@_@_@...HY Facts For CK...@_@_@ - savi

[ArchivalUser]

1.Hypovolemic shock is demonstrated by a low cardiac index, an increased SVR, and a decreased PAWP. Simply, CI and PAWP are low because there isn't enough blood volume to be pumped by the heart (low volume = low pre-load). SVR is elevated to attempt to increase blood pressure.

2. Obstructive shock, characterized decreased CI and normal SVR and PAWP , is typically caused by massive pulmonary embolus. Supportive care with IV fluids and vasoconstrictors along with possible embolectomy is indicated. Note: The only indication for embolectomy is hemodynamic instability.

3. The presentation of painless jaundice is highly suspicious for a pancreatic head mass and in particular adenocarcinoma of the pancreas. Adenocarcinoma of the pancreas accounts for more than 90% of pancreatic malignancies and jaundice is present in about 65% of patients. Risk factors for pancreatic adenocarcinoma include smoking and diabetes. The best initial evaluation for pancreatic masses is by C T of the abdomen and pelvis.

4. Lorazepam is a short acting benzodiazepine with no active metabolites. Lorazepam is metabolized to the glucuronide form and excreted by the kidneys. The drug is tapered over 4-6 days for detoxification purposes. It is safe in patients with severe liver damage, and it won't compromise respiration in severe COPD.

5. Chlordiazepoxide is a long-acting benzodiazepine that is used for detoxification from alcohol in uncomplicated cases. It has several metabolites that are long acting, thus making it difficult to efficiently manage the detoxification without risking the accumulation of drug and its metabolites because of impaired liver metabolism. In patients with severe COPD, it can compromise respiration secondary to sedative effects.
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[ArchivalUser]

1.Renal vein thrombosis. Most commonly occurs in Membranous glomerulonephritis.

2. Excessive friction between the iliotibial band and the lateral femoral condyle can lead to iliotibial band tendonitis. This overuse syndrome commonly occurs in runners and cyclists, although it may develop in any person subsequent to activity involving repetitive knee flexion. Tightness of the iliotibial band, excessive foot pronation, genu varum, and tibial torsion are predisposing factors.

3. The patient with iliotibial band tendonitis reports pain at the lateral aspect of the knee joint. The pain is aggravated by activity, particularly running downhill and climbing stairs. On physical examination, tenderness is present at the lateral epicondyle of the femur, approximately 3 cm proximal to the joint line. Soft tissue swelling and crepitus also may be present, but there is no joint effusion. Radiographs are not indicated.

4. The two live vaccines, MMR and the varicella vaccine, are not recommended for use before the first birthday, but should be given the first time the child sees the doctor after 12 months of age.

5. The findings of diffuse osteoporosis in a patient on hormone replacement therapy are suspicious for a multiple myeloma.
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[ArchivalUser]

THANKS SAVI

what i learnt from u

in 100 cc hemoptysis do cxry and bronchoscopy and coagulate the blleding point after localising it or take a biopsy and refer if there is amass.

2 biopsy diagnosed intraepithelial neoplasm -- leep

3 shock sepsis hemorrage and sickling can cuse stroke like condition due todural thrombosis presenting with neuro deficit and hedache and seizure and cranial nerve defecit.

5 decreased cardic index increased pawp and increasd svr is in cardiogenic shock,

6 adeno ca pancreas
7, obstructive shock due to massive PE HAS A NORMAL pawp

lorazepam is safe drug in detoxification programme dur to safety profile in liver and excreating through kidney

6 sicle cell having fever will be needing broad spectrum for encapsulted bacteria due to reduced functionally depressed RES mainly strep and hemophillus type b

7 septic shock is due to inflammatory mediator of sepsis reducing svr and cusing warm shock pawp is normal or low but can be high during overjealous hydration.

8 chlordizopoxide a good drug for detoxifying programme but becomes a bad drug in liver disese because its metabolites are long acting and difficult o clear and so accumulate and also in copd can compromise respiration in contrast to lorazepam which do not.

9 higher rhe prevalence higher the predective value so lower the prevalence lower the predective value . so lower the prevalence higher the predective value and higher the prevalence lower the predective values. but sensivity and specifity do not change wih predictability

10. sensitivity is about disease and sensibity is possibility that a diseased person will have a positive test\

ii specifity is about NIH NORMAL IN HEALTH. IT IS THE POSSIBILITY THAT A HEALTHY PERSON WILL HAVE NEGATIVE TEST.

12, positive predictability is predictability that a person with positive test has actually the disease

13 negative predictability is the probability that a person with negative test has actually have no disease

14 heat stroke have 105 temp and can have dic


14. prevalence is pid ' that is. incidence with duration.

15. disease like influenza have higher incidence and disease like sle have higher prevalence

16. syncope in athlets may be due to hccm or arrahthymia like woollf parkinsonism syndrome and congenital long QT SYNDROME OR ELECTROLYTE CHANGES SUCH AS HYPERCALCEMIA HYPOMAGNESSIMIA POTASSIUM CHANGES. SO ECG AND ELECTROLYTE IS v important.

17 PE CAUSES VENTILATION PERFUSION MISMATCH. high ventilation low perfusion so ratio is infinity

18 pnemi=othorax causes both reduced

19 tubo ovarian abscess usg multiple septation and fluid in those loculi in the adenexal mass and occurs in stds multiple sexual partner and with iud and px. cefoxitin is DOC

20 ACNS ROSEAsea IS TREATED WITH topical metro ;get metro by metro./ no responce tetra/ of course avoid exogenous factor

[ArchivalUser]

membranous glomerulonepritis can cause renal v rhrombosis

iliotibial tendonitis causes frictional injury of iliotibial tract in cyclist runner due to overuse syndrome and there is lateral knee tenderness and even crepitus no xray is warrented.

mmr and varicella are given in first year not before that because the immune system is not mature enough to handle it,

diffuse osteoporosis in hrt wiil make you review the diagnosis in search of multiple myeloma

[ArchivalUser]

hi Jyoti,I`m posting some more pearls for you.GL

[ArchivalUser]

1. Laboratory data for multiple myeloma includes anemia, an elevated creatinine from secondary renal dysfunction, and elevated IgA and IgG levels and hypercalcemia.

2. Bone scan has a low sensitivity for myeloma lesions and has no role in its workup. Do not confuse a bone survey which is a series of x-rays evaluating all of the bones with a bone scan which is a nuclear medicine scan. NO BONE SCANE FOR MULTIPLE MYELOMA!

3. A postoperative pelvic abscess: This condition may occur after abdominal surgery, and presentation usually occurs after postoperative day 7. Diarrhea is frequently the earliest manifestation of abscess formation. A fluctuant mass is a common finding on physical exam, and a rectal exam should be performed on all postoperative patients who are at risk for developing an abscess. A postoperative abscess will frequently cause an ileus, as manifested by vomiting, abdominal distention, decreased bowel sounds, and radiographic findings. Although the clinical grounds may provide you with the diagnosis of abscess, imaging studies should be undertaken to localize the fluid collection and aid in drainage. A CT scan probably has the highest yield compared to the other imaging modalities. Besides localizing the abscess, a CT scan will aid in the drainage of the fluid collection.

4. APGAR is a named after Virginia Apgar, M.D. who came up with a rating system for neonates a t delivery. One helpful mnemonic is A: appearance, P: pulse, G: grimace or response to catheter in nostril, A: activity or tone, and R: respiratory effort. Each category is rated from 0-2.

5. Cystic fibrosis is a pulmonary/gastric disorder caused by mutation in a protein responsible for maintaining salt and water gradients across cell membranes. The clinical manifestations of the disease stem from the presence of thick, copious secretions in the airways and ducts of the pancreas. The pulmonary manifestations are frequent infection such as pneumonia and eventually bronchiectasis. In addition to antibiotics, aggressive chest physiotherapy to loosen and remove impacted secretions is critical to clearing hyper-acute infections.
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[ArchivalUser]

1. After a myocardial infarction, normal sexual activity can typically be resumed 2-4 weeks after discharge from the hospital.

2. Some of the most common anomalies associated with congenital rubella are intrauterine growth retardation, microcephaly, microphthalmia, cataracts, glaucoma, retinopathy, patent ductus arteriosus, hepatomegaly, jaundice, thrombocytopenia, metaphyseal lucency, and a purpuric rash also known as a "blueberry muffin" rash. Infants may be asymptomatic at birth, but the earlier in pregnancy the mother is infected with the rubella virus, the more likely the baby is to have defects. For example, if a mother is infected in the first 8 weeks of pregnancy, the baby has an 85% chance of having a defect.

3. Toxoplasma gondii is another organism that can cause congenital infection, but 70-90% of infants with congenital infection are asymptomatic at birth. It is important to note that a large percentage of the infants that are asymptomatic at birth w ill develop visual impairment, learning disabilities, or mental retardation months to years later. Signs of congenital toxoplasmosis include: hydrocephalus, microcephaly, cerebrospinal fluid abnormalities, intracranial calcifications, chorioretinitis, hepatosplenomegaly, generalized lymphadenopathy, and a maculopapular rash.

4. Varicella-zoster infection in a mother causes different syndromes in a baby depending on the time of the infection. If the mother is infected in the first trimester or early in the second trimester, the baby may develop varicella embryopathy which is characterized by microphthalmia, cataracts, chorioretinitis, cutaneous and bony aplasia/atrophy, and scarring of the skin of the extremity. If the mother is infected during the second 20 weeks of pregnancy, the baby may show no clinical manifestations of varicella, but may develop zoster later in life without ever having extrauterine infection. If the mother develops varicella from 5 days before delivery until 2 days after delivery, the child may develop severe infection, which may lead to death.

5. Risk factors for (DVT) are pregnancy, trauma, prolonged immobilization, orthopedic and certain neurosurgical procedures are associated with the greatest short-term risk, with the risks of the fracture and the surgery being additive. Some estimates place risk of DVT at greater than 80%. The risk of pulmonary embolism is also high and significant, but not nearly as much as DVT. These estimates range from 2-27%.
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[ArchivalUser]

1. Whenever you use niacin you should monitor liver function and plasma glucose carefully.

2. When do you use niacin? When a patient cannot tolerate statins and also it's the best choice for raising HDL.

3. An angiogram is not necessary in the management of ischemic mucosal colitis. Ischemic colitis is diagnosed by colonoscopy. Patchy depigmented areas confirm mucosal ischemia, which is managed by intravenous fluids and bowel rest.

4. Abdominal pain in an elderly patient associated with bloody diarrhea and hypotension should arouse the suspicion of ischemic bowel.. A classical appearance on the flexible sigmoidoscopy of green mucosa and isolated depigmented patches are suggestive of ischemic colitis. These patients should initially be adequately hydrated and put on bowel rest.

5. White cells generally indicate active inflammation. The presence of leukocytes in a stool sample would be highly suggestive of IBD.
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[ArchivalUser]

1. The treatment of unstable atrial fibrillation (atrial fibrillation associated with hypotension, myocardial ischemia, congestive failure, etc.) is immediate synchronous cardioversion, in an attempt to immediately restore sinus rhythm.

2. Churg-Strauss vasculitis: Prednisone should be started at a moderate dose, along with a bisphosphonate to prevent osteoporotic fractures,in initial therapy no cyclophosphamide.

3. Major depression need not present as classic dysphoria or sadness.It may present as irritability particularly in children and adolescent.

4. In DM with sports this is what we do check ketone.. if positive patient can not participate until ketones are gone. In DM insulin is decreased with snacks during break. Checking glucose before and after sports is also a reccomendation

5. BILATERAL renal aa. stenosis with HTN: what med do you use to treat HTN Calcium channel blocker. If it was unilateral stenosis then ACE inhibitors.
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[ArchivalUser]

1.A male patient with thumb base pain: what is dx. De Quervain Tenosynovitis; treatment is NSAIDs and intrathecal steroids.

2. How do you treat Cocaine abuser with 210/115 BP? Cocaine induced HTN - treated with Benzo, Nitroglycerin or Nitroprusside drip and Phentolamine 1 mg IV. No beta blockers like propranolol.

3. Bilious vomiting in an infant means that there is a malrotation with volvulus until proven otherwise. The radiographic findings of the cecum in the left upper quadrant confirms this clinical diagnosis. An upper gastrointestinal series would likely show a bird-beak deformity of the midgut where there is volvulus of the gut around a mesenteric "Ladd" band.

4. About 20% of malrotation with volvulus is associated with duodenal atresia, annular pancreas, or a duodenal diaphragm. About 33% of cases present in the first week of life and 85% present in the first year of life. The hallmark of malrotation is ischemia of the midgut as the superior mesenteric vein and the superior mesenteric artery are occluded by the twisting mesentery. Immediate surgery is necessary to prevent death or the loss of much of the bowel.

5. Intussusception typically presents in infants from 4 months to 2 years of age, with alternating lethargy and irritability, colicky abdominal pai n, and currant jelly stools. In addition, there is usually a right lower quadrant mass on abdominal x-ray.
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