8-17-11

DeQuervain tenosynovitis: cuased by inflammation of abductor pollicis longus and extensor pollicis brevis tendons as they pass by radial stylod process. finkelsten test positive.(grasping flexed them into palm=pain)

Alz: subtle memory loss, language difficulties, apraxia-->impaired judgement and personality changes-->late psychotic features

Pick's: fronto-temporal dementia. Personality changes, compulsiveness, hyperorality, and impaired memory. Visuospatial in tact

Lewy Body: fluctuating cognitive impairment and bizzare, visual hallucinations. Parkinsonism, poor response to DA agonists, and worsens with neuroleptics.

Multi-infaract: 15-20% of demetia. Cognitive, motor, and sensory dysfunction. Sudden deterioration in the fxnal capacity after each attack. Risks: older age, male sex, black race, cigs, HTN, DM, vasculitis.

ORAL isoretinoin

Parkinsons, younger patient with tremor as primary symptoms

ACEi, NSAIDS, K-sparing diuretics like amilioride and spironolactone. If cardiotoxicity, or paralysis, K>6.5, GIVE 10ML OF 10% CALCIUM GLUCONATE(stabilize cardiac membrane) and IV dextrose+Insulin.

Vestibular Vertigo(inner ear)...must differentiate from other types of "dizziness: lightheaded, imbalance, syncope". Other vestibulopathies: meineres, perilymphatic fistula, Benign positional vertigo, labryinthitis, and acoustic neuromas

1. fluid overload not responsbie to meds
2. Hyperkalemia not responsive to meds
3. Uremic pericarditis (anemia, BUN>60, sx of pericarditis). Seen in 10% of pt with Chronic Renal failure, often hemorrhagic pericarditis. NSAIDS ARE NOT USED TO TX UREMIC PERICARDITIS!
4. Refractory metabolic acidosis

Contraindications: debilatating chronic dz and sever irreversible dementia.

EtOH, Gallstones, and Coffee intake.

SMOKING IS THE MOST CONSISTENT REVERSIBLE RISK FACTOR FOR PANCREATIC CANCER

Lead posining, ask about occupational exposure in adults, which is MCC (batteries, pigments, paint, radiators.)
Dx: Basophilic stippling
Tx: EDTA or succimer chelators.

Enhance naturiesis, dec ATII, and dec Aldosterone

aortic regurg, its a common exam finding, dissection is one of the most common fatal complications of Marfan's

Sphincter of Oddi dysfxn, common bile duct stone, functional causes. Like functional if no increased in Alk Phos or no dilation of biliary tree.

INCREASED TURNOVER AND CATABOLISM OF PURINES. PV(40% get gout) IS A COMMON ONE, AND CAUSES PRURITIS with warm water AND SPLENOMEGALY.

decreased. Get permanent ventriclular dialation with no increase in ICP. Wet, wacky, wably.

Psychosocial causes/anxiety

AR, mutation in chrom 6, causes increased intestinal absorption, accumulates: liver, pancreas, heart, adrenals, testes, pituitary, kidneys, joints, and skin. BRONZE DIABETIC. Late: cirrhosis and pancreatic insufficiency, CHF, and hypogonadism. Increased levels of ferritin and serum Fe.

tx; weekly phlebotomy, then deferoxamine after 2-3 yrs or for patient who cannot tolerate phlebotamy

14 d of oral doxycycline, or a single dose of oral azithromycin.

Iv aqueous crystaline penicillin

Start heparin and warfarin at same time, and stop heparin 5-6 d later. Bridge therapy. (continue warfarin for 6 months for first time clot, lifelong is second clot).

Membranoproliferative type 2, also called dense deposit disease. Unique in that it has C3 nephritic factor, and IgM that activates C3 convertase-->leads to persistent activation of the alternative complement pathway, leading to dense intramembranous deposits and kidney damage.

Administer HBV vaccine and HBIG after exposure

ET tube was pushed too far down, thus, pull it out a bit and listen again for breath sounds

Endometrial cancer, 43% of females in affected families.

Note: must exclude FAP in order to diagnosis lynch syndrome; cancer must be in at least two generations, three relatives, and one case must have been before age 50

TB, signs: kussmals sign (JVD on inspiration). signs of RHF and diastolic dysfxn, pericardial knock(early sound after S2). In usa: viruses, radiation, surgery, CT dz's

Aspiration and C.A.Pneumonia, infxn can become necrotic and progress to an abscess, usually mixed anerobes and aerobes from mouth flora (S. viridans).

Bright red, firm, friable, exophytic nodules in HIV patient, due to Bartonella. DOC: oral erythromycin.

Emphysematous cholecystitis. Given their IC state, diabetics are at risk for infections, and apparently gas-forming bacteria can infect the gallbladder of these men. Lacks peritoneal signs, but occassionaly there is crepitus. Abd radiograph=air fluid levels in gallbladder or an US showing curvilinear gas shadowing in the gallbladder. IV resusicatation, immediate choley, and IV abx to tx clostridia.

Accumulation of myxedema matrix compounds can accumulate in the median nerve sheeth and tendons of the carpal tunnel, compressing the median nerve.

IV NORMAL saline w or w/out pressors, and abx to correct underlying infxn

Always attempt to capture the dog
1. if not captured, post exposure prophylaxis is given
2. If dog is captured or known and does not show features of rabies, keep for observation for 10 days. If rabies develops in the dog, start post-exposure prophylaxis immediately.
3. IF human head or neck involved in the initial bite, start post exposure prophylaxis immediately.

185/110, use labetalol to get it down to below this, must keep it below this for at least 24 hrs after Atelase was administered(give tPA within 3 hrs of stroke, and only if CT ruled out an ICH).

SLE, greater than 90% have arthritis, MCP and PIP jts, like RA

Serum Fe studies, suscpet Hemochromatosis in someone like this. (abnromally increased Fe absorption from intestine). Serum studies, followed by Liver Bx if abnormal

Atherosclerosis and DVT. Tx for DVT in this setting is heparin, warfarin, and PYRIDOXINE TO LOWER HOMOCYSTEINE LEVELS

CMV infection!!! Lymphocytes will appear VACULOATED and atypical on smear

TCA's-amytriptaline (Caution: can worsen urinary sx or ortho hypo; can use gabapentin as an alternative).

NSAIDS!

1. INTERMITTEN FLANK PAIN
2. HEMATURIA
3. NEPHROLITHISIS
4. UTI

Can sometime get a flank mass.