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198361. Gadolinium-Associated Nephrogenic Systemic Fibrosis

Gadolinium-Associated Nephrogenic Systemic Fibrosis Gadolinium-Associated Nephrogenic Systemic Fibrosis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer (...) Administration 4 Gadolinium-Associated Nephrogenic Systemic Fibrosis Gadolinium-Associated Nephrogenic Systemic Fibrosis Aka: Gadolinium-Associated Nephrogenic Systemic Fibrosis , Nephrogenic Fibrosing Dermopathy , Scleromyxedema-like Cutaneous Disease From Related Chapters II. Epidemiology : Rare, overall Severe and exposure to gadalinium: 4% III. Pathophysiology Triad of Gadolinium exposure, Renal disease, and Proinflammatory state IV. Risk Factors Gadolinium Exposure Gadodiamide (Omniscan) Gadopentetate

2015 FP Notebook

198362. Oral Rehydration Therapy Protocol in Pediatric Dehydration

Oral Rehydration Therapy Protocol in Pediatric Dehydration Oral Rehydration Therapy Protocol in Pediatric Dehydration Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure (...) Miscellaneous Abuse Cancer Administration 4 Oral Rehydration Therapy Protocol in Pediatric Dehydration Oral Rehydration Therapy Protocol in Pediatric Dehydration Aka: Oral Rehydration Therapy Protocol in Pediatric Dehydration , Dehydration Management in Children with Oral Replacement , Pediatric Diarrhea Fluid Replacement From Related Chapters II. Indications Mild to moderate Mild to moderate III. Precautions Use (ORS) as this most closely mirrors related losses : 50 mEq/L (WHO ORS contains 75 mEq/L, older

2015 FP Notebook

198363. Congenital Heart Disease Imaging in Adults

Congenital Heart Disease Imaging in Adults Congenital Heart Disease Imaging in Adults Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) , pulmonary arteries and left to right shunts Disadvantages Nephrogenic Systemic Fibrosis risk (when GFR is <30) Contraindicated with implanted metals such as s Computed Tomography (CT ) Advantages Cardiac Gated CT provides functional information CT Angiography identifies s Disadvantages Iodinated exposure IV. Imaging: Third-line and alternative studies Radionuclide Imaging (nuclear scintography) Advantages Alternative evaluation of and function when MRI is contraindicated Evaluates for comorbid ischemic

2015 FP Notebook

198364. Penile Lichen Sclerosus

present) V. Signs Initial Glans and foreskin is thick and white Contiguous edema may be present Later Foreskin in thin, wrinkled and hypopigmented (like cellophane) may be present Last Foreskin and contiguous anatomy distorted May obscure surrounding antomy may occur in men (may result in obstructive uropathy) VI. Labs: Biopsy Biopsy especially indicated if squamous cell hyperplasia present Risk of developing of the foreskin is 4-6% in Biopsy foreskin lesions that fail to heal with management (see (...) Penile Lichen Sclerosus Penile Lichen Sclerosus Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Penile Lichen Sclerosus Penile Lichen

2015 FP Notebook

198365. Lichen Sclerosus

resorbed Later or foreskin in thin, wrinkled and hypopigmented (like celophane) may be present Last or foreskin and contiguous anatomy distorted May obscure surrounding antomy Clitoris and labia minora may appear buried in women may occur in men (may result in obstructive uropathy) V. Labs: Biopsy Biopsy especially indicated if squamous cell hyperplasia present Risk of developing of the vulva or foreskin is 5% in Lichen Sclerosus Also biopsy vulvar or foreskin lesions that fail to heal with management (...) Lichen Sclerosus Lichen Sclerosus Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Lichen Sclerosus Lichen Sclerosus Aka: Lichen

2015 FP Notebook

198366. Radial Nerve Injury at the Wrist

Radial Nerve Injury at the Wrist Radial Nerve Injury at the Wrist Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Radial Nerve Injury (...) at the Wrist Radial Nerve Injury at the Wrist Aka: Radial Nerve Injury at the Wrist , Handcuff Neuropathy From Related Chapters II. Pathophysiology superficial branch is susceptible to injury where it crosses the volar wrist Nerve crosses over the flexor culum that encases the Compression occurs with any item that tightly binds the wrist in this location III. Causes Any compressive device at the volar wrist (e.g. handcuffs, watches) Higher risk if cuffs ride up the proximally Typically affects the dorsal

2015 FP Notebook

198367. Radial Nerve Injury at the Elbow

. Management: Radial Tunnel (sensory) and posterior interosseus nerve (motor and sensory) Eliminate provocative actvities (repetitive motion) Physical Therapy Work on wrist extensor muscles and supinatory muscles Start with after pain has ceased and then gradually introduce strengthening May respond to a single Cock-up Prevent wrist extension splint Indicated for brief use to prevent supination Splint with elbow at 90 degrees (risk of loss of elbow range of motion) Surgical decompression Consider (...) Radial Nerve Injury at the Elbow Radial Nerve Injury at the Elbow Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Radial Nerve Injury

2015 FP Notebook

198368. Median Nerve Injury at the Elbow

. Management Modify activity Consider steroid injection Consider brief with elbow at 90 degrees (risk of loss of elbow range of motion) VII. Course Anticipate 3-6 month course with therapy VIII. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Median Nerve Injury at the Elbow." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Elbow (...) Median Nerve Injury at the Elbow Median Nerve Injury at the Elbow Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Median Nerve Injury

2015 FP Notebook

198369. Tricyclic Antidepressant Overdose

stabilized Toxicology labs Serum Level Serum Level Avoid levels TCA levels are send-out labs that do not assist in acute management VI. Precautions Avoid provocative agents Avoid Avoid Class IA s (e.g. , Quinine) Avoid Class IC s Avoid barbiturates and (see s below) Avoid reducing decreases the and is protective against VII. Management: General Significant risk with ingestions >10 mg/kg Intubate early in serious Tricyclic Overdose (due to rapid decompensation) is preferred paralytic (unless ) less than (...) Tricyclic Antidepressant Overdose Tricyclic Antidepressant Overdose Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Tricyclic

2015 FP Notebook

198370. Sulfonylurea Overdose

Overdose Aka: Sulfonylurea Overdose , Sulfonylurea Toxicity From Related Chapters II. Causes Oral antihyperglycemic medications ( , , ) III. Findings:Signs and Symptoms Confusion Decreased Appetite Lethargy s Weakness ( may occur) IV. Precautions Even a single tablet can cause symptomatic in children Risk of delayed or prolonged Agent half-lives vary, but range from 2-36 hours (in , may last >24 hours) Hepatic excretion is typical for s V. Evaluation See VI. Management: Adults Dextrose 50% IV bolus 1-2 (...) Sulfonylurea Overdose Sulfonylurea Overdose Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Sulfonylurea Overdose Sulfonylurea

2015 FP Notebook

198371. Salicylate Overdose

Salicylate Overdose Salicylate Overdose Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Salicylate Overdose Salicylate Overdose Aka (...) Deafness VI. Differential Diagnosis See with increased VII. Labs: General Comprehensive metabolic panel findings Alkalosis or acidosis with increased is most typical or VIII. Lab: Plasma Salicylate level (Dose related Aspirin effect) Precautions Interpret level based on nomogram in the context of time since ingestion Manage level based on local lab protocols and poison control Be aware of (local lab may use a measurement other than mg/dl) Serious toxicity occurs with ingestion >150 mg/kg Therapeutic

2015 FP Notebook

198372. Narcotic Overdose

Overdose , Opioid Overdose , Opiate Overdose , Narcotic Toxicity , Opioid Toxicity From Related Chapters II. Indications: Narcotic Overdose management Respiratory Depression ( , apnea) Severe sedation (e.g. comatose) III. Epidemiology Opioid Overdose is the leading cause of death in U.S. for those under age 50 years old s have been implicated in 16,000 deaths per year in U.S. as of 2013 IV. Risk Factors equivalents >50 mg/day doubles risk, contrasted with <20 mg/day (e.g. 5 mg every 6 hours) V (...) Narcotic Overdose Narcotic Overdose Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Narcotic Overdose Narcotic Overdose Aka: Narcotic

2015 FP Notebook

198373. Calcium Channel Blocker Overdose

Calcium Channel Blocker Overdose Calcium Channel Blocker Overdose Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Calcium Channel (...) blockade effects (Calcium Channel Blocker Overdose) exit from cell is via the same channel that CCB agents block s result in relative and >250 mg/dl (without ) suggests severe Contrast with which is associated with Cardiac muscle reduced uptake oxidation increased Results in and in some cases, IV. Management: Adults (Beta Blocker and calcium channel Overdose) (e.g. ) Consider if ingestion within last 1 hour, active bowel sounds and alert, cooperative patient caution, as patients rapidly decompensate

2015 FP Notebook

198374. Beta Blocker Overdose

Beta Blocker Overdose Beta Blocker Overdose Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Beta Blocker Overdose Beta Blocker (...) Overdose Aka: Beta Blocker Overdose , Beta Blocker Toxicity From Related Chapters II. Pathophysiology Selective s lose selectivity in d s affect all receptors regardless of whether agent is beta-1 or beta-2 selective Beta Blocker Overdose is treated the same as III. Precautions Beta Blocker Overdoses are high risk of death (on par with s and s) Treat at similar intensity as a full code as these patients decompensate rapidly IV. Symptoms and Signs Primary toxic effects Other effects Acidosis

2015 FP Notebook

198375. Occupational Illness

the injury? Who else was injured? What Mechanism of injury (and circumstances) List possible injuries and pain sources Specific evaluations Independent medical examination (frequently requested by employer) Rating Neuropsychological Exam VII. Management: Return to Work (Workability Letter) Capabilities What activities can a patient safely perform Restrictions What activities is a patient unable to perform (without risk to self or others) Limitations What activities is a patient physically incapable (...) Occupational Illness Occupational Illness Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Occupational Illness Occupational Illness

2015 FP Notebook

198376. Atypical Mole Syndrome

Atypical Mole Syndrome Atypical Mole Syndrome Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Atypical Mole Syndrome Atypical Mole (...) Syndrome Aka: Atypical Mole Syndrome , Dysplastic Nevus Syndrome , Familial Melanoma , Familial Cutaneous Melanoma , FAM-M Syndrome , B-K Mole Syndrome , FAMMM Syndrome From Related Chapters II. Epidemiology Families predisposed to and of relatives with onset at a young age : 32000 in United States with Atypical Mole Syndrome Accounts for ~5% of moles diagnosed in the United States in those with Atypical Mole Syndrome carry significant risk of malignant transformation 10 year risk: 10.7% (>17 fold

2015 FP Notebook

198377. Halo Nevus

Halo Nevus Halo Nevus Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Halo Nevus Halo Nevus Aka: Halo Nevus , Halo Nevi II (...) . Pathophysiology or Halo region is depigmented, without s mediated depigmentation III. Epidemiology Onset in teen years : 1% IV. Signs White, symmetric round halo surrounding a nevus Distribution Trunk is most typical Always spares the palms and soles V. Associated Conditions risk may be increased VI. Course Repigmentation may occur spontaneously over years VII. Prognosis Rare malignant transformation (typically predictable by atypical features) VIII. Reference Habif (2003) Clinical Dermatology, 4th ed.. Mosby

2015 FP Notebook

198378. Becker's Nevus

Becker's Nevus Beckers Nevus Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Becker's Nevus Becker's Nevus Aka: Becker's Nevus (...) , Becker's Nevus Syndrome II. Pathophysiology Does not contain nevus cells Onset in teen boys III. Signs Components Brown with sharp borders and irregular shape tuft Variably present and may be present without the Distribution Back IV. Associated Conditions: Becker's Nevus Syndrome Skin lesion with smooth muscle fiber abnormalities hypoplasia (unilateral) Limb hypoplasia (unilateral) V. Prognosis No risk of malignancy VI. Reference Habif (2003) Clinical Dermatology, 4th ed.. Mosby, p. 773-813 Images

2015 FP Notebook

198379. Pneumonia IRVS Prediction Tool

Pneumonia IRVS Prediction Tool Pneumonia IRVS Prediction Tool Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Pneumonia IRVS (...) : Very low risk of IRVS Score 1 points: Low risk of IRVS Score 2 points: Moderate risk of IRVS (1 in 10 patients) Score 3 points: High risk of IRVS (1 in 6 patients) Score 4 points: Very high risk of IRVS (1 in 3 patients) VII. Interpretation: Standard scoring including lab findings Score 0-2 points: Low risk of IRVS Score 3-4 points: Moderate risk of IRVS (1 in 8 patients) Score 5-6 points: High risk of IRVS (1 in 3 patients) Score 7 points: Very high risk of IRVS (2 in 3 patients) VIII. Resources

2015 FP Notebook

198380. Blood Transfusion

Blood Transfusion Blood Transfusion Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Blood Transfusion Blood Transfusion Aka: Blood (...) Transfusion , pRBC , Packed Red Blood Cells From Related Chapters II. Preparations Packed Red Blood Cells are derived from whole blood by removing 250 ml plasma Most centers filter s before storage Decreases risk CMV-safe III. Indications Acute ( ) Massive acute blood loss >1500 ml (30% of ) <7.0 g/dl and no serious comorbidity (and no ongoing bleeding) <9.0 g/dl with serious comorbidity (e.g. cardiovascular disease, active bleeding) Symptomatic Severe , weakness, or Hospitalized patient criteria (per

2015 FP Notebook

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