1. Transient loss of consciousness - seizure vs trauma vs hypoglycemia vs drugs/alcohol vs stroke/TIA vs syncope
2. Syncope: vasovagal/reflex vs orthostatics vs cardiac
- Vasovagal: ask about pain, anxiety. Pathogenesis: Heart squeezes down until there's no volume left, brain sees that they need to slow down to fill better, tells vagus nerve to brady and peripheral vessels to vasodilate
- Orthostatics: orthostatic BP. Pathogenesis: dehydration, autonomic instability (old people-- can't mount tachycardic response), diabetes (peripheral neuropathy)
- Cardiac: ask about cardiac dx, risk factors for cardiac dx. In someone with a history of heart disease, you have to rule out NSVT as the cause. In someone young and healthy, still get an EKG because if they have a congenital QT prolongation or if they are on a drug that can prolong QT (macrolide, quinolone) they can go into torsades.
3. When to not blow it off as just vasovagal/orthostatic: 
- Occurs lying down (by definition you can't be orthostatic)
- Occurs during exercise

- Any history of heart disease

4. Syncopal convulsions: couple of twitches after syncope is common-- no postictal phase tells you its not a true seizure. 

5. Orthostatics:

- Postural increase in pulse > 30 (97% sens, 98% spec, LR+ 48, LR- 0.03)
- Supine HR > 100 (12% sens, 96% spec, LR+ 3, LR - 0.9)
- Supine hypotension <95 (33% sens, 97% spec, LR+ 11.0, LR- 0.7)
6. EP techinques to work up arrhythmia 
- Measure H-V interval (see how long a signal takes to get thru his-purkinje to check for AV node block)
- Overdrive pace SA node, then stop, see how long it takes the node to recover (longer in sick sinus syndrome).
7. WPW: afib is dangerous, because there's no block through the AV node-- you conduct thru your accessory pathway, and you can pace the ventricle to a rate of 200s-300s.
8. Hypothyroidism: 
- Diagnosis: TSH- LR- <0.01, LR +99
- Elevated TSH + low T4 is overt hypothyroid
- Elevated TSH + normal/high T4 is subclinical hypothyroidism.
- Indications for synthroid: symptoms, TSH > 10 (high risk of progression from subclinical to overt hypoT),
9. Bactrim does not cover strep
10. Skin infections
- Cellulitis: systemic symptoms (ie. fever) are rare except in bacteremia or nec fasc, so when you see them, get worried. Without abscess, usu strep, with abscess, think staph
- Erysipelas - usually strep, clear demarcated border, usually superficial, often with fever (i.e. not a worrisome sign)