O Me Whiteboards

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https://t.me/USMLEOnlineMedED
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+ pulse - pulse
S. tach
2 min cpr 2 min cpr
Arrhythmia nsr
s. brady
afib/flutter
+
IVF vt/vf epi + amio + epi + amio + -
o2
Dig
βb
ccb
sxs?
monitor
pea
asystole epi - absent - epi - absent - -
amio +
chf
+ chf stable sysbp<90
cp
cpr
sob
ams
stable unstable
drugs electricity
fast+wide: amio fast=shock
fast+nar ro w : aden os in e
slow=pace
slow=atropine
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https://t.me/joinchat/zyFOIg0j5goxY2E1
USMLE e e r m h nne s
Me est i e s: https://t.me/USMLEMe est
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mom wants
Aneuploidy screen 1st tri
u/s nuchal trans..<3mm
path: - +
screen papp-a
Down’s Drinking 21
low high hcg
Edwards Election 18 risk risk
Patau’s pg-13 13 stop 2nd tri
-
invasive
triple quad
risk = maternal (35) +
hcg afp estriol inhibin-a
prevalence=younger women generic downs
dz
Pt: asx screen terminate edward’s
• maternal age patau
• aneuploidy
cell-free DNA 1st tri + 2nd tri
Dx: screening tool (non) combined
screen sensitivity
fetal dna
confirm test (invasive) options
maternal blood
Tx: termination - 2nd tri
sequential
genetics screen 1st tri
Cf: whites options +
hgbss: blacks invasive
invasive= fetal loss
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procedure when goal risk extra

1st Iup, ga, 1st=ga +/- 1wk
u/s multiple
any ......oligo/poly...... 2nd=ga +/- 2wks
fetal well
3rd being 3rd=ga +/- 3wks
lie/orientation
fetal anemia highly sensitive

tcd >20wks
(alloimmunization) diagnosis
access
amniocentesis >16wks generic disorders 1/300 >16wks: genetic testing

(down’s) >24wks: liley
fetal anemia
lung maturity >30wks: l:s
genetic disorder early detection

cvs >10wks
karyotype, genes
1/500
early termination
>20wks access-transfuse
pubs <34wks
fetal anemia
hgb
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thyroid htw
u/f/d
u/f/d path: hyper: fetal demise path: bp <140/<80
asx hypo: cretinism
screen
fevers
cva tender
pt: α -methyldopa
pt: hyper: -labetalol
+ pyelo hypo: raiu -hydralazine
sxs u/a + wbc casts
+ u/a dx: hyper: tsh, ft4 acei, arb, ccb
+ u/a + sxs + u/a hypo: tsh, ft4 diuretics
asx ptu pregnancy
tx: hyper: 2nd surg tight eclampsia
cystitis pyelo screening
bacteriuria
radio i2
ceftriaxone hypo: levothyroxine DM
* amoxicillin f/u tsh q4wks
nitrofurantoin reassess f/u: tbg, levothyroxine -before pregnancy
tmp-smx a1c <7%
cipro improved seizure
diet+exercise
path: all aed teratogens
rescreen pyelo abscess pt: epilepsy orals->insulin
u/a 10d abx 14d abx dx: clx
drain -during
ct scan tx: levetiracetam=lamotrigine
requirement insulin
u/s basal-bolus
valproate (x)
post-prandial
culture, sensitivity phenytoin (o) a1c
nitrites carbamazepine (o)
leuk esterase epi cells -post-delivery
balance
lots of wbc
>100,000 colonies insulin macrosomic
bacteria f/u: phenobarb pregnancy transposition shoulder dystocia
folate
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AMS
JVD S3 Dx
PMI 10%
After 10% BNP <100 = CHF >500 = CHF
Xray
R L
LOAD DOE
PND * Echo EF , Dia = HTN
Crackles
LHC
ORTHOPN
Kerley B Ischemic or NOT
Abd Effusions RHC
Body pain
OFF Weight
Gain
JG Peripheral Edema
ON
Ischemic • Diet: <2g Na Ci/ d
PRELOAD Aldo ASA, Statin <2L H2O / d
NYHA
Renin Ang II CLASS <35% AICD • Weight Daily
βB 5lbs / 48 = Diuretic
NYHA ASX I Double
Ace / ARB
Etiology • Avoid NSAIDS
Exertions II Loop Diuretics
EF
BNP Dry
Edema ADLS III Spironolactone 25mg
BiDil
Cr, Hgb, K
@ REST IV
Dry Weight Milrinone
Last Weight Dobutamine LVAD Transplant
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Preload SVR
WARM COLD Diuresis = DOSE
a 2.5x oral as IV
Normal Low-Flow 3L Day 1
DRY -1L / day
Vasodilation
10% ADHF b gtt = Bolus
PL Diuresis
IV Enalapril
Afterload Cardiogenic Vasodilation
WET Overload Shock IV Hydralazine
inotropes
70% ADHF 20% ADHF Dobutamine
inotropes
SVR Milrinone
(wet)
DRY/WET = PRELOAD = VOLUME WARM / COLD = SVR
PRE
LOAD
Afterload (SVR) Hx Phys Hx Phys
DOE * JVD / HJR Fatigue Wrists / Ankles
certain Orthopnea Edema Somnolence Narrow Pulse
PND Crackles AMS Pressure
weight gain Kerley B Pulsus
U/S Alternans
CONT +1 - Abd Pain Effusions
βB? - Xrays
- BNP 90° - 60° - 30° - 0°
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Afib RVR Afib
Sx? IV, Monitor Rate or Rhythm? AFFIRM

Dilitazem Anti x 3wks
Stable? Shock (Sync) Metoprolol Convert
Anti x 4wks
Rate-control <110
ADHF ADHF Anti coagulate? = 1° CVA PPX
C CHF 1
CCB - Diltiazem Digoxin 0 NONE
H HTN 1
βB - Metoprolol Amiodarone A Age>65 1 1 NONE
Anti
ASA
D DM 1
2+ Anti
S CVA/TIA 2
VASC Coagulate
CAD, PVD, etc. 1
Option? Dabigatran
warfarin NOAC Anpixaban
Rivaroxaban
No Bridge No Bridge
Anti Coagulation? Anti Coag x 1 Month INR 2-3 NO Goal
if shocked Labs NO Labs
Diet NO Diet
Reversal NO Reversal
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Identification Treatment
Day 0 1 2 3 4 5
PT: Sputum Steroids
IV
Methylpred
PO
Prednisone
Dyspnea 125 mg x 1 40mg
q4H q6H q6H MDI
ER Tried already Inhalers
Duonebs + PrN PrN
q6H prn
Doxu Po
Abx IV Azithro Abx
Hx: COPD (PFTs) PaO2 < 55
6-min Spo2 < 88%
Pack-years O2 88 - 92 %
walk
Home O2 Chronic
# inhalers Meds X
Intubation Hx
Labs: Co2 (ABG) Bipap
Bicarb (BMP)
pH + Co2 (Baseline) ET
pH + Co2 Exacerbation
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DVT D-Dimer Wells’ Criteria <2 2 -6 >6

BNP ZOMFG!!?! 3
CT scan PE DVT 3 Low Mod High
TROP V/Q D-Dimer V/Q Scan
H/O DVT 1.5
Echo Tachycardia 1.5 H M L
U/S Doppler Immobilization
Surgery
1.5
1.5
H *
Angiogram Hemoptysis 1
Malignancy 1 M
>2 cm difference
DVT Doppler L *
Heparin warfarin Sx Strain Hypo Tx Dispo
Home
ASX
x x x Heparin
warfarin
NOAC
HOME
<4 >4
Heparin
NOAC Floor Sx x x warfarin Floor
NO CT
Heparin CT
Submassive x gtt ICU
ICU
Massive tPA ICU
CTEPH
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T Wide Blocks
ke d QRS Brady
Pea
HYPO K 275 mEq Hyper K EKG K
Magnesium
t
K 0.1 Ig IV
Stabilize IV Calcium
3.0 - 4.0 10 mEq 100 (Mins)
2.5 - 3.0 15 mEq 75 Temporize IV Insulin ( 10 Units)
(4 hrs) +
2.0 - 2.5 20 mEq 100
D50
PIv: 10 mEq/hr (Burns)
CIv: 20 mEq/hr (Die)
Eliminating Diuretics
PO: 20/40, elixir/pill Kayexalate
Dialysis
40 mEq KCl IV q4H x3 (120)
AND
40 mEQ KCl PO QAC x3 (120)
BMP @2:00
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UGIB
Hematemesis
Actions Ng
Lavage?
GI Bleed
1 2 Large Bore IVs = PIV

EGD
2 IVF = 2L LR=NS
orthostatic 3 PPI 80mg x 1 IV, 40mg BiD UGIB LGIB
Hematochezia Hgb Tx FAST
Hgb 4 Type + Cross, Tranfuse <7 = Sx Hgb

Transfuse
t
BUN:CR > 35 5 Call GI Arteriogram STOP
Embolize Colon
cirrhotic 6 Octreotide βB
Meh
Melena 7 Ceftriaxone ?
Melena ICU? 3pRBC + 1 plt + 1 FFP
• Shock MAP = CO X SVR
• Orthostatics
• Rapid Transfusions HR x SV
Stable Reassuring Velocity PL x CONT
Hematochezia • BUN:Cr > 35
A C
LGIB • Hgb (<10)
• Vital Signs
B D
t
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PT PTT “OSI” U/A

Chronic cirrhosis Uprotein 1 Hepatocellular
Liver Nephrosis Prealbumin
INR Dz gastrosis CRP AST, ALT
“Ig”
Alb TP Alb ALP, T.Bili
TP PG >4
HIV-HIV
HepC-HepC
PG T.Bili D.Bili MM-Spep 2 Obstructive
Muscle Sepsis
T.Bili D.Bili = U.Bili CPK AI ALP, D. Bili AST, ALT
Acute CK 2:1 = Cirrhosis
EtOH Hep
AST ALT Liver
DZ ALP
painful painless
ALP 1000s (Gallstones) (cancer)
Bone - Acetaminophen
GGT 3 Jaundice
- Aflatoxin
- Autoimmune Hep unconj conj
PRE HEPATIC 85% Unconj Bili Bili Stool
Indirect - Acute Hep
Hemolysis
INTRA HEPATIC Mix so/so - A Clot (Budd-Chiari)
- Hypotension
4 Infiltrative
Post Hepatic 85% Conjugated
ALP Bx
Direct
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NovoLog (Aspart)
HumaLog (Lispro) Insulin Insulin Insulin Insulin
Lantus (glargine) bG bG bG bG
l Long Eat Eat Eat Sleep
pr andia Acting
Levenir (Detemir)
Bolus Bolus Bolus Basal

Basal Ac Ac Ac qHS
STOP
Basal-Bolus ALL
80 kg ♀ 55 Cr 1.0
HOME
+13
TDI = 0.5 un/kg or 0.3 un/kg DM MEDS TDI = 80 x 0.5 = 40
50% 50% Cr >1.5 +6 +6
Age >65 20 20
bg BMP <180 Insulin pump +4
Bolus Basal
7 7 7
+2 +4 +3
1/ 3 1/ 3 1/ 3
bG Action Aspart 7qAC
Glargine 20qHS
+ <70 D50, Call MD
+ correctional
Scheduled = correctional 70 - 150
151 - 200 1 x DF
201 - 250 2 x DF
251 - 300 3 x DF 26 26
301 - 350 4 x DF
350+ 5 x DF 9 9 9
TDI <25 = 1, 25-75 = 2 , > 75 = 3

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1° Hemostasis = Plt 2° Hemostasis = factor

1 Plt (6 pack, 1 unit)
D-Dimer 3 Hgb (pRBC = 1 Hgb = 3 Hct)
tPA
plasmin plasminogen 1 INR (FFP)
Fibrin
I Ia Fibrinogen (Cryoprecipitate)
* Cirrhotic Albumin 5% 500 cc
DIC TTP HIT ITP

Path : Fibrin Path : Hyaline Renal Path : Abs Plts Path: ?
Pt: SAS Pt: Fever Neuro Pt: 4 Ts Pt: ASX
M AHA Plt <10
Pl T 2+ 1+ 0
Low: 0-3 Dx: Exclusion
Dx: DIC Panel Dx: DIC Panel Timing 5-10 >10 <5 Tx: Steroids
Mod: 4-5 (1 d)
IvIg
Plt Plt High: 6-8 Pl T >50% 30-50 >30% Splenectomy
+ or or
Hgb Hgb 10-20 <10%
20 Rituximab
Schistocytes Schistocytes Thrombosis New EXT
Fibrinogen Fibrinogen
D-Dimer D-Dimer al Ternative Poss
PT PT Dx: Send out
PTT PTT Tx: Stop Heparin
INR INR Start Argatroban
Tx: Underlying DZ Tx: PLT Wait Warfarin
product
Transfusion
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Chronic I II III IV
Liver Compensated decompensated Death
DZ Decades Cirrhosis 15 yrs Cirrhotic 1.5 yrs
IV Fulminant Hepatic
Failure
HCC
Acute Liver Dz
Hypersplenism Plt, WBC AAST, ALT 1000s
B = vaccine Synthetic Dysfxn Alb, INR, AST:ALT 2:1
* V iral Hep Hepatopulmonary
Syndrome Muscle Wasting Acetaminophen
C = Cure
Wilson’s Spider Angiomata, palmar erythema Acute Viral Hep
Caput Medusae Autoimmune
H emochromatosis
Portopulmonary Vasodilation
A utoimmune HTN AFlatoxin
Cirrhosis Splanchnic La.
P BC Map Co
A clot (Budd-Chiari)
P SC Hypotension
Liver Dysfxn II Portal HTN Hyperdynamic Circulation
* E tOH Jaundice Hepatic Varices Variceal Hemorrhage III Healthy Liver
* N ASH Encephalopathy Ascites Refractory Ascites INRD 1.5
Hepatorenal Syndrome Hep. Enceph
S omething
else SBP
Transplant
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Ascites Varices
Cirrhosis
EGD Pre
propanolol
Bleed
NO > Small Nadolol
Carvedilol
Portal Alb RAAS q2-3y Small EVL + NSBB
HTN
NSBB Post
H O Preload EVL + NSBB Bleed
Alb <2g NACi/d
TIPS <2L H2O/d NH3 = HE EGD w/i 12 hrs Octreotide
Ceftriaxone
Intra
Spironolactone 100 Varices Bleed
Blakemore Tube
MELD <15 Furosemide 40 NO BB Hgb <7
TIPS - sick
LVP + Alb Ascites

Ascites 5g/L removed
Renin Ang II Hepatic Encephalopathy
25%
OFF
Aldo Mentation Asterixis
1.1 < 1.1 2-3 BM/d Dispo
SAAG ON
LActulose
Rifaximin 550 ” I Mild Home
Na
Zinc 220”
Hydrostatic Peritoneal
II Moderate Admit
Pathology H2O
Flour
ADH III INCOM ICU
Ascites
TB
< 2.5
Total
> 2.5 Cancer IV COMA
Protein
? FLU
NH3
Cirrhosis Cardiac
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AOCCF = “Flare” “Exacerbation” SBP Anything 1° PPx?
CR Diag ≥250
ANYTHING fever Tap SBP
Sepsis AMS PMNS
Ceftriaxone
Na T. Bili Pain Dyspnea
INR Fluid Variceal Hemorrhage 2° PPx
* MELD Cr CMP Octreotide No βB
Norfloxacin 500cc 5% Alb
INR q8H Day 1 + Day 3
Ceftriaxone Hgb <7
* Encephalopathy CBC
Intravascular
Total Body 500cc 5% Alb Blakemore Deplete Renin Ang II
Fluid intravascular Early EGD - EVL OFF
Aldo
Variceal Renal
u/A, Umicro Hemorrhage Vaso
ON
Na
CXR HRSI Constriction
I nfxn Pan Cx Blooc CX H2 O
Cr x2 OR SBP ADH
SBp = Diag Tap CrCl 1/2
Bleed CBC, Variceal = GI
And Hyperdynamic Splanchnic UNA < 10
W/i Two weeks Circulation Vasodilation
Med -most common
Compliance -last considered Octreotide
Die FIX Midodrine
EVERYTHING ELSE
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Hep C
Hepatopulmonary HCC Cirrhosis HIV
Hep B
Bubble Study Hep B S Cirrhosis
O2 O2 Screening: U/s + AFP
Small
3-6 = HPS Confirm: triple Phase CT
1-2 = PFO
x
Large = Nrml
C Milan Early Art Late Art Venous
Platypnea 1 <5cm
washout
3 <3cm
Portopulmonary HTN RHC Cure HCC Time
+
vasodilator
Child
A Pugh C
>50 <35
one Hospice
Everything
Else
Excluded Transplanted
small Invasion
Congestive
DIE Sorafenib
Staging
Sildenafil
Hepatopathy Inside
Milan
Outside
Milan
Bosentan Portal Liver
Alprostadil Pressure Rdy? No TACE
yes
Resected Transplant RFA
Page 15 of 15
Page 274
CPAP Bipap
K x [con] x SA
NC Venti
Face Tent NRB ET Tube J=
HFNC t x size
1-6 LPM 6-10 CPM 10-15 LPM 20-40 LPM SA
20%-40% 40-60% 60-80% 100%
O2 FiO2
P CPAP = PEEP P Bipap SpO2 O2 Peep
0
__ 10
__ ABG
PSOP
5 5
5
PEEP
O2 ABG CO2 MV = TV x RR
t Co2 t
t
Assidse Con
CHF PSOP
Mo SIMV trol COPD
Bipap PRVC Mod
e
CPAP VC PRVC
Ppeak / Pplateau
O/5 SBT PC PEEP
ET TUBE Teens
FiO2 Ppeak
Low TV OK 20s
Fi P TV RR
T-piece RR
30s
P xx 40s
Page 1 of 6
Page 275
Frank : MAP
< 65 Distributive Sepsis
Shock
MAP = CO x SV R
Anaphylaxis
Occult : Relative
Shock HoTN, Lactate Spinal Trauma
(TONE)
Too Fast Anesthesia
Shock : HR > 1 = Addison’s (Hx)
__
index SYSBP
70 / 60
(ECG) HR x SV Wide pulse pressure
narrow
Too Slow 70 / 20
Sys pulse
pressure
Cold PL x CONT
WARM + Shock
+
Shock (Ivf) vol : D/D/D/H MI BNP
TONE
Whomp CHF TROP
Sys PTX Echo
RV
PT
obst: - TONE = SVR
LV PE DIA
Sys
Distributive
120
___
Cardiogenic 40 TONE
80
Hypovol 80
Obstructive
Page 2 of 6
Page 276
Sepsis inoconstrictors
MAP = CO x SVR Spinal
Anesthesia vasoconstrictors
Too HR x SV Anaphylaxis
β1 β2
α1
PL x CONT
Volume VOL : D/D/D/H MI β1
CHF Vasoconstriction inotrope vasodilation
Obst : PTX
inotropes
PT α1 β1 α1 β1 β2
Alleviate PE
Vasoconstrictors inocontstrictor inodilators vasodilator
vasopressin Norepinephrine Milrinone Nicardipine
phenylephrine Dopamine Dobutamine NO
* epinephrine Esmolol
Sepsis CHF
HTN
Energy
Page 3 of 6
Page 277
SIRS EGDT LGDT

Temp >38 or <36 • IVF = 30cc/kg LR=NS SVR = Art Line = Pressors
HR >90 • ABX
CVP 10 - 12
RR >20 • Source Control PL u/s IVC
WBC >12 or <4 Leg Lift
• Pressors
CONT ScVO2 >70%
Severity * Steroids
Norepi = Dopamine
Vasopressin
Epinephrine HR Monitor
SIRS 2/4
Phone
Floor Sepsis SIRS c Source call
Severe Sepsis + Lacta
or
te (> 2 )
Sepsis MAP (< 65)
Septic Severe Unresponsive to

Shock Sepsis Fluids
ICU Vasopressors
Page 4 of 6
Page 278
2 min
CPR CPR CPR CPR CPR Intubate MD

Airway People
VT/Vfib Epi Amio Epi Amio Epi RT
VENT
C C
PEA Epi Absent Epi Absent Epi RN

Asystole
MD
RN
1. Take Charge
MD
BICARB 2. Assign Roles
RT
3. Clear the Room RN CA
4. Plan Out Loud (charge)
5. Closed Loop Communication
6. Stay Calm
7. Be Confident
Page 5 of 6
Page 279
Proning
Homogeneity O2 Recruited
Derecruitment
Loss of
Homogeneity
PEEP
Resistance
TNF-α 16:8 Prevent
Derecruitment
IL-1
PAralyze
4-6 cc/kg
Ideal
Body Weight High PEEP =
Low TV = Prevent
Barotrauma
Page 6 of 6
Page 280
GI Cocktail
Skin SubQ MSK Pleura Pericardium Heart Esophagus Aorta

Lacs Cellulitis Sprains P Tx
P NA
Pericarditis MI
Myositis
GERD Dissection
Aneurysm
Burns Abscess Strains Esophagitis
Bites FX PE Perforation
HSV * costo P ulm Cancer
chondritis P leurisy Trachea
Tracheitis
Perforation
CXR
12-LEAD ECG Tender Pleuritic Positional + Diamond + BP in
Troponin
Substernal
Both Arms
Exertion
NTG
Page 1 of 17
Page 281
ABG - RT
met Resp CXR - Rad
acid Alka
12-LEAD - ECG
Bad
No Blood Blood BNP - RN / Lab
“Anemia” Carboxy
Meth
MI CHF Arrhythmia Sats Oxygen

SpO2 92%
Asthma
OLD DPLD DAH
CoPD COPD 88 - 92%

ul
PTX PNA PE PEFF P CH
ca
ARDS
Page 2 of 17
Page 282
Epigastric
Pain
Heart Esophagus
RUQ u/s Pericardium Stomach CT
Aorta Pancreas
Somatic Visceral Neuropathic Lung Trachea LUQ
Diaphragm Lung
Liver Diaphragm
Obstructed GB Spleen
Stretched Referred
P B L
Inflamed M A U
D N
C
Obstructive Inflammatory Perforation Ischemia H
colicky Constant SAS POOP Kidney/ureters Kidney/ureters

Fever Fever Fever Afib/CAD/PUD Gonads Gonads
Mesenteric colon = Appendix colon = Divertic
WBC WBC Leuko
Restless Restless Motionless Ischemia
*Rebound /
Guarding Bloody Bladder
Cholelithiasis Cholecystitis Stool Uterus
Nephrolithiasis Pyelonephritis PUD
RLQ LLQ
Pancreatitis Diverticular CT Supra CT
Pubic
Page 3 of 17
Page 283
Type Hxt Pt Dx Tx
W asovagal Situat ional Carot id Tilt BB
Viscer al Recur rent Massa ge table
Baror ecepto rs Prodr ome Asysto le, 50
Orthostatics IVS
LOC Psych ogeni c Orthostatic
O rthostatic
Seizur e Syncope VOL : D/D/D/H
Jerk >20 <10 ANS: Old, Parkinson’s Exert ional Murm ur Echo Surge ry
B U
Post
* ictal >5 min <1 min M echanical Sudde n onset - Holte r -
Gradual rapid Cardia c Prodr ome
Prodrome Aura Vasovagal A rrhythmia Loop
Event
N eurogenic rare FND
Carot id u/s u/s
CTA/m ra
Tongu e Biting
Fallin g Face- Palm -
Loss of P sych
Na, Ca
Bowe l/Bla dder E -lyt es -
- - BMP
K, Mg
Page 4 of 17
Page 284
CvA
Bleed
LAMBERT-EATON Cancer
Pml MYOSITIS
MS Dermato Statin Infxn
TM Polymyo Fungal TB Bacterial
MYASTHENIA GRAVIS ALS IBmyositis
Trauma
Spinal Stenosis
Spinal Abscess
Polio
West-Nile DM R emote cancer
DlO2 = CO x Hgb x %Sat
A lcohol A utoimmune
N utrition, B12 P orphyria
HR x SV
Guillain-Barré I nflammatory
PL x CONT Ng Mg T rauma, Radiculopathy S yphilis
H ereditary, CMT TB
AMS E-Lytes WEAK
E nvironmental, Lead
Ca K
Page 5 of 17
Page 285
J=K(H-O) x Ascites
paracentesis
“INFLAMMATION” “HYDROSTATIC” “OSI”
TRAUMA C LOTS CirrhOSIs

INFXN C UTS nephrOSIs
CANCER C ANCER gastrOSIs
AI C OMPRESSION
LOCAL C HF GLOBAL
C IRRHOSIS
ARDS Sepsis
pancreatitis
Page 6 of 17
Page 286
Temp encephalitis
H tn / Hna
epatic
inflam I nfxn UTI
E -lytes ca Porphyria
S epsis
S troke
non T rauma Acidosis bg
inflam Opiates E ndocrine ft4,t sh
P sych addison’s
I ntoxication / wIthdrawal
S eizure
O / co
2 2
U remia
cbc, bmp, lfts, utox, abg, tsh
ct scan
Page 7 of 17
Page 287
B ronchitis / Bronchiectasis C ystic Fibrosis Coagulopathy

A spergillus / Autoimmune AVM / D AH
TB
M itral value
T umor
L ung Abscess
P neumonia
DVT/ PE
E mbolism PLACENTAL + STREAK STREAK
AIR
FAT + COUGH COUGH
Blood
N/V per + N/V, TARRY STOOLS
os
Hemoptysis Hematemesis
CXR EGD GI
CT PULM
BRONCH
Page 8 of 17
Page 288
inflammation = fever =/ infxn
inpt fever
- blood cx x 2
- u/a, umicro
- cxr
A bscess 3 thermostat 2 AC 1 environment
thalamic heat stroke - think
e ndocardit n ms
i ndwelling infxn stroke heat exhaustion
o steo dvt/pe thyroid malignant hyperthermia
heat exposure
u TI MI storm Serotonin syndrome
clots CVA
ALI
leukemia
lymphoma the meds
cancer
sle
ra
AI seroneg
monoartic
Page 9 of 17
Page 289
1 3 2
Cr
Vol Diurese
Pre-renal
Vol Volume
RAS/FMD
i”
U/S
“OS sis post-renal obstructing
rho is Hydro Foley
Cirphrossis
Ne stro
Ga Hydro
intra-renal
CHF
Vol : D/D/D/H
1 pre = Poor Perfusion 3 GN 2 post = obstruction Call Renal c
AIN Stones - Renal Function
CHF Overload
intra deplete
ATN Cancer - U/A, UMicro
Cirrhosis but overload NEPH- Neurogenic - U creatinine
Vol Depleted NEPHRI- Prostate - U Na, K, Cl
RAS/FMD Special
- Spot Protein
Page 10 of 17
Page 290
1° Hemostasis = Platelets 2° Hemostasis = Factor CBC + COAG

Petechiae Bleeding Hemarthrosis
7 Split gingival Ecchymoses
= Platelet 10 Products vaginal
5
plug 2
1 Plasmin
tPA 1° Hemostasis 2° Hemostasis

Fibrin Plasminogen
I Ia
Fibrinogen tPA
glyc Ia TxA2 warfarin Plt Mixing
UF count Study
vWf Heparin corrects
LMWH
glycIIb NOAC
ADP
Plt Dysfxnal Factor Levels inhibitors
Adhesion Activation Adhesion
cirrhosis DIC Uremia Hemophilia Path
ASA, Clopidogrel Aplastic TTP NSAIDS Vit K Def Heme onc
Marrow Cancer HIT
Anti-Platelets Anti-Coagulants Anti-Platelets Warfarin
ITP
NOACS
Arterial Thrombosis Venous Thrombosis
Anti-Coagulants
PUD CAD CVA DVT/PE
DAPT
Page 11 of 17
Page 291
Laryngo
Dysph agia
ENT
oropharyngeal Initiation
Tumor
oropharyngeal Esophageal
Esophageal
CvA food AND food THEN
GI TM MS
vagus
Liquid Liquid
Endo Speech Therapy
pharyngogram motility Mechanical
Barium Barium
EGD EGD
NG Tube Manometry
PEG Tube GI
Page 12 of 17
Page 292
1 1-3 3+
Mono oligo Poly
V
Hep C, HIV
OA gonorrhea I
(A) Trauma (A) Infectious R EBV, CMV
NOT parvo
U
Gout S
High Low (A) crystal pseudo
gout
S ero SLE
Sudden insidious S ero
onset Acuity RA
+ P soriatic S yphilis
Loss of Toxicity Weight A nk Spond S arcoid
fxn Loss Sero I BD S till’s
R eactive (A) S epsis
Fever Temp
Markers Markers
Page 13 of 17
Page 293
High Rez CT
CXR OLD = COPD
DPLD PFT
CTEPH WHO
Echo CTA, v/q
EPAP CHF - LV 1:
Echo
R L
OSA
Sleep 2: Pulm Venous
Primary Study High Rez Regular Cardiac Dysfxn
Pulmonary
Boo! vasodilate hypertension
RHC CCB
c CCB
Yay! 3: Intraparencyhmal
ANA, RF, ssA, ssB
Experimental
Bosentan HIV, Hep Panel
4: Pulm Art
Alprostedil TSH Clots
Revatio (Sildenafil)
5: Other
Page 14 of 17
Page 294
Cough
< 3 weeks 3 -8 weeks

Duration
Acute Cough SubAcute Cough

8 weeks
IFXN Post-Infxn
Dextromethorphan Chronic Cough Sx
Sx
Benzonatate ACE-I cigarettes
Causes * 8 wks worsening
CXR
1 fails Asthma
Big 3 GERD 1° Pathology
PND
Pulm
Empire
Tx
All Fail
Idiopathic Sputum 1° Pathology

Ct Chest
sx Page 15 of 17
Page 295
VOlume Maintenance Free H2O Calories

Bolus 1/4 NS Tap Po PPN = Protein = IV
=
1/4 NT + D5 Tap Per Tube TPN = everything
Lactated 4mEq K
= 250cc flush Central line
Ringers 1/2 NS
= q6h
Normal Acidosis 1/2 NS + D5 D5W
Saline
1500 + [(Kg - 20) x 20]
24
LR = NS HyperNa Dispo
70 - 150 cc/hr Bolus NS Dependent
154
Page 16 of 17
Page 296
Ca, Alb Hyper Ca >3 Meds
TSH, FT4 Hyper thyroid DO ALL

THINGS
Aldo : Renin 1° Hyperaldosterone
1+
ABI, CXR Aortic Coarctation (Rib Notching)
Continue
24-hr Aldo 2° R enovascular (Hyperaldo) = ESRD
24-hr VMA, Metaneph P heochromocytoma
24-hr Cortisol C ushing’s Low-Dose Dexa Scan.
Sleep Study Osa
Page 17 of 17

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