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Top 20 Pearls for Pimping:

Reading a CXR:
Airway
Bones
Cardiac silhouette
Diaphragms
Effusions
Fields
Gastric bubble
Hardware
Deriving a Diff Dx:
Metabolic
Infectious
Neoplastic
Traumatic
Cardiovascular
Allergic/Autoimmune
Neurologic
Drug Reaction
Youth (Congenital)
Causes of ESR >100:
Temporal Arteritis
Chronic Infxn (Osteo,
SBE, TB, abscess)
Thyroiditis
Vasculitis
Multiple Myeloma
Etiologies of AKI:
Prerenal (most common):
decr volume
renal vasoconstriction
Intrinsic:
ATN
AIN
glomerulonephritis
Postrenal:
bladder neck obstruction
b/l ureteral obstruction
Dont-miss
Causes of Chest
Pain:
Myocardial Infarction
Aortic Dissection
Pulmonary Embolism
Pneumothorax
Esophageal perf.
Eosinophilia:
Neoplasm
Allergy
Asthma
Churg-Strauss
Parasites
Light's criteria:
TPeff/TPserum >0.5
LDHeff/LDHserum >
0.6
LDHeff > 2/3 upper
limit of normal of
LDHserum
Lupus:
Serositis
Oral Apthous ulcers
Arthritis
Photosensitivity
Blood (ITP, Hemolytic
Anemia)
Renal Nephritis
ANA (almost always +)
Immunology (dsDNA, anti-
Sm, low C)
Neurologic (Lupus
Psychosis)
Malar Rash
Discoid Rash

Dx with 4 of these criteria,
sensitivity is ~75%,
specificity is ~95%
Anion Gap
Acidosis:
Methanol
Uremia
DKA
Paraldehyde
INH/ Iatrogenic
Lactic Acid
Ethylene Glycol
Salicylates
Obstruction, sm bowel:
Adhesions
Bulges
Cancer

Obstruction, lg bowel:
Cancer
Diverticulitis
Volvulus
Lower GI Bleeds:
Hemorrhoids
Diverticulosis
IBD
Ischemic Colitis
AVMs
Upper GI bleed
Mortality Benefit in
CHF:
Beta-blocker
ACE inhibitor
Spironolactone if
Class IV CHF
AICDs
ECG changes with PE:
Sinus tachycardia
Specific but not
sensitive:
S1Q3T3 sign - an S
wave in lead I, Q wave
in lead III, and inverted
T wave in lead III
Common bone mets:
Breast
Lung
Thyroid
Kidney
Prostate
BLT w/ Kosher Pickle
Emergent Dialysis:
Acidosis / hypoAlbumin /
Anorexia
Electrolyte imbalance (inc K)
Ingested toxins
Overload (volume)
Uremia with Sx (cns
changes)
Potassium
repletion:
Goal > 4.0
Every 10 mEq K will
raise serum K by
0.1
PO: K-Dur, can give
40-60 mEq at
once
IV: KCl 10 mEq IV
peripherally; need
central line to give
20 mEq
Magnesium Repletion:
Goal > 2.0

Each 1 g Mg will raise
serum Mg by 0.1-0.2

Give IV in multiples of 2
grams
IV Fluids (4:2:1 rule):
4ml/kg/hr for first 10kg
2ml/kg/hr for second
10kg
1ml/kg/hr for remaining
kg

Shortcut for pts >60kg:
Weight in kg + 40 =
cc/hr
CHADS2 Score:
Risk stratification for
anticoagulation in A-fib
CHF = 1 pt
HTN = 1 pt
Age > 75yo = 1 pt
DM = 1 pt
Stroke or TIA hx = 2 pts

Score 2 : warfarin (unless
poor candidate)
Modified Wells criteria for Pulmonary Embolism
PE as likely or more likely than alternate dx; clinical s/sx of DVT 3 each
HR > 100 bpm; prior DVT or PE 1.5 each
Immobilization (bed rest >= 3 d) or surgery w/in 4 wks 1.5
Hemoptysis or malignancy 1 each

Score <= 4: PE unlikely, no CTA; consider D-dimer. Score >4: PE likely, order CTA