DM1 - Fasting Glucose Cutoff - 126 mg/dl

NL - Fasting Glucose - 70-110 mg/dL

CSF glucose 40-70 mg/dl

CSF protein < 40 mg/dl

CSF pressure 70-180 mg/dl

Hematocrit 41-53% / 36-46%

LDH - 45-90 U/L

Bilirubin ttl .1-1.0 mg/dl, Direct 0-.3 mg/dl

Hemoglobin 13.5-17.5 / 12-15

Plates 150-400K

Erythrocytes 5M

Reticulocytes .5-1.5 % of RBCs

AST/ALT 8-20 U/L

Albumin 3.5-5.0 Hypoalbuminemia < 3.4

PT - 11-15, PTT 25-39 Bleed 2-7 min

ESR F <15, > 50yo <20 mm/hr, M <20, >50yo <30mm/hr

K+ - 3.5-5.0, Phosphorus 3.0-4.5, Phosphate 2.7-4.0, Ca2+ 8.4-10.2

HDL  > 40, LDL < 200, Trigs < 150

LDL = TTL  - HDL - TG/5

Lecithin / Spingomyelin < 1.5 in neonatal ARDS

cortisol 08:00 5-23ug/dl 16:00 3-5ug/dl

SGOT / SGPT > 1.5 in alcoholic hepatitis

ALK Phos = 20-70 U/L, Paget's ds = 200-700 U/L

Trasferin Saturation - 20-50%

BUN 7-18 mg/dl Creatinine .6-1.2 mg/dl

Alcoholic hepatitis AST/ALT Viral ALT>AST

STd & T-wave inversion - MI

TSH .5-5.0 uU/ml, PTH 230-260 pg/ml T4 - 5-12ug/dl = Thyroxine Free 7 ng/dl 

T3 - 115-190 ug/dl Triidothyronine

Preganancy increases T4, T3, normal free T4

Fribrinogen - 250 mg/dl is normal

Na 135-145 nEq/L 

Urine SG < 1.006 = DI, normal OSM 275-295

CPK Males 25-90, Females 10-70

MEN -> increased gastrin -> ulcers (also, isolated hyperthyroidism)

Hypofibringenemia - Fibrogen < 50 mg/dl

T3,T4,TSH - 150 ng/dl, 8.0ug/dl, 1uU/nl

RBC Hemolysis - increased LDH, decreased Haptoglobin- binds free hemoglobin

decreased Glucose leads to increased epinephrine, increased glucagon, increased cortisol, increased GH

Leukocyte Differential

Total 4500-11,000

Neutrophils 54-62%

Lymphos - 25-33%

Monos - 3-7%

Bands 3-5%

Eos 1-3%

Basos - 0-.75%

Most Accurate Tests:
Airway hyperresponsiveness (sensitivity to cold air) - Methacholine challenge test - NPV ~ 100%

Integrate the following notes into the web /FCE:

Well's Criteria for PE risk
SNTIPPP 
Sx: 3
No alternative dx: 3
Tachycardia: 1.5
Immobilization > 3 days or surgery in past 4 weeks: 1.5
Prior hx of DVT or PE: 1.5
Presence of hemoptysis: 1
Presence of malignancy: 1
0-1 Low
2-6 Moderate
6-12 High risk of PE
My acronym:
E - Evidence or symptoms
M - Most likely (no alternative)
B - Beats (tachycardia > 100 bpm)
O - Obtunded (immobilized > 3 days or surgery in past 4 weeks)
L - Latent
U - sangUigenous
S - Say "malignancy".

pretest prob / (1-pretest prob) * LR = post-test odds
posttest odds/(1+posttest odds) = post test probability
Remember: LR =2 increases 15%, 5 = 30%, 10 = 45%

Renal & pulmonary systems adjust this: CO2 / HCO3- ratio

Don't give ABX in HUS.
ADAMST-13 deficiency - TTP
- fever, thrombocytopenia, MAHA, CNS, renal insufficiency TX: plasmapheresis
- Ticlopidine, Clopidogrel can precipitate TTP

Cocroft Golf: 140-Age/1.6(50 BMI / 70 mm)

B.S. - hemisection of cervical cord
- all sx ipsi except contralateral pt loss below level of lesion

The big DDX: N/V Altered Mental Status
- Infectious
- Metabolic (Endocrine - DKA), Liver, K. Failure
- Neoplastic
- Drugs / Drug Interactions / Rec. Drugs
- Autoimmune

Empiric Tx for Meningitis:
ceftriaxone 2mg IV q 12hr
vanc
ampicillin 2g IV q 4hr
dex 10 mg IV q6hr (q4Day)
IVF NS 200ccc/ hr
if blood cultures grow S. aureus switch to Nafcillin
Why give Dex w/ ABX in meningits ? Decrease neuro sequalea. (need ref)

Prophylaxis for kid of pts w/ meningitis: 500 mg ciprofloxacin.

PO2 / FiO2 < 300 = shunt or V/Q mismatch

AG acidosis think KLUT - ketoacidosis, uremia, lactic acidosis, toxins

PCO2 = last 2 digits of pH in compensated metabolic acidosis.

NAGMA with resp compensation - acetazolamide
- type 2 RTA (carbonic anhydrase)

delta / delta = (AG-12 / 24-HCO3-) 1 = simul NL anion gap acidosis, 2 = simultaneous met alk or compenstated chronic resp acidosis
- expect resp alk in pts with ESLD

How would you distinguish INO (MLF) from medial adductor palsy ?

ANS: INO can easily be confused with a medial rectus palsy since 
the affected eye appears to have lost its ability to adduct. However, 
most patients with INO still have the ability to converge, as this ocular
movement pattern (bilateral ocular adduction in response to focusing 
on an object moving closer to the eyes) does not require an intact MLF. 
Additionally, INO is often the presenting sign of multiple sclerosis (MS). 
Most (92%) patients who develop INO because of demyelination will 
progress to full-blown MS.

Noto Bene: 50% of patients with MG present initially with extraocular 
muscle weakness. As such, patients in whom there is any question of 
the diagnosis should undergo testing for anti-acetylcholine receptor antibody.

DDX:

1. Brain stem and fourth ventricular tumor
2. Brain stem infarction
3. Drug intoxication (eg, phenothiazines, tricyclic antidepressants, toluene, tacrolimus)
4. Lyme disease
5. Multiple sclerosis (the most common cause of bilateral INO in young adults)
6. Subdural hematoma
7. Syphilis
8. Trauma
   
9. Viral infection