Stephanie liveblogs studying

Where an osteopathic medical student posts factoids, notes, and (rarely) mnemonics as she desperately attempts to pass.

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Insulin Types Lispro: onset 5-10min Aspart: lasts 3-5h; onset 10-20min Regular: lasts 5-8h; onset 30-60min NPH: lasts 18-24h; peaks at 6-10h Glargine: lasts 24-28h; onset 1-4h

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Focal Nodular Hyperplasia of the Liver (FNH) usu asyx and found incidentally; women>men; gross: poorly encapsulated nodule w/ central depressed stellate scar containing blood vessels; CT: hypervascular mass w/ AV connections; tx: observe unless it grows large enough to cause pain usu in RUQ then remove sx

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Gentamicin

IM or IV MOA: aminoglycoside; binds bacterial 30S ribosomal subunit to inhibit protein synth; bacteriocidal Coverage: Gram (-), P. aeruginosa, Proteus, E.coli, Klebsiella, Enterobacter, Serratia, Citrobacter, Staph SE: neurotoxicity, ototoxicity, nephrotoxicity, neuromuscular blockade, Fanconi syndrome Monitor BUN/Cr; monitor audiometry in high risk pts

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Cruetzfeld-Jakob Disease AKA Transmissible Spongiform Encephalopathy AKA the Stuff of Nightmares (Seriously prions terrify me)

Neurodegenerative DZ caused by prions (misfolded proteins AKA the most likely cause of the zombie apocalypse); transmissible btw animals; most cases are sporadic and not inherited; syx: rapid and progressive mental deterioration and myoclonus; death w/in 1 year; behavioral changes and extrapyramidal signs in 1/3 of pts Histo: convalescent clear vesicles giving the brain a spongiform appearance; neuronal loss and proliferation of glial cells

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Acute Cholangitis --> fever, RUQ pain, and jaundice (Charcot's triad); with hypotension and AMS (Reynold's pentad) it is ascending chonlangitis; infection and inflammation of the gallbladder and common bile duct usu due to obstruction with a gallstone; dx with ERCP

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Chronic Granulomatous Disease

             - hereditary -- mx types, many x-linked              - Phagocytes are on the struggle-bus to form ROS to battle pathogens, leading to recurrent infections and formation of granulomata              - Syx: recurrent catalase + pathogen infections such as pneumonia, abcessess, suppurative arthritis, osteomyelitis, bacteremia/fungemia, and cellulitis              - Dx: nitroblue-tetrazolium (NBT) test negative (doesn't turn blue) indicates little-no ROS formation in cells; Dihydrorhodamne (DHR) test preferred for screening/diagnosis; confirm (if screening unclear) with phagocyte oxidative metabolism assay              - Catalase + pathogens: Candida, S.aureus, P.aeruginosa, Listeria, Aspergillus, Serratia, E.coli

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Chvostek Sign -- when the facial nerve is tapped at the angle of the jaw, the ipsilateral facial mm will momentarily contract; signifies existing nerve hyperexcitability (tetany) seen in hypocalcemia

Trousseau Sign -- a BP cuff is placed around the armm, inflated to a pressure greater than systolic BP and held in place for 3 minutes, occluding the brachial artery. positive if spasm of the mm of the hand and forearm (flexion of wrist and metacarpophalageal joints, extension of DIP and PIP joints, adduction of fingers); signifies hypocalcemia; more sensitive than Chvostek sign

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Legionella pneumophila (Legionnaires Disease)

Gram negative bacillus Syx: mild, flu-like syndrome with fever, respiratory syx, diarrhea, hyponatremia; can progress to severe pneumonia; usu affects immunocompromised incl elderly, alcoholics, smokers Tx:fluoroquinolones (eg levofloxacin) for adults with severe disease; azithromycin for children Screening: urine sample to detect Ag; sputum culture on Buffered Charcoal Yeast Extract agar Other: spread via aerosolized contaminated water sources (mist machines, air conditioning units)

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USPSTF Lung CA Screening Guildlines -- Grade B evidence Annual screening for lung CA with low-dose CT in adults 55-80yo w/ 30 pack-year smoking history and currently smoke or have quit w/in the last 15 years. D/C screening once a person has not smoked for >15years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

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Spondylolysis --> stress fracture of the pars interarticularis of a vertebra; MCC of low back pain in adolescent atheletes seen on XR, esp throwing athletes, dancers, and gymnasts; usually 5th or 4th lumbar vertebra; syx can include pain with spinal extension and single leg hop; seen on oblique lumbar XR as the "collar" on the "scottie dog"

Spondylolisthesis --> frx of vertebra as above so great that the body of the vertebra shifts anteriorly; graded based on amount of slippage; can lead to spinal nerve compression thus necessitating surgery; diagnosis and grading done via oblique lumbar XR Grading: Grade I — 1 percent to 25 percent slip Grade II — 26 percent to 50 percent slip Grade III — 51 percent to 75 percent slip Grade IV — 76 percent to 100 percent slip

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Impetigo Skin infection caused most commonly by S. aureus. Blisters or pustules appear and eventually rupture, leaving behind scaley, honey-colored looking plaques usu on face or extremities. Mainly affects small children or immunocompromised. Tx: Mupirocin ointment for uncomplicated cases, oral cephalexin for complicated ones. Clindamycin, bactrim, or vanc for MRSA. Erythromycin or clindamycin for penicillin hypersensitive patients.

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Glasgow Coma Scale -- score from 3 to 15 indicates level of consciousness based on grading of eye response, verbal response, and motor response.

Eye Response 4 -- open spontaneously 3 -- open to verbal command 2 -- open to pain 1 -- no response

Verbal Response 5 -- oriented, converses 4 -- disoriented, converses 3 -- inappropriate responses 2 -- incomprehensible sounds 1 -- no response

Motor Response 6 -- obeys verbal command 5 -- localizes to pain 4 -- withdrawal from pain 3 -- decorticate (flexes) to pain 2 -- decerebrate (extends) to pain 1 -- no response to pain

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Lisinopril

MOA: inhibits angiotensin converting enzyme (ACE-inhibitor) interfering with conversion of antiotensin I to angiotensin II Uses: HTN, CHF Side effects: allergic reaction, kidney failure, angioedema, hyperkalemia, Stevens-Johnson syndrome, cough Other: contraindicated in pregnancy; caution if renal artery stenosis present; nephroprotective anti-HTN drug considered first-line (with other RAS inhibitors) in pts with CKD

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Lachman's Test

1) Pt supine 2) Examiner places one hand on distal femur, other on proximal tibia 3) Place knee in 15 degrees of flexion and external rotation 4) Gently provide anterior translation of the tibia. 5) Positive -- loose end feel, significant anterior translation indicates disruption of ACL; negative -- hard end feel, little to no anterior translation

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Thompson Test

Diagnostic for complete tear of the Achilles tendon Squeeze calf muscle. If negative -- ankle will plantar flex. If positive -- ankle does not plantar flex, achilles tendon tear present.

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Hey med study buddies!

One of my attendings during my pediatrics rotation suggested taking time each day to memorize the mechanism of action (MOA), major/characteristic side effects, and common uses of one common (or commonly tested) drug. I've rather failed to do that overall, but I'm hoping with this blog I can make it into a habit. I encourage you to do the same. There are a hell of a lot of drugs out there and the best way to learn is in small chunks, so let's get going!

Anyway, I'll be posting them under the tag "drug of the day" from now on. 

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Bleomycin

MOA: inhibits DNA synthesis Uses: various cancers and malignancies including squamous cell carcinoma, Hodgkin and non-Hodgkin lymphomas, testicular CA, and malignant pleural effusion Selected Side Effects: pneumonitis, pulmonary fibrosis, MI, CVA, mental confusion, hypotension, rash, scleroderma-like skin changes