1. Osteomalacia
- Vitamin D deficiency-- thus often seen in malabsorptive states (celiac's, bariatric surgery, bacterial overgrowth, etc)
- Initially, Ca and Phos will be low - stimulate PTH, which will bring Ca levels back up by leeching from bone and increasing reabsorption in kidneys
- Final labs: normal ca, low phos, high PTH, high alk phos.
- Sx: weakness, bone pain, pseudofractures (line of increased lucency on bone with surrounding thickened periostium/callouses), real fractures (in wt bearing lower extremities).
2. PCP pneumonia:
- LDH often up
- Treat with bactrim; if unable to tolerate bactrim then pentamidine
- Add steroids if PaO2 < 70 or A-a gradient > 35
3. PORT score (figure out whether to admit for pneumonia)
- Things that get you +30 points: cancer, arterial pH < 7.35
- Things that get you +20 points (end-organ damage): liver disease, AMS, tachypnea (>30), hypotension (SBP < 90), impaired renal function (BUN > 30), Na < 130
- Fever buys you +15 (Temp <35 or >40).
- Things that get you +10 points (comorbidities, labs that imply decreased reserve): nursing home, CHF, CAD, CVD, CKD, tachycardia (>125), glucose > 250, crit <30, PaO2 <60, pleural effusion
- You get 1 point for every year of age.
- Subtract 10 points for women.
- Risk class I if: age <50, no vital sign perturbations, not altered, doesn't have cancer, no major-organ comorbidities (brain, kidney, liver, heart)
- Class II if score is <70
- Class III 71-90
- Class IV 91-130
- Class V >130
- Send I home, use your judgement on II, III and IV need admission, V needs ICU admission

4. ESRD calciphylaxis
- Vessel calcifications and ulcerations on extremities (hand) - dx with skin bx.
- Tertiary hyperparathyroism.
5. Abortive treatments for migraine
- Tryptans
- NSAIDs / tylenol
- Caffeine
- Fioricet/fiorinal (butalbital + caffeine + aspirin/tylenol)
6. Calcifications around heart - chronic pericarditis
- autoimmune
- viral
- malignancy
- drugs
- uremia
- s/p radiation
7. Diagnose this: 
- RA on steroids + back pain + cauda equina sx: compression fracture vs infection/abscess
- Fever, LAD, lung nodules on CXR: HIV vs lymphoma vs disseminated fungal
- DM + diarrhea: metformin side effect (lasts weeks) vs autonomic enteropathy (gastroparesis in colon) vs c.diff
- Hemolytic anemia + bullous myringitis: mycoplasma
- Muscle pain + heavy menses + weight gain: hypothyroid
- Fever + alopecia + palmar rash: secondary syphilis
- History of surgery + vomiting: SBO
8. DVT prophylaxis
- low risk: mechanical prophylaxis, or nothing (make them walk)
- medium: heparin/lovenox,
- high (ortho, neuro): therapeutic anticoagulation (ortho: coumadin,
9. Incidentally found adrenal mass: 
- Likelihood to be cancer increases if the mass is big (2% if <4cm, 25% if >6cm), hypervascular, necrotic, irregular borders. Mets are likely to be b/l.
- Most common are tumors that secrete cortisol (sub-clinical levels) so screen with dex suppression test. Also screen for pheo as they can have intermittent symptoms.
- Don't screen for aldosterone secreting tumor unless you have clinical signs, same with androgens.
10. Cosyntropin = synthetic ACTH. Good to evaluate adrenal function in adrenal insufficiency states.