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2061 Cards in this Set

  • Front
  • Back
What causes S1?
closure of AV valves:
--mitral/bicuspid: LA->LV
--tricuspid: RA-->RV
What causes S3?
increased volume in LV (ie CHF)
Leads affected in lateral MI
I, aVL, V5, V6
Imagine the heart and leads superimposed
I is East, AvF South, aVL NE, II at SE, III at SW, aVR NW
Order of EKG changes in MI
1 - peaked T waves
2- ST elevation
3 - negative T waves
4 - Q waves
Comment on MI pain vs Angina pain
not usually resolving with NTG (like it does with angina)
What is angina?
ischemia d/t obstruction or spasm of coronary artery
Treatment of Vtach
Amiodarone (because tachy with pulses to wide QRS to regular)
MI, when to start anticoagulation?
if presents early, if cardiac thrombus, is large arge of dyskinetic ventricle (b/c will get clot), severe CHF (b/c will get a clot)
What heart valvular lesions can produce CHF?
mitral and aortic valve pathology.
reflux, PUD RF (3)
--Certain foods
--Smoking
--Caffeine
Pathophysiology of stable angina
stable, flow limiting plaque preventing blood flow to heart
EKG stable angina
ST depression that is TEMPORARY, goes away when pain gone.
Stable angina pain usually lasts for
<20min
Achalasia pathophysiology
LES won't relax, likely destruction of Auerbach's plexus
Achalasia treatment
--pneumatic dilation
--botulinum
How to treat nutcracker esophagus or esophageal spasm
CCB or myotomy
EKG pericarditits
diffuse ST elevation
Pericarditis pain characteristics
better leaning forward
Pericarditis on labs
increased ESR
Pericarditis prodrome
viral URI (like Coxsackie usually)
Causes of pericarditis (6)
--VIRAL
--Uremia (remember?)
--TB (yikes!)
--CA (YIKES!)
--Lupus
--Other AI disease
How to diagnosis aortic dissection
CT with IV contrast
Treatment of aortic dissection
If ascending aorta or proximal arch involved, SURGERY.

Otherwise treat with antiHTN.
Cause of aortic dissection
HTN (just too much pressure!)
What subpopulation gets aortic dissections?
Marfan's
Marfan's and heart issues
chronic MR, aortic dissection
Marfan's physical characteristics
increased arm span, arachnodactylyl, loose joints
Ehlers-Danlos characteristics
Joint hypermobility + skin elasticity
Pes Planus
Scoliosis
Velvety skin with miniscars
DEGEN OF MITRAL VALVE
Variant angina definition and cause
=Prinzemtal, angina AT rest, d/t coronary artery spasm
Treat variant/prinzmetal angina
NTG, CCB
Variant/Prinzmetal angina EKG
ST elevation (but cardiac enzymes normal)
Pathophys of unstable angina
disruption of a plaque that causes transient partial thrombosis and blockage to heart getting blood.

It's any CHANGE from previous stable angina
Unstable angina enzymes and EKG findings
Enzymes NORMAL
EKG with ST depression
Unstable angina pain note
doesn't respond to NTG initially, like an MI does. Also can start at rest.
Treat unstable angina
like MI
ALSO IV heparin to anticoagulate
What valvular lesions can cause CHF?
Anything on the left (mitral and aortic valve pathology) - -- because affects what gets pumped out
mitral stenosis auscultation
low pitched diastolic murmur
opening snap
Loud S1
mitral stenosis causes
congenital
mitral stenosis on CXR
can see elevation L mainstem bronchus
prominent pulm arteries
L atrial enlargement
mitral stenosis effect on lungs
pulmonary hypertension, can cause hemoptysis
mitral regurgitation causes
Rheumatic fever
Marfan's
mitral regur on exam
holosystolic murmur
radiates to axilla
Soft S1 (because closing with liquid in there).
Valsalva and grip, murmurs that make them PATHOLOGIC
If decrease with valsalva, (less blood through there)

Increases with grip (more blood through there)
aortic stenosis causes
Age (calcification), rheumatic fever
aortic stenosis on exam
systolic murmur, radiates to carotids,
EJECTION CLICK
aortic stenosis, NEVER treat wieht
no nitates
no ACE-I
aortic regur on exam
diastolic descrescendo
sidenes pulse pressure (b/c diastole less)
mitral proplapse on exam
midsystolic click
late systolic murmur
mitral prolapse associated with what condition?
panic disorder
Acute heart failure, cause?
papillary muscle rupture
infective endocaditis
rupture of chordae tendinae
MR
How to recognize acute heart failure
young, healthy, flash pulm edema
Left sided CHF signs
Reduced EF
RESP ISSUES (pulm congestion, rales, dyspnea)
S3
causes of left CHF
= systolic dysfunction
pump not working (because of ACS, HTN, viral condition)
causes of right CHF
= diastolic dysfunction
--ventricle doesn't relax, gets stiffer, so reduced stroke volume (fibrosis, sarcoidosis, amyloidosis, hemochromatosis, HTN)
Major cause of all CHF
atherosclerosis
Signs of right CHF
excess fluid accumulates in body, peripehral edema, JVD, heaptomegaly, ascites, NORMAL EF
If EF < 35%, what do you do?
AICD, because will go into Vtach of Vfib
BNP interpretation
If >500 CHF highly likely
false positive for high BNP
anything that stretched heart, like PE, pulm HTN, cor pulmonale, ACS, cirrhosis
anemia and CHF connection
anemia can cause CHF!
connection between CHF and TSH
hyperthyroidism can be CHF cause
Main treatment for CHF
Sodium restrction
ACE-I!!!!
Furosemide (but no affect mortality)
Digosxin maybe
connection between myocarditis and CHF
myocarditis can be a cause
cor pulmonale definition and cause
RV enlargement d/t increased resistance in lungs (from COPD and chronic sleep apnea)
cor pulmonale on exam
(RV enlargement d/t increased resistance in lungs) - tachypnea, cyanosis, parasternal heave, loud PD
connection between PE and CHF
PE can be cause of CHF (esp in the young and healthy)
three kinds of cardiomyopathy
dilated cardiomyopathy
restrictive cardiomyopathy
hypertrophic cardiomyopathy
causes of dilated cardiomyopathy
anything that damages the myocardium, so get a large and weakened heart that can't pump

EtOH
myocarditis
doxorubicin
who gets dilated cardiomyopathy
Chagas
Pregnant women
Users of EtOH, myocarditis, doxorubicin
genetic inheritance of HCM
AD
definition and cause of restrictive cardiomyopathy
walls are rigid, so doesn't fill well
From infiltrates!
--amyloidosis
--sarcoidosis
--hemochromatosis
--fibroelastrosis
diagnosis of restrictive cardiomyopathy
you could do a ventricle biopsy, but usually CT or MRI of heart to distinguish between restrictive cardiomyopathy and pericarditis
treatment if unstable tachycardia
cardiovert
classic causes of afib
hyperthyroidism, EtOH
treatment of stable afib
slow rate with dilt, beta blocker
convert with verapamil and digoxin
treatment of multifocal atrial tachycardia
ccb
Treatment of WPW
procainamide )blocks Na channels)
Quinidine (class I antiarrhythmic)
What meds not to give for WPW
digoxin and verapamil
Treatment of VTach
Amiodarone
(or lidocaine)
Treatment of Vfib
defibillation
Treat bradycardia
if severe, atropine
First degree heart block on EKG
increased PR interval (>120ms)
treatment of first heart block
nothing, but avoid bb and ccb
definition of third degree heart block
no synchrony between atria and ventricles
treatment of third degree heart block
pacemaker
Kinds of second degree heart block
MOBITZ I = WENCKEBACH
--gradual prolongation of PR interval then drop QRS

MOBITZ II
--p waves occasionally dropped QRS
treatment of the two second degree heart blocks
MOBITZ I = WENCKEBACH
--pacemaker or atropine IF sx

MOBITZ II
--Pacemaker
Connection b/w OCPs and thyroid
OCPs and estrogen can increase TBG so less T3 and less T4 (b/c are bound). You do need to increase the levo dose in this case.
connection between thyroid and carpal tunnel
seen more in hypothyroidism
connection between hypothyroid and cholesterol
hypothyroidism may cause hypercholesterolemia
5 causes of hypothyroidism
1*** Hashimoto's (AI)
2. Subacute, viral
3. Idiopathic (too much meds)
4. Sick euthyroid, transiently low b/c sick
5. Central cause (pituitary or hypothalamic problem)
definition of hashimoto's thyroiditis
hypothyroid because AI disease.
diagnosis of hashimoto's thyroiditis
hypothyroid
ANTIMICROSOMAL ANTIBODIES

On histology, see lymphocyte infiltration of the poor thyroid gland
Hashimoto's associated with what other conditions
any other AI disease (pernicious anemia, vitiligo, lupus)
subacute thyroiditis, cause and exam
hypothyroid, acute viral infallamtion, recent URI.

Fever, TENDER LARGE THYROID
treatment of subacute thyroiditis
NSAIDs only
danger of hypothyroidism
can get a myxedema coma = hypothermia and acute mental status change
definition of sick euthyroid syndrome
HYPOTHYROID
Caused by any illness. Thyroid isn't dysfunctional, transient decrease in T3 and T4. TSH normal.
Central cause of hypothyroidism, like what?
from pituitary
--pit adenoma, sheehans

from hypothalamus
central cause of hypothyroidism in labs
reduced TSH and T4
diagram of here thyroid hormone comes from
hypothalamus with TRH
to
pit releasing TSH
to
thyroid releasing T3 and T4
workup for thyroid nodule
Check TSH. If normal, do FNA biopsy.

If low, do I131 scan to see if cold or hot. Cold?FNA biopsy. Hot? ablate.
thyroid nodule, if indeterminate FNA biopsy
6mo f/u and do it again
menstrual changes in hyperthyroidism
hyperthyroidism, gen hypomenorrhea!
connection between thyroid and bones
hyperthyroid can give you osteoporosis
pregnancy and thyroid
pregnancy raises TH, TSH normal. Could check free T4 I guess.
what is thyroid storm and how treat
when patients decompensate from very high TH levels. Treat with propanolol.
treatment of hyperthyroidism
PROPYLTHIOURACIL (less iodine so less TH)
METHIMAZOLE (less iodine)
RADIOACTIVE IODINE
SURGERY
side effect of propylthiouracil
(for hyperthyroidism, less iodine)
agranulocytosis
diagram of where cortisol comes from
hypothal release CRH
to
pit releases ACTH
to
adrenal cortex releasing cortisol
5 causes of hyperthyroidism
Graves (AI)
Plummer dz/Toxic (nodule)
Toxic adenoma (1 nodule)
Thyroiditis (before going hypo)
Central cause (high TSH and T4)
potential central cause of hyperthyroidism
high TSH and high T4
get MRI because pituitary adenoma possible, hyperfunctional
how can hashimoto's be associated with hyperthyroidism
before going hypo, get a transient hyperthyroidism
What is plummer disease vx toxic adenoma
BOTH HYPERTHYROID
Plummer is multinodular. nodules make too much TH.

Toxic adenoma is just 1 nodule.
What is Grave's disease
#1 cause hyperthyroidism
get autoAb that activate TSH receptor to increased T3 and T4, decreased TSH.
signs of Grave's disease
hyperthyroidism
--expoththalmosi, pretibila myxedema, nontender goiter, whole gland takes up the radiation
definition of addison's disease
primary adrenal insufficiency (low steroids/cortisol, low mineralcorticodis), AI
cause of addison's disease
adrenal insufficiency, usually autoimmunie
physical exam of addison's disease
adrenal insufficieny
--increased skin pigmentation (increased ACTH)
nausea/vomiting
hypotension (no steroids)
lab findings of addison's disease
Increased Ca
Low glucose (no steroids)
Low sodium (low aldosterone)
High potassium (low aldosterone)
high ACTH
addison's disease + some health stressor
ca have an adrenal crisis, see hypotension, abdominal pain, renal shutdown. GIVE steroids and fluids.
diagnose addison's disease
ACTH and see if cortisol increases (probably won't). But give steroids first if this is a major crisis.
if in question the patient has asthma, think...
probably took steroids (affect labs, adrenal insufficiency...)
primary vs secondary adrenal insufficiency causes and labs
primary - AI = addison's. HIgh ACTH.
secondary - taking steroids or sheehan or malignancy. Low ACTH and electrolyte balances aren't bad because still get mineralcorticoids
physical exam diff between primary and secondary adrenal insufficiency
primary? skin hyperpigmentation (ACTH)
Cushing syndrome vs cushing's disease
Cushing's syndrome == increased cortisol (d/t giving steroids vs adrenal neoplasma, small cell CA)

Cushing's disease - syndrome BUT with pituitary overproduction of ACTH (pit adenoma, get MRI)
Cushing syndrome and BP
hypertension
steroids effect on BP, glucose, bones, muscles
hypertension
high glucose
osteoporosis
muscle weakness
what does ant pit make?
ACTH
TSH
FSH/LH
GH
PRL
what does post pit make?
oxytocin, vasopressin
diagnosis of cushings
24 hr urine collection of cortisol. NOT plasma cortisol level because always changing.

OR Dexamethasone suppression test
Prolactinoma treatment
dopamine agonist (bromocriptine) because dopamine reduces PRL
prolactinoma presentation
in females: galactorrhea and amenorrhea

in males: impotence

And see temporal vision loss
prolactinoma labs and diagnosis
diagnose with MRI
See increased PRL, reduced LH and FSH.
What gland is problem is low TRH, high TSH high T4?
pituitary gland
axis for estrogen/progesterone
hypothal releasing GnRH
to
pituitary releasing LH+FSH
to
ovaries releasing E and P
what is a pheochromocytoma?
neuroendocrine tumor in adrenal medulla, secretes catecholamines
pheo in labs
maybe glucose intolerance because catcholamines so high
diagnose pheo
24hr urine test (VMA, HVA), if positive, order abdominal CT/MRI to confirm there is adrenal mass
treat pheo
alpha AND beta blockers together, otherwise get major HTN

Then surgery. Can go hypotensive once out, give nl saline bolus.
Conn syndrome definition
primary hyperaldosterone (so HTN), d/t adrenal adenoma
labs in Conn syndrome
= hyperaldosteronism
--HTN, HyperNa, HypoK, low renin levels.
diagnose Conn syndrome
CT scan
causes of secondary hyperaldosteronism
renal artery stenosis, CHF/cirrhosis/nephrotic syndrome
labs in secondary hyperaldosteronism
HIGH RENIN
cause and duration of gynecomastia
often seen in puberty d/t excess estrogen, usually regresses in 18-24months
causes of SIADH
morphine
small cell cancer
oxytocin (like if pregnant)
SIADH labs
euvolemic hyponatrenemia
low levels all electrolytes d/t dilution
treatment SIADH
water restriction
if fails, DEMCOCLYCLINE which induces opposite nephrogenic DI!
treat central DI
ADH
cause of central DI
trauma, neoplasm, sarcoidosis
nephrogenic DI cause
medications, like lithium, methoxyflurane
treatment of nephrogenic DI
thiazide diruetics (paradoxical effect)
ADH WON'T HELP (kidneys won't respond)
How can you tell if it is central or nephrogenic DI?
Give ADH, see if it works.
what is SMA syndrome
compression of the duodenum by the aorta and branching off superior mesenteric artery. End up with a fear of food.
pathophys of GERD
inapprorpriate intermittent LES relaxation
GERD and cancer
increased risk of esophageal ADENOCARCINOMA
diagnose GERD
could do endoscopy but gold standard is 24hr esophageal pH monitoring
kinds of hiatal hernia and the importance of this difference
sliding is where GEJ and stomach move through diaphragm. GERD.

paraesophageal is where part of stomach moves through another part in diaphragm. DANGER OF STRANGULATION.
Duodenal vs gastric ulcers - common, cause, acid secretion
DUODENAL - most common, H. pylori, lot of acid

Gastric only 25%, NSAIDs
Duodenal vs gastic ulcers, cancer risk and blood type
DUODENAL - NO CANCER, Type O

GASTRIC - RISK FOR CANCER (bx all), Type A
Duodenal vs gastric ulcer, pain with food?
DUODENAL - better with food, then worse later.

GASTRIC - worse with food
what is ZollingerEllison syndrome and how diagnose
gastrinomas, so gastric acid hypersecretion, get peptic ulcers. From pancreas.

Dx by checking gastrin level.
Triple therapy for H. pylori
Amoxicillin
Clarithromycin
PPI**
what is ZollingerEllison syndrome and how diagnose
gastrinomas, so gastric acid hypersecretion, get peptic ulcers. From pancreas.

Dx by checking gastrin level.
Quadruple therapy for H. pylori
Tetracycline
Metronidazole
Bismuth
PPI**
Triple therapy for H. pylori
Amoxicillin
Clarithromycin
PPI**
staining of H/ pylori
Gram neg
Diagnose H. pylori
urease breath test
serum antibody
fecal antigen
Quadruple therapy for H. pylori
Tetracycline
Metronidazole
Bismuth
PPI**
surgeries that COULD treat the H/ yplori if abx therapy doesn't help
Billroth, vagotomr (resect vagus nerve so no parasyp supply to stomach), antrectomy
staining of H/ pylori
Gram neg
What are the Billroth procedures
used for d/o of the stomach. connecting part of stomach to the duodenum.
Diagnose H. pylori
urease breath test
serum antibody
fecal antigen
what is dumping syndrome. Can happe after these stomach surgeries.
when foods bypass the stomach too quickly and enter small intestine undigested.
surgeries that COULD treat the H/ yplori if abx therapy doesn't help
Billroth, vagotomr (resect vagus nerve so no parasyp supply to stomach), antrectomy
sx of dumping syndrome
n/v/bloating
osmotic diarrhea because H2O enters too fast
Low blood sguar because pancreas releases a lot of insulin
What are the Billroth procedures
used for d/o of the stomach. connecting part of stomach to the duodenum.
what is afferent loop syndrome
obstruction of the rest of the intestinal loop after a bilroth procedure. See B12 deficiency and bilious vomiting.
what is dumping syndrome. Can happe after these stomach surgeries.
when foods bypass the stomach too quickly and enter small intestine undigested.
sx of dumping syndrome
n/v/bloating
osmotic diarrhea because H2O enters too fast
Low blood sguar because pancreas releases a lot of insulin
what is ZollingerEllison syndrome and how diagnose
gastrinomas, so gastric acid hypersecretion, get peptic ulcers. From pancreas.

Dx by checking gastrin level.
what is afferent loop syndrome
obstruction of the rest of the intestinal loop after a bilroth procedure. See B12 deficiency and bilious vomiting.
Triple therapy for H. pylori
Amoxicillin
Clarithromycin
PPI**
Quadruple therapy for H. pylori
Tetracycline
Metronidazole
Bismuth
PPI**
staining of H/ pylori
Gram neg
Diagnose H. pylori
urease breath test
serum antibody
fecal antigen
surgeries that COULD treat the H/ yplori if abx therapy doesn't help
Billroth, vagotomr (resect vagus nerve so no parasyp supply to stomach), antrectomy
What are the Billroth procedures
used for d/o of the stomach. connecting part of stomach to the duodenum.
what is dumping syndrome. Can happe after these stomach surgeries.
when foods bypass the stomach too quickly and enter small intestine undigested.
sx of dumping syndrome
n/v/bloating
osmotic diarrhea because H2O enters too fast
Low blood sguar because pancreas releases a lot of insulin
what is afferent loop syndrome
obstruction of the rest of the intestinal loop after a bilroth procedure. See B12 deficiency and bilious vomiting.
what is the ligament of trietz and what is its significance
it is at the duodenal-jejunal junction.

Upper GI bleed is proximal to it, Lower GI bleed is distal to it
how to stop a diverticula bleed
epi injection, vasopressin, embolization
varices treatment and prevention
treatment - octreotide
prevent - propanolol
GI bleed, what to do?
make sure stable, give IVF.
Endoscopies. If can't find bleed, nuclear RBC tagged scan.
Diagnose diverticulosis
CT with IV contrast
NEVER ENDOSCOPY bc might perf.
cause of diverticulosis
low fiber, high fat diet
osmotic vs secretory diarrhea
osmotic - sugar pulls in the fluid (like mild). Diarrhea stops if don't eat.

secretory - bacterial toxins like cholera has bowel secreting more fluid, diarrhea continues even if not eating.
example of malabsorption d/o causing diarrhea
celiac sprue, crohn's
pathophys of celiac sprue
AI to gliadin/gluten. Pathology is villous atrophy
crohn's on blood tests
antiendomysial antibody
steatorrhea is d/t
small bowel involvement
food poisoning, what was responsible?
if sx <6hrs, Staph or Bacillus.
If sx>6rs, bacterial or viral.
4 causes of bloody diarrhea
Shigella
Campylobacter
Some E. coli
C. diff
5 infectious causes of NONBLOODY diarrhea
Rotavirus
Giardia
Some E. coli
Cholera
Salmonella
Exudative diarrhea is
inflammation in bowel muca ccuases seepage of fluid, like in IBD
Treat C. diff
ORAL metronidazole.
If can't do that
ORAL VANCO
C. diff + loperamide
TOXIC MEGACOLON! BE CAREFUL with that!
C. diff on stain
Gram positive
HUS cause
IN KIDS

After E. coli O57:H7 or Shigella diarrhea, the toxin damages vascular endothelium
what you see in HUS
kids, after diarrhea, toxin damages vasculature
--ARF
--THROMBOCYTOPENIA (activates all the platelets)
--HEMOLYTIC ANEMIA (vasculitis breaks RBCs down)
Tx of cirrhosis
lots of protein (bc low albumin)
If hyponatremia, give 800-1000mL/day
Vit K and FFP if necessary
Hep A source
foodborne
Hep A serology
AgM anti HAV
Hep B transmission
needles
sex
perinatal
If HepB + mother, what do you do for the baby?
HepB vaccine and HepB Ig
HepB associated with what vasculitis
polyarteritis nodosa
HepC serology
HCV AB+ = resolved infxn
HCV RNA = active
complications of HepC
HCC
cryoglobulinemia
Hep D source
same as HepB, usually only WITH HepB. (needles, sex, perinatal)
HepD Ag
chronic infection
HepD IgM
recent resolution
HepE source
food or water born (way worse in pregnant women)
drugs that can induce hepatitis
Tylenol
INH and other TB RIPE
Phenobarbitol
statin
What is reye's
Fatty liver + encephalopathy (from giving ASA for a fever to a kid)
What is and tx for acute fatty liver of pregnancy
in 3rd trimester
Tx with immediate delivery
AI Hepatitis, serology
antismooth muscle
hypergammaglobulinemia on SPEP
tx AI hepatitis
steroids and azathioprine
Tylenol overdose mgmt
don't measure anything, give NAC right away.

Can give cimetidine to protect against hepatic necrosis
Tylenol overdose presentation
2-4hrs after, n/v, pallor
24-48h after, RUQ tenderness
relation between alcohol and tylenol
Chronic alcohol use uses up the protective glutathione, so can get worse hepatotoxicity with tylenol overdose
Acute HepB serology
HBsAg
HBeAg
HbcAb IgM
Acute HepB window period
HBcAb IgM only
Chronic Hep b
HBsAg
HBeAg
HBeAb IgG
Recovered from HepB
HBsAb IgG
HBcAb IgG
Immunized against HepB
HBsAb IgG
If you have HBe Ab that means
not contagious
In anemia of chronic disease, iron, transferrin, TIB, ferritin, trans sat
low Fe
Low transferrin = low TIBC
HIGH FERRITIN
Low transsat
in iron deficiency anemia
low Fe
HIGH transferrin HIGH TIBC
HIGH FERRITIN
low transferrin sat
hemochromatosis genetics and pathophys
AR
absorb too much iron and start depositing in various tissues
tx hemochromatosis
phlebotomy
chlate off with deferoxamine
hemochromatosis men vs women
men symptomatic earlier because women naturally losing iron anyway with menstruation
presentation of hemochromatosis
Iron in:
liver - cirrhosis, HCC
pancreas - DM
heart - DCM
skin - bronze diabetes
joints - arthrtisi
also infertility, amenorrhea, spooning nails
dx hemochromatosis
DNA testing
tx portal HTN
sodium restriction <2g/day
Diruetics
paracentesis
SAAG >1.1
serum ascites-albumin gradient

portal HTN
cirrhosis, CHF, buddchiari, hepatic vein thombosis
SAAG < 1.1
serum ascites -albumin gradient
peritonitis, CA
pancreatitis
trauma
nephrotic syndrome
Wilson dz - genetics and pathophys
AR

TOO MUCH COPPER!
Wilson disease blood and urine tests
blood - low ceruloplasmin (low because can't arry any more copper)
Urine - more copper
tx hemochromatosis
phlebotomy
chlate off with deferoxamine
diagnose wilson
liver biopsy, excess copper
hemochromatosis men vs women
men symptomatic earlier because women naturally losing iron anyway with menstruation
presentation of hemochromatosis
Iron in:
liver - cirrhosis, HCC
pancreas - DM
heart - DCM
skin - bronze diabetes
joints - arthrtisi
also infertility, amenorrhea, spooning nails
dx hemochromatosis
DNA testing
tx portal HTN
sodium restriction <2g/day
Diruetics
paracentesis
SAAG >1.1
serum ascites-albumin gradient

portal HTN
cirrhosis, CHF, buddchiari, hepatic vein thombosis
SAAG < 1.1
serum ascites -albumin gradient
peritonitis, CA
pancreatitis
trauma
nephrotic syndrome
Wilson dz - genetics and pathophys
AR

TOO MUCH COPPER!
Wilson disease blood and urine tests
blood - low ceruloplasmin (low because can't arry any more copper)
Urine - more copper
diagnose wilson
liver biopsy, excess copper
wilson disease presentation
hepatolenticular degeneration
KayserFleisher rings (dk rings around iris)
neuro changes (bc copper in basal ganglia)
Liver changes
psych changes
Tx Wilson' disease
penicillamine (copper chelator)
alpha 1 antitrypsin deficiency - genetics and presentation
AR
younger adult with cirrhosis AND/OR emphysema without risk factors
dx alpha 1 antitrypsin deficiency
low blood levels of antitypsin
SPEP (CNA tests)
alpha 1 antitrypsin deficiency tx
given alpha 1 antitrypsin
likely to need liver transplant :(
liver disease and coag tests
PT long.
Vit K ineffective b/c liver can't use to make coag factors.
tx coagulopathy in liver disease
NOT VIT K (can't use it)
FFP which has coag factors premade
SBP diagnosis
paracentesis, neutrophils >250
AND
can see low glucose, high protein
usual cause of SBP
E. coli, Streptococcus
pathophys of portal HTN
HTN in portal vein which drains GI tract, get backup and get other tributaries to the liver so clears before getting to heart
ammonia and liver disease
liver clears ammonia usually, so can get high if liver damaged. Tx with lactulose (prevents absoprtion of ammonia or neomycin which kills bowerl flora so can't make the ammonia)
Tx hepatorenal syndome
albumin
alpha adrenergic midodrine
octreotide
vasopressin
TIPS
What is TIPS
connects the portal vein to the hepatic vein
glucose and liver disease
liver usually stores glycogen so if it isn't now... LOW GLUCOSE
Reasons to see elevated alk phos
biliary tract disease
paget's disease (bone formation)
imagine the biliary tree
GB into cystic duct
then
R and L hepatic ducts come together to form common hepatic duct
then
joins with cystic duct to make
common bile duct
dark urine, talk about the bilirubin found
it's conjugated. unconjugated won't go into use because bound to albumin
Couvoisier sign
jaundice
+
palpable gallbladder
cholestasis can be caused by
meds (OCPs, sedatives, adrogens)
pregnancy
Primary biliary cirrhosis and PSC causes
both caused by AI destruction
PBC vs PSC labs
PBC - antimitochondrial antibodies

PSC - antismooth muscle, pANCA
PBC presentation
middle aged woman, maybe some osteoporosis, jaundiced
tx PBC
cholestyramine (bile acid sequestrant
liver transpoart
ursodeoxycholic acid
PSC presentation
with ULCERATIVE COLITIS
beaded bile duct strictures
(tx same as PBC)
cholangitis def and cause
bacterial infection superimposed on an obstructive biliary tree, usually from gallstones.
Charcot's triad vs Reynold's pentad
Charcot's triad: RUQ pain, jaundice, fever
Reynold's pentad: AMS, hypotension
treat IBD
5ASA
sulfa
steroids
immunosuppressants
surgery for UC
complications of IBD
uveitis
ankylosing spondylitis
erythema nodosum
PSC if UC

ALSO TOXIC MEGACOLON (UC)
toxic megacolon from what?
cdiff + loperamide
UC/Cohn's
toxic megacolon diagnosis
xray with dilated colon, thumprinting, emergency!!!
tx toxic megacolon
EMERGENCY
NPO, NGtube
IVF and Abx
crohns vs UC location and thickness
crohns - skps around, transmural

UC - rectum up, to submucosa only
crohns vs UC who gets it?
UC gets in two spikes, 15-30yo and >60YO
crohn's vs UC cancer risk and if needs surgery
crohn's - no surgery (still skips), little increase CA

UC - YES CA RISK, YES SURGERY
classic lesions of crohn's
fistulas/abscesses (b/c transmural)
cobblestoning
string sign
noncaseating granulomas
classic lesions of UC
pseudopolyps
leadpipe colon
toxic megacolon
crypt abscesses
friable mucosa
diagnose achalasia
esophageal manometry
what is zenker's diverticulus and how present
outpouching in upper esophagus, foul smeeling breath, reguitation, hard time swallowing
to diagnose esophageal perf
ESOPHAGOGRAM, not an endoscopy, and use water soluble contrast
corkscrew esophagus seen on barium swallow, think
diffuse eso spasm or nutcracker esophagus
scleroderma parts
CREST
calcinosis
Raynaud's
esophageal dysmotility (apreistalsis d/t fibrosis of smooth msucle)
sclerodactylyl
telangiectasias, can become incompetenent LES
mgmt of Barrett's esophagus
periodic endoscopy and biopsies
Mallory Weiss vs Borrhave
Boorhave is a full thickness esophageal rupture
radiolucent bank by heart border, think
pneumomediastinum
FAP labs and def and mgmt
FAP 100s of polysps __> CA.
APC gene
But also risk for intestinal/gastric CA, so do an upper endoscopy too.
pancreatitis labs
DO LIPASE!!! more specific
Grey Turner and Cullen sign
Grey Tuner, pancretatits, blue/black flank
Cullen: blue/black umbilicus.
diffuse calcifications in pancreas means...
chronic pancreatitis, usualyl EtOH induced
gallbladder not involved in CHRONIC pancreatitis bc
gallbladder probably already removed a long time ago
cause of acute ischemic colitis
atherosclerotic disease
causes of pancreatitis
EtOH
GALLSTONES

HyperTG
Mumps/Coxsackie
Trauma via ERCP
Steroids
Tiazides
Azathioprine
anemia and murmurs
can get murmurs with anemia d/t high flow
how does methyldopa cause anemia
Ab to RBCs
how does chloroquine cause anemia
via G6Pd worsening
how do sulfas cause anemia
only through G6Pd
chloramphenicol and anemia
not just anemia, but aplastic anemia
phenytoin and anemia
get a megaloblastic anemia
OA and anemia?
NO NO NO@
vit deficiencies seen in alcoholism
iron
folate
B12
G6PD def pathophy
the deficiency of this enzmye means the enzyme can't eradicate free radicals in RBCs. So you get all sorts of hemolysis to certain triggers.
interpret RI
should be >2%, if not, the marrow isn't reponding well.

If super high, maybe there's hemolysis going on.
teardrop RBCs on smear, think
myelofibrosis (replacement of marros with fibrous CT, get anemia)
if see bit cells on semar, think
hemolytic anemias
if see basophilic stippling on smear, think
lead poisoning
if see rouleaux formation, think
multiple myeloma
what is multiple myeloma
cancer of plasma cells (that make Ab), so get weirdo plasma cells (Ab) deposited into organis
presentation of MM
(CA of plasma cells, Ab)

Ab deposited everywhere, so get
renal failure
neuropathy
anemia
bone lesions
lot of Ca
diagnostic tests for MM
bone scan - see punch out lesions
serum electrophoresis - see albumin and Ab spikes
See Heinz bodies, what look like and what think
dot inside or outisde RBC
G6D def

(it's denature Hgb)
Echinocytes,/burr cells - what look like and associated with
UREMIA!

spiky RBC
teardrop RBCs on smear, think
myelofibrosis (replacement of marros with fibrous CT, get anemia)
if see bit cells on semar, think
hemolytic anemias
if see basophilic stippling on smear, think
lead poisoning
if see rouleaux formation, think
multiple myeloma
what is multiple myeloma
cancer of plasma cells (that make Ab), so get weirdo plasma cells (Ab) deposited into organis
presentation of MM
(CA of plasma cells, Ab)

Ab deposited everywhere, so get
renal failure
neuropathy
anemia
bone lesions
lot of Ca
diagnostic tests for MM
bone scan - see punch out lesions
serum electrophoresis - see albumin and Ab spikes
See Heinz bodies, what look like and what think
dot inside or outisde RBC
G6D def

(it's denature Hgb)
Echinocytes,/burr cells - what look like and associated with
UREMIA!

spiky RBC
see target cells, think
thalassemia
liver disease
see hypersegmented neutrophils, think
folate
Vit B12 deficiency
see Howell Jolly bodies, think and what look like
dot in BC (like Heinz)
asplenia or splenic dysfunction
see iron inclusions in RBCs, what look like and what think
ring of dots around RBCs.
Think sideroblastic anemia

This is d/t iron granuales that can't incorporate into Hgb
see schistocytes, think
intravascular hemolysis
why pathology with spherocytes or elliptocytes
problem with the cytoskeleton, so spleen thinks they're bad so they tear them up
see polychromasia, think
reticulocytosis (maybe hemolysis too)
intravascular hemolysis, causes and pathophys
RBCs lysed in blood vessel
-d/t mech damage by heart vale
-mech damage from vasculitits
-paroxysmal noctural hgburina
intravascular hemoysis in serum and smear
serum - LDH high, haptoglobin low, direct coombs negative

-smear - schistocytes, lot of Hg, l
extravascular hemolysis pathophsy and causes
RBCs abnl or coated with Ab so liver or spleen attacks them

--AIHA
--spherocytosis, membrane issues
--SCD
--HUS
--Any antibodies against it
extravasc hemolysis on serum tests
direct coombs maybe positive in RBC Ab involved

(so consider if blood transfusions will be helpful)
examples (4) of macrocytic anemia
folate def
B12 def
Meds (methotrexate, phenytoin)
liver dz
examples of microcytic anemia (5)
Thalassemia
(nl to high RI)

Iron def
sideroblastic anemia
anemia of chronic disease
lead poisoning
hemolytic anemia labs
high LDH
no haptolobin (only seen with intravascular hemolysis)
The correct labs for IDA
low iron
low ferritin
HIGH TIBC
low TIBC sat
low TI
what is a thalaseemia
anemia d/t defefcts in Hgb resulting from abnormal production of alph and beta globin. The units themselves are okay.
2 alpha 2 beta
Hgb alpha units, how many, what race associated with problems
4 genes

more in africans and asians
Hgb beta units, how many genes involved and what race associated
2 genes involved

more in mediterraneans
sickle cell trait, kind of anemia and Hgb types
NO ANEMIA

See HbA and HbS
What is hemoglobin SC disease
equal HbS and HbC
iron levels in thalassemias
NORMAL, do don't offer it as treatment!
thalassemias MCHC
increased
thalassemias with xrays
skull was hair on end appaearance because of excessive extrameduallar hematopoiesis
when become symptomatic with thalassemia?
depends on what kind.
alpha thal - sx at birth

beta thal - sex at six months because have fetal Hgb
kinds of alpha thalassemias
4 bad genes - hydrops fetalis
3 bad genes - HbH = Hgb Barts
2 bad genes
1 bad gene -
kinds of beta thalassemias
2 bad genes - B thal MAJOR
- no B globin production
-High HbA2 and HbF
- Die without transfusions

1 bad gene = B thal MINOR
- maybe occ transfusion
beta thal major presentation
can see CHF even
thinning of cortical bone d/t expansion of marrow cavity
thalassemias and malaria
B thal major protects against malaria
labs and smear for lead poisoning
labs - elevated free erythroycte protoporphyrin
smear - basophilic RBC stippling
Sideroblastic anemia on iron studies
Fe, TIBC, ferritin all NORMAL
Low RI
anemia of chronic disease, RI?
low
tx siderolbastic anemia
supporitvely, maybe pyridoxine (Vit B6)
No iron (plenty of iron, remember?)
cold agglutinin disease associated w what infections
mycoplasma
mono
cold agglutinin disease - anemia and presentation
it's normocytic anemia
acrocyanosis in cold exposures
AIHA - kind of anemia and coombs test
normocytic anemia
coombs POSITIVE
AIHA etiologies
lupus
Meds like meyldopa, Abs, INH, hydralazine
mycoplasma, EBV, syphilis
drugs that cause lupus
procainamide
hydralazine
isoniazid
spherocytosis genetics and how diagnose (4)
blood smear
fam hx (AD)
positive osmotic fragility yest
increased MCHC
ESRD, kind of anemia and how treat
normocytic
give erythropoietin (usually kidney makes that)
cause of aplastic anemia (and what kind of anemia)
normocytic
chemo/rads
leukemia
chloramphenicol
carbamezpine
sulfa
iron levels in thalassemias
NORMAL, do don't offer it as treatment!
thalassemias MCHC
increased
thalassemias with xrays
skull was hair on end appaearance because of excessive extrameduallar hematopoiesis
when become symptomatic with thalassemia?
depends on what kind.
alpha thal - sx at birth

beta thal - sex at six months because have fetal Hgb
kinds of alpha thalassemias
4 bad genes - hydrops fetalis
3 bad genes - HbH = Hgb Barts
2 bad genes
1 bad gene -
kinds of beta thalassemias
2 bad genes - B thal MAJOR
- no B globin production
-High HbA2 and HbF
- Die without transfusions

1 bad gene = B thal MINOR
- maybe occ transfusion
beta thal major presentation
can see CHF even
thinning of cortical bone d/t expansion of marrow cavity
thalassemias and malaria
B thal major protects against malaria
labs and smear for lead poisoning
labs - elevated free erythroycte protoporphyrin
smear - basophilic RBC stippling
Sideroblastic anemia on iron studies
Fe, TIBC, ferritin all NORMAL
Low RI
tx aplastic anemia
stop whatever med is causing it
May be antithymocyte globulin (knock of Tcells) or BMtransplant
myelophthisic anemia what is it
normocytic anemia
b/c myelodysplasia/myelofibrosis or malignant invasion and destruction of BM
myelodyplastic issues and smera and BM biopsy
BM biopsy usually dry
see crazy RBC that are nucleated, giant, teardrop
G6PD def, genetics, diagnosis
X linked
RBC enzyme assay (way after hemolysis has resolved a bit)
G6PD def offending med/circumstances that can put you into hemolytic crisis
Fava beans
Antimalarials
Salicylates
Sulfas
Infection
what is paroxysmal noctural hemolysis
acquire d/o with intravascu hemolysis, recurrent thrombosis.
dx paroxysmal nocturnal hemolysis
flow cytometry
who gets folate def
alcoholics
pregnant women
causes of folate def
alcoholics
pregnancy
poor diet
methotexate
long bactrim tx
phenytoin
malabsoprtion
how treat folate def
oral folate
vit B12 def ccause
prenicious anemia (Ab against gastric parietal cells)
gastrectomy, surgeries
strict began
chronic pancreatitis
fish tapeworm
Vit B12 def dx
Schilling test
Macrocytic anemia
Low B12
what is schilling test
for B12 def

want to urinate out 5+% labelled B12 (if don't, impaired absoprtion)
lab tests in vitamin b12 def
also get low Cl! No stomach acid secretion either
how treat serum B12
f d/t pernicious anemia, must give B12 IM because we already know they can't absorb it
When transfuse with washed RBCs
IgA deficiency (free of any of trace of anything else)
When transfuse with FFP
DIC, coumadin posioning, liver failure
cryoprecipitate, what is it
has fibrinogen and factor 8(can use VWD, DIC, hemophilia!)
hgb 6, what do you do?
transfuse on clinical grounds
emergency, what blood do you use?
O negative
3 kinds of transfusion reactions
febril reaction (Ab to WBCS0
hemolytic reacion (Ab to RBCs)
Allergic reactive (rxn to component in serum)
if stop peeing after transfusion
IVF and diurese (hemoolytic reaction)
if bleeding after transfusion, because of
high K
dilution (lo plt)
low Ca (from chealtor)
causes of DIC
50% OB! and preg
CA
then sepsis of trauma
DIC, fibrin, FDP, D dimer test
D dimer positive
increased FDP
low fibrin
loffler syndrome
pulmo esoinophilis (parasite?)
causes of basophilia
allergies
CA
blood dyscrasia
FVL test
APC (activated protein C resistance)
coag tests and what prolongs them
PT (extrinsic) WARFARIN prolongs
PTT (intrinsic) HEPARIN
Bleeding time - PLTS BAD FUNCTION PROLONGS IT
if see petechiae, this is a ___ issue
platelets
if cavity/joint bleeding , this is....
clotting factor deficiency (not platelets!)
von Willebran dz, genetics, coag tests
AD
PT normal
PTT and BT high
what is VW diasese
no von Willebrand factor, needed for platelet adhesion
how dx vW dz
Factor VIII
tx of vW dz
desmopressin (because increased VIII)
Hemophilia A/B genetics and problem
X linked
Hemophilia A = low factor 8
Hemophilia B = low factor 9
Hemophilia A/B coag tests
PT normal
PTT high
BT normal
DIC coag tests
High PT, PTT BT
liver failure and coag tests
PT hight
PTT high
BT normal
ITP and TTP coag tests
PT/PTT normal
BT high
scurvy coag tests
all all all normal
what coag factors use Vt K
2, 7, 9, 10
don't give plt transfusions to
TTP
of HITT
orgs that are spirochetes
treponema/syphilis
leptospira
correlia (Lyme's dz)
what orgs only see with darkfield microscope?
treponema (syphilis)
leptospira
erythromycin covers
G+
Resp G-
oral anaerobes
atypicals
osteomyelitis in IV drug use or sickle cell
osteomyelitis in IV drug use = pseudomonas

osteomyelitis in sickle cell = salmonella
H influ in meningitis?
not so much in kids anymore since vaccination, but if NOT vaccinated, most likely cause
bacteroides type of bacteria
NAAERoBIC
borrelia causes what disease
rmsf
meds to treat lyme's disease
doxy amoxicillin
how to treat mycoplasma (atypical)
azithromycin, fluoroquinolone
which abx cover pseudomonas?
4th gen cephalosporin (cefepime)
aminoglycosides (gent)
cipro and levofloxacin
Zosyn/Unasyn/Ticar-b
Carbapenems (meropenem)
How treat <5YO exposed to TB, neg PPD
treat 3 months with INH
tx LTBI
INF for 6-9months
when TB no longer considered infectious?
if clinically improving ON TX
3 negative sputum smears
TB positive with what measurements?
>5cm = immunocompromised, prior RB
>15mm = low risk
TB therapy, how monitor
liver tests, supplement with B12 (pyridoxine for INH)
signs of B6 deficiency (pyridoxine), like in INH
cheilitis
sz
sideroblastic anemia
if multidrug resistant TB, what med do you add
streptomycin or ethambutol
impetigo and counseling patients, how to treat
strep/staph skin honey lesions
CANTGIOUS
tx with dicloxaillin (PCN)
erysipleas vs cellulitis
erysipelas superficial, red shiny, tender.

Cellulitis goes into subcu tissues.
tx dog bites with
amipicilli (pasteurella)
How treat <5YO exposed to TB, neg PPD
treat 3 months with INH
tx LTBI
INF for 6-9months
when TB no longer considered infectious?
if clinically improving ON TX
3 negative sputum smears
TB positive with what measurements?
>5cm = immunocompromised, prior RB
>15mm = low risk
TB therapy, how monitor
liver tests, supplement with B12 (pyridoxine for INH)
signs of B6 deficiency (pyridoxine), like in INH
cheilitis
sz
sideroblastic anemia
if multidrug resistant TB, what med do you add
streptomycin or ethambutol
impetigo and counseling patients, how to treat
strep/staph skin honey lesions
CANTGIOUS
tx with dicloxaillin (PCN)
erysipleas vs cellulitis
erysipelas superficial, red shiny, tender.

Cellulitis goes into subcu tissues.
tx dog bites with
amipicilli (pasteurella)
cellulitis from vibrio, tx
fishermen or other salf water
TETRACYCLINE
Pseudmonas cellulitis, how tx
if DM, trauma

HUGE ABX
endometritis and puerperal fever cause and tx
strep B
amoxicillin/ampicillin
stretococcus viridians causes
subacute endocarditis and dental caries
endocarditis in IV drug users from
staph auerus
toxic shock syndrome from what org?
staph aureus
MRSA covered by which abx
vanco
coxy
linezolid
bactrim
clinda
quinupristin
staph epi causes
IV cath infections
infectious of prestheses
staph saprophyticus causes
UTI
if stpah aureus bacteremia, you must
eval for endocarditis (echo)
if you see strep bovis endocarditis, think about
occult GI malignancy and get colonoscopy!!!!
causes of acute and subacute endocarditis
acute = S. aureus
subacute - insidious onset, strep viridans
What are osler nodes vs roth spots vs janeway lesions vs splinter hemorrhages
all for endocarditis
osler - painful nodes on fingers
roth spot s- retinal hemorrhages
janeway lesions - nontender on palms and soles
splinter hemorrhages - under nails
how long tx endocarditis?
4=6 weeks
how treat endocarditis
vanc and gent (bc sometimes G-)
who gets endocarditis
IV drug users
fake valves
postop patient
who really gets dental prophy for endocarditis?
MVP + audible murmur
bit by ?rabies animal, how tx
rabies IG
rabies vaccine

EXCEPT IF NL LOOKING DOG/CAT
EXCEPT IF RABBIT OR RODENT
how to screen and confirm syphilis
Screen: RPR + VDRL

Confirm: FTA and MFA
options to tx syphilis
PCN (duh
OR ERYTHROMYCIN if allergic
three stages of syphilis
PRIMARY: painless chancre
SECONDARY (6w-18months), condyloma lata wart, sole/palm rash, LAD
Latent phase
Teritary: years later, gummas (Granulomas), neuro changes, paresis, thoracic aortic anuerysms!
lung infection with have CF, from
pseudomonas
Staph aures
how dx mycopllasma pna
positive cold agglutinin titer, + IgM against RBC
stuck with thorn or rash with gardening, ID and treat
Sporothrix (fungus), treat with fluconazole

See spread ni lymphatic, linear raised rash!!
if aplastic crisis in SCD, from
parcovirus B19
spleen out, vaccinate for
Strep pneumo, H, inlue, N meningitidis
PNA around birts, is
chlamydia psittaci
fungus ball after TB
aspergillus
Vit B12 def and abdominal sx, think
fish tapeword (Diphyllobothrium latum)
bladder CA (aquam cell_ in middle east and africa), ID and tx?
from trematode (Schistosoma hematobium)

Dx: urine micro to see eggs
fever, muslce aches, esoinophils, periorbital edema after eating raw meat
trichinella spiralis (Trichinosis)
mech for paralysis after honey
from clostridium botulinum

toxin blocks Ach release
tx malignant external otitis
systemic Abx (antipseudomonal)
genital lesions but no abuse in kids, likely
molluscum (poxvirus)
goats/sheep fever, from
brucella (G-)
PNA by air conditioner or eatwe tower
Legionella (G-)
tx legionella
azithomycin, or fluoroquinolone
gram + stain, Gram negative stain what color?
G+ = blue/purple

G - = red
Gram + cocci in chains
streptococci
gram + cocci in cluster
staph
Gram + cocci in pairs 9diplococci)
strep pneumo
gram - coccobiaccili
haemophilus
Gram neg diplococci
neisseria, moraxella
Gram neg rod that is pump with thick capsule (mucoid)
klebsiella
gram positive rods that form spores
clostridium
bacillus
see pseudohyphae, think
candida
acid fast orgs includ
mycobacterium (TB), nocardia
gram pos with sulfur granules
actinomyces, PID
silver staining org
PCP and cat scrath dz
positive india ink prep
cryptococcus (fungus) - can cause meningitis!
how to recognize multifocal atrial tachy
diff P waves
RR irregular
causes of multifocal atrial tachycardia
hypoxia
COPD
low potassium
how to treat prolactinoma
RARELY SURGERY NEEDED
dopamine agonist (bromocriptine)
lab tests with Prolactinoma
HIGH PRL
low LH low FSH
what is MELD for and what parameters
MELD - to predict mortality in patient with liver dz

BILI
INR
Cr
potassium and sick kidney
will be high

because a healthy kidney will excrete all the extra K+
definition of oliguria
<500mL/day
<20mL/hr
causes of prerenal ARF
hypovolemia
not perfusing the kidneys (CHF)
sepsis
renovascular HTN
how to diagnose prerenal ARF
BUN:Cr>20

FeNa <1%
causes of postrenal ARF
BPH
renal artery stenosis (fibromusc dysplasia)
can kidney stone cause renal failure
not unless bilateral
OR bladder neck stone

(bc other kidney an pick up the slack)
causes of intrarenal ARF
ATN (death of tubule cells in the kidney)
IV contrast
Lupus
Meds
GPS
ATN known by
muddy brown casts
what meds damage the kidney
chronic NSAID-->papillary necrosis or ATN
cyclosporine
aminoglycosides (gent)
methicillin

INTRARENAL ARF
Goodpasture's syndrome pathophys and renal biopsy
path - antiglomerular basement membrane antibodies
renal biopsy - linear immunofluorescence pattern
presentation of Goodpastur'es
young man with:

hemopytsis/dyspnea
AND
RENAL FILURE
How tx Goodpasture's
steroids
Wegen's granulomatosis presentation
LUNG
KIDNEY (like Goodpasture's)
AND SINUS INVOVLEMENT
how to diagnose Wegener's
c-ANCA
= antineutrophilic cytoplasmic antibody
RBC casts
glomerulonephritis
how does poststrep glomerulonephritis present
1-3wks after URI.
Edema, HTN, hematuria
RBC casts
Rhabdo connection with kidneys?
the muscle breaks down and plugs up the renal filtration systme.

See high CPK and CK.
Tx rhabdomyoltsis
hydration
diuretics
when is acute renal failure so bad that need dialysis
uremia --> pericarditis
encephalopathy
metabolic acidosis if pH<7.25
CHF
renal artery stenosis, when suspect
if young woman with inability to control HTN. (d/t fibromuscular dysplasia)
ADPKD presentation
HTN
hematuria
BERRY ANEURYSMS in circle of Willis
Liver cysts
Chronic renal failure, acid/base, potassium, fluid status, Calcium, Phosphate
Metabolic acidosis (increased AG)
HyperK
Fluid retention
HypoCa and Hyperphos because imparied Vit D production so not reabsorbing Ca@+
kidneys connection to bones?
in chronic renal failure, can have impaired vitamin D production, bone loss leads to renal osteodystrophy
chronic renal failure AND
Anemia
Symptoms
Coags
Skin changes
Immunity
Anemia d/t lack of EPO
N/V from buildup of toxins
Bleeding with platelets not working in uremic conditions
skin yellowbrown and itchy
increased infection because immune system doesn't work either in uremia
management of chronic renal failure
dialysis
water solube vitamins (which are removed in dialsis)

Low phophate
Phophate binders (CaCarbnate)

EPO
UTI, alkalotic urine, think
Proteus
what is urobilinogen
in hemolysis
in liver disease
waxy casts, think
CKD
WBC casts, think
pyelonephitis
Calc FeNa
UNaPCr
-----------
UCrPNa
Pyelonephritis usually d/t
E. Coli
if pyelo and doesn't improve after 7whrs of abx...
do CT scan to look for a renal abscess (may need surgical drainage)
asymptomatic bacteruria, tx?
don't treat UNLESS PREGNANT (but don't use bactrim)
nephritic syndrome 3 characteristics
Proteinuria but <3.5g
HTN
Hematuria
examples of nephritic syndrome
poststrep glomerulonephtisis
examples of nephrotic syndrome
minimal change dz (no podocytes)
lupus
IgA nephropathy
FGFS
Membranous nephropahty (spike and dome)
DM nephropathy (kimmel lesions)
MPN (tramtrack)
nephrotic syndrome characteristics
Proteinuria > 3.5g
Low albumin
Edema
HL
medicines that can cause a nephrotic syndrome
gold
penicillamine
captopril
diseases that can cause nephrotic syndrome
DM
HepB
amyloidosis
Lupus
How diagnose Nephrotic syndrome
24h urine collection
adults with ca, which highest incidence vs highest mortality
incidence: prostate and breast
mortality: lung and lung
#1 RF cancer
AGE actually
AFP tumor marker for
liver and testicular CA
CA 19-9 marker for
Pancreatic CA
CA-125 marker for
Ovarian CA
CEA marker for
colon ca
HcG marker for CA
hydatiform moles
choriocarcinoma
B2 microglobulin marker for
MM
APC marker for
familial polyposis
Retinoblastoma inheritance
AD
adults with ca, which highest incidence vs highest mortality
incidence: prostate and breast
mortality: lung and lung
#1 RF cancer
AGE actually
AFP tumor marker for
liver and testicular CA
CA 19-9 marker for
Pancreatic CA
CA-125 marker for
Ovarian CA
CEA marker for
colon ca
HcG marker for CA
hydatiform moles
choriocarcinoma
B2 microglobulin marker for
MM
APC marker for
familial polyposis
Retinoblastoma inheritance
AD
inheritance for MENs
AD
inheritance fo FPC, Gardner, Turcot, Peutz-Jeghers
AD
what is peutz Jeghers
AD
perioral freckles
multiple noncancerous GI polyps
Increased incidence of noncolon CA
peutz jeghers and risk of colon CA
NONE EXTRA
FPC, Gardner and Turcot
FPC - we know
Gardner = FPC + osteomas and soft tissue tumors
Turcot = FPC + CNS tumors
MEN I is
parathyroid
pituitary pancreas tumors
MENII types
MEN IIa =
Thyroid (medullary CA)
Pheo

MENIIb
Thyroid (medullar)
pheo
MUCOSAL NEUROMAS****
PARATHYROID**
NF genetics
AD
NF types
NF type I:
neurofibromas, cafeaulait, pheochromocytomas

NF Type II:
bilateral acoustic schwannomas
tuberous sclerosis genetics
AD
tuberous sclerosis is
(d/t bad tuberin, controls cell growth and division)
ZITS (adenoma sebaceum)
FITS (sz)
NITWITS (MR, glial nodules)
and get ccardia rhabdomyomas
Von Hippel Linau genetics and what is it
AD

Hemangioblastomas in cerebellum
RCC
Xeroderma pigmentosa genetics and what is it
AR
skin CA multiple areas
albinism genetics
AD
(associated with skin CA)
Bloom sydrome genetics and what is it
AR
short
rash on cheeks
little jaw
INCREASED CAN RISK
Fanconi anemia, what is it
multiple chromoscome breaks

Get lots of CA
3 RF for cervical CA
smoking
sex
high parity
mesothelioma, RF?
asbestos
renal cell ca, RF?
smoking
EBV associated with what CA
Nasopharngeal carcinoma
Burkitt lumphoma
Hodgkin
H. pylori associated with CA
Stomach CA
HHV8 assoc with CA
Kaposi's sarcoma
HTLV associated with what CA
Adult T cell leukemia and lymphoma
acute vs chronic leukemia, what are they
acute = prolif of minimally differentiated cells (myeloblasts and lymphoblasts)
>20% blasts in marrow

chronic: prolif of more mature diff cells (myleocytes, lymphocytes)
mycosis fungoides/Sezary syndrome AKA and is it and how dx
= cutaneous T cell lymphoma
itchy skin rash
blood smear with butt cells (cerebriform nuclei)
Pautrier abscesses in epidermis)
ALL, who gets it and what is it
CA of WBC
kids get
AML who gets and dx
adults
auer rods
AML associated with what RF
smoking benzee, ads, chemo
CML age and diagnosis
adults
philadelpha chromsome 9;22
blast crisis
tx of CML
gleevec
CLL who gets and dx
adults
smudge cells
CD5
CLL treatment idea
no teat if asx
Tx of ALL
induction therapy, consolidation, maintenaouce therapy
ALL and LDH and uric acid
high LDH high uric acid
AML and LAP
low LAP (leuk alk phos)
see blasts on BM bx w myeloperoxidase stain
butt cells/cerebriform nuclei, think
mycosis fungoides/sezary syndrome
CNS B cel lymphoma, associated with
HIV
Hodgkin disease, what is it, sx
CA of B cells
cervical LAD, night sweats
Hodgkin dz on smear and how treat
see Reed Sternberg cells (the owl eyes)

Tx: chemo ABVD
Nonhodgkin lymphoma progrnosis
small follicular type is the best

large diffuse type is the worst prognosis
Nonhodgkin lymphoma tx
CHEMO CHOP (vs ABCD IN HODGKIN)
Myelodysplastic syndroms associated with what, CBC findings
anemia
high MCV and high RDW

associated with CML
How to diagnose MM
SPEP and UPEP (Bence Jones)
what is waldenstrom disease/macroglobulinemia
increased B cells that interfere with RBC production
Waldenstroms presentation
(increased B cells)
--Raynaud's d/t cold agglutins
waldenstrom's dz 3 characteristics
-hyperviscosity (extra B cells)
IgM spike (from the B cells)
Cold agglutins --> Raynaud's
most common cause of polycythemia vera
chronic hypoxia from lung d/o
Polycythemia vera sx, tx, labs
High Hg
Pruritis after hot shower
tx phlembotomy
polycythemia vera assoc with CA?
increased risk of AML
breakdown and treatment for the diff kinds of lung cancer
SMALL CELL CA: mets quickly, chemo or rads, no surgery

NONSMALL CELL
--Adenocarcinoma
--Squamous cell
--Large cell
CAN CURE THIS, SURGERY
possible lung ca and see pleural effusion, what do you do?
thoracentesis and look for malignant cells
Horner syndrome and lung CA, what is it and what see
invasion of cervical SYMPATHETIC chain by apical tumor (Pancoast).

Unilateral ptosis, miosis, anhidrosis
diaphragm and lung CA
can ge diaphragm paralysis d/t phrenic nerve involvement
hoarseness and lung CA
recurrenet laryngeal nerve involvement
8 consequences of lung CA
Horner's from Pancoast
Diaphragm paralysis
Hoarseness
SVC syndrome
Cushing syndrome
SIADH
Hyper Ca
Lambert-Eaton
SVC syndrome and lung CA
d/t compression of SVC (carries deoxy blood from upper body to R atrium), so get edema and rendess of face and neck, neuro sx.
small cell lung CA can make (for consequences)
ACTH --> Cushing's
ADH --> SIADH
squamous cell lung CA can make (for consequences)
PTHlike --> hypercalcemia
Lambert-Eaton syndrome vs MG and pathophys
Ab to NMJ so less Ach can go across NMH

So muscles get stronger with repetitive stimulation (because getting more across eventually)
algorithim for new nodule
CXR, go find previous
Get CT scan if >35YO or smokes
If CT not clear, PET.
F/u CT scans if normal looking.

If indeterminate of suspicious, do VATS biopsy for diagnosis.
if see nodule and patient no smoke and <35YO, probably is:
d/t infecions (TB or fungi)
maratoma
Collagen vasc disease
most common breast CA
invasvie ductal carcinoma
What is Li-Fraumeni Syndrome and its genetics
AD
d/t mutations of p53 tumor suppressing gene so get lots of CA early on
breast CA, and medicine with estrogen
don't give woman with h/o breast CA ESTROGEN!!!!
microcalcifications on mammography, think
more serious
tx DCIS
= intraductal carcinoma

Mastectomy or excision + rads
tx LCIS
can become infiltrating, mastectomy and tamoxifen
invasive cancer treatment
if no nodes, breast conservation or chemo of endocrine
when treat breast CA with trastuzumab
HER2-neu POSITIVE
women under 30, want to see in breast, do
U/S NOT MAMMOGRAM
tx ER+ and better PR+
aromatase inhibitors: letrozole, anastrole

AND
Tamoxifen
ER+/PR+ prognosis
breast can, this is a good factor!
prostate CA with mets to
bones
lungs
liver
who gets prostate CA
blacks the most, more if fam history of it
labs for BPH
elevated PSA
elevated acid phosphatase only if CA has broken through the capsule
tx DCIS
= intraductal carcinoma

Mastectomy or excision + rads
tx LCIS
can become infiltrating, mastectomy and tamoxifen
invasive cancer treatment
if no nodes, breast conservation or chemo of endocrine
when treat breast CA with trastuzumab
HER2-neu POSITIVE
women under 30, want to see in breast, do
U/S NOT MAMMOGRAM
tx ER+ and better PR+
aromatase inhibitors: letrozole, anastrole

AND
Tamoxifen
ER+/PR+ prognosis
breast can, this is a good factor!
prostate CA with mets to
bones
lungs
liver
who gets prostate CA
blacks the most, more if fam history of it
labs for BPH
elevated PSA
elevated acid phosphatase only if CA has broken through the capsule
bone lesions in prostate CA
vertebral metastases are OSTEOBLASTIC not osteolytic

b/c new bone growth stimulated by tumor
local prostate CA tx
surgery and ads
tx mets from prostate CA
orchiectomy
androgen depletion with leuprolide, flutamide, DES

RADS good

NO CHEMO (doesn't help_
if painful metastatic prostate CA< do:
flutamide then leuprolide
colon ca mets to
liver and lungs
how use CEA
preop and postop, can periodically check it after surgery too.

NOT SCREENING TOOL
tx colon ca
try everything: chemo, rads, surgery...
pancreatic cancer mets
to liver and lungs
pancreatic cancer is what kind, and physical signs
adenocarcinoma

wt loss, jaundice
migratory thrombophlebitis (troussea syndrome)
Courvoisier sign (paplpae GB)
who gets pancreatic cancer
men
blacks
diabetics
name 3 islet cell tumors
insulinoma (b cell tumor)
gastrinoma
glucagonoma (a cell tumor)
insulinoma, what and where, signs
beta cell tumor in pancreas
secretes insulin

So see Whipple's triad, hypoglyemica, CNS symptoms and glucose makes it better.
cure for insulinoma
resect it
gastrinoma what is it, prognosis
ZollingerEllison syndrome is gastrinoma BUT acid hypersecretion and peptic ulcers. Ulcers are hard to treat and in weird places.

MOST ARE MALIGNANT!!
glucagonoma, what is it and sx
high glucagon level-->hyperglycemia
migratory necrotizing skin erythema!!!!!!!!!!
ovarian CA presentation
weight loss
pelvic mass
ascites
maybe even bowel obstruction
ovarian enlargements, what do you think?
well, if young, benign.

If postmenopausal, CA until proven otherwise.
treatment ovarian CA
debulking and chemo
most common type of ovarian CA
serous cystadenocarcinoma, psammoma bodies
sertoli-leydig tumor, what is it
secretes androgens and vitilizes! sex cord tumor
granulosa/theca cell tumor what is it
secretes estrogens and so can cause precocious puberty in kids
what is meigs syndrome, and how tx
benign ovarian fibroma, ascites
RIGHT hydrothroax.

REsect!
what is krukenbert tumor
stomach CA with mets to ovaries
magament of CIN I
CIN I = LGSIL
most regress spontaneously
observe with Pap and colpo x 3 mo - 1 year
CIN II/III tx
cryosurg or LEEP
high parity, RF for female cancers?
protective if endometrial and breast CA

but increased risk for certical cancer
GB disease and the endometrium
turns out GB dz RF for endometrial CA! weird. maybe d/t obesity...?
what kind of tumors are uterine cancers and how spread
adenocarcinomas

spread by direct extension
location of brain tumors in kids and adults
dults are supratentorial
kids are infratentorial
most common intracranial tumors
glioma (astrocytoma)
meningiomas
presenation of cranciopharyngioma
remnant of Rathke pouch
HEAVILY CALCIRIFIED
visual distrubances, HA, vomiting like alwas
most common type of testicular CA
seminoma (germ cell tumor of testes)
tx testicular CA
surgery and rads (tumors often super radiosensitive)
haloperidol and PRL
haloperidol is a dopamine antagonist so get more PRL made if you are taking it
esophageal CA - kinds and location
middle third is squamous cell
lower third is adenocarc (b/c Barrett's there)
how manage Barrett's?
periodic upper endoscopy with biopsies
cold nodule on thyroid test ,think
malignancy!
increased calcitonin level, think
calcitonin made by thyroid parafollicular cells = anti PTH so lower Ca

indicates medullary thyroid CA
bladder CA classic signs and RF
painless hematuria

smoker, rubber/dyte worker
hepatic adenoma what is it and who gets it
benign tumor in women taking OCPs!
liver tumor - focal nodular hyperplasia, dx and tx
beningn tumor, leave it alone
CT?MIR
No tx
cholangiocarcinoma, what is it, who gets it
Cancer of the bile ducts
Patients are IBD(usually UC!), liver flukes
liver tumor - angiosarcoma, who gets
exposure to industrial vinyl chloride
hepatoblastoma what is it
primary liver malignancy in children, most common
name several adrenal tumors
functional that causes Conn's, Cushings
Pheno
Nonfunctional adenomas
what is an adrenal incidentaloma
if <3cm
RF stomach ca
Japanese
smoking
smoked meat
H. pylori
what is a virchow node
left supraclavicular node enlargement d/t visceral CA spread
where are carincoid tumors
(secrete serotonin)
small bowel
appendix
sx of carcinoid tumors
episodice flushing, cramps, diarrhea, Right heat valve damage
carcinoid tumor labs
increased 5HIAAA
is a carcinoid benign or malignant?
malignant IF having sx because that means the liver is involved
Kaposi sarcoma, from what and how to recognize
from HHV8
rash doesnt respond to multiple treatments
CA, worried about cord compression, how treat
high dose steroids, then get MRI, tx with rads
RF renal call cancer
smoking
vHL
Tuberous scloersis
ADPKD
tx RCC
chemo of nephrectomy
what is histioctosis
Cd1 macophages, too many. See Birbeck granules (tennis rackets)
most common CA in liver
METS!
oropharnygeal CA RF
HPV (oral sex)
Tob?etoh
oropharyngeal CA sx
leukoplaskia, an if quit smoking/EtOh will regress. If erythroplasia (with redness), worse.
what kind of CA is orophayngeal CA?
squamous cell
SCC, prelim lesion, mets, tx
preactinic keratosis
can mets
tx surgery or rads
BCC growth, mets, appearance
slow growing
NO METS
palisading cells, pearly, telangiectasis
Melanoma: precursos, mets, prognosis
precusor dysplastic nevi
METS!!!!
Clarks' levels determine prognosis
need to treat hyperthyroidism but pt with pregnant
use PTU NOT methimazole
pt in cave, how do you know whether he has rabies or histoplasmosis?
first, no bat scratch or bite necessary, can be aerosolized.

second, histo will have RESP SX.
risk of child having cancer
kind of like AR
asthma diagnosis
FEV1/FVC low, but gets better with bronchodilators

OR methacholine challenge
definition of hypoxemia
O2 <85%, PaO2 < 55
theoretical causes of hypoxemia
V/Q mismatch
Hypoventilation
Diffusion decrease
High altitude
Shunt
hypoxemia, ex of V/Q mistamtch, A-A and response to O2
asthma, COPE, PE
increased A-a gradient
responds to O2
hypoxemia, hypoventilation -- examples, and response to O2
from oversedation
responds to O2
hypoxemia, decreased diffusion -- ex, A-a gradient, DLCO and response to O2
interstitial lung disease
responds to O2
Increased A-a gradient
reduced DLCO
hypoxemicashunt - exmpls, O2, A-a gradient
ARDS, Labar PNA, PDA< PFO
NO RESPONSE TO O2!!!!!!!
Increased A-a gradient
tx of acute asthma exacerbations
Beta agonist
systemic steroid
inhaled steroid
prophylaxis for asthma
beta 2 agonist
cromolyn, leukotriene inhibitors
obstructive vs restrictive lung disease, what are they and examples
obstructive: airways low volume and hard to move the air in and out: COPD, CF, asthma

Restrictive: decreased lung compliance
=interstitial disease, obesity
obstructive vs restrictive lung dz lung curbes
obstructve is concave on top, restrictive is all pushed to the left
what is DLCO, and when elevated and decreased
measure diffusing capacity of CO at the capillary-alveolar interface

HIGH in asthma
LOW in COPD, fibrosis
obstructive vs restrictive lung dz on lung function tests
FEV1/FVC ratio <0.75 in obstructive

normal in restrictive
TLD in obstructive vs restrictive lung dz
TLC high in obstructive
TLC low in restrictve
COPD and Co2 levels
can live at a higher CO2 level, so if asx don't really have to tx
prepare to intubate IF
CO2>50
O2<50
pH<7.30
lung hamartoma, what is it
forms from connective tissue, if person under 40 with pulm nodule
What is ARDSand how define`
noncardiac pulm edema
respiratory distress
hypoxemia
PaO2/FiO2>200

NOT BETTER WITH O2
How tx ARDS
PEEP

O2 doesn't help
abx for aspiration PNA
try clinda
alcoholic with PNA, think
klebsiella (current jelly sputum) or aspiration
CF PNA, think
Pseudomonas of Staph aureus
COPD with PNA, think
H. influ or Moraxella
foreign body inhaled, where does it go?
RML
pleural effusion, what do?
thoracentsis, see if transudative or exudative
transudative pleural effusion
LDH<200
pleural/serum LDH<0.6
pleura/serum protein <0.5
pleural effusion, glucose nad portein significance
glucose low in infection, protein high in infection
On ventilators, how regulate CO2
RR
TV
On ventilators, how regular O2
FiO2 and PEEP
Heberden vs Bouchard nodes
Both in OA
Heberden - DIP
Bouchard - PIP
(both d/t osteophyte formation)
pannus, think
RA
when articular cartilage looks like granulation tissue d/t chronic inflammation
RA on Xray
joint space narrowing
no osteophytes
erosive bone changes
RA in spine
get atlantoaxial instability
gout is d/t
too much uric acid, either from
1) not excreting it (diuretics, CKD, ASA)
2) making too much (psoriasis, tumor lysis, idiopathic)
gouth on xray
tophi (uric acid deposits)
punched out smooth erosions on bone
gout: which sex, diet changes
in men
avoid alcohol
tx gout acutely
colchicine (antiinflamm)
NSAIDs
ASA and gout
can be a cause! Because decreased excretion of uric acid by kidney
maintenance of gout
high fluid intake
probenecid
allopurinol
Heberden vs Bouchard nodes
Both in OA
Heberden - DIP
Bouchard - PIP
(both d/t osteophyte formation)
pannus, think
RA
when articular cartilage looks like granulation tissue d/t chronic inflammation
RA on Xray
joint space narrowing
no osteophytes
erosive bone changes
RA in spine
get atlantoaxial instability
gout is d/t
too much uric acid, either from
1) not excreting it (diuretics, CKD, ASA)
2) making too much (psoriasis, tumor lysis, idiopathic)
gouth on xray
tophi (uric acid deposits)
punched out smooth erosions on bone
gout: which sex, diet changes
in men
avoid alcohol
tx gout acutely
colchicine (antiinflamm)
NSAIDs
ASA and gout
can be a cause! Because decreased excretion of uric acid by kidney
maintenance of gout
high fluid intake
probenecid
allopurinol
gout shape and reflection
Needle shaped crystals
NEGATIVE BIREFRINGENCE
how to allopurinol and probenicid work
allopruinol - blocks uric acid production
probenicid - increases uric acid excretion
pseudogout diagnosis
rhomboid CPPD crystals
positive birefringence
tx pseudogout
NSAIDs
colchicine
septic arthritis - cause?
staph
gonorrhoea
remember to do what in septic patients
blood cultures (b/c org probably got to the joing via hematogenous route)
psoriatic arthritis - where in body
hands and feet
RF negative
tx psoriatic arthritis
NSAiDS
methotrexate
etanercept
steroids
HLAB27 positive diseases
ankylosing spondylitis
reiter syndrome
can hemophilia cause arthritis?
yes! tx with tyelnol.
migratory arthritis, think of
Lym'es disease
rheumatic fever (one of Jones criteria)
SCD and arthritis?
yes, even avascular necrosis of humeral or femoral head
ankylosing spondyltitis presentation
20-40yo man
+ fam history
back pain and morning stiffness
may be bent over
+/- UVEITIS!
ankylosing spondyltitis on imaging
bamboo spine
tx ankylosing spondyltitis
exercise
NSAids RA meds
ankylosing spondyltisis in labs
HLA-B27
ESR up
anemia
reiter syndrome presentation and cause
can't see (conjunctivits)
can't pee (arethritis)
can't climb a tree (arthritis)
usually after chlamydia.
3 childhood arthritis
SCFE
LCP
DDH
SCFE what is it
fracture through the growth plat so femoral head slips.
SCFE presentation
waddle, foot is externally rotated (b/c sliipped fem head)
can get avascular necrosis.
LCP what is it
defmoity of femur head, also get avascular necrosis (like SCFE) but d/t reduced blood to joint.
charcot joint - who gets and what is it
in diabetics and neuropathies
lack of sensation --> overuse joints, become deformed and painful
Hemochromatosis and Wilson with arthritis
they both can be depositing their extra stuff in there
SLE - screen and confirm test
screen ANA
confirm w Anti-Smith
SLE on CBC
anemia
low platelets
everything can be low, actually
tx SLE
NSAIDs
hydroxychloroquine (antimalarial but red swelling)
corticosteroids
immunosuppressants
how tx raynaud
nifediipine
dilt
how tx scleroderma
steroids
cyclophosphamide
scleroderma screen and confirm tests
screen with ANA
confirm with anticentroemere or
antitopoisomerases
scleroderma presentation
CREST
calcinosis
raynaud
esophageal dysmotility (so GERD)
sclerodactyly
telangicetasis
sjogren on labs
anti SSA (anti Ro and La)
dermatomyositis presentation
polymyositis
+
skin involvement (helitopr rash around eyes and periorbiral edema)
can't get out of chair of stairclim because hits prox muscles
Gottron's sign (s cales over hands)
dermatomysotitis, muscle enzymes and EMG
CK elevated
EMG irregular
how diagnose dermatomysosis
muscle biopsy
dermatomyositis and CA
increased incidence of malignancy!!!!
pANCA positive in
UC
Churg-Strauss
PSC
PAN
Polyarteritis nodosoa associated with what infections
Hep B
cryoglobulinemia (HepC or MM)
presentatino of PAN
fever
abdominal pain
weight loss
renal changles
peripheral neuropathies
PAN pathophys
vasculitis of small and med arteries. Can cause aneurysms and the breaking down of RBC screws up kidneys
dx PAN
biopsy
Wegener vs Goodpasures in blood
Goodpasture - anti glomerular Ab (type III hypersens)

Wegener's: c-ANCA
goodpasture vs wegener presentation
goodpasutres has kidney and lung invovled

Wegener's has kidney, lung AND SINUS
tx wegener
cyclophosphamide
kawasaki affecting the heart?
well, can get aneurysms, which could thrombse and cause MI. So any kid with MI, consider kawasaki
tx kawasaki
IVIG
ASA
takayasu arteritis presentation
pulseless disease
women
tx takayasu (large vessel vasculitits)
steroids
cyclophosphamide
what is takayasu arteritis
large vessel vasculitis
get granulomatous inflammation
giant cell arteritis
PMR, who gets it and where
women > 50YO
pain no weakness in soulders and pelvis
PMR ESR and muscle bx
high ESR
muscle bx normal
Wegener vs Goodpasures in blood
Goodpasture - anti glomerular Ab (type III hypersens)

Wegener's: c-ANCA
Wegener vs Goodpasures in blood
Goodpasture - anti glomerular Ab (type III hypersens)

Wegener's: c-ANCA
Wegener vs Goodpasures in blood
Goodpasture - anti glomerular Ab (type III hypersens)

Wegener's: c-ANCA
Wegener vs Goodpasures in blood
Goodpasture - anti glomerular Ab (type III hypersens)

Wegener's: c-ANCA
goodpasture vs wegener presentation
goodpasutres has kidney and lung invovled

Wegener's has kidney, lung AND SINUS
goodpasture vs wegener presentation
goodpasutres has kidney and lung invovled

Wegener's has kidney, lung AND SINUS
goodpasture vs wegener presentation
goodpasutres has kidney and lung invovled

Wegener's has kidney, lung AND SINUS
goodpasture vs wegener presentation
goodpasutres has kidney and lung invovled

Wegener's has kidney, lung AND SINUS
tx wegener
cyclophosphamide
tx wegener
cyclophosphamide
tx wegener
cyclophosphamide
kawasaki affecting the heart?
well, can get aneurysms, which could thrombse and cause MI. So any kid with MI, consider kawasaki
tx wegener
cyclophosphamide
kawasaki affecting the heart?
well, can get aneurysms, which could thrombse and cause MI. So any kid with MI, consider kawasaki
kawasaki affecting the heart?
well, can get aneurysms, which could thrombse and cause MI. So any kid with MI, consider kawasaki
tx kawasaki
IVIG
ASA
kawasaki affecting the heart?
well, can get aneurysms, which could thrombse and cause MI. So any kid with MI, consider kawasaki
tx kawasaki
IVIG
ASA
tx kawasaki
IVIG
ASA
takayasu arteritis presentation
pulseless disease
women
tx kawasaki
IVIG
ASA
takayasu arteritis presentation
pulseless disease
women
takayasu arteritis presentation
pulseless disease
women
takayasu arteritis presentation
pulseless disease
women
tx takayasu (large vessel vasculitits)
steroids
cyclophosphamide
tx takayasu (large vessel vasculitits)
steroids
cyclophosphamide
tx takayasu (large vessel vasculitits)
steroids
cyclophosphamide
tx takayasu (large vessel vasculitits)
steroids
cyclophosphamide
what is takayasu arteritis
large vessel vasculitis
get granulomatous inflammation
giant cell arteritis
what is takayasu arteritis
large vessel vasculitis
get granulomatous inflammation
giant cell arteritis
what is takayasu arteritis
large vessel vasculitis
get granulomatous inflammation
giant cell arteritis
what is takayasu arteritis
large vessel vasculitis
get granulomatous inflammation
giant cell arteritis
PMR, who gets it and where
women > 50YO
pain no weakness in soulders and pelvis
PMR, who gets it and where
women > 50YO
pain no weakness in soulders and pelvis
PMR, who gets it and where
women > 50YO
pain no weakness in soulders and pelvis
PMR ESR and muscle bx
high ESR
muscle bx normal
PMR, who gets it and where
women > 50YO
pain no weakness in soulders and pelvis
PMR ESR and muscle bx
high ESR
muscle bx normal
PMR ESR and muscle bx
high ESR
muscle bx normal
PMR ESR and muscle bx
high ESR
muscle bx normal
PMR tx
steroids
PMR classic findings
shoulder and pelvix PAIN not wekaness
temporal arteritis
neuro signs b/c vasculitits goes for the aorta
Can see CHF
PMR dx
CT or MR angiogram
Behcet syndrome, what is it
man in 20s with painful oral and genital ulcers.
MAybe uveitis, arthiritis, erythema nodosum.

D/w SYSTEMIC VASCULITITS
Behcet how tx
steroids (young man with oral and genital ulcers)
Paget disease of bone, what is it and who gets
bone broken down and regenerated
>40yo, men

usually found asx on xray!
paget disease calss signs
pelvic and skull involvement
buying bigger hats
arthritis
nerve deafness (skull)
paget disease of bone on labs
AP up
Normal Ca and Phos (evens out)
Paget'sdisease of bone and CA risk
increased risk of osteosarcoma
tx Paget's disease
NSAIDs
bisphosphonate (prevent loss of bone mass, etiodronate) of calcitonin (reduces Ca)
what is a macule vs papule
macule MAT FLAT
papuled POPPED up
what dz have cafe au lait spots?
(macule)
vHL
NF
McCune Albright
Tuberous sclerosis
pathopshy in vitiligo
the melanocytes don't function
where are junctional nevi and what are you worried about
b/w dermis and epidermis
high risk of malignant melanoma
Lichen planus characteristics
5Ps
pruritic
planar
purple
polygonal
papules
plaque vs patch
plaque is elevated, >0.5cm
patch is flat, >1cm
what is bowen's disease
squamous cell CA in situ
what is nevus flammeus
port wine stair (Gorbachev!)
and
part of Sturge Weber syndrome
what all dz show erythema nodosum
sarcoid
cocci
UC
basic problem in pemphigus vulgaris vs bullous pephigoid
pempihigus vulgaris = loss of keratinocyte adhesion
bullous pemphigoid = breakdown between epidermis and dermis
vitiligo associated with
other AI conditions (b/c it's aI)
roseacea dz presentation
see eryhtmea but not comedones
can get worse with certain foods
rhinophyma late in disease
tx roseacea
oral antibiotics actually! or topical metronidazole.
why polycythemia vera with itching after hot shower
abnl histamine release
contact dermatitis, what kind of reaction? and dx
Type Iv hypersensitivity reaction
May need to do patch teesting
how to diagnose any tinea infection
scrape lesion and do KOH preparation
(caused by Trichophyton)
tina corporis, how to recognize it and tx
red ring shaped lesions with raised borners.

Tx: topical or orals antifungals
tinea pedias how to recognzie and tx
athelet's foot!
scaling web spaces between the toes that itch and bad thick nails

Tx: foot hygiene, topical or oral antifungals
tinea unguium how to recognize and tx
onychomycosis, thickened distorted nails. Tx: orals (terbinafine, fluconazole)
tinea capitis how recognize
scalp.

CONTAGIOUS IN CHILDREN.

Sclay patches of hair loss, maybe even an inflamed gross boggy granuloma of scalp = kerion!!

If do Wood's lamp and fluoresces,s it's microsporum. If doesn't, trichophyton.
tx tinea capitis
terbinafine, fluconazole
tinea cruris, how recognize
jock itch
more in obese males

tx topical or oral agents
candidiasis in mouth and danger signs
patches that CAN be scraped off.

BAD if not child and no vaginal. If a man this is weird.
tinea versicolor what is it how recognize
fungal infection by pityrosporum infection

young adults with multiple patches of tdifferent color
diagnose tinea versicolor and tx
lesion scrapings + KOH
oral or topical imidazoles or selenium shampoo even
scabies caused by and where see
sarcoptes scabei
burrows, flexor surface of wrists
lindane, expired tx for what and the problem
for scabies
BUT CAUSES NEUROTOXICITIY
molluscum contagiosum in microscope and how tx
inclusion bodies
tx with freezing or curettage
treatment lineup for acne
topical benzoyl peroxide
topical clinda/oral tetracycline, oral erythrmycin

topical tretinoin
ORAL isothreinoin
drugs that can cause hirsuitism
minoxidil (rogaine)
phenytoin
psoriasis dx and tx
dx: sight or biopsy if needed

tx: UV light, lubricants, topical steroids, ab therapy if refractory
pityriasis rosea, who gets and what see
ADULTS
herald patch (salmon patch on trunk) then more lesions a week later that itch.
Langerhans skin cleavage lines in Christmas tree pattern
pityriasis rosea prognosis and tx
remits spontaneously in 1-3 months
tx with reassurance.
tx lichen planus
5 Ps
self limiting, just sx treatment (anti-itch)
what drugs commonly cause rashes
PCN
Cephalosporins
Sulfa
what drugs commonly cause photosensitivity
chlorpromazine
compazine
tetracycline
erythema multiforme, what see and cause
target lesions
causes usually by drugs or infections
(can see on palm)
pemphigus vulgaris, the problem
blistering d/t autoab against epidermis (against desmogleins)
bullous pephigoid, ab to what
autoab against BM of epidermis so ballae are subepidermal so less fragile than pemphigus
erythema nodosium how recognize
t's tender red nodules especially over shins
pemphigus vulgaris tx
steroids
rituximab
pemphisu vs bullous pemphighoid what see under microscope?
pemphigus is lacelike or fishney immunofluorescene patern

bullous pemphigoid linear immunofluorescence pattern
dermatitis herpetiformis, why itch and where
IgA deposits everywhere, itchy papules and whales esp on elbows and knees
what is dysplastic nevus syndrome?
genetic condition with multiple dysplastic appear nevi
keratoacanthoma what is it and tx
flesh colored lesion with central crater ith crap in it. usually on face. Looks like CA but grows in 1-2 smonths! OBSERVE and will go away.
how manage a keloid
well don't excise it, will make it worse!
skin cancer and the bottom line on mets
basal cell ca - no mets
SCC - rare mets
melanoma - METS
BCC - how recognize and tx?
shiny papules that enlarges, goes umbilicated and telangiectasias

Tx: excision
squamous cell cancer, precondition
actinic keratosis
kinds of melanoma and prognosis
superficial spreading melanoma (best)
nodular melanoma (worst)

acrolentiginous = see black dots
cause of necrotizing fasciitis
group A strep
causes of stomatitis (inflammation in mouth)
Def of B vitamins
B2, B3, B6 vitamins
the different B vitamins
Riboflavin - B2
Niacin - B3
Pyridoxine B6
Santer's syndrome
asthma + nasal polyps + ASA intolerance

(so don't give ASA to pts with this!)
4 types of hypersensitivity reactions and the working immunosystem part
Type I: anaphylactic --IgE
Type II: cytotoxic -- IgG and IgM
Type III: Immune Complex medicated
Type IV: cell mediated (delayed) --T cell
Type I hypersens reaction, cause, examples
preformed IgE, release histmaine and leukotrienes

ANAPHYLAXIS
ATOPY
HAY FEVER
HIVES
ALLERGIC RHINITIS
C1 esterase inhibitor deficiency, genetics and what is it
AD
hereditary angioedema
all unrelated to allergens
C1 esterase inhibitor deficiency, diagnosis and tx
AD
Low C4 (because all consumed)
Acute Tx: like anaphylaxis
Chronic Tx: androgens *increase liver production of it)
Chronic Type I hypersensitivity, findings
elevated IgE
eosinophilia
seasonal exacerbations
Type II Hypersens Reaction, d/t and ex
preformed IgG and IgM, react with antigens

AIHA
Transfusions reactions
Rh incompatibitility
GPS
MG
Graves
pemphigus
hyperacute transplant rejection
Type III hypersens reactions d/t to and ex
d/t Ag-Ab complexes that usually depositied in vessels.

Serum sickness
lupus
chronic hepatitis
cryoglobulinemia
glomerulocephritis
what is serum sickness
reaction ot proteins in antiserum from animals
Type IV Hypersens reactions d/t and ex
d/t sensitized T cells that release inflamm mediators.

--PPD
--Contact dermatitis
--Granulomatous diseases (liek sarcoid)
HIV test and confirmation
ELISA
confirm with WESTERN BLOT TEST (PCR)
What is Immune Reconstituion Inflammatory Syndrome and tx
In HIV
Sometimes paradoxical worsening of infections, starts after beginning HAART.

Just reassure, keep on the meds!
CD4 count and when to start propht
CD4<350, start retrovirals
Cd4<200 start PCP prophy
CD4<100, MAC prophy
PCP prophy
bactrim, pentamidine
If CD4 <200
MAC prophy
If Cd4<100
Azithro, Clindamycin
What happens to the viral load once start HAART?
decreases to < 50 copies
HIV and sig of thrombocytopenia
Tx with zidovudine
side effect of pentamidine and what is it form
2nd line agent for PCp prophy
can screw up all electrolytes and glucose
Once diagnosed with HIV, how often to check Cd4 count?
Q3-4 mo.
what live vaccine can you give if have HIV?
MMR
below what CD4 count do you have AIDS?
below 200 (so start PCP prophy too)
2 classic malignancies in AIDS?
Kaposi
nonHodgkin lymphoma (CNS B-cell in particular)
Inida ink think
cryptococcus
tx CMV retinitis
ganciclovir
2 AIDS causes of diarrhea
cryptosporidium
isopsora (both protozoa)
HIV and breastfeeding and birth
NO NO NO NO NO NO b/c can transmit through breastmilk

C-SECTION
To prevent HIV transmission vertifically
zidoviudine in last trimester
infant same for 6 weeks after
HIV transmitted to the infant?
Well, will be positive HIV Ab test for 6-12 months because of maternal antibodies.

Can check DNA or RNA PCR test to detect it directly
HIV and hypersensitivity
lose type IV (skin anergy)
PCP diagnosie
silver stains (wright Giemsa, giemsa, silver) with sputum

if no, bronchoscopy with lavage
MI, now when can pt have sex?
MI? no sex x 2 weeks.
MI with intervention? not x 6 wks.
tx chronic constipation
psyllium (fiber) and hudration
reasons NOT to give bisacodyl
bowel stimulant, not if CRF not if HTN
how to recognize if pt presenting with PBC
woman with pruritis and AP
RF for Malleory Weiss
hiatal hernia
side effects of B12 supplements
low K+
what is syndeham's chorea and how treat
this is pt with rheumatic fever
(rdancing and laughing and moving)

TX WITH PCN!!
you can get ATN from
shock
hypotension
drugs
etiology of gastric vs esophageal varices
gastric varices can be from pslenic vein thrombosis (recurrent pancreatitis)

esophag+gastric from portal vein thrombosis
what is budd chiarir
thrombosis of the hepatic veins (RUQ pain, jaundice)
When do only U/S breast in women's ages...
<30yo
cause of diverticular bleeding
erosion of an artery
HPV and effect on delivery
delivery as per normal (Herpes is a different story)
septic pulm embolism, when consider on CXR
if round bullet holes in CXR
presentation of lithitum toxicity and how to induce it
EVERYTHING from renal to skin to neuro changes

induced by thiazides!
side effect of gingko biloba
associated with bleeding and plt dysfunction
If thinking someone has NF1, what is first move
to ophtho referral b/c can get gliomas of the optic nerve
if colon polyp out, what do depending on size
If >2cm, repeat colonoscopy in 3 months

If <2cm, nothing
if adenomatous polyp on colonoscopy, how follow up
3 years colonoscopy
Treatment of HepB vs HepC
HepB supportive
HepC IFN and ribavarin
tx cluster HA
verapamil
O2
difference between creutzfelfjakob, vascular and lowy body dementia
creutzfeldJakob - myoclonus nad ataxia
Vascular dementia - stepwise loss
Lewy Body - parkinson like, visual hallucinations
delirium in alcoholics, think
wernicke encephalopathy (ataxia, opthlamoplegia, nystagmus, confusion )

can progress to korsakoff
how to prevent Wernicke encephalopathy
thiamine BEFORE giving glucose to an alcoholic
tx cluster HA
oxygen
verapamil
why get papilledema
optic disc swelling from ICUP increase
pseudotumor cerebri dx and why tricky dx
dx elevated opening pressure
MRI negative

still get papilledema, intracranial HTN, daily HA, vomiting
tx pseudotumor cerebri
not much, weight loss, repeat LPs
possible causes of pseudotumor cerebri
Large Vit A
large tetracyclines
steroid withdrawal
dx SAH
nONCONTRAST ct
WORST ha OF LIFE
Kallman syndrome
only time CNi really inovlved
anosmia + hypogonadism
becuase no GnRH from hypothalamus s
CN V job
mastication muscles
facial sensation
CN V pathology
trigeminal neuralgia/tic douloureux
CN 7 job
facial expression muscles
traste in ant 2/3 tongue (vs 9)
stapedius muscle
how can you tell different in UMN vs LMN facial lesion?
UMN forehead not involved on affected side (b/c dual UMN innervation)

LMN (bell's palsy), forehead affected
CN IV job
gag reflex
taste in posterio 1/3rd tongue
CN 10 job and loss
muscles of palate
gag refelx
taste buds

see hoarseness, dysphagia, loss of gag or cough

Can be affected by Pancoast tumor!
CN11 and 12 job
11 = spinal accessory (SCM and trapeqius)
if bad, turn toward lesion and same side shoulder droop

12 = hypoglossal, lick wounds
def of simple vs complex sz
simple = no lose consciousness
complex partial = impaired consciousness
absece sz tx and dx
ethosuximide
valproate

cx: 3hz spike and wave
infantile spasms, the problem and how diagnose
in kids, get developmental regression
hysparrhythymia
what age gets febrile sz
6mo - 5yrs (tx with tylenol)
tx cysticercosis and what is it
infx with taenia solium
CT with calcified and ring enhancing lesions

Tx: niclosamide or praziquantel
tx status epilepticus
valium = diazepam
atvia = lorazepam
dangers of anticonvulsants
TERATOGENIC! So before starting a young woman on them, make sure not pregnant
examples of ischemic vs hemorrhagic stroek
ischemic = thrombosis
emobolism

Hemorrhagic
ICH (HTN ruptures vessel)
SAH
what you see in ACA stroke
leg paresis
what you see in PCA stroke
prosopagnosia (no recognize faces)
macular sparing
what you see in basilar stroke
"locked in" syndrome
what you see in lacunar stroke
pure motor o pure sensory deficit
BP in strokes, how manage
can allow increased BP after ischemic stroke
causes of CVA
ischemia d/t atheroscloerosis
afib
spetic emboli from endocarditits
suspect stroke, what imagine?
noncontrast CT scan (but remember can be neg for first 24-36hrs)
sx of acute storke, CT negative, what do?
within 3 hours? ASA and clopidorgrel
how manage TIA
carotid duplex U/S
MRA to look for carotid stenosis
when recommend elective carotid endarterectomy
carotid stenosis >70%
how LMN lesions present
decreased reflexes or no reflexes
fascultations
examples of LMN lesions
GB
Bell's palsy
:yme's
Herpes
signs of UMN leion
hyperreflexia
ex of UMN lesion
storke
TIA
tumor
MS head trauma
signs of brainstem leion
CN changes
1/2 face sensory loss
1/2 body sensory loss
signs of dominal frontal lobe lesion
broac aphasia (vs wernicke is tumorpal lobe)
what is broca vs Wernicke aphasia
Broca = motor = fontal (can't speak well but understands)

Wernicket = sensory aphasia = temporal = fluent speech but can't understand
signs of temporal lobe lesion
memory impairment, agression
signs of dominal parietal lobs vs nondominant parietal lobe lesion
Dominant parietal lobe: can't RRR (read, write, rithmetic)

Nondominal parietal lobe: can't dress, can't copy drawakings, ignores one side of body)
signs of lesion in occipital lobes
visual hallucinations or illusions
where do the CN come out of in brain?
CN 3,4 = midbraine
CN 5,6,7,8 = pons
CN 9. 10. 11. 12 = medulla
signs of cerebellum lesion
ataxia, nystagmus, tremor
signs of basal ganglia lesion
chorea
tremor
signs of subthalamic nuclei lesion
hemiballisumum (flingin of extremitites)
signs of lateral vs medial medulla lesion?
medulla ' CN 9-12
lateral - ipsilat Hornes
Medial medulla - lick wounds
benign tremor genetics, age affects it, tx
not resting, only with intention
Increases with age
tx: beta blocker
AD!!!!!!!!!!!!
causes of a resting tremor include
Parkinson
hyperthyroid, anxiety
drug withdrawal/intoxication
hadol and parkinson
haldol blocks dopamine, so side effect is parkinsonim like sx

tx anticholinergics, antihistamines
parkinson disease cause, presentation
from deaht of dpamine cells in substantia nigra so dopamin doesn't get to basal ganglia.

slow, rigid muscles, resting tremor, shuffles/postural instability
tx parkinsons
increase dopamine!
levodopa+carbidopa
bromocriptine
anticholinergics
antihistamines
huntington disease genetics, what is it
AD, huntington gene. From atrophy of caudate nuceli
huntington dz how present
in 35yos!
choreiform movement
progressive dumbing
dementia
psych issues
tx huntington's
:( maybe antipsychotics only. sad movement disorder.
what is friedreich ataxia
AR, degeneration of nerve tissue in the spinal cord
ALS what is it
degeneration of both UMN and LMN
ALS presentation
both UMN and LMN lesion
tx supportive maybe riluzole (die)
babinski is sign of
upgoing toe, sign of UMN lesion
don't do LP in patient WITH
acute head trauma
signs of intracrnial HTN

UNTIL have Ct
meningitis in AIDS paitients from
TB
funal
cryptococcal
normal CSP, how much glucose, protein, opening pressure
50-100 glucose
20-40 protein
100-200 pressure
bacterial meningitis, cells found, bluose, progein, pressure
>1000 PMNs
low glucose
protein high
pressure high
viral meningitis, cells, lucose, progein, pressure
>100 cells lymphocytes
normal glucose
normal protein
normal pressure
psuedotumor cerebri cells, glucose, protein, pressure
all normal except high pressure
GBS cells, glucose, protein, pressure
PROTEIN HIGH, remember!
cerebral hemorrhage cells, glucose potein, pressure
cells are RBC and bloody, pressure high
MS who gets it
women 20-40YO
northern latitudes
MS d/t
inflammation and demyelination of CNS melin
presentation of MS
Lhermitte's
optic neuritis
Marcus Gunn
anything tempoary
dx MS
MRI - demyelinating plaques

LP - increased IgG/oligoclonal bands and protein
tx MS
steroids
IFN-beta
glatiramer
GBS dz progression
history of mild infection of vaccination 1 week before, sometimes from campylobacter

then symmetric, distal lower extrem weakness or paralysis and NO REFLEXES THERE
GBS watch out for
ascending paralysis and respiratory paralysis, do IS to make sure
dx GBS
LP - increased protein
EMG _ nerve conduction velocity slowed
cause of GBS
immune response to an infection (campylobacter), and body gets confused and attacks body's own nerve tissue instead
tx GBS
plasmapheresis IvIG
NO STEROIDS AS MAKES IT ALL WORSE
albuminocyologic dissociation, think
GBS because high protein in CSF with normal WBC
EMG and LMN lesions
associated with fasciculations/fibrillations

(vs normal which is little electrical activity at rest)
do you lose consciousness with stroke?
not usually, unless stroke in vertebrobasilar system affecting brainstem (like subclavian steal)
what is subclavian steal?
occlusion of the subclavian artery so get retrograde vertebral artery flow
nutritional deficiencies that can cause peripheral neuropathies
low B12, B6 (after INH)
thiamine
vitamin E
lead poisoning and extremities
can see wrist drop (radial nerve) or foot drop (peroneal nerve)
extremity issues in alcoholics
pressure paralysis = radial nerve palsy
Tinel vs Phalen sign
Tinel is tap on nerve and get pins and needles
Phalen is flexing the wrists together
EMG, when are nerve conduction velocities slowed?
peripheral neuropathies
demyelinating diseases
MG vs Lambert Eaton clinically
with MG, gets worse with reition (against AcH receptors)
with L-E, gets better (because eventually all coming out)
pesticide poisoning with what sx and how treat
cholinergic (parasymp)
tx: ATROPINE, PRALIDOXIME
aminoglycosides and anesthesia, how relatied
so gent and amikacin, can cause myasthenic like muscular weakness and prolong effects of muscular blockade in anesthesia
Sturge Weber, what is it?
angiomas in brain (AV malformations)
+
PORT WINE STAINE!!!
Can get seizures and glaucoma too
atropine is an
ANTICHOLINERGIC, so use if too much cholinergics
Tx MG
anticholinesterase = LONG TERM
(pyridostigmine, neostigmine)
steroids
plasmapheresis
IvIG
Thymectomy
which AI dz has the thymoma
MG (see on CT)
what is MG
autoantibodies that attack AcH receptors (postsynaptic)
MG presentation
ptosis
diplopia
muscle fatigability at end of day
dx MG
blood test - Ach antibodies
Nerve conduction velocity and EMG
Tnsilon test (edrophonium = anticholinesterase)
examples of anticholinesterases
edrophonium
neostigmine
pyridostigmine
physostigmine
diff between MG and L-E clinically
MG - fatigue increases with stimulation
L-E fatigue decreases with stimulation

AND L-E has no eye inovelemement
tx lambert-eaton
guanidine (more AcH)
pyridosytigmine
IvIG
L-E associated with what other diseases
small cell lung CA
genetics achondroplasia
AD
genetics Marfan
AD
Marfan syndrome associated medical issues
all
arachnodactylyl
mitral valve prolapse
aortic dissection
lens dislocation
Familial HL genetics
AD
APCKD genetics
AD
hereditary spherocytosis genetics
AD
APKD predisposed to what medical problems
diverticulosis
cerebral aneurysms
aortic aneurysm
MVP
hernias
myotonic dystrophy, genetics and clinical presentation
AD
muscle weakness AND CAN'T RELEASE GRIP
ex of sphingolipidoses and genetics
AR
Tay-Sachs, Gaucher
Fabry disease, what is it and genetics
the one sphingolipidoses that is Xlinked
Examples of mucopolysaccharidoses and genetics
Hutler disease
AR

(but Hunter is X linked)
glycogen storage diseases ex and genetics
Pompe disease
mcArdle disease
AR
cystic fibrosis genetics
AR
galactosemia genetics and presentation
AR
congenital cataracts
neonatal sepsis
amino acid disorders examples and genetics
PKU
AR
Wilson disease genetics, hemochromatosis too
AR
Fragiele X genetics and clinical presentation
Xlinked recessive
mental retardation, large testes
burton agammaglobulinemia genetics and what is it
Xlinked recessive
no make mature B-cells (no no antibodies)
Wiscott-Aldrich syndrome genetics and what is it
eczema, low platelets, immunodef, bloody diarrhea, low IgM

Xlinked
Duchenne Muscular dystrophy cause, presentation, genetics
from mutation in dystrophin gene on X chromosome

X linked

Calf hypertrophy b/c proximal weakness
Lesch-Nyhan syndrome, cause, presentaiton, genetics
cause is buildup of uric acid (HPRT deficiencty)
MR and self mutilation
X linked recessive
G6Pd deficiency genetics
X Linked!!!
hemophilia genetics
x linked
edward vs patau syndrome genetically
edward is trisomy 18 (e=elect)
patau is trisomy 13 (p = puberty)
edward syndrome genetics and how recognize
trisomy 18
MR, small head, clenched fist with index fingers overlapping 3 and 4th fingers
patau syndrome genetics and how recognize
trisomy 13
MR, deafeness, holoprosencephaly (!), cleft lip/palate, rocker-bottom feet!
turner syndrome genetics
XO females
turner syndrome sequelae
female XO
aorta coarctation
horeshoe kidney
hypothyroidism
cystic hygroma of neck
turner syndrome how recognize
Xo
lymphedema of neck
short stature
webbed neck
wide nipples
no breast development (POF, infertile)
cri du chat genetics
deletion on chromo 5
klinefelter genetics and how recognize
XXY (nondisjunction), male

tall, microtestes, gynecomastia, sterility, low IQ
side effects of halogen anesthetics
malignant hyperthermia
side effect of halothane
liver necrosis
what is methoxyflurane and side effect
anesthetic
DI
morphine side effect in GI
stops it
also spincter of oddi spasm so retain bile and pancreatic juices which is painful
opiates side effect
SIADH!!!!!!!!!!!!
succ side effect
malignant hyperthermia
chloramphenicol side effects
aplastic anemia
gray baby
dideoxyinosine what is it and side effect
DDI for HIV
pancreatitis
side effect of ethambutol
optic neuritis
INH side effects x3
B6 def
lupus
liver toxicity
quinolones in fetus
cipro is a teratogen, cartilage damage
thtetracyclines on fetus
photosensitivity
teeth staining
rifampin side effect
orange body fluids
what abx cause c diff
fluoroquinolones
clinda
broad PCN
broad CEPH
acetazolamide side effect
metabolic acidosis
amiodarone side effect
HYPOTHYROID
pulm fibrosis
ACE on fetus
ccan affect fetal kidneys
demeclocycline what is it and side effect
tetracycline
DI
hydralazine side effects
luus
metyldopa side effects
hemolytic anemia
depression
phenytoin side effects x 3
folate def
teratogen
hirsuit
quinine side effect
cinchonism (tinnitus, vertigo)
pentamidine side effect
screws up electrolytes
valproic acid on fetus
NTD
belomycin side effect
pulm fibrosis
cisplatin side effect
nephrotoxicity
cyclophosphamide side effect
hemorrhaic cystitis
doxorubicin side effect
cardiomyopathy
clozapine side effect
for shcizo
agranulocytosis
lithium side effectx x 3
DI
thyroid
Ebstein's heart
Trazodone side effectp
priapism
cyclsporine side effect
renal toxicity
what is minoxidil
rogaine
oxytocin side effect
SIADH (bc sim structure)
gingko biloba side effect
bleeding and platelet dysfunction
beta blockers in diabetics, careful because
can mask the sx of hypoglycemia
ex of alpha 1 antagonists and side effects
doxazosin
terazosin

can cause orthostatic hypotension
diuretics that cause metabolic alkalosis and acidosis
thiazides = alkalosis (low K)
Loop diuretics = alkalosis

Carbonic anhydrase (acetazolaminde) = metabolic acidosis
thiazdes where work and what do
distal tubule
inhibits Na and Cl uptake
thiazides on electrolytes
high glucose
HL
LOW SODIUM
LOS POTASSIUM
HIGH CALCIUM
thiazides and allergies...
they are sulfa drugs!!!
loop diuetics on electrolytes
also sulfa drugs
low sodium, low potassium
BUT
LOW CALCIUM (vs thiazides)
loop diuretics where act and what mech
on loop of henle
inhibits NaKCl
thiazides vs loop diruetics on Ca
thiazides retain calcium, so don't use if hight!

loop diuretics cause ca excretion, can use as tx for high Ca!
drugs that cause constricted pupils
COPS
clonidine
opiates
pontine bleed
sedatives (EtOH, Barb, Benzo)
drugs that cause dilated pupils
amphetamines
anticholinergics
cocaine
cyanide intox, how recognize and tx
bitter breathe
methylene blue
ethylene glycol intox tx
etoh
fomepizole
salicylates intox tx
sodium bicarb
warfarin intox tx
Vit K
FFP
opioid overdose tx
naloxone
lead overdose tx
edetate
iron overdose tx
deferoxamine
dignoxin overdose tx
fix electrolytes
digoxin ab
dooper or gold overdose
penicillamine
beta blocker overdose tx
glucoagon
benzos overdose tx
flumazenil
Tylenol overdose tx
NAC
MAOI + Tyramine =
hypertensive crisis
MAOI + opioids =
coma
MAOI + SSRI =
serotonin syndrome
Aminoglycosides + loop diuretics =
ototoxicity
thiazides + Lithium =
lithium toxicity
2 drugs that inhibit hepatic work
cimetidine
ketoconazole
HRT on chol
can increase TG
reason to give progesterone with E
to eliminate increased risk of endometrial CA
estrogen and chol
incerases HDL hol!!
Estrogen effects (side effects)
endometrial bleeding
breast tenderness
nausea
HA
estrogen and pt with liver disease
estrogen can cause liver adenomas so don't use estrogen if pt has active liver disease
OCPs and HTN
OCPs are the most common cause of secondary HTN in women (stop them if women is HTNive)
Don't use OCps IF
smoking + >35YO
Breastfeeing
liver dz
HL
unctonrollen HTN
h/o clot
SCD
stroke
CA
how recognize alopecia areata
well demarcated round patches of hair loss
side effects of OCPs
glucose intolerance
weight gain
cholelithiasis
liver adenomas
melasma
HTN
what meds interact with OCPs
rifampin and antiepileptics may reduce effectiveness of OCPs
OCPs and ovarian vs endometrial ca
reduce ovarian cancer
decrease endometrial cancer
OCPs and presurgery
stop 1 month before and restart 1 month after
ASA vs NSAID affects on COX
ASA inhibits COX irreversibly
NSAIDS inhiit COX reversibly
ASA can cause these bad things
GI upset and bleeding, uclers
GOUT!
eventually tinnutis, respiratory alkalosis and metabolic acidosis
NASA and NSAIDs bad effects on kidneys
can cause renal insufficiency, whether it be AIN, papillary necrosis, ATN)
ASA in kids?
NO! remember the reye's syndrome if < 15YO = encephaopathy nad liver dysunfction
ASA cannot be given to pts with
allergies
asthma and nasal polyps (could be sander's syndrome)
preop rules for ASA and NSAIDs
ASA stop 1 week before
NSAIDS stop 1 day before
imaging for aortic aneurysm
CT with contrast
aortic tear imaging
CT w contrast
appendicitis imaging
CT with contrast
diverticulitis imaging
CT with contrast
stroke imaging
CT withou contrast
brain tumor imaging
CT or MRI with contrast
head trauma imaging
CT without cntrast
intracranial hemorrhage imaging
CT without contrast
MS imaging
MRI with contrast
PE imaging
CT with contrast (VP scan if can't give contrast)
pulm nodule imaging
CXR followed by CT with contrast
def and etiology isostheniuira/hypostenuria
inability to concentrate urine
DI, SCD
in lupus, what blood test corresponds with lupus activity
anti ds DNA

anti smith is for diagnosis, but doesn't correlated with lupus activity
Hegar sign, Chadwick sign =
PREGNANCY
Hegar is softening of lower uterine segment
Chadwick is darkening of vulva and vagina
3 antibiotics to NOT use in pregnancy
NO CIPRO
NO BACTRIM
NO GENTAMICIN
When first feel quickening?
18-20 weeks
why do pregnant women get cystitis/pyelo?
because progesterone decreases tone of ureters and uterus compresses the ureters
lab tests in third trimester
glucose
UA
rubella vaccine and pregnancy?
DON'T GIVE!
when do DM screen in pregnancy?
24-26 weeks
Tx BV in pregnancy?
is associated with preterm labor, so tx ONLY IF high risk for preterm OR if has sxx
When do a quad screen
15-20 weeks
when do GBS screen
35-37 weeks
Downs syndrome on quad screen
AFP DOWN (like Down syndrome)
Estriol DOWN
hCg UP
Inhibin UP
low AFP means
DOWN'S (because down)
Bad dates
fetal death....
high AFP thinks
NTD (because leaking out)
ventral wall defects
when can start measuring uterine size
20 weeks at umbilicus
FHT when?
@ 10 weeks
What if measurements and LMP have a size discrepancy?
do a U/S.
Could just be inaccurate dates
OR maybe IUGR
Or maybe multiple gestation
hCg levels during pregnancy
double Q2 days at the start.
if hcg stays same or increasing to slow think
fetal problems
ectoppic
if hcg is rapidly increasing or doesn't come back down after delivery
hydatiform mole
choriocarcinoma
how many lbs gain during pregnancy
25lbs
ESR and HgB during pregnancy
ESR high (so don't use)
Hgb is low because plasma voume increases sooo much
relationship b/w GFR and BUN/Cr
CFR down if BUN and Cr up
urine findings in pregnancy
can have mild protein and mild glucose
electrolyes and LFTs during pregnancy
NORMAL
NORMAL
NORMAL
AP during pregnancy
up
BUN/Cr during pregnancy
DECRASE because GFR increases.
So if normal high numbers, this is renal disease.
BP, HR< SV in pregnancy
BP down
HT up
SV up
TV, esidual vol, CO2 in pregnancy
TV up
Reduced residual (obviously)
CO2 down
what is a threatened abortion
bleeding but no dilation, no tissue out
50% have normal pregnancy
what is inevitable vs incomplete abortion
inevitable: dilated, and bleeding, no tissue.

Incomplete: some tissue through. :(
cause of painless, recurrent abotions in 2nd trimester
cervical incompetence
tx cervical incompetence
14-16weeks
signs and dx of ectopic pregnancy
bleeding, abdominal pain
positive hcG
maybe feel an adnexal mass...

U/S
abortion and rhogam
THIS COUNTS AS A SENSITIZATION! Give Rhogam so doesn't sensitize!
transvag U/S can see pregnancy when
5 weeks (MUST SEE THE SAC)

or

HcG >2000
Classification of IUGR etiologies
Maternal (smoking, lupus)
Fetal (torch, infx, congen)
placental (HTN, PREEX!!!)
parts of BPP (biophysical profile)
NonStress Test (x20min)
AFI
Fetal breathing
Fetal body movments
how manage a subchorionic hematom and WHY
follow with U/S
increased risk of spont abortion
interpret BPP
If<6, then do a contraction stress test (uteroplacental dysfunction test... give oxytocin and heart strip monitored... if late, do C-section)
def of olig and causes
<500
IUGR
PROM
postmature
renal agenesis
what can oligohydramnios itself cause?
pulmonary hypoplasia!
abnormalities b/c compression of hypoxia
def of polyhydramnios and causes
>2000mL
DM, multip gestation, NTD, GI issues
what can polyhydramnios itself cause?
uterin atony with hemorhage!
cuase of early decels
head compression (normal)
cause of variable decels
cord compression (Co2 can't get out, O2 can't get in)
manage variable decels
lat decubitus, O2
TOP OXYTOCIN
bradycardia severe

And if no imprvement: fetal scalp
late decels cuase
uteroplacental insufficiency
manage late decels
lat decub
O2
NO OXYTOCIN
TOCOLYIC
fetal scalp electrode as needed
example of tocolytics
beta 2 agonist = ritodrine, mag sulfate
no variability in heart rate, what do
fetal scalp pH... need to deliver!
causes of nonreactive NST
fetal problem
fetus asleep
GA<30weeks, too early
narcotics
normal NST
accel to 156 and lasts at least 15 secods, twice in 20 minutes
how interpret fetal scalp pH
<7.2 = DELIVERY!!!

because the pH assess for degree of fetal hypoxia.
how you know if its just braxton Hicks contractions
contractions are IRREGULAR
and
NO cervical change
difference b/w protraction and arrest disorder
protaction if taking too long but is changing.

arrest if no dilating in 2 hours and no descent in 1 hour
if you have protaction or arrest, what do you do?
check position
check proportions of involved parties
TRY oxytocin or cervidil (pge)
first second and third stages of labor
first is onset of labor to full dilation

second is full dilate to birth

third is birth to delivery of placenta
Latent vs active phase of 1st stage of labor
latent is 0-3cm
active is 3cm-10cm (should follow a rate)
dangers of oxytocin use in augmenting labor
water intoxication (bc like ADH)
hyponatremia
urterin rupure or uterine hyperstimulation
DO NOT AUGMENT LABOR IF
placenta previa, vasa previa
umbilical cord prolapse
known cervical CA
If mother with herpes, when give acyclovir during lpregnancy
during last month,k because can reduce risk of active lesions at time of labor
why don't use general anesthesia in obstretic patients
higher risk of aspiration
more PNA because GE sphinter is relaxed
Also might cross placenta
Order of labor positions
DFIREERE
Descent, flexion, Int rotation, extension, ext rotation, expulsion
if face/brown presentation, what do
watchful waiting, most convert to vertex.
IF DON'T CONVERT, do a C-section
significance of fetal fibronectin
if think someone is preterm, check.
IF VAG SECRETIONS NEGATIVE< won't deliver in 2 weeks. If it's positive, probably going to delviery and shoud do tocolysis and fetal lung maturity
how manage preterm labor
lat decub, bed/pelvic rest, IVF< O2.
Tocolytics.
contraindications to tocolytics
heart disease, HTN, DM
Hemorrhage
Preex, chorio
IUGR
dilated to 4 already
signs of fetal lung immaturity
If ecithin:sphingomyelin <2
OR
NO PHOPHATIDYLGLYCEROL
if PROM, what do?
really? ferning, pooling +blu nitrazine?

Do U/S to check AFI. If no labor in 8hours, and term, induce.
cause of chorioamnionitis
PROM or PPROM.
tx amp and gent.
Can cause nenatal sepsis!
manage postterm pregnancy >42weeks
if unsure about dates, twice weekly BPP.
At 43 induce or C-section.
prolonged gestation classically associated with what congenital anomaly?
anencephaly! terrible.
workup of 3rd trimester bleeding
U/S BEFORE YOUR PELVIC!
Fluids, O2
Labs
causes of 3rd trimester bleeding
placenta previa
placenta abruptia
uterine rupture
fetal bleeding
cervical/vag lesions or trauma
bleeding problems
RF placenta previa
multipartiy,
multiple gestation
preior previa
presentation of placenta previa and mgmt
U/S BEFORE PELVIC
Painless bleeding.
C-section only.
Placenta abruptia RF
HTN
polyhydramnios with rapid deompression
cocaine
PPOM
presentation and mgmt of placenta abruptia
vaginal delivery!
tender painful bleeding. Be careful because bleeding could be hiding, hyperactive contracting, fetal distress...
manage uterin rupture
immediate laparotomy + hysterectomy
cuase of fetal bleeding
vasa previa,
multiple gestation
mgmt of fetal bleeding
painless... fetus looking worse.

Do Apt test, + if fetal to see which is bleeding. Do immediate C-section.
What is Kleihauer-Betke test
quantiful fetal blood in mother's system, can use to calculate Rhogam dose
presentation of acute ischemic colitis
atherosclerotic history.
acute pain then bloody diarhea
where is problem in acute ischemic colitis
in watershed areas like splenic flexure and rectosigmoid junction.
See increased WBC
if CP from cocaine, mgmt
Benzos
phentolamine (alpha antagonist)
tx graves dz
iodine ablation, but this might worsen ophtho problems, so give steroids too
diffuse thyroid uptake think
graves
if see polycythemia (high hgb), what do
could do EPO and if high prob from chronic hypoxia.

If LOW, prob a real polycythemia vera
high PSA, chance of prostate CA?
25% prostate CA
elevated PSA what do
if >4 do biopsy
don't use colchine IF
renal failure (choose steroids)
dx gonococal arthritis
NOT JUST joint fluid, must check urethral swabs and cultures.
if disseminated gonoccoal infection (from arthritis...)
tenosynovitis
tx psoriasis
UV
lubricants
topical seroids
methotrexate if refractory
side effect of antiparkinson medications
can make you psychotic, pull back.
side effect of imipenem
careful, increases sz risk!!
tx psoriasis
UV
lubricants
topical seroids
methotrexate if refractory
side effect of antiparkinson medications
can make you psychotic, pull back.
side effect of imipenem
careful, increases sz risk!!
who and when gets hyperemesis gravidarum
first tri
younger women in first pregnancy or social issues
when do CVS vs amnio vs Quad screen
CVS 10-12 weeks (chromosomes and genetics)
Amnio 14 weeks (NTD!!!!)
Quad screen 15-20weeks
CVS vs amnio and miscarriage rates
CVS slightly higher miscarriage
CVS CANNOT DO WHAT
NTD!! Only for chromos
when can you start having preeclampsia
20 + weeks (third tri)
sx of preeclampsia
HTN
UA with proteinuria
edema
oliguria
HELLP
what is HELLP?
variant of preeclampsia
hemolysis
elevated liver enzymes
low platelets
RF for preeclampsia
chronic renal disease
old or young
mulitple getstation
NULIPARITY
BLACK
tx preeclampsia
hydralazine or labetalol
mag sulfate for sz prophylaxis
eclampsia management
deliver regardless of gestational age
how does preex affect eh infact
IGUR< uteroplacental insufficiency because of vasoconstricution
can you deliver with active HPV or active Herpes?
HPV (flesh colored)
If preeclampsia, risk of HTN in the future?
NOT REALLY
if looks like preex but it's before 20 weeks, what should you consider?
molar pregnancy, bc gte HTN and proteinuria too.
toxic effects of mag sulfate for preeclampsia
no reflexes (#1)
then
resp despression
CND depression
diabetes and IUGR
gestational diabetes = macrosomia
IGUR = preexisting diabetes
complicaitons of DM on fetus
size problem
RDS
NTD
caudal regression
CV hypertrophic interventricular septum
which insulin to use in pregnanct
NPH, want less than 6.5 in first tri
A1 vs A2 DM
A1 diet controlled
A2 meds controlled
baby born to DM mother glucose level
LOW
IgM and IgG in the new baby?
IgG probably from mother
IgM never normal if elevated in baby
dizygotic twins IF
sex different
blood type different
placentas are dichorionic
monozygotic twins IF
same sex
same blood type
placentas are monochorionic
glucose tests 50 vs 100 g
50g 1 hr, + if >150
100g 3 hrs
glucose goals in pregnancy
fasting < 95
postprandial < 120
exact pathology of the Rh problem
If mother Rh neg, baby Rh positive
When Rh+ RBCs leak into mother's circulation, mother form RhIgG which CAN cross placenta and attack baby
when to give rhogam timewise
28w
within72 hours
RH and sensitization
remember that first Rh positive infant probably wont be affected
how can you gauge the severity of fetal hemolysis in Rh disease?
amniotic fluid spectrophotometry
when is it too late to give Rhogam?
if mother is Rh negative and has a high titer of Rh antibodies
is there sensitization with ABO incompatability?
no, because IgG antibodies will cross directly
How to you manage a hemolytic disease with Rh situation?
deliver if mature
intrauterine blood transfusion
phenobarbital (helps fetal liver break down bili)
how manage pregnant women with antiphopholipid antibodies
low dose ASA
los dose heparin! WOW! normally don't use these in pregnancy
examples of Gestational Trophoblastic disease
1) molar
2) choriocarincomia
etiology of choriocacinoma
only de novo
OR
from complete mole
tx choriocarcinoma (GTD)
chemo (methotrexate or actinomycin D)
complete vs incomplete mole
COMPLETE: 46XX FROM FATHER. Sperm /o egg duplicates.

INCOMPLETE: 69XXY. Fetal tissue here!
when suspect a mole
weird acting hcg
preeex but too early
tx HIV in pregnancy?
can continue HAART throughout
do surgery on pregnant women?
yes in all acute surgical conitions. If semiurgent, wait until 2nd trimester. Can still do laparoscopy.
tx TB during pregnancy?
INH just as usualy, just no streptomycin (aminoglycoside)

AND git Vit B6 with isoniazid
aminoglycosides on baby
deafness
renal toxicitiy
aminopterin what is it and effect on fetus
immunosupp

IUGR
CNS deffects
clipt lip
OCPs on fetus (low risk)
VACTERL
carbamazpine on fetus
fingernail hypoplasia
craniofacial defects
diazepam on fetus
cleft lip and palate
progesterone on fetus
masculiniazation of female fetus
valproic acid on fetus
spina bifida
hypospadia
wafarin on fetus
NEVER!
ALL MAJOR ISSUES including nasal hypoplasia
ACEI or ARB on fetus
renal toxicity
pain tx in pregnancy
TYLENOL
No NSAIDS
No ASA
what if mom doesn't want to breastfeed, how help mom
tight bras
ice packs
analgesia
bromocriptine (low PRL) and estrogens
cause of mastitis
staph aureus
manage mastitis
give abx
can keep feeding I think
PCN
drugs mother takes = baby can't breastfeed
drugs
sedatives or stimulants
lithium
chemo
if postpartum fever from endometritis doesn't resolve with abx, think
pelvic abscess or pelvic thrombophelbitis, Get CT scan. Could give heparin for the phlebitis.
tx uterin atony
uhhhh oxyotocin!
binmanual
ergot
prostaglandin F2 alpha
causes of uterine hemorrhage
uterine atony #1
retained parts @2
urtine rupture/inversion
define postpartum hemorrhage
500+ mL blood loss or > 1000mL on a C-section
when get Sheehan
after postpartum hemorrhage, get hypopit because of reduced blood flow
PID and h/o IUD, think
actinomyces israeli
TX PID
outpatient: doxy (chlamydia) + Cef

inpt: azithro (chlamydia) + gent
PID can progress to what emergency
tubo ovarian abscess, and this abscess can burst
chancroid vs chancre
CHANCHROID painful, Haemophilus ducreyi

chancre painless, syphilis
tx chanchroid
this is from hameophilus ducreyi (G-)

Use azithromycin, ceftriaxone
what abx cover chlamydia
doxy + other tetracyclines
quinolones
macrolides (like azithro)
gonorrhea vs chlamydia, when empiricially treat
gonorrhea? cover for chlamydia too.

chlamydia? don't have to cover for gonorrhea
tx crabs
peidulosis
permethrin cream
BV treat partner?
no
def of primary vs secondary amenorrhea
primary: no menses by 16

secondary: no puberty by 14, OR puverty but no menstruation for by 16
presentation of androgen insensitivity syndrome
phenotypically normal female but no axillary nor pubic hair... end up finding no uterus and patient is XY
workup of amenorrhea, bleeds with progesterone
Preg test
THEN
Progesterone. If bleeds, uterus not the problem.
CHECK LH: if high --PCOS. If low pit issue.
when can clomiphene work?
ovaries working
workup of amenorrhea, doesn't bleed with progesterone
FSH.
High FSH: Preamture ovairan failure OR menopause.

If low: hypothal not working, check brain.
presentation of endometriosis
dysmenorrhea, dyspareunia
ALSO DYSCHEZIA
MAYBE TENDER ADNEXAE!!!
dx endometriosis
gold standard is laparoscopy, of course -- see mulberry spots, powder burns, chocolate cysts
tx endometriosis
1. OCP
2. Danazol (testeosteron,e but treats it), GnRH agonists
3. surgery
adenomyosis, what is it and presentation
ectopic endometrial glands, over age 40, LARGE BOGGY UTERUS b/c infiltrated the muscle so it's no longer firm
tx adenomysosiss
D/C or biopsy
hysterectomy
GnRH agonists
DUB mostly d/t
anolvulatory cycles (unopposed estrogen), also PCOS
Cause of PCOS
androgen excess
LH:FSH >2:1...
menopause labs
elevated FSH
sx of fibroid (leiomyoma)
painful or excessive menstrual bleeding
meds that can cause breast discharge
OCPs
Hormones
Antipsychotics
Hypothyroidism...
fibrocystic vs fibroadenoma
fibrocystic: comes and goes with cycle. If over 35, RF breast CA.

fibroadeoma: mobile mass, rubbery. benign tumor. Worse with pregnancy and OCPs. No change with cycle. No RF CA.
tx fibrocystic vs fibroadenoma
fibrocystic: nothing OR progesterone for week at the end of each month or danazol.

Fibroadeoma: exise or nothing
breast mass over 35, do
mammorgram basically no matter what. If a cyst, aspirate it.
phlloides tumor what is it
potentially malignant tumor that starts out looking like a fast growing fibroadeoma.
What are BRCA1 and 2
nomrally tumor supressors. If mutated, increased risk of breast and ovarian cancer
when start ca and vit D
once postmenopausal
managment of bloody nipple discharge
likely intraductal papilloma, do an excisional biopsy to r/o intraductal papillary carcinoma
cause of stress incontinence
poor support of urethral sphincter
cause of urge incontinence
detrusor instability, urinary frequency and urgency. B/c of involuntary detusor muscle contractions.
tx urge incontinence
(detrusor instability)

blader training
antichol
botox
limited fluid intake
emergency contraeption, use
levonorgesterol
fibroids gorw when and can cause
with pregnancy or E
smaller fater menopause

can cause infertility, cure by taking them out.
locations of the prolapses: cystocele, rectocele, enterocele, urethrocele
cystocele: upper anterior vag wall. Urethrocele: lower anterior vag wall.

Rectocele: lower post vag wall
enterocele: upper posterior vag wall
infertility, whose fault and first step
2/3 femal problem
first step though is semen analysis because cheap
when use hysterosalpingogram
radioopaque die -- structural abnormalities of uterus and tubes
time for schizophrenic vs other psychotic d/o
<1mo = brief psychotic d/o
1-6 mo = scizophreniform
> 6mo = schizophrenia
schizophrenia prognosis poins
negative sx worse, no precipitating factor sworse
tx schizoprhenia
HIGH POTENCY: haloperidol, but lot of extrapyramidal effects and nothing on neg sx.

LOW POTENCY: Chlopromazine, but lot of autonomic side effects. Also no effect on neg sx.

ATYPICAL (maintenance) like risperidone, olanzapine, works on neg sx.
dopamine and prolacin
dopamine inhibis PRL.
SO IF BLOCKING DOPAMINE, get high prolactin.
side effect of thioridazine
retinal pigment deposits
side effect of clozapine
agranulocytosis
side effect of chlorpromazine
(with autonomic side effects_ jaundice and photosensitivity
list of extrapyramidal side effects and time line
(with high potency antipsychotics like haloperidol)
Acute dystonia: hours
Akathisia: days
Parkinsonsim: months
Tardive dyskinesia: years
NMS: any time
acute dystonia, sx and when
first few hrs or days
muscle spasms or stifness. Tx with antihistmaines or antichol (benztopine, trihexyphenidyl)
askathisia, when and sx and tx
frist few days.
Feels restless and paces and shifts.
Tx. beta blockers
antipsychotics and parkinsonism, when and tx
first few months of haldol
stifness.
tx: antihistamines, anchicholingerics
ex of anticholinergics
benzropine
trihexyphenidyl
tardive dyskinesia, what, when tx
years of high potency antipsychotics.
--perioral movements, tongue, grimacing, limbs.
STOP ANTIPSYCHOTIC AND SWITH TO ATYPicAL
what is neuroleptic malignant syndrome, cause and timing
any time with high potency antipsychotics
OR
sudden withdrawal of levodopa in parkinsonism
neuroleptic malignant syndrome, presentation and tx
rigidity, mutism, high fever, high CPK, sweating.
STOP MED
SUPPORT
DANTROLENE (same as in malignant hyperthermia)
carinoid tx vs serotonin syndrome tx
carcinoid (d/t mass): tx octreotide
serotonin from drugs, tx with 5HT anatonist like cyproheptadine
bupropion side effect
lowers sz threshold
what is serotnin syndrome
d/t SSI + MAOI, delirium, tachy, diarrhea, high reflexes.
side effects TCA
block alpha adrenegtic too so get dizzy AND block muscarinis and lower seizure threshold,
TCA overdose does what
causes arrhythmias, tx with bicarbonate!
when use MAOI
atypical depression (if hypersomnia or hyperphagia)
MAOI+ ? = HTn crisis
with tyamine foods, because get a lot of NE
ex of MAOIs
phenelzine
traylcypromine
tx bipolar d/o
lithium
valproic acid
carbamazpine
how to diagnose bipolar
really only need mania for the diagnosis
see less need for sleep, pressured speech, etc.
bipolar and antidepressants, caution
because can trigger mania
what is bipolar II
hypomani + major depression (psychosis without occupational dysfunction)
what is cyclothymia
2 years of hypomani and depressed mood but no full bowen episodes of either
side effects of lithium
renal dysfunction (DI!!!)
thyroid dysunftion
tremor
CNS effects
side effects of valproic acid
liver dysfunction
side effects of carbamazepine
bone marrow depression
key points that this is NOT normal grief, could be acute stress disorder, adjustment or depression
feeling worthless
slowing down
suicidal ideation
tx panic disorder
SSRI
Gen Anxiety D/o how treat
SSRIs, buspirone, benzos
simple phobia tx
behavioral tx
flooding
systematic desensitization
beta blockers
PTSD vs acute stress disorder
< 4weeks is acute stress
PTSD is > 4 weeks
what is somatization d/o
multiple complaints in multiple organ systems
difference amon the somatoform d/os
somatoform - not intentionall
factition: intential to be a patient
malingering: fake for secondary gain
schizoid vs schizotypal personality d/o
schizoid is loner
schizotypal, biazrro beliefs
def of avoidant personality disorder
no friends BUT WANT THEM
fear crtique or rejection so won't try
def of antisocial personality disorder
long criminal record, tortured animals... need CONDUCT DISORDER FOR THIS
FEEL NO REMORSE
EtOH and somatization
primitzie idealization
part of borderline disorder about splitting. Tx with behavioral therapy
Obsessive compulsive PERSONALITY DISORDER
this is not the classic OCD.
This is anal, stubborn, cheap, and they don't feel bad or tortured by it.
reaction formation
gay guy that acts homophobic
tx OCD
SSRIs or clomipramine, behavioral therapy
tx narcolepsy
moadafinil (non amphetamine stimulant), amphetamines
what is dependence
abuse and tolerance
cocaine pupils, formications
dilated, feel like bugs on them
cocaine withdrawal
no dangerous
tx opioid overdose
naloxone, methadone later...
opioid withdrawal
won't die, even though they act like it
LSD bad trip tx
reassurance
benzo
antipsychotic
tx PCP intoxciation
urine acidification to eliminate it faster
inhalants withdrawal
nothing
benzo tx
flumazenil
benzo withdrawal
can be fatal
competency vs capacity
competency is legal judment
capactiy is by clinical judment
reportable diseases
TB, HIV< spyhilis, gonorhea
pregnant woman and deciding medical tx for fetus
can refuse lifesaving care for themselves and their baby if they are compenent
if TB+, and not taking tx
resp isolation until sputum free of AFB, can detain them if necessary.
what can you accept from pharma?
books, meals, education
can attend conference but not travel, accept money for lodging
brain death IF
no gag, no pupils, no corneal (no cerebral no brainstem reflexes)
no resp in 2 min
low body temp
EEG negative fo 30 min
no cerebral circulation on MRI
malabsorption disorder
CF
cirrhosis
celiac
sprue
pancreatic insufficiency
vit deficiencies in malabsorption disorders
ADEK (fat soluble)
when start Vit D and Ca2+
50TO or postmenopausal
sx of Vit A def
night blindness
scaly rash
dry eyes
bitot spots on conjunctiva
toxicity of Vit A see
pseudotumor cerebri!
bone thicening!
teratogen!
Vit D deficiency see
rickets, hypocalcemia
Vit E definiciency see
anemia
peripheral neuropathy
ataxia
vit E overdose, see...
NEC in infants!!
B1 is what and deficieny
thiamine
wet beriri (CHF), dry beriberi (peripheral neuropathy
wernicke/korsakoff
What is B2 and its deficient
riboflavin
cheilosis, stomatitis, dermatitis
what is B3 and its deficiency
naicin
pellagra (dementia, dermatitis, diarrhea)
b6 what is it and deficiency
pyidoxine
peripheral neuropathy,
can a b vitamin have toxicity?
B6 can! (pyridoine)... get peripheral neuropathy
what is b12
cobalamin
b12 vs folic acid deficiency
both macrocytic
B12 def HAS NEURO SX
folic acid def NO NEURO SX
too much iodine gets you
mxyedema (pretibial myxedema in graves!)
zinc def sx
hypogeusia (decreased taste), rash, slow wound healing
copper def and toxicity
def = menkes' (xlinked, kinky hair, MR)

excess = wilsons'
manganese madness is
if too much manganeses like in some miners
rickets xray findings
craniotabes (thinning of skull, feels like pingpong ball)
rachitic rosary 9costochondarl beading on ribs)
Delayed fontanelle closure
most common cause of B12 def
pernicious anemia (auto Ab)
ileium out
diphyllobothrium latum
INH, what deficiency
B6 = pyridoxine
Vit K dependent clotting factors
II, VII, IX, X, protein C, S
Vit K and liver failure
won't work, so give FFP. Failed liver is inabaple of making the clotting factors that Vit K is supposed to help do.
the birth rate, death rate, ferility rate, remember
/1000 population
top 3 causes of infant mortality
congenital
prematurity, low birth weight
SIDS
top 3 causes of maternal mortality rate
PE
HTN
Hemorrhage
sensitivity, explained
D+/T+
SNOUT (rule out) - screening
So if a high sens, you're going to catch the disease. So if it's negative, you don't have it. It's ruled out.
it's the ability to detect the disease
specificity, explained
ability to detect HEALTH (no dz)
SPIN (rule in) = confirmation.
So if high ability to detect health and yours says you have the disease, you are SPIn ruled in.
what is PPV vs NPR
PPV how likely pat has the dz, if have positive test.

NPV: how likely pt is actually healthy, if the test is negative.
prevalence and PPV, NPV
PPV and prevalence go togther
NPV and prevalence go opposite
sensitivity and PPV, NPV
sens and PPV in oppositve directions
sens and NPV in same direction (because fewer false negatives)
formula for PPV and NPA
TP/T+
TN/T-
2x2 chart and odds ratio
X is D, Y is test.
AB
CD

Odds is AD/BC
attributable vs relative risk
attributable risk: # cases attribuatle to ONE risk factor.

Relative risk: compares dz risk in exposed population to the unexposed population.
ONLY USE WITH PROSPECTIVE/EXPERIMENAL
ODDS RATIO what mean, when use, how calculate
AB
CD
Do AD/BC
ONLY FOR RESTROSPECTIVE (case control)
Standard deviation 1, 2, 3 SD in population
1SD 68%
2SD 95%
3 SD
99.7%
normal distribution and mean, median, mode and SKEWS
normal: M=M=M
In positive skew: M>M>M
In negative skew: M<M<M
SD in skews
doesn't mean as much because aren't normal distributions
test reliability vs validity
reliability = precision. RANDOM EFFOR is the porblem

VALIDITY= ACCURANCE, Systematic error problem.
incidence euql to
absolute risk
chi squares bs t test vs ANOVA
chi = compare percentages or proportions
T test = compare two means
ANOVA = compare 3+ means
type I error vs Type II error
Type I erro: saying there's a difference when there's not.
Tpye II: say there's no difference when there is
what is POWER
the prability of rejecting the nullhypothesis when it is indeed false
what is an experimental study
CTs
compares two equal groups in which 1 variable is manipulated
what is a prospective study
longitidinal, cohoro,
choose a sample population, divide in 2 groups and follow it over time.
what is a retrospective study
samples chosen after the fact based on presence or absence of siease.
Can use ODDS RATIO
what is a cross sectional study
looking for prevalence or dz and risk factors
no cows milk until
12mo
small infant head, think
micrcephatly from TORCH, rubella, CMS< virus, congeintal problem. NOT FROM DM or PREEX.
when start checking vision and hearing
vision at 3YO
hearing at 4YO
red reflex to pick up waht
congenital catarachts (from rubella or TORCH)
or retinoblastoma
until what age is lazy eye normal
if always bad, problem.
occasional misalignment normal until 3months.
2 infectious diseases associated with acquired hearing loss in kids
meningitis and recurrent OM
what infants get iron supplements
preterm breastfed (formul has a supplement)
bad lead level and tx
?10, tx with DMSA
first see dentist
at 3 yo
when Vit D supplementation
if infant high risk no sun
OR
if breastfeeding only x 6 months
(formula has some)
example of killed vaccines
influenza
cholera
polio
rabies
hep A
example of live attenuated vaccines
MMR
BcG
typhoid
examples of toxoid
tetanus
diptheria
If baby with Hep B, check serology when
@ 9mo
And still chance to get chronic HepB o HCC.
if at risk of tetanus, what give
tetanus ig and toxoid BOTH
rotavirus caution vaccine
intussuception
MMR allergy
eggs or neomycin
infleunza vaccine and allergies
not if allergic to eggs
if asplenic, need vaccines for
pneumococcal
haemophilus
meningococcus (encapsulated bacteria)
APGAR stands for
APPEARANCE: 0=pale, 1= acrocyanosis, 2= pinl
PULSE: 0, 1= <100, 2= >200
GRIMACE: 0, 1=grimace, 3= grimace and cry
ACTIVITY: 0, 1 flexion, 2 active
RESP RATE: 0, 1= weak, 2=good cry
umbilical cord anatomy and if a problem
2 ateries, 1 vein. No urachus.

If only 1 artery, could have congenital renal problems.
cavernous hemangioma what is it and management
brain, dilated blood vessels, resolves.
fontanelle closes by...?
18 mo
if large anterior fontanelle, it's from
hypothyroidism
hydrocephalus
rickets
IUGR
newborn reflexes are and are gone by
Moro = startle
palmar grasp

gone by 6months
bith trauma causes caput succedaneum vs cephalhematoma
caput= succeeds at crossing midling.
cephalhematomas; don't cross midline
PDA what is it and how close or leave open
open ductus ateriosus b/w pulm artery and aorta.
Close with NSAIds
OPEN WITH PRSTAGLANDIN (PROP OPEN)
where hear coarc of aorta murmur
systolic murmur over back.
noncyanotic heart defects
L-->R SHUNTS

ASD
VSD
PDA
(start with D)
cyanotic heart defects
R-->L shunts
ToF
Tricspid atresia
TGA (egg)
Truncus arteriososis

The Ts!!!
heart defects and pophalxis
for all except ASD
PDA what is it, what hear, associated with what conditions
open ductus arteriosis b/w pulm artery and aorta

--macin like LUS border
--associated with rubella dn high altitudes
VSD, what is it and what hear
hosoytolic murmur

LV-->RV
etiology of VSD
FS
TORCH
Down's
ASD is what
LA-->LV
(noncyanotic)
T of F anomalies
VSD leads to
RV hypertrophy
and
pulm stenosis

AND
overriding aorta
T of F sx
cyanotic defect
tet spells (squatting after exertion)
Boot heart.
Coarc of Aorta presentation
UE HTN
systolic murmur over bak
coarc of A associated with
Turner syndrome
def of delayed puberty in boys and girls
boys if nothing by 14
nothing by 13 in girls
what is mccune albright syndrome
cafe au lait spots, fibrous dysplasia, precocsiou pubert in girls
tx precocious pubert
GnRH agonists, to suppress progression and prevent premature epiphyseal closure
CAH in boys vs girls
boys, precosiou pubert. In girls is ambiguous genitalia.
xray findings in abuse
bucket handle and corner gractures
rolls front to back
4-5 months
stranger anxiety
6-9 months
pulls to stand
9mo
first words
9-12months
what is mccune albright syndrome
cafe au lait spots, fibrous dysplasia, precocsiou pubert in girls
bye bye
10 months
tx precocious pubert
GnRH agonists, to suppress progression and prevent premature epiphyseal closure
walks without help
13 month
CAH in boys vs girls
boys, precosiou pubert. In girls is ambiguous genitalia.
xray findings in abuse
bucket handle and corner gractures
rolls front to back
4-5 months
stranger anxiety
6-9 months
pulls to stand
9mo
first words
9-12months
bye bye
10 months
walks without help
13 month
what is mccune albright syndrome
cafe au lait spots, fibrous dysplasia, precocsiou pubert in girls
tx precocious pubert
GnRH agonists, to suppress progression and prevent premature epiphyseal closure
CAH in boys vs girls
boys, precosiou pubert. In girls is ambiguous genitalia.
xray findings in abuse
bucket handle and corner gractures
rolls front to back
4-5 months
stranger anxiety
6-9 months
pulls to stand
9mo
first words
9-12months
bye bye
10 months
walks without help
13 month
cup and spoon use
15-18months
runs
2yrs
never give hypertrophic obstructive cardiomyopathy
no positive inotropes like digoxin
no diuretics
no vasdilators
job of umbilical vein vs artery
umbilical vein carries oxygentaed blood from placenta to fetus
umbilical artery carries deoxygenated blood from fetus to placenta
what closes right at birth
foramen ovale
most common TEF
blind esophagus
trachea with distal esophagus attached
tx constipation in kids
magneisum hydoide
(bisacodyl only for emergencies)
pyloric stenosis what is it and associated with...
erythromycin! crazy.
Also its the narrowing of opening from the stomach to intestines because of an enlarged muscle pylorus
labs in pyloric stenosis
low chloride
low K
metabolic alkalosis
dx hirschsprungs
rectal biopsy, see aganlionic section of bowel
what is choanal atresia
back of nasal passage is blocked
intussecption associated with
HSP
CF
Rotavaccine
presentation of intussuception
currant jelly stools
sausage mass
tx intussceptivon
barium or air enema
2 first signs of CF
mec ileius
rectal polapse
bachdalek
diaphragmetic hernia on left (more common) can cause pulm hypoplasia
omphalocele vs gastroschisis
omphalocele in midline, no ring, sac.

Gastroschisis is RIGHT of midline, small bowel, no sac.
HSP pesentation
GI bleeding and abdominal pain
palpable purpura on lower extrem
arthritis
swelling in feet, hematuria, protinuria
HSP prodrome
upper resp infection...
what IS HSP
small vessel vasculitits and get igA-C3 complexes deposited in the small vessels
congenital hyperbili, unconjugated vs conjugatd
unconjugated - Criggle Najja and Gilbert

conjugated: rotor, dubin johnson
physiologic jaundice looks like
1-2 days AFTER birth, unconjugated
causes of unconjugated hyperbilirubin in infants
HEMOLYTIC
- spherocytosis, G6PD def, SCD, ABO incompat, Breast milk

NONHEMOLYTIC
cephalohematoma
sepsis
hypothyroid
breast feeding
causes of conjugated infant jaundice
HEPATIC
--sepsis, CF, alpha 1 antitrypsin

POSTHEPATIC
biliary atresia
bile duct obstruction
biliary atresia, what kind of bili
CONJUGATED
sulfa and neonates
don't use because displace bili from albumin and can get kernicterus!!!
CAH labs
elevated 17hyroxyprogesterone
hypotension because low Na
Hihg K
treat CAH
steroids and fluids
imagine chart of CAH
progestero down 21 hycolase to aldosteron
to 17 hydroxyprogesterone
with 21 hydrolxylas to cortisl
THEN LEADING ON TO RIGHT WITH ANDROMES
sarcoma boyroidis
malignancy of embryos but can see until 8YO
vesicles or grapes coming from the vagina
why fetus with vaginal bleeding
phsiologic from maternal estrogen withdrawal
what can cause renal papillary necrosis
DM
SCD
analgesic
why spleen involved with SCD
because it's function in clearing the weird RBCs
classic signs of SCD
aplastic crises d/y parvo
bone pain from microinfarcts (avascular necrosis)
renal papillary necrosis
splenic sequenestration,
acute chest syndrome
pigment cholelithiasis
pripasis
stroke
diagnose SCD
Hgb electrophoresis
SCD sx start when
6months bc need adult hemglobin production
t SCD
prophylactic pcn because of encapsulated organism infections until 5YO
vaccination
folate supplementation
how treat sickle cell crsis
O2
IVF
analgesics
narcotics
dacylitis from SCD
hand foot syndrome with swelling and redness because sickled RBcs blocking the small vessels. NSAID tx.
IgA def what infections
respir and GI infections
what infections with X linked agammaglobulinemia
Bruton agammaglobulinemia
Resp infections, males only
DiGeoge presentation
CTCH22
low Ca
tetany (because no parathyroid)
NO THYMUS
SCID genetics and def
AR of Xlinked
B and T cell defects, cutanoues anergy
No thymus no lymph nodes

need Bm transplant to survive
wiskott aldrich deficiency genetics and presentation
Xlinked
males only

eczema,
thrombocyopenia
recurrent resp infections
high IgE and IgA
Chronic grnaulomatous disease genetics and presentation
Xlinked (males )
infections with cat positive, because immune system can't form the ROS to kill the pathogens so get granulomas in organs.
tx of chronic granulomatous disease
daily bactrim
HUS prodorme, presentation
E. coli, shiga toxin
ATR (vs TTP which is FATRN)
tx HUS
dialysis, transfusion
tx HSP
dialsis, transfusion
TTP presentation
FATRN
platelts screwed up, ADAMTS13
causes of TTP
OCPs
HIV
pregnancy
tx TTP
plasmapheresis
NSAIDS
NO PLATELETS!!!!!!!!!!!!!!
ITP cause and prodome
idiopathic low plateles
viral prodrome
See antiplatelet antibodies.
dx chronic granulomatous disease
nitroblue tetrazolium, tests ability to make ROS which is why negative in CHD.
young person with HTN, prob d/t
renal parenchymal disease
HTN, when start a second agent?
>160/100 ( Stage II HTN)
don't use thiazides in patient with
GOUT
Lithium
Pregnancy
beta blockers on electrolytes
High K, low sodium
antiHTN medications for pregnant patients
hydralazine
labetalol
alpha methyldopa
when does ACE-I cause renal failure
if person actually with RENOVASCULAR HTN, because this ends up stenosing the kidneys more
aldosterone receptor blockers on electrolytes
K+ increasing
(like spironolactone)
Conn syndrome - what is it, and electrolytes
primary aldosteronism = aldosterone secreting adrenal adenoma
So high aldosterone, so high Na, Low K+, low renin
what does adrenal medulla make
catecholamines
DM I an II - ketoacidosis vs hyperosmolar vs HLA association
DMI with DKA, II with HHNK
HLA association with Type I
DM I and II and islet cell pathology
Type I with insulitis (because of AI destruction)
DMII with amyloid deposits
DM and blurry vision can be from
retina hemorrhages
but maybe just osmotic lens swelling (near sightedness) which improves with tx
Estimate glucose level
A1c x 20
goal of DM glucoses
fasting < 130, posprandial < 200
why get sweating and paliptations with hypoglycemia
because drops low and you get this huge release of adrenaline
C-peptide significance
FOUND WITH ENDOGENOUS INSULIN
DKA, acid base and tx
metabolic acidosis
give K+ (because insulin high and drove K+ into cell_
hosp replacement too
consequence of DKA (eek!)
cerebral edema (give mannitol)
manifestations of low phos
muscle wekaness
rhabdo
DKA is resolved IF (3)
1. Glucose < 200
2. AG < 12 (otherwise keep insulin)
3. Biarb > 18

but keep the IV insulin a few hours still running
what does NNHK stand for, who gets it and main characteristics
Nonketototic, hyperglycemia, hyperosmolar
Type II DM ONLY

notice hyperosmolarity > 310
NO KETONES
mech of metformin
it's a biguandide
suppresses liver glucose production
sulfonylurea ex and mech
glimepiride, glyburide
(inceased secretion of insulin)
alpha glucosidase inhibitor, example and mech
acarbose
reduced carb absoprtion in gut (get side effects)
what are the insulin secregagogues
don't use them anymore, but are glinide and nateglinide
calc insulin dose
0.5-1u/kg/day
Rapid acting insulin
aspart = novolog
lispro = humalog
intermediate acting insulin
NPH = humulin, novolin
Lente insulin
long acting insulin
glargine = lantus
somogyi vs dawn effect
somogy: rebounding high BG in response to low BG

Dawn phenom: waning insulin so higher BG PLUS higher because GH starts

check 3AM glucose before doing something automatically with ahigh AM glucose
don't use metformin in patients with
ETOH
CHF
how much insulin to give day of surgery
1/2 the amount
beta blocker and DM caution
bb can reduce hypoglycemic signs
corneal arcus, what is it and who gets it
white ring around rius
cholesterol patients!
how to calculate LDL
Tot Chol - HDL - TG/5
5 RF for CHD
Age
FH premature CHD
Smoker current
HTN diagnosis
low HDL
1st line drugs for hyperchol
STATINS
niacin
cholestyramine (bile acid binding resin)
3 ways to increase HDL
EtoH!
exercise
estrogens
what decreases HDL?
smoking
androgens
progesterone
hyperTG
risk of statin + fibrate
increased risk of rhabdo and muscle failue
etoh on lipids
increases HDL!

but also increases TG and LDL
thyroid d/o and lipis
hypothyroidism cause of hyperlipidemia
what meds can increase your lipids
OCPs
steroids
thiazides
beta blockers
what is buerger disease
inflammation and clotting of small-medium vessels. IN A SMOKER!!!!!!!! see painful red fingers and toes
smoker and OCPs
smoker can't take OCps, but can take estrogen replacement therapty
alcohol increased risk of what canacers
oral, pharn, laryn, eso, liver DUH
ALSO maybe breast! gastric and pancreatic!
the staging of alcohol withdrawal
12-48hrs = acute withdrawal syndrome (tremors, sweating, sz)
Then = Alcoholic Hallucinosis = hallucinations but no autonomic sx.
48-72hrs = DT, autonomic cx
etoh and rhabdomyelitis!
yes, these is an association with alcohol!
wernicke vs korsakoff
wernicke is inadequate thimaine, ataxic, can't move eyes.

Korsakoff is can't form new memories, this is a CHRONIC thiamine deficiency
homan sign
abrupt dorsiflexing of foot causes pain in DVT
sx and sig of superficial thrombophlebilitis
palpable clot in superficial vein
BENIGN< not sign of DVT nor PE

Tx NSAIDs/ASA
PE effect on heart
can result in pulm HTN, RV dysfunction
tricuspid regurgitation
oral K antagonist
= warfarin
how to reverse heparin
protamine
how to reverse heparin
FFP (FASTER)
Vitamin K
how to everse ASA
platelet transfusion
monitor heparin?
no, not required. IF EVER ABSOLUTLEY NNED TO could do antifactor Xa assay
hemophilia affects what blood test
PTT
DIC affects what blood test
all of them
liver dz affect what blood test
PT (or course)
uremia on platelets
causes a qualitative platelet defect
vit C deficiency on lab test
ALL NORMAL
calculate AG
Na+ - (Cl+HCO3)
12 normal
>20 met acidosis also
AG Metabolic Acidosis causes
MUDPILES
metahanol, uremia, DKA, paraldhyde, Iron, INH, lactic acidosis, ethylene glyceol, salicylates
how tx ethleneg glycol (antifreeze)
fompeiazole then ethanol maybe
causes of NON AG Metabolic acidosis
DURHAM
Diarrhea, Ureteral diversion, RTA, HypeCl, Acetazolamide, mineralcorticoids
causes of metabolic alkalosis
saline responsive: vomiting, NG draininage, diruetics, hypovolemia

saline resistant: Conn's, Cushing's, Alkali ingestion
ASA intox on labs, and tx
metabolic acidosis and resp alkalosis
tx with alkalinization of urine
COPD and on oxygen the Co2 and PH starts to fall
turn down O2 as high O2 levels may shut down resp drive of COPD patients if severe COPD
OSA on labs
chronic respi acidosis during sleep causes chronic metabolic compensation
Conn syndrome on electrolytes
High Na (aldoesteroneism), low K+
high bicarb (get metabolic alkalosis)
furosemide on electrolytes
low Na, Los K, LOW CA
don't use bicarb to tx low pH unless
pH < 7
hyponatremia breakdown causes
1) make sure not from hyperglycemia.

THEN
Hypovolemic: dehydration, diruetics, DM, addison's, low aldosteronism

Euvolemic: SIADH

Hypervolemic: CHF< renal failrure, cirrhosis.
tx hypovolemic hypona
dehydration, diruetics, DM, addison's, hypoaldosteronism

NORMAL SALINE
euvoluemic hyponatremia, cause and tx
SIADH
free water restriction
hypervolemic hyponatremia, causes and tx
CHF, cirrhosis, nephoritic, renal failure


free water restriction and diruetics
causes of SIADH
small cell ca lung
head truma/surgery
meningitis
opiodids!!
chlopropamide
how tx SIADH
euvolemic hyponatremia
Demeclocyline, tetracycline that causes DI! and free H2O restriction
central pontine myelinolysis
when bring up low Na too fast.
uremia on platelets
causes a qualitative platelet defect
vit C deficiency on lab test
ALL NORMAL
calculate AG
Na+ - (Cl+HCO3)
12 normal
>20 met acidosis also
AG Metabolic Acidosis causes
MUDPILES
metahanol, uremia, DKA, paraldhyde, Iron, INH, lactic acidosis, ethylene glyceol, salicylates
how tx ethleneg glycol (antifreeze)
fompeiazole then ethanol maybe
causes of NON AG Metabolic acidosis
DURHAM
Diarrhea, Ureteral diversion, RTA, HypeCl, Acetazolamide, mineralcorticoids
causes of metabolic alkalosis
saline responsive: vomiting, NG draininage, diruetics, hypovolemia

saline resistant: Conn's, Cushing's, Alkali ingestion
ASA intox on labs, and tx
metabolic acidosis and resp alkalosis
tx with alkalinization of urine
COPD and on oxygen the Co2 and PH starts to fall
turn down O2 as high O2 levels may shut down resp drive of COPD patients if severe COPD
OSA on labs
chronic respi acidosis during sleep causes chronic metabolic compensation
reflexes and Na status
both cause hyperreflexia
Tx neprhogenic vs central DI
central: desmopressin
nephrogenic: paradoxical HCTZ
hypernatermia classification
hypovolemic: mannitol, diarrhea, fever, loop diretics
Euvol: DI

Hypervolemic: high aldosterone
how does Sheehan syndrome result in DI
because no blood flow to pituitary so no PL, but post pit hit also, central DI
hypo vs hyperkalemia on EKG
hypo: U waves and lose T waves

HyperK: peaked K waves
K and digitalis
digitalis can worsen a low K
another word for kayexalate
oral sodium polystyrene resin
manage severe hyperK
calcium gluconate for heart
sodium bicarb (make alkalosis to force K into cells)
IV glucose
Diruetics (furosemide)
what does calcitonin do
from throid parafollicular cells (C-cells)
low Calcium

this is the opposite of PTH
hypo vs hypercalcemia on EKG
hypoCa2+ - QT prolongation

hyperCa2+ - QT shortening
signs of hypocalcemia
tetany (Chvostek sign), convulsions
Trousseau sign, arm spasm with BP
DiGorge genetics and Ca2+
AD
hypocalcemia
Digeorge CATCH22
Cardiac anomalies (ToF)
Abnl facies
Thymus absent (lot infections)
cleft palate
hypocalcemia
22q11 deletion
Ca once parathyroid homrone out
HYPOCALCEMIA
kidney failure on Ca
renal filaure causes hypocalcemia
albumin and Ca
if Ca low, check albumin, can make it look lower
PTH on phos Ca Vit D
reduces Phos
increase Ca
increases Vit D by getting kidney to metabolize and activate it
Vit D on Ca and Phos
both up, free lover
sx hypercalcemia
bones (osteopenia?)
stones (kideny stones)
groans (ileus)
psychiatric overtones (depression, delitirum)
most likely cause of high Ca2+
hhyperparathyroid
diuretics to decrease Ca2+
fursoemide, all low
(thiazides increase it)
cuases of high Ca2+
hyper PTH
familial
CA
High Vit D
Thiazides
High VITAMIN A
Sarcoid
hypoMg who gets and sx
alcoholics
like hypo Ca
who gets hyper Mg
renal failure b/c usually kidney very good at excreting Mg
who gets hypophos
DKA, EtOH, Refeeding syndrome
Keep running glucose all the time
who gets hyper phos
renal failure (Cal carbonate is phos resmin)
low Vit D
low PTH
hypovolemic shock on CO, PCWP, SVR, SVO2
CO low
PCWP low (not lot in there ) = LAP
SVR = diatsolic BP , HIGH!!!!
SVO2 same as CO
cardiogenic shock on CO, PCWP, SVR< SVO2
low CO
HIGH LAP (can't get out!) = LAP
SVR HIGH!!!
SVO2 same as CO
septic shock on CO, PCWP, SVR< SVO2
CO HIGH ONLY ONE!!!!!!!!!! goes hyperdynamic
LOW PCWP
LOW SVR
SVo2 same
neurogenic shock and CO, PCWP, SVR< SVO2
CO LOW
PCWP LOW
SVR LOW
SVO2 LOW
ALL lOW
skin findings in the different shocks
low SVR in Septic and neurogenic, so skin is warm and maybe flused
cardiogenic shock, don't give
fluids if pulm congestion
elderly and calories
need less
most common hearing loss in young people
otosclerosis
sleep changes in elderly
sleep less deeply
wake up more
wake up earlier
less stage 3, 4, REM sleep
Pick disease
frontotemporal lobar degeneration
see tau proteins
what meds in eldery mess with their balance
sedatives
anticholinergics
if too much anticholingerics, what do
give physostigmine
what does swan ganz measure
PCWP, LAP
mech of dobuatmine
beta 1 agonist
INCREASE CO (inotrope)
mech of dpamine
low dose: kidney perfeused.
High dose: Increase HR and SVR
NE mech
alpha 1 agonist
INCREASE SVR
Phenylephrine mech
alpha 1 agonist
INCREASE SVR
EPINEPHRINE mech
increased HR and SVR!!!
# calories and protein goal for enteric feeding
30kcal/kg/day
1g/kg/day protein
HRT side effects of heart, cloths, lipis
increased MI, increased clots
IMPROVES LIPIDS
Lupus activity correlates with
dsDNA
side effect of saw palmetto
HTN
side effect imipenem
increased sz risk
MS treatment, acute and chronic
acute: steroids
chronic to reduce exacerbations: beta interferon or glatimir
best prognostic sign for MS
if first sign is optic neuritis
how to distinguish lewy body from alzehemiers
lewy body has visual hallucinations, alzhemiers doesn't really
how tx keloids
intralesional steroids
ARDS tx on ventilaotr
PEEP
low TV
tx papillary CA
thyroidectomy
medullary cancer in imaging
doesn't take up iodine
bcr-abl think
CML, 9,22, philadelphia tx gleeve or tyrosine kinase inhibitor
confirm clearance of H. pylori by
stool or breath test
C diff dx
immunoassay (not stool cx)
ApKD how monitor and extra effects
MRI onoy if family history for berry aneurtsms
monitor HTN
#1 get hepatic cysts
complications after gastric bypass
malabsoprtion, low vit D and low calcium
how to diagnose chronic granulamotous disease
deficient nitroblue tetrazolium (tests ability to make ROS, which is why it is negative here)
chediak higashi syndrome - genetics, pathophys
AR
defect in microtubule polymerization so low phagocytosis
treatment of chronic granulomatous disease
daily bactrim
chediak higashi genetics and presentation
AR
giant granules
eye and skin albinosis
pyogenic infections
complement deficiencies, management
N meningococaal vaccine because always get recurrent neisseria infections
chronic mucocutaneous candidiasis what is it
cellular immunodeficiency, just get tons of candida
anergy to candida skin testins
T cell definiciency
See with hypothyroidism
HyperIgE syndrome what is it
recurrent staph infections
High IgE
fair skin, red hair, eczema
chronic otitis media may lead to
permanent perf of dum
cholesteatomas (excise them)
abx to cover OM
amox
cefuorxime
bactrim
how treat RECURRENT otitis media
prophy antibiotics
when to do workup for kids UTI
Renal U/S and VCUF
If boy < 6yo x 1
if girl < 6yo x2
meningitis and fontanelle
can be bulging
herpes encephalitis in kids vs adults
in newborns it's HSV2
and children/adults it's HSV II
herpes encephalitis on CT
temporal lob abnormalities
consequences of meningitisi
hearing loss
vision loss
learning d/o
neonatal, regular and elderly causes of meningitis
NEO: GBS, Ecoli, Listeria
OTHERS: S. prnumo, meningocoocal
ELDERLY: strep penumor, listeria, G-
tx of meningitis depending on age
NEO: amp (for listeria) and gent
OTHERS: vanc and cef
ELDERLY: amp (listeria) + cef
rubeola vs rubella vs roseola
rubeola = measles = Cs
rubella = german measles = LN
roseola = exanthem = high fever and trunk out
rubeola presentation
= MEASLES (C MEASLES)
Conjunctivitis
Coryza
Coplik spots
complications of rubeola
= measles
giant cell PNA
subacute sclerosing panencephalitis
rubella presentation
= german measles
the LYMPH NODES

complications as always are encephalitis and OM
roseola presentation
HHV 6
high fever then abrupt normalcy but rash TRUNK OUT
danger of person with shingles to others
CAN cause chickenpox in a person who has never been vaccinated before
how long is a varicella child contagious
until last lesion crusts over
rubella presentation
= german measles
the LYMPH NODES

complications as always are encephalitis and OM
what is scarlet fever
untreated strep (erythrogenic toxin)
circumoral pallor
strawberry tongue
desquamating rash
roseola presentation
HHV 6
high fever then abrupt normalcy but rash TRUNK OUT
tx scarlet fever
PCN in order to prevent rheumatic fever
danger of person with shingles to others
CAN cause chickenpox in a person who has never been vaccinated before
mono on blood tests
atypical lymphocytes with lymphocytosis
heterophile antibodies
how long is a varicella child contagious
until last lesion crusts over
what is scarlet fever
untreated strep (erythrogenic toxin)
circumoral pallor
strawberry tongue
desquamating rash
EBV assoc with what cancers
nasopharyngeal carcinoma
burkitt pymphoma
splenomegaly and sports
NOs contact sports
tx scarlet fever
PCN in order to prevent rheumatic fever
what is toxic erythema
that's the rash you get with try tx EBV with penicillin (because thought it was strep)
mono on blood tests
atypical lymphocytes with lymphocytosis
heterophile antibodies
EBV assoc with what cancers
nasopharyngeal carcinoma
burkitt pymphoma
splenomegaly and sports
NOs contact sports
what is toxic erythema
that's the rash you get with try tx EBV with penicillin (because thought it was strep)
RMSF presentation
only rash at extremities and moves IN.
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
tx croup
humidified O2
racemic EPI
oral steroids
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
tx epiglotittis
prepared to establich airway
cephalosporin x 3
RMSF presentation
only rash at extremities and moves IN.
RSV later in life
could get more asthma
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
tx RSV
supportive although ribavarin and palivizumba as necessary
RMSF presentation
only rash at extremities and moves IN.
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
tx croup
humidified O2
racemic EPI
oral steroids
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
RMSF presentation
only rash at extremities and moves IN.
tx croup
humidified O2
racemic EPI
oral steroids
tx epiglotittis
prepared to establich airway
cephalosporin x 3
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
RSV later in life
could get more asthma
tx epiglotittis
prepared to establich airway
cephalosporin x 3
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
RSV later in life
could get more asthma
tx RSV
supportive although ribavarin and palivizumba as necessary
RMSF presentation
only rash at extremities and moves IN.
RMSF presentation
only rash at extremities and moves IN.
RMSF presentation
only rash at extremities and moves IN.
RMSF presentation
only rash at extremities and moves IN.
tx croup
humidified O2
racemic EPI
oral steroids
tx RSV
supportive although ribavarin and palivizumba as necessary
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
tx epiglotittis
prepared to establich airway
cephalosporin x 3
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
RMSF presentation
only rash at extremities and moves IN.
RMSF presentation
only rash at extremities and moves IN.
RMSF presentation
only rash at extremities and moves IN.
RMSF presentation
only rash at extremities and moves IN.
RMSF presentation
only rash at extremities and moves IN.
tx croup
humidified O2
racemic EPI
oral steroids
tx croup
humidified O2
racemic EPI
oral steroids
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
RMSF presentation
only rash at extremities and moves IN.
RMSF presentation
only rash at extremities and moves IN.
tx croup
humidified O2
racemic EPI
oral steroids
tx croup
humidified O2
racemic EPI
oral steroids
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
rubella presentation
= german measles
the LYMPH NODES

complications as always are encephalitis and OM
RMSF presentation
only rash at extremities and moves IN.
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
RMSF presentation
only rash at extremities and moves IN.
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
RSV later in life
could get more asthma
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
roseola presentation
HHV 6
high fever then abrupt normalcy but rash TRUNK OUT
tx RSV
supportive although ribavarin and palivizumba as necessary
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
tx RMSF
doxy
chlorampheicol (in pregnancy yes use this)
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
tx epiglotittis
prepared to establich airway
cephalosporin x 3
tx epiglotittis
prepared to establich airway
cephalosporin x 3
tx epiglotittis
prepared to establich airway
cephalosporin x 3
tx croup
humidified O2
racemic EPI
oral steroids
tx croup
humidified O2
racemic EPI
oral steroids
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
tx croup
humidified O2
racemic EPI
oral steroids
tx epiglotittis
prepared to establich airway
cephalosporin x 3
tx croup
humidified O2
racemic EPI
oral steroids
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
danger of person with shingles to others
CAN cause chickenpox in a person who has never been vaccinated before
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
tx croup
humidified O2
racemic EPI
oral steroids
tx croup
humidified O2
racemic EPI
oral steroids
tx croup
humidified O2
racemic EPI
oral steroids
RSV later in life
could get more asthma
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
tx croup
humidified O2
racemic EPI
oral steroids
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
tx epiglotittis
prepared to establich airway
cephalosporin x 3
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
croup AKA and presentation
acute laryngotracheitis (parainfl virus)

barking cough
stridor
STEEPLE SIGN (subglottic edema)
RSV later in life
could get more asthma
how long is a varicella child contagious
until last lesion crusts over
RSV later in life
could get more asthma
RSV later in life
could get more asthma
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
tx RSV
supportive although ribavarin and palivizumba as necessary
tx RSV
supportive although ribavarin and palivizumba as necessary
RSV later in life
could get more asthma
tx RSV
supportive although ribavarin and palivizumba as necessary
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
tx RSV
supportive although ribavarin and palivizumba as necessary
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
tx epiglotittis
prepared to establich airway
cephalosporin x 3
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
tx epiglotittis
prepared to establich airway
cephalosporin x 3
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
tx epiglotittis
prepared to establich airway
cephalosporin x 3
what is scarlet fever
untreated strep (erythrogenic toxin)
circumoral pallor
strawberry tongue
desquamating rash
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
tx epiglotittis
prepared to establich airway
cephalosporin x 3
tx RSV
supportive although ribavarin and palivizumba as necessary
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
tx croup
humidified O2
racemic EPI
oral steroids
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
RSV later in life
could get more asthma
tx epiglotittis
prepared to establich airway
cephalosporin x 3
tx epiglotittis
prepared to establich airway
cephalosporin x 3
tx scarlet fever
PCN in order to prevent rheumatic fever
tx epiglotittis
prepared to establich airway
cephalosporin x 3
RSV later in life
could get more asthma
RSV later in life
could get more asthma
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
epiglottitis cause, presentation and careful
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH

Thumb sign in side view

DOn"T EXAMINE THROAT OR IRRITATE CHILD!
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
tx RSV
supportive although ribavarin and palivizumba as necessary
RSV later in life
could get more asthma
RSV later in life
could get more asthma
RSV later in life
could get more asthma
RSV later in life
could get more asthma
tx RSV
supportive although ribavarin and palivizumba as necessary
tx RSV
supportive although ribavarin and palivizumba as necessary
mono on blood tests
atypical lymphocytes with lymphocytosis
heterophile antibodies
tx epiglotittis
prepared to establich airway
cephalosporin x 3
tx RSV
supportive although ribavarin and palivizumba as necessary
RSV later in life
could get more asthma
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
tx RSV
supportive although ribavarin and palivizumba as necessary
EBV assoc with what cancers
nasopharyngeal carcinoma
burkitt pymphoma
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
tx RSV
supportive although ribavarin and palivizumba as necessary
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
tx RSV
supportive although ribavarin and palivizumba as necessary
tx RSV
supportive although ribavarin and palivizumba as necessary
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
splenomegaly and sports
NOs contact sports
diphtheria presentation and tx
cornebacterium (G+)
gray pseudomembrane, myocarditis
erythromycin and antitoxin
what is toxic erythema
that's the rash you get with try tx EBV with penicillin (because thought it was strep)
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
pertussis presentation and tx
whooping tough (Bordella G-)
azithromycin or Bactrim
how to diagnose strep retrospectively
natistrep O
anti DNAse
PCN will only prevent what if strep+
only rheumatic fever + scarlet fever

NOT GN
erythema martginatum
the rash you get with rheumatic fever
toxoplasma in babies
intracranial calcifications
chorioretinitnis
Ring enhancing lesions
how tx toxoplasmosis
pyrimethamine
sulfadiazine
VZV presentation in babies
limb hypoplasia
scarring of skin
syphilis in babies presentation
rhinitis
saber shins
hutchinson teeth
rubella in babies
blueberry muffin
cataracts
heart defects
CMV in babies
sensorineural deafness
ventricular calcifications
causes of floppy baby
wednig hoffman (AR), progressive
botulism, sudden
werdnig hoffman genetics and what is it
AR
degernation of anterior horn cells (motor)

hypotonic at birth

progressive
dx and tx werdnig hoffman
dx with genetics or muscle biopsy

tx supportive
dx botulism
finding toxin or organisms in the feces
tx botulism
human antitoxin
muscular dystorphy genetics and presentation
Xlinked
muscle weakness, large calves, low IQ, gower sign
diagnose and tx muscular dystrophy
muscle biopsy

tx supportive (most die by 20yo)
mitochondrial myopathies presentation
ragged red fibers on biopsy
ophto issues
what is genetics and presentation of myotonic dystrophy
AD
20-30YO
can't relax grip
MR, blaness, testicular atrophy
most common brain tumors in kids
astrocytoma
medulloblastoma
wilms bs neurobalstoma presentation and location
flank masses
wilms fromkidney
neuroblastoma from adrenal (get better on own)
unicameral bone cyst how look, who gets, pronosis
well demarcated black on xray, in humerusin children

Is benign but can weakne bone to cause fractures
osteosarcoma, who gets it, how look
10-20YO
sunburt appearance on xray

maybe can feel a mass
drops in neonataes eyes
silver nitrate, erythromycin OR tetracyline drops to prevent gonorrheal conjunctivitis
lineup of conjunctivits and times in newborn
chemical reaction
gonorrhea (2-5days_ topical
chlamydia (5-14 days) systemic
tx gonorrha conjunctivitis
if not prophy

TOPICAL erythrmocycin PLUS IV/IM ceftriaxone
tx chlamydia conjunctivitis = inclusion conjunctivitis
oral erythmomycine, and treat so you can prevent chlamydia PNA
cataracts in newobrn, think
TOCH infection, or inherited disorder
when refer for strabismus
3 months.
congenital hip diysplasia treatment
pavliks harness
legg calves perthes what is it and how treat
reduction of blood flow to hip so get some osteonecrosis

tx with ORTHSOSIS
SCFE what is it and how treat
fracture in growth plate so femoral head slips from est of feumor

SURGICALLY PIN IT (overweight kid)
LCP, CHD, SCFE how manifest as adults?S
arthritis on hip!
what is nursemaids elbow and how fix it
radial head ssubluxation
see bhild won't move elbow after being lifted by the hand

Do manual reduction by supinating elbow and 90 degrees flexion
osgood schlatter disease what is it and tx
osteochondiritis and tibial tubercle, pain swelling

supportive treatment
juvenile rheum artrtisis, labs, presntation, referral
referr to ophtho for uveitis

pain, limping
eye disease
growth retardation

often RF negative
conduct disorder turns into
antisocial
ADHD tx and side effects
treat with stimulants (methylphenidate)
dextraamphetamine
amoxetin

insmonia, abdominal pain, anorexia, weight loss

Tx with drug holidays to combat side effects
tourette and ADHD
tourette d/o can be caused and maybe unmasked by the use of stimulants for presumed ADHD
tx touette
if severe, haloperidol

otherwise
flupheaazine (dop receptor blockers)
encopresis/enuresis is problem starting when
encopresis @ 4
enuresis @ 5
complications of RDS (no surfactant)
IVH
BPD
tx TTN
self resolves
hypospadia vs episapadias
hypospadia flaccid undersuface
epispadia ventral when rigid
tx surgially

epi also ass with exstrophy of bladder
left vs right gonal veins drain into...
L into left renal veins

right gonadal/testicular/ovarian vein into IVC