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Heerfordt’s Syndrome

Parotitis, Uveitis, and Fever in a patient with Sarcoidosis. ~5% of patients with sarcoidosis. Tx with steroids/immunosuppressants

#usmle step 2 #step 2 ck #internal medicine #shelf #high yield #medical school #sarcoidosis

Lower Mortality in CHF?

ACE inhibitors, ARBs B-Blockers Aldosterone Antagonists (Spironolactone) Hydralazine + Nitrates

#high yield #usmle step 2 #pharmacology #usmle step 2 ck #internal medicine shelf #internal medicine #cardiology

NYHA Classification

Based on physical activity tolerance, with Class I being symptoms only occurring with vigorous activity and Class IV being symptoms at rest.

Mild - Class I-II, Treat with ACE inhibitor first, can add loop diuretic if fluid overloaded

Moderate - Class II-III, Treat with ACE Inhibitor and loop diuretic, add BB if treatment if suboptimal. Avoid BB in Class IV HF!

Moderate to Severe - Class III-IV, Treat with ACE inhibitor, loop diuretic, BB. Add digoxin for relief of symptoms (for systolic dysfunction, does not improve mortality). Can add spironolactone for patients with Class IV symptoms.

#Usmle step 2 #usmle step 2 ck #internal medicine shelf #high yield #internal medicine #cardiology #heart failure #guidelines #clinical knowledge

Decompensated vs Compensated Liver Disease?

Compensation simply means: Can the liver still maintain its function? Remember, that part of its function is filtering, metabolizing, and creating proteins. Decompensated liver disease (cirrhosis) generally will have

hepatic encephalopathy, (due to decreased removal of toxins like ammonia)

ascites, (portal hypertension leading to fluid accumulation)

jaundice,

coagulopathy (unable to make clotting factors)

bleeding varices (portal hypertension)

#internal medicine #usmle step 1 #usmle step 2 #usmle step 2 ck #high yield #cirrhosis #liver #hepatobiliary #ascites #liver disease #shelf

Hypertensive emergency

Goal BP - Lower DBP by 10-15% over 30-60 mins or DBP ~110.

#hypertensive emergency #step 2 ck #usmle step 2 #high yield #clinical knowledge

Acute pericarditis

treatment - ASA, do not give NSAIDs as it may hinder scar formation

Inferior Wall MI

Think about RV Infarctions! Do not treat with Nitro as it decreases preload. Heart becomes preload dependent. Treat with IVF.

EKG Changes : II, III, aVF, possibly in septal leads V1/2

Clinical Features: Hypotension, bradycardia, elevated JVD, hepatomegaly, clear lungs, possibly abdominal discomfort

#usmle step 2 #step 2 ck #high yield #internal medicine #cardiology #mi #myocardial infarction #shelf

complications of acute MI

1. pump failure - most common cause of in-hospital mortality 2. arrhythmias - V.Fib, VTach, Afib, Asytole, AV Block 3. recurrent infarction - re-elevation of CK-MB after 36-48 hrs, trop remains elevated for week or more 4. mechanical complications - free wall/IV septum/papillary muscle rupture, ventricular aneurysm 5. acute pericarditis - PR depression in all leads 6. Dressler’s syndrome - post-MI autoimmune syndrome consisting of fever, malaise, pericarditis, leukocytosis; weeks to months post MI; TX ASA, Ibuprofen

#usmle step 2 #step 2 ck #usmle step 2 ck #high yield #cardiology #mi #myocardial infarction #clinical knowledge #internal medicine #shelf #internal medicine shelf

medicowesome

Hey! Warning: This is an over simplified post. If you are the kind who has a tough time remembering changes in “which lead” correlates with the “where” the heart is injured, this post is for you xD Elevation of ST segment indicates zone of injury, diagnosis is supported by reciprocal changes, ST segment depression in the leads facing the opposite wall. For precordial leads, I use the “SAL” mnemonic. V1 Septal V2 Septal V3 Anterior V4 Anterior V5 Lateral V6 Lateral To be more complete about the lateral wall involvement, I use the “SALLI” mnemonic. L for aVL and I for lead I. So for lateral wall MI: V5 , V6, aVL and lead I. For inferior MI, I remember the word “INF” and the horizontal lines in them. So for inferior wall MI: II , III and aVF. By the end of this post, you should be able to draw this cheat sheet yourself: That’s all! Quote for the day: If you can not see yourself as a winner, you can not perform as a winner. -IkaN Related posts: Evaluating axis from ECG mnemonic Criteria for LVH in ECG The illusion of ST segment elevation in transmural myocardial infarction

medicowesome

Antithyroid drugs mnemonic

1. Durgs that inhibit hormone synthesis (Antithyroid drugs): Propylthiouracil, methimazole, carbimazole.

Mnemonic: Professor Met Carby

2. Drugs that inhibit thyroid trapping (Ionic inhibitors): Nitrates (NO3), thiocyanates (SCN), perchlorate (ClO4) .

Mnemonic: NTP

3. Inhibit hormone release: Iodine, iodides of Na & K, organic iodides.

Mnemonic: I prevents release (Iodine, it’s salts and organic form.)

4. Destroy thyroid tissue: Radioactive Iodine (I 131, I 123, I 125)

Mnemonic: Iodine normal is 128 (+3 &-3 are radioactive so is I 123)

That’s all!

The mnemonics were submitted by Sareer. Thank you, Sareer, you’re awesome.

-IkaN

Complication of AAA repair

IMA is often sacrificed, leading to colonic ischemia, most likely at sigmoid

tx of colonic ischemia - sigmoidectomy with mucous fistula and end colostomy

#surgery #step 2 #pimp questions

Compartment syndrome

Tissue swelling from reperfusion leads to increase in compartmental pressures; this leads to decreased blood flow to region, ischemia, and myonecrosis (at 30mmHg).

PULSE usually present as systolic BP is greater than 30. “5 P’s” - pain out of proportion, paralysis, pain on passive flexion/extension, pallor and paresthesias.

Other reperfusion injuries include hyperkalemia, myoglobinuria (renal failure) and MI.

tx - fasciotomy of all four compartments of calf

#internal medicine #surgery #step 2

MCC embolus from heart

A fib

Acute arterial occlusion

(you probably know but heres a refresher)

“six P’s” - pain, paralysis, pallor, paresthesia, poikilothermia, pulselessness

#step 2 #surgery #internal medicine

Claudication

Conservative management -

PACE - pentoxifylline, ASA, cessation of smoking, exercise