High-yield medicine notes in the video:

1. Cardiovascular Emergencies & Drugs of Choice

• Hypertensive Crisis with Pulmonary Edema (Batwing appearance): The drug of choice is Nitroglycerin.
• Neurological Emergency (Hemorrhagic Stroke): The drug of choice is Nicardipine or Labetalol.
• Sodium Nitroprusside Indications: Used in intraoperative hypertension (e.g., Pheochromocytoma surgery) and hypertensive encephalopathy.
• Atrial Fibrillation with Acute Heart Failure: The drug of choice is Digoxin. (Beta-blockers are contraindicated in acute heart failure).
• Atrial Fibrillation with Asthma: Use Verapamil or Diltiazem (Beta-blockers contraindicated).
• Recent Onset AF (<48 hrs) with crashing BP: DC Shock (Synchronized Cardioversion). If clots are present in the left atrial appendage, do not give DC shock immediately; start anticoagulation for 6 weeks first.

2. JVP Waveforms & Pulses

• Constrictive Pericarditis: Rapid y descent (steep x, steep y). Often presents with a loud diastolic sound (pericardial knock/shudder).
• Cardiac Tamponade: Absent y descent (steep x, absent y). Presents with pulsus paradoxus.
• Tricuspid Regurgitation: Absent x, steep y descent.
• Cannon ‘a’ waves (AV Dissociation): Seen in Ventricular Tachycardia, Complete (3rd degree) Heart Block, and Junctional Tachycardia.

3. Respiratory System & X-Rays

• Empyema vs. Lung Abscess: Empyema shows blunting of the costophrenic angle with a convexity. Lung abscess classically shows an air-fluid level.
• ARDS (Acute Respiratory Distress Syndrome): Diagnosed with bilateral infiltrates and a PaO2/FiO2 ratio < 300. Shows non-cardiogenic pulmonary edema.
• Exudative Pleural Effusion (Light’s Criteria): Pleural fluid protein > 0.5 (relative to serum) and Pleural fluid LDH > 0.6 (relative to serum). Commonly seen in lung malignancies.
• Superior Vena Cava (SVC) Syndrome: Leading cause is Small Cell Cancer of the lung.

4. Endocrinology

• Cushing Syndrome (Ectopic Sources): Commonly caused by Carcinoid tumors and Small Cell Lung Cancer (Oat cell cancer).
• Addison’s Disease: Presents with hypotension, hyponatremia, hyperkalemia, hypoglycemia, and hyperpigmentation (palmar creases/oral mucosa due to high ACTH).
  • Investigation of Choice: ACTH Stimulation Test.
  • Treatment: Hydrocortisone.
• Acromegaly:
  • Investigation of Choice: Glucose Challenge Test (failure to suppress growth hormone).
  • Screening: IGF-1 levels.
• Pheochromocytoma: Follows the “Rule of 10s” (10% malignant, 10% bilateral, etc.). Investigation of choice is 24-hour urinary fractionated metanephrines. Imaging choice: Gallium-68 DOTATATE PET CT.

5. Neurology & Stroke

• Lambert-Eaton Syndrome: Proximal muscle weakness that worsens with rest and improves with exercise (opposite of Myasthenia Gravis). Associated with Small Cell Lung Cancer (anti-VGCC antibodies).
• Miller Fisher Syndrome: A variant of GBS. Triad of ophthalmoplegia, areflexia, and ataxia. Involves the 3rd cranial nerve.
• Pure Motor Stroke: Sudden onset. Caused by lacunar infarcts involving the penetrating branches of the lenticulostriate artery (commonly hitting the putamen/internal capsule).
• Normal Pressure Hydrocephalus (NPH): Triad of “Wet, Wacky, Wobbly” (Urinary incontinence, Dementia, Magnetic gait).
• Subarachnoid Hemorrhage (Berry Aneurysm): “Star of Death” appearance on CT. Treatment of choice: Endovascular coiling.

6. Infections & Imunocompromised States (AIDS)

• Cryptococcal Meningitis: “Soap bubble” appearance on brain MRI. Investigation: CSF ELISA for Cryptococcal antigen. Treatment: Liposomal Amphotericin B + Flucytosine.
• Cerebral Toxoplasmosis: MRI shows ring-enhancing lesions/calcifications in the basal ganglia. Treatment: Pyrimethamine + Sulfadiazine.
• Neurocysticercosis (NCC): Leading cause of acquired epilepsy in adults. Shows an eccentric scolex (dot-in-hole appearance) or an amino acid peak on MR spectroscopy.

7. Nephrology & Acid-Base Disorders

• Renal Tubular Acidosis (RTA):
  • RTA Type 1 (Distal): Hypokalemia + Urine pH > 5.5 (inability to acidify urine).
  • RTA Type 2 (Proximal): Hypokalemia + Urine pH < 5.5.
  • RTA Type 4: Hyperkalemia.
• ECG in CKD: Prolonged QT interval (due to hypocalcemia). If on diuretics, can show ST depression and T-wave inversion (due to hypokalemia). Tall tented T-waves indicate hyperkalemia.
• ABG Analysis Rule of Thumb: Always apply the modified Winter’s formula to check for mixed disorders versus compensatory states. If actual pCO2 does not match expected pCO2, it’s a mixed disorder.

8. Miscellaneous High-Yield Facts

• Dengue Prognostic Marker: Rising hematocrit (concentration > 20% over baseline) indicates vascular leak and impending Dengue Shock Syndrome. Platelets are only transfused if < 10,000.
• Down Syndrome Cardiac Association: Wide split fixed second heart sound (due to ASD), recurrent lung infections, delayed milestones.
• AML M3 (APML): t(15;17) translocation. Highly associated with DIC.
• Heart Failure Mortality Reducing Beta-Blockers: Carvedilol, Metoprolol, Bisoprolol.
• Tumor Lysis Syndrome: Drug of choice is Rasburicase, but initial step is adequate IV fluid hydration.