What I Learned This Summer, Part 1
So, since I spent most of this summer prancing around the hospital in my shirt&tie or scrubs, pretending to be important, I decided I should have something to write down all the little tidbits that I pick up. Many of them are clinical "pearls", some are things that I just wrote down off of UpToDate (I mean uhh...my Attending stated it to me word for word, cuz stealing would be a Copyright Violation:-/), and some are just random things that a normal medical student would know that I didn't (aka the answers to pimping questions). So I decided it would be fun if I shared them with you. I've got 1 and a quarter (guesstimate) little shirt-pocket notebooks filled with info, so it make take more than 1 post. So without further ado, here we go:
- After every 6 units of blood, Calcium must be administered to help the clotting cascade.
- Consequences of Erythropoietin
- High BP (HTN)
- Seizures
- In Endocarditis,
- Janeway lesions --> no pain
- Osler nodes --> pain
- CLUBBING Acronym for causes of Clubbing
- C - cyanotic heart diseasse/Cystic Fibrosis
- L - lymphoma
- U - ulcerative colitis
- B - bronchiectasis
- B - bronchogenic malignancy
- I - idiopathic pulmonary fibrosis
- N - neoplasms
- G - granulomatous diseases
- Part of DDx of BRB in Stools:
- Diverticular bleed
- Aterio-venous malformations
- not too common
- usually in lower GI
- MMSE (Mini-Mental Status Exam)
- out of 30 points
- 28-30 = probably not demented
- 25-27 = borderline
- <25>
- ~13% of >75yo's have a MMSE <25
- Absolute Indications of Dialysis
- Pericarditis
- Fluid overload
- HTN
- Uremia
- N/V
- Creatinine >12 or BUN>100
- 2 Major Abx that cause Antabuse-like reactions when taken w/ alcohol
- Metronidazole (Flagyl)
- Isoniazid
- When UTI culture shows Proteus Mirabilis, a urea-splitting organism, investigations for staghorn calculi (e.g. Renal US) must be performed
- NEVER use Levaquin (levofloxacin) when pt is on Coumadin (warfarin) - raises INR dramatically (=bad!)
- Bicipital tendonitis - hold arm to chest wall; with flexed elbow, rotate humerus laterally while palpating the bicipital tendon (where bicep originates in shoulder) - if inflamed, will cause intense pain
- Pancreatitis (elevated Lipase) + Elevated ALT = Gallstone Pancreatitis
- 3 Leading causes of cough:
- Post-nasal drip
- Asthma
- Acid reflux (GERD)
- Pneumonia (PNA)
- crackles/rales
- CXR lags 3/4 weeks behind clinical (fever, O2 Sat, etc), even after pt feels better
- BUN more specific on CMP for PNA
- Put on abx: macrolide, 3rd generation cephalosporin, and broad spectrum flouroquinolone
- Septic Joint/Nongonoccocal arthritis is sometimes the presenting complaint in Infectious Endocarditis
- Causes of Macrocytic Anemia
- Reticulocytois (reticulocytes are macrocytes)
- Alcoholism
- Liver disease
- Interference with DNA synthesis
- Folate or Cobalamin (B12) deficiency
- Drugs e.g. hydroxyurea, methotrexate, etc
- Myelodysplastic syndromes
- Hypothyroidism
- Hyperlipidemia
- When Increased Creatinine or ARD is due to drug rxn, urine may contain eosinophils - test for them
- When alcoholic patients develop constipation, they develop hepatic encephalopathy - treat with lactulose to move bowels, and thiamine/multivitamins (e.g. banana bag - though these aren't used too much anymore)
- Pts with chest tubes/drains must be outputting 100mls or less over 24hrs before clamping off tube
- 6 Cardioprotective Agents
- Statins
- ACE-I/ARBs
- Heparin/Lovenox (enoxaparin - an LMWH)
- ASA (aspirin)
- B-Blockers
- Thrombolytics/TPA
- When dialysis patients get very itchy, its usually due to uremia
- Hypercalcemia can be secondary to malignancy - both solid tumours and leukemia
- 10-20% of cases are due to this, especially Breast & Lung, and multiple myeloma
- Occurs through:
- osteolytic metastases w/ local cytokine release
- tumor secretion of PTH-related protein
- tumor production of calcitrol
- Procrit (Epoietin) contraindicated in sickle-cell patients - does not differentiate between sickle cells and normal cells, so more of both are made (=bad!)
- In new-onset Type II Diabetes Mellitus, when trying to determine whether to start insulin or oral agents, use a fasting blood glucse of ~400 (mg/dL NOT mmol/L) as a barrier
- Below, use oral
- above, use insulin - but remember, insulin has side-effects!
- In pregnant DM patients, DO NOT use oral medications - insulin only!!
- When I/O is negative (down), you expect H&H to go up (less blood, more cells). If it goes down, check for active bleeding
- Esophageal Spasm, which can cause CP & mimics AMI symptoms can also be relieved by NTG
- AST + ALT in 1000's = Toxic (eg Tylenol OD)
- Normal AST/ALT with Increased Bili = obstruction
- Nitrofurantoin (Macrobid)'s major side effect = Irreversible Pulmonary Fibrosis
- Intracranial HYPOtension Triad:
- MRI showing sagging of the brainstem
- Bilateral subdural hygromas
- Diffuse dural enhancement
- Bronchiectasis (chronic infection of bronchi and bronchioles leading to permanent dilatation)
- Causes:
- Cystic fibrosis
- reccurent PNA
- immunocompromise
- Major bacteria:
- Staph Aureus
- Pseudomonas Aeruginosa
- Antibiotic most likely to cause C. diff infection - Clindamycin
- Can Flagyl (metronidazole - Rx for C. diff) cause C. diff? Yes.
- DVT's below the knee don't need treatment
- Pts on Metformin who are undergoing contrast studies need to hold Metformin for 48-72hrs after contrast administration, while monitoring BUN/Creatinine
- Do not enema/colonoscopy a pt with diverticulitis - you will perforate their bowels.
-AMiB
