PANCE/PANRE Blueprint

• Triads
• Criteria
• Syndromes
• Pathomnemonic Words
• Named Syndromes
• Signs
• Methods
• Antidotes
• Other Random Shit
• Vitamins
• Trivia

This page is just a bunch of notes thrown down and still needs a lot of organization.

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Triads - Triads - Triads - Triads - Triads - Triads - Triads

Beck's triad = Cardiac Tamponade, Pericardial Tamponade, Effusion

1. Distended neck veins/JVD/venous pressure elevation
2. Muffled heart sounds
3. HyPOtension/Pulsus Paradoxus

Charcot's triad = Acute cholangitis

indication of cholangitis - infection of biliary tract

1. RUQ Pain
2. Jaundice
3. Fever

plus 2 = Reynold’s Pentad

4. HyPOtension
5. AMS

Samter’s Triad

Aspirin Allergy - aspirin sensitivity

Nasal Polyps - nasal polyposis

Asthma - nonallergic induced asthma

Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad or Aspirin Sensitive Asthma, is a chronic medical condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Approximately 10% of all adults with asthma and 40% of patients with asthma and nasal polyps are sensitive to aspirin and NSAIDs.

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Criteria - Criteria - Criteria - Criteria - Criteria - Criteria - Criteria

Jones Criteria = Rheumatic Fever

Duke Criteria = Infective Endocarditis

Clinical criteria, also known as the Modified Duke criteria, is widely utilized to establish the diagnosis of endocarditis.

Major criteria:

• 2 positive blood cultures for a microorganism that typically causes endocarditis;
• evidence of endocardial involvement via an echocardiogram (vegetation, abscess);
• development of a new regurgitant murmur.

Minor criteria:

• vascular phenomena (skin hemorrhages, emboli, aneurysms, or pulmonary infarction);
• fever >100.4°F (38°C);
• immunologic phenomenon (glomerulonephritis, Osler's nodes, Roth spots, rheumatoid factor); and
• positive blood cultures that do not meet the specifics of the major criteria.

CHADS2 Score = Afib decision maker

1 CHF

1 HTN

1 Age > 75

1 Diabetes

2 Stroke

if total is >= 2, anticoagulate

Cushing reflex = increased ICP

1. Increase in systolic and pulse pressure
2. Reduction of the heart rate (bradycardia)
3. Irregular respiration.

CENT-or Criteria (Strep Throat)

4. Cough (no cough)
5. Exudates
6. Nodes
7. Temp
8. -or, maybe they have Mono

Amsel’s Criteria for BV

Whiff Test

Clue Cells

white-gray discharge

Ranson’s Criteria = Pancreatitis

Gall/ETOH

Glucose

Age (> 55)

Leukocytosis

LFT (AST>250, LDH>350)

Electrolyte (Ca+)

Third Spacing/Increased BUN

Oxygen

Hematocrit (at least a 10% decrease in their hematocrit at 48 hours after admission)

Ranson's criteria include:

1. (1) Age more that 55 years
2. (2) WBC count more than 16,000/Ul
3. (3) Blood glucose more than 200mg/dL
4. (4) Serum LDH over 350 U/L
5. (5) AST over 250 U/L.
6. 3 or more criteria on admission predict a complicated course with possibility of pancreatic necrosis.

Light’s Criteria for Exudate vs Transudate

Effusion protein/serum protein ratio greater than 0.5

Effusion lactate dehydrogenase (LDH)/serum LDH ratio greater than 0.6

Effusion LDH level greater than two-thirds the upper limit of the laboratory's reference range of serum LDH

(Any one is positive = Exudate)

Add My APGAR?

Color

HR

Irritability

Muscle Tone

Resp

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Syndromes - Syndromes - Syndromes - Syndromes - Syndromes

CREST Syndrome

(pic of a penny with an X = anti-centromere for diagnosis)

Calcinosis

Renaulds

Esophageal dismot

Sclerodactyly

Telangectasia

This is all part of Scleroderma

Plummer-Vincent Syndrome

esophageal webs

iron deficiency anemia

dysphagia

Plummer-Vincent Syndrome

Fingernail (spoon nails - kolynychia)

Web (esophageal webs)

Glossitis

Dysphagia

Atrophic glossitis, dysphagia, and esophageal webs can also be seen with Plummer-Vinson syndrome.

Brown-Sequard's syndrome

The characteristic deficits of the Brown-Sequard's syndrome include a motor deficit and deficit of position sense and vibratory sense ipsilateral to the side of the lesion.

Gilbert’s Syndrome

A mild condition in which the liver doesn't properly process bilirubin.

A major characteristic is jaundice

Inherited

Budd-Chiari Syndrome

Very rare

Caused by occlusion of the hepatic veins that drain the liver

Classical triad

1. abdominal pain
2. ascites
3. liver enlargement

Crigler–Najjar syndrome

Singh-Vaughan Williams

(NaβKC?, 1=Na+, 2=βb, 3=K+, 4=C++, 5=?)

Class I agents interfere with the sodium (Na+) channel.

Class II agents are anti-sympathetic nervous system agents. Most in this class are β blockers.

Class III agents affect potassium (K+) efflux.

Class IV agents affect calcium channels and the AV node.

Class V agents work by other or unknown mechanisms.

Child–Pugh score

The score employs five clinical measures of liver disease. Each measure is scored 1–3, with 3 indicating most severe derangement.

Prehn's sign

Prehn’s + (pain relief w/ elevation) -> Epididymitis

Prehn’s - (NO pain relief w/ elevation) -> Test. Torsion

Five F’s = cholelithiasis

Risk Factors for the development of CholeLithiasis

1. Fair: more prevalent in Caucasian population 1
2. Fat: BMI >30
3. Female gender
4. Fertile: one or more children
5. Forty: age ≥40

cholelithiasis can occur in young patients with a positive family history; in such cases, the 'familial' factor can substitute the 'forty' factor 2

Amsel criteria for BV diagnosis

3 out of 4 should be present

1. Gray discharge
2. Vaginal secretion pH >4.5
3. Positive “whiff test”
4. Presence of clue cells on saline wet mount

There are Wells criteria for both DVT and PE. They are not the same, but similar.

Caprini is an alternate criteria for DVTs

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pathomnemonic words - pathomnemonic words - pathomnemonic words

Cotton Wool Spots [fundoscopy] = Cytoid Bodies [histology?] = Assoc with diabetic or hypertensive retinopathy

With an aortic dissection, the most common finding on chest X-ray is a widened mediastinum.

Prominent pulmonary hila are associated with pulmonary hypertension.

Kerley B lines are usually seen with pulmonary edema and congestive heart failure.

Blunted costophrenic angles are associated with pulmonary effusions.

Splinter Hemorrhage Endocarditis or vasculitis

Fixed, Split, 2nd Heart Sound: ASD

variable w/breathing, Split, 2nd Heart Sound: BBB

Rumbling murmur: ASD

machine-like murmur: PDA

HLA-B27 can be Ankylosing Sponylitis or Reactive Arthritis

Bence-Jones proteins in urine: Multiple Myeloma

Endocarditis

Roth Spots

Splinter Hemorrhage

Osler’s Nodes (painful)

Janeway Lesions (painless)

diplococci (I’m sure there are a million, but these are the most common)

Gram+diplo = Strep

Gram-diplo = Neisseria

Sideroblastic Rings are seen in:

- Iron deficiency

- ETOH

- Isoniazid

Basophilic Stippling

- Lead poisoning

- Thalassemias

Auer Rods = AML

Philadelphia Chromosome = CML

Reed-Sternberg cells = Hodgkins Lymphoma (no reed-S = non-Hodgkins)

Aschoff Bodies = Rheumatic Fever

Smudge Cells

Smudge cells are remnants of cells that lack any identifiable cytoplasmic membrane or nuclear structure. Smudge cells, also called basket cells, are most often associated with abnormally fragile lymphocytes in disorders such as chronic lymphocytic leukemia (CLL).

peripheral reticular opacities = idiopathic pulmonary fibrosis (IPF)

Honeycombing on chest x-ray = idiopathic pulmonary fibrosis (IPF)

perifollicular hemorrhage = scurvy

grape-like clusters = S. aureus

Hypersegmented neutrophils = megaloblastic anemia (folate or deficiency) but controversy!

(mma - methyl melonic acid elevated in B12 def, not in folate)

nucleated red blood cells = β-thalassemia

Celiac is associated with dermatitis herpetiformis

Asthma is associated with atopic dermatitis

snowstorm ultrasound = molar pregnancy

grape-like clusters in blood = molar pregnancy (bleeding with passage of grape-like, edematous villi)

string of pearls on US = PCOS

Blueberry Muffin Baby (yellow with dots) - neonate born with CMV???

Strawberry Cervix = Trichomoniasis

Strawberry Tongue = Kawasaki???

Clue Cell (“caked” in bacteria) = BV

Tzank smear - multinucleated Giant Cells = for HSV detection

Cervical Motion Tenderness = assoc with chlamydia, present in the setting of pelvic inflammatory disease (PID), ectopic pregnancy, and is of some use to help differentiate PID from appendicitis.

Blue dot sign upper scrotum = torsion of the appendix testis

Bag of Worms = Vericocele

oval fat bodies ('Maltese crosses') = nephrotic syndrome

Slippery marble (in breast) = fibroadenoma

Ground Glass on X-Ray can be a bunch of things

• Sarcoid
• DPLD (Diffuse Parenchymal Lung Disease)
• Hypersensitivity Pneumonitis

The differential diagnosis of a solitary coin lesion includes:

Lung carcinoma (most commonly an adenocarcinoma)

Granuloma

Hamartoma

Auer rods = AML

Philadelphia chromosome = CML

multiple myeloma = lytic lesion in bone leaks calcium and proteins

Proteins clog kidney, leak out as Bence-Jones proteins

After splenectomy (or hyposplenism from other etiologies, e.g., splenic infiltration), the average red cell lifespan is increased, and several typical abnormalities arise (e.g., Howell-Jolly and Heinz bodies, basophilic stippling, and nucleated erythrocytes [see table]).

Peripheral blood abnormalities after splenectomy

Finding Composition

Thrombocytosis, leukocytosis (1st 2-3 weeks) Normal platelets and increase in aggregates. Severe thrombocytosis (> 1,000,000 /mm3) and thrombotic complications require antiplatelet therapy

Howell-Jolly bodies Nuclear remains containing condensed DNA; may also be seen in severe hemolytic anemias

Heinz bodies Denaturated hemoglobin formed by oxidation of hemoglobin; also typical of thalassemia and other hemoglobinopathies

Pappenheimer bodies Iron particle inside erythrocytes; also found in sideroblastic anemia, hemolytic anemia, and sickle cell anemia

Basophilic stippling Aggregated ribosomal DNA; also found in thalassemia, chronic heavy metal poisoning (specially lead), and megaloblastic anemia

Nucleated erythrocytes Erythroblast nuclei which remain in circulation because of hyposplenism; often a sign of erythroid hyperproliferation

Squat/Stand//Valsalva murmur changes - - - - - - - -

HOCM: reduced LV volume increases obstruction/murmur (standing, valsalva decrease ventricular volume)

HOCM: increased LV volume or vascular resistance decreases murmur (squatting, sustained hand-grip, lying down, SLR increase ventricular volume)

Aortic Stenosis: reducing stroke volume across valve decreases murmur

MVP: Valsalva and standing prolong murmur and move it earlier. (Activities that reduce end-diastolic volume, such as Valsalva maneuver or a standing position, cause an earlier click and a prolonged murmur. In the supine position, especially with the legs raised for increased venous return, left ventricular diastolic volume is increased, resulting in a click later in systole and a shortened murmur.)

Other Positions

Sit up and lean forward: Epiglottitis, pericarditis

Physical signs

radiates to scapula: MI or cholelithiasis

(cholelithiasis will prolly say right scapula in question)

Named Syndromes - - - - - - - - - - - - - - - - - - - -

In Central and South America, Chagas disease due to Trypanosoma cruzi is the most common infectious cause.

Trousseau's syndrome, or migratory thrombophlebitis, is a malignancy associated hypercoagulable state that is characterized by a recurrent thrombosis in a migratory pattern and involvement of superficial veins in unusual sites. It is generally associated with an occult neoplasm (50%), usually an adenocarcinoma.

Thigh and buttock claudication associated with impotence or erectile dysfunction is called Leriche syndrome a triad of claudication, impotence, and absent femoral pulses

the absence of dynein arms in the respiratory cilia (Kartagener syndrome, a hereditary disease) is associated with chronic respiratory difficulty (e.g., bronchitis and sinusitis). Ciliary motility is severely impaired or absent in these individuals.

Wernicke’s Encephalopathy Thiamin Def

Wernicke, Korsakoff, and Beri-Beri are all B1 deficiencies!

Horner syndrome is comprised of miosis, ptosis, enophthalmos, and hemianhidrosis. In addition, the patients may also have atrophy of hand muscles. due to a bronchogenic carcinoma tumor mass extending to the sympathetic chain.

Lambert-Eaton myasthenic syndrome is an immune-mediated disorder of neuromuscular transmission resulting in impaired release of acetylcholine from nerve terminals. Patients complain of weakness of the scapular and pelvic girdles muscles, and the resultant difficulties in performing activities such as climbing stairs. Other symptoms (e.g., dry mouth, paresthesias, and sexual impotence due to autonomic dysfunction) may also be present. On examination, there is proximal muscle weakness. Deep tendon reflexes are decreased or absent.

Koebner Phenonenon = Minor Trauma leads to new lesions at site of Trauma

Gilbert's syndrome is an inherited disorder affecting the metabolism of bilirubin. Unconjugated hyperbilirubinemia is typical. Jaundice may be present during periods of dehydration or illness, although the condition is largely asymptomatic.

Classically, Leriche syndrome is described in male patients as a triad of the following signs and symptoms:

• claudication of the buttocks and thighs
• absent or decreased femoral pulses
• erectile dysfunction

Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the creation of adhesions.

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Signs - Signs - Signs - Signs - Signs - Signs - Signs - Signs - Signs

Kehr’s Sign L Shoulder pain with splenic rupture (from diaphragmatic rupture)

Homan’s

Acronym Syndromes

HELLP (hemolysis, elevated liver enzymes, low platelets)

an advanced form or variant form of severe preeclampsia

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Methods - Methods - Methods - Methods - Methods - Methods - Methods

Holliday-Segar Method

This is a method to calculate rehydration needs. Jeff says he’s never used it.

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Antidotes

learn antidotes for

• apap
• benzos
• coumadin
• heparin
• etc.

I made a quizlet to study antidotes

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Other Random Shit - Other Shit - Other Random Shit - Other Shit - Other Random Shit - Other Shit

Polycythemia Vera (PV) diagnosis criteria

1. increased RBC mass
2. normal O2 saturation
3. splenomegaly

If splenomegaly is not present, the diagnosis can be made with the first 2 major criteria plus the addition of 2 minor criteria:

1. leukocytosis in the absence of infection
2. elevated platelets with abnormal function resulting in bleeding or thrombosis.

An erythropoietin level can aid in differentiating etiologies of erythrocytosis, but it is not one of the criteria used to diagnose PV. In PV, erythrocytosis is due to a chronic myeloproliferative disorder which results in compensatory low-to-normal erythropoietin production from the kidney.

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Vitamin Deficiencies - Vitamin Deficiencies - Vitamin Deficiencies

Vitamin names and deficiency

A (retinoids, carotenoids) Rhodopsin deficiency, night blindness, retarded growth, skin disorders, and increased risk of infections

B1 Thiamine Wernicke's encephalopathy

The typical triad is comprised of ocular signs, ataxia, and a confused state

Beriberi-muscle weakness (including cardiac muscle), neuritis, and paralysis

B2 Riboflavin Eye disorders and skin cracking, especially at corners of the mouth

B3 Niacin Pellegra (diarrhea, dermatitis, and mental disturbances)

B6 Pyroxidine

B9 Folic Acid

B12 Cobalamin beefy red tongue, neuro, megaloblastic anemia

C Ascorbic Acid Scurvy

D2 Ergocalciferol Rickets?

D3 Cholecalciferol Rickets?

E x nerve problems, retinopathy

K

Pantothenic acid Neuromuscular dysfunction and fatigue

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The correct answer is pyridoxine deficiency. In cases of pyridoxine or (vitamin B6 deficiency), patients can present with peripheral neuropathy, seborrheic dermatosis, glossitis, and cheilosis. Laboratory investigations reveal anemia with lymphopenia. Causes include malabsorption as well as medications, such as isoniazid and penicillamine. Dietary sources of vitamin B6 include liver, legumes, whole grain cereals, and meats.

In cases of vitamin A deficiency, patients can present with the inability to see well in dim light or night blindness. There may also be conjunctival and corneal xerosis, as well as pericorneal and corneal opacities, and Bitot's spots. Bitot's spots are a collection of keratin appearing as triangular foamy spots on the conjunctiva. The patient may also have xeroderma, hyperkeratotic skin lesions, and increased susceptibility to infections. Causes include inadequate dietary intake and malabsorption. Dietary sources of vitamin A include fish, liver, egg yolks, butter, cream, dark green leafy vegetables, and yellow fruits and vegetables.

In cases of vitamin C (or ascorbic acid) deficiency, patients can present with bleeding tendencies (as a result of weakened capillaries) and impaired wound healing due to impaired formation of connective tissue. On examination, the gums may be swollen and friable; the teeth may be loose. There may also be multiple splinter hemorrhages on the nails and ecchymoses, especially over the lower limbs. Causes include inadequate dietary intake and certain conditions, such as pregnancy and lactation, that increase vitamin C requirements. Dietary sources of vitamin C include citrus fruits, such as oranges, lemons, and tangerines, as well as tomatoes and potatoes.

Niacin deficiency causes pellagra, which is characterized by:

Symmetrical dermatitis, usually on parts of the body exposed to sunlight

Scarlet glossitis and stomatitis

Diarrhea

Mental aberrations, such as memory impairment, depression, and dementia. These may appear alone or in combination. Causes include inadequate dietary intake, especially in patients with corn-based diets or alcoholism. Dietary sources include legumes, yeast, meat, and enriched cereal products.

Vitamin E deficiency may cause a hemolytic anemia in premature infants. Laboratory investigations reveal low plasma tocopherol levels, a low hemoglobin level, reticulocytosis, hyperbilirubinemia, and creatinuria. Causes of vitamin E deficiency in premature infants include a limited placental transfer of vitamin E and the resultant low levels at birth combined with its relative deficiency in the infant diet. Dietary sources for older children and adults include wheat germ, vegetable oils, egg yolk, and leafy vegetables.

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There are 2 forms of Friedrich's ataxia—the classic form and the form that occurs in conjunction with vitamin E deficiency.

Two types of vitamin E deficiency can occur in Friedreich's ataxia. The first is abetalipoproteinemia (Bassen-Kornzweig syndrome), which is associated with a defect in the microsomal triglyceride transfer protein. This results in the impairment of formation and secretion of VLDL in the liver and a deficiency of delivery of vitamin E to the tissues, including the CNS. The second type, called ataxia with vitamin E deficiency (AVED), is due to a defect in a tocoferol transfer protein and an impaired ability to bind the vitamin E to VLDL. In these patients, vitamin E supplementation is indicated.

Vitamin A deficiency is associated with visual defects, particularly night blindness. It is not associated with Friedrich’s ataxia.

Vitamin B1 (thiamine) deficiency is typically seen in the context of severe malnutrition. It causes peripheral neuropathy, cardiomyopathy, and anemia. It is not associated with muscle weakness or Friedrich’s ataxia

Vitamin D deficiency causes osteomalacia and may cause muscle weakness but does not cause neuropathy. Vitamin D deficiency is not associated with Friedrich’s ataxia.

Vitamin K deficiency is associated with impaired production of coagulation factors II, VII, IX, and X. It causes a bleeding diathesis.

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This one is pediatrics focused

Vitamin E deficiency may cause a hemolytic anemia in premature infants. Laboratory investigations reveal low plasma tocopherol levels, a low hemoglobin level, reticulocytosis, hyperbilirubinemia, and creatinuria. Causes of vitamin E deficiency in premature infants include the limited placental transfer of vitamin E and the resultant low levels at birth; this is combined with its relative deficiency in the infant diet. Dietary sources for older children and adults include wheat germ, vegetable oils, egg yolk, and leafy vegetables.

In cases of vitamin A deficiency, patients can present with night blindness or an inability to see well in dim light. There may also be conjunctival and corneal xerosis, as well as pericorneal and corneal opacities and Bitot's spots. Bitot's spots are a collection of keratin appearing as triangular, foamy spots on the conjunctiva. The patient may also have xeroderma, hyperkeratotic skin lesions, and increased susceptibility to infections. Causes include inadequate dietary intake and malabsorption. Dietary sources of vitamin A include fish, liver, egg yolk, butter, cream, dark green leafy vegetables, and yellow fruits and vegetables.

In cases of pyridoxine (vitamin B6 deficiency), patients can present with peripheral neuropathy, seborrheic dermatosis, glossitis, and cheilosis. Laboratory analysis reveals anemia with lymphopenia. Causes include malabsorption, as well as medications (e.g., isoniazid and penicillamine). Dietary sources of vitamin B6 include liver, legumes, whole grain cereals, and meats.

In cases of vitamin C (ascorbic acid) deficiency, patients can present with bleeding tendencies (as a result of weakened capillaries) and impaired wound healing due to the impaired formation of connective tissue. On examination, the gums may be swollen and friable; the teeth may be loose. There may also be multiple splinter hemorrhages on the nails and ecchymoses, especially over the lower limbs. Causes include inadequate dietary intake and certain conditions (e.g., pregnancy and lactation) that increase vitamin C requirements. Dietary sources of vitamin C include citrus fruits, (e.g., oranges, lemons, and tangerines), as well as tomatoes and potatoes.

Niacin deficiency causes pellagra, which is characterized by:

1. Symmetrical dermatitis, usually on parts of the body exposed to sunlight
2. Scarlet glossitis and stomatitis
3. Diarrhea
4. Mental aberrations (e.g., memory impairment, depression, and dementia), which may appear alone or in combination

Causes of niacin deficiency include inadequate dietary intake (especially in patients with corn-based diets or alcoholism). Dietary sources include legumes, yeast, meat, and enriched cereal products.

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In cases of Pyridoxine or (Vitamin B6 deficiency), patients can present with peripheral neuropathy, seborrheic dermatosis, glossitis, and cheilosis. Laboratory investigations reveal anemia with lymphopenia. Causes include malabsorption as well as medications, such as isoniazid and penicillamine. Dietary sources of vitamin B6 include liver, legumes, whole grain cereals, and meats.

Vitamin E deficiency may cause a hemolytic anemia in premature infants. Laboratory investigations reveal low plasma tocopherol levels, a low hemoglobin level, reticulocytosis, hyperbilirubinemia, and creatinuria. Causes of vitamin E deficiency in premature infants include a limited placental transfer of vitamin E and the resultant low levels at birth combined with its relative deficiency in the infant diet. Dietary sources for older children and adults include wheat germ, vegetable oils, egg yolk, and leafy vegetables.

In cases of Vitamin A deficiency, patients can present with the inability to see well in dim light or night blindness. There may also be conjunctival and corneal xerosis, as well as pericorneal and corneal opacities, and Bitot's spots. Bitot's spots are a collection of keratin appearing as triangular foamy spots on the conjunctiva. The patient may also have xeroderma, hyperkeratotic skin lesions, and increased susceptibility to infections. Causes include inadequate dietary intake and malabsorption. Dietary sources of vitamin A include fish, liver, egg yolks, butter, cream, dark green leafy vegetables, and yellow fruits and vegetables.

Niacin deficiency causes pellagra, which is characterized by:

A symmetrical dermatitis, usually on parts of the body exposed to sunlight

Scarlet glossitis and stomatitis

Diarrhea

Mental aberrations, such as memory impairment, depression, and dementia.

These may appear alone or in combination. Causes include inadequate dietary intake, especially in patients with corn-based diets or alcoholism. Dietary sources include legumes, yeast, meat, and enriched cereal products.

In cases of Vitamin C (or ascorbic acid) deficiency, patients can present with bleeding tendencies (as a result of weakened capillaries) and impaired wound healing due to impaired formation of connective tissue. On examination, the gums may be swollen and friable; the teeth may be loose. There may also be multiple splinter hemorrhages on the nails and ecchymoses, especially over the lower limbs. Causes include inadequate dietary intake and certain conditions, such as pregnancy and lactation, which increase vitamin C requirements. Dietary sources of vitamin C include citrus fruits, such as oranges, lemons, and tangerines, as well as tomatoes and potatoes.

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Trivia - Trivia - Trivia - Trivia - Trivia - Trivia - Trivia - Trivia - Trivia - Trivia

Suspensory Ligament of Treitz is the border between the Duodenum and Jejunum

This ligament is an important anatomical landmark of the duodenojejunal flexure, separating the upper and lower gastrointestinal tracts. For example, bloody vomit or melena, black tarry stools, usually indicate a gastrointestinal bleed from a location in the upper gastrointestinal tract. In contrast, hematochezia, bright red blood or clots in the stool, usually indicates gastrointestinal bleeding from the lower part of the gastrointestinal tract. It is an especially important landmark to note when looking at the bowel for the presence of malrotation of the gut, a syndrome often suspected in young children when they have episodes of recurrent vomiting. Visualising a normal location of the ligament of Treitz in radiological images is critical in ruling out malrotation of the gut in a child; it is abnormally located when malrotation is present.

bivaliridun (Angiomax or Angiox)

A specific and reversible direct thrombin inhibitor (DTI).[1]

Chemically, it is a synthetic congener of the naturally occurring drug hirudin (found in the saliva of the medicinal leech Hirudo medicinalis).

Bivalirudin clinical studies demonstrated consistent positive outcomes in patients with stable angina, unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI) undergoing PCI in 7 major randomized trials. Patients receiving bivalirudin had fewer adverse events compared to patients that received heparin.\r\n

Ménière's disease

Wernicke-Korsakoff

Misoprostol

Because other classes of drugs, especially H2-receptor antagonists and proton pump inhibitors, are more effective for the treatment of acute peptic ulcers, misoprostol is only indicated for use by people who are both taking NSAIDs and are at high risk for NSAID-induced ulcers,

"DCM is characterized by ventricular enlargement, a reduction in ventricular wall thickness, and impaired systolic function of one or both ventricles. Regardless of the cause, the myocardium dilates, thins, and hypertrophies in compensation."

Ticagrelor and GpIIb/IIIa inhibitors (glycoprotein IIb/IIIa inhibitors) For AngINA and NSTEMI, but not for STEMI

Mirtazipine

Clonidine

Add to ABX chart:

Metronidazole is of the nitroimidazole class. It inhibits nucleic acid synthesis by disrupting the DNA of microbial cells. This function only occurs when metronidazole is partially reduced, and because this reduction usually happens only in anaerobic cells, it has relatively little effect upon human cells or aerobic bacteria.

Shit I just don’t know

SCID

MEN-1 and 2

Scleroderma

Other notes

Acetaminophen/Tylenol liver toxicity not kidney

Crohn: cobblestone, diet modifiable, granulomas, worse with smoking

UC: rectum always, better with smoking

Coronary arterial supply

The LAD-septal branch supplies the septum, represented by leads V1 and V2.

The LCA-circumflex branch supplies the high lateral wall of left ventricle, represented by I, aVL, V5, and V6.

The RCA (right coronary artery) posterior descending branch supplies the inferior and posterior wall of left ventricle, represented by leads II, III, and aVF.

The RCA-proximal branch supplies the right ventricle, inferior, and posterior wall of left ventricle, represented by leads V4R, II, III, and aVF.

A right-sided EKG is done by placing leads V1-6 in a mirror-image position on the right side of the chest. V4R is the most useful: obtained by placing the V4 electrode in the 5th right intercostal space in the midclavicular line.