1. Cardiac temponade: Inc.fuid in pericardium>>Increses the pressure then that o ventricle = Impaired diastolic lling o ventrile (Decreased preload)=Dec C. ... s!s: "ulsus parado#us$ %aised &'"$ potension$ *+sent or mu,ed heart sounds....-ote: arliest nding on C is %ight sided diastolic collapse. i) /est initial diagnostic tst = cho ii) 0ost acc = cath = euali2ation o diastolic pressure iii) 0ost imp ne#t step: "ericardiocentesis and i!v fuids 3. erpes encephlitis is severe orm o viral encephlitis. Causes emorrhagic necrosis o 40"%*5 5/6. i) /est initial test = *D C4 ii) 0ost accurate test = "C% on C67 or 6' D-* iii) C67 8ill sho8 %/C$ 5mphocte predominant and ma +e inc.protein$ +ut glucose is normal iv) /est initial %# = i!v*cclovir... I patient develops acclovir induced crstalluria and %4 damage = reduce the dose and drate the patient 9. Cisplatin= -ephroto#ic$ toto#ic (tinnitus $ +i!uni hearing loss)$ electrolte a+normalities$ nausea and vomiting$ neuroto#icit.. Car+oplatin less liel causes these e;ects +ut can cause melosupression melosupression
<. one o the complication o thoracocentesis = 04%*... leads to intravascular volume depletion and decreased preload and hemodnamic insta+ilit . "ulmonar contusion is one o the hidden in?ur that can maniest sometime ater trauma as hpo#ia hp o#ia @%*A @%*A = "* "*4CA 4CA I%%B5*% I%%B5 *% *5'5*% I-7I5 I-7I 54%*46 4%*46 Dec De c +reath sounds -ote: *ter chest trauma... ater giving I' fuids i) I hpo#ia 8orsens = pul.contusion ii) I "C" 8orsens = 0ocardial contusion(con + CB and cardiac marers).. marers).. -ote: i) nilateral inltrate = pul contusion ii) /ilateral inltrate = *%D6 iii) 6ternal racture = 0ocardial contusion$ *ortic rupture
E. *d e;ects o anti@*ID6: i) viren2: Insomnia$ vivid$ +i22are dreams ii) Didanosine$ 6tuvidine = "ancreatitis$ peripheral neuropath iii) Fiduvodine = Inc.0C' anemia$ pro#imal mopath iv) *+acavir= persensitivit$ epatitis$ 5actic acidosis G. Iron to#icit: *cute iron to#icit occurs in phases rom BI4 0C6*5 I-&%A to the hepatic ailure and death. ii) It commonl occurs in children o pregnant 8omen taing parentral vitamins +.c children oten conuse +rightl colored iron pills or cand. %#: Deero#aine 8hich +inds 7erric iron and e#cretes it into urine iii) %emem+er triad = 054I'I4*0I- I-4*H$ */D "*I-$ 0*406I6........... leading to meta+olic acidosis
i) 4o#ic dose o iron = >Emg!g ii) C!7: 1@Ehr=git (a+d pain$ nause vom$ hemorhage).... E@39)... %*A: radio@opue shad8.... %#: I!' deero# (smptomatic$ iron>4I/C$ iron>9ug!dl)...7or asmpt 8ith intact gag=ipecac -ote: Iron damage mitocondria and cause ree redicl lipid pero#dtn
J. "re@e#isting ?oint disease lie rheumatoid arthritis predisposes the patient to develop 6"4IC *%4%I4I6. 0ost common cause o s.a = 6taph aureus /est initial test: *rthrocentesis 0ost accurate: 6novial fuid culture /est initial emperic %#: CeK'anco *ter culture sensitivit: L ear child = -aK9rd gen cephlo > ear = I!v -acillin I surgical drainage is given in option= al8as chose it +!c dela can lead to avascular necrosis o ?oint s.a in pr.?oint = remove ?ointKa+ M. I ou nd a painless /5*CH -C%4IC 56I- 8ith surrounding edema and erthema = suspect= cthma gangrenosum and *nthra#... i) cthma gangrenosum= caused + pseudomonas in -eutropenis$ Immunocompromised$ /urns$ BCD patinets= %#=*ntipseudomonal anti+iotics ii) *nthra#: loo or environmental e#posure in histor 1. /edridden patients are prone to Decu+itus ulcers: i) /est 8a to prevent: 7reuent turning 3 hrl ii) ther 8as: "lace pillo8s under legs to relieve pressure iii) I ulcer develops = 0oist dressing 11. *) Complications o C'" line insertioin: *rterial puncture$ pneumothora#$ hemothora#$ throm+osis$ *ir em+olism$ 6taph.epid sepsis$ 'essel peroration$ 0ocardial perortn.... /) *ter insertion o C'" line = must do C@%*A to rule out complication!ris o compl.... 4o avoid mocard.perrtnN catheter tip should +e located pro#imal to cardiac sillehoute or pro#imal to angle +!8 trchea and %06+ronchs. Ideall the tip should lie in 6'C (not in smaller veins +!c o ris o rupture 13. 4c@MM scan is the most accurate test or 0erel diverticulum. -ote that this scan identies C4"IC B*64%IC 0C6* (not the em+ronal tissue). as gastric mucosa is prone to +leed and is ound in O cases o merel diverticulum. -ote: 4he most common presentation o merel diverticulum is painless +leeding per rectum 19."ainless o+structive ?aundice 8ith palpa+le g.+ in elderl="ancreatic cancer. *) most common location: ead %!7: Cigerrate$ chronic panc$ >$ ?e8 Pa.americn$ +esit$ 7att diet$ D0 /) C!: *+d pain +ac$ 8t loss$ 0igrator throm+opheli+itis (trossaeu) -te: *lchol is not r! or ca panc.. most sensitive n sp test: *+d C4.. I non dignstc = do %C". "ostop response to chemo = C*@1M@M levels
1<. 7emoral line causes more ris o Catheter related inection (6taph. epidermitus$ g@ve rods) as compared to C'" line 1. 4esticular torsion =6udden onset o testicular pain$ *+sent cremesteric refe#$ igh riding and hori2ontal position.. -e#t +est = +ilateral orchiope# piddmitis:nilateral scrotal pain$ rad.to fan!s.c$ Kprehn sign...-e#t step: do 6B to rule out torsion... Con + u!a and u.c... %#: L9 ear = ceKdo#... >9 ear = #tended release cipro (or e.coli$ pseudomonas)
