HY NOTES ALHPHABETICALY ORDERED

Abrupta Placenta - 4
Pt presents with vaginal bleeding, ABDOMINAL PAIN, and uterine tenderness. The absence of hemorrhage DOES NOT rule out this Dx. DDX:Placenta Previa, absence of bleeding RULES OUT this dx.****Risk factors are:1-HT and preecclampsia, 2-Placental abruption in previous pregnancy, 3-trauma, 4-short umbilical cord, 6-COCAINE abuse. AP is the mcc of DIC in pregnancy, which results from a release of activated thromboplastin from the decidual hematoma in to maternal circulation.****Risk factors are smoking and,Folate def. It can progress rapidly so careful monitoring is mandatory. Once dx is made, large-bore IV , as well as Foley cathater is inserted. Pts with AP in LABOR should be managed aggressively to insure rapid vaginal delivery, since this will remove the inciting cause of DIC and hemorrhage. Now if pt is stable tocolysis with MgSO4 is considered, but remmeber Ritordin is CI in pt with HT. ***Again, once we dx the next step is Vaginal delivery with augmentation of labor if necessary. Now if mother and baby are not stable or if there is CI, then Emergency C-section is indicated. Now if there is Dystocia ( narrowing of the birth passage) then Forcepts can be used.

ABCD of Homeostasis:
1-AIRWAY: An airway is needed for all unconscious pts, in the ER best method is Orotrachial intubation and in the field its needle cricothyroidectomy. For consciouns pt the best airway is chin lift with face mask. 2-BREATHING: Cervical spine injury should be analyzed but the first step is to establish ABC. 3-CIRCULATION: It needs control of bleeding and restoring the BP. In most external injuries pressure is enough to stop bleeding but in case of scalp laceration suturing is needed. Also all pts with hypotension should receive rapid infusion of isotonic fluid like ringer lactate to prevent life threatening hypotension. If IV line is not good for adults do saphaneous vein cut down and for children intraosseous membrane cannulation.

Absence seizures - 3
Ethosuximide is tx. Now remmeber that Phenytoin and Carbamazapine are first line drug used for primary generalized tonic clonic sezure or partial seizures, both work by blocking Na channels voltage dependent, Phenytoin is a second drug line for myoclonic and tonic clonic seizure, its available in both IV and oral forms, SE is gingivial hypertrophy, lymphadenopathy, hirsutism and rash, Both Phenytoina & Carbamazepine can cause Steven Johnson synd and Toxic Epidermal Necrolysis.*****Tx is Ethusuxamide or VALPROATE. Classic EEG is symetric 3mhtz spike and wave .

Acarbose SE
It blocks carbohydrate break down in the intestinal tract. The most significant SE is GI disturbance due to increased undifested CHO in the stool.

ACE inhibitor SE, Respira, 6/2
CAPTOPRIL (Cough, Angioedema, Pregnancy, Taste change, hypOtention, Proteinuria,Rash, Increase renin, Lower AII) and HyperKalemia. Cough is caused by accumulation of Kinins possibly by activation of arachadonic acid pathway. Kinins are degraded by ACE, when there is noACE they increase.*****Angioedema that is seen in ER. Pt presents with non-inflamatory subcutaneous edema and laryngeal edema due to bradykinin stimulation.

Acetaminophen toxicity - 2
Acute alcoholic intake can reduce the risk of hepatic injury by Acetaminophen because it competes with CYP2E1, so there is less production of toxic metabolites. Chronic alcohol intake increases risk of hepatic injury by stimulating P450 system and decreasing the amount of Glutathione (used for metabolism of acetaminophen). Management process: 1-4-hr post ingestion AA levels are determined to decide whether the pt will benefit from NAC or not. 2-On the other hand if the pt has ingested >7.5 gr AA and levels will not be available w/i 8 hours of ingestion, he should be given the antidote.

Acetazolamide Toxicity
Causes normal anion gap metabolic accidosis due to renal loss of bicarbonate. Anion Gap is 140-(114+116)=10 which is normal anionic gap metabolic acidosis.

Achalasia - 3
Dx 1-Barium studies, 2-Esopgaguscopy 3-Manometry. ** the CONFIRMATION test is Manometry. We also need to do Endoscopy to rule out malignancy.

ACL Injury
It prevents gliding of tibia under femur. Injury is seen after Hyperextension. A poping sensation is felt at time of injury. Commonly asso with Medial Meniscus and Medial Colateral Ligament (TRIAD). Lachman test is a test for ACL tear. Flex and pull tibia. Drawer sign also test ACL but its less sensitive. Posterior Drawer sign tests PCL. Mc murry's sign tests Meniscus injury. Valgus test is for MCL.

Acne - 2
1-Comedons (black/white heads): cuase minimal inflamation and tx is topical retinoids. If reactivation occur add topical Erythromycin or Benzoyl peroxide. 2-Papular and inflamatory acne: with moderate-severe inflamation: Oral Doxycycline. 3-Nodular or scaring acne: Oral Isotretinoin.

Acromegaly

Actinomycosis
Cervicofacial actinomycosis presents as slowly progressing , non tender, indurated mass, which evolves into multiple abscesses, fistula, and draining sinus tracts with sulfur granules, which appear yellow. Actinomyces israelii is the agent, Tx is high dose IV peniciline for 6-12 weeks. Surgical debrement comes after penicillin therapy.

Acute adrenal insufficiency:
Acute onset of naseau, vomiting, abdominal pain and hypoglycemia and hypotension after a stressful event (surgery) in a pt sho is steroid dependant is typical. A clue is preoperative steroid use. Exogenous steroids depress pit-adrenal axis and a stressful situation can precipitate AAI. DDX: insulin induced hypoglycemia does not cause naseau and vomit and abdominal pain and hypotension.

Acute Alkali ingestion
When a pt takes Lye (alkali substance for suicide), upper GI contrast studies should be performed as eary as possible, to assess the damage and posible perforation of esophagus. Normal x-ray does not rule out a perforation. Once you know there is no perforation then you can do Diagnostic peritoneal lavage if necessary. But the first thing is to rule out perforation.

Acute Appendicitis - 3
Pt who comes to hospital after 5 days of initial symptoms must be hospitalized with IV hydration and IV Cefotetan. If threre is abcess with CT, percutaneous drainage is an option.****Most pelvic abscesses are due to perforation of AA. Pt might have a 24 hour RUQ pain that resoves spontaneously and then later on in a few days he might come with anal abscess symptoms. Drainage of the abscess is tx of choice.****Experiecne has shown that right hemiclectomy with ileo-transvers anatomosis has best postoperative results when resection of part of ascending is requires. And that is when pt has shown gangrenous rupture of appendix with questionable necrotized colon.