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153 Cards in this Set
- Front
- Back
Cushing triad
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hypertension, bradycardia, respiratory depression (increased intracranial pressure)
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Congenital heart disease, Right-to-left shunts
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The 5 T’s: Tetralogy, Transposition, Truncus, Tricuspid, TAPVR
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Congenital cardiac defect associations: 22q11 syndromes
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Truncus arteriosus, tetralogy of Fallot
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Congenital cardiac defect associations: Down syndrome
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ASD, VSD, AV septal defect (endocardial cushion defect)
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Congenital cardiac defect associations: Congenital rubella
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Septal defects, PDA, pulmonary artery stenosis
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Congenital cardiac defect associations: Turner’s syndrome
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Coarctation of aorta
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Congenital cardiac defect associations: Marfan’s syndrome
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Aortic insufficiency (late complication)
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Congenital cardiac defect associations: Infant of diabetic mother
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Transposition of great vessels
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Churg-Strauss syndrome
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Granulomatous vasculitis with eosinophilia. Most often presents with asthma. sinusitis, skin lesions, and peripheral neuropathy (e.g., wrist/foot drop); can also involve heart, GI, and kidneys. p-ANCA.
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Sturge-Weber disease
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Congenital vascular disorder that affects capillary-sized blood vessels. Manifests with port-wine stain on face and ipsilateral leptomeningeal angiomatosis (intracerebral AVM). seizures, and early-onset glaucoma.
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Henoch-Schönlein purpura
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Most common form of childhood systemic vasculitis. Skin rash on buttocks and legs (palpable purpura). arthralgia, intestinal hemorrhage, abdominal pain, and melena. Follows URIs. IgA immune complexes. Association with IgA nephropathy. Common triad: 1. skin, 2. joints, 3. GI
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Vascular disease, affects small vessels
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Raynaud's disease, Wegener's granulomatosis, Microscopic polyangiitis, 1° pauci-immune crescentic glomerulonephritis, Churg-Strauss syndrome, Sturge-Weber disease, Henoch-Schönlein purpura,
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Vascular disease, affects small and medium vessels
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Buerger's disease, Kawasaki disease, Polyarteritis nodosa
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Vascular disease, affects medium and large vessels
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Takayasu's arteritis, Temporal arteritis (giant cell arteritis),
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Takayasu’s arteritis
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pulseless disease––granulomatous thickening of aortic arch and/or proximal great arteries. Associated with an ↑ ESR. Primarily affects Asian females < 40 years old. Fever, Arthritis, Night sweats, MYalgia, SKIN nodules, Ocular disturbances, Weak pulses in upper extremities. FAN MY SKIN On Wednesday.
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Most common vasculitis that affects medium and large arteries
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Temporal arteritis (giant cell arteritis)
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Embolus types
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FAT BAT: Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor.
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Hydralazine
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↑ cGMP→smooth muscle relaxation. Vasodilates arterioles > veins; afterload reduction. Severe hypertension, CHF, First-line therapy for hypertension in pregnancy, with methyldopa. Frequently co-administered with a β-blocker to prevent reflex tachycardia.
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Minoxidil
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K+ channel opener —hyperpolarizes and relaxes vascular smooth muscle. Severe hypertension. Toxicily: Hypertrichosis, pericardial effusion, reflex tachycardia, angina, salt retention
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Calcium channel blockers efficacy
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Vascular smooth muscle—nifedipine > diltiazem > verapamil; Heart —verapamil > diltiazem > nifedipine
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Antiarrhythmics IA
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Quinidine, Procainamide, Disopyramide
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Antiarrhythmics IB
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Lidocaine, Mexiletine, Tocainide
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Antiarrhythmics IC
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Flecainide, encainide, propafenone
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Antiarrhythmics III
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Sotalol, ibutilide, bretylium, amiodarone
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Pituitary gland hormones
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Acidophils––GH, prolactin. B-Flat: Basophils––FSH, LH, ACTH, TSH
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Don't need insulin for glucose uptake
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BRICK L: Brain, RBCs, Intestine, Cornea, Kidney, Liver
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Cortisol function
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BBIIG: 1. Maintains Blood pressure (by upregulating α1 receptors on arterioles); 2. ↓Bone formation; 3. Anti-Inflammatory; 4. ↓immune function; 5. ↑Gluconeogenesis, lipolysis, proteolysis.
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Signaling pathways of endocrine hormones: cAMP
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FLAT CHAMP: FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2 receptor), MSH, PTH, Calcitonin, Glucagon
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Signaling pathways of endocrine hormones: cGMP
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ANP, NO (EDRF)
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Signaling pathways of endocrine hormones: IP3
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GGOAT: GnRH, GHRH, Oxytocin, ADH (V1 receptor), TRH
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Signaling pathways of endocrine hormones: Steroid receptor
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Glucocorticoid, Estrogen, Progesterone, Testosterone, Aldosterone, Vitman D, T3/T4
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Signaling pathways of endocrine hormones: Tyrosine kinase
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Insulin, IGF-1, FGF, PDGF, Prolactin, GH
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T3 functions
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4 B’s: Brain maturation, Bone growth, Beta-adrenergic effects, BMR ↑
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Pheochromocytoma symptoms
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5 P’s: Pressure (elevated blood pressure), Pain (headache), Perspiration, Palpitations (tachycardia), Pallor
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Hypercalcemia
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CHIMPANZEES: Calcium ingestion (milk-alkali syndrome), Hyperparathyroid, Hyperthyroid, Iatrogenic (thiazides), Multiple myeloma, Paget’s disease, Addison’s disease, Neoplasms, Zollinger-Ellison syndrome, Excess vitamin D, Excess vitamin A, Sarcoidosis.
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SIADH
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Sx: 1. Excessive water retention. 2. Hyponatremia. 3, Urine osmolarity > seruin osmolarity. Causes include: 1. Ectopic ADH (small cell lung cancer). 2. CNS disorders/head trauma. 3. Pulmonary disease. 4. Drugs (e.g., cyclophosphamide).
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Carcinoid syndrome
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Rule of 1/3s: 1/3 metastasize; 1/3 present with 2nd malignancy; 1/3 multiple
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pramlintide
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mimetics for DM type 2, ↓glucagon
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exenatide
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GLP-1 mimetics. ↑insulin, ↓glucagon release. Type 2 DM
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orlistat
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inhibits pancreatic lipases. Long-term obesity management. SE: Steatorrhea. Gl discomfort, reduced absorption of fat-soluble vitamins, headache.
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sibutramine
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Sympathomimetic serotonin and norepinephrine reuptake inhibitor. Short-term and long-term obesity management. SE: Hypertension and tachycardia
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Demeclocycline
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ADH antagonist (member of the tetracycline family). For SIADH.
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Submucosal nerve plexus
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Meissner’s plexus, Regulates local Secretions, blood flow, and absorption.
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Myenteric nerve plexus
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Auerbach’s plexus, Coordinates Motility along entire gut wall. Located between inner (circular) and outer (longitudinal) layers of smooth muscle in GI tract wall.
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Femoral region
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NAVEL: Lateral to medial: Nerve-Artery-Vein-Empty space-Lmphatics.
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Hesselbach’s triangle
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Inferior epigastric artery, Lateral border of rectus abdominis, Inguinal ligament
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Peyer’s patches
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Unencapsulated lymphoid tissue found in lamina propria and submucosa of small intestine. IgA
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most serous and most mucinous Salivary glands
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Serous on the Sides (parotids); Mucinous in the Middle (sublingual).
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the only GI submucosal glands
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Brunner’s glands, Located in duodenal submucosa
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what activates trypsinogen
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enterokinase/enteropeptidase, an enzyme secreted from duodenal mucosa. Trypsin activates other proenzymes and more trypsinogen (positive feedback loop).
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2° achalasia
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Chagas’ disease; Scleroderma (CREST syndrome) is associated with esophageal dysmotility involving low pressure proximal to LES.
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Boerhaave syndrome
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Transmural esophageal rupture due to violent retching
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Esophageal cancer
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ABCDEF. Alcohol/Achalasia, Barrett’s esophagus, Cigarettes, Diverticuli (e.g., Zenker’s diverticulum), Esophageal web (e.g., Plummer-Vinson)/Esophagitis, Familial
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Ménétrier’s disease
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Gastric hypertrophy with protein loss, parietal cell atrophy, and ↑ mucous cells. Precancerous. Rugae of stomach are so hypertrophied that they look like brain gyri.
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Most common congenital anomaly of the GI tract.
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Meckel's diverticulum. five 2’s: 2 inches long, 2 feet from the ileocecal valve, 2% of population, Commonly presents in first 2 years of life, May have 2 types of epithelia (gastric/pancreatic).
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Hirschsprung’s disease
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Congenital megacolon characterized by lack of ganglion cells/enteric nervous plexuses (Auerbach’s and Meissner’s plexuses) in segment on intestinal biopsy. Due to failure of neural crest cell migration.
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Familial adenomatous polyposis (FAP)
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[AD] mutation of APC gene on chromosome 5q. Thousands of polyps; pancolonic; always involving the rectum. 100% progress to CRC.
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Gardner’s syndrome
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FAP+osseous and soft tissue tumors, retinal hyperplasia.
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Turcot’s syndrome
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FAP+malignant CNS tumor.
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Hereditary nonpolyposis colorectal caneer (HNPCC/Lynch syndrome)
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[AD] Mutations of DNA mismatch repair genes. ~80% progress to CRC. Proximal colon always involved.
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risk factor of CRC
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IBD, Streptococcus bovis bacteremia, tobacco use, large villous adenomas, juvenile polyposis syndrome, Peutz-Jeghers syndrome.
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Reye’s syndrome
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Rare, often fatal childhood hepatoencephalopathy. Findings: mitochondrial abnormalities, fatty liver (microvesicular fatty change), hypoglycemia, coma. Associated with viral infection (especially VZV and influenza B) that has been treated with salicylates. Aspirin is not recommended for children (use acetaminophen, with caution).
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Wilson’s disease
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[AR] ABCD. Asterixis, Basal ganglia degeneration (parkinsonian symptoms), Ceruloplasmin ↓, Cirrhosis, Corneal deposits (Kayser-Fleischer rings), Dementia. Hemolytic anemia. Treat with penicillamine.
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Hemochromatosis (classic triad)
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micronodular Cirrhosis, Diabetes mellitus, skin pigmentation → “bronze” diabetes. HLA-A3.
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Acute pancreatitis (risk factors)
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GET SMASHeD. Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/Hyperlipidemia, Drugs (e.g., sulfa drugs).
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WBC differential from highest to lowest:
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Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils. (Neutrophils Like Making Everything Better).
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Causes of eosinophilia
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NAACP: Neoplastic, Asthma, Allergic processes, Collagen vascular diseases, Parasites
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Target cell
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HALT: HbC disease, Asplenia, Liver disease, Thalassemia.
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Basophilic stippling
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TAIL: Thalassemias, Anemia of chronic disease, Iron deficiency, Lead poisoning.
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Schistocyte, helmet cell
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DIC, TTP/HUS, traumatic hemolysis.
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Sideroblastic anemia
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Defect in heme synthesis. [XR] X-linked defect in δ-aminolevulinic acid synthase gene. Treatment: pyridoxine (B6) therapy. ↑ iron, normal TIBC, ↑ ferritin.
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Acute intermittent porphyria
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5 P's: Painful abdomen, Pink urine,Polyneuropathy, Psychological disturbances, Precipitated by drugs.
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Lead poisoning
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LEAD: Lead Lines on gingivae (Burton's lines) and on epiphyses of long bones on x-ray. Encephalopathy and Erythrocyte basophilic stippling. Abdominal colic and sideroblastic Anemia. Drops—wrist and foot drop. Dimercaprol and EDTA 1st line of treatment. Succimer for kids.
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DIC
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STOP Making New Thrombi: Sepsis (gram-negative). Trauma, Obstetric complications, acute Pancreatitis, Malignancy, Nephrotic syndrome. Transfusion.
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Factor V Leiden
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Production of mutant factor V that cannot be degraded by protein C. Most common cause of inherited hypercoagulability.
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Multiple myeloma
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CRAB: hyperCalcemia, Renal insufficiency, Anemia, Bone/Back pain
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imatinib
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anti-bcr-abl antibody, bcr-abl tyrosine kinase inhibitor. treat CML. Toxicity: fluid retention.
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t(15;17)
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M3 type of AML, (responsive to all-trans retinoic acid)
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t(11;22)
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Ewing's sarcoma
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t(11;14)
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Mantle cell lymphoma
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rescue drug. Methotrexate (MTX)
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leucovorin
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rescue drug. 5-fluorouracil (5-FU)
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thymidine
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6-mercaptopurine (6-MP) ↑ toxicity with
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allopurinol (metabolized by xanthine oxidase)
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Trastuzumab (Herceptin)
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Monoclonal antibody against HER-2 (erb-B2). Treat Metastatic breast cancer.
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Unhappy triad/knee injury
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medial collateral ligament (MCL) , anterior cruciate ligament(ACL), and lateral (not medial) meniscus.
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Epithelial cell junctions
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Zona occludens (tight junction), Zona adherens (intermediate junction), Macula adherens (desmosoma), Gap junction, Hemidesmosome
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Rotator cuff muscles
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SItS: Supraspinatus—helps deltoid abduct arm. Infraspinatus—laterally rotates arm. Teres minor—adducts and laterally rotates arm. Subscapularis—medially rotates and adducts arm.
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Sicca syndrome
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dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis. No arthritis.
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SLE features
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I'M DAMN SHARP: Immunoglobulins (anti-dsDNA, anti-Sm, antiphospholipid), Malar rash, Discoid rash, Antinuclear antibody, Mucositis (oropharyngeal ulcers), Neurologic disorders, Serositis (pleuritis, pericarditis), Hematologic disorders, Arthritis, Renal disorders, Photosensitivity.
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Positive antinuclear antibodies
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SLE, Sjogren's (and sicca), scleroderma, polymyositis, dermatomyositis, rheumatoid arthritis, juvenile arthritis, mixed connective tissue disease.
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Sarcoidosis
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GRAIN: Gammaglobulinemia, Rheumatoid arthritis, ACE increase, Interstitial fibrosis, Noncaseating granulomas.
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Mixed connective tissue disease
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Raynand's FAME. Raynaud's phenomenon. Fatigue, Arthralgias, Myalgias, and Esophageal hypomotility. Antibodies lo UI RNP.
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CREST syndrome
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Calcinosis, Raynaud's phenomenon. Esophageal dysmotilily, Sclerodactyly, and Telangiectasia. Associated with antiCentromere antibody (C for CREST).
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Auspitz sign
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bleeding spots when scales are scraped off. Psoriasis
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IgG antibody against desmosomes
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Pemphigus vulgaris
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IgG antibody against hemidesmosomes
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Bullous pemphigoid
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Nikolsky's sign
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separation of epidermis upon manual stroking of skin. Pemphigus vulgaris.
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dermatitis herpetiformis
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Pruritic papules and vesicles. Deposits of IgA at the tips of dermal papillae. Associated with celiac disease.
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Lichen planus
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Pruritic, Purple, Polygonal Papules, Sawtooth infiltrate of lymphocytes at dermal-epidermal junction. Associated with hepatitis C.
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Acanthosis nigricans
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Hyperplasia of stratum spinosum. Associated with hyperinsulinemia (e.g., from Cushing's disease, diabetes) and visceral malignancy.
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PGI2
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Platelet-Gathering Inhibitor. (prostacyclin) inhibils platelet aggregation and promotes vasodilation.
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Astrocyte marker
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GFAP
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Hypothalamus function
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TAN HATS: Thirsl and waler balance, Adenohypophysis control, Neurohypophysis releases hormones from hypothalamus. Hunger, Autonomic regulation. Temperature regulation. Sexual urges.
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Where dose ADH been made
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supraoptic nucleus
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Where dose oxytocin been made
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Paraventricular nucleus
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Limbic system
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The famous 5 F's: Feeding, Fleeing, Fighting, Feeling, and sex.
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Hemiballismus
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Sudden, wild flailing of 1 arm +/- leg. contralateral subthalamic nucleus lesion (e.g.. lacunar stroke in a patient with a history of hypertension).
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Paramedian pontine reticular formation (PPRF)
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Eyes look away from side of lesion
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Frontal eye fields
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Eyes look toward lesion
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Central pontine myelinolysis
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Acute paralysis, dysarthria, dysphagia, diplopia, and loss of conscionsuess. Commonly caused by very rapid correction of hyponatremia.
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Broca's aphasia
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Broca's Broken Boca. Nonfluent aphasia with intact comprehension. Broca's area —inferior frontal gyrus.
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Wernicke's aphasia
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Wernicke's is Wordy but makes no sense. Fluent aphasia with impaired comprehension. Wernicke's area —superior temporal gyrus.
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Condunction aphasia
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Poor repetition but fluent speech, intact comprehension. Arcuate fasciculus —connects Broca's, Wernicke's areas.
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Berry aneurysms
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Associated with adult polycystic kidney disease. Ehlers-Danlos syndrome, and Marfan's syndrome.
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Hydrocephalus triad
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dementia, ataxia, and urinary incontinence
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Parinaud syndrome
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paralysis of conjugale vertical gaze due to lesion in superior colliculi (e.g., pinealoma).
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Bell's palsy
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AIDS, Lyme disease, Herpes zoster, Sarcoidosis, Tumors, Diabetes
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KLM sounds
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Kuh-kuh-kuh tests palate elevation (CN X—vagus); La-la-la tests tongue (CN Xll —hypoglossal); Mi-mi-mi tests lips (CN Vll-facial)
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CN III damage
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eye looks down and out; ptosis, pupillary dilation, loss of accommodation.
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CN IV damage
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diplopia with a defective downward gaze (adjust by tilling head toward lesion). innervates the Superior Oblique.
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CN VI damage
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medially directed eye. innevates the Lateral Rectus.
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Marcus Gunn pupil
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afferent pupillary defect (e.g., due to optic nerve damage or retinal detachment). ↓bilayteral pupillary constriction when light is shone in affected eye.
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ARMD
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Age-related macular degeneration. Degeneration of macula, causes loss of central vision (scotomas). "Dry"/atrophic- ARMD is slow, due to fat deposits and causes gradual ↓ in vision. "Wet" ARMD is rapid, due to neovascularization.
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Uncal herniation
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Ipsilaleral dilated pupil/ptosis (Stretching of CN III); Contralateral homonymous hemianopia (Compression of ipsilateral posterior cerebral artery); Ipsilateral paresis. Duret hemorrhages.
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Differential diagnosis of brain lesions: Ring-enhancing lesion
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Metastases, abscesses, toxoplasmosis, AIDS lymphoma.
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Differential diagnosis of brain lesions: Uniformly enhancing lesion
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Lymphoma, meningioma, metastases (usually ring enhancing).
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Differential diagnosis of brain lesions: Heterogeneously enhancing lesion
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Glioblastoma mulltiforme.
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Ethosuximide
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EFGH — Ethosuximide, Fatigue, GI, Headache.
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Short acting Benzodiazepines
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TOM: Triazolam. Oxazepam, Midazolam. Highest addictive potential.
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Parkinson's disease drugs
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BALSA: Bromocriptine, Amantadine, Levodopa (with carbidopa), Selegiline (and COMT inhibitors), Antimuscarinics (Benztropine).
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Alzheimer's drugs
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Memantine, Donepezil, galantamine, rivastigmine
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Intelligence quotient
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Stanford-Binet IQ test, WAIS III, WISC for Children,
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Manic episode
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Maniacs DIG FAST (3 or more). 1. Distractibility, 2. Irresponsibility—seeks pleasure without regard to consequences (hedonistic). 3. Grandiosity—inflated self-esteem. 4. Flight of ideas—racing thoughts. 5. ↑in goal-directed Activity/psychomotor Agitation. 6. ↓need for Sleep. 7. Talkativeness or pressured speech.
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Major depressive episode
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SIG E CAPS (5 or more). 1. Sleep disturbance. 2. Loss of Interest (anhedonia). 3. Guilt or feelings of worthlessness. 4. Loss of Energy. 5. Loss of Concentration. 6. Change in Appetite/weight. 7. Psychomotor retardation or agitation. 8. Suicidal ideations. 9. Depressed mood.
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Risk factors for suicide completion
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SAD PERSONS. Sex (male), Age (teenager or elderly), Depression, Previous attempt, Ethanol or drug use, loss of Rational thinking, Sickness (medical illness, 3 or more prescription medications), Organized plan, No spouse (divorced, widowed, or single, especially if childless), Social support lacking.
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Panic disorder
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PANICS. Palpitations, Paresthesias, Abdominal distress, Nausea, Intense fear of dying or losing control, lIght-headedness, Chest pain, Chills, Choking, disConnectedness, Sweating, Shaking, Shortness of breath.
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Neuroleptic malignant syndrome (NMS)
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toxicity of antipsychotics. FEVER: Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigidity of muscles
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Lithium side effects
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LMNOP: Movement (tiemor), Nephrogenic diabetes insipidus, HypOthyroidism, Pregnancy problems
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increased Anion Gap in metabolic acidosis
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MUDPILES: Methanol (formic acid), Uremia, Diabelic ketoacidosis, Paraldehyde or Phenformin, Iron tablets or INH, Lactic acidosis, Ethylene glycol (oxalic acid), Salicylates.
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Renal tubular acidosis (RTA)
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Type 1 (distal), Type 2 (proximal), Type 4 (hyperkalemic)
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WAGR complex
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Wilms' tumor. Aniridia, Genitourinary malformation. and mental-motor Retardation.
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Transitional cell carcinoma risk factors
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Pee SAC: Phenacetin. Smoking. Aniline dyes, and Cyclophosphamide
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Most common cause of acute renal failure in hospital
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Acute tubular necrosis
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Furosemide Toxicity
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OH DANG! Ototoxicity, Hypokalemia. Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout.
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Thiazide Toxicity
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HyperGLUC. Hypokalemic metabolic alkalosis, hyponatremia. hyperGlycemia, hyperLipidemia, hyperUricemia, and hyperCalcemia. Sulfa allergy.
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ACE inhibitors Toxicity
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CAPTOPRIL. Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems (fetal renal damage), Rash, Increased renin, Lower angiotensin II. Also hyperkalemia.
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Pathway of sperm during ejaculation
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SEVEN UP: Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory ducts, (Nothing), Urethra, Penis.
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Mittelschmerz
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blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis.
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Menopause causes
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HHAVOC: Hirsutism. Hot flashes. Atrophy of the Vagina, Osteoporosis. Coronary artery disease.
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HELLP syndrome
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Hemolysis. Elevated LFT's, Low- Platelets. (associated with pregnacy-induced hypertension)
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Oxygen-hemoglobin dissociation curve shift to right
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CADET: CO2, Acid/Altitude, 2,3-DPG, Exercise, Temperature
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DVT
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Virchow's triad: Stasis, Hypercoagulability, Endothelial damage. Homan's sign: dorsiflexion of foot → tender calf muscle.
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Lung cancer complications
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SPHERE: Superior vena cava syndrome, Pancoast's tumor, Horner's syndrome, Endocrine (paraneoplastic), Recurrent laryngeal symptoms (hoarseness), Effusions (pleural or pericardial).
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