Alert Medical Series: Internal Medicine Alert II

Ala Sarraj

Description

This series is a compilation of powerful high yield random notes and comparisons that will guarantee laser-sharp comprehensive and effective knowledge acquisition and high score passing rates in the fields of USMLE (US Medical Licensing Exam), Internal Medicine and Emergency Medicine boards.

Sujets

• Médecine
• Spécialités médicales
• Médecine d'urgence
• Emergency Medicine
• Medical

Informations

• Publié par: Outskirts Press
• Date de parution: 31 octobre 2016
• Nombre de lectures: 0
• EAN13: 9781478783725
• Langue: English

Extrait

The opinions expressed in this manuscript are solely the opinions of the author and do not represent the opinions or thoughts of the publisher. The author has represented and warranted full ownership and/or legal right to publish all the materials in this book.

Alert Medical Series: Internal Medicine Alert II
All Rights Reserved.
Copyright © 2016 Ala Sarraj, MD
v5.0 r2.0

Cover Photo © 2016 thinkstockphotos.com. All rights reserved - used with permission.

This book may not be reproduced, transmitted, or stored in whole or in part by any means, including graphic, electronic, or mechanical without the express written consent of the publisher except in the case of brief quotations embodied in critical articles and reviews.

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ISBN: 978-1-4787-8372-5

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PRINTED IN THE UNITED STATES OF AMERICA

Preface
Alert M edical Series is a compilation of powerful random high yield notes and comparisons that will guarantee comprehensive and effective knowledge base and high score passing rates in the fields of USMLE (US Medical Licensing Exam), INTERNAL MEDICINE and EMERGENCY MEDICINE boards alike.
It reflects years of revision and update that will save medical students, residents and physicians measurable time of test prep and knowledge acquisition.
Alert Medical Series will serve you like multitude of pixels creating very high resolution and sharp picture.
The USMLE series notes (basic and clinical) were put in a random manner mixing basic and clinical notes to simulate real life knowledge building and to reflect the future trend in USMLE testing to combine clinical science and the clinically based basic science.
• Hypokalemia leads to:
Metabolic alkalosis.
Decreased urine concentrating capacity: polyuria.
Decreased GFR.
Glucose intolerance.
Worsening hepatic encephalopathy.
• Infected pressure ulcer therapy:
Gentamicin and Clindamycin.
Vit. C.
Wet to moist normal saline wash.
• Delirium: acetylcholine deficiency.
• Most elderly with acute MI present with SOB.
• Methadone does not cause euphoria.
• Long term lithium therapy ---> polyuria (nephrogenic diabetes insipidus ).
• Most children stop wetting their bed by age 4 yo.
• Haldol can lead to neuroleptic malignant syndrome.
• Chemical restraint:
[Ativan 2 mg, Versed 2 mg, Valium 5 mg every 30 minutes prn ] + [ Droperidol (Inapsine 2 mg, can lead to prolonged QT) or Haldol 5 mg iv/ im].
• PCP hits the vestibulocerebellar system ---> dizziness, incoordination, nystagmus..
• Brain lesions sites in psychosis:
Temporolimbic, caudate nucleus, frontal lobes.
• Schizophrenia:
Psychosis.
Emotional blunting.
Clear consciousness.
No brain or systemic disease, no drug abuse.
• Narcolepsy: occurs in REM sleep.
• Most common hearing loss in the elderly: Prebycussis (high end of audible range 4-8 k HZ).
• Most common form of incontinence in the elderly:
Urge incontinence (detrusor hyperreflexia or decreased sensory capability).
• The most common cause of blindness In the elderly: macular degeneration.
• Pes anserine bursitis causes pain located medially, about 6 cm below the joint line, which is worse with activity and at night.
• Impingement syndrome is a special category of supraspinatus tendinitis.
• Limited range of motion in the shoulder (passive and active) may be a sign of adhesive capsulitis.
• Piriformis syndrome is a sciatic nerve compression neuropathy that causes chronic posterior pain.
1. The piriformis muscle overlies the sciatic notch where the nerve exits the sacrum.
2. It occurs in persons who are subject to prolonged sitting, such as truck drivers.
3. An EMG can determine the level of the neuropathy.
4. Stretching exercises and NSAIDs are the initial therapy , but a surgical release may be needed.
• Morton neuroma:
An entrapment syndrome of the interdigital nerve.
Characterized by tenderness between the third and fourth metatarsals.
It affects women in their forties with unilateral predilection.
Lateral compression of the forefoot can reproduce symptoms.
• Quinolones, Bactrim, Flagyl: inhibit the metabolism of coumadin.
• Metabolic acidosis + hypokalemia:
Diarrhea, RTA (renal tubular acidosis), DKA, Amphotericin.
• Bicarb precursor: acetate, lactate, gluconate.
• Renal failure:
GFR < 10.
Hyperkalemia develops when GFR < 40.
• Hypokalemia + metabolic alkalosis:
1. Cl responsive: GI loss, thiazides, Tx: fluids with Kcl or Na cl.
2. Cl unresponsive: primary hyper aldosteronism, Cushing’s, Barter’s syndrome.
• Tagamet or Bactrim elevates Cr level.
• Adrenal glands: rich arterial supply, limited venous drainage (single vessel).
• Aplastic crisis in sickle cell disease: due to viral infection esp. Parvo B19 virus (agent of 5 th disease).
• Albuterol: 0.15 mg/ kg up to 5 mg q 20 minutes.
Continuous: 0.5 mg/ kg/ hour (up to 15 mg).
• Hco3 deficit = 0.4 x wt(kg) X desired Hco3 – measured.
Replace with 2-3 amps / 1 L D5W.
• P (A-a) O2= 3-16 m.
PA O2= 150 - Pa Co2 x 1.2.
• Acute respiratory failure:
1. Hypercapneic- hypoxic:
Normal A-a gradient: Hypoventilation.
Elevated A-a gradient: V/Q mismatch as in COPD.
2. Hypocapneic – hypoxic: V/Q mismatch with shunt as in CHF, ARDS, pneumonia.
• Dilantin, Aspirin, hypoproteinemia---> decreased T4.
• CVAs:
Anterior cerebral artery: leg weaker > arm.
Middle cerebral artery: arm weaker > leg.
Posterior cerebral artery: homonymous hemianopsia.
• EPO (Erythropoieti n): increases BP diastolic, seizures.
• Spot urine: protein/ Cr ratio, correlates with 24 hr urine protein.
• Proteinuria + hematuria: reflect parenchymal renal disease.
• Serum Cr, Cr clearance reflect GFR.
• PPD TB skin testing is +:
1. > 5mm in HIV patients.
2. > 10 mm in persons with risk factors.
3. > 15 mm in persons without risk factors.
• Ursodeoxycholic acid 10 mg/kg/day prevents the formation of gallstones with rapid weight loss patients.
• SLE anticoagulants: elevated PT/PTT, increased thrombosis (abortions..), false + VDRL.
• Methadone can lead to myasthenia gravis like syndrome.
• Staph. Aureus: heat stable , hence heating is ineffective.
• Carafate needs acidic milieu to work, avoid antacids with it.
• All pathogens are facultative anaerobes except clostridia, bacteroides (obligate anaerobes).
• ATN (acute tubular necrosis):
Toxic: proximal.
Ischemic: distal, loops of Henle.
• RhoGam (anti RH IG) doesn’t cross the placenta:
Given within 3 days of birth Rh+ child to RH- mother.
And in trauma as well.
• Guns at home:
Suicide rate: x 5 more likely.
Homicide rate: x 3 more likely.
In domestic violence homicide increases 20 fold.
Drugs and alcohol are important cofactors.
• Vascular necrosis of femoral head:
Steroids use.
SLE.
Alcoholism.
Hyperuricemia.
• Leukemoid reaction:
WBC count 50-100 k / ml.
Persistent infections (osteomyelitis..).
COPD.
Septicemia, malignancy..
• Epididymitis:
Chlamydia, E. Coli
> 35 yo or prepubertal.
Elevated CRP (not in torsion).
• Thalassemia:
Mild anemia, profoundly decreased MCV, normal RDW.
Alpha thalassemia: normal hemoglobin electrophoresis.
• Acute bleed: maximal reticulocyte count lingers behind 3-5 days.
• Marcus Gun pupil:
Pupil dilate despite light.
Multiple sclerosis.
• A-V dissociation:
QRS > 0.11 msec.
LAD.
RBBB in V1
Favors ventricular origin.
• Na bicarb---> hyperosmolar state.
50 g = 6 m osm/ L.
• Compare:
Ca
Po4
Alk. Phos.
Rickets Decreased Vit. D
Decreased
Decreased
Increased
Osteoporosis
Normal
Normal
Normal
Paget disease
Normal
Normal
Increased
Hyper parathyroidism
Increased
Decreased
Normal
• Pellagra“3Ds”:
Dermatitis.
Diarrhea.
Dementia.
• Wernecke’s triad in alcoholics:
Ataxia.
Dementia.
Ophthalmoplegia.
• No need for antibiotics prophylaxis in ASD.
• Urine Na:
Decreased in pre renal failure.
Increased in renal failure.
• Cerebellar lesion: unsteady gait, broad steps.
Extrapyramidal lesions : festinating gait, small shuffling steps.
•