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Hyperlipidemia
Lipid lowering Criteria Any person >35 y should get fasting lipids and repeat every 5 years Hyperlipidemia Total Cholesterol >200 LDL >130 HDL <40 Guidelines No atherosclerosis risk → First 12-week trial of diet and exercise! High risk and DM → High-dose statin (Atorvastatin 80mg) Medium risk and DM →...
Read moreArrhythmia
Bradycardia, AV Block Bradycardia (HR <60) → ECG Sinus Bradycardia Treatment Asymptomatic → No treatment Symptomatic Best initial → Atropin Most accurate → Pacemaker First-Degree AV Block Presentation Fixed PR lengthening Treatment Asymptomatic → No treatment Symptomatic Best initial → Atropin Most accurate → Pacemaker Second-Degree AV Block Mobitz I (Wenckebach) Presentation...
Read moreSyncope
WOMAN 3-2-1 PE History Physical Diagnosis VV (Vaso Vagal) Visceral Organs (micturition, defecation, cough) Carotid Stimulation (turning head, shaving) Psychogenic (site of blood) Situational Often reproducible Positive prodrome Vagal stimulation produces asystole or a ↓ SYS BP of 50 mmHg Tilt Table Orthostatic Volume Down Autonomic Nervous Dysfunction Orthostatic...
Read moreRBC Pathology
Image Pathology What it is Causes Heinz Body Also, Bite cells Oxidized hemoglobin G6PD Howell-Jolly Body Nuclear remnant Asplenia Sickle Cell Disease Ringed Sideroblast Mitochondria Sideroblastic anemia MDS Basophilic stippling Ribosomes All microcytic anemias Lead poisoning Alcohol Target cell Thalassemia Asplenia HbC disease Liver disease Acanthocyte Spur cell Abetalipoproteinemia...
Read moreBlood Transfusion
Adverse Reactions Allergic Etiology Anaphylactic Within seconds Anti-IgA antibodies in recipient Urticarial IgE antibodies in recipient Mast cell activation Presentation Urticaria Flushing Angioedema Pruritus Anaphylaxis Treatment Severe (Anaphylactic) STOP transfusion Epinephrin Mild/Moderate (Urticarial) DON’T stop transfusion ? Antihistamine Febrile Etiology Cytokines during storage Presentation 1-6h after Fever Chills Rigors...
Read moreImmune Coagulation Disorders
ITP Etiology Anti-PLT IgG Presentation PLT-type bleeding ↓PLT Normal size spleen Acute → Children after viral illness Chronic → Young adults, F>M Diagnosis Diagnosis of exclusion Anti-PLT Ab → Not specific U/S, CT → Exclude hypersplenism ↑ Megakaryocytes ⇒ ↑ Mean PLT volume Normal RBC morphology Treatment PLT >30k, No bleeding → No treatment...
Read moreAnticoagulants
Coagulation Cascade Heparins → Antidote → Protamine sulfate Heparin → ↑PTT LMWH → No change in PTT Enoxaparin Dalteparin Contraindicated in Renal Failure Warfarin → Toxicity → FFP, Vit K, Protrombin complex concentrate ↑PT ↓ liver synthesis of K-dependent factors 2, 7, 9, 10 C, S → Shorter half-life ⇒ Paradoxical hypergoagulability Factor Xa inhibitors Direct RiveroXaban (Xarelto) →...
Read moreRTA
Renal Tubular Acidosis Type 1 (Distal) Distal tubule can not generated Bicarb under aldosterone influence ⇒ ↓ H secretion Etiology Amphotericin SLE Sjogren Presentation Normal AG metabolic acidosis ↓K Diagnosis Best initial → UA → pH >5.5 Most accurate → Ammonium Cl (acid) infusion → Urine remains alkaline ↓K Complications Alkaline...
Read moreEndocrine Diagnostic Tests
Condition Problem Test Acromegaly ↑ GH Serum IGF-1 Glucose suppression test Prolactinoma ↑ Prolactin Serum prolactin DI ↓ ADH Water deprivation DDAVP stimulation SIADH ↑ ADH Urine Osm/Na Cushing Syndrome ↑ Cortisol 24h Urine cortisol 1 mg Dexa ACTH 8 mg Dexa Addison ↓ Cortisol 8AM Cortisol Cosyntropin Conn’s...
Read moreMetabolic Syndrome
WEIGHHT (3 out of 5) Waist ↑ → >40 inch Impaired Glucose → >100 Hypertension → >130/85 HDL ↓ → <40 TG ↑ → >150
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