PANCE

Nephrotic Syndrome

(ACEI) Angiotensin Converting Enzyme Inhibitor

• Blocks production of aldosterone
• May cause hyperkalemia (Peaked T-wave on ECG)

• Ca: Breast, Vulva etc
• Associated with pruritis of the vulva, along with lesions that resemble eczema
• Pathology: Eosinophilic Paget's cells

These are particularly common in the hands and lead to enlargement of the PIP joints

These are particularly common in the hands and lead to enlargement of DIP joints

(Alpha Blocker)

Dicloxacillin

acute injury to the ulnar collateral ligament

• hypercalcemia
• *Sarcoidosis can be assoc c hypercalcemia

widened mediastinum

Sulfasalazine

Methyldopa

• Macrolide
• Azithromycin 500 mg 1st dose then 250 mg X 4/days for CAP especially Mycoplasma pneumonia

Vaccine for influenza AB

*Contraindicated in asthma/COPD

Mupirocin cream for small areas

(DIP) Mallet finger refers to a condition in which the end joint of a finger bends but will not straighten by itself. In this situation, the joint can be pushed straight but will not hold that position on its own.

(DIP hyperflexion with PIP hyperextension)

Supracondylar fracture

*FOOH

• Finding this protein is often suggestive of multiple myeloma.
• The proteins are immunoglobin light chains. The light chains have traditionally been detected by heating or electrophoresis of concentrated urine.

Anti DNAase B serology

< 4 hours: N-acetylcysteine (NAC) is the treatment of choice and can be given either orally, nebulized (mucomyst), or intravenously.

Seizures & Migraine Prophylaxis (50 mg 2X/day)

*mechanism of action unknown

• Subclass: Macrolides
• Mechanism of Actionbacteriostatic; binds to P site of 50S ribosomal subunit, interfering w/ protein synthesis

• Subclass: Quinolones
• Mechanism of Action: bactericidal; inhibits DNA gyrase and topoisomerase IV

• Subclass: Macrolides
• Mechanism of Action: bacteriostatic; binds to P site of 50S ribosomal subunit, interfering w/ protein synthesis

Transient monocular vision loss due to retinal emboli

• s/sx: temporary curtain
• The arterial supply branches off from the internal carotid artery

• Disorder characterized by polydipsia, polyuria, increased thirst, and formation of hypotonic urine.
• Two types exist: central DI, due to defective/decreased synthesis or release of arginine vasopressin (AVP) from the hypothalamo-pituitary axis; and nephrogenic DI, due to renal insensitivity to AVP (inability to concentrate urine due to resistance to ADH on the kidney

• Primary Options
• isoniazid : 5 mg/kg orally once daily for 9 months, maximum 300 mg/dose; or 15 mg/kg orally twice weekly for 9 months, maximum 900 mg/dose. Adverse effects: hepatitis, peripheral neuropathy
• Secondary Options
• rifampin : 10 mg/kg orally once daily for 4 months, maximum 600 mg/dose; or 10 mg/kg orally twice weekly for 4 months, maximum 600 mg/dose
• or
• rifampin : 10 mg/kg orally once daily for 4 months, maximum 600 mg/dose; or 10 mg/kg orally twice weekly for 4 months, maximum 600 mg/dose. Adverse effects: hepatitis, etc
• and
• isoniazid : 5 mg/kg orally once daily for 4 months, maximum 300 mg/dose; or 15 mg/kg orally twice weekly for 4 months, maximum 900 mg/dose

Topical metronidazole cream

Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels

Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through the external inguinal ring

• Celiac disease is an inherited, autoimmune disease in which the lining of the small intestine is damaged from eating gluten and other proteins found in wheat, barley, rye, and possibly oats.
• Gluten free diet

**May eat things like potatoes, Rice...

GERD

Nasal Smear

Sore throat, nasal discharge, hoarseness, fever, lesions: brownish/grey membranous

Phenytoin (Dilantin)

1st Tests To Order

• dark field microscopy of swab from lesion
• serum treponemal enzyme immune assay (EIA)
• serum T pallidum particle agglutination (TPPA)
• serum T pallidum hemagglutination (TPHA)
• serum fluorescent antibody absorption (FTA-ABS) tests
• immunocapture assay (ICE)
• serum Venereal Disease Research Laboratory (VDRL) test
• serum rapid plasma reagin (RPR) test
• serum cardiolipin-based test

• Without penicillin allergy
• intramuscular benzathine penicillin-G

• With penicillin allergy: nonpregnant
• oral doxycycline
• oral tetracycline

• A ductus arteriosus is a vascular fetal structure that usually closes in the first 48 hours after birth.
• Persistence of the ductus arteriosus can result in heart failure, increased pulmonary pressures and endarteritis.
• S/Sx: DOE, Machine-like continuous murmur heard at left sternal border, widened pulse pressure, loud S2.
• Dx: MRI, CT, and Echo is helpful
• Tx: Indomethacin
• Surgery (duet closure)

• A defect in the interventricular septum that allows shunting of blood between the left and right ventricles.
• S/Sx: R, L, or Biventricular hypertrophy, murmur, thrill, heave, R-L shunting, ejection systolic murmur at the R upper sternal border
• Also: pulmonary HTN (Eisenmenger physiology).
• Dx: Echo, also MRI, CT
• Tx: Meds,

• Loperamide (Imodium)
• Cipro (Quinolone)

• Chromosomal abnormality involving a complete or partial absence of the second sex chromosome occurring in approximately 1 in 2500 live female births.
• Key Factors
• poor growth, short stature, delayed/absent pubertal development, primary amenorrhea, dysmorphic features, skeletal abnormalities,
• webbed neck, peripheral lymphedema, Possible bicuspid aortic valve and aortic dilation

• 1) Ventricular septal defect with 2) overriding aorta and 3) right ventricular (RV) outflow tract obstruction and 4) resulting RV hypertrophy.
• S/Sx: Hypercyanotic episodes, harsh systolic ejection murmur, cyanosis, tachypnea, "boot shaped heart"
• Dx: Echo
• Tx: Meds (supportive; i.e. B-blockers, O2) & Surgery

• Jock itch, also called tinea cruris or ringworm of the groin, is an infection of the groin area caused by fungus.
• S/Sx: Itching in groin, thigh skin folds, or anus. Red, raised, scaly patches that may blister and ooze -- The patches often have sharply-defined edges and are often redder around the outside with normal skin tone in the center.
• Tx: Keep the skin clean and dry. Don't wear clothing that rubs and irritates the area.
• Apply topical over-the-counter antifungal or drying powders, such as those that contain miconazole, clotrimazole, or tolnaftate.

RUQ pain, jaundice, fever

(+) in 20-70% of pts c acute cholangitis

Asia (India/Africa)

S/Sx: Rice watery stools, profuse, gray, watery diarrhea

Tx: Hydration

Organism: (Fungus) Trichophyton rubrum

Dx: KOH (potassium hydroxide) microscopy

Tx: Systemic Terbinafine or azol therapy

• Suicial ideations are less common with SSRIs
• SSRIs are safer

Transudative pleural effusions are defined as effusions that are caused by systemic factors that alter the pleural equilibrium, or Starling forces. The components of the Starling forces: hydrostatic pressure, permeability, oncotic pressure (effective pressure due to the composition of the pleural fluid and blood), are altered in many diseases e.g., CHF-left ventricular failure, renal failure, hepatic failure, and cirrhosis.

Exudative pleural effusions, are caused by alterations in local factors that influence the formation and absorption of pleural fluid (e.g., bacterial pneumonia, cancer, pulmonary embolism, and viral infection).

Atypical pneumonia that occurs more often in younger age groups

S/Sx: low grade fever, malaise, non-productive cough

• Tx:
• Erythromycin (macrolide)
• or
• Doxycylcine (tetracycline)

Stasis, intimal injury, hypercoagulability

*major risk factor for venous thrombosis and pulm embolism

Initial symptoms: gatigue, musculoskeletal complaints, swelling of hands, Raynauds phenomenon, talangiectasias

• DX: Clinical, ANA, ESR, CBC: anemia, >creatinine (strongly positive in secondary RP)
• Primary RP: U/A = RBCs & protein, the rest of results are normal

TX: CCB

* Seconday RP is more common in women (9:1) in conditions such as SLE, scleroderma, Sjogren syndrome, and other connective-tissue diseases.

• Results of excess stress on achilles tendon that attaches to plantar fascia
• S/Sx: Burning heel pain. pain increases while bearing wt after resting.
• Tx: Conservative treatment involves combination therapy (e.g., heel padding, shoe changes, low-Dye strapping, NSAIDs and stretching exercises).
• Less conservative: Corticosteroid injections if necessary, PT, surgery

S/Sx: knee catching or locking, pain, TTP at joint line

Dx: (+) McMurray test (+) Apley test, < flexion/extension

Proliferative diabetic retinopathy: Neovascularization is hallmark

Nonproliferative diabetic retinopathy: blot hemmorrhages, cotton wool spots, microaneurysms

• *Diabetic retinopathy usually occurs before nephropathy.
• *Can occur within 5 yrs but usually occurs 10 to 20 years after DM onset

Doxycycline (tetracycline) or Azithromycin (macrolide)

Pregnant: Azithromycin, Erythromycin (Macrolides)

S/Sx: dysuria, fever, pruritis, increased pH, fishy odor, discharge, clue cells

Tx: metronidazole, clindamycin, or tinidazole

Estrogen therapy

• A rare, autoimmune disorder of the neuromuscular junction. Can occur with cancer or just autoimmune disease.
• Symptoms include insidious and gradual onset of fatigue, weakness, and a dry mouth.
• Dx: Anti Acetocholine studies, nerve conduction studies, etc
• Tx: intubation, immunoglobins, treat underlying cause 3,4diaminopyridine (3,4-DAP), ± pyridostigmine, supportive care.

• A chronic autoimmune disorder of the postsynaptic membrane at the neuromuscular junction in skeletal muscle.
• A chronic autoimmune disorder of the postsynaptic membrane at the neuromuscular junction in skeletal muscle.
• Characterized by muscle weakness that increases with exercise (fatigue) and improves on rest. Commonly presents with drooping eyelids, double vision, oropharyngeal and/or appendicular weakness and shortness of breath.
• Raised serum acetylcholine receptor antibody or muscle tyrosine kinase antibodies are present. Clinical electrophysiology shows decremental response on repetitive nerve stimulation or increased jitter on single fiber study.
• Treatments include anticholinesterases and immunotherapy. Thymectomy may be required.

• Syndrome of inappropriate antidiuretic hormone (SIADH) is defined as euvolemic, hypotonic hyponatremia secondary to impaired free water excretion, usually from excessive arginine vasopressin (AVP) release.
• Paraneoplastic syndrome associated with bronchogenic carcinoma.
• Labs: hyponatremia, high urin osmololity.
• Tx: Water restiction, supportive, lasix, vasopressor receptor agonist

• Chronic fibrosing condition characterized by insidious, progressive, and severe restriction of both active and passive shoulder range of motion.
• More common in women, previous trauma, diabetes
• Dx: MRI, Plain film
• Tx: Activity modification, PT, NSAIDs, Surgery

Ototoxicity secondary to lasix/loop diuretics which may cause sensory hearing loss.

Nifedipine (CCB)

• A protozoan parasite spread through food or water contaminated with oocysts, through infected meat or though contact with oocysts from feline feces.
• S/Sx: Usually asymptomatic. Symptomatic in immunocompromised pts. (HA, Sz, confusion, malaise, etc) Congentital abnormalities in fetus.
• Tx: HIV-positive with CD4+ T lymphocyte counts <100
• *Prophylactic trimethoprim/sulfamethoxazole
• **Active: pyrimethamine (malarial, antiparasitic), sulfadiazine (sulfonamide-like Bactrim), & leucovorin (oncologic toxicities)

CT or MRI usually shows multiple ringed enhancing cerebral lesions

streptococcus pneumoniae

Progressive weight loss, constipation, decrease in stool caliber "pencil thin stools"

Most important diagnostics are colonoscopy and biopsy

Gerd > Barret's (premalignant) > adenocarcinoma

Adenocarcinoma

(Barret's esophagus = lower esophagus epithelial lining changes from squamous to columnar (Barret's change) leading to adenocarinoma)

Squamous cell

Pneumocystis carinii

CBC and (ANC) absolute neutrophil count

Agranulocytosis (low WBC count, specifically neutrophils)

Papillary

Leukemia

• Pott's disease, is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints.
• Pott’s disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining intervertebral disc space.

optic neuritis with (red-green color discrimination)

• A tumor arising from catecholamine-producing chromaffin cells of the adrenal medulla
• Classic: episodic; HA, diaphoresis, palpitations, paoxysmal HTN

• 24-hour urine collection for catecholamines, metanephrinnes, normetanephrines and creatine
• MRI, CT Scintigraphy, clonidine suppression etc

• HTN control: alpha blockers, hydration, CCB
• Surgery