1. Class I ICD indications:
- EF < 35, s/p at least 3 months of optimal medical management in NIDCM and 9 months in Ischemic DCM.
- Sustained v-tach + structural heart disease
- Syncopal episode of unknown origin + inducible v-tach or v-fib on EP testing
2. CI to spironolactone
- Cr < 2.5 in men, <2 in women
- K > 5
3. Osteoporosis:
- Defined as either fragility fracture (fracture with low impact, like falling from standing) or T-score <2.5 on bone mineral density. Osteopenia is T-score <1-2.5.
- Start bisphosphonae. Aledronate is poorly absorbed orally so it has to be taken on an empty stomach.
- Zaledronate is a long-acting injectable (can be given once a year as IV infusion)
- CI to aledronate: achalasia/stricture/dysphagia, can't remove upright for 30-60 minutes after taking, malabsorption (bad celiac's or IBD)
- Ca + vitamin D supplementation: 50,000 IU vitamin D every day for 1 week (loading), followed by 2,000 IU daily maintenance.
- Screen women at age 65, and at 60 if they are higher risk (weight < 70 kg/154lbs)
- Calcitonin is second line- effects on bone mass are modest and doesn't impact fracture rates
- Raloxifen is also second line- increases bone mass, prevents vertebral fractures but no data showing that it prevents hip fractures. Also carries the estrogen-agonist effects (DVTs, cardiovascular effects, etc)
- Teriparatide is an anabolic agent that stimulates osteoblasts and builds up bone mass and prevents vertebral and non-vertebral fractures. Limit use to 2 years in the most at risk people (T-score <3.0-2.5 with fragility fracture who can't take bisphosphonates). Daily subQ injections. Can increase risk of osteosarcoma so don't use in people with Paget's, history of bone cancer, history of radiation to bone.
4. Psoriatic arthritis: manage with NSAIDs, anti-TNF, methotrexate. Don't use systemic steroids.
5. Hypercalcemia of malignancy
- usually caused by PTHrP secretion, either systemically or locally (ie blood levels normal); PTH binds osteoblasts and increase expression of RANKL which activates RANK on osteoclasts and promotes growth/activity
- Tumors that can secret PTHrP (squamous cell cancer in general, h&n, breast, lung, renal + bladder, esophagus, ovarian and endometrial
- Some tumors also can secrete local cytokines that directly promote bone resorption by osteoclasts: multiple myeloma, lymphoma, breast, leukemia
6. Aortic dissection
- Manage with beta-blockers rather than vasodilators (ca-channel blockers, hydralazine), which can cause reflex tachycardia and worsen the shear forces on the aorta. Only use vasodilators if beta blockade is inadequate to lower BP
- Goal vitals: HR <60, BP <120 systolic {source:study in circulation showing tighter HR control lead to better outcomes}
7. Correcting hypernatremia:
- Euvolemic or Hypervolemic hypernatremia: D5W. Giving straight water may be an osmolar shock and cause red cell lysis-- hence the D5
- Hypovolemic hypernatremia: depending on how bad the hypernatremia is, either 0.9 NS or D5 half-normal.
8. Analgesic nephropathy: 
- Most common cause of drug-induced chronic renal failure.
- 3-5% of ESRD
- Usually females (peak 50-55) who use combined analgesics - aspirin and Naproxen for example.
- Typically occurs after cumulative ingestion of 2-3 kg of index drugs
- Papillary necrosis, tubulointerstitial nephritis
- Polyuria, sterile pyuria (WBC casts) seen early, with hematuria if papillary necrosis happens
- HTN, proteinuria, impaired ability to concentrate urine as disease progresses. May even seen nephrotic range proteinuria in advanced disease.
9. Other complications of chronic analgesia abuse: 
- Atherosclerotic disease
- Premature aging
- Urinary tract cancer
10. Cutoff BMI between anorexia and bullemia - 18.5

1. Milk/Soy protein enterocolitis: 
- Presents at age 2-8 weeks
- Often personal or family history of atopy (allergies, asthma, eczema)
- Pathogenesis: non-IgE mediated immune response to dairy and/or soy proteins => colorectal inflammation
- Sx: regurgitation of food/vomiting, bloody stools, eczema
- Treatment: if breastfeeding, mom has to also eliminate milk/soy from diet, if formula-fed, must move to hydrolyzed formula
- Visible bleeding will usually reduce by 3 days, with complete resolution in 2 weeks.
- Usually resolves spontaneously by 1 year of age.
2. DDx GI bleed in infants: 
- Milk/soy protein enterocolitis: vomiting, good appetite, no pain
- Bacterial colitis (fever, decreased appetite, irritability) - rare in breastfed infants due to lack of intake of contaminated food; C.diff is rare in infants due to lack of intestinal receptor to C.diff toxin until approx age 2 years
- Intussusception: intermittent, crampy pain
- Malro + volvulus: ill appearing, bilious vomiting, pain, poor appetite
- Meckel's: rarely presents in neonates
3. Head ultrasound requires open fontanelle - most useful in patients under 6 mos of age.
4. Drugs that cause hyperkalemia: 
- Dig: from inhibition of Na/K ATPase
- K sparing diuretics: ie spironolactone (anti-aldosterone) and triamterine/amiloride (ENaC inhibitor)
- Nonselective B-blockers: inhibit B-mediated cellular uptake of K
- ACE-I/ARB: anti-aldosterone effects
- NSAIDs: anti-aldosterone effects (from impaired local prostaglandin synthesis - prostaglandins cause renin release). Hyperkalemia may be amplified in patients with renal dysfunction (like... from NSAIDs...)
- In this 1985 paper where 50 patients were given indomethacin, 75% had <1mEq increase, 25% had >1mEq incresae
5. Pesudotumor: 
- Diagnosis: no focal deficits (other than a 6th nerve palsy), no evidence of other causes of hydrocephalus, normal CSF except for elevated OP
- Can be caused by tetracycline, isotretinoin.
- Treat with diamox, +/- lasix -- diamox inhibits choroid plexus carb anhyd, decreasing CSF production
- Encourage weight loss
- May need optic nerve sheatlh decompression or LP shunting if unresponsive to medical therapy
- May use steroids and repeated LPs to bridge to definitive treatment.
6. Post cholecystectomy syndrome:
- Persistent or recurrent pain months/years after chole (often same pain as before surgery)
- May be due to biliary (retained stone, sludging) or extrabiliary (PUD, pancreatitis) causes
- Workup with ERCP, EUS, or MR abdomen.    
7. Types of selection bias: 
- Sampling/Ascertainment: nonrandom selection
- Nonresponse rate: high % non-response*
- Attrition: high % loss to follow up*
- Berkson: study only contains inpatients
- Prevalence/Neyman: long lag time between exposure and disease - miss patients who died early or recovered
*: the missing data may represent a distinct group from retained subjects
8. Types of observational bias: 
- Recall: subjects reacall negative outcomes more than positiv
- Observer: observations influenced by bias
- Reporting: subjects lie about incidence of event for various reasons
9. AIN:
- B-lactams, PPIs
- Occurs 7-10 days after drug exposure; may be associated with rash, eosinophilia, pyuria.
10. RBC artifacts 
- Howell Jolly - asplenia
- Heinz - G6PD/thalassmia (denatured Hb) -> bite cells after splenic phagocytes remove them.

1. Risperidone is most likely to cause tardive dyskinesia, clozapine is the least likely (but may cause myocarditis, agranulocytosis, seizures...)
2. Blood cancers & smears
- Lymphoblastic leukemia: blasts in smears
- CLL: smudge cells, "overmatured" cells (hypercondensed nuclear chromatin). LAD + splenomegaly, then anemia and thrombocytopenia
- Early Hodgkins: normal periperipheral smears - reed-sternberg cells on LN biopsy
- CML - leukocytosis + left shift (myelomonocytes, neutrophils, basophilia) + marked splenomegaly
2. Types of aphasia: 
- Broca's: non fluent speech, impaired repetition, intact comprehension; may be associated with hemiparesis, eye deviation to affected side (i.e. MCA infarct)
- Wernicke's: fluent speech, impaired repetition, impaired comprehension; may be associated with contralateral superior quadrantanopia (meyer's loop)
- Conduction: fluent speech with some errors, impaired repetition, intact comprehension
3. Nondominant hemisphere strokes: 
- Temporal: can lead to sensory aprosodia (inability to comprehend emotional gestures), contralateral quadrantanospia (meyer's loop)
- Parietal: can lead to anosognosia - denial of one's disabilities, contralateral apraxia (can't carry out learned movements), contralateral inferior quadrantanopia (superior optic radiation).
- Frontal: can lead to motor aprosodia (inability to convey emotion through speech), contralateral weaknesss (motor strip), apraxia (pre-motor).
4. Dominant hemisphere strokes: 
- Temporal: wernicke's aphasia, may affect ability to speak nouns (anomic aphasia), may affect broca's if you take superior temporal gyrus, may affect arcuate fasciculus, meyer's loop.
- Parietal: may cause contralateral hemineglect, sensory losses (pain, vibration, agraphesthesia- can't recognize letter written on hand, asterognosis- can't ID object by touching it), contralateral inferior quandrantanopia.
- Frontal: Broca's, pre-motor, motor, frontal eye fields (eyes move towards side of lesion due to unopposed contralateral frontal eye field)
5. Cardiac drugs that interact with Digoxin: 
- Amio (D'oh! decreased dig by 25-50%)
- Verapamil
- Quinidine
- Propafenone (class Ic - also has beta-blockade activity)
6. Femoral head has 2 blood supply sources - ascending arteries and foveal artery (inside ligamentum teres) which is patent early in life but may become obliterated in older patients - this is why aseptic femoral head necrosis is rare in kids.
7. Complete spinal block is a complication of spinal/epidural anesthesia - when the anesthetic migrates all the way up to the cervical spine/medulla - hypotension, bradycardia, respiratory difficulty/apnea, may even lead to cardiopulmonary arrest, loss of consciousness.
8. Inheritance of bipolar disease
- General public: 1%
- First degree relative: 5-10%
- Both parents: 60%
- Monozygotic twin: 70%
9. TCA overdose.  
- Sodium bicarbonate can narrow the QRS, as well as facilitate clearance and correct acidosis.
- Manage seizures with benzos, and not dilantin, as it can increase frequency of ventricular arrhythmias
10. Trauma to the soft palate - may cause ICA dissection or compression of ICA that dislodges a thrombus and causes embolic stroke.

1. Disseminated gonococcal disease; 
- High fever
- Tenosynovitis
- Migratory polyarthraligas (may progress to supprative infectious arthritis)
- 5-40 cutaenous leaseions - pustular lesiosn with hemorrhagic component and occ central necrosis
2. Acute cholecystitis - lap chole performed within 72 hours of onset of symptoms reduces disease duration, duration of hospitalization, and mortality.
3. Trihexyphenidyl - useful in the treatment of parkinsons in younger patients where tremor is the predominant symptom.
4. Essential tremor - propanolol first line, benzos second line due to abuse potential. Primidone (anticonvulsant - metabolized to phenobarb) can also be used to treat, sometimes in combo with beta-blocker
5. Lupus anticoagulant
- 5-10% of lupus patients
- IgM or IgG that binds phospholipids used in various assays (PTT, VDRL)
- Will not correct if mixed in dilution with plasma
- Russell viper venom test designed specifically to test for lupus anticoagulant
6. Fetal drug exposures:
- Heroin/methadone: high pitched cry, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, vomiting, diarrhea - withdrawal presents within 48 hrs of birth (heroin) and 48-72 hrs (methadone). Treat symptomatically - small frequent feeds, low stim environment, morphine PRN
- Cocaine - jitteriness, excessive sucking, hyperactive moro
- Alcohol - smooth philtrum, small palpebral fissures, thin upper lip, CNS abnormalities
7. Batteries in esophagus must be immediately removed - distal to that, 90% will pass uneventfully.
8. Disseminated blastomycosis 
- Can occur even in immunocompetent people
- Skin: violaceous nodules, wart-like, ulcers
- Bone: osteomyelitis
- Lung: acute/chronic pneumonia
- GU: prostatitis, epididymo-orchitis
- CNS: meningitis, epidural/brain abscesses.
- Treat with PO itraconazole, or amphotericin B if severe disease or immunocompromised person
9. Skin lesions in other disseminated fungal diseases:
- Coccidioides: erythema nodosum, erythema multiforme
- Histo: papular, crusting skin lesions-- generally only immunocompromised people will develop tho.
- Sporotrichosis: pustular, ulcerated - localized to wound/associated lymphatic channels
10. Treatment for HELLP: 
- >34 weeks gestation, unstable mom/baby, or mature fetal lungs: delivery
- Otherwise, can stabilize mom, give steroids to mature the baby's lungs, and wait for 34 weeks.

1. Risk factors for newborn respiratory distress 
- Prematurity
- Male sex
- Perinatal asphyxia
- Maternal DM - maternal hyperglycemia -> fetal hyperglycemia -> fetal hyperinsulinism -> insulin antagonizes cortisol and blocks maturation of sphingomyelin (component of surfactant)
- C-section without labor
- Prevent with antenatal steroids, treat with postnatal surfactant administration
2. Pill esophagitis: 
- Tetracyclines
- Bisphosphonates
- NSAIDs
- KCl
3. Platelet dysfunction: 
- Bernard Soulier: big platelets, mild thrombocytopenia, severe platelet dysfunction, bleeding out of proportion to thrombocytopenia
- Hypersplenism: platelets are usually > 30K, and patients don't have clinically significant bleeding
4. When to transfuse platelets: 
- <10K
- <30K if bleeding
- <50K if need surgery
- <100K if need neurosurgery***, DIC, intracranial bleed***
***these are the hematology guidelines... if someone is getting neurosurgery or bleeding into their head you should consult neurosurgery regarding platelet transfusion parameters***
5. ATN:
- Urine osm 300-350 (not <300)
- Urine Na>20 mEq/L
- FeNa > 2%
6. Renal casts: 
- Muddy brown : ATN
- RBC: nephritic
- WBC: pyelo, interstitial nephritis
- Fatty: nephrotic
- Broad/waxy: chronic renal failure
7. Grading of diabetic foot ulcers: 
- Grade 0: high risk foot, no ulcer
- Grade 1: full thickness skin ulcer
- Grade 2: ulcer penetrates to ligament/muscle, not not to bone, no abscess
- Grade 3: ulcer with abscess, osteo, or cellulitis
- Grade 4: local gangrene
- Grade 5: gangrene involving entire foot
8. Management of diabetic foot ulcers: 
- General principles: off-loading, debridement, wound dressings, antibiotics, revascularization, amputation
- Grade 1/2: wound care, debridement
- Grade 3: hospitalization, debridement, biopsy/cx of whatever tissue is affected, IV antibiotics,
- Grade 4/5: hospitalization, possible amputation.
9. HTN + hypokalemia = suspect primary aldosteronism
- First, measure plasma aldo:renin ratio; any ratio > 20:1 + plasma aldo > 15 = primary hyperaldo
- Then do adrenal suppression tests - if suppressible, image to find tumor.
- If imaging shows no tumor, adrenal venous sampling to differentiate adenoma (unilateral) from hyperplasia (bilateral)
- Adenoma gets surgery, hyperplasia gets medicine.
10. Lymphadenopathy: 
- <1cm, rubbery = non concerning, likely reaction to infection, no treatment
- >2cm, firm, immobile = work up for cancer vs granulomatous disease.

1. OCP side effects: 
- DVT/PE
- Hypertension
- Breakthrough bleeding
- Breast tenderness
- N/V
- Bloating
- Decreased risk of ovarian/endometrial cancer
- Increased risk cervical cancer
- Liver disorders (hepatic adenoma)
- Increased triglycerides (estrogen component)
- DO NOT cause weight gain despite the highly prevalent belief among users, not shown to pan out in controlled studies.
2. Uterine bleeding: 
- Abruption: only 25% visible on u/s - fetal vital signs will deteriorate as oxygen delivery is compromised.
- Accreta: less likely with fundal placenta (as most c-sections are done low tranverse, and accretion tends to happen at prior scar sites)
- Previa: placenta overlying os.
3. Epiglottitis: 
- Sudden onset fever, respiratory distress, dysphagia, drooling, inspiratory stridor, leaning forwards and hypertextending neck.
- If unstable vitals, go to OR for intubation- if that fails, then trach; should avoid crich in pre-pubescent kids, as they have increased risk of developing subglottic stenosis

vs peritonsilar abscess: has more subacute onset; unilateral tonsilar swelling with uvular deviation 

vs angioedema: history of allergen exposure 

4. Aspirin exacerbated respiratory disease: 

- asthma, chronic rhinosinusitis, nasal polyps, bronchospasm/nasal congestion following aspirin or NSAIDs 

- polyps tend to recur 

- vs juvenille nasal angiofibroma: tends to cause epistaxis, generally occurs teen males

- vs inverted papilloma: rarely presents in context of AERD 

5. Pregnant women have increased risk of pyogenic granulomas on anterior septum that result in epistaxis. 

6. Pneumonia vaccine: all adults >65 : 13-valent followed by 23-valent 6-12 mos later. 

23 valent alone for younger people who are smokers or have chronic diease 

7. HOCM - prevalence 1:500; Long QT syndrome - prevalence 1:2500

8. Varicella exposure: 

- In immune person (prior varicella or vaccine) - do nothing

- In immunocompetent person who is not immune - varicella vaccine - 70-100% effective in preventing infection if given within 3-5d of exposure 

- In immunocompromised person who is not immune - varicella Ig within 10d of exposure 

9. Ascending paralysis: 

- Tick: hours to days progression, no fever, normal sensation, no autonomic dysfunction; tick needs to feed for 4-7 days to release neurotoxin - meticulous search will often turn out with tick. Removal of tick => spont improvement in most. 

- Guillain Barre: days to weeks, sensation is usually mildly affected, autonomic dysfunction (tachy, urinary retention, arrhythmias) in 70%. Albuminocytologic diassoc on CSF (high protein, few cells) in 80-90% at 1 week. Tx: IVIg/plasmapharesis. 

10. SSRI should be continued for 6 months after symptom response in treatment of single episode of major depression. Multiple episodes = longer treatment. 

1. Friedreich's ataxia: 
- Most common type of spinocb ataxia, sx usually onset <22 years of age
- Neurological dysfunction (ataxia, dysarthria) - degen of spinal tracts (spinocb, posterior columns, pyramidal)
- Concentric hypertrophic cardiomyopathy - develops in up to 90%, most common cause of death
- DM
- Skeletal deformities (hammer toes, scoliosis)
- Median survival after disease onset <20 years
2. Raloxifene
- breast and vaginal tissue: antagonizes ER
- bones: agonises ER
- first line for osteoporosis tx.
- Does NOT increase risk of endometrial cancer like tamoxifen does.
- Does increase risk of DVT
3. Liver pathology stages: 
- first -- Fatty: short term EtOH
- then -- Alcoholic hepatitis: long term EtOH, mallory bodies, neutrophils, hepatocyte necrosis, perivenular inflammation
- then -- Fibrosis/cirrhosis: regenerative nodules (true cirrhosis - irrev at this point)
All of the above up to regenerative nodules is reversible (even early cirrhosis) with abstinence of alcohol.
4. Immunodeficiences: 
- IgA: respiratory infections, giardia
- Complement: C3 - pyogenic respiratory/sinus bacterial infections, C5-8: Neisseria, C1 esterase: hereditary angioedema.
- Phagocytosis: pyogenic (chediak higashi, job, CGD)
5. Untreated HIV with PCP pneumonia: 
- Bactrim + steroids (in severe PCP - ie PaO2<70, A-a gradient > 35)
- If cannot tolerate bactrim, can use pentamidine although less effective
- Restar/start HAART after the acute phase of illness has resolved
- PCP usually affects CD4<200 people
6. Scabies - often affects flexor wrist, lateral fingers, finger webs; diagnose with skin scrapings, treat with 5% permethrin cream, or PO ivermectin
7. Living will vs power of attorney: legally, the living well trumps, but if the two are in conflict should discuss with family first and consult ethics if can't find resolution.
8. Postop fever: 
- Immediate (hours) preop infection, trauma, transfusion reaction
- Acute (first week): infection, wound infection (GAS/clostridium), MI/DVT/PE
- Subacute (first month): wound infection, catheter infection, drug fever, DVT/PE
- Chronic (>1 month): viral, wound infection due to indolent organisms.
Wind, water, walking, wound, wonder
9. Liver diseases of pregnancy: 
- Intrahepatic cholestasis: intense pruritis, worse in palms/soles at night; treat with ursodeoxycholic acid, early delivery to avoid fetal complications. Jaundice rare -- presents warrants further w/u
- Acute fatty liver of pregnancy: rare; hepatitis symptoms (malasie, pain, n/v, jaundice), may progress to liver failure and the complications of liver failure.
- HELLP: pre-eclampsia symptoms; also the lab abnormalities of the acronym (hemolysis, etc)
10. Chlamydia is more common than gonorrhea; they cannot be distinguished clinically; PCR to diagnose. If you have both options on the exam guess the first because its more common.

1. Septic joint in kids: 
- WBC will be >50K
- Organisms: birth to 3 mos - staph, GBS, and GRAM NEGATIVES - so treat with antistaph agent (vanc or nafcillin) PLUS gram neg coverage (gent or cefotaxime)
- Organisms: 3 mos and older - staph, GAS, strep pneumo - anti-staph agent (naf, ancef, vanc)
2. Tinea corporis vs erythema multiforme: 
- Tinea corporis: ring shaped scaly patches, commonly trichophyton rubrum, diagnose with microscopic examination with KOH (hyphae), treat with 2% antifungal lotions like terbinafine - extensive disease - w/u for immunosuppression (DM, HIV)
- Erythema multiforme does not have peripheral scaly border, is mostly acral in distribution, can follow HSV infection but has a huge differential diagnosis.
3. Clubfoot
- Casting, stretching, manipulation should begin from day 1
- Failure to attain satisfactory results may go to surgery - typically at 3-6 mos of age, always before 12 mos.
4. VIPoma vs carcinoid: 
- Both can present with diarrhea, flushing
- VIPoma - "pancreatic cholera" people will get muscle cramps from hypokalemia (intestinal losses), achlorhydria (decreased gastric acid secretion); may have other MEN 1 syndromes. Secretory diarrhea labs. VIP < 75 pg/mL confirms, located in pancreas tail 75% of time and 60-80% have mets to liver at diagnosis. Treat with octreotide, fluid replacement, surgery
- Carcinoid: generally occur in small intestine (70-80%), rarely occur in pancreas
- Gastrinoma can also cause diarrhea but will typically also cause ulcers (zollinger ellison)
5. Peptic vs duodenal ulcers: 
- Gastric - worsen with with food
- Duodenal - improve with food
6. Management of GERD: 
- If alarm symptoms (melena/hematemesis, weight loss, dysphagia/odynophagia, lots of vomiting, male age > 50, any cancer risk factors) => scope
- If no alarm symptoms, manage with qD PPI for 2 months. If that doesn't work, BID PPI or different qD PPI. If that doesn't work, scope.
7. Paraneoplastic weakness: 
- Myasthenia gravis: ocular, bulbar, face, neck, limb
- Lambert eaton: proximal muscles, autonomic dysfunction (dry mouth), CN involvement, diminished or absent reflexes 
- Dermatomyositis/polymyositis: symmetrical, more proximal muscle weakness, other autoimmune (ILD, esoph dysmotil, raynaud's), skin findings (heliotrope rash, grotton's nodules) in dermatomyositis
8. If you suspect diverticulitis (or any acutely inflamed bowel condition) do not scope the colon- the insufflation of air or introduction of scope can cause perforation. Same logic no barium enema. CT for working up diverticulitis
9. Palpable kidneys, nephrotic syndrome, enlarged liver, ventricular hypertrophy, in setting of chronic disease (bronchiectasis or RA) => amyloidosis. Treat underlying disease + colchicine for prophylaxis and treatment of AA.
- vs PCKD- where you will see more of a nephritic syndrome
10. Hydroxychloroquine can cause retinopathy!! Eye exams q6 mos.

1. Osteonecrosis in SCD:
- Up to 50% of Hb-SS will develop this by adulthood
- Most commonly humeral and femoral heads
- Tx: pain management, no weight bearing, joint reconstruction if that fails
2. Kidneys compensate for chronic hypercapnea by increasing bicarb retention
3. Paralytic ileus vs SBO: 
- On the board exams, paralytic ileus will present with absent or hypoactive bowel sounds, while SBO will present with hyperactive or "tinkling" bowel sounds
- In the real world, hard to differentiate as the utility of bowel sounds in diagnosis of acute bowel obstruction is questionable (increased OR decreased bowel sounds have a sensitivity 25-40%, PPV ~10% - prospective cohort study, N=1200, 1998). For what its worth, most of the attending general surgeons I trained under did not listen for bowel sounds, and some of them were really old-school too....
4. Strange thoughts. 
- Delusions: fixed, false belief not consistent with cultural norms - grandiose delusions "I have special powers and a relationship with god"
- Magical thinking: belief in supernatural forces, that ones thoughts can control events
- Ideas of reference: "the TV is talking to me" - common in schizophrenia
- Illusion: misinterpretation of external stimulus
- Hallucination: illusion without external stimulus
5. Types of polyps: 
- Hyperplastic: most common non-neoplastic polyps
- Hamartomatous: juvenile (not cancerous, removed 2/2 bleed risk) & Peutz Jeghers (non malignant)
- Adenoma: most common polyp in colon. Present in 30-50% of old people. Potentially premalignant, <1% will go on to malignancy. <5% +FOBT.
6. Odd of adenomatous polyp transforming into invasive cancer: 
<2% if <1.5 cm
2-10% if 1.5-.2.5 cm
>10% if >2.5 cm
Risk factors: villous pathology, sessile.
7. Endocarditis: 
- AV block development in patient with infective endocarditis: perivalvular abscess. Apparently seen in 30-40% of patients with endocarditis at surgery or autopsy...!
- Tricuspid endocarditis: holosystolic murmur
8. Pseudogout 
- often occurs in setting of recent surgery or illness.
- Rhomboid crystals
- chondrocalcinosis (calcified articular cartilage) on xray
9. Failure to pass meconium in infant
- First: KUB to r/o perforation or surgical emergency
- Second: Water soluble contrast enema -- microcolon -> meconium ileus, dilated descending colon with narrow sigmoid -> Hirschprungs's
- If meconium ileus - hyperosmolar (ie gastrografin) enema may break up the meconium; if that fails, then surgery. Should also w/u CF b/c meconium ileus is almost pathognomonic
- If Hirschprungs suspected - rectal bx (absence of ganglion cells); if that's not diagnostic, may need anorectal manometry.
10. Everyone's favorite endocrinology chart: 
21-OH deficiency is most common, and presents with ambiguous genitalia in girls, salt wasting, hypotension -- too much T and not enough aldo or cortisol.
11-B hydroxylase presents similarly to 21-OH but not as bad because if I remember correctly 11-deoxycortisol (or maybe deoxycorticosterone).. have some mineralcorticoid/corticosteroid effects, so it's a milder disease.
17-a deficiency: no T, no cortisol, only aldosterone.

1. Pancreatitis: 
- Acute onset of epigastric pain + amylase/lipase > 3x upper limit of normal = diagnostic. Do not need confirmatory imaging (this is the boards answer but come on who's not gonna get a scan in these people)
- Amylase: up in 6-12 hours, high for 3-5 days
- Lipase: up in 4-8 hours, high for 8-14 days - more sensitive and specific
2. Spine osteomyelitis: 
- S.aureus = 50%
- Blood cx + in 50-70%
- ESR/CRP usually up
- White count may be nl
3. Patients <50 with no colon cancer risk factors with BRBPR (not blood intermixed c stool) - can get office based anoscopy; negative results or patients that don't fulfill all above criteria => colonscopy
4. Spherocytes on smear: 
- Coombs +, no family hx: AIHA
- Coombs -, family hx: HS
5. DDx: hemolysis
INTRAvascular:
- MAHA (TTP, HUS, DIC, HELLP, malig HTN)
- Transfusion reaction
- Infection (clostridial sepsis)
- PNH
- RhoGAM
EXTRAvascular
- RBC enzyme deficiencies (G6PD)
- Hemoglobinopathy
- Warm/Cold agglutinin AIHA
- Membrane defects (HS)
- Infections (bartonella, malaria)
6. Toxic megacolon diagnosis:
- KUB + 3 out of the following:
- T>38
- P>120
- WBC>10.5
- Anemia
- Treat with IV steroids, NG, antibiotics
7. Ankylosing spondylitis 
- diagnosed with x-ray of sacroiliac joints or spine showing fusion
- HLA-B27 is not specific for AS
8. Cocaine overdose
- 20% complicated by rhabdo from CPK (>20K = ATN)
- CPK from vasoconstriction/ischemia, hyperpyrexia, trauma, seizures.
9. Inherited Hyperbilirubinemias: 
- Crigler-Najjar: indirect, presents early, devastating, phototherapy/plasmapharesis in short term, need liver transplant
- Gilbert's: indirect, mild provoked by fasting/illness
- Dubin-Johnson: direct, mild, black liver
- Rotor syndrome: direct, mild, liver normal color
10. Serous otitis media 
- effusion without infectiou
- common in HIV+ = from LAD/lymphomas that obstruct eustachian tube.

1. Brain abscess: fever, HA, +/- focal deficits, seizure. Subacute course (weeks) vs stroke which is more acute.
2. Recurrent chalazion should be biopsied b/c of risk of underlying carcinoma (of meibomian gland) or basal cell carcinoma. If it turns out to be benign, can treat with steroid injectison or incision & curettage
3. Schizophrenia
- Minimizing conflict at home decreases risk of relapse
- Family interventions warranted for those with psychotic episodes and a disruptive home environment.
4. Cystinuria
- Defective dibasic amino acid transport at brush border (cystine, lysine, arginine, ornithine) of renal tubular and intestinal epithelial cells.
- Cystine is poorly soluble in water - hence forms hexagonal crystals (radioopaque)
- +urine cyanide nitroprusside test.
5. Anemia of chronic disease from ESRD + epo => may lead to depletion of iron stores and a subsequent iron deficiency anemia
6. Hyperemesis gravidarum: 
- 1% of pregnancies
- Severe persistent vomiting, lab derangements (hypoK, ketonuria), and >5% of loss of pre-pregnancy weight.
- Risk factors: greater placental mass - ie multiple fetuses, molar pregnancy - will have higher b-hCG levels at 10-12 weeks when B-hCG levels peak for all pregnant women
- Treat with hydration, ginger, vitamin B6
7. When to operate for SBO: 
- Unstable patient
- Signs of strangulation (acidosis, lactate, fever, septic vitals, leukocytosis)
- Failure to improve with conservative measures (bowel rest - NG, pain ctrl, fluids, correct metabolic derangements)
8. Pediatric skin conditions: 
- Seborrheic dermatitis: "cradle cap" papular, scaly erythematous rash affecting eyebrows, nasolabial folds, scalp - treat with moisturizers, antifungals, topical steroids
- Atopic dermatitis: recurrent, pruritic, eczematous rash on flexor/extensor surfaces - scaling red papules
- Tinea capitis: patchy, fine white adherent scales, with accompanying adenopathy. Does not typically involve eyebrows/paranasal area like seb derm.
9. Hashimotos => thyroid lymphoma -
- risk 60x higher)
- presents as rapidly enlarging thyroid in someone with hashimotos.
- may have compressive sx - dysphagia, voice changes.
- pseudocystic sign on u/s
- rad iodine uptake lower.
- need core needle biopsy for diagnosis
10. Side effects of epo: 
- worsening HTN in 30% of patients. 20-50% of people getting IV epo will have >10mmHg rise in diastolic BP; less common with SubQ admin. Unknown mechanism. Treat with fluid removal (dialysis), beta-blockers and vasodilators, prevent by slowly increasing hematocrit
- HA - 15%
- Flu like sx - 5%, responsive to antiinflammatory drugs
- Red cell aplasia - rare

1. Polymyalgia rheumatica: 
- Associated with neck, shoulder, hip pain, fatigue, malaise that develops over weeks
- ESR and CRP are up
- Treat with low dose steroids (10-20mg/day) and when the symptoms subside, and taper slowly - over months, because this tends to recur
- MTX can be used as steroid sparing agent
2. GCA: 
- Granulomatous vasculitis of medium to large arteries of head and neck - temporal aa, proximal/distal aorta, opthalmic, ciliac.
- M:F ratio 2:1
- Most have headaches in temporal area, 1/3 will have visual symptoms, may have jaw claudication
- ESR is markedly elevated
- Halo sign on temporal artery ultrasound
- Treat with high dose steroids (40-60 mg/day) - does not affect bx if you get it within 4 weeks of prednisone treatment.
- Taper slowly once symptoms resolve and ESR has normalized over months - 10% reduction q1-2 weeks.
- Aspirin may lower risk of cerebral ischemia.
- Neither MTX nor infliximab is effective as steroid-sparing agent in GCA.
3. De Quervain's tenosynovitis: 
- Severe pain on extension of thumb.
- Finkelstein's test: grab thumb, ulnar-deviate hand sharply; pain along distal radius is positive test
4. DDx knee pain in young patients: 
- Patellofemoral pain syndrome: young/middle aged women, pain with climbing stairs/squatting, compression of patella with extended knee reproduces pain - thought to be due to the way the patella slides over femur (ie more at an angle than in men due to wider hips) - treat with PT to strengthen/stretch thigh muscles - resolution may take weeks to months.
- Patellar tendonitis: affects athletes "jumper's knee", episodic pain and tenderness at inferior patella
- Osgood-schlatter: young people (preteen/teen) s/p recent growth spurt, tenderness at tibial tubercle, pain worse with squatting however not seen in adults (vs patellofemoral pain syndrome)
5. Craniopharyngiomas have a bimodal age distribution - in childhood and again at 55-65.
- In kids, growth retardation (GH and TSH deficiency)/DI are more common features, in adults presents with more sexual dysfunction, amenorrhea.
6. Management of carotid disease: 
< 50% occlusion: medical therapy with aspirin and statins, follow q6-12 months with duplex u/s.
50 - 69% occlusion with symptoms - CEA can be considered
70 - 99% CEA recommended for patients who are good surgical risks
Stent is an alternative for CEA in poor surgical risk patients or who have poor predicted 5 year survival.
7. Facts about hepatic disease: 
- Lamivudine (3TC) is used to treat chronic hep B as well as HIV.
- Low salt diet to manage ascites (less Na = less H20 retention)
- All chronic liver disease pts should be vaccinated against hep A and B, as the risk of hepatic failure with superinfection of hepatitis is higher in a vulnerable liver.
8. Birth injuries: 
- Klumpke's palsy ("claw hand"): C8-T1 injury, manifests with weakness of the extensor tendons; grasp reflex is absent. Rarely can manifest as hand paralysis or horner's from injury to sympathetic chain (portends suboptimal outcome). In most cases, function returns in a few months; no improvement by at 3-9 months - can consider surgical tx.
- Erb-Duchenne palsy ("waiters tip"): C5-6 injury, may have decrease Moro reflex but grasp is intact.
- Perinatal stroke: Can present in many ways, incl hyperreflexia, hypertonia.
9. FEV1/FVC > 80 - restrictive <80 - obstructive
10. Neonatal rashes: 
- Erythema toxicum neonatorum: asymptomatic, scattered erythematous macules, papules, pustules - can occur in any part of the body except palms and soles - affects full term infants in first 2 weeks of life - benign, will resolve on its own, no need to treat.
- Staph scalded skin syndrome: ill appearing, febrile, anti-staph antibiotics
- HSV/VZV skin infections in neonates are dangerous as they can quickly disseminate to vital organs; acyclovir should be given immediately.

1. Luekocyte esterase is sensitive and implies presence of WBC, nitrites are specific and imply presence of nitrate-reductase containing bacteria, like e.coli; gram positives (like stap) saprophyticus_ do not contain nitrate reductase
2. Lactose fermenting bugs: 
- E.Coli
- Klebsiella
Pesudomonas is non-lactose-fermenting: this is important because you'll often get whether or not it is lactose fermenting long before you get speciation data from the lab-- if it's a GNR and non-lactose fermenting you should start antipseudomonal coverage
3. Management of acute MS flare: 
- No role for IVIg shown in RCT
- +Role for plasmapharesis that is non-responsive to IV steroids
- Manage with IV methylprednisolone as it is slightly more effective than PO
4. Acute rise in bilirubin in Hep C patient on ribavirin - hemolytic anemia.
5. Hand foot and mouth disease - cocsackie A or enterovirus 571
6. Sweet's syndrome (aka acute febrile neutrophilic dermatosis): sudden onset fever, leukocytosis, tender papules and plaques - bx shows neutrophilic granulocytes.
7. Kaposi's sarcoma - not true sarcomas, as sarcoma implies tumor of mesenchymal origin; while KS is a tumor of endothelial cells and lymphatic tissues associated with endothelium.
8. Terri's nails - nails appear white, with ground glass appearance, and no lunula - suggestive of systemic diseasae (nonspecific). Can be seen in
- Severe liver disease (up to 80% of patients)
- Cirrhosis
- DM
- Hyperthyroidism
- Malnutrition
- CHF
Believed to be due to decreased vascularity and increased connective tissue in nailbed.
9. ANCA-associated vasculidities: GPA/wegener's, MPA, Churg strauss:
- small to medium vessel vasculidities
- pauci-immune necrotizing GN
- lung + renal involvement
10. ANCAs 
- C-ANCA - very sensitive and specific for wegner's; associated with PR3 antibodies (when you apply these you tend to see a cytoplasmic staining pattern - hence C-ANCA)
- p-ANCA is not as specific and can be seen in many other diseases, including PAN, IBD, RA. Associated with MPO antibodies (when you apply these you see a perinuclear staining pattern - hence p-ANCA)

1.Vasculidities that consume complement:
- Hep C cryoglobulinemia
- Lupus vasculitis
2. Drug induced lupus: INH, procainamide, hydralazine, dilantin, anti-TNFa (etanercept, etc)
3. Lyme disease 
- Early localized (days to weeks): erythema marginatum (80% of patients), fatigue, mlaaise, lethargy; mild HA and neck stiffness; pain in muscles and joints
- Early disseminated (weeks to months): carditis (5% untreated - AV block, cardiomyopathy), neuro (15% of untreated patients: unilateral/bilateral CN deficits like 7, meningitis, encephalitis), muscular (60% untreated - migratory arthralgais), conjunctivitis (10% untreated)
- Late/chronic: migratory arthalgias, encephalomyelitis, peripheral neuropathy
- titers are insensitive in early localized disease; IgM antibodies to B.Burgdorferi appear usually around 1-2 weeks, IgG within 2-6.
- If there is clinical suspicion of lyme, the correct management is to treat with PO doxy (if pt is >=8  years old and not pregnant)
4. DMARDs should be started asap in RA as they slow joint damage (begins early in disease): MTX, hydroxychloroquine, sulfasalazine, azathioprine). If DMARDs are not enough, can add another DMARD or add biologic. Can use steroids and NSAIDs to manage symptoms, but steroids do not prevent long term joint destruction.
5. Patients with HIV who complain of esophagitis/odynophagia with evidence of oral thrush should get an empiric treatment with 3-5 days of PO fluconazole. If that fails to improve symptoms, or if there is no evidence of oral thrush, then they should get scoped to look for other causes - CMV, HSV.
6. Emphasematous cholecystitis: acute chole in old, diabetic males- infection of GB wall with gas-forming bacteria.
7. Absent ankle reflexes can be a normal finding in aging, elderly patients.
8. Management of aortic dissection: 
- Beta blocker, as it prevents tachycardia and hypertension, which can exacerbate the dissection (if you use a BP-only agent like nicardipine or hydralazine, you may cause reflex tachycardia which may worsen dissection).
- Anticoagulation (heparin, tPA) should be avoided - as the theoretical risk of extending the dissection
9. Acute pain and swelling over coccyx- likely pilonidal cyst (common in young men with large amounts of body hair) - theorized to be a follicular infection that forms an abscess that spread subcutaenously, then ruptures and forms a sinus tract, that can then itself become obstructed and repeatedly infected. Treat by drainage and excision.
10. Drug toxicity: 
- Salicylate: resp acidosis, metabolic alkalosis, tinnitus, n/v, fever, AMS. Treat with sodium bicarb (alkalinizes urine; also works for TCA o/d, phenobarb, MTX)
- Serotonin (ie serotonin syndrome): flushing, HTN, tachycardia, hyperthermia, diaphoresis. Treat with cyproheptadine
- Cocaine: HTN, tachycardia, cardiac ischemia, intracranial hemorrhage. Manage vital sign abnormalities with benzos.
- Anticholinergics: drowsiness, confusion/AMS, dry mouth, dilated pupils/blurred vision, constipation, urinary retention; treat with physostigmine
- Theophylline: seizures, hyperthermia, cardiac arrhythmia, hypotension. Treat seizures with benzos.

1. Non stress test: 
- Used to evaluate decreased fetal movement; used to evaluate all high-risk pregnancies starting at 32-34 weeks gestation.
- Normal: 2 or more accelerations (HR increases >15 beats/min above baseline for >15 seconds) in 20 minutes.
- If less than 2, considered abnormal - most common cause is fetal sleep cycle; wake fetus with vibroacoustic stimulation and then try again.
2. HTN in pregnancy: 
- Chronic: >140/90 anytime before 20 weeks of conception
- Gestational: new onset HTN at 20 weeks, without evidence of proteinuria or end organ damage
- Pre-eclampsia: new onset HTN at 20 weeks + proteinuria OR signs of end organ damage
- Eclampsia: Pre-eclampsia + seizures
- Chronic HTN + preeclampsia: chronic HTN + worsening HTN/proteinuria/end organ damage beginning at 20 weeks
- Risk factor for IUGR, placetal abruption (other risk factors: DM, smoking, cocaine use, prior abruption)
3. Diagnosing acromegaly: 
- GH => IGF-1; the levels of GH fluctuate in a diurnal pattern but IGF-1 levels are consistent elevated and is thus the preferred initial test to evaluate. IGF-1 levels do tend to decrease with age.
- If IGF-1 is positive, then confirmatory test - oral glucose suppression. Most people suppress GH to <1 ug/dL after 75g glucose load, but those with acromegaly do not.
- If both are positive, should get MRI brain; if no pituitary tumor found, look for ectopic GH-secreting tumor.
4. Esophageal rupture: 
- Most common cause is instrumentation
- Mallory-weiss is an incomplete mucosal tear at GE junction; not a true perforation (ie will not cause mediastinal air)
- Boerhaave syndrome is a complete tear, and typically occurs a few cm above GE junction.
5. Febrile seizures: 
- Typically occur in kids 6 mos - 6 years, at T>38, in association with viral illness (flu, adeno, HHV6) or bacterial infection
- Can be simple (nonfocal - tonic clonic/atonic, one episode) or complex (focal, one ep > 15' or multiple episodes > 30')
- Treat if seizures last > 5 minutes
- If the patient returns to neurologic baseline afterwards, and is otherwise healthy and with a normal exam, there is no indication for more invasive testing or imaging and no indication for further treatment.
- These do not cause brain injury, and these kids go on to develop normally. The recurrence rate is around 30%, and the risk of future development of epilepsy is low (<5%)
6. Bowel ischemia complicates up to 7% of aorto-iliac vascular surgery, and most commonly occurs in distal L colon. Presents with dull pain and hematochezia. Scope shows discrete segment of cyanotic and ulcerated bowel.
- Radiation proctitis, on the other hand, is typically associated with diarrhea, tenesmus, incontinence, with possible development of strictures and fistulae.
7. Malignant otitis externa: 
- If untreated can cause skull osteomyelitis and CN damage (i.e. of 7th nerve)
- Will see granulation tissue in ear canal
- Must treat with systemic antibiotics - topical are ineffective
- Contrast with Ramsey Hunt syndrome, which is a zoster infection of CN 7 (can also cause palsy) - will see vesicles in ear canal.
8. Niacin 
- Flushing related to prostaglandin induced vasodilation - treat with aspirin.
9. Respiratory distress in neonate: 
- Choanal atresia - can be bony (90%) or membranous (10%), presents with cyanosis with feeding; treat with OG tube and definitive surgical/endoscopic repair; may occur alone or with CHARGE syndrome (coloboma, heart defects, atresia of choanae, renal abnormalities, growth impairment, ear abnormalities/deafness)
- Laryngomalaica: inspiratory stridor worse with exacerbation/distress. Rarely cyanosis.
- TOF: cyanosis triggered by stress.
- TEF: typically with have coughing, respiratory distress, and lung sounds in addition to cyanosis
- Transient tachypnea of neonate: tachypnea, nasal flaring, costal retractions, grunting immediately after birth
- Vocal cord paralysis - presents identically to laryngomalacia (stridor, tachypnea, rarely cyanosis) and can only be distinguished by direct visualization.
10. Repeated episodes of thrombosis (ie thrombophlebitis) - think genetic hypercoagulability in younger person, GI/GU cancer in older (gastric, ovarian, pancreatic - pan scan)

1. Hemophilia - recurrent hemarthrosis and skeletal muscle bleeds are most common manifestations. GI bleeds are less common.
2. Restrictive cardiomyopathy:
- Diastolic dysfunction - people will experience significant clinical findings of heart failure (JVD, edema, wet lungs, etc), while systolic function on echo is preserved.
Causes:
- Hemochromatosis - can be reversed with treatment (ie phlebotomy)
- Amyloidosis - not reversible; symptomatic treatment only
- Sarcoidosis - treatable with steroids; will slow progression but will not reverse
- Scleroderma - treatable with steroids; will slow progression but will not reverse
3. Senile purpura: ecchymoses in elderly patients in places exposed to repeated minor trauma; due to age-related loss of elastic fibers in perivascular connective tissue.
4. DDx poor platelet adhesion
- Von willebrands: generally presents quite young
- Antiplatelet drugs (aspirin, plavix, abciximab...)
- CKD (2/2 uremia... some renal transplant surgeons wont operate when BUN>100 due to increased bleed risk)
5. Types of tremor:
- Essential: generally bilateral action tremor or hands, may have isolated head tremor, improves with alcohol
- Parkinsonian: may be unilateral or bilateral of hands and feet, rarely involves head, improves with voluntary movement, worse with mental distraction
- Cerebellar: intention tremor, often associated with ataxia, dysmetria, gait problems
- Physiologic: onset with sympathomimetics (drugs, hyperthyroidsm, anxiety, caffeine); worse with movement, can affect face and extremities
- Orthostatic: tremor of legs that occurs right after standing up
6. Bradycardia, hypotension, AV block, wheezing, hypoglycemia, neuro effects (seizures, delirium) = beta blocker toxicity. Treat with IV fluids and atropine first; if that doesn't work, then glucagon; after that consider calcium, glucose + insulin, epi; if medical therapy fails can consider temporary pacemaker.
7. Sepsis in sickle cell: strep pneumo most common cause; HIB is a distant second. Thus these kids should get the standard 13-valent pnuemo vaccine + HIB vaccine and also the 23-valent polysaccharide pneumo vaccine usually given to old people and the neisseria vaccine as well.
8. Duodenal hematoma in kids - manage conservatively with NG suction and IV nutrition, as these typically resolve in 1-2 weeks.
9. Neuroblastoma: 
- Most common extracranial solid tumor of childhood
- Neural crest cell origin - may originate from anywhere along sympathetic chain or adrenal gland.
- Firm, nodular mass
- Can have calcifications and hemorrhages
- Up to 70% will have mets at presentation - long bones, skull, bone marrow, liver, lymph nodes, skin.
- HVA and VMA elevated, but no pheo symptoms (fainting, sweating, palpitations, HTN)
10. Renal embryology 
- Wilms tumor - from metanephros (embryologic precursur of renal parenchyma)
- Mesonephros - gives rise to seminal vesicles, epididymis, ejaculatory ducts and ductus deferens
- Paramesoneprhon - fallopian tubes, uterus, vagina

1. Colic - presents at 3 weeks of age, lasts 3 months. Crying >3 hours a day for >3 days/week for >3 weeks/month
2. Progestin-only pills preferred during lactation as they do not affect milk production, are not known to affect infant and do not carry DVT risk
3. ITP in kids (usually age 2-5) typically self-resolves in 6 months. You're not supposed to treat cutaneous bleeds, no matter the platelet count, although I have seen it be treated when the platelet count was low enough. If the patient experiences bleeding, you can treat with IVIg or steroids.
- ITP in adults - doesn't tend to self resolve as much, treat when platelets < 30,000
4. Varicocele: dilation of pampiniform plexus of veins around spermatic cord and testis from compression of venous drainage. More common on L as gonadal vein enters renal vein at right angle -- L renal vein often compressed by aorta and SMA
- Soft mass, "bag of worms, does NOT transilluminate
- Worse with standing, valsalva
- Improved with lying supine
- May have no symptoms or a dull scrotal ache
- May lead to testicular atrophy due to increased temperature - for young people who want to maintain fertility, can treat with surgical ligation of gonadal vv vs symptomatic management for older people.
5. DDx testicular mass: 
- varicocele (see above)
- spermatocele (painless, fluid filled cyst at head of epididymis full of nonviable sperm - do not change with position)
- hydrocele (fluid between parietal and visceral layers of tunica vaginalis, usually present in infancy and can change in size with valsalva - typically transilluminate)
- hernia - +/- pain, can worsen with valsalva and improve with lying supine; more common on R side (later descent of R testicle) - associated with patent processus vaginals (indirect hernia) or weakened femoral ring (femoral hernia).
6. Androgen producing adrenal hormones - DHEA-S is produced in adrenals only, so is most specific this kind of tumor. Andostenedione (AS), DHEA, and T are all made by both adrenals and ovaries.
7. Treatment of psoriatic arthritis - NSAIDs, MTX, anti-TNF agents - systemic steroids relatively CI because of a theoretical risk of rebound symptoms with dose reduction or withdrawal, but according to this paper there is little published data on whether or not these events occur.
8. Vagal maneuvers affect both SA node automatism and AV node conductivity; it the latter effect that is believed to break PSVT, as that is believed to be an aberrant re-entrant rhythm.
9. Acanthosis nigricans
- Benign - younger people, associated with insulin resistant states (DM, PCOS)
- Malignant - older people, associated with GI/GU malignancy
10. Review of indication for statin: (original post Feb 13, 2014)
- Anyone with LDL > 190
- Diabetics with LDL > 70
- 10 year cardiovascular risk > 7.5% and LDL > 70
- Anyone with clinically significant heart diseaes