Previous notes Flashcards
The most common side effect of ASA is tinnitus
The most common side effect of ASA is tinnitus
Prophylactic ASA use: -males 45- 79 yrs. - females 55-79 yrs.
Prophylactic ASA use: -males 45- 79 yrs. - females 55-79 yrs.
TMP-sulfa may increase effect of warfarin causing bleeding
TMP-sulfa may increase effect of warfarin causing bleeding
Aortic mechanical valve: INR 2.0-3.0. Mitral mechanical valve: INR 2.5-3.5.
Aortic mechanical valve: INR 2.0-3.0. Mitral mechanical valve: INR 2.5-3.5.
Digoxin toxicity may produce thrombocytopenia and delirium
Digoxin toxicity may produce thrombocytopenia and delirium
thiazide and furosemide (loop) are common cause of hypokalemia
thiazide and furosemide (loop) are common cause of hypokalemia
HCTZ is contraindicated in gout
HCTZ is contraindicated in gout
Pericartitis: chest pain, widespread st changes and friction rub. First-line treatment are NASAIS/ASA, second-line are steroids.
Pericartitis: chest pain, widespread st changes and friction rub. First-line treatment are NASAIS/ASA, second-line are steroids.
Indication for prophylaxis for endocarditis: prosthetic valve, prior endocarditis and cyanotic cardiopathies
Indication for prophylaxis for endocarditis: prosthetic valve, prior endocarditis and cyanotic cardiopathies
Treatment to symptomatic aortic stenosis is cx
Treatment to symptomatic aortic stenosis is cx
Asymptomatic aortic stenosis treatment are serial echos and avoid exertion
Asymptomatic aortic stenosis treatment are serial echos and avoid exertion
IV drug users typically have endocarditis on tricuspid valve
IV drug users typically have endocarditis on tricuspid valve
Hypertrophic cardiomyopathy (hypertrophy of LV outflow tract-septum produces a systolic murmur that increases with valsalva and decreases with handgrip (squeeze one’s hand)
Hypertrophic cardiomyopathy (hypertrophy of LV outflow tract-septum produces a systolic murmur that increases with valsalva and decreases with handgrip (squeeze one’s hand)
hypertrophic cardiomyopathy is the most common cause of death in young athletes
hypertrophic cardiomyopathy is the most common cause of death in young athletes
Most common cause of death within 1 year after cardiac transplantation is infection. After 5 years is allograft CAD followed by malignancy.
Most common cause of death within 1 year after cardiac transplantation is infection. After 5 years is allograft CAD followed by malignancy.
Diastolic failure= normal EF failure
Diastolic failure= normal EF failure
Pulmonary edema treatment: LMNOP (lasix, morphine, nitroglycerin, oxygen, position)
Pulmonary edema treatment: LMNOP (lasix, morphine, nitroglycerin, oxygen, position)
Digoxin enhances the symptoms of CHF, but not the mortality. ACEI lowers mortality
Digoxin enhances the symptoms of CHF, but not the mortality. ACEI lowers mortality
Circunflex occlusion: I and AVL changes. Right coronary artery occlusion: II, II, AVF LAD occlusion: V1-V6
Circunflex occlusion: I and AVL changes. Right coronary artery occlusion: II, II, AVF LAD occlusion: V1-V6
ST elevation in II, II and AVF along with ST depression in V1-V3, it is more likely the left circumflex to be occluded.
ST elevation in II, II and AVF along with ST depression in V1-V3, it is more likely the left circumflex to be occluded.
Mayor risk for cardiovascular disease (Framingham score): age, cholesterol (total and HDL), smoking, HTN and DM. After calculate the risk, take into account family history, which made double it
Mayor risk for cardiovascular disease (Framingham score): age, cholesterol (total and HDL), smoking, HTN and DM. After calculate the risk, take into account family history, which made double it
Women have worst outcome after a MI
Women have worst outcome after a MI
Sumatriptan (for cluster headache) is contraindicated in prinzmetal angina because it produces vasoconstriction
Sumatriptan (for cluster headache) is contraindicated in prinzmetal angina because it produces vasoconstriction
Torsade de points occur in patients with baseline long QT syndrome. Can be treated with magnesium.
Torsade de points occur in patients with baseline long QT syndrome. Can be treated with magnesium.
Supraventricular tach: first carotid massage, if it doesn’t work ADENOSINE
Supraventricular tach: first carotid massage, if it doesn’t work ADENOSINE
AF if unstable, electrical cardioversion
AF if unstable, electrical cardioversion
AF treatment: RACE (rate control, anticoagulation, cardioversion and etiology)
AF treatment: RACE (rate control, anticoagulation, cardioversion and etiology)
AF: Anticoagulation if CHADS2 > 1, fi not ASA. Rate control with beta blocker or CCB (diltiazem, verapamil)
AF: Anticoagulation if CHADS2 > 1, fi not ASA. Rate control with beta blocker or CCB (diltiazem, verapamil)
Flutter, if unstable do electrical cardioversion, if not beta blocker and amiodarone/sotalol
Flutter, if unstable do electrical cardioversion, if not beta blocker and amiodarone/sotalol
Albumin is decreased during sepsis.
Albumin is decreased during sepsis.
preferred vasopressors in sepsis are norepinefrina and dopamine
preferred vasopressors in sepsis are norepinefrina and dopamine
SCLC paraneoplastic syndome: SIADH Squamous carcinoma lung cancer: Hypercalcemia
SCLC paraneoplastic syndome: SIADH Squamous carcinoma lung cancer: Hypercalcemia
Surgery not usually performed for SCLC since it is generally not-curable
Surgery not usually performed for SCLC since it is generally not-curable
Relación lecitina/esfingomielina mayor de 2 se correlaciona con madurez pulmonar del feto
Relación lecitina/esfingomielina mayor de 2 se correlaciona con madurez pulmonar del feto
When a PE is suspected and CT is contraindicated, ventilation perfusion scan must be done
When a PE is suspected and CT is contraindicated, ventilation perfusion scan must be done
Rifampicin interfere with the warfarin action
Rifampicin interfere with the warfarin action
Sarcoidosis: disregulation of immune system that forms non-caseating granulomas which affect mainly the lungs’ lymphatic nodules (bilateral hilar lymphadenopathy). If no symptoms, observation. If symptoms, corticosteroids.
Sarcoidosis: disregulation of immune system that forms non-caseating granulomas which affect mainly the lungs’ lymphatic nodules (bilateral hilar lymphadenopathy). If no symptoms, observation. If symptoms, corticosteroids.
Drugs related to Pulmonary fibrosis: bleomycin, anphotericine andcarbamazepine
Drugs related to Pulmonary fibrosis: bleomycin, anphotericine andcarbamazepine
Copious foul smelling sputum. clubbing and hemoptysis are clues for bronchiectasis
Copious foul smelling sputum. clubbing and hemoptysis are clues for bronchiectasis
Clubbing is not typical of COPD
Clubbing is not typical of COPD
HCTZ has cross allergy with sulfas
HCTZ has cross allergy with sulfas
MDI shorts stays in the ER, they are also as effective as nebulization, but with best cost
MDI shorts stays in the ER, they are also as effective as nebulization, but with best cost
Inhaled corticosteroid is used to suppress the symptoms of chronic persistent asthma rather than a acute attack.
Inhaled corticosteroid is used to suppress the symptoms of chronic persistent asthma rather than a acute attack.
When a patient has a normal or elevated CO2 level during acute asthma is severe disease and he/she may undergo into respiratory failure.
When a patient has a normal or elevated CO2 level during acute asthma is severe disease and he/she may undergo into respiratory failure.
Inhaled corticosteroids are safe in pregnancy
Inhaled corticosteroids are safe in pregnancy
- Beta blockers type 1 selective: act on heart - Non-selective beta blockers: contraindicated in asthma (labetalol)
- Beta blockers type 1 selective: act on heart - Non-selective beta blockers: contraindicated in asthma (labetalol)
The efficacy of oral prednisone has been shown to be equivalent to IV methylprednisolone.
The efficacy of oral prednisone has been shown to be equivalent to IV methylprednisolone.
Carotid stenosis: > 70% meds + surgery 50-99% meds (some selected patients sx) < 50% meds (no benefit from sx)
Carotid stenosis: > 70% meds + surgery 50-99% meds (some selected patients sx) < 50% meds (no benefit from sx)
LDL goal for DM, CAD, AAA and PAD is 2 mmol/l (77 mg/dl)
LDL goal for DM, CAD, AAA and PAD is 2 mmol/l (77 mg/dl)
Ruptures AAA: OR ASAP!!
Ruptures AAA: OR ASAP!!
Consider OR for AAA when > 5.5 cm of diameter
Consider OR for AAA when > 5.5 cm of diameter
Chest pain, PMHx Marfan’s, difference n SBP between arms and wide mediastinum in Rx= Aortic Dissection. Treatment if type A: OR, type B: beta blocker
Chest pain, PMHx Marfan’s, difference n SBP between arms and wide mediastinum in Rx= Aortic Dissection. Treatment if type A: OR, type B: beta blocker
The most beneficial for peripheral vascular disease is strict exercise training program and smoke cessation .
The most beneficial for peripheral vascular disease is strict exercise training program and smoke cessation .
Most effective daily dose for fracture prevention in postmenopausal women: 800 IU via D and 1200 mg calcium
Most effective daily dose for fracture prevention in postmenopausal women: 800 IU via D and 1200 mg calcium
ACE-inhibitor in general are the best option for diabetic patients.
ACE-inhibitor in general are the best option for diabetic patients.
HCTZ may preserve bone density
HCTZ may preserve bone density
Mono therapy for hypertension in black patients is more likely to consist of HCTZ or CCB
Mono therapy for hypertension in black patients is more likely to consist of HCTZ or CCB
HCTZ should be avoided in gout patients
HCTZ should be avoided in gout patients
Avoid beta-blockers in cocaine overdose
Avoid beta-blockers in cocaine overdose
Clonidine, example of rebound hypertension
Clonidine, example of rebound hypertension
Frost-Line therapy for proteinuric kidney are ACEI or ARB
Frost-Line therapy for proteinuric kidney are ACEI or ARB
Prophylactic therapy for cluster headache: verapamil, lithium, prednisolone or methysergide.
Prophylactic therapy for cluster headache: verapamil, lithium, prednisolone or methysergide.
Varenicline is the most effective pharmacological option in smoke cessation
Varenicline is the most effective pharmacological option in smoke cessation
Blacks are 1.5 times as likely as whites to develop prostate cancer
Blacks are 1.5 times as likely as whites to develop prostate cancer
Percentage of canadian population with colonic polyps: 30-40-50 by 50-60-70
Percentage of canadian population with colonic polyps: 30-40-50 by 50-60-70
Colon cancer screening starts at 50 y. In family hereditary non-polyposis colorectal cancer, at 25
Colon cancer screening starts at 50 y. In family hereditary non-polyposis colorectal cancer, at 25
Child neglect is the most common form of child abuse in canada
Child neglect is the most common form of child abuse in canada
An agitated patient with with a brief psychotic episode must be first sedated with a benzodiazepine before giving an antipsychotic.
An agitated patient with with a brief psychotic episode must be first sedated with a benzodiazepine before giving an antipsychotic.
Quetiapina and clozapine are the only atypic antipsychotics that are not related with parkinsonism.
Quetiapina and clozapine are the only atypic antipsychotics that are not related with parkinsonism.
- Schizofrenia: psychotic symptoms for more than 6 months. - Schizophreniform: psychotic symptoms for 1-6 months. - Brief psychotic disorder: psychotic symptoms for less than 1 month - Schizoafective: psychotic symptoms+ mood - Schizoid personality: life-time pattern of social withdraw and no desire for social relations
- Schizofrenia: psychotic symptoms for more than 6 months. - Schizophreniform: psychotic symptoms for 1-6 months. - Brief psychotic disorder: psychotic symptoms for less than 1 month - Schizoafective: psychotic symptoms+ mood - Schizoid personality: life-time pattern of social withdraw and no desire for social relations
TCA overdose produces respiratory depression, therefore on ABGs hypoxia, hypercapnia and acidosis
TCA overdose produces respiratory depression, therefore on ABGs hypoxia, hypercapnia and acidosis
formula de parkland: 4cc/kg/%quemado pasar la mitad en 8 horas y el resto en 16 horas.
formula de parkland: 4cc/kg/%quemado pasar la mitad en 8 horas y el resto en 16 horas.
Any medication that affects the circulation of the skin (clonidina) or the shivering mechanism can predispose to hypothermia.
Any medication that affects the circulation of the skin (clonidina) or the shivering mechanism can predispose to hypothermia.
To prevent calcium stones, give thiazide diuretics (they promote the reabsorption of calcium into the blood stream)
To prevent calcium stones, give thiazide diuretics (they promote the reabsorption of calcium into the blood stream)
kidney stones: - 80% calcium oxalate - 10% struvite - 10% uric acid
kidney stones: - 80% calcium oxalate - 10% struvite - 10% uric acid
the most common cause of abnormal uterine bleeding us anovulation.
the most common cause of abnormal uterine bleeding us anovulation.
Placenta previa: painless,bright red vaginal bleeding
Placenta previa: painless,bright red vaginal bleeding
Most common cause of epistaxis is trauma
Most common cause of epistaxis is trauma
If a stroke happens while the patient is on ASA, it must be switched to clopidrogel.
If a stroke happens while the patient is on ASA, it must be switched to clopidrogel.
In stroke only treat HTN if > 200/120
In stroke only treat HTN if > 200/120
Entre menos síntomas se presenten el compromiso es más distal
Entre menos síntomas se presenten el compromiso es más distal
Endarterectomy with carotid occlusion greater than 70%
Endarterectomy with carotid occlusion greater than 70%
Hypocalcemia is related with prolonged QT
Hypocalcemia is related with prolonged QT
Vitamin D elevates the absortion of both calcium and phosphorus.
Vitamin D elevates the absortion of both calcium and phosphorus.
initial treatment of hypercalcemia is hydration, once the patient is well hydrated, one can add furosemide.
initial treatment of hypercalcemia is hydration, once the patient is well hydrated, one can add furosemide.
Lithium can cause primary hyperPTH
Lithium can cause primary hyperPTH
Thiazides can exacerbate hypercalcemia
Thiazides can exacerbate hypercalcemia
Primary hyperPTH and malignancy are the most common causes of hypercalcemia, accounting for 90% of causes.
Primary hyperPTH and malignancy are the most common causes of hypercalcemia, accounting for 90% of causes.
Insulin and salbutamol lower the K+
Insulin and salbutamol lower the K+
ACE inhibitor can cause hyperkalemia
ACE inhibitor can cause hyperkalemia
Asymptomatic patient without risk factors but with a surprising hyperkalemia results, before doing treatment, it is necessary to repeat the test
Asymptomatic patient without risk factors but with a surprising hyperkalemia results, before doing treatment, it is necessary to repeat the test
The most commun cause of hypoglycemia in a previous stable patient is renal disease
The most commun cause of hypoglycemia in a previous stable patient is renal disease
C peptide is used to measure the amount of endogenous insulin that is synthetized
C peptide is used to measure the amount of endogenous insulin that is synthetized
whipple triad: symptoms of hypoglycemia, low glucose levels and improvement of symptoms after administration of glucose
whipple triad: symptoms of hypoglycemia, low glucose levels and improvement of symptoms after administration of glucose
HCO3 indicator of severity in DKA. Treatment of DKA: - Insuline (short acting/regular): bolus of 0.2 U/kg, then 0.1 U/kg/hr - K+: 20 mEq per 1lt of iv fluids - IV fluids NS
HCO3 indicator of severity in DKA. Treatment of DKA: - Insuline (short acting/regular): bolus of 0.2 U/kg, then 0.1 U/kg/hr - K+: 20 mEq per 1lt of iv fluids - IV fluids NS
Tratamiento anticoagulante se debe continuar por 6 meses luego de parto
Tratamiento anticoagulante se debe continuar por 6 meses luego de parto
dosis inicial de heparina no fracionada en tvp: 80 mg/kg. Se continua bajo una fusión de 18 mg/kg/hr
dosis inicial de heparina no fracionada en tvp: 80 mg/kg. Se continua bajo una fusión de 18 mg/kg/hr
First DVT: tx for 3 months First DVT + risk fx: consider indefinite Recurrent DVT: indefinite therapy
First DVT: tx for 3 months First DVT + risk fx: consider indefinite Recurrent DVT: indefinite therapy
NSAID and high-dose of ASA should be avoided in CHF because they can cause fluid retention
NSAID and high-dose of ASA should be avoided in CHF because they can cause fluid retention
Although digoxin improves EF and symptoms, it doesn’t improve survival in CHF
Although digoxin improves EF and symptoms, it doesn’t improve survival in CHF
Nitroprusside, prazosin, ACE inhibitors and ARA II inhibitors reduce both preload and after load
Nitroprusside, prazosin, ACE inhibitors and ARA II inhibitors reduce both preload and after load
amiodarone treatment is associated with interstitial lung disease and thyroid disorders
amiodarone treatment is associated with interstitial lung disease and thyroid disorders
Most common medication to control rate in AFib are beta blockers
Most common medication to control rate in AFib are beta blockers
Taquicardia supraventricular: masaje carotideo + adenosina (seguida en bolo seguida de SSN). Si luego de dos dosis de adenosina no funciona, calcionatagonista o beta bloqueador
Taquicardia supraventricular: masaje carotideo + adenosina (seguida en bolo seguida de SSN). Si luego de dos dosis de adenosina no funciona, calcionatagonista o beta bloqueador
A specific antibody called IgE is responsible for the adverse reactions in people with allergies.
A specific antibody called IgE is responsible for the adverse reactions in people with allergies.
Anaphylactic shock from latex allergy has been associated with myelomeningocele
Anaphylactic shock from latex allergy has been associated with myelomeningocele
Most common cause of syncope is vasovagal
Most common cause of syncope is vasovagal
Syncope with exercise is a manifestation of organic heart disease in which cardiac output is fixed and does not rise like in aortic stenosis.
Syncope with exercise is a manifestation of organic heart disease in which cardiac output is fixed and does not rise like in aortic stenosis.
Valproic acid is the agent of choice in grand mal seizure (tonic.clonic)
Valproic acid is the agent of choice in grand mal seizure (tonic.clonic)
Most frequent cause of seizure in elderly is stroke
Most frequent cause of seizure in elderly is stroke
Patients with a history of kidney stones should not take topiramate
Patients with a history of kidney stones should not take topiramate
In back pain continue daily activity rather than bed resto helps to recovery
In back pain continue daily activity rather than bed resto helps to recovery
The most common cause for cystic enlargement of the ovary in a reproductive age woman us a functional cyst. Observation and follow-up are needed.
The most common cause for cystic enlargement of the ovary in a reproductive age woman us a functional cyst. Observation and follow-up are needed.
The majority of ovarian cyst diagnosed in early pregnancy represent a corpus lute cyst.
The majority of ovarian cyst diagnosed in early pregnancy represent a corpus lute cyst.
Medial meniscal lesions are more common than lateral ones.
Medial meniscal lesions are more common than lateral ones.
Paciente con caída y dolor en tabaquera anatómica, se sospecha fx de escamondes. Si la rx es normal, se inmoviliza con una thumb spica de todas maneras y se repite la rx una semana después
Paciente con caída y dolor en tabaquera anatómica, se sospecha fx de escamondes. Si la rx es normal, se inmoviliza con una thumb spica de todas maneras y se repite la rx una semana después
Si es atleta o futbolista joven con un cuadro parecido a una claudicación intermitente puede ser un sd compartimentos crónico
Si es atleta o futbolista joven con un cuadro parecido a una claudicación intermitente puede ser un sd compartimentos crónico
pain in passive extension: compartment syndrome until proven otherwise
pain in passive extension: compartment syndrome until proven otherwise
In the case of gross hematuria, the GU system is investigated from distal to proximal
In the case of gross hematuria, the GU system is investigated from distal to proximal
Cardiac tamponade: - Beck triad (hypotension, muffled heart sounds and distended neck veins) - Pulsus paradoxus.
Cardiac tamponade: - Beck triad (hypotension, muffled heart sounds and distended neck veins) - Pulsus paradoxus.
Pneumothorax < 15-20%, observation and oxygen
Pneumothorax < 15-20%, observation and oxygen
nasal septal deviation is the most likely cause of chronic unilateral obstruction
nasal septal deviation is the most likely cause of chronic unilateral obstruction
Leading cause of death in Canada is cancer, followed by cardiovascular diseases
Leading cause of death in Canada is cancer, followed by cardiovascular diseases
Lung cancer is the leading cause of deaths in Canada, followed by colorectal, breast and prostate
Lung cancer is the leading cause of deaths in Canada, followed by colorectal, breast and prostate
1/3 of female deaths are due to cardiovascular diseases (1st) and stroke (2nd)
1/3 of female deaths are due to cardiovascular diseases (1st) and stroke (2nd)
Decision Making: 1. What the patient says 2. What the patient has written 3. Health care proxy (previously appointed by the patient) 4. Next of kin or close friend 5. Hospital ethics committee or courts
Decision Making: 1. What the patient says 2. What the patient has written 3. Health care proxy (previously appointed by the patient) 4. Next of kin or close friend 5. Hospital ethics committee or courts
Permission for release of patient information should always be in writing.
Permission for release of patient information should always be in writing.
Physicians have the duty to warn and protect intended or potential victims.
Physicians have the duty to warn and protect intended or potential victims.
Canada’s health care system budget: 1. Hospitals 30% 2. Drugs 17% 3. Physicians 15% 4. Other professionals 10%
Canada’s health care system budget: 1. Hospitals 30% 2. Drugs 17% 3. Physicians 15% 4. Other professionals 10%
Public health unit: enforcement of water and food regulation, local environmental risk, follow-up reportable disease.
Public health unit: enforcement of water and food regulation, local environmental risk, follow-up reportable disease.
Lower rates of breast, lung, colorectal and prostate cancers are found among First Nations population
Lower rates of breast, lung, colorectal and prostate cancers are found among First Nations population
Asthma is the most common illness related with workplace
Asthma is the most common illness related with workplace
Benzeno produce leucemia, mieloma multiple y anemia aplásica.
Benzeno produce leucemia, mieloma multiple y anemia aplásica.
La exotoxina del S Aureus está presente en la mayoría de casos de diarrea, generalmente asociado a jamones, pudding, derivados del huevo, pastelería y sandwiches.
La exotoxina del S Aureus está presente en la mayoría de casos de diarrea, generalmente asociado a jamones, pudding, derivados del huevo, pastelería y sandwiches.
Waterborne diarrhea: Norwalk virus. Associated with cruises, nursing homes and summer camps
Waterborne diarrhea: Norwalk virus. Associated with cruises, nursing homes and summer camps
E. coli: presente en carnes mal cocinadas
E. coli: presente en carnes mal cocinadas
Most important preventive management for stroke is control of hypertension
Most important preventive management for stroke is control of hypertension
Attack rate: affected / total population in risk
Attack rate: affected / total population in risk
A la hora de evaluar métodos diagnósticos se debe tener en cuenta: valor predictivo postivo, valor predictivo negativo y likelihood ratio.
A la hora de evaluar métodos diagnósticos se debe tener en cuenta: valor predictivo postivo, valor predictivo negativo y likelihood ratio.
When the cut-off point is lowered, test sensivility increases and specificity decreases.
When the cut-off point is lowered, test sensivility increases and specificity decreases.
valor preductivo postivo está dorectamente relacionado con la prevalencia de una enfermedad
valor preductivo postivo está dorectamente relacionado con la prevalencia de una enfermedad
NNT = 1/ARR (absolute risk reduction)
NNT = 1/ARR (absolute risk reduction)
Odds ratio: AxD/BxC
Odds ratio: AxD/BxC
Epidemiological triad: host, agent and environment.
Epidemiological triad: host, agent and environment.
para hablar de incidencia se necesita el dato de la cuanta población está en riesgo.
para hablar de incidencia se necesita el dato de la cuanta población está en riesgo.
Si una conclusion no es estadisticamente significativa es porque la diferencia entre las intervenciones puede ser debida al azar.
Si una conclusion no es estadisticamente significativa es porque la diferencia entre las intervenciones puede ser debida al azar.
Outbreak is synonym of epidemic
Outbreak is synonym of epidemic
Durante la fase 2 un nuevo medicamento se prueba en individuos enfermos,se prueba su eficacia y su seguridad. Es la fase donde se descartan la mayoría.
Durante la fase 2 un nuevo medicamento se prueba en individuos enfermos,se prueba su eficacia y su seguridad. Es la fase donde se descartan la mayoría.
If the value of 1 is not within the 95% of confidence interval, then the odds ratio is statistically significant at the 5% level (p<0.05)
If the value of 1 is not within the 95% of confidence interval, then the odds ratio is statistically significant at the 5% level (p<0.05)
Case-control study is relatively inexpensive and is used for rare diseases.
Case-control study is relatively inexpensive and is used for rare diseases.
Prospective cohort studies: measuring from the exposure to the future outcome. (looking forward) Level of evidence: I (RCT), II (Prospective cohort), III (case-control)
Prospective cohort studies: measuring from the exposure to the future outcome. (looking forward) Level of evidence: I (RCT), II (Prospective cohort), III (case-control)
Enter más uniforme sea la chorote, mejor (patients at an early uniform point in the course of their disease)
Enter más uniforme sea la chorote, mejor (patients at an early uniform point in the course of their disease)
Cross-sectional studies are used to estimate prevalence at a point in time
Cross-sectional studies are used to estimate prevalence at a point in time
Observational studies involve neither manipulation of the exposure nor randomization of the study subjects.
Observational studies involve neither manipulation of the exposure nor randomization of the study subjects.
Cuando se aumenta el punto de cohorte de una prueba, su sensibilidad baja y su especificidad aumenta.
Cuando se aumenta el punto de cohorte de una prueba, su sensibilidad baja y su especificidad aumenta.
- Lead- time: tiempo entre la detección de una condición gracias al tamizaje y el momento en el que la enfermedad se hubiera detectado sin tamizaje. - lead-time bias: al detectar una enfermedad tempranamente se produce un aparente aumento en la supervivencia, pero en realidad esto está sesgado por el tamizaje y no se representa un real aumento de la supervivencia.
- Lead- time: tiempo entre la detección de una condición gracias al tamizaje y el momento en el que la enfermedad se hubiera detectado sin tamizaje. - lead-time bias: al detectar una enfermedad tempranamente se produce un aparente aumento en la supervivencia, pero en realidad esto está sesgado por el tamizaje y no se representa un real aumento de la supervivencia.
Most common cause of mortality in twin pregnancies are respiratory distress syndrome
Most common cause of mortality in twin pregnancies are respiratory distress syndrome
Cambios en las edades de ingreso a los programas de tamizaje pueden producir cambios en las tasas de incidencia.
Cambios en las edades de ingreso a los programas de tamizaje pueden producir cambios en las tasas de incidencia.
most common cause of perinatal mortality is prematurity.
most common cause of perinatal mortality is prematurity.
Meperidina debe ser evitado en pacientes mayores
Meperidina debe ser evitado en pacientes mayores
Primidone (prefered in elderly) and propranolol (prefered in youth) are the cornerstones of maintenance therapy for essential tremor.
Primidone (prefered in elderly) and propranolol (prefered in youth) are the cornerstones of maintenance therapy for essential tremor.
Acute treatment of dystonia: benztropine or diphenhydramine.
Acute treatment of dystonia: benztropine or diphenhydramine.
60% de los tumores cerebrales en niños se dan en fosa posterior. El más común es el astrocitoma de bajo grado y el maligno más común es el meduloblastoma.
60% de los tumores cerebrales en niños se dan en fosa posterior. El más común es el astrocitoma de bajo grado y el maligno más común es el meduloblastoma.
Dentro del manejo de coma de causa indeterminada, no se usan corticoides de rutina
Dentro del manejo de coma de causa indeterminada, no se usan corticoides de rutina
a(P)raxia: daño en (P)arietal
a(P)raxia: daño en (P)arietal
- Sensory ataxia (lesion of dorsal column tracts): Romberg is positive, walk in narrow base and DO HAVE loss in vibration and propiopception. - Cerebellar ataxia: negative romberg, walk in a wilde baseDO NOT have loss in vibration and propipception
- Sensory ataxia (lesion of dorsal column tracts): Romberg is positive, walk in narrow base and DO HAVE loss in vibration and propiopception. - Cerebellar ataxia: negative romberg, walk in a wilde baseDO NOT have loss in vibration and propipception
Ante una parálisis del III par y un paciente con cefalea, se debe pensar en la existencia de un aneurisma a nivel del círculo de Willis.
Ante una parálisis del III par y un paciente con cefalea, se debe pensar en la existencia de un aneurisma a nivel del círculo de Willis.
El factor de riesgo más importante para hemorragia intracerebral es HTN
El factor de riesgo más importante para hemorragia intracerebral es HTN
Ante la sospecha de hemorragia subraracnoidea se hace un TAC sin contrste, si este es negativo, pero la clínica sigue igual de sugestiva, se debe realizar una punción lumbar la cual para ser positiva debe presentar sangre o xantocromia.
Ante la sospecha de hemorragia subraracnoidea se hace un TAC sin contrste, si este es negativo, pero la clínica sigue igual de sugestiva, se debe realizar una punción lumbar la cual para ser positiva debe presentar sangre o xantocromia.
Ependymoma is the most common tumor found within the ventricular system
Ependymoma is the most common tumor found within the ventricular system
Solitary metastasic lesion on the brain can me managed with surgery followed with whole brain radiotherapy. Multiple lesions are treated only with whole brain radiotherapy. Unresectable brain metastasis is treated with irradiation of the mass.
Solitary metastasic lesion on the brain can me managed with surgery followed with whole brain radiotherapy. Multiple lesions are treated only with whole brain radiotherapy. Unresectable brain metastasis is treated with irradiation of the mass.
Most common primary sources of metastatic brain tumors: lung and breast
Most common primary sources of metastatic brain tumors: lung and breast
Normal pressure hydrocephalus (DIA) - Dementia/ memor loss - Incontinence - Ataxia of gait
Normal pressure hydrocephalus (DIA) - Dementia/ memor loss - Incontinence - Ataxia of gait
CSF removal is the diagnostic gold standard of normal pressure hydrocephalus
CSF removal is the diagnostic gold standard of normal pressure hydrocephalus
Cushing’s Triad: -HTN -Bradycardia -Abnormal respiratory pattern
Cushing’s Triad: -HTN -Bradycardia -Abnormal respiratory pattern
Young woman with motor, coodinarion lack, dysphagia and visual symptoms (optic neuritis) that progressively worsen, specially in hot weather: Multiple Sclerosis.
Young woman with motor, coodinarion lack, dysphagia and visual symptoms (optic neuritis) that progressively worsen, specially in hot weather: Multiple Sclerosis.
Multiple Sclerosis: - Limb weakness - Paresthesias - Diplopia - Optic neuritis - Urinary incontinence - Vertigo
Multiple Sclerosis: - Limb weakness - Paresthesias - Diplopia - Optic neuritis - Urinary incontinence - Vertigo
In stroke do not lower the blood pressure unless HTN is severe (> 220/120)
In stroke do not lower the blood pressure unless HTN is severe (> 220/120)
Stroke of posterior cerebral artery produces short-memory impairment and cortical blindness or homonimus hemianospsia.
Stroke of posterior cerebral artery produces short-memory impairment and cortical blindness or homonimus hemianospsia.
CHADS2 (CHF, hypertension, age > 75, DM, and history of stroke or TIA
CHADS2 (CHF, hypertension, age > 75, DM, and history of stroke or TIA
Carotid stenosis greater than 70% is a good candidate for endarterectomy
Carotid stenosis greater than 70% is a good candidate for endarterectomy
Narcolepsy (sudden loss of muscle tone) is treated with methylphenidate.
Narcolepsy (sudden loss of muscle tone) is treated with methylphenidate.
Cipap is the treatment of choice in sleep apnea, weight loss and sleep hygiene are coadyuvant treatments.
Cipap is the treatment of choice in sleep apnea, weight loss and sleep hygiene are coadyuvant treatments.
Any condition that lowers PaCO2 (high altitude or heart failure) will worsen central sleep apnea
Any condition that lowers PaCO2 (high altitude or heart failure) will worsen central sleep apnea
Restless Leg Syndrome, can be produced by iron deficiency, hence iron supplementation is part of the treatment. Also dopaminergic agonist.
Restless Leg Syndrome, can be produced by iron deficiency, hence iron supplementation is part of the treatment. Also dopaminergic agonist.
Acostarse y levantarse a la misma hora siempre ayuda a tener un sueño reparador.
Acostarse y levantarse a la misma hora siempre ayuda a tener un sueño reparador.
Cluster type headache: - Acute Tx: sumatriptan - Prophylaxus: verapamil, lithium, prenisolone
Cluster type headache: - Acute Tx: sumatriptan - Prophylaxus: verapamil, lithium, prenisolone
Migraine prophylaxis: - Frist line: Beta-blokers (Propanolol) - Second line: TCA (Amitriptyline) - Third line: Anticonvulsivants (valproate, topiramate)
Migraine prophylaxis: - Frist line: Beta-blokers (Propanolol) - Second line: TCA (Amitriptyline) - Third line: Anticonvulsivants (valproate, topiramate)
Ergotamines are contraindicated in pregnancy as well as in women of childbearing age. It produces vasocontriction of the uterine vessels leading to intrauterine growth restriction or abrotion.
Ergotamines are contraindicated in pregnancy as well as in women of childbearing age. It produces vasocontriction of the uterine vessels leading to intrauterine growth restriction or abrotion.
Postherpetic neurlagia can be treated with TCA (amitriptyline, nortriptyline) or antoconvulsant (pregabaline, gabapentine)
Postherpetic neurlagia can be treated with TCA (amitriptyline, nortriptyline) or antoconvulsant (pregabaline, gabapentine)
most important factor for developing postherpetic neuralgia is old age
most important factor for developing postherpetic neuralgia is old age
Trigeminal Neuralgia treatmet: - First line: carbamazepine or oxcarbazepine. - Second line: lamotrigine.
Trigeminal Neuralgia treatmet: - First line: carbamazepine or oxcarbazepine. - Second line: lamotrigine.
For the diagnosis of neuropathic pain it’s necessary to think about positive an negative symptoms.
For the diagnosis of neuropathic pain it’s necessary to think about positive an negative symptoms.
Duchenne muscular dystrophy is inherited in a X-linked recessive pattern.
Duchenne muscular dystrophy is inherited in a X-linked recessive pattern.
Children under 1 year should not be given honey (also syrup or home-canned food) because possible contamination with clostridium botulinum
Children under 1 year should not be given honey (also syrup or home-canned food) because possible contamination with clostridium botulinum
Myasthenia gravis: antibodies against Ach receptor. It produces fatigability, weakness, dysphagia, ptosis and diplopia with normal reflexes. It’s widely associated with thymic hyperplasia, thyroiditis and thymic neoplasia
Myasthenia gravis: antibodies against Ach receptor. It produces fatigability, weakness, dysphagia, ptosis and diplopia with normal reflexes. It’s widely associated with thymic hyperplasia, thyroiditis and thymic neoplasia
small cell carcinoma is associated with lambert-eaton myasthenic syndrome (antibodies against presynaptic calcium channels)
small cell carcinoma is associated with lambert-eaton myasthenic syndrome (antibodies against presynaptic calcium channels)
The mos common antecedent infection in Guillian Barré is campylobacter jejuni
The mos common antecedent infection in Guillian Barré is campylobacter jejuni
The most common agents used in diabetic neuropathy are anticonvulsivans (pregabaline) or antidepressants (avoid TCA is > 65)
The most common agents used in diabetic neuropathy are anticonvulsivans (pregabaline) or antidepressants (avoid TCA is > 65)
UMN and LMN symptoms in the absence of sensory symptoms strongly suggest ALS
UMN and LMN symptoms in the absence of sensory symptoms strongly suggest ALS
Paciente menores de 18 años con sintomas de tic motores y vocales quien pueden tener asociado TOC o deficit de atención. Pensar en Tourette.
Paciente menores de 18 años con sintomas de tic motores y vocales quien pueden tener asociado TOC o deficit de atención. Pensar en Tourette.
Clonidina es la primera linea en manejo ce Tourette.
Clonidina es la primera linea en manejo ce Tourette.
SIntomas extrapiramidales producidos por medicamentos como metoclopramida se manejan con anticolinergicos como benztropin o diphenhydramine.
SIntomas extrapiramidales producidos por medicamentos como metoclopramida se manejan con anticolinergicos como benztropin o diphenhydramine.
Huntington’s disease is autosomal dominat.
Huntington’s disease is autosomal dominat.
Positive response with levodopa diagnostic for parkinson’s
Positive response with levodopa diagnostic for parkinson’s
Levodopa dose: 100 mg PO TID
Levodopa dose: 100 mg PO TID
Resting tremor makes de difference between parkinson’s and others parkinsonian syndromes.
Resting tremor makes de difference between parkinson’s and others parkinsonian syndromes.
Difficulty distinguishing left to right: parietal lobe damage.
Difficulty distinguishing left to right: parietal lobe damage.
Left frontal lobe: motor and expression (broca’s area)
Left frontal lobe: motor and expression (broca’s area)
Frontotemporal dementia presentes with behavioral changes like disinhibition, impairment of personal conduct, loss of emotional sensitivity and loss of insight
Frontotemporal dementia presentes with behavioral changes like disinhibition, impairment of personal conduct, loss of emotional sensitivity and loss of insight
Neurocognitive disorder with Lewy bodies: visual hallucinations, parkinsonism, related falls, syncope
Neurocognitive disorder with Lewy bodies: visual hallucinations, parkinsonism, related falls, syncope
Although patients with alzheimer may receive atypical antipsychotics, behaviors like wandering and pacing don’t need special treatment other than cholinesterase inhibitor
Although patients with alzheimer may receive atypical antipsychotics, behaviors like wandering and pacing don’t need special treatment other than cholinesterase inhibitor
Head trauma, advanced age, obesity, hypertension and family history are risk factors for alzheimer
Head trauma, advanced age, obesity, hypertension and family history are risk factors for alzheimer
Studies for ginko biloba support its use in: dementia, tinnitus and intermitent claudicaton.
Studies for ginko biloba support its use in: dementia, tinnitus and intermitent claudicaton.
Creutzfeldt jakob disease is a dementia caused by prion proteins, there’s not treatment currently.
Creutzfeldt jakob disease is a dementia caused by prion proteins, there’s not treatment currently.
Dementia with lewy bodies: visual hallucinations, parkinsonism, fluctuating altertness and behavior mimic delirium.
Dementia with lewy bodies: visual hallucinations, parkinsonism, fluctuating altertness and behavior mimic delirium.
Tonic-clonic seizures: First line: valproic acid. Second line: Carbamazepine, phenytoin and topiramate
Tonic-clonic seizures: First line: valproic acid. Second line: Carbamazepine, phenytoin and topiramate
Topiramate is contraindicated in patients with urolithiasis, or those taking high-dose vitamin C or calcium supplementation because this medication can lead to kidney stones.
Topiramate is contraindicated in patients with urolithiasis, or those taking high-dose vitamin C or calcium supplementation because this medication can lead to kidney stones.
Status epilepticus: lorazepam is the preferred agent
Status epilepticus: lorazepam is the preferred agent
Treatment of choice for absence seizures: ethosuximide + valproic acid
Treatment of choice for absence seizures: ethosuximide + valproic acid
Most frequent cause of seizure in elderly is stroke (50%). Most common are complex partial. Treatment: topiramate, gabapentine and levetiracetam because they are more secure with less secondary effects and reactions.
Most frequent cause of seizure in elderly is stroke (50%). Most common are complex partial. Treatment: topiramate, gabapentine and levetiracetam because they are more secure with less secondary effects and reactions.
Absence seizure: generalized 3-per-second spike and wake pattern
Absence seizure: generalized 3-per-second spike and wake pattern
Inter nuclear ophtalmoglegia (INO) it’s a common complain in patients with Multiple Sclerosis. It’s a lesion in the medial longitudinal fasciculus (Structure that coordinates the conjugated gaze). The paciente will complain of horizontal diplopia and on physical examination when looking away to the site of lesion the ipsilateral eye will not adduce, while the evaluation of mergence will be normal. N15.
Inter nuclear ophtalmoglegia (INO) it’s a common complain in patients with Multiple Sclerosis. It’s a lesion in the medial longitudinal fasciculus (Structure that coordinates the conjugated gaze). The paciente will complain of horizontal diplopia and on physical examination when looking away to the site of lesion the ipsilateral eye will not adduce, while the evaluation of mergence will be normal. N15.
Tumors in parathyroid, think in MEN-I (para, pancreas, putitaria)
Tumors in parathyroid, think in MEN-I (para, pancreas, putitaria)
CN XI is vulnerable to damage during neck surgery. -LMN lesion: paralysis of ipsilateral trapezius and sternocleido. UMN lesion: paralysis of contralateral trapezius and ipsilateral sternocleido
CN XI is vulnerable to damage during neck surgery. -LMN lesion: paralysis of ipsilateral trapezius and sternocleido. UMN lesion: paralysis of contralateral trapezius and ipsilateral sternocleido
LMN symptoms: flaccid paresis, hypotonia, hyporeflexia, atrophy, fasciculations and negative babinsky sign
LMN symptoms: flaccid paresis, hypotonia, hyporeflexia, atrophy, fasciculations and negative babinsky sign
Electroconvulsive therapy is generally contraindicated in increased intracranial tumor, brain tumor and recent stroke or brain hemorrhage.
Electroconvulsive therapy is generally contraindicated in increased intracranial tumor, brain tumor and recent stroke or brain hemorrhage.
Trazolam is the benzodiazepine with the shortest half-life with 3 hrs.
Trazolam is the benzodiazepine with the shortest half-life with 3 hrs.
Short-acting benzodiazepines: alprazolam, lorazepam, triazolam. Long-acting benzodiazepines: clonazepam, diazepam
Short-acting benzodiazepines: alprazolam, lorazepam, triazolam. Long-acting benzodiazepines: clonazepam, diazepam
EKG changes associated with lithium therapy: Flattering or inversion of T waves
EKG changes associated with lithium therapy: Flattering or inversion of T waves
Potential complication of thimium therapy is nephtogenic diabetes insipudus.
Potential complication of thimium therapy is nephtogenic diabetes insipudus.
NSAIDs decreases clearance of lithium, all well as thiazide and ACE inhibitors.
NSAIDs decreases clearance of lithium, all well as thiazide and ACE inhibitors.
Bupuprion (MAOI) decreases the appetite, therefore lest likely to cause gain weight .
Bupuprion (MAOI) decreases the appetite, therefore lest likely to cause gain weight .
Meperidine + SSRIs : serotonine syndrome
Meperidine + SSRIs : serotonine syndrome
Cyproheptadine is a serotonin inhibitor used in serotonin syndrome
Cyproheptadine is a serotonin inhibitor used in serotonin syndrome
When taking SSRIs, MAOIs are contraindicated
When taking SSRIs, MAOIs are contraindicated
paciente agitado: haloperidol+ benzodiazepine+ benztropine (anticolinergico para disminuir el riesgo de parkinsonismo)
paciente agitado: haloperidol+ benzodiazepine+ benztropine (anticolinergico para disminuir el riesgo de parkinsonismo)
antipsicotico + claritromicina, TCA o antiarritimicos: riesgo de QT prolongado
antipsicotico + claritromicina, TCA o antiarritimicos: riesgo de QT prolongado
Dopamine puts the breaks on PRL. Although risperidone is atypical, it has similar side effects to typical
Dopamine puts the breaks on PRL. Although risperidone is atypical, it has similar side effects to typical
Conduct disorder violates basic social rules and is aggressive towards animals, whereas oppositional defiant disorder has not respect towards figures of authority and blame pairs for his faults
Conduct disorder violates basic social rules and is aggressive towards animals, whereas oppositional defiant disorder has not respect towards figures of authority and blame pairs for his faults
Oppositional defiant disorder: 1. lose temper 2. argues with adults 3. defies adults 4. refuses obey rules 5. Annoys people 6. blames other 7. easily annoyed 8. vindictive
Oppositional defiant disorder: 1. lose temper 2. argues with adults 3. defies adults 4. refuses obey rules 5. Annoys people 6. blames other 7. easily annoyed 8. vindictive
Compared to children with ADHD, adults tend to be me less impulsive and less hyperactive
Compared to children with ADHD, adults tend to be me less impulsive and less hyperactive
El manejo con ritalina para ADHD puede producir anorexia, insomnio y pérdida de peso, sin embargo estos síntomas son transitorios y tolerables
El manejo con ritalina para ADHD puede producir anorexia, insomnio y pérdida de peso, sin embargo estos síntomas son transitorios y tolerables
Tratamiento de ADHD en adultos: anfetaminas
Tratamiento de ADHD en adultos: anfetaminas
Childhood autism is not a diagnosis on DSM-V, the correct on is “Autism Spectrum Disorder”
Childhood autism is not a diagnosis on DSM-V, the correct on is “Autism Spectrum Disorder”
Asperger syndrome usually has normal language
Asperger syndrome usually has normal language
Tratamiento de depresión en niños y adolescentes: primera linea CBT, después fluoxetina.
Tratamiento de depresión en niños y adolescentes: primera linea CBT, después fluoxetina.
Cluster C: - Avoidant: timid, shy, low self-esteem, but they want friends. - Deppendet: passive, others direct their life, lack of self-confidence - Obsesivo- compulsive: perfeccionista, tiny details, they don’t like changes in their routines
Cluster C: - Avoidant: timid, shy, low self-esteem, but they want friends. - Deppendet: passive, others direct their life, lack of self-confidence - Obsesivo- compulsive: perfeccionista, tiny details, they don’t like changes in their routines
Coster B: - Antisocial: violate the rights of others - Narcisistic: grandiosity of their own importance - Histrionic: attention seeking, excess emotion - Boder line: Unstable, view others as “all-good” or “all-bad”
Coster B: - Antisocial: violate the rights of others - Narcisistic: grandiosity of their own importance - Histrionic: attention seeking, excess emotion - Boder line: Unstable, view others as “all-good” or “all-bad”
Management for borderline: frequent visits
Management for borderline: frequent visits
Cluster A - Paranoid: No cree en nadir y por eso se aleja y no tiene amigos - Schizoid: No quiere amigos, por eso esta solo y se aleja - Schizotypical: Es raro, se viste raro, piensa raro, pero no tiene esquizofrenia porque no ha hecho un solo episodio de psicótico.
Cluster A - Paranoid: No cree en nadir y por eso se aleja y no tiene amigos - Schizoid: No quiere amigos, por eso esta solo y se aleja - Schizotypical: Es raro, se viste raro, piensa raro, pero no tiene esquizofrenia porque no ha hecho un solo episodio de psicótico.
Eating disorders: - Vomiting: decreased H+, metabolic alkalosis - Laxatives: increased H+, metabolic acidosis
Eating disorders: - Vomiting: decreased H+, metabolic alkalosis - Laxatives: increased H+, metabolic acidosis
Bulimia: metabolic alkalosis, hypokalemia, hypocloremia
Bulimia: metabolic alkalosis, hypokalemia, hypocloremia
In bulimia most evidence for fluoxetine
In bulimia most evidence for fluoxetine
In anorexia nerviosa there is a low level of LH and FSH
In anorexia nerviosa there is a low level of LH and FSH
MAOIs should be avoid in anorexia nerviosa
MAOIs should be avoid in anorexia nerviosa
Desordenes de identidad de genero se presentan con cross-dressing in childhood
Desordenes de identidad de genero se presentan con cross-dressing in childhood
Conversion: un conflicto psicológico por un evento estrsante recientemente ocurrido produce síntomas neurológicos generalmente desmayos o parálisis. Generalmente es autolimitado.
Conversion: un conflicto psicológico por un evento estrsante recientemente ocurrido produce síntomas neurológicos generalmente desmayos o parálisis. Generalmente es autolimitado.
En el conversion disorder muchos paciente experimentan “la belle indifférence” lo que quiere decir que no presentan particular interés por los síntomas que presentan por el convertido.
En el conversion disorder muchos paciente experimentan “la belle indifférence” lo que quiere decir que no presentan particular interés por los síntomas que presentan por el convertido.
Tratamiento de elección para somatic symptom disorder: visitas frecuentes a medico primario
Tratamiento de elección para somatic symptom disorder: visitas frecuentes a medico primario
Somatic symptom disorder is NOT intentional like other disorders like malingering or factitious, hence it doesn’t have secondary gain.
Somatic symptom disorder is NOT intentional like other disorders like malingering or factitious, hence it doesn’t have secondary gain.
In order to maje de diagnosis of somatic symptom disorder the criteria is: - 30 yrs - two GI symptoms - one neurological symptom - one reproductive symptom - involvement of at least 4 body parts
In order to maje de diagnosis of somatic symptom disorder the criteria is: - 30 yrs - two GI symptoms - one neurological symptom - one reproductive symptom - involvement of at least 4 body parts
No existe tratamiento farmacológico para tratar la adicción por metanfetaminas, lo único que se ha visto que funciona es la terapia cognitiva
No existe tratamiento farmacológico para tratar la adicción por metanfetaminas, lo único que se ha visto que funciona es la terapia cognitiva
Drogas que producen paranoia y alucinaciones: cocaina, anfetaminas, cannabis, metanfetaminas
Drogas que producen paranoia y alucinaciones: cocaina, anfetaminas, cannabis, metanfetaminas
Cocaina bloquea la recaptacion de dopamina, produciendo euforia. Además produce aumento de norepinefrina y epinefrina produciendo vasoespasmo e hipertensión
Cocaina bloquea la recaptacion de dopamina, produciendo euforia. Además produce aumento de norepinefrina y epinefrina produciendo vasoespasmo e hipertensión
Marijuana produces paranoia
Marijuana produces paranoia
Opioid overdose’s triad: 1. CNS depression 2. Respiratory depression 3. Miosis
Opioid overdose’s triad: 1. CNS depression 2. Respiratory depression 3. Miosis
bebesodre de inicio tardio tienen mejor respuesta al tratamiento de abuso de alcohol
bebesodre de inicio tardio tienen mejor respuesta al tratamiento de abuso de alcohol
Disulfiram es un medicamento que mediante la inhibición del metabolismo del alcohol produce aumento de acetaldehido produciendo síntomas como ansiedad, taquicardia y flushing en caso de que el paciente tome alcohol. Se usa como tratamiento disuasivo.
Disulfiram es un medicamento que mediante la inhibición del metabolismo del alcohol produce aumento de acetaldehido produciendo síntomas como ansiedad, taquicardia y flushing en caso de que el paciente tome alcohol. Se usa como tratamiento disuasivo.
Screenign in alcoholism (CAGE) - Have you ever felt the need of Cut down? - Have you ever felt Annoyed at criticism? - Have you ever felt Guilty? - Have you ever felt the need of drinking in the morning? (Eye opener)
Screenign in alcoholism (CAGE) - Have you ever felt the need of Cut down? - Have you ever felt Annoyed at criticism? - Have you ever felt Guilty? - Have you ever felt the need of drinking in the morning? (Eye opener)
Dementia us a risk factor for delirium
Dementia us a risk factor for delirium
Obsessive-compulsive disorder first line: fluoxetine (SSRIs)
Obsessive-compulsive disorder first line: fluoxetine (SSRIs)
The presence of compulsions distinguish obsessive-compulsive therapy from other kinds of anxiety disorders
The presence of compulsions distinguish obsessive-compulsive therapy from other kinds of anxiety disorders
Cognitive-behavioral therapy is effective in the treatment of obsessive-compulsive disorder
Cognitive-behavioral therapy is effective in the treatment of obsessive-compulsive disorder
Grief treatment: support and watchful waiting is the first line
Grief treatment: support and watchful waiting is the first line
Litio causa hipotiroidismo
Litio causa hipotiroidismo
Si un paciente con tratamiento crónico con litio decide dejar de tomarlo, lo más probable es que tenga un episodio maniaco en los próximos 6 meses
Si un paciente con tratamiento crónico con litio decide dejar de tomarlo, lo más probable es que tenga un episodio maniaco en los próximos 6 meses
Examenes para realizarle a un paciente con sospecha de TAB antes de iniciar el tratamiento: logras, electrolitos, cbc y tiroides
Examenes para realizarle a un paciente con sospecha de TAB antes de iniciar el tratamiento: logras, electrolitos, cbc y tiroides
Primera línea en tab: Litio y valproato
Primera línea en tab: Litio y valproato
Para considerar un episodio como maniaco, este debe durar 1 semana como mínimo.
Para considerar un episodio como maniaco, este debe durar 1 semana como mínimo.
Maternity blues: inicia a los 2 a 4 días postparto, dura de 2 a 10 días. Depresión postparto: dura de 2 a 6 meses
Maternity blues: inicia a los 2 a 4 días postparto, dura de 2 a 10 días. Depresión postparto: dura de 2 a 6 meses
función tiroides siempre se evalua en pacientes con depresión postparto
función tiroides siempre se evalua en pacientes con depresión postparto
para depresión con rasgos psicóticos se debe tratar con TEC, especialmente si se trata de un paciente mayor
para depresión con rasgos psicóticos se debe tratar con TEC, especialmente si se trata de un paciente mayor
los antidepresivos se deben dar mínimos por periodos de 4 a 6 semanas para evaluar su eficacia. Si no sirven para nada, se cambia. Si mejora un poco se ajusta la dosis y/o se adiciona otro. Si es resistente a todo o es severa, TEC
los antidepresivos se deben dar mínimos por periodos de 4 a 6 semanas para evaluar su eficacia. Si no sirven para nada, se cambia. Si mejora un poco se ajusta la dosis y/o se adiciona otro. Si es resistente a todo o es severa, TEC
para mujeres embarazadas extremadamente deprimidas que pueden poner en riesgo su vida y la de su feto, se marea con TEC, especialmente si se acompaña de síntomas psicóticos.
para mujeres embarazadas extremadamente deprimidas que pueden poner en riesgo su vida y la de su feto, se marea con TEC, especialmente si se acompaña de síntomas psicóticos.
cambio en ciclos circadianos indica depresión atípica
cambio en ciclos circadianos indica depresión atípica
Los triciclos no se usan en viejitos porque producen hipotensión postural y síntomas anticolinergicos (retención urinaria, boca seca y constipación)
Los triciclos no se usan en viejitos porque producen hipotensión postural y síntomas anticolinergicos (retención urinaria, boca seca y constipación)
fluoxetina es el antidepresivo de elección en niños
fluoxetina es el antidepresivo de elección en niños
SSRIs son los medicamentos de elección en adultos mayores, especialmente citalopram por sus beneficios en el manejo de la demencia
SSRIs son los medicamentos de elección en adultos mayores, especialmente citalopram por sus beneficios en el manejo de la demencia
Categorias para embarazo: A: estudios en humanos, se pueden tomar. B: estudios en animales, parece ser bueno. C: estudios en animales, parece ser malo. D: estudios en humanos, no se deben tomar a menos que se estrictamente necesario. X: estudios en humanos, no tomar por nada del mundo.
Categorias para embarazo: A: estudios en humanos, se pueden tomar. B: estudios en animales, parece ser bueno. C: estudios en animales, parece ser malo. D: estudios en humanos, no se deben tomar a menos que se estrictamente necesario. X: estudios en humanos, no tomar por nada del mundo.
Mirtazapina no produce efectos secundarios sexuales ni agitación
Mirtazapina no produce efectos secundarios sexuales ni agitación
Mirtazapina y bupuprion no producen efectos secundarios sexuales, pero bupuprion produce ansiedad y agitación
Mirtazapina y bupuprion no producen efectos secundarios sexuales, pero bupuprion produce ansiedad y agitación
Depresión: - niños: fluexoteina - viejitos: sertralina, no seas triciclos - con problemas sexuales: mirtazapina o bupurpion - con ansiedad: evitar bupuprion
Depresión: - niños: fluexoteina - viejitos: sertralina, no seas triciclos - con problemas sexuales: mirtazapina o bupurpion - con ansiedad: evitar bupuprion
En depresión en 4 a 6 semanas se sabe si el tratamiento funcionó, luego se debe continuar por mínimo 6 meses
En depresión en 4 a 6 semanas se sabe si el tratamiento funcionó, luego se debe continuar por mínimo 6 meses
SSRIs se pueden dar en el embarazo
SSRIs se pueden dar en el embarazo
Regarding the treatment of generalized anxiety disorder, cognitive therapy is as effective as pharmacologic therapy
Regarding the treatment of generalized anxiety disorder, cognitive therapy is as effective as pharmacologic therapy
treatment of generalized anxiety disorder: SSRI and SNRI
treatment of generalized anxiety disorder: SSRI and SNRI
Agoraphobia: anxiety about not being able to scape. The individual fears or avoids these situations because go thoughts that scape might be difficult or help might not be available in the event of developing panic-like symptoms
Agoraphobia: anxiety about not being able to scape. The individual fears or avoids these situations because go thoughts that scape might be difficult or help might not be available in the event of developing panic-like symptoms
Las benzodiazepinas se usan para tratamiento de pánico agudo, no para tratamiento crónico
Las benzodiazepinas se usan para tratamiento de pánico agudo, no para tratamiento crónico
Bupuprion se debe evitar en tratamiento de pánico porque puede exacerbar los síntomas
Bupuprion se debe evitar en tratamiento de pánico porque puede exacerbar los síntomas
cognitive behavioral therapy is the dos efficacious psychological treatment in panic disorder
cognitive behavioral therapy is the dos efficacious psychological treatment in panic disorder
Primera linea de tratamiento de panic disorder son los SSRI como fluoxetina, citalopram, paroxetina y setralina
Primera linea de tratamiento de panic disorder son los SSRI como fluoxetina, citalopram, paroxetina y setralina
en un paciente con panic disorder primer se trata de hablar con el, se le explica la situación para que entre en si. en caso de que esto no sería, se inicia con una benzodiazepina de acción rápida como lorazepam
en un paciente con panic disorder primer se trata de hablar con el, se le explica la situación para que entre en si. en caso de que esto no sería, se inicia con una benzodiazepina de acción rápida como lorazepam
Imipramina debe ser evitada en paciente con HPB porque aumenta los síntomas
Imipramina debe ser evitada en paciente con HPB porque aumenta los síntomas
An agitated patient with brief psychosis should first be sedated with benzodiazepine as required (lorazepam), then treated with an appropriated antipsychotic like risperidone
An agitated patient with brief psychosis should first be sedated with benzodiazepine as required (lorazepam), then treated with an appropriated antipsychotic like risperidone
al momento de cambiar un antipsicótico se debe bajar paulatinamente su dosis y a la vez empezar el nuevo y subirle su dosis progresivamente.
al momento de cambiar un antipsicótico se debe bajar paulatinamente su dosis y a la vez empezar el nuevo y subirle su dosis progresivamente.
Quetiapina es bien tolerado por los paciente con parkinson, mientras que la risperidona no. Por otro lado se debe evitar el uso de haloperidol porque aumenta el riesgo de síntomas extrapiramidales.
Quetiapina es bien tolerado por los paciente con parkinson, mientras que la risperidona no. Por otro lado se debe evitar el uso de haloperidol porque aumenta el riesgo de síntomas extrapiramidales.
Clozapina se usa en casos refractarios de esquizofrenia
Clozapina se usa en casos refractarios de esquizofrenia
Pacientes en tratamiento con clozapina deben ser seguidos con CBC semanales por riesgo de agranulocitosis
Pacientes en tratamiento con clozapina deben ser seguidos con CBC semanales por riesgo de agranulocitosis
Gemelo monocigótoco tiene un 40% de probabilidad de tener esquizofrenia. Siempre evaluar el riesgo de suicidio. Si dura menos de un mes es “brief psychotic disorder”, si dura entre 1 y 6 meses es “schizophreniform diroder” y mas de 6 meses es esquizofrenia
Gemelo monocigótoco tiene un 40% de probabilidad de tener esquizofrenia. Siempre evaluar el riesgo de suicidio. Si dura menos de un mes es “brief psychotic disorder”, si dura entre 1 y 6 meses es “schizophreniform diroder” y mas de 6 meses es esquizofrenia
Schizophrenia se da mas en bajos niveles socioeconómicos porque estas personas por su enfermedad descienden en la escala social
Schizophrenia se da mas en bajos niveles socioeconómicos porque estas personas por su enfermedad descienden en la escala social
women have higher risk of suicide attempt, whereas men have higher risk of completed suicide
women have higher risk of suicide attempt, whereas men have higher risk of completed suicide
2/3 of suicide deaths occur on the first attempt
2/3 of suicide deaths occur on the first attempt
highest rate of death by suicide > 65 yrs
highest rate of death by suicide > 65 yrs
A depressed patient is at very high risk of committing suicide when he begins to regain energy with the treatment
A depressed patient is at very high risk of committing suicide when he begins to regain energy with the treatment
unilateral asthma is a foreign body until proven otherwise
unilateral asthma is a foreign body until proven otherwise
When a battery is located in the esophagus it should be immediately removed, but when it is located in the stomach, it can be observed and repeated the radiograph in 48 hours.
When a battery is located in the esophagus it should be immediately removed, but when it is located in the stomach, it can be observed and repeated the radiograph in 48 hours.
Laringomalacia es una condición en la cual hay inmadurez en la formación de la glotis, por lo que se produce un colapso de la misma durante la inspiración, generando estridor inspiratorio, es de hecho la causa más común de estridor en lactantes. Generalmente no requiere tratamiento ya que tiende a mejorar a medida que se completa su desarrollo.
Laringomalacia es una condición en la cual hay inmadurez en la formación de la glotis, por lo que se produce un colapso de la misma durante la inspiración, generando estridor inspiratorio, es de hecho la causa más común de estridor en lactantes. Generalmente no requiere tratamiento ya que tiende a mejorar a medida que se completa su desarrollo.
Croup: H influenza, tx ceftriaxone
Croup: H influenza, tx ceftriaxone
Drooling, inspiratory stridor, leaning forward: epiglottitis
Drooling, inspiratory stridor, leaning forward: epiglottitis
stridor and barking cough are key words in croup cases
stridor and barking cough are key words in croup cases
Croup’s pathogen: parainfluenza
Croup’s pathogen: parainfluenza
Corticosteroids reduces the chances of a hospitalization in a croup case
Corticosteroids reduces the chances of a hospitalization in a croup case
Dexamenthasone in croup can lower the chances of an hospitalization, it is use for all the croup cases even the mild ones, and even a single dose can be adequate.
Dexamenthasone in croup can lower the chances of an hospitalization, it is use for all the croup cases even the mild ones, and even a single dose can be adequate.
Trismus is almost always present in tonsils abscess
Trismus is almost always present in tonsils abscess
Most common cause of AOM in children is s pneumoniae
Most common cause of AOM in children is s pneumoniae
Cipro os not approved for patients under age of 18
Cipro os not approved for patients under age of 18
Most common cause of recurrent AOM in children is penicillin resistant s pneumoniae
Most common cause of recurrent AOM in children is penicillin resistant s pneumoniae
Nodules with more than 0.5 cm go to FNA if they have suspicious features, otherwise only greater than 1 cm need FNA
Nodules with more than 0.5 cm go to FNA if they have suspicious features, otherwise only greater than 1 cm need FNA
Symptoms of higher incidence of malignancy in a thyroid nodule: - hoarseness - dysphagia - neck pain
Symptoms of higher incidence of malignancy in a thyroid nodule: - hoarseness - dysphagia - neck pain
Thyroid carcinoma (Papilar) Ps Popular, palpable, positive I uptake, positive prognosis
Thyroid carcinoma (Papilar) Ps Popular, palpable, positive I uptake, positive prognosis
Nasopharyngeal carcinoma is treated with radiotherapy and EBV is a well known risk factor
Nasopharyngeal carcinoma is treated with radiotherapy and EBV is a well known risk factor
Sialolithiasis, 80% in submandibular gland
Sialolithiasis, 80% in submandibular gland
Sialadenitis con sabor fetido en boca es indicativo de etiología bacteriana
Sialadenitis con sabor fetido en boca es indicativo de etiología bacteriana
Paciente con asma v a tener disminución de FEV1 así como disminución de FEV1/FVC. Si además se presenta una afectación de la fase inspiradora del cliclo, indica enfermedad extrapulmonar como por ejemplo una obstrucción (disyunción de cuerdas vocales)
Paciente con asma v a tener disminución de FEV1 así como disminución de FEV1/FVC. Si además se presenta una afectación de la fase inspiradora del cliclo, indica enfermedad extrapulmonar como por ejemplo una obstrucción (disyunción de cuerdas vocales)
Sinusitis por más de 10 días, fiebre alta, descarga purulenta-> baeriano (amoxa)
Sinusitis por más de 10 días, fiebre alta, descarga purulenta-> baeriano (amoxa)
multiple falla terapeutica en sinusisitis, se realiza un tac
multiple falla terapeutica en sinusisitis, se realiza un tac
Sinusitis bacteriana: - primera línea: amoxa (macrolido o tmp si alergico) - segunda línea: fluoroquinolona (levofloxacina) o amoxa-clavulanato
Sinusitis bacteriana: - primera línea: amoxa (macrolido o tmp si alergico) - segunda línea: fluoroquinolona (levofloxacina) o amoxa-clavulanato
tratamiento para sinusitis aguda con mayor evidencia son los analgésicos
tratamiento para sinusitis aguda con mayor evidencia son los analgésicos
Tratamiento ideal para rinitis alérgica son los glucocorticoides nasales
Tratamiento ideal para rinitis alérgica son los glucocorticoides nasales
Los descongestionantes nasales como la oximetazolina pueden producir rinitis medicamentosa
Los descongestionantes nasales como la oximetazolina pueden producir rinitis medicamentosa
En zonas endémicas de enfermedad de Lyme, se ha visto que es la principal causa de parálisis facial, más que OMA
En zonas endémicas de enfermedad de Lyme, se ha visto que es la principal causa de parálisis facial, más que OMA
otalgia, discharge, pain + granulation tissue on othoscopy = malignant otitis externa (osteomyelitis of temporal bone) Psudomona is responsible for 99% of cases
otalgia, discharge, pain + granulation tissue on othoscopy = malignant otitis externa (osteomyelitis of temporal bone) Psudomona is responsible for 99% of cases
Swimming pool external otitis is due to pseudomonas aeruginosa and some times to S aureus. The rise on the external pH is the cause.
Swimming pool external otitis is due to pseudomonas aeruginosa and some times to S aureus. The rise on the external pH is the cause.
Acoustic neuroma is suspected when a patient has asymmetric sensorineural hearing loss, the best initial test is the audiometry and then a MRI or CT scan
Acoustic neuroma is suspected when a patient has asymmetric sensorineural hearing loss, the best initial test is the audiometry and then a MRI or CT scan
Diagnostic criteria for Menière’s disease: - Two episodes of vertigo that lasted > 20 min. - Neurosensorial hearing loss - Tinnitus or aura fullness
Diagnostic criteria for Menière’s disease: - Two episodes of vertigo that lasted > 20 min. - Neurosensorial hearing loss - Tinnitus or aura fullness
If the nystagmus disappears during visual fixation is peripheral rather that central vertigo
If the nystagmus disappears during visual fixation is peripheral rather that central vertigo
weber’s lateralization: ipsilateral conductive hearing loss or contralateral sensorial hearing loss
weber’s lateralization: ipsilateral conductive hearing loss or contralateral sensorial hearing loss
Otosclerosis= conductive hearing loss
Otosclerosis= conductive hearing loss
Frequencies for the understanding of speech are 400-2000 Hz
Frequencies for the understanding of speech are 400-2000 Hz
presbycusis affects mainly high frequencies
presbycusis affects mainly high frequencies
most likely cause of hearing loss in newborns are genetics disorders such as alport’s
most likely cause of hearing loss in newborns are genetics disorders such as alport’s
Occupational hearing loss affects high frequencies, typically 4000 Hz
Occupational hearing loss affects high frequencies, typically 4000 Hz
Malignidad es la complicación más común de criptorquidea
Malignidad es la complicación más común de criptorquidea
Child with asymptomatic abdominal mass, which is firma and nontender, with association of genitourinary malformations, retardation and aniridia, has WAGR syndrome (Wilms tumor, aniridia, genitourinary malformation and retardation)
Child with asymptomatic abdominal mass, which is firma and nontender, with association of genitourinary malformations, retardation and aniridia, has WAGR syndrome (Wilms tumor, aniridia, genitourinary malformation and retardation)
Screening test for vesicoureteral reflux: voiding cystourethrography
Screening test for vesicoureteral reflux: voiding cystourethrography
Es normal que con la edad el hombre necesite de mayor estimulo táctil para obtener una erección
Es normal que con la edad el hombre necesite de mayor estimulo táctil para obtener una erección
Si un paciente consulta por disyunción eréctil, pero a la vez es capaz de tener erecciones matinales o en otras situaciones, la causa es psicógena y no orgánica
Si un paciente consulta por disyunción eréctil, pero a la vez es capaz de tener erecciones matinales o en otras situaciones, la causa es psicógena y no orgánica
Disfuncion eréctil organica se presenta en adultos mayores, psicogena se presenta en jóvenes
Disfuncion eréctil organica se presenta en adultos mayores, psicogena se presenta en jóvenes
SSRI (ISRS) tiene como efecto secundario la impotencia, además de nausea, perdida de apetito, diarrea, ansiedad y problemas de sueño
SSRI (ISRS) tiene como efecto secundario la impotencia, además de nausea, perdida de apetito, diarrea, ansiedad y problemas de sueño
Right-sided varicocele may indicate retroperitoneal mass
Right-sided varicocele may indicate retroperitoneal mass
Surgical exploration in testicular torsion should be done within 6 hours
Surgical exploration in testicular torsion should be done within 6 hours
In spermatocele avoid aspiration as it can leads to infection
In spermatocele avoid aspiration as it can leads to infection
Prehn’s sign: patiente with testicular pain, whose pain is relieved with testicular elevation. - Torsion (negative) - epididymitis (positive)
Prehn’s sign: patiente with testicular pain, whose pain is relieved with testicular elevation. - Torsion (negative) - epididymitis (positive)
adolescent with varicocele should have testicular volume evaluation before decide which is the best treatment because if there is a compromise in the testicular volume, it will be an indication for surgical consultation rather than observation
adolescent with varicocele should have testicular volume evaluation before decide which is the best treatment because if there is a compromise in the testicular volume, it will be an indication for surgical consultation rather than observation
In varicocele transilumination test is negative
In varicocele transilumination test is negative
Varicocele disappears on supine position
Varicocele disappears on supine position
Testes and scrotum have different lymphatic drainage, therefore trans-scrotal approach for biopsy or orchidectomy should be avoided
Testes and scrotum have different lymphatic drainage, therefore trans-scrotal approach for biopsy or orchidectomy should be avoided
- PSA is more sensitive tan DRE. - If PSA and DRE are both normal, no further action is required
- PSA is more sensitive tan DRE. - If PSA and DRE are both normal, no further action is required
prostatic cancer with nodule involvement or metastasis -> treatment with hormone therapy
prostatic cancer with nodule involvement or metastasis -> treatment with hormone therapy
black population are in higher risk of prostate cancer
black population are in higher risk of prostate cancer
prostate cancer with nodule involvement or metastasis, treatment with hormones
prostate cancer with nodule involvement or metastasis, treatment with hormones
Gross painless hematuria in an adult is bladder cancer until proven otherwise. The diagnostic test of choice is a cystoscopy
Gross painless hematuria in an adult is bladder cancer until proven otherwise. The diagnostic test of choice is a cystoscopy
Quistes simples renales no requieren mayores tratamientos
Quistes simples renales no requieren mayores tratamientos
Recurrencia de cálculos de calcio se puede mejorar con menor ingesta de grasas
Recurrencia de cálculos de calcio se puede mejorar con menor ingesta de grasas
todo paciente con demasiado dolor debe ser tratado con opioides incluso si es drogadicto
todo paciente con demasiado dolor debe ser tratado con opioides incluso si es drogadicto
ph < 5.5 riesgo de cálculos por acido urico. Uno de los tratamientos para los cálculos de calcio es con una tiazida porque promueve la reabsorción de calcio
ph < 5.5 riesgo de cálculos por acido urico. Uno de los tratamientos para los cálculos de calcio es con una tiazida porque promueve la reabsorción de calcio
Los cálculos por acido rico son radiolucidos (no se ven en la radiografía) se tratan con analgesia, liguidos y se busca alcalinizar la orina con bicarbonato o con nitrato de potasio
Los cálculos por acido rico son radiolucidos (no se ven en la radiografía) se tratan con analgesia, liguidos y se busca alcalinizar la orina con bicarbonato o con nitrato de potasio
tratamiento de epididimitis si edad < 35: ceftriaxona y doxiciclina
tratamiento de epididimitis si edad < 35: ceftriaxona y doxiciclina
epididimitis en mayores de 35 años: e. coli, se trata con ofloxacina
epididimitis en mayores de 35 años: e. coli, se trata con ofloxacina
Cuando en un paciente con pielonefritis se identifica en el cultivo S aureus, se debe sospechar bacteremia y posible embolo infeccioso por endocardidits infecciosa
Cuando en un paciente con pielonefritis se identifica en el cultivo S aureus, se debe sospechar bacteremia y posible embolo infeccioso por endocardidits infecciosa
Trimethoprim/sulfa is a pregnancy category C
Trimethoprim/sulfa is a pregnancy category C
Casos en los que se hace screening para bacteria: - embarazo - transplante renal - inmunosupresion
Casos en los que se hace screening para bacteria: - embarazo - transplante renal - inmunosupresion
E. Coli present in 90% of UTI
E. Coli present in 90% of UTI
asymptomatic + >100,000 CFU/ml: no treatment
asymptomatic + >100,000 CFU/ml: no treatment
Moxifloxacin isn’t use in UTI because its concentration in urine are low
Moxifloxacin isn’t use in UTI because its concentration in urine are low
A less than 4-5 mm stone can be treated medically with pain killers and hydration
A less than 4-5 mm stone can be treated medically with pain killers and hydration
DM-> autonomic neuropathy-> retention-> overflow incontinence Therapy: promore urinarion by the use of cholinergic drugs such as Bethanecol
DM-> autonomic neuropathy-> retention-> overflow incontinence Therapy: promore urinarion by the use of cholinergic drugs such as Bethanecol
hematuria macroscopica requiere mayores investigaciones y hasta valoraciones especializadas. Mientras que microscópica puede ser un hallazgo incidental y transitorio por lo que debe repetir una semana después luego si vuelve a salir positivo se debe realizar un cultivo
hematuria macroscopica requiere mayores investigaciones y hasta valoraciones especializadas. Mientras que microscópica puede ser un hallazgo incidental y transitorio por lo que debe repetir una semana después luego si vuelve a salir positivo se debe realizar un cultivo
b2 micro globulin and albumin ar used to determine the prognosis in multiple myeloma
b2 micro globulin and albumin ar used to determine the prognosis in multiple myeloma
Onion skinning pattern = Ewing’s Sarcoma
Onion skinning pattern = Ewing’s Sarcoma
A patient with multiple myeloma but with neither symptoms nor organ damage, does not need treatment
A patient with multiple myeloma but with neither symptoms nor organ damage, does not need treatment
Osgood-Schlatter disease: Inflation of patellar ligament at insertion point on tibial tuberosity
Osgood-Schlatter disease: Inflation of patellar ligament at insertion point on tibial tuberosity
Osgood-Schlatter disease is self-limited condition
Osgood-Schlatter disease is self-limited condition
Teenage obese patient with groin, thigh or even knee pain that on physical exam has limitation to internal rotation as well as limitation to abduction is highly suspicious of Slipped Capital Femoral Epiphysis
Teenage obese patient with groin, thigh or even knee pain that on physical exam has limitation to internal rotation as well as limitation to abduction is highly suspicious of Slipped Capital Femoral Epiphysis
Tibia is the most common site of stress fractures in children
Tibia is the most common site of stress fractures in children
stress fractures don’t require casting. It can be managed by limiting the activity
stress fractures don’t require casting. It can be managed by limiting the activity
Stretching exercises for the achilles tendon are the first line in the treatment of plantar fasciitis
Stretching exercises for the achilles tendon are the first line in the treatment of plantar fasciitis
treatment of grado I to II ankle sprains: RICE(REST, ICE, COMPRESION, ELEVATION) and it is also recommended early range of motion exercises to maintain flexibility
treatment of grado I to II ankle sprains: RICE(REST, ICE, COMPRESION, ELEVATION) and it is also recommended early range of motion exercises to maintain flexibility
the best treatment of patellofemoral syndrome is physical therapy
the best treatment of patellofemoral syndrome is physical therapy
pain with prolonged sitting is a sing of patellofemroal syndrome
pain with prolonged sitting is a sing of patellofemroal syndrome
major indication for knee replacement is severe pain at rest
major indication for knee replacement is severe pain at rest
Anterior cruciate ligament tears are more common than posterior cruciate ligament tear. Medial colateral ligament tears are more common than lateral colateral ligament tear
Anterior cruciate ligament tears are more common than posterior cruciate ligament tear. Medial colateral ligament tears are more common than lateral colateral ligament tear
Slipped capital femoral epiphysis is a fracture trough the growth plate of the femur below his head; its main complication is te AVN
Slipped capital femoral epiphysis is a fracture trough the growth plate of the femur below his head; its main complication is te AVN
Stress fractures of the femur occurs frequently in military and runners, generally is happens on the neck
Stress fractures of the femur occurs frequently in military and runners, generally is happens on the neck
anterolateral hip joint pain accentuated when pivoting or moving from a seated position to a standing is diagnostic of femoral impingement
anterolateral hip joint pain accentuated when pivoting or moving from a seated position to a standing is diagnostic of femoral impingement
Resumption of physical activity and multidisciplinary rehabilitation in a patient with back pain are better than bed rest
Resumption of physical activity and multidisciplinary rehabilitation in a patient with back pain are better than bed rest
back pain red flags: 1. Nerosensorial abnormalities (bladder/bowel dysfunction, paresthesia/anestesia) 2. Weight loss 3. Age > 50 4. IV drug use 5. Chronic disease
back pain red flags: 1. Nerosensorial abnormalities (bladder/bowel dysfunction, paresthesia/anestesia) 2. Weight loss 3. Age > 50 4. IV drug use 5. Chronic disease
Bilateral back pain that is relieved by flexing the legs or a sitting position is Spinal Stenosis until proven otherwise
Bilateral back pain that is relieved by flexing the legs or a sitting position is Spinal Stenosis until proven otherwise
Test confirmation of Spinal Stenosis is MRI
Test confirmation of Spinal Stenosis is MRI
Fractura de escamondes siempre se trata así las radiografía sean negativas, se coloca una long-arm thumb spica y luego se repiten las radiografías en 2 semanas para confirmar la sospecha
Fractura de escamondes siempre se trata así las radiografía sean negativas, se coloca una long-arm thumb spica y luego se repiten las radiografías en 2 semanas para confirmar la sospecha
Fractura de escamondes se trata en principio con long-arm thumb spica, luego de 4 semana se cambia por short-arm spica
Fractura de escamondes se trata en principio con long-arm thumb spica, luego de 4 semana se cambia por short-arm spica
Para reducir la fractura de calles se debe realizar la siguiente maniobra: ligera flexion de la muñeca, pronacion y desviación cubital
Para reducir la fractura de calles se debe realizar la siguiente maniobra: ligera flexion de la muñeca, pronacion y desviación cubital
La principal complicación de la fractura de escamondes es la AVASCULAR NECROSIS especialmente si la fractura es a nivel proximal porque por ahi entra la arteria que nutre el hueso
La principal complicación de la fractura de escamondes es la AVASCULAR NECROSIS especialmente si la fractura es a nivel proximal porque por ahi entra la arteria que nutre el hueso
Diagnóstico de epicondilitis: clinico
Diagnóstico de epicondilitis: clinico
Compartment syndrome in supracondylar facture of the humerus can lead to Volkmar’s ischemic contracture
Compartment syndrome in supracondylar facture of the humerus can lead to Volkmar’s ischemic contracture
Las fracturas del tercio distal de la clavícula que están desplazadas se operan!
Las fracturas del tercio distal de la clavícula que están desplazadas se operan!
Un paciente con un desgarro en hombro tendrá dolor al movimiento activo pero no al pasivo, mientras que en el síndrome de hombro congelado se presenta dolor tanto en movimiento activo como pasivo
Un paciente con un desgarro en hombro tendrá dolor al movimiento activo pero no al pasivo, mientras que en el síndrome de hombro congelado se presenta dolor tanto en movimiento activo como pasivo
Incidence of frozen shoulder or adhesive capsulitis is higher on diabetic patients
Incidence of frozen shoulder or adhesive capsulitis is higher on diabetic patients
En un paciente que presenta un trauma punzante en una articulación y presenta dolor, edema y lo más importante dolor a lo largo de un tendon, se debe pensar más en una tenosinovitis séptica, más que en una artritis séptica.
En un paciente que presenta un trauma punzante en una articulación y presenta dolor, edema y lo más importante dolor a lo largo de un tendon, se debe pensar más en una tenosinovitis séptica, más que en una artritis séptica.
Study of choice in osteomyelitis is MRI
Study of choice in osteomyelitis is MRI
In compartment syndrome the most importan sign is increased pain with passive extension or stretch. The most importan symptom is pain out of proportion to injury
In compartment syndrome the most importan sign is increased pain with passive extension or stretch. The most importan symptom is pain out of proportion to injury
En un paciente con consumo de alcohol o drogas es común que presente compresión prolongada de una extremidad produciendo un sinrdome compartimentos
En un paciente con consumo de alcohol o drogas es común que presente compresión prolongada de una extremidad produciendo un sinrdome compartimentos
Sintomas en retinitis pigmentosa: 1. night blindness (rods degeneration) 2. Tunel vision (peripheral vision loss) 3. color blindness (cones degeneration) 4. central vision loss
Sintomas en retinitis pigmentosa: 1. night blindness (rods degeneration) 2. Tunel vision (peripheral vision loss) 3. color blindness (cones degeneration) 4. central vision loss
Strabismus is the most common cause of amblyopia
Strabismus is the most common cause of amblyopia
En el contexto de un trauma contundente a nivel de globo ocular y más ante la sospecha de ruptura, NO se debe realizar tonometría
En el contexto de un trauma contundente a nivel de globo ocular y más ante la sospecha de ruptura, NO se debe realizar tonometría
Oftalmopatia tiroidea no responde a antitiroideos, pero si a corticoides
Oftalmopatia tiroidea no responde a antitiroideos, pero si a corticoides
Age-related macular degeneration risk factors: -smoking -female -age
Age-related macular degeneration risk factors: -smoking -female -age
Uno de los síntomas más tempranos de glaucoma es la perdida de visión periférica (vision en túnel)
Uno de los síntomas más tempranos de glaucoma es la perdida de visión periférica (vision en túnel)
Timolol es un beta bloqueador, por lo que sus efectos secundarios incluyen: broncoespasmo (más común), bradicardia, heart block e hipotensión
Timolol es un beta bloqueador, por lo que sus efectos secundarios incluyen: broncoespasmo (más común), bradicardia, heart block e hipotensión
La retinopatia solar (por eclipses generalmente) quesera una quemadura en la macula lo que resulta en un escotoma central
La retinopatia solar (por eclipses generalmente) quesera una quemadura en la macula lo que resulta en un escotoma central
Desprendimiento vivero posterior es el factor de riesgo más común. The most common risk factor for retinal detachment is the posterior detachment of the vitreous
Desprendimiento vivero posterior es el factor de riesgo más común. The most common risk factor for retinal detachment is the posterior detachment of the vitreous
En un paciente con herpes zoster pero con sospecha de compromiso ocular, además del antiretroviral, debe ser visto por oftalmo para evaluar la cornea
En un paciente con herpes zoster pero con sospecha de compromiso ocular, además del antiretroviral, debe ser visto por oftalmo para evaluar la cornea
una abrasion con bordes blancos o grises puede indicar infección y debe ser visto por el oftalmólogo inmediatamente
una abrasion con bordes blancos o grises puede indicar infección y debe ser visto por el oftalmólogo inmediatamente
Deficiencia de vitamina A: ceguera nocturna, ojo seco, ulceras cornales e hiperqueratosis
Deficiencia de vitamina A: ceguera nocturna, ojo seco, ulceras cornales e hiperqueratosis
la principal causa de ceguera en adultos mayores es degeneración macular
la principal causa de ceguera en adultos mayores es degeneración macular
Cognitive behavioral therapy and tricyclics are used in the treatment of fibromyalgia
Cognitive behavioral therapy and tricyclics are used in the treatment of fibromyalgia
Sleep disturbances are commonly seen in fibromyalgia
Sleep disturbances are commonly seen in fibromyalgia
polimialgia reumatica: - edad mayor de 50 - VSG muy elevada, mayor de 100 - dolor bilateral en hombros y caderas - rigidez matinal mayor de 60 mins - respuesta rapida a tratamiento con prednisolona
polimialgia reumatica: - edad mayor de 50 - VSG muy elevada, mayor de 100 - dolor bilateral en hombros y caderas - rigidez matinal mayor de 60 mins - respuesta rapida a tratamiento con prednisolona
tratamiento polimialgia reumatica es con prednisolona 15 mg al día
tratamiento polimialgia reumatica es con prednisolona 15 mg al día
Gota en adultos mayores se presenta de forma diferente, es poliarticular, afecta articulaciones pequeñas generalmente de MMSS y tienden a desarrollar tofos
Gota en adultos mayores se presenta de forma diferente, es poliarticular, afecta articulaciones pequeñas generalmente de MMSS y tienden a desarrollar tofos
Artrocenstesis es el examen de elección en el contexto de un paciente con sospecha de gota, no se usan corticoides a menos que no mejore con NSAIDs o colchicina
Artrocenstesis es el examen de elección en el contexto de un paciente con sospecha de gota, no se usan corticoides a menos que no mejore con NSAIDs o colchicina
Pseudogot se presenta en rodilla, muñecas y tobillo.
Pseudogot se presenta en rodilla, muñecas y tobillo.
Tratamiento de gota aguda: NSAIDs ->colchincina -> corticoides
Tratamiento de gota aguda: NSAIDs ->colchincina -> corticoides
Allopurinol NO se da en cuadros agudos de gota
Allopurinol NO se da en cuadros agudos de gota
Birefingencia postivia y cristales con forma de rombo: pseudogota Birefringencia negativa y cristales con forma de aguja: gota
Birefingencia postivia y cristales con forma de rombo: pseudogota Birefringencia negativa y cristales con forma de aguja: gota
Tratamiento de pseudogota: NSAIDs como indometacina
Tratamiento de pseudogota: NSAIDs como indometacina
Tiazidas pueden precipitar un ataque de gota
Tiazidas pueden precipitar un ataque de gota
Triada de artritis reactiva (sindrome de Behçet): - Artritis - Uveitis/conjuntivitis - Uretritis/cervicitis
Triada de artritis reactiva (sindrome de Behçet): - Artritis - Uveitis/conjuntivitis - Uretritis/cervicitis
HLA-B27 se asocia con espondilitis anquilosan en un 90% de los casos. También se asocia con síndrome de Reiter (triada: artritis, uveitis, uretritis- can’t pee, can’t see, can’t climb a tree)
HLA-B27 se asocia con espondilitis anquilosan en un 90% de los casos. También se asocia con síndrome de Reiter (triada: artritis, uveitis, uretritis- can’t pee, can’t see, can’t climb a tree)
Espondilitis anquilosan da más en hombres en tercera década de vida (20s)
Espondilitis anquilosan da más en hombres en tercera década de vida (20s)
saddle nose deformity=granulomatosis with polyangitis (Wegener). c-ANCA es especifico para wegener
saddle nose deformity=granulomatosis with polyangitis (Wegener). c-ANCA es especifico para wegener
la pilocarpina es un simpaticomimetico lo que estimula la produccion de saliva y lagrimas. Ademas se puede indicar ciclosporina topica para tratar la keratoconjuntivitis sicca
la pilocarpina es un simpaticomimetico lo que estimula la produccion de saliva y lagrimas. Ademas se puede indicar ciclosporina topica para tratar la keratoconjuntivitis sicca
ANA se usa para screening de lupus
ANA se usa para screening de lupus
Actividad de lupus: disminucion de complemento mas anti-dsDNA elevado. Para diagnostico tambien se pueden usar anticuerpos antiphospholipidos
Actividad de lupus: disminucion de complemento mas anti-dsDNA elevado. Para diagnostico tambien se pueden usar anticuerpos antiphospholipidos
factores de mal pronosticoen lupus: hombre, negro, joven, viejo, enfermedad renal, HTA y presencia de anticuerpos antifosfolipidos
factores de mal pronosticoen lupus: hombre, negro, joven, viejo, enfermedad renal, HTA y presencia de anticuerpos antifosfolipidos
enfecto secundario de la hidralazina sintomas de lupus
enfecto secundario de la hidralazina sintomas de lupus
Anti-CCP es el test mas especifico para AR
Anti-CCP es el test mas especifico para AR
El diagnostico de AR es mayormente clínico, el facto reumatoide esta por lo general negativo en los primeros meses de la enfermedad, luego se positiviza
El diagnostico de AR es mayormente clínico, el facto reumatoide esta por lo general negativo en los primeros meses de la enfermedad, luego se positiviza
Solo los biológicos y los DMARDs interfieren en la progresion de la AR
Solo los biológicos y los DMARDs interfieren en la progresion de la AR
Se ha visto que uno de los síntomas secundarios de los corticoides es síntomas afectivos relacionado con TAB, los cuales se pueden revertir al al retirar el medicamento
Se ha visto que uno de los síntomas secundarios de los corticoides es síntomas afectivos relacionado con TAB, los cuales se pueden revertir al al retirar el medicamento
no treatment alters the natural history of OA
no treatment alters the natural history of OA
OA most common in women than in men, rest improves the pain.
OA most common in women than in men, rest improves the pain.
Treatment of OA: weight, physiotherapy, acetaminophen/NSAID
Treatment of OA: weight, physiotherapy, acetaminophen/NSAID
Best initial treatment of OA is acetamoniphen
Best initial treatment of OA is acetamoniphen
El tramadol puede causar convulsiones, especialmente en adultos mayores
El tramadol puede causar convulsiones, especialmente en adultos mayores
No se debe dar meperidina en los adultos mayores porque su metabolismo puede producir convulsiones.
No se debe dar meperidina en los adultos mayores porque su metabolismo puede producir convulsiones.
Signos y sintomas de dolor neuropático son: disminución de sensación de frío, hipoalgesia, hiperalgesia o alodinia
Signos y sintomas de dolor neuropático son: disminución de sensación de frío, hipoalgesia, hiperalgesia o alodinia
Opioides usados en UCI: fentanil, morfina e hidromorfona
Opioides usados en UCI: fentanil, morfina e hidromorfona
Los opioides no tienen techo terapéutico, excepto la codeína
Los opioides no tienen techo terapéutico, excepto la codeína
Para hacer la infiltración menos dolorosa se debe: usar una aguja pequeña, usar la solución tibia, infiltrar lentamente o añadir bicarbonato a la solución
Para hacer la infiltración menos dolorosa se debe: usar una aguja pequeña, usar la solución tibia, infiltrar lentamente o añadir bicarbonato a la solución
Postoperativa fever: 0-2 POD: atelectasia 3-7 POD: infection (UTI most likely) 8-10 POD: PE, DVT, intra abdominal abscess
Postoperativa fever: 0-2 POD: atelectasia 3-7 POD: infection (UTI most likely) 8-10 POD: PE, DVT, intra abdominal abscess
en un paciente con antecedente de AR se debe tomar una placa de cuello para determinar una incubación difícil
en un paciente con antecedente de AR se debe tomar una placa de cuello para determinar una incubación difícil
CT of chest leads to more radiation than CT head
CT of chest leads to more radiation than CT head
Niveles elevados de homcisteina se han asociado con ateroesclerosis
Niveles elevados de homcisteina se han asociado con ateroesclerosis
Litio contraindicado en lactancia en embarazo
Litio contraindicado en lactancia en embarazo
Sulfas se prefieren evitar en el tercer trimestre
Sulfas se prefieren evitar en el tercer trimestre
Dentro del manejo de la retención urinaria postparto esta el uso de catéteres intermitentemente hasta que la paciente recobre su habilidad de orinar
Dentro del manejo de la retención urinaria postparto esta el uso de catéteres intermitentemente hasta que la paciente recobre su habilidad de orinar
Los medicamentos que producen bloqueo de los receptores de dopamina producen galactorea (ej risperidona)
Los medicamentos que producen bloqueo de los receptores de dopamina producen galactorea (ej risperidona)
Lactancia contraindicada en madres con infección por VIH
Lactancia contraindicada en madres con infección por VIH
Congelar la leche puede destruir algunas proteínas. La leche materna no se recalienta a baño maria porque se pierden muchas proteínas importantes.
Congelar la leche puede destruir algunas proteínas. La leche materna no se recalienta a baño maria porque se pierden muchas proteínas importantes.
meperidina se asocia a algunos casos de depresión respiratoria del recién nacido, se debe secar vigorosamente, despejar via aérea, dar naloxina y oxigeno
meperidina se asocia a algunos casos de depresión respiratoria del recién nacido, se debe secar vigorosamente, despejar via aérea, dar naloxina y oxigeno
isotretoinoina se asocia con casos de microcefalia.
isotretoinoina se asocia con casos de microcefalia.
Maternity blues es una respues de tristeza autolimitada de máximo 2 semanas, si dura más de eso, o se presenta desde un principio con síntomas severos como ideación suicida o ideación de infanticidio, se debe dar manejo con antidepresivos y psicoterapia
Maternity blues es una respues de tristeza autolimitada de máximo 2 semanas, si dura más de eso, o se presenta desde un principio con síntomas severos como ideación suicida o ideación de infanticidio, se debe dar manejo con antidepresivos y psicoterapia
Endometritis postparto se maneja con clinda genta
Endometritis postparto se maneja con clinda genta
Atonia uterina es la principal causa de hemorragia postparto
Atonia uterina es la principal causa de hemorragia postparto
Metilergonobina esta contraindicada en los casos de HTA. Misoprostol esta contraindicado en asma
Metilergonobina esta contraindicada en los casos de HTA. Misoprostol esta contraindicado en asma
Ca incita de cervix no es contraindicación para parto vaginal, pero ca invasivo si debe ser por cesárea
Ca incita de cervix no es contraindicación para parto vaginal, pero ca invasivo si debe ser por cesárea
vacuum tiene menos riesgo de general lesiones en la madre como desgarros, comparado con forceps
vacuum tiene menos riesgo de general lesiones en la madre como desgarros, comparado con forceps
Fiebre materna es el signo más común
Fiebre materna es el signo más común
Embolismo de liquido amniotico: desaturación, distress respiratorio, hipotensión y coagulopatía durante trabajo de parto, durante cesárea o en los primeros 30 minutos postparto. Uso de oxitocina es frecuente.
Embolismo de liquido amniotico: desaturación, distress respiratorio, hipotensión y coagulopatía durante trabajo de parto, durante cesárea o en los primeros 30 minutos postparto. Uso de oxitocina es frecuente.
prolonged fetal bradycardia is the most common presentation of uterine rupture
prolonged fetal bradycardia is the most common presentation of uterine rupture
Manejo de distocia de hombro, maniobra de McRoberts (flexion de las rodillas y la cadera, abducción del muslo y presión suprapubica
Manejo de distocia de hombro, maniobra de McRoberts (flexion de las rodillas y la cadera, abducción del muslo y presión suprapubica
Cefalohemaotma asociado con diabetes gestacional
Cefalohemaotma asociado con diabetes gestacional
Aspiración de mconio se presenta con parches de atelectasias en la radiografía del recién nacido
Aspiración de mconio se presenta con parches de atelectasias en la radiografía del recién nacido
misoprostol no se debe usar si hay historial de cirugía uterina
misoprostol no se debe usar si hay historial de cirugía uterina
Desaceleraciones variable se producen por compresión del cordón
Desaceleraciones variable se producen por compresión del cordón
desaceleraciones tardias = insuficiencia placentaria
desaceleraciones tardias = insuficiencia placentaria
desaceleraciones tempranas se dan por compresión de la cabeza del feto, son benignas
desaceleraciones tempranas se dan por compresión de la cabeza del feto, son benignas
Sutura de elección para sutura de desgarros perneares, polyglactin 910
Sutura de elección para sutura de desgarros perneares, polyglactin 910
