Question Notes

Id
long term neurologic sequelae associated w/ bacterial meningitis : 1. hearing loss 2.loss
of cognitive functions due to neuronal loss in dentate gyrus of hippocampus) 3. seizures
326
4.MR 5. spasticity or paresis.... S/E OF CEFTRIAXONE: EOSINOPHILIA,
thrombocytosis, leukopenia, bleeding, skin rash, increase Cr/ast/alt/bilirun levels....
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small face, small jaw, prominence occiput, no skin creases on palmar aspect of his
digits, overlapping of his fingers bil, ocker bottom feet , limite abduction, heart
murmur present --- Edward trisomy 18 VSD...... Down syndrome (trisomy 21
353
associated with ASD and endocardial cushion defect.. william's syndrome associated w/
supravalvular aortic stenosis.... Digeorge & velocardiofacial syndrom associate w/
conotruncal abn ( truncus arterosus, tetralog of fallot, interrupted ao
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1181 externa ear infection+ radiatn to temporomandibular joint exacerbate by chewing...
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blunt trauma - cxr show retroperitoneal air --> duodenal injury.. next step is CT scan
1786
with contrast to confirm and look for if there is present of duodenal hematoma...
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SHY-DRAGER SYNDOME= parkinsonism, autonomic dysfunct (postural hypotension,
disturbance of bladder contr, wide spread neurological signs ( cerebellar, pyramidal or
LMN).. always consider shy drager syndromw when a pt w/ parkinsonism experience
2066
orthosatic hypotension impotence incontinence or other autonomic ... tx is aim at
intravascular vol expansion with fludrocortisone, salt supplment, alpha adrenergic
agonists, and constriction of lower body...
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2153 mc s/e of post sx is hypocalcemia.. would increase DTR... other things increase dtr are
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HIV.... Reccomended vaccines are : infleunza, hep B, and S pna., might need hep A for
gay... SHOULD NOT GET BCG, VARICELLA, VERICLL ZOSER, ANTRHRAX,
2415
ORAL TYPHOID, INTRANASAL INFLEUENZA, ORAL POLIO, YELLOW
FEVER VACCINES;
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UC = cause bloody diarrhea, tenesmus, wt lass , anemia, potentially, sclerosing
2429 cholangitis, uveitis, erythema nodosum, spondyloarhrography,... routine surveillance
with yearly colonscopy
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CLASSIC TRIAD OF DISSEMINATED GONOCOCCAL INFECTION:
polyarthralgia, tenosynovitis, andpainless vesiculopustlar... compare to other rash?
2527
Lyme dz= erythema migrans, typicalally monoarticular knee pain...syphiliss produce
painless ulcer of genitalia, meningococcemia present w/ petechial rash...
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essential tremor: difficulty holding a newspaper, wdrinking coffee, feeding themselvces,
2850
writing eligbilh.. tx beta blocker..
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men genitourogen: PRASTITIS: s/s chill, perineal pain, back pain..w/ leukocytosis w/
114
increased bands . HIs urinary urgency dysuria, and pos leukocyte esterase more likely dx
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trauma- abd wall ecchymoses, tender abdomen corrisome for blunt abdominal trauma
202
(BAT)..
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intoxicatoin: cocained=inc HR, alerness, (w/drawal = increase appetite).. Opioi
intox=decre RR, miosis... Marijuana intox=inc appepite, incr RR, red eye, time
1043 distortion, confusion, dry mouth, inc RR/HR/BP.... Benzodiapeine overdose = slur
speech, unsteady gait, incoordinat, drowsiness ... alcohol into=unsteady gait, nystagmus,
slurred speech
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1857 cardio-syncope: different types: situational syncope, postural hypotension
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2127 cardio-hyponatremia indicare elevatoin fo ESR and president
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cardio.. mechanism: Impaired myocardial contractility = CARDIOGENI SHOCK
occurs when cardiac output unable meet tissue o2 demands .... ventricular filling
restriction =tTRAUMATIC CARDIAC TAMPONADE eventually may lead to
2477
cardiogenic shock.... in tamponade would expect elevated venous filling pressure and
jug venous distention..BLUNT TRAUMA WITH PULMONARY INJRU prod .... air
embolism = ..... loss of vascular tone= occurs in setpic shock and neutrogenic shock..
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Atypical anti-pyschotic med increase risk of obesity, H-glu, dyslip, htn.. Fasting
2822 glucose and lipids must monitor....ALL ATYPICAL ANTI-PSCHYTOTIC LOWER
RISK OF EPS...
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med- OTOTOXIC : aminoglycoside, loop diuretic ( furosemide), ASA @ H-er dose,
and chemotheuropeutic meds ..............HCTZ s/e: orthostatic hypotension,
740 photosensitivity, hypercalcemia (note not good doc 4-pt tend to have gout or stones, but
perfect 4-women to prev osteoporosis)..... ACEI s/e: cough due inc bradykinin,
hyperKalemia, & angioedema...
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 order to testing for MONONUCLEOSIS: Initital test is heterophile antibody test.... IF
result negative but H suspection for IM then do EBV-specific antibody test.....S/S:
1544 triad:high fever, LN-thy, & pharyngitis....LN inv'ed sym, posterior cervical chain more
cmm than anterior chain.. tender hepatosplenomegaly is cmn .... LAB: leuko-osis,
lymphocytic predominance..
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neuro/vascu--- AVM=ARTERIOVENOUS MALFORMATION = severe h/a (
migraine-like h/a) that cause vomiting & ams) hx of seizure... cause subarachnoid
2061
hrrg............. NOTE: trauma usu cause epidural or subdural hrrg... and
INTRSACEREBRAL HRRG usu have focal neurologic deficit & thrombocytopenia &
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biochem- Liver maintain glucose via glycogenolysis & gluconeogenesis... after 24 hr
fasting.. gluconeogenesis sole source of glucose... gluconeogenic aa (muscle), lactate
2212 (anaerobic glycolysis), & glycerol 3-phosphate (from TAG in adipose)....alanine -->
pyruvate at liver via ALT......... Pyruvate from alanaine ( muscle ) and lactate ( from
anerobly glycolysis)
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cardio - Exercise EKG test: has a H predictive accuracy 4-intermediate pretest
probability of CAD grp.. High risk = men over 40 yo & women over 60age)... low risk
2237
= men under 40yo and women under 50yo.... Meds should be w/held 12-24hr prior
exercise EKG test are BB, digoxin, or anti-ischemic meds. This test has a
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inf-LYME- Ixodes scapularis tick - Connecticut--remove tick w/ tweezers grab
2599
mouthpart with steady pressure...w/in 24hrs to reduce risk of tick-borne dz.
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resp & Immun -- ANKYLOSING pt can have restrictive lung dz.. key to differentiate
fibrosis vs autoimmune AS is the FRC.. Normally, restrictve lung dz has decreased
2512
FRC... AS HAS WNL-INCREASED FRC B/C FIXATOIN OF CHEST WALL IN
INSPIRATORY POSIONT...
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SBP: SPONTANEOUS BACTERIAL PERITONITIS: dx is positive ascites fluid c/x &
85 PMN >250/mm.. paracentesis should be done before abx ... E coli & Klebsiella are mcc
organisms..tx: 3rd generatoin of cephalosporin
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ped- FRIEDREICH ATAXIA: (AR) s/s: unsteady wide-bades gait w/ wt shifting to
maintain balance, dec proprioceptn @ LE & ankle jerks bil, high plantar arches, MRI:
cervical sp cord atrophy > cerebellar atrophy, EKG: T-wav inversn @ inf & lat
319
leads..mech: repeat trinucleotide sequenc -->abn tocopherol transfer protein.. poor px..
wheelchair by 25yo, death by 30-35yo.. Associatn: necrosis & degeneratn of cardiac
muscle fiber --> myocarditis, myocardial fibrosis, cardiomyopathy...
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 Wilson Dz: weird s/s: rest tremor, muscle rigidity, clumsy gait, slurred speech,
drooling..Rare Autoso Recessive d/o. Copper deposition @ liver, basal ganglia, cornea.
Childer & adolescent s/s liver dz and young adult present neuropsychiatric dz ( rigidity
844
to paranoia and catatonia..) Dx: serum ceruloplasmin 20mg/dL in conjunction with Inc
urinary copper excretion or Kayser-Fleischer rings. Bx:macrovesicular steatosis,
vacuolated hc nuclei, Mallory body, portal fibrosis,
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1392 racemic epinephrine help croup
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association- obesity cause oestoarthritis.... vegan @ risk for low vit D... alcoholic @
2058
osteoporosis
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-hemolytic anemia: tx prednisone first, if fail then proceed to splenectomy... w/U: dec
haptoglobin, inc LDH, inc ind bilirubin, pos coomb test, reticulocyte elevated, hgb
2374
decrease, wbc inc, ...look for non-tender LN-apathy... (if pos & over 60yo think of
NHL or CLL)
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paget dz = wnl vit D, serum Ca, gamma glutamyl transferase, but elvated alp...frontal
bossing, hearing loss, increase head size, h/a, cranial nerve palsies..... >>> RENAL
11
CELL CARCINOMA = associate VHL... CARPEL TUNNEL SYNDROME =
acromegaly, amylodiosis, hypothyroidism.
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Uncomplicated cystitis = healthy, nonpregn, .. Complicated = pregna, very old, very
uong, dm, immunocomp, abn anatomy of GU tract... s/s dysuria, uri freq, suprepubic
pain, hematuria.... in complicated cystits. URINE CULTURE -when it's complicated
103
cystits, urinary s/s not characterist of cystitis, persistent s/s of cystitis despite tx, or
repeat cyfst 1mo after tx of prev cystits w/o urine cx. DOC for uncompl is bactrim and
nirofurantoi med. complica tx w/ fluoroquiniolc...
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DOWN SYNDROME 21 - simian crease, short broad hands, hypotonia, high arched
palate, Brushfiled spots (speckled irises), hypoplasia of middle phalanx of 5th finger,
376 intestinal atreasia, Dx: confirm by karyotype... Edward=index finger overla w/ 3digit,
5th overlap w/ 4th, rocker bottom feet, prominent occiput, PATAU = trisom 13, cleft
ip, polydactly, ocular hypoterloism,
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PKU 3 TYPES: CLASSIC (TYPICAL)PKU = characteristics ( caucasian race,
musty/mousy odor of urine b/c phenylacetic acid, eczematoid rash, vomit, failure to
thrive, met acidosis, dev delay) and criteria to dx class pku: 3/4 ( Plasma phen
380
>20mg/dl 2.wnl-low plasma tyrosine level 3.wnl tetrahydrobiopterin level, 4.H urine
phenylpruvic & o-hydroxyphenlacetic acid).Benign PKU ( 20mg/dl). Transient
pku=serum mild inc & no urinary phe..only symp at newborn..
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484 mediastinal mass: 4T's thyoma, teratoma, thyroid neoplasm, lymplhoma.
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cardio murmur - AORTIC STENOSIS - systolic murmur, harsh systolic @ R upper
sternal & radiation to carotid arteries, s4, .. in young pt ( bicuspid aortic valve.. in elder
598
think of senile calcific aortic stenosis...... NOTE: HCCM HAS HARSH SYSTOLIC
MURMUR & S4 BUT @ left lower sternal border & nor radation.
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DM INFECTION- DOC Rhzipus / mucormycosis is IV AMPHOTERICIN...
901
itraconazole/flucanaole wont work...
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GYN/ONC - PREMATURE OVARIAN FAILURE: primary hypogonadism in women
40yo. chemotherapy, radiation, autoimm ovarian failure, Turner's syndrome, & fragile
X synd are poss causes. increase FSH and LH. .rise FSH > LH b/c slower clearance of
1750
FSH. s/s: hot flashes, vaginal & breast atrophy, amenorrhea, pscycho-depressn,
anxiety,irritabliy.. w/u:b-hcg, prl level, fsh. Dx: amen more than 3month + signifi inc
FSH
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ANALGESI NEPHROPATHY = hematuria , elder, take NSAID for pain reliever..
1940
unchange RBC in urine,
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classic case of AORTIC DISSECTION: long hx of htn, faints / syncope after
experiencce sudden onset of chest pain radiate to back. tachycard, hypotension, jugular
2317 veins distend, significan variation systolc BP related to respiratory cycle (meanign
pulsus paradoxis = distal pulse disappear upon inspiration), CRX widen mediastinum...
cause of syncope is pericardial fluid accumulation....
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vWD - VON WILLEBRAND DZ = plt cnt wnl, BT and PTT prolonged....
2320
echchymoses, epitaxis,
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CO poisong = cause left shif of curve, reduce O2 deliver to tissues --> anaerobic
2378
metabolism --> increase lactic acid prdtn --> anioin gap hypochloremic met acidosis...
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dx OA = knee hip spine ginders , monoarticular, nodular protruion @ DIP= Heberden,
PIP=Bouchard nodes, DX: 6 classic criteria: >50yo, minimal or no AM stiffness, bony
2523 tenderness, bony enlargemnt, crepitus on active motion, no warmth jt (b/c non-inflam
arthritis)...... RA=palpable popliteal mass = Baker cysts, subcutan nodules @ repetitite
trauma...
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166 Atypical PNA: cause: M.
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 BRONCHOSCOPY VS CT-SCAN BX - bronchoscopy is invasive so done after CT
confirm mass located peribronchial area - peripheral lesion --> CT guided bx
BRONCHIAL OBSTRUCTION --recurrent pna @ same anatomic region suggest
937
obstruction.. -- poss causes: bronchiectasis, foreign body, bronchial stenosis,
bronchogenic carcinoma. -- OBSTRUCTION SHOULD THINK OF CARCINOMA
UNTIL PROVEN OTHERWISE ( so do chest CT scanning)
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Asthma vs GERD: - nocturnal wheeze / cough, hoarseness @ AM & clear during day -
2272
1st line = PPI eg pantoprazole
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Resp:>>CAP-Legionella: intracellular gram neg rod.. S/S: GI complain, prod cough,
focal lobar consolidation, rales,HIGH FEVER >39C differentiate from other CAP,
965 ASSOCIATE w/ CRUISE SHIP/HOT HOTEL WATER def dx charcoal agar/urinary
Ag test. Tx:macrolides or fluoroquinolones. s/s: high fever >39.0C, GI, prod cough,
cruise ship,
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endo-lytes-serum ALBUMIN & CALCIUM measured simultaneously to calc correct
1012 total serum ca.. every 1g/dl decrease of albumin make Ca level decrease by 0.8mg/dL...
If suspect proteinura 4+ cause hypocalcemia.. check Cr level, 1,25(OH)2 D...
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resp-WARFARIN GOAL - 2.0-3..0 for PE prophylaxis. If MECHANICAL VALVE
1539
INR 2.5-3.5
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Resp: RESTRICTVIE LUNG DZ; sarcoidosis, silicosis, asbestosis, pulm fibrosis,
scleroderma, rheumatoid lung Resp:COPD: EMPHYSEMA VS CHRONIC
2052
BRONCHITIS: emphysema has abn DLCO and dec FEV1/FVC... chronic bronchitis
has wnl DLCO and dec FEV1/FVC
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endo-DIABETES- ERECTILE DYSFUNCTION: due to neuropathy, vascular
complication, & meds. DOC=1st line is phosphodiesterase inhibitor
(e.g.SILDENAFIL). PDEi: 1. contraindicated w/ NITRATES & htn to PDEi
2128
2.predispose to priapism 3.concurrent w/ ERYTHROMYCIN/CIMETIDINE prolong
half life of PDEi 4.combining w/ alpha-blocker (e.g.DOXAZOSIN) will have
hypotension so use them at least 4hr interval.
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Resp--VENT MACHINE: PEEP=lower o2 via dec # of alveoli available .. but better
2473 choice to lower FiO2 first.. too much o2 bad. goal to keep paO2>60 VENTILATION =
pCO2 = TV & RR determine this..
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 endo--GALACTORRHEA: W/U:TSH, PRL, cmn cause; overstim nipple, OCP,
prolactinoma, hypothyroid, and med lower da. do mammography if has red flag
2480 symptom (unil d/c, pos guiac,lump). cytologic indicated when guiac pos to help
distinguish carcinoma vs proliferatnv vs inflammatn. Sx indicated when d/c involved w
pos guiac/gross blood/lump..
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resp-ER HANDLE BURN PT: abc then assess for burns on face,singing
2534 eyebrow,oropharyngeal infl, blister, carbon deposit, carboneous sputum, stridor, CO-Hb
>10%, hx of confinement in building ...indication for intubation...
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ped-WEIGHT: wt 2x by 5mo, 3x by 1st yr. HEIGHT inc 50 by 1st yr, 2x by 4 yr, 3x
2759
by 13yrd
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Resp-- ARDS vs CARDIOGENIC PULMONARY EDEMA CRITERI A DX
ARDS:precipiator, PaO2/FiO2 200, bil filtrates, normal PCWP.... cardiogenic cause has
high PCWP ( >18mmHg). LUNG COMPLIANCE: decrease in pulm edema/fibrosis.
927 PEEP is used to counteract decreased compliance.. >LVEDP: increase in CHF caused
by htn or hypertrophic cardiomyopathy. Pulm arterial pressure .ARD cause shnting via
elevatn alveo-arterial O2 gradient. HYPOVENTILTN/dec FiO2 cause hypoxemia w/
wnl alve-art o grad
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endo- MEN2A: 100% hyperplasia C-cell ( inc calcitonin), 50% pheochromocytoma,
20-30% hyperparathyroid.. W/U: measue calciton, NUCLEAR RENAL SCAN indicate
1453
for renovascular htn & not pheochromocyoma. ENDOSCOPY is for MEN 1 ( involve
parathyroid, pituita, pancreatic tumor)
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endo-PHEOCHROMOCYTOMA: young fem c/o paroxysmal htn..Dx: Urinary VMA
(vanillylmandelic acid ).. Tx give alpha blocker before give beta blocker, o/w BP rise
1912 rapidly. Mech: block B-receptor --> unopposed stimulation of vascular a-receptor by
circulating catecholamines --> rapid catastrophic increase BP... MECHANIMSM OF
BETA BLOCKER: tx tachycardia & sympathetic hyperactivity (e.g. tremor, sweating,)
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resp--COPD EXACERBATION: s. pneumonia, H influenza, M catarrhalis. W/U
2033 suspect pna:: 1. CXR 2. EMPIRICAL TX Sputum gram stain= pos indicatn of purulent
if >25PMN & 10 epith cells/low power field . Problem: oral flora -- > false positive
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endo-TOXIC ADENOMA: risk of bone loss ( inc osteoclast activity) if left untreated.
2244 Coronary artery dz can be unmasked or worsen w/ thyrotoxicosis.... LABS: high
T3/T4, low TSH, no infiltrative opthalmo involved..
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 endo- DKA IN UNDX DM-1: teenager dry mucous,polyuria, dec LOC, diffuse abd
pain, met acidosis ( due low HCO3), URI...Infection precipitate DKA via infectn -->inc
glucagon,ctecholamines, cortisol -> hyperglycemia,ketonemia, osmotic diuresis..
2451
DIURESIS --> RENAL LOST K STORES but plasma show elevate K+emia b/c
acidosis & decrease insulin cause K redistribution to extracellular. DKA: cause inc hep
gluconeogenesis,inc lipolysis ->inc free FA, inc ADH -- hyperosmola intravascu
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Resp Sx - Pulm Contussion vs ARDS: timing is the key. CONTUSSION: 1st 24 hrs &
focal lung involved and ARDS is 24-48hrs p trauma & bilateral lung involved... O:
2081 tachycardia, tachypnea, hypoxia. bruse chest wall, dec breath sound L: CXR-irreg
alveola infiltrate, ABG: hypoxemia Dx: patchy alveolar infiltrate on CXR & hypoxia..
all develop w/in first 24 hrs Tx:
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resp sx - PULM CONTUSION = not shown clin immediate p injury.. pt dev hypoxia &
ards hrs later as pulm edema ..adm fluid bad AORTIC RUPTURE = MEDIASTINAL
WIDENING, DEPRESSION OF L MAIN BRONCHIS, DISPLACEMNT OF
2474 TRACHEA & ESOPHAGUS TO RIGHT, & OBLITEATION OF AORTIC KNOB
SHADOW ON CXR. >>> FAT EMBOLISM = AMS,PETECHIAE P 12-72HR
INITIAL UNJURY, RESP DISTRESS...>> MYOCARDIAL CONTUSION = asymp,
may present arrhythmia, heart failure , chest pain,PCWP increase much higher levels
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resp sx- TENSION PNEUMOTHORAX; s/s: mva=blunt chest trauma,
hypotension/tachycar/tachypnea despite recv fluid resuscita... neck vein distended=inc
2475 cvp.. trachea deviated to right side ( mean Left tension pneumothorax) ... best initial
mgt: needle thoracostomy @2nd ICS.. if pt remain hemodyn unstable -->pericardial
tamponade should be supsected
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resp sx- RISK FACTORS POST-SX COMP:smoke,preexist pulm dz, >50yo, sx>3hr,
poor ge hlth. >>POST-SX MEASURES / PREV ATELACTASIS: incentive
2482 spirometry, early ambulation, head bed incline,deep breathe exercise, cpap reserve for
comp casese b/c exoensive... goal increase FRC... >> ATELECTASIS : dev w/in 24hrs
post-sx.
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resp sx- best MGT ATRAUMATIC MASSIVE HEMOPTYSIS = RIGID bronchoscopy
to simulta localize & control bleed site.. (dx & theuropeutic).. Mexicom /ww = mcc of
2486
massive hemoptysis is M. tuberculosis...CONCERN OF HEMOPTYSIS =
ASPHYXIATION
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resp sx= FLAIL CHEST = CAUSE PULM CONTUSSION = primary cause of
2496
respiratory distress --> see severe tachypnea & hypotension tachycardia..
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 resp sx-FLAIL CHEST: inward motion of a side of chest wall on inspiration. become
symmetric post positive pressure mech ventilation...ESOPHAGEAL RUPTURE =shock
2498
via mediastinitis & 3rd spacing fluid into mediastinum...>>TRACHEOBRONCHIAL
INJURY=signs hemoptysis,pneumomediastinum, & air leaf after chest tube placement
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PFT = part of routine f/u of COPD & in lung cancer pt being eval for sx
candidates...>>>>> SPN = SOLITARY PULM NODULES = Llsn 3cm, CXR first then
2533 CT scan... bx via percutanous pronchoscopy or VATS for high risk pt...CXR
monitoring q3mo/6mo, and annually x2yrs for low risk of malignancy based on
demogra & radiographic data...
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resp sx-RQ QUOTIENT = rate prdtn CO2/rate uptake O2.. RQ=1 -->predom oxidatn of
carbohydrate & net lipogenesis.. if RQ>1.0 --> excess carbohydrate oxidatn from
2543 diet...protein RQ=0.8 & lipid RQ=0.7, glucose RQ=1.0.... ASSESSING RQ IS IMP
WHEN ATTEMPTING TO WEAN PT FROM MECH
VENT......sepsis=hypercatabolic fat & prot so RQ1.0...
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resp sx-VAP (VENTILATOR ASSO PNA): on vent >48hr & result of impairment of
2632
lung natural defense. >>>S/S:=fever,hypoxia..psueduomonas,
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gi-HEMEMESIS = w/in hr if due to endoscopy related esophageal
perforation...HEMOBILIA = AST/ALT ratio > 2 typical for alcohol hepatitis..
71
MALLORY WEISS TEARS = ruptured submucosal arteries of distal esophagus and
proximal stomach.
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GI- MICROCYTIC ANEMIA / COLONOSCOPY: elder, fatigue, low iron & ferrtin,
high tibc, Even neg occult need colonoscopy.. then upper GI scope..If both colonoscopy
78
& upper GI endoscopy neg --> do capsule endoscopy look for small intestine dz(AV
malformatn).. tachycardia & flow systolic murmur heard @ L 2nd IC.no eccho nec.
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liver- CHRONIC HEPATITIS B.. STEPWISE APPROACH TX OF ASCITES: Na &
H20 restriction , then start spironolaction, then add loop diuretic (not more than 1L/day
of diuresis to prev hepato-renal syndrome), and then freq abd paracentesis (2-4L/day as
86
long as renal function okay).DISTAL SPLENO-RENAL SHUNT worsen ascites,
SIDE-TO-SIDE-PORTO-CAVAL shunt help ascites but worsen
encephalo,PERITONEO-JUGULAR shunt help
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gi- FOLIC ACID DEF VS VIT B-12 DEF: folic can be stored 4-5mo (vs. 3-4yr), heat
sensitive in food cooking, s/s: macrocytic anemia (vs. macrocytic anemia & neuro
997
deficits & strict vegan)..>>vit D def=osteomalacia & hypocalce -->tetany, vit E
def=RBC fragile,muscle wknss,blindness,..vit c=perifollicul hrrg
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 Gi= PANCREATIC CANCER = s/s epigastric pain, jaundice, chronic pancreatitis hx
1518 --> suspicon of pan cancer --> do CT .. if fails then do ERCP .. if obstruct do MRI...u/s
good for screen..
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GI- SCREENING UPPER ENDOSCOPY=over 55yo w/ nos of dyspepsia or any age
but w/ alarm s/s eg. wt loss/dysphagia/persistent vomiting..causes of dyspepsia=gerd,
1521
nsaid,funct dyspepsia, pud, malignancy.. dyspepsia= 1 or more s/s of epigastric pain,
postprandial fulness, early satiety, can be coexist w/ abd burn/nausea/bloat.
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GI- ZINC DEFICIENCY: s/s skin rash, alopecia, abn taste, impaired wound healing...
1726 pt on TPN diet watch for Zn and selenium deficiency... Selenium cause
cardiomyopathy.
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HY GI-ZENKER'S DIVERTICULUM =motor dysfun btw upper esoph sphincter &
esopha dysmotility...--> outpocket btw fibers of cricopharngyeal muscle..s/s older 50yo
2125 & dysphagia & neck mass..Dx. barium study.. tx: cricopharyngeal myotomy or sx
excision..Exten inflammaton cause diverticula at mid-eso zone=TRACTION
DIVERT..ESOPH WEB=met abn (eg iron def) asso w/ this.
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GI- manometer used to DIFF ACHALASIA/SCLERODERMA/DIFFUSE ESOPH
SPASM /GERD:>>> achalasia (dec-abs peristaltic waves inc LES tone), scleroderma (
2265 dec-abs peristaltic wave & dec LES tone)., diffuse eso spasm (periodic high amplitude
non-peristaltic wave. GERD inc LES but present peristaltic wave...NON-peptic
dyspepsia not asso w/ esophageal dysmotility.
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GI- HERPES ZOSTER (SHINGLES) = constant burning pain right of
2368 umbilicus..severe pain when lightly touching skin .. one wk later skin lesion most likely
to develop.. old with recent radiation or immuno compromised.
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gi-CHRONIC PANCREATITIS: s/s diarrhea xwks pale volumnious foul smell stools
that hard to flush. sev intermittent epigastric pain last 15-30 min p eating.. 72hr fecal
2856
test to confirm steatorrhea..CT help pancreatic calcification & ductal dilation..mcc
alchol & gallston obstruction.
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GI= GLUCAGONOMA = suspect this dx when triad of hyperglycemia,necrotizing
540
migratory erythema and diarrhea...
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812 liver-SIGNS OF HEPATITIS: s/s malaise,myalgia,n/v, mild RUQ pain...
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 OB- IUFD ( INTRAUTERINE FETAL DEMISE = death >28wkGA, s/s no fetal
move't. DX: U/S no move't, W/U: mom vital sign, fibrinogen (low=red sign), plt cnt
2682
MGT: counsel risk of coagulapathy & reccomd spontaneous prompt delivery. C=section
only if mom in danger.. SPONTANOUES ABORTION = FETAL 20wK OR WT 500G
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OB-ASYMPTOMATIC UTI = doc tx E coli are amoxicillin, nitrofuratoin,
2409 cephalosporin... Clindamycin is okay to treat anaerobe.. not for UTI.. Bactrim is a no
no.. Clss med in pregn.
------------ -------------------------------------------------------
renal - IgA NEPHROPATHY VS POST-STREPTOCOCALL
GLOMERULONEPHRITIS: mcc of glom hematuria after URI. IgA is mc in adult and
98
has normal complement and few days after URI.... Post-strept has low complement, avg
10days into pharyngitis or 21days into impetigo...
------------ -------------------------------------------------------
med cancer- RALOXIFENE = SERM=SELECTIVE ESTROGEN RECEPTOR
MODULATOR: do 1st line prevention osteoporosis @ breast & endometrial -->
287
antagonist.. in bone: agonist.... s/e: incr risk DVT, hot flash, leg cramps..unlike
raloxifene, TAMOXIFEN = INC RISK OF ENDOMETRIAL CANCER..
------------ -------------------------------------------------------
heart valves- TETRALOGY OF FALLOT = mc cyanotic spell in child 4yo..PE:
pansystolic murmur ( du to VSD), subpulm stenosis ( give single S2).. cyanosis
correlate to amt of obstructions... PDA VSD = non-cyanotic congenital heart dz...
308
TRANSPOSITION OF GREAT VESSELS = cmn cause of death w/in 1st year of
life..cyanosis w/in fist few days of life.. HYPOPLASTIC LEFT HEART SYNDROME
-heart failure w/in first few weeks of life.. px= grave...
------------ -------------------------------------------------------
gyn-PAP SMEAR - FINDING LSIL/CIN 1 / MILD DYSPLASIA: PLUS adolescent
--> repeat in 12months.... plus premenopa --> colposcopy.... plus post-meno --> do
526 either HPV test or Colposcopy... (ultimate is colposcopy if HPV pos).... S/N:
CONIZATION = CONE BX = done via electrosurgical techn, cold knife, laser.. to eval
cervical transformation zone..
------------ -------------------------------------------------------
anatomy knee- MEDICAL MENISCUS INJURY = MCMURAY SIGN'S= palpable to
audible snap when extend leg at knee from full flexion while simutanously applying
1505
tibial torsion...ACL= hx of foreful hyperextension injury to knee or a noncontact
torsional injury of knee during deceleration..
------------ -------------------------------------------------------
heme-MACROVASCULAR TRAUMATIC HEMOLYSIS= see addtn note for
1543 intravascular vs exrtravascular hemolysis... W/U HEMOLYSIS = HB, MCV, RETIC
CNT, LDH, HAPTOGLOBIN,P/S.... (POSS: coomb test, hemosiderin in urine,
------------ -------------------------------------------------------
 tox- ALCOHOL INTOXICATION = slur speech,ataxia, ams, resp acidosis,
hypopnea..>>CYANIDE =h/a/n/v/abd pain, flush skin.. >>TCA POISON=CNS
depressn,arrhytha,hypotension,anti-chol s/s (sweat/drool/hyperthermia,flush,dil
1792 pupil/dec bowel sounds/urinary retention.. ANTICHOLINERGIC TOXIC=similar to
TCA poison (hyperthermia, urina reten, dec bowel sound) but diff is dry mouth..
caustic poson= cognitive least affected, damage lining of GI.. white tong,
heavysalivation, dysphagialll
------------ -------------------------------------------------------
micro resp- IMMUNOCOMPROMISED + CHEMOTHERAPY + PNA +
2051 CXR-INTERSTITIAL INFILTRATES BILATERAL: think of PCP if nonproductive
cought, tachypn, tachcard, cyanosis, perihilar .... CMV if leukemia + GI s/s
------------ -------------------------------------------------------
inf-OSTEOMYELITES CUASES: in DM chronic foot ulcer spreat to bone via
CONTIGUOUS SPREAD... POST-TRAUMATIC OSTEOMYELITIS via direct
2105
oculation... In children, is via hematogenous.. >>AFTER sx/operationg via nosocomial
contamination
------------ -------------------------------------------------------
micro- STAPH = large fluctant cx LN in children.. dicloxacillin or cephalexin to cv
strepto & staph..... LISTERA & STREPT = pcn.. ( pcn & aminopcn uneffect in tx
2290
staph due to B-lactamase enzyme ....MACROLIDE = erythromycin tx strepto
pharyngitis & mild com pna...
------------ -------------------------------------------------------
endo-ADDISON DZ=PRIM ADRENAL FAILURE: s/s anorexia, fatigue in
100%pt..hyperpigmentant, dec BP, vitiligo, wt loss.. Lab: hyponatremia, hyperkalemia,
2357
inc renin & ATII, midl hyperclhoremic met acidosis... >>> COMMON CAUSE OF
HYPO-MG-EMIA: diuretic use, alcho, malabsorp, & poor intake
------------ -------------------------------------------------------
heart association---RHF = Mitral Stenosis.... mediastinal widening = aortic dissection &
2653 tearing chest pain radiate to back...... MI=left ventricular aneurysm... HOCM=asym
hypertrophy of intraven septum...
------------ -------------------------------------------------------
lung cancer ASBESTOS EXPOSURE = ONLY RISK FACTOR FOR
MESOTHELIOMA...HOEVER, higher incidence of bronchogenic carcinoma than
928 mesothioma... on CXR: mesothioma would have mass on pleura... bronchogenic would
have at ....>>exposure abstosis increased risk of pulm fibrosis, pleural plaques, and
mesothioma, and bronchogenic carcinoma..
------------ -------------------------------------------------------
 renal-BARTER SYNDROME = urine cl >40 High, hypokalemia, normnatremia, met
alkosis, high renin & high aldosteron (due to RAAS activated), low-wnl BP [
PRIMHYPERALDOSTER= LOW RENIN HIGH ALDO,HTN... RENIN-SECRETE
1150
TUMOR- HIGH RENIN, HIGH ALDO, HTN]..BARTER SYNDROME= defective of
NaCl channel at ascending loop Henle ( GITLLEMAN AT distal onv tube) --> renal try
to save Na in expense of K+ and H+
------------ -------------------------------------------------------
endo- ERECTILE IMPOTENCE IN DM PT = cuase are autonomic neuropaty,
vascular, medcation , and functional hypogonadism (=low testosterone, low LH, low
1528 FSh, pos a systemic illness..defective GnRH secretion.)...>>.prim hypogonadism =
elevated Gn levels, elev LH & FSH lead to inc testicular aromatase activity --> high
estradiol prodtn....._)
------------ -------------------------------------------------------
TOXICITY OF AMINOGLYCOSIDE = gait imbalance & to and fro move't -->
739
vestibular insult & ototoxicity.. AG=GENTAMICIN
------------ -------------------------------------------------------
Upper GI BLEEDING MGT = hematemesis & depressed LOC --> risk of aspiration -->
slt:intubation to protect airway... two large bore IV >>intubation >> upper endoscopy
2864 to intervention & thereuptic..PLT TRANSFUSION = INDICATED WHEN PLT
50,000....IF PT HAS ELEVATED INR --> FFP CONSIDERED.. prophyl abx &
somatostatin ( e.g. octreotide ) considered..
------------ -------------------------------------------------------
PULMONARY EMBOLISM = inc HR/RR, dec BP/O2 saturatoin... CXR-clear, no
wheeze.. EKG: Atrial-fibrillation... LOOW OXYGEN SATURATION & A-FIB
170
ASSOCIATED W/ POOR PROGNOSIS....atrial fib = irregular RR interval & narrow
QRS complex & no definite P-wave...
------------ -------------------------------------------------------
endo thyroid - GRAVES'S DZ most likely develop hypothyroidism post radioiodine
1421 therapy. Note, multinodular goiter & toxic adenoma remain euthyroid post radiodine
thereapy...
------------ -------------------------------------------------------
PULMONARY EMBOLISM = desat O2, inc HR/RR, wnl BP, CXR clear, EKG show
non-spec ST/T-wave changes... SOB & pleurtic chest pain... dx studies: Helical CT
1434
pulmon angiography is IOC for wnl creatinine but VENTILATION PERFUSION is
IOC xrenal pt...Typical ABG: hypoxia, respiratory alkalosis, and maybe hypocapnia...
------------ -------------------------------------------------------
PHEOCHROMOCYTOMA & HYPERCALCEMIA and has a sister died of high blood
pressure... ==> think of MEN 2A .. do serum calcitonin test... ( medullary carcinoma
1453 of thyroid)....MEN I = HYPERPARATHYROID, PITUITARY, & PANCREATIC
TUMORE.. would do endoscopy lok for GI ulceration caused by excess gastrin which
secreted by gastinoma that typicalla located @ head of pancreas...
------------ -------------------------------------------------------
 RH INCOMPALITY only in mom has Rh neg...... DIAMOND-BLACKFAN
SYNDROME= CONGENITAL HYPOPLASTIC ANEMIA: macrocytic, low retic cnt,
congenital anomalies. pathology= intrinsic defect of erythroid progenitor cells -->
1754 increased apoptosis.. 90% case dx in 1st yr of life... DBS vs megaloblastic anemia ( no
hypersegmentation in DBS).. electrophorresis reveal elevated fetal Hb levels...
chromosomal wnl... Tx: corticosteroids in conscious pt.. Transfusion therapy in
unresponsive pt...
------------ -------------------------------------------------------
Major Depression w/ psychotic features: depression happen before to pyschosis.. (
socially w/drawn & eccenctrically behavior = psychotic)... SCHIZOAFFECTIVE D/O
= schizophrenia & mood s/s .. at least 2 wks of psychotic without any mood
1991
symptoms...SCHIZOPHRENIA = > 6 months detached & emoionally blunted, social
w/draw, odd behavior, auditory hallucination... DYSTHYMIA = depressed most days
x> 2 yrs & minimal functional impair.. CYCLOTHYMIa=alt hypomani & dep x>2yr
------------ -------------------------------------------------------
IN LEUKEMIA PT RECV CHEMO = if develop pna, dry cough, cxr-diffuse bil
2051 interstitial infiltrate, .. DD: CMV vs PCP... CMV TEND TO ASSOCIATE WITH GI
SYMPTOMS AS WELL..
------------ -------------------------------------------------------
Adrenal insufficen = ANOREXIA in almost 100% pt., fatigue, GI, hypotension,
2357 hyponatremia, hyperkalemia, mild hyperchloremic metabolic acidosis,
hyperpigmentation, decreased BP, vitiligo..
------------ -------------------------------------------------------
cancer breast - INTRADUCATL PAPILLOMA = sympt of unilaterl intermittent blood
2479 d/c and no lump felt on PE, normal u/s .. because super tiny in areolar and has soft
consistency...PAGET's DZ = discharge, eczematous at areolar, dx confirm by histology..
------------ -------------------------------------------------------
CHF = CHRONIC HEART FAILURE = hx of CAD put pt @ risk for CHF b/c of
LVD..typical s/s: bilara crackles, dec breath sound at base due to pl effusion from
CHF... ABG: hypozia, hypocapnia, resp alkalosis highly suggestie of CHF vs COPD (
2507
side note: PE is has this typ ABF profile as well)...(COPD: whould have hypoxia and
resp acidosis ) More specific testing for CHF would includ BNP & pulm capillary
wedge pressure...( in CHF will elevate due to Left ventricular dysfunction)...
------------ -------------------------------------------------------
INFLAMMATORY MONOARTHRITIS = single red/swollen/painful jt are SEPTIC
ARTHRITIS OR CRYSTAL-INDUCED ARTHRITIS..... Hx: fever, had RA before, ...
WORK UP= FLUID ANALYSIS, GRAM STAIN, CX, .. mgt: need to distinguish
2508
crystal induced vs septic ...COLCHICINE = used in acute crystal-induced RA...
CORTICOSTEROID = CIed in septic arthritis..ALLOPURINOL = for prevention or
recurrent gout...
------------ -------------------------------------------------------
 PULMONARY EMBOLISM = D-DIMER has 95% of negative predicted value
2565 meaning if test negative --> can exclude DVT.... Note: venous u/s has low sens &
specific.. so neg result can not exclude DVT...
------------ -------------------------------------------------------
NASOPHARYNGEAL CARCINOMA = undifferentiate ca of squamous cell origin ..
high freq in Medi / Far Eastern descent.. s/s recurent otitis media via eustachia
1433 obstruction, rec epistaxis, nasal obstruction. Strong associatn w/ pos serology EBV -->
EBV titer used as eval of therapy.. Also associated w/ smoking & chronic nirosamine
consumption ( salted fish)....
------------ -------------------------------------------------------
STREPTOCOCCAL PHARYNGIST = GRP A STREPTOCOCCUS fever, bil tender
cx LNapthy, exudative pharyngitis tx is pcn to hasten recovery, prevent RHF, and
prevent transmissio n to close contact...Dx test : rapid test for strepto Ag (high
61
specificiy but limited sensit).. if neg rapid test hen do culture... If pt has GNitis do
Antistreptolysin O Ab to see if pt has infected by strept before..VIRAL
PHARYNGITIS = conjunctivits, rhinorrhea, viral exanthem
------------ -------------------------------------------------------
DYSFUNTIONAL UTERINE BLEEDING: heavey bleeind in absence of dz ... Dx:
pregn test neg and phys exam negative and wnl u/s. TX: mild=iron supplem .. if
269
moderate + no active bleeding --> progestin.. if moderate + active bleeding --> estrogen
indicated.
------------ -------------------------------------------------------
TYPE OF DYSKINESIA (EPS) caused by da-rec blocker, anti-pschy,
metoclopramide..s/s present w/in 1-6mo, ORAL & FACIAL=tongue protrusn/twist, lip
smaking/pouting,chewing/retractn of corner of mouth LIMB=limb twisting,foot tap,
409
dystonic extension of toes NECK & TRUNK=torticollis, shoulder shrug,rocking,sway,
rotary hip mov RESPIRATORY=grunting noises.RISPERIDONE=atyp, most..
CLOSAPINE=lest,atyp watch for agranuloytosis
------------ -------------------------------------------------------
HIV + HHV8 = reddish purple dark vascular plaques or nodule on cutanouse or
662
mucosal surfaces...
------------ -------------------------------------------------------
INTRACRANIAL PRESSURE = brain parenchyma (constant unless mass),CSF(k
unless obstruction), blood flow(CBF).VOL of blood & inc w/ hypercapnia /met
demeand/hypoxia via cerebral vasodialtion. Brain autoreg CBF & perfusn pressure to
1146 maintain a relative constant flow. this mech dysfunct in trauma/stroke.CEREBRAL
vasodil & elev BP raise the ICP. LOWERING ICP=dec CO2 via hyperventiltn
.cautious:poss ischemia,head elevtn(inc ven outflow(,sedatn (dec met demand & control
htn),manitol
------------ -------------------------------------------------------
 PCOS = STEIN-LEVENTHAL SYNDROME= anovultn,androgen exess & ovarian
1295 cysts, infertile problem..cause imbal LH & FSH prdt & insulin resistance.Tx:
clomiphene citrate & metformin..
------------ -------------------------------------------------------
blunt amd trauma not same as penetrating abd trauma... blunt abd trauma = peritoneal
1352 lavage used if u/s not available..... in gun shot which is penetrating do laparotomy in
unstable pt.. no FAST
------------ -------------------------------------------------------
nasal polyps = asthma, allergic d/o.... NASAL FURNCULOSIS = staphyl from nasal
1360
nares... rhinoplasty=septal perforation.
------------ -------------------------------------------------------
FOLLICULAR CANCER OF THYROID - FNAB show histology o invasion of capsule
& blood vessel ( follicle adenoma doesn't)spreads via hematogenous to lung/brain/bone.
Folli cancer is encapsulated & does not have distintive nuclear features. Local LN
1432
involvement is rare in foll can (but cmn in papil ca).. Hurtle cells seen in both papil &
foll ca. Papill can is mc malignancy of thyroid, slow infiltratve local spread after affect
other part of thyroid gland and LN, has psamm,uncapsul
------------ -------------------------------------------------------
MULTIPLE SCLEROSIS = 29yo female paraplegia, urinary incontinence, urgency, no
trauma, hx of trigemnial neuralgia.. PE: UMN lesn= spascitiy, hyperreflexia in LE,
1578 impaired vibration & proprioception of left forarm.. On CSF exam: oligoclonal bands,
elv Ig ( A, M, G) predom increase IgG.. however, oligoband is not diagnostic test b/c
other dz can increase Ig... ..GBS = albumino-cytologic show elev protein & wnl cell cnt
------------ -------------------------------------------------------
GBS-peripheral nerves affected...: 12yo boy have febrile diarrhea 10 days ago and
cannot walk anymore... no h/a/v/n/.. PE: sym flaccid paralysis of both legs, absent
DTR, dec superficial touch & vibr sense. no nuchal rigidity.. INITIAL pin-neeedle sens
1600
of foot -->aswend wkss of LE to trunk to UE --> bulbar & resp mecsle..nerve
conduction velocity show demyelinzation. CSF:ele prote, mild elev cells
(albumino-cytology dissociation)..tx: plasmapheresis or Ig
------------ -------------------------------------------------------
CEREBELLAR HEORRHAGE = ataxia, right-sided facial wknss, deviatn of eye to left
(gaze palsy), occipital h/a, --> lsn at . EMERGENT DECOMPRESSION
LIFE-SAVING. IF left untx, coma may ensue due to brainstem compression....HTN
1662
HRRG =PUTAMEN hemiparesis, hemi-sens loss, homo hemianopsia, stupor/coma. eye
deviate away from paralytic side.. PONTINE HRRG=paraplegia w/in few min, pinpoint
pupils & reactive light,decerebrate rigid.
------------ -------------------------------------------------------
 DIABETIC NEUROPATHY = OVERFLOW INCONTINENCE, inc residual vol, loss
small urine from distended bladder.. DETRUSOR INSTABILITY/IRRITATION
FROM NEOPLASM/INTERSTITIAL CYSTITIS=urge incont, nocturia, freq, abn
2161
urine analysis.. STRESS INCONTINENCE=old women, hgh parity is risk, cause by
floor muscle wknss, cough/sneezing/laugh make out. U/a, cystometry, postvoidal res vol
wnl. Kegel exercis, pessary, estrogen, Burch proc, sling pro,
------------ -------------------------------------------------------
SEPTIC SHOCK:high cardiac output, low sys vasc resistance/right atrial pressure/pcwp,
& freq normal MVo2.significan vasodilation --> decreased sys vasc resistance -->septic
shock. Wnl MVo2 b/c hyperdynamic circulatn & high cardiac Outpt. NEUROGENIC &
2174
HYPOVOLEMIC SHOCKS have low MVO2 b/c increase O2 extraction by
hypoperfused tissues. Low Left ventt preload if sign fr vol depletn or intravascul fluid
redistbtn. CARDIOGENIC SHOCK=high pcwp
------------ -------------------------------------------------------
DYSTONIA =typical anti-psychotic, metoclopramide, &
prochlorperazine).PARKINSON'S DZ = rest tremor, bradykinesia, rigidity, postural
instability. ESSENTIAL= rest & intent tremor resolve during sleep & improved by
2336 alco/BB.CHOREA = brief irreg unintent muscle contractn, flow not
rep/rhythmic.MYOCLONUS=invol rhym jerk AKATHISIA = freq sens of restlessness
that causes pt to move ATHETOSIS=writhing move in
Huntington..HEMIBALLISMUS=unil,violent armfling contral subthal nucleus
------------ -------------------------------------------------------
VAGAL MANUEVES = VALSALVA / CAROTID SINUS MASSAGE ,
IMMERSION IN COLD WATER would increase vagaonl tone, dec condiction thru
2387
AVa node... ... this slows HR and break the rhythm.. ADENOSINE ia a very SA
AV-nodeal blocker that often used as well..
------------ -------------------------------------------------------
VACCINE RECCOMENDATIONS: 1. TD Q 10YR POST AGE 18 2.A single TdaP
booster for adults of all ages in place of Td 3. IM inactivatd influenza vaccine give to
2412
all adult..... (intranasal : healthy, non-pregnant adult 65yo or 65yo with
CV/pulm/hep/renal/met/immusupresn.. booster q 5yr.
------------ -------------------------------------------------------
HYPOGONADOTROPHIC HYPOGONADISM = athlete female c/0 amenorrhea.. at
2417 risk decreased bone mineral density although she wourks out alot... b/c of low
FSH/LH...Cause: excessive exercise, anorexia noervosa, hypothyroid,
------------ -------------------------------------------------------
PAD=extremity claudicatn,exertion-rel pain, restrelieved. mcc=atherosclerotic vasc dz
RISK= incr age,DM,smoker,htn,hyperlipid.ABI=dx PAD = sys bp of post tibial &
pedis/brachial artery. wnl=ratio 1-1.3.If ABI0.9 -->more than 50% occlucion in major
2431
vessel. If ABI0.4--> limb ischemia.Arterial duplex u/s to loc lsn.Gold standard=contrast
arteriography= invasive,do it in unclear dx/plan invas interven. ENDOVASCUL
STENT=sx fail, refractory to meds/not candid for sx
------------ -------------------------------------------------------
OA= excessive bony growth., cartilage degradatoin & mucle atrophy cause
2524 deformity.......RA = subluxation & tendon damage cause permanent deformity.....Septic
Arthritis = distal phalangeal bone resorption give classic "pencil-in-cup" deformities.
------------ -------------------------------------------------------
MS=MRI show bil multifocal asym contrast enhace periventricular white matter (plaque
compromised BBB allowing contrast toaccumulate.Dx:two or more epi of two or more
neuro s/s ..Tx: glatiramer acetate to dec freq & severity of MS exacerbtn. mech:induce
2578
suppressor T-cell that downreg T-cell mediated immun response to myelin Ag that
underlies MS.,.. ARGATROBAN=IV anticoag used in thrombosi in heparin-induced
thrombocytopenia who req anti-coag..
------------ -------------------------------------------------------
2582 Respiratory Muscle Fatigue: GBS, botulism, ALS, myasthenia gravis...
------------ -------------------------------------------------------
ECHOVIRUS & COXSACKIEVIRUS = mcc of viral meningitis. CSF:pleocytosis,
lymp predo, neu predo @ early course, supportive tx. s/s resolved w/in 7-10days. s/s:
2770
URRI, fever,h/a,irritab, nuchal rigid, BACTERIAL MENINGITIS: csf:inc cnt/protein,
dec glu Stain show bacteria.
------------ -------------------------------------------------------
METABOLIC ALKLOSIS + SIGNS OF VOLUME DEPLETION = THINK OF saline
responsive ( Ucl 20mEq/L) vs saline resistant (Ucl >20mEq/L) LAB: low K & Cl, high
HCO3.. wnl Ca, Na.. Ucl 20....this is Met alk saline responsive lab profile cuased by GI
2803
H+ loss ( e.g.vomiting), vol depletion, or diuretic abuse. tx: infusion of isotonic
saline... note:breathe into a bag --> incr PCO2 --> correct pH somewhat but not good
sltn...
------------ -------------------------------------------------------
cardio-SBE=subacute Bacterial Endocarditis=facial injury --> transient bactermia &
seeded mitral valve... b/c of abn valve --> predispose to endocarditis. Do blood Cx .. IV
2664 abx.. never PO abx in endocarditis case... progressive fatigue & chronic waxing &
wanine LGF... Never IV AG ( gentamicin) alone, must combine w/ another abx. IV pcn
G.. not IV pcn V b/c pen V is for orally
------------ -------------------------------------------------------
bio- screening; as X move to Left = lower ends points --> senc increase, FN & PPV
5
dec, prevalence is the same..
------------ -------------------------------------------------------
bio-False negatives will increase when cut off level (enzyme level) increases.. X moves
987
toward the right, sensivity decrease, spec increases, FP decreases.. prevalence same?,
------------ -------------------------------------------------------
bio-RR=RELATIVE RISK... the further value of RR from 1, the stronger association.
1644
eg. RR=1.6 vs RR=4.0... 4.0 is stronger assiciation than 1.6.
------------ -------------------------------------------------------
 Bio-LEAD TIME BIAS = a new screening test for poor prognosis dz like lung or
1816 pancreatic cancer.... typical example of lead time bias is prolongation of apparent
survival in pt whom is applied without chaning the px of the dx..
------------ -------------------------------------------------------
bio- GIVEN: MEAN = 230 STAND DEVIATION =10 WHAT WOULD BE THE
1840
RANGE BASED ON 95% CI... answer: 10x2=20 --> 210-250
------------ -------------------------------------------------------
Bio-COHORT STUDIES RELATIVE RISK GIVEN FIND P-VALUE. If RR=1.6 -->
1845 there is association btw risk factor & dz. Therefore, P-value must be less than 0.05 to
show it's significant and can reject null hypothesis and say there is an association.
------------ -------------------------------------------------------
bio- CROSS SECTIONAL STUDY = PREVALENCE STUDY: measure epposure &
outcome simultanouesly randomly from a pop... Pros: cheap, easy.. Cons: temporal
1858
relationship btw exposure & outcome not always clear.......... COHORT=select a grp &
follow them..
------------ -------------------------------------------------------
bio-GENERALIZABILITY = EXTERNAL VALIDITY = perstains to the applicability
1896 of result of a study to other popn. do not expect result of studying middle women apply
to elder...
------------ -------------------------------------------------------
bio- the r = coefficicent assess a linear relationship btw two variables.. if neg mean the
1925
opposite and grear than pos one mean association in positive way
------------ -------------------------------------------------------
bio- sltn to bias... Confounding = mathcing, restriction, and randomization... Selection
bias= choose representatve sample of popn for stuyd and achieving high rate of follow
1937 up.. Observer bias = controlled by blinding technique.. Ascertainment bias= avoided by
select a strict protocol of case ascertainment.. Effect modification is not a bias so
shouldn't be controllev..
------------ -------------------------------------------------------
bio- if RR is greater than one but has wider range means smaller sample size, lack of
1955
statistical significance....
------------ -------------------------------------------------------
Bio- if prevalence of dz is low (e.g. rare weird dz), the exposure odds ratio
2045 approximates the relative risk. The outcome of a case control study is not common in
popn, the odd ratio is close to the relative risk...
------------ -------------------------------------------------------
bio- increase dx accuracy increase the incidence and prevalence... high mortality rate
2109
would decreased the prevalence...
------------ -------------------------------------------------------
 case control study= dz grp compare w/ healthy grp.. info collected about exposure to
risk factors.. retrospective, odds ratio calculatd.. but indicence of a dz cannot be
calculated...CASE SERIES = determin natural hx of uncommon conditions but no info
2623
on incidencec.. CLINICAL TRIAL COMPARES TO THEURAPEUTIC benefit of diff
interventn.. incidence cant be extracted from clinical study .. CROSS-SECTIONAL
STUDY= incidence cant be extracted either. COHORT STUDY= incidence can cal
------------ -------------------------------------------------------
2458 resp- NEW CLUBBING IN PT W/ COPD OFTEN INDICATION OF CANCER
------------ -------------------------------------------------------
ped -X-LINKED AGAMMA-GLOBULINEMIA= BRUTON'S
2699 AGAMMAGLOBULINEMA... s/s: low CD19 =b-cell.. defect in Bruton's tyrosine
kinase, a signaling molecule expressed in B-cell at all stages of development..
------------ -------------------------------------------------------
sx trauma - anterior vs posterior urethral injury: posterior inj: cant void, prostate
displace= hide riding upon DRE, blood @ urethral meatus, scrotal hematoma, & s/s of
1276 pelvice fracture... ANTERIOR=: NORMAL PROSTATE PLACEMENT, BLEEDING
FROM URTHRA, PERINEAL TENDERNESS/HEMATOMA, MAY NOT C/O CANT
VOID., complica: urine into scrotum/perineum/ad wall..
------------ -------------------------------------------------------
trauma- TENSION PNTHORAX: clinicall dx. cmn s/s tachypnea, decrease breath
sound, tracheal deviation... Confirm tension PNthorax: on phys exam see jugular
1438
venous distention and hypotension --> needl thoracostomy .... must take this breathing
problem before C=circulation.. large IV bore for fluid resusication..
------------ -------------------------------------------------------
endo- Middle age woman gain lbs, insomnia, lab:hypokalemia, UL of Natremia,
hyperglycemia, htn. cause? sumptoms: wknss, central adiposity, thining of skin, wt
gain, psychiatric problems ( insomina, psychosis, depression) ---- CUSHING'S
2658
SYNDROME.. excess cortisol : 1. vasoconstriction ( htn), 2. insulin resistance ( High
Glu) 3. mineralocorticoid activity ( aldo-like act: save Na waste K --> hypokalemia..
poss met alkososis b/c loss H+ too...
------------ -------------------------------------------------------