1. Printzmetal's Angina
    • Variant angina, coronary artery spasm
    • Occurs at rest
    • Many not have  CAD
  2. Percent of AMIs with normal EKG
  3. Predictors of AMI
    • Depression of areas oppositve peredict larger MI with inc mortality
    • T-wave inversion within 4 hours is good prognostic sign
  4. dewinters T waves
    • ST depression into rocket T-waves
    • Acute LAD occlusion
  5. Elevation in aVR
    Acute LMCA occlusion
  6. Post MI papillary muscle rupture causes what murmur
    • Acute mitral Regurgitation
    • Acute onset CHF
    • HD support, IABP, Surgery (OR)
  7. How does paget's dz effect the heart
    High outpt failure due to multiple AV malformations
  8. How does beriberi effect the heart
    High outpt failure due to B1 thiamine deficiency leads to dec SVR, edema, high output failure
  9. Osler nodes
    Tender nodules on the tips of the fingers and toes, IE,Osler=Ow
  10. Janeway lesions
    Non-tender hemorrhagic plaques on the palms and soles
  11. Roth spots
    retinal hemorrhages with central clearing
  12. triple coverage for prosthetic valve endocarditis
    • vanc
    • gent
    • add rifampin (more gram + coverage
  13. Jones Criteria
    • CASES
    • Carditis
    • Arthritis
    • Syndenhams chorea
    • Erythema marginatum
    • subcutaneous nodules

    Minor:  Prev hs, arthralgia, ESR, prolonged PR interval, fever
  14. AS vs AR murmur
    • AS : Systolic radiating into neck
    • AR : Diastolic decrescendo at left lower sternal border, water hammer, duroziez's, Austin-flint, quinckes
  15. Most common cause mitral stenosis
    • RHD
    • Diastolic murmur + pulmonary edma in pregnancy = Mitral Stenosis

    Low apex diastolic murmur to axilla, loud S1
  16. MS vs MR murmur
    • MS - Diastolic rumble at apex
    • MR - loud holosystolic murmur

    MR - may have no murmur if ruptured chordae tendineae
  17. Murmur Hypertrophic Cardiomyopathy
    • Harsh, mid-systolic LLSB
    • Louder with dec preload (standing, valsalva, hypovolemia)
    • Dec with increased afterload (squat, trendenlenberg)
  18. 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
  19. Catecholamine crisis
    • Alpha plus bb
    • Do not use bb alone - unopposed alpha
    • Labetalol plus
    • Phentolamine (alpha blocker)
  20. Pathognomonic for MS
    Bilateral internuclear ophthalmoplegia (eyes can't look at nose)
  21. Myasthenia Gravis caused by?
    • Auto-antibody against acetycholine receptors
    • 25% tumor of thymus

    Hallmark:  Muscle weakness, fatiguability, dipolopia, ptosis

    Tx: Physostigmine - inhibits acetocholinesterase
  22. 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
  23. Botulism
    • Blocks acethycholine RELEASE at neuromusc jct
    • Diplopia, ptosis,
    • DESCENDING flaccid paralysis
    • Anticholinergic symtpoms, dry, ileus, dilated eyes
    • Floopy baby
    • Tx Antitoxiin, PCN
  24. Tick Paralyisis
    • Similar go Guillain-Barre
    • Reapid ascending paralysis
    • Tx, find tick and remove
  25. West Nile Virus
    • Dead crows, birds
    • Meningitis, Encephalitis
    • Anterior Horn Cells, pure motor flaccid paralysis
    • Sensation INTACT
    • Send CSF for IGM antibodies to WNV
  26. 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
  27. Blood pressure goal hemorrhagic stroke
  28. Cerebral - Cortical stroke syndrome
    Contralateal motor and sensory deficits, contralateral cranial nerve palsies,  all on oppositie side
  29. Brainstem stroke syndrome
    • Cranial nerves uncrossed, corticospinal tract crossed
    • Ipsilateral facial weakness
    • Contralateral extremity weakness
    • Face Same, Extremities opp = Brainstem
  30. Pontine stroke syndrome
    coma, miosis, altered breahing
  31. Cerebellar stroke syndrome
    Nystagmus, dizziness, N?V, ataxia
  32. Anterior Cerebral artery (2%)
    • Contralateral legs and sensory
    • Gait disturbance
  33. 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
  34. Seizure vs Stroke
    Which ways do the eye look
    • Eyes look toward the Stroke
    • Eyes look away from the Seizure (scary)
  35. Left MCA stroke
    • Right hemiparesis
    • Right homonymous hemianopsia (looks left)
    • Aphasia
  36. Right MCA stroke
    • Left hemiparesis
    • Left homonymous hemianopsia (looks right)
    • Left hemineglect
  37. 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
  38. Vertebrobasilar
    • Supplies brainstem, cerebellum, visual cortex
    • Vertigo, nystagmus
    • Diplopia
    • Dyarthira, dysphagia
    • Quadriplegia
    • coma, syncope
  39. Wallenberg's Syndrome
    • Vertebral artery thrombosis
    • Ataxia, vertigo, nystagmus, N/V
    • Dec pain and temp ipsilatel face, contra body
    • Ipsilateal Horners (ptosis, miosis, anhidrosis)
  40. 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
  41. 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
  42. Lacunar Syndromes (Clear mental status)
    Pure sensory - Thalamus
  43. Nerve effected
    Mid shaft humerus
  44. Shoulder dislocation
  45. Post elbow dislocation
    Ant elbow
    • Posterior elbow - Median Neve
    • Ant elbow - Ulnar nerve
  46. 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
  47. Brown Sequard
    Ipsilateral loss of motor, proprioception and vibrationContralateral pain and temperature
  48. Central Cord
    • Loss of motor and sensory
    • Upper > Lower
  49. Anterior Cord
    Complete loss of motor, pain and temp below lesion but retains proprioception and vibratory
  50. Ohio mississipi river valley, bird, bad
  51. Southwest, arthritis, erythema nodosum
  52. Southeast, budding yeast, bone lesions
  53. PCP
    • CD4 <200
    • Bat wing interstitial pattern
    • Bactrim and steroids if Pa02 < 70
  54. Cryptococcus meningitis CSF
    india ink encapsulated yeast
  55. Niseria Meningitis csf
    Gram neg diplococcic
  56. S. pneumonia csf
    gram positive cocci in pairs
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