Rotation Tid Bits Flashcards
Rosacea description and treatment
adult acne -> metrogel (metronidazole) -> can cause rhinophyma (inappropriately attributed to alcoholism)
Oxybutinin - MOA and use
muscarinic receptor antagonist -> used for overactive bladder (loss of bladder control, urge incontinence) by reducing detrusor muscle tone.
Triamcinolone
Trazadone
Tramadol
Toradol
Triamcinolone - steroid used for redness, itching, swelling of skin… betamethasone is stronger
Trazadone - serotonin antagonist and reuptake inhibitor - used as sleep aid.
Tramadol - opiod analgesic - round the clock treatment
Toradol (ketorolac) - strong NSAID
Anastrazole
Trastuzumab
A - aromatase inhibitor used for breast cancer prophylaxis - comes with side effects (bone weakness, BPH, gynecomastia, hypogonadism signs, stroke heart attack inflammation) *remember aromatization is increased in adipose tissue
T - HER2 antagonist “herceptin” - can cause cardiomyopathy
what is a good rule of thumb for wound care management?
if its wet dry it
if its dry wet it - diabetic wounds get debridement, vasaline, foam protection
stroke work up?
CT -> MRI HbA1c Lipids Tele Echo w/ bubble study Carotid U/S Swallow Study / SLP - PT/OT
Plaquenil
Synthroid
P - hydroxychloroquine - treats and prevents malaria, lupus, RA, Porphyria Cutanea Tarda, photodermatidis - macular degeneration possible…accumulates in lysosomes increasing pH decreases proteolysis and immune function
S - levothyroxine
whats a clinical sign of spinal stenosis? differentiate from herniated disc…
shopping cart sign = stenosis
herniated disc = dont like leaning forward
PreOperative Exam
FAIL IF —
CHF EF 20%
LFTs - bili > 2, PT >16, ammonia >150
Recent weight loss
DKA is absolute contraindication
Levoquin
levoflaxacin - flouroquinolone - topoII inhibitor - broad spec - achilles tendon rupture / tendonitis and QTc prolongation
Provigil
Flexeril
Gabapentin
P = Modafinil - not clearly understood action - unlike amphetamines - seems to inhibit dopamine reuptake - astronauts and military and narcolepsy …used for narcolepsy, shift work disorder, daytime sleepiness, OSA
F - cyclobenzaprine - muscle relaxant - causes sleepiness, not good to use while driving a car …antagonist at histamine, serotonin, and muscarinic receptors
G - brand name is neurontin - anticonvulsant/analgesic - originally made for epilepsy but also treats neuropathic pain and RLS (diabetic neuropathy, post herpetic neuralgia, central neuropathic pain) ..structurally analogous to GABA … pregabalin is lyrica
which increases PO4? vitD or PTH?
VitD
decreasing microalbuminuria…
ACEi (renal protective) -> CCB #2
first line in edema
Lasix - furosemide - loop diuretic … first line in edema
what’s something that can cause BC failure?
Mirena
Skylaa
Copper IUD (Paragaurd)
Nexplanon
birth control failure is caused by antibiotic treatment, grapefruit
M - 5 years - levonorgestrel - amenorrhea
S - 3 years - levonorgestrel - amenorrhea
C - 10 years - no hormones - bleeding spotting pads check bhCG if no splitting
N - bleed alot
“cradle cap”
seborrheic dermatitis - skin flaking
vs
seborrheic keratosis - brown coin like age spots
Symbicort
budesonide and formoterol - steroid and LABA -> asthma, COPD treatment… cant use LABA alone because it increases mortality by masking disease progression
CKD stages 1 2 3A 3B 4 5
based on GFR 1 >90 2 60-89 3A 45-59 3B 30-44 4 15-29 5 <15
cockcroft gault eq for estimating Crc
(140-Age)Mass(Kg)0.85(if female) / 72*SerumCr(mg/dL)
Centor Score in pharyngitis
estimates risk of strep pharyngitis
Age <14 Tonsils (exudate/swelling) Cervical Nodes (tender/swelling) Fever Lack of Cough**
Droperidole
antidopaminergic - antiemetic/antipsychotic - neuroleptic/analgesic
QTc prolongation / torsades de pointes / extrapyramidal side effects
haldol family knocks em out “drop-eridole”
ketorolac
NSAID - Toradol is brand name
weight gain in pregnancy
1-5 lbs in first trimester
1 lbs per week therafter
Requip
Mirapex
Reglan
Zantac
Zofran
Phenergan
Imodium
Requip - Ropinerole - nonergot dopamine agonist - Parkinson’s disease treatment
Mirapex - Pramipexole - nonergot dopamine agonist - Parkinson’s, RLS
Reglan - metoclopramide - D2 receptor antagonist - anti-emetic, gastroparesis, nausea / vomiting, GERD
Zantac - ranitidine - H2 receptor blocker - GERD
Zofran - odansetron - 5HT-3 receptor antagonist - antiemetic
Phenergan - promethazine - first generation anti-histamine - nausea vomiting motion sickness, neuroleptic/ treat insomnia where benzos are contraindicated
Imodium - loperamide - opiod u-receptors but doesn’t cross BBB - anti-diarrheal (causes constipation)
Creon
Fentanyl
Byetta n Victoza
Saxenda
Creon - pancrelipase - delayed release pancreatic enzyme capsules for patients with pancreatic insufficiency
Fentanyl - opiod pain reliever
Byetta / Victoza - exenatide / liraglutide - GLP-1 agonist - stimulates insulin release - used for weight loss and diabetes… injectable drugs (thyroid cancer risk? pancreatitis risk?)
Saxenda - liraglutide - but for weight loss
Topimax
Demadex
Lasix
Bumex
Colace
Demerol
Topimax - topiramate “dope a max” - seizure / migraine prophylaxis - complex mechanism of action - sodium channels, calcium channels, GABA-a receptors, CA inhibitions
Demadex - Torsemide - loop diuretic - treats fluid retention, works well with Lasix
Lasix - Furosemide - loop
Bumex - stronger loop diuretic
Colace - docusate - stool softener - allows more water to be absorbed by feces - laxative to treat constipation - useful in children with hard feces,
Demerol - meperidine - narcotic / opiod pain reliever
Diabetic Foot Wounds
debride
vasaline, Lubriderm (grease em up)
get rid of edema
protect feet from trauma
simethicone
oral anti-foaming agent used to reduce bloating, discomfort or pain caused by excessive gas…aka Gas-X
does albumin help furosemide diurese patients?
its helpful in patients with hypoalbuminemia due to nephrotic syndrome - it is able to increase oncotic pressure and thus GFR leading to increased diuresis.
Zosyn
Levaquin
Zosyn - piperacillin / tazobactam - penicillin with b-lactamase inhibitor…. similar to ampicillin/sulbactam or amoxacillin/clavulanic acid (augmentin) - good for pseudomonas
Levoquin - levofloxacin - fluroquinolone - antibiotic, same class as ciprofloxacin… gram negatives, topo2 inhibitors, tendon rupture.
Abilify
Zoloft
Buspar
Abilify - aripiprazole - one of the most highly grossing US drugs by sales, can cause tardive diskinesia while or after discontinuing drugs and can cause metabolic syndrome
Zoloft - sertraline - incidence of diarrhea is higher than with other SSRIs, other SEs include - nausea, trembling, sexual dysfunction and weight gain.
Buspar - buspirone - anxiolytic psychotrpoic drug, can cause dizziness, headache, somnolence, premature ejaculation (may be used to counter the effects of SSRIs) binds serotonin and dopamine receptors.
Parkinsons vs Schizophrenia … whos got the dopamine?
Parkinsons - not enough dopamine
Schizo - too much dopamine… (antipsychotics can cause extrapyramidal side effects)
Requip
Symmetrel
Senna
Ropinerol - parkinsons - nonergot dopamine agonist- for Parkinson’s / RLS…can cause hallucinations (think schizo..)
Symmetrel - Amantadine - NMDA receptor antagonist / Influenza M2 Protein inhibitor… parkinson’s and parkinson’s like syndromes
Senna - Senocot - Ex-Lax - tree bark
Heparin
LMWHs
Fondaparinux
Heparin - binds and potentiates antithrombin (AT) to increase inactivation of Xa and prevent the conversion of prothrombin to thrombin - half life 45 mins. Protamine Sulfate Reversible. Monitor PTT for IV drip
LMWHs - Lovenox - enoxaparin - same as heparin but a longer lasting effect on factor Xa - less likely to bind to other stuff (plasma proteins, endothelial cells), longer half life 4-5 hrs. Protamine Sulfate Reversible
Fondaparinux - direct Xa inhibitor - enhances the activity of AT 300 fold, no direct effect on thrombin. 17-21 hours. Not reversible… can use with HIT
Diagnosing neuroleptic malignant syndrome
elevated WBCs and CPK (due to increased muscle activity and rhabdo)
S/S - hyperthermia, confusion, diaphoresis, rigidity, autonomic imbalance… (similar to parkinson’s crisis)
People with Lewy Body Dementia are at risk - careful using neuroleptics in this population.
Caused - by dopamine receptor blockade…
Tx - Dantrolene to reduce muscle rigidity, bromocriptine (dopamine agonist), Amantidine (dopaminergic and anticholinergic properties), aggressive hydration with diuresis may be required (to resuscitate the kidneys)
cyproheptadine for serotonin syndrome
Seroquel
Quetiapine - (qwi tia peen) atypical antipsychotic - treats schizo, bipolar, depression, makes em go night night… also used for parkinson’s psychosis due to lowextrapyrimidal side effects (often used before clozapine)
QTc prolongation, sedation
What are some of the things to consider when using steroids … especially high dose?
blood sugar spikes and the need for insulin… long term you’ll need stress doses, weens, and caution for osteoporosis / cushings
Wheezes vs Crackles vs. Rales vs. Rhonchi vs. Rubs
“Inspiratory crackles, expiratory wheezes”
wheezes rhonchi (coarse wheezes) and rales (crackles)
Wheezes - constriction from asthma or bronchitis, obstruction, narrowed airways, diffuse in asthma/bronchospasm, local in tumor or FB (foreign body)
Crackles -rales - fluid, pneumonia, sound of the lung popping open from inspiration.
Rhonchi - snoring - low pitched gurgling liguid, inflammation, drownings, agonal states
Rubs - pleural friction, like crackling of new leather, either of both phases of respiration, ephemeral rubs may accompany pain, may disappear
Hospital Discharge Criteria
Completed Courses of IV therapy, No longer in need of diagnostic / therapeutic interventions, Place to discharge to…
Medication Reconcilliation,
Education for Patient,
Discharge Summary given to future providers.
Follow Up Care
What do you worry about in alcohol withdrawl? what’s the time frame in which concern is highest?
delerium tremens - tremors, hallucinations, anxiety, and disorientation - 72 hours - rule out electrolyte abnormalities (K and Mg) and vitamin deficiencies (Thiamine)
things to ask the patient…
- last drink/how often
- hospital visits
- seizures
Etoh Mechanism of Action
alcohol descreases sensitivity to GABA (cus when you drink you increase GABA so you body responds by gettin rid of it’s GABA response).. then when you stop drinking… the activity in your CNS cannot be stopped because you can’t respond to natural GABA (excess unregulated tone/excitation)
CIWA - Clinical Institude Withdrawl Assessment tool
for seizure precautions, ten item scored scale
Banana Bags
thiamine, folic acid, and 3 grams of MgSO4… plus multivitamins… used to replenish nutritional deficiencies or correct chemical imbalances.
- Mg deficiency in ICU
- Terminal Illness (as Mg can mitigate nerve pain and cramps)
- Alcoholics (who benefit from the thiamine, or chronic alche’s who benefit from B1 and Mg)
Asterixis
Disdiadokinesia
Tenesmus
A -liver flap, hepatic encephalopathy via ammonia and urea. - caused by diencephalon motor centers being disrupted
D - unable to perform repeated actions, cerebellar ataxia or cerebrum, other cerebellar dyfunctions include (ataxia, intention tremor, and dysarthria
T - recurrent or continual inclination to evacuate bowels or bladder despite being empty…
Lower Back Pain - RED FLAGS
Cauda equina - loss of function of the lumbar plexus -> severe LBP, saddle anesthesia, loss of bowel/bladder, weakness/paraplegia… caused by trauma, spinal stenosis,, inflammation.
Loss of bowel/bladder
Fever
Persistent Neurologic Loss
Cancer
Unexplained weight loss
Nocturnal Pain / Recent Weight Loss
Intermittent Neurogenic Claudication
a spinal stenosis sign
symptomatic with extension. relieved by flexion (shopping cart sign).
Cockkroft-Gault
eCcr = eGFR = 140-Age x Kg x 0.85 (female) / 72-Serumcr
Serumcr - higher if: kidney cannot filter or there’s lots of muscle
Pinguecula vs Pterygium
Pinguecula - yellow deposit of fat, protein or Ca+ near the limbus due to excessive UV light exposure… more common in hispanics
Pterygium - mebranous changes and tissue overgrowth that can cross the limbus… “surfer’s / farmer’s eye”
Complication only if crossing the iris field
CHADS2VASc score is? determines risk for? in what population?
HASBLEDD score is? determines risk for? in what population?
Risk of Thrombosis / Stroke
CHF HTN Age > 75? (2 points) DM Strokes/TIA? (stroke is worth 2 points) Vascular Dx (PVD, CAD, MI, aortic plaque) Age 65-74 Sex - Female
Risk of Bleeding (intracranial bleeds), hospitalization, hemoglobin dz, transfusion in pts. with A.Fib
HTN Abnormal renal / liver fnct (2) Stroke Bleeding Labile INRs Elderly (2) Drugs/alcohol *all others worth one point.
CBI…
continuous bladder irrigation - for potential urethral obstruction such as a blood clot…
people with polycythemia vera tend to develop which conditions?
vWF disease - most common coagulopathy - caused by reduced vWF ( a multimeric protein required for platelet adhesion ) often presents with nosebleeds, bruising, bleeding gums, long periods..
increased risk of AML - acute myelogenous leukemia
compartment syndrome
increased pressure in a body space, particularly a forearm or leg… often presents with
paresthesias. ..
pulseless. ..
pain. ..
paralysis. ..
pallor. ..
hydralazine
direct arteriolar dilator -> treats hypertension often causes bottoming out.
Protonix
Aggrenox
Plavix
P - pantoprazole- PPI
A - aspirin+dipyramidole - Cox Inhibitor + PDE5 inhibitor (blocks prostaglandins required for platelet aggregation)
P - clopidogrel - P2Y12 inhibitor - prevents ATP binding and platelet aggregations
what are the signs of a hip fracture?
shorter leg, externally rotated
what is an oral alternative to vancomycin?
linezolid (Zyvox) - expensive - vanco is for gram (+)
how do you reverse coumadin?
vitamin K + FFP….. if starting coumadin bridge with lovenox (enoxaparin)
SIRS criteria
qSOFA
systemic inflammatory response syndrome - pick two
36>T>38
Tachy >90
Tachy >20
WBCs >
qSOFA
- Change in Mental Status
- Tachypnea >22
- SBP <100
Aztreonam
the big guns - UTI, Pseudomonas - synthetic monocyclic beta-lactam
Causes of elevated troponins
long standing angina, kidney dz, pneumonia, CHF, DKA .. etc.
Epworth Sleepiness Scale
ESS - self administered questionare - asks people about chances of dozing off in certain situations - helps diagnose sleep disorders (sleep apnea and narcolepsy)
Alcohol Withdrawal Timeline
alcohol intially enhances GABA but later it suppressed GABA (or decreases sensitivity to GABA)…also suppresses activity of glutamate (excitability)… in response the glutamate system responds by functioning at far higher levels to maintain equilibrium -> increased activity of glutamate and where alcohol acts like GABA… therefore when you pull out the alcohol the inhibitor element of the system is lost -> over excitation
6-12 hours anxiety
12-24 hours hallucinations, seizures
24-48 hours withdrawal seizures become less likely
48-72 hours DTs
what is a unique sign of chronic alcohol abuse?
atrophy of the thenar and hypothenar eminence from nutritional deficiency (also consider neuropathy from nutritional deficiency)
what does every ACLS patient get? VOMIT
vitals O2 monitor IV/IO Transport
what does every hospital patient get?
IV fluids
Diet
DVT prophylaxis
serum free light chains?
oligoclonal bands in CSF?
SFLC - monitors plasma cell dyscrasias - multiple myeloma and primary amyloidosis
OCBs - suggests MS
side effect of angiotensin receptor blockers?
angioedema
what are some important post-operative considerations
Pain
Gas/Bowel Movements
Infection
PVD - arterial vs venous insufficiency
90% caused by atherosclerosis - chronic and progressive
Stages
1 - asymptomatic - bruits, aneurysm, physical exam
2 - claudication - limp/pain with motion/exercise
3 - resting pain wakes you up
4 - necrosis/gangrene
venous - pain is relieved with elevation, thick skin, significant edema, stasis dermatitis
arterial - pain at rest, relieved by motion, thin skin, pulses diminished, little or no edema, hypotrichosis
6 “Ps” of PVD
pain paresthesia pallor pulses changes poikilothermia paralysis
Carvidolol use
Metoprolol use
carvidolol - BP control
metoprolol - HR control
what is the utility of tapping a chronic pleural effusion?
nothing a chronic Pleural effusion will simply re-effuse due to the fibrosis and pulling of the lung
Jaw Claudication
one of the specific signs of temporal arteritis -> associated syndrome is Polymyalgia Rheumatica
what is clobetasol and its use?
clobetasol - glucocorticoid used for eczema and psoriasis
what causes a cough only at night?
GERD or Asthma
what are the two situations of use for a living will?
terminally ill
persistent veggitative state
AM Stiffness
PM Stiffness
AM - inflammatory - RA
PM - mechanical - OA
CCP
cyclic citrullinated peptide - RA - a little bit better
rheumatoid factor - not very specifc - never choose this on a test.
usually start with inflammatory factors - ESR, CRP
seronegative arthopathies
ankylosing spondylitis
reiter’s syndrome
enteropathic arthritis
psoriatic arthritis
Behcet’s disease
juvenile idiopathic arthritis
anti-synthetase
dermatomyositis - predilection for lung fibrosus (shawl sign, heliotrope rash, gottrons papules) .. often associated with cancer
Migraine Rx
propranolol, tryptans, topimax
what are the s/s of hypoglycemia spells, when is it important to ask about this?
hungry, dizzy, sweating
when they are on diabetic meds.. they get all.. hypoglycemic
Side Effect of CCBs
“dipine” amlodipine/nicardipine/nifedipine”
decreases HR increases Fluid retention - CCB
what can happen after 3 or more years of metformin therapy?
vitamin B12 deficiency, lactice acidosis in renal disease
what are the top 3 causes of peripheral neuropathy?
DM,
B12 (includes etoh),
Thyroid (hypo/er)
…heavy metals…
Agent Orange
Fosamax
Evista
Prolia
Remeron
Cymbalta
F - alendronic acid - prevents/treats osteoporosis, paget’s disease of bone - bisphosphonate - can cause osteonecrosis of the jaw.
E - Raloxifene - SERM - treats osteoporosis (increased estrogen play)… se- hotflashes, leg cramps, blood clots (dvt,pe), teratogen
P - Denosumab - osteoporosis, tx induced bone loss, bone mets, MM, giant cell tumor of bone… joint / muscle pain (binds and inhibits RANKL)
R - mirtazapine - NaSSA (noradrenergic, specific serotinergic antidepressant) - depression, anxiolytic, hypnotic, anti-emetic, appetite stimulant - SEs - somnolence, weight gain, dry mouth, constipation
C - duloxetine - SNRI - MDD - sexual dysfunction, anorgasmia, sleep disruption.
what are normal lung sounds in the apices?
… lower lobes?
apices - bronchovesicular (equal inspiratory / expiratory phase) at 1/2 interspaces anteriorly, bronchial over sternum (longer expiratory phase)
lower lobes - vesicular (longer through inspiration, fade through expiration).
granuloma annulare
rare - benign, unknown causes, Tx - steroids/UV light - can be confused with tinea corporis … may be associated with autoimmune conditions or neoplastic disease however loose, treatment if often futile and lasts 2-10 years.
what is a side effect of DDP-4 inhibitors?
“exenatide and luraglutide” - joint pain, not as effective as GLP1 analogs “-gliptins”
DDP-4 is an enzyme that inactivates GLP1 (a protein that would otherwise go on to stimulate insulin release)
Finasteride, Dutasteride
Doxazosin, Prazosin, Tamsulosin
F (Propecia)/D (Avodart) - 5-alpha reductase inhibitor - BPH/alopecia - decrease conversion of T to DHT -> decrease in prostate size
D, P, T - alpha-1-selective blocking agent - used for HTN and urinary retention associated with benign prostatic hyperplasia
Cutera veins
Reticular veins
Varicose veins
Spider Talengiectasias
small blue varicosities
medium blue varicosities
large blue varicositiesplugged up
spider talengiectasias - like a spider, red though, associated with cirrhosis
epulis
epithelioma
cold water osteoma
epulis - enlargement of the gingiva, can be caused by pregnancy
epithelioma - hyperplasia of the epithelium
osteoma - common in swimmers/divers, little white flecks in the external auditory meatus
Aortic Stenosis symptoms
dyspnea
syncope with exertion
chest pain
Types of incontinence - SURF
stress - increased abdominal pressure - d/t weakened pelvic floor m.s … kegals
urge - aka overactive bladder - d/t damage to bladder nerves, nervouse system, muscles - stroke, parkinsons, diabetes, MS … oxybutinin
retention/overflow - bph, weak detrusor tone, tumors / obstruction, constipation … 5aReductase inhibitors, A1 antagonists
functional - can’t make it to the bathroom in time - physical problems (arthritis) or dementia
Vesicular
Bronchial
Bronchovesicular
Amorphic
Asthmatic
Cogwheel
V - long inspiratory, bases
B - long expiratory, sternum
B - equal insp/exp, 1-2 interspaces
A - blowing air over a pop bottle like
A - long expieratory, wheezes
C - pauses
Whipered Pectoriloquoy
Bronchophony
Egophony
W - atelectasis/pneumonia/consolidation (sounds louder)
B - increased sound of syllables
E - E sounds like A ***Best PE test for consolidation
Risk Factors of Osteoporosis
Low Peak Bone Mass Old Age - Loss of Osteoclasts Sex Steroid Hormone Loss Atherosclerosis decreased activity/ weight bearing / fall risk
Glucocorticoids -> decrease T/E production -> loss of serum Ca and increased PTH
Glucocorticoids -> activation of clasts, inhibition of blasts, decreased VEGF
Diagnosis of Osteoporosis
FRAX score - fracture risk score - 10 year risk calculator, includes dxa scan… (prior fragility fx, parental hx, tobacco/alchol, steroid use, RA…)
DXA - Dual enery x-ray absorptiometry scan and serum vitamin D
0 - -1 at risk
-1 -> -2.5 or fragility fx = osteopenia mean and FRAX >3% chance of hip fx, or 20% any fracture
> -2.5 = osteoporosis
Drugs that cause osteoporosis
steroids
heparin
antiepileptics
Alendronate Zolendronic Acid Denosumab Raloxifen Teriperitide
A - oral, poor absorption - causes osteonecrosis of Jaw (especially with hx of cancer/radiation)
Z - IV if cannot tolerate oral, convenient but hard to reverse…osteonecrosis
D - Ab to RANKL, increases susceptibility to infection
R - SERM - decreases risk of breast cancer, SE- thrombosis, hot flashes
T - PTH, $, subq, adverse effects
Lunesta
Ambien
Sonata
L - eszopiclone
A - zolpidem
S - zaleplon
- non benzo hypnotics -
- SE - hang over, falling asleep while driving… somewhat addictive, increased risk of depression?
Aricept
Namenda
Exelon
Razadyne
A - donepezil - centrally acting acetylcholinesterase inhibitor, palliative tx of Alzheimer’s (increases acetylcholine in cerebral cortex), 70 hour half life, SE - GI upset
N - memantine - NMDA receptor blocker -> decreased glutamate toxicity, can cause dissociative anesthesia at supratherapeutic doses (like phencyclidine - PCP)… also acts on a bunch of other receptors.
E - rivastigmine -parasympathomimetic / cholinergic - tx Alzheimer’s and Parkinson’s dementia…can be used in patch form
R - galantamine - vascular dementia and Alzheimer’s - GI symptoms,
Obtunded vs Psychogenic Sleepiness
Obtunded - raise their arm, let it drop, it will hit them in the face; their eye lids will open easily
Sleepy - they will not let the arm hit their head; they will not let you open their eyes
Compliance vs Elasticity
deltaV/deltaP
Elasticity is the force emptying the lung - lost in obstructive lung disease
what lab value do you watch to trend DKA?
anion gap… want it closed, order BMP q 3 hours, glucose stick q 1hr, until resolved. insulin drip with fluids fluids fluids… ketone of choice to follow response to Tx…beta-hydroxybutyrate
DKA vs HHS/HHNK
DKA - ketoacidosis and hyperglycemia, fruity breath, kussmaul respirations, high anion gap metabolic acidosis
most commonly caused by infection or discontinuation of insulin therapy
S/S - both present with lethargy/obtunded, severe abdominal pain, coma, volume depletion… in acute distress*
Kussmaul Respirations
vs
Cheyne Stokes
Kussmaul - deep compensatory breathing seen in DKA
Cheyne Stokes - tachypnea and apnea cycles
anion gap equation
Anion Gap = Sodium - (chloride + bicarb)
…usually greater than 20mEq/L if in DKA
Mobile
vs
Motile
mobile - moves
moTile - moves by iTself
Hyperacusis
Presbycusis
Presbyopia
H - oversensitivity to a certain range of sounds
P - age related hearing loss
P - age related vision loss
Rapid acting
Short acting
Intermediate acting
Long acting
…insulin
Rapid - Novolog (aspart), Humalog (lispro)
Short - Humulin, Novolin (regular insulin)
Intermediate - Humulin, Novolin (NPH insulin)
Long - Lantus (glargine), Levemir (detemir)
Metalozone
Dyazide
M - thiazide like diuretic - treats CHF and HTN, can be used with loop diuretics but watch out for dehydration and electrolyte disturbances
D - hydrochlorothiazide+triamterene - thiazide diuretic + potassium sparing diuretic … also prevents Ca release into urine preventing kidney stones
which diuretics cause K loss?
loops
thiazides
osmotic diuresis (uncontrolled diabetes)
which diuretics cause K gain?
ACEs ARBs, NSAIDS, COX-2 inhibitors, heparin, tacrolimus (block aldosterone production)
spironolactone, eplerenone - aldosterone receptor antagonists (can be combined with loops and thiazides to counter K loss)
Small Fiber Neuropathy
damage to small unmyelinated peripheral nerves “C-fibers” skin, peripheral nerves, and organ… these nerves help control autonomic function
“polyneuropathy” - usually starting in longer nerves and progressively attack shorter nerves (thus they start in distal extremities)
many causes, no cure, sometimes they try IVIG or plasmapheresis.
lewy body dementia triad
fluctuating cognition
parkinsonism
hallucinations - that are nice
who would you get a consult from for post stroke driving status?
occupational therapists can help with that.
Grading Strength 0-5
0 paralysis 1 visible contraction 2 ROM without Gravity 3 ROM only Gravity 4 decreased strength 5 normal
Grading Edema 1-4
+1 - Trace - 2 mm rapid return to normal
+2 - Mild - 4mm indentation, rebound few seconds
+3 - Mod - 6mm indentation, 10-20s
+4 - Sev - 8mm indentation, >30s
- *also always check peripheral pulses and capillary refill
- *note hair loss for determining length of edema
Grading Pulses 0-4
0 absent 1 weak 2 normal 3 strong 4 bounding
Mallampati Score
can be done with or without phonation but advise that this will change the interpretation
Class 1 - complete visualization of soft palate
Class 2 - uvula dips behind tongue
Class 3 - visualize only the base on the uvula
Class 4 - no visualization
Grading Reflexes 0-4
0 absent even with reinforcement 1 present only with reinforcement 2 normal 3 brisk 4 hyperactive/sustained with clonus
what does a good drug accomplish?
decreased…
mortality
hospital stay
increased…
quality of life
what vaccine is important for people with heart disease?
flu vaccine
angioedema is a side effect of which medication?
acei’s arb’s
why’s bactrim bad for old people?
TMP/SMX
more senstive to its effects - skin reactions, bone marrow problems, or high potassium…
can have supratheraputic blood levels due to loss of renal capacity.
what is procalcitonin and why is it clinically significant?
precursor to calcitonin released by the thyroid parafollicular cells -> rises in response to infection especially of bacterial origin, best studied in respiratory conditions like pneumonia
at what CRP level would you expect infection?
CRP > 120 likely bacterial
Spiriva
Atrovent
Combivent
Dulera
Symbicort
S - Tiotropum - anticholinergic
A - Ipratropium - anticholinergic
**COPD and asthma - less severe anticholinergic SEs than oral…include dry mouth sedation..headache
C - Ipratropium with Albuterol
D - Mometasone / formoterol - steroid and long acting b-agonist - COPD
S - budesonide / formoterol - similar to dulera
Acapella
a rehabilitative breathing device for bronchitis and for clearing mucous secretions.
how to treat COPD exacerbations?
prednisone 40-50mg q5 days and Abx
DDx for inborn disorders of hypercoagulability
factor 5 leiden - resistent to cleavage by protein C which encourages clotting, 6% of white people, rare in others.
protein C&S deficieny
AT3 deficiency - inactivates thrombin, selective proteinuria in nephrotic syndrome.
Antiphospholipid syndrome - placental ischemia and multiple miscarriages is the presenting sign. lupus anticoag, anti-b2-glyocoprotein-1 or anti-cardiolipin
hyperhomocysteinemia - increases coagulability
increased fibrinogen / d-dimers
malignancy
CHF / A.Fib
Obesity
Varicositiy
Fentanyl
Dilaudid
Percocet
Lortab
Demerol
In Descending potency
D - hydromorphone - very potent opiod - more potent than morphine
F - potent opiod with rapid onset and short duration - 80-100x more potent than morphine, transdermal patch in chronic pain tx - SE: diarrhea, nausea, constipation, dry mouth, somnolence, confusion, asthenia (weakness)
P - oxycodone/paracetamol (acetominophen)
L - vicodin - hydrocodone/paracetamol (acetominophen)
D - meperidine - less potent than morphine
oxycodone and hydrocodone (codeine derived - methylated morphine) have similar properties - hydrocodone is more likely to cause constipation and stomach pain
hydromorphone (morphine derived)
constricted pupils
dilated pupils
nystagmus
constrition - miosis - opiods / heroin
dilation - cocaine, decongestants / meth, weed, hallucinogens
nystagmus - PCP, inhalants, depressants
whats the difference in presentation of an atypical migraine resulting in focal neurologic defecits and tia/stroke?
where does a pure motor stroke occur?
where does a pure sensory stroke occur?
onset - migraine comes on slower, stroke is immediate!
motor - internal capsule
sensory - thalamic
what are the steroid dose equivalents?
Dexamethdasone > methylprednisone (solumedrol) > prednisone/nisolone > hydrocortisone
H - 20mg
P/P - 5mg
M - 4mg
D - 0.75mg
minoxidil
androgen induced hair loss therapy to vertex only
originally developed as a vasodilator for hypertension
side effects include may initially cause hair loss to area of application, vasodilatory effects, and hypersensitivity to the drug or vector (vehicle - alcohol/propylene glycol)
relative polycythemia
a type of secondary polycythemia - > apparent rise in RBCs in blood… with actual cause being reduced blood plasma.
Gaisbock syndrome - hypertension in obese men -> reduced plasma volume, especially sedentary lifestyles and high caloric intake.
Tagamet
Remeron
T - cimetidine - H2 blocker prevents release of HCL in stomach for GERD related ulcers
R - mirtazapine - antidepressant / antiemetic
chigger bites
remember what these look like - they are the little red bugs that are found in grass and crawl on you almost imperceptibly
tx - topical hydrocortisone or benadryl
is it peripheral neuropathy?
if it’s painful all the time, yes
if it’s relieved by raising the feet, no, then it’s venous insufficiency -> horse chestnut extract
herpes infections of the eye…
herpes zoster ophthalmicus - CNV3 distribution - a variant of shingles -
herpes simplex keratitis - geographic epithelial defects on florescien stained conjunctiva
discoid lupus erythematosis
tends to prefer the face - sores with inflammation
Diarrhea DDx in elderly person
Clostridium difficile
Abx associated
Norwalk / Norovirus
Bouchard’s nodes
Heberden’s nodes
Trigger finger
B - proximal interphalangial joints -
H - distal interphalangial joints - arthritis most commonly osteoarthritis, more common in women
T - a type of tenosynovitis where the flexor tendon becomes larger than the flexor retinaculum, tx - steroids x2, then surgical release of the retinaculum
where is alk phos found / released?
liver, bone, intestine, placenta
if questioning do a fractionated alkphos
what Abx for diabetic foot ulcer?
Levoquin - aerobics
Flagyl - anaerobics (don’t drink on dis shiz)
what disease is associated with dermatitis herpetiformis?
celiac’s disease
Doxycycline
not for kids for lyme disease, but yes for kids with RMSF
works as antibiotic and antiinflammatory
who are some people who don’t show fevers as well..
Elderly
CKD
Steroids
Tylenol
Hypertrichosis
Hypotrichosis
Hirsuitism
Alopecia Areata
Greying Hair
Hypertrichosis - excessive hair growth, aka Ambras syndrome - anorexia/bulimia, hypothyroid, drugs (minoxidil, phenytoin, hydrocortisone)
Hypotrichosis - may be a sign of hypopituitarism, or drugs that block testosterone
Hirsuitism - androgen mediated excess in hair, androgen secreting tumor, cushings, PCOS, late onset CAH, drugs…
Alopecia Areata - autoimmune hair loss, may accompany trachyonychia (sand paper nails), or ophiasis (wedge shaped hair loss) … commoner in children and female.. can happen to anyone at anytime
Greying Hair - age related, albinism, vitiligo, pernicious anemia, chloroquire Tx
*treatment of hair loss, locks of love, minoxidil…
Acanthosis nigricans
ACTH stimulates melanin production as well as melanocyte stimulating hormone…
excess androgen (cushings, acromegaly, PCOS)
insulin resistance / often obesity related - increased insulin (due to resistance -> increase IGF-1 stimulation of keratinocytes
hereditary - FGF variants
Malignancy - GI adenocarcinoma, GU cancers of prostate, breast, ovary..increased TGF -> epidermal tissue.
**acral acanthotic anomaly -> limited to elbows, knees, knuckles and dorsum of feet -> normal in the abseonce of other findings, ie healthy people.
brown skin conditions
hemosiderin deposits from hemochromatosis
stasis dermatitis - brown pigmentation from venous insufficiency (gets better with elevation - tx horse chestnut extract)
acanthosis nigricans - endocrine, hereditary, benign, malignancy
blue skin conditions
Arggria - silver salts - blue gray
Ochronosis - alkaptonuria -> black accumulations due to lack of homogentisate oxidase - over pinnae, tip of nose, black extensor tendons of hands
Chrysoderma - occasional parenteral administration of gold salts in arthritis tx -> blue/grey skin
yellow skin conditions
Jaundice, Icterus, Bilirubinemia
Carotenemia - orange skin, mangos, apricots, carrots, green veggies.. or inability to metabolize carotene due to liver failure.. or in myxedema or DM
Windkessel
german to english means air chamber but generally taken to mean
elastic reservoir
ABPI
ankle brachial pressure index > 1.3 - 1.5 is diagnostic of PVD, medial calcific sclerosis, atherosclerosis… et al.
Panniculitis
inflammation of subcutaneous adipose tissue - tender skin nodules and systemic signs including weight loss and fatigue.. associated with SLE, A1AT deficiency, scleroderma, pancreatic dz,
calciphylaxis
skin necrosis from ca precipitation in tissues
low RDW with target cells on blood smear…
little variation due to genetic disease -> thallassemia
sideroblasts
nucleated RBCs from the marrow with iron laden mitochondria forming a ring around the nucleus due to an inability to incorporate iron into hemoglobin
high homocysteine normal methylmalonic acid (MMA)…
high homocysteine and high methylmalonic acid (MMA)…
folate deficiency - macrocytic, may also see hypersegmented neutrophils
vitB12 deficiency - macrocytic, may also see neurologic signs
direct bilirubin
indirect bilirubin
conjugated, made and comes directly from the liver, high in bile duct obstruction
if indirect / unconjugated bilirubin is high this suggests increased hemolysis.
minute volume
the volume of gas inspired or expired from the lungs per minute… although it sounds like a measure of volume it is actually a measure of flow (v/min)
causes of shock included
decreased pre load (hypovolemic)
decreased cardiac output (cardiogenic)
decreased SVR (septic/anaphylactic/drugs/toxins)
dopamine
10ug/kg/min - A1 agonist - vasoconstriction (^ SVR)
dobutamine
B1 > B2
primarily inotropic (contractility) and chronotropic (rate) stimulator
some level of vasodilation (via B2 stimulation)
Plaquenil
P - hydroxy chloroquine - used for malaria, RA, lupus and others - can cause retinal toxicity though but verify both daily dose and lifetime exposure to calculate risk in a patient.
Palindromic RA
RA that comes and goes and bops around to different locations…
what is a fund and interesting treatment for vestibular dysfunction?
valium otherwise meclizine
Estimating TBSA for burns…
Degrees of burns - 1st, 2nd, 3rd, 4th
use rule of 9s
1st - epithelial layer 5-10 day heal time
2nd - epidermis, supeficial dermis - blisters, deeper dermis may scar, blisters
cilcoprix3rd - epidermis, dermis, subQ fat
4th - epidermis, dermis, subQ fat, mucles/tendons
a good topical NSAID for burns or skin pain
Voltaren - diclofenac - also used for AKs, arthritis
seborrheic dermatitis
chronic actinic dermatitis
seborrheic keratosis
actinic keratosis
lentigo senilis
stasis dermatitidis
SD - dry flakey scaley itchey red skin inflammation, found on babies and is called cradle cap - particularly effects areas with sebaceous glands - Tx ketoconazole, ciclopirox, selsun blue
CAD - a chronic skin condition where the afflicted’s skin gets inflammed with exposure to sunlight.
SK - benign nodular pigmented lesions with “stuck on” appearance that originate in keratinocytes
AK - aka solar keratosis - precancerous patch of thick scaly or crusty skin -> form squamous cell carcinoma
LS - liver spots, solar lentigo - freckles or blemishes in the skin associated with normal aging and exposure to UV light - not actually caused by the liver or liver disease
StD - hemosiderin laden hyperpigmentation from increased extravasation and hemolysis due to venous insufficiency
Langer Lines
lines of tension for excisions and incisions
use 3:1 ratio for excisional biopsy, make single swipe verses multiple little hashes, sew towards yourself
empirical pseudomonas treatments
beta-lactam (cefipime, ceftazamine) with an amino glycoside (gentamycin)
ciprofloxacin is a good treatment
zosyn - piperacillin/tazobactam - especially for critically ill patients
Chronic alcohol consumption has what two effects on lab studies
decreased Mg/K
bone marrow suppression (pancytopenias)
beta1 selective-blockers - MANBABE
metoprolol
atenolol
nebivolol
bisoprolol
acebutolol
betaxolol
esmolol
decrease heart rate more than they decrease BP (rate controllers)
scopolamine
s - muscarinic antagonist - good for N/V post operatively, also good for drying up secretions in people who are in the active dying process
bird fancier’s lung
vs
parrot fever
BFL - a hypersensitivity pneumonitis - caused by bird droppings, lungs become inflammed with granulomatosis - can have ground glass radiography, fibrosis, may have s/s within a few hours of exposure acutely or chronic exposure can lead to fibrotic changes….treated similarly to allergies / asthma - beta-agonists/steroids
PF - psitticosis - chlamydiophila psittaci - contracted from infected parots (macaws cockatiels) and from, pidgeons, sparrows, ducks, hens…presents as atypical pneumonia can have low white count early, Horder’s “rose” spots, splenomegaly and/or epistaxis - tx doxy/tetracycline
what is the blood sugar range you keep people in ICU or higher acuity settings?
keep them higher rather than lower - 140-180s this improves mortality rather than risking hypoglycemic conditions (high blood sugar is bad long term, low blood sugar is bad short term)
neutropenic fever
aka febrile neutropenia - single temp > 38.3 or 1 hour > 38 with neutropenia… generally recognized as a complication of chemotherapy where there is supression of the bone marrow.
treat with empiric antibiotics, treatment may need to continue for 2 weeks if it’s unresolved, no change in fever after 72 hours add antifungal
Ranson Criteria GALAW and CHOBBS (48 hrs after admission) - non-gallstone ileus
predicts the severity of pancreatitis - GALAW at admission, CHOBBS within 48 hours …
Glucose >200mg/dL AST > 250 IU/L LDH > 350 IU/L Age > 55 WBCs > 16k
Calcium < 8.0 mg /dL Hematocrit fall > 10% PaO2 < 60 mmHg Base Deficit > 4 mEq/L BUN > increased by 1.8 or more after IVFs Sequestration > 6L
when is it a bad time to use bactrim?
if the patient is on an ACEI, elderly folks
dihydroperidine CCBs
vs
non-dihydroperidine CCBs
DHP - “-dipine” amlodipine - dipin down the blood pressure / reduce systemic vascular resistance - SEs - edema, dizziness/HA/redface, constipation, gingival overgrowth
NDHP
Phenylalkylamines - verapamil - selective for myocardium used to reduce myocardial O2 demand and reverse coronary vasospasm for angiina
Benzothiazepines - Cardizem - diltiazem - intermediary between DHP and NDHP - decreases SVR and reduces reflex tachy
Gabapentinoids - gabapentin/pregabalin - epilepsy/neuropathic pain
intrathecal route….
directly into CSF
what antibiotic is bad to mix with amlodipine?
clarithromycin - leads to severe hypotension
Loop Diuretics
furosemide - Lasix - use a K supplement…
K sparing diuretics
spironolactone - aldosterone antagonist, anti-androgen - diuretic, treats hypokalemia, secondary hyperaldosteronism (in cirrhosis), conn’s syndrome (primary hyperaldosteronism)
eplerenone - similar to spironolactone but much more selective for the mineralcorticoid receptor (used mostely for diuresis)
amiloride - blocks ENaC in distal tubule, collecting ducts - promotes sodium and water loss and K sparing
triamterene - Dyazide (when combined with HCT) - same as amiloride
**Careful if using salt replacements as they often contain KCL
treating hypertension in pregnancy
1ST LINE - Labetolol 200-2400 mg/day
also - methyldopa, nifedipine
- thiazides only ok if already on them prior to gettin pregs
- ACEs/ARBs - contraindicated d/t teratogenicity
what are a few causes for posterior shoulder dislocation
electrocution, epileptic seizure, motorcycle accident
malingering
Munchausens
factitious disorder
somatic symptom disorder
illness anxiety disorder
conversion disorder
M - faking it and they know they’re faking it and they know why they’re faking it - usually to get out of something
M - hospital addiciton syndrome, thick chart syndrome - unclear whether or not these folks know they’re doing it or not.
F - deliberately producing symptoms to be cared for or treated
SSD - have symptoms but they are not real - includes conversion, IAD, body dysmorphia, pain disorder
IAD - excessively worrying about getting a disease
C - converting emotional stress into physical symptomology, can be discovered when sx dont match any neuromuscular disease
spinal muscular atrophy - I (infantile), II (intermediate), III (juvenile), IV (adult onset)
I - werdnig-hoffman dz
II - dubowitz dz
III - kugelberg-welander dz
IV - adult
- AR defect in SMN1 gene (most common genetic cause of infant death) necessary for survival in motor neurons, loss of protein causes loss of anterior horn cells with system wide muscle wasting, proximal muscle wasting first
- loss of motor without loss of sensory
apoplexy
loss of consciousness due to intracranial hemorrhage or stroke
anasarca
wide spread soft tissue edema
loperamide
weak narcotic with no CNS activity but still has the side effect of slowing the bowels… used for diarrhea
Valium
Xanax
Ativan
Versed
V - diazepam - PO/IV Rapid Onset - peaks in 1 hour - 20-50hr t1/2
X - alprazolam - PO Intermediate - peaks in 0.5-1.5hr - 6-20hr t1/2
A - lorazepam - IV Rapid, PO Intermediate - peaks in 1-1.5hr - 10-20hr t1/2
V - midazolam - IV Most Rapid - peaks in 0.5-1 hr - 1-4hr t1/2
Lyrica vs Gabapentin
L is the brand name, more expensive and may be habit forming.
gabapentin is the generic
*a type of CCB
N-acetyl-cysteine
Guaifenesin
N - tylenol OD / expectorant / thins secretions
G - expectorant - unknown MOA but increases volume of secretions and decreases viscosity of secretions - SE N/V/D/C kidney stone … take with lots of fluids
SLE treatments
hydroxychloroquine, methotrexate
Mesenteric Ischemia
acute abdominal pain, risk factors for thrombosis (afib, CHF, CKD, MI)
4 mechanisms - blood clot forms somewhere else and travels to mesenteric bowel, clot forms within bowel artery, clot forms in bowel vein, decreased perfusion d/t low pressure or arterial spasm.
dx - clinical picture, CT with dilated loops of bowel
tx - stenting, anticoags/thrombolytics, intervential radiology/surgery.
what is the treatment for hepatic encephalopathy?
lactulose - laxative that also decreases excess ammonia production from gut bacteria
+
Spironolactone / Lasix (100/40mg starting up to 4x this each)
Treatment for aspergillus?
Treatment for PCP pneumonia?
steroids
bactrim
Celebrex
parecetamol
Florinef
Pravachol
Sinemet
Celecoxib - selective cox2 inhibitor - useful NSAID that does not increase bleeding risk - anti-pyretic, analgesic, anti-inflammatory reactions.
P - tylenol/acetominophen
F - fludrocortisone - treats hypotension - corticosteroid with moderate glucocorticoid activity and potent mineralcorticoid activity. (basically an aldosterone analog)
P - pravastatin - lowest incidence of aches and pains or side effects… try with coQ10
S - levodopa/carbidopa
Premarin
pregnant mare urine - conjugated estrogens - HRT - treats hot flashes in women with hysterectomy as well as burning, itching, and dryness of vaginal areas
SE - yeast infections, vaginal spotting/bleeding, painful menses, cramping of the legs
Otezla
O - apremilast - PDE4 inhibitor, which inhibits TNFa production from human rheumatoid synovial cells… anti-inflammatory.
Psoriatic Arthritis, Plaque Psoriasis, AnkSpondy, Behcets, RA
Pathergy
a skin condition where even a small bump or trauma to the skin leads to formation of lesions or ulcers…
Behcets and Pyoderma gangrenosum
stachybotrys
black mold/toxic black mold - found in places with poor indoor air quality especially water damaged building materials… bleach is recommended to remove the mold.
enthesopathy
disorder involving the attachment of tendon or ligament to bone. the site of attachment is known as the entheses.
If it is know to be inflammatory it’s called enthesitis… similar to continuum distortion.
ESR vs CRP
ESR - increases in the presence of inflammation when increased fibrinogen causes RBCs to stick together. Userful for PMR and Temporal Arteritis. signals more of a chronic inflammatory process.
CRP - made in liver, binds phosphocholine on dead or dying cells (apoptotic) to activate the complement and immune system (to enhance phagocytosis by macrophages). rises within 2 hours of insult half life is constant at 18 hours.
what is one way to reduce side effects of methotrexate?
take folic acid supplements with low dose MTX used for arthridities… high dose MTX is useful for malignancy…
5-27.5 mg / week folic acid with 24 hours after MTX dose
Midodrine
Florinef
Octreotide
M - vassopressor / antihypotensive agent - alpha-1-agonist - does not cross CNS so there are no CNS side effects… Uses - symptomatic orthostatic hypotension… has been used with ostreotide for hepatorenal syndrome. SEs include normal sympathetic responses (dry mouth, flushing, feeling pressure/fullness in the head)
F - fludrocortisone - treats hypotension - corticosteroid with moderate glucocorticoid activity and potent mineralcorticoid activity. (basically an aldosterone analog)
O - somatostatic mimetic - more potent inhibition of GH, Glucagon and Insulin than natural hormone. Treats gigantism/acromegaly, diarrhea/flushing assoicated with carcinoid syndrome, and diarrhea in people with VIPomas
Pseudotumor Cerebri
NPH
Tonsillar Herniation
Central Pontine Myelinolysis
PC - aka idiopathic intracranial hypertension - increased intracranial htn in the absence of clear etiology (papilledema blindness more common in women)
NPH - incontinence, ataxia, dementia
TH - rapid correction of hypernatremia - water moves from blood to brain (swells) causes cerebral edema, tonsillar herniation, or multiple cerebral hemorrhages… in TH the cerebellar tonsils press through foramen magnum and compress the brain stem.
CPM - rapid correction of hyponatremia - water moves from brain to blood (shrivels) correct sodium at a rate of no more than 12-20 mmol/L sodium per day. Damage to the myelin sheath -> acute paralysis, dysphagia, dysarthria
Depakote
Tegretol
Keppra
D - Valproate - anticonvulsant and mood stabilizer - epilepsy, bipolar, migraine prophylaxis - MOA - many different binding sites, GABA/sex steroid receptor binders, PIP3 reduction… SE - NVD, diplopia, thrombocytopenia
T - carbamazepine - epilepsy, schizophrenia, neuropathic pain, not effective for abscence seizures or myoclonic seizures… SEs - nausea, drowsiness, aplastic anemia, seizures if you stop taking it suddenly, spina bifida for pregnant women.
K - levitiracetam - apilepsy
leuko. ..
neutro. ..
Left shift -
leukocytosis
neutrophilia
LS - baby WBCs indicate infection vs demargination for example
Sicca vs Sjogrens
Sicca - dryness of the exocrine glands particularly the eyes and mouth, it is just a symptom complex. Can be caused by sjogrens, radiation tx to the head, certain medications, HepC/HIV
Sjogren’s - may affect any organ in the body that secretes moisture, saliva, tears, nasal passages, sinuses, throat, skin, vag
