Step 2 (UWORLD)

Pregnant Patient at 36 weeks GA has Seizure + HTN with Diaphoresis, Agitation, Dilated Pupils, Hyponatremia, and normal Head CT

AMPHETAMINE INTOXICATION - Serotonin-mediated = hyponatremia, dilated pupils (mydriasis), agitation, diaphoresis, HTN - Normal Head CT (unlike eclampsia which would most likely have white matter edema)

25 yo man presents with R shoulder pain and pain with resisted abduction. He has tenderness to palpation of acromioclavicular joint, heels, iliac crest, and tibial tuberosities. What is the most likely dx?

ANKYLOSING SPONDYLITIS - Tenderness to palpation of tendon and ligament insertion points = enthesitis ***Insertion at Achilles tendon is often the most prominent

Acute Stress Disorder vs. PTSD

ASD = 3 days to 1 month PTSD = longer than 1 month ***Sx are similar

Patient recently started RISPERIDONE and is now restless and cannot sit still for even a few minutes. Cause?

Akathisia 2/2 Risperidone - Reduce Dose or Discontinue the medication - If this is NOT possible = try Propranolol or Benzo to help with akathisia

ASEPTIC Mnemonic for Avascular Necrosis

Alcohol Excess Sickle Cell Disease Exogenous steroids Pancreatitis Trauma Infection Caisson Disease = decompression sickness

Avascular Necrosis of Humeral Head

Blood flow is via CIRCUMFLEX HUMERAL ARTERIES

Dopamine Agonist-Induced Impulse Control Disorder

Causes manic-like signs and symptoms - Impulsive overspending - Gambling - Compulsive eating - Elevated mood + restlessness D/C Medication and monitor pt's mental status

Work-Up of Pharyngitis

Centor Score of 0-1 = Symptomatic Tx Centor Score of 2-3 = Rapid Strep Test Centor Score of 4 = Consider Penicillin or Amoxicillin w/o testing

Tonsillar Herniation

Cerebellar tonsil herniation through foramen magnum - Coma, loss of CN reflexes, Flaccid paralysis, and Respiratory arrest

What provides MAXIMAL TENSILE STRENGTH to a patient's wound within the healing process?

Collagen Cross-linking

Management of Serotonin Syndrome

D/C all serotonergic medications Manage severe BP with short-acting antihypertensive IV hydration + cooling techniques (antipyretics are not used; high temperature is due to sustained muscle contractions, NOT hypothalamic temp point. Benzos to decrease agitation, muscle contractions, BP, and HR

CXR of Neonatal RDS

Diffuse reticulogranular (ground-glass) pattern with AIR BRONCHOGRAMS

Decerebrate Positioning

Extensor positioning - Extremities are extended - Sign of lesion at or below Red Nucleus (found in midbrain - involved in motor coordination)

FOOSH

Fall On Outstretched Hand - Posterior Glenohumeral Dislocation - Supracondylar Humeral Fracture - Colles (Distal Radius) Fracture - Scaphoid Fracture - Ulnar Styloid Fracture

Evaluation of Pt with Myasthenia Gravis

Get Imaging of CHEST (CT, MRI) = to evaluate for thymoma - Thymus abnormalities are seen in most patients with Myasthenia Gravis = thymic hyperplasia, thymoma - This can allow for future surgical planning since thymectomy can improve clinical course in patients with and without thymoma

Episodic Jaundice with INDIRECT HYPERBILIRUBINEMIA but no other lab abnormalities (ALT, AST, Alk Phos, Hb, Reticulocytes)

Gilbert Disease - Genetically decreased enzyme activity (UDP-glucuronosyltransferase) for bilirubin conjugation - Precipitated by stress, illness, dehydration, fatigue, vigorous exercise, menstruation, surgery NO TX REQUIRED

Diagnosis of Osteoarthritis

Hard periarticular enlargement Crepitus with movement Mild tenderness Pain worsens throughout the day with activity XR = dec joint space, subchondral sclerosis, periarticular osteophytes

CREST Syndrome

Limited Scleroderma = skin findings confined to face and fingers Calcinosis Raynaud Phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia

Addressing Splitting by Borderline Patient in an INPATIENT SETTING

Present JOINTLY AS A TEAM - This minimizes splitting and provides clear consistent communication

Joint Pain that improves with continued use + Nail Pitting + DIP Involvement

Psoriatic Arthritis

What to do for Pregnant Patients with Prior Cervical Surgery (i.e. cold knife conization)?

Require TVUS Cervical Length measurement - Check at 16-24 weeks GA - At increased risk of preterm delivery

Older man with PMH of DM2 and previous smoking hx with 20 pack years has chest pain that resolves + elevated troponins + T wave inversions at lead III and AVF. What is the NBSOM?

This is an NSTEMI in a patient with many risk factors for ACS (male, older age, smoking hx, DM2) - DUAL ANTIPLATELET THERAPY = Aspirin + P2Y12 Inhibitor (i.e. Clopidogrel) ***Reduces risk of recurrent MI and cardiovascular death ***Pts with NSTEMIs should also receive anticoagulants (heparin) for 48 hours

Creatinine Elevation with ACEi/ARB

Usually occurs rapidly within 3-5 days of STARTING MEDICATION

CT Findings on Eclampsia

White Matter Edema

Can Eclampsia occur POSTPARTUM?

YES!!!!! - Can occur up to 6 weeks postpartum - Can cause headache, seizure, stroke

Disinhibited Social Engagement Disorder

condition in which a child shows no inhibitions whatsoever in approaching adults 2/2 severe negligence/abuse - Over-familiarity and lack of appropriate boundaries

Treatment of Hidradenitis Suppuritiva

1) MILD = Topical Clindamycin 2) MODERATE = Oral Tetracycline 3) SEVERE = TNF-alpha inhibitors (adalimumab) or Surgical Excision ***Prolonged course of topical or oral abx is often required

Recurrent UTIs

2 or more in 6 months 3 or more in 1 year Risk Factors = hx of cystitis at age 15 or younger; Spermicide; New partner; Postmenopausal Evaluate via UA and Urine Culture Tx with postcoital or daily Abx prophylaxis, Behavior modification, and TOPICAL ESTROGEN IN POSTMENOPAUSAL WOMEN

Splenomegaly with associated L-sided abdominal tenderness + Signs of Acute Anemia (flow murmur, fatigue, pale mucosa)

Acute Splenic Sequestration in the setting of Sickle Cell Disease Abdominal Pain + Splenomegaly + Signs of Anemia + Hypotensive Shock = acute drop in Hb, Reticulocytes, Thrombocytopenia

Systemic Sclerosis Antibody

Anti-Scl-70 (ANTI-TOPOISOMERASE)

Antiphospholipid Syndrome

Can occur in setting of lupus which is the BIGGEST RISK FACTOR (constitutional sx, possible mitral regurgitation, thrombocytopenia, positive ANA) - Can cause thrombotic event (i.e. stroke) or spontaneous abortion - Positive Serology for 1 of 3 Antiphospholipid Abs: 1) Anticardiolipin 2) Anti-Beta2-Glycoprotein-I 3) Lupus anticoagulant

Breast Discharge Evaluation

Common finding in women of reproductive age - Bilateral non-bloody discharge with normal breast exam = likely Physiologic = check prolactin, TSH, and pregnancy test - Bloody, Unilateral, or Abnormal Breast Exam (mass, LAD, skin/nipple changes) = Pathologic - REQUIRE IMAGING (US in women less than 30; mammogram in women older than 30) ***NOTE = men with pathologic nipple discharge need Mammogram + US since there is a higher risk of malignancy

Management of NSTEMIs and Coronary Artery Disease

DAPT = aspirin + P2Y12 inhibitor Beta-Blockers (reduces myocardial O2 demand) Statins (anti-inflammatory effects) ACEi/ARBs (facilitates cardiac remodeling) Aldosterone Antagonists (in certain pts)

Increase of UTIs in Postmenopausal Women

Estrogen deficiency causes: - Vulvovaginal atrophy - Decrease bulk and elasticity of bladder trigone and urethra (inc risk of ascending infection) - Dec vaginal lactobacilli levels and elevated vaginal pH = increased rate of E. coli colonization Tx with behavioral modification (increased fluid intake) + TOPICAL VAGINAL ESTROGEN

Decorticate Positioning

Flexor positioning - Extremities are flexed to the CORE - Sign of lesion at or above the Red Nucleus (found in midbrain - involved in motor coordination)

Cerebral Venous Thrombosis

HA + Elevated ICP + Seizures + Encephalopathy - Clot formation in dural sinuses = causes venous congestion which leads to dec cerebral perfusion and impaired CSF resorption (increased ICP) - Can be 2/2 Pregnancy, Postpartum, OCPs, Malignancy, Infection, and Inherited Thrombophilia - Dx via MR VENOGRAPHY - Tx with anticoagulation (heparin acutely) Since initial CT can be normal in 1/3 of patients = if there is high clinical suspicion with a normal CT head = go ahead and get a MR venography

Uncal Herniation

Herniation of uncus (medial temporal lobe) underneath the tentorium cerebelli - Ipsilateral Dilated Fixed Pupil (CN III Compression) - Early = Contralateral hemiparesis (ipsilateral cerebral peduncle compression) - Late = Ipsilateral hemiparesis (contralateral cerebral peduncle compression) - Kernohan Phenomenon

Young women G2P1 at 33 weeks GA has painful contractions that began every 10-15 minutes and are now 5-8 minutes apart. She is currently 3 cm dilated. She has a previous hx of GBS UTI that was treated at 12 weeks. Her BP is 110/70 and FHR is 150 with multiple accelerations and moderate variability. What is the NBSOM?

In women LESS than 34 weeks = attempt to delay delivery and minimize neonatal morbidity - Antenatal Corticosteroids (IM betamethasone) = to reduce risk of NRDS, intraventricular hemorrhage, necrotizing enterocolitis - Penicillin = to prevent vertical transmission of GBS - Nifedipine Tocolysis = temporarily halts preterm contractions and delays delivery

Neonatal CXR shows lung hyperinflation + patchy bilateral infiltrates

Meconium Aspiration Syndrome = occurs in term and post-term infants - Severe respiratory distress + coarse breath sounds - Meconium-stained amniotic fluid is a sign

Lab Evaluation of Paget Disease

Normal Calcium + Phosphate HIGH ALK PHOS Elevated Urine Hydroxyproline (derived from breakdown of collagen) Urine Calcium may be elevated, as well

Food Protein-Induced Allergic Proctocolitis

Presumed if child has blood streaks and mucus in stool, looser stools, and are less than 6 months - If Breastfed = remove milk, soy from mom's diet - If Formula-fed = switch to hypoallergenic extensively hydrolyzed formula ***If symptoms resolve = PROCTOCOLITIS CONFIRMED --> reintroduce the food at age 1 ***If symptoms do NOT resolve = look for other cause

Location of Pathology in Lambert-Eaton

Presynaptic Membrane Calcium Channels ***Have diminished or absent DTRs

Risk Factors for Preterm Delivery

Prior preterm delivery Multiple gestation Prior cervical surgery = cold knife conization* b/c it causes a short cervical length = another risk factor Short interpregnancy interval (6-18 months) GU tract infection (GBS, Chlamydia)

Pathophysiology of HELLP SYNDROME

***Hemolysis, Elevated Liver enzymes, Low Platelets Abnormal placental development with release of antiangiogenic factors = maternal endothelial dysfxn and vascular tone dysregulation (new HTN) Endothelial dysfxn leads to microangiopathy and excessive platelet consumption = microthrombi formation + thrombocytopenia RBCs are sheared as they pass through = microangiopathic hemolytic anemia Portal system thrombi cause hepatocellular injury and distension of hepatic (glisson) capsule = Elevated ALT/AST

4 Phases of Wound Healing

1. Hemostasis, occurs immediately after tissue injury and involves small vessel constriction, platelet aggregation, clotting cascade. Clot formation provides fibrin matrix scaffold for future wound healing. 2. Inflammation, starts within hours of injury and lasts 5 days. Inc vascular permeability and cell recruitment. 3. Proliferation, begins during inflammatory process and continues afterwards. Superficial epithelial layer forms to act as barrier against bacteria. Fibroblasts produce Type III Collagen and Ground Substance into an amorphous gel where new vessels can grow (this initial collagen is disorganized). 4. Maturation, occurs between 3 weeks to 2 years. Disorganized Type III Collagen is replaced with Type I Collagen and reorganized along tension lines with covalent cross-linking of collagen subunits. LOTS OF TENSILE STRENGTH.

Generalized Convulsive Status Epilepticus

5 or more minutes of a convulsive seizure OR 2 or more convulsive seizures without recovery of consciousness in between Causes: - Infections - Medication nonadherence - Drug withdrawal - Structural brain abnormality (tumor) - Metabolic abnormalities

Diagnosis of HTN

>140 systolic or >90 diastolic Must have 2 different BP readings that are elevated over a period of 1-several weeks ***If only mild elevation in clinic setting with no signs of end-organ damage = obtain some home BP readings, since White Coat HTN is so common

Modifiable Risk Factors of Alzheimers

Aggressive control of cardiovascular risk factors can help reduce risk - Obesity/Physical Inactivity - DM2 - HTN Engaging in cognitively stimulating activities and maintaining social relationships is also important

New Diagnosis of HTN

BP greater than 130/80 - Check Renal fxn, serum Cr, Electrolytes, UA - HTN is a common cause of CKD and kidneys can cause secondary HTN - Risk of CV complications are also HIGHER in patients with comorbid DM and HLD = check A1C and Lipid Panel ***Also, check TSH since thyroid disorders are common and can present with asymptomatic HTN

Adjustment Disorder

Behavioral or Mood changes that are within 3 MONTHS OF IDENTIFIABLE LIFE STRESSOR (not getting into school of choice, breakup/divorce, moving, losing job, etc.) - Distress and functional impairment, but does not meet criteria for other diagnosis (i.e. MDD, Anxiety) ***Psychotherapy is Tx of choice ****Can add adjuvant medication - short term, for rapid relief of symptoms = anxiolytic, sleep aid

CXR in Neonate shows coarse lung markings with cystic changes

Bronchopulmonary Dysplasia - Occurs after prolonged oxygen therapy (>1 month) - NRDS is a risk factor

Centor Criteria for Strep Pharyngitis

CENTOR CRITERIA = FACT - Fever - Absence of cough - Cervical LAD - Tonsillar exudates +1 = ages 5-14 0 = ages 15-44 -1 = older than age 45

Congenital Biliary Cyst

Can cause acute cholangitis (RUQ pain, fever, jaundice) - Leads to obstructive cholestasis = direct hyperbilirubinemia, elevated alk phos - Tx with Abx, IVF, and Urgent Biliary Drainage via ERCP + Sphincterotomy and/or Biliary Stent - ONCE PT HAS RECOVERED FROM ACUTE CHOLANGITIS = COMPLETE CYST RESECTION

Central Brain Herniation

Caudal displacement of Diencephalon and Brainstem - Rupture of paramedian basilar artery branches - Unconsciousness - Bilateral mid-position (Midsized) and fixed pupils (loss of sympathetic and parasympathetic innervation) - Decorticate (Flexor) --> Decerebrate (Extensor) positioning

Patient Presentation of Fibromyalgia

Common in young and middle-aged women - Widespread pain, Fatigue, Cognitive/Mood disturbances - Usually have normal physical exam except for point tenderness along mid-trapezius, lateral epicondyle, costochondral junction of chest, and greater trochanter - NO SPECIFIC DIAGNOSTIC LAB FINDINGS ***Recommend Patient Education, Regular Aerobic Exercise, and Good Sleep Hygiene ***Medications, such as TCAs, are reserved for patients that fail initial therapy

Infarct of Vertebrobasilar System

Contralateral hemiplegia Ipsilateral cranial nerve involvement Possible ataxia

ACA Occlusion

Contralateral motor and sensory deficit (predominantly in LOWER LIMBS) - Abulia = lack of will or initiative - Dyspraxia (lack of motor planning/coordination) - Emotional Disturbances - Urinary Incontinence

MCA Occlusion

Contralateral somatosensory and motor deficit (face, arm, legs) = most prominent in face and upper limbs - Conjugate eye deviation towards side of infarct - Homonymous hemianopia - Aphasia (dominant hemisphere) - Hemineglect (Nondominant hemisphere) ***N = N -->Neglect, Nondominant

Early and Late Signs of Congenital Syphillis

Early Signs: - Syphilis Snuffles - Long Bone Abnormalities (Metaphyseal lucencies) - Maculopapular Rash = palms, soles, butt, legs ***Can lead to desquamation and hyperpigmentation Late Signs: - Saddle Nose - Hutchinson Teeth - Saber Shins - Sensorineural Hearing Loss

When patient requests/inquires about PHYSICIAN-ASSISTED SUICIDE, what is the NBSOM?

Explore the patient's reasons behind their request - Identify their fears and concerns - This can allow the physician to optimize palliative care interventions to address concerns and improve quality of life

Occlusion of Internal Carotid Artery

Extensive neurologic deficits since ACA and MCA are both affected - Contralateral hemiplegia (with face, arms, and legs equally affected --> since both ACa and MCA are involved) - Contralateral sensory, visual, language, and spatial involvements

Fibromyalgia vs. Polymyositis vs. Polymyalgia Rheumatica

Fibromyalgia = widespread pain in young to middle-aged women with tenderness at trigger points + NORMAL LAB STUDIES Polymyositis = proximal muscle weakness + elevated muscle enzymes, autoantibodies, and abnormal muscle biopsy; PAIN IS GENERALLY ABSENT/MILD Polymyalgia Rheumatica = occurs in older women (>50); STIFFNESS in shoulder and pelvic girdle, not really muscle tenderness + ELEVATED INFLAMMATORY MARKERS

Subfalcine Brain Herniation

Herniation of cingulate gyrus under FALX CEREBRI Contralateral Leg Weakness - Ipsilateral ACA compression

Preterm Birth Prevention

If NO previous preterm delivery: 2nd Trimester TVUS = weeks 16-24 - If Normal = routine care - If Short (≤2.5 cm at <24 wks) = Vag Progesterone IF Prior Preterm Delivery - With Painful Contractions = Prior Preterm Labor = Intramuscular 17-Hydroxyprogesterone - Without Painful Contractions = Cervical Insufficiency = Cervical Cerclage

Reactive Attachment Disorder

In children, a pattern of inhibited, withdrawn behavior toward adult caregivers 2/2 insufficient care - Social withdrawal, lack of response to positive affirmation, emotional outbursts (i.e. hitting other kids) - Do NOT seek reassurance or respond to comfort - Lack of positive emotions (constricted affect) - Symptoms can improve with consistent and nurturing caregiving

Infant Dyschezia

Infant strains to stool Characteristic crying, turning red in face, straining for over 10 minutes, followed by passage of soft stool ***Reassure parents, resolves spontaneously by 9 mo Overall well-appearing Normal stool consistency No concerning signs (failure to pass meconium, failure to thrive, abnormal rectal tone, sacral findings) Pathogenesis: - Failure to coordinate increased intraabdominal pressure + pelvic floor relaxation - Inability to generate proper abdominal muscle tone

Ankylosing Spondylitis

Inflammatory back pain with insidious onset that begins younger than age 40 - Sx last LONGER THAN 3 MONTHS - Relieved with exercise, NOT REST - Reduced chest expansion and spinal mobility - Enthesitis, Dactylitis, Uveitis, Arthritis/Sacroiliitis

7-yo boy has acute flare up of atopic dermatitis and is given medium-potency topical steroid + emollients, which parents are properly applying. He comes back to clinic after 10 days with no improvement in his skin. What is the most likely cause and NBSOM?

Lack of improvement with appropriate treatment measures raises suspicion for INFECTIOUS COMPLICATION - Lesion has crusting, weeping appearance = Impetigo --> treat with TOPICAL MUPIROCIN for localized; ORAL ABX (cephalexin) for widespread Eczema compromise the skin barrier and allows introduction of bacteria into wound = Staph aureus is the most common since it already colonizes most people

High Altitude Pulmonary Edema

Less PiO2 (atmospheric inspired oxygen pressure) is LOWER AT HIGHER ALTITUDES - Hyperventilation (to inc O2, causes resp alkalosis) - RBCs inc 2,3-BPG to inc O2 unloading - Kidneys inc bicarb excretion (2/2 alkalosis) AND stimulate erythropoiesis (2/2 hypoxia) Hypoxia stimulates diffuse hypoxic pulmonary vasoconstriction = some individuals have genetic predisposition to uneven vasoconstriction - Capillary beds in less vasoconstricted areas are hyperperfused = TRANSUDATION --> PULM EDEMA

Management of Tourette Syndrome

Mild, Infrequent Sx with NO DISTRESS = watchful waiting and counseling More Severe, Distressing Sx = - Behavioral therapy = habit reversal therapy - Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors = Tetrabenazine - Antipsychotics (i.e. risperidone) - Alpha-Adrenergic Agonists (clonidine, guanfacine) = especially helpful with concurrent ADHD and behavioral issues

Incision and Drainage with HS

NOT RECOMMENDED due to risk of recurrence - When there is a painful abscess = immediate relief can be provided through unroofing the abscess via a scalpel or skin punch

Initial Treatment of Ankylosing Spondylitis

NSAIDs COX-2 Inhibitors

Elderly patient with a PMH of restless leg syndrome is started on ropinirole. He has started buying lots of lottery tickets, maxing out his credit cards, quit his job recently, and is generally restless. What is the most likely cause?

New onset behavioral changes in an Elderly patient with no psych history is most likely substance or medication related cause Dopamine Agonist-Induced Impulse Control Disorder

Shoulder Dislocation Management

No associated fracture or neurovascular compromise (normal pulse and sensation) = CLOSED REDUCTION under sedation ***Postreduction = immobilize shoulder for 2-3 weeks + post-reductive PT program Concomitant Humeral Neck Fracture = increased risk of avascular necrosis - closed reduction can further displace fracture = OPEN SURGICAL REPAIR ***Most common associated fractures with shoulder dislocation = often minor, not contraindications to closed reduction - Hill-Sachs Defect = avulsion fracture of posterolateral humeral head - Bankart Lesions = glenoid labrum dislocation

What is the mechanism of Food Protein Induced Allergic Proctocolitis?

Non-IgE Mediated Allergic Reaction = protein in infant's diet causes eosinophilic inflammation of distal colon and rectum - Cow's Milk (casein, whey) and Soy proteins = food triggers

Brief morning stiffness in joints (<30 minutes)

Osteoarthritis ***Rheumatoid Arthritis has morning stiffness that lasts LONGER THAN 30 MIN

Physician-Assisted Suicide vs. Euthanasia

PAS = physician provides medication, substance, or information to patient to administer with the understanding that the patient will use it to commit suicide; controversial - legal in some states Euthanasia = physician administers lethal dose of drug; considered unethical and is illegal in ALL states

Lacunar Stroke

PURELY MOTOR DEFICITS - Unilateral motor impairment - NO sensory, cortical, or visual deficits

Older woman with right leg pain and intermittent headaches. XR of the skull shows areas of bone resorption and sclerosis. XR of leg shows cortical thickening with mild bowing. What is the most likely cause?

Paget Disease - Sclerosis and Resorption (mixed lytic/sclerotic lesions on XR)

Patient with significant smoking hx has right lower lobe mass on CXR + weight loss, along with new-onset proximal muscle weakness that does not improve with repeat contractions and erythematous patches and violaceous papules on the dorsum of his fingers. What is the most likely dx?

Paraneoplastic Syndrome 2/2 Lung Cancer of DERMATOMYOSITIS - Immune-mediated muscle fiber injury - Symmetric proximal muscle weakness - Heliotrope rash + Gottron Papules

Management of Preterm Labor at 34-37 Weeks

Penicillin = to prevent GBS transmission Antenatal Corticosteroids (betamethasone) = for NRDS ***Tocolysis is not done since maternal risks outweigh the neonatal benefits

Signs of Pathologic Constipation

Poor weight gain Low extremity neuro dysfxn (weakness) Sacral anomalies (i.e. hair tuft) = concern for spinal dysraphism (think spina bifida)

Patellofemoral Pain Syndrome

Poorly localized anterior knee pain in young women Not due to intra-articular (meniscal) or peripatellar (tendon/ligament) issues - Worse with running, stairs, or prolonged sitting - Atrophy or Weakness of Quads and Hip Abductors - PAIN IS PROVOKED WITH CONTRACTION OF QUADRICEPS = Clarke's Sign - Normal imaging Tx with HIP ABDUCTOR + QUAD STRENGTH TRAINING or short course of NSAIDs

Effect of Positive Pressure Ventilation on Decompensated HF with Cardiogenic Pulm Edema

Pressure (5-20 cm H2O) is usually applied to patient's airways through face mask Decreases LV preload - Intrathoracic pressure is inc, lowers LV preload - Elevated intrathoracic pressure compresses pulm capillaries causing inc RV afterload

Postpartum Femoral Neuropathy

Prolonged hip hyperflexion in lithotomy position during second stage of labor = can compress FEMORAL NERVE - Impaired leg extension/difficulty walking + decreased anteromedial thigh sensation ***Tx with CONSERVATIVE MANAGEMENT = resolves within a few weeks

Rhinitis Medicamentosa

Rebound nasal congestion commonly associated with overuse of over-the-counter nasal decongestants

Approach to Straining Infant

Red Flag Signs: - Severe abdominal distension - Abnormal rectal tone - Spinal dysraphism - Hypothyroidism

Older man with HTN treated with Lisinopril and Well-Controlled DM has increased urinary frequency, nocturia, impaired flow, palpable bladder, and enlarged prostate with RISING CREATININE LEVEL. What is the NBSOM?

Renal US - BPH-Induced Obstructive Uropathy - Can cause permanent kidney damage due to blockage of free flowing urine - Typically reveals HYDRONEPHROSIS - Can assess extent of kidney injury - If irreversible damage has not occured = can reverse creatinine elevation through BPH management --> signs on US of irreversible damage = cortical atrophy

Morning stiffness in joints that lasts LONGER THAN 30 MINUTES

Rheumatoid Arthritis

Serology Testing for Rheumatoid Arthritis

Rheumatoid Factor Anti-CCP = higher specificity

Rebound Nasal Congestion from Nasal Decongestants

Rhinitis Medicamentosa - Occurs due to vasoconstriction leading to relief - Continued use ultimately damages the vessels and causes increased vascular permeability and edema = leads to nasal congestion symptoms ***Physical Exam shows beefy-red nasal mucosa as opposed to pale edematous mucosa from allergic rhinitis ***NEED TO STOP USING DECONGESTANTS

18-yo girl has sudden onset severe headache that starts as she is moving into her new dorm. CT Head without contrast is done and shows no focal abnormalities (unremarkable). Next, LP is done which shows high opening pressure and elevated RBCs in CSF that remain elevated in subsequent samples. What is the most likely diagnosis?

SUBARACHNOID HEMORRHAGE - Low volume bleed - initial CT head may be negative - High opening pressure and elevated RBC count that remains elevated on subsequent samples is significant for SAH --> if it reduced, RBCs would be more indicative of a traumatic tap - Xanthochromia = yellow CSF due to RBC breakdown ***NOTE = normal CSF contains NO RBCs

Management of Generalized Convulsive Status Epilepticus

Stabilize circulation, airway, breathing Start Benzo Begin Antiepileptic drug EEG monitoring for refractory causes or failure to regain consciousness

Fluid within fissures of CXR in Newborn

Transient Tachypnea of Newborn = delayed resorption of alveolar fluid - Common in premies

Tx of High Altititude Pulmonary Edema

Unloading of patient (remove their backpacks) = to reduce oxygen consumption to prevent further hypoxemia = lowers CO and edema Supplemental O2 + Descent to lower altitude = alleviate pulm vasoconstriction and high pulmonary arterial pressure