Tx of asymptomatic & symptomatic HOCM
o Symptomatic = BB & CCB(Verapamil)
o Asymptomatic = avoid competitive exercise
SVT
what is it? tx?
Supraventricular Tachycardia – 150 bpm + - Narrow QRS complex on ECG - Management: o 1. Vagal maneuvers (carotid massage, gagging, ice to face, bearing down) = decrease AV nodal conduction o 2. Adenosine o 3. CCB > Digoxin > BB
pt with SHORTEN P-R INTERVAL & SLURRED UPSLOPE OF THE QRS COMPLEX & BROAD QRS INTERVAL.
dx? tx if stable? what if unstable?
Wolff-Parkinson-White(WPW) Syndrome –
- “SHORTEN P-R INTERVAL & SLURRED UPSLOPE OF THE QRS COMPLEX(delta wave) & BROAD QRS INTERVAL”
- ACUTE management if unstable = Synchronized Cardioversion
- Stable = procainamide > amiodarone
1st line tx in HTN emergency
IV nitroprusside
Whats the diff between Adjustment disorder and Acute distress disorder?
Adjustment: develops as a result to an identifiable stressor w/in 3 months of exposure
Acute Stress: extraordinalry and potentially life-threatening stressor. Event is RELIVED in dreams and waking thoughts. sx include re-experiencing, avoidance, hyperarousal lasting <1m
ideal solution for dehydration
½ NS(0.45% NaCl) + 5% dextrose is ideal
**For every 3mEq/L that serum sodium is elevated = 1L of water deficit
MCC in Polycythemia Vera?
thrombosis
Formula for rehydration of a burn pt? what type of solution do u give them?
- MUST GIVE RINGER’S LACTATE!
o 4 cc/kg x total burned SA = amount given
Only give ½ within the first 8 hours
WBC cut off for dx of septic arthritis?
WBC > 50K
VACTREL
- Vertebral defects
- Anal Atresia
- Cardiac defects
- TE fistula
- Esophageal abnormalities
- Renal anomalies
- Limb anomalies
Bacterial vs Viral Pneumonia
- Viral Pneumonia : mononuclear shit, low fever, low sputum
- Bacterial Pneumonia: neutrophils, high fever
Pt w/fever, abdominal pain and pain over liver. he is a recent immagrant form mexico. dx? tx?
Liver Abscess/Entamoeba Histolytica
- Often seen in patient with “mexico connection”
- SX: fever, abdominal pain & tenderness over liver
- DX: U/S & SEROLOGY
- TX: can be treated with METRONIDAZOLE ALONE & doesn’t require drainage
hormones levels in levothyroxane abuse
o Low TSH, low RAIU, low TG(TBG) & elevated T4
TB PPD positive test measurements
tx?
5mm = + in steroid users or HIV 10mm = + in homeless, immigrants, alcoholics, heathcare workers, and prisoners 15mm = + in all others
tx: INH 9m in +PPD & -CXR; if both + do 4 for 2 then 2 for 4
Treatment of Hypergemesis Gravidarum
o 1: avoid triggers + ginger lollipops or tea, acupressure or acupuncture, saltines, small frequent meals
o 2: Pyridoxine-doxylamine(vitamin B6)
o 3: Promethazine or diphenydramine(antihistamine)
o 4: metoclopramide (D-agonist)
o 5: ondansetron(5HT)
Whats a leukamoid reaction? how can this be differentiated from leukemia?
Leukemoid Reaction = SIGNIFICANT increase in early neutrophil precursors in the peripheral blood.
- Seen with trauma
- Marked LEFT SHIFT
- > 50,000L leukocytes
- Elevated LAP differentiates this from leukemia
bartonella lymphadenitis vs francisella lymphadenitis
Bartonella Henselae
- Cat scratch disease = MCC of CHRONIC LYMPHADENITIS in children
- SX:
o Enlarging, localized lymph node with increasing erythema of the overlying skin
o Tender lymph node
o MC effects axillary, cervical, submandibular and preauricular nodes
- DX: warthin-starry stain
Francisella Tularensis = Tularemia
- SX:
o Ulcerative lesion at the site of inoculation with regional lymphadenopathy
- RF: contact with blood-sucking insects, live or dead wild animals
What is dumping syndrome? cause? tx? sx?
Dumping Syndrome
- Due to dumping of hyperosmolar chime into the small intestines causing loss of pyloric regulation resulting in fluid shifts and painful bowel distension
- SX: sweating, dizziness, abdominal pain, diarrhea, palpitations, facial flushing after eating
- Tx: eating smaller meals with less fat
Lady wants to know if her baby is gonna be a downsie. whats the earliest test that cna tell her dis? weeks?
- CVS(10-12 wks) > Amniocentesis(15-20 wks)
Alkaline Phosphatase is elevated with what shit?
ALP = Liver(elevated GGT too) & Bone
PKU vs Maple syrup urine disease
Phenylketonuria: - AR disease, results from a hydroxylation of phenylamine to tyrosine - SX: o Mental retardation o Projectile vomiting o Fair-skin, fair-haired o Photosensitivity o Eczematous or seborrheic rash o MUSTY OR MOUSY ODOR Maple Syrup Urine Disease - AR defect in Branch-chain amino acid metabolism - SX: o Vomiting o Refusal to feed o Dehydration o Hypoglycemia o Acidosis ketosis o Neurological shit o MAPLE SYRUP-LIKE ODOR
Necrotizing Fasciitis vs Cellulitis
sx? tx? rf for nec fas?
- NECROTIZING FASCIITIS(infection of fascia = right ontop of blood vessels) = BULLAE + CANT MOVE limb bc its so painful
o SX:
Bullae, severe pain(cant move so painful)
Oozing, crepitus
Rhabdomyolysis
HIGH fever + pt is toxic
o TX:
MUST DO SURGERY to remove necrotic shit + IV Abx(IV abx will not be enough alone must do surgery)
o RF: DM, ummunocompromised, alcoholism, vascular insufficiencies, organ transplants & neutropenia or recent surgery - Cellulitis = red skin
o SX:
Erythema, swelling
Mild pain
Fever
Dermis + subq infection
Why hyperparathyroidism due to renal failure? how do you tx this?
- Ex: kidney failure causing GFR < 25-40 = kidneys can no longer excrete P = P binds free Ca & decreases vita D production = hypocalcemia. Elevated P causes increase in PTH = increases bone reabsorption = osteodystrophy
o TX: supplementing Ca will decrease PTH levels and
What is Enthesopathy?
- Enthesopathy = inflammation and tenderness at insertion sites of tendons and ligaments to bones = seen with HLAB27s = ankylosing spondylitis and reactive arthritis
