goodduck

step 1. 找出primary acid-base disorder

(1) 先看pH -> 決定acidosis或alkalosis

(2) 再看Paco2及pH兩者"變化方向(上或下)" -> 同向: metabolic ; 反向:respiratory (記法:呼吸一吐一吸,方向相反)

(3) 合併上面即可"秒殺"出primary disorder!

step 2. 算代償的量夠不夠 -> 如果不夠代表可能有合併其它問題

Keypoint: chronic inflammation involving genetic defect!

Clinical Manifestation

1. course: 60%(1歲前)->85%(5歲前)

2. dry skin!

infantile(0~2y/o)

[基本比較]

1. 大小: Parotid >  submandibular > sublingual

2. 分泌量: Submandibular> Parotid> sublingual

3. Parotid Gln. -> Stenson's Duct   ;   Submandibular -> Warthin's Duct

4. Serous: parotid ; Mucus: sublingual ; Mix: submandibular

step1. 看症狀來決定嚴重度以及要不要給anti?

1. increased dyspnea

2. increased sputum purulency

3. increased sputum volume

# 1個 -> mild -> 不用給anti / bronchodilator加量(症狀治療即可)/monitor symptoms

1. minor withdrawal  symptoms (CNS hyperactivity)

    a. timing: within 6hr; if no pregress -> cessation in 24-48hr

    b. symptoms: insomnia, anxiety ; palpitation, diaphoresis, tremor ; GI upset, anorexia

2. alcoholic hallucination

    a. timing: within 12-24 hr ; cessation in 24-48hr

[symptoms] -- 我還是覺得SM ACE PIGS 比up to date的口訣好記 =.=

1. Suicide

2. Mood

3. Appetite

4. Concentration

1928.1.4 : born in Lawrence, Massachusetts -> NY city grow up
1942 (14): Drop out school
1944 (16): into US Navy 
1946 (18): discharge from US NAVY -> become profession boxer ->
1951 (23): University of Oklahoma 

[Two No]
1. no valve abnormal (43%~72%)
2. no IV drug related

remember:  ask  "from onset to recovery"

                                         seizure                        syncope
precipitating                   none                            Valsava, emotion, Hx of heart disease

[S&S]

1. forward decrease -> low C.O -> fatigue / exertional dyspnea -> LV failure

ECG

during exercise
1. ST depression (看J point後2格) 

1. kidney: Lindsay nail (half and half nail)
                  a. proximal (40%~80%)-> white
                      distal ->red, pink, brown (depend on pressure)

Brugada Syndrome

[epidemiology]
1. most Asian, japan~ 1%
2. male : female = 9 : 1

1. amebiasis: infected by E. histolytica 
2. infectied -> 90% -> asymptom
                         10% -> dysentery, liver abscess..etc
# free-living amebas

[mechanism]
1. colon bacteria degrade -> acid pH -> convert ammonia to ammonium ion -> poor absorb
2. GI ammnoia decrease -> blood  amonia diffuse to GI -> in GI with acid pH, converted to ammonium ion

[bone / cartilage]
1.

[Soft tissue]

stimulation test -> for defeciency states

rapid ACTH stimulation test
1. for glucocorticoid reservation ; screening test
2. measure cortisol -> 0.25mg cosyntropin  IV or IV -> 30~60 minutes -> minimal increase = 7ug/dL

sentinel cell recognition pathogen -> initiate and amplify innate immunity

1.sentinel cell 

paralysis/paresis
hyper/hypotonia

[meningitis]
1. fever,headache, nuchal rigidity (>90%) 
2. mental status change (>75%)
3. nausea, vomit, photophobia
4. seizure