- SBP (spontaneous bacterial peritonitis) is an infxn of ascites.

S/s; fever,
none, AP, AMS. dx with ascitic fluid has PMN count > 250/mm^3, culture is
positive, and secondary causes excluded. MCC -> E. coli
- orbital cellulitis is an infxn posterior to the orbital septum. MC predisposing
factor is sinusitis, others include local infxn or trauma. PE: unilateral, signs of
elevated intraocular pressure (proptosis, eye pain, chemosis, blurry vision,
limited extraocular motion). CT scan is dx test. MCC -> S. auerus and strep
- periorbital celluitis is an infxn anterior to the orbital septum. MC
predisposing factor is sinusitis, others include local infxn or trauma. PE:
unilateral periorbital swelling but no signs of elevated intraocular pressure!
- s/s compartment sydrome: 6 Ps - pain, paresthesia, paralysis, pulselessness,
pallor, poikilothermia
- Chapman's points:
1st ICS: tonsils
1st rib & clavicles, lateral to where they cross the 1st ribs: middle ear
2nd ICS: thyroid gland; esophagus; myocardium; bronchi
4th ICS: lung disease
6th ICS: stomach peristalsis (L), liver (R), gallbladder (R)
7th ICS: spleen (L), pancreas (R)
8-10th ICS: small intestine
1st superior & 1st lateral to the umbilicus: kidneys
periumbilical region: bladder
- RBBB: QRS complex is >120 ms; rSR' in V1 (& usually V2); slurred S waves (I
& V6)
- the hirsutism of PCOS can be tx w/ spironolactone (testosterone antagonist)
- PCOS is dx with 2/3: ovulatory dysfxn (oligo or amenorrhea), polycystic
ovaries on US, and hyperandrogenism (hirsutism or acne on PE or elevated
serum androgen levels); classic finding is an LH:FSH ratio greater than 2:1
- Clomiphene citrate - induces follicle maturation so that the ovum can be
released for fertilization. Targets the anovulation that occurs in PCOS for pts
who have concomitant infertility
- screening for chlamydia and gonorrhea infxn is indicated for all sexually
active females 24 and younger. pap smear is started at age 21 q3 yrs. HIV
screening is recommended for thoese 15-65 y/o
- syphyllis screening only for high risk individuals and pregnant patients
- ileal resection results in Vitamin B12 deficiency anemia secondary to

malabsorption of the vitamin B12-intrinsic factor complex. Megaloblastic

anemia with a blood smear showing hypersegmented neutrophils. Neurologic
symptoms.
- in illness anxiety d/o, pts are preoccupied w/ development of a severe
physical illness despite minimal concerning sxs
- Escherichia coli O157:H7 is a common cause of HUS in kids under 5. Sxs:
uremia, thrombocytopenia, and hemolytic anemia following bloody diarrhea
- cohort studies are prospective (forward looking) observational studies which
take a healthy population w/ an exposure to look at the # of people who
develop an outcome.
- Duchenne's muscular dystrophy found in male kids and caused by a deleted
dystrophin gene. pt will have trouble getting up from the floor due to lower
extremity ms weakness. enlarged calf muscles are also prominent due to fat
replacing necrotized ms. ms necrosis causes an increase in serum CPK
- body dysmoprhic d/o -> preoccupation w/ an imagined or minor physical
defect marked by distress. tx: CBT, SSRI
- coarctation of the aorta MC occurs just distal to the left subclavian artery
causing HTN in the upper extremities, hypotension in the lower extemities,
and asynchronous radial pulses (if it is before the left sub. a). buzzwords on xray are rib notching and figure 3 sign.
- CPAP in sleep apnea reduces complication chance of HTN, CVA, TIA, and MI
- Apt test is used to differentiate fatal/neonatal blood from maternal blood
- when knee's Q angle is increased -> genu valgus; when decreased -> genu
varus
- cushing's syndrome is a d/o of excess cortisol production that leads to
central adiposity, moon facies, hirsutism, striae, glucose intolerance, and
HTN. seen in pt w/ small cell lung carcinoma due to ectopic production of
ACTH
- classic EKG findings for PE are RBBB, sinus tachycardia, and S1-Q3-T3
pattern
- hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome is a/w
development of several cancers. (colorectal, ovarian, gastric, biliary tract,
brain, prostate, skin, esp endometrial) autosomonal dominant. test writers
will always mention a family hx of multiple cancers.
- peutz-jeghers syndrome is characterized by multiple pigmented spots most

often found on the lips, oral mucosa, and GI mucosa. Hamartomas are found
on colonoscopy
- Gardner's syndrome is a/w adenomatous polyps - plus osteomas, lipomas,
fibromas, cysts, and dental abnl
- testicular torsion should be treated emergently w/ surgical detorsion and b/l
orchiopexy
- Misoprostol may be used to prevent NSAID induced ulcers
- cholangiocarcinoma is a cancer of the bile ducts. Klatskin tumors are those
that arise at the confluence of the hepatic ducts. The MC RF is primary
sclerosing cholangitis. Painless jaundice, due to obstruction of bile flow, is the
MC presentation. dx is made w/ tumor markers CEA and CA19-9 coupled w/
the finding of a mass lesion on U/S. .tx is possible surgical &/or
chemoradiotherapy
- metformin is the 1st line drug for tx of DM type 2 w/ normal kidney fxn. if
A1C is btw 7-8.5%, add sulfonylurea. If over 8.5%, add insulin
- dx test of choice for lactose intolerance is the hydrogen breath test
- fibromyalgia affects women ages 20-50 y/o. pain and tenderpts are located
primarily in the b/l neck, shoulders, low back, and hip areas, symmetrically.
1st line tx includes duloxetine, milnacipran, and pregabalin. TCA off label
- OCD ego dystonic, tx w/ CBT + clomipramine or SSRI
- superior vertical strain, the sphenoid will flex and the occiput will be in
extension and is commonly due to a centrally located blow to the frontal bone
- inferior vertical strain, sphenoid extended and inferior to the flexed and
superior basiocciput. due to trauma either anterior or posterior to the SBS
- PVC's are common findings that appear as a wide QRS, unrelated to P-wave.
tx w/ beta blockers only when symptomatic
- fulminant meningococcemia is characterized by prominent petechiae and
purpursa, hypotension, DIC, acidosis, adrenal hemorrhage, multi-organ
failure, & sometimes coma. concomitant meningococcal meningitis occurs in
significant %. tx ASAP (even before LP) - IV vanco, IV ceftriaxone, IV
dexamethasone
- tight hamstrings cause ipsilateral posterior inominate rotation
- RF breast cancer: early menarche, late menopause, late age at 1st delivery,
no having a full term delivery, not breastfeeding, obesity, alcohol use (1-2

drinks daily)
- a scaphoid fx is MC type of wrist fx which classically occurs during a fall
onto an outstretched hand. pain/swelling over lateral wrist. when xray
positive, casting/pain mgmt for 6 weeks. xray negative, snuffbox tenderness,
then cast 7-10 days and reimaged w/ xray
- Tourette syndrome is a/w ADHD, OCD, learning d/o, & conduct d/o; Tx:
fluphenazine or haloperidol
- completed abortion before 20 wga and characterized by passage of all
products of conception, vaginal bleeding, and a closed cervical os. mgmt:
follow beta hcg
- threatened abortion is vaginal bleeding less than 20 wga. closed cervical os
- incomplete abortion partial expulsion of fetal products and open cervical os
- missed abortion dx by U/S revealing nonviable pregnancy. closed os, no
bleeding, no abd cramping
- inevitable abortion cervical dilation, open cervical os, no expulsion of fetal
product
- Ascites caused by portal hypertension has a serum ascites albumin gradient
greater than 1.1 g/dL. Portal hypertension may be pre-hepatic (portal vein
thrombosis), intrahepatic (cirrhosis, hepatic fibrosis, hepatocellular
carcinoma), or post hepatic (CHF, constrictive pericarditis, Budd-chiari
syndrome)
- healthy adult w/ thrush - work up for HIV an tx w/ localized antifungal
(clotrimazole lozenges or nystatin mouthwash)
- membranous glomerulonephritis has a spike and dome appearance on
electron microscopy w/ diffuse thickneing of membranes and granular
immunofluorescene. proteinuria (>3.5 g/day), hypoalbuminemia,
hyperlipidemia, generalized edema, lather-rich/foamy urine. IgG and C3
deposits. a/w syphilis, HBV, HCV, occult malignancy, SLE, malaria,
penicillamine,and gold salts
- VSD is MC congenital heart defect. acyanotic, 80% close spontaneously.
larger defects a/w failure to thrive and freq respiratory infxn. common
etiologies: down, trisomy 13 & 18, fetal alcohol syndrome, Torch syndrome.
harsh holosystolic murmur best at Lower LSB
- rhabdomyolysis should be treated with IVF and get an EKG. common
scenario are use of statins or extreme physical exercise. primary concerns are
toxicity to the kidneys due to the release of large amts of myoglobin (it

clumps & clogs nephrons when released in large amts) and the potential for
cardiac arrhythmias due to massive K release from necrosing myocytes.
- NMs for pt recently started on antipsychotics. "FEVER" - fever,
encephalopathy, vital sign instability, elevated enzymes esp CK, and rigidity
of ms
- right sided murmur usually get louder w/ inspiration
- tricuspid regurgitation: blowing holosystoli mumur heard best at the left
lower sternal border; increases w/ inspiration; will present w/ signs of right
sided heart failure (jugular pulsation, hepatic pulsation, edema,
hepatomegaly, JVD)
- response to tx of osteomyelitis is monitored w/ ESR and CRP
- gastrinomas cause an increase in fasting serum gastrin; most often
duodenum
- Wilson's dz a/w hypoalbuminemia, decreased serum ceruloplasmin,
elevated aminotransfereases, and elevated urinary excretion of copper. Liver
biopsy will reveal copper deposits. total serum copper is decreased w/ an
increase in free serum copper. sialorrhea (drooling) is seen once the pt is
neurologically impaired as a result of copper deposits
- common cause of torsades de points are long QT syndrome, drugs that
prolong the QT interval, diarrhea, hypomagnesia, hypokalemia. IV magnesium
sulfate is first line tx
- sequence of teeth eruption: central incisors, lateral incisors, first molars,
canines, second molars
- Exudative effusions - pleural fluid has atleast 1/3: 1) ratio of total pleural
fluid protein to protein in serum >0.5, 2) ratio of LDH in pleural flui to serum
>0.6, 3) pleural LDH level >2/3 the upper limit of nl serum LDH. Major causes
are lung CA, TB, PNA, trauma, asbestosis. basically, lung dz causing leaky
blood vessels or impaired lymphatic drainage
- intraductal papilloma has unilateral, gross bloody discharge. undergo
surgical removal
-candidiasis of the nipple pain, burning redness. shiny appearance on the
nipple w/ peeling of the skin at the areola. check the baby's mouth for oral
thrush. -azole cream to the nipple and oral -azole to infant.
- staph auresus mcc mastitis. nipple cracks and fissues on exam
- twin to twin transfusion syndrome is caused by disproportionate blood

transfer btw monochorionic twins. donor twin gets hypovolemia, anemia, &
oligohydramnios. recepient twin gets hypervolemia plethora, polyhydramnios,
CHF, and jaundice
- AML: pts over 30, bone marrow biopsy reacts w/ myeloperixodase and
sudan black, a/w auer rods
- angiodysplasia is a common cause of GI bleeding in the elderly. colonoscopy
will reveal a cherry red spot w/ radiating vessels
- delirium tremens is manifested by AMS, autonomic hyperactivity,
hallucinations, and sz. first line tx: benzo. 2-3 days after cessation of Etoh
consumption in heavy drinkers
- anemia of chronci dz microcytic, iron and TIBC decreased, ferritin nl or
increased
- hemolytic anemia elev retic ct, micro/macro/normo, increased RDW, dec
haptoglobin, elevated LDH
- thalassemia is microcytic, nl Fe, nl TIBC
- iron deficiency microcytic, low fe, high TIBC (not like in chronic dz!).
transferrin elevated. decreased ferritin!
- CO poisoning characterized by HA, dz, N, LOC, SOB, loss of ms control,
cherry red skin
- cavernous venous thrombosis is a cause of HA a/w palsie of the cranial
nerves that pass thru the sinus (3,4,V1,V2,6) clasically presents after
manipulation of a skin lesion located in the central face. nerve palsies: facial
sensory involvement (V1,V2), sparing of the jaw (V3), complete
opthalmoplegia (C3,4,6). often presents as failed attempt to drain a furnucle.
present w/ F, CN palsies, and HA. tx w/ IV abx (septic thrombophlebitis)
- mnemonic for eye ms innervation : SO4 (superior oblique), LR6(lateral
rectus) and AO3(all other cranial nerve 3)
- psoas syndrome acute shortening w/ difficulty extension at the hip. so pt will
be stooped over and lean to one side. tx OMM begins w/ upper lumbar spine
then psoas muscle itself
- Necrotizing enterocolitis high incidence up to 3 m/o of age for premature
infants. mucosal intestinal necrosis. emesis, rectal bleeding, diarrhea, abd
distention, poor feeding. xray signs pneumatosis intestinalis and portal
venous gas. tx is bowel rest, abx, and surgical consult.
- sinusodial FHT indicates fetal anemia

- malrotation w/ midgut volvulus classically presents before 1 m/o age with

bilious vomting, blood per rectum, AP, intestinal obstruction. upper GI
(barium) - corkscrew or coiled apeparance. duodental obstruction may
manifest as a double bubble sign. tx is surgical
- in duodenal atresia - a/w trisomy 21/down, vomiting w/in first few horus of
life. double bubble sign
- double bubble sign is seen w/ any cause of duodenal obstruction: duodenal
atresia, duodenal stenosis, and malrotation/midgut volvulus
- rubella causes cataracts, hearing loss, and cardiac defects in newborn.
blueberry muffin rash
- most torch causes jaundice, hepatosplenomegaly, MR, and microcephaly
- toxoplasma gondii will cause cerebral calcifications and chorioretinitis
- treponema pallidum causes syphillis. early congenital syphilis has stillbirth,
late (age 2+) w/ frontal bossing, saddle nose, chorioretinitis, sensorineural
hearing loss, teeth malformations, sz, and skeletal malformations
- CMV causes cerebral calcifications and hearing loss
- first line tx of sideroblastic anemia with ringed sideroblasts (prussian blue
stain shows erythroblasts with stainable deposits of iron in the cytoplasm) is
pyridoxine (B6). high iron, high ferritin and nl/dec/or inc TIBC. common cause:
EtOH, isoniazid, chloramphenicol, lead, neoplastic, and genetic
- inhalation dysfxn rib. if pump handle (ribs 1-5), flex head; if bucket handle
then sidebend patient while they reach for their knee
- all postmenopausal women should receive bone mineral density testing at
65. if RF then earlier (no specific age)
- TB is a complication of silicosis (work hx of mining, sand blasting, granite,
glass and ceramic work) pt will c/o f, DOE, fatigue, cyanosis, CP, and/or cgh.
CXR - nodular opacities in the upper lobe
- tx strep pneumo w/ amox/amp or third gen ceph
- TiA will commonly present with amaurosis fugax (sudden painless loss of
vision from central retinal artery occlusion), hemiparesis, paresthesia, and
aphasia. ususally plaque dislodged from carotid or from afib
- erythema infectiosum is caused by parvovirus B19. starts w/ nonspecific
symptoms f/by slapped cheek rashed and then a lace like rash on the trunk
and extr.

- plummer vinson sydrome - iron def anemia w/ pica, koilonychia (spoon

shaped nails), and dysphagia 2/2 esophageal webs
- primary sclerosing cholangitis MC presents w/ pruritus and jaundice.
cholangiography will show a bead like pattern due to inflammation and
narrowing of intrahepatic and extrahepatic bile ducts. tx is liver transplant.
a/w ulcerative colitis
- tx of parkisons dz is based on increasing dopamine, decreasing metabolism
of dopamine, and increasing anticholinergic activity
- myxedema coma complication of hypothyroidism. pt present w/ AMS,
hypothermia, hypotension, and hypoventilation. tx consists of IV T3 and/or
T4, hydrocortisone, fluids, a blanket, and respiratory therapy
- wound dehiscence occurs btw 1-20 days s/p. RF: technical error in suture
placement, intra abdominal infxn, adv age, wound infxn, hematoma, obesity,
inc intra-abd pressure, chronic steroid use, uncontrolled DM, radiation
therapy, chemotherapy, & malnutrition
- meralgia paresthetica is entrapment of the lateral femoral cutaneous nerve.
MC occurs as the nerve passes through the inguinal ligament. RF: tight belts,
obesity, pregnancy. c/o numbess and tinglihg of upper lateral thigh area.
entrapment may also cause severe pain in this area. sx typically unilateral
and made worse w/ standing or walking and relieved w/ sitting. PE: numbness
at anterolateral thigh. tapping over inguinal ligament or extending the thigh
(stretches the nerve) will reproduce symptoms. tx is supportive. injection w/
lidocaine and corticosteroid may be used if sx are severe.
- patellofemoral syndrome presents with knee pain with knee flexion and
contraction of the quadriceps
- spinal stenosis is a/w lower BP and leg pain w/ standing and walking
- disc herniation at L4/L5 causes L5 nerve impingement. weakness in
extending the big toe. numbness and pain on top of the foot and pain may
also radiate into, or from, the buttock
- disc herniaton at L5/1 causes S1 impingement. may cause loss of the ankle
reflex. numbness and pain can radiate down to the sole of the foot
- Viscerosomatics:
T4 - head, neck, heart, or respiratory
T6 - respiratory, upper GI
T9 - upper GI
T11 - middle GI (lower duodenum to prox 2/3 TV colon)

T12-L2 - lower GI/GU (distal 1/3 TV colon, descending colon, sigmoid

colon, rectum, prostate, lower ureter and bladder)
- infants of DM moms: macrosomia; respiratory distress syndrome;
hypoglycemia; hypocalcemia (low PTH); polycythemia (high EPO);
hypomagnesia (elevated renal excretion of Mg by DM mom);
hyperbilirubinemia (inc hemolysis); premature delivery; hypertrophic
cardiomyopathy (elevated insulin)
- CREST syndrome: calcinosis, raynaud's phenomena, esophageal dysmotility,
sclerodactyly, & telangiectasias. MC women 30-50.2 forms: limited and
diffuse. limited includes crest, and limited skin involvement to the face, neck
and extr, gradual onset, better prognosis. specific test: anti-centromere ABs
- polycythemia vera is a myeloproliferative disease. due to malignant
proliferaton of RBC in bone marrow. hyperviscosity and thrombocytosis cause
the s/s. c/o: HA, vertigo, pruritus after shower, and signs of thrombosis. PE:
splenomegaly and plethora of the face. Labs: elev H/H / RBC mass / WBC /
leukocyte alkaline phosphatase / bilirubin / vitamin B12. Gout is common 2/2
hyperuricemia. EPO levels are reduced in response to elevated erythrocyte
production. Elevated RBC mass is specific for this! tx: hydroxyurea and
chronic phlebotomy.
- erythromelalgia is a thrombotic complication that presents w/ red, burning
extremities that is relieved by ASA and cold temp and made worse w/
warmth. seen in thrombotic d/o especially polycythemia vera and essential
thrombocytosis.
- Surgical wounds:
Clean: uninfected operative wounds, no violation of
Resp/alimentary/GI/GU tract
Clean-contaminated: respiratoy, alimentary, GI, or urinary tract
entered under controlled conditions and w/out unusual contamination of the
field
Contaminated: open, fresh, accidental or surgical wounds in which
major breaks in sterile technique or gross spillage from the GI tract.
Dirty: old traumatic wounds or operative fields w/ pre-existing infxn
- scoliosis is named for the direction of the apex. cobb mild <20, mod 20-45,
severe >45. OMT generally indicated. mild - mod conservative w/ OMt,
special exercises. mod - braced. severe >45 may require surgery
- pap starts at 21 (doesnt matter when she lost V card) and every 3 years.
30+ yr, if 3 neg consecutive pap than once/3 yrs or with combo HPV /5 yrs
- mammo / 2 yrs starting at 50 y/o

- multiple sclerosis - neuro c/o separated by space and time. MC initial is

paresthesias. usually will mention visual disturbance
- transposition of the great vessels - newborn cyanosis. ASD, VSD, or PDA
present. chest x-ray: egg on string apperance. Tx with IV PGE1, cardiac cath,
balloon atrial septostomy and surgery
- unilateral facial spasm usually caused by pressure placed on the facial
nerve. starts w/ myokymia (involuntary eyelid contractions) and moves down.
facial nerve traverses the temporal bone - so somatic dysfxn of it can lead to
it!
- edward / trisomy 18 - presents under 12 m/o. microcephaly, micrognathia
(small jaw), clenched first, prominent occiput, and rocker bottom feet
- fragile X syndrome - a/w long face, large body size, mental retardation, and
hand clapping or biting
- Patau / trisomy 13 - cleft lip or palate, polydactyly, microcephaly,
micropthalmia, micrognathia, close set eyes, and rocker bottom feet
- external hemorrhoids are more likely to become painful due to thrombosis.
a/w fullness or sense of incomplete evac of bowels. tx sitz baths, high fiber
diet, & hydrocortisone/analgesic cream
- premature ovarian failure - cessation of ovarian fxn prior to 40 y/o,
amenorrhea, hypoestrogenism, hypergonadotropinism
- diverticulosis often presents w/ painless bleeding. dx w/ colonoscopy.
bleeding is most often right sided and initial mgmt IVF
- forward fall on outstretched arm - posterior radial head / pronation.
- tuberous sclerosis is an AD d/o that presents w/ sz, progressive MR, and
psychomotor retarding. cutaneous findings are adenoma sebaceum (facial
nodules in a butterfly pattern), ash leaf spots (hypopigmented macules), and
shagreen patches (plaques on the trunk). can develop retinal lesions, renal
lesions, cardiac rhabdomyomas. in brain, subependymal nodules and tubers
of cortex. tx aimed at sz control
- struge weber syndrome port wine stain on the face and sz. mRI. on skull
xray or CT youll see intracranial calfications on the same side as the facial
port wine stain (nevus flammeus)
- bronchiectasis in pt who present w/ chronic productive cough, dyspnea, and
hemoptysis. usually young, have hx of severe pulm infxn w/out RF for
malignancy. MC etio: CF

- sacral motion axes:

superior transverse - respiratory and craniosacral
middle transverse - postural
inferior transverse - innominate
right and left oblique - dynamic (ambulatory)
- wallenberg teset is performed by having the pt hold their head in 6 diff
planes of motion (F/E, flex w/ left rotationk etc) for 10 sec each to detect
vertebral artery insufficiency. positive if it elicits neuro s/s esp dz and visual
changes. do not do HVLA on positive test!
- drop arm test integrity of supraspinatus ms. supraspinatus responsible for
the first 30 degrees of upper extr abduction.
- apley's scratch test for rom of GH joint. tests IR and ADD (reach behind back
and touch oppposite shoulder)
- spurling test (pressure or bop on head when it is SB and ext) - cervical
radiculopathy positive if pain or paresthesias in ipsi arm
- adson's thoracic outlet
- speeds for bicipital tendinitis. elbow ext and forearm supinated. pt flex
shoulder against resistance. pain in groove is positive.
- trendelenburg - hip drop on side of gluetus medius weakness
- lasengue straight leg test - reproduction of shooting leg and back pain due
to sciatic nerve or nerve root compression
- thomas test - raising of CL hip during hip flexion due to a tight hip flexors
(iliopsoas)
- lachman test - excessive sliding forward of the tibia on the femur due to ACL
tear
- patrick FABERE test - hip pain during flexion, abduction, ER, and then
extension due to hip jt pathology (usually OA)
- pemphigus vulgaris is an autoimmune blistering disease MC present in 3060 y/o. caused by IgG Abs against an adhesion molecule (desmoglein). starts
in oropharynx and may spread to the skin. affects mucosa and is extremtly
painful secondary to rupturing blisters. nikolsky's sign - superficial skin
slipping awa from the lower layers when rubbed. dx via biopsy of skin lesions
with immunofluorescene revealing deposits of IgG btw epidermal cells. tx
with high dose systemic corticosteroids o/w fatal

- RhoGAM is admin to all Rh (-) women at 28 wga. unless if father is also Rh

(-)
- vigorous hydration before and after IV contrast is the cornerstone to prevent
contrast induced nephropathy in pt w/ kidney dz
- osteogenesis imperfecta - hx of multiple fx w/ minimal trauma. PE: hearing
loss and blue sclera. 2/2 abnl type 1 collagen.
- alport dz a/w glomerulonephritis and hearing loss
- meckel's diverticulum. commonly present either: painless rectal bleeding vs
vomiting and abd distention due to intestinal obstruction.
- major RF for placenta acreta are scarring from previous C-sections and
current placenta previa. if dx before delivery, schedule C-s w/ hysterectomy.
usually during delivery, you get multiple parts and bleeding - embolization
and/or hysterectomy
- cushing disease caused by ACTH secreting Pituitary tumor. low dose no
reduce cortisol but high dose dose does.
- clozapine most effective of all antipsychotics. not a/w significant EPS. s/e:
agranulocytosis, seizures (dose dependent), bowel obstruction, myocarditis
- reflexes: 0 no contraction, 1 diminished contraction, 2 normal, 3
hyperreflexive no sustained clonus, 4 clonus
biceps (c5)
brachioradialias (c6)
triceps (c7)
patellar (L4)
achilles (S1)
- lumbar roll for type 1 somatic dysfxn - if posterior TV process pointing up,
pull inferior arm cephaladl; if posterior TV pointing down, pull inferior arm
caudally (type 1: up/up, down/down). lumbar roll for type 2 - if posterior TV
process pointing up, pull inferior arm caudually. (type 2: up/down, down/up)
- MOI scaphoid fx: fall on outstretched hand with dorsiflexed wrist
- fifth metacarpal fx (boxer's fx) - force to MCP joint when first clenched and
usually at neck of fifth metacarpal. on PE: knuckle of 5th digit flattened
- focal nodular hyperplasia - common benign liver tumor MC affects
reproducive women. "central scar." d/c OCPs otherwise leave alone unless if
get sx

- left translation induces right sidebending

- pseudogout: proximal single jt, RF hyperparathyroidism, DM, wilsons,
hemochromatosis. acute onset of joint pain, erythema, and swelling. xray
with cartilaginous calcifications int he affected joint in presence of blue
rhomboid positive birefringent crystals on joint aspiration. acute tx with
NSAID and colchicine for chronic mgmt
- tx symptomatic sarcoidosis - oral corticosteroids. if no symptoms it should
resolve
- acute interstitial nephritis - fever, rash, arthralgias, elevated IgE and
eosinophilulria/eosinophilia abt 10-14 days after starting a new drug (i.e
NSAIDs, abx, PPI, allopurinol, phenytoin) wright or hansel staining of urine.
eosinophils + elevated creatinine = AIN
- CEA diagnostic marker for colorectal carcinoma before and after surgery to
monitor recurrence
- AFP tumor marker for HCC and found in nonseminomatous germ cell tumors
(yolk sac, embryonal carcinomas)
- CA 125 tumor marker to monitor response of ovarian cancer to tx
- CA 19-9 tumor marker in mgmt of pancraetic cancer
- duodenal ulcer MC in type O blood. Gastric ulcer MC in type A blood.
- nephrotic syndrome proteinuira >3.5g/day, hypoalbuminemia,
hyperlipidemia, and generalized edema. Focal segmental glomerulosclerosis
is MCC of nephrotic syndrome in pt with HIV, IVDA and sickle cell. might have
refractory HTN
- membranous glomerulonephritis is one of the MCC nephrotic syndrome in
adults. a/w HBV, HCV, malaria, syphillis, gold salts, penicillamine, SLE, and
malignancy. biopsy: granular deposits of IgG and C3 at basement membrane
"spike and dome". tx: prednisone and cyclophosphamide.
- narcolepsy. tx excessive daytime sleepiness if modafinil and for cataplexy is
SSRI (venlafaxine, fluoxetine, atomoxetine)
- BPPV tx w/ epley maneuver (reposition canalith). vertigo episodic lasting
about 30 sec and brought on by changes in head position. dx with dix-hallpike
maneuver nystagmuc elicit as pt changes position
- meniere dz - think of "many ear" problems: vertigo, tinnitus, hearing loss.
vertigo can be hrs to day. acute mgmt w/ benzo . diuretic and low salt diet

- labyrinthitis: viral infxn abt a week later gets vertigo, N/V, hearing loss, and
nystagmus. tx w/ steroids to reduce inflammation
- Vtach - wide QRS no P wave, > 100 bpm. if unstable hemodyanicamlly
immediate DC cardioversion. if no pulse, defib.
- c5-c6 herniation compresses C6. sx: weakness in biceps and wrist
extensors, reduce brachioradialis reflex, dermatome is thumb and part of the
FA
- T1 dermatome - decreased sensation of the inner forearm in T1-T2 or C7-T1
herniation
- T2 dermatome - decreased sensation of the upper inner arm T2-T3
herniation
- L5-S1 herniation affect S1
- C7 dermatome - decreased sensation of hte middle finger. C6-C7 herniation.
triceps weak
- bupropion is an antidepressant used when pts c/o of SSRI induced weight
gain or sexual dysfxn
- superficial thrombophlebitis manifests as a painful, erythematous cord that
can progress to DVT. repeat exam in 7-10 days to look for progression
- breast milk production may be increased by tx w/ the dopamine antagonist,
metoclopramide
- L5 sidebending always towards axis of sacrum
- cerebral contusion - punctuate areas of cerebral hemorrhage mixed w/
edema
- subdural hematomas - crescent shaped, high attenuation, extra axial
collection that crosses suture lines
- subarachnoid hemorrhage - high attenuation of the subarachnoid cisterns
and sulci
- a congenital diaphragmatic hernia presents w/ respiratory distress and
cyanosis soon after birth. pt will also have a scaphoid abd, poor air entry on
the affected side, and a cxr showing herniation of the bowel into the left
chest cavity. tx includes gastric decompression, intubation, and proper
ventilation until the defect can be repaired
- procainamide can cause pericarditis. d/c and tx w/ nsaid

- thoracic inlet release - physician wrapping their thumbs over and under the
patient's clavicles with a gentle and steady force.
- osteoarthritis - bony enlargement of DIP and PIP jts, brief morning stiffness,
xray shows narrowing of joint space / osteophyte formation / bone cysts.
painful joints on movement
- the midline bones (occiput, sphenoid, ethmod, vomer) move in flexion and
extension around TV axis. paired bones (temporals, parietals, maxilla,
zygoma, nasal, palantines) move in IR and ER
- during sphenobasilar flexion, there is flexion of midline bones, ER of paired
bones, decreased AP diameter of cranium, and extension of sacrum
(counternutation / sacral base posterior). bregma descends with SBS flexion
- pauciarticular onset JRA: female pt under 5 y/o, four or fewer joints, c/o or
physical findings will be painless limp and knee swelling. complications:
uveitis, iridocyclitis, and asymmetrical leg length. tx nsaids and yearly eye
exams
- epididymitis - fever/chills, erythematous tender scrotum, freq/urg/dysuria.
uretheral d/c. cremasteric reflex intact (absent in torsion). if <35 y/o:
chlamydia; >older men is E coli
- cluster A (weird); cluster B (wild); cluster C (worried)
- the standard of care is an objective standard based on what a reasonably
prudent physician should exercise under the same or similar circumstances
- pneumococcal vacc for 65+. always start with pneumo conjugate vaccine
f/by pneumoccoal polysaccharide vaccine in 12 m/o
- glucagonoma - alpha cells of the pancreas. c/o necrotizing migratory
erythema, DM, wt loss, glossitis, stomatitis, cheilitis. amino acids drastically
reduced caused by gluconeogenesis from amino acids. lab values revealed
elevated glucagon levels. tumor localization is made w/ US or CT scan.
symptomatic relief w/ octreotide.
- TCA OD Ekg: sinus tach, prolonged PR, wide QRS, QTc prolongation
- cardiac tamponade manifests as Beck's triad: hypotension, JVD, and distant
heart sounds. pulsus paradoxus, electrical alternans, enlarged cardiac
silhouette. dx w/ echo
- croup: barking cough, hoarseness, stridor. respiratory compromise due to
swelling of the subglottic tissues and tx w/ aerosolized racemic epinephrine to
decrease swelling and open up the airway

- ulcerative colitis inflammation of the mucosa and submucosa of the colon

and rectum. c/o AP, bloody diarrhea, tenesmus, fever, and weight loss.
Rectum and entire colon. a/w cholangiocarcinoma, scleroising cholangitis, and
colon cancer. dx w/ colonoscopy or flex sig revealing friable mucosa,
erythema, and pseudopolyps. biopsy: crypt abscesses. tx 5-ASA/mesalamine
or sulfasalazine. colectomy is indicated if megacolon is present and case is
not responsive to med mgmt
- coccidioidomycosis found in SW US. erythema nodosum. biopsy reveals
spherules filled w/ endospores.
- heat stroke: hx of activity prolonged sun exposure, hypotension,
tachycardia, tachypnea, high body temperature, AMS, and cutaneous
vasodilation (w/ dehydration the person may not be able to sweat fast
enough to dissipate heat). pt should be undressed completely, sprayed with
cool water, and fanned. pt who suffer from anhidrosis are at an increased risk
for heat stroke. if no high temp/cutaneous vasodilation/ams then consider
heat exhaustion.
- McCune Albright - short stature, cafe au lait spots, precocious puberty, bone
lesions (polyostotic fibrous dysplasia, unilateral, increased risk for fx), a/w
endocrinopathies.
- testicular cancer painless mass or firmness of a testicle. testicular cancer is
almost always malignant. majority are germ cell tumors (seminoma and
nonseminoma). beta hcg elevated in seminomatous and nonseminomatous
cancers and AFP increased in embryonal. leydig cell tumors have precocious
puberty and gynecomastia. confirm w/ US and beta hcg -> invasive . inguinal
radical orchiectomy of the affected testicle
- ER of the temporal bone - posterior displacement of the mandibular fossa
and the chin displaced toward the side of temporal ER.
- fibroadenoma of the breast firm, round, smooth, rubbery, mobile mass in
women 15-35 y/o. US and fine needle biopsy used for dx. frequent RUQ
breast.
- Vit B12 def is differentiated from folate def by an increased serum
methylmalonic acid. both are a/w increased homocysteine levels
- causes of B12 def: pernicious anemia (inadequate prod of intrinsic factor),
crohn's dz, diphyllobothrium latum infxn, gastric resection, poor diet,
alcoholism
- autonomic hyperreflexia occurs w/ spinal cord lesions T6 and above. s/s:
diaphoresis, HTN, HA, and flushing. most commonly triggered by an
overdistended bladder. relief after catheterization. sometimes due to rectal

distention from constipation. painful stimuli are third MCC.

- DM should be screened annually for diabetic nephopathy with a
microalbumin assay of urine. proteinuria should be confirmed w/ a 24 hr urine
test. BP monitor, cholesterol screen, annual eye exam
- tx acute exacerbation of MS w/ high dose corticosteroids
- galacatosemia manifest when the pt is given milk. it causes failure to thrive,
cataracts, and liver dz. tx consists of minimizing galactose in the diet (soy
based milk)
- homocystinuria - (methionine metabolism d/o) - s/s are tall stature, lens
subluxations, intellectual disability, osteoporosis, and hypercoagulability. Vit
B6 replacement for life
- osgood schlatter - osteochrondritis of the tibial tubercle caused by overuse
and affects 9-15 y/o. usually asymmetrical and affects taller children who are
involved in sports. c/o knee pain that may be severe enough to cause a limp.
ex: bony prominence of the tibial tubercle and tenderness, warmth, and
swelling at th eknee. self limited. rest, apply ice, and NSAIDs for pain
- legg calve perthes dz - 409 y/o at head of femur and thigh pain
- toxoplasmosis - hydrocephaly, chorioretinitis, and intracranial calcification
(esp basal ganglia). tx: pyrimethamine and sulfadiazine. maternal exposure
to cat feces or raw meat.
- bronchiolitis affects children up to 2 y/o who are exposed to RSV. expiratory
wz, tachypnea, and cyanosis. nasal flaring and intercostal retractions.
common in the winter, with low grade fever and 2-3 days later respiratory
distress. tx w. O2 by NC
- characteristics of FAS (fetal alcohol syndrome) are microcephaly, smooth
philtrum, cardiac septal defect, small palpebral fissure, midfacial hypoplasia,
and microphthalmia
- chronic pancreatitis classic triad of DM, steatorrhea, and pancreatic
calcifications on CT scan
- hemorrhagic pancreatitis complication of pancreatitis. fox sign (dislocation
of inguinal ligament), grey turner (flank), periumbilicus (cullen sign)
- ribs 1-5 pump handle around TV axis; Rib 6-10 bucket handle motion around
AP axis; rib 11 and 12 caliper around vertical axis
- anterior subluxation of the rib are named for position and wil have
prominence at the anterior (sternal end) of the rib and depression on

posterior as if shifted forwards

- posterior subluxation with protruded rib angle
- typical ribs anterior tenderpoints "depressed ribs" are tx w/ flexion, SB, and
R towards tenderpoint
- pleural effusion TB lymphocytes >80% and a greatly increased total protein.
an adenosine deaminase level less than 40 RULES OUT TB
- conditions that cause low glucose in the pleural fluid: rheumatoid arthritis,
empyema, and malignancy.
- chylothorax (white, milky appearance) MCC are lymphoma and trauma
caused by thoracic surgery. triglycerides >110 mg/dL
- MCC bloody effusion: PE and malignancy
- Fanconi anemia - AR d/o before 10 y/o w/ sx of pancytopenia: petechiae,
bruises, pallor, fatigue, and recurrent infxn as a result of primary bone
marrow failure. suspect w/ thumb abnl, multiple cafe au lait spots, renal
anomalies, microcephaly, and short stature. definitive dx test is a
chromosome breakage test. at increased risk of AML, myelodysplastic
syndrome, liver tumors.
- AML - classic is down syndrome that develops fatigue, hepatosplenomegaly,
lymphadenopathy, pallor, recurrent infxn, and fever. auer rods, red rods w/in
cytoplasm, def dx w/ bone marrow biopsy
- AML likely a/w fanconi anemia, down syndrome, advanced age, or exposure
to: benzene, radiation and chemotherapy
- https://www.youtube.com/watch?v=Lq7zsi60tVc
- https://www.youtube.com/watch?v=N-r_QriTMSc
- Still technique is indirect to direct. the starting position is the position of
ease and the final position is the position of restriction. the region is taken
through a smooth arc of motion while the force vector (either compression or
distraction) is applied
- superficial thrombophlebitis in pt w/ varicose veins. localized extremity pain
and redness. cordlike area of induration, erythema, and tenderness
corresponding to dilated and thrombosed vein. tx with NSAID, elevation, heat,
support stockings.
- polymyalgia rheumatica has elevated ESR. symmetric pain and stiffness in
ms and jts, esp in shoulder and pelvic area. commonly a/w giant cell arteritis

(HA, jaw claudication, visual disturbance)

- rheumatoid arthritis - pt w/ morning stiffness in symmetric joints (PIP, MCP,
wrist, elbow, knee, and/or ankle). PE: deviation of b/l PIP and MCP and
rheumatoid nodules on elbows or wrists. anti-cyclic citrullinated peptide
antibody is most specific dx marker
- tx OA w/ acetaminophen (b/c nsaid - gi bleed)
- postnasal drip syndrome - constant swallowing/spitting of mucoid sputum,
constant clearing of the throat, and nasal/sinus congestion. tx includes
steroids, antihistamines, and decongestants
- hemochromatosis - high serum iron/ferritin/transferritin saturation, low TIBC
- almost all causes of congenital adrenal hyperplasia (CAH) are caused by 21
hydroxylase def. so order 17 hydroxyprogesterone level b/c that will be
elevated. dec cortisol synthese - no neg fb - incr ATCH. excess in androgens early puberty and virilization. adrenal insufficency - hyponatremia,
hyperkalemia, hypotension, hypoglycmia, FTT
- when suspecting ALS - order EMG and nerv conduction
- rheumatoid arthritis 20-40 y/o F>M. prodromal period of fever, wt loss, and
fatigue. sx: symmetrical joint stiffness after inactivity, particularly in the AM,
along w/ tenderness, pain and warmth. MC joints are PIP and MCP, wrist and
knees. SQ nodules. ulnar deviation of fingers, boutonniere deformity
(hyperextension of DIP w/ flexion of PIP ), swan neck deformity (flexion of DIP
w. extension of PIP) and valgus deformity of knees. most specific test is xray
and anti-CCP abs. xray shows jt space narrowing and erosions
- cubital tunnel syndrome - ulnar nerve entrapment at medial elbow. s/s:
numbness and tingling of the 5th finger and medial part of the 4th finger.
positive tinel at elbow
- malaria: P falciparum in africa and caribbean . prop w/ atovaquoneproguanil for last min travelers or mefloquine 2 weeks start prior, tx infxn w/
quinine and doxycycline. p.vivax in south america, prop w/ primaquine, tx
infxn w/ primaquine and chloroquine
- infant ingestion of drain cleaner (alkali): drooling, intraoral burns (eschar),
dysphagia, vomiting, severe may have stridor or wheezing. tx w/ endoscopy
first
- first line tx for ascites is spironolactone and/or furosemide
- tx acute gout w/ NSAID. long term maintenance w/ allopurinol

- adrenal insuffiency - addisons dz - fatigue, GI, weakness. hyperpigmentation

skin from excess ACTH. dec cortisol - hypoglycemia, hyponatriemia, and
hperkalemia, low BP.
- RF for PROM/PRROM are genital tract infxn, grand multiparity,
polyhydramnios, smoking, and previous prom/pprom
- work up fertility after 1 year of trying w/ semen analysis first. otherwise if
under 1 year of trying, then just reassure
- hypertrophic pyloric stenosis - hypokalemic, hypochloremic, metabolic
alkalosis
- permanent tooth avulsion - rinse off w/ saline, reinsert into socket w/ gentle
pressure, hold position, refer to dentist
- RF endometrial carcnioma (post menopausal w/ vag bleed) - unopposed
estrogen, early menarche, late menopause, obesity, tamoxifen, PCOS, age,
DM, family hx of breast/ovarian/endometrial cancer
- MCC meningitis: newborn to 3 m/o is GBS; 3 m/o to 9 yrs is strep pneumo;
teens and young adults is n. menigitis; adults is strep pneumo
- polyarteritis nodosa (PAN) is a systemic vasculitis - glomerulonephritis,
systemic (f, wt loss, myalgias), AP, neuro sx, cardiac dz (CHF, HTN,
arrhythmia), skin sx (livedo reticularis, ulcers, gangrene of fingers). flank
tenderness, mild proteinuria, and elev Cr. mononeuritis multiplex and hep b!
always spares lungs. young person w/ stroke! leukocytosis, anemia, elev ESR,
hypergammaglobulinemia. ANCA negative.
- torsion of the appendix testes mcc of acute scrotum in 7-14 y/o. tenderness
and pathognomonic "blue dot" sign is present on the scrotum. supportive
therapy (superior pole of testicular pole)
- endometriosis - pelvic pain, dyspareunia, dysmenorrhea, dyschezia. MC
structure is the ovary leading to endometrioma "chocolate cyst" - adnexal
enlargement and tenderness. second MC affected is cul de sac.
- conn dz / primary hyperaldosteronism: 1) measure plasma aldosterone
concetration to plasma renin, if greater than 25 2) sodium loading test, if
plasma aldosterone level not suppressed - dx
- transient tachypnea of the newborn: shortly after birth with tachypnea,
nasal flaring, grunting, intercostal retractions, cyanosis. very common after C
section. cxr perihilar interstitial markings and pleural effusions. self limited. tx
with IVF and O2.
- spondylolisthesis is anterior displacement of a vertebral body in relation to

the vertebral body below. grade 1 0-25%; grade 2 26-50%; grade 3 51-75%
- tricuspid stenosis is usually 2/2 rheumatic heart dz or congenital.
auscultation: opening snap w/ high pitched diastolic rumble at lower left
sternal border. intensifies w/ inspiration.
- age MC RF for dementia
- enterobius vermicularis (pinworm) perianal pruritis esp at PM. dx scotch
tape test. tx is mebendazole
- leukemoid rxn is leukocytosis 2/2 infxn. inc leukocyte alkaline phosphatase
- prune belly syndrome - bulging, thin, wrinkled abdomen. renal dysplasia,
dilated ureters, enlarged bladder, cryptorchidism, pulmonary hypoplasia, and
cardiac/GI anomalies
- parvovirubs B19 MC infxn causing aplastic crisis in sickle cell dz. tx aplastic
crisis w/ blood transfusion
- lumbar spinal stenosis - narrowing of canal - bp radiates to but or legs,
worse w/ straight back /walking downhill, relieved w/ bending over or sitting
down. best initial therapy is NSAID and exercise
- compartment syndrome MC anterior compartment
- unstable vtach - synchronized cardioversion; stable v-tach - IV amiodarone
and elective sync cardiovert
- LSIL further eval w/ colposcopy immediately (unless if <24 y/o) and unless
concurrent neg hpv dna viral test
- tinea versicolor hypopigmented macules after exposure to sun. malassezia
furfur underlying infxn and KOH prep shows hyphae w/ budding spore
(spaghetti and meatball appearance). tx is selenium sulfide, topical
terbinafine, or ketoconazole. always start w/ topical or selenium sulfide
- initial tx of prolactinoma is dopamine receptor agonist (cabergoline or
bromocriptine). if no response switch to other dopamine agonist. if not, then
transsphenoidal pituitary surgery
- transvaginal sonogram using crown-rump length is the most accurate dating
procedure during the first semester
- aspiration pna can lead to a lung abscess. rf: seizure, drug, alcoholic. c/o
fever, foul smelling sputum, wt loss. cxr cavitation with air fluid level. doc is
clindamycin
- acute intermittent porphyria abd pain, neuropathy, nonspecific psych sx. NO

rash. urine porphobilinogen and aminolevulinic acid elevated

- erythema nodosum is a septal panniculitis common in young women that
generally presents as tender erythematous nodules on the anterior legs.
commonly a/w sarcoidosis and IBD
- tPA first line tx for hemodynamically unstable pt w/ high likelihood of PE
- tx of zollinger ellison syndrome should start w/ PPI, f/by surgery once tumor
is localized
- varenicline and bupropion first line pharmacologic tx for smoking cessation
- perforated PUD - sudden onset of severe AP and s/s peritonitis. upright chest
xray reveal free air
- herpes simple virus infxn fever, dysuria, HA, painful genital vesicles, tender
inguinal lymphadenopathy. confirmatory test not necessary when clinical
presentation clear. tx w/ valacyclovir, acyclovir, or famiciclovir. tzanck smear
is best initial test
- most sensitive test for SLE is ANA screening. anti dsDNA and anti Sm Ab are
specific for SLE. anti histone Abs for drug induced lupus
- pt w/ nl BMI (18.5-24.9) gain 25-35 lbs during pregnancy
- for obese pt (BMI over 29.9) gain 11-20 lbs in pregnancy
- 15-25 lb gain in pregnancy for overwt pt (BMI 25.0-29.9)
- hepatorenal syndrome results in renal artery vasoconstriction secondary to
liver dz. tx w/ liver transplant increases survival
- MOI blow to the medial or lateral side of the leg during rotation of the knee meniscal tear. pt will describe locking or clicking sensation of the knee wiht
walking. (+) Mcmurray a/w high likelihood of meniscal injury. RICE method
plus analgesics is initial tx strategy
- cardiogenic shock is characterized by high filling pressures (pulmonary
capillary wedge pressure), low CO, high systemic vascular resistance
- malignant gastrointestinal stromal tumors (GIST) malignant neoplasm of
small bowel. common in jejunum and ileum. tx w/ wide surgical excision and
postoperative imatinib if positive for c-kit mutation.
- low risk pt take 0.4 mg folic acid before conception. high risk take 4.0 mg
- stress fx is a micro fx that is the result of chronic, accumulated trauma from
repeated stress which is very common in athletes and runners. MC bones

affected are the tibia, metatarsals, and navicular bone. acute stress fx rarely
show up on xray. tx is 4-8 wks of rest, casting, and PT
- RF osteomyelitis: DM, open fx, IVDA. long bones MC affected. s/s: edema,
warmth, tenderness to palpation, reluctuance to move the involved
extremity, late presentations: sinus tract drainage. initial test: x-ray. earliest
finding: elevation of the periosteum
- AIDs defining illness: candiadiasis of esophagus/lungs/trachea; cryptococcal
infxn; intestinal isosporiasis or cryptosporidioisis; kaposi's sarcoma; cerebral
lymphoma; PCP PNA; cerebral toxoplasmosis; invasive cervical ca; hiv wasting
syndrome
- informed consent: dx, nature of intervention, risk and benefits of
intervention and alternatives, assessment of understanding, and acceptance
- fibrocystic breast changes are present in premenopausal women. lumpiness
and breast pain fluctuate w/ periods. US reveals if it solid or cystic. FNA is
initial treatment and dx test of choice. sx may be tx w/ NSAIDs.
- MEN 2B: medually thyroid cancer, pheochromocytoma, MARFARNOID body
habitus, amd mucosal neuromas
- acute somatic dysfxn: sharp pain, edema, bogginess, erythema, and
warmth on palpation
- chronic somatic dysfxn: coolness of skin, dull pain, pallor, ropy fibrotic
texture, muscle hypotonicity
- wilson dz - ceruloplasmin def. copper accumulation in liver dz, kayser
fleischer ring, neuropsych sx, and renal dz. tx w/ penicillamine
- lynch syndrome / hereditary non-polyposis colorectal cancer suspected in pt
w/ very strong famhx of colorectal and endometrial cancer. colonoscopy start
at age 20-25, repeat 1-2 yrs
- polyarteritis nodosa: f, wt loss, abd pain, pm sweats, joint/ms pain, skin
ulcers, tender nodules, mononeuritis multiplex. a/w hep b! transmural
vasculitis with fibronoid necrosis on biopsy. if related to hep b infxn, treat w/
interferon alpha 2b
- antiviral and meds:
influenza: amantadine, zanamivir, osteltamivir
HSV, EBV, HZV: acyclovir
Hep B: interferon, lamivudine, telbivudine, adefovir, entecavir,
tenofovir
Hep C: ribavirin and interferon

HIV: protease inhibitors ("navir"), NRTIs, NNRTIs, Maraviroc,

enfuviritide, raltegravir
CMV: ganciclovir, foscarnet
- sheehan syndrome - extensive postpartum hemorrhage. AP hormones
decreased. unable to lactate. Decreased ACTH, TSH, FSH, LH, GH, and
prolactin
- asherman syndrome (intrauterine adhesions/intrauterine synechiae)
postpartum amenorrhea. typically follows D&C resulting in endometrial scar
tissue
- red man syndrome MC adverse effect of vancomycin. s/s: hypotension,
dyspnea, erythema, and pruritis. mgmt: slowing the rate of infusion or d/c
until sx have resolved
- unilateral foul smelling nasal d/c in child - 2/2 FB
- bullous pemphigoid - abs against basement membrane. widespread pruritic
blistsers along abd, extr, groin, and axilla. rarely involves mucous
membranes!! biopsy - linear pattern of IgG and C3 along the basemente
membrane. nikolsy sign Negative!
- overflow incontinence c/o pelvic pressure due to its incomplete emptying,
nocturia, dribbling, frequency, and hesitancy. typically caused by a
neurogenic bladder (hx of DM or spinal cord trauma), BPH in men, tumors,
and kidney stonees. dx made w/ catheterization with increased residual
volume. tx is intermittent self cath and tx underlying cause
- neurocardiogenic (vasovagal) syncope occurs in times of prolonged
standing, stress, hyperthermima, pain, fatigue, and in the setting of blood or
medical procedure. a/w prodrome. tilt table test is positive. resassurance is
indicated
- subdural hematomas commonly occur in alcoholics and elderly pts. CT will
show crescent shaped, concave hyperdensity. pupillary dilation on the same
side of the hematoma
- werdnig hoffman dz, spinal muscular atrophy type 1, AR dz caused by
progressive apoptosis of motor neurons. in first 6 m/o life with severe
hypotonia, generalized weaness, and inability to feed. EOMI intact (not like
botulism). supportive tx. pt die
- prerenal acute renal failure is MCC acute renal failure. etiologies: volume
depletion, CHF, liver failure, sepsis, antiHTN meds, renal artery stenosis.
BUN/CR > 20/1 b/c kidneys are fxn; Urine Na <20, FENa<1%, urine osmolality
>500; hyaline casts

- conjunctivitis w/in first 24 hours of life is chemical until proven otherwise (tx
is reassurance)
- negligence: duty,breach,causation, damages. this is the cascade of where
things go in a regular malpractice suit.
- acetaminophen poisoning is the MCC of acute liver failure in the US. if w/in 4
hours, oral activated charcoal to decrease absorption from stomach and small
intestine. Obtain serum levels at 4-,6-, and 8- hours post ingestion to see if
you need to give NAC. if comes 8 s/p ingestion, give NAC
- folliculitis presents w/ multiple small pruritic pustules in areas that are
shaved. MCC s. aurerus
- rosacea- chronic skin d/o that affects the face. erythematous face w/
papules and pustules. rhinophyma - enlarged nose due to soft tissue and
sebaceous hyperplasia
- milaria - heat rash. hot, humid climates and presens with small papules and
pustules similar to follicutuis
- VIPoma - watery diarrhea (common cause of hypokalemia), hypochlorhydria,
hyperglycemia
- ectopic preg - AP and vag spot 6-8 wks after LMP. TVUS perform to look for
IUP or ectopic. if not diagnostic, repeat bhcg in 48-72 hours. it should double
by then by in ectopic, it is abnormally low rise in level
- gestational sac w/ IUP on TVUS with beta >1500, and abd US w/ Beta >6500
- isotonic contractions are either concentric (shortening) or eccentric
(lengthening). think of a bicep curl: upward movement is concentrate and
downward movement is lenghtening. isolytic contraction is an operator's
force overcoming a contraction resulting in lengthening. isometric is an
operator's force equaling a contraction (no short no length)
- transurethral US w/ biopsy on all pt w/ a hard, nodular finding or asymmetry
on digital rectal exam.
- HVLA CI in Down b/c of wkness of alar and transverse ligament
- Mammary paget dz (of nipple, of breast) red, scaly, unilateral chronci
eczematous rash over nipple developing into a plaque and then spreading to
the surrounding areola. c/o pruritis or burning. a/w underlying breast cancer
in most. if suspected, first step in mgmt is skin biopsy (punch, wedge,
excisional)
- Prader Willi - floppy baby w/ hypogonadism, almond shaped eyes, poor

feeding as an infant. after 12 m/o, child gets hyperphagia. obesity

- cervical cancer - dyspareunia, post coital vag bleeding
- singultus (hiccups) caused by spasmodic contractions of the diaphragm - tx
w/ myofascial diaphragm release
- polymyositis spares facial muscles. symmetrical prox ms weakness upper
extr>lower. CK, AST, ALt, LDH, Aldolase elevated. (+) ANA and Anti jo1
antibody. EMG: fibrillations and high freq APs
- sarcoidosis - b/l lymphadenopathy on CXR and on histo noncaseating
granulomas. erythema nodusum, arthritis, fever, and uveitis. serum ACE and
calcium levels increased.
- ankle 1-2 achiles, knee 3-4 patellar, inner elbow 5-6 and triceps 7-8 and rest
5-6-7 (brachioradials?) REFLEXES dance by Dr Jermyn
- behcets syndrome - recurrent oral and genital ulcers. most pt will have
arthritis and other get ocular and CNS involvement
- primary biliary cirrhosis - fatigue, pruritus, primarily women. jaundice,
hypercholesterolemia, elev alk phos, elev IgM. antimitochondrial Abs. tx
supportive and ursodeoxycholic acid to slow progression
- trisomy 13 (Patau) mental retardation, polydactyly, holoprosencephaly,
meningomyelocele, rocker bottom feet, cleft palate, eye malformations,
GI/cardiac/renal dz.
- trisomy 18 (edward) -mental retardation, microcephaly, micrognathia (small
jaw), clenched fist, prominent occiput, rocker bottom feet, widely spaced
eyes. renal/cardiac/and or GI malformations at birth
- Trisomy 21 (Down) - a/w flattened nose, simian crease, upward slanting
eyes, delayed mental/social development
- elderly /hospitalized pt treat w/ indirect OMT (counterstrain, FPR, myofascial
release)
- spinal cord compression presents w/ severe BP, UMN signs, decr sensation,
and loss of bowel/bladder control. common complication of cancer that
metastasizes to the spine. tx promptly w/ corticosteroids
- preeclampsia - new onset HTN + proteinuria + end organ damage after 20
wga. pt are asx
- elampsia - sz in women w/ preeclampsia
- HELLP syndrome - hemolysis, elev LFT, low plts

- gestational HTN - new onset HTN s/p 20 wga but no proteinuria

- axillary nerve MC damaged w/ compression of the axilla w/ a crutch or fx of
the surgical neck of the humerus. wkness in shoulder ABduction
- acute chest syndrome - MCC sickle cell pts. new pulmonary infiltrate w/
alevolar consolidation on CXR w/ F, CP, tachypnea, wz/cough, hypoxia. tx:
blood transfusion (hgb should not be > 10), abx (3rd gen ceph + macrolide),
venous thromboembolism prop
- cleft lip is usually unilateral and should be surgically removed by 3 m/o of
age.
- influenza causes HA, COUGH!, ST, rhinitis, F, arthralgia, myalgia, and
malaise. dx is made w/ viral isolation in respiratory tract secretions
- nl physiologic changes during pregnancy: systolic murmur, increased blood
vol/hr/sv/co; decreased BP and SVR
- epligottitis 2-7 y/o
- hypothyroidism can mimic Depression! clues that hypothyroidism is
mimicking is: weight gain (depr pt usually lose weight), slowed speech,
hyporeflexia, nonpitting pedla edma, bradycardia, constipation, cold
intolerance, and hypothermia. wt gain w/ depression is either atypical or
hypothyroidism.
- avoid beta blockers in acute chf. tx w/ salt restriction, ACEI, lasix
- dysentery caused by gram neg bacteria in o/w healthy pt is only tx w/
supportive care unless if suspect Shigella (nonmotle, no lactose fermet, no
H2S production) and treat that with Cipro
- dysentery starts as watery diarrhea f/by smaller BM containing blood or
mucus. abd cramps, tenesmus, N, and F accompany bloody diarrhea. caused
by shigella, salmonella entercolitica, yersinia, e. coli, campylobacter,
entamoeba histolytica, giardia. dx is all done bhy culture. all are gram
negative.
- CMV infxn neonate: hearing and visual loss, petechiae, sz, and cerebral
calcifications
- toxoplasma infxn neonate: intracranial calcifications, chorioretinitis,
hydrocephalus
- syphillis infxn neonate: hutchinson teeth, interstitial keratitis, rash
- rubella infxn neonate: cataract, hearing loss, and cardiac defects

- a therapeutic thoracentitis for large or symptomatic transudative effusions

and malignant exudative effusions. insertion of a chest tube w/ empiric IV Abx
is first line for an empyema
- subclavian steal syndrome - neuro deficits and upper arm claudication w/
exercise of the upper extremity. PE: significant decrease in SBP and radial
pulse in LUE. dx w/ duplex, MRI, MRA. tx is surgical revascularization
- tx achlasia is laparoscopic myotomy
- dermatitis herpetiformis found is pt w/ celiac dz. caused by complement
activation due to IgA-gluten formations. pruritic, erythematous papules and
vesciles on elbows, knees, trunk, or buttock. dx confirm w/ skin biopsy. tx is
dapsone (diaminodiphenyl sulfone) and gluten free diet.
- erythema multiforme - sudden onset of macular or papular lesions that look
like targets on the hands and feet and a/w herpes simplex virus
- type 1 peptic gastric ulcer, type 2 means duodenal ulcer also present, type
3 is a prepyloric ulcer; type 4 is a proximal gastroesophagel ulcar, typ5 along
gastric body MC due to NSAID
- croup: mcc parainfluenza virus. barking cough, inspiratory stridor,
hoarseness. sx worse at night. kids 3 or younger. more common in winter. AP
neck xray tapering of trachea "steeple sign". tx: humidified air, epinephrine,
steroids, and O2
- perforated PUD - NG tube, IVF, broad spectrum abx, surgery
- ASD asx until adult. then eisenmenger - cyanosis, digital clubbing. slowly
progressive s/s of dyspnea, CP, peripheral edema, syncope. EKG = rvh.
auscultation = wide fixed splitting of S2
- aortic stenosis: mid systolic crescendo-decrescendo murmur, heard best
over the right second ICS, with radiation into carotid arteries and apex.
angina,syncope, and exertional dyspnea are common c/o. pulsus parvus et
tardus (pulse is late, weak/small)
- spermatocele - painless, cystic mass separate from the testes. freely
movable and transilluminates. located superior and posterior to the testes. tx
not necessary unles pt wants it removed
- varicocele exclusively found on the left b/c right spermatic vein drains
directly into IVC and left into left renal. texture similar to "bag of worms"
- hydrocele - painless scrotal swelling collection of peritoneal fluid. worse
later in the day. clear transillumination. anterior and lateral

- wernicke encephalopathy - triad of ACE - ataxia, confusion, and d/o of Eye.

thiamine def. seen in Etoh-ism.
- SITs (rotator cuff) - supraspinatus (ABduction); Infraspintus (ER) ; teres minor
(ER); subscapularis (IR). drop arm test of supraspintus; yergason and speed
for bicpital tenosynvotitis
- main concern crush injury - rhabdo - so get an ekg man!
- rett syndrome - female pt w/ microcephaly, autism like behavior, sterotypic
hand movemnts. lose speech prior to 18 m/o. nl up to then
- osteitis fibrosa cystica - skeletal d/o 2/2 advanced hyperparathyroidism. c/o
bone pain, fx, wt loss, fatigue, kidney stones, nausea, ,weakness. elev PTH,
calc and alk phose. Dec in phosophate. xray shows thin bones, brown cystic
tumors, and bowed or fractured bones. tx w/ vit D and parathyroidectomy
- sigmoid voluvuls on xray: markedly dilated sigmoid colon w/ its apex in the
RUQ "bent inner tube" or "coffee bean" sign. tx of sigmoid volvulus first
endoscopic decompression then used sigmoidoscope to untwist.
- marjolin ulcer - malignant transformation of a chronic wound MC due to a
burn. usually 30 yr s/p original insult. usually a squamous cell carcinoma
- osteosarcoma pain and swelling around the knee. PE hard, nonmobile mass
in the prox tib/distal femur
- drugs that shorten stages 3-4 of sleep are helpful in tx of somnambulism
(sleep walking). benzos and occasionaly trazodone
- appendicits is most often a result of a fecalith or lymphoid hyperplasia
leading to obstruction of the appendiceal lumen
- fugue state: pt suddenly travel, develop amnesia, and assume a new
identity
- EMTALA - ex and tx be offered to each ER pt tha trequest or appears to have
emergent condition. if refuses tx, inform risk/benefit of tx, document in
records
- conjugated hyperbilirubinemia - elevated levels of urine urobilinogen. (ie:
dubin johnson and rotor syndrome)
- most specific test for myasthenia gravis is the acetylcholine receptor
antibody test
- CD5 is HIGHLY SENSITIVE for CLL. men over 60; painless lymphadenopathy;
lymphocytosis; neutropenia; thrombocytopenia; and anemia. spleen is MC

enlarged organ. biopsy will show lymphocytes that are CD5 positive and
smudge cells
- akathisia - inner restlessness that develops days to weeks after pt is started
on a high potency antipsychotic. pt cant sit still. tx: lower or switch
antispychotic and beta blocker or benzo (propranolol)
- Conn syndrome: primary hyperaldosternonism. hypokalemia; HTN;
hypernatriema; elevated aldosterone; decreased renin. tx depends on
etiology. if idiopathic bilateral hyperplasia - spironolactone
- multifocal atrial tachycardia: 3 or more different P wave morphologies in the
same lead and a HR >100.
- wandering pacemaker: 3 or more different P wave morphologies int he same
lead and a HR <100 !
- most specific tests for SLE are anti-smith AB and Anti-ds DNA
- tachycardia w/ pulse: abc, O2, check stable. if stable, get ekg. ekg: wide
complex QRS and regular rhythm - vtach. tx of stable w/ symptoms:
amiodarone 150 mg IV over 10 minutes. if symptomatic and unstable: IV
access, sedate, and synchronized cardioversion
- bradycardia can be managed with atropine
- erectile dysfunction can be caused by venoocclusive disease w/ repeated
episodes of priapism in sickle cell pts. vascular dz, meds, neuron damage,
performance anxiety, and hypogonadism are other causes. tx primarily w/
PDE-5 inhibitors. psychogenic is MCC. noctural erections suggest psychogenic
cause
- FNA to evaluate solitary thyroid nodule
- ribs 1-5: pump handles; ribs 6-10: bucket handle; ribs 11-12: caliper
- 21 hydroxylase def is MC form of CAH. female infants have ambiguous
external genitalia, whereas male infants have normal male external genitalia.
other features: hyperkalemia, hyponatremia, hypoglycemia, and shock w/in
several days of birth. if electrolyte abnl develop, tx with IV bolus of NS and IV
hydrocortisone once blood samples are drawn
- meningitis: fever, HA, photophobia, and nuchal ridigity:
-

MCC adults: strep pneumo

MCC neonates: GBS
recent brain surgery or indwelling cath: staph
immunocompr or eldery: listeria

- AIDS w/ CD4<100: cryptococcus

- concurrent pulm TB: meningitis 2/2 TB
- camper w/ target like rash: lyme dz (borrelia)
- camper w/ a centripetally spreading petechiael rash from extr to
trunk: rocky mt spotted F (ricketsia)
- young w/ petechiael: neisseira
- tx bacterial meningitis w/ vancomycin, ceftriaxone, and steroids (if not
immunocompromised). for neisseira, close contact tx w/ rifampin or cipro
- choanal atresia presents w/ cyanosis that is worse w/ feeding and better w/
crying. NG tube insertion is not possible due ot obstruction so insert a
catheter thru the nose into the oropharynx.
- churg strauss syndrome = allergic rhinitis, asthma, blood eosinophilia,
positive P-ANCA
- Marfan's syndrome: arachnodactyly, scoliosis, pectus carinatum or
excavatum, ectopic lentis, long extremities, and hypermobile joints.
complication: aortic aneurysm
- MAOI: phenelzine; tranylcypromine; isocarboxazid; selegiline. tyramine crisis
or combining w/ SRRI (serotonin syndrome)
- short leg syndrome is treated w/ a heel lift. replace 50-75% of the leg length
discrepancy unless due to acute cause in which you do full. 1/8 inch initial
and then increase by 1/8 inch every 2 weeks until you get it.
- inhalatan anthrax - tx w/ cipro
- cholesterol embolism syndrome (atheroemboli) triad of eosinophilia, renal
failure, and livedo reticularis
- breastfeeding decreases the incidence of childhood episodes of O/M
- subclavian steal - CNS syncope, vertigo, confusion, ataxia, dysarthria. BP
usually lower in affected arm and c/o arm claudication. dx carotid duplex presence of retrograde flow w/in vertebral artery.
- early prosthetic valve endocarditis: staph epidermidis; late (1 year later):
strep viridans
- prolonged thiamine B1 def - berberi (biggest RF is alcoholism). wet beriberi CV sx of tachycardia, peripheral edema, and DOE. ex: JVD, cardiomegaly.
Dilated cardiomyopathy - decreased EF (systolic dysfxn). IV thiamine and stop
EtOH.
- SIADH: hyponatremia, low serum osmolality, low urine vol. dec BUN and/or

uric acid. tx: fluid restriction

- turner syndrome treated w/ human growth hormone and estrogen
replacement therapy
- restricted in right translation - sidebent right
- ATN - muddy brown , granular or renal tubular casts. BUN:Cr <20:1, urine
sodium >40, FENa>2% urine Osm <350
- hyperthyroidism suspect in child w/ unexplained anxiety, tachycardia,
unintentional wt loss, and prox ms weakness. mcc: graves. confirm w/
radioidone uptake scan
- vitamin D deficiency results in dec calcium and phosphate absorption. so
PTH increases. so serum phosphate goes down more. = secondary
hyperparathyroidism - inc calcium, dec phos, inc PTH
- pseudohypoparathyroidism - target organ resistance to PTH - hypocalcemia,
elev phos, and PTH. a/w albright hereditary osteodystrophy (bone
deformation)
- hypocalcemia in CRF is secondary to decreased renal clearance of
phosphate and insufficient 1-hydroxylation of 25-hydroxyvitamin D
- CRF: normocytic normochromic anemia, hyperphosphatemia, hypocalcemia,
hyperkalemia, azotemia
- indications for hemodialysis in renal failure: metabolic acidosis,
hyperkalemia, intoxications, volume overload, and pericarditis
- trichomoniasis causes genital inflammation increasing suspectibiltiy to HIV
infxn if she's exposed
- dx rapid c diff with C. Difficle toxin PCR
- workup of syphilis start w/ RPR or VDRL and then if positive, FTA-ABS or
MHA-TP.
- Infective endocarditis prop: resp tract, major dental proc, proc involving
infected skin, tissue just under skin, or msk tissue
- C section indications: placenta previa; vasa previa; placenta accreta; active
or symptomatic herpes lesions; maternal HIV w/ viral load >1000; irreversible
fetal distress; and malpresentation
- no muscle energy on critically ill pt, recent major CV event, or recent
surgery

- HVLA CI in osteoporosis
- hypothermia J or Osborne waves. Extra deflection at the end of the QRS
complex due to disturbance of repolarization. sinus bradycardia. prolonged
intervals
- sudden d/c of glucocorticoid therapy - MCC of adrenal insufficency. (CRH and
ACTH suppressed). s/s: abd pain, wkness, nausea, vomiting, wt loss,
hypotension, arthralgia/myalgia, hypoglycemia due to hypocortisolism,
confusion. this is secondary , so there is NO hyperkalemia and NO
hyperpigmentation.
- endometriosis - commonly affects cul de sac causing tender nodules and
dyspareunia. nodularity can be palpated on rectovaginal exam of the
uterosacral ligaments. dx w/ laparoscopy. shows powder burn or gun powder
lesions due to sequestered hemosiderin
- conn syndrome - aldosterone secreting tumor of adrenal gland hyperaldosteronism, HTN, hypoKalemia, metabolic alkalosis. confirm w/ CT of
abd showing mass or hyperplasia of adrenal. HTN AND HYPOKALEMIA! mgmt:
surgical remover of tumor
- posterior chapman pt w/ appendix: TP of T11. anterior is tip of right 12th ib.
- inferior wall MI - right coronary artery, ST elev in 2,3,avF
- Left main occlusion STT in AVR
- LAD - anterior left ventricle and septum. septal leads are V1-v4; total V1-V6
- ALS motor neurons only. Look for UMN and LMN signs. aspiration pna MCC
death. Riluzole can slow progression of dz
- symptomatic paraesophageal hernias - surgery. sliding hiatal hernia tx
symptomatically (gerd mgmt)
- GI volvulus MC at sigmoid. acute onset of ap,distention, vomiting. a/w
chronic constipation. PE: tympanic abd. axr: distended sigmoid loop devoid of
haustra and retention of feces in the prox colon. CT scan "whirl sign'. test of
choice: sigmoidoscopy - it will dx and helps in decompression
- bullimics will be of NORMAL or OVERWT
- Ogilvie's syndrome - acute colonic pseudo obstruction - s/s of bowel
obstruction but no mechanical obstruction. gross dilatation of the cecum and
the ascending colon. causes: trauma, serious illness, meds, neuro dz,
abd/pelvi surgey. s/s: N,V constipation, AP, labored breathing 2/2 abd
distention. PE: tympanic abd w/ bowel sounds. AXR: dilated colon often from

the cecum to the splenic flexure

- rotor sysndrome - defect in bili storage - elev direct bili / conjug bili. oral
cholecystography will visualize GB and total urinary coproporphyrin level
increased (unlike in dubin johnson). tx not required
- beck triad: hypotension; distant or muffled heart sounds; elevated jugular
venous pressure
- pulsus paradoxus - drop in systolic BP of more than 10 mmHg on inspiration
- ekg in tamponade: electrical alternans
- klinefelter syndrome: 47 XXY karyotype. pt are tall, long lims, gynecomastia,
small penis, sparse facial hair, small and firm testes. labs: elevated
gonadotropin levels, low testosterone, decreased sperm count. definitely dx
w/ karyotype. infertility issues w/ incr risk of extragonadal germ cell tumor
(mc mediastinal nonseminomatous germ cell tumor).
- pt w/ mediastinal mass: chronic cough, CP, superior vena cava syndrome,
horner syndrome.
- superior vena cava syndrome - SVC compressed and characterized by facial
plethora, localized edema of the face and upper extr, cough, distended neck
veins
- biotin def: alopecia, dermatitis, central and peripheral neuropathy,
depression, N, and V
- copper def: neutropenia, osteoporosis, hypochromic anemia
- iron def: anemia, pica, spoon nails, restless leg syndrome, esophageal web
- Vitamin A def: xerophthalmia and night blindness
- Vitamiin K def: ecchymosis, petechiae, bleeding
- aortic dissection - intimal tear in wall of aorta - second lumen. MC symptom:
onset of sudden tearing cp rad back. first intial step low bp w/ beta blockers
f/by sodium nitroprusside
- renal papillary necrosis - necrotic kidney tissue from papillay sloughing on
the U/A. Imaging w/ CT or IV pyelography - anatomical defects (medullary
ring shadows) and/or hydronephrosis. RF: tyl/nsaid use, sickle cell anemia,
urinary tract obstruction, DM. s/s: flank pain, F, abd pain, hematuria. tx is
supportive
- tx of salicylate toxicity: gastric lavage, activated charcoal, alkanization of
urine, dialysis if severe

- TCA antidote: sodium bicarb

- Beta blocker antidote: glucagon
- acetaminophen antidote: NAC
- methanol or ethylene glycol antidote: fomepizole or ethanol
- organophosphate poisoning: tx w/ atropine and pralidoxime
- opoid antidote: naltrexone or naloxone
- warfarin antidote: FFP, Vit K
- tPA antidote: aminocaproic acid
- Heparin antidote: protamine sulfate
- carbon monoxide antidote: 100% O2
- methemoglobin antidote: methylene blue
- Sturge Weber Snydrome - congenital port wine stain (hemangioma) in
distribution of V1 and V2. a/w mental retardation, glaucoma, hemiparesis,
hemianopsia, and seizures
- tuberous sclerosis: hypomelanotic macules ("ash leaft spots"), seizures,
mental retardation, shagreen patch (cutaneous nevus) and facial
angiofibromas
- neurofibromatosis type 1: cafe au lait spots, neurofibromas, freckling of the
groin or axilla, skeletal abnl, lisch nodules (hamartomas of the iris). NF type 2
causes b/l acoustic neuromas
- von Hippel Lindau - heritable multisystem cancer a/w esp clear cell renal cell
carcinoma, pheochromocytoma, and hemangioblastoma
- in hodgkin's lymphoma - mc enlarged LN in cervical and supraclavicular. is
painless but AFTER ETOH WILL BE PAINFUL!
- forgetting copayments and deductibles may constitute fraud
- dactylitis - inflammation of digits seen in sickle cell dz, arthropathy, and TB
- fetor hepaticus is a sweet, fecal odor of breath, and is a late sign of liver dz
- asterixis MC a/w hepatic encephalopathy. but also seen in renal failure, CO
toxicity, and wilson's disease
- medical records must be made available within 5 working days after a

written request is made

- gardner's syndrome - adenomatous polyps in addition to osteomas, dental
abnl, desmoid tumors, and cutaneous lesions.
- turcot's syndrome - CNS tumors and FAP.
- Acute HIV illness: presents much like influenza except w/ the addl sx of
lymphadenopathy and a diffuse maculopapular rash. acute HIV is dx using
both an ELISA and viral load. screening in pt w/out acute sx is done w/ an
ELISA and confirmed with an HIV 1/2 antibody-antigen combination test. pt w/
a CD4 under 500, or w/ opportunistic infxn should be treated w/ antiretroviral
therapy
- IgA nephropathy - follows viral illness, IgA and C3 on staining. normal C3
- PSGN: occurs at least 1 week after strep throat or skin infxn. high ASO. Low
C3. lumpy bumpy pattern of deposition on microscopy
- Granulomatosis w/ polyangitis - damages both lungs and kidneys. C-ANCA
positive. inolves upper airway: sinusitis, O/M, nasal ulceration
- goodpasture's: damages both lungs and kidneys. linear deposit of anti
glomerular basement membrane antibodies. does not affect upper airway
- MCD: fusion of podocyte foot processes. asx child becomes puffy and
edematous
- Alports: deafness and hematuria
- membranous nephropathy- adult w/ proteinuria and a thickened glomerular
BM. spike and dome pattern
- diabetic nephropathy - kimmelsteil-wilson nodules
- FSGS: a/w IVDA and HIVA. sclerosis is on biopsy
- lupus nephritis: multiple types so biopsy is essential to determine tx
- amyloidosis - apple green birefiregrence w/ congo red staining
- membranoproliferative nephropathy: tram track appearance of the BM
- chapman point for the tonsils: first ICS
- chapman pt for eyes: surgical neck of the humerus
- chapman pt for the middle ear: on the first rib and clavicles lateral to where
they cross the first ribs

- to dx RSV and parainfluenza - nasopharyngeal swab

- C ANCA targets proteinase-3
- P ANCA targets myeloperixodase
-signs of bowel infarction: hypotension, tachypnea, anion gap metabolic
acidosis due to lactic acidosis, fever, and AMS. tx: emergent lap. IVF broad
spectrum abx.
- MRI angio most def and specific test for dx of acute mesenteric ischemia.
"pain out of proportion" w/ elevated levels of lactate and abd pain
- BUM c spine, BUL t spine, BUL L spine (superior joint facets)
- mycosis fungoides MC type of cutaneous T cell lymphoma and is MC in
african americans. Cutaneous t-cell lymphoma is malignant dz of helper t
cells w/in skin and lymph nodes. initial appearance of scaly plaques along w/
an erythematous, pruritic rash.
- Fragile X syndrome MC inherited cause of mental impairment/retardation.
FMR1 gene on X chromosome mutated. s/s: macroorchidism, elonged face,
large ears, low muscle tone, cluttered speech, hand flapping movements
- external hemorrhoids causes pain, pruritus, and difficult hygeine but only
bleed when thrombosed. sx may be worse at the end of a long day of
standing due to blood pooling w/in the cushions. below the dentate line.
- doc guillian barre is plasmapheresis or IVIG (albuminocytologic dissociation).
elev CSF protein, nl WBC
- newborns exposed to opiates (morphine, codeine, heroin) during pregnancy:
w/drawal sx at 48-72 hrs after birth. high pitched cry, irrtability, tachypnea,
diarrhea, and vomiting
- newborns exposed to cocaine in pregnancy: high pitched cry, increased
alertness, and dec weight and head circumference
- neuroleptic malignant syndrome - rxn to antipsychotic med w/in first 10
days of tx. hyperthermia, diaphoresis, "lead pipe" muscular rigidity, AMS,
metabolic acidosis, autonomic dysfxn. high CK, myoglobinruina, low serum
iron. common w/ typicals antipsychotics (haloperidol, fluphenazine,
chlorpromazine) tx. 1) stop med, 2) IVF, 3)
dantrolene/bromocriptine/amantadine
- serotonin syndrome - ams, hyperthermia, myoclonus hyperreflexia, HTN,
tachycardia, dilated pupils, and tremor.

- symptomatic HCM should be tx w/ beta blocker or verapamil

- uremia can lead to pericarditis, encephalitis, platelet dysfxn. typical sx:
fatigue, anorexia, a metallic taste (dysgeusia), pruritus, vomiting, and weight
loss
- uremic pericarditis - NO EKG CHANGES bc it is due to fibrin deposition in the
epicardium and not inflammation
- methadone, tramadol, buneonorphine, oxycodone, and fentanyl don't show
up on UDS
- biliary atresia congenital dz of the liver, discontinuity or obliteration of the
extrahepatic biliary ducts resulting in cholestasis. atresia of the L and R
hepatic ducts to the level of the portia hepatis. sx w/in 1st few wks of life:
jaundice, dark urine, acholic stools, & hepatosplenomegaly. no neuro sx of
kernicterus b/c its CONJ DIR elev of bili! in full term infants primarily. most
reliable test: intraoperative cholangiography and preceded by a liver biopsy
or HIDA. tx: surgery
- galactosemia - carb metabolism d/o - def of galactose-1-phosphate
uridyltransferase. s/s: poor feeding, hepatomegaly, cataracts, and unconju or
mixed inc bili. suspectible to e. coli sepsis
- LAD - anterior - V1-V6 ST
- tx for endometriosis is NSAIDs + OCP
- positive lumbosacral spring test: resistance to springing at the lumbosacral
junction. positive if sacral base has moved posterior (sacral extension)
- somatostatinoma - somatostatin secreting tumors of duodenum or delta
cells of pancreas. DM, diarhea/stettorrea, cholelithiasis, hypochlorhydria, and
wt loss. dx w/ US or CT abd, tx: surgical resection
- glucagonoma - DM, necrolytic migratory erythema, wt loss, and diarrhea
- tetrabenazine DOC for chorea a/w huntington's disease
- MCC hyperparathyroidism is an adenoma
- acute mesenteric ischemia presents w/ severe periumbilical abd pain that is
disproportionate to benign PE. look for hx of heart dz. dx w/ angiography. tx:
IVF, NGT, broad spectrum abx, prompt laparotomy and resection of infarct
bowel
- interstitial lung dz has restrictive findings on PFT: nl or elev FEv1/FVC
- VSD - if doesnt close, too much blood pump to lungs - pulm HTN and heart

failure. holosystolic murmur with a palpable thrill, loudest at the 4th ICS.
complications: endocarditis, heart failure, pulm htn, aortic regur,
eisenmenger syndrome
- ASD systolic pulmonary flow and diastolic rumble
- impetigo - honey crusted lesions that sometimes ooze. spreads to ppl easily.
regional lymphadenopathy. dx: clinical, tx: mupirocin or retapamulin
- eryispelas - sharply demarcated, erythematous lesion taht is raised, has
advancing borders, and has regional lymphadenopathy. strep pyogenes. tx
w/penicillin
- tx postherpetic neuralgia w/ TCA, topical analgesic, opoids, gabapentin, and
pregabalin.
- excessive amount of canned tuna fish - mercury! mercury poisoning: tremor,
ataxia, asymmetric sensory deficits, and delirium
- Safer v Pack: physician has a duty to take reasonable steps to warn those
known to be at risk of avoidable harm from a genetically transmissible
condition
- colon chapman's point: anterior iliotibial band.
- rectum chapman point: over the lesser trochanter
- tx community acquired pna: azithromycin or FQ (moxifloxacin). if in ICU, add
beta lactam. curb65: 0-1 outpt, 2 inpt, 3 above ICU
- euthyroid sick syndrome presents in hospitalized pts 2/2 to their primary
illness. nl TSH, dec T3, nl T4. no tx necssary just f/up with thyroid studies.
- drug induced hypothyroidism: causes MTX, lithium, and amiodarone.
- amebic liver abscess - entamoeba histolytica - ignestion of cysts in
contaminated water or veggies - cellular lysis and hepatic necrosis gets a
cavity containing cellular debris and blood - aspiration is achovy like paste. sx
days to wks of abd pain, f, abd t, hepatomegaly, anorexia, wt loss, diarrhea,
and jaundice. odorless!
- pyogenic abscess fluid has a foul odor
- Wilms tumor a/w aniridia, GU malformations, and mental retardation
- O/M: bulging, pale, immobile TM, no light reflex. doc: amoxicillin
- DES: barium swallow corkscrew pattern. tx: CCBs, imipramine, and nitrates.
botulism toxin for temporary relief

- hydrosalpinx - collection of fluid inside the fallopian tube and almost always
complication of acute saplingitis / PID. may cause infertility. U/S: sausage like,
cystic lesions w/ clear fluid.
- reflux in babies is very commonly due to vagal irritation 2/2 congestion from
occipital condylaer compression. tx w/ condylar decompression
- rubeola (measles) fever, conjunctivities, coryza, cough, and koplik spots
(blue/white spots on the oral mucosa). f/by maculopapular rash that appears
on the face and spreads caudally. prevention: MMR vaccination. tx: vitamin A
supplementation. contagious for 4 days after onset of rash
- colon ca: right sided tumors melena and occult blood in stool leading to iron
def anemia. left sided tumors hematochezia and narrow stools
- augmentation of MDD: antidepressant + lithium, or antidepressant in a diff
class, or atypical antipsychotics
- hyperthyroidism in preg usually due to graves dz. tx w/ PUT in first TM and
methimazole on subsequent TM
- pars defects (spondylolysis) dx w/ oblique views of Lspine; spondylolisthesis
dx w/ latera views
- Blastomycocis: BLAS-to (Bones, Lungs, and Skin)! in midwest and
southcentral states. f, cough, wt loss, cp, fatigue, painless well demarcated
verrucous or ulcerated skin lesions, bone lesions, and CNS dz. KOH prep:
borad based budding organisms. doc: itraconazole
- chlamydial/inclusion conjunctivitis begins btw 5-14 days of age; discharge
watery at first then mucopurulent. tx s PO erythromycin
- gonorrheal conjunctivitis w/in 2-7 days of neonate. purulent d/c and eyelid
swelling. tx w /cefotaxime.
- a previous hx of radioactive ablation for hyperthyroidism w/ subsequent
galactorrhea -> hypothyroidism! b/c TRH stimulates TSH and prolactin
secretion. so tx thyroid and it should decrease
- antipsychotics inhibit dopamine. so that increases prolactin: galactorrhea,
decrease in menstruation
- malpractice claim: duty owed to the patient, breach of duty, damages,
causation (dereliction of a duty directly causing damages)
- graves dz MCC hyperthyroid. thyroid stimulating IgG Abs that activate TSH
receptors. proptosis/exopthalmos and local or pretibial myxedema. initial test
TSH. TSH decreased. and T4/T3 increased. radioiodine uptake scan will reveal

increased uptake.
- anal abscesses: throbbing pain, F/chl. ex: erythema, fluctuance, edema
- fistula in ano - discharge, pruritus, and pain w/ defecation
- anal fissure - severe pain during defecation. MC location is posteriorly in the
midline. tx is increase fiber and take warm sitz baths to decrease the spasms.
also can use ntg ointment, topical ccbs, and botox injxn.
- anal cancer - bleeding and painful mass
- VSD murmur: holosystolic blowing murmur at the left lower sternal boder
- thymoma: sob, hoarseness, dysphagia, CP, SVC syndrome. a/w myasthenia
gravis. surgery is tx
- human placental lactogen (chorionic somatomammotropin) leads to insulin
resistance in preg - so mom is hyperglyemic and UA may show glycosuria
- hyperlipoproteinemia type 2A is the MC of familial hyperlipoproteinemia. pt
will have very high HDL levels
- anterior dislocation MC type of shoulder dislocation. MCC trauma or falls
onto an outstretched hand. c/o: shoulder pain, loss of shoulder shape,
numbness over the deltoid ms (axial nerve palsy), and arm that is ABDucted
and ER. (thats how you distinguish it from posterior dislocation)
- ulnar nerve injury: passes thru cubital tunnel in medial aspect of the elbow
(MC result of medial epicondyle fx, sleeping w/ elbow behind head, bracing
elbow against a hard surface, or bench pressing). curling of the last 2 fingers
is the ulnar claw. (clawing of the 4th and 5th digits and paresthesias in the
medial one and a half finger). tx is w/ removing pressure from the cubital
tunnel or repairing the fx
- posterior sholder dislocation - arm IR and ADDucted. coracoid process will
be prominent w/ a flattening of the anterior shoulder where the humeral head
used to be. tx: prompt immobilization w/ a sling until a closed reduction can
be performed in the ER, if unsuccessful then surgery.
- radial nerve entrapment or injury leads to wrist and finger extensor muscle
weakness along w/ paresthesia on the back of the hand
- chronic intestinal ischemia presents w/ postprandial pain (esp w/ fatty
foods) and wt loss. MC in pt w/ pre-existing atherosclerotic dz. on exam:
abdominal bruit
- TB induced MCC adrenal insuffiency world wide

- adrenal insufficiency: hypotension, fatigue, wt loss, N/V, abd pain,

hypoglycemia, hyperkalemia, fever.
- postcoital contraception (morning after bill - plan b- levonorgestrel is a
progrestin only pill) if given w/in 72 hours
- mitral stenosis - mid diastolic heart murmur - major cause of atrial dilation atrial scarring - abberant atrial activity - atrial fibrillation
- tx of afib focused on rate control w/ beta blockers or CCBs. once controlled,
pt placed on anticoag due to risk of thrombus formation
- ekg for WPW: short PR interval and a delta wave
- cocaine and amphetamine withdrawal - dysphoria, excessive sleep, and
hunger
- opoid withdrawal - rhinorrhea, lacrimation, yawning, abd and leg cramping,
piloerection, n/v/d, dilated pupils
- alcohol withdrawal - seizures
- von willebrand disease MC inherited bleeding d/o. autosomal dominant. s/s:
cutaneous and mucosal bleeding, menorrhagia, and GI bleeding. prolonged
bleeding time and PT. 1st line tx: desmopression.
- angiodysplasias (AVM or vascular ectasia) MC vasular anomalies in the GI
tract and a very common cause of painless lower GI bleed in pt over 60.
dilated tortous submucosal vessels. a/w aortic stenosis, von willebrand dz,
ESRD. most of the time, bleeding SR. o/w colonoscopic coagulation of the
lesion.
- treatment of choice for acromegaly is transsphenoidal surgical resection
- gastroschisis - protrusion of abd contents thru right of umbilicus with no
tissue sac. RF: meth babies, cocaine, asa, ibuprofen, young maternal age.
immediate fluid resuscitation and urgent surgical replacement of the bowel
into the abdominal cavity
- to dx DM: 1) HgbA1C >6.5%, 2) fasting over 125, 3) serum over 200 , 2 hrs
after 75 g oral glucose, 4) random over 200 w/ classic DM sx
- cancer's w/ bone mets: "BLT with Mayo and a Kosher Pickle: breast, lung,
thyroid, MM, kidney, and prostate
- retinal artery occlusion - acute, painless, monocular loss of vision due to
embolus. fundoscopic: pale retina with a cherry red macula.
- occlusion of the opthalmic artery can cause amaurosis fugax - brief

ipsilateral visual loss with no cherry red spot on fundoscopic

- if less than 30, breast US best next in workup for mass
- lochia is a vag d/c during postpartum for up to 6 weeks. first red (rubra)
then pink and thin for a week or so (serosa) and then yellow/white d/c (lochia
alba) for the remainder
- malignant hyperthermia (after inhalational agents or succinylcholine):
muscle rigidity, tachycardia, acidosis, elevated temp. d/c agent, 100 % O2
(stabilize pt) and then dantrolene
- seborrheic dermatitis affects areas w/ sebaceous glands. known as dandruff.
dry scales w/ flakng, may c/o pruritus. MC areas: scalp, axilla, body folds and
external ear canal. dx clinical. tx selenium sulfide shampoo for the scalp and
hydrocortisone cream for other affected areas
- trazodone: trazoBONE! causes priapism, orthostatic hypotension, and
excessive sedation
- RR narrow complex QRS tachy - SVT. tx adenosine / vagal
- Vtach - wide QRS - amiodarone
- if unstable SVT: IV access, sedation, sync cardiover
- atropine for bradycardia
- group a strep - mcc pharyngitis 5-15 y/o. contagious until abx for 24-48 hrs
- MCC hypothyroidism - hashimoto's. antithyroid perioxidase (anti-TPO) abs in
serum and lymphocytes infiltrating thyroid gland. nontender goiter. initially
destruction causes hyperthyroid state. eventual: high TSH, low T4, anti TPO
abds (antimicrosomal antibody)
- strep pharyngitis will cause atleast 2 of: tonsillar exudates, lack of cough,
tender anterior cervical lymphadenopathy, or temp over 100.4.
- otitis externa MC s aures and pseudomonas. c/o hearing loss, pruritis,
drainage, and otalgia. pushing the tragus or auricle causes pan. TM difficult
to visualize but freely moveable. tx: cleaning plus topical acidic abx/steroids
(topical cipro plus hydrocortisone otic)
- if you test positive for chlamydia. dont assume gonorrhea and just treat w/
azithro or doxy. BUT IF positive for gonorrhea, then for chlamydia
- anti-jo-1 ab and ANA positive - highly suggestive of
polymyositis/dermatomyositis. "progressive, b/l ms weakness. initially trouble
combing hair and now has trouble climbing stairs" (proximal upper extr first)

- intraductal papilloma benign growth into one of the ducts - serious or bloody
nipple d/c. or straw colored. tx: duct resection
- capitation - when a physician is paid a contracted rate for each member
assigned regardless of the number or nature of services provided.
- fee for service - fee is paid to a physician, according to the service
performed, by a patient or insurer, after a service is rendered
- Aortic regurgitation: high pitched, blowing early diastolilc murmur heard at
the left sternal border or second ICS to the right; PMI will be displaced; wide
pulse pressures
- alzheimer head ct will show enlarged ventricles and cerebral atrophy
- picks dz aka frontotemporal lobe dementia. personality changes and speech
disturbance
- boerhaaves syndrome transmural tear in the distal esophagus. hx: vomiting
and retching f/by retrosternal CP. cxr initial dx modality
- spondylolysis defect in pars interarticularis mcc stress fx in young athletes.
most freq at L5. oblique x-ray "scotty dog" dark band representing defect
looks like a collar
- spondylosis - OA of the vertebrae. xray shows djd
- spondylolisthesis - anterior displacement of the vertebra dx w/ lateral xray
and mcc spondylolyis
- fetlys synddrome - RA, neutropenia, and splenomegaly. pt can also present
w/ thrombocytopenia and anemia
- tx insulinoma w/ surgical resection. if poor surgical candidate: diazoxide.
- budd chiari syndrome - thrombosis of the hepatic vein or IVC leading to
hepatic congestion as blood cannot flow out of the liver. most pt have an
underlying hypercoaguable state. triad: RUQ, jaundice and ascites! dx: US:
thombi "obliteration of the hepatic vein", large collateral vessels, and ascites.
most specific/sensitive test is hepatic venography. tx: anticoagulation,
diurectics, thrombolytics, managing the ascites, and sodium restriction.
- nicotonic receptors only on skeletal muscle
- muscarinic receptors on cardiac, smooth ms, and glands
- myasthenia gravis: autoantibodies directed against acetylcholine
postsynaptic receptors

- in folic acid: methylmalonic levels normal! in Vitamin b12 def: inc mMA and
homocysteine!! b12 level might be normal!
- TCA o/d" convulsions, coma, cardiac conduction. cyclobenzaprine is similar
in structure! TCA: amitriptyline, nortriptyline, imipramine, clomipramine,
despiramine, doxepin
- ALL peaks in 3-5 y/o. bone invasion causes pancytopenia -> anemia, bone
pain, infxns, and signs of low plts. BM biopsy will show increased blasts of
lymphoid lineage
- full thickness/ 3rd degreen burn: epidermis and dermis down to SQ fat. hard,
leathery eschar that is painless and black, white, or cherry red in color.
prompt excision f/by skin grafting
- voyeurism - sexual arousal watching unsuspecting people
- frotteurism - rubbing against an unsuspecting person
- masochism - humilate MYSELF
- sadism - humilate SADIE - someone else
- pth activates osteoclasts resulting in bone resorption and osteodystrophy
- in renal failure, get secondray hyper-pth b/c increased phosphate binding to
calcium and activing pth gland
- CRI is the inherent motion of the craniosacral system. allowed by 5
components of PRM: 1) inherent motion of the brain and spinal cord, 2)
fluctuation of CSF, 3) mobility of intracranial and intraspinal membrae, 4)
articular mobility of the cranil bones, 5) involuntary mobility of the sacrum
btw the ilia
- transitional cell bladder carcinoma c/o painless hematuria. rf: smk, radation,
aniline, diesel, cyclophosphamide. dx test: cytoscopy w/ biopsy
- porphyria cutanea tarda - mc type of porphyria. a/w hep c, hiv, etoh abuse,
increased iron, and estrogen. painless blistering of sun exposed areas (dorsal
hands) that rupture and become crusted. increased facial hair (hypertricho).
def of uroporphyrinogen decarboxylase. no belly pain (like the other
porphyrias). tx: chloroquine or plhebotomy
- copper def: fatigue, anemia, osteoporosis, and leukopenia. neutropenia,
thrombocytopenia, microcytic hypochromic anemia
- fluoride deff: tooth decay and osteoporosis.
- selenium def: keshan dz: cardiomyopathy and ms weakness. breath smells

like garlic
- magnesium deF: anorexia, tremors, seizures, palpitations, AMs, depression.
- MC type of anal cancer is squamous cell. RF: HPV, receptive anal
intercourse, smoking
- Sturge weber syndrome - port wine of the stain (nevus flammeus) and sz.
mental retardation, hemianopsia, hemiparesis. "intracranial calcifications" on
skull xray or CT. MRI brain most sensitive imaging. tx control seizure
- gilberts syndrome - dec UGT, unconjug hyperbili, asx
- henoch schonlein purpursa: palpable purpura, abdominal pain, and
arthralgia. vasculitis w/ IgA deposition that MC affects the skin and kidneys.
Mc in children. palpable purpura usually on buttocks and low extr. vasculitis
of GIT-gi bleed. renal involvement: hematuria. renal biopsy shows IgA
deposits. dz is self limited
-notching of the ribs seen w/ coarctation of the aorta
- PDA: left to right shunt, pulmonary vascular dilated seen as increased
vascular markings on cxr, murmur is continuous machine like murmur loudest
at the 2nd left ICS; tx indomethacin or ibuprofen in premies. surgery if large.
- in pt w/ hypercoaguable states and abd pain that is out of proportion to PE
findings, suspect acute mesenteric ischemia and start heparin
- anterior cerebral a. - medial surface of the cerebral cortex, frontal pole, and
anterior portion of the corpus callosum. b/l occlusion - lower extr paraplegia,
incontinence, motor aphasia, and personality change. unilateral occlusion: CL
sensorimotor deficit of upper extr
- middle cerebral a. - supplies temporal lobe, anterolateral frontal lobe, and
parietal lobe. occlusion - CL hemiplegia affecting the face and arm,
homonymous hemianopia, apraxia, and aphasia
- posterior cerebral a. - supplies the midbrain, thalamus, part of the temporal
lobe, and occpital and occipitoparietal cortices. occlusion: homonymous
hemianopsia w/ sparing of the macula and prosopagnosia (cannot recognize
faces)
- posterior inferior cerebellar a - occlusion : ataxia, dysphonia, CL loss of pain
and temp from the pain, ipsi lossof pain and temp from face, ipsi horners,
hoarseness, diminished gag reflex, diplopia, and dysphagia
- levator ani syndrome - pelvic floor dysfxn w/ sx including poorly localized
pelvic pain, dysmenorrhea, dyspareunia, and issues w/ urination including

difficulties voiding and incre urg and freq. fecal incontinence and sexual
dysfxn. OMT can help.
- chapmain point for vagina: just distal to the ischial tuberosity, on the
proximal posteromedial thigh
- chapman for blader: TP of L2
- lichen planus inflammatory dermatitis w/ lesions commonly occuring on the
flexural surfaces of the extr. affects the mucous membranes, hair, nails, and
the genitals. PE: typical cutaneous lesions which are erythematous to
violaceous, polygonal, flat with a small central dimple and coalesced into a
group. Purple, Polygonal, Pruritic, Papules. Wickham striae are fine white
reticulations seen on the surface on the lesions and in the oral cavity.
histological characteristics: 1) damaged basal epidermal keratinocytes, 2)
linear arrangement of lymphocytic infiltrate in the papillary dermis at the
interface w/ the epidermis "lichenoid pattern". for localized , tx w/ medium to
high potency topical corticosteriods
- myxoma - MC primary tumor of the heart in adults. connective tissue tumor.
right or left atria. sx: wt loss, fatigue, dyspnea, syncope. pedunculated , "ball
valve" obstruction of the mitral valve. "tumor plop " sound - early diastolic
thud f/by diastolic murmur. complications: arterial vein occlusion due to
tumor embolization and sudden death
- legg calves perthes dz is avascular necrosis of the femoral head; pt afebrile
4-10 y/o, c/o pain and limping
- painful limp after a URI = transient synovitis. afebrile, nl ESR and nl WBC
- Neimann Pick dz: def in sphingomyelinase - progressive loss of early motor
skills, hepatosplenomegaly, and feeding difficulities. mental retardation.
cherry red macular spot. mc in ashkenazi jewish
- tay sachs dz: def in hexosaminidase A - progressive loss of motor skills,
neuro deficits, and cherry red macula. NO HEPATOSPLENOMEGALY.
- Fabry's dz: def in galactosidase A - neuro and renal dz. skin lesions in the
groin area
- Gaucher dz: def in glucocerebrosidase - neuro sx, hepatosplenomegaly,
hypersplenism (thrombocytopenia/anemia), and osteoporosis
- infective endo: mitral murmur w/ rheumatic heart dz. tricuspid systolic
murmur w/ IVDA. left sided septic emboli, splinter hemorrhages, janeway
lesions, and osler nodes. right side: fever, PE, pyopneumothorax.
- ASD mid systolic ejection murmur

- VSD pansystolic harsh murmur

- PDA continuous machine like murmur, tachycardia, poor growth, dyspnea
- if <35 y/o and epididymitis: chlamydia trachmatis and neisseira gonorrhoea.
if >35 y/o: ecoli.
- duodenal atresia manifests w/in hours w/ bilious vomiting and abd
distention. abd xray 2 large air filled spaces (double bubble sign)
- nerve entrapment at guyon canal - ulnar nerve - add/abd of digits,
extending PIP little finger, opposing little finger
- to determine if pulmonary edema is due to ARDS vs cardiogenic, echo!
- labyrinthitis - inflammation of CN VIII - vertigo, hearing loss, nausea, and
vomiting. MCC virus. clue: preceding viral illness. self limited. require an
audiogram to document their hearing loss
- meds that cause hearing loss: furosemide, salicylates, aminoglycosides
- meniere: vertigo, hearing loss, and tinnitus. chronic in nature w/ multiple
relapses. overproduction of endolymph. tx diuretics and salt restriction
- benign positional vertigo - vertigo that worses w/ head movement. no
hearing loss. otoliths in semicircular canals. ex: positive dil halpike. epley
manuever to move it
- charcot marie tooth - presents in the first 2 decades of life w/ progressive
distal limb weakness, decreased proprioception, decreased reflexes, tremors,
spinal deformities, high arched foot defect (pes cavus). c/o foot drop. fmhx
mc inherited neuro dz. child clumsy & falls frequently. hand wkness may
cause poor handwriting.
- congenital talipes equinovarus - club foot - presents at birth w/ IR ankles
- ataxia-telangiectasia - ataxia, spider angiomas, progressive neuro dysfxn,
sinopulmonary infxns (IgA decr)
- tracheoesophageal fitsula - sx in 1st wk of birth and present w/ coughing
and choking w/ feeding, gastric distention, aspiration pneumonia, and
regurgitation. Drooling! is a clue! dx made by unablet to pass NGT into
stomach and confirm w/ xray. need surgery
- choanal atresia blockage of nasal passage. also inability to insert NGT BUT
NOT GASTRIC distention!
- small cell lung carcinoma - lambert eaton myasthenic syndrome autoantibodies against presynaptic calcium channels - proximal muscle

wkness and hyporeflexia. dx w/ nerve stimulation - incremental response to

repeated ms stimulation.
- MCC pancreatitis in children and adolesects: blunt trauma to the abdomen.
epig ap rad to back, n/v. pain aggravated by eating. fever, tachycardia, dec
bowel sounds.
- cubital tunnel syndrome - compression of the ulnar nerve- MC at the medial
elbow. numnbess and tingling at the 5th finger and ulnar half of the 4th finger
- dequervain tenosynovitis - pain localized to the distal radius and (+)
finkelstein's
- klumpke paralysis - injury to C8-T1: horner syndrome, ulnar nerve
distribution numbness, paralysis of intrinsic ms of hands
- hip drop test - evaluate sidebending of lumbar spine. less than 20 degree
drop is restriction
- sciatic nerve compression evaluated by SLR
- wiskott aldrich syndrome - x linked recessive characterized by
thrombocytopenia, ezcema, and immunodefienccy. petechieae, purpura,
hematochezia,, melena, epistaxis, prolonged bleeding s/p circumcision,
unusual bruising. hx of eczema and freq infxn (encapsulated organisms). tx
supportive. cure: hematopoietic stem cell transplant
- von willebrand dz - autosomal dominant d/o - easy bruising, recurrent
epistaxis, menorrhagia, or prolonged bleeding after surgery or dental
extraction. prolonged PTT b/c of f8 def.
- lead neuropathy: b/l wrist drop or foot drop or sensory loss a/w abd pain,
HTN, insomnia, and if severe, encephalopathy. kids: language delay,
behavioral changes, ha, abd pain, lethary, N, constipation. dx w/ blood lead
level w/ fingerstick. hypochromic, microyctic anemia and basophilic stippling.
xray long bones "lead lines". chelators succimer, edta, and dimercaprol. "ED
for lead and SUCCs to be a kid w/ lead poisoning"
- subacute granulomatous thyroiditis / de Quervani's thyroiditis inflammatory process s/p viral infxn. PAINFUL, diffusely enlarged thyroid and
hyperthyroidism. c/o neck pain that may radiate to the jaw. tender, diffusely
enlarged thyroid gland. low tsh, elevated t4/t3/ESR. low uptake on
radionuclide scan. tx symptomatic relief w/ NSAID
- EMTALA applies to situations where a patient requests an examination or
where the pt appears to have an emergency med condition. if no exam is
requested or where there is no emerg med condition, EMTALA does not apply

- so surgical site infxn 4-10 days after: s. aureus, pseudomonas, e coli. but
w/in 24 HOURS: group A strep and clostridium spp. b/c dont need that big of a
bacterial load.
- newborn male w/ urinary tract obstruction almost always caused by
posterior urethral valves. US: oligohydramnios, b/l hydronephrosis, dilated
bladder. dx: voiding cystourethogram (Vcug)
- nephrotoxic drdugs: aminoglycosides, amphotericin B, cisplatin, ACE
inhibitors, NSAID, loop diuretics, cyclosporine, tacrolimus, acylovir
- basal cell carcinoma - affects men, mc due to sun exposure, so found on
face. rash is translucent or pearly papules w/ telangiectasias. rolled up edges
"rodent ulcer" if ulceration present. dx w/ shave or punch biopsy and tx w/
excision.
- squamous cell - keratin pearls, ulcerated red, nodular mass on lower lip,
actinic keratosis is precursor.
- Langerhans cell histiocytosis - prolilferation of specialized bone marrow
derived langerhans cells. a/w interstitial lung dz closely related to smoking.
Pulmonary langerhans cell histiocytosis affects 20-40 y/o smk. c/o dyspnea,
nonprod cgh, fatigue, wt loss. cxr: b/l nodules, cysts, honeycombing, any
bony lesiosn of the ribs. smk cessation and corticosteroids
- beta blockers can also tx essential tremor, thyrotoxicosis, migraines, and
some arrhthytmias
- thiazides can also tx osteoporosis or kidney stones
- CCBs can also tx raynauds, esophageal spasm, and some arrhythmias
- alpha 1 antagonists can also tx BPH
- non maleficence - do no harm
- vicarious liability - liable for someone elses action
- digeorge syndrome - 22q11.2 delation - neonatal hypocalcemia, immunodef,
cleft palate, cardiac and renal anomalies, development delay, char facial
features. tet of fallot, truncus arteriosus, interrupted aortic arch or VSD.
parathyroid hypoplasa - hypocalcemia and twitching or sz. impaired T cell fxn
b/c of aplasia or partial aplasia of the thymus. CXR w/out thymus. recurrent
infxn like O/M. cleft palate, micrognathia, long face, narrow palpebral fissues,
hgih and broad nasal bridge. order FISH and karyotype to dx.
- beckwith - wiedemann syndrome - distal tip of chr 11p. LGA infant :
hypoglycemia soon after birth, macroglossia, organomegaly,

hemihypertrophy, GU defects, anterior abd wall defect, or a wilms tumor

- eye chapman point: lateral humerus
- middle ear chapman point: clavicles just lateral to where they cross the ribs
- sinuses chapman point: first rib
- tonsils chapman point: 1st ICS
- tongue chapman point: 2nd rib
- conn syndrome - primary hyperaldosteronism - hyper natremia,
hypokalemia, low renin. HTN
- SIADH - euvulemic hyponatremia, dec BUN, dec uric acid. low serum Osm.
low urine vol
- addison- primary hypoadrenalism - hyperpigmentation, hyponatremia,
hyperkalemia, hypotension, decreased cortisol.
- lithium toxicity a/w tremulousness, confusion, dysarthria, dystonia,
hyperreflexia, and ataxia
- primary adrenal sufficency tx w/ glucocorticoid and fludrocortisone. but
other types (secondary and tertiary) are tx w/ only glucocorticoid tx
- ASD - wide fixed splitting of S2. close spontaneously so observe in kids, if
older or symptomatic - surgical patching
- pt w/ fmhx familial adenomatous polyposis - flex sig or colonoscopy starting
at puberty
- imperforate hymen - dx as a neonate (when causing urinary problems) or
adolescence (menarche). bulging, bluish mass at the introitus. c/o int
abd/pelv pain c/w menstrual period but no bleeding
- methanol poisoning - windshield wiper fluid, anti freeze, home made EtOH
drinks. hx of attempted suicide or homemade EtOH. c/o hyperpnea,
confusion, sz or coma. anion gap metabolic acidosis. fomepizole alcohol
dehydrogenase antagonist used to treat it
- mammogram: every 2 years starting at 50 or 40
- posterior fontanelle closes w/in 6 m/o and is now lambda. anterior closes
w/in 24 m/o and is now bregma (sagittal, frontal, coronal suture meet).
- middle meningeal artery is just deep to the pterion (where the sphenoid,
temporal bone, parietal bone, and frontal bone meet)

- atypical depression: mood reactivity + wt gain, hypersomnia, leaden

paralysis, or sensitivity to rejection
- granulosa theca cells secrete estrogen. pt present w/ large adnexal mass.
young pt - precocious puberty, premenopausal - irregular menses,
postmenopasual - vag bleeding thickened endometrium
- APCKD - hematuria, AP, HTN, palpable kidneys. dx via US. complications:
intracerebral berry aneurysms, hepatic cysts, and thoracic aortic aneuryoms
- congenital hypothyroidism - large anterior fontanelles, poor feeding,
decreased stooling, macroglossia, developmental delay, dry skin, hypotonia,
myxedema, goiter, and decreased activity
- peritonsillar abscess - fever, unilateral sore throat, odynophagia, hot
potato/muffled voice, trismus, uvula might get displaced towards unaffected
side. fx clx, confirm w/ drainage of pus. tx: airway mgmt, drain abscess,
empiric abx w/ clindamycin
- open angle glaucoma - painless and gradual visual loss. increased cup to
disk ratio.
- HVLA ribs (if key is 2-12): supine pt crosses their arms across their chest, pt
body flexed and sidebent away from dysfxn rib, doc stands on opp of dysfxn
rib and places thenar eminence over the posterior angle. inhalation treated
w/ caudal directed HVLA thrust and exhalationt reated w/ thurs that is angle
45 degrees cephalad
- endometritis mcc fever immediate postpartum. pe: f and uterine fundal
tenderness w/ foul smelling lochia and tachycardia. r/o uti, mastitis, wound
infxn, PNA, and septic pelvic thrombosis. usually s/p C section. tx: clinda and
genta
- glucagonoma: necrotizing migratory erythema, DM, wt loss, glossitis,
stomatitis, cheliatis. dec amino acids.
- celiac dz - initial test igA Ab to tissue transglutamine (tTG) and
endomysium. anti-gliadin IgA highgly specific but poor sensitivity so dont
screen w/ it. confrim with EGD with multiple biopsies of small bowel. biopsy:
blunted villi and crypt hyperplasia. other manifestations: erythematous
papules and vessicles that is pruritic (dermatitis herpetiformis), iron def
anemia, delayed puberty, osteopenia, hypertransaminaemia
- L3-L4 herniation impinges L4: decreased patellar reflex, sesnation over the
medial malleolus, and ankle dorsiflexion
- L4-L5 herniation impinges L5: decreased sensation over dorsum of foot and

toes 1-3, decreased big toe extension

- L5- S1 herniation impinges S1: decreased achilles reflex, sensation over the
lateral malleolus, and toes 4 and 5, and ankle plantar flexion
- anytime the pt has increased AM glucose, measure it again at 3 am before
making changes to the insulin regimen
- Dawn phenomena: occurs as a result of early morning growth hormone
secretion. GH is an antagonist to insulin, pt will be hyperglycemic in the
middle of the night. So at dinner, you would increase the basal insulin
- Somogyi effect: occurs w/ overtx of NPH causing the pt to become
hypoglycemic overnight. 3am glucose will be low. pt will counter the
hypoglycemia and become hyperglycemic in the morning. So at dinner you
would decrease the NPH.
- eclampsia: preeclampsia+ grand mal sz. tx: airway mgmt, IV mag sulfate,
delivery after stabilizing mom. betamethasone is used if gestational age <34
wks for fetal lung maturity
- contraindications to labor induction: uncomplicated preg under 39 wks,
placenta previa, vasa previa, active genital herpes, breech, and umbilical
cord prolapse
- indications for labor induction: preg over 42 wks, maternal or fetal danger,
chorioamnionitis, placental abruption, and premature ROM
- secondary hypothyroidism - pituitary dysfxn - dec TSH and dec T4.
- at 3 m/o: propping up on FA in prone and rolling on the side. chuckle and
vocalize when addressed
- at 5 m/o: rolling back to front and sitting wih arms supporting anteriorly.
infant will respond to his or her name
- at 7 m/P: roll from a prone position to a supine, sit without support, transfer
object from hand to hand, raking grasp, sleep all night, respond to name,
respond no, babble, may have stranger anxiety
- at 9 m/o: prop up on ft and hands, creep, able to pull up to standing w/out
support
- at 12 m/o: begin to walk, should be able to follow 1 word commands, say
atleast 1 word
- strep pneumo: gram positive, alpha hemolytic, coccoid, chain forming
bacteria, single MCC of CAP, sinusitis, OM. tx CAP w/ PCN G or Amox

- S3 indicates increased ventricular filling due to systolic dysfxn caused by

CHF or severe MR or TR
- EtOH withdrawal: in first 12 hrs - insominia, tremor, anxiety, GI upset, HA,
diaphoresis, palpitations, and a/v/tactile hallucinations. w/in 12-24 hrs - gen
tonic clonic sz . w/in 24-48 hrs: DTs, visual hallucinations, disorientation,
tachycardia, HTN, low grade fever, agitation, and diaphoresis
- tactile hallucations can also occur in cocaine use and withdrawal
- insulinomas - elevated insulin and C peptie levels, and hypoglycemia.
persistence of hyperinsulinemia after a 72 hr fast confirms the dx
- silicosis - nodular opacitis in the upper lobe. tx glucocorticoids
- berylliosis - cough, DOE, wt loss, F. cxr: b/l hilar adenopathy. tx
glucocorticoids
- neurofibromatosis type 1 - axillary freckling cafe au lait, and iris
hamartomas (lisch nodules), scoliosis, RAS, pheochromacytoma sz
- neurofibromatosis type 2 - cafe au lait spots , b/l acoustic neuromas,
meniongomas, sz
- von hippel lindau dz - hemangiomas in the brain, spinal cord, and retina. a/w
renal cell carcinoma, pheochromacytoma, renal angiomas
- tuberous sclerosis - sz, hamartomas, learning disability, hypopigmented
lesions (ash leaf) on the trunk and extr. affects also eyes, heart, lungs, kidney
- lithium side effects: nephro DI. check bun/cr, tfts, preg test
- breath holding spells occur btw 2-8 y/o. kid become cyanotic and lose
consciousness. tx is to avoid triggering events and protect the child from
trauma when losing consciousness. no pharm tx required
- RF shouler dystocia: macrosomia, maternal DM, post term pregnancy,
prolonged second stage of labor, multiparity, history of previous. tx:
mcroberts and suprapubic pressure
- paternalism - tx of a pt in a way that ignores his/her wishes but aims at
promoting the pt's best interest
- de quervain tenosynvoitis - inflammation of the sheath that surrounds the
extensor pollicis brevis and the abductor pollicus longus ms. caused in the
post pregnancy per from repeated lifting of an infant. first tx w/ rest, nSAID,
and splint. c/oL pain, tenderness, and sweling over thumb side of the wrist.
pain on thumb extension and abduction. finklestein test (grasping the thumb

and sharp ulnar deviation)

- intracranial mass: projectile vomiting, AM HA. disturbed vision, sz, AMS.
papilledema (swelling of the optic nerve) - seen as blurring of disc margins.
MC compressed nerve is CN VI - paralysis results in abduction weakness in
the eyes
- white patches on the retina - cotton wool spots caused by damage to nerve
fibers in DM or HTN
- AV nicking - HTN retinopathy
- pallor of the optic disc - esp in glaucoma
- peutz jeghers presents w/ pigmented spots ont he lips, oral mucosa, and GI
mucosa. colonoscopy: <100 hamartomas in small bowel. prone to
intussception and obstruction. a/w testicular, uterine, cervical, ovarian, and
breast cancer
- turcot's syndrome - CNS malignancy a/w FAP
- FAP - over 100+ polyps
- Gardner' sydrome - adenomatous polyps and osteomas, lipomas, fibromas,
cysts, and dental abnl
- 'respondent superior' - let the master speak - theory of vicarious liability
that an employer is responsible for the actions of employees performed w/in
the course of their empooyment
- intussusception - small bowel at the ileocecal junction invaginates into distal
segment of intestine (telescoping) btw 3-36 m/o. sx: bilious vomiting, pulling
legs to the chest to relieve AP, red current jelly stool. PE: palpable sausage
shaped abd mass. if clear present like that, then barium / water soluble/ or air
contrast (pneumatic) enema are the best next step because both dx and
therapeutic. if not clear, then US will show coiled spring or bulls eye sign
- nonocclusive mesenteric ischemia typically seen in the critically ill and
eldery pt bc of CVD and low CO - splanchic vasoconstriction. vasconstrictive
meds (epi and norepi) can exacerbate mesenteric ischemia in pt who are
critically ill and hemodynamically unstalble. so use dobutamine or milrinone if
you need inotropic agents.CT for acute mesenteric ischemia is pneumatosis
intestinalis (gas cysts in bowel wall), portal venous gas, lack of bowel wall
enhancement, and ischemia of other organs. pt who present w/ peritonitis
due to bowel necrosis - immediate ex lap.
- at 2 y/o - running, standing on tiptoes, walking up and downstairs w/
support, building a tower of 4+ blocks, recognizing names, using 2-4 word

sentences, using cups and spoons, make believe play, showing defiant
behavior
- 1st line tx for osteoporosis is bisphosphanates w/ vit D and calcium
supplementation
- polyarteritis nodosa - necrotizing arteritis of medium sized vessels (skin,
heart, renal, cns) skin: livedo reticularis, SQ nodules, digital gangrene, ulcers.
HTN. abd pain w/ meals due to mesenteric ischemia. negative p-anca. 10%
have underlying hep b infxn so get serologies. dx w/ biopsy
- ^ basically: polyarteritis nodosa may be caused by Hep B infxn. pt present
w/ abd pain, HTN, wt loss, and skin lesions.
- involuntarily psych admit reqs: 1) danger to self, 2) danger to others, 3)
inability to care for themseves due to a psychiatric illness
- acute intermittent porphyria - porphobilinogen deaminase def that leads to
elevated aminolevulinic acid and porphobilinogen. mc in women. episodic
acute attacks of abd pain. other s/s: vomiting, constipation, tachycardia, HTN,
ms weakness, pain in the extr, psychologic sx. attacks precipitated by smk,
stress, certain drugs. dx w/ detection of increased levels of both in urine
during aacute attack. not a/w rash (like the other tpyes of porphyria)
- allergic rhinitis. most significant RF family hx of atopy or asthma. pt c/o
congestion, rhinorrhea, snz, itchy eyes and throat. dx clx. tx intranasal
corticosteroids
- hypotension, oliguria, lactic acidosis, AMS common in shocks
- cardiogenic shock - increased pulm cap wedge pressure and JVD. low CO,
high SVR
- neurogenic shock - disruption of ANS control over vasoconstriction (usually
due to trauma). peripheral vasodilation causing warm, flushed skin. low CO,
low pulm cap wedge pressure, and low SVR. in other types of shock a low SVR
increases CO but not in neurogenic!
- septic shock - peripheral vasodilation with warm, flushed skin. SVR decre,
CO increased in response. pulm cap wedge pressure low.
- hypovolemic shock usually caused by trauma, diarrhea, vomiting, GI, SBO,
burns. decreased preload - decreased CO. SVR increases to compensate.
pulm cap wedge pressure low.
- all shock - abcs. protect airway, give O2, large gauge peripheral IV access,
and 1-2 liter bolus of NS (unless if signs of CHF present)

- acute stress disorder ( < 1 m/o), acute PSTD (1-3 m/o), chronic (> 3 m/o)
- PTSD tx w/ SSRI, prazosin (dec PMmares), and densitization exposure
psychotherapy. if actively suicidal - inpt !
- measles (rubeola) caused by paramyxovirus. cough, conjunctivitis, coryza.
koplik spots (grey spots on buccal mucosa). after 1 week of this,
maculopapular rash on face to caudal
- hand foot mouth dz - coxsackie A virus - fever and vesciles on palms, soles,
inside mouth, infxn spread by direct contact w/ nose and throat discharges,
saliva, or stool. prevent w/ handwashing
- rubella is a member of togavirus - german measles - suboccipital and
postauricular lympahdenopathy. a/w maculopapular rash that starts on face
and spreads caudal. arthralgias also seen.
- human herpesvirus 6 causes roseola infantum/exanthem subitum/ sixth
disease. fever for 2-5 days self limiting f/by maculopapular rash on the trunk
that spreads to the neck and extr
- RTA in general: nonanion gap hyperchloremic metabolic acidosis
- RTA 4: hypOaldOsteronism - hyponatremia, hypercholemia, and
hyperkalemia, and acidid urine. seen in pt w/ DM and interstitial nephritis.
ONLY RTA that has hyperkalemia! if ekg changes, Iv calcium otherwise loop or
thiazide diurectics +/- bicarb
- RTA 1: distal tubular defect in h+ secretion leading to urinary pH over 6.0.
hypokalemia. higher predisposition to kidney stones b/c inc calcium and
phosphate exrection caused by alkaline urine. common cause: sjrogen, SLE,
other autoimmune. tx bicarb
- RTA 2: defect at proximal tubule fxn to reabsorb bicarb. tx w/ alkali
replacement. occurs in kids as fanconi syndrome (abnl excretion of glucose,
amino acids, citrate, and phosphate into the urine, as well as, vit D def and
hypokalemia). a/w multiple myeloma and carbonic anhydrase inhibitor use.
low bicarb, high chloride, low potassium can be seen in type 2. so use urine
ph. in 1: can't acidify urine. in RTa 2: acidic urine.
- gAstric ulcers - type A blood; duOdenal ulcers - type O
- pt 55+ y/o and /or w/ alarming sx such as wt loss, dysphagia, new onset
anemia, hemorrhage, and early satiety - upper endoscopy w/ biopsy
- gonoccocal arthritis - migratory and usually leads to tenosynvoitis (pain,
swelling, and difficulty moving affected jt). pustules over palms and soles

- amphetamine intox - agitation, increased alertness, bruxism, euphoria,

diaphoresis, dilated pupils, confusion, anorexia, tachycardia, HTN, F, dental
erosion. may lead to sz and stroke (withdrawal sx opposite - sleepiness,
increased appetite). cocaine similar but does NOT affect the teeth!
- opoid intox - pinpoint pupils!, sedation, slurred speech, respiratory
depression, euphoria, constipation
- PCP - impulsiveness, psychosis, violent behavior, HTN, tachycardia,
agitation. Nystagmus! (horz, vert, rotary), rhabdomylosis is a common
complication
- LSD intox - expanded experience of senses (radiant colors, visual
hallucinations, echoiing of sounds), delusions, dilated pupils, F, tachycardia,
HTN, diaphoresis, paranoia, dry mouth, and sleepiness. can see music and
hear colors. flashbacks