Buzz words and core concepts for review
Pulmonary
5 gm deoxygenated Hgb to have central cyanosis – you cannot be both anemic and
cyanotic; you can look fine with cyanosis if you are polycythemic
carbon monoxide – co-oximetry, pulse ox normal
bronchiolitis – RSV
bad bronchiolitis – preemies, congenital lung/heart disease
ribavarin – RSV with congenital heart/lung defects
bad asthma – ER visit 1 mo, more than 2 inhalers, 1 ICU/intubation, 2
hospitalization in 12 mo, 3 ER visits in 12 mo
Aa gradient (quick): 140-PCO2 –PO2
NL max Aa gradient – (10+age)/10
asthma deaths – inspissated secretions – mucus plugs
RSI in asthma - ketamine
intubated asthma – think barotraumas if worse; permissive hypercapnia
nasal polyps, RAD, NSAID’s combo (also atopic dermatitis)
methemoglobin – co-oximetry; sats are low but look fine
- dapsone, pyridium, well water, nitrites/nitrates/ peds with GI
ARDS – aka NCPE – NL PCWP (<18), PO2<60 mmHg with FiO2>50%, bilateral
alveolar infiltrates, normal heart size
ARDS TV 6 cc/kg (NL 10 cc/kg)
PNA
-
strep pneumo – most common, rusty sputum, rigor
Klebsiella – currant jelly sputum, ethanol
Legionella – older people, AMS, elevated LFTs, hyponatremia, cooling
towers, GI stuff, relative bradycardia
Staph aureus – post influenza, cavitation, empyema
Chlamydia – staccato cough, intracellular
Mycoplasma – extrapulm (GBS, encephalitis, EM, agglutinins)
PCP – HIV <200 CD4, butterfly pattern, low sats, elevated LDH
o Pentamidine – hyponatremia, hypotension
o Dapsone - methemoglobinemia
Miliary TB – millet seed
-
TB – upper lobe
Pscitacossis – birds
Histoplasma – Mississipi River, Ohio river valley
Coccidioidomycosis – SW area
Blastomycosis – SE USA
Q fever – sheep, cow, abbatoir worker
Anthrax – G pos rods, mediastinal nodes
Hantavirus – SW USA, rodents
Amp and gent for < 1 month (no ceftriaxone for newborns!)
Doxycycline works for all exotic/bioterror stuff
TB drugs side effects
INH – neuropathies
Ethambutol –gout, red-green color blindness
PPD
15 mm if no risk factors
10 mm if IVDA, recent immigrants from high-risk location
5 mm HIV
FB aspiration – expiration X rays best, lat decubs also good
L sided effusion – PNA, dissection, Boerhaave’s, pancreatitis
Cavitation – Staph, TB, pseudomona, klebsiella, aspergillus
Anterior mediastinal mass – T’s (thymoma, teratoma, thyroid, T cell lymphoma,
terrible bronchogenic CA)
Tension pneumo – hypotension, JVD, absent breath sounds (also tracheal deviation)
Massive hemoptysis - >200 ml in 24 hrs
Bad side down (if you can ID)
Embolization is best tx
Pneumomediastimun – Hamman’s crunch
Pleural effusion
Transudate (liquid)– CHF, renal failure (nephrotic), CLD
Exudates (have stuff)– PNA, inflammatory, neoplastic
Virchow’s triad – stasis, endothelial damage, hypercoagulable
PE ECG – nonspecific STT changes, TWI ant-inf leads, RAD, new RBBB, pulmonary P,
S1Q3T3
CXR – elevated hemidiaphragm, Hampton’s hump (pleural based wedge infarct),
Westermark sign (oligemia in proximal vessel)
D-dimer – must be ELISA, not latex agglutination
Testing in PE
CT angio in PE – very specific, good sensitivity
VQ scan – very sensitive but not very specific
Pulm angio – gold standard
TPA in PE – in shock only (clinically, and probably on echo)
RSI
Preparation, preoxygenation, premedication, performance, post-procedure
Angioedema – C1 esterase deficiency, ACEI
Pediatrics
Colic – crying 3 hrs/d, 3 d/wk, x 3 weeks
Hypoglycemia, metabolic acidosis combo – inborn errors of metabolism
Bilious vomiting – malrotation of gut
HPS – first born males, olive mass, projectile vomiting, hypochloremic/hypokalemic
metabolic alkalosis
Bloody diarrhea and febrile seizure = shigella
Intussusception – colicky pain, currant jelly stool. Most common pedi surgical
emergency in <2 y/o, US (dx) or air contrast enema (dx and tx)
Jaundice admission
Based on time and amt
ALTE – scares people, apnea, color change (cyanosis/pallor), (tone) limp,
coughing/gagging
SIDS most common cause of death from 1 mo to 1 yr
Bronchiolitis – wheezing/tachypnea/dyspnea. RSV (50-70%)
Nebulized epi
Pertussis – paroxysmal cough, post-tussive emesis
TDaP used now due to resurgence (added acellular pertussis to diphtheria
and tetanus)
Simple febrile sz – GTC, <10 min, short/no post-ictal, 6 mo-6 yrs, neuro intact before
or after, First 24 hrs illness, runs in families, fever usually >102
Hydrocephalus – large head, large scalp veins, bulging fontanelle, decreased upward
gaze, decreased mental status, vomiting, increased LE tone
Most commonly involved CN eye deficit – 6th (lat rectus) – due to long tract
Idiopathic intracranial HTN – (pseudotumor) – HA, white/overweight females,
tunnel vision
TOF: Cyanosis not relieved by oxygen, “tet spells”, blood flowing from R to L,
squatting increases PVR and increases lung blood flow, boot shaped heart
Other cyanosis: tricuspid atresia, truncus arteriosus, transposition, TAPVR
Cystic fibrosis: most common genetic disorder in whites
Sickle cell: most common genetic disorder in blacks
HSP: rash(purpura), abd pain, arthritis. Intussusception, renal involvement
(hematuria)
HUS (think TTP in peds): micronagiopathic hemolytic anemia, uremia,
thrombocytopenia, neuro stuff, GI stuff. E. coli assoc. No abx.
Meningitis
<2 months: think Listeria (ampicillin)
 2 months: usual stuff – Strep, Neisseria, H flu
 steroids – H flu

Most common cause of pedi hip pain – toxic synovitis
SCFE- rapid growth ages, boys, overweight, often bilateral. Referred knee pain.
Slipped snowcone
AVN – think sickle cell
NEC X ray – pneumatosis intestinalis
ITP – most common platelet disorder of childhood
Pedi dehydration
Mild: 50 cc/kg down
Moderate: 100 cc/kg down
Severe: 150 cc/kg down
Maintenance (per 24 hrs):
100cc/kg x first 10 kg
50 cc/kg for second 10 kg
20 cc/kg thereafter
PALS pearls
2J/kg defib
0.5Jkg for sync CV
ETT size (uncuffed): (age/4)+4, subtract 0.5 – 1 for cuffed
Uncuffed tube until age 8
Asystole most common arrest rhythm; brady 2nd
No cric until age 10
Bolus 20 cc/kg
Epi 0.01 mg/kg
Atropine 0.02 mg/kg (min 0.1mg)
ENT
Air conduction>bone conduction
Pinna hematomas: cauliflower ear if not treated
Perichondritis/chondritis – cover pseudomonas
Otic barotraumas: pain, hemorrhage, decreased hearing
Otitis externa – pseudomonas
Malignant otitis externa – elderly, diabetics
Otitis media – 1/3 viral; strep pneumo, H flu, M. catarrhalis
Bullous Myringitis – used to be Mycoplasma, now S. pneumo
Serous OM – sterile, decreased hearing (affects learning and speech)
Cholesteatoma – squamous epithelium mass
Onset
Nystagmus
Central vertigo
Slower onset
Horiz/vertical nystagmus
Not fatigable
Symptoms
Not that severe
Peripheral vertigo
Rapid onset
Torsional or horizontal
nystagmus
Fatigable with fixation
Severe
No N/V/diaphoresis
Deficits
Other CN deficits
No hearing loss
Worse with movement
N/V, diaphoresis
No other CN deficits
Hearing loss
BPPV – most common cause of peripheral vertigo, otoliths, Dix-Hallpike, worse with
head movement
Vestibular neuronitis: nystagmus, sudden onset, no hearing loss (different from
labyrinthitis)
Labyrinthitis – infection, decreased hearing, and tinnitus
Meniere’s – vertigo, tinnitus and decreased hearing, can last week to years
Sinusitis
Complications of sinusitis – orbital cellulitis, brain abscess/meningitis, cavernous
sinus thrombosis, skul osteo
Pott’s puffy tumor – skull osteo
Same bugs as OM – Strep pneumo, H flu, M. catarrhalis
Orbital cellulitis – pain with eye movement
Kiesselbach’s plexus –most common source of anterior nosebleed
Posterior packing risk – hypoxemia, hypercarbia, coronary ischemia, bradycardia,
sinusitis, OM
Posterior epistaxis – 5%, atherosclerosis
Septal hematoma – saddlenose deformity if not drained
CSF leaks – ring sign, glucose >30 mg/dl
LeFort
1 – maxilla
2 – maxilla and nose
3 – maxilla, nose, orbit, and zygoma (craniofacial dissociation)
Cavernous sinus thrombosis – fever, toxic looking, proptosis, chemosis, CN deficits
(3,4,6)
Salivary glands – mumps (viral), Staph (bacterial)
Luwig’s angina – bilateral cellulitis of submandibular space; brawny edema, mixed
aerobes and anaerobes
ANUG (trench mouth) – gum problems – swollen, red, tender, foul odor. Flagyl and
PCN
Gum hyperplasia – dilantin, leukemia
PTA – most common deep ENT infection
Retropharyngeal abscess – most common deep ENT infection in peds; duck like
voice; won’t look up; duck-like voice
Diphtheria – pseudomembrane, bull neck, systemic symptoms (neuro, liver, heart,
kidney). Antitoxin
Bacterial tracheitis – look sick, airway obstruction, stridor
Epiglottitis – pain with movement of thyroid cartilage, thumb sign on X ray
Croup – laryngotracheitis, barking seal cough, stipple sign, viral. Rx steroids and epi
Madible fx – neck (1), angle (2), body(3)
Herpangina (coxsackie) – sore throat, fever, HA. many vesicles that spare buccal
mucosa/gingival/lips
Pericoronitis – third molar
Alveolar osteitis – dry socket; severe pain 2-5 days post-extraction
Avulsed teeth – 1% survival per minute out
Ellis classification
I – enamel
II – dentin
III – pulp
IV – alveolar bone
Thyroglossal duct cyst – central
Brachial duct cyst – lateral
Central vs peripheral VII palsy – forehead does not work on peripheral lesions
Ramsay-Hunt syndrome: herpes zoster oticus, worse prognosis than Bell’s
Hutchinson sign – herpes zoster ophthalmicus. Nasociliary branch of trigeminal
nerve
Trigeminal neuralgia – electric shock facial pain. Rx tegretol
Scarlet fever – strawberry tongue and sandpaper rash, skin lines
Nasal FB – unilateral foul smelling discharge
Esophageal FBs – coronal plane
Neuropsych
Nerve levels
Reflexes:
Biceps – C6
Triceps – C7
Sacral nerves –rectal tone
Knee – L4
Ankle – S1
Sensory:
C4- clavicle
Hand – C6 1st finger (OK): C7 MF, C8 - last 2 fingers
T4 – nipple line
T10 – belly button
L1 – inguinal ligament (IL)
AMS – DON’T mnemonic – dextrose, oxygen, naloxone, thiamine
Cold calorics “COWS” – cold opposite, warm same (for the nystagmus part,
which is a cortical function). The tonic deviation is cold same, hot opposite,
which is a brainstem function.
Doll’s eyes – eyes should stay ML when moving head L and R. brainstem
reflex
8th nerve lesions – CPA tumor. Hearing loss/tinnitus, dizzy, ataxia/cerebellar.
INO – palsy of medial gaze on affected eye, the other one has nystagmus, dx =
MS
Corneal reflex – 5 sensation and 7 for blink
Headaches
Trigeminal neuralgia – shooting facial pain
Migraine – with/without aura
Preventive therapy: BB’s, TCAD’s
Abortive therapy: ergot (alpha constrictors), triptans (also
alpha), antiemetics, narcotics +/-
Clusters – minutes, in groups, ocular findings, males. Rx 100% oxygen
Tension HA – tight
Toxic metabolic – fever, hypoxia, ethanol, CO
Post-concussive – follows trauma, more in peds
Post-LP HA – 2-3 days after LP, worse when sitting up. Correlates: size
of needle, number of attempts. Tx: caffeine, hydration, analgesia,
blood patch (definitive, diagnostic and therapeutic)
SAH – sentinel HA, “worst HA of life”, sudden onset (thunderclap), LP
with xanthochromia. LP better early, LP better later, CT > 90%
sensitive if within 12 hours
Pseudotumor cerebri – young females, overweight. Papilledema. Slit-like ventricles.
High OP
Hydrocephalus ex vacuo – from cerebral atrophy
NPH – triad of ataxia, incontinence, dementia
SDH – more common than EDH, bridging veins. Assoc with brain parenchymal injury
(worse outcome), crescent shaped. Does not cross ML.
EDH – lucid interval, arterial bleed (middle meningeal artery), lens shaped. Does not
cross suture lines
Mass – HA worse in am or valsalva
Toxo – most common brain infection in AIDS
Meningitis
HA, fever, AMS, stiff neck
Kids: irritability, poor feeding, bulging fontanelle
Meningitis and rash – meningococcemia
Ages:
< 1 month – GB strep, E coli, Listeria (add ampicillin + gent/cefotaxime)
1 mo-3 yrs – adults plus H. flu
>3 yrs– pneumococcus, neisseria meningitidis (3rd gen cephalosporin and vanc)
add vancomycin for bacterial meningitis (resistant strep)
steroids: needed for bacterial meningitides, esp pneumococcus (NNT 5 for
morbidity of hearing loss)
needs CP prior to LP: >age 60, immunocompromised, hx prior CNS dz, recent sz,
abnormal neuro exam
LGB (Guillain-Barre) – ascending arreflexic paralysis.
MS: optic neuritis (aching visual loss, color or saturation loss). Young females.
Pathognomonic: bilateral INO. Dx MRI. LP: oligoclonal bands (IgG)
Periodic paralysis – post exercise, assoc with high or low K, thyroid, pure motor.
MG - antibody against Ach receptor. Bulbar muscles first. Fatigue with use.
Thymoma association. Tensilon test.
Myasthenic crisis – MG poor control
Cholinergic crisis – too much physo
Lambert Eaton syndrome - antibodies against presynaptic Ach receptor. Think with
distal weakness in cancer.
Other pure motor paralysis: tick paralysis, botulism, Eaton Lambert
Wernicke’s encephalopathy: AMS, ataxia, EOM palsy or nystagmus. B1 deficiency
Korsakoff – add confabulation
West Nile virus – birds. Can give pure motor problems.
Seizures:
Todd’s paralysis: focal weakness after sz
Generalized – T/C or absence. Both hemispheres
Partial: simple (preserved mentation) or complex (affects mentation or behavior)
Seizure tx: BDZ, phenytoin, phenobarb sequence for most
Status – more than 2 sz without return to normal in between
Status: think INH (use B6 – pyridoxine 5 gm or gm/gm ingested)
UMN: spasticity, NL muscle mass, increased DTR’s
LMN: atrophy, fasciculations, no DTR’s
ALS (Lou Gehrig’s) – both UMN and LMN signs, sensation intact
Cauda equina: LMN. Weakness, incontinence, saddle anesthesia. Think HNP. Urinary
retention most sensitive finding > 90% sensitivity
Conus medullaris – same symptoms, but no recovery
Epidural abscess: back pain, +/- fever, weakness/paralysis. anything that causes
bacteremia. Get MRI. Neurosurgical emergency.
Syringomyelia – collection of fluid in center of cord. IO weakness, decreased
pain/temp to fingers. Position vibration (post horns are normal)
Stroke
Ischemic most common
Cortex – contralateral weakness to face and body
ACA – more leg than arm weakness
MCA: more arm than leg, Broca’s aphasia with dominant hemisphere,
homonymous hemianopsia, hemineglect with non-dominant
PCA – homonymous hemianopsia, cortical blindness when bilateral
Brainstem – ipsilateral face and contralateral body
Pons – coma and pinpoint pupils but NL respiration
Cerebellar – balance, N/V, nystagmus. Can herniated quick.
Vertebrobasilar – coma, “locked in” (can blink and vertical gaze)
Lacunes – small vessels. Small defects.
Wallenberg syndrome – decreased P/T one side, ipsilateral horner, ipsilateral face
and contralateral body
TPA: ischemic, measurable neuro deficit, not rapidly improving, time from onset 3
hrs, no contraindications
Uncal herniation – ipsilateral blown pupil, contralateral weakness
Cushing reflex – HTN (response to maintaining CPP) and bradycardia (carotid body
response to HTN)
Gardner wells tongs – 5lbs per vertebral level
Myopathy – more prox weakness
Neuropathy – more distal weakness
RSD – pain, skin changes. Sympathetic problems to extremity
Psych
Functional – gradual onset, younger, clear sensorium, oriented, visual hallucinations
Organic – age extremes, acute onset, disoriented, abnormal vitals, auditory/tactile
hallucinations.
Transient global amnesia – no recent or immediate memory
Personality disorder
Antisocial personality – impulsive behavior, no remorse
Borderline – emotional lability, difficulty with relationships
Histrionic – attention seeking
Narcissistic – center of attention
Anxiety disorders:
PTSD: stress after traumatic event
Panic attack – impending doom
OCD – repetitive ritualistic behaviors
Mood disorders
Bipolar – mood changes, flamboyant, pressured speech
Eating disorders – anorexia and bulimia (purge)
Catatonia – waxy flexibility
Munchausen – fake illness/create illness. Want test/procedures/admission
Malingering – fake illness, have secondary gain or external incentives
NMS – lead pipe rigidity
Serot syndrome – AMS, autonomic instability, motor irritability
Dystonia – sustained contraction
Akathisia – inner restlessness
Parkinsonism – cogwheeling, shuffling gait, masked facies
Suicide – recently widowed men at greatest risk. Men succeed more; females
attempt more
Tarasoff – duty to protect potential victims supersedes confidentiality duty.
Tourette’s – vocal/motor tics
Night terror – 15 mins, “awake”, incoherent, amnesia
Environmental
Drowning – suffocation from immersion
Near drowning – recover
Secondary drowning – dies of complications later
Immersion syndrome – immediate death from cold
Dry (85%) vs wet drowning
Shock and drowning – think trauma (spinal cord)
Drowning survival: duration of immersion (#1), age, water temp, water
contamination, bystander CPR, assoc trauma, assoc dysbarism
Diving
Boyle’s law – the volume of the gas is inversely proportional to the pressure applied
to it. Squeeze syndromes
Henry’s law – the partial pressure of a gas in a liquid is proportional to the partial
pressure of that gas in contact with the surface of the liquid. Decompression
sickness. Champagne bottle example.
Dalton’s law – total pressure of a mixture of gases is equal to the sum of the partial
pressure of each gas in the mixture. Nitrogen narcosis.
Middle ear barotraumas – ear squeeze. Blocked Eustachian tubes
External ear barotraumas – cerumen plugs
Inner ear barotraumas – vertigo and hearing loss
Barosinusitis – from URI’s
Face barotraumas – mask squeeze
AGE: rapid ascent, immediate symptoms. AMS. Dive immediately
Nitrogen narcosis – euphoria, confusion, disorientation. Occurs at depth
Decompression sickness (“the bends”). Depend on length and depth of dive. Delayed
presentation.
Type 1 – Caisson’s disease. Musculoskeletal. Cutis marmorata – skin bends
Type 2 – CNS and spinal cord. Inner ear (“The staggers”), pulmonary (“the
chokes”)
POPS – from ascent with mouth closed. PTX, pneumomediastinum.
Blast
1. Pressure wave. Top 4 organs – ears, lungs, GI, CNS
2. Shrapnel
3. Flying human
4. Other stuff – toxic chemicals, etc
high altitude
hypoxemia leading to vasodilatation and vascular leakage
factors_ rate of ascent, ultimate altitude, duration at altitude (esp sleeping at
altitude)
Even 1K descent is useful
brain:
acute mountain sickness - >8K feet. HA/nausea/fatigue/insomnia. Rx acetazolamide
(not to sulfa allergics), descent/oxygen/steroids
HACE – ataxia/confusion/sz/coma. Rx descent, steroids, mannitol, HBO
Lung
HAPE – 2nd day. Leading cause of high altitude deaths. Steroids, HBO, nifedipine,
descent.
Hypothermia
Radiation – most of heat loss (head)
Conduction – increased 30-50x when wet
Evaporation – important in hot environments
Convection – windchill
Hunter’s response – Cold-induced vasodilatation
Cold diuresis
Paradoxical core afterdrop – when rewarming, periphery vasodilates, cold lactate
rich blood returns to core, both central pH and temp drop.
Frostbite is irreversible, frostnip is reversible
Frostbite – refreezing is very bad. Leave blisters intact. Conservative surgical
management
ECG in hypothermia – slow afib and Osborn J waves. Myocardial irritability
Heat related illness
Minor (cramps, edema, syncope, prickly heat) – NL core temp
Moderate: exhaustion (slight core temp elevation). Dehydrated but sweaty.
Severe: heat stroke. No/little sweat. Core temp >41
Classic – epidemic, non-exertional. High death rate
Exertional – isolated, more complication, less deaths
Target organs – brain (AMS), liver, blood (DIC)
Treatment: fans with mist (convection), immersion
Demerol and thorazine, IV BDZ – stop shivering thermogenesis
Burns
1st 2nd
3rd
4th – muscle, fascia
4 cc/kg x BSA of LR – ½ in first 8 hrs. UOP 1 cc/kg/hr
burn admits – 2nd degree >15% adults and 12% peds, 3rd 2-5%; inhalational;
hand/perineum/face/feet/joints; co-morbid disease
escharotomy – arterial insufficiency with circumferential burns; inadequate
ventilation in chest burns
current more important than voltage; AC (hold) worse than DC (thrown)
low voltage< 1000V
oral commissure burn – delayed labial artery (day 5)
lightning – massive DC shock. 30% mortality. Asystole 1st, ST, motor paralysis, then
VF
keraunoparalysis – transient spinal cord dysfunction
Lichtenberg figure – fern like rash
HF acid burns – throbbing pain out of proportion. Rx calcium
Radiation
Ionizing radiation
Alpha – least penetration
Beta – 8mm burns
Gamma – deep penetration
2Gy – probable survival
medial lethal dose 4.5Gy
8Gy – no survival
Earlier/more severe symptoms – worse outcome
ALC at 48 hrs most important
>1200 – good
<300 lethal
Biological weapons
Doxy covers all organisms here
Anthrax – black eschar, mediastinitis. Rx cipro or doxy
Plague – pneumonic and bubonic, sepsis
Cholera – rice water stools
Smallpox – all lesions in same phase
Ricin – castor bean
Botulism – bulbar findings
Strychnine – seizures while awake
Nerve agents
G agents – cholinesterase inhibitors. SLUDGE. Rx atropine and pralidoxime
VX – same, liquid
CN,CS, capsicum – irritating
Phosgene – delayed pulm edema, fresh mown hay
Mustard gas/lewisite – blistering
Mammalian bites
All Rx Augmentin
Dog bite – Pasteurella, not that bad
Human bite – Eikenella corrodens, worst
Cat bite – Pasteurella, very bad
Rabies – negri bodies. Bats, raccoon, skunk, fox
Active – 0,3,7,14,21 (HDCV)
20 IU/kg (50% at wound, HRIG)
paralytic vs furious rabies
snakes
seasnakes – neurotoxic
coral – neurotoxic, red on yellow
crotalidae – hemotoxic>>neurotoxic
Wyeth – 5-10 vials, anaphylaxis, serum sickness
CroFAB 4-6 vials, may need repeat doses
Spiders
Black widow – red hourglass, mimics acute abdomen. Analgesia, BDZ. Has
antivenom
Brown recluse – dark violin top, necrotic lesion (delayed). Dapsone, HBO, surgery
Scorpions
Centuroides- fasciculation, salivation, delirium. Have antivenom
Hymenoptera (bees, ants, wasps, hornets)
Anaphylaxis
>10 stings can have toxic systemic reaction (DIC, renal failure)
Tickborne diseases: hyponatremia, fever, tick bite. Hand and feet soles
Tick paralysis – camper
Tularemia – rabbits
Dengue – breakbone fever, retroorbital pain
Lyme disease – Bell’s palsy, target lesions
Vibrio vulnificus – seawater, 3rd gen ceph + doxy
Vibrio cholera – rice water stool
Marine envenomations
Most are heat labile – immerse in hot water, vinegar
Box jellyfish – most deadly. Has antivenom
Nematocysts – will deploy and make things worse
Fish: zebra, lion, scorpion, stone (admit this, has antivenom)
Cone snail – paralysis
Pufferfish (fugu)- paralysis
Endocrine
Epinephrine and glucagon are counter-regulatory hormones
C peptide differentiates too much endogenous vs exogenous insulin
Glucose
D50W adults
D25W kids
D10W neonates
Octreotide – antidote for sulfonylurea. Blocks insulin release from pancreas
Diabetes agents
Sulfonylureas - end in “ide”. Long half lives.
Repiglanide
Metformin – no hypoglycemia. Metabolic acidosis
Alpha glucosidase inhibitors – block hydrolysis of carbohydrates
Thiazolidenediones – “glitazones”; no hypoglycemia
Glucagon will not help in those with low glycogen stores (kids, alcoholics,
malnourished, etc
DKA – dehydration, free ketoacids, glycosuria, total body K deficit
TX: fluids, insulin, treat precipitant, K
Bicarb may increase risk of cerebral edema in peds. Also hypokalemia,
hypernatremia, paradoxical spinal acidosis, decreased O2 offload to
tissues
Na correction – decreased 1.6 for each 100 of glucose >100
Alcoholic ketoacidosis
Too little insulin and too many counter-regulatory hormones
Tx: D5W saline
Non-ketotic Hyperosmolar state (HONK)
Glucose very high, profound dehydration, AMS, scant/no ketones,
slow onset
Tx – fluids (slow), tx precipitant, +/- insulin
Thyroid
Thyroid problems are generally primary
Hyperthyroidism
Grave’s disease #1 – antibodies to thyroid gland
Thyroid storm – neurologic dysfunction
RX – supportive (ASA displaces thyroid hormone from thyroglobulin),
steroids (decreased conversions T4 to T3); peripheral blockade (beta
blockers); blockade of hormone synthesis (PTU, methimazole); blockade of
thyroid hormone release (Iodine after PTU or methimazole); tx precipitating
events
Hypothyroidism
Post-Grave’s #1 and Hashimoto’s #2
Symptoms – myxedema, slowed DTR’s, “myxedema madness”
Myxedema coma – most severe form
Rx - supportive, steroids, IV T4 (thyroxine).
Adrenals
Most problems are from the pituitary (secondary) and hypothalamus
(tertiary – from exogenous steroids)
Glucocorticoids (cortisol) and mineralocorticoids (aldosterone – retain Na
and pee K)
Waterhouse Friderichsen syndrome – B adrenal hemorrhage post
meningococcemia or trauma
Addison – primary adrenal insuficiency (hyperpigmentation from too much
ACTH). Cosyntropin stimulation abnormal
Hallmark – low Na (most common) and high K. Also fever and hypotension
Tx: fluids, hydrocortisone
Cushing’s syndrome – from too much steroid, pituitary adenoma
Truncal obesity (moon facies, buffalo hump, purple striae), HTN,
hirsutism, glycosuria
SIADH
ADH = vasopressin – posterior pituitary
Too much ADH when I don’t need it – dilution of serum and concentrated
urine
To solve problem – brain, lung, drugs (chlorpropamide, etc)
Diabetes insipidus (the opposite of ADH)
Pee too much, dilute urine too much and serum too concentrated
Central (CNS not making ADH), nephrogenic (kidney not responsive to ADH,
lithium)
Pheochromocytoma – too much epi release from adrenal medulla. P’s –
pressure, pain, perspiration, palpitations, pallor, paroxysms
DX ; 24 hr urine for VMA
Carcinoid syndrome – tumor secretes serotonin (flushed, diarrhea,
vasodilation, wheezing)
Sodium
Hyponatremia: Symptoms depend on level and how fast it got there
Hypovolemic_ V/D, diuretics (lost both Na and water). Rx saline
Euvolemic – SIADH, psychogenic polydypsia. Rx water restriction
Hypervolemic - IV volume is low so more ADH (CHF, cirrhosis,
nephritic). Na and water restriction, +/- diuretics
Pseudohyponatremia – glucose, lipids, proteins
Central pontine myelinolysis – confusion, locked in. Restrict
correction to 0.5-1mEq/hr
Hypernatremia
Most commonly from free water loss (GI, renal, skin) or decreased
intake (CVA, kids, elderly)
Tx – restore IV volume;
Correct slow (0.5mEq/hr) to prevent cerebral edema
Total water deficit: TBW (70% weight) – 1(desired Na/actual Na)
Potassium
Major intracellular cation
Hypokalemia = weakness. ECG U waves
Oral replacement best; 10MEq/hr when using IV
Need normal magnesium to replace
Hyperkalemia = arrhythmias, weakness
Remember – kidney failure, digoxin toxicity, hemolysis, succ,
acidosis
ECG progression– peaked Ts, decreased PR, flat Ps, wide QRS,
sine wave
Rx – calcium gluconate (fast but short lived), albuterol,
insulin/glucose, bicarb, kayexalate, HD
Calcium
PTH – increases Ca and lowers Phosphorus via kidneys
VitD – kidney plus sunlight. Increases intestinal absorption of
calcium
Hypercalcemia (PAM P SCHMIDT)– hyperpara, MM, Paget’s,
Cancer, milk alkali, excess vitamin D, thiazides.
Stones, bones, moans, and psychic undertones
ECG – short QTc
Tx: volume and then diuretics
Hypocalcemia
Causes – post – parathyroidectomy, kidney failure, pancreatitis
Chvostek and Trousseau
ECG – long QTc
Tx – calcium
Magnesium
Hypermagnesemia – rare. Renal failure, iatrogenic. Tx with
calcium. Hyporrelexia
Hypomagnesemia – think in malnourished
Phosphate
High phosphate – low PTH, renal failure. Rx phosphate binding
gel or HD
Low phosphate – weakness. Rx with oral vs IV phosphate
Anion gap
HAG – MUDPILES. Na- (Cl + Bicarb)
Low anion gap – decreased unmeasured anions (proteins) or
increased unmeasured cations (lithium, high calcium, high
magnesium). Bromide is measured as chloride
Normal anion gap – HARDUP. Think renal (RTA) or GI
Metabolic alkalosis – GI loss of acid or to much base intake
Osmolarity
Normal: 285-295, NL gap up to 10
(Na) + glucose /18 + BUN/2.8 + ethanol /4.6
Dermatology and ID
Eczema (atopic dermatitis) – related to hay fever or asthma. AC/pop
fossa; infants in face. Rx steroids
Contact dermatitis – immediate or delayed (allergic)
Exfoliative dermatitis (erythroderma)– red skin all over. Drugs or
malignancy
Psoriasis – thick white/silver scales. Nail pitting. Arthritis assoc.
Seborrheic dermatitis – yellow waxy scales. Scalp and face. Seborrhea
shampoo
Pityriasis rosea – herald patch. Christmas tree distribution.
Supportive
Petechia (<3mm) and purpura (>3mm): nonpalpable (superficial –
low platelets), palpable (deep, vasculitis)
Urticaria – hives, wheals. Superficial epidermis. IgE
Angioedema – deeper dermis. Bradykinin mediated.
Erysipelas – cellulitis from Group B strep. Shiny red. Well demarcated
border
Erythema nodosum – vasculitis of fat. Painful red/viotel nodules.
Pretibial region classic
Drug eruptions – think in all acute symmetric rashes
Erythema multiforme/Stevens Johnson (<10%)/TEN(>30%) – target
lesions, Nikolsky, mucosal involvement. Rx like burns
SSSS – Nikolsky positive, assoc with Staph. Exotoxin. Young kids
Pemphigus vulgaris – flaccid bullae. Autoimmune. Worst one
Bullous pemphigoid – tense/thick bullae. Autoimmune. Better of two
Basal cell – most common cell malignancy. Pearly rolled borders. Slow
growing
Malignant melanoma – worst one. #1 skin cancer cell. Sun exposed
areas. Irregular (shape, color)
Squamous – 2nd most common skin malignancy. Indurated raised
borders, central ulcer. Face/ear/tongue/hands
Dermatophytes (tineas)
Capitis, barbae, pedis, cruris
Hair loss in areas with hair
Kerion – inflammatory reaction
Topical antifungals – may need oral in hair or nails
Versicolor – malassezia furfur, like seborrhea. Shampoo
Gonococcemia – fever and arthritis (large joints), tenosynovitis.
Aspiration often negative, but blood cultures positive
Spirochetes
All Doxy susceptible
Leptospirosis – Weil’s disease (worst: fever, DIC, hepatitis, nephritis)
Lyme’s – Ioxdes tick, erythema chronicum migrans (stage 1), Bell’s or
myo/pericarditis/heart block or meningitis (stage 2), arthritis (stage
3)
Syphilis – painless chancre (1st stage), rash palms and soles,
condyloma lata (2nd stage), neuro and CV (third stage).
Jarisch Herxheimer rxn – due to abx treatment
TORCHS infections – cause congenital transmission
Toxo, rubella, CMV, herpes, syphilis
Meningococcemia – fever, HA, rash
Purpura fulminans – bad outcome
Waterhouse Friderichsen syndrome - adrenal hemorrhages
from this
Necrotizing soft tissue infections
Nec fasc – pain out of proportion.
Fournier’s gangrene – scrotum or vulva.
MRSA
CA-MRSA: purulent skin and soft tissue infections. Rx doxy, bactrim or
clinda; vanco or linezolid for serious
Toxic shock syndrome – tampons. Staph exotoxin
Ticks
RMSF – SE USA, centripetal rash, palms and soles. Thrombocytopenia
and hyponatremia. Tetracycline
Ehrlichiosis – like RMSF with no rash and affects WBC’s
Babesiosis – NE USA. like malaria, affects RBC’s. Milder than malaria.
Herpes virus
CMV – congenital very bad, also bad in AIDS. Rx gancyclovir or
foscarnet. One of TORCHS
Herpes 1 – oral; herpes 2 – genital. Grouped vesicles. Rx acyclovir
Herpetic whitlow
Tzank smear – multinucleated giant cells
Herpes encephalitis – temporal lobe, blood in CSF
Herpes zoster (varicella) – dermatomal distribution, very
painful
Hutchinson sign – eye involvement
Ramsay Hunt – CN 7 involvement
Disseminated zoster – admit
AIDS
PCP is most frequent opportunistic infection
Crypto meningitis – most common CNS fungal infection
Toxo – most common cause of encephalitis. Ring enhancing
lesions
Oral candida – most common GI infection
Kaposi’s – purple painless plaques
Molluscum – umbilicated papules
Mononucleosis – EBV. LAD, exudative pharyngitis, atypical
lymphocytes. Splenic rupture. Dx with Monospot. NO abx (rash), no
sports
Occupational
Needlesticks:
Hep B surface antigen- infectious. Surface antibody –
immunized. E antigen – highly infectious. 2% risk infection
with surface antigen and 25-30% with E antigen
Antibody >10 probably good for life. Can rx with
immuneglobulin +/- vaccine.
Hep C – 2% risk for exposures. No tx available
HIV risk from needlestick 0.3%. increased risk – visible blood
contamination; deep injury, hollow needle, source with heavy
viral load. Rx – start 1-2 hrs; multi-drug regimens (2-3 meds)
x4 weeks.
Malaria – most important travel-related illness. Falciparum – most
severe disease, lots of resistance. Tx = quinidine + doxy in chloroquine
resistant areas (i.e. Africa)
Black water fever – severe hemolysis
Thick and thin smears
Pedi rashes –
Erythema infectiosum (5th disease)– Parvo B19, slapped cheeks, lacy
rash. Keep away from SCD and pregnant patients (aplastic crisis with
parvo, hydrops in pregnancy)
Hand foot mouth – Coxsackie. Painful oral lesions to anterior mouth;
fever; gray vesicles to palms and soles. Supportive
Herpangina – oral ulcers on back of OP.
HSP – vasculitis. Abd pain (GIB, intussusception), renal (hematuria),
joints, and the vasculitic rash (buttocks and legs)
Kawasaki – MCLNS. Vasculitis. Coronary artery aneurysms. Criteria –
5 days of fever and 4 of these – conjunctivitis, oral changes, extremity
changes, rash, adenopathy. Tx ASA, IV IG
Impetigo – honey colored crusts. Bullous impetigo – staph
Rubella (German Measles) – 3day measles. adenopathy (posterior),
rash goes head down. TORCHS
Rubeola (measles) – bad one – 3C’s – cough, coryza and conjunctivitis,
Koplik’s spots.
Roseola (exanthema subitum)– herpes. Fever/febrile sz. Fever stops
and the rash
Scarlet fever – strawberry tongue, exudative pharyngitis, sandpaper
rash. While lines in skin folds. Desquamation. ASO titer. Tx PCN
Varicella (chicken pox) – different stages (dew drop on a rose petal).
Complications – PNA, encephalitis. Can rx acyclovir. Vaccine (live)
Salycilate – Reye’s syndrome
Lice – Scabies (burrows; thin skin areas), crabs, etc. rx Kwell, Nix, RID,
Elimite, etc
Norwegian scabies – high mite burden
Heme onc
Central cyanosis – 5 gm deoxygenated Hgb. Look in tongue
metHgb – 1.5 grams deoxygenated hgb. Fe+3. Local anesthetics, nitrates, aniline
dyes. O2 sat 85% regardless on O2 administration. Rx methylene blue
COhgb – “chery red”, but more like don’t turn blue
Sulfhgb – 0.5 grams for cyanosis. Irreversible.
95% oxygen carried in Hgb, not dissolved
cyanosis unresponsive to O2 – abnormal Hgb or R to L shunt
coombs positive – antibodies to RBC’s
G6PD – most common enzyme deficiency
PRBC – each until increases Hgb 1 grams
Citrate – chelates Ca – hypocalcemia
HyperK, worse with older blood
Infuse with NSS (LR has calcium)
Blood content – 70 cc/kg or 5L in man
Massive transfusion – early transfusion of other products – platelets and FFP
Transfusion rxns
Acute hemolytic transfusion rxn - Wrong blood type. Fever, back pain,
SOB. Stop, hydrate, send blood to lab – free Hgb, haptoglobin, Coombs.
Febrile non-hemolytic – rxn to protein antigens. like the hemolytic
one. Labs above are negative.
Allergic transfusion rxns – Not dose related. hives, wheezing, can be
anaphylactic. Can continue depending on severity
Infections – HIV 1:2million, Hep C 3:10K
Other – vol overload, hypothermia, hyperK, hypoCa
Type O - universal donor. Rh negative for women of child bearing age.
Type AB – universal recipient
Platelets – 5 day storage. Donated by apheresis.
1 unit of platelet raises by 10K (50-60 K if apheresis unit)
spont bleeding with platelets <10K; 50K for procedures/trauma
dysfunctional platelets – ASA (irreversible inhibition), kidney failure
low platelets – ethanol, aplastic marrow, large spleen
ITP – immune rxn to platelets. low platelets. Stop immune system first and then give
platelets if bleeding. Tx = steroids  splenectomy
TTP – systemic endothelial damage, release of vWF, platelet aggregation,
microangipathic hemolytic anemia
HUS – like TTP but kids and more kidney involvement
FFP - what remains after RBC and platelets removed – give 1 per each 5U PRBC’s
Cryo – subproduct of FFP. Pooled (more risk of infection)
Hemostasis test
Bleeding time now done by platelet function test
Von Willebrand factor – released from vessels, tells platelets to
aggregate if not in vessel lumen. It also carries factor 8
Protime - measures extrinsic system and common pathway (5, 7, 9).
Warfarin
PTT – measures intrinsic and common. Heparin
DIC – can either cause ischemia (consumption coagulopathy) or bleeding. Low
platelets, low fibrinogen, increased FSP, high dimmer, fragmented RBC’s. Prolonged
PT!! Rx – give FFP if bleeding, consider heparin if thrombosis
Heparin – does not cross placenta. HIT complication, antidote: protamine
LMWH - smaller molecule, no monitoring. Less freq dosing.
Warfarin – inhibits 2,7,9,10, C, S (Vit K dependent). Rx with vit K and PCC (FFP if no
PCC)
Contraindications to thrombolysis – BP >185/100, active bleeding or recent <14d
bleeding, recent spine or brain surgery (2 weeks), brain tumor or
malformations, recent CVA (2-6 mo) or hemorrhagic CVA, bleeding
diathesis, on anticoagulants, pregnancy, suspected aortic dissection or
pericarditis.
Sickle cell anemia – anemia, high retic count, pain, functional asplenia
Pain crisis – from cell sludging
Chest syndrome – leading cause of death in sicklers. Pulm infarction.
Tx = abx, exchange transfusion
Splenic sequestration – kids with shock. 2nd most common cause of
death
Aplastic crisis
CNS crisis – strokes
Hand foot syndrome – kids with swollen hands and feet.
Priapism
Salmonella – it thrives on iron rich tissues
Hemophilia – blood bad to cartilage
A – 85% of cases. factor 8 def. Give DDAVP and then factor 8
concentrate (FFP if not available). Treat before studies.
B – factor 9 def
Von Willebrand disease – Most common inherited coagulation disorder. “guides”
platelets and carries factor 8. Rx same as hemophilia
HIV related emergencies
Lactic acidosis – mitochondrial damage. Medication reaction
Immune reconstitution syndrome – when HAART reactivates immune
system, exaggerated immune response
Kidney stones – indinavir. Radiolucent
Hypoglycemia – pentamidine
metHgb - dapsone
CMV and varicella – eye complications
PCP – single cell fungus. CD4<200. Disproportionate dyspnea and
hypoxemia. Steroids before abx if hypoxic (PaO2<70 or A-a gradient
>35, Bactrim 1st line, atovaquone or pentamidine 2nd line
Toxo (ring enhancing lesion) and criptococcus (most common
systemic fungus, India ink)– CD4<50.
Thrush
Oncology
Cord compression –lung, breast, prostate. Thoracic back pain
Airway obstruction – voice changes, stridor
Pericardial effusions – lung and breast, melanoma. Beck’s triad – JVD, hypotension,
muffled heart sounds. ECG – low voltages, electrical alternans
SVC syndrome – Lung cancer. egress of blood from head is obstructed. Neck veins,
plethora, face swelling, HA
Hypercalcemia – PTH hormone-like substance secretion. Also from mets. Lung,
renal, MM, breast. ECG short QTc. Stones, bones, moans, and psychic
undertones. Rx fluids and diuretics. Biphosphonates etc later.
Calcium x phosphorus product =40
Hyperventilation causes functional hypocalcemia (twitchy etc)
SIADH – tumor secrete ADH. Hyponatremia and concentrated urine.
Hyperviscosity syndrome – proteins (MM) or WBCs (leukemia). Roulleaux
formation
Adrenal insufficiency – consider with fever, dehydration, resistant shock.
Hyponatremia/hyperkalemia/eosinophilia/hypoglycemia
Tumor lysis – post chemo. hyperK, hyperphos, low calcium. High uric acid. Rx fluids,
lower phosphorus, alkalinize urine, lower uric acid (allopurinol – inhibits
xanthine oxidase; or rasburicase – recombinant urate oxidase)
Neutropenic fever – 50% have occult infection
Rheumatology
Joint fluids
Septic arthritis –low glucose, WBC >75K, low viscosity, very turbid. Staph
(most common overall), salmonella in SCD
Gonococcal – rash (necrotic pustules), girls, menses
Inflammatory - <50K WBC’s, NL glucose, can have crystals
Gout – needle like. Negative birefringence. Podagra – big toe (75%). Rx
NSAIDs and colchicine
Pseudogout – calcium pyrophosphate, rhomboid. Positive birefringence. Rx
as gout.
Lyme – rash (ECM, central clearing), neuro (CN 7th), heart (arrhythmias, heart block)
SLE
Antiphospholipid syndrome – excessive clotting. recurrent fetal loss
Butterfly rash (malar), or discoid lesions (scars)
Renal – nephritic, nephritic
cerebritis
Rx steroids
Seronegative spondyloarthropathies (rheumatoid factor negative) – symmetric,
sacral involvement of joints and tendon/ligament insertions
Ankylosing spondylitis – bamboo spine, uveitis (most common extra articular
finding)
Reiter’s – arthritis, urethritis, conjunctivitis. Heel preference (“lover’s heel”)
Psoriatic arthritis
IBD arthritis – both UC and Crohn’s
Rheumatic fever – Jones criteria (CASES); GABHS infection
2 major, or 1 major and 2 minor
OB/Gyn
STD’s
Ulcerative lesions increase risk for HIV
Non-ulcerative lesions have discharge
Chlamydia - #1 STD. related to PID. Can be asymptomatic. Nuclear amplification test.
Rx doxy
PID – cause of infertility and ectopics. Fever, discharge, CMT, abd pain,
and adnexal tenderness – treat empirically
TOA – Admit.
Fitz-Hugh-Curtis – perihepatitis from PID. Admit
LGV – C. trachomatis also. Buboes (groove sign) with no genital lesion. Rx doxy x 3
weeks
GC – #2 STD. related to PID. gram neg diplococci. Copious purulent discharge. Rx
cephalosporin. Gonococcemia (dermatitis arthritis syndrome). Eye
emergency (melts cornea)
Syphilis – painless chancre. Rash, condyloma latum (2ry); CNS –
psychosis/neuropathies/tabes dorsalis – no propioception, and heartaortitis (3ry). Rx PCN LA 2.4 million units
Chancroid – painful ulcer and bubo at same time.
Herpes – type 2. Painful vesicles in crops. Recurrent
Trichomonas - strawberry cervix. Grey yellow malodorous frothy discharge.
pH>4.5. rx flagyl
Genital warts – HPV, assoc with cervical CA.
BV – Polymicrobial. copious vaginal discharge, fishy odor. Clue cells. pH>4.5. rx
flagyl
Candida – white cottage cheese, KOH with hyphae. Rx fluconazole
Bartholin gland abscess – lower aspect of introitus at 5 and 7 o’clock. Drain and
insert Word catheter x weeks
Mittleschmerz – ovulation 14 days before menstrual cycle. Pain with ovulation
Ovarian cyst – usually in luteal phase. Ruptured look like ectopic. Can torse if bigger
(>4 cms) (like torsed testicle, dx with US).
Ovarian masses – can also torse, esp dermoids. Ovarian CA – 2nd most common gyn
malignancy. Meig’s syndrome (ascites and pleural effusion)
Endometriosis – chocolate cysts. Can be anywhere. Catamenial PTX. Assoc with
infertility.
Uterine fibroids – excessive bleeding
Uterine CA – consider in AUB in perimenopausal women; painless uterine
enlargement.
Cervical CA – HPV assoc. is an AIDS defining illness
AUB: irregular excessive bleeding
Do pregnancy test
DUB – anovulatory bleeding. No luteal phase
OB stuff
Fundus at umbilicus at 20 wks
HCG doubles every 2-3 days for 1st 7-8 weeks
Positive within days of ovulation, stays positive x 2-3 weeks
Miscarriage
Threatened – bleeding, closed os
Inevitable – open os, bleeding
Incomplete – bleeding pain, products at os
Complete – bleeding decreased, sono negative (empty uterus)
Missed – retained products
Septic abortion – infection, rare
Ectopic pregnancy – positive preg test, abd pain, bleeding. Discriminatory zone: 2K
for transvag and 65K for transabdominal
Beware of heterotopic in assisted reproduction patients.
RhoGam: passive immunization to all Rh negative moms. 50 mcg if <12 weeks and
300 mcg after that
Molar pregnancy – very high HCG’s, snowstorm appearance on US; passing “grape
like stuff”
Abruptio placentae – risks – cocaine/trauma. Uterine tetany, fetal distress. Painful
3rd trimester with dark blood
Placenta previa – reliably seen in US, bright red painless bleeding. NO pelvic exam!
Pregnancy-induced HTN – unknown cause
>20 weeks, >140/90
pre-eclampsia – HTN, edema, proteinuria
HELLP – Hemolytic anemia, elevated LFTs, low platelets, NL clotting
Eclampsia – pre-eclampsia plus seizures. RX magnesium and
hydralazine/labetalol
Hypermagnesemia – rx calcium
Appendicitis – most common surgical emergency in females. Do same w/up. Same
risk as non-pregnant, but more dx delays and more complications
Drugs to avoid in pregnancy – Coumadin, tetracycline, quinolones, live vaccines,
erythromycin estolate, sulfa (3rd trim), ASA (3rd trim), flagyl (1st
trimester)
Trauma
Maternal stabilization is 1st
Displace uterus in hypotension third trimester
KB test for fetomaternal hemorrhage
APGAR – appearance, pulse, appearance, grimace, respiration
PROM – ferning test, nitrazine paper – high pH. Sterile exam.
Umbilical cord prolapse – knee chest position, arrest delivery, emergent C-section
Amniotic fluid embolism – CV collapse soon after delivery. Supportive. 50-80%
mortality
Fetal distress – late decelerations, also marked tachycardia and bradycardia
Monitor after 26 weeks after trauma
Post partum hemorrhage - #1 cause is uterine atony
Perimortem C section – within 5 minutes of CPR
Endometritis – foul smelling lochia
Mastitis – staph, analgesia, warm compress, abx (dicloxacillin)
Renal/urology
Nephrotic syndrome – protein in urine; hypercoagulable (urinates antithrombin 3),
high lipids (lose lipid transporting proteins)
Nephritic syndrome (active sediment – casts, red cells); HTN, volume up
Test taking strategies
Note key word and red flags
Eliminate obviously wrong answers
OK to guess
Do questions!
Avoid controversial answers, stay with gold standard
Pictorial – read the question and try to answer before you see the picture
Don’t get stuck on calculations – waste of time and increases frustration
B most common correct answer; D after that – for numerical questions.
Written choices are randomized by first letter of answer, and most verbs start with
vowels, which tends to randomize most to ABC
Stem – question part
Foil –wrong answer
4 types of questions
Fact questions often have a destabilizer – a rarely know fact. Often not the answer.
Can be a “red herring” if in the stem – nothing do to with the case.
2 part question – present a disease and then ask about management or
complications. Look at the answers then go back and make the dx
long question with lots of info (camouflage)– look at the answers first and then read
the statement again
research questions – similar questions throughout the exam. They are looking at
correlation with scores (“test questions”)