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A bifurcation occurs on 4th level of each vertebral column:


C4: bifurcation of common carotid artery
T4: bifurcation of trachea
L4: bifurcation of aorta

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Alkalosis vs. acidosis: directions of pH and HCO3



ROME:
Respiratory= Opposite:
· pH is high, PCO2 is down (Alkalosis).
· pH is low, PCO2 is up (Acidosis).
Metabolic= Equal:
· pH is high, HCO3 is high (Alkalosis).
· pH is low, HCO3 is low (Acidosis).

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Amiodarone:
action, side effects ⬇️

6 P's:
Prolongs action potential duration
Photosensitivity
Pigmentation of skin
Peripheral neuropathy
Pulmonary alveolitis and fibrosis
Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism

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Ankylosing spondylitis: extra-articular manifestations⬇️

6 A's:
Atlanto-axial subluxation
Anterior uveitis
Apical lung fibrosis
Aortic incompetence
Amyloidosis (kidneys)
Autoimmune bowel disease (UC)

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causes of impalpable Apex beat:

COPD
Obesity
Pleural, Pericardial effusion
Dextrocardia

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Carcinomas having tendency to metastasize to bone:

Prostate
Thyroid
Lung
Kidney
Breast

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Appendicectomy complications:

Wound infection
Respiratory (atelectasis, pneumonia)
Abscess (pelvic)
Portal pyemia
Ileus (paralytic)
Fecal fistula
Hernia (r. inguinal)
Obstruction (intestinal due to adhesions)
Thrombus (DVT)

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Colon carcinoma: left vs right sided common characteristics⬇️

- Left:

Obstruction
Bowel habits altered
Encircling lesion


- Right:

Iron defiency anemia
Bleeding
Bulky

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Eye rotation by oblique muscles:

Inferior oblique: Lateral eye rotation (extortion).
Superior oblique: Medial eye rotation (intortion).

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Aortic stenosis characteristics:

Syncope
Angina
Dyspnoea

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Multi Drug Resistant Organisms:

E.coli
MRSA
Klebsiella (mainly carbapenems)
Acinetobacter bomani
Pseudomonas
Enterococcus

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Presentation of STDs

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There are 4 SIRS criteria; the presence of at 2 or more indicates SIRS.

1. Body temperature <36°C or >38°C

2. Heart rate >90 BPM

3. Tachypnea >20 breaths per minute, or PCO 2 <32 mm Hg

4. WBC <4,000 cells/mm³ or >12,000 cells/mm³

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The 6 signs of compartment syndrome are:


Pain: most commonly the first symptom
Pallor: lack of blood flow causes pale skin
Paresthesia: “pins and needles” sensation
Paralysis: inability to move the limb
Pulselessness: lack of distal pulses
Poikilothermia: cold to the touch

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Postoperative Fever Assessment

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Pulses⬇️

Pulsus alternans: sign of left ventricular systolic dysfunction

Pulsus bigeminus: sign of hypertrophic obstructive cardiomyopathy (HOCM)

Pulsus bisferiens: in aortic regurgitation

Pulsus tardus et parvus: aortic stenosis

Pulsus paradoxus: cardiac tamponade and tension pneumothorax

Irregularly irregular: atrial fibrillation

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Mackler’s triad:


1. Emesis
2. Lower chest pain
3. Cervical emphysema (subQ air)

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Macular Degeneration:


- The most common cause of blindness in older persons in the United States.
- Far more common in older patients.
- Bilateral.
-Normal external appearance of the eye.
-Loss of central vision.

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One of the first signs of pregnancy that is seen on physical exam is the Goodell sign, softening of the cervix that is felt first at 4 weeks. Quickening is the first time the mother feels fetal movement.

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Prenatal care:

A thickened or enlarged nuchal translucency is an indication of Down syndrome.

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Target-shaped rash of Lyme disease or erythema migrans.