Presents @ scribble between QRS on EKG
QRS is 100-175bpm @ irregular rates
HTN, CAD, Valvular Disease, DM, Alcohol, Obesity
All cause atrial stress resulting in tissue heterogeneity & subsequent abnormal tissue conduction.
Autonomic Foucs Theory: Ectopic Foci @ pulmonary vein outlet w/ tissue heterogeneity promotes AF
1) Paroxysmal AF <1wk
2) Persistent AF >1wk b/c of progressive fibrosis & tissue heterogeneity
3) Long Standing Persistent AF >12mo
Symptoms: General Fatigue, SOB, Palpitations, Dizziness
Complication: Embolic Stroke
Tx: Rate Control with BB/CCB/Digoxin & Rhythm control w/ Antiarrhythmic agents, Pacemaker, or Radiofrequency Catheter Ablation (Maze Procedure)
Complicated scoring system used to measure the severity of disease for adult patients admitted to intensive care units
AaDO2 or PaO2 (depending on FiO2), Temperature (rectal), Mean arterial pressure, pH arterial, Heart rate, Respiratory rate, Sodium (serum), Potassium (serum), Creatinine, Hematocrit, White blood cell count, Glasgow Coma Scale
10 10% morality
20 40% mortality
30 75% mortality
>34 85% mortality
Grade severity of stroke
0 No stroke symptoms
1-4 Minor stroke
5-15 Moderate stroke
16-20 Moderate to severe stroke
21-42 Severe stroke
Level of Consciousness, LOC Responsiveness, LOC Questions, LOC Commands, Horizontal Eye Movement, Visual field test, Facial Palsy, Motor, Arm, Motor Leg, Limb Ataxia, Sensory, Language, Speech, Extinction and Inattention
If <5 then excludes tPA therapy
Hyper: Primary Hyperparathyroidism, Familial hypocalciuric hypercalcemia, Increased Vitamin D, TB or Sarcoidosis, Hyperthyroidism, Thiazide Diuretics, MM, Pagets Disease, CKD & Secondary Hyperparathyroidism, Adrenal Insufficiency
Hypo: Decreased Vitamin D, Bisphosphonates, Denosumab, Calcitonin, CKD, Tumor Lysis Syndrome, Hyperphosphatemia, EDTA, Alkalosis
Never forget decreased and increased intake as causes!
Most Common: Adhesions & Carcinoma
Other: DM/EtOH, Scleroderma, TCA, Opioids, Benzodiazepines, Crohns, Gallstone Illeus, Foreign Body, Volvulus, Hernia, Intussusception, SMA Syndrome, Post-Op Ileus, Hirschprungs Disease, Metabolic Acidosis, Hypokalemia & Hypercalcemia
>1.1 g/dL: Alcoholic Hepatitis, HF, Hepatitc Metastases, Constrictive Pericarditis, Budd-Chiari Syndrome, Idiopathic Portal Fibrosis
<1.1 g/dL: Carcinoma, TB, Pancreatitis, Nephrotic Syndrome
If SAAG is >1.1g/dL then determine if HTN is sinusoidal or post-sinusoidal by using total protein
>2.5 g/dL: Cardiac Ascites, Veno-Occlusive Disease, Early Budd-Chiari
<2.5 g/dL: Cirrhosis or Late Budd-Chiari
Note: Of all etiologies of <1.1 g/dL SAAG only Nephrotic Syndrome has <2.5 g/dL of total protein
Picornaviruses: No envelope, SS(+) RNA, Icosahedral
Examples: Polioviruses, Echoviruses, Rhinoviruses, Coxackievirus, HAV
Paramyxoviruses: Enveloped, SS(-) RNA, Helical
Examples: Parainfluenza, RSV, Measles, Mumps
Wolffian: Bladder Trigone, Epididymis, Ejaculatory Duct, Ductus Deferens, Seminal Vesicles
Mullerian Ducts: Uterine tubes, Uterus, Cervix, and the Upper one-third of the vagina
Urogenital folds/sinus: Labia Minora (Females), Urethra (Males)
Genital Tubercle: Clitoris (Females), Penis (Males)
Gonadal Ridge: Ovarian Follicles (Female), Rete Testes (Male)
Vaginal process: Developmental outpouching of the parietal peritoneum. Failure of closure in males can result in hydrocele, inguinal hernia, or testicular torsion.
Gubernaculum: Ovarian/Round Ligament (Females), Scrotal Ligament (Males)
Medications, Acidosis, Cellular Destruction, Hemolysis, Hyperaldosteronism, Intake, Nephrons (Renal Failure), Excretion Impaired (RTAIV)
Muscle Weakness, Urinary Abnormalities, Respiratory Distress, Decreased Cardiac Contractillity, EKG changes, Reflex Changes
1) Fungal: Cryptococcus, Aspergillus, Blastomyces, Histoplasma, Coccidioides, Candida
2) Protozoal: Toxoplasmosis, Malaria, Naegleria Fowleri
3) Bacterial: TB, Leprosy, Syphillis, Lyme, GBS, Listeria, Neisseria, Strep pneumoniae, Hib, E coli, Staph, Pseudomonas
4) Viruses: Enteroviruses, HSV, VZV, WNV, Mumps, HIV, LCMV, Measles, Polio, JC
CNS: Tay-Sachs, Niemann-Pick, Gaucher's, Krabbe's, Metachromatic Leukodystrophy, PKU, Wilsons Disease, Wernicke Encephalopathy, Korsakoff Syndrome, Subacute Combined Degeneration, Kernicterus
PNS: Diabetic Neuropathy, Hypothyroid Neuropathy
1) Ear: S pneumoniae, Moraxella, H influenzae, GAS, S aureus (AOM & EOM), E coli (Neonates and EOM), Pseudomonas (EOM)
Sinus: Rhinovirus, Influenza, Parainfluenza, Haemophilus, Moraxella, Staph, Strep pneumoniae
Pharynx: GAS, EBV, HSV, CMV, Rhinovirus, Adenovirus, Influenza, Coronavirus
Nares: Viral, Strep Pneumoniae, Staph Aureus
Conjunctiva: Staph Aureus, Chlamydia, Gonorrhoeae, Strep Pneumoniae, Haemophilus, Measles, Chickenpox, Rubella, Mumps, Adenovirus, Enterovirus
Epiglottis: Hib, Strep Pneumoniae, Staphylococcus Aureus
Glucagonoma: Presents with dermatitis (necrolytic
migratory erythema), diabetes (hyperglycemia), DVT, declining weight, depression.
Insulinoma: May see Whipple triad: low blood glucose, symptoms of hypoglycemia (eg, lethargy, syncope, diplopia), and resolution of
symptoms after normalization of glucose levels.
Treatment: surgical resection.
Somatostatinoma: Dec secretion of secretin,
cholecystokinin, glucagon, insulin, gastrin. May present with diabetes/glucose intolerance,
steatorrhea, gallstones. Treatment: Surgical Resection & Octreotide
Hypertrophic: Inherited, Aortic Stenosis, HTN (Diastolic Dysfunction, predisposition to Ischemia, Association w/ S4)
Restrictive: Amyloidosis, Idiopathic Fibrosis, Sarcoidosis, Hemochromatosis, Radiation Fibrosis, Tumor Infiltration, Scleroderma (Diastolic Dysfunction)
Dilated: Aortic Regurgitation, CAD, MR, Viral Myocarditis, Muscular Dystrophy, Alcohol, Drugs (Systolic Dysfunction, Association w/ S4)
Esophagus: Obstruction, Reflux, Esophagitis, Varices, Tumors
Stomach: Ulcer, Gastroparesis, Outlet Obstruction, Gastritis, Tumors, Pernicious Anemia
Small Intestine: Malabsorption, Obstruction, Mesenteric Ischemia, Tumors
Large Intestine: Diarrhea, Constipation, Obstruction, Mesenteeric Ischemia, Colitis, Tumors
Note: Crohn's Disease can occur anywhere!
2: Visual Defect & Impaired Pupillary Light Response
3: Eye Down & Out, Dilated Pupil
4: Weakness of downward gaze & extortion
5: Decreased facial sensation, absent corneal reflex, weakness of chewing
6: Inability to abduct left eye
7: Facial weakness, decreased taste, dry eye
8: Hearing loss, tinnitus, balance difficulties, vertigo, nystagmus
9: Impaired Gag Reflex
10: Hoarseness, difficulty swallowing, impaired palatal elevation
11: Weakness turning head to opposite side & Shoulder Drop/Weakness
12: Tongue Deviation to affected side
Gram (+): Vancomycin, Linzeolid, Daptomycin, First Gen Cephalosporins
Gram (-): Zosyn, Carbapenems, 4th Gen Cephalosporins, Fluroquinolones, Aminoglycosides
Anaerobic: Metronidazole, Clindamycin, Carbapenems, 2nd Gen Cephalosporins, Moxifloxacin
GVHD, ITP, TTP, Kawasaki Disease, Guillain-Barre Syndrome, MG, Polymyositis/Dermatomyositis, MS, RA, SLE, Hemolytic Transfusion Rection, Various Immunodeficiencies
1) Blockade of macrophage Fc receptors
2) Inhibit MAC Formation
3) Neutralize autoantibodies
1) cAMP: FSH, LH, ACTH, TSH, CRH, hCG, ADH, MSH, PTH, Calcitonin, Glucagon, Histamine
2) cGMP: BNP, ANP, EDRF (NO)
3) IP3: GnRH, Oxytocin, ADH, TRH, Histamine, ATII, Gastrin
4) TK: Insulin, IGF-1, FGF, PDGF, EGF
Inducers: Chronic Alcohol Use, St Johns Wort, Phenytoin, Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine
Inhibitors: Valporate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Acute Alcohol Abuse, Chloramphenicol, Erythromycin, Sulfonamides, Cirpofloxacin, Omeprazole, Metronidazole
1) Ampicillin: Gram (+) (Not MSSA) and limited Gram (-) Coverage (N meningitidis & H influenzae)
2) Cefazolin & Cephalexin: Excellent Gram (+) (MSSA and strep), minor Gram (+) (Proteus, E.coli, Klebsiella)
3) Doxycycline: Fairly broad spectrum with some Staph and MRSA coverage, some gram negative coverage, and atypicals. Has activity for unusual pathogens including: Rickettsia, Lyme disease, Tularemia, Vibrio, Brucella, Q fever, Anthrax
4) Clindamycin: Excellent activity vs. Anaerobes and Gram positive cocci - Strep and Staph, including ~ 50% of community-acquired MRSA, but NOT Enterococci.
A meniscus is a crescent-shaped fibrocartilaginous anatomical structure that, in contrast to an articular disk, only partly divides a joint cavity. In humans they are present in the knee, wrist, acromioclavicular, sternoclavicular, and temporomandibular joints.
Generally, the term 'meniscus' is used to refer to the cartilage of the knee, either to the lateral or medial meniscus. Both are cartilaginous tissues that provide structural integrity to the knee when it undergoes tension and torsion. The menisci are also known as "semi-lunar" cartilages, referring to their half-moon, crescent shape.
The term meniscus is from Ancient Greek μηνίσκος (meniskos), meaning 'crescent.
1) Neutrophillic: Bacterial Infections, Tissue Necrosis
2) Eosinophillic: Allergic, Parasitic, NHL/HL, SLE, Vasculitis
3) Basophilic: Myeloproliferative Disease
4) Monocytosis: Chronic Infections (SLE, IBD, TB, Malaria)
5) Lymphocytosis: Viral Infections, Pertussis, CLL & ALL
1) Demargination secondary to stress
2) Decreased Extravastation due to glucocorticoids
3) Increased release from marrow (infection and hypoxia)
4)Increased production from marrow (growth factor dependent or myeloproliferative disorders
Defects in mitochondria result in decreased energy production and atrophy of cells reliant on high levels of energy, including nerve cells and muscle cells.
Diseases caused by mitochondrial defects include myopathies and neuropathies, such as Leber hereditary optic neuropathy and mitochondrial encephalopathy.
Symptoms can vary depending on the distribution of diseased mitochondria within the organs of the body, but major phenotypic subcategories include muscle weakness, visual/hearing problems, encephalopathies, seizures, heart disease, liver disease, and intellectual disability.
Mitochondrial diseases are caused by mutations within the mitochondrial DNA, which is inherited maternally.
1) One: Walks Steps Independently, two finger pincer grasp, 3-5 words
2) Two: Two words sentences and running
3) Three: Draw circle, ride a tricycle, three word sentences, dress/undress
4) Four: Draw cross/rectangle, hope on one foot, cooperative play, recognize colors/numbers
5) Five: Draw a square, skip, catch a ball, print name, tie shoelaces
Progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity due to loss of sensation. Onset is usually insidious.
The neurotraumatic theory attributes bony destruction to the loss of pain sensation and proprioception combined with repetitive and mechanical trauma to the foot. The neurovascular theory suggests that joint destruction is secondary to an autonomically stimulated vascular reflex that causes hyperemia and periarticular osteopenia with contributory trauma. Intrinsic muscle imbalance with increased heel and plantar forces can produce eccentric loading of the foot, propagating microfractures, ligament laxity and progression to bony destruction.
The first stage is the developmental, or fragmentation, stage (acute Charcot) and is characterized by periarticular fracture and joint dislocation leading to an unstable, deformed foot (Figure 2). Patients in the coalescence stage (subacute Charcot) present with resorption of bone debris. The consolidation, or reparative, stage (chronic Charcot) is associated with re-stabilization of the foot with fusion of the involved fragments (Figure 3). This leads to the return of a stable, although deformed, foot.
Diphenhydramine is a potent anticholinergic agent. This activity is responsible for the side effects of dry mouth and throat, increased heart rate, pupil dilation, urinary retention, constipation, and, at high doses, hallucinations or delirium.
Therefore can be used to prevent EPS.
Other side effects include motor impairment (ataxia), flushed skin, blurred vision at nearpoint owing to lack of accommodation (cycloplegia), abnormal sensitivity to bright light (photophobia), sedation, difficulty concentrating, and short-term memory loss.
Oncogenes: ALK, BCR-ABL, BRAF, BCL-2, BRAF, c-MYC, KRAS, RET, JAK2, c-KIT
Tumor Suppressor: APC, BRCA1/2, MEN1, PTEN, NF1/2, P53, WT1
1) Breast: BRCA1/2, AA Ethnicity (Triple Negative Disease), Older age at first birth, obestiy, early menarche or late menopause
2) Endometrial: Obesity, Nulliparity, Late Menopause, Estrogen only HRT, Lynch Syndrome
3) Ovarian: Infertility, Endometriosis, PCOS, BRCA1/2, Lynch Syndrome, Estrogen Only HRT
Metoclopramide acts as a muscarinic agonist in the GI tract, causing increased lower esophageal sphincter tone, improved gastric peristalsis and emptying, and decreased pyloric sphincter tone.
The D2 antagonist action of metoclopramide at CNS dopamine receptors also decreases nausea and vomiting in patients with gastroparesis.
Adverse effects of metoclopramide include extrapyramidal symptoms, such as dystonia, parkinsonism, and akathisia, also due to dopamine D2 receptor antagonism.
Rarely, metoclopramide may have more serious side effects, such as neuroleptic malignant syndrome.
Because metoclopramide is also a rare cause of tardive dyskinesia, a serious and usually permanent condition, use of the drug should be limited to no more than 12 weeks
— 1°: loss of adrenal gland (glucocorticoid AND mineralocorticoid) function, e.g., autoimmune, infection (TB, CMV, etc.), hemorrhage, malignancy.
Autoimmune, infection (TB, CMV, MAI), hemorrhage, malignancy.
— Central: loss of function upstream of adrenal gland (pituitary or hypothalamus) → loss of glucocorticoid function only.
2°: loss of pituitary ACTH secretion, e.g., Sheehan syndrome, pituitary tumor.
3°: loss of hypothalamic CRH secretion, e.g., due to exogenous steroids
— Inflammatory: frequent, small volume, bloody. Often associated with tenesmus, severe abdominal pain, fevers. Obtain fecal leukocytes, stool guaiac, stool culture, C. diff testing, fecal ova and parasites.
— Fatty: greasy, bulky, difficult to flush and often leaving a residue in the bowl. Often associated with weight loss. Obtain Sudan stain to estimate fat in stool; celiac serologies.
— Watery: watery osmotic diarrhea improves with fasting, while watery secretory diarrhea continues unabated while fasting. Calculate stool osmotic gap.
— Factitious diarrhea: calculate stool osmolality; <290 mOsm/kg = hypotonic solution added; >600 mOsm/kg = hypertonic solution added to stool