Alert Medical Series: Internal Medicine Alert III

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: 01 novembre 2016
• Nombre de lectures: 0
• EAN13: 9781478782643
• 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 III
All Rights Reserved.
Copyright © 2016 Ala Sarraj, MD
v5.0 r1.0

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: 978-1-4787-8264-3

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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.
• Brachial plexus:
Abduct arm: axillary nerve.
Flex elbow: musculocutaneous nerve.
Extend wrist: radial nerve.
OK sign: median / ulnar nerves.
Able to shake hand or show the OK sign: suggest normal brachial plexus.
• BIPAP (Biphasic positive airway pressure):
Useful in the fatigued patient.
Offers more support during inspiration.
IPAP 8-20, EPAP: 0-15.
Gradient at least of 5 to be effective.
• Assist control: preset tidal volume at minimum rate.
• ET cuff pressure < 40 (25-35) cm H2o.
• RBBB: RSR’(V1), S (V6).
LBBB: S(V1), wide R (V6).
LAHB (L ant. Hemiblock):
Q1 R3, LAD, no LVH.
LPHB (L post. Hemiblock):
R1 Q3, RAD, no RVH.
• Decreased C2,3: increased incidence of encapsulated bacterial infection.
• Decreased C4: increased incidence of SLE.
• Decreased C5 to 8 : increased incidence of Neisserial infection.
• Differentiating cortical and brainstem lesions:
Ice water test, nystagmus(fast phase):
1. Both eyes deviate --> cold water side with nystagmus: patient is not comatose.
2. Both eyes deviate ---> cold water side without nystagmus: brainstem intact, cortical lesion.
3. No eye movements: no brainstem function.
4. Only one eye moves: + brainstem damage, intra nuclear lesion.
• Medications safe in pregnancy:
Tylenol, Naprosyn, Mg So4, Acyclovir, Benadryl, Digoxin, Chlortrimeton, Inderal, Hydralazine, Haldol, Thiazides, Morphine, Vicodin, Norco.
• Pupils are resistant to metabolic insult:
Small, reactive: metabolic, diencephalon.
Bilateral Pinpoint: pontine lesion.
Mid position, fixed: mid brain.
Bilateral Large, fixed: tectal lesion.
• 3 rd nerve palsy:
Ptosis, inability to to turn the eye upward,downward or inward.
• At sea level, the air weight is 15 LB / sq. inch (one ATA), in salt water the air weight increases 1 ATA every 34 feet (10 meters).
Scuba diving: down to 2-4 ATA.
• MMSE (mini mental state exam):
Orientation.
Registration.
Attention.
Calculation.
Recall.
Language (naming, repetition).
3 stage command.
Copying (shapes).
• Recurrent erythema multiforme: herpes simplex.
• Pyoderma gangrenosum:
Inflammatory bowel disease.
Rheumatoid arthritis.
Chronic hepatitis.
Myeloproliferative disorder.
• D-dimers which are fragments of cross-linked fibrin (already formed into a mesh by action of factor XIII), are degraded from clot matrix by plasmin and released from thrombi soon after formation.
Each fragment has two D units and one E unit in a linkage that cannot be further broken down by plasmin .
The plasma concentration of D-dimers is usually elevated in patients with DVT or PE.
• The D-dimer levels reflect the rate of fibrinolytic activity on preexisting thrombi but not necessarily the rate of thrombus formation.
• Only a normal perfusion scan virtually excludes PE (the only exception is a non occluding central saddle embolism that allows reduced but equal flow to all the distal areas of both lungs).
• Childhood sunburn: the greatest risk factor for developing melanoma.
• URI + vasculitis: suspect Wegner’s granulomatous disease.
• In evaluating emergencies, sequence of priorities:
ABCs, vitals (including blood glucose), trauma, toxins.
• Rapidly progressive Glomerulonephritis:
SLE.
HS (Henoch Schoenlein) purpura.
Hemolytic uremic syndrome.
Polyarteritis nodosa.
• Testicular torsion: predilection toward 1 st year and puberty.
• Priapism:
Sickle cell disease, spinal cord injury.
Tx: Terbutaline 0.25 – 0.5 mg sq.
• In multiple myeloma: + charged monoclonal proteins offset the – charged Cl and bicarb ---> Low anion gap.
• Reservoirs:
Salmonella: eggs, poultry.
Histoplasmosis: infected birds, bat droppings.
Leishmania: infected rodents.
Toxocariasis: dogs, cats.
Hepatitis A, Cholera: contaminated water.
Aspergillosis: soil, demolished old buildings.
Schistosomiasis: water snail.
• Lymphogranuloma venerium:
Chlamydia, painless skin lesions, lymphadenopathy,sinus formation.
• Granuloma inguinale:
Calymatobacterium granulomatis, painless lesions on mucous membranes.
• Rubella: patient is nontoxic, no conjunctival involvement whereas they are in measles.
• Yellow fever: exists in narrow band around the equator, but not in Asia.
• Herpes zoster (shingles):
If nasociliary branch is affected (nose tip involved) corneal scarring can occur.
• Surgical scarlet fever: strep. infections of wounds and burns.
• Avoid Wellbutrin in seizure patients, can lower seizure threshold.
• Semen fluoresces with wound light.
• Acute psychosis (“ WHHHIMP”):
Wernicke’s.
Hypoxia.
Hypoglycemia.
Hyponatremia.
Intracerebral bleed.
Meningitis.
Poisoning.
• Carotid artery TIAs (anterior circulation TIAs):
Transient monocular blindness (amaurosis fugax), weakness, loss of sensory or speech.
• Vertebrobasilar TIAs (post. Circulation TIAs):
Loss of balance, sensory impairment.
• Subarachnoid hemorrhage:
30% in anterior cerebral artery/ anterior communicating artery.
Most aneurysms are in the subarachnoid space, berry aneurysms or AVMs.
• Urine dipstick + for urobilinogen : reflects conjugated (water soluble) hyperbilirubinemia.
• Lithium, Amiodarone can lead to hypothyroidism.
• IDDM: ketosis prone, negative C. Peptide.
• Hypothermia can be encountered in:
Addison’s disease.
Myxedema.
Alcohol abuse.
Hypoglycemia.
• With risk of aspir ation use barium swallow , avoid gastrograffin.
With risk of perforation use gastrograffin.
• Thyrotoxicosis can lead to onycholysis.
• In acute viral hepatitis , total bilirubin > 20 mg/DL, PT> 3 sec reflect poor prognosis.
• Spontaneous bacterial peritonitis (SBP):
Ascitic fluid WBC > 250 / ml.
• Allergic reactions:
Type 1
Immediate
IgE
Asthma, food allergy
Type 2
Cytotoxic
IgG,M reaction to Ag on cell surface
Blood transfusion, ITP, hemolytic anemia
Type 3
Immune complex (Arthrus)
Complexes activate complement
Tetanus toxoid
Type 4
Cell mediated