Cardiovascular V fib: give CPR, defibrillation, vasopresorr (epi, vasopressin).

If no respond, thn try amiodarone, if not there then lidocaine. Chest pain: should get PA and lateral chest radiographs. Endocarditis: vanco and genta. ENterococcus, strep, MRSA. Aspirin decreases MI In men. Increased hemorrhagic stroke. Decrease women ischemic stroke. Anti-PL syndrome: low platelets. Aspirin and heparin best. TIA: Prevent with warfarin. Niacin: can lead to hepatotoxicity in elderly. Gingko: intracerebral bleeding, inhibit platelet aggregation. Kava: GI AE, skin rashes. Yohimbine: HTN. PE: risk is high in postpartum period. If px had DVT during pregnancy, continue tx for 6 weeks with LMWH or warfarin. If px has a heart block, get an echo. Long QT: recurrent syncope, sudden death in family members. Tx BB, ICD, no sports. Non-HDL cholesterol should be less than 20 greater then LDL. Adenosine can cause hypotension, transient a fib. Amiodarone: has I, can cause thyroititis, hyperthyroidism. Athletes may develop eccentric LVH. Post-thrombotic swelling: complication of DVT. Chronic pain, swelling, skin changes in that limb. Decrease risk with compression stockings, start when also start anticoagulation. LMWH: monitor anti-Xa levels in obese and renal failure. PAD: aspirin, exercise until you have pain. Statins, ACEI VTE ppx: >40 with limited mobility for 3 days with one of: infectious disease, class 3-4 CHF, previous VTE, acute MI, acute respiratory disease, stroke, rheumatic disease, IBD, recent surgery or trauma, obese, central venous cath, varicose veins, estrogen tx, thrombophilia. Digoxin: in CHF with a fib. Amiodarone in s/p MI with risk of fatal arr. A blockers can cause depression. BB can cause impotance. Abciximab: for cath patients with chance of coronary events. No NSAIDs Omega 3 fats decrease sudden death, nonfatal MIs, stroke Aneurysms. Thoracic: often no sx. Dissection: branch vessel compression, ebolization. Ascending aorta: hoarseness, paralysis of hemidiaphargm, wheeze, cough, hemoptysis, dyspnea, dysphagia, SVC syndrome, AR acute heart failure. CXR shows large aortic knob, tracheal displacement. Angio best way to evaluate. Ascending surgery. Descending BB, then nitroprossude. Descending surgery when occlude major beanch, continued dissection, rupture. Cardiac resynchronization therapy: use in class III or IV CHF with QRS 130+, LVEDV 55mm, EF<30%, sinus rhythm, dilated on ischemic or nonischemic cardiomyopathy. Gets ventricles to contract at same time in LBBB. SVT: no P waves, narrow QRS. Try adenosine, then verapamil or BB for tachycardia. Last resort cardioversion Stills murmur: from vibrations in heart, no sx, systolic, in lower precordium, sounds like plucked string, does not radiate, decrease with inspiration. Venous hum: continuous low pitch, from collapse of jugular veins and then fluttering. Worse with inspiration, diastole. Enoxaparin: cleared by kidneys. BB liver. tPA same doses in renal disease, but higher includence of hemorrhages. Thombolysis: do in infarction, not ischemia. Use in LBBB, RBBB because it means an artery is occluded. Axillosubclavian vein thrombosis: most commonly from compressive anomaly in thoracic outlet. Swelling and aching in forearm and hand.

PVD: first screen with ankle-brachial index, <0.5 means pathology, decreases after exercise. >20 mm Hg decrease in systolic blood pressure when exercise. DVT: use Vitamin K anatagonist for 3 months. 3-6 months if related to travel, eg enoxaparin SC BID. More in neurological and orthopedic surgeries. Ppx in total hip or knee replacement with lovenox or warfarin. CHF with symptomatic heart block: do not use BB. BNP levels correlated to LVEDP. High in lung cancer, cor pulmonale, PE. Cleared by kidneys BB help in CHF II and III, previous MI. Use in perooperative in px with cardiac risks to decrease mortality. Decrease mortality after MI WPW: radiofrequency ablatio. Digoxin risk v fib. A fib: want rate control. CCB or BB. Also warfarin. Rhythm control does not help. Digoxin as add on or if LV dysfunction. Cilotazol: PDEI for arterial occlusive disease and intermittent claudition. Do not use in CHF. Can use ins troke, DM. can help with low HDL, third degree heart block. Long QT: arr from torsades or v fib. WPW: procaimamide. Aspirin in CVD prevention: men 45-79, women 55-79. Decreases MI in men, stroke in women. MVP: tx BB if have sx. Horse chestnut seed extract as tx for venous insufficiency. Milk thistle for cirrhosis. Postural orthostatic tachycardia: HR increases by 30 or goes up to 120 when upright. Sx: position dependent HA, abdominal pain, lightheaded, palpitations, sweat, nausea. Most no pass out. More in white females 15-50. High correlation with chronic fatigue syndrome. Causes: genetic, after virus. Tx: fluid and salt, then exercise, then BB. AAA: more in smokers. DM is protective. Women in 60s, men 50s. more whites. Atrial fltter and CHF: cardioversion. If stable, then digoxin, verapamil. Arm DVT: usually from catheter. Also cancer, OCPs, inherited, compression of axillary0subclavian vein in athletes. Less complications than leg. Tx heparin 5 days, Coumadin 3 months. H&H should be 10-12 if risk of stroke, CHF. PE: orthopnea in CHF, fever infgection, asthma COPD. Rhonchi: CHF, lung disease, infection. DES: need clopidogrel and aspirin for 12 months. Minimum 6 months for DES, 1 month bare metal. HTN crisis: 180/120. Venous ulcers: pentoxifylline, compression, aspirin. Hypovolemia: pulmonary capillary wedge pressure 8mm. give NS VSD: harsh holosystolic, hear at LLSB. Cardiomegaly, increased pulmonary vasculature markings. Hyplplastic left heart: obliterate LV, cyanosis. TGA: AV conduction issues, one side hypertrophy. PDA best heart below L clavicle, large LA and LV. PE: heparin or fondaparinaux for 5 days, then stop when INR >2 for 24 hours. Renvovascular HTN: Doppler to dx. Warfarin: start at 5mg/day in elderly, heart, liver, surgery. Pericardial effusion: echo to dx. IV Mg: for vtach in torsades, rapid a fib. DES: do antiplatelet therapy for 1 year. Aspirin, clopidogrel. PE: normal V/Q scan rules out. Normal D dimer only rules out in low to moderate risk. Ischemic colitis: abdominal pain, bloody diarrhea, CV risks.

Heparin-induced thrombocytopenia: within 1-2 weeks. Thrombosis, anaphylaxis, skin lesions. Uncontrolled stage 2 HTN: no static exercise, such s rowing. Amiodarone: use in vtach, a fib if sx and CHF Renal artery stenosis: stage II HTN after 50, ACEI increases Cr. Endocrine Subclinical hypothyroid: high LDL. Subclinical hyper: a fib, decreased bone density, cardiac issues. Do not treat either. Li can increase PTH secretion high Ca. discontinue for 3 months before evaluate again. Secondary hypothyroid: need free T4 to determine propr replacement dose. High PTH: usually from one adenoma. Surgery when kidney stones, <50, Ca >1 than normal, decreased bone density Solitary thyroid nodule: more malignancy in male, <20, >65, rapid growth, dysphagia, neck pain, hoarse, hx of radiation, family hx, hard fixed nodule >4cm, cervical LAD Hypothyroid child: delayed bone age relative to height and actual age. Thyrotoxicosis bone resorption low PTH DM Metformin: start at same time as lifestyle modifications. Increases insulin sensitivity the most. Hold if px is getting IV contrast because of risk of kidney damage. GI distress early in therapy. no hypoglycemia. Exenatide, pramlinitide: make gastroparesis worse in DM. DM in elderly: insulin glargine. Acarbode: glucosidase inhibitor, delays glc absorption DM should have folate for vasculoprotection Acarbose inhibits glucocidase less absorption of sugars other than glc. Gliptins prevent incretin breakdown. Renal disease: can use glipizide, acarbseor DM dx: test if BMI>25 with one or more risk factors sedentary, Gliptins: not in liver disease, anovulatory. DM: exenatide and metformin cause weight loss. Acute new superficial foot infection: Staph aureus, beta strep. Glycemic control does not hlp CV M&M, metformin does GI

Crohn: young person, episodic pain after eating, periumbilical, low grade fever, mild diarrhea. Anorexia, nausea, vomit, weight loss. May be tender in RLQ with palpable mass. Celiac: associated with RA, thyroid disease. Diarrhea, constipation, bloating, flautus, belching. Fatigue, depression, fibromyalgia-like sx, aphthous stomatitis, bone pain, dyspepsia, GERD. IgA entiendomysial Ab is sensitive and specific. Dx with esophagogastroduodenoscopy with bx of distal duodenum. Appendicitis: spiral CT is sensitive and specific. Leukocytosis, pyuria, hematuria is not specific. If CT is inconclusive, admit and monitor. Pancreatitis: lipase is more sensitive and specific. Alcoholics may have normal amylase, amylase in general does not correspond to the severity. Gilbert: AD, high UCB, decreased glucuronyl transferase. Dubin has high CB. Gastroparesis: autonomic neuropathy. Dx with scintigraphy. Integumentary Bariactric surgery: PE most common COD. HFMD: enterovirus can also cause. Oral, foot, buttock lesions. Low grade fever. Evaluate abdominal injury: do with peritoneal lavage. Herpangina: severe sore throat, vesicles and ulcers. Tonsils, C diff: semiformed instead of watery stool fecal WBC. Main soft palate, uvula. source is fomites in hospitals, chronic care facilities. Travelers diarrhea in kid: z pack. Loperamide, Bis salicylate.

Barrett: risk of adenocarcinoma is less than 1% Sessile adenoma: need repeat colonoscopy in 2-6 months to make sure it is gone. C jejuni: most common cause of bacterial foodborne illness, chicken is main source, more summer, more males, more old and young, 2-5 days after exposure, mainly diarrhea with some n/v. Shigella: fecal-oral, water, leukocytosis. Diverticulitis: tx augmentin. LLQ, can seem like abscess. Proctalgia fugax: episodic sudden sharp pain in anorectal area. Normal exam. GI bleeding: more important to find out site and not cause. Dx with blood pool scan, laparatomy if cannot dx. IBD: onset during adolescence or young adulthood. Crohn more systemic signs, perinaal disease Probiotics: decrease incidence, duration, and severity of Abassociated and infectious diarrhea. AE flatulence and diarrhea, AE short gut syndrome. C diff: if at risk, stop Ab. No tx for C diff unless stool has toxins A and B, use oral metro. ALT: good PPV for gallstone pancreatitis. CRP in pancreatic necrosis. SBP: high neutrophils Water: Giardia and Cryptosporidium resist chlorine HCV screen in: IVID, clotting factor, high ALT, recent needsstick. Maternal-fetal transmission rare unless mom has HIV. HBV exposure: test immunized person for Ab. If low, then vaccine and Ig. If not immune, then Ig immediately, then vaccine within 1 week. C jejuni: most common cause of bacterial diarrhea. Cholelithiasis: plain radiograph. Does not show radiolucent or biliary dilation. US. Celiac: weight loss, frequent mild abdominal pain, diarrhea, bleeding. Osteoporosis Zencker: halitosis, regurgitation, choking, dysphagia, weight loss. Dx barium swallow. Tx surgery. Celiac: abdominal pain, nonbloody diarrhea, weight loss. High AST and ALT, osteopenia, low iron. Dermatitis herpetiformis: itchy rash, vesicles IBD: first dx with WBC, platelet, K, ESR. SMA embolization: severe abdominal pain, vomit, diarrhea. Cardiac source, arr. May have normal abdominal PE. Severe leukocytosis, microscopic hematuria, blood in stool. Dx angio. Tx embolectomy. Abdomen distended, soft, diffudely tender, pale extremity with no palpable pulse. A fib. FAP: all have cancer by 40 if no colectomy. IBS: restrict alcohols, sorbitol, some carbs, daily peppermint oil. Ascites: tx diuresis, salt restriction, aldosterone. If severe, do paracentesis. PPI AE: C diff, CA PNA, decrease B12 and Ca absorption Acute pancreatitis: total enteral nutrition better than TPN. Non-alcoholic fatty liver: age, obese, TG, DM, HTN. Statins can help. Postcholecystectomy pain with jaundice: retained commen duct stone.

Keratoacanthoma: dome shaped lesion with central plug, heals on own within 1 year. Lichen somplex chronicus: from scratching or rubbing. Isolated edematous hyperpigmented lesion. Scaly and thick in center Melanoma: ellipicital excision as soon as possible. Milia: pearly keratin plugs. No erythema. On trunk and limbs. Cutaneous larva migrans: Ancylostoma. From walking barefoot outside. Paronychia: from irritants or being wet for a long time. Tx topical betamethasone Atopic dermatitis: eczema. Tx steroids. Itchy rash on face and extensors. Secondline topical calcineurin inhibitors. Melanoma: most in men over 50 Leishmaniasis: boils, tender lesions, central ulceration, crust formation, no systemic sx. Can look like folliculitis, epidermal inclusion cysts. Tx Na stibgluconate Pemphigoid gestationis: AI, itchy bullae that spare face Acne: mild no nodules, use topical benzoyl, retinoids, Ab. Moderate few to several nodules Cellulitis: A strep Herpes gladiatorum: aka HSV Molluscum: keratinized plugs Chronic plaque psoriasis: most common psoriasis. Thick, red. Topical Vit D and high potency steroids best. Actinic keratosis: precursor for SCC. More malignancy in thicker, cutaneous horns, lesions with ulceration. Pityriasis rosea: mild prodrome, salmon colored raised herald pathc on trunk with smaller similar lesions on Langers lines. Rosacea: women 30-60. Central facial erythema and telangiectasias, can become papules and pustules. Facial edema, rhinophyma. Flushing. Conjunctivitis. Tx sunscreen, metro, doxy. Clonidine or BB for flushing. Psoriasis: associated with CV risk. Smoking incrases risk of psoriasis. Associated with obese, DM. Pernio: aka chilblains: local skin inflammation. Extremities after cold. Red purple plaques, deep swelling, itch and burn. Malignant melanoma: aka lentigo: older, face. Impetigo: augmentin, mipirocin, cephalexin. Staph aureus. Topical tx ok. Alopecia: inject steroid into site if older than 10. If younger, then minoxidil. MRSA most common skin and soft tissue infection in ER Dermatomyositis: Grottons papules: flat topped, violaceous papules on knuckles and PIP RMSF: fever, hypotension, rash, myalgia, vomiting, HA. Rash 24 days after fever. Small, pink, blanching macules. Face usually spared. UV radiation biggest risk factor. Superficial: most common, men torso, wmen ligs. Lentigo: old, upper . Thickness mopst important. Shave raised. Musculoskeletal Secondary osteoporosis: phenytoin, cyclosporine, hep Phenobarbita HRT: decrease colorectal cancer. increase breast cancer risk Developmental dysplasis of the hip: subluxation and dislocation of newborn hip. More in firstborns, females, breech, oligohydramnios, family hx. Clunking sensation and feeling of movement when adduction and applying posterior pressure. Resolve spontaneously in most. Refer for orthopedist. Screen breech babies and positive family hx. Sesamoid fracture: two in metatarsophalangeal joint. Can happen with sudden dorsiflexion, gradual development.

Tenderness and swelling of medial plantar aspect of MT joint. Pain with passive toe dorsiflexion. Mortons neuroma: between 3rd and 4th toes. Numbness. Fro pinched nerve. PMR: normal creatine kinase at all levels. Neck, shoulder, hip girdle. No swelling. Symmetric. High ESR and CRP. May have high LFTs Slipped capital femoral epiphysis: pain with activity. More in obese, anterior thigh. Limited internal rotation of hip. Asolescents with recent growth spurt. Polymyositis: inflammation. Proximal mm. high creatine kinase and aldolase. Tx steroids. Normal neuro aside from weakness. Femoral anteversion: observation up to 10 years. RA: hydroxychloroquine can delay progression. Lateral ankle sprain: pain over distal anterior talofibular ligament, swelling, tender to palpation. Should to early ROM exercises Do ankle radiograph when: pain in malleolus, bone tenderness at back or tup of malleolus, cannot bear weight after injury or in ER Intoeing: from internal tibial torsion. From sleeping in prone position and sitting on feet. Usually resolves without intervention by 8 years. Anterior fontanelle: closes at about 1 year. If closes early, monitor head circumference to check for craniosynostosis and brain development, can check with radiograph. Male osteoporosis: tx PTH, bisphosphonate. Midshaft posteromedial tibial stress fractures: common, low risk. Manage with air stirrup leg brace. Plantar fasciitis: common cause of heel pain. Worst when first stand up after sleeping or sitting. Point tenderness to palpation at medial calcaneal tuberosity. Tx with heel inserts. PMR: dramatic response to corticosteroids. Pain in shoulder, pelvic girdle. Fever, night sweats Pyogenic tenosynovitis: finger pain, swollen, fixed poition, pain with passive extension, tenderness to palpation. Tx Ab, splint in first 48h, then drain and Ab. Can lead to ischemia of tendons. Patellofemoral pain: overuse in adolescent girls. Anterior knee pain, worse with stairs, running in hills. Associated with inadequate hip abduction and core strength. Tx rehabilitations. Nursemaids elbow: common injury <5 years. When hand jerked up elbow extended radial head slip out from mannular ligament. Stress fracture: plain radiograph. If negative, can redo in 2weeks. CT less sensitive. MRI is secondline. Stress fracture: pain, hurts when press, little pain at rest, worse with weight bearing and ambulation. Tender to palpation, trace edema near area of tenderness. Pseudogout: fluid has PMNs, Ca pyrophosphate. Chrondrocalcinosis on imaging. Chronic neck pain: dx with complete C spine series. Then MTI or CY myelography if contraindicated. Per anserine bursitis: pain in area of insertion when flex and extend knee, tender. May have swelling. Tx nSAID, PT, sterolid. Associated with OA in medial knee compartment, overuse, trauma. Biceps tendon rupture: visible lump in upper arm. Loud painful pop. From eccentric load to fixed elbow. Risks: >40, contralteral rupture, deconditioning, past rotator cuff tear, RA, smoking. Weak supination and elbow flexion. Biceps squeeze test and hook test are sensitive and specific.

Acute anterior shoulder dislocation: restricted movement, Plantar fasciitis: most common cause of hl pain in runners, painful. pain at beginning of workout. Overuse injury. Heel or arch pain. Tender site, pain with dorsiflexion. Steroids if Lateral epicondylitis: pain and tender over proximal lateral conservative therapy fails. forearm. Patellofemoral pain syndrome: clinical dx. Most common Biceps tendinitis: deep throbbing pain over anterior shoulder, cause knee pain in outpatient setting. Anterior knee pain with bicipital groove tenderness. stairs, run, squat. Popping, catching, stiffness, giving way. Clavicle: fracture medial third common in kids. Tx figure of 8 Positive J sign: patella moving from medial to lateral location apparatus. when knee fully extended from 90 degree position. No locking, Boxers fracture: fracture fifth metacarpal head. Slight volar if there is, then consider meniscal tear. angluation, no displacement. Tx ulnar gutter splint for 3-4w Major tendon rupture: repair asap, surgery if px is active. Frozen shoulder: 40-60, idiopathic, common. DM risk. Fight bite: get radiograph to r/o fracture. Ppx with Ab if there Shoulder stiff, less passive and active rotation, pain. Dx with are any breaks in the skin. Painful distal fifth metacarpal with clinical because imaging ir normal. superficial abrasion. Rotator cuff tear: normal passive ROM. Impingement: normal Femoral neck stress fracture: common in runners, military passive ROM, pain with shoulder elevation. recruits. Persistent groin pain, limited hip flexion and internal ACL tears: prevent with plyometrics, strenghtneing. More in rotation. Normal radiographs early. females, risk of OA. Injured without physical contact. Iliotibial band syndrome: in runners. Stinging pain over lateral Tarsal coalition: fusion of 2+ tarsal bones. Mid to late femoral epicondyle. adolescence, bilateral in hald. Pain around ankle, decreased Ostetitis pubis: in distance runners, pain in anterior pelvic ROM of hindfoot, pain on inversion. area, tender over symphysis pubis. Spinal stenosis: worse with extension, walking downhill. Hawkins impingement: positive in subacrominal Thoracic vertebral compression fracture: decreased activity impingement, rotator cuff tendinopathy or tear. Flex arm with until pain is tolerable, then bracing. Vertebroplasty if not elbow bent, pain with internal rotation. beter in 2 weeks. RA going into surgery: need to image C spine Posterior tibial tendinopathy: twisting foot (like step in hole). Gout: dont eat nuts or beans. Women over 40. Pain, swelling. Pain with single leg toe raise. Brachial neuritis: pain before weakness. No trauma. Not in Tx immobilization for 2-3 months. Pain posterior to medial dermatomal distribution. EMG can show. Burning pain. Full malleolus, worse with weight bearing and inversion. ROM of neck and shoulder without pain. Femoroacetabular impingement: anterolateral hip pain, worse No epidural steroids without radicular signs when pivot laterally on affected hip, worse sit to stand, not tender or warm. FADIR (flex, adduct, internal rotation) most Patellofemoral stress syndrome: runners knee. Tx with PT. sensitive. Avascular necrosis: worse with weight bearing, pain gradual onset, no effusion. Tendernss over medial with any hip motion. OA pain in groin, worse with FABER. retinaculum. Normal ROM. Patella deviates laterally when Bursitis: sore after exercise, tender. knee is extended from flexion. Paget: risk of sarcoma. Tx with bisphosphonates. Normal Ca h Neurology Dupuytrens disease: more in men over 40, progressive. Reflex syncope: high SNS then withdrawal vd and Fibrous fasic of palmar surface gets shorter and thickr. May hypotension. Before cold sweat, lightheaded, yawn, dimming need steroid injection, surgery. Associated with DM. vision. No HA, neuro issues. Can dx with tilt testing. contractures in hands, nodules, bands. First no sx. Surgery if contracture severe or PIP contracture. Vasovagal syncope most common cause of fainting. Reflex mediates changes in vascular tone or HR. Midshaft clavicle fracture: usually medical management. Higher risk of nonunion in: females, fracture communition or Migraines: biofeedback helps, do not use triptans or displacement, clavicle shortening, advanced age, larg trauma. ergotamines in pregnancy. Cluster HA oxygen, Epley benign Heal well in kids. positional vertigo Acute ankle sprain: tx with semi-rigid or soft lace up brace. Lewy body dementia: PD, can look like delirium, visual hallucinations, no specific tx. Normal CT. vivid dreams, Quad tendon rupture. Complete: cannot straighten leg daytime sleeping, falls, visuospatial deficits, REM sleep issues. actively, painful indentation above patella (sulcus sign), can fill with blood so no longer palpable. Wrinking of fascia over Frontotemporal dementa: disinhibition, aphasia. Apathy, distal quads. speech lacks meaning. Memory preserved but not insight. Younger age than AD. Fat pad atrophy: common cause of heel pain in geriatric patient. Pain as day progresses. Normal radiograph. PD: last resort stereotactic thalamotomy Plantar fasciitis: morning pain. Tarsal tunnel radiates to the Skull fractures. Basilar fracture shows air-fluid level in tow. Lumbar radiculopathy: weak dorsiflexion, decreased sphenoid sinus. Orbital fracture has double vision, air fluid ankle reflexes. levels in maxillary sinus, diplopia. Zygomatic arch has swelling and lateral orbital bruising. Osteomyelitis dx with MRI. Leukocyte scan to dx foot ulcers. Median n: tip of thumb to pinky. Radial thumb and finger Tibial plateau fractures: intra-articular, make large extension, thumb abduction. Ulnar n finger abduction hemarthrosis, seen on radiograph. Pain inhibits knee movement. Autonomic hyperreflexia: HA and HTN sudden in px with lesion above T6. Bradycardia, sweat, dilated pupils, blurre Patellar subluxation: tender along mdial retinaculum, effusion, vision, nasal stuffiness, flushing, piloerection. Bowel and positive apprehension sign when patella is pushed laterally. bladder dysfunction common causes. HTN is most worrisome Posterior tibial nerve entrapment: tarsal tunnel syndrome. sx because of risk of seizures and cerebral hemorrhage. Causes: varices, tenosynovitis of flexor tendon, trauma. Pain Stroke. Dont do thrombolysis if more than 3 hours later, glc with pronation, medial paresthesia. <50 or >400, hemorrhage.

Respiratory COPD: mild 80, mod 50, severe 30, very sev 30. SABA LABA ster O2 Pneumococcal polysaccharide vaccine after 2 years: chronic illness, DM, cerebrospinal fluid leaks, bronchopulmonary dysplasia, cyanotic congenital heart disease, cocheal implants. Get 2 months after last conjugate vaccine dose. Revaccinate in sickle, IC, renal failure, leukemia after 5 years Eye Live attenuated vaccine for 5-49, nonpregnant. Not in chronic Pain with eye movement: orbital problem. disease, GBS, pregnant, long term aspirin or salicylate, egg Visual impairment affecting gait: abducted limbs, walking on allergy ice, wide stance, en bloc turns. Cerebellum: ataxis, wide based, Bordatella: macrolides first line. Bactrim secondline staggering. Frontal lobe: apraxia, magnetic, start and turn hesitation and freezing. PD: flexion, festination. Nosocomial PNA: pseudomonas, klebsiella, acinetobacter. Gentamicin, ceftazidime. Central retinal aa occlusion: painless, unilateral, sudden loss of vision. Same as retinal vein thrombosis, but engorged Exercise-induced bronchoconstriction: FEV decreases by 10%. vessels and hemorrhages. More in winter. PE is normal. Tx with albuterol trial. Optic neuritis: blurred disc, no cherry red spot. Spontaneous pneumothorax: observe, oxygen. Resolve in 10 days. Decompress with catheter if tension pnemuthorax. Chest Macular degeneration: most common cause blindness in tube of more than 20% lung involved. older. More in light skinned. Risks: smoking, HTN. Acute sinusitis: CT if no resolve. Acute angle closure glaucoma: sudden severe pain, blurred vision, halos around lights, red conjunctiva, mid-dilated Pleural effusion. Exudates: LDH 0.6 and protein 0.5 for and sluggish pupil, normal or hazy corna. fluid/serum, TB, PE, malignancy, bacterial PNA. Transudate CHF, cirrhosis Retinal detachment: peripheral or central vision loss. No pain. Floaters. Normal conjunctiva, cornea, pupil. Influenza tx: oseltamivir. Zanamivir for over 7. Central retinal aa occlusion: pale fundus, boxcarring of Rotavirus vaccine: 3 doses at 2, 4, 6 months. Cannot start first retinal vessels, red conjunctiva, cherry red spot at fova. dose after 12 weeks, cannot give after 32 weeks. Flashs of light, visual field defects. Cold in babies: nasal saline, bulb suction, humidified air, good Mechanical injury to globe: pain, decreased vision, hydration <2 years. hemorrhage around cornea, pupul deviatd to injury. Restrictive pattern on spirometry: get PFTs for static lung Globe rupture: do not do tonometry. Antiemtic because volumes and diffusing capacity of lung for CO. increased abdominal pressure will extrude intraocular Varenicline AE: aggression, erratic, suicidal contents. Histoplasmosis: Midwest. Bat and bird droppings. BB shaped Glaucoma: most common sx is tunnel vision on CXR. Age related maular defeneration most common cause Asbestos: collagen in pleura can calcify, most no sx. blindness over 65. Hemothorax: can happen after rib fracture. Tx remove blood Vitreous detachment: in >60, young people with myopia. Sx and re-expland lung light flashes, floaters, peripheral vision loss. Croup: laryngeal inflammation. Mild: occasional barking cough, no stridor at rest. Moderate has stridor, no agitation. Ear Steroids help (dexamethasone). Epinephrine in severe. If Otitis externa: Pseudomonas, aureua. Swimmers long water crackles and wheezes, use Ab. exposure increase pH more bacteria Pleurisy: get D dimer, EKG, CXR. Most cases viral, use NSAIDs. Acoustic neuroma: hearing loss, tinnutis, crhonic. From CN Meconium aspiration: patchy atelectasis or consolidation. involvement and tumor growth. Asymmetric sensorineural Transient tachypnea: wet silouhette around heart, diffuse hearing loss. Dx with MRI, CT. screen with audiometry. infiltrates, or intralobar fluid accumulation. Hyaline Lose higher frequencies. membrane disease: air bronchograms, homogenous opaque Vertigo: diplopia in central causes; peripheral: changes infiltrates. with position, n/v. Transient tachypnea: most common cause of neonatal Otosclerosis: mor ein women. 3rd-5th decades. Progressive respiratory distress. Bening. From fluid still in lungs after conductive hearing loss. delivery. Risks: C section, macrosomia, males, mom DM or Meniere: fluctuating hearing loss. asthma.

Femoral neuropathy: in DM. weak lower leg, discomfort in anterior thigh. Less motor strength in hip flexion and knee extension Meralgia paresthetica: lateral femoral n Cervical radiculopathy and normal films: NSAID first. MRI if fever, myelopathy, neuro issues. Pseudotumor: loss of vision, CN6 palsy, palpable tinnitus, n/v. CT normal or small ventricles. LP elevated pressure, low protein. Achase inhibitor AE: bradycardia, syncope, pacemaker therapy. tacrin high LFTs. Psychotropic agent for agitation, wandering. PD: distal resting tremor, asymmetric. Tx thalamotomy, pallidotomy contralateral. CVA most common cause seizure in elderly, hemorrhagic strokes. SAH: if suspect get head CT without contrast. If positive, get angio and tx. If negative or equivocal, get LP. Syncope: prodrome <5 s if arr. EKG to dx. Status epilepticus: give lorazepam.

Psychogenic Nightmares more in second half of night during REM. All other issues non REM. Quetiapine good for PD Nicotine: physical dependence. Can be in withdrawal for months PMDD: many dont have depressive sx. SSRIs during second half of cycle. Do not use Li if breastfeeding Refrctory MDD: T4, Li, atypical AP. Li and T4 best. Trazodone: sedation, ortho hypo. Bupriopion insomnia. Bupropion: least weight gain. Paroxetine most weight gain.

CA PNA: anizthromycin. If on Ab in past 3 months, do quinoline or macrolide+lactam. 2 doses flu vaccine for <9 Beta carotene increases risk of lung cancer in smokers Recent converters (2 years) for TB should be treated regardless of age. Physical every 3-5 years until 40 years. Drug induced pleuritis: (think SLE): hydralazine, procainamide, quinidine. Pleural disease: amiodarone, bleomycin, bromocriptime, cyclophosphamide, MTX, minoxidil, mitomycin Spontaneous pneumothorax: tall thin, under 40. If <15% involved, normal PE with some tachycardia. Can use expiratory film if normal one does not show anything. Risk of recurrence. Tx when progression, delayed expansion, sx. CT: subcutaneous bullae. Acid laryngitis: complication of GERD. Morning hoarseness, need to clear throat, night or early morning wheezing. Allergic rhinitis: tx intranasal corticosteroids Laryngoscopy when: hoarse for 3 months Hantavirus: exposure to deer mouse droppings, white footed mouse. Nicotine replacement: doubles chances of quitting. Bupropion: decrease relapse rate, blunt weight gain for 12 months. Varencicline is nicotine partial agonist, so do not use with nicotine replacement or will get HA, nausea, dizzy, fatigue. Nursing home inpatient PNA: cover MRSA, double cover for pseudomonas. If no cx, use levofloxacin to cover spectrum. Latent TB: tx with INH. Combination only in active infection to prevent resistance. Emergency tracheotomy: incision right above cricoids cartilage through cricothyroid membrane. If controlled, then right below cartilage. Horner: ptosis, miosis, decreased sweat. Check superior sulcus tumor in apices and paracervical areas. Phenylephrine and other decongestants should not be used for more than 3 days because of rebound congestion. Can cause rhinitis if used for too long. Spontaneous pneumothorax: PE only shows tachycardia if <15% lung involved. Dx with radopgraph. Recurs. Repeat CXR in 1-2 days. SC bullae on chest CT. CT if recurrent, lung disease. Chest tube if involve >15% lung volume. Laryngeotracheitis: croup: tx is IM or oral dexamethasone one time. COPD: steroids decrease exacerbations and rate of decline, do not decrease moetality. Can cause hoarseness, candida in oropharynx. Spirometry does not help if there are no sx. OSA: most common sx is daytime sleepiness. Morning HA, nocturia, enuresis, GERD, decreased lubudo. Occupational asthma: allergic rhinitis before. H1N1: treat with NA inhibitors (oseltamivir, zanamivir). Use in all px that need hospitalization even if more than 48 hours. No use zanamivir in COPD, asthma, respiratory distress. OBGYN Galactorrhea: most commonly from medications: metoclopramide, cimetidine, MeDA, codeine, morphine, verapamil, SSRI, TCA, phenothiazine BV most common cause of dc, vaginitis. pH is most sensitive. Clue cells most specific. Red firable cervical lesion: get bx with colpo Amenorrhea in athlete: either increase calories or decrease exercise intensity

Leaving diaphragms in can cause TSS. Refit if gain more than 15 pounds, pregnant, pelvic surgery. Do not use if px has history of TSS. Vulvar ca: itch most common sx. HPV: can use topical trichloroacetic acid if need to apply on musosa. Most pregnancy risk 1 day before ovulation PID, TOA: inpatient if high fever. 24h IV cefoxitin, doxy. ASC-US: most common finding is CIN. If acetominphen does not help in PMS, try naproxen. Girl 6-12 normal to have vaginal disrcharge, white-gray, not irritating. HRT increase breast cancer risk 38w pregnant: seat belt under abdomen over symphysis. Shoulder harness between breasts FNA with straw or grey-green fluid is simple cyst. If bloody, then need cytology. Black cohosh: for menopause sx Epidurals do not cause urinary incontinence Hematoma at episiotomy site: remove sutures and clots, reclosure Ectopic: empty uterus, may have thick endometrium BP diameter for second trimester. Breastfeeding contraindications: HSV in region, TB, isotopes, chemo Vacuum delivery: more perineal laceration, shoulder dystocia. Acute pelvic pain: do transvaginal US. IUD: ok in endometriosis. PCOS: ovulation with metformin, clomiphene, glitazone. Nausea in pregnancy: B6, antihistamine Women: slower GI transit time less absorption. Need to wait longer after eating for meds that need to be taken on empty stomach. Less gastric acid secretion, lower BMIs, longer duration of action of lipophilic drugs. Slower clearance of renal excreted drugs. Breast cancer screening: more dx of local dz. Cannot detect more aggressive or premalignant. Metformin decrease hirsutism, make menses regular. Can use quinolone in pregnancy Nausea and vomit: usually end by 9 weeks. Metcoclopromaide for tx Neurogenic bladder: first tx with strict schedule. Then betanechol, self-cath, resection of internal sphincter. Cholestasis: itch without lesions. GGT normal. Teriparatide: for osteoporosis when bisphosphonates faile. Use for 2 years, not in bone cancer, Paget, high Ca, skeletal radiation. Urge incontinence: tx AC, behavioral. Dc diuretics would not help. PRLoma: when >200. Overactive bladder: Kegel, bladder training in urge and stress. AGS-NOS is most severe precancerous Pap Most Fe demand is in second hald of pregnancy. If trying to get pregnant, cannot do conservative management of cervical dysplasia. CVS is best dx for Down in first trimester. Amnio better. Osteoporosis: Fall from standing fracture. Dx with central DXA scan. Ralxefine: increases VTE risk. Decrease invasive breast cancer risk. DUB: progestin for 21 day cycle. PMS: luteal phase spironolactone helps.

No OCP: retino or liver, liver tumor, migraine aura. OCP dec colon ca. patch more VTE. Peds Head circ <3 years. BP if 3+ years. No booster when 49, 8-12 years. Frontseat 13. Acne neonatorum: closed comedones on forehead, nose, cheeks. From mom and baby androgen stimulation. Erythema neonatorum: papules, pustules, erythema Candida, herpes in babies: vesicles and pustules High BR in newborn at 35+ weeks: breastfeed in first few days so no dehydrate. Phototherapy if at risk Volvulus in baby: sudden bilious vomiting and abdominal pain, feeding problems with vomit, failure to thrive with feeding intolerance. Double bubble on film: airless abdomen. Dx with upper GI contrast study. Colic: 2nd week of life, evening. Screaming episodes with distended or tight abdomen. Normal PE, resolves by 12 weeks. Necrotizing enterocolitis: irritable, poor feeding, distended abdomen, bloody stools. Gas in intestine wall. Intussusceptions: males, vomit, bloody mucous stools. Meckel;s diverticulum: can bleed, has heterotopic gastric mucosa. Can look like appendicitis. Pain distension, vomit. Rectal bleeding (not in appendicitis). RLQ pain. Malrotation: bilous vom. Dx upper GI series. beaklike Diarrhea in baby: continue oral feeding. No simple sugars, fatty foods. Rotavirus vaccine: for viral gastroenteritis. At 6-12 weeks. Does not increase risk of intussusceptions. Intussusceptions: <2 years. Paroxysms of colicky abdominal pain, screaming, doubling up. Palpable mass in RUQ, PE otherwise normal. Pyloric stenosis: 4-6 w. choledochal cyst: RUQ pain + jaundice + palpable mass. Meckel: painless lower GI bleed. Malrotation of intestine: first 4w, bilious vomiting. Erythema toxicum neonatorum: eos in pustules, macules, papules, 2-3mm. spare palms and soles. No other sx, no distress. Staph pyoderma: PMNs in vesicles. Acne: comedones on forehead, nose, cheeks. SIDS: most common cause of death in first 6 months. Clenched fists, serosanguinous discharge from mouth or nose. Lividity and mottling in dependent areas. Think suffocation if pulmonary hemorrhage, recent cyanosis or apnea. GAS in perineum is common in kids. Itching, beefy redness. Varicella: vaccinate 2x in kids unless IC. Breath holding spells: 6 months-6 years benign. Fear, anger, frustration ANS overactive pallor, cyanosis, LOC. Self limited. May be associated with Fe deficiency anemia. Not volitional. Resolve spontaneously Bronchiolitis: before 2 years, RSV. Tx supportive, can try bronchodilator. Can recur. Can lead to wheezing and asthma Migraines in children: BB to prevent. Rescue ibuprofen, acetaminophen. Atopic dermatitis: breastfeeding decreases incidence. Separation anxiety: 4 weeks. Duchenne muscular dystrophy: most common NM disease in kids. 4-5 years present with gait issues. High CK, slow walkers. Cannot walk by 1.5 months. CA PNA in kids: amoxicillin outpatient. Tachypnea, wheeze, occasional cough, no rhinorrhea. Slight fever, inspiratory crackles. Suspect PNA in fever, cyanosis, abnormal respiratory finding. Lab tests not useful. S pneumo most common under 2 years.

HSV in kids: gingivostomatitis. Refusal to eat, sores inside lips, temperature, irritable, ulcers, cervical LAD. Erythema toxicum neonatorum: flea bitten rash, surrounding erythema. Not ill. Erythema infectiosum: viral prpodrom with URI. Rash: facial flushing, then trunk and xtremities, then central claring (lacy and reticulated). Can recur with heat, stress, sunlight Laryngotracheobronchitis: croup. Edema of subglottic region cough, stridor, distress. Need aerosol epi for stridor and IM dxamethasome. Ab do not help. Can use nebulized budenoside. Bronchiolitis: RSV. Rhino wheeze, fever lung. Nasal flare, intercostals retractr. Tx O2. Risk asthma. Croup: hoarse, stridor, uri prodrone. Steeple sign. Steroids Epiglottitis: H fly. Muffle voice, drool, tripod. Thumb. Bacterial conjunctivitis: can stay in school as long as on Ab. Orthostatic proteinuria: common in kids. More in adolescents. UTI in infants: Mor ein boys, then females. Dysuria, hematuria, frequency, incont, suprapubic tenderness, low grade fever. All kids should hav valuation of anatomy of urinatry tract: voiding cystourethrogram. Head banging: normal, ends by age 3. Febrile seizure: most common seizure disorder of childhood. Most commonly from URI, otitis media, roseola. Tx with antipyretics. Lss than half have recurrence. Kawasaki: untreated leads to CHF, coronary anrutysm, MI, arr, occlusion of arteries. Under 5 years. Dx with fever for 5 days with no other explanation with 4+: conjunctivitis, oral membrane changes (strawberry tongue), cervical LAD, palm erythema, rash. Hospitalize, give IVIG, aspirin. HSP: after URI. Low grade fever, arthralgia, colicky abdominal pain. Rash starts as pink maculopapules to petechia. Blood in stool. High WBC, low platelets, high ESR, anemia. Tx supportive. RA: salmon pink rash. RMSF: rash starts distally on lgs. High BR in kids: phototherapy if BR>15. Surgery: no solids 8 hours, formula 6, 4 breast milk, 2 clear liquids. Babies up to 3 months old with fever and nehative basic workup can be sent home, follow up again in 24 hours. If under 29 days, get sepsis workup and admit. Constitutional growth delay: delayed but eventually normal. Genetic. Strabismus: ocular misalignment. Corneal light reflex is deviated. Can lead to ambylopia. PNA: usually from RSV in 4 months 4 years. Wheezing, rhinorrhea, mid winter. Hearing disorders: mainly from genetic issues. Growing pains: more between 4-6, unknown cause. Not bone pain. Wakns child, around knes. Normal physical. Reassurance. No cows milk until 1 year, solid food at 4-6 months. 2-6 years: kids think they are responsible for death of loved one, may deny it or think reversibl GERD: common cause of wheezing in kids. Hydrocele of tunica vaginalis: frequently seen at birth. Resolves within months, no tx unless hernia. Pyloric stenosis complications: oliguria, low Cl alkalosis. Jaundice is rare. Bronchiolitis: trial of B agonist or epinephrine, repeat only if it works. Ab, steroids, drainage no hlp. Cough, fver, retractions, wheezes. MRSA: skin fluctuant and tender, fever, high WBC.

Chlam PNA: sick for several weeks, infants up to 4 months. Nontoxic, no fevr. Tacnypna, cough, diffuse rales and wheezes, conjunctivitis,. CXR shows hyperinflation and diffuse interstitial or pactchy infiltrates. Staph PNA: sudden onset. Baby appears ill. Fever, expiratory wheeze, high WBC. RSV: rhinorrhea and pharyngitis for 3 days, then cough and wheeze. Rhonchi, rales, wheeze. Normal CXR. Eos. Usually no fever. Parainfluenza: like a cold Bronchiolitis: imaging is not indicated. Do not return child to day care. Rhinorrha, wheeze, fever, low O2 sat. No OTC cough or cold meds for kids under 2. Otitits media: fever, pull at ear, drain from ears, poor appetite, nasal congestion. Red bulging immobile tympanic membrane. Acute rheumatic fever: carditis, migratory polyarthritis, erythma marginatum, chorea, SC nodules (JONES). High ESR and CRP, fever. CAH: failure to regain birth weight, weight loss, dehydration, vomit, cyanosis, dyspnea, disturbances in cardiac rate, hypospadia. Lice: permethrin is firstline. Anemia that does not respond to Fe: get Hb electrophoresis. BUN:Cr does not help in kids. Low bicarbonate indicates dehydration. Bullous impetigo: aureus. Oral bactrim, clinda for outpatient. Vanco for inpatient. ID

HCV: if positive immunoassay, then immunoblot. If negative, means false positive. PCR shows active versus resolved. Nursing home PNA: MRSA, pseudomonas. IV vanco/linezolid + Renal quinolone/aminoglycoside + pseudomonas drug. <30 with <2 g protein in urine, normal Cr: orthostatic Urinary sx without cx: think urethritis with gon, chlam, HSV. proteinuria. No follow up Try tetracyclines. Hematuria: get CT urography or IVP. Unless kid, pregnant, Influenza: sudden onset, HA, myalgia, rhinitis, sore throat, renal disease, hemorrhagic cystitis. cough. Complications: encephalitis, PNA, respiratory failure. Positive Hb dipstick but no RBC: myoglobin. Clinical dx. Rapid tests are often false negative, so tx right Interstitial nephritis: sulfa, PCN, NSAIDs. High protein if away. NSAID. No RBC casts. Eos. Just withdraw agent to tx. Within 2 Scromboid poisoning: from fish, from high histamine and weeks, not dose related. saurine skin flushing, oral paresthesias, itch, hives, n/v/d, Nephrotic syndrome in adults: first kidney disease, secondary vertigo, HA, bronchospasm, dysphagia, tachycardia, from DM. hypotension. Tx as if anaphylaxis Isolated proteinuria: get urine P:C. if sx, get ANA, C. Malaria: prodrome of delirium and erratic behavior, Renal colic: dx with CT. convulsion then coma, fever, no focal neuro sx. Normo normo Gadolinium can cause nephrogenic systemic fibrosis anemia. Tx IV quinidine gluconate. Hematuria: get IVP, US, Ct. Ehrlichiosis: thrombocytopenia. Renal failure: keep Hb below 10-12. Higher gives risk of CV Intertrigo: inflammation of skinfolds from friction. Can lead to events. erythrasma from corynebacterium, macules, tx erythromycin Stone: get helical CT of abdomen Pertussis: prodrome 1-2w that looks like viral URI. Cough can ACEI can make renal failure worse if HTN from renal issues. cause vomit, fracture ribs. Lacrimation, conjunctival injection. Use captopril renography Fever rare. Decreased renal function and metformin lactic acidosis. Dc Tetanus: minor wounds with <3 previous toxoid doses. No Ig drug 48 hours before procedures, restart 48 hours after once if wound is clean. check Cr. MRSA tx: clinda, doxy, bactrim. NSAIDs not in chronic kidney disease. No high dose aspirin Giadia: stinky soft poop, stinky farts, belching, abdominal because will act as NSAID distension. No mucous or blood in stool. Rarely eos. Drugs causing interstitial nephritis: Ab, PCN, cephalosproins, Pasteurella: risk of cellulitis. Complications: abscess, arthritis, sulfonamides. Tx steroids. boen infection, tenosynovitis. Ca oxalate most common stones. Do low Na, protein diet. Low HSV: PCR best to dx. Ca does not help. Decrease oxalate. Take K citrate at meals to Urethritis: workup gon and chlam, UA if no discharge, RPR, increase urine pH and urinary citrate. HIV, HBV. Z pack or doxy +cef. If not sexually active, think High urea emesis. High K: Na polystyrene. mycoplasma, trichomonas. Otitis media: do not give oral decongestants or antihistamines.

Candida: bilateral nipple pain, soreness. Bartonella: z pack. Quinolones: risk tendon rupture, especially Achilles. More risk in steroids, >60. Legionella in urine. Blood cx rare positive Cutaneous larvae migrans: red serpiginous tracjs. Itch or sting with penetration, crreping eruption. Self-limited. Reactive lymphocytosis: EBV, mono, CMV, bordatella, CT disease. Herpangina: fever, vesicles and ulcers in posterior pharynx. Coxsackie and echovirus. HSV anterior mouth. Mono petechiae soft palate, pharynx no lesions. TB: interferon gamma release assay to screen for latent. Sore throat management: empiric with Ab if risk of GAS. Sore throat, tonsillar inflammation, fever, tender nodes. No cough or runny nose. Center scoring system. Norovirus: viral shedding before illness. Can recur. Most common cause of diarrhea in adults. PPD: 5mm for HIV, transplant, household contacts. 10mm: nursing home / correctional facilities / homeless shelthers employees and workers, recent immigrants, IVID, hospital workers, chronic illness. Pyelonephritis in pregnant: amp + gent Epididymitis: nesseria and gon. Under 14: quinolone. Moxifloxacin not for UTIs. Flu: abrupt onset, nonproductive cough. Oral thrush, LAD: think HIV. Esophagitis: candida, HSV, CMV. Rhinosinusitis: when 7-10 days sx. Tx amoxicillin, if allergic then z pack or bactrim. If no work, then quinolon. If exposure to HBV, get Ig.

Random Poison ingestion: single dose activated charcoal within 1 hour of ingestion. If F, Li, sustained release, entric coatingdo gastric High altitude sickness: more in young. Tx acetazolamide (sulfa). Dexamethasone lavage ADL: bathe, dress, eat, bed to chair, toilet. Polycythemia vera: portal vein thrombosis, splenomgaly. Increased MCV, splenomegaly, normal O2 saturation. High Surgery risk: DM, stroke, renal dz, CHF, angina, previous MI. B12, high leukocyte ALP. Gout, high urate. check with coronary angio, PFTs. RMSF: no arthralgias. Fever, HA. Losartan decreases urate. Finasteride: good for obstruction. False decrease PSA, so not Anemia of chronic disease: Hb 9-10. High ferritin. Decreased good in px with prostate carcinoma. Fe, TIBC. Multiple myeloma with sx: autologous stem cell Ethylene glycol poisoning: acidosis, renal failure. Intoxicated transplantation. px but no smell of alcohol, low Ca, urine crystals, normal BAC. Tx fomepizole, hemodialysis, Na bicarbonate. Torsion: get US. Acute pain, no urinary sx, transverse testis, abnormal cremater, pain. Decreased flow in Doppler. Essential tremor: worse with movement. Tx BB, primidone. High 5 nucleotidase in liver problems. Weight reduction diet does not help in CVD. BB would be better. Bulimia: K most affected Latex allergy: cross react with avocados, bananas, chestnuts, Varencicle: AE nausea, so take with food. kiwi. Liver disease: low acute phas response proteins. Methadone: long QT, torsades. High Ca: get PTH first. High K: insulin and glc will lower fastest. Ca for arr. Fibromyalgia: trigger points in scapula, neck, upper outer Macroglossia: Down syndrome, tumor, amyloid, acromegaly, gluteus, medial fat pads of knees. cretinism. Bald tongue: less iron or B12, pellagra, syphilis, BPH: watchful waiting. Saw palmetto. xerostomia. . Essential tremor: topiramate, propanolol Protate cancer: do not tx if older than 65 and 10-15 year life Sarcoid: bilateral facial n palsy. expectancy. Fatigue: get TSH, CMP, CBC, UA, hcg, ESR Platelet transfusion: when <10,000. Do in <50,000 if px Familial low Ca hypercalcemia: low urine Ca:Cr undergoing invasive procedure. Varicocele: adolescent, L, no sx. Pneumococcal vaccine: all over 65. Before 65 if in sititution, Sepsis: NE and DA if IVF no work. cardiopulm disease, DM, asplenia, liver or kidney disease, Permission for px information release should always be in healthcare workers. writing. Secondary prevention: asymptomatic dz, prevent Testosterone: increases Hct, polycythemia. May increase bone complications (Pap, screen for HLD HTN DM) density. Scrotal pain: US with Doppler. Hemolytic anemia: increasd LDH, low haptoglobin. Cortisol deficiency: hypotension that does not respond to IVF. Graves ophtal: may get worse at first with radioactive iodine. HSP: palpable purpura. May have low platelets, bowel angina, SIADH: low BUN, high FeNa. Tx free water restriction <20, renal, IgA deposition. Prognosis depends on renal High K: CaCl and gluconate first for heart, no change plasma K. involvement. then Nabicaronate, albuiterol. Polychythemia vera: splenomegaly, high red cell mass, normal Waldenstrom: IgM spike, Bence Jone. No lytic bone lesions. SpO2, high ALP. Secondary: high carboxy-Hb. Lymphocytes. Critically ill px: glc should be 140-180. Supraclavicular nodes malignant Delayed bone age with decreased growth velocity: systemic Hx best way to check bleding risk before surfery issue, ex GH deficiency Echinacea to prevent URI, no evidence it works. Post-coma prognosis: myoclonic status epilepticus means will Sepsis: give recombinant activated protein C. not recover. RLS: tx iron supplement, ropinrole Vaccines Refeeding syndrome: artificial feeding low phosphate. n/v, Pneumo: DM, alcohol, cochlear implants, Hb, CSF leaks. 24 in hypotension, delirium. adults, kid 7. Morphine may be found in screen when px took codeine HIV: MMR, varicella, zostrer if >400 and no AIDS illnesses. 1 Hypercalcemia of malignancy: NS, once euvolemic give HAV, 3 HBV. pamidronate. PEG tibes associated with increased use of restraints UPSTF Hodgkin: most common sx is painless LAD. Screen adults for: HTN, MDD< obese, smoke. Isolated enlarged cervical node: bx if no systemic sx and node STD all sexually active. HIV 15-65. HCV 1945-65. >3 cm, if supraclavicular, night sweats, weight loss. If no risk Aspirin men 45. factors for ca and no concerning sx, just monitor for 4-6 Women: folate, DV. weeks. 55-80: CT, 30 pack years, quit 15. Radiation risk: more in chest, abdomen, younger. Women Pregnant: Fe, HIV, smoke, suph, HBV, Rh, bac greater risk than men for lung cancer after radiation. Newborn: ocular meds, hearing, sickle Serum 25-vitamin D to measure because it is the circulating 6 mos F, Fe. 3-5 vision. 6 obese, 12 MDD. 10 sun. 15 HIV form. Adrenal mass: get overnight dexamethasone duppression test, pheo, morning aldosterone and renin.