Myasthenia crisis with resp depression: stop pyridostigmine to reduce secretions, and perform

plasmapheresis + corticosteroids after intubating

Alzheimers first line tx is cholinesterase inhibitors like Donepezil galantamine and rivastigmine.

Idiopathic Intracranial Hypertension: Forty Fat Female: Headache, transient vision loss, pulsatile tinnitus,
diplopia (can be LR muscle dysfunction) perform lumbar puncture

Unprovoked seizure and more than 2 years on meds without it, discontinue by tapering it

CerebroVascular Accident ( like stroke) highest risk factor is hypertension (more than cigs and alcohol
and cholesterol )

Myasthenia gravis investigation is acetycholine receptor antibodies and not edrophonium test. Then CT
scan to chest to evaluate for thymoma

Vascular dementia: sudden change in executive function but not memory (stop cleaning). Ischemic
changes (pronator drift for ex)

Alzheimer: first memory then executive then personality changes at the end

Essential tremor: beta block

Cauda equina: spinal nerve root compression

Diabetic neuropathy is LMN so no Babinski or increased reflex, if present check MRI spine

Tick borne paralysis: rapid progressibve ascending paralysis (unlike GBS, no autonomic dysfunction)

Spinal Epidural abscess: triad of fever, focal back pain, neurologic findings. Suprapubic mass can be
found from urine distention. Check with MRI of spine

Anterior Coronary artery stroke: contralateral motor and sensory loss, more pronounced in leg (MCA
more pronounced in arms and face)

In MS, optic disk on fundocsopy appears hyperemic and swollen (optic neuritis)

Small vessel lypohyalinosis: from microatheroma, leads to lacunar stroke in internal capsule, mostly
motor deficit (posterior limb has corticospinal tract). Hypertension, diabetes, cholesterol are risk factors

Hypertensive hemorrhage: basal ganglia from hypertension. Putamen is involved + adjacent internal
capsule: contralat motor and sensory (post limb), and conjugate gaze deviation(ant limb)

Cerebral amyloid angiopathy = parietal lobe hemorrhage

Headache on awakening: increased pressure: MRI of brain

Ring enhancing lesion in brain can be brain abscess from Staph Aureus or Viridans Stretococci

MS can present with bilateral trigeminal neuralgia: demylination of nucleus of the nerve in face

Migraine treatment: prophylaxis: Topiramate, Divalproex sodium, TCA, Beta blockers (propranolol).
Sumatriptan is abortive

Generalized seizure: tongue biting, urinary incont, perioral cyanosis

Difference between homocystinuria and marfan: homocystinuria is recessif, has intellectual disability,
eye problems (down), fair skin and eyes. Both can have hyperelastic skin andjoints

Hepatic encephalopathy with hypokalemia treatment = replenish K

Isoniazid can interfere with tryptophan transforming to niacin. Causes pellagra: dermatitis diarrhea
dementia

For PBC, anti mitochondrial positive. Use Ursodeoxycholic acid (hydrophilic bile acid

Insulin resistance = fat breakdown = high triglycerides and FFA to liver = non alcoholic steatorhea

Osmotic diarrhea have elevated stool osmotic gap, secretory diarrhea have low SOG.

Stopping cigarette have the greatest impact on decreasing pancreatic CA. on the other hand, drinking
will cause chronic pancreatitis which does not have a huge impact on panc CA

Celiac disease = low D-Xylose even after antibiotics

Abdominal xray to exclude perforation of colon

Contrast esophogram for zenker

Albumin blood – albumin ascites = SAAG. If = or > than 1.1 = portal hypertension (Cardiac ascites,
cirrhosis, Budd Chiari). If less than 1.1 = TB, peritoneal carcinomatosis, pnacreatic ascies, nephrotic
syndrom

Laxative abuse= alkalosis and hypokalemia

After alcoholic cirrhosis is dx, upper gi endoscopy is performed tp check for esophageal varices
Beta blockers are good to prevent bleeding

Chronic pancreatitis better when leaning forward

Esophageal stricture = symmetric narrowing

Esophageal adenoCa = asymmetric

Valproic acid can cause pancreatitis

Oropharyngeal dysphagia get videofluoroscopic modified barium swallow study (food come out of nose)
Esophageal dysphagia: solid AND liquid at onset -= barium and monometry
Esophageal dysphagia: solid THEN liquid: endoscopy

Blunt trauma to pelvis (snowmobile) if signs of RBC in urine = CT with contrast of pelvis to assess renal
injury. If unstable then do pyelography prior to surgery

Esophagus rupture: water soluble contrast esophogram

Anal fissure treatment: lidocaine and nifedipine

Diverticulitis: abdominal ct with contrast

Diverticulitis complicated with an abscess of more than 3 cm should be drained with ct guided
percutaneous drainage

Meckel: painless rectal bleed: technetium 99 scan

Intususseption: currant jelly stool and lethargy: ultrasound guided contrast enema
Pyloric stenosis: 3-5 weeks: Abdominal US

Reye syndrome: microvesicular fatty infiltrates

Pellagra (niacin) rash is photosensitive – B6 deficiency rash is not photosensitive

CT of abdomen if pyelonephritis not improved after 72 hours of treatment or if obstruction signs

In PCP, give TMP SMX + corticosteroids if PaO2 <70

HIV diarrhea with blood: CMV if CD4<50

Splenomegaly, diarhea, night sweats, weight loss, abdominal pain, high ALP = MAC = give azithro

Leprosy: depegmentation + loss of sensation and motor = biopsy

After hep C, do PCR to know the subtype, then treat with ledipsavir sofosbuvir
Signs: myalgia, joint pain, excoriations on back of hands (lichen planus), cryoglub

Mild leukocytosis and bilateral diffuse reticular infiltrates on xray = influenza

Induration more than 5, treat if xray positive or if immunocompromised or HIV

Human bite = amoxicillin-clavulanate is good cover of + and –

HIV with mouth thrush and esophagus pain = give fluconazole. If no thrush do endoscopy

Eggshell calcification cyst in liver = echinoccocus granulosus = hdatid cysts

Entamoeba histolytica cyst is treated with metronidazole, will regress, if huge and symptoms then drain
that bitch
Progressive multifocal leukoencephalopathy : JC virus: confusion paresis ataxia seizure, what matter
lesions with NO enhancement or edema.
HIV associated dementia: deep gray matter, causes cognitive and behavioral and motor deficits.
Ventricular enlargement
Primary CNS lymphoma: well defined enhancing focal lesion and not multiple!

Disseminated gonococcal: monoarthritis or and tenosynovitis, dermatitis spares soles and feed and
polyarthralgias

Syphylis ican have grey mucosal patches in mouth, along with rash all over body

Prophylaxis against malaria: mefloquine, or atovaquone-proguanil, or doxycycline, until 4 weeks after

return!

If oregnant and lyme disease: NO doxy, give amoxicillin

Systemic blastomycosis can cause ulcerated skin lesions, and lytic bone lesions, and verrucous skin tags

In infective endocarditis, use empyric treatment vancomycin and not ampiclin sulbactam

HIV screen: HIV p24 antigen and antibody testing, confirmation = HIV1 /2 antibody diffirentiation
immunoassay

Reactivation of tb = upper lobe / aspiration pneumonia = lower lobe and foul smelling sputum

Reheated rice = enterotoxin from bacillus cereus

Febrile neutropenia = pseudomonas qeruginosa . give piperacillin tazobactam or cefepime or

meropenem

Skin ulcers, mucosal, diarrhea can be HIV

Histoplasmosis: hepatosplenomegaly, pancytopenia, lymphadenopathy (unlike PCP)

Splenic abscess is a thing where fluid collects around spleen. From infective endocarditis. Have left
pleural effusion and pleuritic chest pain

Rheumatoid factor can be elevated in Infective endocarditis

Ring enhancing lesions on MRI + HIV = toxoplasmosis

Trichenellosis: swelling around eyes, muscle pain, abdominal pain nausea vomit diarrhea high temp
subungual splinter hemorrhage. From undercooked pork = larvae

Ulcer that doesn’t heel then bone is infected = contiguous spread from the ulcer (in diabetic people)
Widened prevertebral space on XRAY = Retropharyngeal abscess in kids: soft tissue infection = neck pain
with extension, muffled voice, dysphagia,

Puncture wound deep infection like osteomyelitis after rusty nail: pseudomonas and staph aureus are
most common. Not tetani

Cat bite: amoxicillin/clavulanate for Pasteurella (and not Bartonella because its not common in
immunohealthy) . only administer tetanus booster if last vaccine was more than 5 y in children

HCV vertical transmission is very low. Advice pregnant woman to get vaccine for A and B

If Asymptomatic bacteriuria is found in pregnancy ( more than 100 000 growth) give amoxicillin
clavulanate

Metronidazole can be used in pregnancy for bacterial vaginosis (grey off white discharge)

In case of prolactinoma = if bigger than 3cm transsphenoidal resection. In all other cases give
dopaminergic agonists like cabergoline and wait to see if it goes away or reduces. If asymptomatic leave
it alone.

Thyroid lymphoma: raising the arms will compress the subclavian and internal jugular with the tumor =
venous distension (facial congestion). We also have B symptoms.

When checking for hypercalcemia, first order PTH. If low then order PTHrP, Vit D and Vit D (25 and 1,25)

1.5 cm pituitary adenoma do not compress the pituitary enough to decrease TSH. The level of prolactin
is usually around 200 or more (up to 1000(

Screen all patients more than 45 yo with fasting flucose or OGTT or Hem A1c

MEN1: burning pain in stomach all the time. Constipation and excess urination. Kidney stones. High
calcium.

In hypothyroidism: we ca have hypercholesterolemia and hypertriglycerides. Also can have

hyponatremia. Also can have slightly elevated CK.

In diabetes: polyneuropathy (axonopathy) can affect SMALL FIBER = POSITIVE symptoms = pain
paresthesia allodynia. Or can affect LARGE FIBER = NEGATIVE symptoms = loss of proprioception and
vibration, diminished ankle reflex, numbness)

Thyroid hormone increases sensitivity to catecholamine so we can have lid lag. BUT ONLY with graves
we have true exophthalmos from fibroblasts and adipocytes by TRAB. Have difficulty with extraocular
motion.

Hashimoto (antithyroid peroxide) can be responsible for miscarriage. Check it.

How to assess risk of ulcers in diabetics? Monofilament test! Not ankle brachial index
After 3 months of stopping OCP women should go back to normal period. If not= investigate. The next
step is checking b hcg. After that, its equal to these: Prolactin, FSH, TSH, testosterone

Hypocalcemia can have prolonged QT

Refeeding syndrome: after everything is depleted you give food and insulin is high so cells start taking up
Phosphorus, thiamine, magnesium and potassium. They get depleted. We have HF, Wernicke, seizures,
arrhythmias.

In pregnancy, high BHCG will stimulate the thyroid and increasw t3 and t4 ,and supress Tsh!!! NOT
GRAVES!!

Some babies will have slowing down of growth after normal height and weight until they reach 3 y o.
then, they will continue with the 5th percentile up. Puberty will eventually happy don’t worry.

Normal bone age + pubic hair = premature ADREnarche.

Normal bone age + breasts. = premature THElarche

When woman comes with abdominal pains, first and foremost BHCG preg test to rule out pregnancy,
this will decide if we do US or CT because babies don’t like CT radiations.

Clear mucus at cervix = ovulation

Post transplant, patients take TMP SMX for against PCP, they also get Hepatitis and pneumonia
vaccination. They can also get ganciclpvir and valganciclovir for CMV prophylaxis depending on the
donor.

HIV: cryptococcal meningitis: no personality change / vs Herpes encephalitis: personality change

Meningococcal vs pneumococcal meningitis: pneumococcal is most common but meningococcal is

associated with rapid deterioration and shock and skin manifestations

Mycoplasma pneumonia: incessant dry cough, interstitial infiltrates, in students

Acute lymphadenitis in children: swelling of one lymph cervical node and tender: staph aureus

Most common mumps complication: aseptic meningitis.

Infant hypothermia, lethargy, low wbc with left shift is neonatal sepsis. Groub B strep can cause
meningitis in newborns and cause neonatal sepsis. Bulging ofntanelles as well

Enterobius vermicularis can be on vagina in kids. Night itch . Helminth infection. Give albendazole or
pyrantel pamoate

Impetigo treatment: topical mupirocin (antibiotic)

Less than one month: BEL for meningitis. More than 1 month = Neiseria and strep pneumo
Acute bacterial rhinosinusitis most common bacteria is Strep pneumo, Hib, and Moraxella catarrhalis

After upper resp infection, child cant bear weight on leg = septic arthritis. Arthrocentesis is diagnostic
and therapeutic

Rubella in neonates: hearing loss, cataracts, patent ductus arteriosus, small head

Lyme disease in younger than 8yo don’t use doxy! Use amoxicillin. Doxy is only used because it also
covers Anaplasma

Preseptal cellulitis has no EOM pain, or proptosis or ophthalmoplegia. Orbital cellulitis has !

Pertussis in less than 1 month old: use azithromycin. Erythromycin causes pyloric stenosis

Oropharyngeal ulcers and grey vesicles = coxsackie virus herpangina. Tonsillar exudates only =
adenovirus.

Pneumonia in CF before 20 yo = Staph Aureus. Affter 20 yo = Pseudomonas

OCP increases hypertension risk. It decreases endo and ovarium cancer risk.

Penicillin or amoxycillin can cause warm igG autoimmune hemolytic anemia (coombs + )

Glomerular hematuria: microscopic more, RBC casts and protein are seen. Caused by post strep, or IgA
nephropathy (synpharyngeal).
All other non glomerular hematurias are gross more than microscopic, we see RBCs but no protein

Diabetic autonomic dysfunction: slow gastric emptying. So people that take insulin right after meal wont
have enough time for meal to go to intestine and will have hypoglycemia. In this case give
metoclopramide because its prokinetic.

In hyperglycemia. Measured sodium Na and add 2x the number of hundreds that glucose is increased
above 100. That’s the true natremia. Neurologic symptoms are not from hyponatremia but from
hyperosmolarity of serum

When theres hypercalcemia , and then PTH is low, check 3 things: PTHrP, 25 vit D, 1-25 Vit D. that’s all !!
it will solve many problems. Rule out game. High 1,25 vit d is from lymphoma btw.

Something called painless (silent) thyroiditis. It’s a prerequisite of hashimoto, but with elevated T4
because of release of preformed thyroid hormone! So what we give is usually just propranolol and not
methimazole or whatever. Radioactive iodine uptake is very low (confirm that the released thyroid is
preformed) .
Postpartum thyroiditis is the same thing. But only diagnosed less than 1 year. Brief hyperthyroid, then
hypothyroid. Hypothyroid can cause hyponatremia (decrease GFR or high secretion of ADH)

High thyroid causes high osteoclast activity

For every 1 g/dl decrease in albumin, calcium decreases by 0.8. so to measure true calcium after loss of
albumin, first do (4 – albumin) = should be equal to around 2. Then we do true calcium = calculated
calcium + 0.8* (4 – albumin) . tada

When medullary carcinoma of thyroid is present, check urine metanephrine ( men2 a and b have
pheochromocytoma)

Euthyroid sick syndrome is when only T3 is low and t4 and tsh is normal ! its due to decreased t4
iodinization due to low calories. Happens when someine is sick

In diabetes. Control BP most importantly to control kidney damage. (not glycemic control! )

Add GLP1 if you wanna lose weight

Subacute thyroiditis = DeQuervain = postviral

TBG transports T4!!! So taking contraceptives will increase total T4 but not free T4

Milk alkali syndrome: excess intake of Calcium!! Constipation and polyuria and dypsia. Low GFR because
of renal vasoconstriction. Thiazides, ACE and NSAID increase the risk

Tight glycemic control in diabetes reduces MICROvascular complications like retinopathy and
nephropathy. BUT NOT MACROvascular compls. Like heart and stroke.

VIPoma: watery diarrhea and secretion of K in intestins