What I Learned This Summer, Part 2

• When treating DKA, you cannot stop treatment before the bicarbonate has been corrected (~22-24)
• When a joint is inflamed, always feel the temperature - Warmth could be significiant of a septic joint
• When doing arthrocentesis of the knee, find the bottom of the patella, and go medial OR lateral (Dr. A thinks lateral is better)
• 7 Causes of Monoarticular Arthropathy
1. Septic Joints
2. Gonococcal Infection
3. Gout
4. Pseudogout
5. Bechet's
6. Trauma
7. Reactive Arthropathy
• Gout
• no need to tap if suspected in 1st metatarsal
• uric acid crystals found on microscopy
• 90% due to under-excretion of uric acid
• 10% due to over-production
• either way, Rx is NSAIDs + steroids
• in over-production, add allopurinol
• Pseudogout
• Calcium oxalate crystals
• Tx is NSAIDs and steroids
• Septic Joint will have >50,000 WBCs on microscopy
• True Iron deficiency shows low iron AND low iron saturation
• For the first 2 weeks s/p Acute CVA, allow for autoregulation of BP, except in hemorrhagic stroke
• AIDS
• CD4+ < 200 =" AIDS
• CMV Retinitis
• Toxoplasmosis
• Esophageal Cadidia
• TB
• MAI Reccurent
• Kaposi's Sarcoma
• Cryptosporidium
• Lymphoma
• General wasting, CD4+ count
• AIDS --> treat
• CD4+ < 350 =" treat
• CD4+ 350-500 = treat if >60,000 viral load
• CD4 >500 = don't treat
• If HAART works after 8 weeks, viral load should be gone
• If viral load is still present, they are resistant to part/all of the regime
• Geno/phenotyping to help determine what anti-virals to use
• Most common cause of Pulmonary HTN that is not easily explained is a chronic pulmonary embolus
• DVT's below the knee = no treatming
• DVT's above knee = Coumadin (warfarin)
• Recurrent DVT's = indication for continuous anticoagulation
• Best place to look on 12-lead EKG for A-Fib are in the inferior leads - II, III, aVF