1. Glucagonoma

- Derm: erythematous plaques that can coalesce and blister around perineal area, extremities, face

- Neuro: ataxia, dementia, proximal muscle weakness

- Can cause increased DVT

- Serum glucagon > 500.
- Other conditions that cause elevated glucagon: cushing's, pancreatitis, sepsis and hypoglycemia, although in these cases serum glucagon is generally < 500 

2. Theophylline toxicity 

– CNS stimulation – Headaches, insomnia, seizures

– G.I. disturbances: nausea and vomiting

– Arrhythmias: Atrial tachycardias, SVT, v-tach

– Narrow therapeutic window, levels can be increased by CYP inhibitors (macrolides, Verapamil, cimetidine, cipro), by acute illness and by cirrhosis.

3. DDx SVC Syndrome

– Malignancy: lung cancer, non-Hodgkin's lymphoma

– Fibrosing mediastinitis: 2/2 Histo, TB 

– Giant clot from an indwelling line 

4. Hep C cryoglobulinemia: 

– Think of it like lupus with elevated transaminases: vasculitis of skin, kidneys, nerves, joints.
– Renal: proteinurea and hematuria 

– Skin: Palpable Purpura. 

– Joints: Arthralgias
– Systemic inflammatory symptoms: malaise, fatigue

– Nerves: peripheral neuropathy

– Hepatosplenomegaly

– Labs: Decreased complement (low C3, C4), elevated RF. 

5. DDx Pulsus paradoxus

– cardiac tamponade

– Severe asthma or COPD 2/2 significantly increased intrathoracic pressure on inspiration - sucks blood out of the heart into the pulmonary venous system, reducing preload 

6. Dermatology 

– Tinea versicolor: flat white pink or brown macules that do not tan, scale on scraping. Treat with ketoconazole or selenium sulfide. 

– Seborrheic keratosis: brownish stuck on lesions
– Seborrehic dermatitis: rash that affects anywhere with sebaceous glands (face, intertriginous, parasternal, scalp). Greasy yellow scale over erythematous base. Often associated with underlying Parkinson's or HIV.

– Tinea corporis: erythematous rings with scaly edges 

– Pityriasis rosacea: flat fawn colored macules up to 2 cm, christmas tree, herald patch

– Sudden onset seborrheic dermatitis or severe psoriasis - think HIV or GI malignancy 

– Photo allergic contact dermatitis can occur with certain kinds of sunscreen. Prior exposure is needed

7. Optho 

- Tarsal conjunctiva = conjunctivae lining the inside of the eyelid. Granular appearance suggests viral conjunctivitis (among other things). Treat viral conjunctivitis with cool moist compresses

- Macular degeneration causes central vision loss - can be atrophic with sores or proliferative with increased blood vessels.

- Open angle glaucoma causes loss of peripheral vision and is more common among diabetics. On exam you will see increased cupping. 

- Acute closed angle glaucoma: hard eye, dilated/fixed pupil, blurred vision, halo, pain, conjunctivitis, headache, nausea. Treat with pilocarpine to open canals of schlemm and timolol to reduce synthesis of aqueous humor. 

- Anterior uveitis: inflammation of uvea, especially iris. May have conjunctival inflammation next to cornea is usually spared. 

- Conjunctivitis vs keratitis: keratitis implies involvement of cornea. 

- Fungal keratitis is often found in agricultural workers and immunocompromised patients; you'll see multiple stromal abscesses

- Bacterial keratitis is common in contact lens wearers (particularly gram negatives like pseudomonas and serratia). The cornea will appear hazy with a central Ulcer and surrounding stromal abscess-  you may see hypopyon. 

- Herpes simplex keratitis: recurrent infections triggered by sun exposure (outdoor work) fever or immunodeficiency and are characterized by dendritic ulcers & corneal ulcers

- Episceritis: mild pain and discharge. RA, IBD. Does not affect vision or cornea. 

- Standard diabetic retinopathy includes micro hemorrhages and cottonwood spots

- Central Retinal vein thrombosis causes sudden loss of vision often in the morning; you will see dilated and torturous veins on exam, and disc swelling

8. Indications for aortic valve repair in aortic stenosis

– Any symptoms: Syncope, dizziness or lightheadedness, dyspnea

– Significant stenosis in a patient getting a CABG or other valve surgery

– Significant AS + plus poor LV function, poor exercise tolerance, or significant LV hypertrophy

9. Liquid cancer treatment

– Hairy cell: cladribine (purine analog) 

– CLL: prednisone plus chlorambucil

– Non-Hodgkin's: CHOP
- Hodgkins: ABVD (adriamycin, bleomycin, vincristine, dacarbazine)
- APML: All-trans retinoic acid
- AML: induction (cytarabine + anthracycline like daunorubicin) + consolidation (more chemo drugs or stem cell transplant depending on cancer genetics) 

10. NAFLD

– Due to insulin resistance => increased peripheral lipolysis, which is taken up by the liver