Foils

• Variant angina, coronary artery spasm
• Occurs at rest
• Many not have  CAD

4%

• Depression of areas oppositve peredict larger MI with inc mortality
• T-wave inversion within 4 hours is good prognostic sign

• ST depression into rocket T-waves
• Acute LAD occlusion

Acute LMCA occlusion

• Acute mitral Regurgitation
• Acute onset CHF
• HD support, IABP, Surgery (OR)

High outpt failure due to multiple AV malformations

High outpt failure due to B1 thiamine deficiency leads to dec SVR, edema, high output failure

Tender nodules on the tips of the fingers and toes, IE,Osler=Ow

Non-tender hemorrhagic plaques on the palms and soles

retinal hemorrhages with central clearing

• vanc
• gent
• add rifampin (more gram + coverage

• CASES
• Carditis
• Arthritis
• Syndenhams chorea
• Erythema marginatum
• subcutaneous nodules

Minor:  Prev hs, arthralgia, ESR, prolonged PR interval, fever

• AS : Systolic radiating into neck
• AR : Diastolic decrescendo at left lower sternal border, water hammer, duroziez's, Austin-flint, quinckes

• RHD
• Diastolic murmur + pulmonary edma in pregnancy = Mitral Stenosis

Low apex diastolic murmur to axilla, loud S1

• MS - Diastolic rumble at apex
• MR - loud holosystolic murmur

MR - may have no murmur if ruptured chordae tendineae

• Harsh, mid-systolic LLSB
• Louder with dec preload (standing, valsalva, hypovolemia)
• Dec with increased afterload (squat, trendenlenberg)

Coxsackie B

• Sinus tach out of proportion to fever
• Young person with acute CHF = myocarditis
• 10 bpm per degree temp
• 100.5 at 150 is out of proportion

• Alpha plus bb
• Do not use bb alone - unopposed alpha
• Labetalol plus
• Phentolamine (alpha blocker)

Bilateral internuclear ophthalmoplegia (eyes can't look at nose)

• Auto-antibody against acetycholine receptors
• 25% tumor of thymus

Hallmark:  Muscle weakness, fatiguability, dipolopia, ptosis

Tx: Physostigmine - inhibits acetocholinesterase

• Similar to myasthenia gravis
• Autoimmune effects calcium channels
• Decreased DTRs
• Proximal thighs and hips, improves with use
• Associated with Cancer
• MS with Cancer

• Blocks acethycholine RELEASE at neuromusc jct
• Diplopia, ptosis,
• DESCENDING flaccid paralysis
• Anticholinergic symtpoms, dry, ileus, dilated eyes
• Floopy baby
• Tx Antitoxiin, PCN

• Similar go Guillain-Barre
• Reapid ascending paralysis
• but NO PARESTHESIAS
• Tx, find tick and remove

• Dead crows, birds
• Meningitis, Encephalitis
• Anterior Horn Cells, pure motor flaccid paralysis
• Sensation INTACT
• Send CSF for IGM antibodies to WNV

• Upper AND lower motor neurons
• Upper: Spasticity, no sendor deficits
• Lower: ant horn cells, atrophy, fasiculations
• Death slowly by respiratory failure
• Weakness, difficulty eating and swallowing

160/90

Contralateal motor and sensory deficits, contralateral cranial nerve palsies,  all on oppositie side

• Cranial nerves uncrossed, corticospinal tract crossed
• Ipsilateral facial weakness
• Contralateral extremity weakness
• Face Same, Extremities opp = Brainstem

coma, miosis, altered breahing

Nystagmus, dizziness, N?V, ataxia

• Contralateral legs and sensory
• Gait disturbance

• Contralateral arms and face and sensory
• Aphasia or hemi-neglect
• Homonymous hemianopsia (blindness in the same field of vision each eye
• Eyes look toward side of stroke

• Eyes look toward the Stroke
• Eyes look away from the Seizure (scary)

• Right hemiparesis
• Right homonymous hemianopsia (looks left)
• Aphasia

• Left hemiparesis
• Left homonymous hemianopsia (looks right)
• Left hemineglect

• Supplies occipital cortex
• Homonymous hemianopsia (contralateral)
• Visual agnosia (can't recognize objects)
• Cortical blindness (after CPR)
• Minimal motor involvement.
• Just eye things think Posterior Cerebral

• Supplies brainstem, cerebellum, visual cortex
• Vertigo, nystagmus
• Diplopia
• Dyarthira, dysphagia
• Quadriplegia
• coma, syncope

• Vertebral artery thrombosis
• Ataxia, vertigo, nystagmus, N/V
• Dec pain and temp ipsilatel face, contra body
• Ipsilateal Horners (ptosis, miosis, anhidrosis)
• VERTEBRAL ARTERY THROMBOSIS

• Basilar artery at PONS
• Also seen with pontine hemorrhage and central pontine myelinolysis
• Awake and alert
• No motor except vertical eye movements

• Sudden inability to walk or stand (drop attack)
• Headache, dizzy, nystagums, ataxia, N/V
• Can present only N/V
• Early Sx consult
• Rapid deterioration with hemorrhage

Pure sensory - Thalamus

Radia

Axiallary

• Posterior elbow - Median Neve
• Ant elbow - Ulnar nerve

This method is sometimes shortened to the 4-2-1 method of 4 ml/kg/hr for the first 10 kg, 2 ml/kg/hr for the next 10 kg, and 1 ml/kg/hr for each additional kilogram.

(100 ml/kg/day x 10 kg) + (50 ml/kg/day x 3kg) = 1150 ml/kg/day/24hr = 47.9ml/hr

Ipsilateral loss of motor, proprioception and vibrationContralateral pain and temperature

• Loss of motor and sensory
• Upper > Lower

Complete loss of motor, pain and temp below lesion but retains proprioception and vibratory

Histoplasmosis

Coccidioidomycosis

Blastomycosis

• CD4 <200
• Bat wing interstitial pattern
• Bactrim and steroids if Pa02 < 70

india ink encapsulated yeast

Gram neg diplococcic

gram positive cocci in pairs