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Question Notes Id long term neurologic sequelae associated w/ bacterial meningitis : 1. hearing loss 2.

loss of cognitive functions due to neuronal loss in dentate gyrus of hippocampus) 3. seizures 326 4.MR 5. spasticity or paresis.... S/E OF CEFTRIAXONE: EOSINOPHILIA, thrombocytosis, leukopenia, bleeding, skin rash, increase Cr/ast/alt/bilirun levels.... ------------ ------------------------------------------------------small face, small jaw, prominence occiput, no skin creases on palmar aspect of his digits, overlapping of his fingers bil, ocker bottom feet , limite abduction, heart murmur present --- Edward trisomy 18 VSD...... Down syndrome (trisomy 21 353 associated with ASD and endocardial cushion defect.. william's syndrome associated w/ supravalvular aortic stenosis.... Digeorge & velocardiofacial syndrom associate w/ conotruncal abn ( truncus arterosus, tetralog of fallot, interrupted ao ------------ ------------------------------------------------------1181 externa ear infection+ radiatn to temporomandibular joint exacerbate by chewing... ------------ ------------------------------------------------------blunt trauma - cxr show retroperitoneal air --> duodenal injury.. next step is CT scan 1786 with contrast to confirm and look for if there is present of duodenal hematoma... ------------ ------------------------------------------------------SHY-DRAGER SYNDOME= parkinsonism, autonomic dysfunct (postural hypotension, disturbance of bladder contr, wide spread neurological signs ( cerebellar, pyramidal or LMN).. always consider shy drager syndromw when a pt w/ parkinsonism experience 2066 orthosatic hypotension impotence incontinence or other autonomic ... tx is aim at intravascular vol expansion with fludrocortisone, salt supplment, alpha adrenergic agonists, and constriction of lower body... ------------ ------------------------------------------------------2153 mc s/e of post sx is hypocalcemia.. would increase DTR... other things increase dtr are ------------ ------------------------------------------------------HIV.... Reccomended vaccines are : infleunza, hep B, and S pna., might need hep A for gay... SHOULD NOT GET BCG, VARICELLA, VERICLL ZOSER, ANTRHRAX, 2415 ORAL TYPHOID, INTRANASAL INFLEUENZA, ORAL POLIO, YELLOW FEVER VACCINES; ------------ ------------------------------------------------------UC = cause bloody diarrhea, tenesmus, wt lass , anemia, potentially, sclerosing 2429 cholangitis, uveitis, erythema nodosum, spondyloarhrography,... routine surveillance with yearly colonscopy ------------ ------------------------------------------------------CLASSIC TRIAD OF DISSEMINATED GONOCOCCAL INFECTION: polyarthralgia, tenosynovitis, andpainless vesiculopustlar... compare to other rash? 2527 Lyme dz= erythema migrans, typicalally monoarticular knee pain...syphiliss produce painless ulcer of genitalia, meningococcemia present w/ petechial rash...

------------ ------------------------------------------------------essential tremor: difficulty holding a newspaper, wdrinking coffee, feeding themselvces, 2850 writing eligbilh.. tx beta blocker.. ------------ ------------------------------------------------------men genitourogen: PRASTITIS: s/s chill, perineal pain, back pain..w/ leukocytosis w/ 114 increased bands . HIs urinary urgency dysuria, and pos leukocyte esterase more likely dx ------------ ------------------------------------------------------trauma- abd wall ecchymoses, tender abdomen corrisome for blunt abdominal trauma 202 (BAT).. ------------ ------------------------------------------------------intoxicatoin: cocained=inc HR, alerness, (w/drawal = increase appetite).. Opioi intox=decre RR, miosis... Marijuana intox=inc appepite, incr RR, red eye, time 1043 distortion, confusion, dry mouth, inc RR/HR/BP.... Benzodiapeine overdose = slur speech, unsteady gait, incoordinat, drowsiness ... alcohol into=unsteady gait, nystagmus, slurred speech ------------ ------------------------------------------------------1857 cardio-syncope: different types: situational syncope, postural hypotension ------------ ------------------------------------------------------2127 cardio-hyponatremia indicare elevatoin fo ESR and president ------------ ------------------------------------------------------cardio.. mechanism: Impaired myocardial contractility = CARDIOGENI SHOCK occurs when cardiac output unable meet tissue o2 demands .... ventricular filling restriction =tTRAUMATIC CARDIAC TAMPONADE eventually may lead to 2477 cardiogenic shock.... in tamponade would expect elevated venous filling pressure and jug venous distention..BLUNT TRAUMA WITH PULMONARY INJRU prod .... air embolism = ..... loss of vascular tone= occurs in setpic shock and neutrogenic shock.. ------------ ------------------------------------------------------Atypical anti-pyschotic med increase risk of obesity, H-glu, dyslip, htn.. Fasting 2822 glucose and lipids must monitor....ALL ATYPICAL ANTI-PSCHYTOTIC LOWER RISK OF EPS... ------------ ------------------------------------------------------med- OTOTOXIC : aminoglycoside, loop diuretic ( furosemide), ASA @ H-er dose, and chemotheuropeutic meds ..............HCTZ s/e: orthostatic hypotension, 740 photosensitivity, hypercalcemia (note not good doc 4-pt tend to have gout or stones, but perfect 4-women to prev osteoporosis)..... ACEI s/e: cough due inc bradykinin, hyperKalemia, & angioedema... ------------ -------------------------------------------------------

or anti-ischemic meds... LN-thy......... dec proprioceptn @ LE & ankle jerks bil.. E coli & Klebsiella are mcc organisms. death by 30-35yo... LAB: leuko-osis.. This test has a ------------------------------------------------------inf-LYME...LN inv'ed sym..w/in 24hrs to reduce risk of tick-borne dz... wheelchair by 25yo.mech: repeat trinucleotide sequenc -->abn tocopherol transfer protein.. Normally.. cause subarachnoid hrrg.. EKG: T-wav inversn @ inf & lat leads.AVM=ARTERIOVENOUS MALFORMATION = severe h/a ( migraine-like h/a) that cause vomiting & ams) hx of seizure. Associatn: necrosis & degeneratn of cardiac muscle fiber --> myocarditis.. Pyruvate from alanaine ( muscle ) and lactate ( from anerobly glycolysis) ------------------------------------------------------cardio .....1544 -----------2061 ------------ 2212 -----------2237 -----------2599 -----------2512 -----------85 ------------ 319 ------------ order to testing for MONONUCLEOSIS: Initital test is heterophile antibody test...... paracentesis should be done before abx . & glycerol 3-phosphate (from TAG in adipose)....Liver maintain glucose via glycogenolysis & gluconeogenesis.. digoxin. key to differentiate fibrosis vs autoimmune AS is the FRC.ANKYLOSING pt can have restrictive lung dz. & pharyngitis. ------------------------------------------------------neuro/vascu--... NOTE: trauma usu cause epidural or subdural hrrg... gluconeogenic aa (muscle)...tx: 3rd generatoin of cephalosporin ------------------------------------------------------ped.. after 24 hr fasting. Meds should be w/held 12-24hr prior exercise EKG test are BB.S/S: triad:high fever. High risk = men over 40 yo & women over 60age). ------------------------------------------------------- .. low risk = men under 40yo and women under 50yo. lactate (anaerobic glycolysis).... high plantar arches.. ------------------------------------------------------resp & Immun -.. MRI: cervical sp cord atrophy > cerebellar atrophy.Connecticut--remove tick w/ tweezers grab mouthpart with steady pressure. myocardial fibrosis.. gluconeogenesis sole source of glucose........Ixodes scapularis tick .. poor px.FRIEDREICH ATAXIA: (AR) s/s: unsteady wide-bades gait w/ wt shifting to maintain balance. and INTRSACEREBRAL HRRG usu have focal neurologic deficit & thrombocytopenia & ------------------------------------------------------biochem...alanine --> pyruvate at liver via ALT.Exercise EKG test: has a H predictive accuracy 4-intermediate pretest probability of CAD grp... restrictve lung dz has decreased FRC.... AS HAS WNL-INCREASED FRC B/C FIXATOIN OF CHEST WALL IN INSPIRATORY POSIONT... tender hepatosplenomegaly is cmn ... cardiomyopathy.. lymphocytic predominance. posterior cervical chain more cmm than anterior chain. ------------------------------------------------------SBP: SPONTANEOUS BACTERIAL PERITONITIS: dx is positive ascites fluid c/x & PMN >250/mm.. IF result negative but H suspection for IM then do EBV-specific antibody test.

slurred speech.simian crease.Benign PKU ( 20mg/dl). if fail then proceed to splenectomy.. prominent occiput. vomit.. Brushfiled spots (speckled irises). cleft ip. . inc ind bilirubin. Dx: confirm by karyotype. 4. ocular hypoterloism.) Dx: serum ceruloplasmin 20mg/dL in conjunction with Inc urinary copper excretion or Kayser-Fleischer rings.wnl tetrahydrobiopterin level.wnl-low plasma tyrosine level 3.Rare Autoso Recessive d/o. clumsy gait. reticulocyte elevated. portal fibrosis. persistent s/s of cystitis despite tx.. Childer & adolescent s/s liver dz and young adult present neuropsychiatric dz ( rigidity to paranoia and catatonia.. Copper deposition @ liver. rocker bottom feet. musty/mousy odor of urine b/c phenylacetic acid. met acidosis.. hypoplasia of middle phalanx of 5th finger. s/s dysuria. . ------------------------------------------------------racemic epinephrine help croup ------------------------------------------------------association.. Complicated = pregna. or repeat cyfst 1mo after tx of prev cystits w/o urine cx... 5th overlap w/ 4th. abn anatomy of GU tract. basal ganglia. ------------------------------------------------------PKU 3 TYPES: CLASSIC (TYPICAL)PKU = characteristics ( caucasian race.look for non-tender LN-apathy.. hematuria. eczematoid rash.. h/a.frontal bossing. Bx:macrovesicular steatosis. CARPEL TUNNEL SYNDROME = acromegaly. PATAU = trisom 13. URINE CULTURE -when it's complicated cystits.only symp at newborn.. nonpregn. complica tx w/ fluoroquiniolc.. ------------------------------------------------------Uncomplicated cystitis = healthy. vacuolated hc nuclei. suprepubic pain. drooling. short broad hands. immunocomp. Mallory body. dm... urinary s/s not characterist of cystitis. serum Ca. very uong... >>> RENAL CELL CARCINOMA = associate VHL... very old.obesity cause oestoarthritis. Edward=index finger overla w/ 3digit. cornea.. Transient pku=serum mild inc & no urinary phe... cranial nerve palsies. hearing loss.. gamma glutamyl transferase.H urine phenylpruvic & o-hydroxyphenlacetic acid)...844 -----------1392 -----------2058 -----------2374 -----------11 ------------ 103 ------------ 376 ------------ 380 ------------ Wilson Dz: weird s/s: rest tremor.... alcoholic @ osteoporosis -------------------------------------------------------hemolytic anemia: tx prednisone first. increase head size. uri freq. ------------------------------------------------------- . polydactly... (if pos & over 60yo think of NHL or CLL) ------------------------------------------------------paget dz = wnl vit D. in complicated cystits. w/U: dec haptoglobin. hgb decrease. high arched palate. DOC for uncompl is bactrim and nirofurantoi med. hypothyroidism. muscle rigidity.. intestinal atreasia. wbc inc. failure to thrive. vegan @ risk for low vit D.. amylodiosis. ------------------------------------------------------DOWN SYNDROME 21 . pos coomb test.. hypotonia.. but elvated alp. inc LDH. dev delay) and criteria to dx class pku: 3/4 ( Plasma phen >20mg/dl 2.

2320 echchymoses.systolic murmur. hypotension. -----------.484 mediastinal mass: 4T's thyoma. PIP=Bouchard nodes. elder. monoarticular.. harsh systolic @ R upper sternal & radiation to carotid arteries... autoimm ovarian failure. minimal or no AM stiffness.. -----------.. bony 2523 tenderness. teratoma.. s4.... -----------.. lymplhoma. CRX widen mediastinum. Dx: amen more than 3month + signifi inc FSH -----------.------------------------------------------------------166 Atypical PNA: cause: M.. -----------..------------------------------------------------------cardio murmur .rise FSH > LH b/c slower clearance of 1750 FSH.PREMATURE OVARIAN FAILURE: primary hypogonadism in women 40yo. fsh... s/s: hot flashes. thyroid neoplasm.... increase FSH and LH. vaginal & breast atrophy. prl level. & fragile X synd are poss causes. -----------. epitaxis.------------------------------------------------------DM INFECTION. 901 itraconazole/flucanaole wont work. RA=palpable popliteal mass = Baker cysts.. take NSAID for pain reliever. radiation. in elder 598 think of senile calcific aortic stenosis. significan variation systolc BP related to respiratory cycle (meanign pulsus paradoxis = distal pulse disappear upon inspiration).VON WILLEBRAND DZ = plt cnt wnl. w/u:b-hcg. chemotherapy. jugular 2317 veins distend. faints / syncope after experiencce sudden onset of chest pain radiate to back. . cause of syncope is pericardial fluid accumulation. Turner's syndrome. anxiety.. amenorrhea. in young pt ( bicuspid aortic valve. -----------. subcutan nodules @ repetitite trauma.------------------------------------------------------GYN/ONC .------------------------------------------------------ANALGESI NEPHROPATHY = hematuria .AORTIC STENOSIS .------------------------------------------------------vWD . reduce O2 deliver to tissues --> anaerobic 2378 metabolism --> increase lactic acid prdtn --> anioin gap hypochloremic met acidosis... bony enlargemnt. NOTE: HCCM HAS HARSH SYSTOLIC MURMUR & S4 BUT @ left lower sternal border & nor radation.DOC Rhzipus / mucormycosis is IV AMPHOTERICIN..------------------------------------------------------CO poisong = cause left shif of curve.------------------------------------------------------dx OA = knee hip spine ginders ..irritabliy. -----------.------------------------------------------------------classic case of AORTIC DISSECTION: long hx of htn. ...------------------------------------------------------- ... DX: 6 classic criteria: >50yo... crepitus on active motion. -----------. -----------. pscycho-depressn. 1940 unchange RBC in urine.. nodular protruion @ DIP= Heberden. BT and PTT prolonged. no warmth jt (b/c non-inflam arthritis). tachycard.

.8mg/dL..predispose to priapism 3. scleroderma. foreign body.0 for PE prophylaxis.. chronic bronchitis has wnl DLCO and dec FEV1/FVC ------------------------------------------------------endo-DIABETES. check Cr level.. PDEi: 1. S/S: GI complain. too much o2 bad.25(OH)2 D.DOXAZOSIN) will have hypotension so use them at least 4hr interval. bronchogenic carcinoma. ------------------------------------------------------endo-lytes-serum ALBUMIN & CALCIUM measured simultaneously to calc correct total serum ca. s/s: high fever >39.937 -----------2272 ------------ 965 -----------1012 -----------1539 -----------2052 ------------ 2128 -----------2473 ------------ BRONCHOSCOPY VS CT-SCAN BX . cruise ship. ------------------------------------------------------resp-WARFARIN GOAL .0C.0-3. ------------------------------------------------------Resp--VENT MACHINE: PEEP=lower o2 via dec # of alveoli available .bronchoscopy is invasive so done after CT confirm mass located peribronchial area .HIGH FEVER >39C differentiate from other CAP. -.concurrent w/ ERYTHROMYCIN/CIMETIDINE prolong half life of PDEi 4. pulm fibrosis. asbestosis.. If suspect proteinura 4+ cause hypocalcemia.g..poss causes: bronchiectasis. hoarseness @ AM & clear during day 1st line = PPI eg pantoprazole ------------------------------------------------------Resp:>>CAP-Legionella: intracellular gram neg rod. prod cough. vascular complication... sarcoidosis. If MECHANICAL VALVE INR 2.. focal lobar consolidation. rheumatoid lung Resp:COPD: EMPHYSEMA VS CHRONIC BRONCHITIS: emphysema has abn DLCO and dec FEV1/FVC.SILDENAFIL). DOC=1st line is phosphodiesterase inhibitor (e. contraindicated w/ NITRATES & htn to PDEi 2. ASSOCIATE w/ CRUISE SHIP/HOT HOTEL WATER def dx charcoal agar/urinary Ag test.5-3. silicosis. bronchial stenosis. -. goal to keep paO2>60 VENTILATION = pCO2 = TV & RR determine this.2..g.5 ------------------------------------------------------Resp: RESTRICTVIE LUNG DZ. every 1g/dl decrease of albumin make Ca level decrease by 0. Tx:macrolides or fluoroquinolones. prod cough. ------------------------------------------------------- . GI.nocturnal wheeze / cough.OBSTRUCTION SHOULD THINK OF CARCINOMA UNTIL PROVEN OTHERWISE ( so do chest CT scanning) ------------------------------------------------------Asthma vs GERD: .. rales. but better choice to lower FiO2 first..ERECTILE DYSFUNCTION: due to neuropathy.peripheral lesion --> CT guided bx BRONCHIAL OBSTRUCTION --recurrent pna @ same anatomic region suggest obstruction. & meds.. 1.combining w/ alpha-blocker (e..

and med lower da. M catarrhalis. pneumonia. pos guiac. overstim nipple.. cmn cause. no infiltrative opthalmo involved. pituita. bil filtrates. Tx give alpha blocker before give beta blocker. LABS: high T3/T4. H influenza. cytologic indicated when guiac pos to help distinguish carcinoma vs proliferatnv vs inflammatn. tremor.. MECHANIMSM OF BETA BLOCKER: tx tachycardia & sympathetic hyperactivity (e. 20-30% hyperparathyroid.. hx of confinement in building . 2x by 4 yr. sweating.. PRL.ARD cause shnting via elevatn alveo-arterial O2 gradient. Mech: block B-receptor --> unopposed stimulation of vascular a-receptor by circulating catecholamines --> rapid catastrophic increase BP. Coronary artery dz can be unmasked or worsen w/ thyrotoxicosis. 3x by 1st yr. 3x by 13yrd ------------------------------------------------------Resp-. low TSH..2480 -----------2534 -----------2759 ------------ 927 -----------1453 ------------ 1912 -----------2033 -----------2244 ------------ endo--GALACTORRHEA: W/U:TSH.oropharyngeal infl.MEN2A: 100% hyperplasia C-cell ( inc calcitonin).> false positive ------------------------------------------------------endo-TOXIC ADENOMA: risk of bone loss ( inc osteoclast activity) if left untreated. Problem: oral flora -. carbon deposit. prolactinoma. PaO2/FiO2 200. pancreatic tumor) ------------------------------------------------------endo-PHEOCHROMOCYTOMA: young fem c/o paroxysmal htn.lump). ------------------------------------------------------- .. do mammography if has red flag symptom (unil d/c. blister.. Pulm arterial pressure .) ------------------------------------------------------resp--COPD EXACERBATION: s. HEIGHT inc 50 by 1st yr.Dx: Urinary VMA (vanillylmandelic acid ). W/U suspect pna:: 1. PEEP is used to counteract decreased compliance. Sx indicated when d/c involved w pos guiac/gross blood/lump. NUCLEAR RENAL SCAN indicate for renovascular htn & not pheochromocyoma. ------------------------------------------------------resp-ER HANDLE BURN PT: abc then assess for burns on face.. EMPIRICAL TX Sputum gram stain= pos indicatn of purulent if >25PMN & 10 epith cells/low power field .ARDS vs CARDIOGENIC PULMONARY EDEMA CRITERI A DX ARDS:precipiator. hypothyroid.. stridor. carboneous sputum.. ------------------------------------------------------ped-WEIGHT: wt 2x by 5mo...g.singing eyebrow... HYPOVENTILTN/dec FiO2 cause hypoxemia w/ wnl alve-art o grad ------------------------------------------------------endo. ENDOSCOPY is for MEN 1 ( involve parathyroid.. normal PCWP. o/w BP rise rapidly.. W/U: measue calciton. CO-Hb >10%. cardiogenic cause has high PCWP ( >18mmHg). >LVEDP: increase in CHF caused by htn or hypertrophic cardiomyopathy. LUNG COMPLIANCE: decrease in pulm edema/fibrosis. CXR 2.. 50% pheochromocytoma.indication for intubation.. OCP.

>>> FAT EMBOLISM = AMS.......DKA IN UNDX DM-1: teenager dry mucous.ctecholamines.2451 ------------ 2081 ------------ 2474 ------------ 2475 ------------ 2482 -----------2486 -----------2496 ------------ endo. head bed incline. trachea deviated to right side ( mean Left tension pneumothorax) . cpap reserve for comp casese b/c exoensive.. s/s: mva=blunt chest trauma.. URI. cortisol -> hyperglycemia.deep breathe exercise..adm fluid bad AORTIC RUPTURE = MEDIASTINAL WIDENING.. dec LOC.TENSION PNEUMOTHORAX.inc lipolysis ->inc free FA.hyperosmola intravascu ------------------------------------------------------Resp Sx . >50yo. & OBLITEATION OF AORTIC KNOB SHADOW ON CXR. RESP DISTRESS. osmotic diuresis.Infection precipitate DKA via infectn -->inc glucagon. ABG: hypoxemia Dx: patchy alveolar infiltrate on CXR & hypoxia. CONTUSSION: 1st 24 hrs & focal lung involved and ARDS is 24-48hrs p trauma & bilateral lung involved. O: tachycardia. ------------------------------------------------------- ... >> ATELECTASIS : dev w/in 24hrs post-sx. (dx & theuropeutic). diffuse abd pain.RISK FACTORS POST-SX COMP:smoke..best MGT ATRAUMATIC MASSIVE HEMOPTYSIS = RIGID bronchoscopy to simulta localize & control bleed site. tachypnea. poor ge hlth. DEPRESSION OF L MAIN BRONCHIS. DIURESIS --> RENAL LOST K STORES but plasma show elevate K+emia b/c acidosis & decrease insulin cause K redistribution to extracellular. bruse chest wall.ketonemia. may present arrhythmia..CONCERN OF HEMOPTYSIS = ASPHYXIATION ------------------------------------------------------resp sx= FLAIL CHEST = CAUSE PULM CONTUSSION = primary cause of respiratory distress --> see severe tachypnea & hypotension tachycardia. heart failure . pt dev hypoxia & ards hrs later as pulm edema . DKA: cause inc hep gluconeogenesis. early ambulation. Mexicom /ww = mcc of massive hemoptysis is M. ------------------------------------------------------resp sx. best initial mgt: needle thoracostomy @2nd ICS.PCWP increase much higher levels ------------------------------------------------------resp sx.. neck vein distended=inc cvp. if pt remain hemodyn unstable -->pericardial tamponade should be supsected ------------------------------------------------------resp sx. sx>3hr.PULM CONTUSION = not shown clin immediate p injury.polyuria..preexist pulm dz... met acidosis ( due low HCO3)... >>POST-SX MEASURES / PREV ATELACTASIS: incentive spirometry.. inc ADH -. chest pain.. dec breath sound L: CXR-irreg alveola infiltrate. tuberculosis. hypotension/tachycar/tachypnea despite recv fluid resuscita... hypoxia..PETECHIAE P 12-72HR INITIAL UNJURY.>> MYOCARDIAL CONTUSION = asymp. all develop w/in first 24 hrs Tx: ------------------------------------------------------resp sx .Pulm Contussion vs ARDS: timing is the key. goal increase FRC. DISPLACEMNT OF TRACHEA & ESOPHAGUS TO RIGHT.

If both colonoscopy & upper GI endoscopy neg --> do capsule endoscopy look for small intestine dz(AV malformatn). and annually x2yrs for low risk of malignancy based on demogra & radiographic data...blindness. fatigue. bx via percutanous pronchoscopy or VATS for high risk pt.... ------------------------------------------------------gi-HEMEMESIS = w/in hr if due to endoscopy related esophageal perforation.protein RQ=0.>>>>> SPN = SOLITARY PULM NODULES = Llsn 3cm. RQ=1 -->predom oxidatn of carbohydrate & net lipogenesis. CXR first then CT scan. ASSESSING RQ IS IMP WHEN ATTEMPTING TO WEAN PT FROM MECH VENT.. s/s: macrocytic anemia (vs.DISTAL SPLENO-RENAL SHUNT worsen ascites. become symmetric post positive pressure mech ventilation.muscle wknss...sepsis=hypercatabolic fat & prot so RQ1..2498 ------------ 2533 ------------ 2543 -----------2632 -----------71 -----------78 ------------ 86 -----------997 ------------ resp sx-FLAIL CHEST: inward motion of a side of chest wall on inspiration. and then freq abd paracentesis (2-4L/day as long as renal function okay)..PERITONEO-JUGULAR shunt help ------------------------------------------------------gi...no eccho nec.MICROCYTIC ANEMIA / COLONOSCOPY: elder. SIDE-TO-SIDE-PORTO-CAVAL shunt help ascites but worsen encephalo.. >>>S/S:=fever. Even neg occult need colonoscopy. then add loop diuretic (not more than 1L/day of diuresis to prev hepato-renal syndrome).>>TRACHEOBRONCHIAL INJURY=signs hemoptysis... MALLORY WEISS TEARS = ruptured submucosal arteries of distal esophagus and proximal stomach.. low iron & ferrtin....7. ------------------------------------------------------liver.HEMOBILIA = AST/ALT ratio > 2 typical for alcohol hepatitis. then upper GI scope...FOLIC ACID DEF VS VIT B-12 DEF: folic can be stored 4-5mo (vs. tachycardia & flow systolic murmur heard @ L 2nd IC.0...>>vit D def=osteomalacia & hypocalce -->tetany.CXR monitoring q3mo/6mo. & air leaf after chest tube placement ------------------------------------------------------PFT = part of routine f/u of COPD & in lung cancer pt being eval for sx candidates....... glucose RQ=1..pneumomediastinum. STEPWISE APPROACH TX OF ASCITES: Na & H20 restriction . ------------------------------------------------------GI...hypoxia.psueduomonas.. ------------------------------------------------------resp sx-RQ QUOTIENT = rate prdtn CO2/rate uptake O2. heat sensitive in food cooking... if RQ>1.8 & lipid RQ=0. high tibc. vit E def=RBC fragile. 3-4yr).0. then start spironolaction.0 --> excess carbohydrate oxidatn from diet. macrocytic anemia & neuro deficits & strict vegan). ------------------------------------------------------resp sx-VAP (VENTILATOR ASSO PNA): on vent >48hr & result of impairment of lung natural defense.vit c=perifollicul hrrg ------------------------------------------------------- .ESOPHAGEAL RUPTURE =shock via mediastinitis & 3rd spacing fluid into mediastinum..CHRONIC HEPATITIS B..

..SCREENING UPPER ENDOSCOPY=over 55yo w/ nos of dyspepsia or any age but w/ alarm s/s eg.causes of dyspepsia=gerd..... postprandial fulness.. tx: cricopharyngeal myotomy or sx excision.ESOPH WEB=met abn (eg iron def) asso w/ this.u/s good for screen. jaundice. diffuse eso spasm (periodic high amplitude non-peristaltic wave. impaired wound healing.1518 -----------1521 -----------1726 ------------ 2125 ------------ 2265 -----------2368 -----------2856 -----------540 -----------812 ------------ Gi= PANCREATIC CANCER = s/s epigastric pain. one wk later skin lesion most likely to develop.. sev intermittent epigastric pain last 15-30 min p eating..Exten inflammaton cause diverticula at mid-eso zone=TRACTION DIVERT.necrotizing migratory erythema and diarrhea. dyspepsia= 1 or more s/s of epigastric pain. barium study..NON-peptic dyspepsia not asso w/ esophageal dysmotility.CT help pancreatic calcification & ductal dilation. Selenium cause cardiomyopathy.n/v. wt loss/dysphagia/persistent vomiting. ------------------------------------------------------HY GI-ZENKER'S DIVERTICULUM =motor dysfun btw upper esoph sphincter & esopha dysmotility.HERPES ZOSTER (SHINGLES) = constant burning pain right of umbilicus. nsaid.s/s older 50yo & dysphagia & neck mass..--> outpocket btw fibers of cricopharngyeal muscle.ZINC DEFICIENCY: s/s skin rash... malignancy. old with recent radiation or immuno compromised.myalgia.. pt on TPN diet watch for Zn and selenium deficiency.funct dyspepsia. ------------------------------------------------------- .. early satiety. scleroderma ( dec-abs peristaltic wave & dec LES tone). 72hr fecal test to confirm steatorrhea.. chronic pancreatitis hx --> suspicon of pan cancer --> do CT . ------------------------------------------------------liver-SIGNS OF HEPATITIS: s/s malaise...... GERD inc LES but present peristaltic wave. ------------------------------------------------------GI.severe pain when lightly touching skin . ------------------------------------------------------GI= GLUCAGONOMA = suspect this dx when triad of hyperglycemia... ------------------------------------------------------gi-CHRONIC PANCREATITIS: s/s diarrhea xwks pale volumnious foul smell stools that hard to flush.....manometer used to DIFF ACHALASIA/SCLERODERMA/DIFFUSE ESOPH SPASM /GERD:>>> achalasia (dec-abs peristaltic waves inc LES tone). mild RUQ pain... pud. if fails then do ERCP .. alopecia.Dx. ------------------------------------------------------GI. can be coexist w/ abd burn/nausea/bloat. abn taste.. ------------------------------------------------------GI.mcc alchol & gallston obstruction. if obstruct do MRI. ------------------------------------------------------GI.

hemosiderin in urine. W/U: mom vital sign. S/N: CONIZATION = CONE BX = done via electrosurgical techn.... ------------------------------------------------------med cancer. Clss med in pregn.. plus premenopa --> colposcopy.. IgA is mc in adult and has normal complement and few days after URI. px= grave. plus post-meno --> do either HPV test or Colposcopy. hot flash. nitrofuratoin.IUFD ( INTRAUTERINE FETAL DEMISE = death >28wkGA..... not for UTI. ------------------------------------------------------gyn-PAP SMEAR .. (ultimate is colposcopy if HPV pos).ACL= hx of foreful hyperextension injury to knee or a noncontact torsional injury of knee during deceleration.. ------------------------------------------------------- .FINDING LSIL/CIN 1 / MILD DYSPLASIA: PLUS adolescent --> repeat in 12months... PDA VSD = non-cyanotic congenital heart dz. cyanosis correlate to amt of obstructions.RALOXIFENE = SERM=SELECTIVE ESTROGEN RECEPTOR MODULATOR: do 1st line prevention osteoporosis @ breast & endometrial --> antagonist.IgA NEPHROPATHY VS POST-STREPTOCOCALL GLOMERULONEPHRITIS: mcc of glom hematuria after URI... leg cramps.... ------------------------------------------------------renal ..P/S.. SPONTANOUES ABORTION = FETAL 20wK OR WT 500G ------------------------------------------------------OB-ASYMPTOMATIC UTI = doc tx E coli are amoxicillin.2682 -----------2409 -----------98 -----------287 ------------ 308 ------------ 526 -----------1505 -----------1543 ------------ OB. ------------------------------------------------------anatomy knee. TRANSPOSITION OF GREAT VESSELS = cmn cause of death w/in 1st year of life.. C=section only if mom in danger.. (POSS: coomb test...TETRALOGY OF FALLOT = mc cyanotic spell in child 4yo.. in bone: agonist. HAPTOGLOBIN.. Bactrim is a no no. Clindamycin is okay to treat anaerobe.. plt cnt MGT: counsel risk of coagulapathy & reccomd spontaneous prompt delivery. LDH.. RETIC CNT..unlike raloxifene.... to eval cervical transformation zone.. DX: U/S no move't.. s/s no fetal move't.... ------------------------------------------------------heart valves. cold knife.. laser.PE: pansystolic murmur ( du to VSD).cyanosis w/in fist few days of life. W/U HEMOLYSIS = HB.. Post-strept has low complement. ------------------------------------------------------heme-MACROVASCULAR TRAUMATIC HEMOLYSIS= see addtn note for intravascular vs exrtravascular hemolysis. TAMOXIFEN = INC RISK OF ENDOMETRIAL CANCER..MEDICAL MENISCUS INJURY = MCMURAY SIGN'S= palpable to audible snap when extend leg at knee from full flexion while simutanously applying tibial torsion... cephalosporin... MCV. s/e: incr risk DVT. avg 10days into pharyngitis or 21days into impetigo.. fibrinogen (low=red sign). HYPOPLASTIC LEFT HEART SYNDROME -heart failure w/in first few weeks of life... subpulm stenosis ( give single S2)...

higher incidence of bronchogenic carcinoma than mesothioma.. tachypn.. ams.arrhytha... pleural plaques... & poor intake ------------------------------------------------------heart association---RHF = Mitral Stenosis.dil pupil/dec bowel sounds/urinary retention. dysphagialll ------------------------------------------------------micro resp.. >>> COMMON CAUSE OF HYPO-MG-EMIA: diuretic use... ------------------------------------------------------endo-ADDISON DZ=PRIM ADRENAL FAILURE: s/s anorexia. alcho. resp acidosis..flush. mediastinal widening = aortic dissection & tearing chest pain radiate to back.. LISTERA & STREPT = pcn.1792 -----------2051 -----------2105 -----------2290 -----------2357 -----------2653 ------------ 928 ------------ tox.IMMUNOCOMPROMISED + CHEMOTHERAPY + PNA + CXR-INTERSTITIAL INFILTRATES BILATERAL: think of PCP if nonproductive cought.ALCOHOL INTOXICATION = slur speech.... urina reten. and mesothioma...>>CYANIDE =h/a/n/v/abd pain.. inc renin & ATII... malabsorp.. damage lining of GI... bronchogenic would have at ... tachcard. HOCM=asym hypertrophy of intraven septum.. ------------------------------------------------------- . >>AFTER sx/operationg via nosocomial contamination ------------------------------------------------------micro. perihilar .. and bronchogenic carcinoma. >>TCA POISON=CNS depressn. CMV if leukemia + GI s/s ------------------------------------------------------inf-OSTEOMYELITES CUASES: in DM chronic foot ulcer spreat to bone via CONTIGUOUS SPREAD. ------------------------------------------------------lung cancer ASBESTOS EXPOSURE = ONLY RISK FACTOR FOR MESOTHELIOMA.... hypopnea..HOEVER. MI=left ventricular aneurysm. midl hyperclhoremic met acidosis.anti-chol s/s (sweat/drool/hyperthermia. flush skin.hyperpigmentant. dec bowel sound) but diff is dry mouth.. fatigue in 100%pt... is via hematogenous.ataxia.. dec BP. white tong..hypotension.. POST-TRAUMATIC OSTEOMYELITIS via direct oculation.. vitiligo..MACROLIDE = erythromycin tx strepto pharyngitis & mild com pna.. Lab: hyponatremia. heavysalivation. dicloxacillin or cephalexin to cv strepto & staph. cyanosis.. on CXR: mesothioma would have mass on pleura.>>exposure abstosis increased risk of pulm fibrosis.. hyperkalemia... ANTICHOLINERGIC TOXIC=similar to TCA poison (hyperthermia.. caustic poson= cognitive least affected.STAPH = large fluctant cx LN in children. ( pcn & aminopcn uneffect in tx staph due to B-lactamase enzyme ... wt loss.. In children....

------------------------------------------------------- ...... LOOW OXYGEN SATURATION & A-FIB ASSOCIATED W/ POOR PROGNOSIS... two large bore IV >>intubation >> upper endoscopy to intervention & thereuptic.>>...... vascular.. PITUITARY.PLT TRANSFUSION = INDICATED WHEN PLT 50. multinodular goiter & toxic adenoma remain euthyroid post radiodine thereapy.HIGH RENIN..defective GnRH secretion.).Typical ABG: hypoxia. Note. met alkosis.... & PANCREATIC TUMORE.. EKG show non-spec ST/T-wave changes.... dec BP/O2 saturatoin. octreotide ) considered. CXR clear..GRAVES'S DZ most likely develop hypothyroidism post radioiodine therapy.. normnatremia. low FSh. dx studies: Helical CT pulmon angiography is IOC for wnl creatinine but VENTILATION PERFUSION is IOC xrenal pt.. low LH. RENIN-SECRETE TUMOR.g.. would do endoscopy lok for GI ulceration caused by excess gastrin which secreted by gastinoma that typicalla located @ head of pancreas. CXR-clear. medcation .. AG=GENTAMICIN ------------------------------------------------------Upper GI BLEEDING MGT = hematemesis & depressed LOC --> risk of aspiration --> slt:intubation to protect airway. elev LH & FSH lead to inc testicular aromatase activity --> high estradiol prodtn.. HIGH ALDO.. no wheeze.. ------------------------------------------------------endo thyroid ._) ------------------------------------------------------TOXICITY OF AMINOGLYCOSIDE = gait imbalance & to and fro move't --> vestibular insult & ototoxicity... ------------------------------------------------------PULMONARY EMBOLISM = desat O2. do serum calcitonin test.. prophyl abx & somatostatin ( e..1150 ------------ 1528 -----------739 ------------ 2864 -----------170 -----------1421 -----------1434 ------------ 1453 ------------ renal-BARTER SYNDROME = urine cl >40 High.. SOB & pleurtic chest pain. wnl BP.000.. EKG: Atrial-fibrillation. ( medullary carcinoma of thyroid).... high renin & high aldosteron (due to RAAS activated).. HTN]. and maybe hypocapnia.ERECTILE IMPOTENCE IN DM PT = cuase are autonomic neuropaty. and functional hypogonadism (=low testosterone. hypokalemia. ------------------------------------------------------PULMONARY EMBOLISM = inc HR/RR.IF PT HAS ELEVATED INR --> FFP CONSIDERED.BARTER SYNDROME= defective of NaCl channel at ascending loop Henle ( GITLLEMAN AT distal onv tube) --> renal try to save Na in expense of K+ and H+ ------------------------------------------------------endo.MEN I = HYPERPARATHYROID.. ==> think of MEN 2A . respiratory alkalosis.. pos a systemic illness. ------------------------------------------------------PHEOCHROMOCYTOMA & HYPERCALCEMIA and has a sister died of high blood pressure... inc HR/RR......prim hypogonadism = elevated Gn levels.. low-wnl BP [ PRIMHYPERALDOSTER= LOW RENIN HIGH ALDO.HTN.atrial fib = irregular RR interval & narrow QRS complex & no definite P-wave..

PAGET's DZ = discharge..1754 ------------ 1991 -----------2051 -----------2357 -----------2479 ------------ 2507 ------------ 2508 ------------ RH INCOMPALITY only in mom has Rh neg.. electrophorresis reveal elevated fetal Hb levels. Hx: fever. ( socially w/drawn & eccenctrically behavior = psychotic)... ------------------------------------------------------- . cxr-diffuse bil interstitial infiltrate.. normal u/s .. ABG: hypozia. . had RA before. SCHIZOAFFECTIVE D/O = schizophrenia & mood s/s ... mild hyperchloremic metabolic acidosis. CYCLOTHYMIa=alt hypomani & dep x>2yr ------------------------------------------------------IN LEUKEMIA PT RECV CHEMO = if develop pna.( in CHF will elevate due to Left ventricular dysfunction).. 90% case dx in 1st yr of life..INTRADUCATL PAPILLOMA = sympt of unilaterl intermittent blood d/c and no lump felt on PE. pathology= intrinsic defect of erythroid progenitor cells --> increased apoptosis. social w/draw. ------------------------------------------------------cancer breast ... .(COPD: whould have hypoxia and resp acidosis ) More specific testing for CHF would includ BNP & pulm capillary wedge pressure... hyperpigmentation.. hypotension.. auditory hallucination... hyperkalemia... DBS vs megaloblastic anemia ( no hypersegmentation in DBS).... DD: CMV vs PCP... hyponatremia. chromosomal wnl... resp alkalosis highly suggestie of CHF vs COPD ( side note: PE is has this typ ABF profile as well).. DYSTHYMIA = depressed most days x> 2 yrs & minimal functional impair.typical s/s: bilara crackles. hypocapnia.. CX...... eczematous at areolar. congenital anomalies.ALLOPURINOL = for prevention or recurrent gout....SCHIZOPHRENIA = > 6 months detached & emoionally blunted. dx confirm by histology.. dry cough. CORTICOSTEROID = CIed in septic arthritis. ------------------------------------------------------INFLAMMATORY MONOARTHRITIS = single red/swollen/painful jt are SEPTIC ARTHRITIS OR CRYSTAL-INDUCED ARTHRITIS.. DIAMOND-BLACKFAN SYNDROME= CONGENITAL HYPOPLASTIC ANEMIA: macrocytic. vitiligo. WORK UP= FLUID ANALYSIS. Transfusion therapy in unresponsive pt..COLCHICINE = used in acute crystal-induced RA.. decreased BP... odd behavior.. ------------------------------------------------------Major Depression w/ psychotic features: depression happen before to pyschosis. ------------------------------------------------------CHF = CHRONIC HEART FAILURE = hx of CAD put pt @ risk for CHF b/c of LVD. dec breath sound at base due to pl effusion from CHF. because super tiny in areolar and has soft consistency... . GI..... mgt: need to distinguish crystal induced vs septic ... CMV TEND TO ASSOCIATE WITH GI SYMPTOMS AS WELL... fatigue.. Tx: corticosteroids in conscious pt.. GRAM STAIN. low retic cnt... ------------------------------------------------------Adrenal insufficen = ANOREXIA in almost 100% pt. at least 2 wks of psychotic without any mood symptoms.

.. ------------------------------------------------------NASOPHARYNGEAL CARCINOMA = undifferentiate ca of squamous cell origin . Note: venous u/s has low sens & specific. ------------------------------------------------------INTRACRANIAL PRESSURE = brain parenchyma (constant unless mass).rocking.. CLOSAPINE=lest. dystonic extension of toes NECK & TRUNK=torticollis... nasal obstruction. anti-pschy. Strong associatn w/ pos serology EBV --> EBV titer used as eval of therapy..s/s present w/in 1-6mo. ------------------------------------------------------STREPTOCOCCAL PHARYNGIST = GRP A STREPTOCOCCUS fever..cautious:poss ischemia.. prevent RHF.. rhinorrhea.VIRAL PHARYNGITIS = conjunctivits. Dx: pregn test neg and phys exam negative and wnl u/s.. If pt has GNitis do Antistreptolysin O Ab to see if pt has infected by strept before. bil tender cx LNapthy. if neg rapid test hen do culture. rec epistaxis.. s/s recurent otitis media via eustachia obstruction...2565 ------------ 1433 ------------ 61 -----------269 ------------ 409 -----------662 ------------ 1146 ------------ PULMONARY EMBOLISM = D-DIMER has 95% of negative predicted value meaning if test negative --> can exclude DVT.. blood flow(CBF)...sway. and prevent transmissio n to close contact. viral exanthem ------------------------------------------------------DYSFUNTIONAL UTERINE BLEEDING: heavey bleeind in absence of dz ..atyp watch for agranuloytosis ------------------------------------------------------HIV + HHV8 = reddish purple dark vascular plaques or nodule on cutanouse or mucosal surfaces. Brain autoreg CBF & perfusn pressure to maintain a relative constant flow. exudative pharyngitis tx is pcn to hasten recovery.. if moderate + no active bleeding --> progestin. ORAL & FACIAL=tongue protrusn/twist... LOWERING ICP=dec CO2 via hyperventiltn .VOL of blood & inc w/ hypercapnia /met demeand/hypoxia via cerebral vasodialtion. lip smaking/pouting.CEREBRAL vasodil & elev BP raise the ICP.Dx test : rapid test for strepto Ag (high specificiy but limited sensit).. Also associated w/ smoking & chronic nirosamine consumption ( salted fish). metoclopramide..CSF(k unless obstruction). this mech dysfunct in trauma/stroke. shoulder shrug. if moderate + active bleeding --> estrogen indicated.sedatn (dec met demand & control htn).foot tap.RISPERIDONE=atyp. rotary hip mov RESPIRATORY=grunting noises. so neg result can not exclude DVT.. ------------------------------------------------------TYPE OF DYSKINESIA (EPS) caused by da-rec blocker.chewing/retractn of corner of mouth LIMB=limb twisting. high freq in Medi / Far Eastern descent...head elevtn(inc ven outflow(. most..manitol ------------------------------------------------------- . TX: mild=iron supplem .

. absent DTR.. ------------------------------------------------------FOLLICULAR CANCER OF THYROID . deviatn of eye to left (gaze palsy). On CSF exam: oligoclonal bands. oligoband is not diagnostic test b/c other dz can increase Ig. has psamm. PONTINE HRRG=paraplegia w/in few min. mild elev cells (albumino-cytology dissociation).. however. M... infertile problem. ------------------------------------------------------blunt amd trauma not same as penetrating abd trauma. dec superficial touch & vibr sense.FNAB show histology o invasion of capsule & blood vessel ( follicle adenoma doesn't)spreads via hematogenous to lung/brain/bone. Papill can is mc malignancy of thyroid... coma may ensue due to brainstem compression. --> lsn at . slow infiltratve local spread after affect other part of thyroid gland and LN.. G) predom increase IgG... . urinary incontinence.nerve conduction velocity show demyelinzation. pinpoint pupils & reactive light.. Local LN involvement is rare in foll can (but cmn in papil ca). no nuchal rigidity... EMERGENT DECOMPRESSION LIFE-SAVING.tx: plasmapheresis or Ig ------------------------------------------------------CEREBELLAR HEORRHAGE = ataxia.1295 -----------1352 -----------1360 ------------ 1432 ------------ 1578 ------------ 1600 ------------ 1662 ------------ PCOS = STEIN-LEVENTHAL SYNDROME= anovultn. impaired vibration & proprioception of left forarm..androgen exess & ovarian cysts. INITIAL pin-neeedle sens of foot -->aswend wkss of LE to trunk to UE --> bulbar & resp mecsle...HTN HRRG =PUTAMEN hemiparesis. CSF:ele prote. homo hemianopsia.. NASAL FURNCULOSIS = staphyl from nasal nares. no h/a/v/n/.GBS = albumino-cytologic show elev protein & wnl cell cnt ------------------------------------------------------GBS-peripheral nerves affected.... Hurtle cells seen in both papil & foll ca. in gun shot which is penetrating do laparotomy in unstable pt. urgency... PE: UMN lesn= spascitiy. eye deviate away from paralytic side.cause imbal LH & FSH prdt & insulin resistance.. no trauma.uncapsul ------------------------------------------------------MULTIPLE SCLEROSIS = 29yo female paraplegia.. ------------------------------------------------------- .Tx: clomiphene citrate & metformin. IF left untx. right-sided facial wknss. hyperreflexia in LE.: 12yo boy have febrile diarrhea 10 days ago and cannot walk anymore. stupor/coma.. elv Ig ( A....decerebrate rigid. PE: sym flaccid paralysis of both legs. hemi-sens loss.. blunt abd trauma = peritoneal lavage used if u/s not available. rhinoplasty=septal perforation. allergic d/o. hx of trigemnial neuralgia. no FAST ------------------------------------------------------nasal polyps = asthma.. Folli cancer is encapsulated & does not have distintive nuclear features... occipital h/a..

. anorexia noervosa.. cystometry. booster q 5yr. & prochlorperazine). -----------. Wnl MVo2 b/c hyperdynamic circulatn & high cardiac Outpt. hgh parity is risk..smoker. TD Q 10YR POST AGE 18 2.DM.. at 2417 risk decreased bone mineral density although she wourks out alot.do it in unclear dx/plan invas interven.significan vasodilation --> decreased sys vasc resistance -->septic shock.. -----------. cough/sneezing/laugh make out. this slows HR and break the rhythm. If ABI0. CARDIOGENIC SHOCK=high pcwp ------------------------------------------------------DYSTONIA =typical anti-psychotic..CHOREA = brief irreg unintent muscle contractn.9 -->more than 50% occlucion in major 2431 vessel..htn.. U/a. loss small urine from distended bladder.Arterial duplex u/s to loc lsn. (intranasal : healthy. Low Left ventt preload if sign fr vol depletn or intravascul fluid redistbtn.. b/c of low FSH/LH.ABI=dx PAD = sys bp of post tibial & pedis/brachial artery..3. restrelieved. postural instability. hypothyroid.A single TdaP booster for adults of all ages in place of Td 3. Kegel exercis.hyperlipid..Cause: excessive exercise. non-pregnant adult 65yo or 65yo with CV/pulm/hep/renal/met/immusupresn. flow not rep/rhythmic.. dec condiction thru AVa node. sling pro.MYOCLONUS=invol rhym jerk AKATHISIA = freq sens of restlessness that causes pt to move ATHETOSIS=writhing move in Huntington..2161 ------------ 2174 ------------ 2336 -----------2387 ------------ DIABETIC NEUROPATHY = OVERFLOW INCONTINENCE.. ESSENTIAL= rest & intent tremor resolve during sleep & improved by alco/BB.------------------------------------------------------PAD=extremity claudicatn.Gold standard=contrast arteriography= invasive. mcc=atherosclerotic vasc dz RISK= incr age..4--> limb ischemia. cause by floor muscle wknss. postvoidal res vol wnl. abn urine analysis.HEMIBALLISMUS=unil.exertion-rel pain. ------------------------------------------------------VACCINE RECCOMENDATIONS: 1. ENDOVASCUL STENT=sx fail.. rigidity. ------------------------------------------------------SEPTIC SHOCK:high cardiac output. inc residual vol. NEUROGENIC & HYPOVOLEMIC SHOCKS have low MVO2 b/c increase O2 extraction by hypoperfused tissues.If ABI0. IMMERSION IN COLD WATER would increase vagaonl tone. low sys vasc resistance/right atrial pressure/pcwp.. estrogen. metoclopramide. & freq normal MVo2. IM inactivatd influenza vaccine give to 2412 all adult. wnl=ratio 1-1.PARKINSON'S DZ = rest tremor. pessary.. . DETRUSOR INSTABILITY/IRRITATION FROM NEOPLASM/INTERSTITIAL CYSTITIS=urge incont. STRESS INCONTINENCE=old women. freq.------------------------------------------------------HYPOGONADOTROPHIC HYPOGONADISM = athlete female c/0 amenorrhea.violent armfling contral subthal nucleus ------------------------------------------------------VAGAL MANUEVES = VALSALVA / CAROTID SINUS MASSAGE . nocturia. Burch proc. bradykinesia. ADENOSINE ia a very SA AV-nodeal blocker that often used as well.. refractory to meds/not candid for sx .

.. FP decreases. neu predo @ early course. mech:induce 2578 suppressor T-cell that downreg T-cell mediated immun response to myelin Ag that underlies MS. high HCO3.6. CSF:pleocytosis.. the further value of RR from 1.------------------------------------------------------cardio-SBE=subacute Bacterial Endocarditis=facial injury --> transient bactermia & seeded mitral valve. the stronger association. as X move to Left = lower ends points --> senc increase. note:breathe into a bag --> incr PCO2 --> correct pH somewhat but not good sltn... RR=1.0 is stronger assiciation than 1. supportive tx... sensivity decrease. -----------.... never PO abx in endocarditis case. s/s: 2770 URRI. -----------..------------------------------------------------------bio-False negatives will increase when cut off level (enzyme level) increases.Dx:two or more epi of two or more neuro s/s . tx: infusion of isotonic saline. IV pcn G..RA = subluxation & tendon damage cause permanent deformity.g... Na.-----------. ALS.. spec increases...Tx: glatiramer acetate to dec freq & severity of MS exacerbtn. -----------. BACTERIAL MENINGITIS: csf:inc cnt/protein. vol depletion. Ucl 20. nuchal rigid. not IV pcn V b/c pen V is for orally -----------.. progressive fatigue & chronic waxing & wanine LGF. prevalence same?.h/a. -----------.------------------------------------------------------OA= excessive bony growth. 4. b/c of abn valve --> predispose to endocarditis...6 vs RR=4.------------------------------------------------------2582 Respiratory Muscle Fatigue: GBS..------------------------------------------------------- .------------------------------------------------------MS=MRI show bil multifocal asym contrast enhace periventricular white matter (plaque compromised BBB allowing contrast toaccumulate..screening.------------------------------------------------------bio.vomiting).. fever. Do blood Cx . IV 2664 abx.. -----------.. -----------. or diuretic abuse... prevalence is the same.. dec glu Stain show bacteria.------------------------------------------------------bio-RR=RELATIVE RISK. botulism.. FN & PPV 5 dec... -----------.. s/s resolved w/in 7-10days.------------------------------------------------------METABOLIC ALKLOSIS + SIGNS OF VOLUME DEPLETION = THINK OF saline responsive ( Ucl 20mEq/L) vs saline resistant (Ucl >20mEq/L) LAB: low K & Cl.... Never IV AG ( gentamicin) alone.this is Met alk saline responsive lab profile cuased by GI 2803 H+ loss ( e.. wnl Ca.Septic Arthritis = distal phalangeal bone resorption give classic "pencil-in-cup" deformities. 1644 eg. must combine w/ another abx.------------------------------------------------------ECHOVIRUS & COXSACKIEVIRUS = mcc of viral meningitis.irritab. myasthenia gravis.... ARGATROBAN=IV anticoag used in thrombosi in heparin-induced thrombocytopenia who req anti-coag... lymp predo. X moves 987 toward the right.. cartilage degradatoin & mucle atrophy cause 2524 deformity. -----------..0.

sltn to bias.. the odd ratio is close to the relative risk.. ------------------------------------------------------bio.increase dx accuracy increase the incidence and prevalence. Effect modification is not a bias so shouldn't be controllev....1816 -----------1840 -----------1845 -----------1858 -----------1896 -----------1925 ------------ 1937 -----------1955 -----------2045 -----------2109 ------------ Bio-LEAD TIME BIAS = a new screening test for poor prognosis dz like lung or pancreatic cancer.... easy. if neg mean the opposite and grear than pos one mean association in positive way ------------------------------------------------------bio.if RR is greater than one but has wider range means smaller sample size. ------------------------------------------------------bio... Cons: temporal relationship btw exposure & outcome not always clear... Observer bias = controlled by blinding technique.. ------------------------------------------------------bio. and randomization. do not expect result of studying middle women apply to elder.. typical example of lead time bias is prolongation of apparent survival in pt whom is applied without chaning the px of the dx.CROSS SECTIONAL STUDY = PREVALENCE STUDY: measure epposure & outcome simultanouesly randomly from a pop. If RR=1.. high mortality rate would decreased the prevalence......05 to show it's significant and can reject null hypothesis and say there is an association. ------------------------------------------------------bio. ------------------------------------------------------- ..the r = coefficicent assess a linear relationship btw two variables.. lack of statistical significance. COHORT=select a grp & follow them. P-value must be less than 0......if prevalence of dz is low (e.... the exposure odds ratio approximates the relative risk. ------------------------------------------------------bio-GENERALIZABILITY = EXTERNAL VALIDITY = perstains to the applicability of result of a study to other popn.. ------------------------------------------------------bio.6 --> there is association btw risk factor & dz. Confounding = mathcing.. restriction....g. Selection bias= choose representatve sample of popn for stuyd and achieving high rate of follow up. rare weird dz). The outcome of a case control study is not common in popn.GIVEN: MEAN = 230 STAND DEVIATION =10 WHAT WOULD BE THE RANGE BASED ON 95% CI.. Ascertainment bias= avoided by select a strict protocol of case ascertainment. answer: 10x2=20 --> 210-250 ------------------------------------------------------Bio-COHORT STUDIES RELATIVE RISK GIVEN FIND P-VALUE.. Pros: cheap.. ------------------------------------------------------Bio.. Therefore.

. complica: urine into scrotum/perineum/ad wall..TENSION PNTHORAX: clinicall dx. insomnia.Middle age woman gain lbs. htn. cmn s/s tachypnea. & s/s of pelvice fracture. scrotal hematoma. insulin resistance ( High Glu) 3. decrease breath sound. retrospective. large IV bore for fluid resusication. tracheal deviation...CUSHING'S SYNDROME... blood @ urethral meatus. odds ratio calculatd.. ANTERIOR=: NORMAL PROSTATE PLACEMENT. psychiatric problems ( insomina. psychosis. ------------------------------------------------------- . lab:hypokalemia.. s/s: low CD19 =b-cell. UL of Natremia. ------------------------------------------------------sx trauma . defect in Bruton's tyrosine kinase.. CLINICAL TRIAL COMPARES TO THEURAPEUTIC benefit of diff interventn..2623 -----------2458 -----------2699 ------------ 1276 -----------1438 ------------ 2658 ------------ case control study= dz grp compare w/ healthy grp. MAY NOT C/O CANT VOID.. Confirm tension PNthorax: on phys exam see jugular venous distention and hypotension --> needl thoracostomy . wt gain.. a signaling molecule expressed in B-cell at all stages of development. poss met alkososis b/c loss H+ too. hyperglycemia. prostate displace= hide riding upon DRE..anterior vs posterior urethral injury: posterior inj: cant void. vasoconstriction ( htn).NEW CLUBBING IN PT W/ COPD OFTEN INDICATION OF CANCER ------------------------------------------------------ped -X-LINKED AGAMMA-GLOBULINEMIA= BRUTON'S AGAMMAGLOBULINEMA.. BLEEDING FROM URTHRA. must take this breathing problem before C=circulation.CASE SERIES = determin natural hx of uncommon conditions but no info on incidencec... PERINEAL TENDERNESS/HEMATOMA.. thining of skin. ------------------------------------------------------trauma. ------------------------------------------------------endo... incidence cant be extracted from clinical study . but indicence of a dz cannot be calculated.... excess cortisol : 1. depression) ---... COHORT STUDY= incidence can cal ------------------------------------------------------resp. cause? sumptoms: wknss... central adiposity. CROSS-SECTIONAL STUDY= incidence cant be extracted either. 2. mineralocorticoid activity ( aldo-like act: save Na waste K --> hypokalemia. info collected about exposure to risk factors..