PicmonicUserXAEA-Twelve Shared "ARCHIVEDUserXAEA-12 Playlist" - 102 Picmonics

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ARCHIVEDUserXAEA-12 Playlist

Tremors
Resting tremor
s/s: asymmetric, 4-6 Hz, pill rolling
dec w/voluntary mvmt; inc w/stress
etiologies: PD, drug induced parkinsonism, PSP
Action tremors
Intention tremor
s/s: cerebellar sx
etiologies: cerebellar lesion (stroke, tumor, MS, Wilson dz, drugs)
mgmt: PT > thalamotomy
Essential tremor (ET)
epi: familial, autosomal dominant, bimodal age
s/s: 4-10 Hz flex-ext, can involve head/voice
mgmt: propranolol, primidone
Physiologic tremor
Orthostatic tremor
mgmt: clonazepam, gabapentin
Diabetic Neuropathy
MECHANISMS
Microvascular injury
Demyelination
Oxidative stress
Glycosylation end product deposition
POLYNEUROPATHY
Symmetric, distal, sensorimotor
Large fiber injury: Negative sx
Small fiber injury: Positive sx
Complications: Ulcers, Charcot arthropathy, Amputation
MONONEUROPATHY
Carpal/Tarsal tunnel syndrome, CN Palsies
AUTONOMIC NEUROPATHY
Gastroparesis, Orthostatic hypotension, Urinary retention/incontinence
Schizoaffective Disorder
Diagnostic criteria
Psychosis >2w WITHOUT Mood episode
Schizophrenia s/s (psychosis) WITH Mood episode
Cryptogenic Organizing Pneumonia (COP)
formerly Bronchiolitis Obliterans Organizing PNA (BOOP)
type of Idopathic Interstitial PNA
Noninfectious bronchiole inflammation d/t Intraluminal Polyps
Masson Bodies
Secondary: Chronic dz (RA), Drugs (amiodarone)
S/S: preceding Flu-like illness, mimics CAP
Workup: No response to Abx, Ground glass opacities, Restrictive pattern
Mgmt: Reassess (mild), PO Steroids (mod-sv), AZT, Cyclophosphamide (refractory)
Tachyarrhythmia Management
Parosyxmal SVT (PSVT)
HDS: Vagal maneuvers → Adenosine
Unstable: DC Cardioversion
Prevention: Verapamil, BBs, radiofrequency ablation
Multifocal Atrial Tachycardia (MAT)
Oxygen, ventilation
Preserved LV: CCBs, Selective BBs
Atrial Fibrillation (Afib), Atrial Flutter (AFL)
Ventricular Tachycardia (VT, Vtach)
Sustained
HDS, SBP >90: IV Amio, procainamide, sotalol
Unstable: DC Cardioversion → IV Amio
Ventricular Fibrillation (VFib)
IMMEDIATE Defibrillation + CPR
Persists: Epi, intubation, continue CPR, defibrillate again
Refractory: IV Amio
Premature Atrial or Ventricular Contractions (PAC, PVC)
if ASx: supportive
if sx: BB
Atrial Fibrillation (AF) Acute Management
All Patients: CHADS-VASc Scoring
without Hypotension, Sv CHF
HDS
mgmt: rate ctl - BB, dilt, dig
mgmt: dig > amio (if dec LVEF)
Rhythm Ctl: Cardioversion
Unstable
Rhythm Ctl: Cardioversion
>48h: TEE Algorithm
with Hypotension, Sv CHF
IV Digoxin (1st Line)
Pancreatic Adenocarcinoma
KRAS GOF mutation
activates GTPase → MAPK → cell growth
DPC, SMAD4 LOF mutation
CDKN2A (p16) mutation
Tumor markers: CA 19-9 > CEA
pancreatic Head is MC location
RFs: Tobacco, DM, Elderly, Ashkenazi Jew, chronic pancreatitis
Sx: epigastric pain radiates to back, weight loss, pale stools
Courvoisier Sign: PAINLESS obstructive jaundice + NONTENDER palpable gallbladder
Trousseau Sign: Migratory thrombophlebitis, DVT
Workup: Abd U/S → CTAP → ERCP, PTC
Mgmt: Whipple surg, 5-FU
NYHA Heart Failure Classification & Staging
Staging
A: at high risk for HF but no structural dz
Mgmt: Lifestyle mods
B: Structural Heart Dz
Mgmt: ACEIs, ARBs
C: stage B + CHF Sx
Mgmt: stage B + Diuretics + BBs + Salt Restriction
D: Refractory CHF
NYHA Class
Anticoagulants
Antiplatelet Agents
Aspirin (ASA)
ADPR-i: Clopidogrel, Prasugrel, Ticagrelor, Ticlopidine
GPIIb/IIIa-i: Eptifibatide, Tirofiban, Abciximab
PDE-i: Cilostazol, Dipyridamole
Direct Thrombin Inhibitors (DTIs)
Bivalirudin
Dabigatran, Argatroban
Indirect Thrombin Inhibitors
UFH
LMWH: Enoxaparin, Dalteparin, Fondaparinux
contraindicated in AKI/CKD
Thrombolytics
tPA (alteplase, reteplase), streptokinase, tranexamic acid
Factor Xa Inhibitors
Apixaban, Rivaroxaban
containdicated in AKI/CKD
Vitamin K antagonists
Warfarin
Methemoglobinemia
Oxidation of Fe2+ to Fe3+
Etiologies: Local anesthetics, Benzenes, Nitrites, Dapsone
s/s: cyanosis, chocolate-colored blood
Labs: Hb curve left shift, Pulse ox 85%, Nml PaO2
Mgmt: Methylene Blue, Vit C, NADH
DDx: Sulfhemoglobinemia
Etiologies: Sulfur products e.g. Sumatriptan, SSz
s/s: blue-green blood, mucocutaneous surfaces
Neonatal Sepsis
S/S: non-specific, dec activity, poor feeding, irritability, lethargy, hypotonic
Workup: CBC, BCx, UA, UCx | LP if suspect bacterial meningitis
Mgmt: Empiric Abx
Amp + Gent
Cefotaxime for Gram(-)
Acyclovir
Vanc (bacterial meningitis)
Levetiracetam (Keppra)
MoA: Inhibits N-type Cav Channels, Facilitate GABAergic transmission
Indications: Myoclonic, Tonic-clonic, Partial sz
SFx: Emotional lability (aggression), Depression, HTN, Nasopharyngitis
Pneumonia Management
Aspiration PNA: Clindamycin
Community Acquired Pneumonia (CAP)
Healthy Outpt: azithro, doxy
Comorbid Outpt: floxacin or [B-lac+ macro]
Inpt: IV floxacin or [B-lac + macro]
ICU: IV [B-lac + fluoro] or [B-lac + macro]
PCN Allergy: floxacin + aztreonam
Ventilator Associated Pneumonia (VAP): 3 Drugs
S. pneumo: ceph, PCN, carbapenem
Pseudonomas: fluoro, aminoglycoside
MRSA: vanc, linezolid
Meningitis Cerebrospinal Fluid (CSF) Analysis
acute Bacterial
Inc. WBC (PMNs), Protein, Opening pressure
Dec. Glc
Cx(+), Gram stain(+)
partially treated Bacterial
Monocytic predmoninance | Protien & Glc move towards nml
Viral
MCC Coxsackievirus
Inc. WBC (Lymphocytes)
Fungal, TB
Inc. WBC (Lymphocytes), Protein, Opening pressure
Dec. Glc (<10)
Drugs Contraindicated in Breastfeeding, Lactation
ALI: Atropine, Lithium, Iodide
CAN: Cyclosporine, Alcohol, Nicotine
Chloramphenicol
BB: Bromocriptine, BZDs
RR: Rizatriptan, Radiopharmaceuticals
EE: Ergotamine, Ethosuximide
AA: Amiodarone, Amphetamines
SS: Sex hormones, Stimulant laxatives
TT: Tretinoin, Tetracycline
Methotrexate (MTX)
Aplastic Anemia Etiologies
Congenital: Fanconi
Acquired
Drugs: NSAIDs, Sulfonamides, AEDs, Chloramphenicol, EtOH, PTU, MMI
Chemicals: Benzene, glue
Radiation
Viral: Parvo, EBV, CMV, HIV
Immunue: SLE, PNH, Thymoma
Fetal Alcohol Syndrome (FAS)
3 pathognomonic facial dysmorphisms
small palpebral fissures
smooth philtrum
thin vermilion border
MR/DD, Social withdrawal
Decreased growth (height, weight)
Holoprosencephaly, Microcephaly
Diazoxide
opens KATP channels --> Hyperpolarization
pancreatic beta cells: decreases insulin release
vascular SMCs: decreases b/p
Indications: Hypertensive Emergency, Congenital Hyperinsulinism, Insulinoma
SFx: PH, Hyperglycemia, Hypertrichosis, sodium retention, HA, reflex tachycardia
Fanconi Anemia
epi: MCC Inherited Aplastic Anemia, Ashkenazi jews
pathophys: auto rec NHEJ defects → BM failure
s/s: pancytopenia
derm sx
MSK sx
Head/neck sx
Eyes, Ears, Kidney anomalies
Comorbid Malignancies: MDS, Leukemias (AML), SQCC of Head, Neck, Vulva
Labs: inc AFP, HbF
Dx: Expose lymphocytes to Mitomycin C → observe Chromosomal Breakage
Tx: Allogeneic HSCT
Collagen Types
Type 1: MSK, Fascia, Skin, Cornea (Bowman, Stroma layers)
Osteogenesis Imperfecta
Type 2: Cartilage (hyaline), Vitreous Body, Nucleus Pulposus
Relapsing Polychondritis
Type 3 (Reticular), Blood, Uterus, Fetus, Granulation Tissue
Type 4: Basement Membrane, Lens, Descement Membrane (Cornea)

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