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Printzmetal's Angina
- Variant angina, coronary artery spasm
- Occurs at rest
- Many not have CAD
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Percent of AMIs with normal EKG
4%
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Predictors of AMI
- Depression of areas oppositve peredict larger MI with inc mortality
- T-wave inversion within 4 hours is good prognostic sign
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dewinters T waves
- ST depression into rocket T-waves
- Acute LAD occlusion
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Elevation in aVR
Acute LMCA occlusion
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Post MI papillary muscle rupture causes what murmur
- Acute mitral Regurgitation
- Acute onset CHF
- HD support, IABP, Surgery (OR)
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How does paget's dz effect the heart
High outpt failure due to multiple AV malformations
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How does beriberi effect the heart
High outpt failure due to B1 thiamine deficiency leads to dec SVR, edema, high output failure
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Osler nodes
Tender nodules on the tips of the fingers and toes, IE,Osler=Ow
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Janeway lesions
Non-tender hemorrhagic plaques on the palms and soles
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Roth spots
retinal hemorrhages with central clearing
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triple coverage for prosthetic valve endocarditis
- vanc
- gent
- add rifampin (more gram + coverage
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Jones Criteria
- CASES
- Carditis
- Arthritis
- Syndenhams chorea
- Erythema marginatum
- subcutaneous nodules
Minor: Prev hs, arthralgia, ESR, prolonged PR interval, fever
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AS vs AR murmur
- AS : Systolic radiating into neck
- AR : Diastolic decrescendo at left lower sternal border, water hammer, duroziez's, Austin-flint, quinckes
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Most common cause mitral stenosis
- RHD
- Diastolic murmur + pulmonary edma in pregnancy = Mitral Stenosis
Low apex diastolic murmur to axilla, loud S1
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MS vs MR murmur
- MS - Diastolic rumble at apex
- MR - loud holosystolic murmur
MR - may have no murmur if ruptured chordae tendineae
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Murmur Hypertrophic Cardiomyopathy
- Harsh, mid-systolic LLSB
- Louder with dec preload (standing, valsalva, hypovolemia)
- Dec with increased afterload (squat, trendenlenberg)
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Common viral cause of myocarditis
Coxsackie B
- Sinus tach out of proportion to fever
- Young person with acute CHF = myocarditis
- 10 bpm per degree temp
- 100.5 at 150 is out of proportion
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Catecholamine crisis
Pheo
MAOI
Cocaine
Treatment?
- Alpha plus bb
- Do not use bb alone - unopposed alpha
- Labetalol plus
- Phentolamine (alpha blocker)
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Pathognomonic for MS
Bilateral internuclear ophthalmoplegia (eyes can't look at nose)
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Myasthenia Gravis caused by?
- Auto-antibody against acetycholine receptors
- 25% tumor of thymus
Hallmark: Muscle weakness, fatiguability, dipolopia, ptosis
Tx: Physostigmine - inhibits acetocholinesterase
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Lambert-Eaton Syndrome
- Similar to myasthenia gravis
- Autoimmune effects calcium channels
- Decreased DTRs
- Proximal thighs and hips, improves with use
- Associated with Cancer
- MS with Cancer
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Botulism
- Blocks acethycholine RELEASE at neuromusc jct
- Diplopia, ptosis,
- DESCENDING flaccid paralysis
- Anticholinergic symtpoms, dry, ileus, dilated eyes
- Floopy baby
- Tx Antitoxiin, PCN
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Tick Paralyisis
- Similar go Guillain-Barre
- Reapid ascending paralysis
- but NO PARESTHESIAS
- Tx, find tick and remove
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West Nile Virus
- Dead crows, birds
- Meningitis, Encephalitis
- Anterior Horn Cells, pure motor flaccid paralysis
- Sensation INTACT
- Send CSF for IGM antibodies to WNV
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ALS
Amyotrophic Lateral Sclerosis
- Upper AND lower motor neurons
- Upper: Spasticity, no sendor deficits
- Lower: ant horn cells, atrophy, fasiculations
- Death slowly by respiratory failure
- Weakness, difficulty eating and swallowing
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Blood pressure goal hemorrhagic stroke
160/90
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Cerebral - Cortical stroke syndrome
Contralateal motor and sensory deficits, contralateral cranial nerve palsies, all on oppositie side
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Brainstem stroke syndrome
- Cranial nerves uncrossed, corticospinal tract crossed
- Ipsilateral facial weakness
- Contralateral extremity weakness
- Face Same, Extremities opp = Brainstem
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Pontine stroke syndrome
coma, miosis, altered breahing
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Cerebellar stroke syndrome
Nystagmus, dizziness, N?V, ataxia
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Anterior Cerebral artery (2%)
- Contralateral legs and sensory
- Gait disturbance
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Middle Cerebral Artery (90%)
- Contralateral arms and face and sensory
- Aphasia or hemi-neglect
- Homonymous hemianopsia (blindness in the same field of vision each eye
- Eyes look toward side of stroke
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Seizure vs Stroke
Which ways do the eye look
- Eyes look toward the Stroke
- Eyes look away from the Seizure (scary)
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Left MCA stroke
- Right hemiparesis
- Right homonymous hemianopsia (looks left)
- Aphasia
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Right MCA stroke
- Left hemiparesis
- Left homonymous hemianopsia (looks right)
- Left hemineglect
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Posteriror Cerebreal Stroke
- Supplies occipital cortex
- Homonymous hemianopsia (contralateral)
- Visual agnosia (can't recognize objects)
- Cortical blindness (after CPR)
- Minimal motor involvement.
- Just eye things think Posterior Cerebral
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Vertebrobasilar
- Supplies brainstem, cerebellum, visual cortex
- Vertigo, nystagmus
- Diplopia
- Dyarthira, dysphagia
- Quadriplegia
- coma, syncope
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Wallenberg's Syndrome
- Vertebral artery thrombosis
- Ataxia, vertigo, nystagmus, N/V
- Dec pain and temp ipsilatel face, contra body
- Ipsilateal Horners (ptosis, miosis, anhidrosis)
- VERTEBRAL ARTERY THROMBOSIS
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Locked in Syndrome
- Basilar artery at PONS
- Also seen with pontine hemorrhage and central pontine myelinolysis
- Awake and alert
- No motor except vertical eye movements
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Cerebellar Infarct
- Sudden inability to walk or stand (drop attack)
- Headache, dizzy, nystagums, ataxia, N/V
- Can present only N/V
- Early Sx consult
- Rapid deterioration with hemorrhage
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Lacunar Syndromes (Clear mental status)
Pure sensory - Thalamus
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Nerve effected
Mid shaft humerus
Radia
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Shoulder dislocation
Axiallary
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Post elbow dislocation
Ant elbow
- Posterior elbow - Median Neve
- Ant elbow - Ulnar nerve
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Pediatric Fluid Calcuations
This method is sometimes shortened to the 4-2-1 method of 4 ml/kg/hr for the first 10 kg, 2 ml/kg/hr for the next 10 kg, and 1 ml/kg/hr for each additional kilogram.
(100 ml/kg/day x 10 kg) + (50 ml/kg/day x 3kg) = 1150 ml/kg/day/24hr = 47.9ml/hr
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Brown Sequard
Ipsilateral loss of motor, proprioception and vibrationContralateral pain and temperature
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Central Cord
- Loss of motor and sensory
- Upper > Lower
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Anterior Cord
Complete loss of motor, pain and temp below lesion but retains proprioception and vibratory
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Ohio mississipi river valley, bird, bad
fungal
Histoplasmosis
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Southwest, arthritis, erythema nodosum
fungal
Coccidioidomycosis
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Southeast, budding yeast, bone lesions
Blastomycosis
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PCP
- CD4 <200
- Bat wing interstitial pattern
- Bactrim and steroids if Pa02 < 70
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Cryptococcus meningitis CSF
india ink encapsulated yeast
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Niseria Meningitis csf
Gram neg diplococcic
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S. pneumonia csf
gram positive cocci in pairs
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