Benzo's (lorazapam)

Ca channel blockers

Over 35 - assume CAD - do cardiac cath

DiGorge - hypocalcemia

SCID - adenosine deaminase deficiency

Prerenal azotemia (ratio >20)

IV fluids (or blood)

Live Vaccines: Varicella, zoster, intranasal influenza, OPV, yellow fever, BCG, anthrax, oral typhoid, smallpox

Exception MMR if no evidence of immunity, CD4+ count >200, and no AIDS-defining illnesses

HIV pts should get influenza, pneumococcal and hep B/A vaccines

Platelet count drops >50% in a pt on heparin

Most feared complication is thrombosis - hypercoagulable - DVT, PE, Ischemic stroke

Must maintain 02 at 92-95%

Intubate and ventilate if: cannot maintain 02 sat, cannot talk d/t work of breathing or AMS

46xy

Testes in labia

Androgen receptor defect

normal-appearing female

rudimentary vagina

absent uterus and fallopian tubes

Labs: increased testosterone, estrogen and LH

Hypogonadism

Premenopausal female - oligo/amenorrhea, infertile, rarely galactorrhea, 

Postmenopausal female - no sx, galactorrhea

Men - decreased libido, decreased testosterone, gynecomastia, galactorrhea, decreased sperm count, impotence

Hypernatremia

Hypokalemia

Increased serum aldosterone (24hr)

Metabolic alkalosis

Antedotes

1.  Opioids

2.  Heparin

3.  Benzo's

4.  Barbiturates

5.  CO

1.  Narcan

2.  protamine sulfate

3.  flumazenil

4.  Bicarb, dialysis, activated charcoal

5.  100% 02, hyperbaric 02

Development of secondary sexual characteristics but no period by age 16

or

no secondary sexual characteristics or period by age 13

Avoid combo estrogen/progesterone in breast feeding

Give progestin-only pills or IM medroyprogestrone

post-partum = hypercoagulable!

Amp + gent to mother during labor and delivery

Test mother before delivery

MCC = GBS or e. coli

Meningitis - neck pain, headache, n/v, fever

Encephalitis - AMS, focal neuro deficits

CT w/o contrast

CTA /MRA

MRI

Echocardiogram

Carotid duplex ultrasound

Visual deficits

Vertigo

Contralateral full body weakness

Descreased sensation

AMS

Coma

Pontine ischemia

BP goals/medications in strokes

1. Ischemic

2. Parenchymal

3. SAH

1.  BP goal >220/120 unless giving TPA, give labetalol, no nitrates!

2. BP goal <140-160/XX, give labetalol or nitroprusside

3.  BP goal <150/XX  give labetalol or nimodipine (vasospasm) no nitrates!

Signs and symptoms of TCA overdose

management

Cardiotox

Neurotox

Anticholinergic sx

Tx - sodium bicard, benzo's for seizures, monitor for at least 6 hrs

Stop lithium

Give HCTZ and amiloride

1.  Acute dystonia

2. Tardive dyskinesia

1.  Muscle contraction - neck spasm - give diphenhydramine or benztropine

2.  chewing movements of face, wreathing - switch to new antipsychotic

Sudden painless onset of flashing lights or floaters

Shade being pulled down

Unilateral

Categories of antidepressants

1. SSRI

2. TCA

3. MAOI

4. NDRI

5. SNRI

6. Tetracyclics

1.  fluoxetine, sertraline, paroxetine, fluvoxamine, acetalopram, escitalopram

2.  imipramine, amitryptiline, desipramine, noretryptaline, chlomipramine, doxapin

3. phenylzine, tranylcipromine, selegiline

4.  bupropion

5. Venlafaxine, duloxetine, milnacipran, nefazidone

6.  mirtazepine, trazadone

Other SSRI's

MAOI's

St. John's wart

SNRI's

Levadopa

Meperidine

Cocaine, amphetamine

LSD, ecstacy

MCC of 

1. Sensorineural hearing loss

2.  Conductive hearing loss

1.  Presbycusis - progressive symmetric high-freq. hearing loss

2.  Otosclerosis

TCA's

Bupropion

Alpha 2 agonists (clonidine)

Fluphenazine

Pimozide

Tetrabenazine

Increased r/o suicidal ideations

Liver injury

Decreased protein

Decreased Glucose

Increased PMN's w/ left shift

Increased opening pressure

Remove 3.5 parathyroid glands

Mark remaining half w/ surgical clip 

Autologous transplantation

Neuroleptics - potencies

1. high

2. low

3. moderate

4. Atypicals

1. haloperidol, fluphenazine, thiothixine, droperidol

2. chlorpromazine, thioridazine

3. malindone, loxapine, trifluoperazine

4. Clozapine, risperidone, aripiprazole, quetiapine, paliperidone, olanzapine

Lesions to areas of brain

1.  Contralateral hemibalismus

2.  Hemispatial neglect syndrome

3. Coma

4.  Poor repitition

5.  Poor vocal expression

6.  Resting tremor

7.  Intention tremor

8.  Hyperorality, hypersexuality, disinhibited behavior

9.  Personality changes

10.  Dysarthria

11. Agraphia, acaculia

1.  subthalamic nucleus

2.  right parietal lobe

3.  Reticular activating system

4.  Arcuate fasciculus

5.  Wernicke's area

6.  Basal ganglia

7.  Cerebellar hemisphere

8.  Bilateral amigdala lesions

9.  Frontal love

10.  cerebellar vermis

11. Left parietal lobe

At what age to physicians begin to dose dexamethasone with or prior to the first dose of antibiotics in cases of suspected bacterial meningitis?

Calcium carbonate

Calcium acetate

Do not use calcium citrate - increases Aluminum absorption

Respiratory alkalosis -> mixed respiratory alkalosis and metabolic acidosis w/ increased anion gap

Dehydration

N/V

AMS

Tinitis

Antidotes:

1.  Salicylates

2. Beta blockers or verapamil

3. Digoxin

4. Iron

5.  Copper 

6.  TPA / streptokinane

1.  Bicarb, charcoal, dialysis

2. Glucagon, insulin/glucose, calcium, atropine

3.  Anti-dig AB, charcoal, NO CALCIUM

4.  defuroxime

5.  Penicillamine

6.  Aminocaproic acid

ABX: ceftazadine after neurosurgery

Also, vancomycin

Needle aspiration

corticosteroids

100% 02 by nonrebreather

Same as migraines

CAD

Printzmetal's angina

Pregnancy

Seizures

hypotension

tachyarrhythmias

hyperthermia

Types of heart disease

1.  ST segment elevation in leads corresponding to perfusion of multiple coronaries

2.  Hypertension, distant heart sounds, distended neck veins

3.  Cardiac cath shows equal pressures in all four chambers

4.  Chest pain that lessens when pt leans forward

1.  Acute pericarditis

2. Cardiac tamponade (Beck's triad)

3.  constrictive pericarditis

4. pericarditis

Sodium nitroprusside

nitroglycerin

Antidotes:

1. Antimucarinics/anticholinergics

2.  Benzo's

3. TCA's

4.  Warfarin

5.  Methanol/ ethylene glycol

6.  Arsenic

1.  physostigmine

2.  Flumazenil

3. Bicarb

4.  Vit k/ FFP

5.  Ethanol, fomepizol

6.  dimercaprol, succimer or penicillamine

Muscle rigidity

Rhabdomyolysis

Hyperthermia 

Autonomic instability

AMS

Dantrolene, bromocriptine, amantidine, IV fluids and cooling

Classes of antihypertensives contraindicated in:

1.  COPD

2. Bilat renal artery stenosis

3.  Pregnancy

4. Advanced Renal Failure

5. Gout

1.  nonselective beta blockers

2.  ACEI's ARB's

3.  ACEI's ARB's

4.  w/ hypercalemia, no ACEI's or ARB's or K+ sparring

5.  thiazides (chlorthalidone)

What heart sounds are considered benign when no evidence of disease?

split s2 w/ inspiration

quiet early systolic murmurs

S3

Split s1

Heart defects w/ following disorders

1. chromosome 22q11 deletions

2. downs

3.  Congenital rubella

4. turners

5. marfans

1.  truncus arteriosis, tetrology of fallot

2.  Endocardial cushion defects, VSD

3.  PDA, pulmonary artery stenosis

4.  coarctation

5.  Aortic root dilation/ regurg/ insufficiency

Wind (atalectasis, pneumonia)

Water (UTI)

Wonder Drugs (anesthesia)

"Wein" / Walking (DVT)

Wound (infection)

Sinusitis

Meds for TB meningitis

RIPE

Rifampin

Isoniazide

Pyrazinamide

Ethambutol

Diffuse ST elevations in leads corresponding to perfusion of multiple coronaries

Pain less when leaning forward

Pericardial friction rub

Pleuritic chest pain

Cough

Fever

JVD

Antidotes

1. Acetaminophen

2.  Lead

3. Cyanide

4. Methemoglobin

5.  opioid

1. N-acetylcysteine

2.  succimer, dimercarpol, EDTA

3.  sodium thiosulfade, hydroxycobalamin, amyl/sodium nitrate

4.  methylene blue, vit C

5.  Narcan

50 year old male with a 25 pack year history presents with second bout of pneumonia in less than 6 months - CXR shows lobar consolidation in same location as previous pneumonia

Next step?

CSF from nose or ears

Blood behind tympanic membrane

Battle's sign (bruising over mastoids)

Raccoon eyes

Tx for:

1. NPH

2. Pseudotumor cerebri

1.  Ventriculoperitoneal shunt

2.  Weight loss, acetazolamide, serial LP's, shunting

IV Ig

or

Plasmaphoresis

Supportive care

No Corticosteroids

1. Somoygi effect

VS 

2. Dawn Phenomenon

1.  When you dose too much NPH before bed time - stress hormones elevate glucose - 3am glucose will be LOW

2.  When you do not dose enough NPH before bed time - glucose slowly creeps up throughout the night - 3am glucose will be HIGH

First line antihypertensives in:

1. No comorbidities

2. DM

3. Heart failure

4. LVH

5.  BPH

6.  Hyperthyroid

7. Osteoporosis

8. Benign essential tremor

9.  Post-menopausal female

10.  Migraines

1.  Thiazides (chlorthalidone)

2. ACE's / ARB's

3. ACE's, ARB's, beta blockers, aldosterone antagonists

4. ACE / ARB

5. Alpha blocker

6. beta blocker

7. Thiazides

8.  beta blocker

9.  thiazide

10. beta blocker

H. flu

Actinobacillus

Cardiobacterium

Eikinella

Kingella

02 sat < 88% on room air

peripheral edema

pulmonary htn

polycythemia

Dx w/ angiogram

bowel resection

hemicolectomy

hemodynamic monitoring

broad spectrum antibiotics

NG tube decompression

Heparin or enoxaparin

PAPAVERINE to decrease vasospasm

When is rifampin prophylaxis indicated in cases of bacterial meningitis?

Close contacts of those w/ Neisseria

HIB

Transphenoidal resection of pituitary adenoma

Radiation therapy if nonresectable

Octreotide or cabergaline for medical management

infectious agents

1. Food poisoning from mayonnaise sitting out too long

2. rice water stools

3. diarrhea from pet feces

4. food poisoning from reheated rice

5. MCC traveler's diarrhea

6. diarrhea after course of ABX

7. Diarrhea and recent ingestion of water from a stream

8.  mild intestinal infection that can become neurocystercircosis

9.  Food poisoning from undercooked hamburger

10.  diarrhea from seafood

11. bloody diarrhea from poultry

12. diarrhea + pink eye

13. bloody diarrhea leading to liver abscess

14.  Diarrhea in an AIDS patient

15. dehydrated child w/ greenish diarrhea in winter months

1.  staph aureus

2.  vibrio or E. coli

3. yersinia enterocolitica

4. B. cereus

5. E coli

6. C. diff

7.  giardia or entamoeba histolytica

8.  tinea solium

9.  e coli

10.  vibrio 

11.  salmonella or campylobacter

12.  adenovirus

13. entamoeba histolytica

14.  cryptosporidium parvum or isospora

15. rotavirus

alchohol

gall stones

Elevated TAG's

Trauma

Drugs

Antihypertensive side effects

1. First dose orthostatic hypotension

2.  Hypertrichosis

3. dry mouth, sedation, severe rebound htn

4. bradycardia, impotence, asthma exacerbation

5. reflex tachycardia

6. cough

7.  Avoid in pts w/ sulfa allergy

8.  Angioedema

9.  Development of drug induced lupus

10. cyanide toxicity

1.  alpha blockers

2. minoxidil

3. clinidine

4. beta blockers

5. vasodilators

6. ACE's

7. thiazides

8. ACE's

9. hydralazine

10. sodium nitroprusside

No anticonvulsants!

cooling

2 mo - macrolide w/ or w/o cefotaxime

2 yr - amoxicilln or ampicillin

palpable purpura of the buttocks and lower legs, not due to thombocytopenia!

Arthralgias

renal disease - hematuria / proteinuria

intussuception

abdominal pain/vomiting

50% have guaiac positive stool

Ranson's Criteria for Prognosis in Pancreatitis

1.  Admission

2. w/in first 48 hrs after admission

1. greater than 55 yrs old

serum glucose >200

serum LDH >350 IU/L

serum AST > 250 IU/L

WBC's  > 16000/mL

2.  Hematocrit down by 10%

BUN increases > 5 mg/dL

serum Ca < 8mg/dL

Pa02 < 60mmHg

Base deficit >4meq/L

Fluid sequestration

Tx for:

1. Entamoeba histolytica

2.  Giardia lamblia

3. Salmonella

4. shigella

5.  campylobacter

1. metronidazole

2. metronidazole

3. hydration, fluoroquinolones, TMP-SMX, 

4.  Hydration, cipro, TMP - SMX

5. hydration, erythromycin

Types of lung CA w/ the following paraneoplastic syndromes

1.  Elevated ACTH ->glucocorticoid excess -> cushings syndrome

2. elevated PTHrP -> hypercalcemia

3. Elevated ADH -> SIADH -> hyponatremia

4.  Antibodies to presynaptic calcium channels -> Lambert Eaton syndrome

1. small cell

2.  squamous cell

3.  small cell 

4.  small cell 

Types of Vasculitis

1.  Weak pulse in upper extremities

2. Necrotizing granulomas of lung and necrotizing glomerulonephitis

3. Necrotizing immune complex inflammation of visceral and renal vessels

4. young male smokers

5. young asian women

6. young asthmatics

7. infant/ young children - involves coronaries

8. MC vasculitis

9. a/w hep B infection

10. Occlusion of ophthalmic artery -> blindness

11. perforation of nasal septum

12. unilateral headache and jaw claudication

1. takayasu's

2. Wegener's

3. PAN

4. burger's

5. takayasu's

6. Churg Strauss

7.  Kawasaki

8.  Temporal arteritis

9. PAN

10. temporal arteritis

11. Wegener's

12. Temporal arteritis

Lipid Lowering Agents:

1.  Facial flushing

2. Elevated LFT's and myositis

3. GI discomfort / bad taste

4.  Best effect on HDL

5. Best effect on TAG's / VLDL

6.  Best effect on LDL / cholesterol

7.  Binds C. diff toxin

1.  Niacin

2. statins / fibrates

3. bile acid sequestrants

4. Niacin

5. Fibrates

6. Statins

7. cholestyramine

Phenothiazines

Risperidone

haloperidol

methyldopa

verapamil 

dopamine-depleting drugs

A 4 month old presents w/ nonbilious vomiting despite changing formulas from milk-based to soy based.

Most likely etiology

Pt presents to clinic for followup and is found to have BP of 150/85.  You note in the chart that during his last visit one month ago his bp was 140/90

Next step?

Glomerular diseases:

1. MC nephotic syndrome in children

2. IF shows granular pattern of immune complex deposition and LM shows hypercellumar glomeruli

3. IF shows linear pattern of immune complex deposition

4. Kimmelsteil wilson lesions (nodular glomerular sclerosis)

5. MC nephrotic syndrome in adults

6. EM shows loss of epithelial foot processes

7.  Nephrotic syndrome a/w Hep B

8. Nephoritic syndrome a/w HIV

9.  Anti-GBM antibodies, hematuria, hemoptysis

10. EM shows subendothelial humps, tram track apprearance

11. Nephritis, deafness, cataracts

12. LM shows crescent formation in glomeruli

13. LM shows segmental sclerosis and hyalinosis

14. Purpura on back arms, legs, abdominal pain, IgA nephropathy

15. Positive ANCA

16.  Anti-ds DNA antibodies

1. minimal change disease

2. acute post-streptococcal 

3. Goodpastures

4. Diabetic glomerulosclerosis

5. Membranous 

6. minimal change disease

7. membranoproliferative

8.  focal segmental

9.  Goodpastures

10.  membranoproliferative

11. Alports

12. Crescentic (rapidly progressive)

13. Focal segmental

14. HSP

15. Crescentic

16.  Lupus

Most likely cause of secondary Htn:

1. hypertension in arms but low in legs

2. proteinuria

3. hypokalemia

4. tachycardia, diarrhea, heat intolerance

5. hyperkalemia

6.  episodic sweating, tachycardia

1.  Coarctation

2. renal failure

3. Conn's

4. hyperthyroid

5. renal failure / renal artery stenosis

6. Pheochromocytoma

Incarcerated inguinal hernia

Surgery

Calcium Gluconate

Glucose / Insulin

Beta agonists

Kaexalate

Furosemide

Sodium Bicarb

Phosphate binders

EPO (Hb goal = 11-12)

Vit D

ASA

Statins

BP/glucose control

ACEI's

Spironolactone

Eplerinone

Emiloride

Triamterine

Abdominal Signs

1. Deep palpation RUQ -> arrest of inspiration due to pain

2. Charcots triad (fever, jaundice, RUQ pain), hypertension, AMS

3. RLQ pain on passive extension of pain

4. RLQ pain on passive internal rotation of flexed hip

5. LUQ pain and referred shoulder pain

6. Ecchymosis of skin overlying flank

7.  Ecchymosis of skin overlying periumbilical area

1.  murphy's - acute cholecystitis

2. Reynold's pentad - cholangitis

3. Psoas sign - appendicitis

4. Obturator sign - appendicitis

5. Kerr's sign - splenic rupture

6. Gray -turner - acute pancreatitis

7.  Cullen's sign - pancreatitis

x ray finding indicative of:

1. Croup

2: Acute epiglottitis

1.  Steeple sign

2. Thumb sign 

humidified air

racemic epinephrine 

hydration

beta 2 agonist

(ribavirin)

CBC

Blood / Urine Cultures

CXR

UA

DVT assessment

Types of Leukemias:

1. MC neoplasm in children

2. MC leukemia in adults

3. Philadelphia chromosome almost always seen

4. Smudge cells on peripheral smear

5. Peripheral blasts PAS and tDd positive

6. peripheral blasts PAS -ve and myeloperoxidase positive and have Auer rods

7.  Pancytopenia in a Downs Syndrome Pt

1. ALL

2. CLL

3. CML

4. CLL

5. ALL

6. AML

7. ALL

Manual detorsion

Bilateral orchipexy

Thiazides

Addisons

Fluid loss, sweating, burns, vomiting, diarrhea

Fluid replacement w/ water

1. Primary biliary cirrhosis

VS

2. Primary sclerosing cholangitis

1. Associate w/ other autoimmune diseases, antimitochondrial antibodies, ANA females

2.  P-ANCA positive, males, a/w ulcerative colitis, ERCP - beads on a string - alternating dilations and strictures

Hepatitis:

1. HBsAg

2. Anti-HBs

3. HBcAg

4. Anti-HBc

5.  HBeAg

6. Anti-HBe

1. Detectable during entire symptomatic phase and suggests infectivity

2. Appears after successful HBV vaccination or clearance of HBsAg; detectable for life; indicator of non-infectivity and immunity

3.  Not detectable in serum - normally sequestered w/in HBsAg coat

4. Detectable long after pt recovers; IgM = acute phase and IgG = chronic phase; IgM anti-HbC = most specific marker for dx of acute HepB

5. Indicates active viral replication and infectivity; a/w presence of HBV DNA

6. Suggests cessation of active viral replication and low infectivity

Differentials for ground glass appearance on CXR

ARDS

Hypersensitivity pneumonitis

Interstitial pneumonia

pulmonary edema (ie CHF)

pulmonary hemorrhage

PCP pneumonia

Compartment syndrome

Cardiac dysrhythmias

Bony injuries

myoglobinuria ->renal failure 

Neuro disturbances

Fixed and dilated pupil

Eye looks down and out

Blood cell pathologies:

1. a/w EBV

2. Reed-Sturnberg cells, cervical lymphadenopathy, night sweats

3. Bence-Jones proteins, osteolytic lesions, high calcium (local osteolytic factors)

4. Translocation 14;18

5.  MC lymphoma in US

6. Translocation 8;14

7.  Translocation 9;22

8. MC form of Hodgekins

9. Starry sky pattern

10.  High hematocrit / hemoglobin, pruritis, burning pains in hands and feet

11.  Hairy projections of cells, splenomegaly

1.  Burkitt's

2. Hodgekins

3. Multiple myeloma

4. Follicular

5. diffuse large B cell

6. Burkitts

7. CML

8. Nodular Sclerosing

9.  Burkitt's

10. PCV

11. Hairy Cell Leukemia

MAOI's in the last two weeks

Bulemia

Seizure disorder

Benzo or Alcohol w/d

Stop agent

Benzo's

Paralysis

Supportive care

BPPV

Dx

Tx

Dx - Eply maneuver

Tx  Dix-Hallpike Maneuver

Antidotes:

1. Anticholinesterases

2. Mercury

3. CO

4. Heparin

5. IZD

1. Atropine, pralidoxime

2. Dimercaprol, succimer

3.  100% 02 or hyperbaric 02

4.  Protamine sulfate

5. B6 (pyridoxine)

Types of Heart Murmurs

1. Diastolic murmur heard best in left sternum - increases w/ inspiration

2. Late diastolic murmur w/ opening snap

3. systolic murmur heard best in right second interspace

4.  Systolic murmur heard best in left second interspace

5. late systolic murmur heard best at apex

6. diastolic murmur w/ widened pulse pressure

7. Holosystolic murmur louder w/ inspiration at left lower sturnum

8. Holosystolic murmur heard best at apex and radiates to axilla

1. tricuspid stenosis

2. mitral stenosis

3. aortic stenosis

4. pulmonic stenosis

5. mitral prolapse

6.  Aortic Regurg

7. Tricuspid regurg

8. Mitral regurg

1. schizotypal

2. schizophrenia

3. schizoaffective

4. schizoid

5. schozophreniform

6. Brief psychotic disorder

1. wacky dress, odd thoughts

2. sx > 6 mo

3. sx w/ mood disorder

4. voluntary social isolation

5. sx < 6 mo

6. psychosis w/ duration < 1 month

Marfans 

Homocysteinuria

Alports

Tx:

1. Macular Degeneration

2. Retinal Detachment

1. Intravitrious ranavizumab, Vit E and C

2. Laser photocoagulation

Next Step:

1. Pelvic fracture + DPL shows blood in pelvis

2.  Pelvic fracture + DPL shows urine in pelvis

3. Pelvic fracture + DPL shows nothing + hemodynamic stability

4. Blunt abdominal trauma + unstable vitals + FAST shows fluid in pelvis

5. Blunt abdominal trauma +unstable vitals + FAST shows no fluid in pelvis

6. Blunt abdominal trauma +unstable vitals + FAST inconclusive

7.  Blunt abdominal trauma + stable vitals

8. Abdominal stab wound +hypotensive  or signs of peritonitis

1. emergent laparotomy

2. urgent laparotomy

3. Angiography w/ possible embolectomy (retroperitoneal hemorrhage)

4. Urgent Laparotomy

5. Angiography w/ possible embolectomy (retroperitoneal hemorrhage)

6. DPL

7. CT of abdomen and pelvis

8. Emergent Laparotomy

Major :Joints (polyarthritis, hot/swollen joints)

Heart (carditis, valve damage)

Nodules (subcutaneous extensor surfaces)

Erythema nodosum (painless rash)

Sydenham's choria

Minor: Previous RF

EKG w/ PR prolongation

Arthralgias

CRP and ESR elevated

Elevated Temp

Botox injections

Bracing

Dantrolene

Benzo's

Baclofen

PT

Common primary brain tumors in :

1. Adults

2. Children

1. Metastases, GBM, Meningioma, Schwannoma

2. Medulloblastoma, astrocytoma, ependymoma

Vasopressors:

1. theoretically causes renal vasodilation

2. high doses optimize alpha one vasoconstriction

3. ADH analog

4. Anaphylactic shock

5. septic shock

6. Cardiogenic shock

7. Vasocontriction/bradycardia

1. dopamine

2. epinephrine

3. vasopressin

4. epinephrine

5. norepinephrine

6. dobutamine

7. phenylephrine

Zone 1: CT angio 

Zone 2: surgical exploration

Zone 3: CT angio and triple endoscopy

EKG in WPW

Delta Wave

Reentry / accessory bundle of Kent

Give amiodarone or procainamide / ablation

Do NOT give Adenosine

Folic Acid (4mg)

Vitamin K during last month of pregnancy 

Culposcopy

Endometrial Currettage

>35 - endometrial biopsy

Compare iron levels, ferritin and transferrin in :

1. Iron deficiency anemia

2. Chronic disease

1. Iron low, ferritin low, transferrin increased

2. Iron low, ferritin high, transferrin decreased