Explore Flashcards

Nasogastric/Nasoenteric Tubes

A nasoenteric tube is passed through the nares into the duodenum or jejunum when it is necessary to bypass the esophagus and stomach.

Nasoenteric tubes have a decreased risk of aspiration compared with nasogastric tubes; however, a nasoenteric tube can become dislodged to the lungs, causing aspiration of enteral feedings.
If a client with a feeding tube develops signs of aspiration pneumonia (diminished or adventitious lung sounds [eg, crackles, wheezing], dyspnea, productive cough), the feeding should be stopped immediately and tube placement checked (eg, measure insertion depth, obtain x-ray, assess aspirate pH).

Some facilities use capnography to determine placement; if a sensor detects exhaled CO2 from the tube, it is in the client's airway and must be removed immediately

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing.

Seborrheic dermatitis

Seborrheic dermatitis is a non-contagious skin condition. It leads to scaly patches of skin with oily, dandruff-like flakes, especially on your face and scalp. It is only rarely itchy.

Signs of Cushing's syndrome.

• Weight gain in face (moon face)
• Weight gain above the collar bone (supraclavicular fat pad)
• Weight gain on the back of neck (buffalo hump)
• Skin changes with easy bruising in the extremities and development of purplish stretch marks (striae) particularly over the abdomen or axillary region
• Red, round face (plethora)
• Central obesity with weight gain centered over the chest and abdomen with thin arms and legs
• Excessive hair growth (hirsutism) on face, neck, chest, abdomen and thighs
• Female balding
• Generalized weakness and fatigue
• Blurry vision
• Vertigo
• Muscle weakness
• Menstrual disorders in women (amenorrhea)
• Decreased fertility and/or sex drive (libido)
• Hypertension
• Poor wound healing
• Diabetes mellitus
• Severe depression
• Extreme mood swings

Cushing's syndrome.

Cushing's syndrome is a disorder caused by the body’s exposure to an excess of the hormone cortisol. Cortisol affects all tissues and organs in the body. These effects together are known as

Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid arthritis (iatrogenic Cushing’s syndrome), excess production of cortisol from a tumor in the adrenal gland or elsewhere in the body (ectopic Cushing’s syndrome) or a tumor of the pituitary gland secreting adrenocorticotropic hormone (ACTH) which stimulates the over-production of cortisol from the adrenal gland (Cushing’s disease).

Rate limiting enzymes

A rate-limiting enzyme is a key enzyme of which the activity determines the overall rate of a metabolic pathway.

1. Glycolysis : phosphofructokinase

2. Gluconeogenesis : PEP (phosphoenol pyruvate) carboxylase

3. Glycogenesis : glycogen synthase

4. Glycogenolysis : glycogen phosphorylase

5. Kreb cycle : isocitrate dehydrogenase

6. Ketone body synthesis : HMG co A synthase

7. Cholesterol synthesis : HMG co A reductase

8. Porphyrin synthesis : ALA synthase

9. Fatty acid synthesis : acetyl CoA carboxylase

10. Uric acid synthesis : xanthine oxidase

Bone density testing

A bone density test uses x-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone. The bones that are tested are in the spine, hip and forearm.

Bone density test results are reported in 2 numbers: T-score and Z-score.

The T-score is the bone density compared with what is normally expected in a healthy young adult of the same sex. The T-score is the number of units—standard deviations—that bone density is above or below the average. T-score >2.5 SD indicates the likelihood of osteoporosis and increased risk of fracture. The diagnosis of osteoporosis by DEXA scan also means that treatment
should be initiated with bisphosphonates, oral daily calcium supplementation, and vitamin D.

The Z-score is the number of standard deviations above or below what is normally expected for someone of the same age, sex, weight, and ethnic or racial origin. Z-score ≤-2 may suggest that
something other than aging is causing abnormal bone loss (consider drugs causing osteoporosis such as corticosteroids). The goal in this case is to identify the underlying problem.

Electroconvulsive Therapy

Electroconvulsive Therapy is the induction of a grand mal (generalized) seizure through the application of electrical current to the brain.

Type 1 familial hyperlipidemia

Lipoprotein lipase helps breakdown triglycerides into fatty acids and glycerol so they can be absorbed by tissue. A defect in this enzyme leads to type I familial hyperlipidemia, which causes pancreatitis and eruptive xanthomas.

Sudden deterioration of an intubated baby (DOPES)

Sudden deterioration of an intubated baby (DOPES)
Displacement of the tube

Obstruction of ET tube

Pneumothorax

Equipment failure

Stomach distension

Identify and rectify the problem urgently

The PHC elements listed at the Alma Ata Declaration

Enterohepatic circulation, Extracorporeal circulation, The mesenteric circulatio, collateral circulation

 Enterohepatic circulation involves substances that are metabolized in the liver, excreted into the bile, and passed into the intestinal lumen; there they are reabsorbed across the intestinal mucosa and returned to the liver via portal circulation

Extracorporeal circulation is a procedure in which blood is taken from a patient's circulation to have a process applied to it before it is returned to the circulation

The mesenteric circulation refers specifically to the vasculature of the intestines, whereas the splanchnic circulation provides blood flow to the entire abdominal portion of the digestive system that includes the hepatobiliary system, spleen, and pancreas.

collateral circulation is a network of tiny blood vessels, and, under normal conditions, not open. ... This allows blood to flow around the blocked artery to another artery nearby or to the same artery past the blockage, protecting the heart tissue from injury

Positive symptoms of schizophrenia

Positive symptoms of schizophrenia respond to drug therapy more readily than negative symptoms. The secondgeneration “atypical” nonphenothiazine drugs may be slightly more effective in treating negative symptoms of schizophrenia

Mechanism of CD4 Cell Depletion

• HIV-mediated direct cytopathicity (single cell killing) – infected CD4 cells die
• HIV-mediated syncytia formation
• Defect in CD4 T-cell regeneration in relation to the rate of destruction
• Maintenance of homeostasis of total T-lymphocytes (decreased CD4, increasedCD8)
• HIV-specific immune response (killing of virally infected and innocent cells)
• Auto-immune mechanism
• Programmed cell death (apoptosis)
• Qualitative abnormalities (even the existing CD4 cells are dysfunctional)
• Impaired expression of IL-2
• Defective IL-2 and INF-Alfa production
• Decreased help to B-cells in production of immunoglobulins

Scalp layers medical mnemonic

SCALP:
From superficial to deep:
Skin
Connective tissue
Aponeurosis
Loose areolar tissue
Pericranium

Predisposing Factors For Acute Pyelonephritis Medical Mnemonic

Acute pyelonephritis is a bacterial infection that affects the renal pelvis and kidney. Use the mnemonic SCARRIN' UP to memorize the predisposing factors for acute pyelonephritis.

SCARRIN' UP mnemonic stands for;

Sex (females <40 years, males >40 years)
Catheterization
Age (infant, elderly)
Renal lesions
Reflux (vesciouteral urine relux)
Immunodeficiency
NIDDM, IDDM (Non-insulin dependent diabetes mellitus and insulin dependent diabetes mellitus)
Urinary obstuction
Pregnancy

Inferior venacava tributaries medical mnemonic

"I Like To Rise So High":
Illiacs
Lumbar
Testicular
Renal
Suprarenal
Hepatic vein.
 Think of the IVC wanting to rise high up to the heart.

Features of Kallman Syndrome

Kallmann syndrome is a genetical disorder that prevents a person from starting or fully completing adolescence. It is a form of a group of conditions known as hypogonadotropic hypogonadism.

To distinguish it from other forms of hypogonadotropic hypogonadism, Kallmann syndrome has the additional symptom of a total lack of sense of smell or a reduced sense of smell

The mnemonic to master Kallman syndrome features is : KALMAN

   Color blindness (K sounds like C)
   Anosmia
   Low LH, FSH, Sex hormones → delayed puberty
   Midline defects (cleft palate, cleft lip)
   Ataxia (cerebellar ataxia)
   Nerve deafness

Imaging of Kallman Syndrome

 It is easiest to appreciate the anatomical anomalies present in Kallman syndrome by comparing it to a normal patient.

The normal anatomy of the region consists of the olfactory bulbs (blue arrows) located in the olfactory grooves of the anterior cranial fossa.

The inferior surface of the frontal lobes usually consists gyrus rectus (aka straight gyrus) (R) separated from the medial orbital gyrus (M) by the olfactory sulcus (yellow arrow). These are absent in Kallman syndrome. 

Duodenum: lengths of parts

The duodenum has four parts; superior, descending, inferior and ascending part. Together these parts form a 'C' shape, that is usually around 25cm long, and wraps around the head of the pancreas

To rememner the length of these parts use the mnemonic;

"Counting 1 to 4 but staggered":
1st part: 2 inches
2nd part: 3 inches
3rd part: 4 inches
4th part: 1 inch

Differentials of Testicular Atrophy Mnemonic

Testicular atrophy is a condition wherein the testicles gradually shrink in size. It may be caused by a number of factors

Mnemonic to master the differentials of testicular atrophy is : TESTES SHRINK:

Trauma
Exhaustional atrophy
Sequelae
Too little food
Elderly
Semen obstruction
Sex hormone therapy
Hypopituitarism
Radiation
Inflammatory orchitis
Not descended
Kleinfelter's

Differential Diagnoses of Hydronephrosis Medical Mnemonic

Hydronephrosis is a distention of the renal calyces and pelvis with urine as a result of a urinary outflow obstruction.

Use this mnemonic 'PACT SUPER' to memorize the differential diagnoses of hydronephrosis.

Unilateral is PACT:

Pelvic-uteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis

Bilateral is SUPER:

Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis

Diaphragm apertures spinal levels Medical mnemonic

Diaphragm apertures: spinal levels Medical mnemonics

Aortic hiatus = 12 letters = T12
Oesophagus = 10 letters = T10
Vena cava = 8 letters = T8

Causes of Urinary incontinence Medical mnemonic

Urinary incontinence is an involuntary leakage of urine due to loss of bladder control. To master the causes of acute and reversible urinary incontinence is DRIP:
The mnemonic DRIP atands for;

Delirium
Restricted mobility/ Retention
Inflammation / Infection/ Impaction [fecal]
Pharmaceuticals / Polyuria

Causes Of Secondary Nephrotic Syndrome Medical Mnemonic

Nephrotic syndrome is kidney disease characterized by proteinuria, hypoalbuminemia, and edema. Use the mnemonic DAVID to memorize the cayses of secondary nephrotic syndrome

The mnemonic DAVID stands for;

Diabetes mellitus
Amyloidosis
Vasculitis
Infections
Drugs

Bowel Component Anatomy mnemonic

"Dow Jones Industrial Average Closing Stock Report":
 From proximal to distal:

Duodenum
Jejunum
Ileum
Appendix
Colon
Sigmoid
Rectum

To include the cecum, the mnemonic will be; "Dow Jones Industrial Climbing Average Closing Stock Report".

Atrioventricular valves Medical mnemonic

Atrioventricular valves
"LAB RAT":
Left Atrium: Bicuspid
Right Atrium: Tricuspid

Abdominal muscles medical mnemonic

Abdominal muscles 
"Spare TIRE around their abdomen":
Transversus abdominis
Internal abdominal oblique
Rectus abdominis
External abdom

5-F risk factors for cholelithiasis Medical mnemonic

The 5-F rule refers to the mnemonic of risk factors for the development of cholelithiasis in the event of upper abdominal pain:

• Fair: more prevalent in the Caucasian population 1
• Fat: BMI of more than 30
• Female sex
• Fertile: one or more children
• Forty: age of more than 40 years.

Thoracoacromial artery branches medical mnemonics

Thoracoacromial artery branches
ABCD:
Acromial
Breast (pectoral)
Clavicular
Deltoid

Neuroleptic Malignant Syndrome.

This is an idiosyncratic reaction to a wide variety of phenothiazines or butyrophenones such as haloperidol.

Muscular rigidity and rhabdomyolysis may occur as well. Treatment, besides stopping the drug, is with bromocriptine or dantrolene.

Central Core Disease (CCD)

Central Core Disease (CCD) is a rare non progressive myopathy with autosomal dominant inheritance, presenting in infancy and characterized by hypotonia and proximal muscle weakness.

Five ‘Rs’ of intravenous fluid administration

Five ‘Rs’ of intravenous fluid administration

• Resuscitation
• Routine maintenance
• Replacement
• Redistribution
• Reassessment

Diloxanide

Diloxanide furoate is the drug of choice for asymptomatic patients with E. histolytica cysts in the faeces. Metronidazole and tinidazole are relatively ineffective.
Diloxanide furoate is relatively free from toxic effects and the usual course is of 10 days, given alone for chronic infections or following metronidazole or tinidazole treatment.

Biphasic Pills

Biphasic pills are forms of COC pills containing two different dose combinations of oestrogen and
progestin usually in packets of 21 or 28 tablet e.g. in 21 active pills, 10 may contain one combination,
while 11 contain another. Examples include Biphasil, Ovanon, and Normovlar

Chvostek’s sign

Chvostek’s sign consists of twitching of muscles supplied by the facial nerve when the nerve is tapped about 2 cm anterior to the earlobe, just below the zygomatic arch.

When hypocalcemia develops from parathyroid disease, Chvostek’s sign, a facial spasm, may be an early symptom

Atopic dermatitis

Atopic dermatitis is a pruritic disease of unknown origin that usually starts in early infancy; approximately 85% of cases occur within first year of life. Usually presents with pruritus, eczematous lesions, xerosis (dry skin) and lichenification (thickening of skin)

Tactile or vocal fremitus

Tactile or vocal fremitus is the palpable vibration you feel when the patient speaks (says ‘99’).

Assessment of tactile fremitus is used to evaluate airflow and density of underlying tissue. Normally, the thicker the chest wall, the more diminished the fremitus; the lower the voice pitch, the greater the fremitus.

Increased fremitus (low voice pitch): conditions causing fluid or exudates in lungs (e.g consolidating pneumonia, atelectasis, pulmonary fibrosis, pulmonary edema, or pulmonary infarction) and sometimes lung tumor depending on size and mobility.

Decreased or absent fremitus (high pich): air trapping, solid tissue, or decreased air movement (e.g. emphysema, asthma, pleural effusion, pneumothorax, or distal to airway obstruction)

hypotonic uterine action

The diagnosis is made by palpation and timing the length of contractions. Repeated vaginal examination will demonstrate a cervix which fails to dilate.

Contractions may be strengthened by rehydration, relaxation (e.g. by epidural anaesthesia), rupture of the membranes and the use of intravenous syntocinon.

Immunoglobulins and their roles

Ig G
-Only antibody that pass placental circulation causing passive immunity.
-Short term protection.
-Has an Immediate action.
Ig A
–Present in all bodily secretions (tears, saliva, colostrums).
Ig M
–Acute in inflammation.
Ig E
–For allergic reaction.
Ig D
–For chronic inflammation

Growth Factors

These are substances that promote cell division.
Many act locally as autocrines or paracrines

• Epidermal growth factor (EGF)
  
• Platelet-derived growth factor (PDGF)
  
• Fibroblast growth factor (FGF)
  
• Nerve growth factor (NGF)
  
• Tumor angiogenesis factors (TAFs)
  
• Insulin-like growth factor (IGF)
  
• Cytokines

Pancreatic islets (islets of Langerhans)

Pancreatic islets (islets of Langerhans)

• Alpha cells (20%) produce glucagon
  
• Beta cells (70%) produce insulin
  
• Delta cells (5%) produce somatostatin
  
• F cells produce pancreatic polypeptide

Posteriour pituitary gland hormones

Posterior pituitary gland does not synthesize hormones, but it does store and release two hormones made by the hypothalamus.

• Oxytocin (OT)
  
• Antidiuretic hormone (ADH)

Hormones of the anterior pituitary gland are;

Hormones of the anterior pituitary gland are;

• Human growth hormone (hGH)
  
• Thyroid-stimulating hormone (TSH)
  
• Follicle-stimulating hormone (FSH)
  
• Luteinizing hormone (LH)
  
• Prolactin (PRL)
  
• Adrenocorticotrophic hormone (ACTH)
  
• Melanocyte-stimulating hormone (MSH)

Medications That Can Cause Acne

Fetal and Delivery complications of gestational diabetes mellitus

Stillbirth
Lung immaturity
Intrauterine growth restriction
Macrosomia
Prematurity
Underdevelopment (ie, sacral agenesis, ventricular septal defect, neural tube defect, cerebral palsy)
Shoulder dystocia
Hypoglycemia, Hypocalcemia, Hyperbilirubinemia

Causes of dystocia

Power(ie, poor or uncoordinated uterine contractions)
Passenger(ie, fetus too large or malpresentation)
Passage (ie, pelvis too small or unusual shape)

Risk factors for ectopic pregnancy

Ectopy( ie, previous ectopic pregnancy)
PID(ie, pelvic inflammatory disease)
IUD(ie, intrauterine device)
Surgery (ie, previous lower abdominal surgery)
Endometri (ie, endometriosis)

HELLP Syndrome

HELLP Syndrome is a severe variant of pre-eclampsia

Hemolysis
Elevated Liver enzymes
Low Platelets

Prerequisites for forceps Delivery

Analgesia is adequate
Bladder empty
Cervix is dilated
Descent past ischial spines
Ead (ie, head) presentation

Complications of polyhydramnios

Prolapse of umbilical cord
Placental abruption
Preterm labour
Presentation (ie, malpresentation)

Causes of postpartum pyrexia

Wind(ie, lung atelectasis)
Water ie, urinary tract infection)
Womb(ie, endomyometritis)
Wow (ie, mastitis)
Wind (ie, pneumonia)
Wound (ie, C-section or episiotomy site)
Walk (ie, deep venous thrombosis)

Risk factors of preeclampsia

Multiple gestation
Age extremes (mother is younger or older)
Diabetes mellitus
Primigravida
Renal disease
Intrauterine growth restriction
Mole (ie, hydatidiform mole)
Increased blood pressure (ie, chronic hypertension)

Common causes of bone metastases

Malignant melanoma
Breast
Thyroid
Kidney
Lung
Pants

Causes of proptosis

Tumour (eg, retinoblastoma)
Hemorrhage (eg, traumatic posterior orbital hematoma)
Endocrinopathy (eg, Graves' disease)
Infection (eg, orbital cellulitis)

Causes of persistent Pupillary dilatation

3rd nerve palsy
Anti-muscarinic eye drops (eg to facilitate fundoscopy)
Myotonic pupil (Holmes Adie pupil):most commonly in young women, with absent/delayed reaction to light and
convergence, and of no pathological significance.

Innervation of the Extraocular Muscles

All extraocular muscles are innervated by the third cranial nerve except the Lateral Rectus by the 6th cranial nerve and the Superior Oblique by the 4th cranial nerve

Clinical Characteristics of Myopia

Long eyeball is ...
Myopic, requiring ...
Minus diopter lens for correction, and the patient is ...
Nearsighted

Carpal Tunnel Syndrome Causes: TENS

Trauma (eg, Colles' fracture, daily overuse at typing keyboard)
Endocrinopathy (ie, pregnancy, hypothyroidism, diabetes
mellitus, acromegaly)
Neurological (C5-C6 disk herniation can mimics a CTS)
Synovitis (eg, rheumatoid arthritis)

Signs of compartment syndrome

Passive stretching causes severe pain (moat reliable sign)
Pain
Pallor
Paresthesiae
Poor capillary refill
Pulselessness (late sign)

Epiphyseal Injury, Salter-Harris Classification: SALTER

Type I: Straight through the epiphyseal growth plate
Type II: Above the epiphyseal growth plate (ie, in a fragment of metaphysis attached to the epiphysis)
Type III: Lower (ie, through and below the epiphyseal growth plate)
Type IV: Through the epiphysis and metaphysis
Type V: Emergency (ie, crush of the epiphyseal growth plate

Neuromuscular causes of scoliosis

Muscular dystrophy
Muscular atrophy (i.e., spinal muscle atrophy)
Myelodysplasia
Mcocutaneous syndromes (e.g., neurofibromatosis)
Arthrogryposis multiplex congenita
Cerebral palsy

Differentials for uncounciousness

Fainted
Illness/ Infantile febrile convulsions
Shock
Head injuries
Stroke (CVE)
Heart problems
Asphxia
Poisons
Epilepsy
Diabetes

Criteria for Diagnosis of Cerebral Palsy,

Posturing (especially abnormal extensor thrusting)
Oropharyngeal problems (tongue thrusts, grimacing, W swallowing difficulties)
Strabismus
Tone increased or decreased in muscles
Evolutional responses (ie, persistent primitive reflexes or failure to develop equilibrium and protective responses)
Reflexes (ie, deep tendon reflexes are increased and plantar reflexes are up going.

In order to diagnose CP require four criteria in a child older than one year who has no evidence of a progressive disease by history

Organic causes of cinstipation in childhood

Hirschprung's disease, Hypothyroidism, Hypercalcemia
Anal fissure
Neurogenic bowel (eg, spina bifida)
Diabetes mellitus

Causes of failure to thrive -7Cs

Congenital abnormalities (eg, ventricular septal defect)
Chromosomal abnormalities (eg, Down's syndrome)
Cystic fibrosis
Celiac disease
Cow's milk protein intolerance (allergy)
Calorie-protein malnutrition
Cruelty (eg, parental neglect, abuse, environmental deprivation)

Symptoms and Signs of Henoch-Schonlein Purpura,

Rash (ie, purpuric rash over buttocks, estensor surfaces of legs, pre-tibial region)
Arthralgia
Sore abdomen
Hematuria
Hematochezia

Complications of obesity in childhood

Furunculosis
Acanthosis nigricans
Triad (1. diabetes mellitus, 2. atherosclerosis, 3. hypertension)
Slipped femoral capital epiphysis
Obesity in adulthood

Causes of seizures in neonates- 5Hs

Hypoxia
Hypoglycemia
Hypocalcemia
Hypomagnesemia
Hemorrhage (ie, periventricular, subarachnoid, subdural)
Infection (ie, fever, meningitis, TORCH organisms)

Components of Tunner syndrome

Cardiac abnormalities (specifically Coartication)
Lymphoedema
Ovaries underdeveloped (causing sterility, amenorrhea)
Webbed neck
Nipples

Kwashiorkor distinguishing features from Marasmus

Fatty Liver
Anemia
Malabsorption
Edema

Components of APGAR score

Skin color: blue or pink
Heart rate: below 100 or over 100
Irritability (response to stimulation): none, grimace or cry
Respirations: irregular or good
Tone (muscle): some flexion or active

Features of potter syndrome

Pulmonary hypoplasia
Oligohydrominios
Twisted skin (wrinkly skin)
Twisted face (Potter facies)
Extremities defects
Renal agenesis (bilateral)

Symptoms and Signs of epiglotitis

Distressed
Drooling
Dysphagia
Dysphonia
Dyspnea

Stages of Sexual Development in the Female ABCDE

Accelerated growth (ie, height)
Breast development
Cunnus (vaginal) hair
Distal hair growth (ie, axillae)
Endometrial sloughing (ie, menarche)

Metabolism enzyme inducers

Mnemonic - "Randy's Black Car Goes Putt Putt and Smokes"

Rifampin
Barbiturates
Carbamazepine
Grisoefulvin
Phenytoin
Phenobarb
Smoking cigarettes

Effects of nicotine

Nicotinic effects: MTWTF (days of week):
Mydriasis/ Muscle cramps
Tachycardia
Weakness
Twitching
Hypertension/ Hyperglycemia
Fasiculation

Direct sympathomimetic catecholamines

Dopamine
Isoproterenol
Norepinephrine
Epinephrine
Dobutamine

ACE Inhibitor contraindictions

Pregnancy
Allergy
Renal artery stenosis
K increase (hyperkalemia)

Burns, initial resuscitation: SAVE A PATIENT

Stop the burning process
ABCs of basic life support
Visualize the patient for all injuries
Estimate burn size and begin fluid resuscitation
Airway (intubate if inhalation injury present)
Penicillin (i.e., start antibiotics)
Analgesic
Topical therapy (e.g., flumazanine cream)
Intoxicants/Inhalants
Nasogastric tube
Tetanus toxoid

Carpal tunnel syndrome treatment

Wear splints at night
Rest
Inject steroid
Surgical decompression
Take diuretics

Burn Size Estimation by Total Body Surface Area: Rule of 9's

Entire Head: 9%
Entire trunk: 18% + 18% = 36%
Entire arm: 9%
Entire leg: 18%
Whole body: 100%

Alcoholism Screening Questions: CAGE

Have you ever tried to Cut down on your drinking?
Do people ever Anger you about your drinking?
Do you ever feel Guilty about your drinking?
Do you ever require an Eye opener (ie, drink of alcohol) to get going in the morning?

Side effects of anticholinergic drugs

Confusion
Blurred vision
Reduced lacrimation
Reduced salivation
Heart acceleration (tachycardia)
Urinary retention
Constipation

Signs of delirium

Acute onset, then fluctuation over days
2. Inattentiveness (especially to conversation)
3. Disorganized thinking (ie, incoherent speech)
4. State of consciousness either reduced or hypervigilant

For diagnosis of delirium need both 1 and 2 + either 3 or 4 (sensitivity 94-100%, specificity 90-95%)

Signs and symptoms of depression

Appetite diminished +/- weight loss
Sleep disturbance (especially diminished number of sleep hours)
Sexual libido diminished
Energy diminished
SuicidalitySelf-worthlessness and guilt
Psychomotor agitation
Anhedonia
Thought process impaired

Symptoms of Generalized Anxiety Disorder

Scanning and vigilance
Two or more worries
Organic causes should be ruled out
Motor tension
Anxiety unrelated
Course of mood or psychotic should be ruled out
Hyperactive autonomics

Side effects of lithium

Vertigo
Ataxia
Nystagmus
Intention tremor
Stupor
Hperreflexia
Leukocytosis
Insipidus (ie, nephrogenic diabetes insipidus)
T-wave inversion on the electrocardiogram
Heaviness (ie, weight gain), Hypothyroidism, Hyperparathyroidism

Symptoms of mania

Grandiosity
Racing thoughts
Euphoria
Activities, goal-directed
Talkative
Sleep deprived
Activities, reckless
Disractibility

Mental status examination

Cognitive function (calculation, concentration, insight, judgment)
Overview (appearance, attitude, level of consciousness, movements)
Memory (recent and remote)
Orientation (to person, place & time)
Emotion (affect & mood)
Speech (fluency, form, & comprehension)
Thought (process, content, & perceptual disturbances)
Attention (abstract thinking, recall, and intelligence)
Something else (that might be important to the patient)

Symptoms of Post-Traumatic Stress Disorder

Insomnia and nightmares
Re-experiences of traumatic event at a later date
Arousal is increaseda
Numbing of general responsiveness to the real world

5 Drugs causeing depression

Propranolol
Reserpine
Oral contraceptives
Methyldopa
Steroids

Differentials of Dementia, Alzheimer's

Drugs
Encephalitis
Metabolic (eg, electrolyte or liver abnormality, dehydration, acute intermittent porphyria)
Endocrine (thyroid disease, diabetes mellitus)
Normal-pressure hydrocephalus
Trauma (eg, chronic subdural hematoma)
Infection (eg, of lung or urine, AIDS, syphilis)
Affective disorder (ie, depression manifesting as pseudodementia)
Structural defect of brain (eg, infarction, tumour, abscess)

Side effects of Tricyclic Antidepressants

Anticholinergic (see above for Anticholinergic Drug Side Effects)
Antihistaminic (eg, sedation, weight gain)
Ani-alpha 1 adrenergic (eg, orthostatic hypotension)
Arrhythmogenic (eg, quinidine-like ventricular cardiac effects)

Causes of dyspnea of sudden onset

Mucous plug
Asthma,
Aspiration, RDS
Pulmonary embolus,
Pneumonia,
Pneumothorax,
Pulmonary edema,
Psychogenic
Sepsis

Causes of finger clubbing

Fibroses of lung
Infections (e.g., lung abscess, bronchiectasis, infective endocarditis)
Neoplastic (e.g., lung adenocarcinoma)
Gastrointestinal (e.g., chronic liver disease, inflammatory bowel disease, celiac disease)
Endocrine (e.g., hyperthyroidism)
Renal disease (chronic)
Cardiac (i.e., cyanotic congenital cardiac disease)

Differentials of chronic cough

When cough in nursery, rock the "CRADLE"
Cystic fibrosis
Rings, slings, and airway things (tracheal rings)/ Respiratory infections
Aspiration (swallowing dysfunction, TE fistula, gastroesphageal reflux)
Dyskinetic cilia
Lung, airway, and vascular malformations (tracheomalacia, vocal cord dysfunction)
Edema (heart failure)

Classification of arthritis

Metabolic (ie, gout, pseudogout, hemochromatosis)
Endocrine (ie, acromegaly)
Degenerative (ie, osteoarthritis)
Infectious (ie, septic joint, infectious synovitis, rheumatic fever)
Connective tissue disorders (rheumatoid factor-positive) (i.e, systemic lupus erythematosus, rheumatoid arthritis, progressive systemic sclerosis/scleroderma, polymyositis/dermatomyositis)
Inflammatory vasculitides (ie, polyarteritis nodosa, Wegener's granulomatosis, hypersensitivity vasculitis, giant cell arteritis)
Seronegative spondyloarthropathies (rheumatoid factor-negative) (ie, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis, inflammatory bowel disease)

Causes of joint pains

Sepsis
Osteoarthritis
Fractures
Tendon/muscle
Epiphyseal
Referred
Tumor
Ischaemia
Seropositive arthritides
Seronegative arthritides
Urate
Extra-articular rheumatism (such as polymylagia)

Causes of drug induced lupus

Chorpromazine
Hydralazine
Isoniazid
Methyldopa
Procainamide

Radiological Features of Osteoarthritis

Osteophytes
Subchondral sclerosis
Subchondral cysts
Space between joint diminished

Three Necessary Tests for Synovial Fluid Analysis

Cell count and differential
Crystal examination
Culture and Gram's stain

Systemic Lupus Erythematosus (SLE), Eleven Diagnostic Criteria:

1. Photosensitivity
2. and 3. Rashes (ie, 2. Discoid rash; 3. Malar rash)
4. Ulcers in mouth
5. Neurologic (ie, seizures, psychosis)
6. and 7. Elevated blood tests (ie, 6. raised antinuclear antibody; 7. positive SLE cells seen, positive anti-double-stranded DNA antibody, positive antismooth muscle antibody, false-positive VDRL test)
8. Renal (ie, proteinuria, hematuria, cellular casts)
9. Arthritis (non-erosive)
10. Serositis (ie, pleuritis, pericarditis, peritonitis)
11. Hematologic (ie, hemolytic anemia, leukopenia, thrombocytopenia)

Note: Need 4 of 11 criteria for diagnosis of SLE

Incontinence, Causes of Transient Form

Delirium
Infection of urinary tract
Atrophic urethritis
Pharmacologic agents
Endocrine (e.g., glycosuria)
Restricted mobility ("geographic incontinence" of new setting)
Stool impaction

Urinary incontinence: causes of acute and reversible

Delirium
Restricted mobility/ Retention
Inflammation / Infection/ Impaction [fecal]
Pharmaceuticals / Polyuria
"Drip" is convenient since it is urinary incontinence, so urine only drips out.

Indications of dialysis - AEIOU

Acid-base problems (severe acidosis or alkalosis)
Electrolyte problems (hyperkalemia)
Intoxications
Overload, fluid
Uremic symptoms

Causes of enlarged kidneys

Sclerderma
HIV nephropathy
Amyloidosis
Polycystic kidney disease
Endocrinophathy (diabetes)

Causes of impotence

Mnemonic - PLANE

Psychogenic: performance anxiety
Libido: decreased with androgen deficiency, drugs
Autonomic neuropathy: impede blood flow redirection
Nitric oxide deficiency: impaired synthesis, decreased
blood pressure
Erectile reserve: can't maintain an erection

Penile Pain, Differential Diagnosis: P^8

Priapism
Phimosis
Paraphimosis
Peyronie's disease
Penile tumour
Purulence (ie, venereal disease)
Prostatitis
Push (ie, coitus-related trauma/overuse)

NAMED ULCERS

• CURLING- burns > 35% in body and fundus
  
• PHAGEDENIC ULCER/TROPICAL: vincets organism
  
• TROPHIC/PRESAURE SORES/NEUROGENIC MARTORELLES: hypertension
  
• BURILLIS: m.ulcerans/m.marinum
  
• MELENEYS: postoperative gangerene
  
• BAZINS:  localised fat necrosis
  
• CUSHINGS: raised ict
  
• CAMERON ULCERS- linear gastfic erosikns in hiatal hernia
  
• KISSING ULCER-both ant and post duodenal ulcers are present( seen in urinary bladder too)
  
• HUNNERS ULCER- interstitial cystitis
  
• MALENEYS ULCER- squamous cell cancer
  
• MARJOLINS ULCER-squamous cell cancer
  
• RODENT ULCER- basal cell cancer
  
• MOORENS ULCER- Moorens ulcer-corneal ulcer
  
• SEPTIC ULCER: slopping edge
  
• TB ULCER: undermined edge
  
• MALIGNANT ULCER-everted edge
  
• RODENT ULCER: pearly edge
  
• SYPHILITIC ULCER: puncuated edge

Causes of Hypocalcemia in Surgical Patients

1. Artifactual as a result of hypoalbuminemia
   
2. Acute pancreatitis
   
3. Surgically induced hypoparathyroidism (transient or permanent)
   
4. Necrotizing fasciitis
   
5. Inadequate intestinal absorption
   
6. Excessive fluid losses from pancreatic or intestinal fistulae
   
7. Chronic diarrhea
   
8. Renal insufficiency with impaired calcium resorption
   
9. Hypomagnesemia
   
10. Hyperphosphatemia
    

Vincristine

Vincristine has a high neurotoxicity level and so must never be administered intrathecally, as it can cause ascending radiculomyeloencephalopathy -- which is almost always fatal.

Side Effects of corticosteroids

Side Effects of corticosteroids

C - Cushing's syndrome

O - Osteoporosis

R - Retarded growth

T - Thin skin I - Immunosuppression

C - Cataracts

O - Oedema

S - Suppressed HPA axis

T - Thin gastric mucosa

E - Emotional

R - Rise in BP

O - Overweight

I - Increased hair

D - Diabetes

S - Striae

Metformin and IV contrast

Metformin must be withheld before and for 48-hours after injection of IV contrast media - due to the increased risk of renal impairment, metformin accumulation, and lactic acidosis

Impertigo

Group A streptococci and S. aureus are the most common causes of impetigo

Necrotizing fasciitis

Necrotizing fasciitis is commonly associated with varicella infection, where the skin lesions are infected by Streptococcus or Staph

Diaphragm

The right hemidiaphragm will appear higher on a lateral x-ray and a PA film because the liver pushes it upward

Interstitial Syndromes of the Lung

Interstitial Syndromes of the Lung include:
• Sarcoidosis
• Histiocytosis X
• IPF (interstitial pulmonary fibrosis)
• Tumor
• Failure
• Asbestosis
• Collagen disorders
• Environmental
• Dust
• Drugs

Tetracycline

Tetracycline is an antibiotic.

Don't take with milk or other things containing calcium, bc will cause chelation and change absorption.

Also: Cholesteramine causes decreased absorption.

Quinidine

Quinidine is an anti-arrythmic drug.

It impairs Warfarin liver metabolism, so increases the amount of active Warfain, thus increasing INR and bleeding risk.

Also may be caused by decreased production of VitK in the gut.

Also: if taken with digoxin, binds to muscle tightly, so causes Dig Tox.

Probenecid

Probenecid inhibits uptake of uric acid in renal tubules.

Used in treatment of gout and to increase the action of penicillin and methotrexane (decrease excretion).

Phemobarbital

Phenobarbital is a barbituate.

It induces liver P450 enzymes that metabolize Warfarin. Thus, need to take more Warfarin when on this drug.

However, if taken patient off Penobarbital, INR rises, too much Warfarin effect.

Also: cholesteramine causes decreased abosorption.

Also: renal clearance is increased by alkalinization.

Penicillin and warfarin

Penicillin use increase risk of bleeding when taking Warfarin.

2 possibilities

1) change gut flora, so decrease amt of VitK, so increase action of Warfarin.

2) inhibit liver enzyme responsible for Warfarin metabolism.

Also: cholesteramine causes decreased abosorption.

Also: excretion decreased by Probenecid and salicylate.

Methotrexate

Methotrexate is used as chemo,

It can cause gout like symptoms from cell breakdown.

However, the drug is metabolized by xantine oxidase, so dont give with Allopruinol, as that would increase the effects of chemo.

Also: renal excretion decreased by Probenecid and Salicylate.

Lidocaine

Lidocaine is given  with epinepherine to vasoconstrict and keept drug local.

Also: in CHF, increased action of the drug because decreased blood flow.

Erythromycin and other macrolides

Erythromycin and other macrolides increase risk of bleeding when taking Warfarin. 2 possibilities 1) change gut flora, so decrease amt of VitK, so increase action of Warfarin. 2) inhibit liver enzyme responsible for Warfarin metabolism.

Also: increases Digoxin bioavailability by the above 2 mechanisms and also maybe inhibitin p-glycopritein transport system in kidney for Dig.

Epinephrine

Epinephrine is given with lidocaine to vasoconstrict and keep the drug local.

Ditropan

Ditropan is an anticholinergic.

When taken with Amitriptyline, causes abdominal distension and constipation.

Because of a pharmacodynamic interaction : tricyclics inhibit the cholinergic system via a different mechanism.

Digoxin

Digoxin binds to muscle tissue, Vd=400.

If something else binds to muscle tissue, digoxin is displaced, leading to higher blood levels and lower Vd. = Digoxin toxicity. (eg, quinidine)

Also: Can cause increased bleeding if taken with Warfarin.

Also: Cholestyramine causes decreased absorption. Also: Erthromycin increases bioavail by 3 mechanisms.

Warfarin effects and interaction

Warfarin is an anti-coagulant, b/c reduces VitK dependent clotting factor production in the plasma.

It has a narrow therapeutic index: with a little Warfarin, the INR = 2, but with a little more, INR = 6+. Highly bound to plasma (95%).

Too much Warfarin leads to bleeding.

Interactions: Increased bleeding (asprin), GI bleeding (NSAIDS), Impairment of Warfarin metabolism and increased bleeding (Quinolone or phenytoin), increased bleeding, maybe bc less VitK (sulfa drugs). Bartituates like phenobarbital increase metabolism, so need more Warfarin.

Also: cholesteramine causes decreased abosorption.

Cholestyramine

Cholestyramine is an ion exchange binding resin. Used to lower cholesterol by disrupting enterohepatic circulation. It is a charged molecule, so it just sticks to the wall and blocks cholesterol absorption. Will also block the absorption of other drugs (decreased bioavail): such as digitalis, Warfarin, phenobarbitol, tetracycline, penicillin.

Calcum

Calcium is found in milk etc. Ion, so can cause chelation. Ion binds to drug, gets trapped inside drug in a wierd shape.

It changes absorption of the drug (eg, Tetracycline).

Asprin

Asprin works by inhibiting platlet function/ anti-thrombosis/ decreases vasoconstriction. 

Pharmacokinetic: Also, is highly bound to plasma (99%), so displaces Warfarin, leading to increased levels of Warfarin that is active. Therefore increases bleeding if taken with Warfarin.

Also: decreases renal excretion of Penicillin and Methotrexate by competing for the transport mechanism.

Amitriptyline and Ditropan

Amitriptyline is a tricyclic antidepressant. If taken with Ditropan (an anticholinergic), causes abdominal distension and constipation. Because of a pharmacodynamic interaction: tricyclics inhibit the cholinergic system also via diff mech. Also: tricyclics affect membrane pump that moves nts and antihypertensive drugs into intracellular storage sites. So may alter anti-HTN treatments. Also: metabolized via CYP 2D6, inhibited by Prozac.

Allopurinol

Allopurinol is used in gout, xanthine-oxidase inhibitor. Xanthane-oxidase creates uric acid, but also metabolizes methotrexane. So, dont give this with methotrexane, even though it might be tempting to decrease gout symptoms in chemo. Also: Increased absorption if taken with iron.

Alcohol and CYP

Alcohol Induces CYP 2E1, increasing acetominophen toxicity.