- Eosinophiluria, eosinophilia, low grade fevers, mild proteinuria, and arthralgias, in the setting of exposure to medication, should raise your suspicion for acute interstitial nephritis (AIN). The most important treatment is to stop the offending agent.
- Autosomal dominant: Adult polycystic disease, Familial hypercholesterolemia (Type IIa), Marfan’s syndrome, Neurofibromatosis (Types 1 and 2), Von Hippel-Lindau, Huntington’s disease, Familial adenomatous polyposis, Hereditary spherocytosis
- CO poisoning is characterized by carboxyhemoglobinemia, cellular hypoxia, a normal arterial blood gas (normal PaO2) and a normal O2-saturation (measured with pulse oximetry).
- Hepatitis B is the most commonly transmitted infectious disease acquired during the transfusion of blood products.
- Raloxifene should be avoided in women with a past history of thrombosis.
- Clomiphene is used in anovulation and acts as an antagonist at the hypothalamus. Tamoxifen is used in breast cancer (antagonism in breast) and acts as an agonists at the uterus and bone. Raloxifene is used in breast cancer (antagonist in breast) and osteoporosis (agonist in bone), plus it acts as an antagonist at the uterus thus is not associated with endometrial cancer risk.
- Otitis externa with questionable tympanic membrane perforation should be treated with ofloxacin otic, even if on an existing course of antibiotics.
- Newborn follow-up after early discharge should take place in 2 days.
- Status epilepticus refers to an epileptic seizure that lasts more than 30 minutes or a constant or near-constant state of having seizures. Initial therapy for status epilepticus should include a benzodiazepam medications such as lorazepam . Alternative medications would include diazepam or midazolam. Phenobarbital and phenytoin are also used to treat status epilepticus, but they are second-line agents and should not be used until lorazepam has been tried first. Valproic acid and levetiracetam are use to treat seizure disorders, but they are not used in the acute management of status epilepticus.
If a patient in status epilepticus does not respond to lorazepam, then phenytoin should be administered. If the patient does not respond to phenytoin, then phenobarbital, pentobarbital, midazolam, or propofol can be tried. - Alprazolam (Xanax) is a short-acting benzodiazepines which can produce confusion and amnestic problems like blackouts in the elderly population.
- Torsions occur literally when there is torsion at the SBS. The sphenoid will rotated to one direction and the occiput will rotate to the opposite direction. They are named for the greater wing of the sphenoid that is more superior. Therefore this torsion is a left torsion as the left greater wing is more superior. In side bending rotation, the sphenoid and the occiput will be rotated to the same direction, therefore this strain pattern cannot be side bending rotation These strains are named for the area of convexity that they create. In a lateral strain the sphenoid will simply deviate laterally without rotation at the SBS. It is named for the direction in which it deviates in relation to the occiput.
- The best post-treatment test to assess the eradication of H. pylori following therapy is the urea breath test because it is non-invasive and has a high specificity.
- Assess leg length discrepancy by measuring the distance from the anterior superior iliac spine (ASIS) to the medial malleolus on each side. Measurement of leg length should be correctly determined by drawing a straight line from the anterior superior iliac spine (ASIS) to the medial malleolus of the same extremity. Anatomical leg length discrepancies most commonly occur following unilateral total hip replacements. Structural findings include the following: sacral base unleveling (the sacral base will be lower on the side of the short leg), anterior innominate on the side of the short leg, posterior innominate on the side of the long leg, and a lumbar dysfunction (type I) with sidebending away from and rotation toward the short leg.
Elderly persons should undergo therapy with an initial heel lift of approximately 1.5 mm (1/16”), whereas flexible persons should begin with a heel lift of approximately 3.2 mm (1/8”). In the above case, the full distance should eventually be replaced with incremental 1/16” increases in heel lift thickness every two weeks until this goal is reached. The flexible patients should undergo incremental lifts of 1/8” until ½ to ¾ of the measured discrepancy is reached. There is no indication that increasing the frequency of osteopathic manipulative therapy at this time will yield the best results - Common early signs of pregnancy include the following:
- Closed angle glaucoma presents acutely with a unilateral headache, blurry vision and a non-reactive pupil. It can be triggered by anti-cholinergic medications.
A high optic cup/disc ratio is the fundoscopic finding for chronic (open angle) glaucoma. - Diarrhea is the most common complication of measles.
- The classic ECG finding of hypothermia is the Osborn wave (or prominent J wave), which is an extra positive deflection between the terminal portion of the QRS complex and the beginning of the ST segment. The Osborn wave is usually positive in the left precordial leads, and has an amplitude that is inversely proportional to body temperature. Other ECG changes caused by hypothermia include prolongation of the PR, QRS, and QT intervals, T wave inversion, and bradyarrhythmias consisting of sinus bradycardia, junctional rhythm, or atrial fibrillation with a slow ventricular response. Profound hypothermia (core temperatures < 32 C) causes peripheral vasoconstriction, impaired enzymatic activity, decreased cardiac output, and reduced respirations. Complications of hypothermia include aspiration pneumonia, adult respiratory distress syndrome, pulmonary edema, rhabdomyolysis, acute tubular necrosis, gastric dilatation, upper GI bleed, hyperviscosity syndrome, and DIC.
- The level-II ultrasound is the best test to assess fetal limb development and cardiac function, given its extensive ability to view the heart.
- Lithium use during pregnancy has been associated with Ebstein's anomaly, which is a congenital malformation of the heart caused by apical placement of the posterior and septal tricuspid leaflets. This leads to atrialization of the right ventricle.
- As a code team leader arriving to a patient with cardiopulmonary resuscitation in progress, the next step is to check for a pulse.
- Hereditary hemochromatosis is characterized by diabetes, skin pigmentation and cirrhosis of the liver. It is caused by iron accumulation.
- Amiodarone pulmonary toxicity can present as community-acquired pneumonia that is unresponsive to antibiotic therapy.
Autosomal recessive: Cystic fibrosis, albinism, alpha-1 antitrypsin deficiency, phenylketonuria, thalassemias, sickle cell anemia, glycogen storage diseases, hemochromatosis
X-linked recessive: Fragile X, Duchenne’s muscular distophy, Hemophilia A and B, Fabry’s disease, G6PD-deficiency, Hunter’s syndrome, Wiscott-Aldrich syndrome
Mitochondrial inheritance: Progressive external ophthalmoplegia, Myoclonus epilepsy
X-linked dominant: NONE
1- Neck: T1-T4
2- Heart: T1-T5
3- Lungs: T2-T7
4- Esophagus: T2-T8
5- Foregut (Stomach, liver, gallbladder, spleen, portions of the pancreas and 1st and 2nd parts of the duodenum): T5-T9
6- Midgut (Portions of the pancreas and 3rd and 4th portions of duodenum, jejunum, ascending colon, proximal 2/3 of transverse colon, ilium): T10-T11
7- Hingut (Distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum): T12-L2
8- Appendix: T12
9 Upper ureters: T10-T11
10- Lower ureters: T12-L1
11- Adrenal medulla: T10
12- Kidneys: T10-T11
13- Bladder: T11-L2
14- Uterus and cervix: T10-L2
15- Prostate: T12-L2
16- Upper extremities: T2-T6
17- Lower extremities: T11-L2
Chadwick's sign: Bluish discoloration of vagina and cervix.
Goodwell's sign: Softening and cyanosis of the cervix at or after 4 weeks gestation.
Ladin's sign: Softening of the uterus after 6 weeks gestation.
Other signs: Breast swelling and tenderness, development of the linea nigra from the umbilicus to the pubis, telangiectasias, and palmar erythema.
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