#sclc gen 5 | Explore Tumblr Posts and Blogs

furasims · 7 months

Text

~ gen 5 - Sulani

#such colorful lives #ts4 challenge #sims 4 #ts4 legacy challenge #generation 5 #sclc gen 5 #Adeline Pessoa #ts4 scenery

32 notes · View notes

doctorfoxtor · 3 years

Text

surprise bitch. bet you thought you'd seen the last of me

100 days of productivity

day 23

CVS/RS

AS has the worst prognosis when associated with LVD (AS+AR has a poor prognosis but not as bas as AS+LVD)

in acute mitral regurgitation, tachycardia actually reduces the volume of the regurgitant jet (so don't give BBs/CCBs)

PEFR specifically works as an indicator for large airway disease

acute pericarditis, normal kidney function = give NSAIDs AND colchicine for 3 months (colch reduces the duration of NSAID tx); sub steroids if not tolerated/not effective

coarcts are associated w/ bicuspid aorta, NF1 and berry aneurysms (and ofc Turner's)

atrial myxoma can cause PUO, afib, middiastolic murmur, clubbing

WPW assoc w/ MVP, Ebstein anomaly, HOCM and thyrotoxicosis

CNS

dorsal midbrain (medial longitudinal fasciculus) → vertical eye movements

Parinaud syndrome = MLF insult: paralysis of upward gaze with convergence-retraction nystagmus on attempted upward gaze, light-near dissociation aka pseudo-Argyll-Robertson pupils, eyelid retraction, preference for downward gaze in neutral position, papilloedema

statins may be associated with increased risk of secondary bleed in ischaemic stroke → commence statin after 48 hours after symptom onset

meningococcal meningitis: benzylpenicillin > III gen cephalosporin > chloramphenicol

for ischaemic stroke affecting the proximal anterior circulation ONLY, consider thrombectomy either alone (if between 6-24 hours after symptom onset, including wake-up strokes, AND if parenchyma is salvageable) or with thrombolysis (if confirmed within 4.5 hours of symptom onset); thrombectomy can also be considered in proximal posterior circulation strokes but not as strong evidence

Endocrine

to prevent refeeding syndrome, give at most 50% of caloric requirement in the first two days

to prevent adrenal insufficiency, pts on long term steroids should *double* their doses in periods of intercurrent illness

Rheum/Derm

Still disease: nonbiologics → anti-TNFs → anakinra → rituximab

Sjögren's → assoc w/ Raynaud's, RTA, sensory polyneuropathy

monomorphic papular rash without vesicles, cysts or comedones on chest and back (esp. after starting roids) = drug-induced acne; withdraw offending drug

DILE: skin and pleural involvement are common, with possible myalgia, arthralgia; nephritis very uncommon

AnkSpon: syndesmophytes = ossification of annulus fibrosus

Schober test → locate L5 on patient's back; mark one point 5 cm below L5 and one 10 cm above; measure the distance between the two points; ask patient to touch toes with knees straight; measure the distance between the two points; positive test <5 cm of increase in the distance (sign of AxSpA)

GIT

PSC: 75% are assoc w/ IBD (either occurring before or after intestinal symptoms); also, more than 20% proceed to develop cholangiocarcinoma

IBS + iron/calcium deficiency, especially worse during or after pregnancy → HUGE red flag for coeliac

s/p needlestick w/ confirmed HCV+ pt's fluids, do monthly HCV RNA testing, and the moment it turns positive, slam them w/ IFN+ribavirin OR sofosbuvir-velpatasvir-voxilaprevir; if done quickly enough, has a >90% likelihood of cure

ulcerative colitis → goblet cell depletion on biopsy is specific

Onc/Haem

vocal cord palsy due to nerve invasion is a contraindication to resection of a Pancoast or thyroid tumour

shelf lives of blood products: platelets = 5 days; RBCs = 4-5 weeks; cryoprecipitate/PCC/FFP = 2 years

cryoprec is used to replace fibrinogen, indicated when serum fibrinogen <0.15 g/dl

hu painful is it? → anti-Hu = painful sensory neuropathy ± cerebellar signs (SCLC, sometimes neuroblastoma)

reflexes like a yo-yo → anti-Yo = cerebellar signs (ca ovary, ca breast)

ripid eye movements → anti-Ri = opsoclonus-myoclonus (neuroblastoma***, ca breast, SCLC)

purkipheral neuropathy → anti-Purkinje cell = peripheral neuropathy (ca breast)

muscle riGADity → anti-GAD = diffuse hypertonia (ca breast, ca colon, SCLC)

Renal/Biochem/Toxo

activated charcoal may be useful in aspirin poisoning beyond the described 1-hr point as aspirin absorption actually slows down when ingested in large quantities and persists in the gut for a long time

peritoneal dialysis peritonitis → CoNS (esp S. epidermidis) > S. aureus

Immuno

Neutrophils Love Cheddar Cheese → neutrophil disorders are Leukocyte adhesion deficiency, Chédiak-Higashi, Chronic granulomatous disease

Some Call B-cells Brutal → B-cell disorders are Selective IgA deficiency, Common variable immunodeficiency, Bruton's agammaglobulinaemia

diGeorge is a pure T-cell disorder (that may in turn lead to secondary B-cell dysfunction)

BuT Her Son WAS Ataxic → combined B/T-cell disorders are Hypermacroglobulinaemia, Severe combined immunodeficiency, Wiskott-Aldrich Syndrome, Ataxia-telangiectasia

in immunocompromise, give abx for otherwise 'benign' conditions anyway (eg, mild Campylobacter diarrhoea in a pt taking biologics—tx as if severe w/ macrolide)

#100 days of productivity #medblr #medicine #studyblr #studying #mine #long post

14 notes · View notes

furasims · 6 months

Text