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149 Cards in this Set
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Ectopic Prenancy. Indication for MTX tmt
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*<3.5 unruptured ectopic + no FHR, BhCG <5000
*no hepatic/renal/hematologic disease, *compliant, able to ensure follow-up |
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Dyspepsia red flags
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1. Age >50 2. weight loss
3. persistent vomiting 4. anemia 5. hematemesis 6. palpable abdo mass 7. fam hx of upper GI cancer 8. personal hx of prev pathology |
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IBD - external manifestations
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Derm = erythema nodosum, pyoderma gangrenosum, perianal skin tags, oral mucosal lesions, psorisis
Rheum - periph arthritis, Ank Spon, Sacroilitis, vasculitis Ocular = uveitis, episcleritis Hepatobiliary = cholelithiasis. PSC, fatty liver, Urologic - stone, obstruction, fistulas other - thrombosis, osteoporosis, Vitamin deficiency (vit b12 + DEKA), Cariopul disorders,rarely pancreatitis |
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Proteinuria work up. (esp if >0.5g/day, casts and/or hematuria, hypoalbuminemia, edema, lipiduria = nephrotic disease)
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• CBC, glucose, electrolytes, 24-hr urine protein and Cr
• urine and serum immunoelectrophoresis, • abdominal/ pelvic ultrasound • serology: ANA, RF, p-ANCA, c-ANCA, Hep B, Hep C, HIY, ASOT |
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Ped vitals
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Age HR RR Blood Pressure
0-1 month 93-182 26-65 45-80/33-52 1-3 months 120-178 28-55 65-85/35-55 3-6 months 107-197 22-52 70-90/35-65 6-12 months 108-178 22-52 80-100/40-65 1-2 years 90-152 20-50 80-100/40-70 2-3 years 90-152 20-40 80-110/40-80 3-5 years 74-138 20-30 80-115/40-80 5-7 years 65-138 20-26 80-115/40-80 8-10 years 62-130 14-26 85-125/45-85 11-13 years 62-130 14-22 95-135/45-85 14-18 years 62-120 12-22 100-145/50-90 |
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Scarlet fever presentation
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pastia's lines - pathogneumonic
strawberry tongue sandpaper rash. sunburn w/ bumps/fever |
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AOM org
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Strep pneumo/pyogenes, H. flu, Moraxella,
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AOM tmt
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analgesia - tylenol/advil. if severe consider benzocaine otic 2-3 drops q 4-6 hr PRN
ABX 48-72 hrs post. Amox 80-90mg /kg, Amoxiclav if fever, consider ceftriaxone, cefuroxine, macrolide if not responsive. if >2 yo treat 5-7 days if younger 10 days. if perf use ciprodex 4 Drops BID 7-10days |
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AOM recurrent
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>=3 in 6 mo or >=4 in 12mo
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Tinea Capitis
P/E W/U +tmt |
p/e = scaling, alopecia round, broken hairs, kerion, pustules
scrapings for KOH and culture. terbenafine oral x 4 wks |
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AST:ALT 2:1 reasons
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ETOH and cirrhosis bc of need for nutritional factor to make ALT
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CSF sign of bacterial infection
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Appearance = N or cloudy
Glucose = decreased (eat) Protein = Increased (poop) WBC = 500-1000 microL largely neutrophils |
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Meningitis tmt
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<1mo old = amp / gent
older = ceftriaxone + vancomycin DEx - 10 mg IV q6hr x 4 days. w/ first dose if purulent CSF. +/- seizure prophylaxis Treat contacts with rifampin or cipro if exp to H. flu/ N. meningitis. |
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CSF order
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=cell count + differential
=gram stain =C/S =Protein =PCR +/- viral serology |
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Meningitis causes
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1. bacterial = S. pneumo, N. meningitidis, H. flu. (N pt)
S. pneumonae, N. meningitidis. L. monocytogenes (elderly, immunocompromised) GBS, E. coli, L monocytogenes. S. Pneumo, viral (GELS + viral in neonates) Viral = enteroviruses, HIV, HSV-2, West Nile, Other - fungus, Lyme, syphilis, TB |
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Contraindications to OCP
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*Smoking greater than age 35
*History of CVA or MI or multiple risk factors for coronary artery disease (older, smoker, hypertension, DM) *Moderate or severe hypertension ( baseline BP > 160/100), should also avoid in pt have controlled HTN as risks usually outweigh benefits *Diabetes with significant vascular complications *Complicated valvular heart disease *Thrombophilia or Thromboembolic disorder (history of DVT/PE) *Major surgery with prolonged hospitalization *Known or suspected pregnancy *Undiagnosed vaginal bleeding *Known or suspected breast cancer (or history of breast cancer) *Markedly abnormal liver function, active viral hepatitis, malignant liver tumor *Avoid in patients with symptomatic gall bladder disease current or treated *Migraine with focal neurologic symptoms (flashing lights, loss of vision, weakness, slurred speech, dizziness, cranial nerve abnormalities) |
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features of benign pediatric murmurs.
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1. asymptomatic
2. systolic ejection 3. grade <3/6 4. no extra clicks or sounds 5. > if supine |
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types of GI decontamination for ingestion
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1. ipecac induced emesis. Gen not recommended
2. gastric lavage - used if life threatening early, none caustic materials 3. activated charcoal-within 1-2hrs of ingestion 4. cathartics +/- activated charcoal 5. whole bowel irrigation - delayed release formulation, risk of bezoar formation, iron/heavy metal ingestion incl lead/lithium, body stuffers carrying drugs 6. urinary alkalization - 1-2 mgEq of sodium bicarb or 3-4 mEq/kg IV infusion over 1 hr. Goal - urine pH 7.5-8.5 serum 7.45-7.55 7. hemodialysis = methanol, ethyline glycol, lithium 8. hemoperfusion = theophylline, carbamazipine |
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common antidotes
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*Acetaminophen = n-acetyl cysteine
*CCB = glucagon 3-10mg IV + calcium chloride 10% (for hypotension). (IV lipid emulsion 20% if resistant) *B blocker = glucagon. (IV lipid emulsion 20% if resistant) *ethylene glycol/methanol = ethanol 10% 10 ml/kg over 30 min then 1.2ml/kr/hr *benzos = flumazenil 0.2 mg /IV *opiod/clonidine = naloxone (0.4 - 2 mg IV *anticholinergics (except TCA) = physostigmine *coumadin = octoplex, FFP, vitamin K *heparin = protamine *cholinergics = atropine, pralidoxime *oral hypoglycemics = glucose, octreotide (if refractory) *hypermagnesia = calcium gluconate 10% (antagonizes Mg) *Iron = deferoxamine *cyanide = sodium nitrite, sodium thiosulfate, amyl nitrite |
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Antiemetics and where they work
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Stemetil D2
Haldol D2 metoclopramide/domperidone D2 + prokinetic ondansetron = 5ht gravol= muscarinic, AC octreotide = <secretion in GI dexamethasone = anti-inflammatory |
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stigmata of marfans syndrome
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arachnodactylism, hyperextensible joints, ectomorph build, dislocated lenses
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DDX elevated JVP
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RVF, pericardial tamponade, tension pneumo, SVCO,
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6 P's of arterial insufficiency
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*Pulselessness *Pain *Pallor
*Polar *Paresthesia / fatigability *Paralysis ALSO - think/shiny skin, thick rigid nails, ulceration at points of trauma eg. toes plantar foot, slow cap refill, bruits. |
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fundoscopic signs of HTN
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* narrowed arterioles, copper/silver wire, exudates, hemorrhages, papilledema
eye, CV, abdomen, bruits, neuro exams for HTN |
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Secondary causes of hypertension
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*vascular =Renovascular disease, coarctation of aorta
*endo = conn syndrome (hyperaldosterinism), cushings, hypo/hyperthyroidism, acromegaly, aldosterone/renin secreting tumors, congenital adrenal hyperplasia, pheo, > PTH, diabetic nephropathy *Idiopathic/Iatrogenic - sleep apnea, renal disease (eg. polycystic kidney) *Drugs - OCP,"", NSAIDS, COX-2, sympathomimetics, steroids, decongestants, cocaine *PIH |
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PCOS dx criteria
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2/3
1. oligomenorrhea/irregular menses for 6 months 2. clinical or lab evidence of hyperandrogenism (hirtuism, acne, 3. polycystic ovaries on U/S |
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> cholesterol causes
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hypothyroidism, DM, cholestasis (eg PBC),
nephrotic syndrome, obesity familial, anorexia, nervosa, monoclonal gammopathy Rx = cyclosporin, diuretics (higher doses_ carbamazapine |
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> TG causes
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obesity, ETOH, DM, liver failure, hepatitis
hypergammaglobulinemia glycogen storage disease hypothy, hypopit acromegaly drugs (steroids, estrogen, HCTZ, retinoic acid, Bblocker, anti-retroviral drugs) familial |
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CHF on CXR
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1. alveolar infiltrates
2. kerley B lines 3. pleural effusion 4. enlarged cardiac silhouette 5. pulmonary vasc redistribution |
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becks triad
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- 1. hypotension
2. muffled heart sounds 3. distended JVP signs of tamponade |
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Contraind for thrombolysis for ACS
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absolute
1. aortic dissection 2. pericarditis 3. active bleed that is difficult to control relative 1. CVA disease 2. dm retinopathy 3. oral anticoag 4. HTN (>180-110 within 10 day of hemorrhage, surgery trauma |
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Panic attacks criteria:
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period of intense fear / discomfort, in which >=4 of following developed abruptly / reached a peak w/in 10 minutes:
*Palpitations, and/or accelerated heart rate *Sweating * Trembling or shaking *Sensations of shortness of breath or being smothered * Feeling of choking *Chest pain or discomfort *Nausea or abdominal distress *Feeling dizzy, unsteady, lightheaded, or faint * De-realization or depersonalization * Fear of losing control or going insane *Sense of impending death * Paresthesias (numbness or tingling sensations) *Chills or hot flashes |
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asthma (samter's) triad
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Asthma, ASA sensitivity, nasal polyps
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asthma control criteria:
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*daytime symptoms < 4 times a week
*nighttime symptoms <1 night a week *no limitations on physical activity *mild and infrequent exacerbation *no absences from work or school *< 4 doses a week of short-acting β2-agonists *FEV 1 or PEF > 90% personal best *PEF diurnal variation <10–15% *Sputum eosinophils* <2–3% |
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signs of severe asthma attack
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* dyspnea at rest
*inability to speak *use of accessory muscle use / tracheal tug / intercostal indrawing * cyanosis * pulsus paradoxus * quiet chest!! *confusion |
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differential of solitary lung nodule
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Infarct, vascular lesion
TB, aspergilossis, abscess, pneumonia, histoplasmosis hematoma cyst cancer = benign (hamartoma), primary (bronchial carcinoma, metastasis |
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adenocarcinoma on lung related to smoking. T/F
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false.
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lung TB diagnosis
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nodular scaring in apex of lung
acid-fast bacilli in sputum smear sputum culture PCR for TB |
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pleural effusion - Causes + DDx transudate
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1. hypoproteinemia: nephrotic syndrome, protein-loosing enteropathy
2. increased venous pressure: CHF, constrictive pericarditis, fluid overload, cirrhosis, PE, myxedema |
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pleural effusion - Causes + DDx exudate
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1. Infectious: pneumonia, TB, fungal, viral, abscess
2. inflammatory: pulmonary infarction, collagen vascular disease, pancreatitis, Dressler's sydrome (post inj to heart causing fever, pleuritic CP, p. effusion) 3. neoplastic: lung, mesothelioma, lymphoma, mets 4. misc: asbestos exposure, drubs, Meige's syndrome (ovarian bening tumor, ascities, p. effusion) 3. neoplastic: 4. miscellaneous: |
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what to order with pleural fluid analysis
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order:
pleural cell count/diff, protein, albumin, LDH, glucose, Gram stain, culture, cytology serum protein and LDH to compare +/- others according to clinical setting |
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transudate pleural effusion lab characteristics:
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*protein <30g/L
*LDH <200U/L *ratio protein vs serum <0.5 *ratio LDH vs. serum <0.6 |
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atypical pneumonia Dx, causative orgs and tmt
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aka "walking pneumonia" refers to pneumonias from non typical orgs.
1. SS can be less severe there may not be leukocytosis, when with mycoplasma can cause - myalgia, sore throat, cough, rash. Moderate to no sputum. Lack of alveorla exudate. Xrays may show subtle or ill-defined areas of involvement. Betalactams/septra does not work. Legionella can have severe symptoms. Needs urine for antibody detection + sputum culture. 2. mycoplasma pneumo, chlamydia pneumo, legionella, fungus etc 3. macrolides or FQ |
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pneumothorax xray view some physical findings
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A/P inspiration /expiration
> RR, tactile fremitus <. percussion hyper-resonant, < breath sounds, > JVP/hepatojugular reflex (+). +/- trach deviation. |
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(+) urine dipstick for hemoglobin but negative RBC on microscopy what should you consider?
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myoglobinuria
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newborn feeding. Number of feeds / day and quantity / feed
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until 1 wk = 2-3 oz x 6-10/day
1 mo = 3-4 oz x 6-8/day 3 mo = 4-6 oz x 5-6/day 7 mo = 6-7 oz x 4-5/day 12 mo = 7-8 oz x 3-4/day |
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what is goodpasteur's disease?
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autoimmune attack on lungs and kidneys causing cough, hemoptysis, blood in urine. TMT: steroids and immunemodulators
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HSP SS
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recent URTI
abodo pain polyarthralgias purpuric rash |
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TTP SS
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jaundice, fever, neuro findings, renal disease
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Wegeners granulomatosis
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epistaxis, sinusitis, hematuria, constitutional symptoms, skin lesions
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features of thyroid nodule suspicious for malignancy
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Age <20 >60
M rapid growth hoarseness/dysphagia hc of radiation to head/neck firm / fixed nontender nodule nodule >2cm asso lymphadenopathy cold nodule on thyroid scan complex cystic nodule fam hx of MEN II, medullary cancer of thyroid |
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Addison's SS
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1. hyperpigmentation: sun-exposed areas, pressure areas, palmar crease, nipples, scars, mucous membranes
2. vitiligo 3. loss of axillary and pubic hair in females 4. post hypertension 5. change in mood/mentation |
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ACROMEGALLY SS
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1. skin = thick, coarse, increased hair, oily skin, acanthosis nigricans, acne
2. head/neck = prognathism, increased teeth spacing, prominent supraorbital ridge, large tongue, visual fields 3. CN exam |
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EDC calc
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LMP - 3mo + 7 days + 1 yr
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when to suspect lynch syndrome
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Colon cancer that occurs at a younger age, especially before age 50
A family history of colon cancer that occurs at a young age A family history of endometrial cancer A family history of other related cancers, including ovarian cancer, kidney cancer, stomach cancer, small intestine cancer, liver cancer and other cancers |
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when and how to monitor for lithium
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serum lithium levels q 3 mo
TSH and renal function q 6 mo |
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what to monitor for pt on indapamide?
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Blood pressure (both standing and sitting/supine);
Cr, serum electrolytes, hepatic function, uric acid; assess weight |
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advice for pt suffering domestic violence
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1. domestic violence is illegal
2. have an escape plan 3. assess for guns in house 4. tell others about it 5. leave paper track 6. hide money, ID, credit cards, important documents/objects in case need to leave quickly 7. choose safe plac eto go. 8. give info re: legal aid, safe houses, counselling services 9. assess for child abuse |
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assessing risk of risk for neonatal sepsis w/in 2 mo of birth
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generally well-appearing
previously healthy full term (at ≥37 weeks gestation) no antibiotics perinatally no unexplained hyperbilirubinemia that required treatment no antibiotics since discharge no hospitalizations no chronic illness discharged at the same time or before the mother no evidence of skin, soft tissue, bone, joint, or ear infection WBC count 5,000-15,000/mm3 absolute band count ≤ 1,500/mm3 urine WBC count ≤ 10 per high power field (hpf) stool WBC count ≤ 5 per high power field (hpf) only in infants with diarrhea Those meeting these criteria likely do not require a lumbar puncture, and are felt to be safe for discharge home without antibiotic treatment, or with a single dose of intramuscular antibiotics, but will still require close outpatient follow-up. |
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risk factors of recurrent febrile seizures
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>1 seizure in 24hrs
seizure longer than 15 min focal seizure (most are tonic clonic age <1yo FH of seizure disorder. |
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Geriatric depression scale
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1. are you basically satisfied with your life?
2. Do you often feel bored? 3. Do you often feel helpless? 4. Do you prefer to stay at home rather than going out and doing new things? 5. Do you feel pretty worthless the way you are now? >2 is positive screen |
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HELLP syndrome TMT
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FFP and plasma exchange.
Mg sulfate if eclampsia 4 mg IV over 20 min |
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Pagets' disease of breast. what group affected most?
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post menopausal women. Peak 50-60yo
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Definition of CKD?
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1. GFR <60 or signs of kidney dmg for >=3 mo
2. known pathology 3. one or more kidney small in size. |
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What fibrate can be used in CKD? When to start? Monitoring
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1. Gemfibrozil. less SE with renal failure. fenofibrate good in DM in combination with statins less risk of myopathy
2. start : if statins not tolerated as alternative, or if TG >10 to reduced risk of pancreatitis. Avoid w/ statin if stage 4 3. serial CK and LFT q 3 mo as > risk of rhabdo |
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topical steroids dosing
common ADE |
1. max 3 wk use. if longer need to taper down, need 1 wk steroid free interval to reapply.
2. most common ADE = skin atrophy, hypopigmentation can also cause contact dermatitis. HC and budesonide have less risk of this. Other:adrenal supp, glaucoma, septic necrosis of femoral head, hypergly, HTN, etc |
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DDX of oral painful lesion
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1. Candidiasis, ulcerated erythema multiforme, erosive lichen planus, viral infection, pemphigoid (conjuctiva affected as well), Beceht (lesion on groin and mouth)
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delirium how to recognize
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CAM criteria:
1. Acute onset / fluctuating course 2. Inattention 3. Altered LOC 4. Disorganized thinking 1+2 w/ 3 or 4 |
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Delirium non pharm tmt
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1. minimize lines catheters, restraints
2. early mobilization 3. nutrition monitoring 4. visual and hearing aids 5. pain control 6. avoid dehydration 7. monitor bladder and bowel function 8. review meds 9. reorient communications with pt 10. familiar objects 11. cognitive stimulating activities 12. faciliate sleep hygiene meausres, music, warm drinks, massage 13. minimize noise and interventions at bed time. |
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Rheumatic fever Major criteria. Hx of documented exposure to strep: + major / minor
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2 major or 1 major + 2 minor
Major = SPACE (Subcutaneous nodules), Pancarditis, Arthritis, Chorea, Erythema marginatum MInor = prev hx, ferver, arthalgia, > ESR/CRP, prolonged PR |
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Evidence of strep infection
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1. (+) culture
2. antistreptolysin O titre 3. (+) rapid strep test 4. scarlet fever |
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child with fever + migratory pains + murmur =????
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acute rheumatic fever
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High INR tmt
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1. if active bleed = IV vit K 10 mg slow infusion + prothrombin complex concentrate or recombinant human FVIIa
**if INR < 5.0 - lower dose or omit dose. 5-9 then omit 1-2 doses and monitor INR closer or omit dose and give Vit K oral 1-2.5 mg PO x1. if >9 then give 5-10 mg PO vit K and monitor INR start warfarin once therapeutic INR. |
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methanol/ethynyl glycol tmt
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1. ethanol / fomepizole
2. hemodialysis 3. IV sodium bicarbonate 4. vitamins (thiamine, folate) |
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CO poisoning. What level of carboxyhemoglobin confirms exposure?
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3% in non-smoker 10% in smokers.
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SS of chronic CO poisoning?
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chronic fatigue, affective conditions, emotional distress, memory deficits, difficulty working, sleep disturbances, vertigo, neuropathy, paresthesias, recurrent infections, polycythemia, abdo pain, diarrhea
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% of pt on nicotine therapy that will achieve abstinence for 6 mo?
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4-5%. but they are more likely to be lifelong abstainers
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Alzheimer's risk factors
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Age, family history, apolipoprotein E4, head injury, depression, hypertension, diabetes, high cholesterol, a.fib., low physical and cognitive activity, herpes simplex
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risk of stroke post TIA
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*Age > 60 years
*Blood pressure > 140/90mmHg *Clinical features: unilateral weakness (2), speech disturbance (1) *Duration: >60 (2), 10-60 (1), <10 (0) *Diabetes (1) Risk of stroke 2d: 0-3:1% (start ASA + O/P investigations), 4-5: 4%, 6-7: 8% (ASA + I/P invest) |
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effect of antipsych in AD
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1. rapid cognitive decline
2. increased mortality 3. reduce agitation 4. increaed risk of stroke |
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>> resting HR is assoc with what?
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autonomic tone, > risk of MI. not assoc w/ stroke.
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recommended tmt for endocarditis prophy before dental procedure? what antibiotics and doses
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1. ampicilling/ amox 2g
2. cephalexin 2g PO, 3. clindamycin 600 mg PO, im, iv 4. azith 500 mg PO 5. cefazolin 1g IM/IV, |
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Amiodarone SE
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corneal deposits, optic neuropathy/neuritis, blue-gray skin discoloration, photosensitivity, hypothyroidsm, hyperthyroidism, pulmonary toxicity, hepatotoxicity, hepatitis, chirosis
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indications of amiodorone
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1. perioperative cardiac sugery for prophylaxis
2. LVH and CHF 3. Cardiac arrest, stable ventricular tachy 4. with implantable cardioverdefibrillators (ICD) to reduce shocks 5. electrical storm along w/ Beta block 6. AF w/ CHF and LVH 7. not usually in a flutter, SVT |
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oxytocin dose for induction and augmentation.
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10 U in 1 L. Start 0.5-2 mU/min increase by 1-2 mU q 20-60 min.
Max dose = 36-48 mU/min. |
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Lecithin/sphingomyelin ration <2:1 what are you worried about?
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lack of lung maturity in fetus
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Zavenelli maneuver - what is it?
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replace head back into vaginal canal then try rescue through C/S abdo
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indications for operative vaginal delivery
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1. nulliparous woman with no progress in second stage 3 hrs if epidural anesthesia 2 hrs without
2. multiparous woman w/ no progress in second stage of 2 hrs with anesthesia or 1 hr with out 3. fetal compromise possitble |
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Contraindication to VBAC
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* prior classical or T shaped uterine incision
* mulitiple uterine incisions * previous uterine rupture * contracted pelvix * contraind to vaginal delivery. |
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oxytonin for PPH dose
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20-80 U in IV 1L open can also give 10 U (intrauterine)
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hemabate (prostaglanding) dose for PHH + contra
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0.25 mg IM or IU q 15 min max 8 (2 mg)
Contraind = pulmonary, cardiac, hepatic or renal disease |
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Ergotamine dose and contraind in PPH
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0.25 mg IM q ?? frequency max dose 1.25 mg
contra - preeclampsia, or PPH |
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misoprostyl dose for PPH
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600-1000 mcg PR/ PO single dose.
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Amiodarone indications
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1. Afib in symptomatic pt w/ LV dysfunction anc CHF
2. prophylaxis in pericardiac surgery 3. < number or shock in pt w/ implantable cardioverter-defibrillator. 4. VF/ pulseless VT, |
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meds that cause insomniea
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1. SSRI, SNRI
2. OCP 3. steroids 4. stimulants (methylphenidate) 5. sympathomimetics (salbutamol) |
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rem when prescribing sleeping aid
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1. do not use hypnotic drugs by themselves use other therapies too
2. start low, go slow 3. avoid benzo 4. use cautiously in pt w/ substance abuse 5. monitor for tolerance/dependance and withdrawal 6. discuss risk of hang over 7. taper gradually to avoid withdrawal/rebound |
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SS of psychophysiological insomnia
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1. > focus on sleep and anxiety re sleep
2. diff falling asleep at desired time, but find easy to sleep in monotonous activities 3. able to sleep better away from home 4. mental arousal in bed(many thought) 5. perceived inability to relax |
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in drug desensitization there needs to be a maintenance dose maintained or it will come back. T/F??
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true
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folic acid supplementaion before pregnancy what does it protect from?
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1. NTD
2. CV disease 3. pyloric stenosis 4. limb defects |
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latex allergy cross reactivity with food stuff includes
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1. nuts
2, kiwi 3. avocado 4. banana 5. potato 6. tomato |
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surgical vs med vs watful waiting for miscarriage
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1. surgery= < bleeding, unplanned admissions
2. sick leave and infection risk all the same. |
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how you can diagnose?
when to treat for whooping cough? |
a. serum pertussis IgG titres or NPS PCR (polymerase chain reaction)
b. within 2 wk. there is no evidence that beyond that it will decrease. |
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Shock + bradycardia. what are you thinking?
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neurogenic shock
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drugs that don'\t absorb with activated charcoal
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1.PHAILS
*pesticides, potassium *hydrocarbons *Alkali, Acids, Alcohols *Iron * Lithium , Lead * Solvents |
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Anion Gap formulat
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AG = measured - [Na+ - (Cl + HCO3)]
normal <12 |
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Urine alkalization
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3 amps NaHCO3 in 1 L D5W at 1.5x normal
-eg use in ASA overdose -contra = < K, renal insuff |
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Osmolar Gap equation
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OG = Measured - [2Na + glucose + (1.25x ETOH)] normal <10
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High AG causes
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1.MUDPILERS
*Methanol *Uremia *DKA *Paraldehyde *Iron, ibuprofen, isoniazid *Lactate *Ethylene glycol *Salicylates |
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ASA overdose SS
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N/V, tinnitus, hearing loss, crazy, wrose if chronic intake
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antichol SS
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Hot, Dry, Red, Blind, Crazy, +/- dysrhythmia, seizure
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antichol tmt
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benzo, cooling, physostigmine,
MgSO4 for QT prolongation, HCO3 for QRS widening |
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sympathomimetics SS
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Hot, Wet, Red, Blind, Mad, HTN, Tachy, agitaion.
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sympathomimetic tmt
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cooling, benzo, avoid Beta blockade if cocaine
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Cholinergic SS
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DUMBELS
Diarrhea, diaphoresis, urination, miosis, bradycardia, bronchorreha, emesis, lacrimation, salivation |
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cholinergic tmt
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ABC
atropine pralidoxime (30 mg / Kg over 30 min) |
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Wells score for PE
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Suspected DVT (3)
Alternative less likely than PE (3) HR >100 (1.5) prior VTE (1.5) Immobilization/ surgery w/in last 4 wks (1.5) Active malignancy 1 hemoptysis 1 if < 4 do D-dimer if higher scan |
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CHADS2
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CHF
HTN AGE >75 DM Stroke TIA. 0 ASA 1 ASA, warfarin, dabigatran higher warfarin/dabigatran |
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Lyme disease tmt
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doxycycline
amoxicillin cefuroxime usually 10-14 hrs. can also use doxycyline if tick has been on for at l3ast 36 hrs x 1 200 mg PO |
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lyme disease early manifestations (5)
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1. facial nerve palsy
2. aseptic meningitis 3. radiculopathy 4. heart block 5. erythema migrans |
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acne pharma tmt in pregnancy
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1. azelaic acid
2. benzoyl peroxide 3. erythromycin |
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acne lifestyle management
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1. Limit washing,
2. use a gentle, oil-free, alcohol-free, and non-abrasive cleanser 3. Use your fingertips instead of a washcloth or sponge 4. After washing, rinse your skin with lukewarm water. Then gently pat dry and apply moisturizer. 5. Avoid over-cleansing. 6. If you have oily skin, it's best to shampoo daily. |
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Steroid cream. Mild, Mod, strong
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mild = hydrocortisone
mod = betamethasone valerate strong = betamethasone dipropriate |
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PERC rule (R/O PE). Use in low risk patients and Wells <4. No need for D-dimer if PERC is negative
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1. Age< 50
2. HR >100 3. O2 >95% 4. no unilat leg swellling 5. no hemoptysis 6. no recent surgery / trauma w/ hosp in 4 wks 7. no prev of DVT/PE 8. no estrogen ALL need to be met |
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Wells PE criteria
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signs of DVT = 3
PE is more likely diagnosis = 3 HR>100 = 1.5 Prev DVT/PE = 1.5 Immob >= 3 days or surgery in 4 wks = 1.5 malignancy = 1 hemoptysis = 1 Score <=4 unlikely. > 4 likely |
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TMT for PE
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treat if Wells >6
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INdications for Higher dose folic acid
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1. prev preg w/ NTD
2. on anticonsulsnats 3. DM - insulin dependant 4. BMI>29 5. non compliance to 1 mg dose 6. fam hx of NTD |
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folic acid supplementation duration?
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3 months before to 12 wks post
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Foods that contain vit K
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1. brussel sprouts
2. spinach 3. avocado, 4. green tea 5. spinach, 6. mayo |
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H/A red flags
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1. fever/rash
2. neck stiffness 3. change in LOC 4. sudden onset 5. new onset >50yo 6. head trauma 7. change in pattern 8. risk factors for HIV(toxo)/cancer 9. worse in am 10. focal neurological sumptoms 11. papilledema |
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APLAS diagnosis
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*>0 clinical = thrombosis (venous or arterial), fetal loss (>=3 <10wks, >=1 > 10 wks, premature birth <34 wks if due to preecalmsia, eclampsia, placental insuff,
*>0 lab = anticardiolipin antibody, or lupus anticoagulant antibody persistent x 6 wks |
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hypercoag DDX
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CALMSHAPE
Protein C deficiency Antiphospholipid Ab Factor V Leiden Malignancy Protein C/S deficiengy >Homocysteine Antithrombin deficiency Prothrombin G2021OA > Factor VIII (Eight) |
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migraine DDX
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1. > 4 attacks
2. 2-72 hr duration 3. >2: unilateral, pulsatile, > activity, mod/severe in intensity 4. >0 N/V, photosens |
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DDX of insomnia
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1. psych: depression, anxiety, PTSD
2. sleep apnea 3. restless leg syndrome 4. CHF 5. pain 6. parasomnias - eg sleep walking/talking 7. central sleep apnea, hyperthy, GERD, COPD, BPH 8. meds (caff, nicotine, ETOH, diuretics, htn, SSRI, broncho, decongestants, steroids) |
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hypothy SS
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HISFIRMCAP
hypoventilation intolerance to cold slow HR fatigue impotence renal impairment menorrhagia constipation anemia parasthesia |
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tmt for myedema coma
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secondary to hypothy
1. hydrocortisone IV 2. T4 IV then oral when stable |
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hyperthy SS
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THYROIDISM
T- tremor H- HR > Y - Yawn (fatigue) R - restlessness O - oligo/amenorrhea I - intolerance to heat D - diarrhea < weight I - insomnia S - sweating M - muscle wasting / mood change |
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Thyroid storm
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SS = fever, tachy, dehydration, delirium, coma, N/V, diarrhea
Causes = trauma, surgery, RAI RX = betablockers, PTU, iodine, IV steroid |
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GRave P/E
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goiter, thyroid bruits, proptosis, exophtalmous, lid lag/retraction, diplopia,
acropachy, thickended phalanges, clubbing pretibial myxedema stick tongue out - oving of thyroglossal cyst |
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tmt measles
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vitamin A 100 000 - 200 000
NSAIDS vaccinate contacts |
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Post op fever 5 W
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Wind
Water Walking Wound Wonder drug |
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post partum fever
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1. wound (endometrial infection)
2. weaning (mastitis) |
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HACEK
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Haemophilus
Actinobacillus Cardiobacterium Eikenella Kingella |
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FQ SE on children
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arthropathy and tendinopathyrisk of chondrotox was 0.04%
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CA- MRSA most common infection
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furuncles, superficial abscesses, boils (often diagnosed as spider bite)
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hair loss DDX
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TOPHAT
Telogen efflavum, tinea capitis Out of Fe, or ZINC Physical- "corn-row", tricholomania Hormonal- hypothyroidism, androgenic Autoimmune- SLE, alopecia areata Toxins- heavy metals, anticoagulants, chemo, SSRI, vit A chemotherpa, Vit A, SSRI |
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tmt for hair loss
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1. minoxidil 2% BID
2. finasteride 1mg /d 3. spironolactone |
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five A's of smoking
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Ask about smoking
Advice to stop Assess willingness to stop Assist smoking cessasation Arrange f/u |
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ETT sizing in peds. How to determine diameter / length?
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Diamter = [age/4] + 4 in mm
length = [age/2] +12 |
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ped airway assessment
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* look for baseline obstruction while lying down (mallampati is also taken when lying down)
*size of mandible/chin *adequacy of mouth opening *presence /size of dentition *size of tongue *tonsillar size *anatomical abN of neck/airway eg. hard palate *neck mobility |
