 18 gastroschisis is lateral w no sac. requires slow surgery to avoid third spacing
	umbilical hernia assoc w	hypothyroid, weak rectus muscle should close by itself by 3yo
	anticholinergics	opposite of choline = nonleaky dry mouth, urine retent, QRS widening on EKG tx w PHYSOSTIGMINE, a cholinesterase inhibitor
	mcc of increased AFP	wrong dates but can also mean abdominal wall or neural tube defects
	kids exposed to TB	get isoniazid regardless of PPD results
	if replace folate in b12 defic	cocaine baby
	sisters of fragile x boys	evaluate genetically as heterozygotes can present w ADHD
	hydroceph, poor feed, irritable, down activitiy, tense fontanelle, distended scalp veins, sunset eyes	germinal matrix hemorragea
	atopic dermatit	erthematous papules w excoriations scaling plaques - lichenification assoc w asthma and milk allergy emollients and hydration no steroids on skin = striae
	nevus sebaceus	congenital hamartoma on scalp surrounded by alopecia - small well demarcated oval yellow orange raised plaque
	herpetic whitlow	HSV infexn on finger - observat and analgesics oral acyclovir
	osteoid osteoma	radiolucent nidus w reactive sclerotic bone sclerotic cortical lesion pain better w aspirin/NSAIDs worse at night leg length discrepancy 5-24 yrs surgical excision
	hydroxyurea	painful mass w bone destruction and periosteal elevation
	ewing's	malig bone tumor from medullary tissue of cylindrical bones - pain fever leukocytos w onion skinning
	CF	resp infect, neonatal jaundice, bronchilit, and nasal polyps diarrhea, malabsorpt, meconium ileus recurrent sinusit, FTT chrom 7 IV tobra and ceftazidime in acute exacerbat
	Her2/neu	post viral encephalopathy w high ammonia levels
	gaucher	aut rec lysosomal storage 25% pts asympt w painless HSMegaly bone abl and growth delay risk of splenic or pulm rupture tx w enzyme replacement - glucosyl cermidase glucoverebrosidase defic
	hunter synd	x linked mucorpolysacc w coarse facial features and bone abl. lysosomal hydrolase deficiency
	chalazion	lid discomfort dt chronic granulomatous inflammat of meibomian glad hard painless lid nodule recurrent - do histopathology to r/o underlying meibomian gland carcinoma
	hordeolum	abscess over upper or lower eyelid s aureus red tended swelling
	dacrocystitis	inflammat in medial canthal region of eye staph or strep
	forceful torsion of knee with foot planted and popping with sever pain	medial meniscus tear knee locks mc murray sign positive (click with rotation while extending) snapping felt on torsion
	low calcium and PTH w high phosphate	hypoparathyroid
	diabetic kidney	microangiopathy and glomerulosclerosis mild to mod protenuria and CKD w elevated cretinine
	sodium bicarb	alkalinizes urine in aspirin OD and excretes salicylates increases serum pH and alleviates action on myocardial Na channels in TCA OD to tx cardiac tox w prologed QRS and ventric arrythms
	fever and sore throat with antithyroid drugs	HA, n/v, AMS nitrates, hydroxocobalamin, sodium thiosulfate occurs in smoke inhalation blocks ox phos = anaerobic metabolism - lactic acidosis = tachypnea reduced oxygen utilization by tissues
	antimitochond abs	testost ovarian, DHEAS adrenal
	wallenberg synd	lateral medulla infarct occlusion of PICA loss of pain/temp ipsi face and contra body vertigo and nystagmus and horners
	fever w leukopenia and throbocytopenia and elevated LFTS	ehrlichiosis - tx w doxy - rash uncommon
	f	f
	adenomyosis	dysmenorrhea, pelvic pain menorrhagia bulky globular tender uterus
	prosthetic join infection	early on - staph aureus and pseudomonas delayed - staph epiderm
	irritable, high pitch cry, poor sleep and feed, tremor/seizures, sweating, sneezing, tachypnia, vomit/diarrhea in neonate	heroin baby
	kallman synd	delayed/absent puperty anosmia and short stature normal XX or XY genotype no GnRH secretion - low LH/FSH
	tremor at rest that improves w activity	parkinsons as opposed to essential - worse w intention = beta blocker and primidone
	elevation of semidiaphragm on CXR	volume more important than insulin
	bradycardia, hypotens, wheezing, hypoglyc, delirium, seizures, cardiogenic shock	beta blocker OD tx w fluid and atropine iv glucagon next
	comedonal acne tx	topical retinoids and benzoyl peroxide
	nitroprusside toxicity	cyanide
	hypersensitivities 1-4	no IgA reverses warfarin (together with vit K is the antidote for warfarin OD)
	paget dz = osteitits deformans	nml Ca and P up AlkPhos and urinary hydroxyproline can be isolated asympt AlkPhos elevation osteoclast hyperfx up bone turnover bone pain, fractures, hearing loss, UP bone scan uptake alendronate and calcitonin
	proteinuria in kids	often transient - repeat urine dipstick
	citrate	in stored blood products chelates Ca and Mg, lowering them in blood and causing paresthesias
	chi square	compares proportions of a 2x2 table
	PSVT	accessory conduction pathway vagal maneuvers - valsavla, cold water, carotid sinus massage - inc vagal tone and dec conduction through AV node
	pregnancy screening for all	syphilis (RapidPlasmaReagin), HIV, hep B meanwhile, G/C, hep C based on pt's risk
	2 months	lifts head tracks to midline alert to voice and cooing social smile and knows parents
	4 months	sits w drunks support and starts rolling eyes past midline hands open and reach midline laughs and turns to voice looks around
	6 months	nml Ca and P up AlkPhos and urinary hydroxyproline can be isolated asympt AlkPhos elevation osteoclast hyperfx up bone turnover bone pain, fractures, hearing loss, UP bone scan uptake alendronate and calcitonin
	9 months	pulls to stand and cruises 3 finger pincer graps and holds bottle/cup dada mama waves byebye, pattycake
	12 months	stand well, walks, throws ball 2 finger pincer grasp first word separation anxiety, comes when called
	increase in cortisol with cosyntropin	rules out primary adrenocort insuffic = addison's
	trachoma	follicular conjunctivitis and pannus (neovascularization)
	septic shock	down systemic vascular resist dt periph vasodilat low PCWP up CO high mixed venous oxygen saturation
	primary amennorhea with uterus eval	no boobs - FSH if FSK down - pituitary MRI if FSH up - karyotype
	amehorrhea w no uterus	karyotype 46XX w nml female testost = abl mullerian development 46XY w nm male testost = androgen insensiticity
	number needed to treat	# of ppl who should reveive tx to prevent 1 adverse event inverse of absolute risk reduction
	Right axis deviation	leads III and aVF are positive; leads I and aVL are negative
	glycogen storage dz type I	leads i and avl are positive; leads ii and avf are negative
	bipolar I does not require	an episode of deperession for dx
	edward's synd	trisomy 18 micrognathia and cephaly rocker bottom feet overlapping fingers absent palmar creases VSD mc heart prob (meanwhile ASD is mc in DOWNS) (ASD and VSD are endocardial cushion defects)
	stress incontinence tx	kegels and urethropexy urethral straining angle of 45 deg
	syphilis dx	CDRL and RPR are for SCREENING FTA-ABS and darkfield microscopy CONFIRMS
	postinfectious GN	10-21 days after URI mc in kids gross hematuria LOW C3! (unlike Iga) up ASO or antiDNAseB subepithelial humps made of C3 complement HTN, red cell casts, mild proteinuria
	IgA nephropathy	5 days after URI mc in young men recurrent gross hematuria NORMAL C3!!! (unlike postinfectGN) mesangial IgA deposits
	complete AV canal defect	assoc w Downs UP pulm markings and cardiomegaly
	round blue inclusions of RBCs on wright stain	howel jolly bodies assoc w hypo/asplenism
	langherhan's cells histiocytosis	solitary painful lytic bone lesion w overlying swelling and hypercalcemia in kid
	3yrs	copies circle feeds self w utensils stacks 9 blocks climbs stairs w alternating feet rides tricycle kicks ball 3 word sentences and 3/4 speech intelligible states name washes/dries hands and helps at home group play
	4yrs	copies cross and draws person and square can use scissors and hold crayon hops on one foot and jumps over objects counts to 10 tells stories, uses plurals, prepositions cooperative play imaginary friends imitates adult roles
	HIV pt w ICP	penicill, cephalo, sulfa fever rash arthralgia eosinophilia, hematuria, sterile pyuria, eosinophiluria
	3yrs	caused by VARICELLA zoster (herpes simplex is orolabial and genital)
	4yrs	TEN is more - over 30% of surface area SJS - less - under 10% both sudden onset of mucocutaneous lesions and exfoliation of skin antibax, anticonvulsants, allopurinol tx w agressive fluid support
	amiloride	potassium sparing diuretic together with beta andrenergic blockers, ACE, ARBS, and NSAIDs causes hyperKalemia
	syphilis tx if can't penicill	doxy
	mc injured nerve assoc w midshaft humerus fracture	radial nerve
	IUP seen on US if bHCG at	1500-2000, if level below, repeat in few days
	clear cell adenocarci vs squamous cell carci of vag and cervix	clear cell adeno = diethylstilbesrol during pregnancy of mom squamous cell carci - HPV and tobacco
	down hematocrit =	autrecess increased intest Fe absorpt skin = hyperpigment msk = arthralgia, arthropathy, chondrocalcinosis GI = up liver enzymes, hepatometaly, cirrosis, up risk of hepatocell carci endo = DM, 2ndary hypogonadism, hypopituitary cardiac = restrictive or dilated cardiomyopathy w conduction abl (sick sinus) infections w vibrio, listeria, yersenia
	CHF effect on kidney	vasoconstriction of efferent arterioles = up intraglomerular pressure to maintain GFR
	warfarin inhibits	sythesis of vit K = 2,7,9,10,C,S
	diamond blackfan	macrocytic pure red aplasia congenitcal macrocytic RBC anemia head and arm deformitiesp short stature, webbed neck, cleft lip, shielded chest, triphalangeal thumbs
	fanconi's anemia	pancytopenia and macrocytos cafe au lait, microcephaly, micophthalmia, short stature, horshoe kidneys, absent thumbs
	plantar warts	dt HPV hyperkeratotic papules on sole of foot - painful walking/standing
	mysathenia tx	down capacity and TIBC ferretin UP bc it is STORED Fe
	hashimoto abs	anti-thyroid peroxidase assoc w lymphoma of thyroid
	severe abdominal pain worsening w food leading to avoidance of food	early activation of adrenal gland (peripheral)
	mc nutritional defic in kids	iron, esp if drinking cow milk microcytic anemia w elevated RDW and UP TIBC TIBC measures how much space is available for iron transfer, increases when iron decreases
	sinusoidal congestion w hemorragic necrosis of liver	hepatopathy of CHF
	reye synd	cuagulopathy and encephalopathy hyperammonemia, transaminitis, coagulopathy, vomit, mental status change microvesicular steatosis of liver
	abort cluster headache	hypoxia polycythemia hypoglyc hypothermia hypoCalc
	best way to reduce diabetic nephropathy	BP control
	abl secretin	folate - homocysteine, b12 - MMA
	abort cluster headache	NPV, varies w pretest probability of dz. Pt w high probability of dz whill have low NPV
	alcoholic electolytes	hyPO - kalemia, magnesemia, phosphatemia hypoMG causes refractory hypokalemia
	antiparietal abs	pernicious anemia (which doubles gastric cancer risk) pernic anemia also assoc w hashimoto hypothyroid
	ABO mismatch vs IfA anaphylax	ABO happens in 1-6 hrs - fever, flank pain, hemolysis, oliguric renal fail IgA defic happens within minutes - angioedema, hypotens, dyspnea, LOC, shock, resp fail
	dysphagia w solids and liquids together	100% oxygen
	thyroid changes in preggos	increased thyroid hormone w increased total T3 and T4 and DOWN TSH
	lupus anticoagulant	APLA - antiphospholipid antibody lifelong 2-3 warfarin prothrombotic prolongs PTT conterintuitively
	high iron	100% oxygen
	dead space	wasted ventilation of poorly perfused areas = PE. no hypoxemia
	CD4 below 200	need prophylaxis for PCP w TMPSMX if drop below 50, add azithro/clarithro for MAC prophylax
	CAH vs aromatase defic	CAh hass estrogen, aromatase defic doesn't. Virilization of females w normal internal but abl external genitals
	metoclopramide	dopamine receptor antagonist for n/v and gastroparesis can cause EPS (TD, dystonia, parkinson) and neuroleptic malignant
	consolidation vs pleural effusion	vivid dreams
	methanol poison	A = dry skin, headache, abd pain, blurry vision D = hypercalc - constipat, abd pain, polyuria/dipsia
	guillan barre	ascending flaccid paralysis UP protein on CSF w nml cell count = albuminocytologic dissociation tx w immunoglob
	poly and dermatomyosistis dx/tx	muscle biopsy and coritocsteroids. ESR and CK up dermato tx w cyclosporine but must dx a biopsy or EMG initial tx = prednisone also look for malignancy
	anticholinergic poisoning	down Ach anticholinergic symptoms CNS depression, hypotension dilated pupils, dry mouth, hyperthermia, intestinal ileus, urinary retention QRS prolongation (ventric arrythm) tx w sodium bicarb to improve BP and prevvent arrythm tx w physostigmine
	dx of diverticulitis	abd CT
	pneumopariutoneum	air under diaphragm can be dt perforated peptic ulcer surgical emergency
	beta blockers or CCB tox	hydralazine for emergencies methyldopa for long term in HTN preggos
	mobile cavitary mass in the lung	aspergilooma - presents w hemoptysis
	alcoholic hepatitis	ast twice ALT and ferretin and GGT UP
	hydro vs varicocele	abl estrogen receptor give trastazumab/herceptin check echo as drug can be cardiotoxic
	hypospadias vs epispadias	hypospadias ventral and assoc w chryptorch, wiat to circumcise epispadias dorsal assoc w incontinence surgery for both surgery for cryptoch if not out by 1 yr - reduces chances of cancer, but not fertility issues
	anuria in neonate 24 hrs	posterior urethral valves drain bladder w catheter then dx w VCUG and surgically remove
	chronic otitis media over 3 months	HA, visual changes, dizziness tx w ethanol, fomepizole, dialysis
	bullous impetigo	toxin B desmoglein1
	ITP in kids	can be precipitated by viral illness -also causes red cell aplasia tx w prednisone, splenectomy if severe isolated thrombocytopenia megakaryocytes elevated
	beta thalassemia	low MCV nml iron studies chronic transfusions
	infant weight	doubles by 6 mo triples by 12 quadruple by 24 mo LENGTH doubles by 4 yrs
	when trasfuse w RBCs	if hypotensive or organ dysfx
	mc heart problem in babies w DM mom	asymmetric septal hypertrophy obstruction of ventric flow = DOWN perfusion weak pulses, hypotens, prolonged regill supportive tx, improves over time prominent perihilar vessels, large heart
	GAS strep pyogenes	rheumatic hear dz can cause MR makes valve susceptible to VIRIDANS S AUREUS is MC in ENDOCARDIT
	painful red eye with blurred vision photophobia and tearing	uveitis inflammatory cells in aqueous humor miosis emergency opho referral
	unilateral eye redness with purulent discharge	bacterial conjunctivit may be bilateral topical abx like sulfa
	meckel's diverticulitis	complication of meck diverticulum presents like acute appendix h/o painless rectal bleed
	HSP	low extremity palpable purpura arthritis abd pain and possible intussiception or scrotal swelling check hematuria after viral URI vasculit of small vessles "leukocystolytic vasculit"
	clinodactly (deflected pinky) + enlarged tongue	trisomy 21
	6 months vaccinats	HBV, DTap#3, IPV#3, PCV#3
	abacavir	EDTA add BAL if encephalopathy
	corneal ulcer	fungus bacteria virus or prolonged lenses pain tearing photophobia visual loss scrape and gram stain
	dacryostenosis	lactic acidos, hepatit, hypersens rxn
	abacavir	inc indirect bili
	fitzhugh curtis	adhesion btw liver capsule and diaphragm in PID
	choking/drooling at feeding	lactic acidos, hepatit, hypersens rxn
	pancreatit	can have nml amylase levels
	DM babies	small left colon anencephaly neural tube - meningomyelocele heart - transposit, VST, assym sept hypertropy skelet - sacral agenesis GU - renal agenesis or vein thrombos
	infantile hemangioma	benign vascular tumor - spontaneous involution, asympt but assoc w CHF dt inc vascular flow
	duodenal atresia	can be seen on prenatal US = scaphid abdomen and epigast fullness
	ulcerative colitis marker	pANCA (asca for crohns)
	congenital cataract	lens opacity dt rubella or galactosemia
	free air on lateral decubitus baby	replaces fibrinogen
	optic glioma and osseous lesions	NF - sphenoid dysplasia or thinning of long bone cortex
	neovascularization of choroidal vessels	macular degenetation tx w laser photocoagulation
	wbautoantibodies in DM1	glutamic acid decarboxylase destruction of beta cells w cytotoxic T lymphos
		up ESR, fever, vertebral tenderness sensory level, hyperreflexia can come from ednocartid/bacteremia that developed into vertebral osteomyelitis if compresses spinal cord = neuro findings
	rrdx of hirschprung	first anal manometry, then biopsy
	crohn's	neutrophilic cryptitis - in BOTH crohns and UC +/- rectal bleed some rectal dz ileus, perianal, strictures (SBO), fistula transmural, skip lesions, cobblestone mouth ulcers w granulomas
	ulcerative colitis	up ESR, fever, vertebral tenderness sensory level, hyperreflexia can come from ednocartid/bacteremia that developed into vertebral osteomyelitis if compresses spinal cord = neuro findings
	punctuate hemorrages on strawberry cervix	diaphragm rupture from blunt trauma respi distress mediastinal contents shift to opp side nasogastric tube in pulm cavity usually on left bc right protected by liver
	corneal abrasion	painful red eye w sensation of foreign body topical anesthetic - tetracaine then inspect w flourescent slit lamp topical abx and eye batch for 24 hrs
	allopurinol safe in renal fail but	can cause hypersense rash + stevenjohnson inibits xanthine oxidase don't use in acute gout decreases uric acid losartan good for BP in gout
	pesudogout	ca phosph deposit + birefringent rhomboid nml uric acid up WBC in synovial fluid: 2000-50,000 hemochromatos and hyperparathyroid wrist/knee
	DJD osteoarthritis	old pt, worse w use DIP, PIP, hips knees less than 200 WBC osteophytes narrow joint space crepitus tx w losing weight and resist training acetaminophen
	gout	men, acute, drinking 1st toe 2000-50,000 WBC negative birefring needles
	RA	flush diarrhea wheeze dx w 5HIAA means liver mets niacin defic dt being used up in extra serotonin and tryptophan production niacin defic = pellagra w dermatit diarrhea dementia tx w octreotide
	septic arthrit	acute w fever single hot joint over 50,000 WBC culture fluid 50% gonococcal - gram POS - IV ceftriax migratory arthrit surgically drain the nurbid synovial fluid w neutrophil predom leukocytos
	epidural abscess	up ESR, fever, vertebral tenderness sensory level, hyperreflexia can come from ednocartid/bacteremia that developed into vertebral osteomyelitis if compresses spinal cord = neuro findings
	negative straight leg excludes	flush diarrhea wheeze dx w 5HIAA means liver mets niacin defic dt being used up in extra serotonin and tryptophan production niacin defic = pellagra w dermatit diarrhea dementia tx w octreotide
	cord compression	cancer, vertebral tenderness, sensory level, hyperreflexia decrease pressure w steroids! dexamethasone = glucocorticoid evaluate w MRI after
	cauda equina	bowel/bladder incont, ED, bilat leg weak, saddle anesth
	ankylosing spondylitis	under 40, pain worse w rest, down chest mobility dx w xray BHLA27 seronegative (so no steroids) axial joint fusion and deformity sacroilitis squaring of vertebral bodies calcificat of anterior longitud ligament NSAID and TNF restrictive lung pattern of breathing down vital and total lung capacity normal FEV1/FVC ant uveitis
	disk herniation	pain/numb in calf or foot, down knee/ankle reflex and positive straight leg raise
	spinal stenosis	back pain in over 60yo while walking can radiate to butt and legs worse downhill better w leaning fwd ABI and pedal pulses nml MRI and surgery
	dilated retinal veins, microaneurysms, retinal hemorrage, edema, hard exudate	non-proliferative diabetic retinopathy
	loefingen	acute sarcoid fever systemic arthrit + anterior uveit erythema nodosum bilateral hilar adenopathy but in CAUCs not AA
	calcium hyydroxyapatite	DJD/osteoarthrit + hyperparathyroid
	bisphosphonate mech	inhibit osteoclasts
	painful/tingly butt	piriformis syndrome - worse w sitting
	popping at time of injury	ACL - hyperextended knee
	wegener	cANCA = AntiNeutrophilCytoplasm pna unresolving w abx granulomatosis w polyangiitis nasal cartilage destruction vasculitic cutaneous lesion - tender nodules, palpable purpura, ulcerations upper and loeer airway granulomatous inflammation glomerulonephrit
	churg strauss	eosinophilic vasculit
	anticentromere	CREST
	gray vesicles/ulcers on posterior oropharynx	RA
	dermatomyositis
	polymiositis	proximal weakness w skin findings up CK and antisythase antibodies muscle biopsy = mononuclear infiltrate w CD8 + lymphos w no amyloid inclusions up CPK and LDH
	soft tissue sarcoma (fibrosarcoma)	under 5 cm - resect, over 5 cm - radiation then resect
	hordeolum vs chalazion	hordeolum = stye - painful red lump near lid margin chalazion = painless lump away from lid margin tx both w warm compress
	retinal artery occlusion	sudden painless unilateral transient loss of vision pale opaque fundus with cherry red spot emboli from carotids or temporal arteritis "amarosis fugax" = temporary blackening of vision, usually embolic massage w oxygen to tx
	retinal vein occlusion	cotton wool spots sudden unilateral vision loss cotton wool spots also seen in DM and HTN
	retinal detachment	sudden painless unilateral vision loss w curtain and floater black spots
	Caplan	RA+ pneumoconiosis _ lung nodule
	young pt w high spiking fever and rash	JRA rash only w fever - salmon color - abd and chest splenomegaly pericard effusion joint sympts, rarely hip nml ANA up ferretin and leukocytosis anemia down albu
	IgG IgM antibods against neg phospholipids	antiphospholipid synd lupus anticoagulant increases PPT and clotting, nml PT anticardiolipin = recurrent abortions - prevent w heparin and aspirin some pts w APLS also have SLE throbotic risk - so no OCPs violacious rash - rivedo reticularis
	cyclosporine	inhibit self attacking T cells txs aplastic anemia together with thymocyte globuline and tacrolimus side effs = nephro/hepatotox HTN and hyperK hirsutism, gingival hyperplasia gout
	osteoporos	low bone mass T score under -2.5 pathologic vertebral fracture and pain
	polycythemia vera	HA + TIA pruritus, flushing, sweating splenomegaly JAK2 mutation mcc death - thrombos down erythropoetin, up LAP tx w phlebotomy and hydroxyurea
	multiple myeloma	plasma cell malignancy bone pain and patho fractures monoclonal spike in beta/gamma globulin on electrophores in serum/urine renal insuffic, anemia, bone lesions renal tubule damage amyloidos and monoclonal immunoglob glomerular deposition clonal marrow plasma cell - plasmacytomas init dx = xray bone scan doesnt show lesions urine stick only shows albumin bence jones seen only on immunoelectophores tx - dexamethasone lenalidomide melphalan brotezomib or under 70 - BMT most accurate BM biopsy confirms dx
	reactive arthritis	chlamydia, yersenia, salmonella, shigella, campy NSAID, sulfasalazine, abx
	CREST	calcinosis raynaud esophag dysmotility sclerodactly telangeactasias anticentromeres
	triptans should not be given with	anti Scl 70 topoisomerase raynaud, thick skin, masklike facies, sclerodactly, esopahg dysmot, pulm intertstitial fibros (pulm HTN = mmc death), renal insuffic, cardiomyopathy mc lung problem = interstitial lung dz
	anticholinergics tox	UIRNP autoantibods raynaud, sclerodactily arthritis, myositis heart dz, pulm dz
	de quevrain's tenosenovitis	crusty staph or strep
	relapsing polychondritis	auricular chondritis seroneg inflamm arthrit ocular inflammat respi tract chondrit inner ear dysfx down expiratory flow
	hematuria + hemoptysis	goodpasture anti GBM antibods
	antimitochond abs	crusty staph or strep
	antiparietal abs	pernicious anemia (which doubles gastric cancer risk)
	anti smooth musc	autoimmune hepatitis
	Sjorgen	anti Ra(SsA)/Lo(SsB) initial = shiner test, accurate = biopsy parotid enlargement, sicca, xeropthalmia, keratoconjunctivit complication = lymphoma
	tennis elbow	lateral epicondiliytis - extensor carpi radialis brevis
	stoke in young pt	Polyarteritis nodosa HepB/C HepC = down C4 lungs spared
	pencil in cup, nail pitting, sausage finger	psoriatic arthrit. neg RF
	charcot joint	neurogenic arthropathy h/o DM periph neuropathy + destructive osteoarthrit swell warm red effusion
	silver wiring and AV nicking on retina	HTN retinopathy. cotton wool spots and flame hemorrages also possible
	tumor lysis	anti Scl 70 topoisomerase raynaud, thick skin, masklike facies, sclerodactly, esopahg dysmot, pulm intertstitial fibros (pulm HTN = mmc death), renal insuffic, cardiomyopathy mc lung problem = interstitial lung dz
	CT of intersitial lung dz	reticular opacities ground glass fibrosis DOWN diffus capacity seen in scleroderma w pulm HTN
	colchicine	prevent pseudogout attacks renally cleared - don't use it or NSAIds in renal gouty pts - use steroids instead
	quad screen	UP beta and inhibin and DOWN AFP and estriol = down's - do ultrasound to evaluate anatomy low AFP, estriol, AND betaHCG = trisomy 18 up AFP = neural tube and abdominal wall
	JRA	rash only w fever - salmon color - abd and chest splenomegaly pericard effusion joint sympts, rarely hip nml ANA up ferretin and leukocytosis anemia down albu
	atrial tachycardia w AV block	digitalis toxicity
	JRA	rash only w fever - salmon color - abd and chest splenomegaly pericard effusion joint sympts, rarely hip nml ANA up ferretin and leukocytosis anemia down albu
	5 alpha reductase defic	can't convert testost to the more potent DHT 46 XY w maleinternal genitals female or undermasculinized external masculinization at puberty no breasts
	vasa previa	bleeding from fetus so mom unchanged diff from placentra previa - where mom, not fetus suffers dx w dopper ultrasound tell apart mom from vaby vag blood w apt or kleihaure betke testa
	low set ears, micrognathia, cleft palate, no thymus, tuncus arteriosus	di george chrom 22q11 deletion defective development of pharyngeal pouches CATCH conotruncal cardiac defects abl facies thymic aplasia cleft palate hypocalcemia!
	normocytic anemia	thrombocytopenia w thromposis or over 50% decline in platelets 5-10 days after tx w heparin heparin antidote = protamine sulfate
	CLL	aspirin n/v, tinnitus hypervent, anion gap, met acid tx w charcoal, dialysis, sodium bicarb
	isoniazid hepatotox	cryptococcal menengit - look for antigen in serum or CSF or yeast on ink stain of CSF, CD4 below 100
	fatigue dyspnea anemia w reticulocytosis	warm agglutinin AIHA can be dt CLL, viral, mono, SLE, penicillin normocytic anemia, jaundice, hyperbili indi up LDH down haptoglobin BM responds w reticulocytosis tx w glucocorticoids or splenectomy if severe
	babesiosis	endemic in north east hemolysis no rash clinically significant in asplenics dx w giemsa stain blood smear quinine clinda and atovaquone azithro
	PE pressures	UP right atrial and pulm artery nml PCWP
	mg sulfate	for torsades and digitalis tox for preeclampsia lowers Ca influx and decs early afterdepolarizat
	absent bowel sounds w gaseous distention	paralytic/adynamic ileus often after surgery or retroperitoneal surgery assoc w vertebral fracture decreased or absent bowel sounds tx all w bowel rest dilated bowel loops w air fluid levels in contast SBO and LBO have high pitched bowel sounds
	inflammatory breast CA	erythematous edematous cutaneous plaque overlying mass w axillary LAD breast pain erythema warmth peau dorange rapidly progressive ductal carcinoma
	TTP	inability to take oral meds dt nausea/vomit
	ropinirole	domapine agonist like bromocriptine and apomorphine txs parkinsons somnolence, hypotens, confusion, hallucinats
	selegiline	MAOB inhbitor for parkinsos - causes confusion and insomnia
	obesity and bones	adipose tisuue stores estrogen and causes extra weight bearing so actually prevents osteoporosis, but is associated w osteoarthritis
	osteoporosis risks	age, thin body, smoking, etoh, corticosteroids, menopause, hyperthyroid, malnutrition, fam hx, asian and cauc
	tx for lyme dz when can't use doxy (preggos, lactating, kids)	amoxicillin
	constitutional growth delay	delayed growth spurt, puberty, and bone age
	normal jugular venous pressure	less than 3 cm above sternal angle
	cyclophosphamide	prevents sicle recurrence by upping HbF
	cisplatin and carboplatin	for ball ovary and bladder cancer chochlear dysfx also aminoglycosides ototoxic
	ethambutol and hydroxychloroquine side eff	optic neuritis
	peripheral neuropathy caused by	phenytoin, isoniazid, vincristine, heavy metals, etoh
	paroxysmal nocturnal hemoglobinuria vs acute intermit prophyria	thrombocytosis w large platelets no response to ristocetin w plasma addition
	giant cell tumor of bone	benign and locally agressive pain swelling down ROM soap bubble osteolytic lesions in epiphyseal regions long bones around knee
	osteitis fibrosa cystica	von recklinghausen from hyperparathyroid osteoclastic reportion - replacement w fibrous tissue bone pain, bown tumors, salt and pepper
	glycogen storage dz type I	von gierke g -6-phosphatase defic 3-4 months hypoglyc and lactic acidos w poss seizures hyperuricemia and hyperlipid doll-like face - fat cheeks, short stature, thin limbs, protuberant abdomen enlarged liver and kidneys, not spleen or heart
	glycogen storage dz type 2	pompe acid maltase defic first few weeks of life - floppy baby w feeding difficulties and macroglossia hepatomegaly and hypertrophy cardiomyopathy leading to HF
	glycogen storage dz type 3	cori debranching enzyme defic hepatomegaly hyproglycemia and hyperlipid drowth retardat up trsnasminaes nml lactate and uric acid
	HIV pt w ICP	cryptococcal menengit - look for antigen in serum or CSF or yeast on ink stain of CSF, CD4 below 100
	severe abdominal pain worsening w food leading to avoidance of food	occlusion/atheroscleros of visceral arteries = abdominal angina = mesenteric ischemia bloating nausea diarrhea
	Her2/neu	abl estrogen receptor give trastazumab
	HCG up in all testic cancers, alphafetoprot only in	abl estrogen receptor give trastazumab/herceptin check echo as drug can be cardiotoxic
	ASCUS	test for HPV + = colposcopy - = repeat in 6 mo low/high displasia on pap = colpo/biopsy cervical CA = postcoital bleed. hysterect
	normocytic anemia	acute blood loss or hemolysis
	FFP	no IgA reverses warfarin (together with vit K is the antidote for warfarin OD)
	cryoprecipitate	replaces fibrinogen
	low ferretin	Fe defic microcytic anemia up TIBC = capacity to fill w Fe up RDW (new cells smaller, variability in size) mc cause = gi bleed - look for it before resupplementing iron orally
	high iron	sideroblastic - can be macro or micro prussian blue down TIBC happens in pts w vit B6 defic like drugs/etoh
	nml iron	thalassemia microcytic anemia electrophoresis nml RBC and RDW target cells mild fatigability in heterozygous alpha thalassemia
	anemia of chron dz	bleeding only (plt fx and #)
	if replace folate in b12 defic	cori debranching enzyme defic hepatomegaly hyproglycemia and hyperlipid drowth retardat up trsnasminaes nml lactate and uric acid
	down hematocrit =	up LDH, indi bili, reticulocytes
	CLL	cold smudge cells starts w asympt leukocytos - no tx later flutarabine chlorambucil for palliation
	anemia of chron dz	responds to reistocetin if add fnx plasma factor 8 antigen
	hemophilia	affects PTT up- (coag factors) not PT deep bleeding - joints desmopressin and factors for tx normalize after mixing studies
	aspirin affects	bleeding only (plt fx and #)
	bernard soulier	thrombocytosis w large platelets no response to ristocetin w plasma addition
	glanzman thrombastenia	nml PT/PTT defective platelet aggregation up bleed time IIa/IIIb defic
	tumor lysis	up P and uric acid down Ca rasburicase, allopurinol, IV fluids, diuretics
	atrophic gastritis type A	from pernicious anemia achloridia up gastrin G cells no longer inhibited by acid B12 defic and periph neuropathy thyroid + anemia - think b12 defic
	abl secretin	ZE"cretin" multiple ulcers
	what is up in folate and b12 defic	folate - homocysteine, b12 - MMA
	polycythemia vera	HA + TIA pruritus, flushing, sweating splenomegaly JAK2 mutation mcc death - thrombos down erythropoetin, up LAP tx w phlebotomy and hydroxyurea
	TTP	thrombocyto, neuro sympts, fever renfail, microangio hemoplytic anemia schistocytes up creatitine nml PT/PTT tx w plasmaphares
	hydroxyurea	prevents sicle recurrence by upping HbF
	parvovirus b19 in sickle cell	suddenly drops the usually high retuculocytes and drops Hct PCR/DNA most accurate
	down MCV, up MCHC, negative coombs	hereditary spherocytos hemolytic anemia jaundice splenomegaly reticulocytosis w low corpuscular volume up mean corpusc hemoglobin and RDW = acute cholecystitis w pigmented gallstones more Hgb per cell test = osmotic fragility in hypo folic acid if asympt splenectomy if sympt
	spherocytes also seen in	autoimm hemolytic anemia positive coombs clean smear - cells destructed inside spleen (extravasc)
	quadruple screen - betaHCG, inhibinA, estriol, AFprotein	UP beta and inhibin and DOWN AFP and estriol = down's low AFP, estriol, AND betaHCG = trisomy 18 up AFP = neural tube and abdominal wall
	flail chest	paradoxical chest mvmt w breathing dt several rib fractures in 2 places per rib
	elevation of semidiaphragm on CXR	diaphragm rupture from blunt trauma respi distress mediastinal contents shift to opp side nasogastric tube in pulm cavity usually on left bc right protected by liver
	organophosphate poinsoning	anticholinesterase toxicity cholinergic toxicity up ACh = bradycardia, miosis, salivation tx w atropine and pralidoxime DUMBBELSS = diarrhea, urination, miosis, bronchospasm, bradycard, excitat of skeletal muscle, lacrimation, sweating, salivation CHOLINE MAKES YOU LEAK
	TCA overdose	down Ach anticholinergic symptoms CNS depression, hypotension dilated pupils, dry mouth, hyperthermia, intestinal ileus, urinary retention QRS prolongation (ventric arrythm) tx w sodium bicarb to improve BP and prevvent arrythm
	acetaminophen tox	sudden painless unilateral transient loss of vision pale opaque fundus with cherry red spot emboli from carotids or temporal arteritis "amarosis fugax" = temporary blackening of vision, usually embolic massage w oxygen to tx
	anticholinergics tox	opposite of choline = nonleaky dry mouth, urine retent, QRS widening on EKG tx w PHYSOSTIGMINE
	beta blockers or CCB tox	sudden painless unilateral transient loss of vision pale opaque fundus with cherry red spot emboli from carotids or temporal arteritis "amarosis fugax" = temporary blackening of vision, usually embolic massage w oxygen to tx
	cyanide poison	HA, n/v, AMS nitrates, hydroxocobalamin, sodium thiosulfate occurs in smoke inhalation blocks ox phos = anaerobic metabolism - lactic acidosis = tachypnea reduced oxygen utilization by tissues
	isopropyl alcohol posion	dec consciousness, nausea, abd pain supportive care
	methanol poison	HA, visual changes, dizziness tx w ethanol, fomepizole, dialysis
	ethelyne glycol (antifreeze) poison	ataxia, hallucinations, seizures, sweet breath tx w ethanol, dyalysis AKI and hypocalcemia oxalic acid and oxalate envelope crystals
	salicylate poison	dec consciousness, nausea, abd pain supportive care
	gray vesicles/ulcers on posterior oropharynx	herpangina from cocksackie A virus - supportive tx
	randomization controls	confounders
	dx of zenker's diverticulum	contrast esophogram false diverticulum above upper esophag sphinct
	kids fall on outstretched hand	supracondylar humerus forearm fractures entrapment of brachial artery and median nervevolkman's contracture = ischemia and infarction from compartment syndrome (rare)
	subarachnoid bleed delayed morbidity	vasospasm leading to infarction - can be prevented with nimodipine
	viral conjunctivitis	warm/cold compresses. adenovirus
	gastrinoma	occurs in pancreas causes diarrhea increasted gastrin release = refractory gastric ulcers and dyspepsia = zollinger ellison check serum gastrin, if negative, check secretin
	VIPoma	pancreatic tumor vasoactive intestinal peptide water diarrhea and muscle weakness/crapts dt hypokalemia and hypochrolemia dt dec gastric secretion stool stupdies and VIP over 75 confirms dx
	normal amniotic fluid index	5-25
	hypoalbuminemia also shows up with	decreased total serum calcium but the unbound/ ionized, phsyio active form is hormonally regulared and remains stable unbound/ionized Ca will drop during respiratory alkalosis (frees up albumin to bind w Ca) and then you get sympts of hypocalcemia
	barrett's and GERD assoc w	ADENOcarci of esophagus - DISTAL (sssssmoking and alcohol and lye and achalasia w ssssquamous = prox/mid esoph) both will be progressive dysphagia to liquid and solid weight loss and constitut sympts evaluate w barium swallow and endoscopy
	pneumonitis and colitits	CMV in immunosuppressed thrush also possible multifocal diffuce pathcy infilatres on CXR parenchymal opacification and multiple small nodules BAL diagnostic gi ulcers - diarrhea and abd pain
	viridans tx	penicillin or ceftriaxone always do IV (not oral) for endocardit
	steroids and splenectomy for	warm igG AIHA
	HUS and TTP	schistocytes intravasc hemolysis ren fail negative coombs nml PT/PTT platelets make worse tx w plasmapharesis HUS more renal TTP more mental
	anagrelide/hydroxyurea	for essential thrombocythemia/polycythemia
	myelofibrosis	extramedullary hematopoesis hepatosplenomegaly tear shaped, nucleated cells tx w thalidomide, lenalidomide TNF inhibs
	MALT lymphoma	assoc w H pylori (duod ulcers = anemia + heme stools) lymphoid follicles and sheets and gram - rods cd 19 20 22 can transition to bcell lymphoma tx w amoxi clarithro omeprazole
	CML	bcr-abl on FISH or philly 9/22 on cytogenetics fatigue night sweats fever splenomegaly bone/abd pain all neutrophils LAP down TK inhibitors - imatinib cure w BM transplant transfrom to acute leuk = blast crisis down LAP plt and erythro nml or up
	familial melanoma gene	CDKN2A - also ups risk of panc cancer
	platelet bleeding	superficial - gums, nose, etc
	factor bleeding	deep - joints hemophilia
	up PT/INR (extrinsic)	down fx of K-dependent factors 2 7 9 10 (warfarin) seen in vit K defic - tx w FFP
	up PTT	inactivated factors iia, 9a, 11a, 12a (heparin)
	only 2 factors not made by liver	vWF and VIII
	von williebrand	AD, mc bleed disorder easy bruising and mucosal bleeding superficial (platelet) bleeding but normal platelets! worse w aspitin up PTT and bleeding time desmopressin (subendothelial reserves) for minor bleeding vWF and factor VIII concentrate before surgery or major bleed
	AML	sympts of pancyto - fatigue, bleeding, infexn even if total lymphos normal auer rods, myeloperoxidase esterase chemo, cytosine arabinose, dano/idarubicin tx
	IgA heavy chain dz	middle east behaves like abd lymphoma abd mass w malabsorpt down gamma fraction or broad band alpa and beta regions
	leukemoid rx	leukocytosis over 55k in resoinse to infexn/trauma, also elevates leuk alk phos
	NSAIDs decrease and increase	down platelet thromboxane 2 and up bleed time
	ITP	petichiae, gingival bleed, epistax, bruising isolated thrombocytopenia PT/PTT nml igG autoantibodies against platelet memb glycoprots check for HIV/HepC - can be first presentation tx w steroids/immunoglobs
	myelodysplastic synd	pre-leukemic, suggests leukemia 5q deletion mc of death = infexn and bleed asympt pancytopenia = macrocytic anemia, leukopenia, thrombocytopenia ovalo macrocytes w hyposegmented neutrophils up MCV, nucleated red cells hypercellular marrow and pruss blue sideroblasts pelger-huet cell w bilobed nucleus transfusion erythropoetin (can worsen HTN) lenalidonide
	cladribine pentostatin	for hairy cell leukemia TRAP cd11 cd22 dry tap despite hypercellular marrow
	hyper IgM	coombs + hemolytic anemia x recessive
	monoclonal spike IgG	most specific finding of multiple myeloma (sometimes IgA)
	monoclonal spike IgM	waldenstrom macroglob
	phototoxicity in sun exposed areas	doxy, thisazies, sulfa, fluoroquinolones, NSAIDS = keratinocyte necrosis in UV
	cisplatin	ren fail and deaf
	bleomycin and busulfan	hyperproloactin = DOWN GnRH = 2ndary amenorrhea and galactorrhea also HTN d/t TPR hypercholest dt DEC renal LDL excret fatigue, cold intol, constipat, weight gain, dry skin, bradycard
	cytarabine	eye problems - prevent w topical steroids
	NHL	hyperproloactin = DOWN GnRH = 2ndary amenorrhea and galactorrhea also HTN d/t TPR hypercholest dt DEC renal LDL excret fatigue, cold intol, constipat, weight gain, dry skin, bradycard
	hodgkin's lymphoma	large nontender rubbery lymph nodes disseminated reed sternberg cells lympho predom = worse prognos adia, bleomycin, vinblast cd 15/30
	radiation ups risk of solid tumor	breast lung thyroid
	keloids can be tender and pruritic	tx w intralesional steroids
	plummer vinson	fe defic anemia - down MCV and ferrtin, up TIBC dysphagia dt esophageal webs glossitis also pica and angular chelitisA
	ALL	bone and joint pain lymphoblasts lack peroxidase positive granules and contain cytoplasmic acid schiff PAS material best test = BM - look for lymphoblasts anemia leukopenia thrombocyto bone pain HSM LAD ALL antigen and TdT expressed by pre B and T lymphoblasts prophylax w methotrex tx - daunorubicin, vincristinem prednisone mc cancer in kids
	thyroid meds	propilthyuracil and methimazole - cause agranulocytosis
	no tx for afebrile neurtopenia	common after chemo, but if fever - tx w cefepime and carbapenem
	INR for mitral vlave replace	2.5-3.5
	aplastic anemia	fat cells in marrow stroma hypocellular marrow w no precursor cells radiation, toxins/drugs
	splenectomy vaccination	n mening, h influ, pneumococc
	factor V leiden	hypercoag/throbophilia. warf 2-3 INR 6mo
	bugs in sickle cell	septic arthrit = s aureus osteomyelit = salmonella sepsis = s pneum
	cardiogenic shock	pump failure reduced cardiac index up PCWP - indirect measure of LA pressure if LV fails, PCWP up (over 20) up SVR
	lmanomentry for	achalasia, spasm, scleroderma
	steatorrhea in chrohn's	caused by bile salt defic inflamed terminal ileum ADEK not absorbed CaOx nephrolithias hypocalcemia osteomalacia
	chronic Hep B	anti HBC igG and HbsAg
	previous Hep B infect	anti HBC igG and anti-HBs
	surface ag appears w , and core w	vaccination = surface core = resolution
	HbsAg and igM antiHBC	acute infexn
	antiHBs only	vaccination (surface antigen)
	hepatitis B surface antiGEN (HBsAg)	tests for the presence of virus. A "positive" or "reactive" HBsAg test result means that the person is infected with the hepatitis B virus, which can be an "acute" or a "chronic" infection
	hepatitis B surface antiBODY (HBsAb oranti-HBs)	person has successfully responded to the hepatitis B vaccine or has recovered from an acute hepatitis B infection
	hepatitis B core antiBODY (HBcAb)	past or present infection with protective surface antibody (positive HBsAb or anti-HBs) = prior infection and recovery with the virus (positive HBsAg) = chronic infexn
	acute HepB
	vaccine HepB
	past HepB
	chronic HepB
	window HepB
	HepB tx	lamivudine and IFN alpha
	HepC tx	peg interferon and ribavirin for portal/bridging fibrosis
	IBS gets better with	at night. normal mucosa
	tenesmus, urgency, bloody diarrhea in AIDS pt	CMV colitis
	gastric ulcers need to be	biopsied to r/o malignancy
	if penicill allergy, tx h pylori w	metro, tetra, bismuth, omeprazole
	hyperTG can cause	acute pancreatit if TG over 1000. amy/lipase will be artifically reduced
	smoking+ CDKN2A+ chronic pain	panc CA
	renal stone imaging	NONcontrast CT!!!!
	degeneration of dorsal and lateral spine tracts	B12 defic - imparied vibration/proprioception and spastic muscle weakness
	cytochrome p450 inhibitors (up warfarin effect and bleeding risk)	acetaminophen and NSAIDs antibiotics/antifunglas amiodarone cometidine cranberry, vit E, ginko omeprazole thryroid hormone SSRI
	cytochrome p450 inducers (down warfarin)	carbamazapine, phenobarbital ginseng green veggies OCPs rifampin st John's wort
	ASCUS	21-24 - repeat cyto in 1 yr over 25 - test for HPV positive HPV - colpo neg HPV - follow w pap and HPV test in 3 yrs
	5% dextrose and .45% saline	for mild hypovolemic hypernatremia
	angioedema	from ACE-is. can occur anywhere in body. also possible - cough and hyperkalemia
	bony mets	from lung, breast, prostate, thyroid, kidney pain constant, worse at night, point tenderness
	clopidogrel	secondary prevention following UA/NSTEMI for 1 yr 30 days for metals tents one year for drug eluting stents after PCI
	sharply demarccated erythematous edematous tender skin lesion w raised borders and fever	erysipelas - mc = group a strep
	mcc of mitral regurg	MVP
	chronic bronchitis	normal DLCO, but decreased FEV1 and FEV/FVC (emphysema and restrictive lung dz have low DLCO)
	mcc brain mets	amebic - from entameba histolytica protozoa from mexico = liver abscess hydatid - echonochoccus from intimate contact w dogs
	pulmonary contusion	dysp, tachypnea chest pain hypoxemia worsened by intravasc vol expansion patchy, irreg alveloar infiltrates on CXR
	pertussis post exposure prophylax	amebic - from entameba histolytica protozoa from mexico = liver abscess hydatid - echonochoccus from intimate contact w dogs
	mcc nephrotic synd in kids	MCD - responds to steroids, no biopsy needed edema fatigue proteinuria, hypoalbuminemia
	neuroblastoma	arises from neural crest cells elevated cathecolamines and metabolites mc extracranial solid kid tumor firm nodular w calcificats and hemorrages
	TSS presentat	fever, rash throughout body including palms and soles, hypotens
	noncardiogenic pulm edema	up CO, low or nml PCWP
	increased marrow cellularity with megakaryocytic hyperplasia	essential thrombocytosis
	hypernatremia, low urine, high serum osmolality	diabet insipidus
	hypotonic hyponatremia and euvolemia with low plasma and high urine osmolality with high urine sodium	urge incontinence (mc) detrusor instability tx w muscarinic antagonists pelvic floor exercises voiding schedules
	slowly progressive anterior him pain w limitation of ROM	avascular osteonecrosis disruption of bone vasculature dt corticosteroids or alcohol dx w MRI
	IV acyclovir	urge incontinence (mc) detrusor instability tx w muscarinic antagonists pelvic floor exercises voiding schedules
	AIN - interstitial nephritis	dt drugs like beta lactams and PPIs 7-10 days post drug exposure skin rash, eosinophilia, eosinophiluria, pyuria
	male pattern baldness seen in	PCOS
	SBO	n/v, abd bloating, dilated loops on CXR HYPER bowel sounds postoperative adhesions mc
	corticosteroids for preemies	under 34 wks
	mgmt of chorioamnionit	broad spectrum abx followed by deliver, NOT c-section
	cor pulmonale	opposite of choline = nonleaky dry mouth, urine retent, QRS widening on EKG tx w PHYSOSTIGMINE, a cholinesterase inhibitor
	portal HTN/venous resistance	cirrhosis - palmar erythema, spider angiomata, caput medusae, gynecomastia
	serum to ascites albumin (SAAG)	opposite of choline = nonleaky dry mouth, urine retent, QRS widening on EKG tx w PHYSOSTIGMINE, a cholinesterase inhibitor
	loop diuretics lytes disturb	hypokalemia and hypomagnesemia vtach and digoxin potentiation
	untreated hyperthyroid risk	rapid bone loss dr up osteoclasts, also tachyarrythm like afib
	attributable risk percent = excess risk in exposed popl that can be attributed to risk	derive from relative risk ARP=(RR-1)/RR
	multiple small abscess cavities/pneumatocoeles	s aureus necrotizing bronchopneumona
	distortion of straight lines on visual acuity test	macular degeneration
	coccidiodomycosis	pulmonary infections vague sympts like fever, fatigue, cough arthralgias desert, southwest and central valley skin lesions UNUSUAL but can be erythema nodosum or multiforme
	histoplasmosis	soil based from mississippi and ohio asymptomatic or mild pulm infect crusting lesions in immunocompromised can mimic sarcoid dx by urinary antigen tx w itroconazole
	blastomycosis	central US mild pulmonary illness disseminated infection possible in immunocompetent and not patients well-curcumscribed verrucous nodules and plaques that progress to microasbcesses lung, skin, bone, GU oral itroconazole or amphotercin B
	raising cutoff value	UP specificity (fewer false positives) - good for confirmatory tests - need high SPEC DOWN sensitivity (more false negs) - so low screening value, as screening test need to be SENS
	AIDS pt w multiple ring enhancing lesions on CT	toxoplasmosis focal neural deficits sulfadiazine and pyrimethamine dx and tx TMPSMX prophylaxes!
	yellow-white patches of retinal opacification and hemorrages	CMV retinitis, CD4 below 50
	enuresis	desmopressin first line, imipramine next
	methotrexate side eff	GI, oral ulcers, stomatitis, rash, alopecia, hepatotox, BM suppress - supplement w folic acid
	RA predisposes to AA amyloidosis, multiple myseloma to AL	renal involvement = nephrotic syndo. congo red apple green birefringence under polarized light
	hyalinosis affecting afferent and efferent arterioles	diabetic nephropathy
	linear deposits on IM	antiglomerular basememt memb = goodpasture
	granular deposits = immune complex glomerulonephrit	lupus nephritis, IgA, postinfectious GN
	h pylori + pernicious anemia + nitrosamines	adenocarci
	high fat, lw fiber, ulc colit	colon CA
	hemochromatos, NAfatty liver, Hep B/C, aflatoxin, wilson, alpha1antitrypsin	hepatocell carci
	pancreatic pseudocyst	surgically drain if symptomatic
	nonbloody diarrhea that presents like appendicit - fever + RLQ pain and lekocytosis	yersenia, but appendicit comes w CONSTIPAT
	ulc colit + pruritus + up alk phos	primary sclerosing cholangitis dx w ERCP beads on a string tx w liver transplant multifocal strictures and dilation of bile ducts
	ascites and cirrhotic edema tx	spironolactone + HCTZ
	potassium sparing	spironolact, eplenerone, triametrene, amiloride
	RUQ	cholecystit, biliary colic, cholangit, perf duod ulcer
	LUQ	splenic rupture, IBS
	RLQ	appendicit, ovarian torsion, ectopic, cecal diverticulit
	LLQ	sigmoid, volvolus, diverticulit, pregg/egg
	midepigast	pancreatic, aort dissect, peptic ulcer dz
	mcc of epigast pain	nonulver dyspepsia. eval of epigast pain is w endoscopy
	PPI	-prazole. before H2 - tidine
	mc invasive blooby diarrhea in all age groups	intrecellular and interstitial edema - soft tissue swelling - compartment syndrome
	reprefusion after arterio-occlusive ischemia over 4-6 hrs can lead to	solid food only - from stricture
	acute vs chronic panc	aaaacute causes aaaARDS phospholipase damages alveloli cccchronic causes ccccancer
	if recently exposed to hepA	get vaccine immunoglobulin to kids under 1 yr, immunocompromised, liver dz
	first test for dysphagia	barium swallow
	obstruction starts w solid	EGD
	NASH / fatty liver	assoc w DM / metabolic synd - asympt w abl LFTs
	familial polyposis	aut dom - APC gene do genet test, if can't - sigm/colonosc starting 12 yo tx w proctocolectomy
	prodromal nausea/pallor/sweat vs prodromal dizziness/blurred vision before syncope	nausea/pallor = vasovagal - like micturition dizzy/blurry = orthostatic
	chest pain, down CO, pulsus paradoxus after viral infection	cardiac tamponade after acute pericarditis RA filling impaired, up systemic venous pressure down CO = wekaness/dizziness/syncope clear lungs
	lymphocytic pleocytosis, up protein, UP RBC, nml gluc	HSV encephalit - hemorragic destruction of frontal lobes
	lymphocytic pleocytosis, up protein, slightly DEC glucose	chronic bacterial menengit - myco TB
	nml FEV1/FVC	70-85% bc FVC and FEV1 decreased proportionally TLC down too the case in pulm fibros (restrictive lung dz) sarcoid fine bibasilar velco dry crackles
	down FEV1, nml FVC, down FEV1/FVC	COPD - bronchitis and emphysema
	ectopic ACTH is a polypeptide protein	secreted in small cell lung carci cushing's synd + hyperpigmentation dt MSH, a cleavage product of ACTH ACTH not suppressed by dexamethasone
	arrest	cervix ceases to dilate after reaching 4 cm
	decrease risk of stroke in Afib	warfarin
	empyema vs TB exudate	empyema will have low glucose and up PMNs TB will have high protein and nml glucose
	SVC syndrome	lung cancer or lymphoma - tx w radiation
	blistering of flexure surfaces, groin and axilla w subepidermal blisters on biopsy	bullous pemphigoid - autoimmune
	mc intracranial tumor in adults	brain mets from lung, breast, renal, melanoma
	upper motor neuron	hyperreflexia, babinski
	lower motor neuron	bullous pemphigoid - autoimmune
	blank stare, automatism, postictal confusion and (todd's) paralysis	complex partial seizure possibly with automatisms - lip smacking or chewing caused by temporal lobe epilepsy
	verapamil	for SVT if adenosine ineffective
	wide complex vtach tx	amiodarone
	pneumomediastinum suggests	mediastinitis caused by esophageal rupture - complication of esophageal dilation CP, hematemesis, SOB, L side pleural eff can lead to sepsis - hemodynamic instability and fever surgiccal debridement and abx can happen after cardiac surgery fever CP leukocytos
		viral, self limiting no meds or testing no tonsillar exudates or palatal petichiae cough runny nose and vesicles consistent w herpangina - cocksakie A
	hematuria can be dt glomerular or extraglomerular. proteinuria suggests	glomerular - igA or poststrep
		viral, self limiting no meds or testing no tonsillar exudates or palatal petichiae cough runny nose and vesicles consistent w herpangina - cocksakie A
	urinary frequency, nocturia, freqent small volume leakage	overflow incontinence neurogenic bladder in DM detrusor underactivity timed voids and indwelling cath cholinergic agonists like bethanechol
	intense urges that can't be delayed	urge incontinence (mc) detrusor instability tx w muscarinic antagonists pelvic floor exercises voiding schedules
	urine leaks with laughing/coughing	stress incontinence pelvic floor exercises
	iron tox	GI hemorrage - bloody diarrhea and hematemesis metabolic acidosis hepatotox bowel obstruct death
	afib, dizziness, and weight loss	hyperthyroid - check T4 and TSH
	locking and catching joint, knee effusion, pain w squatting	meniscal tear caused by twisting doesn't hurt right away
	mammogram	every 2 years after 50
	pain relief w elevation of testis	epidydimitis - in sexually active males chlamidya gonorrhea in younger e coli in older painful enlargement of testes and irritative voiding symptoms
	SAAG	over 1.1 = portal HTN = cardiac ascites, cirrosis, portal veous thrombos, constrictive pericardit under 1.1 = nonportal = malig (up capillary permeability), pancreatit, peritonit, nephrotic, TB
	lennox gestault	children under 7 with wide array of seizure types accompanied by MR, slow spike and wave activity on EEG
	juvenile myoclonic epilepsy	uni or bilateral myoclonic jerks - sympts in AM precipitated by sleep deprivat
	amebic vs hydatid cyst	amebic - from entameba histolytica protozoa from mexico = liver abscess hydatid - echonochoccus from intimate contact w dogs
	mcc pharyngitis in kids	viral, self limiting no meds or testing no tonsillar exudates or palatal petichiae cough runny nose and vesicles consistent w herpangina - cocksakie A
	distributive shock	UP CO, DOWN PVR and PCWP
	anemia hypoalbuminemia coaglopathy in elderly	malnutrition
	abort cluster headache	100% oxygen
	DKA	polyuria, polydipsia, n/v, abd pain, met acid low serum bicarb, up anion gap, hyperglyc = dx lack of insulin causes breakdown of fatty acids and ketones in liver Na - Cl - bicarb normal saline and potassium for over 1 hr subq insulin after anion gap closes
	lamivudine	hepatotox
	efavirenz	vivid dreams
	abacavir	lactic acidos, hepatit, hypersens rxn
	triptans should not be given with	ergotamine
	migraine abortives	acetaminophen/NSAIDs ergots antiemetics - prochlorperazine/metoclopramide triptans
	tocolytics that can cause pulm edema	beta agonists hypoxia tachypnea bibasilar crackles
	migraine abortives	acetaminophen/NSAIDs ergots antiemetics - prochlorperazine/metoclopramide triptans
	tocolytics that can cause pulm edema	beta agonists hypoxia tachypnea bibasilar crackles
	best way to prevent progress of diabetic nephropathy	BP below 130/80
	tenderness or nodularity in rectovaginal septum	endometriosis also possible in uterosacral ligaments retroverted uterus laparoscopy for dx
	loss to followup	type of selection bias
	worst risk for stroke	HTN
	long PT and PTT	vit K defic
	increased bleeding time and PTT, but nml PT	von williebrand
	standard deviations in bellshaped distribution	68% fall within 1 SD 95% fall within 2 SD 99.7% fall within 3 SD
	adult lower GI bleed	diverticulos - dx w CT angiodysplasia - AV malformat - endoscopic ablation single hemorraging arteriole - tx = resuscitat, colonosc, possible surgery
	small bowell stasis	dt intest dysmotitlity baceterial overgrowth leads to diarrhea seen in scleroderma tx w abx
	zollinger ellison	ulcers in DISTAL duod gastrin UP despite secretin normally secretin should decrease gastrin increased somatostatin receptors tx w surgery and lifelong PPI init test is CT/MRI although less sensitive more accurate is scintigraphy = nuclear octreotide s can w endoscopic US
	prokinetics for diabetic gastroparesis	erythromycin and metoclopramide can't sense stretch in gastropares = down motility
	gallstones in sickle cell	require cholecystectomy even if asymtomatic are black in color dt Hb breakdown
	preggo itching in 2nd/3rd trimester	intrahepatic cholestasis benign for mom BAD for BAby = deliver
	gardner synd	APC chrom 5 colonic polyps, osteomas epidermal inclusion cysts congentical hypertrophy of retinal pigment epithels
	turot synd	polyps and CNS tumors
	peutz-jagers	acral (palms, soles) and periorificial macules hamartamous polyps adenocarci of colon STK11 gene chrom 19
	hepatic adenoma	benign tumor assoc w OCP can rupture - hemoperitoneum
	toxic megacolon tx	exacerbated w antimotility/antidiarrheal loperamide tx w colectomy
	dopamine and hydromorphone GI effects	PROemetic
	metoclopramide and ondansetron	metoclopramide is a dopa antag = antiemetic ondans = 5HT antag = better for chemo vomit
	give packed RBCs	Hct below 30
	give FFP	active bleeding and plt under 50K (unless DIC)
	variceal bleed tx	1. octreotide/somatostatin 2. band 3. TIPS propranolol for prophylax
	gi bleed tx	PPI
	IV doesn't cross bowel wall	give oral
	chronic pancreatit	down endocrine fx down lipase = steatorrhea DM also downs panc
	primary biliary cirrosis	anti mitochondrial abs yellow middle aged itchy woman up AlkPhos and bili - 1/2 indi, 1/2 direct liver biopsy = mononuclear infiltrate with bile duct destruction xanthelasmas and osteoporos tx w ursodeoxy acid
	recurrent pyogenic cholangitis, sclerosing cholangit, and chronic liver dz	cholagiocarcinoma - from bile duct epithels RUQ tenderness, yellow, itchy
	ETEC enterotoxic ecoli	traveler's diarrhea NO blood mucus or leuks found in fresh fruit salad water
	ulc colit tx	start w topical mesalamine 5ASA for mild ASA enema prevents relapses steroid foams/suppositories for mild also olsalazine and balasalazine progress: oral 5ASA, topical/oral corticos, azathiprine lastly IV corticos and TNF inhibs colonoscopy every 8-10 yrs after oncet for colorectal CA
	budd chiari	acute thrombosis of suprahepatic veins - ascites abdominal pain and acute liver fail
	peritoneal carcinomatosis	ascites from ovarian CA
	PPI better than H2	helps prevent recurrence of peptic strictures from GERD
	vit B12 needs for absorption	panc enzymes
	most accurate test for chronic pancreatit	secretin release
	rotor	asymptomatic CONJ hyperbili nml liver fx up urinary corpoporphyrins
	dubin johnson	benign/asympt CONJ hyperbili hepatocytes can't secrete bilirubin into bile canaliculi DDDDDARK dddubin liver on biopsy no corpoporphyrins jaundice w infexn, preggo, OCPs
	gilbert	UNCONJ/INdirect hyperbili down UGT no urine components gluconyl transferase gene problem
	hemolysis raises	LDH and UNconj bili
	ascending cholangitis	IV resusc, abx, sphincterotomy in 72 hours
	wilson's	no skin hyperpigment init dx = slipt lamp accurate dx = up copper despite penicillamine neuropsych, neg coombs, hemol anemia, nephrolithias tx w zinc and trientene kaiser flesher hepatolenticular degenerat
	osler weber rendu	hereditary (AD) hemorragic telengiactasia - epistaxis, anemia
	up alk phos and bili, but nml LFTs	primary biliary cirrosis
	fever abd pain, AMS, ascites in liver pt	no skin hyperpigment init dx = slipt lamp accurate dx = up copper despite penicillamine neuropsych, neg coombs, hemol anemia, nephrolithias tx w zinc and trientene kaiser flesher hepatolenticular degenerat
	GERD w no red flags	lifestyle before PPI
	crigler najar	UNconj hyperbili
	PPIs up serum gastrin by	supressing gastic acid secretion, so d/c PPIs before serum gastrin test
	down LES pressure and down peristalsis	scleroderma
	UP LES pressure and down peristalsis	achalasia
	panc damage consequences	down lipase = fat malabsoprt seteatorrhea up fat binds to Ca and causes hypOcalcemia 30% panc necrosis - tx w imi/meropenem and resect to prevent ARDS necrosis = worst complication - sample by aspiration and if yes - debride
	most hepatocellular carci assoc w cirrosis	hemorragic ascites and trabecular cells of varying size/shape
	ascites + fever = paracentesis	SBP= neutrophil over 250 SAAG over 1.1 cefotaxime, ceftriaxone
	acalculous cholecystit	DM, critical illness, parenteral nutrit RUQ pain, up LFTs, AlkPhos, up WBC tx w abx and cholecystectomy
	defuroxamine	for hemosiderosis from repeat blood transfusions
	hemochromatos	overabsorpt in duodenum hearlt lungs liver panc ant pit ferretin UUUP TIBC down hyperpigment skin c2824 mutation
	GGTP up in	binge drinking
	both HepB and C assoc w	cirrosis, liver cancer, PAN
	panc adenocarci presentat	migratory thrombophlebit vein thrombosis palpable cords CT bes for dx
	IFN sideff	arthralgias, thrombocyto, leuopenia, depress
	ribavirin sideff	anemia (also bocephevir)
	adefovir sideff	renal dysfx
	telapevir sideff	rash
	total Ca down	w albumin, but ionized nml in liver dz
	if suspect cholecystit, but US equivocal	do HIDA scan aka cholesintigraphy
	mooth-margin ulcer	benign
	yprochlorperazine	antiemetic
	biliary colic w/o stones	sphincter of oddi dysfx - tx w ERCP w manomtry
	vibrio and giardia	watery nonbloody diarrhea
	bloody diarrhea	campy mc salmonella shigella
	schizophrenia neuroimaging	enlarged lateral cerebral ventricles
	pleural effusion, ARDS, ileus, ren fail are complicats of	pancreatit
	precocious puberty and postmenopausal bleed in elderly	granulosa cell tumor making excessive estrogen
	vaccines in preemies	given to chronologic age, except hep B when they're over 2kg
	any penetrating wound below 4th intercostal (nipple)	is considered to involve abdomen and require exlap in unstable pts BLUNT, not penetrating, in contrast, is evaluated w peritoneal lavage in unstable pts
	compare two means	two-sample t test p value under 0.05 - reject null hypothesis
	CF pneumonia in adults vs kids	adults - p areuginosa = amikacin, ceftazidime, cipro kids - s aureus = vanci
	fluphenazine	typical antipsychotic - causes hypothermia
	RA pts at risk for	osteopenia, osteoporos, bone fractures - optimize calcium and exercise
	trihexyphenydil	anticholinergic like benztropine used in parkinson's tox ="red dry hot blind" dry mouth constipation urinary retent flushing vision changes confusion
	Afib caused by	ectopic foci in pulmonary veins
	esinos in pee	acute interstitial nephritis
	dysmorphic RBC in pee	glomerulonephritis
	hyaline casts in pee	dehydration - protien concentrates
	brown granular casts in pee	acute tubular necrosis = dead cells
	broad waxy casts in pee	chronic dz
	prerenal kidney injury	BUN WAAAAY up creatinine up BUN/creat ratio over 20:1
	acute AKI signs	hyperkalemia and acidosis uremic pericarditis possible = dialysis
	sodium and water in prerenal kidney injury	low urineNa (below 20) low FENa (under 1%) because hypotension causes aldosterone rise to reabsoprb Na in attempt to elevate blood vol so Na is reabsorbed so less is in urine water will also be reabsorbed to try to keep up BP, so pee will be very concentrated, up osmolality - over 500
	sodium and water in intrinsic acute tubular necrosis	Na is high - over 20, because damaged kidney can't reabsorb also cant concentrate urine, so urine osmolality will be similar to blood - 300 = isosthenuria
	pOOOontine myelinOOOlysis	from fixing hyPOOOnatremia too fast
	brain EEEdEEEma	from fixing hypEEEEErnatremia too fast
	hypercalciuria tx	thiazides for decreased renal excretion of calcium cellulose phosphate for decreased intestinal absorption prevents calcium oxalate stones
	GI ischemia/infarction presents with which disturbance	anion gap met acid - tx w fluids and abx
	colcichine vs allopurinol	colchicine for acute gout allopurinol for hyperuricemia (stones - urate crystals)
	contrast media vs drugs nephrotox	contrast media - 1 day drugs - 5-10 days saline hydration helps prevent contrast nephropathy looks like prerenal in terms of #s
	tumor lysis syndrome causes AKI	in 2 days - from hyperuricemia from DNA breakdown - tx w rasburicase
	oxalate crystals can come from	bowel resection
	FSGS	mc nephrotic glomeruloscleros obese, Afamer, drugs, HIV, massive proteinuria, HTN, up CK opiates
	IBU and NSAIDS renal tox	constrict afferent arteriole allergic interstit nephrit and papillary necros fever and sudden pain
	rhabdo	hyperK = arrythmia up CK and uric acid down Ca
	acute tubular necrosis tx	underlying cause - dilaysis if fluid overloaded AEIOU - acidos, electrolytes (hyperK), intox (ecephalop), overload, uremia
	ototoxic	furosemide and genta (aminoglycoside)
	hepatoreanal labs looks like	prerenal - BUN:cr over 20, down urine sodium, FeNa below 1% tx midorine, octerotide, albumin, liver transplante
	pyelonephrit tx	amp/gent and fluoroquins
	excessive loops can cause	met alk - switch to acetazolamide
	nephrotic	proteinuria over 3.5 g/day edema and albumin down and hyperlipid DM, SLE, amyloidos, drugs/toxins, HebB/C, syph
	muscle cramps if missed dialysis	hyperkalemia - wekaness, paralysis, resp fail, arrythmia, peak T, wide QRS, loss of P
	hypOkalemia	U wave and small ST depress, flat T wave, AV block
	RTA 1 and 2	hypOkalemia
	RTA4	hyperkalemia DA, addison, sickle cell
	eosinos in pee	acute interstit nephritis accurate = wright/hansel stain
	TTTubular = acuTTE, TToxin	not nephrotic, no biopsy, no steroids correct hypoperfusion and remove toxin
	glomerular	chronic, not toxins need biopsy and steroids dismorphic RBCs and casts UA w hematuria down urine Na and FeNa b/c abl filtration
	goodpasture	linear biopsy - accurate anti GBM abs - init plasmapharesis, setroids, cyclophosph
	igA/Berger	hematura 2 days after URI vs poststrepGN = 2 WEEKS - igA deposits on biopsy - strep - skin or throat - cola pee
	amyloidos tx	melphalan and prednisone
	nephrotic can look like maltese crosses. causes include	cancer=membranous kids/NSAIDs=MCD AIDS/drugs=FSGS edema, HLD, prothrombotic
	HTN, metalk, up Na, down K	primary hyperaldost - Conn's = low serum renin if serum renin is up = secondary
	gaucher	defic = glucocerebrosidase so glucocerebroside up in histocytes lysosomes BM, liver, spleen pancytopenia and fractures tx w imigluverace or enzyme replacement
	RTA2 assoc w	multiple myeloma nonanion gap metacid down proximal tubule bicarb reabsorpt dt up monoclonal immunoglob excretion
	papillary necrosis in sickle cell	hematuria, polyuria, nocturia
	what to supplement in ren fail	calcium
	high volume nocturia with dilute urine	diabetes insipidus no/bad ADH urin vol high despite deprivation
	cardiogenic shock	pump failure reduced cardiac index up PCWP - indirect measure of LA pressure if LV fails, PCWP up (over 20) up SVR
	noncardiogenic pulm edema	up CO, low or nml PCWP
	reprefusion after arterio-occlusive ischemia over 4-6 hrs can lead to	intrecellular and interstitial edema - soft tissue swelling - compartment syndrome
	breast milk jaundice vs failure	no dehydration in breast milk jaundice red crystal in diaper = dehidrat in first week of life, baby should have as many wet diapers as days old yellow seedy stools after 2 days less stooling = less bilirubin eliminat
	vision assessment for kids	every wellchild visit
	lead buildings year	before 1978
	elevated serum DHEAS	androgen producing adrenal tumor - virilization
	WPW + Afib tx	procainamide and cardioversion
	what to avoid in WPW	betas, CCBs, digox, adenosine - because increase conductance through accessory pathway
	oxytocin produced and realeased	produced in hypothalamus, released from posterior pituitary (also ADH)
	hormones deficient in Sheehan's	anterior pituitary - GH, LH, FSH, TSH, ACTH, prolactin
	mediastinal tumor locations	anterior - thymoma bronchogenic cyst (benign) - middle neurogenic - posterior
	hypertrophic cardiomyopathy (not HOCM)	aut dom harsh cresc decresc syst murmur at apex mutation in myocardial contractile proteins of sarcomeere - myosin binding protein C and beta myosin heavy gene diuretics help in HCM, but CI in HOCM
	valsalva and abrupt standing	decrease preload, like nitorglycerin
	hand grip, squatting, leg raise	up afterload and preload
	MMR for HIV	if CD4 above 200 and no h/o AIDS illness other live = varicella, zoster, influenza
	lupus nephritis management	depends on how advanced - do renal biopsy first
	low back pain under 40 yo worse at night and no improvement w rest but yes improve w activity	inflammatory - aklylosing spondylitis - apophyseal joint arthritis
	unilateral varicocele that does not empty when recumbent	RCC (renal cell carci) - obstructs venous flow - do CT scan
	HGSIL during pregnancy	often regress spontaneously - manage conservatively
	migraine tx	amytriptiline/TCAs - PROPHYLAX prochrolperazine/ IV antiemetics for ACUTE monotherapy
	ACE mechanism	extracellular enzyme blockage
	statin mech	inhibition of intracell sythesis pathway
	palpable breast mass under and over 30	under = US, over = US and mammogram, even if probably benign
	thrmobocytopenia, eczema, recurrent bacterial infexns	wiskott aldrich = x linked - decreased plt production
	cor pulmonale	RV failure dt pulm HTN from severe lung dz tricuspid regurg and dilated RV on echo
	progressive periph edema, ascites, elevated JVP, pericardial (iddast) knock, pericard calcificats on CXR	constrictive pericardit - causes Right HF
	herniated disk	radicular pain radiating along thigh to knee (sciatica) positive leg raise dt nerve root compression
	vertebral compression fracture	acute back pain after minimal trauma (bending) point tenderness complication of osteoporos
	CML tx	tyrosine kinase inhibitors - inhibit abl BCR/ABL (9,22 philly)
	tx of MALT lymphoma w no mets	eradicate h pylori - omeprazole, clarithro, amoxi
	removing potassium from body vs shiftin into cells	remove w loop diuretics, cation exchange, hemodialysis drive into cells w beta2 agonists, insulin w glucose, sodium bicarb
	bowel ischemia	decreased bowel sounds, disproportionate pain, metabolic acidosis
	horizontal nystagmus, cerebellar ataxia, confusion	phenytoin toxicity
	tremor, hyperreflexia, ataxia, seizures	lithium tox
	slurred speech, unsteady gait, drowsiness, w/o respi depress of pupil constrict	benzos
	recurrent respi infects - sinusit, otit media, pna btw 6-18 months	bruton's xlinked agammaglob nml Tcells (CD3) but low Bcells (CD19) tx w IVIG defect in tyrosine molecule on Bcells
	decreased leuk alk phos	assoc w CML decreased apoptosis of myeloid cells - accumulate but are nonfunctional
	high leuk alk phos	polycythemia and leukemid rxn of infxn - functionally active cells
	stress (hairline) fracture	of metatarsals - rest and analgesia and hard soled shoe
	prolonged QT should avoid and use	avoid electolyte abl and potassium channel blockers, but should USE beta blockers w pacemaker to prevent cardiac arrest
	pts w cirrosis need	US every 6 mo to check for hepatocell carci and endoscopy to r/o vaarices
	hypovelemic shock	hypOtension tachycardia down cardiac output down central venous press down PCWP up SystemicVR
	hyper vs hyponatremia	hyper = loss of free H20. hypo = in relation to body volume, nnot just salt
	addison	down aldost = down Na up K and H
	hyponatremia tx based on sympts not #	no sympts = fluid restrict min confusion = nml saline and furosemide severe = hypertonic 3% saline ADH antagonist - demeclocyclin, tolvaptan/conivaptan
	recurrent UTI stones	struvites = ammonium+mg+phosphate
	SLE assoc w RTA1	nephrocalcinosis and lithiasis down H+ ion secretion in collecting tubules down serum K
	testic cancer markers	hcg, AFP, LDH - must resect whole - orchiectomy
	HTN in chronic ren fail dt	erythropoetin
	refractry hypokalemia	dt hypomg
	ketorolac	NSAID good for kidney stones - give before proceeding w workup nifedipine and tamsulosin for stones 5-7mm CT wOUT contrast
	HTN crisis	labetalol/nitroprusside, but don't lower to nml or will cause stroke- lower 25%
	Tdt vaccine	clean or minor wound and vaccine over 10 years ago clean or minor wound and unclear vaccination dirty or severe wound and last booster over 5 years ago the vaccine is the booster
	Tdt vaccine plus tetanus immune globulin	dirty or severe wound and unclear vaccination status
	noninvasive, high sens and spec for aneuploidy test at 10 wks	cell-free fetal DNA
	malnourished, dehydrated preggo	hyperemesis gravidarum higher risk in molar pregnancy and multiple gestat
	caput caccudaneum vs cephalohematoma	caput is diffuse and crosses suture lines, is usually presenting vertex part cepahlo is supberiosteal hemorrage presenting a few hrs after birth and limited to one cranial bone - resorbs spontan
	increase venous return (preload)	leg raise, squat, supine position, handgrip. all but handgrip increase regular murmur, but handgrip makes AS murmur betterc
	capacitance vessels	veins (nitroglycerin acts on them to provide anginal relif) arteries are resistance vessles
	hypercalcemia of malignancy tx	bisphosphonates - zoledronic acid, pamidronate, also agressive hydration
	target sign on ultrasound	itussuception - reduce with air or water contrast enema
	phototoxic drug eruption	tetracyclines (doxy)
	pancytopenia in SLE	concurrent peripheral immune mediated destruction of all 3 lines
	hemi-neglect	right parietal cortex (nondominant) - causing ignoring of left (opposite) side
	graft vs host	targets skin, intestine, liver donor t cells recognize host minor HLA antigens and consequent cell mediate immune response
	confirm IUFD with	real time ultrasonography
	mc bacterial rhinosinusitis	s pneum and h influ
	ethanol vs methanol poisoning	both cause anion gap acidosis and increased osmolar gap, but methanol damages eyes and ethylene glycol damages kidneys
	complication of late and post term pregnancy	oligohydramnios
	insensitive hypopigmented skin patch	leprosy - dx w skin biopsy
	rubella spares palms and soles, unlike	syphilis rubella also causes arthralgias unlike measles, which would also be told apart by higher fever
	nephrotic synd assoc w hodkin's lymphoma	MCD
	eaton lambert synd	small cell lung carci auntoabs against voltage gated calcium channels in presynaptic defective release of Ach = proximal muscle weakness electrophysio confirms tx w plasmapheres and immunosupress
	diabetic neuropathy bladder effect	overflow incintinence - urine leaks for overdistended bladder
	urge incontinence caused by	detrusor instability, bladder irritation, neoplasm, interstitial cystitis noctura and frequency sudden frequent losses
	AKI vs loops disturbances	AKI = AKIdosis and hyperK loops = alkalosis and hypOkalemia
	complement deficiency	gonococcl and meningococcal infections - s pneum and h influ
	t cell defic (such as digeorge) puts at tisk of	viral and fungal infexns
	adenosine deaminase defic	SCID - deficiency of both B and T - so bacteria, fungi, and viruses
	B cell defic	recurrent infections after 6 months, like sinopulmonary. lack of IgA = giardia
	pronator drift sensitive and specific for	UMN damage
	upward drift and dysmetria	cerebellar fx
	anticuagulation for renal insuffic (glomerular filtration rate under 30 ml/min/1.73	unfractionated heparin
	hip dysplasia dx	US under 6 months, xray 4-6 mo
	pneumomediastinum and subq emphysemia	thracheobronchial rupture - can also cause persistent pneumothorax
	spleen vs panc injury in blunt abd trauma	spleen injury seen right away, panc can be missed and present later w cyst or retroperitoneal abscess
	kid torticollis	get cervical spine xray to r/o cervical spine fract/dislocat
	bacillary angiomatosis	in immunocomp bartonella henslae/quintana cutenous/visceral angioma blood vessel growth abd pain plus lesions of skin and viscera biopsy abx - azirthro for b hesale cat scratch dz
	precicious puberty - nml bone age =isolated telarche/adrenarche, but if bone age advanced - check	basal LH - high = gonadotropin dependent = central low LH - do GnRH stimulation test, if high = central = brain MRI if LH still low = gonadotroping insens = peripheral = adrenal gland/ovaries/tested US
	involved in metabolism of homocyteine	vit B6, folate, B12 - will lower it
	pruritic elevated serpingious =progressive creeping, red brown skin lesion from sand contact	cutaneous larva bigrans - dog and cat hookworm
	relative risk	over 1 = positive relationship btw risk and outcome under 1 = negative the higher the value above 1, the stronger the association
	BV vs trich	both pH over 4.5 BV thin off white w no erythema/inflammat trich is erythematous and inflamed and yellow green and frothy
	pna in CF kids	staph aureus. p ereug is in ADULTS
	isolated unilateral motor weakness	internal capsule
	MS tx	steroids for exacerbation beta IFN and glatiramer for prevention
	methotrexate sideff	inhibits dihidrofolate reductase - macrocytic anemia nausea stomatit rash hepatotox, interstiti lung dz, alopecia, fever
	elevated PCWP	suspect myocardial dysfx dt cardiac contusion - do echo
	male teen w epistaxis and a localized mass w bony erosion	angiofibroma
	renal artery stenosis presents w	syst-diast abdominal bruit w HTN and atheroscleros
	ptosis with down and out gaze and nml light/accommodation	CNIII diabetic mononerupathy dt ischemic damage - affect somatic, not parasympathetic nerve fibers
	unstable pt w abd trauma	fuilds and abd US - if blood on US = laparotomy
	single loud second heart sound	transposition of great vessels mc congential cyanotic heart defect in neonatal period presents in first few hrs of life give prostoglandins to mix blood
	osteosarcoma	mc primary bone tumor in kids metaphysis of long bones large and tender mass sunburts periosteal reaction and codman traingle
	HIV pt w AMS, EBV DNA in CSF, and solitary weakly ring-enhancing periventricular mass on MRI	CNS lymphoma (nonenhancing lesions in PML)
	cortical and subcortical atrophy and 2ndary ventric enlargement	AIDS dementia complex
	prim vs 2nd hyperparathyroid	primary = up PTH which in in turn raises Ca and lowers phosphate secondary happens in response to depleted Ca - PTH rises to try to make up for it and phosphate is up too - in chronic ren fail
	cystinuria	inherited - recurrent renal stones hard and radioopaque hexagonal crystals on urinalysis urinary cyanide nitroprusside screens
	hypoxemia induces	erithropoetin prduction - leads to polycythemia like in OSA
	eczema herpeticum	primary herpes simplex virus infection on top of atopic dermatitis - umbilicated vesikles over erythematous skin - acyclovir
	exudative pharyngitis w tender anterior cervical LAD and no sniffles (viral)	strep pharyngit - dx by troat culture and tx w penicillin or amoxicillin
	screening for women over 65	one-time DEXA scan for osteoporosis - (serum Ca and Phosph nml)
	waxing/waning LFTS	Hep C porphyria cutanea tarda mixed cryoglobulinemia = vesicles and erosions on dorsum of hands membranoproliferative GN
	aspirin reduces risk of early recurrent stroke but	does not improve neuro sequela of stroke that has already occurred - need fibrinolytics for that
	chlamydia tx	single shot of azithro or 7 days of doxy
	homocysteinuria	aut recesss - cystathionine synthase defic marfanoid body habitus intellectualy disability downward lens dislocation hypercoagulability tx w vitamins and anticoags to prevent thromboembolism
	pansyst murmur loudest at left lower sternal border and diastolic rumble at apex	dt increased flow across mitral valve - VSD
	hard unilateral nontender solitary lymph nodes in head or neck	squamous cell carci of head/neck
	correlation coefficinet "r"	shows strength and direction (pos, neg) of linear assoc btw 2 variables, but does not mean causality
	broca's (expressive) aphasia location	dominant frontal lobe also contralat hemipares and apraxia
	wernike (receptive) aphasia location	dominant temporal lobe also conductive/repetition if arcuate fasciculus
	hypoxia in pts w pna dt	alveolar and interstit inflammat = v/q mismatch = increase of A-a gradient

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