lactic acidosis
wight neutral meds
low risk hypoglycemia
metformin
weight gain and hypoglycemia side effects
sulfonylureas
cant use sulfaonueras/metformin
weight gain,edema, chf, bone fracture, bladder cancer
low risk hypoglycemia
safe with renal side effects
pioglitazones
low risk hypoglycemia
weight neutral
renal insufficiency
DPP4 inhibitors
weight loss
low hypoglycemiaa risk when used alone or with metformin
GLP-1 agonist
fatigue, low hb not treated with iron supplementation
b thalassemia
aoritc dissection treatment
labetolol b blockers
euvolemic hypervolemic hypernatremia give
5% dextrose
mild hypovolemic hypernatremia
1/5 D5W and 0.45% saline
left axis deviation, peaked t waves, small r waves,
av septal defect
pulmonary markings
small left ventricle
tricuspid atresia
decreased breath sounds, sob,
dull to percussion right lobes
what to do
thoracentesis
pleural effusions w/ or w/o lung mass
stroke, hyperkalemia, facial droop, aki, wide qrs, peak t waves treatment
give calcium gluconate -cardiac membrane stabilization
insulin with glucose rapid acting
b2 agonist
sodium bicarb
otiitis media, vomiting, headaches, mastoiditis pain what is management
temporal lobe abscess-do a CT even if a kid with contrast or MRI
hypointense center plus ring enhancement
worsening acne not helpful benzoyl peroxide
oral erythromycin/clindamycin-acne vulgaris-erythma acne
w scarring-oral retinoin merge with possible scarring
HIV, fevers, chills, pleuritic chest pain, cocaine/heroin
staph aureus-infective endcarditis
diminished
trigeminal neuralgia then no vibratory/sensory and incr dtr
oligoclonal bands-MS in CSF and T2 MRI
recent infection, fatigue, distend jugular veins, sob
nonpalpable point of maximal impulse
pericardial effusion, hypotension, jvp, muffled heart sounds
intermittent ptosis
myasthenia gravis
pulsus bifriens
aortic regurg, hypertrophic cardio, big pda
septic shock with elevated ast/alt one day later
ischemic hepatic disease
treat torsades de point
magnesium
supraventricular tachycardia
adenosine
atrial and ventricular tachycardia
amiodarone
atrial brady
av block
atropine
hyperkalemia
calcium gluconate
quinidine use causes torsades de point
sodium bicarb-hyperkalemia, metabolic acidosis
painful nodules on ankle what to do
x ray-erythema nodosum-sarcoidosis or tb
different arm htns, no cp, abdominal bruit previous ca, aorta>1.5 cm, inc creatinine, arb, resistant htn greater than 3 meds not helping
renal artery stenosis
imbalance between hydrostatic and oncotic pressure that requires movement across membrane to increase capillary movement into viscera and pleural membrane
transudate
increase inflammation causing increased cappillary and membrane permeability
exudate-pleural fluid/serum protein >0.5
LDH/serum LDH >0.6
LDH pleural fluid >2/3 the upper limit of normal serum ldh
glucose concentration in empyema is decreased due to high metabolic activity
exudative effusions with low glucose concentration due to high metabolic activity of leukocyts and bacteria within pleural fluid
pain, parasthesia, pallor, pulselessness
acute arterial occlusion of left lower extremity due to thromboembolism
afib
warfarin or non vitamin k antagonist oral anticoagulants like apixaban
pulmonary hypoplasia, flat facies, limb defects
oligohydramnios sdue to urinary tract anomaly like posterior urethral valve-hydronephrosis
noncaseating granuloma, tender nodules shin (erythema nodosum), cough, sweats, deterioration after steroid therapy
histoplasmosis
who should get hep A vaccine?
men sex men, travel endemic areas
blood and protein in urine asx post pharyngitis
glomerular hematuria-gross-glemerulonephritis due to igA nephropathy
if no protein, renal flank pain, macroscopic hematuria-polycycstic kidney disease, stones, cancer bladder
ards causes
decreased lung compliance
impaired gas exchange
increased pulmonary pressure
jaundice, scleral icterus, n/v/ruq pain, inc alk phos/ast/alt
hep A-recover 3-6 weeks
pericardial effusion next step?
ct angio-aortic dissection in hemodynamically stable
wheezing, cough with blood, fatigue, wt loss, clubbing, rul infiltrate
bronchiectasis-chloride channel clearing sucks
stroke with afib
anticoag -warfarin//dabagitran/rivaroxaban
stroke
aspirin
3.5 hrs sx onset and no contraindications
ateltapase
sharp x,y, inc jvp, ascites, edema, pericardial calcifications
constrictive pericarditis-TB
fatigue, delayed carotid pulses, pre-syncope, thickening and calcifications, dyspnea, angina, syn
aortic stenosis-soft second heart sound
air conduction hearing loss,
otosclerosis
acute urinary retention, bph
bladder ultrasound
floating spots, blurred vision, vision loss
uncovering hidden antigens
sympathetic opthalmia
hemoptysis, ground glass opacities-ruq, low leukocytes, halo sign
immunocompromised, neutropenia
invasive asperogillosus
severe eye pain, dilated eye, nausea, vomiting
acute angle closure glaucoma
hypercalcemia, shoulder pain, lytic bone lesion
langerhans histocytosis younger patient
diarrhea, leukopenia, hepatoxicity
azathoprine
bone marrow suppression
mycophenalate
tremor,GI, nephrotoxicity, hyperkalemia, htn, gum hypertrophy, hirsuitism,
cyclosporine
neurotoxicity, diarrhea, glucose intolerance
tacrolimus
round mass lung, smoking history, dyspnea, plumber what is it?
bronchogenic carcinoma
improve of type 1 mobtiz heart block
atropine/exercise
improves type 2 mobitz heart block
vagal maneuver
dilated pupils, tachy, htn, no murmur/rubs, st depression, t wave inversion
cocaine use-diazepam, aspirin, nitro
no bblockers
dizzyness, fullness, rinne weber positive, single epispode that lasts days
menieres-increased endolymphatic pressure
vestibular schwannoma
sensorineural hearing loss, imbalance and tinnitus, symptoms persistent and progressive,
vertigo, hearing los and tinnitus
acute-resolve in WEEKS
inflammatory labryintihitis
loose calcium in semicircular canal
bpph-head movement vertigo
reduced mobility of ossicles
otosclerosis-progressive conductive, not sensorineural
hypotension, kaussmaul respirations, elevated jvp, diaphoresis, chest pain, brady, st depression avl and I, ST elevation 2,3,avf
RV infarction
loud holosystolic murmur, left to right shunt, rv failure
IV septum rupture
psudopolyps, petechie, bloody stools, fatigue, pruritis, ulcerative colitis-bloody diarrhea, elevated liver function tests, cholangiopancreatography, onion skin fibrosis, panca, IgM increased,
primary sclerosing cholangitis
fever, ruq pain, jaundice
acute bacterial cholangitis
acute/chronic hepatitis
elevated serum aminotransferases, cholestasis, mixed pattern, 5-asa/steroid
drug induced hepatoxicity
elevate alk phosphatase, wt loss, hepatomegaly
metastatic colon cancer
medium sized necrotizing vasculitis, neuropathy
polyerarteritis nodosa
ama, middle aged women, ulcerative colitis
primary biliary cholangitis
urinary incontinence >5 what to do
desmopressin after alarm doesnt work
edema, fatigue, proteinuria, ab pain, in 5 year old what would you see on kidney microscopy
normal-minimal change disase-effacement of foot processes-nephrotic disease-steroid therapy
nasal congestion, clear rhinnorhea, pale nasal mucosa, nasal creasing, cobblestoning, conjunctival edema, thick green discharge
allergic rhinitis-corticosteroid
acute retinal necrosis, keratitis, uveitis, in HIV patients, peripheral pale lesions-central necrosis
hsv or vzv
patient post endoscopy-tachy/pain, what to do
pleural effusion
cxray/ct/
water soluble esophagram
perforation
then abx plus surgery
pass out, sleep deprived, fever hypoglycemia with/w/o aura, posictal state
general seizures
tongue laceration
prolonged standing, physical/emotional stress
lightheaded, sweating, pallor, baseline after event
vasovagal syncope
exertion, dehydration, immediate return to baseline after
cardiogenic syncope
wilsons disease also known as
hepatolenticular degeneration
nonblanching purple purpura, positive rf, hematuria, proteinueia, hypocomplement
mixed cryoglobinuria-immune complex deposition in small-medium leading to endothelial injury and end organ damage
likely have hep c or sle
muscle stiffness, fatigue, wt loss, jaw tenderness, temporal artery tenderness, increased esr >50 means
aortic aneurysm most possible complication-giant cell arteritis-do chest x ray
gential ulcer-small vesicles on erythematous base, mild lymphadenopathy
herpes simplex
large deep genital ulcer with gray/yellow exudate, irregular soft borders, sevr lymphadenopathy may supparate
h. ducreyi-chancroid
single ulcer chancre, regular borders hard base
syphilis-treponema pallidum
chlamidya
small, shallow can progress to painful fulminant adenitis
maternal fever, tachy, uterine tenderness, malodorous amniotic fluid, purulent vaginal discharge
intramniotic infection-chorioamnitoitnis 39 weeks fluid
treat-abx oxytocin
sob, ha, chest discomfort bounding pulse-water hammer
aortic regurg
systemic arterial pressure fall more than 10 durig inspiration
pulsus paradoxus-cardiac tamponade
pulsus parvus tardus
dec amp delayed pulse upstroke-aortic stenosis
down syndrome assoication, squirt sign positive, normal meconium consitency, rectosigmoid level
hirschprung disease
alzheimer and hypothyroidism are increased risk with downs
cystic fibrosis, ileum, insippated meconium, no squirt sign
meconiu ileus-sinopulmonary disease
shiny tongue, lower extremity weakness, pale conjunctivae, ankle refelx decreased, less sensitive to cold lower extremity
b12 deficiency assoc with gastric cancer (pernicicous anemia)
loss of right eye vsison progressive, bent and wavy vertical lines when look at grid instead of straight
macular degeneration-grid test
visual loss from cataracts
lens opacity
enlarged blind spot
papilledema
dry mucous membranes, n/v/ab pain, hasnt used insulin in last 5 days, high ketones in urine and serum what is best index to treatment
aniion gap and beta hydroxyutyrate best markers dka
dka-iv insulin, fluids, replace electrolytes
test for nf 2
mri with gandolium
smoker, white plaque on buccal mucosa wont scrape off
leukoplakia
inferitlity 12 months but her and his organs all good no menses issues what to do
semen analysis
staph aureus blood post lower extremity infection, incontinence, back pain, suprapubic mass, cant lift legs, what to do next, ince es, temp increase
spinal epidural abscess-mri
distended bladder-cant pee
dizzy-spinning when look up, normal vitals, neuro negative
semicicular canal dysfunction-bppv-dix hallpike maneuver
hypocalcemia cause first ask self
magnesium high or low-resistance to pth-malnutrition/malabsorption
boy joint pain/swelling shoulder, 3 months getting worse, plays bball 5days/week, esr alk phosp ldh increased
osteosarcoma-sunburst 13-16 years old
chest pain, helps sit forward, previous mi, bun inc cr in
uremic pericarditis BUN>60
tx-dialysis
brief loss of consciousness post accident, weakness upper extremities films just show arthritis what is it
central cord syndrome-hyperextension, degenerative changes in spine -central corticospinal and lateral spinothalamic -loss pain/temp
anterior cord syndrome
motor paresis distal to lesion-asa
complications of ebv-mono
air obstruction
complication of kawasaki
coronary artery anerysm
baby 20 days old-jaundic, wont eat, fussy, hypotensive, tachy, dry membranes, scelral icterus, decreased tone, what to do
culture and abx=sepsis
what do you see in absence seizures
eyelid fluttering/lip smacking
<20 seconds
lack of response to voice
automatisms
6 year old, ab pain, curl up legs, last bm 2 days ago, vtials normal, palpable mass right abdomen what is it
small bowel diverticulum-intussepstion at age 2-target sign on ultrasound, currant jelly stools, recent rotavirus,meckels diverticulum, henoch schonelin purpura, celiac disease, intestinal tumor, polyps
tech 99m for meckels
tumor involving ileum and presents as intussusception
burkitt lymphoma
autoimmune vasculitis and risk intussesption with small bowel hematoma
henoch schonlein purpura
breast tenderness post menopause, little vag bleeding, left adnexal mass, thick end stripe what to do
endometrial biopsy
granulosa cell tumor ovary
33 year old no peridos 18 months, tubal ligation, normal tsh prolactin, fsh and lh what is cause
anovulation-secondary to moribid obesity-progesterone not being produced normally
lh>25
fsh>40
premature ovarian failure
premature ovarian failure
fever, jaundice, ab pain, dark urine, bite cells, red blood cell inclusions, crystal violet staining
G6PD deficiency-NADPH created required to prevent oxidation of hemoglobin
acute-hemolysis crisis
pinpoint brusises all over with recent respiratory infection
no bleeding, cooperative healthy,
low platelets, leukocytes
observe
immune thrombocytopenia
viral infection
petechie/ecchymoses, epitacis, hematuria, gi bleed
megakaryocytes
kids-skin only-observe
bleed-IVIG or glucocorticoids
adults-platelets>30,000 observe
<30,000 or bleed-IVIG or glucorticoids
steattorhea, fatigue, weight loss, several years ago n/v/epi pain back pain
what to do with pmhx of alcoholism
pancreatic enzyme supplementation
skin rash, 14 year old itch/burned then filled with clear liquid, on insulin, pallor, vesicular symmetric over extensor surfaces
celiac disease
type1dm, down, thyroiditis
anti-tissue transgluaminase ab asay
anti-endomysial ab
duodenal biopsy inc intra epithelial lymphocytes and flattened villi
what meds cause hyperkalemia
bblockers
aceI
arbs
K sparing diurectics-block enac
glycosides-digoxin
nsaids-impair pg syntheseis-reduce renin/aldosterone secretion
man v/n/cp/sweating/smoking history/brady/hypotension
2 pwaves to 1 qrs
st depression v1/v2 (posterior wall MI)
q wave/st elevation-2/3/avf (inferior wall MI)
st depresion 1/avl (recipricol changes)
rca infarct
anterior wall mi
LAD V1-V6
inferior wall MI
RCA or LCX
2,3, avF st elevation
Posterior wall MI
LCX or RCA
st depression V1-3, I and AVL (RCA)
ST elevation I and avL (LCX)
lateral wall MI
LCX diagonal
st elevation I, avL, V5/V6
st depression 2,3, avF
RV MI
RCA
V4-6 ST elevation
what supplies blood to the AV node
RCA
house fire what are you treating for?
hydorgen cyanide or CO
no burns-black soot, capillary refill
tx-charcoal-hydroxycobalmin/sodiu thiosulphatem nitrites,
iv fluids
cause-reduced ocygen utilization by tissues
diastolic murmur but asx what to do next
echo TEE
diastolic murmurs are pathologic
sob/left sided chest pain, chills, cough, green phlegm, smoker/drinker. temp 102, tachy decreased breath soudns left lung base
empyema-
ph<7.2
dec glucose, wbc>50,000
positive gram stain
abx and drain
parapnemonic effusion-ph>7.2, dec to normal glucose, <50,000
negative
abx
seizures from alcohol
creatinine increased
large amount rbc
what to look for
rhabdomyolysis
female, headache, elevated csf
increase intracranial pressure-blindness
egypt vaccines
hep A, B, tphoid, polio
downgoing babinski reflex
hallucinations
alertness
confusion
insomnia
lewy bodies-eosinophilic,
rivastigmine
skin rash, rhinnorhea, chorioretinitis, hepatosplenomegaly, jaundice, iugr
calcifications
abnormal long bone radiographs
syphilis
swelling knee, constipation, excessive urination, fatigue
kidney stone
hyperpth-hypercalcemia-pseudogout rhomboid shape crystals
patient with brca2 breast cancer on chemo wants contraception without horomones what do you give?
copper IUD
patient pregnant given rhogam within 28 weeks and 72 hours
use klehauer betke test to make sure correct dosing of rhogam
sustained mva with high ph what is most likely to also happen
high urine ph-high bicarb level excreted and kidneys retain H+
boy found on ground, blue lips, ate before bed, unconcious, now alert and awake, not remember anything what happened
general seizure
cystic fibrosis with recurrent infections, what to give 6 year old kid with pulmonary issues
IV vanco prophylaxis if recurent
cefepime if first time
before 20 staph aureus
after 20 pseudomonas
amoxacillin-strep
ciprofloxacin-psudomonas
azithromycin-mycoplasma
anemic patient refractory to blood transfusions, increased risk of pneumococcal sepsis for how long, even with splenectomy
hereditary spherocytosis-more than 10 years susceptible to infection
3-5 years of pcn meds
patient has a gastrectomy, shiny tongue, high ldh, high indirect bilirubin, pale palmar crease, easy fatigue,
B12 deficiency post gastrectomy-cant make purine and thymidylate for dna synthesis, decreased transition to mature rbc, increased imature megaloblasts, increased intramedullary hemolysis of megaloblasts causes indirect hyperbilirubinemia manifests as jaun
soccer player pop knee, pain/swelling, cant bear weight, blood fluid when aspirated
acl ligament injury
MRI
RICE
lachman test
pinpoint rash, flexed hip and head, drowsy, lethargic, immunized, fever, vomiting, lethargic, responded to acetominophen
neisseria meningitis-most common meningitis in the us
unresponsive homeless dude nontender enlargement of submandibular glands known as
sialadenosis-found in alchoholic and nonalcoholic cirrhosis
78 year old, bilateral butt pain to calf/thighs, worse with ambulation cant walk, sitting/leaning forward helps. cabg past, normal reflexes/strength, normal pulses, abi 1.1/1.2
neurogenic claudication osteoarthritis spine
lumbar spinal stenosis
-degenerative disk, arthritis, thickening flavum
exertional pain, pain with rest stops, lower extremity tighness, no weakness, decreased pulses, cool extremities, decreased hair growth, pallor with leg elevation
vascular claudication
back pain, paralysis, hyperreflexia, fecal incontinence, urinary too,
spinal cord compression
cant walk, weak and pain in her thighs, hypertension, bruit left carotid, esr 12, hypreflexia, deceased strength, flat and broad t waves, premature ventricular contractions
electrolyte disturbance
hypokalemia
exposure with high and normal
test proportions of an outcome
chi square-compare proportions
anova-3+
presbyopia
cant see near-lens elasticity decreases
find testicular mass in scrotum
orchiectomy
nausea, anorexia, palpitations, color change all side effects of what cardiac drug
digoxin
dont use with amiodarone
calf pain swelling, worse with knee flexion,
hep C chronic liver diesease , ascites,
causes of shoulder dystocia
obesity mom, fetal macosomia, weight gain, dm, post-term
what is antiphospholipid syndrome
vascular thrombosis (stroke/dvt) or preganancy complications plus (anticardiolipin ab, lupus anticoag, andti-b2 glycoprotein ab)
loss of preganancies
runner with pain at metatrsal 2 on dorsal surface on right foot
stress fracture-repetitive activities, increase in physical, not enough calcium and vit d
xray can be negative
clicking between 3 4th toes on plantar, with pain
morton neuroma
inadequate controlled hypertension despite meds
secondary htn
htn, with inc cr and abnormal ua
renal parenchymal disease
htn, >180/110, flash pulm edema, ince cr, abdominal bruit
renovascular disease
htn, hypokalemia, hypernatremia, adrenal incidentaloma
primary aldosternism
htn, bounding pulses, diaphoresis, palpitations, headache,
pheo
obese, facial plethora, htn, mm weak, abdominal stria, ecchmosis, amenorrhea, erectile dysfunction,
cushing
calcium ince, htn, confusions, kidney stones, depression, psycho
hyperparathyroidism-primary
hypercalcemia, lung mass, weight loss, what is first step in management
aline-restore volume, and calcitonin to inhibit one resoprtion
TB RIPE treatment, fatigue, dimorphic hypochromic and normochromic rbc, what to treat
pyridoxine-isonizad causes decrease pyridoxine and causes impaired portoprophin synthesis causing sideroblastic anemia
dec TIBC inc iron, hb is 8
vulvar itching, burning, sex painful 67 year old female, thin dry plaque
lichen sclerosus,
do a punch biopsy , spares the vagina
topical corticosteroid
vaginal bleeding, 3 cm dilated cervix, low ab pain, proteinuria, contractions, smoker what is it
DIC-placental abruption,
nitrates do what
venodilators, lower preloa, left ventricular end diastolic volume, and oxygen demand
3 w boy increased gastric residual volume, vomiting, mechanical ventilation, tachy, tachypnea, lehtargic, ab distension met acidosis, leukocytosis, low birth weight, FORMULA FED
necrotizing enteroclitis-xray bowel wall and portal veins,
PARAPLEGIA, BLADDER AND FECAL INCONTINECNE, CANT FEEL BELOW NIPPLE WHERE IS LESION
upper thoracic cord lesion
nasea, vomiting ataxia
cerebllar lesion
lower lesion thoracic
no sensation below umbilicus
supratentorially
hemiparesis
3 day old, spontaneous movements, decreased tone, seizures, rapid head circumference, 3 pounds, igh pitched cry, tense fotanels, hypotonia what is it
iv hemmorhage
treat steroids
erectile dysfunction, decreased libido, gynecomastia, decreased testes size, testosterone low what to do
secondary hypogonadism MRI/trasnferrin/check prolactin se
3 week old, hypolastic left heart syndrome, 1 episode vomiting, tachy, 80% pue ox, heart sounds distant,
pericardial effusion
HIV diarrhea, ab pain, fever, pneumo jivroceii, anicteric,
stool ova and parasite exam
bbq indoors, ha/vomiitng/tachy/confusionpink-blue skin what is cause
CO poisoning
burning rubber/plastic bitter, almond exposure
inhaled cyanide
kid ate pills hematemesis, ulcer stomach/duod, acidosis what did he ingest
iron
chest pain, squeezing chest discomfort radiates to his neck, noctunrnal pain, regurgitation, nausea, dysphagia
GI esophageal distease
right sided chest pain, dyspnea, sudden onset, 35 pack year smoker, tactile fremitus and breath sounds decreased on the right and wheezes on left
ankle edema
secondary spontaneour pneumo
rupture of apical bulb
palpable purpura, proteinuria, hematuria
arthralgia, hepatosplenomegaly, hypocomplementemia, circulating cryoglobulins
HCV antibodies
mixed cryoglobinuria
heavy menses, constipation urinary freq, pelvi heavy, enlarged uterus
fibroids
adenomyosis
pain periods, heavy menses, bulky globular tender uterus-iron deficiency syncope, palpitations, and tachy
pain in right arm, back pain, pale mucous membranes, normocytic anemia, osteolytic lesions on xray, low hb, low leuko, what to do
multiple myeloma-spep protein electorphroesis
post op day 3, dec ab sounds, ruq pain, fever
abdominal ultrasound or HIDA
acalculous chlecystitis
sharp pain over anteromedial tibia below joint line knee
valgus not aggravate, xray normal
pes anserinus syndrome
anterior knee pain-peripatellar pain
patella femoral
man wakes up choking then falls asleep, htn, dm, 150./88 bp 34 bmi, no jvd, lugs clear, no murmur, no organomegaly, edema present what is it
intermittent upper airway collapse-obstructive sleep apnea
fever, swetas, dark urine, fatiue, splenectomy, new england travel with 2 tick bites, hepatomegaly, scleral icterus low hb, high bilirubin, ldh, lfts, thrombocytopenia what to do
babesiosis-thin blood smear-intraerythroytic rings, maltese rings, intravascular hemolysis
tx-atovaquone, azithromycin
or quinine and clinda
fever, headache, myalgias, prominent rash, that spreads centripetally and includes palms and soles
rocky mountain spotted fever
how to treat dengue fever-myalgia, fever, headache-leukopenia and thrombo common
torniquet test
chest pain, cough, diabetes, eczema, st depression, sob, dry cough, on aspiring, clopidegreol, metoprolol, lisinopril
whats cause resp sx
adverse medication
aspririn and bblocker enhance bronchoconstriction
ace inhibitors-dry cough
face ab distension, htn, dm, perioribital edema, ascites, 1+ pitting edema, proteinuria, urine excretion 5g/day
accelerated atherosclerosis-nephrotic syndrome, a thrombosis
nonreactive dilated pupil, erythematous right eye, lacrimation, visual acuity is decreased, esr increased, narrowing or closure of chamber angle, increased intra-ocular pressure, halos, n/v
acute angle closure glaucoma
erection difficulties what to not give patient with sildenafil(PDE5 inhibitor) vasodilatory effects?
Doxazosin-a blocker-hypotension
cyanosis, 80/40, 140 bpm, breathing okay, machine like murmur 100%O2 and still failed treatment what to do
PGE1-vasodilator
sever right periorbital pain, autonomic manifestations, improve with what
cluster headache-100% oxygen , sumatripta
dvt cause
protein c resistance, factor 5 leiden in white ethnicity
leg swelling/tenderness, history ovarian cancer, thrombosis right popliteal vein, sent home on enoxaparin, returns follow up with dec leuko, platelets,
arterial/venous thrombus due to thrombocytopenia