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Differential Diagnosis of Alcohol Poisoning
*Metabolic acidosis with an increased gap may occur due to production of lactic acid or hypoglycemia(ketones)
- All are commonly used as an ethanol substitute.
- All are initially metabolized by alcohol dehydrogenase (ADH).
- Blood levels of each alcohol - is the most specific test!
Key Clues
- Alcohol and Isopropyl alcohol look similar except fruity breath!
- Isopropyl alcohol can be distinguished from Methanol and ethylene glycol because of the absence of anion gap metabolic acidosis!
- Fluorescence of the urine under Wood’s lamp suggests ethylene glycol because of fluorescein, a component of antifreeze.
Download the Alcohol Poisoning CheatSheet!
Intergrated Cases by Dr. Lionel Raymon
Here's a sample of Dr. Raymon! This guy is awesome:
Read more: Tuberculosis by Dr Raymon
Here's a recent case from the wards to inspire you to become the best doctor that you can be. You will save lives and change the world for the better!! Can you make the diagnosis?
Hey John:
I'm one of your Kaplan students whom you taught in Newark NJ back in 2010. Currently I'm in my final year in internal medicine and will do hepatology next. The reason I'm sending you this message is to thank you for your valuable lectures. They were so awesome that not only helped me in Step 1 , 2, 3 but also helped me save a life...
I was in the MICU, on call, when I had this patient sent from the floor with severe altered mental status and she had been intubated so history out of the equation. I examined her and found asymmetric reflexes in the knees on the physical. During the rounds, the intern read the labs which were significant for a low platelet count and elevated creatinine. I was sitting beside the attending who was emphasizing on some point about the platelet count and the need for transfusion. She then asked the intern and me what do we think is the diagnosis?
Stages of a Contusion (Bruise)
Can you tell me why you get the different color changes of a bruise?
Read more: The Stages of a Contusion
Here are the distinguishing features of some of the most tested causes of Short stature (Dwarfism):
Psychosocial Short Stature
Here are the key points for this rare cause of short stature:
Read more: Psychosocial Dwarfism
New Gestational Age Designations
The American College of Obstetricians and Gynecologists (ACOG) has decided to change the definition of Term pregnancy. Here is the new designations along with the former designation:
The reasoning behind the change is that:
- Research has shown that babies born in the "early term" have a 20% greater risk of significant complications compared to those born after 39 weeks.
- "The frequency of adverse neonatal outcomes is lowest among uncomplicated pregnancies delivered between 39 0/7 weeks of gestation and 40 6/7 weeks of gestation" (Full Term)
Source: American College of Obstetricians and Gynecologists (ACOG)
Von Hippel Lindau (VHL) Mnemonic
Here's a visual way to remember the key associations for VHL:
Read more: BaroneMnemonic: VHL
Hashimoto's Thyroiditis Mnemonic
Here's a way to remember some key facts about Hashimoto's Thyroiditis by using it's name!:
Read more: Hashimoto's Thyroiditis Mnemonic
Retinoblastoma Mnemonic
Here's a fun way to remember the key associations for familial retinoblastoma :
Read more: Retinoblastoma Mnemonic
Abetalipoproteinemia
Here's a simple way to remember some important features of this autosomal recessive genetic disorder:
Read more: BaroneMnemonic: Abetalipoproteinemia
The Consequence of Not Preparing Well for the Dragons!
What's your guess?
Residency directors are less likely to look at your application if you have a failure on your first attempt of which board exam?
A) Step 1
B) Step 2 CK
Answer:
Source: "The Agnew Clinic," an 1889 oil painting by Thomas Eakin, shows a 19th century operating theater in action. (Image: Philadelphia Museum of Art/Public Domain)