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Medicine Poop

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jigipufu's version from 2017-05-09 15:07

Medicine poop

Signs and when to's

Question Answer
HypercalcemiaTroussea (tourniqit), Chvostek's (cheek) signs, Stones, Bones, Groans, Throans, Psych overtones (renal/bilairy stoens, bone pain, abdominal pain, N/V, polyuria, cognitive disfunciton)
hypocalcemiaCATS go numb, Convulsions, Arrhythmias, Tetany, numbness/parasthesias (feet, hands, lips)
When to get dialysisAEIOU - Acidosis, Electrolytes (K+), Intox (methanol, Li, ASA) Overload (volume), Uremia (>90)
SLE?MD BRAIN SOAP Dx w/ 4/11 - Malar rash, Discoid lesions, Blood dyscrasias, Renal disease, ANA titer, Immune findings, anti dsDNA and anti Sm which are specific and antiphospholipid or falsf positive VDRL or anticardiolipin, Neurological Sx (seizure psychosis), Serositis (peuritis, pericarditis, peritonitis), Oral ulcers, Arthritis (indistinguishable from RA), Photosensitive rash
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stuff

Question Answer
Ketones in Alcoholicsalcoholic ketones = beta-hydroxybutyrate which is not really detected in serum ketones, so there will be an anion gap but ketones won't be detected, DKA ketones (acetoacetate) are detected
TTP PentadeThrombotic thrombocytopenic purpura - Nasty fever Torched His Kidney (Neurological Sx, Fever, Thrombocytopenia, Hemolytic anemia, Renal Failure)
Cr scale?Logarythmic or something, so 0.5 -> 1 is a reduction in 1/2 your kidney function
first sign of line infectiontrouble drawing from it
Kussmaul signincreased in JVD w/ inspiration
kussmaul respirationbreathing deep and fast trying to expel C02
Linezolid and antidepressantsLinezolid is a Leak MAOI Serotonin syndrome!
Promethazine and metoclopramideHave dopamine like SE can precipitate NMS
what 3 things should you order with dyspnea?CXR, ABG, EKG (PE not ruled out)
2 Qs for screening depression?over the past 2 wks, have u felt down depressed or hopeless? little interest or pleasure in doing things? sn96% spec 57%
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formulas and criteria

Question Answer
Winter's1.5(bicarb) +8 +/- 2 = expected pCO2
Lights criteriafor effusion v transudate .5 .6 .7 -> pfluid/serum protein, pfluid/serum LDH, pfluid > 2/3 upper normal - any 1 indicates exudate
SIRS criteriaHR above 110, temp <96.8 or >100.4, RR >20 or PaCO2 <32, leukocytes >4k or <12k - need 2 of 4 = suspected infecton
Delivery of O2sat% x (Hb) x CO
PAO2?150-(PCO2/0.8)
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Cardiology

Question Answer
Brugada syndromefamilal condition from dysfunctional cardiac Na channels, RBBB and ST elevaton in leads V1-V3, Tx is AICD, responsible fo 1/2 of the sudden deaths in young healthy people
arrhythmogenic right ventricular dysplasiaRV poops out, genetic non ischemic cardiomyopathy, causes sudden death in young people via ventricular arrhtymias, treat with AICD
role of BNP testingSensitive for HF, <100 can rule out HF in pts with dyspnea
aortic stenosis and age?30-40 think rheumatic fever, 50-60 think bicuspid, 70+ normal degeneration
pulsus parvus et tardussmall and delayed pulse, can be seen in aortic stenosis
CHF exacerbation and Txnegative EKG and enzymes, Echo shows HF and increased BMP, treat with LMNOP - Lasix, Morphine, Nitrates, Oxygen and Position
pericarditis EKGglobal ST elevation, PR segment depression (pathoggmenoic)
Beck's triadHypotention, JVD and muffled heart sounds
pericardial knockin constricive pericaridits, Tx with pericardectomy
narrow and regularsinus tach, a flutter, atrial tach (short P-R), AVNRT, AVRT
Narrow and IrregularA fib, A flutter (variable block), multifocal atrial tach
Wide and regularVT
Wide and irregularpolymorphic VT
PEA6H and T's, Hypovolemia, Hypoxia, H+, Hypo/Hyper K, Hypoglycemia, Hypothermia, Toxins, Tamponade, Tension pneumothorax, Thrombosis pulmonary or coronary
PEA? 3 most common causes?inability of cardiac muscle to generate suficient force in response to electrical dpeolariztion, 3 most common are severe hypovolemia, pump failure, obstruction
Chest pain TxMONA BASH - morphine, oxygen, Nitro, ASA, beta blokers (prevent arrhthmia) Ace, Statin, Heparin
BBBR to left pass through the gates (V1,V2) and find the eye of sauron LBB (V5,V6)
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Endocrine

Question Answer
Metabolic Syndromewaist circumference m40 w35, TG >150, hel m 40, w50, BP 130, fasting glucose >110
LDL goals0-1RFs LDL goal <160, initaite drug therapy >190, CAD or equivalent goal <100, initiate drug >100
Myxedema comasevere hypothyroidism resulting in AMS
euthyroid sick syndromesupression of TSH in nonthyroid illness, T3 sharply declines and T4 remains unchanged, adaptive response to stressol,;
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ID

Question Answer
CD4 200-350Candida, HSV, TB, CAP, MRSA, Kaposi's
CD4 200PCP, Histo, Blasto, coccidio,
CD4 150Toxo, Crypto
CD4 <50MAC, CMV, Crypto, EBV / CNS Lymphoma, JC / PML
every degree of fever o2?O2 consumption increases 13%, so pts with heart and lung disease have problems with fever
G - rods and temp?increase temp but decrease HR!
One degree of fever ?increase in 10bpm
MRSA blood infection?Vanc, Linezolid, Daptomycin
MRSA skin?Bactrim, clinda (for community), Doxy
HyperthermiaCHASE NMS - CNS damage, Heat stroke, Anti-chol, Serotonin syndrome, Endocrine, NMS, Malignant hyperthermia, Sympathomemetics (cocaine, especially when dehydrated)
Hidden causes of feverAEIOU - Abscess, Endocarditis, IV catherters, Osteromyelitis/discitis, UTI/Foley
Fever other than infectionDIVA 1) Drug induced 2) Inflammatory - Neoplasm, Transfusion, 3) Vascular - PE, DVt (low grade), MI 4) Autoimmune - Vasculitis, Crohns, SLE, RA
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pulm

Question Answer
COPD long term mortalityonly cessation of smoking and supplemental O2
pseudonomralizaiton in asthma1st ABG probably shows respiratory alkalosis, then 2nd looks normal but it could be large airways closing and catastrophe is near
resp alk and tinglingincreased pH causes ionized clacium to bind more readily to albumin seemingly causing hypocalcemia, also alkalosis causes vasoconstriction
cotton feverfilter drugs with cotton, seed Enterobacter agglomerans in lungs
transudatesNephrosis, cirrhosis endocardiosis (CHF 80% and pericarditis)
exudatesempyema, malignancy, PE
cough receptorsin the larynx, trachea, bronchi and cough in etting of rhinitis, rhinosinusitis and pharyngitis is attributed to reflex stimulation from postnasal drainage or throat clearing
Upper Airway Cough Syndromerecurrent cough that occurs when mucous drains and hits cough receptors
Interstitial lung diseaseEnvironmental (coal, silica, beryllium asbestos, hypersensitivity pneumonitis [birdhandler's/anything]), drugs (methotrexate, amiodarone, hydralazine, bleomycin, phenytoin, crack lung), Vascular disease (scleroderma, SLE, vasculitis), Sarcoid, idiopathi pulmonary fibrosis (only 1%)
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GI

Question Answer
Abdominal wall pain types1) Visceral - i.e.hollow organ, pain is colicky, occurs when muscular tube squeezes against obstruction (bowel, ureter, bile duct) 2) Solid Organ - pain is constant but does not induce guarding 3) Peritonitis - inflammation of hte peritoneal cavity, induces involuntary contraction of abdominal muscles with even slightest pressure, results from ruptured viscous, death imminent 4) Vascular 5) Abd Wall 6) Referred
Pt with abdominal bleeding what line do you start?2 large bore peripheral IVs, central line catheters are small and long in diameter, bad for pushing fluids for resuscitation
5 causes of AST/ALT >1,000Toxins (not EtOH alone!) acetaminophen, Isoniazid, Mushrooms, Extasy, CCl4, Viral/autoimmune hepatitis, Budd-Chiari (hepatic vein after liver), Shock liver (low BP) congestive hepatopathy (sever HF)
budd-chiari is associated with?Myoloproliferative diseases e.g. CML, polycythemia
Causes of cirrhosisVW HAHPPENS - Viral, Wilsons, Hematomachrosis, Anti-trypsin deficiency, PSC, PBC, EtOH, NASH, Something else
what kills patients with GI bleeds?Myocardial ischemia
possible causes of upper GI bleeds?PUD, Varices, M-W tear, AVMs, Malignancy, Esophagitis (toxic/caustic, CMV, HSV, Candida, tetracyclines, bisphosphanates, pill esophagitis) gastritis,
Referred Causes of Abd pain1) Thorax - pneumonia, pleuritis, inferior wall MI, diaphragmatic irritation /hernia 2) Testicular - torsion, injury or orchitis 3) Neurologic - nerve impingement, VZV, neuritis
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MSK

Question Answer
L4-L5 herniationpain radiating to the anterolateral leg and great toe with weakness in the anke and dosriflexion of great to is consistent with L5 nerve impingement
L5-S1 herniationpain radiating to the posterior leg with weakness in ankle plantar flexion and a decreased ankle jerk reflex suggest S1 nerve impingement
straight leg testsensitive but not specific, electric shock down effected side (everyone has tight hamstrings)
crossed leg raiselift unaffected leg to reproduce pain in the affected leg, low sensitivity, high specificity
Medial plica syndromeextra synovium, pain at the beginning of exercise
Balotmentfluid wave for knee
BAck pain Red flagsIncontinence, addle anesthesia, fever and weight loss, prevoius cancer, decreased reflexes, babinski, long term steroid use, iv drug abuse, urinary retention, gait abnormalities, hx of osteoperosis
Tests for back painstraight and crosse dleg, rectal tone, cremasteric reflex, strenght, spurling sign, sensory
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