Download Miscellaneous True Facts 1

Dr. Merrill’s True Facts, 10/28/02


















Migraine
- Unilateral, throbbing
- Visual aura
- Nausea, vomiting, photophobia
- Any recurrent, severe headache probably has migraine component
- Prophylaxis if > 1x/week or so: tegretol, inderal, tricyclic
Cluster headaches:
- Wake patient in morning or after falling asleep (often start in REM)
- Ice pick to the eye
- “This is the worst pain known.”
- Ipsilateral Horner syndrome, tearing and rhinorrhea.
- Male, tall
- Oxygen, lidocaine nasal drops, sumitriptan, ergotamine, prednisone.
Tension headache
- Best abortive is muscle relaxant.
- “like a band going around my skull”
- bilateral
Pseudotumor cerebri:
- Associated with steroids, tetracycline and vitamin A.
- Young woman on birth control pills
- Peripheral visual field loss
Wernicke encephalopathy: ocular nerve palsy, gait ataxia, mental disturbance.
Korsakoff syndrome: residual amnesic state with confabulation.
Standing will make spinal stenosis worse but claudication better.
Tremor:
- Normal physiologic: 9 Hz.
- Essential/familial: 7 Hz.
- Parkinsonian: 4-6 Hz.
Theophylline does not add to albuterol in acute asthma attack, but does add in
COPD maintenance, poss by strengthening diaphragm.
Anticholinergics are more effective than beta agonists only in COPD. They may
be a decent addition in some asthma (e.g. SO2) but not much.
Continuous prednisone may be necessary in some asthma.
< 15% of smokers develop emphysema.
Chronic bronchitis: excess bronchal mucus for at least 3 consecutive months for at
least 2 years. 20% adult males.
Ischemic colitis - Thumbprinting/pneumatosis intestinalis. Suspect on seeing
acidosis of unknown cause and vague abdominal pain. Endoscopic view is
diagnostic. Treat by hydration.
Esophageal obstruction in young patients usually caused by Schatzki ring.
Pill-induced esophagitis: doxy, KCl, FeSO4, quinidine. *Young patient with acne
and acute onset of odynophagia.
LES pressure is decreased by progesterone.
GERD alarm signals: nausea/emesis, dysphagia, FHx PUD.








It takes a long time for GERD-related cough/hoarseness to resolve with treatment.
Zenker: regurgitate foods days later.
In achlorhydria and pernicious anemia, gastrin levels skyrocket.
PUD bleeding:
o Urgent scope if gastric lavage doesn’t clear.
o Oral H2 blockers OK.
o Use angiographic therapy if patient fails EGD and is not a surgical
candidate.
Most bloody diarrhea is not due to IBD.
Celiac disease:
o String sign on SBFT: terminal ileum is very edematous.
o Malabsorption problems: oxalate kidney stones, cholesterol gallstones,
B12 deficiency, Vit D deficiency, diarrhea due to bile acids
Zoster in a young person is a sentinel sign for HIV.
Hepatitis C causes:
o rhematologic manifestations: polyarthritis, trigger finger.
o itchy skin, even with normal LFT’s.