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
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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)
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[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
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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
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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
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[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
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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
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S. bovis
[Two No]
1.
no valve abnormal (43%~72%)
2. no IV drug related
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remember: ask
"from onset to recovery"
seizure syncope
precipitating none Valsava, emotion, Hx of heart disease
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[S&S]
1. forward decrease -> low C.O ->
fatigue / exertional dyspnea -> LV failure
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ECG
during exercise
1. ST depression (看J point後2格)
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[Discolored of Nail Bed] ->In nail bed, therefore color is white/pink change
1. kidney:
Lindsay nail (half and half nail)
a. proximal (40%~80%)-> white
distal ->red, pink, brown (depend on pressure)
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Brugada Syndrome
[epidemiology]
1. most Asian, japan~ 1%
2. male : female = 9 : 1
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[intro]
1. amebiasis: infected by E. histolytica
2. infectied -> 90% -> asymptom
10% -> dysentery, liver abscess..etc
# free-living amebas
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lactulose
[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
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[bone / cartilage]
1.
[Soft tissue]
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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
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sentinel cell recognition pathogen -> initiate and amplify innate immunity
1.sentinel cell
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[contraction]
paralysis/paresis
hyper/hypotonia
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[meningitis]
1. fever,headache, nuchal rigidity (>90%)
2. mental status change (>75%)
3. nausea, vomit, photophobia
4. seizure
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