UWorld 2 CK Notes 2 PDF

UWorld Notes: Step 2 CK avoidant personality disorder: shyness, feelings maternal infection may be asymptomatic
of inferiority with a desire for friends, but intense ----------------------------------------------------------------

malingering: intentional production of false fear of embarrassment or rejection; low self-esteem ceftriaxone should be avoided in infants with
physical symptoms for secondary gain ---------------------------------------------------------------- hyperbilirubinemia displacement of bilirubin
factitious disorder: intentional production of prolonged hypotension from any cause can lead from albumin-binding sites, risk of kernicterus
false physical or psychological signs or symptoms to acute tubular necrosis oral erythromycin: Rx chlamydial conjunctivitis
to assume a sick role; no secondary gain o U/A: muddy brown granular casts consist of & pneumonia
hypochondriasis: fear of disease & renal tubular epithelial cells o risk of infantile hypertrophic pyloric stenosis
preoccupation with the body, manifests as o serum BUN:Cr ratio < 20:1 topical erythromycin: prophylaxis for neonatal
multiple somatic complaints; at least 6 months o urine osmolality 300 - 350 mOsm/L gonococcal conjunctivitis; regardless of screening
o prominent during psychological stress o urine Na+ > 20 mEq/L, FENa > 2% topical silver nitrate: prophylaxis against
o inquire about current emotional stressors ---------------------------------------------------------------- penicillinase-producing strains of N. gonorrhea
o Rx: refer for brief psychotherapy broad casts: a/w chronic renal failure (not available in the US)
conversion disorder: unexplained neuro symptoms o arise in dilated tubules of enlarged nephrons nasolacrimal duct obstruction (dacryostenosis):
preceded by an obvious emotional trigger; symptoms that undergone compensatory hypertrophy in unilateral chronic tearing & minimal conjunctival
are not artificially produced, unexplained by any response to the reduced renal mass injection; Rx massage nasolacrimal ducts
medical condition; cause social & functional waxy casts: chronic renal disease ----------------------------------------------------------------
impairment (la belle indifference) o shiny & translucent neonatal gonococcal conjunctivitis: acquired
---------------------------------------------------------------- RBC casts: glomerulonephritis or vasculitis; through infected genital secretions
conduct disorder: middle childhood/adolescent o Wegeners, SLE, Henoch-Schonlein prophylaxis: erythromycin ophthalmic ointment
o Dx: at least 3 symptoms from the following WBC casts: interstitial nephritis & pyelonephritis Rx: IV or IM ceftriaxone or cefotaxime
categories: (1) aggression towards people or o WBCs that originate in kidneys complications: corneal ulcers, scarring, blindness
animals, (2) destruction of property, theft, fatty casts: nephrotic syndrome ----------------------------------------------------------------
deceitfulness, or (3) serious violation of rules hyaline casts: asymptomatics & prerenal azotemia meniscal & ligamentous tears can both be a/w a
oppositional defiant disorder: pattern of angry, o proteins that pass unchanged along urinary tract popping sensation following precipitating injury
irritable mood & argumentative toward authority ---------------------------------------------------------------- meniscal injury: gradual joint swelling, 12 24 hr
o children; less severe vs. conduct disorder Neonatal conjunctivitis etiologies ligamentous injury (ACL): rapid joint swelling
antisocial personality disorder: age 18 yrs or onset features Rx & effusion due to hemarthrosis (ligaments have
older; evidence of conduct disorder as minors Chemical 24 mild conjunctival eye lubricant greater vascular supply than menisci, which rely
---------------------------------------------------------------- hrs irritation/injection on diffusion for nourishment)
borderline personality disorder show a pattern & tearing after definitive Dx: MRI
of unstable relationships, impulsivity, reckless; silver nitrate ----------------------------------------------------------------
identity disturbance, suicidal or self-mutilating ophthalmic Ulcerative colitis: MC in females, Ashkenazi Jew,
behavior, feelings of emptiness; splitting prophylaxis peak @ age 15 - 25
histrionic personality disorder: excessively Gonococcal 2 - 5 eyelid swelling, IV or IM MC site: rectum, confined to mucosal layer
labile emotions & attention seeking behavior; days purulent exudate, ceftriaxone or bloody diarrhea, tenesmus, pseudopolyps
uses physical appearance to draw attention corneal ulceration cefotaxime severe disease: weight loss, fever, or anemia
paranoid personality disorder: suspiciousness Chlamydia 5 - 14 eyelid swelling; oral +p-ANCA
& distrust; negatively interpret actions, words & l days chemosis; watery erythromycin confirm Dx: friable mucosa on colonoscopy &
intentions of others; holds grudges or mucopurulent biopsy with mucosal inflammation
dependent personality disorder: submissive & discharge extraintestinal: erythema nodosum, uveitis,
clingy; fear of separation, indecisive, does not sclerosing cholangitis, spondyloarthropathy
take initiative; difficulty expressing disagreement best way to prevent neonatal chlamydial & complications: toxic megacolon & colorectal ca
gonococcal conjunctivitis: screen, Dx, Rx pregos surveillance: annual colonoscopies beginning at
screen for chlamydia @ 1st & 3rd prenatal visit 8 - 10 yrs after Dx for colon cancer detection
o colonic dysplasia is a/w progression to DASH diet is the next most effective approach o HPV infection is transient & malignant
adenocarcinoma; Rx: total colectomy in prevent & treat HTN especially non-obese; transformation is rare
---------------------------------------------------------------- then exercise, dietary sodium, alcohol intake colposcopy only if ASC in 3 consecutive paps
young patient, aphthous ulcer, chronic diarrhea, smoking causes a transient rise in BP or ASC-H, atypical glandular cells, or HSIL
abdominal pain, weight loss: Crohns ---------------------------------------------------------------- ASC-US in age 25: HPV testing
non-caseating granulomas, cobblestone, HPV vaccine for all girls/women age 9 26 o HPV positive colposcopy
transmural inflammation, skip lesions, creeping fat, (except pregos) regardless of HPV status or o HPV negative repeat pap & HPV in 3 yrs
non-lymphoid aggregates sexual activity (also immunocompromised) ----------------------------------------------------------------
MC site: terminal ileum; rectum is spared all boys/men age 9 - 21 High-grade squamous intraepithelial lesion (HSIL)
---------------------------------------------------------------- routine HPV screening (Pap) should not begin age 21 24: colposcopy
primary features of Chagas disease: recent prior to age 21, regardless of sexual activity o if no CIN 2,3 repeat colposcopy & cytology
immigrant from Latin America with chronic **sexually active women age < 21 can be @ 6-month intervals for 2 yrs
megacolon/megaesophagus & cardiac disease HPV+ & develop cervical dysplasia that is age 25: LEEP (except postmenopause & pregos)
(CHF: pedal edema, JVD, S3, cardiomegaly) transient with regression within 2 yrs pregos with HGSIL colposcopy
systolic & diastolic heart failure, RBBB o thus no Pap smear o if colposcopy is negative repeat cytology
Rx: benznidazole or nifurtimox age 21 29: cytology every 3 years & colposcopy @ 6 wks after delivery
---------------------------------------------------------------- routine HPV testing not for women age < 30 o 50% of HGSIL & CIN 2 or 3 regress
adjustment disorder: emotional or behavioral o HPV in most young women is transient, spontaneously during pregnancy
symptoms within 3 months of identifiable stressor; clearing within 2 years o no cervical biopsy or LEEP during pregnancy,
rarely > 6 months after the stressor ends o age 30 65: cytology every 3 yrs, OR unless colposcopy suggests invasive cancer
marked distress in excess of expected from exposure cytology + HPV testing every 5 yrs ----------------------------------------------------------------
to the stressor, with significant impairment cephalohematoma: subperiosteal hemorrhage,
Rx: cognitive or psychodynamic psychotherapy Routine cervical cancer screening does not cross suture lines; presents several
to develop coping mechanisms, response to & Immunocompromised screen at onset of hours after birth; resolves spontaneously
attitude about stressful situations (HIV, SLE, organ intercourse Caput Succedaneum: diffuse, ecchymotic
SSRIs can be an adjunct for depressive symptoms transplant patients) 6 months x2 then annual swelling of the scalp that Crosses Suture lines
---------------------------------------------------------------- Age 21 No screening** ----------------------------------------------------------------
generalized anxiety disorder: excessive worry 21 to 29 Pap (cytology) every 3 years Rheumatoid arthritis
over many aspects of life, at least 6 months cytology every 3 years o morning stiff >30 min, improves with activity
acute stress disorder: PTSD-like symptoms o tenosynovitis of palms (trigger finger)
30 to 65 OR cytology + HPV test
develop within 4 wks, last > 3 days, but < 1 month o cervical joint involvement can lead to spinal
every 5 years
PTSD: anxiety symptoms > 1 month subluxation cervical cord compression
no screening if negative
OCD: recognizes unreasonable nature of behavior 65 o positive anti-cyclic citrullinated peptide
prior screens & not high-risk
o ego-dystonic beliefs no screening if no Hx of (anti-CCP)
OCPD: preoccupied with orderliness & perfection; Hysterectomy
high-grade lesions, cervical o CRP & ESR correlates with disease
does not see the behavior as a problem without cervix
cancer, or exposure to DES o XR: soft-tissue swelling, bony erosions,
o ego-syntonic beliefs ---------------------------------------------------------------- joint space narrowing
---------------------------------------------------------------- atypical squamous cells of undetermined significance greatest risk for osteoporosis
altered levels of serotonin involved in OCD (ASC-US) is MC cervical cytological abnormality, Rx: physical activity, optimize Ca++ & Vit D
Rx: SSRI or clomipramine (TCA) but risk of invasive cervical cancer is low intake, minimize corticosteroids, bisphosphonates
---------------------------------------------------------------- atypical squamous cells, cannot rule out high-grade ----------------------------------------------------------------
weight loss = most effective lifestyle intervention squamous epithelial lesion (ASC-H) is a/w Pagets disease of bone = osteitis deformans; due
to reduce BP premalignant lesions to osteoclast overactivity, leads to replacement of
ASC-US/LSIL in age 21 24: repeat pap in 1 yr lamellar bone with abnormal woven bone
----------------------------------------------------------------
Osteitis fibrosa cystica (Von Recklinghausen avoid interventions that provoke vomiting (smoking-induced emphysema is centrilobular)
disease of bone): due to hyperparathyroidism 2/2 (activated charcoal, milk, vinegar, NG lavage) also causes liver disease: cirrhosis, or HCC
parathyroid carcinoma in absence of perforation, upper endoscopy within liver Bx: hepatocyte inclusion stain +PAS &
excessive osteoclastic resorption, leads to 12 24 hr to assess damage & guide therapy resists digestion by diastase
replacement with fibrous tissue & bony pain ---------------------------------------------------------------- Rx: purified human AAT
XR: subperiosteal bone resorption, salt-&-pepper chronic GERD with new dysphagia & symmetric ----------------------------------------------------------------
appearance of skull, bone cysts, & brown tumors LES narrowing: esophageal stricture chemotherapy-induced peripheral neuropathy
of long bones bodys reparative response to chronic acid exposure from vincristine (also cisplatin, paclitaxel)
---------------------------------------------------------------- other causes: radiation, systemic sclerosis, caustic begins after several weeks
Bronchiolitis: MCC is RSV Dx: endoscopic biopsy to r/o adenocarcinoma symmetric paresthesia in fingers/toes, spreads
older children self-limited, mild URI DDx: adenocarcinoma (asymmetric narrowing), proximally in stocking-glove pattern
age < 2 yrs involves lower respiratory tract hiatal hernia, achalasia (aperistalsis) loss of ankle jerk reflexes, pain/temp sensation,
o wheezing/crackles & respiratory distress ---------------------------------------------------------------- occasional motor neuropathy (B/L foot drop)
with waxing/waning; peaks @ days 5-7 early-onset HTN, progressive renal insufficiency, ----------------------------------------------------------------
Rx: supportive care gross hematuria, flank pain, B/L abdominal masses Pinworm infection: erythematous vulvovaginitis in
prophylaxis: Palivizumab for high risk cases prepubertal females; absence of vaginal discharge
complications: apnea & respiratory failure; ADPKD recurrent episodes of nocturnal itching should be
develops recurrent wheezing through childhood symptoms most are asymptomatic examined with Scotch tape test
o increased risk of acute otitis media; but hematuria empiric Rx: mebendazole
rarely bacterial pneumonia or sepsis flank pain (due to renal calculi, cyst ----------------------------------------------------------------
---------------------------------------------------------------- rupture, hemorrhage, or upper UTI) early Lyme disease: erythema chronicum migrans
Caustic ingestion clinical signs early onset HTN also a/w headache, malaise, fatigue, fever
features chemical burn or liquefaction necrosis B/L upper abdominal masses unilateral Bells palsy
results in: mild proteinuria, CKD early Dx is based on trademark rash & recent travel
laryngeal damage: hoarseness, extra-renal cerebral aneurysm MCC: B. burgdorferi (spirochete)
stridor, orofacial inflammation manifestation hepatic/pancreatic cysts Rx: oral doxycycline (age > 8)
esophageal damage: dysphagia, cardiac valves (MVP, AR) Rx: oral amoxicillin (age < 8, pregos, or lactating)
odynophagia diverticulosis
or cefuroxime
gastric damage: epigastric pain, ventral/inguinal hernias
----------------------------------------------------------------
GI bleeding diagnosis abdominal USS doxycycline A/E: permanent tooth discoloration
management ABCs management monitor BP, renal Fx, & potassium & skeletal retardation in children & fetuses
remove contaminated clothing, control cardiovascular risk factors ----------------------------------------------------------------
irrigate exposed skin ACE-inhibitors for HTN avascular necrosis is a/w heavy alcohol use, SLE,
upper GI XR with water-soluble ESRD: dialysis, renal transplant chronic systemic corticosteroids, sickle cell disease
contrast for suspected perforation DDx ----------------------------------------------------------------
CXR if respiratory symptoms central obesity, facial plethora, proximal weakness, sudden onset C/L lower extremity motor & sensory
upper endoscopy within 24 hr abdominal striae, ecchymosis: Cushings deficits with UMN signs, urinary incontinence:
barium contrast (2 3 wks) headaches, palpitations, diaphoresis a/w anterior cerebral artery (ACA) occlusion
complications esophageal strictures paroxysmal BP elevations: pheochromocytoma MCC: ischemic stroke
o urinary vanillylmandelic acid, & metanephrines ----------------------------------------------------------------
pyloric stenosis
---------------------------------------------------------------- Spinal cord compression
ulcers, perforation
alpha-1-antitrypsin: protease inhibitor that protects causes spinal injury (MVA), disk herniation,
cancer
from neutrophil elastase, which breaks down elastin malignancy (lung, breast, prostate, MM),
AAT deficiency: uninhibited elastase cause bullous, infection (epidural abscess)
panacinar emphysema of lower lobes features gradual, severe focal back pain;
pain worse when recumbent & at night serum Na+ should be corrected by 0.5 mEq/dL/hr, infants: Zidovudine for 6 wks & serial HIV
early: B/L LE weakness, absent DTRs, as cerebral edema can result if too rapid PCR testing
flaccid paraplegia ---------------------------------------------------------------- ----------------------------------------------------------------
late: B/L +Babinski, absent rectal tone, high serum & low urine osmolality due to PDA-dependent congenital heart disease
paraparesis with DTRs, sensory loss, inadequate ADH response is most likely due to aortic coarctation
bowel/bladder dysfunction, lithium-induced nephrogenic DI transposition of great vessels
urinary retention Lithium induces ADH resistance, resulting in hypoplastic left lung syndrome
manage high-dose IV glucocorticoids, acute-onset nocturia, polyuria, & polydipsia total anomalous pulmonary venous connection
emergency spinal MRI, hypovolemic hypernatremia tricuspid atresia
radiation-oncology, neurosurgery consult Rx: discontinue lithium; salt restriction & diuretics normal ductus arteriosus constricts ~day 3 of life
pain worse on recumbent due to distension of (amiloride: K+ sparing diuretic) prostaglandin E1 keep ductus arteriosus open
epidural venous plexus Rx: hemodialysis for lithium level 4 mEq/L or inspired O2 stimulates PDA constriction
---------------------------------------------------------------- 2.5 mEq/L + signs of toxicity or renal disease
anterior spinal cord infarct: abrupt onset indomethacin is a potent prostaglandin inhibitor,
----------------------------------------------------------------
flaccid paralysis, loss of pain & temp sensation stimulates PDA closure
normal aging: stage 4 sleep (deep sleep)
(anterior spinal artery), & autonomic dysfunction ----------------------------------------------------------------
becomes shorter & eventually disappear Common complications after acute MI
---------------------------------------------------------------- ----------------------------------------------------------------
recurrent pneumonia in the same anatomic region hours 2 days reinfarction
increased contractility & reflex tachycardia
o bronchial obstruction or recurrent aspiration hours 7 days ventricular septal rupture
are secondary effects provoked by nitroglycerin
bronchogenic carcinoma obstruction is most days 2 wks LV free wall rupture
due to changes in baroreceptor activity in
concerning with a smoking history response to decrease BP from venodilation hours 1 month post-infarct angina
chest CT is indicated initially ---------------------------------------------------------------- 1 3 days acute pericarditis
o central masses or negative CT: bronchoscopy fever, headache, N/V, petechial rash, stiffness, & 2 7 days papillary muscle rupture
o peripheral lesions: CT-guided biopsy photophobia: meningococcemia 5 days 3 months LV aneurysm
recurrent aspiration, same lung region fever, arthralgia, sore throat, lymphadenopathy, weeks months Dresslers pericarditis
o seizures mucocutaneous lesions, diarrhea, weight loss: ----------------------------------------------------------------
o ethanol/drug use acute HIV infection acute pericarditis occur 1 - 3 days post-MI
o GERD, dysphagia, achalasia migratory arthritis of large joints, carditis, o pericardial friction rub with/without chest pain
recurrent pneumonia in different regions erythema marginatum (raised ring-shaped lesions o self-limited, resolves with supportive care
o sinopulmonary disease (CF, immotile cilia) over trunk & extremities), subcutaneous nodules, posted-MI pericarditis occurring wks to months
o immunodeficiency (HIV, leukemia) Sydenham chorea: acute rheumatic fever after an MI: Dressler syndrome
o vasculitis, bronchiolitis obliterans o pharyngitis precedes onset by 2 - 4 wks o immune-mediated pericarditis
---------------------------------------------------------------- ---------------------------------------------------------------- o Rx: NSAIDs
painless vesiculopustular rash, tenosynovitis, & best method of reducing maternal-fetal transmission ----------------------------------------------------------------
migratory polyarthralgia: disseminated of HIV infection: triple HAART therapy for the MCC blunt abdominal trauma: MVAs
gonococcal infection mother throughout pregnancy MC injured: liver & spleen
2 - 10 skin lesions similar to furuncles or pimples HAART: dual NRTI + NNRTI or protease inhibitor o free peritoneal fluid should raise suspicion
Hx of recent unprotected sex with a new partner test viral load monthly until undetectable, then for liver or splenic laceration
all patients should undergo HIV screening every 3 months; CD4 cell count every 3 months hemodynamically unstable & free intraperitoneal
avoid amniocentesis until viral load undetectable fluid on USS emergency laparotomy
----------------------------------------------------------------
hypotension, tachycardia, poor skin turgor, lethargy, mothers with undetectable viral loads at delivery hemodynamically stable splenic lacerations &
confusion: hypovolemic hypernatremia have 1% risk for transmission no evidence of other intra-abdominal injuries
o Rx: IV normal saline (0.9%) until intrapartum mother not on HAART: Zidovudine non-operative management
euvolemic, then 5% dextrose intrapartum viral load > 1000 copies/mL: ----------------------------------------------------------------
Zidovudine + C-section ventricular septum rupture: 3 to 5 days post-MI
sudden onset hypotension, holosystolic murmur holosystolic strabismus after age 4 months is abnormal &
@ LLSB (VSD), CHF murmur requires Rx to prevent amblyopia (vision loss
---------------------------------------------------------------- IV septum Acute, LAD shock & left-to-right from disuse of deviated eye)
papillary muscle rupture: 3 to 5 days post-MI rupture 3-5 = chest pain, shunt VSD intermittent strabismus can be expected in
hypotension 2/2 severe acute mitral regurgitation, days apical holosystolic infants < 4 months due to immaturity of
holosystolic murmur & pulmonary edema RCA murmur, extraocular muscles; reassurance & observation
--------------------------------------------------------------- = biventricular new onset strabismus can be a sign of
ventricular free wall rupture: mechanical basal failure retinoblastoma if accompanied by white reflex
complication 5 days 2 wks post- MI (anterior) free wall 5 days LAD shock & pericardial acute onset strabismus can result from
hemopericardium & cardiac tamponade rupture of - 2 wks chest pain, effusion intracranial hemorrhage, brain abscess, or
acute onset chest pain & profound shock, JVD, ventricle JVD, distant with encephalitis
with rapid progression to PEA & death heart sounds, tamponade ----------------------------------------------------------------
LV free wall rupture should be suspected in PEA first 5 years of life are critical to development of
patients with PEA after a recent first MI & no large pericardial effusion presenting as cardiac visual acuity, a time of visual cortex maturity
signs of heart failure tamponade post-MI: LV free wall rupture esotropia beyond infancy must be treated to
---------------------------------------------------------------- o dyspnea, hypotension, pulsus paradoxus, JVD prevent amblyopia
ventricular aneurysm: late complication of o EKG: low voltage QRS, electrical alternans deviated eye can be strengthened by patching the
acute STEMI (5 days to 3 months) ---------------------------------------------------------------- normal eye (occlusion therapy) or blurring the
MC complication of anterior MI Sarcoidosis: no definitive diagnostic test normal eye with cycloplegic drops (penalization)
scarred or fibrotic myocardial wall resulting CXR: hilar adenopathy, reticulonodular infiltrates ----------------------------------------------------------------
from healed transmural MI Bx: noncaseating granulomas; serum ACE Rx for SLE, malaria prophylaxis, acute malaria,
decompensated CHF, refractory angina, erythema nodosum, acute polyarthritis, cough, rheumatoid arthritis: hydroxychloroquine
ventricular arrhythmias, or mural thrombus anterior uveitis, dyspnea Rx for Crohns, ankylosing spondylitis, RA,
EKG: persistent STEMI with deep Q waves asymptomatics Rx: followed without treatment psoriasis: infliximab (TNF--blocker)
unchanged from discharge after recent MI due to high rate of spontaneous remission Rx for histoplasmosis: itraconazole
Dx: echo shows dyskinetic LV wall motion symptomatic Rx: systemic glucocorticoid Rx SLE with renal involvement: cyclophosphamide
---------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------
LV free wall rupture: hemopericardium & sudden onset abdominal pain a/w vaginal bleed, encephalopathy, ocular dysfunction, gait ataxia:
cardiac tamponade PEA death fetal distress, loss of fetal station in active labor: Wernicke encephalopathy
---------------------------------------------------------------- uterine rupture giving IV fluids containing glucose prior to
hypotension or shock, JVD, clear lungs, o risk factors: pre-existing uterine scar, thiamine can precipitate or worsen WE
Kussmaul sign: RV infarct abdominal trauma, macrosomia thiamine is given along with or before glucose
o Kussmaul sign: JVD with inspiration o prior low transverse c-section: < 1% risk ----------------------------------------------------------------
EKG: inferior MI &/or ST elevation in V4R V6R o prior vertical c-section: as high as 9% acute onset back pain after physical exertion,
Rx: IV fluid bolus to improve RV preload HTN & cocaine use: risk for placental abruption paravertebral tenderness, absence of radiation,
nitro, diuretics, opioids may worsen hypotension sinusoidal fetal HR tracing: vasa previa negative straight leg raise test, normal neuro
---------------------------------------------------------------- fever, tender uterus, foul-smelling lochia, exam: lumbosacral strain
Mechanical complications of acute MI progression to sepsis: endometritis o Rx: NSAIDs, early mobilization
time artery features echo o polymicrobial infection ----------------------------------------------------------------
RV failure Acute RCA hypotension, hypokinetic o Rx: IV clindamycin & gentamicin acute back pain, local spinal tenderness, &
clear lungs, RV clindamycin for Gram+ & anaerobes decreased spinal mobility after minimal trauma,
Kussmal sign gentamicin for Gram-negatives coughing, lifting: vertebral compression fracture
papillary Acute, RCA acute, severe severe MR ---------------------------------------------------------------- worse with standing, walking, laying on back
muscle 3-5 pulmonary with flail point tenderness, but normal neuro exam
rupture days edema; new leaflet risk factors: postmenopausal or senile osteoporosis
o also: steroid Rx, osteomalacia, osteomyelitis, serial LPs may be required to reduce ICP Rx: ganciclovir (or Foscarnet)
trauma, bone mets, hyper-PTH, Pagets antiretroviral therapy should be deferred at least complications: toxic megacolon
complications: risk of future fractures, 2 weeks after completing induction antifungal ----------------------------------------------------------------
hyperkyphosis ( respiratory capacity, risk of therapy for cryptococcal meningitis bone marrow transplant recipient with lung &
atelectasis, early satiety, weight loss) o initiating retroviral therapy with acute infection interstitial involvement: CMV pneumonitis
---------------------------------------------------------------- risk of immune reconstitution syndrome develops 2 wks 4 months post-transplant
Eikenella corrodens: G-negative anaerobe part itraconazole does not cross the BBB CXR: multi-focal, diffuse patchy infiltrates
of normal oral flora ---------------------------------------------------------------- high-resolution CT: parenchymal opacification
o infective endocarditis due to E. corrodens is sulfadiazinepyrimethamine: Rx cerebral toxo or multiple small nodules
seen in poor dentition, periodontal infection, (headache, focal neurologic deficits, seizures); Dx: bronchoalveolar lavage
or manipulative dental procedures multiple ring-enhancing lesions with edema ----------------------------------------------------------------
o E. corrodens belongs to the HACEK group ---------------------------------------------------------------- dizziness, spinning sensation with nausea:
congenital heart lesions (bicuspid aortic valve, prostaglandin-only oral contraceptives are vertigo
PDA, ToF, VSD) predisposes to risk of IE preferred for hormonal contraception for vertigo classification: central or peripheral
ulcerative colon lesions due to colonic neoplasia lactating mothers o peripheral vertigo has a shorter interval
or inflammatory bowel disease predisposes to IE o does not affect volume or composition of o ear fullness suggests peripheral vertigo
due to Strep gallolyticus (S. bovis type I) milk produced, or risk of venous thrombosis o CN VIII lesions lead to central vertigo
S. aureus is the MCC of IE among IVDA a/w combination OCPs vertigo with a sensation of ear fullness suggests
Enterococci (E. faecalis) MC endocarditis a/w lactation causes anovulation, thus some degree
Menieres disease, from abnormal accumulation
nosocomial UTIs of contraception due to high prolactin levels of endolymph in the inner ear
---------------------------------------------------------------- which inhibit GnRH release, but not reliable tinnitus, vertigo, sensorineural hearing loss
flumazenil: GABA/benzodiazepine Rc antagonist ----------------------------------------------------------------
----------------------------------------------------------------
o Rx benzodiazepine overdose (slurred speech, CMV retinitis: MC when CD4 < 50
Baker cysts: excess fluid produced by an inflamed
ataxia, hypotension, depressed mental status) o yellow/white patches of retinal opacification
synovium accumulates in popliteal bursa, results in
labetalol: Rx hypertensive encephalopathy & hemorrhages a tender mass; a/w RA, osteoarthritis, cartilage tears
(BP 180/120 mmHg, headache, N/V, confusion) o Rx: ganciclovir or foscarnet Baker cyst rupture presents similar to DVT
nitroprusside: hypertensive emergency HSV encephalitis: cognitive & personality changes, o cystic fluid leaks down the inner leg, results
(BP > 220/120 with evidence of organ damage) focal neurologic deficits; temporal lobe hemorrhage in a hematoma over medial malleolus
---------------------------------------------------------------- PML: JC virus detected on PCR of CSF, patchy (crescent sign)
Cryptococcal meningoencephalitis areas of white matter due to demyelination DDx: subcutaneous abscess, lymphedema
Features develops over 2 weeks (subacute) o focal neurologic deficits; no mass effect ----------------------------------------------------------------
headache, fever, malaise, vomiting, o hemiparesis; speech, vision, & gait dysFx ARDS: non-cardiogenic pulmonary edema
altered mental status, B/L papilledema o no cure; 6 month survival caused by leaky alveolar capillaries
more acute & severe in HIV (CD4 100) ---------------------------------------------------------------- mechanical vent.: FiO2 improves oxygenation,
Dx CSF features mononucleosis-like symptoms, atypical lymphocytes, PEEP prevents alveolar collapse
high opening pressure negative Monospot: CMV mono arterial pO2 measures oxygenation influenced
low glucose, high protein absence of pharyngitis & lymphadenopathy by FiO2 & PEEP
WBC 50/L large basophilic lymphocytes with a vacuolated arterial pCO2 measures ventilation affected
(mononuclear predominance) appearance by respiratory rate & tidal volume
cryptococcal antigen positive ---------------------------------------------------------------- initial ventilator management is decrease FiO2
transparent capsule on India ink +HIV, bloody diarrhea, normal stool: CMV colitis to non-toxic values (< 60%); goal = paO2 60
culture on Sabouraud agar typically CD4 < 50 cells/L PEEP can be increased to maintain oxygenation
Rx initial: amphotericin B with flucytosine Dx: colonoscopy multiple ulcers, mucosal erosions o decreasing PEEP lowers oxygenation by
maintenance: fluconazole biopsy: large cells with eosinophilic intranuclear decreasing availability of alveoli
& basophilic intracytoplasmic inclusions
hypoxemia is best treated by increasing PEEP function) pulmonary edema, a-fib, late diastolic murmur
PEEP complications: barotrauma, tension SVR with opening snap: mitral stenosis
pneumoTx (resulting hypotension) (afterload) ----------------------------------------------------------------
---------------------------------------------------------------- Mixed sudden severe chest pain radiating to back,
ARDS can develop in the setting of sepsis, venous severe HTN, decrescendo diastolic murmur of
severe bleeding, severe infection, toxic ingestion, O2 aortic regurgitation: acute aortic dissection
burns, or acute pancreatitis saturation o systolic BP > 20 mmHg difference between
inflammatory mediators are released locally or to arms, & weak/absent peripheral pulses
distant tissues, damage the alveoli intravascular volume loss leads to LV preload o heard @ right sternal border
alveolar capillary permeability allows fluid to C.O. & systemic BP HR & SVR CXR & EKG to exclude other Dx
leak into alveoli, resulting in pulmonary edema o pulmonary capillary wedge pressure serum creatinine, contrast allergy?
excessive IV fluids hydrostatic pressure, thus (PCWP) measures of LA & LVED pressure Dx: transesophageal echo (TEE) is preferred
can worsen pulmonary edema cardiogenic shock leads to C.O. & BP over chest CT with contrast in patients with
Rx: mechanical ventilation with low tidal volumes o PCWP due to heart failure kidney disease or contrast-induced nephropathy
& PEEP to work of breathing & oxygenation o HR & SVR maintains organ perfusion Rx: IV labetalol
---------------------------------------------------------------- C.O. decreases tissue perfusion, thus o patients should not receive antiplatelets
ventilation = product of RR & tidal volume signals tissues to extract more O2 (ASA, clopidogrel) or anticoagulation
mechanically ventilated patients with respiratory vasodilatory/distributive shock, MC due to without first excluding aortic dissection
alkalosis in the setting of appropriate tidal volume sepsis, anaphylaxis, SIRS, or CNS injury o nifedipine is a vasodilator that can induce
RR should be lowered o peripheral vasodilation SVR & BP, with reflex tachycardia & aortic shear stress
o reducing tidal volume can trigger an RR compensatory HR & C.O. complications: Horners, LE weakness/ischemia,
worsens alkalosis o hyperdynamic circulation, which decreases hemothorax, abdominal pain
o increasing tidal volume would ventilation organ perfusion venous O2 saturation DDx: acute pericarditis, acute pancreatitis, PE,
worsens alkalosis o as sepsis progresses vasoconstriction is MI, angina, mediastinal tumor, pleuritis
---------------------------------------------------------------- a/w SVR & C.O. ----------------------------------------------------------------
hypotension, tachycardia, flat neck veins, ---------------------------------------------------------------- aortic dissection can extend to aortic valve,
confusion, & cold extremities despite IV fluid acute massive PE can present as hypotension & carotids, renal arteries, or pericardium, leading to
resuscitation: hypovolemic/hemorrhagic shock syncope, leading to PEA in some patients aortic regurgitation, stroke, ARF, or tamponade
cardiogenic shock: decreased C.O. causes SVR, PE occluding part of pulmonary artery results in ----------------------------------------------------------------
PCWP, venous filling pressures & JVD RA, RV, & pulmonary artery pressure blunt abdominal trauma can cause splenic injury
loss of vascular tone occurs in septic & neurogenic compensatory hyperdynamic LV function: early delayed onset hypotension, LUQ pain radiating to
shock with compensatory C.O./index cardiac index, but no effect on PCWP or SVR left shoulder 2/2 diaphragmatic irritation (Kehr sign)
o less blood return: PCWP & SVR ---------------------------------------------------------------- Dx: abdominal CT with contrast if
---------------------------------------------------------------- RV infarct: RA & RA pressures hemodynamically stable
Hemodynamic measurements in shock PCWP & cardiac index 2/2 reduced preload hemodynamic instability despite IV fluids
Normal Hypovole Cardiogen Septic ---------------------------------------------------------------- requires laparotomy
mmHg mic shock ic shock shock exertional dyspnea, syncope, angina: aortic stenosis ----------------------------------------------------------------
RA 4 nrml o systolic murmur, radiates to apex & carotids bipolar disorder is an episodic illness; periods of
pressure or o peripheral pulse: pulsus parvus et tardus severe irritability during discrete mood episodes
(preload) (decreased amplitude & delayed upstroke) strong genetic component
PCWP 9 nrml hypotension, tachycardia, distended neck veins, bipolar I: manic episodes with/without Hx of
(preload) or electrical alternans, pulsus paradoxus, major depressive episodes
Cardiac 2-4 (exaggerated decrease (> 10 mmHg) in systemic o Dx can be made with a first manic episode
index L/min/ arterial BP with inspiration): cardiac tamponade bipolar II:, hypomanic episodes (less severe, less
(pump m2 functional impairment, no psychotic symptoms)
o Hx of 1 depressive episodes required Baseline BUN/creatinine, U/A Entamoeba histolytica causes amebiasis,
o never met criteria for a past manic episode studies Ca++ resulting in abdo pain & bloody diarrhea
cyclothymic disorder: 2 years of fluctuating, Thyroid function ----------------------------------------------------------------
mild hypomania & mild depressive symptoms EKG if coronary risk factors constrictive pericarditis is a complication of
that do not meet criteria for hypomanic episodes A/E Acute mediastinal irradiation (Hodgkin lymphoma), TB,
nor major depressive episodes tremor, ataxia, weakness & cause of right heart failure (hepatomegaly,
polyuria, polydipsia progressive peripheral edema, JVD, ascites)
Manic episode Hypomanic episode vomiting, diarrhea, weight gain can present 10 20 yrs after irradiation or
Symptoms more severe, Symptoms less severe, cognitive impairment anthracycline therapy
one week (unless 4 consecutive days scarring & inelastic pericardium results in
Chronic
hospitalized) symptoms not severe diastolic dysfunction
nephrogenic DI
marked impairment in enough to cause marked CXR: pericardial calcifications
thyroid dysfunction
social or occupational impairment or necessitate confirm Dx: echo show pericardial thickening,
functioning, hospitalization, hyperPTH with hyperCa++
abnormal septal motion, bi-atrial enlargement
psychotic features no psychotic features Rx: diuretics for temporary relief;
---------------------------------------------------------------- Lithium has a narrow therapeutic window, thus
pericardiectomy for refractory symptoms
bipolar disorder is at high risk of relapse after monitor every 6 12 months or 5 7 days after
remission from an acute episode dose changes or drug interactions (diuretics, SSRIs,
Constrictive pericarditis
#1 maintenance Rx: atypical + lithium or valproate NSAIDs, ACE-I, phenytoin, carbamazepine)
Etiology idiopathic or viral, cardiac surgery,
Guidelines for maintenance Rx of bipolar disorder pregnancy: Ebsteins anomaly, polyhydramnios,
radiation therapy (Hodgkins),
first episode maintenance at least 1 yr nephrogenic DI, floppy infant syndrome
TB (developing countries)
2 episodes long-term maintenance (years) if no effect on liver function, lipids, or glucose
Features fatigue, dyspnea on exertion,
episodes were severe or +family Hx ---------------------------------------------------------------- right heart failure (peripheral edema,
3 relapses lifetime maintenance complications following rhinoplasty: ascites, JVD, Kussmaul sign )
---------------------------------------------------------------- dissatisfaction, nasal obstruction, epistaxis hepatojugular reflux
sunscreen: 30 min before exposure nasal septum has poor blood supply & pericardial knock (mid-diastolic sound)
reapply every 2 hrs regenerating capacity, thus trauma or surgery pulsus paradoxus
may result in septal perforation complication: cardiac cirrhosis
avoid sunscreen in infants < 6 months
presents as a whistling during respiration due to Dx EKG: a-fib, or low voltage QRS
----------------------------------------------------------------
a septal hematoma following rhinoplasty pericardial calcifications & thickening
long-acting injectable antipsychotics (depot)
---------------------------------------------------------------- prominent x & y descents
Rx chronic noncompliance, who previously
> 2 weeks of persistent, high-volume, non-bloody Rx NSAIDs, diuretics, pericardiectomy
responded to oral antipsychotics
watery diarrhea after recent travel; no fever, ----------------------------------------------------------------
o must assess tolerability of oral medication
tenesmus or vomiting: Cryptosporidium parvum spontaneous esophageal rupture after severe
o 1st & 2nd generations available as depot
travel-associated diarrhea > 2 weeks; parasitic retching/vomiting: Boerhaaves
o given as IM every 2 4 wks
o cryptosporidium cystoisospora, CXR: left-sided pleural effusion with/without
Rx-resistant schizophrenia: clozapine
microsporidia, Giardia pneumothorax, subcutaneous emphysema, &
o fail to respond to 2 antipsychotics diarrhea < 1 week: viral or bacterial widened mediastinum
o risk of agranulocytosis o rotavirus/norovirus: vomiting exudative pleural fluid: low pH, high amylase
o requires routine monitoring: CBC o ETEC/EPEC: contaminated food/water (>2500 IU)
---------------------------------------------------------------- o Campylobacter: abdo pain, bloody diarrhea, Dx: CT or contrast esophagogram w/ Gastrografin
Lithium therapy pseudoappendicitis (water-soluble contrast)
Indications mania due to bipolar o Salmonella: frequent fever Mallory-Weiss Boerhaave
C/I chronic kidney disease o Shigella: fever, bloody diarrhea, abd pain etiology mucosal tear transmural tear 2/2
cardiovascular disease
2/2 forceful retching;
hyponatremia or diuretic use
forceful retching; o pleural fluid shows elevated WBCs, protein, a/w children with endocrinopathies
submucosal esophageal perforation & LDH, but not amylase (hypothyroidism, growth hormone deficiency)
arterial or venule with air/fluid leakage ---------------------------------------------------------------- have B/L disease & present at an earlier age
plexus bleeding RA, moderate anemia, low serum iron, low TIBC, Dx: XR in frog-leg lateral view
features vomiting, vomiting, retching, transferrin: anemia of chronic disease Rx: surgical screw fixation at current slippage
retching retrosternal pain, WBC a/w chronic inflammatory diseases (RA) complication: avascular necrosis
epigastric pain odynophagia, fever, iron trapping within macrophages, leads to poor ----------------------------------------------------------------
hematemesis dyspnea, or septic shock iron availability for Hb synthesis Legg-Calve-Perthes: idiopathic avascular necrosis
subcutaneous emphysema low reticulocyte count of femoral capital epiphysis
Dx EGD endoscopy CT or contrast Rx underlying cause can improve anemia MC in boys, age 5 7 yrs
esophagography with ---------------------------------------------------------------- insidious hip, groin, or knee pain & antalgic gait
Gastrografin stress fractures: MC in anterior middle third of the (indication of pain with weight bearing)
CXR: tibia in jumping sports & posteromedial distal third limited internal rotation & hip abduction
pneumomediastinum & of the tibia in runners Dx: high suspicion; early XR may be negative
exudative pleural effusion microfractures within cortical bone that coalesce Rx: observation & bracing; surgery if severe
(low pH, high amylase)
risk factor: female athlete triad ( caloric intake, DDx: SCFE, transient synovitis
Rx self-limited; cervical perforations:
oligo-/amenorrhea, osteoporosis) ----------------------------------------------------------------
endoscopic Rx conservative measures
MC site: 2nd metatarsal MCC of hip pain in children: transient synovitis
as needed thoracic perforations:
(clipping or surgery XR is normal initially, 6 wks boys age 3 10 yrs; after viral infection or trauma
coagulation) Dx: MRI or bone scan well-appearing, able to bear weight
---------------------------------------------------------------- Rx: rest & analgesia affected hip is flexed, slightly abducted &
allergic rhinitis: rhinorrhea, nasal pruritus, cough; Rx: surgery for displaced fx or 5th metatarsal fx externally rotated which maximizes joint space
nasal mucosa is edematous & pale; polyps? ---------------------------------------------------------------- Dx: XR to exclude bone lesions, fx, Legg-Calve
nasal furunculosis: 2/2 staphylococcal folliculitis child with severe headache of gradual onset a/w Rx: ibuprofen & rest, F/U in 1 wk
due to nose-picking or hair plucking N/V, photophobia, visual aura: migraine o recovery within 1 4 wks; no complications
o pain, tenderness, erythema in nasal vestibule most common form of headache < age 20 ----------------------------------------------------------------
o life-threatening if spreads to cavernous sinus migraines in children are often bifrontal & amenorrhea > 3 months, hypoestrogenism, FSH,
---------------------------------------------------------------- shorter duration than adult migraines age < 40: premature ovarian failure
fetal distress (repetitive late decelerations) is an Rx in < age 12: supportive (dark, quiet room, & may be secondary to accelerated follicle atresia
indication for emergent c-section cool cloth on forehead), acetaminophen or or low number of primordial follicles
---------------------------------------------------------------- NSAID (ibuprofen) MC is idiopathic; or a/w mumps, oophoritis,
chronic ankylosing spondylitis (> 20 yrs) are at alternative Rx: triptans irradiation, chemotherapy, autoimmunity
risk for vertebral fractures with minimal trauma ---------------------------------------------------------------- (Hashimotos, Addisons, DM Type I, pernicious
DDx: spinal root compression, bone mets indications for neuroimaging in a child with anemia)
---------------------------------------------------------------- headache: Hx of coordination difficulties, tingling, Dx: FSH/LH, hypoestrogen
acute pancreatitis can cause unilateral, left-sided numbness, focal neurologic signs; headache that o do not wait for 1 yr of amenorrhea for Dx
pleural effusion with high amylase concentration, awakens from sleep, headache frequency early Dx prevents osteoporosis
but not widened mediastinum ---------------------------------------------------------------- Rx: in vitro fertilization with donor oocytes
cocaine use predisposes to aortic dissection with obese boy with a limp, knee pain, decreased ROM, ----------------------------------------------------------------
wide mediastinum & unilateral pleural effusion, pain with hip internal rotation: slipped capital pulsatile GnRH agonists: induces ovulation
but not high amylase content femoral epiphysis (SCFE) progesterone: corrects luteal phase defect (failure
aspiration pneumonia is MC in right lower lobe MC in obese boys, age 10 16 yrs of corpus luteum to produce progesterone to
& unilateral pleural effusion due to insidious onset dull hip or referred knee pain, maintain the endometrium for implantation)
parapneumonic effusion or empyema altered gait with no preceding trauma ----------------------------------------------------------------
affected hip is held in passive external rotation
exertional dyspnea, fatigue, pale conjunctiva infant with failure to thrive, B/L cataracts, jaundice, most important pathogenic factor in development
iron deficiency is MCC of microcytic anemia hypoglycemia: galactosemia of Zenker: motor dysfunction
iron studies confirm Dx galactose-1-phosphate uridyl transferase deficiency develops above the upper esophageal sphincter,
Microcytic/Hypochromic anemias also vomiting, hepatomegaly, convulsions with posterior herniation between
Iron-def anemia ferritin, TIBC risk for E.coli neonatal sepsis cricopharyngeal muscle fibers
Thalassemias normal/ serum iron & ferritin early Dx & Rx: eliminating galactose from diet risk for aspiration pneumonia
Anemia of ferritin & transferrin, o breastfeeding is C/I Dx: barium esophagram
chronic disease TIBC complications: cirrhosis, mental retardation Rx: excision, cricopharyngeal myotomy
Sideroblastic normal/ iron & ferritin, ---------------------------------------------------------------- ----------------------------------------------------------------
anemia TIBC galactokinase deficiency: cataracts only battery ingestion requires an XR
---------------------------------------------------------------- batteries in the esophagus should be removed
iron deficiency: 2/2 intake or blood loss Dx for PCOS ( 2 criteria) under endoscopic guidance to prevent mucosal
o RDW, reticulocyte count o androgen excess (hirsutism, acne, alopecia) damage & esophageal ulceration
thalassemia or hemaglobinopathies: globin o olio- or anovulation batteries distal to the esophagus need
production & elevated HbA2 o polycystic ovaries on USS observation with stool exam or follow-up XR
o reticulocyte count & total bilirubin 2/2 o exclusion of other hyperandrogenic states do not use NG tube or induce vomiting
hemolysis Rx for PCOS ----------------------------------------------------------------
anemia of chronic disease: defective utilization of weight loss aortic dissection is the most dangerous
storage iron, due to suppression of RBC production combined OCPs: Rx hyperandrogenism & complication of Marfan
by inflammatory cytokines menstrual dysfunction, progestin risk of o aortic regurgitation is a complication
o ferritin = ongoing inflammation endometrial hyperplasia o autosomal dominant; fibrilin-1 mutation
lead poisoning or sideroblastic anemia: o clomiphene citrate: estrogen analog; induces all Marfan patients with chest pain require
reduced heme synthesis ovulation with some ovulatory reserve evaluation for aortic dissection
hemochromatosis: intestinal iron absorption o Metformin: promotes ovulation in PCOS aortic regurgitation: early decrescendo diastolic
& deposition prevented by insulin resistance; also for murmur along the LSB, 3rd/4th IC space, sitting
o iron, ferritin, & transferrin, TIBC prevention or coexisting DM Type II upright, leaning forward, after full expiration
---------------------------------------------------------------- Comorbidities of PCOS
child with a painful, solitary, lytic long bone lesion o obesity Clinical features of Marfan syndrome
with overlying tender swelling & hypercalcemia: o insulin resistance/glucose intolerance/DM Skeletal arachnodactyly
Langerhans histiocytosis o dyslipidemia upper:lower body segment ratio
locally destructive, but resolves spontaneously arm:height ratio
o OSA
benign, Rx conservative pectus deformity, scoliosis/kyphosis
o endometrial ca risk 2/2 chronic anovulation
---------------------------------------------------------------- joint hypermobility
----------------------------------------------------------------
thin vaginal discharge, erythematous mucosa, motile Ocular ectopia lentis (lens subluxation)
DM screening: sustained BP > 135/80 mmHg
pear-shaped organisms: trachomonal vaginitis Cardio aortic dilation, regurgitation, dissection
OGTT is preferred to screen glucose intolerance MVP
Rx: metronidazole & DM Type II
alcohol intake with metronidazole is a/w Pulmonar spontaneous pneumothorax due to
Dx: Type II DM y apical blebs
disulfiram-like reaction; acetaldehyde 2 hr OGTT 200 mg/dL
accumulates, causes flushing, N/V, hypotension ----------------------------------------------------------------
o fasting blood glucose > 126 aortic dissection risk factors
----------------------------------------------------------------
o HbA1c 6.5% o HTN (most significant)
chronic inflammatory diarrhea (< 4 wks): anemia,
o random plasma glucose 200 o Marfan
weight loss, ESR, acute phase reactants, reactive
---------------------------------------------------------------- o cocaine use
thrombocytosis, +occult blood/leukocyte stool
age > 60, dysphagia, regurgitation, halitosis, cough, ----------------------------------------------------------------
----------------------------------------------------------------
variable neck mass: Zenker diverticulum
office-based anoscopy/proctoscopy is the initial DDx: HSV-1 (vesicular eruption), HPV mass on valve rheumatoid factor,
procedure for age < 50 with minimal bright red (verrucous papules), Staph (furuncles, carbuncles) Osler nodes, Roth spots
blood per rectum & no colon cancer risk factors ---------------------------------------------------------------- Dx : 2 Major, 0 Minor predisposing heart condition
o blood intermixed with stool is not included Staph aureus is MCC of healthcare-associated Dx : 1 Major, 3 Minor or IVDA
MCC: hemorrhoids, anal fissure, polyps, infective endocarditis (S. epidermidis) Dx : 0 Major, 5 Minor fever: > 38.0 C (100.4)
proctitis, rectal ulcers, cancer o prosthetic valves, indwelling catheters, IVDA, ----------------------------------------------------------------
anoscopy has higher sensitivity for hemorrhoids implanted devices (pacemakers, defibrillators) Acute rheumatic fever
than flexible endoscopy Streptococci is MCC of community-acquired IE epidemiology MC in females, age 5 15 yrs
colonoscopy/sigmoidoscopy for age > 50 or o viridans strep: S. sanguinis, S. mutans MCC: group A Strep pharyngitis
other risk factors for colon cancer o after dental procedures or procedures precedes onset of ARF by 2 4 wks
---------------------------------------------------------------- involving incision/biopsy of respiratory tract Major o Joints (migratory arthritis)
DNA testing for RET proto-oncogene germline Enterococci: E. faecalis: a/w nosocomial UTIs criteria o (carditis, mitral stenosis)
mutation is screening test for suspected MEN 2 Strep bovis: S. gallolyticus (JNES) o Nodules (subcutaneous)
o no further monitoring for a negative result o colon cancer & inflammatory bowel disease o Erythema marginatum
o total thyroidectomy for a positive test result; ---------------------------------------------------------------- o Sydenham chorea
risk of invasive MTC is 100% Endocarditis overview Minor fever, arthralgias, elevated ESR/CRP
risk poor dentition, congenital heart disease, criteria prolonged PR interval
Multiple endocrine neoplasia classification factors valve abnormalities (MVP, MR), IVDA, late features mitral regurgitation/stenosis
Type I o Pituitary tumors intravascular catheters prevention PCN (regardless of +/- pharyngitis)
o Primary hyperPTH (90%) features subungal hemorrhages, petechiae,
o Pancreatic/GI tumors (gastrinoma) Janeway lesions, Oslers nodes, Dx: 2 major, or 1 major + 2 minor criteria
Type 2A o Medullary thyroid cancer (MTC) Roth spots, splenomegaly, supportive findings: ASO titer, Strep antigen test
(Sipples) o Pheochromocytoma mitral valve disease (MVP, MR) DDx: SLE, Henoch-Schonlein, Juvenile arthritis
o Parathyroid hyperplasia labs positive blood cultures, WBCs,
Type 2B o MTC glomerulonephritis, septic emboli Hx of rheumatic fever increases risk of recurrence
o Pheochromocytoma Rx vancomycin (initially), based on cultures & progression of rheumatic heart disease
o Mucosal neuromas Janeway lesions: macular, erythematous, Dx: continuous ABX prophylaxis to prevent
o marfanoid habitus nontender lesions of palms/soles recurrent group A Strep pharyngitis
Oslers nodes: painful, violaceous nodules on
MEN1 pancreatic tumors: gastrinoma, insulinoma, fingertips/toes ABX prophylaxis for rheumatic fever (RF)
Roth spots: edematous, hemorrhagic retinal lesions IM benzathine PCN G every 4 wks
glucagonoma, VIPoma
o gastrinoma causes recurrent peptic ulcers ---------------------------------------------------------------- RF without carditis 5 yrs or until age 21
blood cultures from 2 separate venipuncture sites RF with carditis, but no 10 yrs or until age 21
----------------------------------------------------------------
firm, flesh-colored, umbilicated, dome-shape plaques for suspected IE prior to initiating ABX heart or valvular disease
on trunk, limbs, anogenital areas; spares palms/soles: RF with carditis & 10 yrs or until age 40
Duke Criteria for Infective Endocarditis persistent or valve dz
molluscum contagiosum (poxvirus)
MCC due to sexual contact MC occur on genitalia, Major Criteria Minor Criteria ----------------------------------------------------------------
lower abdomen, inner thighs 2 positive blood culture Vascular phenomena: sore throat, skin infection, generalized edema,
transmitted: skin-skin or fomites for typical IE organisms systemic arterial emboli, dark urine, HTN: post-strep glomerulonephritis
(strep viridans or bovis, pulmonary infarcts, mycotic recurrent high fevers, rash, arthritis: Adult Stills
self-limited, localized infection
S. aureus, enterococcus aneurysms, Janeway o maculopapular, non-pruritic rash on the
linear pattern due to spread 2/2 scratching HACEK) lesions, conjunctival
MC a/w cellular immunodeficiency (HIV), trunk & extremities during febrile episodes
hemorrhages hypotension, hyperpigmentation, hyponatremia:
corticosteroid use, chemotherapy Echocardiogram with Immunologic phenomena: adrenal insufficiency (Addisons)
oscillating intracardiac glomerulonephritis, ----------------------------------------------------------------
cutaneous Kaposi sarcoma appear as violaceous asthma exacerbation leads to acute respiratory pallor, fatigue, weakness, anorexia, easy bruising,
papules due to increased vascularity alkalosis due to tachypnea petechiae, mucosal hemorrhage, fever
MC on face, oral mucosa, genitalia, lower extremity persistent vomiting & excessive diuresis causes bone marrow Bx: hypocellularity & fatty infiltration
Dx is clinical, but may need biopsy to exclude volume contraction with increased HCO3 & ----------------------------------------------------------------
bacillary angiomatosis 2/2 Bartonella metabolic alkalosis pallor & poor feeding in first 3 months of life,
---------------------------------------------------------------- persistent vomiting results in hypochloremic normocytic anemia with reticulocytopenia:
condyloma acuminata (anogenital warts) is due metabolic alkalosis from gastric H+ losses Diamond-Blackfan anemia (aka congenital
to HPV; appear as skin-colored, white or gray ---------------------------------------------------------------- pure red cell aplasia)
verrucous & papilliform lesions primary respiratory alkalosis decreases arterial ----------------------------------------------------------------
HPV 16, 18 a/w risk of SCC PaCO2, leading to metabolic compensation that short stature, caf-au-lait spots, pancytopenia,
Rx: HIV screening serum HCO3 by 2 mEq/L for every 10 mmHg congenital abnormalities, hyperpigmentation on
Rx: self-limited; trichloroacetic acid, podophylin decrease in PaCO2 trunk, neck & intertriginous areas, hypogonadism,
---------------------------------------------------------------- acute respiratory acidosis leads to metabolic renal malformations: Fanconis anemia
20 syphilis: condyloma lata, flat pink/gray compensation that serum HCO3 by 1 mEq/L initial manifestation: thrombocytopenia
velvety papules for every 10 mmHg increase in PaCO2 neutropenia anemia
o MC at mucous membranes & moist genital ---------------------------------------------------------------- ----------------------------------------------------------------
skin, perineum, mouth ASA toxicity causes mixed respiratory alkalosis recent ABX use, watery bowel movements, mild
30 syphilis: ascending aortitis, tabes dorsalis, (low PaCO2) & metabolic acidosis (low HCO3) abdominal tenderness: C. difficle colitis
psychosis, tumors (gumma) of skin, bone, liver respiratory alkalosis is due to direct stimulation of unexplained leukocytosis in hospitalized patients
o brief stabbing pains, Argyll-Robertson pupils medullary respiratory center causing tachypnea should raise suspicion, even without diarrhea
(accommodate but do not react) metabolic acidosis is due to the production & complications: toxic megacolon, severe ileus
---------------------------------------------------------------- renal elimination of lactic acids & ketoacids Dx: stool studies for C. difficle toxin
Neurofibromatosis Type I ---------------------------------------------------------------- Rx mild/moderate: empiric oral metronidazole
AD inheritance; neurocutaneous syndrome A-A women age 20 40 are at great risk for SLE Rx severe: oral vancomycin (+ IV metronidazole
caf-au-lait spots, Lisch nodules, neurofibromas arthritis in 90%, may be a presenting symptom, if ileus is present)
(benign peripheral nerve sheath tumors), short stature non-deforming arthritis affects MCP & PIP o fidoxomicin: Rx recurrent colitis or severe
risk of intracranial neoplasms: optic glioma fatigue, low-grade fever, painless oral ulcers, colitis who cannot tolerate oral vancomycin
(chronic headache, early morning vomiting, HTN, malar/discoid rash, weight loss, serositis (pleuritis), surgical consult for acute peritoneal signs or
progressive unilateral vision loss, dyschromatopsia proteinuria (RBC casts) severe C. difficile colitis (toxic megacolon, ileus,
(disorder of color vision)) hematologic abnormalities: anemia, leukopenia, WBC > 20,000/L): subtotal colectomy
o Dx: MRI brain & orbits thrombocytopenia ----------------------------------------------------------------
---------------------------------------------------------------- ---------------------------------------------------------------- Gentamicin: Rx resistant G-negative bacteria
Neurofibromatosis Type II joint space erosion, articular demineralization, IV vancomycin: empiric Rx for bacteremia
B/L acoustic neuromas (vestibular schwannoma) soft tissue swelling: rheumatoid arthritis secondary to a cutaneous source (central line) or
cause sensorineural hearing loss osteophytes, narrowed joint spaces, subchondral infection (pneumonia) due to resistant G-positive
screening: audiometry; Dx: MRI with gadolinium sclerosis & subchondral cysts: osteoarthritis o not excreted into the colon, thus not
---------------------------------------------------------------- arthropathy of MCP joints, hepatomegaly, diabetes, effective against C. difficile colitis
tuberous sclerosis: neurocutaneous genetic bronze skin, erectile dysfunction, hypogonadism, ----------------------------------------------------------------
syndrome 2/2 intracranial tumors dilated cardiomyopathy: hemochromatosis solitary pulmonary nodule: coin-shaped lesion,
ash leaf spots, facial angiofibromas, cardiac dactylitis (sausage digits), DIP joints, nail pitting, 3 cm or less surrounded by normal parenchyma;
rhabdomyomas, renal agnioleiomyomas psoriatic plaques: psoriatic arthritis evidence of calcification is considered benign
---------------------------------------------------------------- o can occur without skin changes low-risk patients (age < 40, non-smoker):
allergic reaction with stridor: laryngeal edema, ---------------------------------------------------------------- compare with old XR; F/U CXR every 3 months
results in respiratory acidosis (CO2 retention) pancytopenia following drug intake, exposure to for 12 month
toxins, radiation, or viral infection: aplastic anemia high-risk patients: chest CT & FNA
bronchoscopy cannot reach peripheral lesions pelvic exam is contraindicated in a patient with ----------------------------------------------------------------
---------------------------------------------------------------- antepartum hemorrhage until placenta previa is negative D-dimer (fibrin split product) best
headache, jaw claudication, proximal muscle ruled out by transvaginal USS excludes pulmonary VTE in low-risk patients
weakness, temporal area tenderness, ESR: management depends on gestational age & (negative predictive value > 95%)
giant cell arteritis severity of bleeding positive D-dimer requires further studies with
Dx: temporal artery biopsy stable mother, fetus at term: scheduled c-section CT angiography
complication: blindness, aortic aneurysms stable mother, fetus not at term: expectant ----------------------------------------------------------------
o F/U: serial CXR management; amniocentesis @ 36 wks to assess brain death: irreversible loss of function of the
---------------------------------------------------------------- lung maturity whole brain & brainstem; legal definition of death
asymptomatic carotid artery stenosis (CAS) extended/massive bleeding, regardless of gestation: no further steps are legally required to remove a
can progress to TIA or embolic stroke emergency c-section patient from artificial life support
symptomatic CAS: sudden onset focal neurologic ---------------------------------------------------------------- ----------------------------------------------------------------
symptoms within 6 months polymyositis & dermatomyositis are clingy & submissive, crave protection & care,
indications for carotid endarterectomy (CEA) inflammatory myopathies; ESR & CK avoids taking initiative due to feeling inadequate,
o asymptomatic carotid stenosis, men: > 60% confirm Dx: muscle biopsy indecisive: dependent personality disorder
o symptomatic carotid stenosis: > 70% Rx: high-dose corticosteroids hypersensitive to criticism, social inhibition,
< 50% stenosis: Duplex USS annually, & ---------------------------------------------------------------- desire friendships, but fear embarrassment or
medical management alone Dermatomyositis ridicule: avoidant personality disorder
patients with CVD should start on ASA & statins features proximal, symmetric extensor restricted range of emotions, social detachment,
---------------------------------------------------------------- muscle weakness; UE = LE do not enjoy close relationships, aloof, indifferent
emphysematous cholecystitis is a common form Grottons papules, heliotrope rash to praise/criticism: schizoid personality disorder
extramuscular interstitial lung disease, odd & eccentric behavior, magical thinking,
of acute cholecystitis in elderly diabetic males
(age 50 70) findings dysphagia, myocarditis clairvoyant, capacity for close relationships:
gallbladder infection with gas-forming bacteria Dx CPK, aldolase, LDH schizotypal personality disorder
anti-RNP, anti-Jo-1, anti-Mi2 ----------------------------------------------------------------
(Clostridium, Escherichia, Strep, Staph,
equivocal: EMG, muscle biopsy schizoaffective disorder: lifetime Hx of delusions
Pseudomonas, Klebsiella)
RUQ pain, N/V, fever, abdo pain & crepitus Rx high-dose glucocorticoids PLUS & hallucinations co-occurring with depressive or
glucocorticoid-sparing agent, manic episodes & Hx of at least 2 weeks of
complications: gangrene, perforation
screen for malignancy psychotic symptoms without mood episodes
Dx: abdominal XR shows air fluid levels in the
---------------------------------------------------------------- mood symptoms are present for majority of illness
gallbladder; USS shows curvilinear gas shadows
Riluzole slows progression of ALS ----------------------------------------------------------------
Rx: cholecystectomy within 72 hrs, IV ABX
TCAs decrease the pain of fibromyalgia dysphagia, Raynauds, extensive skin thickening:
----------------------------------------------------------------
---------------------------------------------------------------- diffuse systemic sclerosis
beta-cell tumor (insulinoma): hypoglycemia
Herpes zoster is a reactivation of VZV due to pulmonary complication are MCC of death
with insulin, c-peptide, & pro-insulin
decreased cell-mediated immunity o MC is interstitial fibrosis
non-beta cell tumor: large mesenchymal tumors
pain precedes onset of vesicular rash by 48 hr ----------------------------------------------------------------
that produce IGF-II with insulinomimetic action
Rx: valacyclovir, or oral acyclovir (cheaper); chronic cough after a recent URI, primarily at night,
after binding insulin receptors
reduces incidence of post-herpetic neuralgia no expectoration: postnasal drip
o insulin & c-peptide are suppressed
TCAs can also prevent/Rx post-herpetic neuralgia cough is caused by mechanical stimulation of the
sulfonylureas output of endogenous insulin
---------------------------------------------------------------- afferent limb of cough reflex in upper airway
from beta cells; insulin & c-peptide
hyposthenuria: inability to concentrate the urine Rx: empiric 1st-generation antihistamine or
o confirm Dx with plasma sulfonylurea level
nocturia & polyuria combined antihistamine-decongestant
glucagonoma causes necrotic migratory erythema
MC a/w sickle cell disease & trait Dx: elimination of nasal discharge & cough
----------------------------------------------------------------
RBC sickling in the vasa rectae impairs with empiric H1-antagonisists
countercurrent exchange & free water absorption no response after 2 - 3 wks require investigation
---------------------------------------------------------------- EOM weakness (diplopia, proptosis) with MRI: enlarged ventricles
upper airway cough syndrome (postnasal drip), symmetrical proximal muscle weakness (upper CJD rapidly progressive behavior changes,
GERD, asthma: > 90 % of chronic cough (> 8 wks) more than lower), neck, bulbar muscles myoclonus, akinetic mutism
in non-smokers without pulmonary disease (dysarthria, dysphagia): myasthenia gravis Huntington choreoathetosis, behavioral disturbances,
Rx neurodegenerative disease, men age 40 to 60; dementia
o postnasal drip 1st-generation H1 blocker asymmetric muscle atrophy, muscle weakness chronic insidious decrease in consciousness,
o on ACE inhibitors stop ACE inhibitors (distal more than proximal), hyperreflexia, subdural headache, cognitive & memory deficits,
o asthma PFTs, inhaled corticosteroids spasticity, fasciculations: ALS hematoma aphasia, or motor deficits
o GERD empiric PPI DDx: electrolyte disturbance, fibromyalgia, pernicious dementia with megaloblastic anemia,
CXR if no improvement after these interventions polymyositis, multiple sclerosis, Guillain-Barr, anemia posterior spinal column deficits
---------------------------------------------------------------- thyroid-related myopathy
CXR is indicated in those with no clear etiology ---------------------------------------------------------------- ataxia, ophthalmoplegia, confusion (Wernicke);
or possible parenchymal disease, purulent sputum, sickle cell anemia presents after the first 6 months with confabulation & amnesia (Korsakoff)
immunocompromised, or smoking Hx of life, due to presence of Hb F ----------------------------------------------------------------
Common etiologies of chronic cough dactylitis may be the initial presentation that fluctuating cognition, insomnia, decreased alertness,
postnasal drip warrants further workup visual hallucinations, Parkinsonism, repeated falls:
ACE inhibitors ---------------------------------------------------------------- Lewy body dementia
asthma & cough-variant asthma hypothyroidism can cause reversible changes in Lewy bodies: eosinophilic intracytoplasmic
GERD or laryngopharyngeal reflux memory & mentation; accompanied by systemic inclusions due to alpha-synuclein accumulation
changes such as weight gain, fatigue, constipation early appearance of dementia
o post respiratory tract infection
Rx: levothyroxine will improve cognitive symptoms Dx: progressive, cognitive decline, interferes
o chronic bronchitis or sinusitis
---------------------------------------------------------------- with social & occupational functions
o bronchiectasis
best indicator of dementia: functional impairment DDx: Parkinsons (motor symptoms present early),
o lung cancer
of ADLs (hygiene, dressing, self-medicating) Alzheimers (early anterograde memory loss),
o non-asthmatic eosinophilic bronchitis occasional forgetfulness, word finding aphasia, & lacunar strokes (patchy neurologic findings), NPH
---------------------------------------------------------------- insomnia can occur with normal aging ----------------------------------------------------------------
anemia of prematurity is the most common ---------------------------------------------------------------- NPH: urinary incontinence, dementia, abnormal gait
anemia in premature & low birth weight infants DDx of dementia subtypes dementia is characterized by memory loss, but
due to diminished RBC production, shorter RBC Alzheimer early: insidious anterograde memory loss, no focal neurologic changes
lifespan in neonates, & fetoplactental transfusion s visuospatial & language deficits, broad-based, shuffling gait
(baby held above placenta after delivery) word finding difficulty transient increase in intracranial pressure or due
poor weight gain, poor feeding, pallor, lethargy, late: personality changes, hallucinations, to decreased CSF absorption causing
tachypnea, tachycardia dyspraxia, urinary incontinence permanent ventricular enlargement
labs: normocytic/normochromic anemia, low Vascular stepwise decline, cerebral infarction, Dx: LP, enlarged ventricles on CT or MRI
reticulocyte count, normal WBC & total bilirubin dementia early executive dysfunction (ADLs), Rx: serial large volume LPs, with subsequent
Rx: iron supplementation; but does not prevent focal neuro deficits (+pronator drift, ventriculoperitoneal shunt
falling Hb levels; iron deficiency is not the cause +Romberg, unsteady gait) ----------------------------------------------------------------
---------------------------------------------------------------- Picks early personality changes, insidious decreased consciousness, headache,
hemolytic disease of the newborn is due to Rh or apathy, disinhibition, compulsive, cognitive & memory deficits, frequent falls, aphasia,
ABO incompatibility +primitive reflexes, +family Hx motor deficits: chronic subdural hematoma
jaundice, hepatosplenomegaly, pallor, & hydrops late: memory deficits MC in elderly & alcoholics
fetalis in severe cases Lewy body fluctuating cognition, altered alertness, Dx: noncontrast CT shows a white crescent
Type II hypersensitivity visual hallucinations, parkinsonism
with or without midline shift
reticulocyte count due to hemolysis late: memory deficits
----------------------------------------------------------------
---------------------------------------------------------------- NPH dementia, gait ataxia, urinary incontinence
dietary modification & exercise is the first step physiologic jaundice of the newborn is common bitemporal hemianopia: pressure on optic chiasm
in treating GDM on days 2 4, benign, resolves by age 1 2 wks exerted by a pituitary tumor, craniopharyngioma,
if nutritional therapy fails, insulin or oral agents indirect hyperbilirubinemia is due to or anterior communicating artery aneurysm
(metformin, glyburide) physiologic differences in bilirubin metabolism ----------------------------------------------------------------
insulin does not cross the placenta o bilirubin production: elevated RBC progressively worsening headache, focal motor
---------------------------------------------------------------- concentration & shorter RBC life span weakness, visual disturbance, cognitive deficits:
GDM screening @ 24 - 28 wks gestation o bilirubin clearance: immature hepatic UGT glioblastoma multiforme
GDM target blood glucose levels levels (especially Asians) acute/subacute painful vision loss with abnormal
o fasting 95 mg/dL o enterohepatic recycling: sterile newborn gut pupillary response to light in the affected eye:
o 1-hour postprandial 140 mg/dL cannot break down bilirubin to urobilinogen for optic neuritis a/w multiple sclerosis
o 2-hour postprandial 120 mg/dL fecal excretion; bilirubin is resorbed/recycled headache, transient visual symptoms, tinnitus:
GDM is at increased risk for gestational HTN, encourage frequent feedings to promote gut idiopathic intracranial HTN
preeclampsia, & fetal macrosomia colonization & fecal excretion o papilledema, visual field loss, 6th nerve palsy
GDM resolves after childbirth, 50% develop Rx: phototherapy for rapidly rising homonymous superior quadrantanopsia (pie in
Type 2 DM hyperbilirubinemia to prevent kernicterus; the sky): temporal lobe stroke affecting the
---------------------------------------------------------------- exchange transfusion for severe cases inferior optic radiations in the Myers loop
uncontrolled maternal hyperglycemia causes ---------------------------------------------------------------- ----------------------------------------------------------------
fetal hyperglycemia fetal hyperinsulinemia newborns of mothers with Rh-negative or O- vision assessment should be performed at every
1st trimester: spontaneous abortion, congenital blood group are at risk for hemolytic anemia & well-child visit
malformations (small left colon syndrome), NTDs severe hyperbilirubinemia evaluate infants by observing fixation & tracking
2nd/3rd trimester complications neonatal sepsis can cause hemolysis & cover-uncover test for older infants/children to
o macrosomia (shoulder dystocia) exacerbate hyperbilirubinemia assess for strabismus
o neonatal hypoglycemia o fever & risk factors for neonatal sepsis visual acuity begins at age 3 with Snellen or
o polycythemia (PROM, +GBS screen) tumbling E chart
---------------------------------------------------------------- ----------------------------------------------------------------
o organomegaly (heart, liver)
-thalassemia can cause hemolysis & dyslipidemia universal screening: age 9 11 &
since the fetus is in constant anabolism, placenta
unconjugated hyperbilirubinemia again @ 17 21
may not be able to meet metabolic demands,
newborns are asymptomatic due to fetal Hb = o lipid levels are stable prior to & after puberty
leading to fetal hypoxemia; erythropoietin
alpha + gamma globin chains also if high risk for CVD (obesity, DM, tobacco,
production causes polycythemia
hemolytic anemia symptoms after age 6 months family Hx of premature CAD) & men age 35
----------------------------------------------------------------
small left colon syndrome: transient inability to as gamma chains replaced with beta chains ----------------------------------------------------------------
---------------------------------------------------------------- Minors & consent
pass meconium; resolves spontaneously
sellar mass medical circumstances emergencies, STDs, prenatal
risk: infants of GDM mothers
o visual defect (diplopia, vision loss, that do not need consent care, mental health services,
----------------------------------------------------------------
bitemporal hemianopsia) substance abuse, contraception
prego with HTN, proteinuria & edema: preeclampsia
o headache unemancipated minors consent from one parent or
o ANA may be weakly positive in pregnancy
o symptoms of pituitary hormonal deficiency guardian is legally sufficient
HTN in a prego with massive proteinuria, malar
(decreased libido, amenorrhea) emancipated minors homeless, parent, married,
rash, & strongly positive ANA titer: SLE do not need consent financially independent,
benign causes
signs that favor lupus as the origin of proteinuria military, high school grad
o pituitary adenoma (most common)
include rapid aggravation of proteinuria, clinical minors who are parents can consent for Rx of
signs of active SLE, & RBC casts indicates o craniopharyngioma (common in children)
o meningioma their own minor children
nephritis rather than simple protein loss
Dx: CT scan or MRI parents cannot deny their children life-saving
Dx: renal biopsy after delivery
---------------------------------------------------------------- treatment unless benefits are minimal or would
----------------------------------------------------------------
not alter the prognosis
---------------------------------------------------------------- Rx: PLT 30,000 L, no bleeding = observe DDx: acute pancreatitis, DKA, gastric outlet
innocent murmurs result from blood flow from a Rx: PLT 30,000 L, OR bleeding = IV Ig or syndrome, peptic ulcer perforation
structurally normal heart; grade I or II intensity, & glucocorticoids ----------------------------------------------------------------
changes intensity with position ( with standing) ---------------------------------------------------------------- diuretic abuse: technique for rapid weight loss
Rx: reassurance APGAR: Appearance, Pulse, Grimace, Activity, hypovolemia, orthostatic hypotension, dizziness
pathologic murmurs are grade III Respiratory effort; measured at 1 & 5 minutes hyponatremia, hypokalemia; urine Na+ & K+
---------------------------------------------------------------- blue extremities, pink body is common/benign suspect an eating disorder
live-attenuated virus vaccine can be given with cyanosis of face or central body is concerning DDx: self-induced vomiting, laxative abuse,
routine inactivated vaccinations score of 7 9/10 = no intervention mineralocorticoid deficiency (low serum Na+,
live virus vaccines score < 7/10 = further evaluation & resuscitation high serum K+)
given 4 weeks apart of routine vaccinations if HR < 100 & irregular respiration pulse ----------------------------------------------------------------
o do not give to pregnant women oximetry & positive-pressure ventilation acute limb ischemia post-MI suggests possible
o can be given to household contacts of pregos if HR < 60 CPR arterial embolus from LV thrombus
---------------------------------------------------------------- ---------------------------------------------------------------- large anterior STEMI are high risk, LV thrombus
quadrivalent meningococcal vaccine: 11 12 yrs confounder: extraneous factor which is Rx: immediate IV heparin, vascular surgery
followed by a booster at age 16 independently a/w both exposure & outcome of consult, TTE to screen for LV thrombus
rotavirus vaccine: @ age 2 8 months due to interest; mixing up the effect of exposure with ----------------------------------------------------------------
risk of dehydration from severe gastroenteritis the effect of an extraneous factor always obtain a CXR to confirm placement of a
---------------------------------------------------------------- smoking explains part of the association observed central venous catheters before use
MCC of gastroenteritis in infants & young between alcohol consumption & oral cancer o catheter tip should lie in the SVC
children worldwide: Rotavirus ---------------------------------------------------------------- complications: arterial puncture, pneumothorax,
highly contagious, fecal-oral transmission peripheral edema is a common side effect with hemothorax, thrombosis, air embolism, sepsis,
fever, vomiting, watery osmotic diarrhea dihydropyridine CCB (amlodipine) due to myocardial perforation tamponade
results in severe dehydration dilated peripheral vessels, leads to increased ----------------------------------------------------------------
prevention: rotavirus vaccine capillary hydrostatic pressure Heparin-induced thrombocytopenia (HIT)
o age 2 6 months also headache, flushing, dizziness MCC: unfractionated heparin, LMWH
o live attenuated virus vaccine Rx: ACE-I or ARBs causes post-venodilation 50% drop in PLT count from baseline
o A/E: risk of intussusception DDx of peripheral edema: CHF, renal disease, Type I HIT: non-immune direct effect of heparin
C/I: Hx of intussusception, Hx of uncorrected liver disease, venous insufficiency on PLT activation; within 48 hr of exposure;
GI malformations (Meckels), SCID ---------------------------------------------------------------- o mild, non-immune PLT degradation
---------------------------------------------------------------- sudden, diffuse periumbilical tenderness out of o PLT count normalizes with continued heparin;
isolated thrombocytopenia & petechiae after viral proportion to exam findings, metabolic acidosis: no clinical consequences
infection (URI): immune thrombocytopenia acute mesenteric ischemia o no Rx; spontaneous recovery
o petechiae & ecchymosis most common MC site: SMA Type II HIT: immune-mediated antibodies to
o also mucocutaneous bleeds (epistaxis, labs: metabolic acidosis from serum lactate, PF4-heparin complex; occurs within 5 10 days;
hematuria, GI bleed) if severe leukocytosis, amylase life-threatening; stop all heparin products
antibodies bind to PLTs, with destruction of CT: focal or segmental bowel wall thickening, o necrotic skin lesions at injection sites
Ab/PLT complexes in the spleen dilation, & mesenteric stranding o prone to arterial & venous thrombosis:
labs: PLT < 100,000 L, megakaryocytes on PBS Dx: high index of suspicion with risk factors for warmth, erythema, swelling, tenderness
Rx children: age 2 5 yrs; spontaneous recovery thromboembolic dz (a-fib, PVD, atherosclerosis) o Rx: direct thrombin inhibitor (argatroban)
within 6 months, regardless of PLT count confirm Dx: angiography or fondaparinux; Treat first, test later
Rx: skin manifestations only = observe Rx: supportive, IV fluids, ABX, NGT o confirm Dx: serotonin release assay
Rx: +bleeding = IV Ig or glucocorticoids complications: bowel infarct, perforation,
Rx adults: peritonitis, sepsis, death
onset, a/w a stressor; not intentional, unconcerned also central obesity, facial plethora, ecchymosis,
(la belle indifference) proximal muscle weakness, erectile dysfunction,
---------------------------------------------------------------- amenorrhea, thin skin, abdominal striae
diabetic nephropathy begins with hyperfiltration causes: exogenous steroid use, ectopic ACTH,
( GFR) & microalbuminuria, then progresses to adrenal cortical adenoma, ACTH pituitary
macroproteinuria with progressive decline in GFR adenoma (Cushings disease)
screening: spot urine mciroalbumin/Cr ratio DDx: pheochromocytoma, renal artery stenosis,
hallmark: nodular glomerulosclerosis hypothyroidism, renal parenchymal disease
intensive BP control is proven to slow GFR ----------------------------------------------------------------
decline once azotemia develops primary hyperparathyroidism: hypercalcemia
o diabetics target BP: 140/90 mmHg (polyuria, polydipsia, constipation), kidney stones,
o diabetics with nephropathy: 130/80 mmHg confusion, depression, psychosis
Rx: ACE inhibitors intraglomerular pressure; ----------------------------------------------------------------
but may induce acute GFR decline & hyperkalemia renal artery stenosis: flash pulmonary edema,
thrombosis consumes PLTs & worsens ---------------------------------------------------------------- resistant heart failure, chronic kidney disease,
thrombocytopenia abdominal USS for Dx & follow-up of AAA severe HTN > 180/120 after age 55
---------------------------------------------------------------- ---------------------------------------------------------------- systolic-diastolic abdominal bruit
protamine sulfate: Rx heparin reversal; HIT Metastatic brain tumors DDx: AAA (systolic bruit)
directly binds heparin o MC type of intracranial tumors ----------------------------------------------------------------
---------------------------------------------------------------- o MC @ grey-white matter junction all chronic hepatitis C patients, including pregos,
Initial Rx of HTN o MC mets from non-small cell lung cancer should be immunized against hepatitis A & B;
blacks: thiazide or CCB, alone or combo Rx solitary brain mets in patients with good both are safe during pregnancy
(ACE/ARB not first-line) performance status & stable extracranial disease: vertical transmission is a/w maternal viral load
o all others: thiazide, ACE-I/ARB, or CCB alone surgical resection o c-section is not protective
or combo whole brain radiation for multiple brain mets or breastfeeding does not increase transmission risk,
o all with CKD or diabetes: ACE-I/ARB alone or poor performance status unless nipple is actively bleeding
combo ( intraglomerular pressure) chemotherapy for mets from small cell lung cancer, Ribavirin is teratogenic, avoid in pregos
---------------------------------------------------------------- lymphoma, choriocarcinoma ----------------------------------------------------------------
statins: Rx all diabetics age 40 75, regardless ---------------------------------------------------------------- frostbite Rx: rapid rewarming with warm water
of baseline lipids HTN, mild hypernatremia, hypokalemia, immersion, continuously circulated
---------------------------------------------------------------- metabolic alkalosis, no peripheral edema: do not debride any devitalized tissue initially
dyspnea, tachypnea, pleuritic chest pain: PE primary hyperaldosteronism ----------------------------------------------------------------
---------------------------------------------------------------- MCC: mineralocorticoid-producing adrenal tumor splenectomy: Rx autoimmune hemolytic anemia,
factitious disorder: intentional falsification of found incidentally symptomatic hereditary spherocytosis, massive
S/S to assume a sick role rapid hypokalemia in response to diuretics splenomegaly a/w -thalassemia major or HbH
Munchausens: severe factitious disorder, seeks o aldosterone, renin, bicarbonate ----------------------------------------------------------------
invasive/life-threatening surgical procedures secondary hyperaldosteronism: Cushings, splenectomy risk of sepsis by encapsulated spp
somatic symptom disorder: excessive anxiety renal artery stenosis, renin-secreting tumor (S. pneumo, N. meningitides, H. influenza)
& preoccupation with 1 unexplained symptoms o aldosterone, renin, & bicarbonate o impaired Ab-mediated phagocytosis by
illness anxiety disorder (aka hypochondriasis): ---------------------------------------------------------------- opsonization
prolonged fear of a serious illness despite few/no Cushings causes secondary HTN risk of sepsis for up to 30 yrs after splenectomy
symptoms & negative evaluations ACTH-dependent hormones cause vasoconstriction Rx: pneumococcal, Hib, & meningococcal vaccine
conversion disorder: neurologic symptoms (HTN), insulin resistance (hyperglycemia), & 2 wks prior to or post-splenectomy
incompatible with any neurologic disease; acute mineralocorticoid activity (hypokalemia) daily oral PCN prophylaxis 3 - 5 yr post-splenectomy
----------------------------------------------------------------
chronic granulomatous disease: defective Rx: complex, loculated effusion with thick rim management of splenic trauma depends on
intracellular killing by phagocytes surgery for decortication & drainage hemodynamic status & response to IV fluids
o XR defect in NADPH oxidase ---------------------------------------------------------------- hemodynamically unstable & improves with
SCID: number of circulating lymphocytes CHF due to LV systolic dysfunction is IV fluids: abdominal CT, admit to ICU
leukocyte adhesion defect: impaired chemotaxis characterized by cardiac output/index, SVR, unresponsive to fluids: exploratory laparotomy
DiGeorge: defective cell-mediated immunity & LVEDV ----------------------------------------------------------------
o fungal & viral infections are common a holosystolic murmur at the apex is likely due to transient, painless, monocular vision loss,
---------------------------------------------------------------- functional mitral regurgitation, from mitral curtain falling down: amaurosis fugax
Guillain-Barr: ascending radiculoneuropathy annulus enlargement with LV dilatation &/or MCC: retinal emboli due to atherosclerosis
preceded by URI or diarrhea illness (C. jejuni) papillary muscle displacement due to remodeling fundoscopy may show zones of whitened retina
distal paresthesia, ascending flaccid paralysis, ---------------------------------------------------------------- following the distribution of retinal arterioles;
diminished DTRs, respiratory compromise Hemodynamics Hollenhorst bodies (cholesterol particles)
autonomic disturbances: tachycardia, HTN, Cardia Systemic LVED Dx: duplex USS (MC site: carotid bifurcation)
orthostatic hypotension, urinary retention c index vascular volum ----------------------------------------------------------------
risk of respiratory failure resistanc e light flashes, floaters, or curtain coming across
monitor autonomic & respiratory function with e visual field from the periphery: detached retina
Distributive shock fundoscopy: wrinkled, detached retina
serial spirometry measurements of FVC
o declining FVC requires intubation Intravascular ----------------------------------------------------------------
volume loss central retinal artery occlusion: painless
Rx: IV Ig or plasmapheresis
LV systolic dysFx monocular vision loss; ophthalmic emergency!!
----------------------------------------------------------------
---------------------------------------------------------------- ophthalmic artery is 1st intracranial branch of ICA;
CSF Analysis
epigastric pain, weight loss, jaundice, distended GB: a/w amaurosis fugax
WBC Glucose Protein
pancreatic cancer fundoscopy: diffuse ischemic retinal whitening
Normal 05 40 -70 < 40
nontender but palpable gallbladder in a jaundiced & cherry red fovea
bacterial meningitis
patient is unlikely gallstones (Courvoisiers sign) Rx: ocular massage & high flow O2
TB meningitis
bilirubin & ALP suggest bile duct obstruction, ----------------------------------------------------------------
viral meningitis normal normal
leading to intra- & extrahepatic bile duct dilation central retinal vein occlusion: painless, sudden
Guillain-Barr normal normal
Dx: abdominal USS for patients with jaundice vision loss 2/2 venous thrombosis
Dx: CT with contrast, patients without jaundice fundoscopy: dilated, tortuous veins leading to
Guillain-Barr: albuminocytologic dissociation
ERCP is reserved for nondiagnostic USS & CT diffuse hemorrhages (blood & thunder) with
(high protein, normal WBC count)
percutaneous transhepatic cholangiogram (PTC) disk swelling, & cotton wool spots
herpes meningoencephalitis: high RBC &
if ERCP is not indicated ----------------------------------------------------------------
protein, 2/2 temporal lobe hemorrhage
CA 19-9 is only useful for post-op monitoring & floaters in the visual field: vitreous hemorrhage
----------------------------------------------------------------
empyema occur from untreated pneumonia with evaluate response to chemotherapy MCC: diabetic retinopathy
---------------------------------------------------------------- fundoscopy: fundus is difficult to visualize
parapneumonic effusions or 2/2 hemothorax
CA-125 antigen testing & pelvic USS can be used ----------------------------------------------------------------
low-grade fever, cough, dyspnea, chest pain
to Dx ovarian cancer only for those with progressive dyspnea on exertion, orthopnea,
MCC: S. aureus, Strep pneumo, Klebsiella
suggestive symptoms or physical findings hemoptysis, young immigrant: mitral stenosis
CXR: loculated, abnormally contoured effusion
women with a strong family Hx of ovarian cancer, symptoms are precipitated by conditions causing
with adjacent consolidation
should test for BRCA1/BRCA2 genes tachycardia (fever, anemia, pregnancy)
Dx: CT scan
o positive results should be screened with severe LA enlargement, leads to elevation of
Rx recent onset empyema: fibrinolytic
pelvic USS &/or CA-125 left main bronchus on CXR, compresses
(streptokinase, urokinase) into the chest tube; no screening for average risk patients
but contraindicated in MVAs recurrent laryngeal nerve (hoarseness), or a-fib
---------------------------------------------------------------- CXR: pulmonary vascular congestion with
Rx: ABX for early empyema
cephalization of blood flow to upper lobes
DDx: acute pericarditis, interstitial lung disease, DDx: alcohol withdrawal, excessive hypotensive abnormal urinary sediments: RBCs, red cell casts
malignancy, sarcoidosis response, hypertensive encephalopathy DDx: pretibial myxedema in Graves, cirrhosis,
---------------------------------------------------------------- hypoalbuminemia in nephrotic syndrome, renal
orotracheal intubation with rapid-sequence Manifestations of cyanide toxicity hypoperfusion 2/2 heart failure, RV failure
intubation is preferred for an apneic patient with skin flushing (cherry-red) ----------------------------------------------------------------
cervical spine injury, unless there is facial trauma CNS headache, altered mental status, Causes of peripheral edema
nasotracheal intubation is a blind procedure; hyperreflexia, seizure, coma capillary hydrostatic pressure
C/I in apneic/hypopneic patients & basilar skull fx CVS arrhythmias (CHF, cirrhosis, renal disease)
cricothyroidotomy is preferred over surgical respirator tachypnea followed by respiratory capillary oncotic pressure
tracheostomy, but converted to formal tracheostomy y depression, pulmonary edema (hypoalbuminemia, nephrotic syndrome, cirrhosis)
in 5 7 days if prolonged airway is necessary GI abdominal pain, N/V capillary permeability
---------------------------------------------------------------- renal metabolic acidosis 2/2 lactic acidosis, (burns, trauma, sepsis, ARDS)
p-value: probability of observing a given result by renal failure interstitial oncotic pressure
change alone, assuming null hypothesis is true ---------------------------------------------------------------- (lymphatic obstruction)
if p = 0.001, there is a 0.1% probability of delusion: fixed, false beliefs not consistent with ----------------------------------------------------------------
observing a given relative risk by chance alone cultural norms; grandiose, paranoid, or somatic uncomplicated diverticulitis: fever, leukocytosis,
both p-value & confidence interval measures magical thinking: ones thoughts can control LLQ pain/tenderness, Hx of constipation
statistical significance events not explained by natural cause & effect o Dx: CT scan shows soft tissue stranding &
a confidence interval containing 1.0 (null value) illusion: misinterpretation of external stimuli colonic wall thickening
is not statistically significant hallucinations: sensory perception in the o stable patients are managed as outpatient:
---------------------------------------------------------------- absence of external stimuli bowel rest, oral ABX, observation
extreme fatigue, malaise, sore throat, fever, ------------------------------------------------------------------ o immunocompromised, comorbidities, or
generalized maculopapular rash, palatal petechiae, polycythemia: Hct > 65% in term neonates elderly hospitalization & IV ABX
posterior cervical adenopathy, splenomegaly: lethargy, irritability, jitteriness, poor feeding, complicated diverticulitis: a/w abscess,
infectious mono cyanosis, respiratory distress perforation, obstruction, or fistula
labs: leukocytosis with atypical lymphocytes risk factors: in utero hypoxia (maternal HTN, o Dx: CT scan
Dx: heterophile antibodies peak 2 6 wks after smoking), poor gas exchange (maternal diabetes), o fluid collection 3 cm Rx: IV ABX & observe
primary EBV infection; thus, an initial negative delayed cord clamping, IUGR fluid collection 3 cm Rx: CT-guided drainage
antibody test does not exclude IM repeat test hypoglycemia & hypocalcemia 2/2 cell uptake failure of CT drainage: surgical drainage
alt Dx: anti-EBV antibodies asymptomatic Rx: hydration only by feeding or CT guided percutaneous drainage is standard
---------------------------------------------------------------- parenteral fluids Rx for complicated diverticulitis with abscess
screen all pregos for syphilis, HIV, & Hep B symptomatic Rx: partial exchange transfusion surgery with sigmoid resection is reserved for
regardless of STI risk factors to normalized Hct patients with fistulas, perforations with peritonitis,
screening for chlamydia, gonorrhea, & Hep C is DDx: cyanotic heart disease, dehydration, RDS, obstruction, or recurrent diverticulitis
based on risk factors transient tachypnea of the newborn ----------------------------------------------------------------
---------------------------------------------------------------- ---------------------------------------------------------------- B/L hip, thigh, or buttock claudication, impotence,
cyanide toxicity can occur with nitroprusside, anasarca, facial edema, HTN, pulmonary edema, symmetric atrophy of LEs due to chronic ischemia:
for rapid BP control in hypertensive emergency JVD, proteinuria & microscopic hematuria: aortoiliac occlusion (Leriche syndrome)
o nitroprusside metabolism releases nitric oxide acute nephritic syndrome with fluid overload arterial occlusion at the aortic bifurcation into the
(arteriolar & venous dilation) & cyanide ions primary glomerular damage leads to GFR & common iliac arteries; pulse is soft/absent B/L
altered mental status, lactic acidosis, seizures, coma retention of sodium & water resulting in volume impotence is always present in men; otherwise
occurs with prolonged infusions or higher doses overload & peripheral edema seek out another Dx
of nitroprusside, MC with renal insufficiency MCC: post-streptococcal glomerulonephritis, ----------------------------------------------------------------
Rx: sodium thiosulfate lupus nephritis, IGA nephropathy, RPGN, Mycoplasma pneumonia is MCC of atypical
membranoproliferative GN pneumonia the ambulatory setting
indolent course, nonproductive cough, higher score 4: antigen testing; or empiric oral PCN or ACE inhibitors are contraindicated in pregos
incidence of extrapulmonary symptoms amoxicillin o fetal growth restriction, renal failure,
(headache, sore throat, skin rash) ---------------------------------------------------------------- pulmonary hypoplasia, oligohydramnios,
CXR out of proportion to physical findings endothelial cell dysfunction or vasospasm is the skeletal abnormalities in 2nd or 3rd trimester
erythema multiforme is typical of Mycoplasma pathophysiologic finding in preeclampsia due to ----------------------------------------------------------------
Gram stain reveals only PMNs, but no organisms abnormal placental vasculature development in viral arthritis presents as symmetric polyarticular
---------------------------------------------------------------- early pregnancy small joint inflammation; resolves within 2 months
Strep pneumoniae (Gram+ diplococci): MCC of previously normotensive patients, preeclampsia positive ANA & rheumatoid factor may occur
community-acquired pneumonia is diagnosed as new onset HTN ( 140/90 mmHg) Rx: NSAIDs; no antivirals necessary
productive cough, rusty colored sputum @ 20 wks gestation, with new onset proteinuria DDx: RA, OA, polyarthritis in sarcoidosis, septic
few extrapulmonary symptoms; more virulent OR signs of end-organ damage & psoriatic arthritis, ankylosing spondylitis,
Rx: high-dose oral amoxicillin proteinuria is not required for Dx if signs of polymyalgia rheumatica
---------------------------------------------------------------- end-organ damage is present ----------------------------------------------------------------
Legionella pneumophilia causes pneumonia with end-organ damage (severe headache, RUQ earliest manifestation of vaso-occlusive disease
extrapulmonary symptoms: bradycardia, headache, or epigastric pain, renal insufficiency, in sickle cell anemia = dactylitis
confusion, watery diarrhea pulmonary edema) are considered to have presents @ age 6 months - 2 years with acute
Dx: urine antigen testing preeclampsia with severe features onset pain, symmetric swelling of hands & feet
---------------------------------------------------------------- Preeclampsia with severe features ----------------------------------------------------------------
fever, tender posterior cervical lymphadenopathy, o BP 160/110, 4 hrs apart during bedrest clubbing of toes & fingers, enlarged extremities,
significant fatigue, pharyngitis, tonsillar exudates, o thrombocytopenia < 100,000 swollen joints: hypertrophic osteoarthropathy
palatal petechiae, young adult: infectious mono serum creatinine > 1.1 or doubling MCC: pulmonary adenocarcinoma
heterophile (Monospot) test: 25% false-negative o elevated transaminases ----------------------------------------------------------------
rate during the first week; initial negative test o pulmonary edema staphylococcal osteomyelitis: localized bone pain,
does not rule out IM o new onset visual or cerebral symptoms soft tissue swelling, erythema
mild leukocytosis with atypical lymphocytes ---------------------------------------------------------------- sinus tracts with purulent drainage on skin surface
can cause autoimmune hemolytic anemia & normal pregnancy: C.O., renal perfusion, & XR: initially normal but later show periosteal
thrombocytopenia up to 2 3 wks after onset GFR, results in low baseline creatinine (0.4 0.8) elevation & necrotic areas
due to cross-reactivity of EBV-induced antibodies ---------------------------------------------------------------- ----------------------------------------------------------------
against RBCs & PLTs; Coombs positive chronic HTN: BP 140/90 mmHg @ < 20 wks elevated DHEA-S levels are specifically seen
DDx: Strep pharyngitis, acute HIV infection gestation or prior to conception with androgen producing adrenal tumors
---------------------------------------------------------------- gestational HTN: new onset HTN @ 20 wks DHEA-S is produced in adrenal glands only
acute HIV infection causes febrile illness gestation; no proteinuria or end-organ damage androstenedione, testosterone, & DHEA are
similar to infectious mono chronic HTN with superimposed preeclampsia: hormones produced by ovaries & adrenals
o rash & diarrhea more common in HIV chronic HTN + new onset proteinuria or worsening androstenedione, DHEA, DHEA-S are not true
o tonsillar exudate common in mono proteinuria @ 20 wks gestation above baseline, androgens because they do not interact with
---------------------------------------------------------------- worsening HTN, or signs of end-organ damage androgen receptors, but converted to testosterone
Centor criteria for pharyngitis ---------------------------------------------------------------- o overproduction of these hormones can lead
o fever by history IV hydralazine & labetalol (or PO nifedipine) used to clinical features of androgen excess
o tender anterior cervical lymphadenopathy for pregos, Rx hypertensive emergencies ----------------------------------------------------------------
o tonsillar exudates o (BP 160/110) dihydrotestosterone (DHT) is a product of
o absence of cough methyldopa is safe for pregos but not for testosterone conversion in peripheral tissues by
score 0 to 1: no testing or treatment hypertensive emergencies; slow onset & sedative 5- alpha-reductase
score 2 to 3: rapid streptococcal antigen testing; magnesium sulfate for seizure prophylaxis a potent androgen that interacts with testosterone Rc
oral PCN or amoxicillin for positive results o definitive Rx: removal of the placenta ----------------------------------------------------------------
----------------------------------------------------------------
always consider substance abuse in any resuming CHO intake, PO or IV, stimulates an o non-proliferative: retinal hemorrhages,
child/adolescent with significant changes in insulin surge, which promotes cellular uptake of dilated veins, microaneurysms, hard exudates
behavior, emotions, & social circles phosphorus, K+, & Mg++ o proliferative: neovascularization
interview the patient & parents individually o phosphorus is the primary deficient electrolyte ----------------------------------------------------------------
urine toxicology screen is indicated o K+ & Mg++ deficiency potentiate arrhythmias ToF presents with varying degrees of cyanosis,
---------------------------------------------------------------- aggressive initiation of nutrition rehab without depends on the degree of RV outflow obstruction
null hypothesis: statement of no relationship adequate electrolyte repletion results in clinical tet spell: sudden hypoxemia & cyanosis due to
between exposure & outcome manifestations sudden spasm from exertion or agitation
alternative hypothesis opposes the null hypothesis o arrhythmias, cardiopulmonary failure o pulmonary vascular resistance
---------------------------------------------------------------- o CHF (pulmonary edema, peripheral edema) Rx: knee-chest position decreases right-to-left
Feature of anorexia o seizures ventricular shunt & improves cyanosis by SVR,
osteoporosis** o Wernicke encephalopathy pulmonary blood flow
cholesterol & carotene anorexia nervosa: a/w euthyroid hypothyroxinemia Rx: inhaled O2 stimulates pulmonary vasodilation
prolonged QT, arrhythmias (normal TSH, low/normal T3/T4) 2/2 starvation & o pulmonary vascular resistance
euthyroid sick syndrome malnutrition DDx: VSD typically does not cause cyanosis,
anovulation, amenorrhea, estrogen deficiency ---------------------------------------------------------------- late stage pulmonary HTN with shunt reversal
2/2 hypothalamic-pituitary axis dysfunction African-American, gradual peripheral vision loss, leads to cyanosis (Eisenmengers)
hyponatremia 2/2 polydipsia high ocular pressure with cupping of optic disc: ----------------------------------------------------------------
pregos are at risk of IUGR, prematurity, open angle glaucoma maternal risk factors for fetal macrosomia:
hyperemesis gravidarum, postpartum depression annual fundoscopic exam in high-risk groups advanced age, obesity, diabetes, multiparity
---------------------------------------------------------------- Rx: Timolol ( aqueous humor production) African & Hispanic males are at increased risk
anorexia nervosa patients require hospitalization o laser trabeculoplasty as adjunct Rx for fetal macrosomia & shoulder dystocia
for unstable vital signs, severe bradycardia or ---------------------------------------------------------------- excessive traction on the neck during delivery
cardiac arrhythmias, or electrolyte disturbances acute severe U/L eye pain, halo around lights, can result in Erb-Duchenne palsy
Rx: CBT, nutritional rehab & weight gain; blurred vision, non-reactive fixed & dilated pupil, o involves 5th, 6th, 7th CN
monitor for refeeding syndrome & unilateral orbitofrontal headache a/w N/V: o most recover spontaneously within 3 months
Rx: olanzapine, if failure to gain weight & lack angle closure glaucoma o Rx: gentle massage, PT to prevent contractures
response to CBT conjunctival erythema, corneal opacification ----------------------------------------------------------------
---------------------------------------------------------------- aggravated by pupil dilation 2/2 darkness, stress, MS
Rx bulimia nervosa: SSRI + CBT, nutrition rehab; medications (decongestants, anticholinergics, females, 30s 40s
does not aid in weight gain sympathomimetics) unpredictable, erratic, focal neurologic dysFx
Rx anorexia nervosa: CBT, nutrition rehab; avoid atropine (mydriatic; precipitates glaucoma) symptoms last a few weeks; variable recovery
olanzapine if no response Dx: tonometry (increased IOP) transient arm weakness
---------------------------------------------------------------- o gonioscopy is gold standard B/L trigeminal neuralgia**
olanzapine A/E: weight gain & sedation mainly #1 Rx: IV mannitol (rapid effect) ----------------------------------------------------------------
o also hyperglycemia, dyslipidemia, new DM #2 Rx: acetazolamide & timolol ( aqueous humor depression, subcortical dementia, chorea,
clozapine A/E: weight gain, agranulocytosis, & production), topical pilocarpine ( drainage) atrophy of caudate nucleus (enlarged lateral
lowers seizure threshold untreated complication: permanent vision loss ventricles): Huntingtons
---------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------
Bupropion is C/I with eating disorders as it can moderate pain, blurred vision, hazy cornea, periodic back pain radiating to thigh & buttocks,
provoke seizures anterior chamber shows flare & cells on slit lamp, related to walking & climbing stairs, numbness
---------------------------------------------------------------- constricted pupil & poor light response: uveitis & tingling of lower extremities, relieved with
refeeding syndrome: potentially fatal complication ---------------------------------------------------------------- lumbar flexion: lumbar spinal stenosis
of nutritional rehabilitation in anorexia nervosa diabetic retinopathy: MCC of acquired blindness; aka neurogenic claudication
MC 2/2 vitreous hemorrhage
compression of spinal roots due to enlarging o CXR: hilar adenopathy, areas of pneumonitis lightening-like pain on the face, 20 -30x per day,
osteophytes at facet joints &/or hypertrophy of blastomycosis: north/south central, Ohio/Miss distributed in CN V branches: trigeminal neuralgia
ligamentum flavum; degenerative joint disease o flu-like S/S; severe in immunocompromised Rx: carbamazepine
normal peripheral pulses o ulcerated skin lesion, lytic bone lesions (A/E: aplastic anemia, fetal hydantoin syndrome)
neuro exam can be normal coccidioidomycosis: southwestern US DDx: maxillary sinusitis, herpes zoster
confirm Dx: spinal MRI o primary pulmonary infection, arthralgia MS can present with B/L trigeminal neuralgia
DDx: lumbar disk herniation, metastatic disease, erythema multiforme & erythema nodosum ----------------------------------------------------------------
iliac artery atherosclerosis, ankylosing spondylitis sporotrichosis: subcutaneous papules at hypopituitarism with mild/moderate prolactin
---------------------------------------------------------------- inoculation site, ulcerates; along lymphatic flow (35 ng/mL): non-functioning pituitary adenoma
low back pain radiating to calf & foot, worsens ---------------------------------------------------------------- central hypogonadism & hypothyroidism
with prolonged sitting, positive straight leg test, suspected sarcoidosis (cough, hilar adenopathy, arise from gonadotrophs in pituitary gland;
unilateral symptoms: herniated lumbar disk erythema nodosum, noncaseating granulomas) that dysfunctional cells overproduce only -subunits
exertion-dependent pain, relieved with rest; deteriorates after high-dose corticosteroids: of dimeric hormones (LH, FSH)
decreased peripheral pulses, cool extremities, histoplasmosis symptoms 2/2 mass effect with disruption of
decreased hair growth: vascular claudication sarcoidosis & histoplasmosis present with dopaminergic pathways that normally suppress
back pain, paralysis, hyperreflexia, urinary & similar symptoms & CXR prolactin
fecal incontinence: spinal cord compression biopsy reveals yeast forms in histoplasmosis Rx: trans-sphenoidal surgery
chronic back pain, worse at night, non-radiating, Dx: urine antigen testing DDx: prolactinoma (> 200 ng/mL), Klinefelter,
dull, does not change with activity: metastatic ---------------------------------------------------------------- excessive alcohol intake, antipsychotics
disease of the vertebrae fever, night sweats, productive cough, weight loss, ----------------------------------------------------------------
---------------------------------------------------------------- acute & chronic pneumonia, wart-like violaceous Common etiologies of interstitial lung disease
progressive back stiffness, worse in AM, improves nodules & skin ulcers with yeast: blastomycosis o sarcoidosis, amyloidosis
with activity, young male: ankylosing spondylitis primary infection via inhalation pulmonary o vasculitis (granulomatosis with polyangitis)
apophyseal (facet) joint arthritis infection with hematogenous spread to skin o infection
lumbar spine mobility & tender SI joint heaped-up verrucous ulcerated skin lesions that o occupational/environmental (silicosis,
anterior uveitis (monocular pain, redness, blurring) evolve into microabscesses hypersensitivity pneumonitis)
Dx: sacro-iliac XR shows B/L sacroiliitis, fusion of sputum: broad-based budding yeast o connective tissue disease (SLE, scleroderma)
SI joint &/or bamboo spine CXR: upper lobe consolidation & lytic lesions o idiopathic pulmonary fibrosis
HLA-B27 is not specific for AS, not needed for Dx Dx: urine antigen testing o cryptogenic organizing pneumonia
---------------------------------------------------------------- Rx mild pulmonary dz, immunocompetent: no Rx ----------------------------------------------------------------
pulmonary aspergillosis: fever, chronic cough, Rx moderate pulmonary disease: oral itraconazole idiopathic pulmonary fibrosis: excess collagen
dyspnea, weight loss, intermittent hemoptysis Rx severe pulmonary disease, immunocompromised: deposition in peri-alveolar tissue, causes
risk factors: immunocompromised, asthma, COPD, IV amphotericin B interstitial lung disease
TB, sarcoidosis, malignancy ---------------------------------------------------------------- scarring leading to lung volumes (TLC, FRC, RV)
aspergilloma MC with pre-existing lung cavity (TB) MCC of priapism with preserved or FEV1/FVC ratio
CXR: rapidly progressing, mobile cavitary lesion o drug-induced (trazodone, prazosin) impaired gas exchange; DLCO, A-a gradient,
CT scan: pulmonary nodules with a halo sign or o sickle cell disease & leukemia (children) results in hypoxemia due to V/Q mismatch
lesions with an air crescent o perineal or genital trauma (laceration) progressive exertional dyspnea, persistent dry cough,
Dx: CXR & Aspergillus IgG o neurogenic lesions (SCI, cauda equina) fine crackles, digital clubbing
Aspergilloma Rx: surgical resection ---------------------------------------------------------------- o resting ABG may be normal
invasive aspergillosis: itraconazole or caspofungin SSRIs: a/w impotence, sexual dysfunction, o exertion can cause significant hypoxemia
---------------------------------------------------------------- delayed orgasm CXR: reticular or nodular opacities
histoplasmosis: SE & central US o Rx: premature ejaculation CT: fibrosis, honeycombing, traction bronchiectasis
o acute pneumonia, cough, fever, malaise ---------------------------------------------------------------- o lung biopsy required for equivocal Dx
> 50% with significant +smoking Hx ----------------------------------------------------------------
---------------------------------------------------------------- Classification of psychiatric illness by phase
cryptogenic organizing pneumonia: dry cough, acute phase aims to achieve remission of acute
chronic systemic symptoms symptoms (absent/minimal symptoms)
CXR: B/L ground glass infiltrates o treatment response = 50% reduction from
---------------------------------------------------------------- baseline of severity; significant improvement
receiver operating characteristic (ROC) curve: continuation phase: sustained remission to prevent
shifting upward, sensitivity relapse
shifting ROC curve to the right, specificity maintenance phase: recovery signifies the
accuracy = total area under the ROC curve episode is over; prevent recurrence
|------specificity------||--sensitivity--| ----------------------------------------------------------------
---------------------------------------------------------------- sarcoidosis: young/mid-aged African-American
syringomyelia: fluid-filled cavity within the females, insidious onset dyspnea & dry cough,
cervical & thoracic spinal cord absence of constitutional symptoms
a/w Arnold Chiari malformation type I & SCIs erythema nodosum & anterior uveitis is common
areflexic upper extremities weakness, B/L ankle arthritis
dermatomal cape-distribution loss of pain/temp, auscultation: dry rales
with preserved vibration & proprioception CXR: B/L hilar lymphadenopathy, diffuse
(dissociated sensory loss) interstitial infiltrates
may present with burn injury 2/2 loss of sensation DDx: PCP pneumonia, CHF (bibaslar infiltrates),
Dx: MRI idiopathic pulmonary fibrosis, ankylosing spondylitis
DDx: anterior cord syndrome (2/2 aortic surgery), ----------------------------------------------------------------
transverse myelitis (2/2 MS), ALS (no sensory loss), Pneumococcus is MCC of sepsis in patients
subacute combined degeneration (2/2 Vit B12 def.), with sickle cell anemia
cervical spondylosis (neck pain & stiffness) clumping of sickled cells slows blood flow in the
---------------------------------------------------------------- spleen, permits splenic sequestration of RBCs,
---------------------------------------------------------------- Rx of hyperkalemia depends on severity, cause
sensitivity & specificity depend on the cutoff value results in auto-infarction & functional asplenia
& rapidity of rise in K+ levels susceptible to encapsulated species (S. pneumo,
raising the cutoff value, it is harder to obtain a 3 approaches to Rx hyperkalemia
true positive result & easier to obtain a negative H. influenza, N. meningitides)
1. antagonize cardiac effects of K+ with Ca++ pneumococcal vaccination & PCN prophylaxis
o causes FN to increase & TP to decrease, o hyperkalemia a/w EKG changes (peaked T,
leads to sensitivity & specificity until age 5 prevents pneumococcal sepsis
PR prolonged, wide QRS)
lowering the cutoff point increases # of TP o 13-valent conjugate & 23-valent polysacch
IV calcium gluconate
(directly proportional to sensitivity), but also o H. influenza Type B vaccine
o rapid & transient effect
decreases # of FP ( specificity) o meningococcal conjugate vaccine
2. drive extracellular K+ into cells
specificity is important for confirmatory tests PCN prophylaxis protects against other
o moderate hyperkalemia, no EKG change
to minimize FPs pneumococcal serotypes
insulin/glucose (fastest), beta-2-agonist
----------------------------------------------------------------
(albuterol), sodium bicarbonate renal biopsy is required for classification of all
o rapid-acting, but transient effects
new onset lupus nephritis for baseline histology
3. remove excess K+ from the body & determine appropriate Rx
o severe hyperkalemia, ESRD low complement levels & positive antibodies
sodium polystyrene sulfonate (Kayexelate),
(ANA, anti-dsDNA, anti-Smith)
diuretics (furosemide), cation exchange resins ---------------------------------------------------------------
(stool elimination), hemodialysis (definitive Rx)
o slow-acting (2 24 hr)
thermal or smoke inhalation injury in burn victims, NO inflammation inflammation inflammatio omphalocele: umbilical cord inserts at apex of
warrant early intubation to prevent supraglottic n defect; covered by peritoneum
airway obstruction by edema & blistering pH > 4.5 ph > 4.5 normal pH o Rx: surgical staged closure with silastic silo
carboxyhemoglobin > 10%, stridor, Hx of clue cells, +Whiff motile, pear-shape pseudohyphae ----------------------------------------------------------------
confinement in a burning building, blistering (amine odor in trichomonads, AFP in pregos: a/w open NTD (anencephaly),
Rx: high-flow O2 with non-rebreather, with a KOH) strawberry cervix ventral wall defects, multiple gestation
low threshold for intubation oral metronidazole metronidazole; fluconazole Dx: USS, clarify # of fetuses
---------------------------------------------------------------- (OK for pregos) treat partner (pregos OK) DDx: HCC, gonadal tumors, viral hepatitis
weakness & decreased pain sensation of B/L LE normal: white/transparent, odorless discharge ----------------------------------------------------------------
after a MVA suggests a spinal cord injury vaginal inflammation: vulvar pruritus, erythema, regression of milestones can be a complication
in absence of pelvic injury & blood at the urethral burning, dyspareunia, dysuria of previous episode of bacterial meningitis
meatus, urinary catheter can assess for retention confirm Dx: wet mount & vaginal pH long-tern neurologic sequelae a/w meningitis
& prevent bladder injury due to acute distension ---------------------------------------------------------------- o loss of cognitive function
---------------------------------------------------------------- patients with PID should also be screened for o hearing loss
Medications to withhold prior to cardiac stress testing HIV, syphilis, hepatitis B, cervical cancer (pap); o seizures
48 hr hold -blocker, CCB, nitrates also hepatitis C if Hx of IVDA o mental retardation
continue ACE-I/ARBs, digoxin, statins, diuretics ---------------------------------------------------------------- o spasticity or paresis
N-acetylcysteine ----------------------------------------------------------------
stress tests detect reversible ischemia or prior MI o acetaminophen hepatotoxicity Liver disorders of pregnancy
medications should be continued for those with CAD o mucolytic for cystic fibrosis HELLP
undergoing stress testing to assess the efficacy of o contrast-induced nephropathy prevention intrahepatic cholestasis of pregnancy
antianginal therapy ---------------------------------------------------------------- acute fatty liver of pregnancy
---------------------------------------------------------------- child with sudden-onset respiratory distress ----------------------------------------------------------------
TB is a common cause of primary adrenal without preceding illness, focal findings on life-threatening complication of pre-eclampsia
insufficiency (Addisons) in endemic areas pulmonary exam: foreign body aspiration
no rise in serum cortisol with cosyntropin MC in right mainstem bronchus HELLP Syndrome
CT: B/L adrenal calcification (hallmark) focal monophonic wheezing on affected side
Hemolysis: microangiopathic hemolytic anemia,
non-anion gap metabolic acidosis with hyperK+, generalized wheezing, inspiratory stridor, hoarse
schistocytes, bilirubin, haptoglobin
hyponatremia, hypoglycemia, eosinophilia CXR: hyperinflation in partial obstructions, or
Elevated LFTs: AST or ALT x2 upper limit
deficiency of aldosterone results in inappropriate atelectasis in complete obstructions
Low Platelets: < 100,000 L
sodium loss, while retaining K+ & H+ Dx & Rx: rigid bronchoscopy
Rx of TB does not normalize adrenal function ----------------------------------------------------------------
umbilical hernia: MC in A-A infants; reducible, abnormal placentation triggers systemic
Rx: lifelong glucocorticoid & mineralocorticoid inflammation, with activation of coagulation &
---------------------------------------------------------------- low risk of incarceration or strangulation
o defects at linea alba, covered by skin PLT consumption
candida vaginitis & bacterial vaginosis are hepatocellular necrosis cause elevated LFTs,
caused by an imbalance of vaginal flora, not o a/w Beckwith-Wiedemann, hypothyroidism,
liver swelling, & distension of Glissons capsule
sexual transmission; but increases risk for STDs prematurity
RUQ or epigastric pain, N/V
recent systemic corticosteroid use, ABX, DM o spontaneously resolves by age 5 yr
gastroschisis: protrusion of bowel to the right side proteinuria, elevated LDH
of normal umbilicus; no membrane coverage Rx: prompt delivery at 34 wks, Mg-sulfate
DDx of vaginitis
o elevated AFP o c-section only for normal OB indications
Bacterial Trichomoniasis Candida
o Rx: cover with sterile saline dressing & complication: DIC with multi-organ failure
Vaginosis vaginitis vaginitis
plastic wrap, NGT, ABX DDx: acute fatty liver of pregnancy, ITP, HUS,
thin, off-white thin, frothy, thick, cottage
discharge, fishy green-yellow, cheese-like; o surgical repair with single-stage closure intrahepatic cholestasis, placental abruption
malodorous; ----------------------------------------------------------------
complication of severe preeclampsia: acute secondary Raynauds: a/w connective tissue dz if significant total body surface area burns, major
pulmonary edema asymmetric attacks; males, age > 40 cause of morbidity/mortality is hypovolemic shock
acute onset dyspnea, hypoxia, crackles, LE edema tissue ischemia & digital ulcers in the setting of adequate fluid resuscitation,
due to generalized arterial vasospasm leading work-up: ANA, RF, ESR bacterial infection (bronco pneumonia or burn
to SVR & pulmonary capillary pressure Rx: underlying cause, CCB wound infection) leading to sepsis & septic shock
also due to renal function, albumin, & ---------------------------------------------------------------- are pneumonia & wound infections
vascular permeability Tourette disorder: multiple motor tics & at least 1 MCC: S. aureus & P. aeruginosa
Rx: supplemental O2, fluid restriction, & vocal tic; must persist for 1 yr after initial onset criteria indicating development of sepsis:
diuretics with caution due to third-spacing before age 18; exacerbated by stress worsening hyperglycemia (worsening insulin
---------------------------------------------------------------- a/w comorbid OCD & ADHD resistance), leukocytosis, thrombocytopenia,
intrahepatic cholestasis of pregnancy: functional Rx: risperidone & habit reversal training hyperthermia, tachypnea, tachycardia
disorder of bile formation during 2nd & 3rd trimester only haloperidol & pimozide are FDA-approved following a severe burn injury, in circulating
intense pruritus on palms & soles, worse at night ---------------------------------------------------------------- cortisol & catecholamines cause protein losses as
bile acids; hyperbilirubinemia; no jaundice pleuritic chest pain, dyspnea, tachypnea, muscle degradation is used for gluconeogenesis;
aminotransferases x10 (r/o viral hepatitis) tachycardia in a long-distance truck driver: PE extensive protein breakdown is a normal response
Dx of exclusion CXR has poor sensitivity & specificity, but can = hypermetabolic phase
Rx: symptomatic, pruritus resolves after delivery; ----------------------------------------------------------------
exclude other causes of chest pain & dyspnea
weakness, cold intolerance, hoarseness, dry skin,
ursodeoxycholic acid may be helpful DDx for chest pain & dyspnea: acute MI,
---------------------------------------------------------------- constipation, depression, menorrhagia,
pneumonia, pneumothorax, aortic dissection,
acute fatty liver of pregnancy: acute hepatic bradycardia, myxedema: hypothyroidism
pericardial effusion, peptic ulcer perforation
----------------------------------------------------------------
failure in 3rd trimester; due to acute microvesicular ----------------------------------------------------------------
plasmapheresis removes pathogenic autoantibodies:
fatty infiltration of hepatocytes very large PEs may cause hypotension due to
N/V, abdominal pain Rx TTP
acute RV failure
----------------------------------------------------------------
significantly elevated LFTs, prolonged PT & PTT, ----------------------------------------------------------------
S. aureus is MCC of lactational mastitis
hypoglycemia, leukocytosis, encephalopathy SIRS: non-infectious causes of sepsis
Dx: based on history & exam
Rx: prompt delivery two out of four criteria
Rx: nurse every 2 to 3 hours; direct feeding with
---------------------------------------------------------------- a/w pancreatitis, autoimmune dz, vasculitis, burns
Dresslers: pericarditis presenting weeks months both breasts to completely drains milk ducts
Rx: ibuprofen, frequent feeding/pumping, ABX
post-MI; immune-mediated Systemic Inflammatory Response Syndrome (SIRS)
chest pain, worse with deep inspiration, empiric Rx for MSSA: dicloxacillin, cephalexin
Temp 38.5C (101.3F) or 35C (95F) empiric Rx for MRSA: clindamycin, TMP-SMX,
improves by leaning forward Pulse 90 bpm
elevated ESR or vancomycin
RR 20/min ----------------------------------------------------------------
EKG: diffuse ST elevation, except aVR; WBC 12,000, 4000 cells/mm3, or 10% bands benztropine: Rx/prevent EPS a/w antipsychotics
consistent with pericarditis
Rx: NSAIDs; corticosteroids for refractory cases clozapine: Rx treatment-resistant schizophrenia
sepsis: SIRS with known infection methylphenidate: Rx ADHD
---------------------------------------------------------------- o infection or injury leading to inflammation
primary Raynaud phenomenon: vascular ----------------------------------------------------------------
& dysregulated host response Duchenne muscular dystrophy: age 2 5 yrs,
response to cold temp or emotional stress o severe sepsis = end-organ dysfunction
symmetric episodic attacks; women age < 30 X-linked recessive, B/L calf pseudohypertrophy
(hypotension, thrombocytopenia, oliguria, screening: serum creatine kinase & aldolase
absence of peripheral vascular disease, tissue injury, metabolic acidosis, hypoxemia)
or abnormal nailfold capillary exam fibrosis & fatty infiltration on calf muscle biopsy
---------------------------------------------------------------- support the Dx
Rx: CCB (nifedipine, amlodipine) & avoid patients with severe burns manifest evidence of
aggravating factors, smoking cessation confirm Dx: genetic studies show deletion of
SIRS & hypermetabolic response in the 1st week dystrophin gene
----------------------------------------------------------------
----------------------------------------------------------------
progressive dyspnea, exercise tolerance, a-fib XR: reduced bone density, thinning cortex, ----------------------------------------------------------------
with rapid ventricular response, LV systolic dysFx: symmetric pseudofratures (Looser zones) altered mental status, volume depletion, polyuria:
tachycardia-mediated cardiomyopathy ---------------------------------------------------------------- hyperosmolar hyperglycemic state (HHS)
develops in patients with persistent or recurrent 2 major treatment issues for all new-onset a-fib hyponatremia in HHS is due to osmotic shift of
tachyarrhythmias with prolonged periods of 1. rate or rhythm control strategy H2O into extracellular space & Na+ renal loss
rapid ventricular rate (a-fib, a-flutter, AVNRT) 2. risk assessment of systemic embolization from osmotic diuresis
Rx: aggressive rate or rhythm control using CHA2-DS2-VASc score: assesses long-term
AV nodal blocking agents, antiarrhythmics, or stroke risk in patients with non-valvular a-fib DKA HHS
catheter ablation o score 0: low risk, no therapy Type I diabetics Type II diabetics
---------------------------------------------------------------- o score 1: intermediate risk, no therapy or younger age older age
infants with hydrocephalus may present with ASA or oral anticoagulation rapid onset of symptoms gradual symptoms onset
the following findings: o score 2: high risk, oral anticoagulation hyperventilation altered mental status
warfarin reduces risk of embolization in groups abdominal pain neurologic symptoms
symptoms physical findings at moderate- to high-risk of thromboembolism glucose 250 500 mg/dL glucose > 600 mg/dL
poor feeding tense & bulging fontanelle bicarbonate < 18 mEq/L bicarbonate > 18 mEq/L
irritability prominent scalp veins CHA2-DS2-VASc score anion gap metab. acidosis normal anion gap
decreased activity widely spaced cranial sutures C CHF 1 ketonemia negative ketones
vomiting rapidly increasing circumference H HTN 1 serum Osm < 320 serum Osm > 320
A2 Age 75 2 total body K+ deficit due to osmotic diuresis
Dx: brain CT scan D DM 1
o USS requires a widely open anterior fontanelle; S2 Stroke/TIA 2 Thiazides can precipitate HHS by reducing
infants < age 6 months V vascular disease (prior-MI, 1 intravascular volume, thus GFR, leads to
lumbar puncture for suspected meningitis PAD, aortic plaque) decreased renal glucose excretion
skull radiograph to evaluate abnormal head shape A Age 65 74 1 osmolality leads to altered mentation, lethargy, &
---------------------------------------------------------------- Sc Sex 1 weakness
Serum Serum Serum Max score 9 Dx: serum glucose, plasma Osm, absent ketonemia
Ca++ phosphate PTH ---------------------------------------------------------------- ----------------------------------------------------------------
10 hyper-PTH DM Type 2 a/w physiologic stressor (infection) best markers for resolution of DKA
hypoparathyroidism are prone to nonketotic hyperosmolar syndrome o serum anion gap
/nrml osteomalacia (NKHS) o beta-hydroxybutyrate assay (ketones)
normal normal normal osteoporosis/Pagets risk factors: URI, MI, stroke, trauma, burns measure serum glucose every hour
---------------------------------------------------------------- stress causes catecholamines & cortisol, both measure electrolytes & anion gap every 2 4 hr
osteomalacia due to vitamin D deficiency: insulin counterregulatory hormones
o mildly low serum Ca++ severe hyperglycemia (> 600 mg/dL), with Management of DKA & HHS
o marked hypophosphatemia resultant osmotic diuresis, causes dehydration IV fluids high-flow 0.9% NS; change to D5% in
o PTH & alkaline phosphatase & serum hyperosmolarity (> 320 mOsm/L) 0.45% @ serum glucose < 200 mg/dL
o low plasma 25-OH vitamin D altered consciousness (confusion) & acute onset IV initial continuous IV infusion;
o decreased urinary Ca++ of blurred vision are common regular switch to SC when patient is able to eat,
secondary hypo-PTH brings serum Ca++ to #1 Rx: IV fluids can reduce hyperglycemia insulin glucose < 200, anion gap < 12, or
normal/near-normal by increasing bone & renal o if hypovolemic: NS until euvolemic, then HCO3 > 15
Ca++ reabsorption & urinary phosphate replace with 0.45% saline IV K+ if < 5.2 mEq/L
excretion #2 Rx: insulin HCO3- only if pH < 6.9
bone pain, muscle weakness, cramps #3 Rx: K+ supplementation once K+ reaches phosphate if phosphate < 1.0, cardiac dysFx, or
causes: malabsorption (Crohns, Celiac), GI normal levels respiratory depression,
bypass surgery, chronic liver/kidney disease DDx: cataracts, diabetic retinopathy, uveitis monitor serum Ca++
---------------------------------------------------------------- humoral immune deficiency leads to impaired loud S2
cataracts can manifest in chronic diabetics with antibody production; presents with recurrent, ----------------------------------------------------------------
suboptimal glycemic control upper & lower RTI due to encapsulated bacteria macrovesicular steatosis, polymorphonuclear
gradual accumulation of intralenticular sorbitol ---------------------------------------------------------------- infiltrates, & necrosis in a non-drinker:
---------------------------------------------------------------- MCC of hypernatremia is hypovolemia nonalcoholic steaohepatitis (NASH)
unexplained thrombocytopenia & hemolytic anemia mild cases: 5% dextrose in 0.45% saline risk factors: obesity, DM, hypertriglyceridemia,
in a patient with renal failure & neuro deficits severe cases (mental status changes): 0.9% saline medications, TPN, endocrinopathies
(headache, confusion): TTP-HUS initially (isotonic saline is hypoosmolar compared impaired responsiveness to insulin causes fat
o schistocytes are characteristic to the hypernatremic plasma); once volume deficit accumulation in the liver, progressing to fibrosis
idiopathic TTP-HUS: ADAMTS-13 deficiency, a is restored, switch to 0.45% saline & steatohepatitis; 2/2 lipid peroxidation &
von Willebrand factor cleaving protease; plasma Na+ correction 1 mEq/L/hr; rapid correction oxidative stress
accumulation of large von Willebrand factor of hypernatremia leads to cerebral edema hepatomegaly is common, mild LFT elevations
multimers & PLTs ---------------------------------------------------------------- Dx: percutaneous liver biopsy
Rx: plasmapheresis (removes autoantibodies & 5% dextrose in water (D5W): Rx euvolemic & complications: hepatic fibrosis, cirrhosis
repletes ADAMTS-13) hypervolemic hypernatremia Rx: treat underlying conditions,
o PLT transfusion is contraindicated IV free water can cause RBC lysis due to ursodeoxycholic acid to improve LFTs
---------------------------------------------------------------- osmotic shock ----------------------------------------------------------------
advanced COPD: supplemental O2 improves ---------------------------------------------------------------- cyclosporine & tacrolimus: calcineurin-inhibitors
hypoxia, but worsens hypercapnia due to isolated, symmetric lower extremity weakness, (immunosuppressants)
1) increased dead space perfusion & loss of loss of sensation & UMN signs: spinal cord both: nephrotoxic, HTN, hyperkalemia, tremor
compensatory vasoconstriction worsens compression cyclosporine A/E: gum hypertrophy & hirsutism
V/Q mismatch causes: disk herniation, abscess, malignancy ----------------------------------------------------------------
2) decreased affinity of oxyHb for CO2; epidural abscess is common with IVDA azathioprine A/E : dose-related marrow suppression,
reduces uptake of CO2 from tissue Dx: spine MRI; medical emergency! leukopenia, hepatotoxic, pancreatitis
3) reduced alveolar ventilation due to o lumbar puncture is contraindicated for mycophenolate A/E: bone marrow suppression
decreased respiratory drive; slows RR possible epidural abscess glucocorticoid A/E: Cushings, osteoporosis,
lethargy, confusion, seizures (reflex cerebral Rx: high-dose IV glucocorticoids poor wound healing, adrenocortical atrophy
vasodilation) ---------------------------------------------------------------- ----------------------------------------------------------------
---------------------------------------------------------------- acute Lyme disease: erythema migrans, female, jaundice, marked pruritus, +AMA:
pre-existing atopic dermatitis (eczema) headache, arthralgia, myalgia primary biliary cirrhosis
increases risk for latex allergy late disseminated Lyme disease (months/yrs) can noncaseating granulomatous inflammation
---------------------------------------------------------------- manifest as subacute encephalopathy portal tracts are infiltrated by lymphocytes,
adrenal insufficiency should be suspected in ---------------------------------------------------------------- macrophages, plasma cells, eosinophils
patients who becomes suddenly hypotensive Becks Triad (hypotension, JVD, muffled heart portal tract scarring & bridging fibrosis leads to
under stress (surgery) sounds) suggests cardiac tamponade cirrhosis; a/w ductopenia of intrahepatic ducts
---------------------------------------------------------------- MC: viral pericarditis due to recent viral URI ----------------------------------------------------------------
risk factors for aspiration pneumonia include
due to an exaggerated shift of the interventricular inflammation, fibrosis, & stricturing of
altered consciousness due to excessive alcohol,
septum towards the left ventricular cavity which intrahepatic & extrahepatic bile ducts
neurologic dysphagia, disruption of GE junction
reduces LV preload, stroke & C.O.
(GERD), mechanical disruption of glottis closure
clear lungs, pulsus paradoxus, hepatojugular reflux; Primary sclerosing cholangitis
recurrent pneumonia involving same lung region
worsens with inspiration features fatigue & pruritus, or asymptomatic
is 2/2: bronchial obstruction or recurrent aspiration
---------------------------------------------------------------- a/w comorbid ulcerative colitis
CXR: infiltrate in lower or posterior upper lobes
pulmonary HTN can be due to pulmonary labs, imaging cholestatic pattern: LFTs, ALP
Dx: chest CT scan
arterial pressure (primary pulmonary HTN), or +p-ANCA
---------------------------------------------------------------- pulmonary venous pressure (LV failure) liver Bx fibrous obliteration of small bile ducts,
concentric replacement by connective o genetically predisposed @ age 40 60 ----------------------------------------------------------------
tissue = onion skin pattern o excessive sun exposure; premalignant for SCC Tinea capitis
Dx cholangiogram: periductal portal tract patchy, fine, white, adherent scales on the scalp: dermatophyte infection, MC in A-A children
fibrosis; segmental stenosis of tinea capitis feature scaly erythematous patch on scalp,
extrahepatic & intrahepatic bile ducts o Rx: oral griseofulvin s alopecia with residual black dot,
Rx: ursodeoxycholic acid, pruritic ring-shaped, scaly, erythematous rash lymphadenopathy,
liver transplant with central clearing: tinea corporis transmission: human-human or fomite
complications biliary stricture, o MCC: Trichophyton rubrum Dx clinical; KOH of hair shaft: spores
cholangitis, cholelithiasis, cholestasis o Dx: KOH reveals hyphae Rx oral griseofulvin,
end-stage liver disease, portal HTN o Rx: topical antifungals (terbinafine) or household contacts: selenium sulfide or
cholangiocarcinoma, colon cancer griseofulvin (extensive disease) ketoconazole shampoo
cholangiogram: ERCP or MRCP recurrent, pruritic, eczematous eruption on flexors ----------------------------------------------------------------
---------------------------------------------------------------- & extensor surfaces: atopic dermatitis (eczema) flank pain, N/V, fever 38C (100.4F), CVA
asymptomatic bacteriuria in pregos risk of o Type I hypersensitivity tenderness: acute pyelonephritis in pregnancy
cystitis, pyelonephritis, low birth weight, o light microscopy: spongiosis Rx: hospitalization for IV ABX (ceftriaxone),
prematurity, & perinatal mortality erythematous, pruritic vesicles & edema 2/2 to then switch to oral ABX for 10 - 14 days after
MCC is E. coli being afebrile for 24 hours
contact with allergen/irritant: contact dermatitis
screen all pregos @ 12 16 wks gestation salmon-colored, sharply demarcated, scaling lesions avoid aminoglycosides in pregnancy
Dx: positive urine culture 100,000 colonies/mL that coalesce into oval plaques on extensors, ----------------------------------------------------------------
without symptoms of cystitis covered by a thick silvery scale: psoriasis Whipples disease: rare, multi-systemic illness
Rx options slow-growing papule or nodule with a pearly Tropheryma whippelii (G+ bacillus)
o nitrofurantoin 5 - 7 days rolled border & overlying telangiectasia with white males, age 40 - 60
o amoxicillin or augmentin 3 - 7 days ulceration: basal cell carcinoma chronic malabsorptive diarrhea (weight loss,
o fosfomycin as a single dose solitary, firm, reddish, dome-shaped nodule & steatorrhea, flatulence, distension)
fluoroquinolones (fetal cartilage abnormalities) central keratinous plug: keratoacanthoma intermittent low-grade fever, chronic cough,
& TMP-SMX should be avoided smooth-surfaced, dome-shaped melanocytic plaque pigmentation, lymphadenopathy
F/U urine culture after one week to document < 1 cm with blue color: blue nevi migratory polyarthropathy, myocardial/valvular
resolution of bacteriuria, then monthly for the skin tag, flesh-colored or pedunculated papules involvement leads to CHF or regurgitation
duration of pregnancy to monitor recurrent infections in high friction regions: acrochordon late stage: dementia, ophthalmoplegia, myoclonus
---------------------------------------------------------------- ---------------------------------------------------------------- PAS-positive macrophages in lamina propria
benign growths with a waxy, well-circumscribed rosy hue with telangiectasia on cheeks, nose, chin, of small intestine biopsy
stuck on, appearance: seborrheic keratosis & scalp; 30 60 y/o: rosacea DDx: Celiacs, Crohns, cystic fibrosis, HIV
o Dx: clinical appearance; no therapy chronic inflammatory disorder ----------------------------------------------------------------
sudden onset of multiple occurrence may intermittent flushing precipitated by hot drinks, gallstones & chronic alcohol abuse are MCC of
indicate occult internal malignancy heat, emotion, rapid body temp changes acute pancreatitis
papulosquamous patches with a fine, loose, & papules & pustules may be present o other etiologies: hyperlipidemia, medications,
greasy yellow scale on an erythematous base: Rx: metronidazole or laser surgery infections, trauma, iatrogenic (post-ERCP)
seborrheic dermatitis ---------------------------------------------------------------- Dx requires 2 out of 3 criteria: acute epigastric pain
o scalp, central face, eyebrows, nasolabial folds Clinical features of melanoma (screening) radiating to back, lipase 3x normal, imaging
o all age groups; infant cradle cap Asymmetry o imaging not necessary if first two criteria met
o MC a/w Parkinsons, HIV Border irregularities Dx: abdominal USS to evaluate for
o Rx: moisturizer, antifungals, dandruff shampoo Color variegation cholelithiasis or choledocholithiasis
dry, scaly papules with an erythematous base & Diameter 6 cm o equivocal USS endoscopic USS or ERCP
central scale; sandpaper-like; may turn into Evolving size, shape, color abdominal CT is used for those who fail to
cutaneous horns: actinic keratosis improve with conservative Rx for pancreatitis
HIDA scan to diagnose acute cholecystitis if Schizoaffective disorder: significant manic Type III hypersensitivity: immune-complex
USS is non-diagnostic episodes with concurrent psychotic symptoms & mediated; antibodies of IgG or IgM form
complications: pleural effusion, ileus, ARDS, at least 2 weeks without mood symptoms complexes with antigens to activate complement
pancreatic pseudocyst/abscess/necrosis, ARF delusions/hallucinations 2 wks in absence Serum sickness, Arthus reaction, drug fever
---------------------------------------------------------------- of major mood episode (depressive or manic) ----------------------------------------------------------------
HIV a/w fever, malabsorptive diarrhea, weight loss: mood symptoms present for majority of illness prodrome fever & influenza-like symptoms,
Mycobacterium avium-intracellulare DDx conjunctivitis, mucositis, mucocutaneous lesions,
PAS-positive macrophage & acid-fast o bipolar disorder or major depression with erythematous & pruritic macules, desquamation &
---------------------------------------------------------------- psychotic features: psychotic symptoms bullae progressing to epidermal necrosis &
intussusception: ileocecal junction is MC occur only during mood episodes sloughing, +Nikolsky sign: SJS
preceding viral infection (gastroenteritis) inflames o schizophrenia: absence of mood symptoms inflammatory hypersensitivity reaction
intestinal lymphatic tissue (Peyer patches) can ---------------------------------------------------------------- < 10% of body surface area = SJS
serve as a lead point schizophreniform: > 1 month, but < 6 months > 30% = Toxic epidermal necrolysis (TEN)
risk factors: Meckels, polyps, rotavirus vaccine, schizophrenia: > 6 months triggers: allopurinol, sulfonamides, lamotrigine,
hematomas (Henoch-Schonlein purpura) ---------------------------------------------------------------- phenytoin, carbamazepine, NSAIDs, sulfadiazine,
periodic abdominal pain with drawing up the legs maculopapular eruption on wrists & ankles, Mycoplasma pneumo, vaccination, GVHD
emesis may follow episodes of abdominal pain spreads to trunk, extremities, palms & soles on Rx: supportive, wound care, IV fluids
ongoing obstruction causes mucosal ischemia, day 5: rickettsial infection ----------------------------------------------------------------
leading to currant jelly stools fever, conjunctivitis, headache, diffuse myalgias asymmetric tingling & burning of the hand a/w
RUQ sausage-shaped mass ---------------------------------------------------------------- vesicular rash: herpetic whitlow
Dx: abdominal USS shows target sign erythema, edema, severe pruritus, vesicles & inoculation of HSV 1 or 2 by direct contact with
Rx: air enema (or water-soluble contrast) weepy crusted lesions 24 48 hr after contact orotracheal secretions via broken skin
complications: bowel necrosis with an allergen: contact dermatitis non-purulent vesicles on volar hand
---------------------------------------------------------------- cell-mediated hypersensitivity (Type IV) Dx: Hx of exposure & multinucleated giant cells
hypercalcemia of malignancy: 80% due to involves T-cell activation on Tzank smear
PTHrP production due to allergic reaction or chemical irritant Rx: self-limited; oral acyclovir
breast cancer MC 2/2 locally produced PTHrP requires sensitization before a reaction develops ----------------------------------------------------------------
via bone metastasis antigen is presented to sensitized lymphocytes, cutaneous flushing & intense generalized pruritus:
metastatic tumor cells do not directly cause which release cytokines within 24 48 hr A/E of high-dose niacin therapy for
bone resorption, but secrete factors that Rx: topical glucocorticoids hypertriglyceridemia
activate osteoclasts also seen in PPD skin test, SJS/TEN prostaglandin-induced peripheral vasodilatation
ectopic PTH is a rare cause ---------------------------------------------------------------- Rx: prevented with low-dose ASA, taken 30 min
---------------------------------------------------------------- Type I hypersensitivity: IgE- mediated; allergen prior to niacin
Technetium-99m scan can detect gastric mucosa binds & cross-links IgE molecules on a mast cell ----------------------------------------------------------------
in Meckels diverticulum releases vasoactive substances painless chancres that resolves in 3 6 wks:
---------------------------------------------------------------- causes mast cell & basophil degranulation primary syphilis
COPD have increased TLC, FRC, & RV leading atopy, urticaria, anaphylaxis o recurs weeks/months later as 20 syphilis
to hyperinflation & diaphragmatic flattening, ---------------------------------------------------------------- fever, malaise, sore throat, lymphadenopathy,
thus increases work of breathing Type II hypersensitivity: antibody-mediated; diffuse maculoopapular rash on the trunk that
lung hyperinflation preserves max expiratory cytotoxic reaction of IgG or IgM to cell antigens spread peripherally to extremities + palms & soles,
airflow as higher lung volume increases elastic leads to complement activation & cell damage condyloma lata: secondary syphilis
recoil pressure, thus more difficult to decrease Rh hemolytic anemia of newborns Rx: IM benzathine penicillin
intrathoracic pressure during inhalation ---------------------------------------------------------------- o A/E: Jarisch-Herxheimer reaction (acute
Rx: lung volume reduction surgery febrile reaction with headache & myalgias)
---------------------------------------------------------------- non-prego, PCN-allergic: doxycycline x14 days
Rx pregos: PCN alcoholism can also cause basophilic stippling; Auscultation TVF Percussn Mdstinum
o PCN-allergic should confirm with skin testing, nonspecific to lead poisoning & Thalassemias Consolid dull none
then undergo PCN desensitization ---------------------------------------------------------------- ation bronchial breath sounds ( expiratory)
DDx: cutaneous drug reaction. pityriasis rosea, all patients with hypotension/shock after MVA (lobar) crackles, egophony ( sound transmission),
psoriasis, rickettsial infection should be presumed to have hypovolemic shock bronchophony, whisper pectoriloquy
---------------------------------------------------------------- PCWP at baseline & increases after saline Pleural breath dull away
black stool, epigastric pain, nausea, pain relieved infusion without systolic BP change: myocardial effusion sounds from
with food, weight gain: PUD contusion effusion
MCC: H. pylori or NSAIDs o LV dysfunction results in filling pressures (large)
duodenal ulcer symptoms occur in absence of Dx: urgent echocardiogram COPD breath hyperres none
food buffers (2 -5 hr after meals, nighttime) ---------------------------------------------------------------- sounds onant
PUD is MCC of melena anaphylaxis: a type of distributive/vasodilatory PnmTX breath hyperres away
Dx: upper endoscopy shock due to severely decreased SVR sounds onant (tension)
DDx: gastric cancer, colon cancer, diverticulosis, o /normal PCWP, improves with fluids
inflammatory bowel disease, ischemic colitis, hypovolemic shock: C.O., SVR sound travels faster in solids (consolidation),
mesenteric ischemia o PCWP at baseline, improves with fluids resulting in increased TVF in lobar pneumonia
---------------------------------------------------------------- ---------------------------------------------------------------- consolidation presents with bronchial breath sounds,
ischemic colitis: inflammation & injury of the tension pneumothorax after MVA can present airway patency causes over-transmission of sound
colon result from inadequate blood supply with hypotension & shock due to extracardiac consolidation does not cause blunting of the
a/w procedures on aortoiliac vessels compression of the right/left ventricle costophrenic angles
MC @ splenic flexure PCWP is /normal, only slight change with fluids ----------------------------------------------------------------
abdominal pain, fever, vomiting; followed by ---------------------------------------------------------------- Torsades de pointes due to prolonged QT
hematochezia or bloody diarrhea within 24 hr massive PE after MVA (air/fat embolism) can Rx: Mg++ sulfate
risk factor: atherosclerosis lead to hypotension & shock ----------------------------------------------------------------
Dx: colonoscopy or flexible sigmoidoscopy PCWP is /normal; minimal change with fluids CNS, cardiac, & anticholinergic abnormalities
---------------------------------------------------------------- ---------------------------------------------------------------- altered mental status, hypotension, hyperthermia,
mesenteric ischemia: injury of small intestine Gross painless hematuria miosis, urinary retention,: TCA overdose
occurs due to inadequate blood supply initial test: U/A to rule out UTI & confirm decreases myocardial conduction velocity, leads to
abdominal pain out of proportion to relatively microhematuria prolonged QRS & risk of ventricular arrhythmia
normal physical exam bladder tumors are MC malignancy a/w Rx: ABCs, supplemental O2, IV fluids
pain exacerbated by eating, bloody diarrhea, painless hematuria in age > 35 & smoking Hx activated charcoal if within 2 hr of ingestion
food aversion, weight loss o Dx: CT urogram & cystoscopy Rx: sodium bicarbonate improves systolic BP,
risk factors: atherosclerosis, a-fib, heart failure, DDx: neoplasms, infection, trauma, ADPKD, shortens QRS, & prevents arrhythmias
CRF, risk of forming blood clots, previous MI nephrolithiasis, glomerulonephritis, BPH QRS > 100 msec is an indication for NaHCO3
Dx: angiography ---------------------------------------------------------------- Rx: benzos for seizures 2/2 GABA Rc inhibition
---------------------------------------------------------------- obesity is a common cause of amenorrhea ----------------------------------------------------------------
megaloblastic (impaired DNA synthesis due to secondary to anovulation intrauterine fetal death < 20 wk gestation; retained
B12 or folate deficiency) vs. nonmegaloblastic anovulation: FSH/LH are normal, ovaries are products of conception, non-viable: missed
(alcoholism, hypothyroidism, liver disease) producing estrogen, but progesterone is not o closed cervix; Dx: transvaginal USS
macrocytic anemia produced at normal post-ovulation levels, thus any hemorrhage before 20th week of gestation with
o MCV & MCH, normal MCHC progesterone withdrawal menses does not occur active fetal heart tones: threatened abortion
megaloblastic: MCV > 110, low reticulocytes, ---------------------------------------------------------------- o closed cervix, no passage of fetal tissue
macroovalocytes, hypersegmented neutrophils, premature ovarian failure: FSH > LH; age < 40 vaginal discharge of blood/tissue, abdo cramps,
anisiocytosis, poikilocytosis ---------------------------------------------------------------- partial expulsion: incomplete abortion
nonmegaloblastic: reticulocyte count varies Pulmonary auscultation findings o dilated cervix; retain conception products
vaginal bleeding, abdo cramps radiates to the back negative Staph in neonatal ICU petechial or purpuric rash within 24 hrs on the
& perineum, dilated cervix: inevitable abortion (S. epidermidis) axilla, wrists, flanks, ankles
o ruptured/collapsed gestational sac other Gram- (Klebsiella, Enterobacter, Pseudomonas) Rx: isolation, IV ABX, ICU setting
o no fetal cardiac motion on USS negatives late-onset sepsis, ICU ----------------------------------------------------------------
acute onset abdo pain, dark red vaginal bleed in the jaundice, maculopapular rash, microcephaly,
1st trimester, adnexal mass: ectopic pregnancy hypotonia, full/bulging fontanelles, nuchal rigidity, chorioretinitis, hepatosplenomegaly, hydrocephalus,
o no gestational sac in uterus on USS seizures: bacterial meningitis intracranial calcifications: congenital toxoplasmosis
fever, malaise, foul-vaginal discharge, uterine & poor feeding, lethargy, hyper- or hypothermia, maternal infection by feces of infected cats, ingest
cervical motion tenderness: septic abortion respiratory distress, vomiting, jaundice: sepsis infected raw meat, or unpasteurized goats milk
o infection of retained products of conception neonatal sepsis: infants < 28 days old ----------------------------------------------------------------
o MC with induced abortions o early-onset: age < 3 7 days midshaft humerus fracture is a/w radial nerve,
Rx: suction curettage, IV fluids, IV ABX preterm infants: more likely hypothermic passes via radial groove on the posterior humerus
o Rx: hysterectomy for severe cases MC infection during passage through birth canal o a/w wrist drop
1st trimester vaginal hemorrhage a/w expulsion Dx: CBC, blood cultures PRIOR to ABX supracondylar fracture is a/w brachial artery
of vesicles, N/V, enlarged uterus: molar prego (ampicillin + gentamicin) without waiting for LP o ischemia (pain, pallor, pulselessness,
o -hCG, no fetal heart tones neutrophilia with significant left shift indicates paresthesia, paralysis)
---------------------------------------------------------------- neonatal sepsis from bacterial infection ----------------------------------------------------------------
Rx threatened abortion neonates have low risk of herniation after LP due winged scapula: injury of long thoracic nerve
o ascertain fetus is present & alive with USS to their open fontanelles; head CT not required results in paralysis of serratus anterior muscle
o reassurance & F/U USS in one week ---------------------------------------------------------------- MC after axillary lymphadenectomy for breast ca
no hospitalization required Group B Strep: MC neonatal infection acquired ----------------------------------------------------------------
---------------------------------------------------------------- by exposure to amniotic fluid after ROM hypotension, hyperpigmentation, hyponatremia,
hyperkalemia: peaked T-wave, followed by PR screening: 3 -5 wks prior to estimated delivery hyperkalemia, eosinophilia, low serum cortisol,
& QRS lengthening; eventually bradycardia & (@ 35 37 wks); vagina & rectum cultures elevated ACTH: primary adrenal insufficiency
sine wave pattern GBS negative status do not need prophylaxis for MC developed countries: autoimmune adrenalitis
Rx: calcium gluconate (rapid, but transient) prolonged ROM > 18 hr infectious causes: CMV, fungal, TB
---------------------------------------------------------------- ABX prophylaxis in labor without testing if a/w autoimmune dz (vitiligo, pernicious anemia)
smoking cessation has the greatest impact on o Hx of GBS bacteriuria ----------------------------------------------------------------
decreasing risk of pancreatic cancer o GBS UTI patients on warfarin can have adrenal hemorrhage
hereditary risk factors: hereditary pancreatitis, o prior birth to infant with GBS from acute stress (sepsis), even if INR is therapeutic
pancreatic cancer in 1st degree relative, germline missed screening or unknown GBS status is stress increases ACTH levels, which increase
mutation (BRCA 1/2, Peutz-Jegher) treated in labor if adrenal blood flow, predisposing to hemorrhage
environmental: obesity, low physical activity, o < 37 wks gestation ----------------------------------------------------------------
chronic pancreatitis o intrapartum fever B/L, lower-extremity pain, occur only at night,
alcohol or caffeine reduction, & glycemic control o ROM > 18 hr age 2 12 yrs: growing pains
do not significantly incidence of pancreatic ca Rx: PCN (prophylaxis 4 hr prior to delivery) monitor pain for increased frequency/intensity
---------------------------------------------------------------- ---------------------------------------------------------------- Rx: observation, reassurance, massage, heat,
Causes of neonatal bacterial sepsis neonatal HSV encephalitis presents with seizures; stretching, OTC analgesics
Group B Strep, MC of early- & late-onset sepsis acquired from infected genital tract DDx: osteoid osteoma, osteosarcoma, osteomyelitis
E. coli (preterm MC due to E.coli) ---------------------------------------------------------------- ----------------------------------------------------------------
S. aureus skin, bone, or joint infections fever, headache, stiff neck nausea, hypotension: sclerotic, cortical lesion with a central nidus of
Listeria early-onset sepsis during outbreaks meningococcal meningitis lucency: osteoid osteoma
Enterococcus preterm infants MC in age 3 yr to adolescence; high contagious pain worse at night, unrelated to activity
Coagulase- indwelling umbilical venous catheters myalgia is common benign, bone-forming tumor
MC in adolescent males
Rx: NSAIDS (suggestive of Dx); spontaneous recurrent catalase-positive infections (S. obstruction consistency
resolution over several years aureus) Hirschsprung rectosigmoid normal
---------------------------------------------------------------- lymphadenitis, skin abscesses meconium ileus ileum inspissated
changing the cutoff point of a quantitative Gram stain: neutrophils filled with bacteria meconium ileus results in microcolon
diagnostic test inversely affects sensitivity & Dx: nitro blue tetrazolium test Dx: contrast enema
specificity ---------------------------------------------------------------- ----------------------------------------------------------------
lower the cutoff INCREASES sensitivity & Chediak-Higashi: chemotaxis, degranulation, Hirschsprung disease should be suspected in a
decreases specificity (more true positives) & granulopoiesis newborn with failure to pass meconium within
raising the cutoff DECREASES sensitivity & mild coagulopathy, pancytopenia 48 hr, in the setting of Down syndrome
increases specificity (more true negatives) partial albinism, peripheral & cranial neuropathy, poor feeding, abdo distension, absent air in rectum
---------------------------------------------------------------- hepatosplenomegaly, infections (S. aureus), failure of neural crest cell migration in the
recurrent sinopulmonary infections, persistent progressive lymphoproliferative syndrome rectosigmoid; positive squirt sign on exam
diarrhea, oral candidiasis, viral infections: SCID Dx: neutropenia, giant lysosomes in neutrophils Dx: rectal biopsy show absence of ganglion cells
adenosine deaminase (ADA) deficiency Rx: daily TMP-SMX & ascorbic acid ----------------------------------------------------------------
Dx: absent lymph nodes & tonsils, lymphopenia, ---------------------------------------------------------------- C3 deficiency predisposes to encapsulated bacteria
absent thymic shadow on CXR, abnormal T, B, Leukocyte adhesion defect (LAD): failure of C5 C7 deficiency: recurrent Neisseria infections
& natural killer cell count by flow cytometry innate host defenses due to defective tethering, C1 esterase deficiency: hereditary angioedema
---------------------------------------------------------------- adhesion, & targeting of myeloid leukocytes to ----------------------------------------------------------------
Brutons (X-linked) agammablobulinemia: sites of microbial infection anticholinesterase toxicity due to
male infant, asymptomatic until age 6 9 months; o absence of neutrophils/pus at infection sites organophosphate poisoning
recurrent pyogenic infections (S. pneumo, H.infl) recurrent bacterial infections of skin & mucosal bradycardia, miosis, salivation
o decreased IgG, IgA, IgM, IgE, & surfaces, necrotic periodontitis, gingivitis, Rx: atropine & pralidoxime
absent/decreased B cells delayed umbilical cord separation (> 30 days) ----------------------------------------------------------------
o sinusitis, bronchitis, otitis media, Giardia early loss of deciduous & permanent teeth hazard ratio: ratio of an event rate occurring in
CVID presents similar to Brutons, but CVID has leukocytosis with neutrophil predominance treatment vs. control group
less severe symptoms & later onset (age 15 35 yrs) cultures: S. aureus, G-negative bacilli ratio < 1 = treatment group has lower event rate
o normal circulating B cells ---------------------------------------------------------------- ratio > 1 = treatment group has higher event rate
o decreased IgG, IgA, IgM, IgE increased gastric residual volume, vomiting, & ----------------------------------------------------------------
---------------------------------------------------------------- abdominal distension in a preterm neonate: asymptomatic bacteriuria of pregnancy is
thrombocytopenia, eczema, recurrent infections: necrotizing enterocolitis (NEC) treated with ABX to prevent pyelonephritis,
Wiskott-Aldrich (WAITER) risk factors: prematurity, very low birth weight preterm birth, low birth weight, perinatal mortality
XR, defective WASP gene gut immaturity & exposure to bacterial from risk of pyelonephritis is due to progesterone
young boy with eczema, thrombocytopenia, enteral feeds result in inflammation & damage to causing smooth muscle relaxation, thus ureteral
recurrent encapsulated spp infections bowel wall dilation
o Strep pneumo, N. meningitidis, H. influenza XR: pneumatosis intestinalis (intramural air with screen all pregos @ 12 16 wks gestation
@ birth: petechiae, bleeding from circumcision, train tracks) & air in portal vein Rx: amoxicillin, nitrofurantoin, cephalexin are safe
bruises, bloody stools leukocytosis, metabolic acidosis C/I: tetracycline, fluoroquinolones, TMP-SMX
PLT production, small PLTs Rx: decreased rates of NEC in premature infants (interferes with folate metabolism in 1st trimester,
low IgM, high IgA & IgE who are breastfed & risk of kernicterus in 3rd trimester)
---------------------------------------------------------------- complications: pneumoperitoneum ----------------------------------------------------------------
Chronic granulomatous disease (CGD): defective DDx: duodenal atresia, pyloric stenosis, strongest indicator for future suicide attempt: Hx
phagocytes due to NADPH oxidase dysfunction Hirschsprung of previous attempt(s)
impaired oxidative metabolism within phagocytes; ---------------------------------------------------------------- ----------------------------------------------------------------
defective intracellular killing DDx of delayed passage of meconium -blocker A/E: worsening of CHF, bradyarrhythmia,
(within 48 hrs) level of meconium airway resistance (asthma), sexual dysfunction
---------------------------------------------------------------- older patient with rapidly progressive dementia, ----------------------------------------------------------------
loop diuretics can cause hearing loss &/or tinnitus myoclonus, akinetic mutism, behavior changes: hydroxyapatite: osteoarthritis
ototoxicity occur with high doses, renal failure, or Creutzfeldt-Jakob disease (CJD) monosodium urate: gout
combo with other ototoxic drugs (aminoglycosides) triphasic sharp wave complexes on EEG, &/or calcium oxalate: renal calculi
---------------------------------------------------------------- 14-3-3 CSF proteins struvite: renal calculi; UTI of urease spp (Proteus)
HCTZ/thiazides can cause photosensitivity, Dx: brain biopsy show spongiform changes ----------------------------------------------------------------
orthostatic hypotension, hypercalcemia Rx: supportive; death within one year of onset osteoarthritis: non-inflammatory arthritis
---------------------------------------------------------------- DDx: ALS, Lewy body dementia, Alzheimers, age > 50, morning stiffness < 30 min
HTN & hypokalemia: 10 hyperaldosteronism NPH, peudodementia decreased ROM, stiffness after prolonged rest;
prone to diuretic-induced hypokalemia, resulting ---------------------------------------------------------------- anterior hip pain exacerbated by walking
in weakness & muscle cramps scheduled cholecystectomy is indicated for all crepitus, no TTP, no warmth of joint
also metabolic alkalosis, mild hypernatremia symptomatic gallstones (acute pancreatitis), once bony enlargement; Heberden & Bouchard nodes
no peripheral edema due to spontaneous diuresis medically stable due to risk of recurrent episodes XR: joint space narrowing, osteophytes,
(aldosterone escape) Rx poor surgical candidate: ursodeoxycholic acid subchondral sclerosis & subchondral cysts
screening: morning aldosterone:renin ratio asymptomatic gallstones should not be treated, Rx: weight loss slows OA progression
o ratio > 20, with aldosterone > 15 ng/dL except morbidly obese undergoing gastric bypass or ----------------------------------------------------------------
suggests primary hyperaldosteronism presence of porcelain GB Rx mild/moderate OA pain: acetaminophen
confirm Dx: adrenal suppression testing after ---------------------------------------------------------------- Rx OA exacerbation: NSAID, intra-articular steroid
oral saline load genital HSV eruptions: painful vesicles on an Rx OA refractory to NSAID & intra-articular steroid:
positive result requires adrenal CT erythematous base that evolve to shallow, colchicine
MCC: unilateral adenoma or B/L hyperplasia punched-out ulcerations/erosions ----------------------------------------------------------------
Dx: CT scan to confirm unilateral mass; equivocal Hx of genital HSV: Rx prophylactic acyclovir or recurrent hemarthrosis & skeletal muscle
results require adrenal venous sampling valacyclovir @ 36 wks to risk of outbreak hemorrhage after mild trauma: hemophilia A & B
U/L adenoma Rx: surgery (#1) or aldosterone during delivery menorrhagia & mucosal bleeding is common in
antagonist (spironolactone, eplerenone) neonatal HSV risk factors: maternal infection,
women with von Willebrand disease (AD)
B/L hyperplasia Rx: aldosterone antagonists vaginal delivery with active lesions ----------------------------------------------------------------
---------------------------------------------------------------- Rx: c-section for pregos with active genital lesions MCC of nephrotic syndrome in children age < 10:
spironolactone: aldosterone/progesterone/androgen or prodromal symptoms (burning, pain) minimal change disease
Rc antagonist vaginal delivery only in absence of active lesions periorbital edema in the AM, pretibial pitting,
A/E: libido, gynecomastia, breast tenderness, ---------------------------------------------------------------- nephrotic range proteinuria, hypoalbuminemia
menstrual irregularities burning, localized pain & regional hyperesthesia or T-cell mediated injury to podocytes cause
eplerenone: selective mineralocorticoid antagonist allodynia, in the context of recent cancer therapy: increased permeability to albumin
---------------------------------------------------------------- herpes zoster (shingles) renal biopsy not required for Dx
dehydration is a risk factor for venous thrombosis pain may precede rash by several days
Rx: empiric steroids upon suspicion of Dx
due to hemoconcentration ----------------------------------------------------------------
o 90% have complete remission of proteinuria
sudden pleuritic chest pain, cough, dyspnea, acute arthritis of right knee, fatigue, constipation,
renal biopsy indicated in age > 10, or if
hemoptysis: PE polyuria: pseudogout
unresponsive to steroid Rx; exclude other causes
also tachycardia, tachypnea, & hypoxemia hyperparathyroidism predisposes to pseudogout
----------------------------------------------------------------
chest CT: wedge shaped infarction acute formation of calcium pyrophosphate bradycardia, miosis, rhonchi, fasciculations,
contrast-enhanced CT: filling defects dehydrate (CPPD) crystals, leading to salivation, lacrimation, urination, defecation:
CXR: Hamptons hump, Westermark sign chondrocalcinosis (calcified articular cartilage) organophosphate poisoning
attacks are precipitated by trauma, surgery, illness
causes transudative & exudative pleural effusion Rx: removal of clothing & washing of the skin
Dx: synovial fluid (rhomboid-shaped positively
DDx: TB, PCP, bacterial pneumonia, lung cancer prevents transcutaneous absorption
birefringent crystals) Rx: atropine & pralidoxime
----------------------------------------------------------------
DDx: gout, septic arthritis
---------------------------------------------------------------- pericardial knock, pulsus paradoxus, Kussmaul DDx: myocardial contusion (tachycardia)
TCA overdose Rx: sodium bicarbonate & EKG sign, prominent x & y descents ----------------------------------------------------------------
---------------------------------------------------------------- ---------------------------------------------------------------- ipsilateral ataxia, nystagmus, intention tremor,
bicuspid aortic valve, aortic coarctation, & aortic CXR: parenchymal nodules (silicosis) loss of coordination: cerebellar tumor
root dilation; risk of aortic dissection: Turners CXR: pleural plaques (asbestosis) patient falls/sway TOWARD the lesion side
ovarian dysgenesis; low estrogen & amenorrhea ---------------------------------------------------------------- ----------------------------------------------------------------
results in a high FSH/LH & low inhibin hard, irregular, fixed breast mass: malignancy age > 40, personality change, dementia, chorea:
normal GH levels rubbery, firm, freely mobile mass: fibroadenoma Huntingtons
---------------------------------------------------------------- Hx of 1st-degree relative with breast cancer wide-based gait, steppage gait: Tabes dorsalis
Social anxiety disorder (social phobia) requires diagnostic (vs. screening) breast imaging affected arm adducted, affected leg extended; leg
anxiety about 1 social situations, > 6 months palpable breast mass age < 30: USS is swung out in a semicircle: hemiparesis/stroke
fear of scrutiny, humiliation, embarrassment palpable mass age > 30: mammogram, then USS waddling gait: muscular dystrophy
marked functional impairment simple cyst Rx: needle aspiration ----------------------------------------------------------------
complex cyst/solid mass: image-guided core Bx risk factor for cervical insufficiency: Hx of
generalized social anxiety disorder suspicious malignancy: core needle biopsy maternal OB trauma, prior GYN surgery (LEEP,
o Rx: SSRI (paroxetine) & CBT ---------------------------------------------------------------- cone Bx), multiple gestation, Hx preterm birth,
performance-only social anxiety disorder both folate & Vit B12 are involved in conversion or 2nd trimester abortion
o Rx: propranolol 30 - 60 minutes prior & CBT of homocysteine methionine, thus a deficiency o Dx: transvaginal USS
o alt: benzodiazepine (avoid if substance abuse) in either results in homocysteine levels risk factors for placental abruption: chronic HTN,
Buspiron: Rx GAD only, not social anxiety Vit B12 is involved in conversion of smoking, cocaine use, Hx of maternal trauma, Hx
---------------------------------------------------------------- methylmalonyl-CoA succinyl-CoA of external cephalic version
ischemic cardiac pain can be mistaken for Vit B12 deficiency results in methylmalonic acid risk factors for uterine rupture: multiparity, Hx
epigastric pain ---------------------------------------------------------------- of c-section or myomectomy, adv maternal age,
SLE & chronic steroid use are risk factors for haptoglobin binds free Hb to form Hb-haptoglobin fetal macrosomia
accelerated coronary atherosclerosis complexes removed by the liver ----------------------------------------------------------------
exercise stress test without imaging if baseline haptoglobin in hemolytic anemias abdo pain that refers to one or both shoulders
EKG is normal ---------------------------------------------------------------- suggests subdiaphragmatic peritonitis due to
o positive stress test coronary angiography alpha-fetoprotein is elevated in HCC & irritation of subdiaphragmatic parietal peritoneum
blunt traumatic bladder injuries, bladder dome
---------------------------------------------------------------- testicular germ cell tumors
acute exacerbation of MS Rx: methylprednisone ---------------------------------------------------------------- is the only region covered by peritoneum, most
low-grade fever & leukocytosis are common susceptible to rupture
(high-dose IV corticosteroid)
MC site of extraperitoneal bladder rupture:
long-term steroid therapy provides no benefit during the first 24 hr postpartum
intrapartum & postpartum chills are common bladder neck
& does not prevent future relapses
----------------------------------------------------------------
long-term Rx: beta-interferon can decrease lochia rubra (bloody discharge) is characteristic
unfractionated heparin is preferred over
frequency of acute exacerbations & relapses postpartum; after 3 4 days lochia serosa
enoxaparin (LMWH), fondaparinux, &
o also glatiramer acetate, IV Ig, (pale) lochia alba (white/yellow)
rivaroxaban for severe renal insufficiency
cyclophosphamide, or plasmapheresis foul-smelling lochia suggests endometritis
reduced renal clearance anti-Xa levels,
---------------------------------------------------------------- fever & elevated WBCs beyond 24 48 hr
thus bleeding risk
MCC of constrictive pericarditis in developing requires UTI work-up: U/A, blood cultures
monitor unfractionated heparin with aPTT
countries: TB ----------------------------------------------------------------
once therapeutic, initiate warfarin
MCC in the US: viral pericarditis blunt deceleration trauma (MVA, fall from > 10 ft),
o warfarin takes 5 7 days to be therapeutic;
pericardial scarring & thickening results in must rule out blunt aortic injury
high mortality rate must bridge with heparin
diastolic dysfunction; pericardial calcifications
----------------------------------------------------------------
decreased cardiac output & venous overload Dx: CXR widened mediastinum
Rivaroxaban has immediate onset of action, does esophageal perforation MC occurs following
not require bridging with heparin; but no antidote best predictor of opioid intoxication: RR instrumentation of the esophagus
---------------------------------------------------------------- Rx of severe psychomotor agitation a/w PCP o less commonly due to Boerhaaves
upper GI bleeding, depressed consciousness level, intoxication: benzo retrosternal pain & crepitus @ suprasternal notch
& ongoing hematemesis due to esophageal ---------------------------------------------------------------- due to pneumomediastinum
variceal hemorrhage should first be intubated cocaine withdrawal: dysphoria, appetite, DDx: Mallory-Weiss (self-limited hematemesis)
Rx: endoscopic band ligation or sclerotherapy hypersomnia, difficulty concentrating ----------------------------------------------------------------
after patient is stabilized & intubated opioid withdrawal: yawning, mydriasis, cat bites: prophylactic augmentin for 5 days
---------------------------------------------------------------- lacrimation, rhinorrhea, diaphoresis, N/V, Pasteurella multocida
Acute intoxication diarrhea, arthralgia, muscle spasms ----------------------------------------------------------------
Marijuana appetite, dry mouth, ---------------------------------------------------------------- fluoroquinolones is a/w tendon rupture in children
conjunctival injection, recurrent fractures, hearing loss, opalescent teeth, ----------------------------------------------------------------
tachycardia, slow reaction time, blue sclerae: osteogenesis imperfecta (AD) large thymic silhouette in the anterior mediastinum
euphoria/dysphoria/paranoia, normal intelligence, osteopenia is a normal finding on CXR in age < 3 yrs
psychomotor impairment (days) ---------------------------------------------------------------- triangular shape, sail sign, scalloped border
gynecomastia (chronic use) pain, followed by well-demarcated lesions & bullae residual thymic tissue can undergo malignant
phencyclidin violent behavior, impulsivity, with skin necrosis: warfarin-induced necrosis transformation into a thymoma
e hallucinations, amnesia, MC @ breasts, buttocks, thighs, abdomen DDx: lymphoma
P dissociation, vertical a/w protein C deficiency ----------------------------------------------------------------
C nystagmus, Rx: vitamin K; discontinue warfarin if lesions home O2 therapy & smoking cessation have
P mydriasis, ataxia progress, maintain anticoagulation with heparin been shown to decrease mortality in COPD
LSD visual hallucinations, ---------------------------------------------------------------- ----------------------------------------------------------------
mydriasis, worsening renal function, HTN, & distal ischemia hyperpigmentation of palmar creases, anorexia,
euphoria/dysphoria/panic, following an invasive arterial procedure: fatigue, GI complains, weight loss, hypotension:
perceptual intensification, cholesterol embolization primary adrenal insufficiency (Addisons)
tachycardia/palpitations/HTN, livedo reticularis on skin exam hyponatremia, hyperkalemia
Cocaine euphoria, agitation,
---------------------------------------------------------------- hyponatremia is due to volume contraction
formication (cocaine bugs)
plantar warts are due to HPV infection (aldosterone deficiency) & increased vasopressin
chest pain, stroke, MI, seizures
painful hyperkeratotic papules on the soles (lack of cortisol suppression)
tachycardia, HTN, mydriasis
Meth violent behavior, tooth decay common in young adults & immunocompromised mild hyperchloremic acidosis
diaphoresis, tachycardia, HTN, ---------------------------------------------------------------- ----------------------------------------------------------------
choreiform movements, scaly, erythematous, ulcerated skin lesion that is hypernatremia, hypokalemia: Cushings
psychosis slow-growing, non-resolving with irregular growth ----------------------------------------------------------------
Heroin euphoria, miosis, on sun-exposed area: squamous cell ca Wolff-Parkinson-White: accessory pathway
(opioid) respiratory depression, ---------------------------------------------------------------- that bypasses AV node; atrioventricular reentrant
depressed mental state, suspected appendicitis with delayed presentation tachycardia (AVRT)
constipation, hypotension, (> 5 days) after onset of symptoms: appendiceal persistent a-fib with rapid ventricular response
hypothermia, & bradycardia abscess (contained, perforated abscess = phlegmon) can deteriorate to v-fib
amphetamin agitation, paranoia, delirium, Dx: CT scan Rx hemodynamically unstable: cardioversion
e palpitations, tachycardia, HTN, if stable, Rx: hydration & IV ABX, bowel rest, Rx hemodynamically stable: procainamide
diaphoresis, mydriasis, elective appendectomy AV nodal blockers (adenosine, -blocker, CCB,
seizures, hyperthermia, ---------------------------------------------------------------- digoxin) can accessory pathway conduction,
intracerebral hemorrhage anemia, constipation, weight loss: colon cancer thus worsen WPW
Alcohol slurred speech, unsteady gait, fever, dysuria, flank pain: pyelonephritis ----------------------------------------------------------------
disinhibition, nystagmus ----------------------------------------------------------------
AV nodal reentry tachycardia (AVNRT) 2 separate bimodal onset: age 4 6 yrs or early puberty two or more distinct identities that alternatively
conducting pathways (slow/fast) within AV node nocturnal enuresis can be a presenting assume control behavior: dissociative identity
sudden onset & termination, absent P, narrow QRS symptom in toddlers disorder (multiple personality disorder)
---------------------------------------------------------------- DDx: UTI, maturational delay of sphincter, persistent/recurrent feelings of detachment from
abrupt onset of sharply-demarcated, edematous, psychological stress, nephrogenic DI ones own physical or mental processes, with
erythematous, tender skin lesion with raised border, ---------------------------------------------------------------- intact sense of reality; significant impairment:
& fever: erysipelas enuresis: urinary incontinence in age 5 yrs depersonalization disorder
inflammation of superficial dermis primary enuresis: never achieved dryness experiencing familiar persons & surroundings as
legs most common, or face secondary enuresis: return of incontinence after if strange or unreal: derealization disorder
MCC: Group A strep 6 months of dryness ----------------------------------------------------------------
---------------------------------------------------------------- ---------------------------------------------------------------- proximal DVT of lower extremities; MCC of PE
Todds paralysis: focal neurologic deficit immune-mediated muscle inflammation: o continue warfarin for 3 months for patients
following a seizure polymyositis with reversible risk factors
---------------------------------------------------------------- multicentric CNS inflammation & demyelination: o continue warfarin for 6 12 months for
muscle weakness & dry mouth: Lambert-Eaton MS idiopathic DVT
a/w lung small cell carcinoma & Hodgkins ---------------------------------------------------------------- ----------------------------------------------------------------
antibodies against presynaptic voltage-gated Ca++ infertility: inability to conceive for > 1 yr glucose-6-phosphatase deficiency (Von-Gierkes):
channels in motor nerves infertility for women age > 35: > 6 months Type I glycogen storage disease
muscle response to motor nerve stimulation o MCC of fertility in the 4th decade who are affects liver, kidneys, intestinal mucosa
increases with repetitive stimulation menstruating: age-related decreased @ age 3 4 months, hypoglycemia, lactic acidosis,
diminished/absent DTRs ovarian reserve hyperuricemia, hyperlipidemia
Rx: plasmapheresis & immunosuppressants Dx: early follicular phase FSH level, clomiphene doll-like face (fat cheeks), thin extremities,
---------------------------------------------------------------- challenge test, or inhibin-B level protuberant abdomen, short stature
Myasthenia crisis can be exacerbated by RTI DDx: premature ovarian failure (amenorrhea & hypoglycemic seizures
diplopia, ptosis, proximal muscle weakness, & menopause before age 40) ----------------------------------------------------------------
weakness of bulbar muscles & diaphragm can ---------------------------------------------------------------- Acid maltase deficiency (Pompes): Type II
lead to respiratory distress rapid & massive increase in transaminases with glycogen storage disease
Rx MG with respiratory failure: intubation, then modest elevations in total bilirubin & ALP in the floppy baby with feeding difficulties,
corticosteroids + IV Ig or plasmapheresis (preferred) setting of hypotension (septic shock, heart failure): macroglossia, cardiomegaly, hepatomegaly
---------------------------------------------------------------- ischemic hepatic injury ----------------------------------------------------------------
Myasthenic crisis: exacerbation of symptoms due DDx: alcoholic liver disease (AST rarely >300), glycogen debranching enzyme deficiency: Type
to undermedication of AChE-ases or infection acute hepatitis (significant hyperbilirubinemia), III glycogen storage disease
Rx: withhold AChE-ase inhibitors TB, sarcoidosis, acalculous cholecystitis, elevated liver transaminases, fasting ketosis,
(pyridostigmine), remove respiratory secretions autoimmune hepatitis (elevated bilirubin) normal blood lactate & uric acid levels
Cholinergic crisis: exacerbation of symptoms due ---------------------------------------------------------------- ----------------------------------------------------------------
to overmedication with AChE-ases if suspicion for subarachnoid hemorrhage is high, branching enzyme deficiency: Type IV glycogen
Rx: atropine (anticholinergic, prevents A/E but head CT is negative lumbar puncture storage disease (amylopectinosis)
of AChE inhibitor therapy) ---------------------------------------------------------------- age 18 months, hepatosplenomegaly, failure to
Dx: edrophonium (Tensilon) test (short-acting sudden & unexpected travel, confusion about thrive, progressive liver cirrhosis
AChE-inhibitor) personal identity, inability to remember the past: ----------------------------------------------------------------
o myasthenic crisis improves muscle strength dissociative fugue new onset neurologic deficits (confusion),
o MG cholinergic crisis worsens weakness episodes of inability to recall important personal occipital headaches, Hx of HTN & a-fib &
---------------------------------------------------------------- info; related to a traumatic or stressful event: vascular disease, on warfarin: stroke
polyuria & polydipsia are classic for new-onset dissociative amnesia Dx: non-contrast head CT
Type I DM o ischemic stroke not evident until > 24 hrs
o hemorrhagic stroke white hyperdense regions asthma may present with chronic cough (> 8 wk) A/E: myelosuppression (pancytopenia) predisposes
---------------------------------------------------------------- that is predominantly nocturnal to infection
all patients with B/L carpal tunnel syndrome Dx: spirometry to asses bronchodilator response acute Rx: hydration, analgesia (NSAIDs)
(CTS) should be screened with TSH o Methacholine challenge test if no maintenance Rx: folate, pneumococcal vaccine,
CTS 2/2 hypothyroidism is a/w deposition of bronchodilator response is seen PCN until age 5 yrs, hydroxyurea
mucopolysaccharide protein complexes within Rx: empiric inhaled glucocorticoids 2 4 wks; ----------------------------------------------------------------
perineurium & endoneurium of median nerve; improvement is diagnostic thyroid storm is triggered by trauma, infection,
commonly B/L, more severe ---------------------------------------------------------------- surgery, iodine contrast, or childbirth; due to
---------------------------------------------------------------- febrile seizures are common, benign causes of underdiagnosed or undertreated hyperthyroidism
accumulation of fluid can cause CTS in pregos convulsions in children; no not cause brain injury tachycardia, HTN, arrhythmias (a-fib), high fever,
amyloid fibril deposition causes CTS in systemic risk factors: family Hx of febrile seizures, fever N/V, tremor, altered mentation, lid lag, goiter
amyloidosis (ESRD, chronic hemodialysis) from infection, recent immunization Dx: clinical & thyroid function studies
soft-tissue enlargement due to synovial edema & Dx: age 6 months 6 yrs, 380C (100.40F), no thyroid storm Rx
tendon hyperplasia causes CTS in acromegaly previous of afebrile seizure, no CNS infection; o propranolol (symptom control)
inflammation of tendon & synovial sheaths cause normal neurologic exam o PTU (block new hormone synthesis)
CTS in RA Rx: acetaminophen & reassurance o iodine solution (block hormone release)
---------------------------------------------------------------- no hospitalization for observation or work-up o glucocorticoids ( peripheral conversion)
severe hypovolemic hypernatremia Rx: isotonic prognosis: normal development & intelligence ----------------------------------------------------------------
normal saline or lactated Ringers ---------------------------------------------------------------- epidural hematomas do not cross suture lines
hypernatremia causes weakness, lethargy, irritability, #1 Rx of acute variceal bleeding: vascular access Rx: emergent craniotomy
altered mental status, seizures, muscle cramps & o 2 large bore IV needles or central line ----------------------------------------------------------------
decreased DTRs o prophylactic ABX glucocorticoids cause neutrophilia by mobilizing
---------------------------------------------------------------- #2 Rx: control bleeding with terlipressin marginated neutrophil pool & bone marrow
periodic abdo pain, multiple duodenal ulcers & a (vasopressin analogue), IV octreotide, or release
jejunal ulcer: Zollinger-Ellison syndrome somatostatin (splanchnic vasoconstriction) also eosinophils & lymphocytes
steatorrhea due to pancreatic enzyme inactivation Rx within 12 hrs: endoscopic sclerotherapy or ----------------------------------------------------------------
---------------------------------------------------------------- band ligation for active bleeding dark brown discoloration with lymph follicles
pancreatic enzyme deficiency: chronic pancreatitis o Rx: balloon tamponade is temporary Rx for shining as pale patches on colon biopsy:
reduced bile salt absorption: ileal resection uncontrollable bleeding laxative abuse (factitious diarrhea)
---------------------------------------------------------------- o Rx: TIPS for refractory or recurrent cases o melanosis coli develops within 4 months
hyperventilation decreases CO2 concentration secondary prophylaxis once bleeding controlled: - ----------------------------------------------------------------
promotes vasoconstriction syncope blocker (propranolol) + endoscopic band ligation 1- PLT dysfunction is MCC of abnormal hemostasis
---------------------------------------------------------------- 2 wk later in patients with chronic renal failure
brief psychotic > 1 day, < 1 month; sudden onset, o Rx small, non-bleeding varices o abnormal bleeding & bruising
disorder return to full function o -blocker decreases progression to large varices o due to uremic coagulopathy
Schizophreniform > 1 month, < 6 months; & risk of variceal hemorrhage due to BT is prolonged (normal PT, PTT, PLT count)
functional decline not required unopposed alpha-mediated vasoconstriction & Rx: desmopressin (DDAVP), which increases
Schizophrenia at least 6 months; decreased portal venous flow release of factor VIII:von Willebrand multimers
functional decline required ---------------------------------------------------------------- from endothelial storage sites
Schizoaffective at least 2 week Hx of psychotic hydroxyurea: increases HbF do not transfuse PLTs (quickly become inactive)
symptoms w/o mood symptoms Rx frequent vaso-occlusive crises episodes a/w ----------------------------------------------------------------
delusional 1 delusion, at least > 1 month, sickle cell disease; frequency & severity respiratory quotient (RQ): steady-state ratio of
disorder no other psychotic symptoms, also risk of acute chest syndrome & need for CO2 produced to O2 consumed per unit time
normal functioning otherwise blood transfusions steady state RQ close to 1.0 indicates predominant
----------------------------------------------------------------
oxidation of CHO as fuel source
RQ for lipid (0.7) & protein (0.8) as sole sources o TSH hypothyroidism 5--reductase deficiency: 46, XY
of energy o FSH premature ovarian failure o male gonads
normal full-body steady-state RQ ~ 0.8 if Hx of uterine procedure or infection, may have o female/undermasculinized/ambiguous
assessment of RQ is used when weaning patients scarring of uterine cavity (Asherman syndrome) external genitalia at birth
from mechanical ventilation o hormone therapy to test for ability to grow a o often raised as girl, but male identity
---------------------------------------------------------------- uterine lining o masculinization at puberty; phallus size,
chronic HTN: 140/90 @ < 20 wks gestation or o hysteroscopy to visualize uterine adhesions muscle growth, but lack breasts
persisting beyond 12 wks postpartum ---------------------------------------------------------------- o infertility; risk of cryptorchidism
o Rx: labetalol boobs organs axillary, ----------------------------------------------------------------
gestational HTN & preeclampsia: HTN 20 wks pubic hair Lyme arthritis is the MC late manifestation of
trace urine protein & mild peripheral edema is Complete 46, Yes absent uterus minimal untreated Lyme disease (months/years)
common in normal pregnancy androgen XY & upper or absent migratory arthralgias progress into
o 3+ proteinuria is abnormal insensitivit vagina monoarticular arthritis of the knee; travel history
HTN is MC risk factor for placental abruption y Dx: synovial fluid show inflammatory profile
o other complications: preterm birth, IUGR, Mullerian 46, Yes absent or normal confirm Dx: ELISA & Western blot
oligohydramnios, superimposed preeclampsia agenesis XX rudimentary Rx: doxycycline or amoxicillin
---------------------------------------------------------------- uterus & DDx: reactive arthritis (1 4 wks after urethritis
risk factors for placental abruption: HTN, DM, upper vagina or diarrheal infection), acute osteomyelitis, gout
prior placental abruption, cocaine use, smoking Transverse 46, Yes abnormal normal ----------------------------------------------------------------
risk factors for placenta previa: prior c-section, vaginal XX vagina, 17-hydroxyprogesterone = nonclassic CAH
multiparity, multiple gestation, adv maternal age septum normal uterus
due to 21-hydroxylase deficiency
---------------------------------------------------------------- Turners 45, streak ovaries normal hyperandrogenism in late childhood
10 amenorrhea: absence of menses by age 15, X normal uterus
male pattern hair distribution, severe acne
normal growth & secondary sexual character ----------------------------------------------------------------
non-classical CAH presents similar to PCOS
o can be normal up to age 16 Androgen insensitivity syndrome (46, XY)
end-organ resistance to androgens ----------------------------------------------------------------
o MCC is Turners DDx of stridor: croup, foreign body aspiration,
testicular descent is an androgen-dependent process
Evaluation of primary amenorrhea epiglottitis, laryngomalacia, vascular rings,
initial test: pelvic exam & pelvic USS cryptorchid testes secretes testosterone which is
retropharyngeal abscess
uterus absent karyotype & serum testosterone aromatized to estrogen breast development laryngomalacia is MCC of chronic stridor
o 46,XX & normal female testosterone = external female genitalia
----------------------------------------------------------------
abnormal Mullerian development no axillary or pubic hair high-grade fever, sore throat with odynophagia,
o 46,XY & normal male testosterone = primary amenorrhea; no uterus or upper vagina muffled voice, drooling, stridor: epiglottitis
androgen insensitivity syndrome due to anti-Mullerian hormone from testes tripoding with inspiratory stridor
uterus present serum FSH o Wolffian ducts degenerate neck hyperextension provides relief
FSH (peripheral) karyotype cryptorchid gonads risk of dysgerminoma or MCC in adults: Hib & Strep pyogenes
(hypergonadotropic amenorrhea) gonadoblastoma after puberty o especially unvaccinated immigrants
FSH (central) pituitary MRI Rx: gonadectomy after puberty + estrogen
CXR: enlarged epiglottis thumbprint
(hypogonadotropic amenorrhea) ----------------------------------------------------------------
Dx: clinical, high suspicion
---------------------------------------------------------------- Mullerian agenesis (Mayer-Rokitansky-Kuster-
Rx: emergency intubation in the OR
secondary amenorrhea: absence of menses 6 Hauser syndrome): hypoplastic/absent mullerian
ductal system; normal ovaries DDx: peritonsilar abscess (uvular deviation),
months in those who menstruated previously angioedema, vascular ring, croup, foreign body
initial test: -hCG for pregnancy genotypic & phenotypic female
no menstruation due to absent/underdeveloped ----------------------------------------------------------------
next: prolactin, TSH, FSH inspiratory stridor that worsens when supine &
o prolactin brain MRI uterus, cervix, & upper 2/3 vagina
---------------------------------------------------------------- with crying or feeding: laryngomalacia
laxity of supraglottic structures N/V, myalgias, arthralgias, diarrhea, rhinorrhea, Complete abortion
peaks @ age 4 8 months lacrimation, cramps: opioid withdrawal whole conceptus expelled before 20 wks gestation
increased risk for GERD mydriasis, piloerection, hyperactive bowel sounds solid white mass covered with blood
Dx: flexible laryngoscopy, shows collapse of within 6 12 hr, peaks @ 24 48 hr abdo pain & contractions subsides
supraglottic structures on inspiration; omega sign Rx: methadone -hCG still positive; undetectable after 4 -6 wks
Rx: reassurance; self-limited by age 18 months; ---------------------------------------------------------------- risk factors: smoking, advanced maternal age,
PPI for GERD symptoms; supraglottoplasty for Streptokinase is a fibrinolytic for STEMI only previous spontaneous abortion
severe symptoms (cyanosis, apnea) Cilostazol: anticoagulant for chronic claudication,
DDx: vocal cord paralysis not acute limb ischemia Management of spontaneous abortion
---------------------------------------------------------------- ---------------------------------------------------------------- Threatene expectant management until
biphasic stridor, difficult feeds: vascular rings GnRH stimulation test: precocious puberty d symptom resolution OR progression to
screening: barium swallow ---------------------------------------------------------------- inevitable, incomplete, or missed
Dx: MRI with angiography anovulation & amenorrhea in lactating mothers abortion
---------------------------------------------------------------- is due to prolactin, which suppresses GnRH, Missed, hemodynamically unstable, heavy bleed:
fever, drooling, dysphagia, neck pain, stridor: thus LH/FSH Inevitable, surgical evacuation (D&C)
retropharyngeal abscess o not a reliable method of birth control Incomplet hemodynamically stable, mild bleeding:
high risk of infection into posterior mediastinum ---------------------------------------------------------------- e expectant O/P management, misoprostol,
acute necrotizing mediastinitis human placental lactogen (hPL): insulin antagonist or surgical evacuation
Dx: neck CT scan causes maternal lipolysis & insulin resistance, thus Septic blood & endometrial cultures,
---------------------------------------------------------------- delivery of fatty acids & glucose to the fetus broad-spectrum ABX,
headache, palpable B/L abdominal masses, ---------------------------------------------------------------- surgical evacuation (D&C)
microhematuria, +family Hx: ADPKD significant blood loss from MVA, receives Ectopic MTX
hepatic cysts are the MC extrarenal manifestation several units of pRBCs (inhibits actively proliferating fetal cells)
whole blood is mixed with citrate coagulant ----------------------------------------------------------------
intracranial berry aneurysms also common;
pRBCs derived from whole blood contains citrate IV oxytocin: augment labor, Rx postpartum
MVP or aortic regurgitation, colonic diverticula,
infused citrate chelates Ca++ & Mg++, thus hemorrhage, expel a retained fetus or POC
abdominal wall & inguinal hernia
----------------------------------------------------------------
---------------------------------------------------------------- reducing serum levels paresthesia 2/2 hypoCa++
progesterone: prevention of preterm labor of a
distortion: altered perception of disturbing aspects Rx: Ca++ gluconate
singleton pregnancy in patients with a Hx of
of external reality to make it more acceptable ----------------------------------------------------------------
spontaneous preterm delivery
displacement: shifting of emotions a/w an spontaneous abortion: < 20 wks gestation
----------------------------------------------------------------
upsetting object/person to a safer alternate advanced maternal age is a significant risk factor Congenital diaphragmatic hernia
object/person that represents the original absent fetal movement on USS is the most pulmonary hypoplasia, pulmonary HTN,
acting out: directly expressing an unconscious significant indicator of fetal loss polyhydramnios from esophageal compression,
wish or impulse to avoid addressing the
right heart deviation, gasless abdomen
accompanying emotion (temper tantrum) Types of miscarriages worsened with positive-pressure ventilation as
introjection: assimilating of another persons bleeding cervix products of air into GIT compresses the lungs
attitude into ones own perspective conception Rx: intubation, then gastric tube to prevent
suppression: intentionally postponing Threatened yes closed +fetal heart tones bowel distension against the lungs
exploration of anxiety-provoking thought by Missed none closed no cardiac activity, ----------------------------------------------------------------
substituting other thoughts or empty sac pulmonary cavitation in HIV patients DDX: TB,
denial: failure to accept a disturbing aspect of Inevitable yes dilated no cardiac activity, atypical mycobacteria, Nocardia, G-negative rods,
external reality collapsed sac anaerobes
dissociation: blocking disturbing thoughts/feelings Incomplete yes dilated partial expulsion Nocardia: aerobic, G-positive, weakly acid-fast,
from consciousness to avoid emotional upset Complete maybe closed conceptus expelled beaded, branching, filamentous rod
----------------------------------------------------------------
o CXR: pulmonary nodules # needed to treat (NNT): # that need to receive normally, newborns have enlarged RV appears as
o Rx: TMP-SMX treatment to prevent 1 additional adverse event right-axis deviation & R waves in V1 V3 on
---------------------------------------------------------------- NNT = 1/ARR (absolute risk reduction) EKG since blood is shunted away from the lungs
persistent culture-negative monoarthritis that ---------------------------------------------------------------- by the PDA in utero
fails to respond to ABX: TB arthritis ankylosing spondylitis patients can develop newborn with left-axis deviation & small/absent
---------------------------------------------------------------- restrictive lung disease due to diminished chest R-waves in precordial leads: tricuspid valve
pain, pulselessness, paresthesia, poikilothermia wall & spinal mobility atresia due to a hypoplastic RV
(coldness), pallor (5 Ps): acute limb ischemia PFT show a mild restrictive pattern o cyanotic congenital defect
sudden-onset severe pain (reduced VC & TLC, but normal FEV1/FVC) o ASD & VSD are necessary for survival
numbness due to nerve ischemia (not compression) FRC & RV due to fixation of the rib cage in an CXR: pulmonary markings
Dx: angiography inspiratory position Rx: surgical repair
Rx: IV heparin immediately ---------------------------------------------------------------- ----------------------------------------------------------------
definitive Rx: intra-arterial thrombolysis or obstructive lung disease complete AV canal defect
surgical embolectomy o FEV1 (< 80%) & FEV1/FVC (< 70%) o a/w Down syndrome
DDx: thrombosis (insidious), arterial vasculitis restrictive lung disease o CXR: pulmonary markings, cardiomegaly
---------------------------------------------------------------- o FEV1 (< 80%) & FEV1/FVC (> 70%) Ebsteins anomaly
patients with acute renal failure, liver failure, or ---------------------------------------------------------------- o a/w lithium use during pregnancy
sepsis (community-acquired pneumonia) should pupil dilation, rhinorrhea, myalgia & arthralgia, o droopy tricuspid valve RA enlargement &
discontinue metformin until renal function returns cramps & spasms, nausea, diarrhea, lacrimation, tricuspid regurgitation
risk of lactic acidosis HTN, diaphoresis: heroin withdrawal o EKG: tall P wave, right-axis deviation
---------------------------------------------------------------- o resolves within 24 hrs; not life-threatening Total anomalous pulmonary venous return
ACE-I/ARB can temporarily worsen renal function ---------------------------------------------------------------- o pulmonary veins fail to make normal
& hypotension, thus should not be started in the Alcohol withdrawal connections to left atrium
setting of acute kidney injury acute phase (12 48 hr): sweating, o right atrium receives blood from pulmonary
---------------------------------------------------------------- hyperreflexia, insomnia, seizures, then acute & systemic circulation
bedwetting is normal before age 5 yrs hallucinosis in absence of autonomic symptoms o RA & RV enlargement
interventions including enuresis alarms & final phase (2 4 days): delirium tremens, HTN, ----------------------------------------------------------------
desmopressin should not begin before age 5 fever, agitation, tachycardia, hyperthermia hyperkalemia-inducing medications:
---------------------------------------------------------------- Rx: chlordiazepoxide (long-acting benzo) nonselective -blockers, ACE-I/ARBs, NSAIDs,
status epilepticus (any single seizure > 5 min) ---------------------------------------------------------------- K+ sparing diuretics (amiloride)
risk of permanent injury due to excitatory nicotine withdrawal: irritability, anxiety, ----------------------------------------------------------------
cytotoxicity insomnia, depression, poor concentration, E. histolytica: bloody diarrhea, trophozoites on
cortical necrosis is hallmark increased appetite, weight gain, bradycardia stool exam; flask-shaped colonic ulcers
may cause intracranial pressure ---------------------------------------------------------------- ----------------------------------------------------------------
---------------------------------------------------------------- 3 treatment options for Graves fatigue, dyspnea, abdo pain, dark urine,
chi-square test: compares two proportions o radioactive iodine (RAI) hypercoagulable state (portal vein thrombosis):
o if the difference between observed vs expected o antithyroid drugs (PTU, methimazole) paroxysmal nocturnal hemoglobinuria (PNH)
values is large, assumes an association is o thyroidectomy LDH, haptoglobin, hemoglobinuria,
present RAI is preferred, hypothyroid within 2 6 months hemolytic anemia, pancytopenia
two sample z-test/t-test: compares two means RAI is a/w worsening of Graves ophthalmopathy Dx: flow cytometry absence of CD55 & CD59 on
o t-test: uses sample variance due to destroyed thyroid cells RBC surfaces, which normally inhibits activation of
o z-test: uses population variance Rx: prophylactic glucocorticoids or antithyroidal complement on RBCs
o both are used to obtain the p-value to deplete existing stores prior to RAI o absence of CD55 causes hemolytic anemia
ANOVA: compares means of 3 or more variables C/I to RAI: severe ophthalmopathy & pregos induced by the complement system
---------------------------------------------------------------- ---------------------------------------------------------------- Rx: eculizumab (inhibits complement activation)
DDx: acute intermittent porphyria, aplastic anemia, o noninvasive positive pressure ventilation chronic diarrhea, malabsorption, Hx of living in
G6PD deficiency, hereditary spherocytosis (NPPV) for moderate/severe exacerbations endemic areas 1 month: tropical sprue
---------------------------------------------------------------- o tracheal intubation (no improvement after glossitis, cheilosis, protuberant abdomen, pallor,
ectopic ACTH production is commonly a/w 2 hr trial of NPPV or NPPV is C/I) pedal edema, fatty diarrhea, fatigue, weight loss
small cell lung cancer & carcinoid NPPV is a/w decreased mortality, rate of intubation, hyperactive bowel sounds (boborygmi)
rapidly growing malignant tumors cause HTN, hospital stay, & incidence of nosocomial infections Dx: biopsy: blunting of villi with infiltration of
hypokalemia, metabolic alkalosis, hyperpigmentation maintenance Rx: salmeterol (long-acting 2 agonist) chronic inflammatory cells (lymphocytes,
without other features of Cushings (moon facies, inhaled corticosteroids are indicated in long-term eosinophils, plasma cells)
dorsal hump, central obesity, striae) Rx of asthma, not COPD ----------------------------------------------------------------
o benign/slow-growing tumors cause more ---------------------------------------------------------------- hypotension is a common side effect of
characteristic features of Cushing syndrome acetylcysteine: mucolytic (Rx cystic fibrosis) epidural anesthesia due to blood redistribution
high levels of cortisol from ectopic ACTH can ---------------------------------------------------------------- to lower extremities & venous pooling from
saturate 11-beta hydroxyl dehydrogenase & bind phenelzine: MAOI; Rx refractory depression sympathetic blockade
to mineralocorticoid receptors directly to cause MAOIs are a/w dietary restriction, foods high in prevented by aggressive IV fluids prior to
HTN & hypokalemia tyramine (aged meats, cheese, wine) epidural placement
--------------------------------------------------------------- o a/w hypertensive crisis Rx: left decubitus position to improve venous
uncomplicated cases of acute epigastric pain with ---------------------------------------------------------------- return, or vasopressors
amylase or lipase ( 3x normal) do not need anemia, painless GI bleed, aortic stenosis murmur: ----------------------------------------------------------------
imaging for diagnosing acute pancreatitis angiodysplasia (AVM) of GIT episodes of dysphagia, regurgitation, &/or chest
risk factors: alcohol, gallstones, hyperTGemia MC @ age > 60 pain radiating to the back, precipitated by
Dx: abdominal CT with contrast for patients MC discovered with underlying aortic stenosis or emotional stress: diffuse esophageal spasm
with unclear diagnosis or failing to improve with ESRD (uremic PLT dysfunction) resolution of chest pain with nitroglycerin
conservative Rx angiodysplasia: dilated, distended, thin-walled Dx: esophageal manometry shows repetitive,
---------------------------------------------------------------- vessels lined by endothelium, prone to recurrent & non- peristaltic, high amplitude contractions
hypochromic/microcytic anemia, depressed iron chronic painless bleeding ----------------------------------------------------------------
& ferritin levels: iron deficiency anemia Dx: colonoscopy or endoscopy acute otitis media
MCC: chronic blood loss ---------------------------------------------------------------- MCC: Strep pneumo, H. influenza, Moraxella
initial management: test for blood in stool homocysteine levels predisposes to venous MC age 6 36 months
DDx: right-sided colon cancer, PUD, diverticula, thrombosis & atherosclerosis otalgia, middle ear effusion + acute inflammation
angiodysplasia thus, patients with DVT in the setting of elevated (bulging, fever, erythema)
---------------------------------------------------------------- homocysteine requires supplementation with Rx: empiric amoxicillin; or augmentin
acute respiratory distress, hypoxemia, smoking Hx: pyridoxine (B6) & folate Rx: myringotomy with tympanostomy tube
acute exacerbation of COPD ---------------------------------------------------------------- placement for recurrent episodes
COPD management statins inhibit intracellular HMG-CoA reductase, complications: conductive hearing loss, mastoiditis,
o supplemental O2 (target: 88 92%) prevent conversion of HMG-CoA to mevalonic acid, meningitis
o inhaled bronchodilators & LDH receptors to remove circulating LDH ----------------------------------------------------------------
albuterol (beta-2-agonist) A/E: statin-induced myopathy ( CPK) DDx of menorrhagia
ipratropium (short-acting anti-muscarinic) ---------------------------------------------------------------- endometriosis chronic pelvic pain, endometrioma,
o systemic glucocorticoids osteophytes are MC finding in cervical spondylosis pain peaks 1-2 days before menses,
oral prednisone (mild/moderate) o also narrowing of disk spaces & dyspareunia, infertility,
IV methylprednisolone (severe) hypertrophic vertebral bodies endometrial glands outside uterus
o ABX if 1 cardinal symptom Hx of chronic neck pain, limited neck rotation & fibroids heavy menses with clots,
( dyspnea, cough, sputum) lateral bending firm, irregular, enlarged uterus,
azithromycin, levofloxacin, or augmentin ---------------------------------------------------------------- constipation & urinary frequency
due to extrinsic compression
adenomyosis dysmenorrhea, menorrhagia, B/L retinal hemorrhages: suspect child abuse ----------------------------------------------------------------
chronic pelvic pain, repetitive acceleration-deceleration forces cause estrogen-induced cholesterol secretion results in
bulky, globular, tender uterus shearing of subdural veins cholesterol gallstones during pregnancy & on OCPs
endometrial Hx chronic anovulation, obesity, seizures, head circumference, bulging/tense progesterone contributes by reducing bile acid
hyperplasia/c nulliparity (estrogen excess), anterior fontanelle, altered mental status secretion & slows GB emptying
a irregular, intermenstrual, Dx: non-contrast head CT & skeletal survey ----------------------------------------------------------------
postmenopausal bleeding, ---------------------------------------------------------------- ADHD is a clinical diagnosis
small, nontender uterus Phenylketonuria Hx of core inattention & hyperactive/impulsive
endometritis recent procedure of the uterus AR mutation of phenylalanine hydroxylase for symptoms for 6 months & prior to age 7
(instrumentation, IUD, abortion), conversion of phenylalanine to tyrosine functional impairment in at least 2 settings
PROM, prolonged labor, o phenylalanine is neurotoxic Rx: methylphenidate (A/E: loss of appetite,
foul-smelling discharge, severe intellectual disability, musty body odor, weight loss, nausea, insomnia, nervousness)
fever, tender uterus seizures, fair complexion (skin, hair, eyes) ----------------------------------------------------------------
Dx: tandem mass spectrometry (newborn sickle cell trait have no specific clinical symptoms
adenomyosis: endometrial glands invade the & no change in life expectancy
screening); quantitative amino acid analysis
uterine myometrium, results in blood deposition (late presentations) renal complications: painless hematuria, UTI,
between smooth muscle fibers Rx: dietary restriction of phenylalanine renal medullary cancer, hyposthenuria
o risk factors: multiparous, age > 40 MCC of hematuria is papillary necrosis due to
----------------------------------------------------------------
o Dx: surgical pathology after hysterectomy aldolase B deficiency: fructose intolerance low pO2 in the vasa rectae
fibroids: benign, smooth muscle tumor arising accumulation of fructose-1-phosphate U/A: normal-appearing, intact RBCs
from myometrium; does not cause intermenstrual vomiting, poor feeding, lethargy, seizures DDx: acute cystitis, acute glomerulonephritis,
or postmenopausal bleeding AIN, ATN
Rx: restrict fructose from diet (fruits, veggies)
o Dx: pelvic USS ----------------------------------------------------------------
----------------------------------------------------------------
---------------------------------------------------------------- dysuria, urinary frequency, WBCs on U/A,
jaundice, hepatomegaly, failure to thrive after
all women age > 45 with irregular bleeding positive nitrite & LE: acute cystitis
first few days after consumption of breast milk
require endometrial biopsy o MCC: Staph saprophyticus
or regular formula: galactosemia
---------------------------------------------------------------- hematuria, HTN, proteinuria, dysmorphic RBCs,
absent galactose-1-phosphate uridyl transferase
side effects of depot medroxyprogesterone acetate
G-1-P accumulates in liver, brain, kidney, leads RBC casts: acute glomerulonephritis
(DPMA) can overlap with pregnancy symptoms medication use, rash, eosinophilia, serum Cr,
to cirrhosis, mental retardation, Fanconis
o weight gain, nausea, breast tenderness
Rx: breastfeeding is C/I WBC casts: acute interstitial nephritis
o Rx: offer alternative contraception method cola-colored urine, hematuria, elevated creatinine,
----------------------------------------------------------------
initial test: exclude pregnancy granular casts, renal tubular epithelial cells: ATN
acute onset dyspnea, tachypnea, normal lung exam,
DPMA suppresses ovulation, given every 3 months ----------------------------------------------------------------
right-axis deviation on EKG: PE
causes menstrual irregularities in the 1st 6 months Dx: CT angiography (test of choice) delayed sleep phase syndrome: inability to fall
amenorrhea after 1 yr of use contrast allergic or renal insufficient Dx: V/Q scan asleep at normal hours (10 pm midnight)
---------------------------------------------------------------- o large perfusion defect without ventilation defect advanced sleep phase disorder: inability to stay
otitis media with effusion: middle ear effusion awake in the evening (after 7 pm)
----------------------------------------------------------------
without acute inflammation chronic TPN or fasting causes gallbladder stasis, ----------------------------------------------------------------
otitis externa: erythematous & swollen external dominant frontal lobe lesion: expressive
predisposes to gallstones & bile sludging, leading
auditory canal, ear discharge, hearing loss, & to cholecystitis (Brocas) aphasia, C/L hemiparesis, C/L apraxia
pain with tragal traction o due to absence of stimulus for CCK release conjugate gaze deviation TOWARD the lesion
chronic suppurative otitis media: hearing loss, ----------------------------------------------------------------
& GB contraction
otorrhea > 6 wks, lack of fever & ear pain, small bowel resection & ileal Crohns contributes dominant parietal lobe lesion: C/L sensory loss,
tympanic membrane perforation C/L inferior homonymous quadrantanopsia
to gallstones, due to enterohepatic circulation
---------------------------------------------------------------- (superior optic radiations)
of bile acids
---------------------------------------------------------------- CSF: elevated proteins, normal WBCs Horners occurs due to tumor invasion of
dominant temporal lobe lesion: receptive & ---------------------------------------------------------------- paravertebral sympathetic chain or inferior
conductive aphasia, C/L superior homonymous S. epidermidis is a common cause of prosthetic cervical ganglion
quadrantanopsia (Meyers loop) valve endocarditis Dx: CXR initially, chest CT for staging
intact expressive speech, motor, primary sensory Enterococcal endocarditis affects older men after ----------------------------------------------------------------
---------------------------------------------------------------- GU manipulation or women after OB procedures dilated pupils, blood-crusted nose: cocaine abuse
hepatojugular reflux can differentiate between ---------------------------------------------------------------- o Rx: CCB & alpha blocker (phentolamine)
cardiac vs. liver disease-related cause of LE edema transient spike in Cr within 24 hr; returns to baseline severe cocaine-induced vasospasm can cause
+ test: due to heart failure (reflects a failing RV) 5 7 days: contrast-induced nephropathy cocaine-induced STEMI
o constrictive pericarditis, RV infarction, Rx: non-ionic contrast, pre-CT IV hydration & o Rx: PTCA or thrombolysis
restrictive cardiomyopathy acetylcysteine avoid -blockers, due to unopposed alpha activity
- test: due to hepatic disease/cirrhosis prednisone minimizes hypersensitivity reactions avoid fibrinolytics due to ICH risk
o increase in venous return below the liver to contrast media & dye allergies avoid thrombolytics for suspected aortic dissection
---------------------------------------------------------------- withhold NSAIDS; causes renal vasoconstriction
subtle memory loss, language difficulties, ---------------------------------------------------------------- Acute cocaine intoxication
apraxia, followed by impaired judgement & painless hematochezia in a toddler: Meckels features tachycardia, HTN, dilated pupils,
personality changes: Alzheimers due to incomplete obliteration of vitelline duct atrophic nasal mucosa,
o CT scan: diffuse cortical atrophy, especially ectopic gastric tissue causes mucosal ulceration chest pain (coronary vasoconstriction)
temporal & parietal lobes, hippocampus; severe anemia or hemorrhagic shock psychomotor agitation, seizures
used to exclude other causes, not diagnostic Dx: technicium-99m pertechnitate scan complications o acute myocardial ischemia
euphoria, disinhibition, apathy, compulsive complications: intussusception, obstruction o aortic dissection
behavior, hyerorality, impaired memory: Picks ---------------------------------------------------------------- o intracranial hemorrhage
o visuospatial function intact pruritic lesions on flexor wrist, web spaces, elbows, management supplemental O2,
fluctuating cognitive impairment, Parkinsonism, &/or penis with short, linear burrows: scabies IV benzodiazepine (BP & anxiety),
visual hallucinations: Lewy body excoriations with small, crusted, red papules ASA (prevent thrombus formation),
o worsening of features with neuroleptics contagious by direct person-to-person contact nitro & CCB (prevent vasoconstrictn)
sudden deterioration of cognitive, motor, sensory delayed Type IV hypersensitivity reaction cocaine enhances thrombus formation by
function with each attack: multi-infarct dementia Dx: skin scrapings under light microscopy promoting PLT activation & aggregation
o MRI: multiple hypodense areas, periventricular Rx: topical permethrin or oral ivermectin ----------------------------------------------------------------
---------------------------------------------------------------- Rx: sheets & clothing cleaned or in plastic bag IVDA are at risk for tricuspid valve endocarditis
anterior horn cells impaired: ALS, for 3 days (mites cannot live without humans) with pulmonary septic emboli
poliomyelitis, spinal muscular atrophy DDx: eczema, tinea, seborrheic dermatitis MCC: S. aureus
peripheral nerves impaired: Guillain-Barre, ---------------------------------------------------------------- cough, chest pain, & hemoptysis
diabetic neuropathy stroke is a complication of sickle cell disease CXR: scattered, round alveolar infiltrates;
muscle fibers impaired: muscular dystrophy, 2/2 sludging & occlusion in cerebral vasculature peripheral cavitary lesions
polymyositis, dermatomyositis, hypothyroidism Rx: exchange transfusion, continue hydroxyurea Rx: vancomycin (native valve) covers MRSA
neuromuscular junction impaired: botulism ----------------------------------------------------------------
o fibrinolytics, heparin, & warfarin are not
(descending flaccid paralysis), Myasthenia Gravis, pruritic, elevated, serpiginous skin lesions, through
useful; not a true thrombus
Lambert-Eaton, organophosphate poisoning contact with sand: cutaneous larva migrans
----------------------------------------------------------------
---------------------------------------------------------------- o helminthic disease by dog/cat hookworm
I/L shoulder pain, Horners (I/L ptosis, miosis,
acute ascending polyneuropathy after a recent ----------------------------------------------------------------
anhidrosis), supraclavicular node enlargement,
URI or GI infection: Guillain-Barre Vit B12 deficiency: subacute degeneration of
weakness/atrophy of hand muscles,
demyelination of peripheral motor nerves dorsal & lateral spinal columns
pain/paresthesia in the arm: Pancoast tumor
ascending weakness, then flaccid paralysis with MCC non-small cell lung cancer ataxia, B/L paresthesias, loss of vibration/position,
absent DTRs & autonomic symptoms memory deficits, irritability
---------------------------------------------------------------- o RR = 1.0: null value; no association; leakage of protein-rich fluid into alveolar
Legionella: MC in immunosuppressed receiving outcome occurs with equal frequency interstitial spaces forms hyaline membranes
corticosteroids o RR > 1.0: exposure is a/w risk of disease o impaired gas exchange
o fever with bradycardia, cavitary lesions, o RR <1.0: exposure is a/w risk of disease o lung compliance
watery diarrhea confidence intervals & p-values are interrelated, o pulmonary HTN
S. epidermidis: a/w infection of prosthetic valves, expresses statistical significance (p < 0.05) ARDS causes shunting increased A-a gradient
intravascular shunts, & prosthetic joints o confidence interval must not contain null value ARDS is a/w hypoxemia (PaO2/FiO2 300) &
o uncommon cause of native valve endocarditis wider CI corresponds to smaller sample size B/L alveolar opacities
---------------------------------------------------------------- larger sample narrows CI power o mild: 200 300 mmHg
premenstrual syndrome (PMS) begins 1 2 wks 95% confidence 99% confidence o moderate: 100 200 mmHg
prior to menses & regress around menstrual flow interval interval o severe: < 100 mmHg
symptoms occur repeatedly & predictably null value is p < 0.05 p < 0.01 MCC: sepsis, pneumonia, pulmonary contusion,
confirm Dx: menstrual symptom diary outside CI fractures, transfusions, pancreatitis
Rx: SSRI, caffeine reduction null value is p 0.05 p 0.01 ARDS can be due to acute pancreatitis
---------------------------------------------------------------- inside CI o pancreatic enzymes leak across pulmonary
DDx of hematochezia in a toddler: Meckels, ---------------------------------------------------------------- capillaries & damage surfactant; inflammation
infectious colitis, intussusception, hemorrhoids, fever, nonproductive cough, tachypnea, dyspnea, leads to breakdown of endothelial barrier,
milk protein allergy, inflammatory bowel disease pleuritic chest pain: acute eosinophilic pneumonia recruits inflammatory cytokines, results in
---------------------------------------------------------------- CXR: diffuse reticular or ground glass opacities diffuse alveolar damage
bloody, mucousy, loose stools or severe constipation: a/w pulmonary edema & pleural effusions Dx of exclusion: exclude hydrostatic pulmonary
milk protein allergy causes painless rectal bleed ---------------------------------------------------------------- edema in patients w/o ARD risk factors
exclusive to infants, resolves by age 1 yr pain relief is the prime objective in management ----------------------------------------------------------------
Rx: elimination of milk/soy from maternal diet if of rib fractures, to allow proper ventilation, & hepatic encephalopathy (HE): CNS complication
breastfed; hydrolyzed formula if formula-fed prevent atelectasis & pneumonia of cirrhosis; inability to convert ammonia to urea
---------------------------------------------------------------- Rx: opiates &/or NSAIDs precipitated by medications, hypovolemia,
5-HT antagonists (ondansetron) to Rx/prevent intercostal nerve block provides relief without infection, excess nitrogen load (GI bleed),
chemotherapy-induced N/V affecting respiratory function electrolyte disturbances (hypokalemia)
o add corticosteroids for better prophylaxis ---------------------------------------------------------------- hypokalemia increases renal ammonia production
---------------------------------------------------------------- mild metatarsus adductus: feet that overcorrect metabolic alkalosis stimulates conversion of
scopolamine: anticholinergic to Rx vomiting & passively & actively into abduction (Type I) ammonium (NH4+) to ammonia (NH3) (cross BBB)
reduce motion sickness o spontaneously corrects; no Rx needed hyperactive DTRs, +Babinski, nystagmus
---------------------------------------------------------------- Type II: feet that overcorrect into neutral position initially: diurnal sleep disturbances (insomnia,
IV erythromycin is a motilin receptor agonist o Rx: orthosis or corrective shoes hypersomnia) anorexia, cognitive deficits, mental
o Rx nausea 2/2 gastroparesis; prokinetic Type III: rigid feet that do not correct status change, & neuromuscular (asterixis)
metoclopramide: DA Rc antagonist o Rx: serial casts Rx precipitating causes (IVF, electrolytes)
o prokinetic & anti-emetic ---------------------------------------------------------------- Rx: oral lactulose (lowers serum ammonia into
o peristalsis, gastric contractions, relaxation fever, confusion, focal neurologic deficits, seizures, non-absorbable ammonium)
of pyloric sphincter lymphocytic pleocytosis: HSV encephalitis Rx: Rifaximin ( # of ammonia-producing
o Rx: diabetic gastroparesis & N/V Rx: IV acyclovir colonic bacteria), laxatives (catharsis)
o A/E: EPS, NMS ---------------------------------------------------------------- furosemide improves ascites, but not HE
---------------------------------------------------------------- pulmonary hemorrhage is a manifestation of ----------------------------------------------------------------
relative risk (RR): probability of an outcome of Goodpastures or Wegeners; nephritic syndromes confusion, gait ataxia, nystagmus: Wernickes
interest occurring in the exposed group compared ---------------------------------------------------------------- ----------------------------------------------------------------
to the non-exposed group; a/w cohort studies ARDS: diffuse injury to the pulmonary capillary
endothelium & alveolar epithelium, results in
indications for electroconvulsive therapy (ECT): ---------------------------------------------------------------- Dx: bone marrow sampling ringed sideroblasts
severe depression, depression in pregnancy, NMS, distended neck veins: PTX or cardiac tamponade Rx: Vit B6 supplementation
refractory mania, catatonic schizophrenia collapsed neck veins: hemothorax, hypovolemia ----------------------------------------------------------------
MC A/E: amnesia (anterograde & retrograde) ---------------------------------------------------------------- INH causes idiosyncratic liver injury
---------------------------------------------------------------- PPD Patients to treat (positive PPD) not dose dependent; variable latent period
MC complication seen post-thyroidectomy: 5 mm HIV-positive LFTs & liver Bx presents similar to viral hepatitis
hypocalcemia recent contact with TB liver Bx: panlobular mononuclear infiltration &
o non-specific: fatigue, anxiety, depression previously healed TB on CXR hepatocyte necrosis
o severe: tetany, seizures, QT prolongation organ transplant recipients ----------------------------------------------------------------
---------------------------------------------------------------- immunosuppressed patients severe isoniazid hepatitis presents clinically
Nephrotic syndrome 10 mm recent TB-endemic immigrants (< 5 yrs) similar to viral hepatitis; discontinue INH
o 3+ proteinuria IVDA mild INH hepatotoxicity with mild elevations
o hypoalbuminemia residents/employees in high-risk settings of aminotransferases has excellent prognosis;
o edema (prisons, nursing homes, shelters) hepatic injury is self-limited, continue INH with
o hyperlipidemia high risk for reactivation TB (diabetes, regular F/U of LFTs
hypercoagulability is a common manifestation, as ESRD, chronic malabsorption) pyridoxine does not prevent INH-induced hepatitis
age < 4 yrs or exposed to high-risk adults ----------------------------------------------------------------
venous or arterial thrombosis
renal vein thrombosis is most common, 15 mm all of the above & healthy individuals Kleihauer-Betke test: measures the amount of
especially in membranous glomerulopathy fetal Hb transferred to the maternal bloodstream
active TB Rx: INH, rifampin, ethambutol, performed in Rh-negative prego with Rh-positive
----------------------------------------------------------------
Placental abruption pyrazinamide (8 wks) fetus to determine dosage of Rh Ig to prevent Rh
o then INH + rifampin (4 months) sensitization
risk maternal HTN, pre-eclampsia/eclampsia,
factors abdominal trauma, prior placental abruption also differentiates maternal vs. fetal blood during
cocaine use or tobacco use Treatment options for latent TB infection vaginal bleeding
feature acute onset vaginal bleeding, o INH & rifapentine weekly: 3 months ----------------------------------------------------------------
s hyperactive, hypertonic & tender uterus, (direct observation therapy) Dumping syndrome: postgastrectomy complication
high-frequency, low-intensity contractions, o INH monotherapy: 9 months rapid emptying of hypertonic gastric content into
constant abdominal pain, late decelerations o INH (6 months) & Rifampin (4 months) the duodenum & small intestine releases
Dx clinical presentation primarily; o INH & rifampin: 4 months vasoactive polypeptides
USS used only to r/o placenta previa Rx: dietary modification of small, frequent meals
Rx unstable maternal VS or non-reassuring pyridoxine is added for those taking INH & Rx: octreotide for resistant cases
fetal tracing: emergency c-section presence of diabetes, uremia, alcoholism, ----------------------------------------------------------------
stable maternal VS, reassuring fetus, 34 malnutrition, HIV, pregnancy, or epilepsy acute bacterial rhinosinusitis
wks gestation: trial of vaginal delivery o does not prevent INH-induced hepatitis o persistent symptoms 10 days
complication: DIC rifampin A/E: benign red/orange discoloration o severe symptoms: 39C (1020F), purulent
of body fluids; normal U/A nasal discharge, face pain 3 days
vaginal bleeding in 80%, but lack of bleeding does ---------------------------------------------------------------- o worsening symptoms 5 days after initial
not exclude the Dx INH can cause peripheral neuropathy, hepatitis, improving viral URI
Rx: 2 large-bore IV lines & urethral catheter & sideroblastic anemia viral URI is MC predisposing factor
---------------------------------------------------------------- o INH is a pyridoxine antagonist, which MMC are Strep pneumo & H. influenza
undescended testicles by age 6 months are impairs early protoporphyrin synthesis Rx: oral augmentin for uncomplicated cases
unlikely to descend spontaneously causes microcytic, hypochromic anemia
adjunct Rx: intranasal corticosteroids for Hx of
Rx: orchiopexy before age 1 yr simulating iron-deficiency anemia
allergic rhinitis
early surgery improves fertility, but sperm count dimorphic RBCs: hypochromic, normochromic
Dx: CT scan of sinuses for complications
& quality remain substandard serum iron, TIBC
o sinus XR are not useful delirium tremens at 2 4 days; altered sensorium ----------------------------------------------------------------
Rx: sinus aspiration for persistent symptoms & autonomic instability returning from a developing country with
after 3 days of ABX Rx: lorazepam, diazepam, or chlordiazepoxide chronic symptoms of malabsorption: giardiasis
---------------------------------------------------------------- o IV lorazepam for liver diseased trophozoites adhere to mucosal surfaces by
chronic sinusitis (> 12 wks): S. aureus o phenobarbital (anti-convulsant) can be adhesive disks, producing malabsorption
---------------------------------------------------------------- adjunct in refractory cases Rx: empiric metronidazole
Jarisch-Herxheimer reaction: a/w syphilis Rx ---------------------------------------------------------------- ----------------------------------------------------------------
10 or 20 syphilis Rx with PCN spirochetes die hematuria, arthralgia, colicky abdominal pain, female between age 30s 40s, recurrent attacks
rapidly releases antigen-antibody complexes purpuric rash on LE without thrombocytopenia of multiple focal neurologic presentations, &
immunologic reaction following a minor infection (viral URI): interspersed episodes,: MS
appears like an acute flare-up of syphilis Henoch-Schonlein purpura optic neuritis blurry vision, retrobulbar pain,
---------------------------------------------------------------- IgA-mediated leukocytoclastic vasculitis afferent pupillary defect
epistaxis, turbinate destruction, palatal eschars, normal PLT count ----------------------------------------------------------------
maxillary cyanosis: fungal sinusitis hematuria, RBC casts, proteinuria, mild Cr TIAs: emboli from carotid artery plaques, which
MCC: Aspergillus fumigatus, Rhizopus renal biopsy: mesangial deposition of IgA occlude the distal ophthalmic artery
risk factors: poorly controlled DM, HIV Rx: hydration & NSAIDs (pain control) o painless loss of vision
---------------------------------------------------------------- o severe Rx: hospitalize, systemic glucocorticoids ----------------------------------------------------------------
acute pancreatitis is MCC by gallstones & complications: intussusception, GI hemorrhage Stevens-Johnson syndrome involve mucosal
alcohol use ---------------------------------------------------------------- surfaces
Dx: USS of RUQ to detect gallstones hemophilia-associated arthropathy is a ----------------------------------------------------------------
Rx: IV fluids, NG tube section, NPO, analgesia; delayed consequence of recurrent hemarthrosis, a chronic scar (burn) that develops into a painless,
monitor Ca++ & Mg++ chronic inflammatory process non-healing, bleeding skin ulcer suggests
stable patients should undergo cholecystectomy a/w hemosiderin deposition & fibrosis of joints squamous cell carcinoma
for biliary pancreatitis prior to discharge joint contractures & limited ROM risk factors: smoking, radiation, immunosuppression
---------------------------------------------------------------- Dx: MRI Dx: biopsy (punch, shave, excisional) that
Marfan: AD, fibrillin-1 gene mutation Rx: prophylaxis with factor concentrates includes deep reticular dermis
upward lens dislocation, aortic root dilation ----------------------------------------------------------------
----------------------------------------------------------------
resulting in aortic regurgitation primary spontaneous PTX: no preceding event
clenched fist injury, human bite, dog bite
complications: aneurysms, aortic dissection, MVP or Hx of lung disease
Rx: amoxicillin-clavulanate (augmentin)
---------------------------------------------------------------- secondary spontaneous PTX: complication of
----------------------------------------------------------------
homocysteinuria: AR cystathionine synthase underlying lung disease (COPD)
erythromycin: Rx Legionnaires & outpatient
deficiency; a/w metabolism of methionine tension PTX: trapped air, with mediastinal shift
Rx of community-acquired pneumonia
elevated homocyteinuria & methionine AWAY from affected side, & compromised
----------------------------------------------------------------
marfanoid habitus, fair complexion, thrombosis, cardiopulmonary function
VZV incubation period: up to 3 weeks
(CVA, stroke), intellectual disability suspected tension PTX should be treated prior to
o contagious from 2 days prior to rash onset
downward lens dislocation intubation, as PPV will worsen the PTX
until all vesicles are crusted
Rx: Vit B6, folate, Vit B12; anticoagulation PTX Rx:
Varicella post-exposure prophylaxis
---------------------------------------------------------------- o small: observation & O2
Hx of immunity observation
scoliosis, joint laxity, aortic dilation: Ehlers-Danlos o large/stable: needle aspiration or chest tube
if asymptomatic & no Hx of immunity
---------------------------------------------------------------- o unstable: urgent needle thoracostomy, then
o immunocompetent varicella vaccine only
seizure, diaphoresis, tremulousness, elevated chest tube under water seal
within 3 5 days of exposure
pulse & BP one day following hospitalization: needle decompression @ 2nd or 3rd IC space,
o immunocompromised VZ Ig within 10 days
alcohol withdrawal midclavicular line
varicella vaccine is live, attenuated, thus
seizures likely at 12 48 hr chest tube @ 5th IC space, mid-axillary line
contraindicated in pregos & immunocompromised
----------------------------------------------------------------
neurocardiogenic (vasovagal) syncope: preceded lobe parietal: C/L hemisensory loss a/w hemorrhagic cystitis & bladder carcinoma
by nausea, diaphoresis, bradycardia, pallor (rare) occipital: homonymous hemianopsia caused by acrolein
pallor & weak pulses suggest syncope eyes deviate AWAY from hemiparesis Rx: mesna, hydration, frequent voiding
triggers: prolonged standing, stress, pain pons total paralysis in minutes followed by ----------------------------------------------------------------
benign & self-limited (pinpoint) deep coma, pinpoint reactive pupils, cisplatin & carboplatin: a/w cochlear dysfunction
immediate spontaneous return to baseline neuro decerebrate rigidity -blockers & ergotamine: a/w Raynauds
---------------------------------------------------------------- internal capsule lies adjacent to putamen, leads cyclosporine: a/w gout
essential tremor: action tremor in absence of to C/L dense hemiparesis amiodarone & lithium: a/w thyroid dysfunction
additional neurologic signs ---------------------------------------------------------------- ----------------------------------------------------------------
affects any part of the body, B/L hands MC elderly with dementia have increased risk of
resolves with sleep, improves with alcohol agitated delirium in the hospital
Rx: propranolol (especially if also hypertensive); MCC: medications, infection, electrolytes,
primidone or topiramate (anticonvulsants) metabolic, systemic illness, CNS
o primidone may precipitate acute intermittent Rx: low-dose haloperidol for acute agitation in
porphyria (abdominal pain, headaches, elderly with dementia
confusion, hallucinations, dizziness) o typical & atypical antipsychotics are safe
o Dx: urine porphobilinogen o prolonged use increases mortality in elderly ----------------------------------------------------------------
typical antipsychotics not for Lewy body dementia breech presentation before 37th wk gestation
----------------------------------------------------------------
HTN is the most important risk factor for ---------------------------------------------------------------- does not require intervention; routine follow-up
benzos OK for Rx agitation in young patients external cephalic version is indicated 37th wk
intracerebral hemorrhage
MC site: putamen (basal ganglia) ---------------------------------------------------------------- o contraindications: placental abnormalities,
---------------------------------------------------------------- firm, hyperpigmented nodule with dark edges, & feto-pelvic disproportion, hyperextended head
occipital headache, neck stiffness, gait ataxia, N/V, central dimple when pinched: dermatofibroma ----------------------------------------------------------------
o benign fibroblast proliferation; MC on LE heat stroke: thermoregulatory center fails to
gaze palsy or nystagmus: cerebellar hemorrhage
o no hemiparesis or sensory loss o Rx: no treatment unless symptomatic, dissipate heat at the necessary rate
bleeds, change color or size o risk factors: hot/humid weather, obesity, meds
risk factor: HTN
pearly plaque/papule with small telangiectasias (anticholinergics, TCAs, antihistamines)
Dx: non-contrast head CT, surgical decompression
on sun-exposed areas: BCC non-exertional heat stroke: chronic illness or
----------------------------------------------------------------
firm, scaly papule/plaque/nodule on sun-exposed medication causes impaired thermoregulation
intracranial hemorrhage: focal neuro deficits
area: SCC o Rx: evaporative cooling
worsen over minutes hours; not maximal at onset
multicentric, red/purple/brown macules/papules, exertional heat stroke: failure of thermoregulation
headache, N/V, decreased LOC
or nodule on trunk/face/extremities: Kaposi in healthy individuals in extreme heat/humidity
MC risk factor: HTN
small red papule grows rapidly into a pedunculated o > 400C (1050F)
or sessile shiny mass on lip or oral mucosa, bleeds CNS dysfunction (altered mental status),
Intraparencymal brain hemorrhage
with minor trauma: pyogenic granuloma hypotension, tachycardia, tachypnea, ARDS
neurologic findings
o benign vascular skin tumor o rhabdomyolysis (large blood, but no RBCs),
basal C/L hemiparesis & hemisensory loss
---------------------------------------------------------------- coagulopathic bleeding (epistaxis), DIC
ganglia homonymous hemianopsia
hazard ratio: chance of an event occurring in Rx: ice water immersion, fluids & electrolytes;
(putamen) gaze palsy AWAY from lesion**
the treatment group compared to control group no antipyretics
cerebellum no hemiparesis, occipital headache,
HR < 1: event is more likely in the control group DDx: anticholinergic toxicity, serotonin syndrome,
neck stiffness, gait ataxia, nystagmus
thalamus C/L hemiparesis, hemisensory loss HR > 1: more likely in the treatment group malignant hyperthermia,
(toward) nonreactive pinpoint pupil HR = 1: no difference ----------------------------------------------------------------
upward gaze palsy ---------------------------------------------------------------- heat exhaustion: inadequate fluid & Na+
eyes deviate TOWARD hemiparesis** cyclophosphamide: alkylating immunosuppressant replacement; unable to maintain C.O.
cerebral frontal: C/L hemiparesis Rx for SLE, vasculitis, & cancer o no CNS dysfunction
---------------------------------------------------------------- endemic to Mississippi & Ohio River valley mitral stenosis increases pulmonary vascular
fever results from the thermoregulatory centers usually asymptomatic; can cause acute pneumonia pressure thus causing pulmonary congestion
temporary upregulation of body temp by the CXR: asymptomatic pulmonary nodule or ----------------------------------------------------------------
hypothalamus patchy/multinodular infiltrates temporal headache, jaw claudication, vision loss,
---------------------------------------------------------------- ---------------------------------------------------------------- ESR: Giant cell (temporal) arteritis
high fever, muscle rigidity, rhabdomyolysis, rapidly developing hyperandrogenism with chronic vasculitis of medium & large vessels
metabolic acidosis, hemodynamic instability: virilization suggests an androgen-secreting tumor anterior ischemic optic neuropathy presents as
malignant hyperthermia of the ovary or adrenal swollen pale optic disc with blurred margins
uncontrolled sarcoplasmic reticulum Ca++ efflux Dx: serum testosterone & DHEA-S a/w polymyalgia rheumatica
AD inheritance; +family Hx o elevated testosterone ovarian source Rx vision problems: high-dose IV corticosteroids
MCC: inhaled halothane & succinylcholine o elevated DHEA-S adrenal source (methylprednisolone) immediately
---------------------------------------------------------------- DHEA is secreted by ovaries & adrenals Rx mild cases: oral prednisone
Serotonin syndrome ---------------------------------------------------------------- Rx polymyalgia rheumatica only: low-dose oral
HTN, hyperthermia, diaphoresis, agitation, panic disorder is a/w other psychiatric illnesses: glucocorticoids
tremor, muscle rigidity, clonus, hyperreflexia major depression, agoraphobia, bipolar, ----------------------------------------------------------------
Rx: benzo (lorazepam) substance abuse acetazolamide: Rx open angle glaucoma &
---------------------------------------------------------------- high rate of suicide attempts & suicide ideations benign intracranial HTN (ICH)
extracellular pH promotes binding of Ca++ to immediate Rx: benzos ----------------------------------------------------------------
albumin, thus ionized Ca++ long-term Rx: SSRI/SNRI &/or CBT anovulation, hirsutism, acne, ovarian cysts: PCOS
---------------------------------------------------------------- ---------------------------------------------------------------- abnormal GnRH secretion stimulates the pituitary
warfarin-induced skin necrosis: due to rapid pulmonary contusion symptoms develop in the to secrete excess LH & insufficient FSH
decline of protein C in those with underlying first 24 hours o excess LH stimulates androgen production
protein C deficiency tachypnea, tachycardia, hypoxia by ovarian theca cells
occurs within the first few days CXR: patchy irregular alveolar infiltrates anovulation is due to LH/FSH imbalance &
skin lesions on extremities, breast, trunk, penis; DDx: ARDS (manifests after 24 to 48 hrs) insulin resistance
marginates over hours ---------------------------------------------------------------- ----------------------------------------------------------------
Rx: stop warfarin, protein C concentrate 3 Ds: dyspareunia, dysmenorrhea, dyschezia Pathogenesis of endometriosis
---------------------------------------------------------------- (pain with defecation), infertility: endometriosis ectopic endometrial tissue form beneath pelvic
heparin-induced thrombocytopenia (HIT): disappears/improves during pregnancy mucosal/serosal surfaces
autoantibodies to PF4 complexes with heparin risk factors: nulliparity, early menarche, short cyclic hyperplasia & degeneration
occurs within 5 10 days chronic hemorrhaging leads to pelvic adhesions
menstrual cycles, menstrual flow obstruction
necrotic skin lesions @ injection sties ---------------------------------------------------------------- risk of impaired fertility or infertility
a/w arterial or venous thrombosis tachypnea, tachycardia, mental status changes, ----------------------------------------------------------------
PLT count reduction > 50 % hypotension, thrombocytopenia, petechiae on chronic pelvic pain, dyspareunia, infertility,
Rx: stop heparin; direct thrombin inhibitor the chest after long bone fracture: fat embolism bowel/bladder symptoms: endometriosis
(argatroban, fondaparinux) ---------------------------------------------------------------- rectovaginal tenderness or movement of uterus
---------------------------------------------------------------- hypotension unresponsive to IV fluids, MC in nulliparous, age 25 - 35
Factor V Leiden mutation increases risk for tachycardia, JVD after blunt thoracic trauma: evaluation: pelvic USS to r/o endometrioma
venous thromboembolism (DVT, PE) due to acute pericardial tamponade (cystic ovarian mass); normal lab studies
protein C resistance CXR: may appear normal Rx if no complications: empiric NSAIDs +/-
---------------------------------------------------------------- Rx: pericardiocentesis or surgical pericardiotomy combined OCPs (ovulation suppression)
risk of tick-borne disease is low if removed < 24 hr ---------------------------------------------------------------- Rx if complications, or refractory to medical Rx:
---------------------------------------------------------------- exertional dyspnea, nocturnal cough, hemoptysis laparoscopy (Dx & Rx)
Histoplasma is MC in bird/bat droppings rheumatic fever is MC in developing countries ----------------------------------------------------------------
dimorphic fungus: yeast in tissue, mold in culture
pernicious anemia: MCC of Vit B12 deficiency small bowel disease, surgical resection or chronic Pneumococcal
in N. European whites diarrhea leads to malabsorption of fatty acids & Meningococcal
atrophic glossitis, neurologic abnormalities bile salts, predisposing to calcium oxalate stones HPV
loss of position & vibration sense o unabsorbed fatty acids chelate calcium, influenza (injection)
comorbid autoimmune dz: vitiligo, thyroid disease making oxalate free for absorption live attenuated rotavirus
complication: gastric cancer risk ---------------------------------------------------------------- MMR
---------------------------------------------------------------- posterior shoulder dislocation is common after varicella
Ca++-phosphate stones: primary hyper-PTH a tonic-clonic (grand mal) seizure influenza (intranasal)
uric acid stones: acidic urine or cell turnover arm is held adducted & internally rotated administer vaccines according chronologic age
cysteine stones: inborn error of metabolism; XR: light bulb sign, rim sign, trough line sign except Hep B: weight should be 2 kg
hexagonal crystals on U/A, positive family Hx ---------------------------------------------------------------- ----------------------------------------------------------------
struvite stones: alkaline urine due to infection anterior shoulder dislocation is a/w direct blow, compartment syndrome can be a complication
with urease-producing bacteria (Proteus) forceful abduction, or fall on outstretch arm of supracondylar humerus fractures
struvite stones that fill the entire renal pelvis: arm is held slightly abducted & externally rotated severe pain, pallor, poikilothermia, paresthesia;
staghorn calculi Dx: evaluate axillary nerve function late findings of pulselessness or paralysis
---------------------------------------------------------------- ---------------------------------------------------------------- Rx: remove bandages, measure compartment
Td vaccine: every 10 yrs to all adults after age 18 transient unilateral weakness following a tonic- pressures, orthopedic evaluation for fasciotomy
Tdap vaccine: one-time dose in place of Td; clonic seizure that is self-limited: Todd paralysis complication: Volkmann contracture
also with each pregnancy, regardless of status ---------------------------------------------------------------- ----------------------------------------------------------------
influenza vaccine: annually to all adults Infantile hypertrophic pyloric stenosis precocious puberty: 20 sexual development;
o healthy, non-pregnant adults age < 50 may risk first-born male, age 3 5 wks girls < 8 yrs, boys < 9 yrs
receive live-attenuated intranasal vaccine factors erythromycin use, formula feeding o initial test: bone age
---------------------------------------------------------------- features projectile non-bilious emesis o next: test: basal serum LH
13-valent pneumococcal conjugate (PCV13) poor weight gain, good appetite, all elevated LH requires MRI with contrast to
induces a T-cell-dependent B-cell response dehydration, sunken fontanelles r/o hypothalamic or pituitary tumors
o improves immunogenicity tachypnea, olive-shaped mass next test: GnRH stimulation test
o Rx all infants & young children Lads hypochloremic, hypokalemic metabolic high or low baseline LH, with GnRH stimulation:
alkalosis with compensatory respiratory gonadotropin-dependent (central) precocious
23-valent polysaccharide vaccine (PPSV23)
acidosis puberty
induces a T-cell independent B-cell response
Dx abdominal USS o idiopathic precocious puberty: premature
o less effective in children & elderly
Rx IV hydration hypothalamic-pituitary-gonadal axis activation;
o Rx adults age < 65 with comorbidities
pyloromyotomy MC in girls; LH/FSH
----------------------------------------------------------------
13-valent pneumococcal conjugate (PCV13) & premature adrenarche (axillary, pubic hair),
formula-fed infants have slow gastric emptying thelarche (breasts), & menarche
23-valent polysaccharide vaccine (PPSV23)
& consume more volume in less time, which advanced bone age
o all age 65, 6 12 months apart
stimulates growth of the pylorus muscle o Dx: brain CT or MRI
o age < 65 at high-risk: sickle cell disease, prior to surgery, stabilize electrolytes with IVF;
CSF leaks, cochlear implants, asplenia, o Rx: continuous GnRH agonist
alkalosis increases risk of post-op apnea low LH/FSH at baseline, does not increase with
immunocompromised, chronic renal failure ----------------------------------------------------------------
PPSV23 alone GnRH stimulation = gonadotropin-independent
Pediatric immunizations (peripheral) precocious puberty
o age 19 64 with chronic heart, lung, or liver inactivated (killed) polio, hepatitis A
disease; diabetic, alcoholic, current smoker o gonadal or adrenal release of sex hormones
toxoid (inactivated) diphtheria, tetanus Dx: USS of adrenals, ovaries/testes
o subsequent PCV13 & PPSV23 @ age 65
subunit (conjugate) hepatitis B o advanced bone age, coarse axillary/pubic hair,
---------------------------------------------------------------- Pertussis severe cystic acne, normal testicular volume:
H. influenza Type B non-classic (late-onset) CAH
o MCC: 21-hydroxylase deficiency o chronic respiratory alkalosis with significant vomiting leads to hypochloremic
accumulation of 17-hydroxyprogesterone metabolic compensation ( HCO3) metabolic alkalosis ( HCO3)
normal bone age with isolated premature ---------------------------------------------------------------- ----------------------------------------------------------------
thelarche or adrenarche Rx: reassurance neonate with lethargy, hypocapnia, high-pitch cry, diabetics are at high risk of erectile dysfunction
---------------------------------------------------------------- rapidly head circumference, bulging fontanelles tight glycemic control does not improve symptoms
classic CAH neonates present with adrenal intraventricular hemorrhage is a common Rx: sildenafil (PDE inhibitor)
insufficiency, ambiguous genitalia, salt-wasting complication premature & underweight neonates o if taking sildenafil & alpha-blocker together,
late-onset CAH occurs in late childhood with born at < 32 wk gestation or < 1500 g wait at least 4 hours in between
androgen excess: premature adrenarche/pubarche, due to capillary fragility of subependymal ----------------------------------------------------------------
Rx-resistant cystic acne, advanced bone age, germinal matrix survivors of sexual assault are at highest risk for
accelerated linear growth screening: serial head USS, shows B/L IVH & PTSD, depression, & suicidality
---------------------------------------------------------------- dilated ventricles ----------------------------------------------------------------
Leydig cell tumor gonadotropin-independent Rx: antenatal corticosteroids consider carbon monoxide poisoning in patients
precocious puberty complication: communicating hydrocephalus, with environmental/occupational risk factors
o unilateral testicular enlargement/mass cerebral palsy 20 polycythemia, headache, nausea, dizziness
---------------------------------------------------------------- ---------------------------------------------------------------- Hct is due to carboxyhemaglobinemia
MCC of primary hypogonadism: Klinefelters Arnold-Chiari & Dandy-Walker: congenital ----------------------------------------------------------------
o small testes, small phallus, hypospadias, malformations that cause non-communicating polycythemia can cause pulmonary HTN by
cryptorchidism, gynecomastia, hydrocephalus due to obstruction a CSF flow in increasing viscosity in the pulmonary vasculature
---------------------------------------------------------------- the posterior fossa severe pulmonary HTN can cause polycythemia
o Calcium (hypercalcemia) ---------------------------------------------------------------- ----------------------------------------------------------------
o Renal failure (IgG or Bence Jones proteins) hepatic hydatid cysts are due to Echinococcus dyspnea, hemoptysis, ankle edema, dark urine, U/A
o Anemia (Hb < 12) granulosus from close contact with dogs or sheep with proteinuria, dysmorphic RBCs, & red cell casts,
o Bones (lytic lesions, fractures) causes unilocular cystic lesion in any organ CXR: B/L alveolar infiltrates: Goodpastures
CRABs present in multiple myeloma mostly asymptomatic or compressive symptoms pulmonary-renal syndrome as a manifestation of
monoclonal plasma cell proliferation of IgG hepatomegaly, RUQ pain, N/V anti-GBM antibodies against collagen IV, damages
functional antibodies & leukopenia, risk for encapsulated cysts containing fluid & budding glomeruli & alveolar lining
recurrent infection cells that become daughter cysts affects lungs (cough, dyspnea, hemoptysis) &
elevated protein:albumin gap > 4 CT scan: egg shell calcifications kidneys (nephritic proteinuria, ARF, dysmorphic
paraproteinemia results in renal failure due to Rx: surgical resection/aspiration & albendazole RBCs & red cell casts)
obstruction by large laminated casts o aspiration risk of anaphylactic shock a/w alveolar hemorrhage & glomerulonephritis
---------------------------------------------------------------- ---------------------------------------------------------------- Dx: renal biopsy shows linear IgG deposits
Normal physiologic changes during pregnancy RUQ pain, nausea, liver USS shows a smooth, along glomerular BM
o GFR & renal size round cyst with daughter cells: Echinococcosis Rx: emergency plasmapheresis to remove
o BUN & creatinine definitive host: dogs anti-GBM antibodies minimizes kidney damage
o urinary frequency, nocturia intermediate host: sheep ----------------------------------------------------------------
o mild hyponatremia ( ADH) dead end host: humans fever, exertional dyspnea, non-productive cough,
o dilutional anemia transmission: dogs living in close proximity to severe hypoxia, CD4 < 200: PCP pneumonia
( plasma volume & RBC mass) humans are fed viscera of home-slaughtered CXR: B/L diffuse interstitial infiltrates
o prothrombotic state (risk of DVT/PE) animals; eggs excreted by dogs in feces Dx: bronchoalveolar lavage
o cardiac & renal blood flow ---------------------------------------------------------------- TMP-SMX for PCP pneumonia may experience
progesterone directly stimulates central brachial artery injury is a concern with initial worsening of pulmonary function
medullary respiratory centers: tidal volume & supracondylar humerus fractures o add corticosteroids to minimize the initial
minute ventilation, PaO2, PaCO2 ---------------------------------------------------------------- pulmonary complications
hyperemesis gravidum occurs early in pregnancy
alt Rx for PCP: TMP + dapsone, IV pentamidine, hematology iron deficiency anemia recipient IgE & mast cell
oral atovaquone, or clindamycin-primaquine neuro peripheral neuropathy, headache activation
---------------------------------------------------------------- endocrine autoimmune thyroiditis, Type I DM transfusion-related respiratory distress, non-
male adolescent with epistaxis, visible nasal mass, psych depression, psychosis acute lung injury cardiogenic pulmonary edema
bony erosion in back of nose: angiofribroma ---------------------------------------------------------------- (within 6 hrs) donor anti-leukocyte Abs
benign, but can erode & invade locally lidocaine: class IB anti-arrhythmic delayed hemolytic mild fever & hemolytic anemia
---------------------------------------------------------------- frequency of PVCs & risk of v-fib (within 2 10 days) direct Coombs test positive
reactive nasal polyps do not cause bony erosions do not use prophylactically to prevent v-fib in anamnestic Ab response to
a/w chronic infections or allergies patients with acute MI RBC antigen
---------------------------------------------------------------- risk of asystole
giant cell tumor of bone: locally aggressive ---------------------------------------------------------------- leukocytes release cytokines during blood storage
skeletal neoplasm, benign; MC in adolescents Pain management for terminal cancer that cause transient fever, chills, & flank pain;
knee pain, swelling, decreased joint ROM initially Rx: short-acting morphine; subsequent causes febrile non-hemolytic reaction
distal femur or proximal tibia doses titrated to achieve complete pain control o prevented by using leuko-reduced blood
XR: osteolytic bone lesion, soap-bubble in the once established, switch to long-acting narcotics IgA-deficient individuals are at risk for
epiphyseal region of long bones (patches), with short-acting morphine PRN for anaphylactic transfusion reactions
Rx: surgery break-through pain o Rx: IM epinephrine, vasopressors, histamine
---------------------------------------------------------------- ---------------------------------------------------------------- blockers, glucocorticoids
loss to follow-up in prospective studies has vesiculoureteral reflux (VUR) is a risk factor o future transfusions: IgA-deficient plasma &
potential for attrition bias (selection bias) for recurrent UTIs, leading to renal scarring washed RBC products
can over- or under-estimate the association all children age 2 24 months, first febrile UTI ----------------------------------------------------------------
between exposure & disease should undergo renal USS altered mental status, acute renal failure, fever,
---------------------------------------------------------------- Dx recurrent UTIs: voiding cystourethrogram hemolytic anemia, thrombocytopenia: TTP
Celiacs screening: o not routine for first UTI reticulocytosis, indirect bilirubin, schistocytes
IgA anti-tissue transglutaminase Ab assay not a/w bladder cancer, RCC, abscess, or calculi Dx: clinical; ADAMTS13 not used for diagnosis
o IgA anti-endomysial antibodies ---------------------------------------------------------------- Rx: plasma exchange
may be absent with selective IgA deficiency Immunologic blood transfusion reactions
Dx: if suspicion is high, measure total IgA anaphylactic rapid onset shock, hypotension, Indications for specialized RBC treatments
confirm Dx: upper GI endoscopy with biopsy (seconds minutes) angioedema/urticaria, Irradiated BM transplant recipients,
respiratory distress/failure cellular immunodeficiency,
Features of malabsorption in celiac disease recipient anti-IgA IgG blood donated by 10 or 20 relative
Nutrient Symptoms primary transient hypotension, Leukoreduced chronic transfusions,
fat bulky, foul-smelling, floating stools hypotension patients on ACE-I, caused by CMV at-risk patients (AIDS),
protein loss of subcutaneous fat & muscle mass reaction (minutes) bradykinin in blood products Hx of febrile non-hemolytic rxn,
iron pallor, fatigue, iron deficiency anemia normally degraded by ACE potential transplant recipient,
Ca++, vit osteoporosis, osteomalacia acute hemolytic fever, flank pain, hemolysis, Washed IgA deficiency,
D (within 1 hr) hemoglobinuria, DIC complement-dependent autoimmune
medical emergency! direct Coombs test positive** hemolytic anemia,
Vit K easy bruising
ABO incompatibility urticaria despite antihistamines
Vit A hyperkeratosis
febrile fever & chills (most common) ----------------------------------------------------------------
nonhemolytic cytokine accumulation during Cat-scratch disease: Bartonella henselae
Extraintestinal symptoms of Celiacs
(within 1 6 hrs) blood storage (from leukocytes) local skin lesion evolves through vesicular,
general fatigue, weight loss
urticarial/allergic urticarial, flushing, pruritus, erythematous, papular phases
skin dermatitis herpetiformis, vitiligo
(within 2 3 hr) angioedema tender, localized, regional lymphadenopathy
MSK osteopenia/osteoporosis
Rx: azithromycin (5 days) to reduce symptoms, Alveolar-arterial gradient: estimates the degree deposits humps with C3
but mainly self-limited of alveolar oxygen transfer to blood Px benign, children: good
---------------------------------------------------------------- o normal: < 15 ( with age); > 30 is elevated if RPGN or nephrotic adults: CKD
membranous glomerulonephritis is a/w Hep B patients with Hx of CAD & sudden onset dyspnea syndrome (worse Px)
focal segmental glomerulosclerosis are MC a/w after IV fluids is likely pulmonary edema ----------------------------------------------------------------
HIV, blacks, HTN, obesity, IVDA, sickle cell o pulmonary edema the A-a gradient due to B/L sensorineural hearing loss, recurrent hematuria,
o segmental sclerosis & hyalinosis V/Q mismatch; excess fluid reduces lung ocular abnormalities, renal insufficiency: Alports
---------------------------------------------------------------- compliance by preventing alveolar expansion X-linked defect in collagen IV formation
collagenous colitis: chronic watery diarrhea o Rx: supplemental O2 normal complement levels
colonoscopy: normal mucosa extensive ARDS results in a poorly aerated lung EM: thin & thick capillary loops, GBM splitting,
biopsy: mucosal subepithelial collagen deposits that is stiff & less compliant tram-track appearance
---------------------------------------------------------------- left-to-right shunts (VSD) lowers lung compliance ----------------------------------------------------------------
anorexia, fatigue, weight loss, cognitive impairment, by pulmonary blood flow, causing fluid leakage necrotizing fasciitis: erythema & swelling,
Hx of IVDA: HIV testing into the interstitium severe pain out of proportion to physical exam
HIV patients are at risk of depression & dementia ---------------------------------------------------------------- involves subcutaneous tissue & deep fascia
DDx: MDD, chronic primary adrenal insufficiency, Hx of travel to endemic area (Mexico), dysentery, systemic symptoms: fever, hypotension
iron deficiency anemia RUQ pain, single cyst in right lobe of liver: signs of tissue necrosis: crepitus, purulent drainage,
---------------------------------------------------------------- amebic liver abscess (E. histolytica) radiographic evidence of gas in deep tissues
phenytoin & carbamazepine: block voltage-gated primary infection in the colon bloody diarrhea rapidly progresses to discoloration, bullae, necrosis
Na+ channels ALP MCC: Group A Strep
Rx primary generalized tonic-clonic seizures Dx: trophozoites in stool, serology, or imaging to Rx: surgical debridement & ABX
with/without secondary generalization r/o pyogenic abscess DDx: abscesses, cellulitis, deep muscle hematoma,
A/E for both: SJS/TEN, fetal hydantoin syndrome Rx: empiric metronidazole thrombophlebitis
phenytoin A/E: gingival hypertrophy o also paromomycin (luminal agent to ----------------------------------------------------------------
---------------------------------------------------------------- eradicate intestinal colonization) anti-ischemic & anti-anginal effects of nitrates
phenobarbital: acts at GABA receptors by o do not drain the abscess are due to systemic vasodilation
extending GABA-mediated Ca++ channels open DDx: pyogenic liver abscess (2/2 surgery, GI o concomitant use of -blockers prevents
A/E: sedation infection, acute pancreatitis), hepatic adenoma reflex tachycardia caused by nitrates
---------------------------------------------------------------- (solid lesion), hydatid cyst (Echinococcus) ----------------------------------------------------------------
A-a PaCO2 corrects ---------------------------------------------------------------- recurrent epistaxis, ruby-colored papules on the
gradient with O2? gross hematuria a/w URI, HTN, proteinuria, lips that blanch, widespread AVMs: hereditary
reduced inspired O2 normal normal yes RBC casts, AKI: glomerulonephritis telangiectasia (Osler-Weber-Rendu syndrome)
tension (high altitude) AVMs occur in mucous membranes, skin, GIT
hypoventilation normal yes IgA nephropathy Post-infectious GN diffuse telangiectasias, digital clubbing
(CNS depression) features within 5 days of URI 10 21 days after URI pulmonary AVMs can cause R-to-L cardiac shunt,
diffusion limitation normal yes (synpharyngitic) (post-pharyngitic) resulting in hypoxemia & reactive polycythemia; &
(interstitial lung dz) men, age 20 30 yrs, age 6 10 or adults massive hemoptysis
intracardiac shunt, normal NO gross hematuria ----------------------------------------------------------------
extensive ARDS recurrent gross adults: asymptomatic Henoch-Schonlein Purpura: systemic form of IgA
V/Q mismatch normal yes hematuria or acute nephritic involvement of glomeruli, skin, joints, intestines
(obstructive disease, or syndrome ----------------------------------------------------------------
pulmonary edema, Dx normal C3 low C3** Causes of postoperative fever (> 380C)
atelectasis, pneumonia) elevated ASO &/or Wind PE, pneumonia, aspiration
anti-DNase B Wound SSI
Bx: mesangial IgA Bx: subepithelial Water UTI
Walk DVT comorbidities: fluoroquinolone, Rx: supportive; self-limited within 1 wk
Wonder drug fever, IV lines OR beta-lactam + macrolide DDx: gingivostomatitis (anterior oropharynx)
drugs blood products inpatient fluoroquinolone, OR ----------------------------------------------------------------
(non-ICU) beta-lactam + macrolid peritonsilar abscess is a complication of tonsillitis
Timeline course of post-operative fever inpatient beta-lactam + macrolide (IV), OR muffled voice, uvula deviation, & prominent
immediate (0 -2 hr): prior trauma/infection, (ICU) beta-lactam + fluoroquinolone unilateral lymphadenopathy
transfusion reaction, malignant hyperthermia ICU patient ABX to cover: S. aureus, Legionella, Rx: IV ABX & urgent abscess needle aspiration
acute (1 day 1 wk): nosocomial infections (UTI), Pseudomonas ----------------------------------------------------------------
SSI (GAS, or C. perfringens), MI, PE/DVT ---------------------------------------------------------------- retroperitoneal hematoma can occur without a
subacute (> 1 wk, < 1 mo): drug fever, PE/DVT, copious white/yellow vaginal discharge, non- supratherapeutic INR while on warfarin
C. difficile, other SSIs, catheter site infection malodorous, absence of other findings on vaginal back pain, hemodynamic compromise
delayed (> 1 mo): viral, indolent SSIs, IE exam: physiologic leukorrhea Dx: abdominal CT
---------------------------------------------------------------- ---------------------------------------------------------------- DDx: RCC, vertebral fracture, hydronephrosis
fever, rash, peripheral eosinophilia: drug fever stillbirth: 20 wks gestation ----------------------------------------------------------------
---------------------------------------------------------------- risk factors: HTN, DM, adv maternal age, smoking primary inciting event of acute cholecystitis is
severe, acute-onset mid-abdominal pain out of gallstone obstruction in cystic duct; no jaundice
proportion to physical exam findings, N/V: acute Stillbirth delivery options ALP is a/w cholangitis or choledocholithiasis;
mesenteric ischemia 2nd trimester D&C (up to 24 wks) + jaundice
MCC is an embolus induction ----------------------------------------------------------------
progression to bowel infarction causes spontaneous delivery OGTT in all pregos @ 24 28 wk gestation to
peritoneal signs & bloody stool 3rd trimester induction with oxytocin (preferred) screen for gestational diabetes
---------------------------------------------------------------- (after 28 wks) spontaneous delivery o screen with 1 hr 50g OGTT
coagulase-negative staphylococci (S. epidermidis) c-section o confirm with 3 hr 100g OGTT
is the MCC of nosocomial bloodstream infections spontaneous delivery occurs within 2 wks risk factors: obesity, family Hx of DM, excessive
with intravascular devices (triple-lumen catheter) vaginal birth after c-section increases risk of weight gain during pregnancy
---------------------------------------------------------------- uterine rupture, but vaginal delivery is preferred high risk or symptomatics (polyuria, polydipsia)
Staph saprophyticus (coagulase negative): regardless of prior cesarean should undergo HbA1C & fasting glucose at the
common cause of uncomplicated acute cystitis ---------------------------------------------------------------- first prenatal visit
a young, sexually active females hemarthrosis after minor trauma in a young child ----------------------------------------------------------------
---------------------------------------------------------------- is suspicious for bleeding disorder pregos at high risk of fetal aneuploidy require
MCC of community-acquired pneumonia: screening: coagulation studies & CBC cell-free fetal DNA testing
Strep pneumo, H. influenza, Mycoplasma ---------------------------------------------------------------- ----------------------------------------------------------------
Rx: empiric ABX; isolating causative organism fever, dysphagia, odynophagia, neck pain with Rx acute cystitis & pyelonephritis in non-pregos
is difficult movement (particularly neck extension), trismus uncomplicated oral nitrofurantoin (5 days)
management of CAP requires risk assessment for (jaw spasm): retropharyngeal abscess cystitis TMP-SMX (3 days)
hospitalization using the CURB-65 algorithm Dx: neck CT &/or lateral radiographs fosfomycin (single dose)
o Confusion Rx: IV ABX, drainage complicated **requires urine culture prior to Rx
o Uremia (BUN > 20 mg/dL) DDx: meningitis, herpangina, epiglottitis, IM cystitis fluoroquinolones (5 14 days), but
o Respiratory (RR > 30) ---------------------------------------------------------------- not for pregos
o BP (< 90/60 mmHg) high fever, severe sore throat with dysphagia, pyelonephritis **requires urine culture prior to Rx
o age > 65 ulcerative lesions on palate, tonsils, & pharynx: outpatient: oral fluoroquinolones
score > 2: inpatient herpangina (ciprofloxacin, levofloxacin)
score 4 : ICU MCC: Coxsackie A inpatient: IV fluoroquinolones, or
gray vesicles/ulcers on posterior oropharynx aminoglycoside +/- ampicillin
outpatient healthy: doxycycline or macrolide lesion on palms & soles = hand-foot-mouth disease
dysuria, urinary frequency, suprapubic tenderness: reaction formation: substituting behavior/feelings rebleeding is a major cause of death within 24 hrs
uncomplicated cystitis that are opposite of their own unacceptable feelings vasospasm is a delayed complication of SAH
Dx: U/A; urine culture only if initial Rx fails sublimation: consciously unacceptable (after 3 days), resulting in cerebral infarct
---------------------------------------------------------------- instinctual drives are diverted into socially or Dx: CT angiography
complicated cystitis: factors that increase risk of personally acceptable activities (channeling Rx: prevented with nimodipine (CCB)
ABX resistance or Rx failure (diabetes, CKD, explosive anger into athletic pursuits) ----------------------------------------------------------------
urinary tract obstruction, nosocomial infection, dissociation: temporarily eliminating a memory lone A-fib: paroxysmal, persistent, or permanent
indwelling catheters, pregos, immunocompromised) or perception of themselves or environment to a-fib without cardiopulmonary or structural heart
Dx: obtain urine culture prior to Rx avoid a problem or distressing situation disease; CHADS2 score = 0
---------------------------------------------------------------- suppression: intentionally postponing the Rx: no anticoagulation
failure to thrive, persistent diarrhea, lymphopenia exploration of anxiety-provoking thoughts by ----------------------------------------------------------------
recurrent fungal, viral & bacterial infections substituting other thoughts smoke inhalation injury victims (house fire):
ADA deficiency (SCID): deficient formation of displacement: shifting emotions a/w an upsetting empiric Rx for cyanide toxicity
mature B & T lymphocytes 2/2 toxic accumulation object/person to a safer alternative that represents o HCN & CO
of adenosine the original in some regard Rx: empiric IV hydroxocobalamin, or
---------------------------------------------------------------- acting out: enacting an unconscious wish or sodium thiosulfate (directly binds CN)
complement deficiencies risk of autoimmune fantasy through impulsive physical action to o nitrates to induce methemoglobinemia;
conditions avoid painful feelings increases ferric iron (Fe3+) to bind CN
---------------------------------------------------------------- ---------------------------------------------------------------- Rx cyanide ingestion: activated charcoal
chronic granulomatous disease: defective fluid resuscitation & IV dexamethasone: Rx ----------------------------------------------------------------
intracellular killing due to impaired respiratory acute adrenal insufficiency CN potently inhibits cytochrome oxidase a3 of the
burst from active phagocytes IV dantrolene: Rx malignant hyperthermia ETC & binding Fe3+, thus prevents reduction to
---------------------------------------------------------------- ---------------------------------------------------------------- Fe2+ & ATP production promotes anaerobic
opsonization defects result from asplenia renal compensation for respiratory alkalosis: metabolism metabolic acidosis (lactic acidosis)
o infection with encapsulated bacteria excretion of HCO3 in urine (high urine pH) with respiratory compensation (tachypnea)
---------------------------------------------------------------- contraction alkalosis occurs in states of ----------------------------------------------------------------
insulin-like growth factor (IGF-1) is used to intracellular volume contraction, where levels methmoglobinemia occurs with exposure to
screen for acromegaly of aldosterone restores intravascular volume, but oxidizing agents: dapsone, nitrates, topical/local
o GH levels fluctuate (diurnal) also urinary H+ loss anesthetics; formed by oxidation of Fe2+ Fe3+
IGF-1 oral glucose suppression test ---------------------------------------------------------------- affinity of Fe2+ to O2 (left shift), thus reduces
o adequate GH suppression rules out acromegaly orchitis is the MC complication of mumps O2 delivery to tissues
o inadequate GH suppression brain MRI to other complications: aseptic meningitis, encephalitis Fe3+ binds avidly to CN; unable to bind O2
look for a pituitary mass ---------------------------------------------------------------- Rx: methylene blue
---------------------------------------------------------------- SIDS is more frequent in males, age 2 4 months, ----------------------------------------------------------------
psychological defense mechanisms serve to & low socioeconomic status all pregos should receive inactivated influenza
decrease anxiety ---------------------------------------------------------------- & TdaP vaccinations
immature defense mechanisms: used by HTN can be a presenting sign of polycythemia ----------------------------------------------------------------
children/adolescents, socially unacceptable plethoric face, splenomegaly Colon cancer screening options begin at age 50
behavior that prevents coping with reality incidence of peptic ulcers (histamine release o colonoscopy every 10 yr
neurotic defense mechanisms: used by adults, from basophils) & gouty arthritis ( cell turnover) (most sensitive & specific test, but $$$)
short-term relief, with long-term complications ---------------------------------------------------------------- o FOBT annually
mature defense mechanisms: used by adults; abrupt onset severe headache, meningeal irritation o flexible sigmoidoscopy every 5 yr
healthy & constructive approach to reality with neck pain/stiffness: SAH + FOBT every 3 yr
---------------------------------------------------------------- Dx: non-contrast head CT within 24 hr high risk polyps: F/U colonoscopy ever 3 5 yrs
o lumbar puncture if CT is normal ----------------------------------------------------------------
granulosa cell tumor: solid malignant ovarian ---------------------------------------------------------------- #1 Rx major depression: SSRI
tumor that produce excess estrogen ethylene glycol poisoning (anti-freeze) is a/w Dx: must have depressed mood or anhedonia
bimodal age distribution hypocalcemia & calcium oxalate deposition with at least 4 symptoms of SIGECAPS
o presents as isosexual precocious puberty or flank pain, hematuria, oliguria, AKI, profound for patients with advanced cancer, also consider
postmenopausal bleeding & uterine anion gap metabolic acidosis (HCO3 < 8) adjustment disorder w/ depressive features
myohyperplasia U/A: rectangular, enveloped-shaped crystals is o symptoms must occur within 3 months
Rx: tumor removal results in symptom regression a/w Ca++ oxalate ----------------------------------------------------------------
---------------------------------------------------------------- Rx: fomepizole or ethanol to inhibit alcohol Antipsychotic extrapyramidal effects
dysgerminoma: malignant ovarian tumor dehydrogenase; sodium bicarbonate to relieve (related to degree of D2 blockade)
women age < 20 yr acidosis, & hemodialysis for severe acidosis a/w high-potency typical antipsychotic, acute dystonic
unilateral; can undergo torsion &/or end-organ damage onset after 4 hours to 4 days, reaction
undifferentiated gonadal germinal cells ---------------------------------------------------------------- sudden, sustained contraction of neck,
neutral; does not secrete sex hormones methanol poisoning: vision loss & coma mouth, tongue, EOM, opisthotonus
testes equivalent = seminoma within 24 hr: headache, N/V, epigastric pain Rx: benztropine (anticholinergic) or
---------------------------------------------------------------- optic disc hyperemia diphenhydramine (antihistamine)
sertoli-leydig cell tumor: produce androgens, ---------------------------------------------------------------- subjective restlessness, akathisia
causes defeminization, then masculinization in Toxicity Features Labs onset can occur at anytime
child-bearing age women alcohol slurred speech, high osmolar gap, Rx: benzodiazepine (lorazepam) or
serous cystadenomas: MC benign cystic ovarian ketoacidosis unsteady gait, anion gap beta-blocker (propranolol)
neoplasm; no estrogen or androgens altered mentation metabolic acidosis onset within 4 days to 4 months; drug-induced
o ovarian mass & abdominal pain due to ketosis tremor, rigidity, bradykinesia Parkinsonism
---------------------------------------------------------------- methanol visual burning, high osmolar gap, Rx: benztropine or amantadine
Constipation in children (EYES) central scotoma, anion gap onset within 1 6 months; Tardive
afferent pupil defect, metabolic acidosis dyskinesia of mouth/face, extremities; dyskinesia
risk factors transition to solid foods & cows milk,
altered mentation, lip smacking, puckering, biting,
toilet training, & school entry
acute pancreatitis grunting, tongue protrusion
complications anal fissures, hemorrhoids, vomiting, ethylene flank pain, oliguria, high osmolar gap, no effective treatment
encopresis, enuresis, recurrent cystitis glycol hematuria, tetany, anion gap ----------------------------------------------------------------
Rx dietary fiber, limit cows milk < 24 oz (KIDNEYS) CN palsy metabolic acidosis, atypical antipsychotic most likely to cause EPS:
oral laxative (polyethylene glycol, Ca-oxalate risperidone
mineral oil) crystals Rx: replace with clozapine; least likely for EPS
isopropyl CNS depression, high osmolar gap, o CBC before starting clozapine
recurrent cystitis in toddlers 2/2 constipation can alcohol disconjugate gaze, NO anion gap, ----------------------------------------------------------------
cause rectal distension compresses the bladder absent ciliary reflex NO metabolic amiodarone: Rx conversion & maintenance of
resulting in urinary stasis acidosis sinus rhythm for patients with a-fib
---------------------------------------------------------------- ---------------------------------------------------------------- does not prevent thrombus formation
musculoskeletal infections (osteomyelitis, abscess) NPV: probability of being disease-free if test ----------------------------------------------------------------
results from hematogenous spread from other result is negative Running injuries of the foot &ankle
sites such as the skin (furuncles) NPV varies with the pretest probability of disease a/w sudden in activity, Stress
MCC S. aureus o high probability of disease = low NPV insidious, localized pain in navicular fracture
---------------------------------------------------------------- o low probability of disease = high NPV or metatarsals; microfractures that
if anion gap is markedly elevated with absence of prevalence is directly related to pretest probability coalesce within cortical bone,
frank uremia, calculate osmolar gap to assess for o sensitivity & specificity to not vary with burning pain, worse when initiating Plantar
ethanol, methanol, or ethylene glycol intoxication pretest probability first steps of the day, fasciitis
o high osmolar gap & severe metabolic acidosis ---------------------------------------------------------------- pain decreases with activity, but
worsens with prolong weight-bearing deep, recurring variable decelerations; painless clear cell adenocarcinoma of vagina & cervix
burning pain or stiffness 2 to 4 cm Achilles ---------------------------------------------------------------- structural abnormalities of reproductive tract
above posterior calcaneus tendinopathy placenta acreta: implantation of villi into infertility
numbness/pain between 3rd & 4th toe, Morton myometrium; abdominal pain & vaginal bleeding ----------------------------------------------------------------
clicking sensation when palpating neuroma risk factor: prior c-section when placenta is next endometrial adenocarcinoma risk factors:
plantar space between 3rd & 4th toes to uterine scar (low-lying anterior) prolonged estrogen stimulation (early menarche,
while squeezing metatarsal joints ---------------------------------------------------------------- late menopause, obesity, chronic tamoxifen use)
compression of tibial nerve at ankle Tarsal tunnel uterine atony: painless postpartum hemorrhage ----------------------------------------------------------------
burning, numbness, aching of distal syndrome ---------------------------------------------------------------- #2 highly malignant bone tumor, common with
plantar surface; MCC: ankle fx PEP after a bite wound from wild carnivore children in lower extremity: Ewings sarcoma
---------------------------------------------------------------- o MCC raccoons; exposure to saliva white males, < age 20 yr
placenta previa: painless, 3rd trimester bleeding rabies post-exposure prophylaxis: rabies Ig & joint pain & swelling for weeks or months
hemorrhage is fetal origin rabies vaccine immediately (passive & active) MC sites: metaphysis & diaphysis of femur; also
no fetal deterioration hydrophobia & aerophobia: encephalitic rabies tibia & humerus
risk factors: prior placenta previa, prior c-section ascending flaccid paralysis commonly mets to lungs & lymph nodes
or uterine surgery, multiparity, adv maternal age ---------------------------------------------------------------- XR: central lytic lesion was endosteal scalloping;
Dx: transabdominal, then transvaginal USS post-menopausal female with vaginal dryness, onion-skin periosteal reaction, followed with
no digital vaginal exam before USS due to pruritus, dysuria; pale, dry vaginal mucosa, moth-eaten or mottled appearance
risk of massive hemorrhage diminished labial fat pad, scarce pubic hair: DDx: osteomyelitis (fevers, leukocytosis, local
Rx unstable mother, regardless of gestational age: atrophic vaginitis joint pain, swelling, anemia, ESR)
emergency c-section Dx: Hx & physical findings ----------------------------------------------------------------
Rx stable mother, fetus at term: scheduled c-section Rx: vaginal estrogen (moderate/severe cases), asbestos exposure risk of pulmonary fibrosis
Rx stable mother, fetus not at term: expectant; moisturizers/lubricants (mild) & malignancy (x6)
amniocentesis @ 36 wks to assess lung maturity DDx: UTI MC malignancy is bronchogenic carcinoma
o if lungs mature scheduled c-section ---------------------------------------------------------------- smoking synergistically lung cancer risk
---------------------------------------------------------------- Rx vulvar lichen planus & lichen sclerosis: symptoms develop 20 yrs after initial exposure
abruptio placenta: hypertonic, uterine tenderness high-potency corticosteroid cream cough, sputum, & wheezing not typically present
premature separation due to hemorrhage in ---------------------------------------------------------------- progressive dyspnea, bibasilar end-inspiratory
decidua basalis; hemorrhage is maternal origin risk stratification of stroke using CHADS2 for crackles & clubbing
MC risk factor: HTN all a-fib to assess for long-term anticoagulation CXR: bibasilar reticulonodular infiltrates,
---------------------------------------------------------------- anti-thrombotic therapy with warfarin (or honeycombing, B/L pleural thickening
vasa previa: painless, antepartum hemorrhage dabigatran, rivaroxaban, apixaban) is the most o pleural plaques
upon ROM with rapid deterioration of fetal tracing effective at risk of systemic embolization with ----------------------------------------------------------------
(sinusoidal tracing); no maternal symptoms nonvalvular a-fib asbestos is the only risk factor for malignant
hemorrhage is fetal origin ASA is less effective in preventing pleural mesothelioma
fetal death by exsanguination thromboembolic events CXR: unilateral pleural abnormality with a large
Dx: antenatal transvaginal Doppler USS ASA + clopidogrel is better than ASA alone, but pleural effusion
Rx: emergency c-section inferior to warfarin ----------------------------------------------------------------
---------------------------------------------------------------- ---------------------------------------------------------------- pulsus paradoxus is a frequent finding of cardiac
uterine rupture: sudden onset intense pain, tinnitus, fever, hyperventilation: ASA overdose tamponade, but also severe asthma or COPD
vaginal bleeding, hyperventilation, tachycardia o mixed anion gap metabolic acidosis & ----------------------------------------------------------------
hemorrhage is maternal origin respiratory alkalosis; no osmolar gap Proteus is the most likely cause of UTI in those
fetal deterioration, palpable fetal parts Rx: sodium bicarbonate with alkaline urine, due to its secretion of urease,
---------------------------------------------------------------- ---------------------------------------------------------------- forming struvite stones, a source of bacteria
cord prolapse occurs with rupture of membranes Complications in DES exposed daughters formation of ammonium increases urine pH
chronic indwelling urinary catheters are a lung cancer DDx: acute cholecystitis, acute pancreatitis,
source of urease-producing bacteria (Proteus) cardiac MS/acute pulmonary edema PUD, Crohns, SMA syndrome
---------------------------------------------------------------- infectious TB, lung abscess ----------------------------------------------------------------
elderly patients with anemia, renal failure, hematologic coagulopathy prodromal fever, irritability, skin tenderness,
hypercalcemia, back pain, recurrent infections: vascular AVMs, severe thrombocytopenia followed by generalized erythema & superficial
multiple myeloma systemic Wegeners, Goodpastures, flaccid blisters; + Nikolsky sign: Staphylococcal
total serum protein, normal albumin SLE, vasculitis scalded skin syndrome
ESR > 100, +Bence Jones proteins ---------------------------------------------------------------- scaling & desquamation (5 days), then resolution
Dx: serum immunoelectrophoresis shows M-spike Diabetic autonomic neuropathy within 1 2 wks
due to IgG production by plasma cells cardiac tachycardia, postural hypotension, children age < 10 yrs
---------------------------------------------------------------- impaired exercise tolerance superficial flaccid blisters with flexural accentuation,
internal carotid artery dissection is a potential peripheral dry skin, pruritus, retinopathy, perioral crusting, & facial edema
cause of stroke in children nerves foot ulcers, poor would healing ----------------------------------------------------------------
o delayed stroke symptoms after trauma Charcot arthropathy ( fx risk) erythema multiforme: targetoid papule or plaque,
Hx of trauma to the soft palate with a foreign body GI gastroparesis, delayed gastric emptying acrofacial distribution, involves palms & soles
---------------------------------------------------------------- esophageal dysmotility, dyspepsia a/w HSV, coccidiomycosis, Mycoplasma
acute bronchitis commonly cause new onset GU erectile dysfunction, decreased libido ----------------------------------------------------------------
blood-tinged sputum; MCC is viral URI neurogenic bladder, urinary retention, use dependence: enhanced pharmacologic effects
mild wheezing & ronchi that clear with coughing overflow incontinence, high PVR, during faster HR (Class IC & IV antiarrhythmics)
epithelial sloughing makes yellow/purulent sputum nephropathy flecainide (class IC): Rx a-fib for maintenance
Rx: supportive, observation ---------------------------------------------------------------- of sinus rhythm with structurally normal hearts
if recurrent/active bleeding > 30 mL, risk factors foot ulcers are graded from 0 - 5 o slowest rate of drug binding & dissociation
for malignancy, or abnormal CXR Management of diabetic foot ulcers from Na+ channel receptors
o Dx: high-resolution chest CT o off-loading o normally does not prolong QRS or QT
---------------------------------------------------------------- o debridement o faster HR causes progressive impulse
pulmonary airway disease (chronic bronchitis, o wound dressing conduction, leading to wide QRS
bronchogenic carcinoma, bronchiectasis) is o ABX Rx: supraventricular arrhythmia
MCC of hemoptysis in adults with a Hx of o revascularization ----------------------------------------------------------------
smoking o amputation non-dihydropyridine CCB (verapamil, diltiazem)
chronic bronchitis: chronic productive cough ---------------------------------------------------------------- displays use dependence by prolonging AV node
for 3 months in 2 successive years; a/w smoking Hx of cyanotic congenital heart disease & refractory period, thus PR interval
bronchiectasis: irreversible dilation & destruction recurrent sinusitis predisposes to brain abscess ----------------------------------------------------------------
of bronchi results in chronic productive cough & o direct spread from sinuses to frontal lobe Digoxin: inhibits ATPase-dependent Na+/K+
inadequate mucus clearance cyanotic heart disease hematogenous spread pump, thus intracellular Na+
o high-resolution CT: dilated bronchi & fever, headache, focal neurologic deficits, seizure o results in decreased Na+/Ca++ exchanger,
bronchial thickening indolent process thus intracellular Ca++
o complication: hemoptysis ---------------------------------------------------------------- enhances vagal tone & slows AV node conduction
o Rx: bronchial artery embolization urinary diverticulum: outpouchings of the Rx: systolic dysfunction (+inotrope)
a/w Hx of recurrent URI & chronic production of bladder or urethra into adjacent tissue ----------------------------------------------------------------
mucopurulent sputum with airway drainage MC in women excisional biopsy with narrow margins & depth
crackles, ronchi, & wheezing are common post-void dribbling, dysuria, dyspareunia through SC fat is preferred for Dx of melanoma
---------------------------------------------------------------- urinary stasis leads to recurrent cystitis/UTI tumors > 1 mm in depth should have a sentinel
Common causes of hemoptysis ---------------------------------------------------------------- lymph node study
pulmonary chronic bronchitis, PE, post-op adhesions cause mechanical SBO depth is the most important prognostic factor
bronchiectasis, Mallory-Weiss, congenital adhesions: Ladds bands ----------------------------------------------------------------
mild TBI with GCS 13 15, vomiting, headache, dry, rough skin with horny plates over extensor DDx: MM (involve IgG or IgA), MGUS (mild
seizure, LOC < 5 min, focal neurologic finding, surfaces: ichthyosis vulgaris symptoms or asymptomatic)
altered mental status: CT without contrast & lizard skin; worsens in winter ----------------------------------------------------------------
observation 4 6 hr ---------------------------------------------------------------- serum protein with normal albumin (gamma gap)
hospitalization unnecessary unless CT is abnormal medulloblastoma: pediatric tumor o DDx: multiple myeloma, amyloidosis,
provide detailed return precautions upon discharge nocturnal or morning headaches, ataxia Waldenstroms, MGUS
---------------------------------------------------------------- a/w posterior vermis syndrome: truncal dystaxia monoclonal gammopathy uncertain significance
minor head trauma: GCS = 15 with non-severe ---------------------------------------------------------------- (MGUS) can be differentiated from MM by
mechanism, no vomiting, no headache, no LOC, method to improve communication of relevant absence of renal insufficiency, hypercalcemia,
no signs of skull fx: no head CT info during patient transfers: sign-out checklist anemia, & lytic bone lesions
serious TBI: GCS < 13, prolonged LOC, ---------------------------------------------------------------- o MGUS is asymptomatic; 1% per year risk
neurologic deficits, signs of basilar skull fx: exercise-induced bronchoconstriction Rx: of progression to MM
requires neuroimaging, inpatient monitoring short-acting -agonist (albuterol) 10 20 min prior Dx: metastatic skeletal bone survey to exclude
(neuro exam q2h), & neuro consult alt Rx: montelukast or inhaled steroids daily lytic bone lesions that suggest MM
---------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------
DDx of stridor in infants/children cirrhosis & ascites with fever or mental status single photon emission CT (SPECT) scan is useful
Croup age 6 mo 6 yrs change: spontaneous bacterial peritonitis (SBP) for evaluating CAD; indicates inducible ischemia
(laryngotracheo parainfluenza virus hypotension, hypothermia, or paralytic ileus when a reversible defect is noted on stress & at rest
-bronchitis) barky cough, inspiratory stridor indicates severe infection Rx: antiplatelets (ASA)
fever, rhinorrhea, congestion MCC: E. coli & Klebsiella ----------------------------------------------------------------
Rx: nebulized racemic epinephrine Dx/Rx: paracentesis (performed before ABX) metformin can cause lactic acidosis if given to
Epiglottitis stridor, dysphagia, excess drooling, Dx = PMN count > 250, +culture patients predisposed to hypoxia (CVD, CKD)
high fever, tachypnea, tachycardia SAAG > 1.1 g/dL (indicates portal HTN) ----------------------------------------------------------------
muffled hot potato voice Rx: empiric 3rd gen cephalosporin (cefotaxime) male infant, recurrent pneumonia & otitis media
lateral XR: thick aryepiglottic folds after age 6 9 months: Brutons
----------------------------------------------------------------
Laryngomalaci age 4 8 months XR defect in B-cell tyrosine kinase
Riluzole (glutamate inhibitor) Rx: ALS
a stridor worsens when supine, all serum Igs & B-cells levels decreased
corticosteroids: Rx acute exacerbations of MS
improves when prone recurrent pyogenic infections (S. pnemo, H. infl)
----------------------------------------------------------------
foreign body age 6 mo 4 yr maternal IgG maintained for first 6 months
hepatic adenoma: benign tumor common in
aspiration acute onset inspiratory stridor, ----------------------------------------------------------------
focal monophonic wheezing, young/mid-aged women; chronic OCP use
solitary mass in right hepatic lobe CVID: serum Igs decreased; similar to Brutons
moderate/severe respiratory distress less severe symptoms & later onset (age 15 35 yrs)
Vascular ring age < 1 yr; difficulty feeding ALP & GGT
Bx: sheets of enlarged hepatocytes containing normal circulating B cells
wheezing, cough, dysphagia
glycogen & lipid deposits ----------------------------------------------------------------
improves with neck extension,
Rx: surgical resection if symptomatic neonate with hypocalcemic seizures: DiGeorge
a/w cardiac abnormalities
complications: intra-tumor hemorrhage & ----------------------------------------------------------------
malignant transformation ( AFP) mortality benefits in CHF: ACE-I, -blockers,
vascular ring: does not improve with corticosteroids,
---------------------------------------------------------------- ARB, spironolactone
racemic epinephrine, or bronchodilators; requires
abdominal fat pad Bx for suspected amyloidosis digoxin decreases hospitalizations in CHF
high index of suspicion
o Dx: barium contrast esophagogram, ---------------------------------------------------------------- dobutamine: temporary Rx for severe
bronchoscopy, CT or MRA IgM spike on electrophoresis, hyperviscocity decompensated CHF to improve contractility, but
o Rx: surgical correction due to excess IgM: Waldenstroms risk for arrhythmia
anemia, lymphadenopathy, hepatosplenomegaly ----------------------------------------------------------------
----------------------------------------------------------------
Friedrich ataxia: MC spinocerebellar ataxia
AR, median survival rarely beyond 20 yrs
gait ataxia, frequent falls, dysarthria ---------------------------------------------------------------- ----------------------------------------------------------------
concentric cardiac hypertrophy, scoliosis, endometrial ablation is contraindicated with acute Hep B markers: HBsAg & IgM anti-HBc
hammer toes endometrial hyperplasia; prevents future o both are elevated during window period
MCC death: cardiomyopathy evaluation of the endometrium by biopsy HBsAg: first to appear 4 -8 wk after infection
---------------------------------------------------------------- ---------------------------------------------------------------- HBcAg is not detectable
Causes of AUB in premenopausal women peripheral artery aneurysm: pulsatile mass that ----------------------------------------------------------------
o structural: fibroids, adenomyosis, compresses adjacent structures, results in fever, lethargy, signs of heart failure after a viral
endometrial polyp, malignancy thrombosis & ischemia prodrome in a child: viral myocarditis
o non-structural: coagulopathy, infection anterior thigh pain 2/2 femoral nerve compression MCC: Coxackie B, Adenovirus
o ovulatory dysFx: prolactinoma, PCOS, popliteal & femoral artery aneurysm are a/w AAA myocyte necrosis impairs systolic/diastolic function
thyroid disorder, eating disorder, weight loss ---------------------------------------------------------------- heart failure signs: dyspnea, syncope, N/V,
#1 Dx: exclude pregnancy Cervicitis tachycardia, hepatomegaly
Dx: endometrial Bx #1 MCC: C. trachomatis CXR: cardiomegaly, pulmonary edema
---------------------------------------------------------------- #2 MCC: N. gonorrhea (urethritis & PID) echo: diffuse hypokinesis
postmenopausal women with AUB are at high risk o 50% asymptomatic Dx: myocardial biopsy shows inflammatory
for endometrial cancer o friable cervix with easy bleeding, infiltrate of myocardium with myocyte necrosis
Dx: transvaginal USS, then endometrial Bx mucopurulent discharge Rx: diuretics, inotropes, ICU
Rx uncomplicated gonococcal cervicitis/urethritis: ----------------------------------------------------------------
endometrial biopsy is indicated for evaluating ceftriaxone + azithromycin or doxycycline, Pagets disease of bone is typically asymptomatic,
abnormal uterine bleeding for. which covers resistant gonococci & simultaneous with incidentally ALP
all women 45 & all postmenopausal bleeding Rx C. trachomatis o normal Ca++, phosphorous, & GGT
women < 45 with persistent symptoms or risk do not delay empiric Rx to confirm Dx symptomatics present with pain a/w long bone fx
factors for endometrial cancer Dx: nucleic acid amplification testing resulting in secondary arthritis of hip or knee
unopposed estrogen exposure (obesity, PCOS) ---------------------------------------------------------------- defective osteoid formation at sites of high bone
prolonged amenorrhea with anovulation amiodarone causes pulmonary toxicity turnover; abnormal bone remodeling
---------------------------------------------------------------- related to cumulative dose Dx: elevated ALP; also nuclear bone scan to
Risk factors avoid in patients with pre-existing lung disease determine extent of skeletal involvement
Endometrial carcinoma Breast cancer 2/2 decreased pulmonary reserve Rx: bisphosphonates only if symptomatic
advancing age family Hx ---------------------------------------------------------------- highest risk for hearing loss & osteosarcoma
unopposed estrogen BRCA1/BRCA2 IM epinephrine can prevent/reverse progression DDx: prostate ca with bone mets, MM, statins,
chronic tamoxifen early menarche of anaphylaxis to anaphylactic shock biliary obstruction, osteoporosis
obesity late menopause 2-agonist effect: bronchodilation & systemic ----------------------------------------------------------------
nulliparity prolonged HRT release of inflammatory mediators Indications for treating Pagets disease of bone
chronic anovulation nulliparity 1-agonist effect: vasoconstriction raises BP & symptomatic bone & joint pain
(PCOS) upper airway edema hypercalcemia of immobilization
HNPCC bee stings: refer for venom immunotherapy neuro-compressive symptoms
---------------------------------------------------------------- ---------------------------------------------------------------- high-output cardiac failure
Endometrial biopsy for AUB ASA/salicylate intoxication leads to
involvement of weight-bearing bones
hyperplasia without atypia (< 3% cancer risk) respiratory alkalosis by stimulating respiratory
symptomatic pseudofractures
Rx: progestin therapy to oppose estrogen center, & anion gap metabolic acidosis by
----------------------------------------------------------------
uncoupling oxidative phosphorylation, leads to
F/U in 3 months to assess response sudden worsening of asthma & nasal congestion
anaerobic metabolism
hyperplasia with atypia (30% cancer risk) 30 min 3 hr after NSAIDs ingestion
triad: fever, tinnitus, tachypnea
if considering pregnancy progestin
ABG: low PaCO2, low HCO3, normal pH
if no pregnancy plans hysterectomy
mixed respiratory alkalosis & metabolic acidosis
ASA-exacerbated respiratory disease (AERD): inguinale) does not resolve with ABX also volume depletion, altered mental status,
non-IgE mediated reaction due to ASA-induced hypotension, electrolyte abnormalities
prostaglandin/leukotriene imbalance vulvar pain, malaise, dysuria, painful labial ulcers XR: dilated right or transverse colon (> 6 cm)
o arachidonic acid is diverted to production of a/w inguinal lymphadenopathy: genital herpes Dx: XR, +anemia, fever > 380C, pulse > 120,
leukotrienes via 5-lipoxygenase pathway due to HSV WBC > 10,000
development of asthma & chronic rhinosinusitis non-tender pedunculated lesions (genital warts) medical emergency!!
with nasal polyps, bronchospasm & nasal due to HPV; can progress to SCC if untreated Rx: IV fluids, ABX, bowel rest
congestion following ASA or NSAID ingestion: primary syphilis Dx: dark field microscopy o IV steroids if IBD-induced
pseudoallergic drug reaction o high rate of false negatives with RPR, FTA-ABS ----------------------------------------------------------------
Rx: montelukast, avoid NSAIDs serologic testing right-sided colon cancer presents with anemia
---------------------------------------------------------------- ---------------------------------------------------------------- left-sided colon cancer presents with obstruction
volume overload & ascites are complications of familial colonic polyposis (FAP): 100% cancer risk both are a/w change in bowel habits
decompensated liver cirrhosis AD inheritance, APC gene mutation ----------------------------------------------------------------
Rx: loop diuretics; A/E: hypokalemia, Rx: elective proctocolectomy intestinal lymphoma: diffuse infiltrate by
metabolic alkalosis, prerenal azotemia ---------------------------------------------------------------- atypical lymphocytes
---------------------------------------------------------------- EEG: symmetrical 3 Hz spike-and-wave activity occult blood in stool, abdo pain, weight loss, N/V
pulmonary HTN: long-standing primary on a normal background; provoked/simulated by ----------------------------------------------------------------
pulmonary or cardiac disease hyperventilation: absence seizure (petit mal) clinical evidence of PE should be anticoagulated
o dyspnea on exertion, fatigue, LE edema MCC: age 4 8 yrs before undergoing diagnostic evaluation
pulmonary edema: fluid accumulation in air spaces daydreaming episodes, no post-ictal state Rx:
& parenchyma of the lungs, leading to impaired gas Rx: valproate or ethosuximide presence of DVT features should have Dx
exchange, due to either LV failure to adequately ---------------------------------------------------------------- confirmed before starting anticoagulation
remove blood from the pulmonary circulation complex partial seizures: brief episodes of impaired Wells criteria for
("cardiogenic "), or injury to the lung parenchyma or consciousness, postictal confusion, staring spells, pretest probability of PE
vasculature of the lung ("noncardiogenic ") failure to respond to stimuli, automatisms +3 points
---------------------------------------------------------------- (swallowing, lip smacking, hand picking movements) o clinical signs of DVT
Infectious etiology of genital ulcers EEG: normal or brief discharges; hyperventilation o alternate Dx less likely than PE
HSV multiple, grouped shallow ulcers cannot simulate complex partial seizures +1.5 points
(genital herpes) with erythematous base, ---------------------------------------------------------------- o previous PE or DVT
(PAINFUL) tender lymph nodes, Lennox-Gastaut syndrome: childhood seizures
recurrence is common o HR > 100
of multiple types, mental retardation, age < 7 yrs o recent surgery or immobilization
H. ducreyi single/multiple deep ulcers with EEG: slow spike-and-wave
(chancroid) irregular/ragged border, friable base, +1 point
---------------------------------------------------------------- o hemoptysis
gray/yellow exudate, H. pylori with MALT lymphoma w/o metastasis o cancer
(PAINFUL) matted & tender lymph nodes
Rx: omeprazole + clarithromycin + amoxicillin Total score
o Rx: CHOP chemotherapy if ABX fails < 2 low risk
T. pallidum single, indurated, well-circumscribed
(10 syphilis) papule/chancre that ulcerates (cyclophosphamide, adriamycin, vincristine, 2 6 moderate risk
punched-out, clean base, prednisone) > 7 high risk
(PAINLESS) painless inguinal lymphadenopathy ----------------------------------------------------------------
Toxic megacolon is a complication of UC evaluation of DVT: assess pretest probability
C. trachomatis painless, small shallow ulcers,
(LGV) large & painful buboes UC: multiple bloody BMs, fever, weight loss using Modified Wells Criteria
(PAINLESS) megacolon: total or segmental nonobstructive o if DVT not likely D-dimer testing
Donovanosis ulcers with red, beefy base colonic dilation, severe bloody diarrhea, fever, low D-dimer DVT unlikely
(granuloma no lymphadenopathy tachycardia, leukocytosis high D-dimer compression USS
o if DVT likely compression USS prophylactic anti-D Ig for unsensitized Rh- mom Rx: potassium citrate to alkalinize urine
negative USS DVT unlikely o @ 28 30 wk gestation o citrate inhibits stones & crystallization
positive USS anticoagulate repeat within 72 hr of delivery of Rh+ infant o Rx recurrent stones due to citrate deficiency
DDx of DVT: venous insufficiency, cellulitis, or spontaneous, threatened, or induced abortion allopurinol can be added if hyperuricosuria
ruptured Baker cyst, post-thrombotic syndrome o ectopic or hydatidiform pregnancy ----------------------------------------------------------------
---------------------------------------------------------------- o after CVS or amniocentesis mucormycosis due to Rhizopus: direct extension
tachypnea, weight loss, polydipsia, polyuria: DKA o abdominal trauma, 2nd or 3rd trimester bleed of rhinosinusitis via paranasal sinuses
Dx: fingerstick glucose o external cephalic version MC in immunocompromised & uncontrolled DM
---------------------------------------------------------------- Kleihaur-Betke test: calculates anti-D Ig dose; fever, bloody nasal discharge, nasal congestion
atlantoaxial instability should be suspected in performed if placental abruption occurs in pregos also eye involvement: chemosis, proptosis, diplopia
Down syndrome presenting with UMN findings ---------------------------------------------------------------- necrotic nasal turbinates shows hyphae on KOH
behavioral changes, urinary incontinence, OCPs can cause HTN Rx: surgical debridement & IV amphotericin B
torticollis, dizziness, vertigo, diplopia o switch to an alternate birth control method complication: blindness, cavernous sinus thrombosis,
Rx: surgical fusion if HTN persists Dx: essential HTN coma & death if untreated
---------------------------------------------------------------- initial Rx: diet & exercise ----------------------------------------------------------------
DDx of metabolic alkalosis Rx: low-dose thiazide MTX: purine antimetabolite, DMARD
low urine chloride ---------------------------------------------------------------- A/E: oral ulcers, stomatitis, hepatotoxicity, rash,
o vomiting, NG aspiration, laxative abuse hypertrophic cardiomyopathy (HCM): pulmonary toxicity, bone marrow suppression,
o volume depletion, decreased oral intake asymmetric LVH leads to outflow tract alopecia, macrocytic anemia
o prior diuretic use** obstruction folic acid supplementation reduces A/Es
high urine chloride AD inheritance, MC in African-Americans ----------------------------------------------------------------
o hypovolemic/euvolemic current diuretic use* crescendo-decrescendo systolic murmur @ LLSB -thalassemia major: impaired -globin
o hypervolemic excess mineralocorticoid due to interventricular septal hypertrophy & production, leads to excess -globin chains
(primary hyperaldosteronism, Cushings, systolic anterior motion (SAM) of mitral leaflet chronic hemolysis, transfusion-dependent anemia
ectopic ACTH, severe hypokalemia) dual upstroke carotid pulse -thalassemia minor: one normal -globin allele
saline-resistant type: high urine chloride Rx: -blocker (prolongs diastole); or diltiazem o mainly asymptomatic, mild anemia
o Rx underlying disorder Effect of maneuvers on HCM o high RBC count, low MCV, Hb > 10
saline-responsive type: low urine chloride preload = intensity (Valsalva, standing, nitro) Rx: no therapy required
o Rx: isotonic saline corrects hypochloremia & preload/afterload = murmur intensity o can present similar to iron deficiency anemia
promotes urinary HCO3- excretion (hand grip, squatting, passive leg raise) iron deficiency: low RBC count,
loop diuretics would worsen metabolic alkalosis, ---------------------------------------------------------------- becomes microcytic when Hb < 10
hypokalemia, & volume depletion no detailed metabolic evaluation needed for a ----------------------------------------------------------------
---------------------------------------------------------------- first renal stone
blood type & Ab screen @ first prenatal visit Management of nephrolithiasis
HIV screen @ first prenatal visit; rescreen @ 3rd Dx: abdominal CT without contrast
trimester if high-risk Rx: NSAIDs & narcotics are equally effective
asymptomatic bacteriuria screen @ 1st trimester o narcotics can exacerbate N/V
routine GBS rectovaginal screen @ 35 37 wk, < 5 mm can pass spontaneously
results valid for 5 weeks o conservative Rx: fluid intake > 2 L/day
---------------------------------------------------------------- urology referral for anuria, urosepsis, ARF
Rh alloimmunization/sensitization ----------------------------------------------------------------
anti-D antibodies that form after prior pregnancy uric acid stones are radiolucent, seen on USS or CT
or blood transfusion to Rh+ fetus/blood MC in patients with low urine pH
antepartum prophylaxis not need if father is Rh- ----------------------------------------------------------------
Rx: hydration, urine alkalization, low protein diet
iron - -
deficiency thalassemia thalassemia #2 Rx: CBT pelvic USS: enlarged, edematous
anemia ---------------------------------------------------------------- ovary with blood flow
MCV somatic symptom disorder: 1 persistent physical ruptured sudden onset U/L abdominal pain
RDW normal normal symptom; excessive anxiety, concern & energy ovarian cyst after strenuous or sexual activity,
RBC low high devoted to symptoms; persists 6 months pelvic USS: free fluid near cyst
count physiologic symptoms: pain, heartburn, fatigue PID fever/chills, new vaginal discharge,
PBS microcytic, target cells target cells Rx: regularly scheduled appointments focusing dysuria, cervical motion tenderness,
hypochromi on psychological distress; emphasize reassurance transvaginal USS: r/o tubo-ovarian
c ---------------------------------------------------------------- abscess
iron ferritin, normal/ iron normal/ iron depression with comorbid medical conditions, uncomplicated ovarian cyst rupture: no fever,
studies TIBC & ferritin & ferritin including terminal illness hypotension, tachycardia, or hemoperitoneum
response Hb does not does not short life expectancy Rx: rapid psychostimulants o Rx: analgesics as outpatient
to iron improve improve (methylphenidate, modafinil) ----------------------------------------------------------------
Hb normal normal Hb A2 long life expectancy Rx: SSRI (takes longer to situational syncope: 2/2 autonomic dysregulation
electro reach therapeutic effect) (LOC after urination or during coughing fits)
thalassemia trait: often found incidentally on ---------------------------------------------------------------- ----------------------------------------------------------------
universal screening for anemia at age 1 yr preterm labor: uterine contractions @ < 37 wks postexposure HIV prophylaxis: immediately start
low MCV, total RBC count, normal RDW gestation; cervical dilation &/or effacement with 3-drug antiviral therapy for 4 weeks following
o rarely require Rx, but Dx for genetic counseling preterm labor @ < 34 wks should receive high-risk occupational exposure to blood or body
o iron Rx can cause hemochromatosis o tocolytic (CCB, -blockers, NSAIDs) fluids from HIV-infected individuals
iron deficiency: RDW, total RBC count o Mg-sulfate for neuroprotection Rx: tenofovir, emtricitabine, + raltegravir
---------------------------------------------------------------- o corticosteroids for lung maturity HIV testing immediately to establish baseline
folic acid supplementation: megaloblastic anemia, ---------------------------------------------------------------- status; repeat @ 6 weeks, 3 months, & 6 months
hereditary spherocytosis, PND, sickle cell disease, crampy lower abdominal & back pain during ----------------------------------------------------------------
-thalassemia major, on MTX menses, normal exam: primary dysmenorrhea Strep pneumoniae: MCC of community-acquired
---------------------------------------------------------------- o Rx: NSAIDs & OCPs pneumonia & nursing homes
prednisone: Rx autoimmune hemolytic anemia pain 1 to 2 days before menstruation, dyspareunia, ----------------------------------------------------------------
---------------------------------------------------------------- dysmenorrhea, infertility: endometriosis pivoting/twisting injury or knee struck from
TNF- inhibitors: anti-cytokine heavy menses with clots, constipation, urinary lateral side with foot planted: MCL tear
o infliximab, etanercept frequency, pelvic pain; irregular/enlarged uterus: immediate swelling of knee joint 2/2 effusion
Rx: chronic RA fibroids Rx: bracing & early ambulation
A/E: neutropenia, latent TB reactivation, CHF, dysmenorrhea, menorrhagia, pelvic pain; bulky, o surgery is rarely needed
demyelination, risk of malignancy globular & tender uterus: adenomyosis ----------------------------------------------------------------
---------------------------------------------------------------- dull & ill-defined pelvic pain that worsens with high index of suspicion for physical/sexual abuse
renal vein thrombosis is a/w nephrotic syndrome standing & relieved with menses, dyspareunia: in children with sudden behavioral problems,
membranous glomerulopathy pelvic congestion unstable economic backgrounds, or parents with a
due to loss of anti-thrombin III in urine ---------------------------------------------------------------- Hx of drug/alcohol abuse
---------------------------------------------------------------- DDx of acute pelvic pain ----------------------------------------------------------------
conversion disorder: sudden onset of neurologic Mittelschmer recurrent mild, unilateral mid-cycle vertigo, ear fullness, tinnitus, & hearing loss:
symptoms incompatible with neuro exam z pain 2/2 normal follicular enlargement Menieres disease
unexplained weakness, non-epileptic seizures, prior to ovulation endolymph accumulation in inner ear
paralysis, ataxia, aphonia, blindness, or paresthesia ectopic crampy abdominal pain, amenorrhea, horizontal nystagmus during acute attacks
triggered by stress or emotions pregnancy vaginal bleed, +-hCG #1 Rx: environmental & dietary modifications
not feigned or intentional; la belle indifference ovarian acute onset unilateral abdominal pain, low-salt diet; avoid caffeine, nicotine, alcohol
#1 Rx: education, encouragement, support torsion N/V, tender adnexal mass, ----------------------------------------------------------------
inflammation of pericolic fat, thickened bowel wall, (18 20 wks) position soft markers o edrophonium: short-acting anticholinesterase;
soft tissue mass (phlegmons), pericolic fluid Dx only
suggesting abscess: diverticulitis pregos age 35 at increased risk of aneuploidy ----------------------------------------------------------------
Dx: abdominal CT should be offered cell-free fetal DNA atropine: Rx to prevent muscarinic side effects
---------------------------------------------------------------- o abnormal cffDNA should be confirmed by of AChE inhibitor with myasthenia gravis
calcium oxalate crystals are a frequent finding fetal karyotyping with CVS (1st trimester) or ----------------------------------------------------------------
in urinary sediment, not clinically significant amniocentesis (2nd trimester) incentive spirometry is the most effective at
unless symptoms suggest acute nephrolithiasis low risk of aneuploidy: 1st trimester combined test preventing post-op pulmonary complications
---------------------------------------------------------------- o PAPP, -hCG, USS nuchal translucency ----------------------------------------------------------------
persistent PTX & significant air leak following 2nd trimester (18 20 wks) Quad screen PAPP-A is produced by trophoblast
chest tube placement in a patient with sustained o maternal AFP, -hCG, estriol, inhibin A 1st trimester screen with PAPP-A + -hCG along
blunt chest trauma: tracheobronchial rupture o AFP & estriol, with -hCG & inhibin A is with USS nuchal translucency to detect Downs
pneumomediastinum & subcut. emphysema a/w Downs o Downs produces less PAPP-A
confirm Dx: high-resolution CT, bronchoscopy, next: transabdominal USS to evaluate fetal ----------------------------------------------------------------
or surgical exploration anatomy & growth; abnormal markers risk well-appearing infant with intermittent cyanosis
---------------------------------------------------------------- o next: amniocentesis to confirm abnormal & distress during feeing, relieved by crying:
painless blisters on back of hand, hypertrichosis, quad screen choanal atresia
hyperpigmentation: porphyria cutanea tarda ---------------------------------------------------------------- Dx: head CT
uroporphyrinogen decarboxylase deficiency aminoglycosides cause ototoxicity (hearing loss) ----------------------------------------------------------------
a/w Hep C by damaging cochlear cells CHARGE syndrome: Coloboma, Heart defects,
triggers: alcohol, estrogens gentamicin causes selective vestibular injury Atresia of choanae, Renal anomalies, Growth
Dx: elevated urine porphyrin (vestibulopathy) without significant ototocity impairment, Ear abnormalities
Rx: phlebotomy, hydroxychloroquine, oscillopsia: sensation of objects moving around ----------------------------------------------------------------
interferon-alpha in the visual field when looking in any direction; dermatitis herpetiformis is a/w Celiacs
---------------------------------------------------------------- leads to gait disturbance intensely pruritic papules, vesicles over elbows,
Prenatal testing for fetal aneuploidy Dx: head thrust test (inability to maintain eyes knees, buttocks, posterior neck, scalp
advantages disadvantages on a target) IF: granular IgA deposits along dermal papillae
cff DNA high sensitivity & ---------------------------------------------------------------- +anti-endomysial antibodies
( 10 wks) specificity for not diagnostic myasthenia gravis: diplopia, jaw fatigue after Rx: dapsone (heals within hours)
aneuploidy prolonged chewing, dysarthria with talking ----------------------------------------------------------------
1st trimester normal reflexes benign paroxysmal positional vertigo (BPPV):
combined noninvasive not diagnostic hallmark: resolution of weakness with rest Ca++ crystals in semicircular canals (canaliths)
test Dx: EMG & ACh Rc antibody test MCC of vertigo
(9 13 wks) also chest CT to screen/exclude for thymoma brief, recurrent episodes of room spinning with
2nd trimester ---------------------------------------------------------------- head movements or position change
quad screen noninvasive not diagnostic Rx options for myasthenia gravis no neurologic or auditory symptoms
(15 20 wks) o pyridostigmine: symptomatic relief only Dx: Dix-Hallpike maneuver cause nystagmus
CVS early definitive pain, vaginal (A/E: cramps, fasciculations, weakness) Rx: Epley maneuver
(10 13 wks) karyotypic Dx spotting, risk of o atropine: anticholinergic; prevents ----------------------------------------------------------------
pregnancy loss lateral cerebellar infarction: dizziness, ataxia,
muscarinic A/E of anticholinesterases
amniocentesi definitive pain, risk of bleed weakness, swaying TOWARD the lesion side
o immunosuppressives: induce remission
s karyotypic Dx & amniotic fluid ----------------------------------------------------------------
(prednisone, azathioprine, cyclosporine)
(15 20 wks) leak hypercalcemia, renal insufficiency, metabolic
o thymectomy: induces remission
2nd trimester fetal growth, cannot identify all alkalosis: milk-alkali syndrome
o plasmapheresis: Rx myasthenia crisis
USS anatomy, placenta abnormalities; normal phosphate & ALP levels
---------------------------------------------------------------- CSF: normal pressure & total protein, elevated IgG o meningocele, enteric cysts, lymphoma,
methamphetamine: CNS stimulant & oligoclonal bands (not diagnostic) esophageal tumors, diaphragmatic hernias,
HTN, tachycardia, agitation, aggressiveness Dx: MRI show cerebral or cerebellar plaques as aortic aneurysms
acne or facial sores due to skin picking hypo/hyperdense lesions involving white matter ----------------------------------------------------------------
---------------------------------------------------------------- ---------------------------------------------------------------- seminomas: -hCG only
drug-induced hypersensitivity reaction, Type I: contraindication for use of succinylcholine for non-seminomatous germ cell tumors
drug-specific IgE occupy receptors on mast cells rapid-sequence intubation: hyperkalemia o yolk sac tumors, choriocarcinoma,
& basophils; immediate onset also burn & crush injury (rhabdomyolysis), embryonal carcinoma
o Rx: antihistamines for urticarial & pruritus prolonged demyelination (Guillain-Barre, tumor o AFP, -hCG
o Rx: epinephrine & corticosteroids for lysis syndrome) ----------------------------------------------------------------
anaphylaxis with systemic symptoms succinylcholine causes significant K+ release & Neonatal bowel obstruction
ABX-induced rash due to infectious mononucleosis life-threatening arrhythmias if stable, initial test: abdominal XR to rule out
2/2 EBV develops after 24 hr safe alternatives: vecuronium, rocuronium pneumoperitoneum due to bowel perforation,
---------------------------------------------------------------- ---------------------------------------------------------------- which would require emergency surgery
confusion, lethargy, fatigue, anorexia, polyuria, CBT: reduces automatic negative thoughts & next test: water-soluble contrast enema
constipation, CXR suggestive of lung cancer: avoidance behaviors that cause distress microcolon is caused by viscous meconium
hypercalcemia of malignancy uses: depression, anxiety, PTSD, OCD, accumulation in terminal ileum due to CF
2/2 PTHrP production somatoform disorders, eating disorders o Rx: Gastrografin hyperosmolar enema
a/w squa-Ca++-mous cell lung cancer ---------------------------------------------------------------- narrow rectosigmoid & dilated megacolon
---------------------------------------------------------------- psychodynamic psychotherapy focuses on the transition zone: Hirschsprung disease
tremor is often first manifestation of Parkinsons, role that unconscious conflict causes symptoms; o next test: rectal biopsy (absent ganglion cells)
can present asymmetrically emphasize ways in which passive experiences ----------------------------------------------------------------
Rx: trihexyphenidyl (anticholinergic) for shape the present situations CXR: widened mediastinum, left-sided hemothorax,
younger patients if tremor is the primary symptom ---------------------------------------------------------------- right-sided mediastinal deviation, disruption of
---------------------------------------------------------------- chorioamnionitis: maternal fever PLUS 1: normal aortic contour
all suspected BPH: U/A & serum creatinine uterine tenderness, maternal or fetal tachycardia, rapid deceleration blunt chest trauma are high risk
Cr suggests bladder outlet obstruction malodorous amniotic fluid, or purulent discharge for aortic injury with contained aortic rupture
Dx: renal USS risk factor: PROM (> 18 hr) confirm Dx: CT angiogram
Rx: urinary catheter, tamsulosin, finasteride MCC: polymicrobial ----------------------------------------------------------------
o TURP for refractory symptoms Dx: IV ABX & oxytocin to accelerate labor pneumomediastinum & pleural effusion:
---------------------------------------------------------------- o c-section for normal OB indications esophageal rupture
Charcot joint: neurogenic arthropathy ---------------------------------------------------------------- Dx: water-soluble contrast esophagography
a/w Vit B12 deficiency, diabetes cor pulmonale: isolated RHF 2/2 pulmonary HTN; ----------------------------------------------------------------
proprioception, pain & temp sensation MCC is COPD sudden onset dyspnea, colicky abdominal pain,
unknowingly traumatizes weight-bearing joints, exertional syncope, exertional angina, JVD, ascites rapid-onset for edema of the face, extremities, &
results in secondary DJD & joint deformities RV heave, dependent pitting edema, hepatomegaly genitals without urticaria: hereditary angioedema
XR: loss of cartilage, osteophytes, loose bodies Dx: right heart catheterization show RV dysFx, complement C1 inhibitor deficiency results in
Rx: underlying disease, mechanical devices to pulmonary HTN, & absence of left heart disease elevated bradykinin; normal C1q levels, C4
decreased further trauma ---------------------------------------------------------------- episodes following infection, dental procedures,
---------------------------------------------------------------- DDx of anterior mediastinal mass: 4 Ts = or trauma
patchy neurological deficits, painful loss of vision, thymoma, teratoma, thyroid, terrible lymphoma ----------------------------------------------------------------
central visual field defect, normal fundoscopy: MS bronchogenic cysts: middle mediastinum MCC of acquired isolated angioedema: ACE-I
optic neuritis, Uhthoff phenomenon, Lhermitte sign all neurogenic tumors: posterior mediastinum low C1q levels
scanning speech can occur at anytime
also, ACE-I can precipitate ARF in patients with headache, vomiting, abdo pain, phosphorus skin, elderly, memory impairment, social withdrawal,
B/L renal artery stenosis bitter almond odor: cyanide toxicity depressed mood: pseudodementia
---------------------------------------------------------------- o Rx: sodium thiosulfate poor effort with cognitive testing
child with nocturnal headaches, morning vomiting, tinnitus, N/V, fever, acid-base abnormalities: distressed by impaired memory
with coexisting otitis & mastoiditis: temporal salicylate intoxication (Alzheimers are indifferent & confabulate)
brain abscess o Rx: sodium bicarbonate to alkalinize urine Rx: SSRI improves depression & cognition
intracranial pressure increases in supine position HTN, hyperthermia, tachycardia, diaphoresis, ----------------------------------------------------------------
& stimulates medullary vomiting center mydriasis, hyperreflexia: serotonin syndrome crescent formation on light microscopy: RPGN
Dx: solitary ring-enhancing lesion on CT with o Rx: benzo (lorazepam) hyalinosis of afferent & efferent arterioles:
contrast or MRI horizontal nystagmus, cerebellar ataxia, confusion: diabetic nephropathy
Rx: high-dose corticosteroids phenytoin toxicity linear deposits & anti-IgM: Goodpastures
---------------------------------------------------------------- tremor, hyperreflexia, ataxia, seizure: lithium tox. granular deposits: immune complex GN
3 phases of viral hepatitis: prodromal, enteric, o Rx: hemodialysis (postinfectious GN, lupus nephritis, IgA neph)
convalescent ---------------------------------------------------------------- ----------------------------------------------------------------
Hep A Hep B Hep C undiagnosed pleural effusion is best evaluated unexplained chronic & severe abdo pain, weight
incubation 30 days 13 40 50 with thoracocentesis loss, food aversion: chronic mesenteric ischemia
period months days Dx: diagnostic thoracocentesis chronic occlusion of visceral arteries leads to
transmssn contaminated sexual, parenteral o if clear evidence of CHF trial of diuretic worsening postprandial pain & food avoidance
food or water, parenteral, transudate or exudate? evidence of atherosclerotic disease (HTN,
fecal-oral vertical transudative effusion rules out malignancy CAD, DM type II, hypercholesterolemia, PVD)
risk factors recent travel IVDA lung carcinoma, breast carcinoma, & lymphoma: nonspecific physical exam, XR, CT scan
prognosis self-limited cirrhosis, Dx: angiography or Doppler USS
MCC malignant exudative pleural effusion
HCC ----------------------------------------------------------------
----------------------------------------------------------------
artificial heart valves or severely calcified valves acute aortic dissection can cause hemopericardium,
acute onset malaise, anorexia, N/V, mild abdo pain, progress to cardiac tamponade & cardiogenic shock
cause microangiopathic hemolytic anemia
aversion to smoking: Hep A LDH, haptoglobin, indirect bilirubin, Dx: TEE (hemodynamically stable)
hepatosplenomegaly, AST/ALT spike Rx: IV labetalol
reticulocytosis, schistocytes
Rx: supportive; close contacts: Hep A Ig chronic hemolysis leads to iron loss & Rx: pericardiocentesis (hemodynamically unstable)
---------------------------------------------------------------- microcytic anemia ----------------------------------------------------------------
dysphagia, salivation, mouth burns, severe pain, ---------------------------------------------------------------- sharp, pleuritic chest pain, pericardial friction rub,
white tongue: caustic poisoning autoimmune hemolysis: +direct Coombs, uremia (BUN > 60): uremic pericarditis
does not cause altered mental status +spherocytes do not have classic EKG changes
complications: peritonitis, mediastinitis ---------------------------------------------------------------- Rx: hemodialysis
---------------------------------------------------------------- AL amyloidosis (primary): MM, Waldenstrom ----------------------------------------------------------------
hyperthermia, mydriasis, delirium, dry, mouth, AA amyloidosis (secondary to chronic inflmmation): brain infarct: hypodense on CT scan
urinary retention, decreased bowel sounds: RA, TB, Crohns, lymphoma, vasculitis IC hemorrhage: hyperdense on CT scan
anticholinergic toxicity ---------------------------------------------------------------- o Rx: stop warfarin & ASA, give FFP & Vit K
o Rx: physostigmine rheumatoid arthritis predisposes to AA amyloidosis ----------------------------------------------------------------
CNS depression, arrhythmias, hypotension, causes nephrotic syndrome after blunt chest trauma, hemorrhagic shock a/w
anticholinergic signs: TCA poisoning enlarged kidneys, hepatomegaly decreased breath sounds & dullness to percussion
o Rx: sodium bicarbonate renal Bx: amyloid deposits stain with Congo red over one hemithorax & C/L tracheal deviation:
anticholinergic symptoms, drowsiness, confusion: & apple-green birefringence massive hemothorax
diphenhydramine toxicity ---------------------------------------------------------------- MCC: traumatic laceration of lung parenchyma or
o Rx: physostigmine damage to intercostal/internal mammary artery
DDx: tension PTX (hyperressonance), pulmonary exception is emergency conditions, transfusions, MDD
contusion (no hemorrhagic shock) & surgery o 2 wks, 4/9 SIGECAPS
---------------------------------------------------------------- ---------------------------------------------------------------- o significant functional impairment
alopecia, skin lesions, abnormal taste, impaired o no lifetime Hx of mania
wound healing: zinc deficiency Adjustment disorder with depressed mood
2/2 chronic TPN or malabsorption o onset within 3 months of identifiable stressor
found in animal protein, whole grains, beans, nuts o marked stress & significant impairment
digested in the jejunum o does not meet other DSM-5 criteria
---------------------------------------------------------------- Normal stress response
selenium deficiency: cardiomyopathy o not excessive or out of proportion to severity
---------------------------------------------------------------- of stressor
fever, focal spinal tenderness, neurologic dysFx: o no functional impairment
spinal epidural abscess ----------------------------------------------------------------
risk factors: IVDA, immunocompromised, impaired social & occupational functioning is a
infectious hematogenous spread, vertebral body DSM-5 requirement for all psychiatric disorders
osteomyelitis, steroid injections, epidural anesthesia ----------------------------------------------------------------
MCC: S. aureus Herpes simplex (HSV) keratitis
---------------------------------------------------------------- Dx: spine MRI with gadolinium, ESR, CRP, CT- pain, photophobia, blurred vision, tearing
case-control study: determines outcome first guided aspiration & culture dendritic ulcers is MC presentation
then compares past associated risk factors Rx: ABX, surgical decompression & drainage recurrence due to excessive sun exposure
retrospectively assess outcomes with risk factors complications: cord compression, cauda equina complication: corneal blindness
obtained by interviews, health records, lab reports ---------------------------------------------------------------- ----------------------------------------------------------------
used to measure odds ratio Common skin infections dendriform corneal ulcers & vesicular rash in V1
---------------------------------------------------------------- fiery red, tender, painful plaque Erysipelas trigeminal distribution: herpes zoster (VZV)
retrospective cohort: reviews prior records for with demarcated edges; limited to (S. pyogenes) ophthalmicus
risk factor exposure then determine incidence epidermis & superficial dermis MC in elderly; or a presenting sign of HIV
o both risk factors & outcome occur in the past folliculitis: purulence in hair follicle Cellulitis vesicular rash in CN V1 cutaneous branch
---------------------------------------------------------------- in areas of heavy friction/sweating (purulent) periorbital burning & itching, fever, malaise
prospective cohort study: chose subjects based on furuncles: folliculitis extending into S. aureus conjunctivitis & dendriform corneal ulcers
risk factors, then compare disease incidence dermis, leads to abscess
Dx: high-dose acyclovir within 72 hrs
allows for calculation of relative risk carbuncle: severe infection due to
aggregation of multiple furuncles ----------------------------------------------------------------
observational HIV retinopathy: benign, cotton-wool spots
better ability to prove causation than case control erythema, edema, tenderness Cellulitis
flat subcut. lesions, less demarcated (non-purulent) which remit spontaneously
& cross-sectional studies ----------------------------------------------------------------
---------------------------------------------------------------- regional lymphadenopathy Group A Strep
bacterial keratitis: MC in contact lens wearers
cross-sectional study: current risk factor hazy cornea + central ulcer; adjacent stromal abscess
exposures compare disease prevalence risk factors: venous insufficiency, skin disruption,
obesity MCC: Pseudomonas
observational ----------------------------------------------------------------
Rx: oral ABX; or IV ABX if systemic involvement
assess exposure & outcome simultaneously Todd paralysis: post-ictal hemiparesis,
(hypotension, tachycardia)
shows an association, but not causation restoration of motor function within 24 hr
o nafcillin: IV anti-staphylococcal
---------------------------------------------------------------- ----------------------------------------------------------------
----------------------------------------------------------------
informed consents obtained from either parent hydatid cysts caused by Echinococcus spp affect
flail chest Rx: pain control, supplement O2, PPV
of a minor prior to performing a procedure the liver & lungs
----------------------------------------------------------------
DDx of depressed mood MC in sheep breeders & exposure to dogs
---------------------------------------------------------------- Isotretinoin: must not be taken by reproductive age o hemodynamic instability requires surgical eval.
T. solium: neurocysticercosis women unless 2 effective forms of contraception are ----------------------------------------------------------------
consuming T. solium eggs in human feces used for at least 1 month prior to initiating, during, Hepatic metabolism of bilirubin
not contracted by eating infected pork & 1 month after treatment 1. bilirubin uptake from bloodstream
multiple, small fluid-filled cysts in brain parenchyma pregnancy test 1 wk before starting & 2. storage within hepatocyte
---------------------------------------------------------------- periodically during therapy 3. conjugation with glucuronic acid
Enterobius vermicularis (pinworm) infection ---------------------------------------------------------------- 4. biliary excretion
Rx: albendazole or pyrantel pamoate; including hemolytic anemia, jaundice, splenomegaly; or ----------------------------------------------------------------
all household contacts infant with persistent jaundice despite photo-Rx: Dubin-Johnson: conjugated hyperbilirubinemia,
---------------------------------------------------------------- hereditary spherocytosis dark granular pigment in hepatocytes (black liver)
risk factors for gallstones: fat, fertile, female, 40, AD inheritance, northern European descent o normal urinary coproporphyrin
Native American, DM, rapid weight loss, OCPs ankyrin gene mutation spectrin deficiency & o elevated coproporphyrin I
Dx: abdominal USS extravascular hemolysis o normal AST, ALT, & ALP
Rx #1: lap chole jaundice, dark urine, acute cholecystitis due to o no Rx needed, benign, good prognosis
Rx #2 (poor surgical candidates): ursodeoxycholic pigmented gallstones Rotor syndrome: defect of hepatic storage of
acid (bile acid, dissolves gallstones) high recurrence MCHC, RDW, negative Coombs conjugated bilirubin with leakage into plasma
---------------------------------------------------------------- Dx: acidified glycerol lysis test o conjugated bilirubinemia; +urine bilirubin
HIDA scan: visualizes bile duct obstruction, GB o & eosin-5-maleimide binding test o dark urine; normal AST, ALT, & ALP
disease, & bile leaks Rx: folate, blood transfusions, splenectomy o no Rx, benign, absence of black liver
ERCP Rx: therapeutic intervention for bile duct o chronic hemolysis consumes folate Crigler-Najjar Type I: severe jaundice,
obstruction or cholangitis complications: pigmented gallstones, aplastic crises kernicterus, neurologic impairment & death
PTC: visualize interahepatic & extrahepatic 2/2 parvovirus B19 o unconjugated bilirubinemia
biliary tree; invasive ---------------------------------------------------------------- if given IV phenobarbital bilirubin unchanged
---------------------------------------------------------------- Tularemia: Francisella tularensis (rabbits) o Rx: liver transplant
Indications for aortic valve replacement U/L cervical lymphadenopathy, fever/chill, headache Crigler-Najjar Type II: less severe than Type I
all symptomatic aortic stenosis (AS) ---------------------------------------------------------------- o survival into adulthood
SAD: syncope, angina, dyspnea Toxic shock syndrome due to S. aureus exotoxin o if given IV phenobarbital bilirubin is reduced
severe AS undergoing CABG or valvular surgery a/w tampons, nasal packing, post-surgery infection o no Rx in mild cases
asymptomatics with severe AS & poor LV systolic fever, marked hypotension, altered mentation, Gilberts: familial disorder of reduced bilirubin
function, LVH > 15 mm, valve area < 0.6 cm2, or myalgia, multi-organ injury glucuronidation; unconjugated bilirubin
abnormal response to exercise diffuse erythematous macular rash on the trunk, o triggers: fasting, fat-free diet, illness, stress
---------------------------------------------------------------- spreads to extremities (includes palms/soles), o normal LFTs, CBC, blood smear, reticulocytes
only left-sided murmurs on expiration desquamation 1 2 wk after onset Alloimmune hemolytic disease (erythroblastosis
---------------------------------------------------------------- thrombocytopenia fetalis): unconjugated, +Coombs
cholesterol embolism is a complication of ---------------------------------------------------------------- o Rh disease, ABO incompatibility
cardiac catheterization & vascular procedures meningococcemia: petechial rash ecchymosis, physiologic jaundice: unconjugated, appears
blue toe syndrome, livedo reticularis, bullae, vesicles gangrenous necrosis after 24 hr of life, resolves within 1 wk
Hollenhorst plaques in the retinal artery, AKI, fever, N/V, myalgias, meningeal signs breast milk jaundice: unconjugated, appears
cerebral infarction, intestinal ischemia ---------------------------------------------------------------- after 2nd wk of life, benign
Rx: supportive, statins prevent recurrence lightheadedness, diffuse abdo pain, adnexal & ----------------------------------------------------------------
---------------------------------------------------------------- cervical motion tenderness, hemodynamic instability: hemolysis leads to unconjugated hyperbilirubin
acute, unilateral cervical lymphadenitis in children: ectopic pregnancy & +urine urobilinogen assay
S. aureus Hx of syncope, hypotension, tachycardia: o urine bilirubin assay is negative since there
enlarged, tender & erythematous lymph node ruptured ectopic pregnancy is no hepatic dysfunction
---------------------------------------------------------------- Dx: -hCG & transvaginal USS
---------------------------------------------------------------- elevated LA & LV filling pressures results in initial evaluation of suspected BPH: urinalysis
liver steatosis: 2/2 long-term OCP usage acute pulmonary edema to assess for UTI & hematuria
---------------------------------------------------------------- does not change chamber size or compliance cytoscopy if U/A shows hematuria
hypoalbuminemia can total serum Ca++, but ---------------------------------------------------------------- PSA screen for prostate cancer if life
ionized Ca++ is hormonally regulated & stable moderately obese middle-aged male, fatigability, expectancy > 10 yrs
o serum Ca++ by 0.8 mg/dL for every 1 g/dL daytime somnolence, morning headaches, snoring, ----------------------------------------------------------------
in serum albumin mild HTN: sleep apnea syndrome severe persistent HTN: > 185/110 is a C/I to
---------------------------------------------------------------- hypoxemia-induced in EPO causes polycythemia thrombolytics
lymphocytic infiltration of salivary glands in Rx: weight reduction, avoid sedative & alcohol, Rx: labetalol or nicardipine
Sjogren syndrome causes enlarged & firm avoid sleeping supine ----------------------------------------------------------------
submandibular glands polycythemia improves with OSA Rx intravascular hemolysis: RBC structural damage
---------------------------------------------------------------- complications: pulmonary HTN, RV failure (PNH, DIC)
CHF causes preferential vasoconstriction of ---------------------------------------------------------------- o haptoglobin, LDH
efferent renal arterioles, thus increased OSA alone causes nocturnal hypoventilation, extravascular hemolysis: RBCs destroyed by
intraglomerular pressure to maintain GFR resulting in transient hypoxia & hypercarbia that phagocytes in spleen RES (AIHA, HS, G6PD def.)
o also ADH secretion to maintain C.O. resolves during wakefulness o less Hb release, slight elevation of LDH,
---------------------------------------------------------------- o morning headaches, impotence, arterial HTN normal haptoglobin
salmon-colored, hypopigmented & hyperpigmented o normal ABG ----------------------------------------------------------------
macules on the upper trunk: Tinea versicolor obesity hypoventilation syndrome (Pickwickian): autoimmune hemolytic anemia, G6PD
MCC: Malassezia globosa due to obesity & untreated OSA deficiency & hereditary spherocytosis all cause
exposure to hot & humid weather chronic hypercapnic respiratory failure, hypoxia, extravascular hemolytic anemia & +spherocytes
KOH: large, blunt hyphae & thick-walled secondary erythrocytosis, pulmonary HTN, & o AIHA: negative family Hx, +Coombs
budding spores (spaghetti & meatballs) cor pulmonale o HS: +family Hx, negative Coombs
Rx: selenium sulfide, ketoconazole, terbinafine chronic respiratory acidosis compensatory o G6PD deficiency: Heinz bodies, neg Coombs
---------------------------------------------------------------- metabolic alkalosis ----------------------------------------------------------------
ring-shaped lesions with enlarging raised, scaly Cl reabsorption due to HCO3 retention decreased passive & active ROM, more stiffness
border & central clearing, or patchy scales on the ---------------------------------------------------------------- than pain: adhesive capsulitis (frozen shoulder)
trunk: Tinea corporis (ringworm) obesity hypoventilation syndrome: obesity inability to lift arm above head; due to fibrosis
scalp = Tinea capitis (a/w hair loss) impedes chest & abdomen expansion in breathing risk factors: idiopathic, rotator cuff tendinopathy,
Rx: terbinafine or itraconazole BMI > 30; daytime hypersomnolence subacromial bursitis, paralytic stroke, DM,
---------------------------------------------------------------- obesity reduces chest wall & lung compliance, humoral head fracture
ABI 0.9 is abnormal thus tidal volume, TLC, & FRC ----------------------------------------------------------------
---------------------------------------------------------------- persistent hypoventilation factors that aggravate prerenal azotemia:
ASA: antiplatelet; early Rx of acute ischemic stroke awake daytime hypercapnea: PaCO2 > 45 decreased fluid intake, ACE-I, NSAIDs
---------------------------------------------------------------- increases respiratory work, respiratory drive due decreased effective renal blood flow activates the
recombinant tPA (alteplase): Rx acute ischemic to decreased chemosensitivity to hypercapnia RAA axis, which constrict glomerular arterioles
stroke; initiated within 3 4.5 hr of onset renal HCO3 retention compensates for (efferent > afferent) to maintain intraglomerular
Dx: head CT r/o intracranial hemorrhage respiratory acidosis, which blunts the ventilatory pressure & GFR
C/I: unknown duration, severe & persistent HTN, response to CO2 hypoventilation continued volume depletion GFR
small deficits, rapid recovery of deficits normal A-a gradient persistent untreated renal hypoperfusion leads to
---------------------------------------------------------------- #1 Rx: nocturnal positive-pressure ventilation intrinsic renal failure due to ischemia
acute mitral regurgitation can occur due to o also: weight loss, bariatric surgery o tubules undergo acute ischemic necrosis &
papillary muscle displacement during acute MI o avoid sedatives reabsorption of solutes is impaired
abrupt & excessive volume overload ---------------------------------------------------------------- o BUN/Cr ratio falls (< 20:1)
----------------------------------------------------------------
compartment syndrome: pain out of proportion adults: PLUS arthralgias/arthritis ----------------------------------------------------------------
to injury, pain with passive ROM, paresthesia transmit mild disease 2 3 wks after inhalation of Viridans group Streptococci (S. mutans) causing
sensory loss & motor weakness present later respiratory droplets native-valve IE are susceptible to PCN
arterial pulses are present Dx PCR, anti-rubella IgM & IgG IV ABX is preferred for initial Rx
Dx: measure compartment pressures Rx supportive, acetaminophen empiric Rx: IV vancomycin
Rx: urgent fasciotomy prevent live attenuated rubella vaccine (MMR) Rx: IV aqueous PCN G or IV ceftriaxone
---------------------------------------------------------------- first trimester infection results in spontaneous PCN-allergic: vancomycin
Kawasaki disease (mucocutaneous lymph node abortion & congenital rubella; teratogenic ----------------------------------------------------------------
syndrome) is a clinical diagnosis ---------------------------------------------------------------- ALL: lymphoblasts lack peroxidase positive
o common in age < 5 Measles (rubeola) granules but contain cytoplasmic aggregates of
o fever 5 days transmission respiratory droplets (hours) PAS positive material
o B/L non-exudative conjunctivitis manifest 1 3 wks after exposure positive TdT: expressed only by pre-B & pre-T
o cervical lymphadenopathy > 1.5 cm features prodrome fever, malaise, anorexia; lymphoblasts
o mucositis (injected/fissured lips or cough, coryza, conjunctivitis, & recurrent infection, lymphadenopathy, splenomegaly
strawberry tongue) Koplik spots, followed by Dx: > 25% lymphoblasts
o swelling/erythema of palms/soles blanching, red-brown maculopapular rash with ----------------------------------------------------------------
o polymorphous rash cephalocaudal/centrifugal spread; spares palms/soles myeloblasts contain peroxidase positive material
Rx: ASA & IV immunoglobulin within 10 days Dx PCR, anti-measles IgM & IgG ----------------------------------------------------------------
of fever to prevent cardiac complications, but prevention live, attenuated vaccine mass involving mandible or abdominal viscera,
usually self-limited (Reye syndrome risk with Rx supportive, anti-pyretics, hydration high mitotic index, starry sky appearance:
ASA; life-threatening hepatic encephalopathy) Vitamin A ( morbidity/mortality) Burkitt lymphoma
complications: coronary artery aneurysms, complications otitis media, pneumonia, Rx: high-dose chemotherapy
leading to MI & ischemia gastroenteritis, encephalitis ----------------------------------------------------------------
o perform a baseline echocardiography in all (subacute sclerosing panencephalitis) abdominal pain, constipation, polydipsia
suspected cases; repeat to monitor changes a single elevated Ca++ must be confirmed with a
---------------------------------------------------------------- known/suspected cases: immediate isolation with second serum Ca++ to confirm hypercalcemia
congenital syphilis: rhinorrhea, cataracts, negative air pressure, N95 mask next: measure PTH levels
sensorineural hearing loss; no cardiac defects Koplik spots: tiny, white lesions in conjunctiva elevated PTH measure urinary Ca++
congenital CMV: unilateral deafness, IUGR, & buccal mucosa o high urine Ca++ 10 & 30 hyperPTH
chorioretinitis; no cardiac defects ---------------------------------------------------------------- o low urine Ca++ familial hypercalcemic
congenital toxoplasmosis: chorioretinitis, complication of untreated Strep pharyngitis: hypocalciuria
hydrocephalus, intracranial calcifications, Scarlet fever suppressed PTH measure PTHrP, 25(OH)D,
sensorineural hearing loss; no cardiac defects preceding Group A Strep infection (tonsillitis, & 1,25(OH)D
---------------------------------------------------------------- pharyngitis) with tonsillar gray/white exudates o PTHrP malignant tumor
Rubella (German measles, RNA togavirus) produces erythrogenic exotoxins o 25(OH)D Vit D toxicity
features congenital: sensorineural deafness, cardiac incubation: 1 7 days o 1,25(OH)D CXR for lymphoma, sarcoid
defects (PDA), glaucoma/cataracts, prodromal fever, headache, vomiting, sore throat, o all normal hyperthyroidism, MM,
microcephaly, thrombocytopenic blueberry acromegaly, milk-alkali syndrome
circumoral pallor, then 12 48 hr later
muffin rash purpura ----------------------------------------------------------------
fine pink blanching papules on neck, axilla, groin;
children: low-grade fever, coryza, antipsychotics cause hyperprolactinemia by
sandpaper-like texture; spares palms/soles
conjunctivitis, cervical lymphadenopathy, blocking DA activity of tuberoinfundibular path,
Forschheimer spots (petechiae on soft palate) Dx: throat culture
projects from hypothalamus to pituitary
transient (< 3 days) cephalo-caudal Rx: rapid response to PCN V; or amoxicillin o amenorrhea, galactorrhea, gynecomastia,
blanching maculopapular rash in centrifugal complications: rheumatic fever sexual dysfunction
pattern DDx: Kawasakis (B/L conjunctival injection)
therapeutic effects of antipsychotics work on the Abs to ABO antigens cause mild disease in DDx: bulimia, GERD, malrotation, Munchausen,
mesolimbic pathway, projects from ventral most newborns compared to Rh incompatibility mesenteric adenitis, viral gastroenteritis
tegmental area (VTA) to limbic system can occur in the first pregnancy ----------------------------------------------------------------
decrease DA activity in the nigrostriatal path ---------------------------------------------------------------- severe bilious emesis & hypovolemic shock
causes EPS effects of antipsychotics, extend MCC of postpartum hemorrhage within 24 hr upper GI series to Dx intestinal malrotation
from the substantia nigra to basal ganglia of delivery: uterine atony ----------------------------------------------------------------
o DA activity causes chorea & tics soft, boggy, poorly contracted uterus transient proteinuria is MCC of isolated
---------------------------------------------------------------- risk factors: multiple gestation, polyhydramnios, proteinuria in children
chorioretinitis: posterior uveitis macrosomia, prolonged labor 2/2 fever, exercise, seizure, stress, volume depletion
---------------------------------------------------------------- Rx: fundal or bimanual uterine massage, repeat urine dipstick on 2 subsequent occasions
shortened PR, widened QRS, delta waves: WPW crystalloid infusion, oxytocin to r/o persistent proteinuria
due to an anterograde accessory AV pathway, alternative Rx: uterine packing ----------------------------------------------------------------
allow early depolarization of the ventricle ---------------------------------------------------------------- diarrhea, weight loss, anemia, mild DM or
causes pre-excitation & risk of tachyarrhythmia Henoch-Schonlein purpura are at risk for hyperglycemia, necrotic migratory erythema:
retrograde conduction can result in SVT ileo-ileal intussusception glucagonoma
---------------------------------------------------------------- o does not reduce spontaneously compared to necrotic migratory erythema: papule/plaques that
Hx of caustic ingestion pyloric stricture ileocolic intussusceptions coalesce to form a large, painful blister &/or
abdominal succussion splash Rx: surgical crusting with central clearing; perineum, face
Dx: upper endoscopy ---------------------------------------------------------------- Dx: glucagon > 500 pg/mL
---------------------------------------------------------------- statin A/E: hepatotoxicity & myopathy DDx: gastrinoma, late-onset Type I DM,
odorless vaginal spotting/bleeding in a newborn: ASA & NSAIDs A/E: allergic angioedema thyrotoxicosis, carcinoid syndrome
effects of maternal estrogen ---------------------------------------------------------------- ----------------------------------------------------------------
Rx: reassurance VSD is common in Edwards (trisomy 18) MCC of pneumonia in HIV: Strep pneumo
---------------------------------------------------------------- ---------------------------------------------------------------- CXR: pleural effusion
initial management of children with speech delay: liver Bx is required for HCV staging also susceptible to other encapsulated spp
audiology evaluation Candidates for chronic Hep C therapy ----------------------------------------------------------------
---------------------------------------------------------------- age > 18 Causes of fetal growth restriction (weight < 10th %)
massive hemoptysis: > 600 mL/24 hr or 100 mL/hr detectable HCV RNA in serum asymmetric vascular disease (HTN, preeclampsia, DM)
complication: asphyxiation liver Bx with bridging fibrosis (maternal antiphospholipid Ab syndrome
Management of ongoing hemoptysis compensated liver disease (no ascites) factors) autoimmune disease (SLE)
establish an adequate patent airway & ventilation stable lab studies cyanotic cardiac disease
ensure hemodynamic stability willingness for Rx & compliance substance abuse (tobacco, alcohol, cocaine)
place bleeding lung in the dependent position no contraindications (ongoing alcohol/drug abuse, symmetric genetics (aneuploidy)
bronchoscopy to localize bleed site (fetal congenital heart disease
major uncontrolled depression)
---------------------------------------------------------------- factors) intrauterine infection (malaria, CMV,
Rx: peginterferon & ribavirin
radioiodine therapy causes permanent rubella, toxoplasmosis, varicella)
o HCV genotype 1 also receive protease
hypothyroidism with Graves since the entire inhibitor: telaprevir or boceprevir impaired blood flow due to suboptimal maternal
thyroid gland is hyperfunctional ----------------------------------------------------------------
toxic adenoma & multinodular goiters remain factors result in asymmetric growth, as fetal blood
recurrent, predictable, self-limited episodes of
flow redistributes to vital organs (brain, heart) &
euthyroid after radioiodine; only destroys vomiting without apparent cause in a child: appears late in pregnancy
autonomous areas cyclic vomiting syndrome ----------------------------------------------------------------
---------------------------------------------------------------- no symptoms between episodes Natural history of diabetic nephropathy (DN)
ABO incompatibility occur in group O mother a/w family Hx of migraines hyperfiltration (0 5 yr after onset)
with a group A or B baby resolution in 5 10 yrs o glomerular hypertrophy, GFR
incipient DN (5 15 yrs) #1 Rx: discontinue drug, ICU, aggressive cooling, papillary necrosis & tubulointerstitial nephritis
o microangiopathy 2/2 advanced glycation end antipyretics, fluids & electrolytes, alkaline diuresis with focal glomerulosclerosis
(AGE) products Rx: dantrolene (muscle relaxant) or bromocriptine results in CKD & ESRD
o mesangial expansion, glomerular sclerosis, (DA agonist) or amantadine (DA properties) severe cases: nephrotic range proteinuria
glomerular BM thickening, complication: rhabdomyolysis CT: small kidneys, B/L papillary calcifications
microalbuminuria, arteriolar hyalinosis, HTN ---------------------------------------------------------------- ----------------------------------------------------------------
overt DN (15+ yrs) management of placenta previa depends on simple renal cyst: thin wall, no solid component,
o mesangial nodules (Kimmelstiel-Wilson), gestational age & bleeding severity no contrast enhancement on CT, no septae
tubulointerstitial fibrosis, nephrotic syndrome, active, uncontrolled antepartum hemorrhage with o incidental finding; no Rx, no follow-up
GFR; CKD unstable vital signs & non-reassuring fetal HR, malignant cystic mass: irregular septae walls,
---------------------------------------------------------------- regardless of gestational age c-section multilocular, heterogeneous (solid & cystic),
air in the biliary tract: gallstone ileus o induction of labor will aggravate bleeding contrast enhancement on CT
---------------------------------------------------------------- by triggering uterine contractions ----------------------------------------------------------------
porcelain gallbladder results from deposition of prior c-section increases risk for placenta accreta HTN, low plasma renin, hypokalemia,: primary
Ca++ salts 2/2 chronic cholecystitis ---------------------------------------------------------------- hyperaldosteronism
incidental finding, a/w risk of GB carcinoma Fibromuscular dysplasia: causes arterial stenosis, ----------------------------------------------------------------
definitive Rx: cholecystectomy aneurysm, or dissection; MCC of secondary HTN COPD exacerbation with cor pulmonale
---------------------------------------------------------------- o renal artery involvement resistant HTN (peripheral edema, hepatomegaly, clear lungs,
ASD, VSD, PDA, & dextrocardia are acyanotic o cerebrovascular arteries TIA, stroke, JVD, pulmonary HTN)
congenital heart diseases amaurosis fugax, Horners #1 Rx: bronchodilators, glucocorticoids
---------------------------------------------------------------- o non-specific: headache, dizziness, tinnitus Rx: furosemide is used to lower RV filling &
Congenital cyanotic heart diseases ---------------------------------------------------------------- reduce peripheral edema
MCC in the neonatal period, Transposition increased intragastric pressure during vomiting o caution: C.O. reduction & prerenal azotemia
cyanosis within 24 hr, single S2 of great causing tears in submucosal arteries of distal ----------------------------------------------------------------
CXR: narrow mediastinum vessels esophagus & proximal stomach: Mallory-Weiss Medication side effects
egg-on-a-string rupture of dilated submucosal veins at GE junction: levodopa/carbidopa early: hallucination, agitation,
Rx: prostaglandins keep PDA open esophageal varices (DA precursor dizziness, headache, confusion
MCC after the neonatal period, ToF ---------------------------------------------------------------- late: dyskinesia, dystonia
harsh pulmonary stenosis murmur, complication of IE: cerebral septic emboli trihexyphenidyl dry mouth, blurry vision,
VSD murmur, single S2, DDx: carotid thrombosis, drug-induced vascular (anticholinergic) constipation, urinary retention
CXR: RVH, boot-shaped heart spasm, migraine, lacunar stroke amantadine livedo reticularis, ankle edema
single S2, minimal pulmonary flow Tricuspid ---------------------------------------------------------------- bromocriptine, somnolence, hypotension,
VSD murmur, hypoplastic RV atresia post-ictal lactic acidosis occurs following a ropinirole confusion, hallucination
newborn with left-axis deviation tonic-clonic seizure (DA agonist)
single S2, systolic ejection murmur, Truncus transient anion gap metabolic acidosis entacapone dyskinesia, hallucinations,
increased pulmonary flow, edema arteriosus resolves without Rx within 60 90 min (COMT inhibitor) confusion, orthostatic
severe cyanosis, pulmonary edema, Total following resolution of seizure activity hypotension
respiratory distress anomalous Rx: repeat labs after 2 hrs selegiline insomnia, confusion
RA & RV enlargement pulmonary ---------------------------------------------------------------- (MAO-B inhibitor)
CXR: snowman sign venous return painless hematuria, sterile pyuria, WBC casts: ----------------------------------------------------------------
---------------------------------------------------------------- analgesic nephropathy trihexyphenidyl: anti-muscarinic used for
fever, muscle rigidity, autonomic instability, females chronically using combined analgesics Parkinsons & drug-induced EPS
diaphoresis, confusion, elevated CPK: NMS asymptomatic; incidental increase in Cr red as a beet, dry as a bone, hot as a hare,
MCC: haloperidol; occurs within 2 weeks blind as a bat, mad as a hatter, full as a flask
painless hematuria due to papillary ischemia from
analgesia-induced vasoconstriction of vas recta
flushing, anhidrosis, hyperthermia, mydriasis, focal deficits initially (hemiplegia, hemiparesis, causes of BUN/Cr: prerenal azotemia
delirium, urinary retention/constipation hemisensory disturbances), then ICH symptoms (dehydration), GI bleeding, systemic steroids
---------------------------------------------------------------- (vomiting, headache, bradycardia) o GI bleeding results in bacterial breakdown of
BPH: affects central portion; @ transitional zone Dx: brain CT Hb in the GIT with resultant urea absorption
prostate cancer: lateral lobe of prostate; firm ---------------------------------------------------------------- ----------------------------------------------------------------
---------------------------------------------------------------- lacunar stroke: occluded single penetrating branch Kallmann syndrome: XR disordered migration
initial BPH workup: one-time PSA measurement of a large cerebral artery; MC basal ganglia of fetal GnRH & olfactory neurons
---------------------------------------------------------------- unilateral pure motor impairment hypogonadotropic hypogonadism & anosmia
prostate Bx: suspected prostate cancer with no cortical signs (aphasia, hemianopsia) normal genotype & internal reproductive organs
abnormal prostate exam, or persistently elevated main cause: HTN, which induces microatheroma primary amenorrhea, low FSH & LH
PSA > 4 ng/dL & lipohyalinotic thickening absent breast development, small phallus
---------------------------------------------------------------- o small vessel hyalinosis no body hair, short stature
initial evaluation of essential HTN should assess MC site: posterior limb of internal capsule Rx: hormone replacement
possible secondary causes symptoms over a short period, slow progression ----------------------------------------------------------------
o U/A for occult hematuria & protein/Cr ratio over 24 36 hr; limited neurologic deficits bilious vomiting, abdominal distension, gassless
o chemistry panel pure motor, pure sensory, or ataxic hemiparesis; colon, triple bubble sign: jejunal atresia
o lipid profile (risk stratification for CAD) or dysarthria-clumsy hand syndrome risk factors: prenatal cocaine or tobacco exposure
o baseline EKG pure sensory stroke (VPL nucleus of thalamus) DDx: necrotizing enterocolitis, pyloric stenosis,
---------------------------------------------------------------- ---------------------------------------------------------------- duodenal atresia, Hirschsprungs
unexplained elevation of serum CK & myopathy: Brain lesions ----------------------------------------------------------------
hypothyroidism pure motor hemiparesis, posterior limb Antepartum fetal surveillance
fatigue, myalgia, proximal muscle weakness, pure sensory stroke, clumsy-hand, of int. capsule o NST: Nonstress test; #1 test
sluggish ankle reflexes, normal ESR no visual field abnormalities (lacunar infarct) o BPP: Biophysical profile; #2 test
Dx: TSH, T4 C/L somatosensory & motor deficit o CST: Contraction Stress test; #2 test
DDx: polymyositis (normal DTRs, ESR) @ face & upper limbs, o umbilical artery Doppler velocimetry
---------------------------------------------------------------- conjugate eye deviate toward infarct, MCA occlusion ----------------------------------------------------------------
Major stroke types homonymous hemianopia, NST is performed when there is loss of perception
local artery obstruction, ischemic aphasia (dominant hemisphere), of fetal movements or in high-risk pregnancies at
symptoms fluctuate, stuttering progress (thrombotic) hemineglect (non-dominant parietal) 32-34 wks gestation; fetal heart tones by Doppler
Hx of a-fib, endocarditis, carotid bruit, ischemic C/L somatosensory & motor deficit reactive: within 20 min, 2 accelerations at
abrupt onset, (embolic) in lower extremities, ACA occlusion least 15 beats/min > baseline, lasting 15 seconds
maximal symptoms at the start abulia (lack of will or initiative), high negative predictive value
focal neurologic deficits early, dyspraxia, urinary incontinence abnormal result yields a low PPV
progress over minutes to hours, then intracerebral homonymous hemianopia,
MCC of non-reactive NST: fetal sleep cycle (20 min)
features of increased ICP (vomiting, hemorrhage alexia without agraphia (dominant), PCA occlusion
o Rx: vibroacoustic stimulation
headache, bradycardia) visual hallucinations,
3rd nerve palsy, C/L motor deficits weekly NST for 3rd trimester pregos requiring
ruptured berry aneurysm or AVM,
severe headache at onset, subarachnoid alternate syndrome: vertebrobasilar ongoing antenatal surveillance
meningeal irritation, hemorrhage C/L hemiplegia, system lesion non-reactive NST requires BPP or CST
focal deficits are uncommon** I/L cranial nerve deficits (brainstem) ----------------------------------------------------------------
anterior vasculature: internal carotid artery, Biophysical profile (BPP): assess fetal well-being
ADPKD: risk of berry aneurysm, results in SAH ACA & MCA o NST
---------------------------------------------------------------- posterior circulation: paired vertebral arteries o amniotic fluid volume
hypertensive intracranial hemorrhage MC in form the basilar artery, then divide into PCAs o fetal movement
basal ganglia, thalamus, pons, & cerebellum ---------------------------------------------------------------- o fetal tone
o fetal breathing movements o rare: stroke, MI erythematous macules, toxicum in 2 wks
if abnormal NST amniotic fluid volume & fetal women who smoke, with uncontrolled HTN, papules, or pustules neonatorum
activity are assessed with real-time USS, 30 min end-organ damage, or age > 35 should consider vesicular clusters on skin,
score 8 10 = normal contraception without estrogen eyes, mucous membranes, neonatal acyclovir
score 6 = equivocal ---------------------------------------------------------------- CNS infection (seizures), HSV
score 4 = delivery! Emergency contraception multi-organ disease
---------------------------------------------------------------- method mechanism time frame efficacy fever, ranges from neonatal
contraction stress test (CST): infusion of oxytocin copper inflammatory rxn is 0 120 hr vesicular clusters to varicella acyclovir
sufficient to result in 3 contractions every 10 min IUD toxic to sperm, (5 days) 99% disseminated disease
normal CST suggests a low likelihood of stillbirth impairs implantation fever, irritability, diffuse (SSSS)Staph oxacillin,
within 1 wk of the test; F/U testing in 1 wk ulipristal anti-progestin, 0 120 hr 85% erythema; blistering & scalded skin nafcillin,
late decelerations is an indication for delivery pill delays ovulation (5 days) exfoliation, +Nikolsky syndrome vanco
---------------------------------------------------------------- levonorg progestin, 0 72 hr ----------------------------------------------------------------
umbilical artery Doppler velocimetry: estrel delays ovulation (3 days) 85% hoarseness, barking cough, respiratory distress:
evaluation of IUGR only (Plan B) croup (laryngotracheitis)
---------------------------------------------------------------- OCPs progestin 0 72 hr) 75% o age < 3 yrs; due to Parainfluenza
Dx of intrauterine fetal demise: real-time USS delays ovulation o lateral XR: subglottic narrowing
occurs @ >20 wks, before onset of labor ----------------------------------------------------------------
fetal heart tone not heard by Doppler copper IUD & OCPs are also precoital methods exertional dyspnea, heart pounding sensation,
autopsy of fetus & placenta should be performed copper IUD is the most effective emergency widened pulse pressure: aortic regurgitation
contraceptive method, regardless of parity or age MMC in developing countries: rheumatic fever
in the first episode of intrauterine fetal demise
also perform maternal coagulation profile o C/I: acute cervicitis & PID MCC in developed countries: aortic root dilation
---------------------------------------------------------------- ---------------------------------------------------------------- or congenital bicuspid valve
ovulation occurs on day 14 DPMA & etonogestrel subdermal implants are ----------------------------------------------------------------
systemic progestin-based precoital contraceptives Features of TCA overdose
fertilization is possible 24 hr after ovulation
that inhibit GnRH secretion, thus FSH/LH CNS drowsiness, delirium, coma,
pregnancy = embryo implants @ 6 12 days
---------------------------------------------------------------- seizure, respiratory depression
after fertilization; -hCG produced by blastocyst newborns with suspected DiGeorge must be cardio sinus bradycardia, hypotension,
can be detected on a pregnancy test
assessed for life-threatening hypocalcemia (MCC death) prolonged PR/QRS/QT,
----------------------------------------------------------------
(tetany, seizures, arrhythmias) ventricular tachycardia, v-fib
Combined estrogen/progestin OCPs
o Conotruncal defects (truncus arteriosus) anticholinergi dry mouth, blurred vision,
early A/E: nausea, bloating, breast tenderness;
o Abnormal facies c mydriasis, flushing, hyperthermia,
improves with use; does not cause weight gain
o Thymic aplasia/hypoplasia urinary retention
MC A/E: breakthrough bleeding due to lower
o Cleft palate TCAs inhibit fast Na+ channels, thus conduction
estrogen dose
o Hypocalcemia velocity, duration of repolarization, & prolongs
benefits
T-cell lymphopenia risk for bacterial, viral, & absolute refractory period
endometrial & ovarian cancer risk ----------------------------------------------------------------
o risk of iron deficiency anemia fungal infections
---------------------------------------------------------------- TCA overdose decreases myocardial conduction
risks velocity, leading to QRS prolongation & risk of
appendicitis begins as vague periumbilical visceral
HTN ventricular arrhythmia or seizure
pain caused by stretching of the appendiceal wall
o venous thromboembolism QRS complex duration is the best
peritoneum becomes inflamed & localize to RLQ
o hepatic adenoma (chronic OCP use) prognostic indicator of TCA overdose
----------------------------------------------------------------
o amenorrhea supportive Rx: supplemental O2, IV fluids,
Neonatal rashes
risk of cervical cancer activated charcoal if within 2 hrs of ingestion
Features Dx Rx
triglycerides asymptomatic, blanching Erythema resolves
Rx: sodium bicarbonate narrows the QRS severe symptoms throughout, frequent nighttime
complex & incidence of ventricular arrhythmia persistent awakenings, extreme limitations, FEV1
o indicated when QRS > 100 msec <60% predicted
o pH decreases TCA avidity for Na+ channels Rx: add high-dose inhaled corticosteroid
sodium load alleviates depressant action on or oral prednisone
myocardial fast sodium channels ----------------------------------------------------------------
---------------------------------------------------------------- Management of asthma exacerbation
B/L hydronephrosis, B/L hydroureters, bladder mild/moderate asthma exacerbation
distension: posterior urethral valves (PUV) o O2, until saturation 90%
diagnosed prenatally; can present later in life as o inhaled short-acting -agonists (SABA)
recurrent UTIs & renal failure; only boys if no response: oral systemic corticosteroids
Potter sequence moderate/severe asthma exacerbation ----------------------------------------------------------------
o urinary tract anomaly oliguria in utero o O2, until saturation 90% Features of crystal-induced AKI
oligohydramnios pulmonary hypoplasia, o inhaled high-dose SABA etiologie IV acyclovir, sulfonamides, MTX,
flat facies, & limb deformities PLUS ipratropium nebulizer s ethylene glycol, protease inhibitors
Dx: voiding cystourethrogram & cytoscopy o oral systemic corticosteroids features creatinine within 24 48 hr,
---------------------------------------------------------------- impending or actual respiratory arrest intratubular obstruction & direct toxicity
hypercalcemia of malignancy can be due to o mechanical ventilation with intubation on U/A: hematuria, pyuria, crystals
tumor production of PTHrP, osteolytic metastasis, 100% O2; admit to ICU risk with volume depletion or CKD
tumor production of 1,25(OH) vitamin D, or o nebulized SABA + ipratropium Rx discontinue drug & volume repletion,
increased IL-6 levels, IL-3, TNF- IV corticosteroids concurrent volume repletion with drug can
PTH is suppressed; Ca++ > 13 mg/dL prevent kidney injury
o if no improvement: Mg++-sulfate
N/V, polyuria, polydipsia, constipation, fatigue, adding ipratropium to SABA causes greater
poor appetite, Hx of smoking AIN occurs 7 10 days after drug exposure
bronchodilation than either alone
---------------------------------------------------------------- o skin rash, eosinophilia, eosinophiluria, pyuria
systemic corticosteroids take several hours to
pain, swollen eyelid, visual acuity, hypopyon, ----------------------------------------------------------------
exert its effects
conjunctivitis, corneal edema: post-operative MC renal malignancy in childhood: Wilms tumor
----------------------------------------------------------------
endophthalmitis (aka nephroblastoma); asymptomatic
asthmatic child with altered mental status,
MC within 6 wk; due to infection of the vitreous ----------------------------------------------------------------
unresponsive to Rx, poor air entry on exam,
hypopyon = pus in anterior eye chamber excess tearing, burning, mild pain, conjunctival &
hypoxemia & CO2 retention: acute asthma
---------------------------------------------------------------- exacerbation eyelid edema, vision is not affected: conjunctivitis
Classification & management of asthma elevated or normal pCO2 suggest decreased blurry vision, moderate pain, conjunctival injection,
intermittent daytime symptoms 2 days/wk, respiratory drive due to respiratory muscle fatigue miosis: uveitis
nighttime awakenings 2x/month, & impending respiratory failure significant pain, photophobia, miosis, vision loss:
-agonist use 2x/wk Rx: intubation & mechanical ventilation anterior uveitis (iritis)
normal baseline FEV1 & FEV1/FVC o inhaled SABA + inhaled ipratropium, & proptosis, ophthalmoplegia, chemosis, vision loss:
no limitations of daily activities cavernous sinus thrombosis
systemic corticosteroids; admit to ICU
Rx: short-acting -agonist (albuterol) PRN pain with eye movement, proptosis, diplopia,
----------------------------------------------------------------
mild symptoms 2x/wk, but not daily, prevalence is directly related to pre-test probability impaired EOM: orbital cellulitis
persistent nighttime awakenings 3 4x/month, corneal vesicles, opacification, dendritic ulcers:
if a test result is negative, probability of
normal PFTs, minor limitations viral keratitis (HSV or varicella)
having the disease = 1 NPV
Rx: add low-dose inhaled corticosteroid ----------------------------------------------------------------
false positive ratio = 1 specificity
moderate daily symptoms, weekly nighttime Differentiation of conjunctivitis
false negative ratio = 1 sensitivity
persistent awakenings, FEV1 60 80% of predicted Viral Bacterial Allergic
Rx: add long-acting inhaled 2-agonist unilateral unilateral bilateral
stuck shut stuck shut stuck shut N. ampicillin, & ----------------------------------------------------------------
watery, scant purulent, thick, watery, scant meningitidis, 3rd gen diabetic, severe ear pain, granulation tissue in ear
stringy mucus white/yellow stringy mucus Listeria cephalosporin canal, otorrhea,: malignant otitis externa MCC
burning, sandy, unremitting intense itching, immunocomp. pneumococcus, vancomycin, is P. aeruginosa
gritty feeling discharge Hx of allergy N. ampicillin, & MC in elderly with poorly controlled diabetes
follicular or non-follicular conjunctival meningitidis, cefepime aggravated by chewing, difficulty eating
bumpy edema (chemosis) Listeria, G- rod worsens despite topical ABX
self-limited self-limited, 24 hr Dx: CT or MRI
alternative to ampicillin: TMP-SMX for Listeria Rx: systemic anti-pseudomonals (ciprofloxacin)
intense itching, hyperemia, tearing, edema of ---------------------------------------------------------------- risk factor: immunosuppressed conditions
conjunctiva & eyelids, subsides in 24 hr: allergic empiric Rx for bacterial meningitis for complications: osteomyelitis of skull base & CN
viral pink eye presents similar to allergic, but immunocompromised: vancomycin, ampicillin, damage (facial drooping)
lasts several days; a/w URI, MCC adenovirus + cefepime with dexamethasone ----------------------------------------------------------------
o adding corticosteroids prevent complications anxiety restricted to social & performance, also
Conjunctivitis Rx of meningitis due to S. pneumoniae fear of scrutiny & embarrassment: social phobia
if there is delay in performing LP, empiric Rx DDx: specific phobia, panic disorder, GAD
topical erythromycin ointment, bacterial
fluoroquinolone drops (contact lens) must be given after obtaining blood cultures ----------------------------------------------------------------
cool, moist compress viral ---------------------------------------------------------------- Specific phobia
Rx dehydration: IV Na+-containing crystalloid marked anxiety > 6 months
OTC antihistamine/decongestant drops allergic
---------------------------------------------------------------- (0.9% NS) no fear of scrutiny by others
hyperestrogenism in cirrhosis: gynecomastia, can unmask subclinical heart failure in elderly #1 Rx: behavior therapy
testicular atrophy, body hair, spider angiomas, ---------------------------------------------------------------- #2 Rx: short-acting benzo (limited role)
palmar erythema colloid solutions contain albumin
----------------------------------------------------------------
---------------------------------------------------------------- Rx: burns, hypoproteinemia anemia, bone disease, & HTN persist with dialysis,
liver functions ---------------------------------------------------------------- but controlled with renal transplantation
synthesis of clotting factors, cholesterols, protein post-op cholestasis is a benign condition after transplant patients have return or normal
metabolism of drugs & steroids, detoxification prolonged surgery characterized by endocrine, sexual, & reproductive functions
excretion of bile hypotension, extensive blood loss into tissues, & ----------------------------------------------------------------
---------------------------------------------------------------- massive blood replacement bupropion inhibits re-uptake of NE, DA, 5-HT
portal HTN leads to esophageal varices, ----------------------------------------------------------------
C/I to use of bupropion: Hx of anorexia/bulimia
liver has dual blood supply: hepatic arteries &
hemorrhoids, & caput medusae since development of electrolyte abnormalities
---------------------------------------------------------------- portal veins
can precipitate seizures
asterixis is a neurologic sign a/w poor hepatic ----------------------------------------------------------------
----------------------------------------------------------------
raising the cut-off point of a test
function & hyperammonemia acute pancreatitis can cause an acute abdomen
a/w CO2 retention, hepatic encephalopathy, & o specificity & sensitivity
Rx: analgesics, IV fluids, NPO
uremic encephalopathy ----------------------------------------------------------------
Px: self-limited, subsides in 4 7 days
uremic encephalopathy Rx: urgent hemodialysis CKD causes decreased renal production of Vit D,
----------------------------------------------------------------
hepatic encephalopathy Rx: lactulose leading to hypocalcemia, hyperphosphatemia, &
medial meniscus is injured during forceful torsion
secondary hyperPTH
---------------------------------------------------------------- of the knee with foot planted
circulating PTH increases with declining GFR,
Bacterial meningitis delayed evidence of effusion
correlates with severity of renal failure
risk group MCC empiric ABX swelling & pain within 24 hrs
hyperphosphatemia directly stimulates parathyroids
age 2 50 yrs N. vanco & 3rd gen limited ROM, popping, catching, locking
to synthesize & release PTH
meningitidis, S. cephalosporin (inability to extend the knee)
DDx: Vit D deficiency (low/normal phosphate,
pneumoniae joint line tenderness
normal serum Ca++)
age > 50 yrs S. pneumo, vancomycin,
evaluation: positive McMurrays & Apleys pulmonary chronic interstitial pneumonitis, infants losing > 7%: formula supplementation
Dx: MRI pulmonary fibrosis ----------------------------------------------------------------
---------------------------------------------------------------- endocrine hypothyroid (MC), hyperthyroid # of wet diapers = age in days for 1st wk
ACL tear from forceful hyperextension GI/hepatic transaminases, hepatitis 6 diapers/day after the 1st wk is normal
swelling & effusion immediately ocular optic neuropathy, pink stains or brick dust in neonatal diapers
Dx: positive Lachmans corneal deposits = uric acid crystals, common in first few weeks
---------------------------------------------------------------- skin blue-gray discoloration (face) ----------------------------------------------------------------
theophylline has a narrow therapeutic window neuro peripheral neuropathy dysthymia (persistent depressive disorder)
o CNS (headache, insomnia, seizure), N/V, ---------------------------------------------------------------- depressed mood 2 yrs (1 yr in childhood)
cardiac toxicity (palpitations, arrhythmia) Dofetilide A/E: risk of TdP o MDE symptoms may occur concurrently or
Dx: measure serum levels Procainamide A/E: drug-induced lupus, intermittently
---------------------------------------------------------------- agranulocytosis, QT prolongation ----------------------------------------------------------------
HIV patient with altered mental status ---------------------------------------------------------------- hairy cell leukemia: bone marrow is fibrotic,
primary CNS lymphoma: MCC is EBV quinidine A/E: diarrhea, tinnitus, QT prolongation, leading to dry taps of aspirates
MRI: solitary, weakly ring-enhancing TdP, hemolytic anemia & thrombocytopenia pancytopenia & splenomegaly
periventricular mass hydralazine A/E: peripheral edema, salt & fluid +tartrate resistant acid phosphatase (TRAP)
CSF: EBV DNA retention, palpitations, orthostatic hypotension, Rx: cladibine (2-CdA)
---------------------------------------------------------------- drug-induced lupus ----------------------------------------------------------------
multiple, ring-enhancing lesions in basal ganglia: metoprolol A/E: worsening of heart failure, Hep B vaccination decreases HCC incidence,
Toxoplasmosis bradyarrhythmia, bronchoconstriction, fatigue, especially if from Asia & Africa; MCC due to
o @ cortical grey-white matter interface depression, weight gain, sexual dysfunction vertical transmission
multiple, non-enhancing lesions, no mass effect: ---------------------------------------------------------------- ----------------------------------------------------------------
PML Antihypertensive in pregnancy hemodynamically unstable with penetrating
solitary, periventricular ring-enhancing lesion: first-line contraindicated abdominal trauma exploratory laparotomy
primary CNS lymphoma **labetalol ACE-I/ARBs any penetrating wound below the 4th IC space is
solitary ring-enhancing lesion, bacterial infection, **methyldopa (slow) spironolactone considered to involve the abdomen
hydralazine direct renin inhibitor ----------------------------------------------------------------
sinusitis, immunocompetent: brain abscess
nifedipine furosemide detrusor instability, bladder irritation from neoplasm,
o direct extension from contiguous infection
second-line interstitial cystitis results in urge incontinence
(sinusitis, mastoiditis, otitis media)
thiazides o sudden, infrequent loss of moderate to large
o MCC: Viridans strep (S. mutans), anaerobes
clonidine amounts of urine, nocturia & frequency
----------------------------------------------------------------
---------------------------------------------------------------- ----------------------------------------------------------------
brain abscesses from hematogenous spread
labetalol & hydralazine: Rx pre-eclamptic diabetic neuropathy causes overflow incontinence
from lung infection or endocarditis
hypertensive emergencies (BP 160/110) loss of small amounts of urine from overdistended
o MCC is S. aureus
o not methyldopa (slow onset) bladder; residual volume
----------------------------------------------------------------
---------------------------------------------------------------- ----------------------------------------------------------------
fatigue, memory loss, constipation, weight gain,
severe antepartum hemorrhage first requires cerebellar astrocytoma: #1 MC posterior fossa
dry skin: amiodarone-induced hypothyroidism
hemodynamic resuscitation, then emergency USS tumor, MC site is lateral hemispheres
monitor thyroid & hepatic function
o vaginal exam is C/I for risk of aggravating medulloblastomas MC arise from the vermis
pulmonary symptoms require CXR & PFTs
possible placenta previa bleeding o #2 MC posterior fossa tumor; infratentorial
corneal deposits does not necessitate disuse ---------------------------------------------------------------- posterior vermis syndrome: truncal dystaxia
healthy infants can lose up to 7% of birth weight
Major side effects of amiodarone o highly radiosensitive
in the first 5 days of life
cardiac sinus bradycardia, heart block ----------------------------------------------------------------
no Rx required; continue exclusive breastfeeding
QT prolongation, TdP idiopathic thrombocytopenic purpura (ITP) is
F/U @ age 10 14 days for weight gain
a Dx of exclusion
antecedent viral infection, mucocutaneous bleeding microcolon diabetics have risk of atherosclerotic CV disease
isolated thrombocytopenia < 100,000 reproductive infertility ( 95% males) Indications for statins
inhibition of megakaryocyte PLT production due to MSK growth failure, osteopenia (fractures), all diabetics age 40 75 regardless of baseline
IgG autoantibodies against PLT membrane clubbing, kyphoscoliosis lipid levels statin
glycoproteins & PLT destruction o CHD risk for any baseline lipid levels
inspissated mucus predisposes to rhinosinusitis clinical CVD: ACS, MI, angina, TIA, stroke
Management of ITP fecal elastase testing (exocrine pancreas status) LDL 190 (no recommended LDL goal)
children no bleeding: observe Dx: sweat chloride test via quantitative 10-year atherosclerotic CVD risk 7.5%
bleeding: IV Ig or glucocorticoids pilocarpine iontophoresis ----------------------------------------------------------------
adults PLT > 30,000, no bleeding: observe Strep pneumo: MCC pneumonia overall hemorrhagic pancreatitis: life-threatening illness,
PLT < 30,000 or bleeding: IV Ig or S. aureus is MCC of CF-pneumonia in age < 20 yr retroperitoneal hemorrhage & pancreatic necrosis
glucocorticoids Rx: IV vancomycin bluish discoloration of the flanks (Grey Turner
P. aeruginosa is MCC of CF-pneumonia in adults sign) or periumbilical region (Cullen sign) due to
r/o pseudothrombocytopenia due to PLT clumping Rx: IV ceftazidime or aminoglycosides blood accumulation intra-abdominal fascial planes
by EDTA, abciximab, or inadequate coagulation frequent Rx with aminoglycosides can ----------------------------------------------------------------
isolated thrombocytopenia can be the initial result in sensorineural hearing loss Felty syndrome: a/w rheumatoid arthritis
presentation of chronic HIV Rx: high-calorie diet, fat-soluble vitamin & o neutropenia, recurrent infections, splenomegaly
also test for HIV & Hep C pancreatic enzyme replacement ----------------------------------------------------------------
DDx: Bernard-Soulier, aplastic anemia, DIC, ---------------------------------------------------------------- constitutional growth delay: simultaneous
dilutional thrombocytopenia, TTP, HUS male infertility 2/2 CF is due to congenital B/L deceleration in length & weight before age 2 yrs;
---------------------------------------------------------------- absence of vas deferens normal growth velocity after age 2 yrs; idiopathic
chronic GI disease (steatorrhea, Celiac) can cause o inspissated mucus in fetal genital tract MCC of short stature & delayed puberty
Vit D deficiency due to malabsorption obstructs vas deferens development o family Hx of delayed puberty
results in hypocalcemia, hypophosphatemia, & spermatogenesis is normal, but no ejaculation catch-up growth, onset of puberty, & growth spurt
secondary hyperPTH (obstructive azoospermia) occur later than average
bone pain, muscle weakness, abnormal gait ---------------------------------------------------------------- delayed bone age, but final adult height is normal
---------------------------------------------------------------- diarrhea, dermatitis, dementia, death: pellagra ----------------------------------------------------------------
CREST syndrome: calcinosis cutis, Raynauds, o niacin (Vit B3) deficiency familial short stature: standing height > 2 SDs
esophageal dysmotility, sclerodactyly, telangiectasias scaly dermatitis on sun-exposed areas become below the mean for age & gender
calcinosis cutis: localized dystrophic Ca++ skin thick & hyperpigmented, resembles a sunburn normal height velocity, puberty, & bone age
depositions; subcutaneous pink/white nodules abdominal pain, watery diarrhea, glossitis, anorexia predicted adult height appropriate to familial pattern
on upper extremities irritability, aggressiveness, poor concentration
Raynauds: fingers progress through white, blue,
a/w bowel disease (UC) that interfere with vitamin
& hyperemic stages
absorption, immigrants on corn-based diets,
sclerodactyly: fibrosis of skin distal to MCP joint
alcoholics, carcinoid syndrome, Hartnups
telangiectasias: mat-like patches on face & palms DDx: SLE (no diarrhea), seborrheic dermatitis,
---------------------------------------------------------------- acute intermittent porphyria (no photosensitivity)
Clinical features of cystic fibrosis ----------------------------------------------------------------
respiratory bronchiectasis, recurrent pneumonia, cheilosis, glossitis, seborrheic dermatitis, pharyngitis,
chronic rhinosinusitis, nasal polyps oral erythema: riboflavin (Vit B2) deficiency ----------------------------------------------------------------
GI meconium ileus, steatorrhea, ---------------------------------------------------------------- post-op patient with hypotension, syncope, JVD,
fat-soluble vitamin malabsorption irritability, depression, dermatitis, stomatitis, new-onset right BBB: massive PE
(night blindness, rickets, neuropathy, homocysteine : pyridoxine (Vit B6) deficiency massive PE = PE complicated by hypotension
coagulopathy), ----------------------------------------------------------------
exocrine pancreatic insufficiency &/or acute right heart strain
syncope is common no previous imaging chest CT age > 50 with B/L pain & stiffness >1 month,
right heart strain ventricular dysFx C.O., o benign features serial CT scans morning stiffness > 1 hr, constitutional symptoms,
bradycardia, & cardiogenic shock o intermediate suspicion Bx or PET ESR, normal CK
Dx: CT angiography o high suspicion surgical excision active ROM of shoulder, neck, & hip
Rx: fibrinolysis (relative C/I: surgery within 2 cm, low density, speculated/irregular, no focal tenderness or weakness
preceding 10 days) eccentric calcification favors carcinoma Rx: low-dose prednisone (rapid, thorough relief)
---------------------------------------------------------------- high risk: age > 60, current smoker, weight loss, a/w giant cell arteritis
pancreatic pseudocyst: fibrous capsule containing previous malignancy o Dx: temporal artery Bx if suspected
enzyme-rich fluid, tissue, & debris accumulates Bx central lesions: bronchoscopy o Rx: high-dose prednisone
within the pancreas elevated amylase Bx peripheral lesions: CT-guided percutaneous Bx ----------------------------------------------------------------
palpable epigastric mass a/w chronic pancreatitis ---------------------------------------------------------------- euvolemic hyponatremia due to renal Na+ losses
Dx: USS uncomplicated proximal LE DVT when normal saline bolus is given, urine Na+
Rx: resolves spontaneously Management of SIADH excretion, while serum Na+ is unaffected
---------------------------------------------------------------- asymptomatic/mild fluid restriction (< 800 mL/day), SIADH findings
diffuse infection of necrotic pancreatic tissue, (forgetfulness, oral Na+ tablets, o serum osmolality < 290
MC 1 2 wks after acute pancreatitis episode: unstable gait) furosemide if urine Osm > 2x urine osmolality > 300 (concentrated urine)
infected pancreatic necrosis serum Osm urine Na+ > 40 mEq/L
Rx: surgical debridement moderate hypertonic saline (3 4 hrs) to o absence of hypovolemia (euvolemic)
---------------------------------------------------------------- (confusion, lethargy) Na+ > 120 mEq/L o normal Cr, K+, acid-base
DDx of flaccid paralysis severe hypertonic saline bolus until o normal renal, adrenal, & thyroid function
infant botulism foodborne Guillain-Barre (mental status symptoms resolve, asymptomatic or mild symptoms of SIADH
botulism change, seizure, +/- conivaptan (ADH Rc respond to fluid restriction &/or Na+ tablets
C. botulinum C. botulinum autoimmune &/or coma) antagonist; cause water diuresis) severe, symptomatic hyponatremia requires
spore ingestion preformed peripheral nerve Rx: anticoagulation (unfractionated or LMWH) hypertonic saline
from environmt toxin demyelination anticoagulation C/I: recent surgery, active bleed, serum Na+ correction: 0.5 1 mEq/L/hr or 10
dust/soil Hx of HIT, hemorrhagic stroke, bleeding diathesis mEq/24 hr to prevent osmotic demyelination
descending descending ascending flaccid Rx: IVC filter ----------------------------------------------------------------
flaccid paralysis flaccid paralysis paralysis proximal DVT with hemodynamically unstable PE demeclocycline: responsiveness to ADH
CA, PA, UT prodrome N/V, absent DTRx or massive proximal DVT with severe swelling or Rx SIADH by inhibiting ADH-mediated aquaporin
diarrhea limb-threatening ischemia insertion
Rx: botulism Ig Rx: anti-toxin IV Ig or plsmphrss Rx: thrombolytics A/E: nephrotoxic
previously healthy infant with B/L bulbar palsies o if C/I: iliac stenting, mechanical or ----------------------------------------------------------------
(ptosis, sluggish pupillary response, poor suck or surgical thrombectomy effective management of SIADH required the
gag reflexes), symmetric hypotonia, constipation, ---------------------------------------------------------------- infused fluid to have a higher electrolyte
drooling middle-aged woman, widespread pain, fatigue, concentration than urine & plasma
Rx: empiric IV botulism Ig cognitive/mood disturbance: fibromyalgia NS (0.9%) is only slightly higher than serum
---------------------------------------------------------------- normal lab findings, normal ESR osmolality & leads to NaCl excretion
mucopurulent vaginal discharge, friable cervix: symptoms > 3 months excessive ADH causes more water retention,
cervicitis Dx: widespread pain index/symptom severity scale thus concentrates the urine, dilutes the serum, &
#1 MCC: C. trachomatis; #2: N. gonorrhea #1 Rx: education, exercise, & sleep hygiene worsens hyponatremia
Dx: nucleic acid amplification #2 Rx: amitriptyline (TCAs) ----------------------------------------------------------------
---------------------------------------------------------------- alt Rx: pregabalin, duloxetine, milnacepran ACE-I are recommended for patients with
solitary pulmonary nodule on CXR: compare ---------------------------------------------------------------- proteinuria, heart failure, or CKD with HTN
with previous CXR Polymyalgia rheumatica C/I in B/L renal artery stenosis
stable lesion, 2 3 yrs no further testing
---------------------------------------------------------------- perineal or scrotal hematomas are a/w pelvic fx ----------------------------------------------------------------
cirrhosis causes signs of total body water overload ---------------------------------------------------------------- chronic Rx with supra-physiologic doses of
(ascites, interstitial edema) 2/2 hypoalbuminemia Histoplasmosis glucocorticoids (Rx giant cell arteritis) is a/w
edema causes relative depletion of intravascular immunocompetent: asymptomatic or mild hyperglycemia, bone loss, chronic myopathy
volume, causing kidney to maximally retain water, pulmonary disease glucocorticoid-induced myopathy progresses
resulting in low urine Na+ immunocompromised: pneumonia, pancytopenia, over weeks to month after Rx initiation
---------------------------------------------------------------- adenopathy, hepatosplenomegaly, mucocutaneous painless proximal weakness, no tenderness
sodium bicarbonate: Rx severe metabolic acidosis, lesions normal CK & ESR, no inflammation
hyperkalemia, & TCA overdose Dx: urine or serum antigen DDx: MS, Myasthenia, polymyalgia rheumatica
---------------------------------------------------------------- Rx (mild): oral itraconazole ----------------------------------------------------------------
chronic phenytoin can cause megaloblastic anemia Rx: (severe): amphotericin B, then oral itraconazole DDx of myopathy
due to impaired absorption of folic acid ---------------------------------------------------------------- features ESR CK
also primidone, phenobarbital, TMP, MTX short-acting benzos (alprazolam) is a/w seizures glucocorticoid progressive proximal nrml nrml
---------------------------------------------------------------- & confusion following abrupt discontinuation -induced weakness, mainly LE,
low-dose prednisone: Rx polymyalgia rheumatica dose-dependent A/E of bupropion use: seizures no pain or tenderness
high-dose prednisone: Rx giant cell arteritis ---------------------------------------------------------------- statin-induced pain & tenderness, nrml
MTX: Rx rheumatoid arthritis AAA screening: 1x abdominal USS for male w/without weakness,
hydroxychloroquine: Rx SLE for skin & joint active or former smokers ager 65 75 rhabdomyolysis
---------------------------------------------------------------- selective screening for male never smokers hypothyroid pain, cramps, weakness nrml
mittelschmerz: mid-cycle pain is due to ovulation women age 65 - 75 who have ever smoked myopathy of proximal muscles,
unilateral abdo pain, 2 wks after LMP o insufficient evidence delayed DTRs,
regular menstrual periods, not on OCPs surgical Rx AAA 5.5 cm hypothyroid features
---------------------------------------------------------------- ---------------------------------------------------------------- polymyalgia pain & stiffness nrml
nephrotic syndrome can cause dyslipidemia, acute onset back pain & profound hypotension: rheumatica decreased ROM at hip
increasing risk for accelerated atherosclerosis & shoulders
evaluate for presumptive ruptured AAA
& intrinsic hypercoagulability (venous) rapid response to
Rx: emergent surgical AAA repair
complications: stroke, MI glucocorticoids
complication: AAA can rupture into retroperitoneum,
---------------------------------------------------------------- inflammatory proximal weakness,
creating an aortocaval fistula with the IVC venous
Metabolic syndrome (at least 3/5) myopathies pain & tenderness,
congestion in the bladder fragile, distended veins rash, arthritis
o abdomen (men: > 40 in, women > 35 in) can rupture gross hematuria
----------------------------------------------------------------
o fasting glucose > 100 mg/dL DDx: renal colic, mesenteric ischemia,
Management of blunt abdominal trauma in
o BP > 130/80 mmHg pancreatitis, diverticulitis, biliary disease
hemodynamically unstable: FAST exam
o triglycerides > 150 mg/dL ----------------------------------------------------------------
o positive laparotomy
o HDL (men < 40, women < 50) symptoms of impending eclampsia: persistent
o negative abdominal CT
pathogenesis: insulin resistance (results in frontal/occipital headache, visual disturbance,
o inconclusive DPL
increased insulin secretion to compensate) altered mental status, RUQ or epigastric pain, SOB
tonic-clonic (grand mal) seizures last 3 4 min ----------------------------------------------------------------
o endothelial dependent vasodilatation is hearing tests for children with behavioral concerns,
impaired in insulin resistance & self-limited
fetal bradycardia is common during seizures; poor language & social skills, inattentive
---------------------------------------------------------------- MCC: conductive hearing loss due to recurrent
blood at urethral meatus, inability to void, & resolves once patient is stabilized
Rx: Mg++ sulfate prevents seizure recurrence; ear infections
high-riding prostate: posterior urethral injury ----------------------------------------------------------------
Dx: retrograde urethrogram prior to Foley continued through labor & postpartum period
SGA infant: weight < 10th percentile
o Foley catheter will predispose to abscess, Rx: labor induction/augmentation if no evidence
complications: hypoxia, polycythemia,
hematoma, or urethral damage of fetal distress
o c-section reserved for typical OC reasons hypoglycemia, hypothermia, hypocalcemia
Anti-diabetic medications
o polycythemia is 2/2 hypoxia A1c features o biliary dilatation: extrahepatic cholestasis
---------------------------------------------------------------- Metformin 1 2% initial therapeutic agent ----------------------------------------------------------------
preseptal cellulitis: anterior to orbital septum weight neutral polyuria, polydipsia, mild hypernatremia (> 145)
orbital cellulitis: posterior to orbital septum low risk of hypoglycemia & serum hypertonicity: diabetes insipidus
presepta orbital A/E: lactic acidosis nephrogenic DI: intact thirst mechanism
l celluliti C/I: renal insufficiency o serum Na+ ~ 145
cellulitis s Sulfonylurea 1 2% added for metformin failure central DI: no intact thirst mechanism
eyelid edema & erythema + + weight gain, hypoglycemia o serum Na+ > 150
fever, leukocytosis +/- +/- Pioglitazone 1 - 1.5% 2nd line to metformin/sulfon. o desmopressin: #1 Rx for central DI
ophthalmoplegia, diplopia - + (TZDs) low risk of hypoglycemia ----------------------------------------------------------------
pain with eye movement - + can use in renal insufficiency 10 polydipsia central DI nephrogenic DI
proptosis - + A/E: weight gain, edema, H2O intake ADH release ADH resistance
decreased visual acuity - + CHF, bone fx, bladder cancer
anxious idiopathic, trauma chronic lithium,
Dx: orbital CT scan Insulin 1 - 3.5% basal insulin added in middle-age pituitary surgery, hyperCa++,
Rx preseptal: outpatient, oral ABX metformin failure, A1c >8.5% female on ischemic hereditary
weight gain, hypoglycemia
Rx orbital: inpatient, IV ABX antipsychotics encephalopathy
Sitagliptin .5 - .8% weight neutral
complication: cavernous sinus thrombosis polyuria, low urine osmolality (dilute urine)
(DPP-IV low risk of hypoglycemia
---------------------------------------------------------------- Na+ < 137 Na+ > 150, Na+ 142 150,
inhibitors) can use in renal insufficiency
circumferential full-thickness burns of extremity thirst impairment intact thirst mech
Exenatide 0.5 - 1% 2nd agent to metformin
o Rx: IV fluids, analgesia, topical ABX, & ----------------------------------------------------------------
(GLP-1 Rc weight loss**
wound dressing diuretic: hypoK+, hyperglycemia, hyperuricemia
agonist) low hypoglycemia risk
eschar: firm necrotic tissue on exposed tissue o stimulates ADH concentrated urine
A/E: acute pancreatitis
following burn wounds ----------------------------------------------------------------
----------------------------------------------------------------
o compromises blood & lymph circulation demeclocycline: Rx SIADH by inhibiting the
secondary dysmenorrhea: age 20s 30s,
compartment syndrome: deep pain out of ADH-mediated aquaporin insertion
previous Hx of non-painful menses
proportion to injury, pulselessness, paresthesia ----------------------------------------------------------------
MCC: endometriosis, adenomyosis, fibroids,
Dx: Doppler USS to document peripheral pulses tolvaptan: V2 vasopressin Rc antagonist, causes
pelvic infection
& tissue compartment pressure selective free water loss
----------------------------------------------------------------
Rx: escharotomy for edema & constriction of Rx severe hypervolemic/euvolemic hyponatremia
chronic corticosteroids & chronic alcohol are
vascular supply or peripheral pulses ----------------------------------------------------------------
a/w avascular necrosis
o evaluate for signs of adequate perfusion hypersensitivity pneumonitis: inflammation of
progressive hip pain, normal ROM; normal XR
fasciotomy: Rx compartment syndrome lung parenchyma due to antigen exposure
Dx: MRI
---------------------------------------------------------------- cough, dyspnea, fever, malaise within 4 6 hr
----------------------------------------------------------------
decreased appetite, behavioral changes, erythema chronic: weight loss, clubbing, honeycomb lung
hemodynamic compromise 3 7 days post-MI:
of turbinates in nasal septum: cocaine abuse CXR: ground-glass opacity, haziness
MR due to papillary rupture, LV free wall rupture,
---------------------------------------------------------------- Rx: avoidance of antigen
or interventricular septum rupture
primary dysmenorrhea: lower abdo cramping ---------------------------------------------------------------- complications: pulmonary fibrosis
with menses, in absence of other pathology young patient with a fleshy, immobile mass on ----------------------------------------------------------------
o MC onset during adolescence the midline hard palate: torus platinus SSRIs take 4 6 wks for benefits
cramping in 1st few days of menses, due to o benign, congenital lesion o should be continued if no significant A/E
release of prostaglandins from sloughing ---------------------------------------------------------------- initial change: dosage
endometrium causes uterine contractions elevated ALP indicates cholestasis next: prescribe another SSRI
normal physical exam Dx: RUQ USS; intrahepatic or extrahepatic ----------------------------------------------------------------
Rx: NSAIDs & OCPs cause of biliary obstruction PTU A/E: hepatic failure (black box)
methimazole A/E: 1st trimester teratogen ---------------------------------------------------------------- o obtunded, bowel sounds, miosis,
patients with sore throat & fever stop med & clavicle fractures require a neurovascular exam; hypotension, hypothermia
check WBC for agranulocytosis (WBC < 1,000) proximity of subclavian artery & brachial plexus ----------------------------------------------------------------
Rx: IV ABX (anti-pseudomonals) bruit heard under the clavicle requires angiogram GBS prophylaxis for unknown GBS status
30 - 40% on anti-thyroidal after 1 yr go into middle 1/3 fx Rx: brace/sling, ice, rest delivery @ < 37 wks
permanent remission distal 1/3 fx Rx: ORIF to prevent non union membrane rupture > 18 hr
---------------------------------------------------------------- ---------------------------------------------------------------- GBS bacteriuria during current pregnancy
hyperactive DTRs post-surgery: hypocalcemia MCC of aortic stenosis prior Hx of newborn with GBS sepsis
MCC: volume expansion & hypoalbuminemia o senile calcific aortic stenosis (MC age > 70) ----------------------------------------------------------------
in patients requiring multiple transfusions bicuspid aortic valve (MC age < 70) presence of a VSD requires an echo to determine
caused by citrate binding to ionized Ca++ o rheumatic heart disease location & size, also r/o other defects
---------------------------------------------------------------- DDx: hypertrophic cardiomyopathy (heard @ small VSDs close spontaneously by age 2 yrs
severe hypoMg++ can mimic hypocalcemia LLSB, does not radiate to carotids) ----------------------------------------------------------------
PTH secretion & peripheral PTH resistance ---------------------------------------------------------------- V-fib (reentrant ventricular arrhythmias) is MCC of
serum phosphate level is normal young female immigrant with a-fib & symptoms sudden cardiac arrest, immediately post-MI
---------------------------------------------------------------- of pulmonary edema: mitral stenosis 2/2 o re-entry is the predominant mechanism
severe hyperMg++: loss of DTRs, paralysis, rheumatic heart disease causes syncope
apnea, cardiac arrest females become symptomatic during pregnancy due ----------------------------------------------------------------
---------------------------------------------------------------- to increased blood volume Neonatal displaced clavicle fracture
sensorineural hearing loss due to aging: ---------------------------------------------------------------- risk fetal macrosomia, shoulder dystocia,
presbycusis lateral epicondylitis: pain with supination, factors instrumentation delivery
o B/L high-frequency hearing loss passive wrist flexion, or resisted wrist extension features crying with passive motion, crepitus,
o difficulty hearing in noisy, crowded spaces point tenderness distal to lateral epicondyle asymmetric Moro reflex
---------------------------------------------------------------- extensor carpi radialis brevis tendon degeneration Dx XR
chronic conductive hearing loss a/w overgrowth DDx: radial tunnel syndrome Rx reassurance, gentle handling, analgesics,
of stapes bone: otosclerosis ---------------------------------------------------------------- spontaneous healing in 7 10 days,
o low-frequency hearing loss medial epicondylitis: pain with passive wrist place affected arm in long-sleeved garment
o women age 30s 40s extension or resisted wrist flexion & pin to chest with elbow flexed 900
---------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------
steatorrhea can be due to pancreatic insufficiency ASA & -blockers can trigger bronchoconstriction fat necrosis of the breast: fixed mass with skin
(chronic pancreatitis, CF), impaired bile salt in asthmatics (acute dyspnea, prolonged expiration) or nipple retraction, appears solid on USS
absorption (Crohns), impaired intestinal surface o especially with chronic rhinitis & nasal polyps coarse calcification on mammography
epithelium (Celiacs), or Whipples cardioselective -blockers (metoprolol, atenolol) (breast malignancy: microcalcifications)
MCC of chronic pancreatitis: alcohol abuse act on -1; safe for mild/moderate asthmatics fat globules & foamy histiocytes/macrophages
---------------------------------------------------------------- ---------------------------------------------------------------- Rx: routine F/U, no intervention, self-limited
Seizures stress incontinence Rx: Kegel exercise, urethropexy ----------------------------------------------------------------
generalized seizure: diffuse brain involvement Dx: urethral hypermobility (> 300 urethrovesical ALT is predominant in the liver, more specific
partial seizure: arise from a discrete focus; can angle with increased intra-abdominal pressure) for hepatocyte injury
be preceded by an aura (burning smell) ---------------------------------------------------------------- screen Hx for hepatitis risk factors: drugs, alcohol,
o simple partial: no loss of consciousness oxybutynin: Rx urge incontinence travel outside US, transfusions, sexual practices
o complex partial: a/w LOC & automatisms bethanechol & -blockers: Rx overflow incont. repeat LFTs: if chronically elevated transaminases
(chewing, picking, lip smacking) ---------------------------------------------------------------- (> 6 months); evaluate for Hep B & C, fatty liver, &
partial with secondary generalization: most predictive sign of opioid intoxication: hemochromatosis
tonic-clonic manifestations (muscle aches, bradypnea (respiratory depression) ----------------------------------------------------------------
CK, loss of bowel/bladder control)
pallor, fatigue, bloody diarrhea, scattered petechial best assessment for risk of diabetic foot ulcers: chronic alcoholics present with hypoK+, hypoMg+
rash, oliguria: HUS monofilament testing +, & hypophosphatemia
hemolytic anemia, thrombocytopenia, ARF ---------------------------------------------------------------- Mg++ regulates K+ uptake & intracellular levels
MCC: E. coli O157:H7; also S. pneumo (causes venous insufficiency ulcers: stasis dermatitis @ hypoMg++ causes refractory hypoK+ despite
pneumonia or meningitis instead of diarrhea) medial aspect above medial malleolus K+ supplementation
progressive renal involvement: oliguria, arterial ulcers: tissue necrosis @ tip of toes ----------------------------------------------------------------
microscopic hematuria, hyaline casts ---------------------------------------------------------------- hypoalbuminemia in alcoholics can result in
results in fluid overload (pulmonary edema, CHF) factorial design study: randomization to 2 or more hypocalcemia
Rx: supportive, plasmapheresis, dialysis interventions with assignment to 2 or more o Ca++ is largely albumin-bound
DDx: Henoch-Schonlein (normal PLT count), variables studied independently ----------------------------------------------------------------
ITP, post-strep GN, RMSF effect of two or more independent variables upon a vaccines for chronic liver disease
---------------------------------------------------------------- single dependent variable o Tdap 1x substitute (Td every 10 yrs)
Chikunguna fever: mosquito-borne viral illness ---------------------------------------------------------------- o influenza annually (IM inactivated)
incubation: 3 7 days trichotillomania: recurrent hair pulling, results PPSV23 1x, then PCV13/PPSV23 @ age 65
flu-like illness, symmetric polyarthralgia, in hair loss, distress, & functional impairment o Hep A & B
maculopapular rash, cervical lymphadenopathy, o shared features & comorbidity with OCD ----------------------------------------------------------------
peripheral edema Rx: CBT all sexually active women age 24 should be
lymphopenia, thrombocytopenia DDx: alopecia acreta, body dysmorphic disorder, screened for C. trachomatis & N. gonorrhea by
Rx: supportive, resolves in 7 10 days GAD, SLE, OCD nucleic amplification testing
---------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------
initial hematuria: urethral damage fever, productive cough, RLL infiltrate, extremely screen for chlamydia: all sexually active women
terminal hematuria: bladder or prostate damage WBC with lymphocyte predominance: CLL age 24 or > 25 if new/multi partners, Hx of STD
o Dx: cystoscopy (r/o bladder ca) atypical lymphocytes with smudge cells or incarceration
total hematuria: kidney, glomerular, or ureter MC in elderly age > 70 MCC of urethritis, cervicitis, vaginitis
---------------------------------------------------------------- risk of recurrent infections asymptomatic in 80% of women
conjunctivitis, urethritis, arthritis: reactive arthritis presence of thrombocytopenia = poor prognosis intracellular organisms (-wet mount, -Gram stain)
1 4 wks after GI/GU infection (urethritis) Dx: flow cytometry Dx: nucleic acid amplification
asymmetric oligoarthritis, conjunctivitis, ---------------------------------------------------------------- Rx: azithromycin (single dose) or doxycycline;
mucocutaneous oral lesions (stomatitis) Howell-Jolly bodies: nuclear remnants of RBCs also treat partners
Chlamydia infection can cause reactive arthritis generally removed by a functional spleen complications: PID, infertility
---------------------------------------------------------------- single, round, blue inclusions on Wright stain ----------------------------------------------------------------
infant with failure to thrive, lymphadenopathy, suggests functional asplenia or splenectomy gonorrhea screen: high-risk sexually active
diarrhea, thrush, maternal IVDA: HIV infection a/w sickle cell anemia women, age < 24 yrs, new/multi sexual partners,
high risk mother: HIV antibody test @ 1st & 3rd ---------------------------------------------------------------- Hx of STIs; including pregos in this category
trimesters; Ab detection can take up to 3 months, Heinz bodies: aggregates of denatured Hb ----------------------------------------------------------------
occurs after the infectious window period o Hb is oxidized & become insoluble precipitants febrile neutropenia: absolute neutrophil count <
infants (birth 18 months) Dx: PCR testing a/w G6PD deficiency & thalassemia 1500 (severe < 500); medical emergency!
---------------------------------------------------------------- phagocytes extract Heinz bodies bite cells no obvious focus of infection; normal CXR & U/A
diabetic foot ulcers result from neuropathy, ---------------------------------------------------------------- MCC is P. aeruginosa
microvascular insufficiency, immunosuppression basophilic stippling: ribosomal precipitates Rx: empiric anti-pseudomonal
a/w Charcot joint deformities appear as blue granules in RBC cytoplasm (cefepime, meropenem, piperacillin-tazobactam)
MC site: plantar surface of 1st metatarsal head, thalassemia, lead/heavy metal poisoning, alcoholism Dx: blood & urine cultures
under bony prominences ---------------------------------------------------------------- ----------------------------------------------------------------
communicating hydrocele: processus vaginalis
fails to obliteration
non-communicating: fluid within tunica vaginalis LMN signs UMN & LMN signs G6PD catalyzes reduction of NADP to NADPH;
most spontaneously disappear by age 1 yr B/L radicular pain sudden severe back pain NADPH is necessary to reduce glutathione, which
Rx: reassurance & observation for 1 yr saddle anesthesia perianal anesthesia protects RBCs from oxidation by oxidizing agents
unresolved communicating hydrocele surgical asymmetric motor weak symmetric motor weak (bacterial toxins, meds)
removal due to risk of inguinal hernia hypo-/arefflexia hyperreflexia o without G6PD, Hb become oxidized &
---------------------------------------------------------------- late-onset bowel/bladder early-onset bowel/bladder denatured into Heinz bodies hemolysis
sick sinus syndrome: impaired SA node automaticity Rx: MRI, IV glucocorticoids, neurosurg consult Rx: supportive; manage underlying cause
o 2/2 degeneration or fibrosis of SA node ---------------------------------------------------------------- ----------------------------------------------------------------
fatigue, lightheadedness, palpitations, syncope acute mechanical back pain w/o neuro deficits, arteriovenous fistula causes high-output cardiac
EKG: tachycardia-bradycardia syndrome, pain radiation, +Straight-leg raise: disc herniation failure by shunting blood from arterial to venous
sinus pause/arrest, SA exit block unilateral radicular pain in dermatome distribution increase preload
---------------------------------------------------------------- Rx: early mobilization, relaxants, NSAIDs o also systemic vascular resistance
painless, hard testicular mass + suggestive USS: o 4 6 wks circulation is unable to meet O2 demands of
radical orchiectomy (testis & cord) return to daily activities ASAP peripheral tissues
o kill first, investigate later o bed rest, exercise program, & PT not helpful MCC: trauma, iatrogenic (femoral catheterization),
o determine cancer type to guide treatment severe pain may result in urinary retention due atherosclerosis (aortocaval fistula)
highest cure rate of all cancers to inability to Valsalva in those with BPH wide pulse pressure, brisk carotid upstroke,
---------------------------------------------------------------- ---------------------------------------------------------------- systolic murmur, flushed extremity, LVH
burst fracture of vertebra, loss of motor function Opportunistic infections in HIV Dx: Doppler USS
below lesion, loss of pain/temp B/L below lesion, P. jirovecii CD4 < 200 TMP-SMX (10) ----------------------------------------------------------------
intact proprioception: anterior cord syndrome Toxoplasma CD4 < 100 TMP-SMX (10) Primary humoral deficiencies
B/L loss of vibratory & proprioception, weakness, MAC CD4 < 50 azithromycin (10) Bruton /absent B-cells
paresthesias, urinary incontinence or retention: Histoplasma CD4 < 150 Itraconazole agammaglobulinemi all Ig
posterior cord syndrome (MS) a
burning pain & weakness in upper extremities from optimal approach to preventing opportunistic CVID normal B-cells
forced hyperextension neck injury with pre-existing all Ig
infections: anti-retrovirals, vaccination
degenerative cervical changes: central cord primary prophylaxis (CD4 < 200) IgA deficiency normal B-cells
o localized deficit in pain & temp IgA only
o TMP-SMX & azithromycin
I/L motor weakness, spasticity, loss of vibration & Hyper-IgM normal B-cells
secondary prophylaxis: after an infection to
proprioception, C/L loss of pain & temp 2 levels syndrome IgG & IgA, IgM
prevent relapse or recurrence; regardless of CD4
below lesion: Brown-Sequard o acyclovir/valacyclovir for HSV
paraplegia, variable sensory loss, urinary & fecal all result in recurrent sinopulmonary infections
o fluconazole for Cryptococcus
incontinence, saddle anesthesia: Cauda equina with encapsulated spp, viruses, opportunistics
----------------------------------------------------------------
---------------------------------------------------------------- hyper-IgM syndrome prevents class switching
sudden onset back pain, pallor, dark urine,
Cauda equina syndrome: sacral nerve root due to CD40 ligand deficiency
jaundice, bite cells: G6PD deficiency
compression 2/2 herniation, spinal stenosis, o lymphoid hyperplasia
X-linked; MC in A-A, Asian, Mediterranean
metastasis, tumors, infection, iatrogenic injury o Giardia & sinopulmonary infections
hemolytic anemia after oxidative stress/injury
provides sensory innervation to saddle area, IgA def: recurrent respiratory, GI, GU infections
( indirect bilirubin, LDH, haptoglobin)
motor to sphincters, PNS to bowel & bladder & anaphylactic transfusion reaction
precipitated by infection, meds (TMP-SMX, sulfa,
LMN signs, hyporeflexia o episodic diarrhea: Giardia
antimalarial, nitrofurantoin), fava beans
gradual, severe back pain with U/L radiculopathy, ----------------------------------------------------------------
G6PD activity assay can be normal during attack
saddle numbness, asymmetric weakness diabetic foot ulcers allow contiguous spread of
as G6PD deficient RBCs are hemolyzed early
---------------------------------------------------------------- infection, resulting in osteomyelitis
+Prussian blue stain = hemosiderin
Cauda equina Conus medullaris ----------------------------------------------------------------
PBS: bite cells with Heinz bodies
syndrome syndrome
episodic vision loss, diplopia, sensory deficits, ABG: hypoxemia, hypocapnia, resp. alkalosis itchy, painful, erosive purple lesions on the vulva:
motor weakness, gait/balance disturbance: MS Rx: pain control, breathing exercises, directed vulvar lichen planus
relapsing-remitting pattern coughing, early mobilization, incentive spirometry MC in middle-aged women
optic neuritis, internuclear ophthalmoplegia ---------------------------------------------------------------- ----------------------------------------------------------------
MRI: multiple, B/L, asymmetric hyperintense Preventing post-op pulmonary complications Down syndrome comorbidities
lesions in periventricular white matter pre-operative cardiac AV septal defect, VSD, ASD
acute exacerbation Rx: high-dose IV smoking cessation at least 8 wks prior GI duodenal atresia, Hirschsprung
methylprednisolone o COPD symptom control neuro intellectual disability
o plasma exchange if no response o Rx respiratory infections early-onset Alzheimers
---------------------------------------------------------------- o education on lung expansion maneuvers hematologi acute leukemia
M. tuberculosis occurs when droplets of bacilli post-operative c
reach the alveolar space & replicate; accumulation o incentive spirometry, deep breathing exercises endocrine hypothyroidism, Type I DM
of macrophage & neutrophils, with bacilli o CPAP, chest PT MSK atlanto-axial instability
proliferation form a tubercle ---------------------------------------------------------------- ----------------------------------------------------------------
tubercle + lymphadenopathy = Gohn complex Rome criteria for irritable bowel syndrome Small intestinal bacterial overgrowth: native
cell-mediated immune response forms a recurrent abdo pain/discomfort, 3 days/month & non-native bacteria causing excess
granuloma, resulting in latent TB for the last 3 months + 2 fermentation, inflammation, & malabsorption
---------------------------------------------------------------- o improves with bowel movement causes: anatomic or dysmotility disorders
initial menstrual cycles at menarche are anovulatory o change in stool frequency (strictures, fistulas, systemic sclerosis, diabetes,
2/2 immature hypothalamic-pituitary-ovarian axis o change in stool form immunodeficiency, chronic pancreatitis, cirrhosis)
causes irregular cycles &/or menorrhagia diarrhea- or constipation-predominant, or mixed bloating, flatulence, abdominal pain, diarrhea,
some cyclic bleeding due to breakthrough no extensive workup if no alarm features, & no weight loss, malabsorption
---------------------------------------------------------------- Dx: endoscopy with jejunal aspirate
family Hx or IBD or CRC
acute low back pain colonoscopy: normal colonic mucosa Rx: ABX, trial of metoclopramide, diet changes
o no red flags, sciatica or cord compression ---------------------------------------------------------------- DDx: IBD, IBS, lactose intolerance, SBO
Rx: conservative therapy 4 6 wks severe vulvar itching with numerous excoriations, ----------------------------------------------------------------
back XR & ESR if no improvement & skin is thin, dry, & white; post-menopause: post-op DVT prophylaxis: LMWH
o red flags or sciatica: back XR & ESR lichen sclerosis ----------------------------------------------------------------
MRI if results abnormal porcelain-white polygonal macules & papules Breastfeeding failure Breast milk jaundice
cord compression signs/symptoms: MRI with atrophic, cigarette paper quality jaundice
premalignant lesion SCC 1st week of life 3 -5 days, peak @ 2 wks
red flags: age > 50, nighttime pain, constitutional
Dx: vulvar punch biopsy (r/o vulvar SCC) lactation failure, -glucuronidase in
symptoms (fever, weight loss), unrelieved by rest,
Rx: high-potency topical corticosteroids unconjugated breast milk deconjugate
not exacerbated with movement or palpation,
hyperbilirubinemia, intestinal bilirubin, &
neurologic symptoms, Hx of malignancy, IVDA ----------------------------------------------------------------
bilirubin elimination, & enterohepatic circulation
cord compression signs: back pain, paralysis, clusters of small teardrop-shaped growths at
enterohepatic circulation
hyperreflexia, urinary & fecal incontinence vestibule of the vulva: HPV genital warts
sub-optimal feeding, adequate breastfeeding
---------------------------------------------------------------- (condyloma acuminata)
dehydration signs, normal exam,
atelectasis: common post-op complication clusters of smooth, pink/skin-colored lesions
inadequate stooling no dehydration
peak severity: 2nd post-op day Rx: trichloroacetic acid (complete resolution) or
Rx: feeding 15 minutes per
MC due to airway obstruction from retained airway podophyllin side every 2 -3 hrs
secretion, lung compliance, post-operative pain, DDx: condyloma lata (20 syphilis; flat & velvety),
& medications interfering with deep breathing vulva ca (single, fleshy lesion), lichen sclerosis, causes of lactation failure: inadequate milk supply,
results from shallow breathing & weak cough vulvar lichen planus
infrequent feedings, cracked/clogged nipples,
V/Q mismatch evident ----------------------------------------------------------------
engorgement, poor latching
inadequate stooling results in bilirubin elimination confounding: the exposure-disease relationship ----------------------------------------------------------------
& enterohepatic circulation is obscured by the effect of an extraneous factor hyperkalemia can cause ascending muscle
yellow-seedy stool = normal that is associated with both exposure & disease weakness with flaccid paralysis
brick-red urate crystals in diaper = dehydration Methods to control confounding initial evaluation: EKG
---------------------------------------------------------------- matching: used in case-control studies; selecting next: exclude acute treatable secondary causes
all newborns have mild unconjugated matched known or suspected variables (age, race), (CKD, hyperglycemia, tumor lysis syndrome)
hyperbilirubinemia due to high Hb turnover & both groups having a similar distribution next: review current/recent meds (non-selective
immature hepatic UDGT activity o stratified analysis -blockers, triamterene, ACE-I/ARB, NSAIDs)
---------------------------------------------------------------- restriction: limited specific characteristics ----------------------------------------------------------------
Biliary atresia randomization: used in clinical trials, minimizes steppage gait: unilateral foot drop 2/2 weakness
features jaundice, acholic stool, dark urine, selection bias of foot dorsiflexion; exaggerated hip/knee flexion
conjugated hyperbilirubinemia & o controls known, unknown, & difficult-to- L5 radiculopathy: back pain radiates to foot,
hepatomegaly in first 2 months of life measure confounders weak foot inversion & plantar flexion
Dx USS: absent/abnormal GB ---------------------------------------------------------------- common peroneal neuropathy: lateral fibula
hepatobiliary scintigraphy: failure of effect modification: an external variable that compression, paresthesia & sensory loss over foot
tracer excretion into small bowel positively or negatively impacts the effect of a dorsum; normal inversion & plantar flexion
cholangiogram: biliary obstruction; risk factor on the disease of interest Dx: electromyography or NCV
done intraoperatively (gold std) distinguished from confounding by performing a ----------------------------------------------------------------
liver Bx: expanded portal tracts with stratified analysis on the variable of interest normocytic anemia, splenomegaly, reticulocytosis,
bile duct obstruction & proliferation; o if the variable is a cofounder no significant indirect bilirubin, LDH, haptoglobin:
portal tract edema, fibrosis, inflammtn association in risk between stratified groups autoimmune hemolytic anemia
Rx hepatoportoenterostomy (Kasai), as the confounding effect is removed MCC: infectious mono, CLL, SLE, PCN
liver transplant inevitable o if the variable is an effect modifier strong spherocytes (not schistocytes)
MC indication for pediatric liver transplant association exists between stratified groups confirm Dx: +direct Coomb show IgG or C3 on
---------------------------------------------------------------- example: family Hx increases the risk of breast ca RBC surface
cerebellar ataxia @ vermis (truncal ataxia) or in patients taking OCPs Rx: high-dose glucocorticoids if symptomatic
hemisphere (I/L ataxia): staggering, swaying, ---------------------------------------------------------------- o splenectomy or immunosuppressives for
impaired tandem gait & titubation (nodding) observer bias: investigators decision is adversely refractory cases
TOWARD the affected side affected by knowledge of exposure status DDx: sickle cell, microangiopathic hemolytic
---------------------------------------------------------------- recall bias: inaccurate recall by participants anemia (DIC)
Acute Lymphoblastic Leukemia (ALL) o MC with case-control studies ----------------------------------------------------------------
etiology MC childhood cancer ---------------------------------------------------------------- renin is produced in juxtaglomerular cells in
peak age: 2 5 yrs; M > F Tumor lysis syndrome: oncologic emergency response to hypoperfusion
features bone pain, pallor (anemia), releases K+, phosphate & uric acid into circulation renin cleaves angiotensinogen angiotensin I,
petechiae o Ca++, K+, phosphate, uric acid converted to angiotensin II by ACE in the lung
(thrombocytopenia)
MCC: massive lymphoma or leukemia, chemoRx angiotensin II is a potent vasoconstrictor & also
nontender lymphadenopathy,
Rx: allopurinol reduces acute urate nephropathy promotes aldosterone production in adrenal cortex
hepatosplenomegaly
---------------------------------------------------------------- aldosterone Rc antagonist: induce natriuresis
confirm bone marrow Bx
eye exposure to acid: full recovery likely angiotensin II Rc blocker: cause natriuresis &
Dx shows > 25% lymphoblasts
Rx chemotherapy alkaline exposure: corneal damage likely aldosterone production
---------------------------------------------------------------- ---------------------------------------------------------------- direct renin inhibitor (aliskiren): angiotensin I/II
aphthous ulcers, granulomatous inflammation, parkinsonism, orthostatic hypotension, impotence, & aldosterone
weight loss, vague abdominal pain: Crohns incontinence: multiple system atrophy
---------------------------------------------------------------- (Shy-Drager syndrome)
parkinsonism + autonomic & neurologic dysFx
triad: tenosynovitis, dermatitis, toxic adenoma presents as thyroid toxicosis
migratory asymmetric polyarthritis o RIU uptake only in the nodule
without purulent arthritis Graves: diffuse RIU uptake, infiltrative
Dx synovial fluid: > 50,000 (septic), ophthalmopathy, pretibial myxedema
urethral, cervical, or rectal cultures, multinodular goiter: patchy RIU uptake
HIV & syphilis screen painless thyroiditis: reduced RIU uptake
Rx IV ceftriaxone, ----------------------------------------------------------------
joint drainage for purulent arthritis, all diastolic, continuous, & loud systolic murmurs
empiric azithromycin for Chlamydia, require transthoracic echo
treat sexual partners ----------------------------------------------------------------
purulent arthritis in a sexually active individual primary tumors of the GIT, lungs, & breast are
is gonococcal arthritis until proven otherwise MCC of liver metastasis (multiple liver masses)
---------------------------------------------------------------- o Dx: colonoscopy
causes of high-output cardiac failure: anemia, solitary mass in the setting of chronic liver disease:
thyrotoxicosis, bone Pagets, thiamine deficiency MCC is HCC
---------------------------------------------------------------- o Dx: AFP & USS (poorly defined mass)
Bacterial meningitis in children age > 1 month liver abscess: DDx amebic vs. pyogenic
MCC S. pneumoniae & N. meningitidis o Dx: serology
features fever, vomiting/poor feeding,
encapsulated, calcified cyst with fluid & budding
lethargy, irritability, seizures,
cells; immigrant or exposure to sheep & dogs
bulging anterior fontanelle
o hydatid cyst (Echinococcus)
nuchal rigidity, +Kernig, +Brudzinski
benign epithelial liver tumor, solitary mass in
Dx CBC, electrolytes, blood cultures, LP
Rx IV vancomycin & ceftriaxone right hepatic lobe, young female, chronic OCPs
(newborns 28 days: cefotaxime) o hepatic adenoma
---------------------------------------------------------------- exposure to vinyl chloride gas, thorium dioxide
loop diuretics induce natriuresis, but the decreased PLUS dexamethasone for HiB meningitis
(reduces risk of sensorineural hearing loss) arsenic,; vascular spaces with malignant cells
blood volume stimulates renin, angiotensin II, & o angiosarcoma of the liver
aldosterone
Rx: LP first, then prompt empiric ABX ----------------------------------------------------------------
----------------------------------------------------------------
o ABX can sterilize CSF hindering definitive Dx Prinzmetal angina is a/w Raynauds & migraines
Causes of Vit K deficiency
ceftriaxone displaces bilirubin from albumin & precipitated by emotional stress, hyperventilation,
fat malabsorption, fat-soluble vitamin deficiency
increases risk for kernicterus in newborns exercise, cold, cocaine use
ABX
herniation is rare in infants, thus head CT is greatest risk factor: smoking
hepatocellular disease
reserved only for comatose, focal neuro signs, or Rx: CCB or nitrates
----------------------------------------------------------------
Hx of neurosurgical procedures o non-selective -blockers (2) & ASA
fever, migratory polyarthralgia, & pustular rash on
---------------------------------------------------------------- promote vasoconstriction
trunk & extremities, with Hx of high-risk sexual
milk production at delivery ----------------------------------------------------------------
behavior: disseminated gonococcal infection
o sudden in estrogen & progesterone which protease inhibitors (indinavir) commonly cause
MC STD causing septic arthritis
normally interferes with actions of prolactin crystal-induced nephropathy
Dx: nucleic acid amplification
o suckling stimulatory effects on prolactin o periodic monitoring of U/A & serum Cr
DDx of fever, rash, arthritis: IE, parvovirus B19,
& oxytocin release NRTI: a/w lactic acidosis
secondary syphilis, toxic shock syndrome
suppression of breast milk: tight-fitting bra, avoid NNRTI: a/w SJS
nipple stimulation, ice packs, analgesics nevirapine: a/w liver failure
Disseminated gonococcal infection
feature septic arthritis without skin lesions do not use DA agonists (bromocriptine) ----------------------------------------------------------------
s OR ----------------------------------------------------------------
intermittent chest pain, dysphagia, young female: ---------------------------------------------------------------- o monitor BMI, fasting glucose & lipids
diffuse esophageal spasm primipexole (DA agonist): Rx RLS & Parkinson ----------------------------------------------------------------
a/w emotional factors & functional GI disorders ---------------------------------------------------------------- monitor renal & thyroid function: lithium
relieved by nitrates & CCBs circumstantial thought: deviates from original o a/w nephrogenic DI, interstitial nephritis,
barium swallow: corkscrew or normal subject, but eventually return hypothyroidism
Dx: manometry simultaneous high amplitude tangential thought: drift away, never returns monitor CBC weekly: clozapine
contractions & normal LES flight of ideas: loosely associated thoughts o a/w agranulocytosis, lowers seizure threshold
Rx: anti-spasmodics, diet, psych counseling that move from topic to topic 1st gen anti-psychotics & risperidone are a/w
DDx: Zenker, achalasia, scleroderma, infectious loose association: lack of logical connection hyperprolactinemia
esophagitis (candida, HSV, CMV) between thoughts or ideas; severe tangentiality o galactorrhea, amenorrhea, decreased libido
---------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------
scleroderma can present with loss of distal signs of deliberate scald injury in toddlers clomaphine citrate (estrogen analogue)
peristalsis of esophagus o linear demarcation, no splash marks improves GnRH & FSH release in PCOS
fibrosis & atrophy of esophageal smooth muscle o extensive burns to back/buttocks metformin also improves ovulation
LES is incompetent reflux stricture o sparing of flexural creases, zebra pattern ----------------------------------------------------------------
---------------------------------------------------------------- ---------------------------------------------------------------- unvaccinated or unknown vaccination Hx with
CVD is MCC of morbidity & mortality in PAD positive pressure mechanical ventilation exposure to blood from Hep B infected patients
& intermittent claudication acutely intrathoracic pressure, thus venous require post-exposure prophylaxis (PEP)
5-yr risk of nonfatal MI & stroke return, ventricular preload, & C.O. o Rx: HBV Ig + HBV vaccine (within 24 hr)
PAD is a CAD risk equivalent can cause circulatory collapse in known vaccinated workers do not require PEP,
#1 Rx: supervised graded exercise program hypovolemic shock if intravascular volume but recommend a HBV booster vaccine
o goal: reproduce claudication symptoms is not replaced before mechanical ventilation ----------------------------------------------------------------
o reduces symptoms & improve distance ---------------------------------------------------------------- anti-Jo antibodies = polymyositis
#2 Rx: low-dose ASA & statin reduces flexible bronchoscopy: Rx life-threatening ----------------------------------------------------------------
atherosclerotic CV mortality hemoptysis, locate & treat bleeding source MC foreign body ingestion: coins in esophagus
#3 Rx: add cilostazol for persistent symptoms ---------------------------------------------------------------- Rx: observe for 24 hrs if asymptomatic
MCC of dyspepsia: GERD, NSAIDs, GI cancer, o Rx: flexible endoscopy if symptomatic or
#4 Rx: percutaneous or surgical revascularization
functional dyspepsia, H. pylori time of ingestion is unknown
for persistent symptoms
dyspepsia + alarm symptoms upper endoscopy ingested batteries, sharp objects, & magnets
----------------------------------------------------------------
aminoglycosides: Rx multi-drug resistant o alarm symptoms for gastric or esophageal require preemptive removal
pyelonephritis or serious G-negative infections cancer: age > 55, weight loss, dysphagia, o Rx: endoscopy or laparotomy
aminoglycosides (amikacin) are nephrotoxic persistent vomiting, early satiety, anemia, ----------------------------------------------------------------
gross/occult bleed child with sudden onset stridor, dyspnea wheezing,
o can cause acute renal failure in setting of CKD
dyspepsia, no alarm symptoms coughing,: tracheobronchial foreign body
o monitor drug levels & renal function
o GERD symptoms PPI or H2 blocker aspiration
----------------------------------------------------------------
o NSAID-induced dyspepsia PPI Rx: rigid bronchoscopy
Nafcillin is used for Rx MSSA
o if no GERD, no NSAID use H. pylori test ----------------------------------------------------------------
o MCC of AIN (eosinophils & WBC casts)
(breath test or stool assay, not serology) situs inversus, recurrent sinusitis, bronchiectasis:
----------------------------------------------------------------
o if no improvement upper endoscopy Kartageners
daytime drowsiness & cataplexy (sudden loss of
---------------------------------------------------------------- AR disorder of dysmotile cilia; dextrocardia
muscle tone triggered by strong emotions), sleep
GERD can present as chronic cough or hoarseness ----------------------------------------------------------------
paralysis, hypnagogic/hypnopompic hallucination:
narcolepsy Rx: H2 antagonist (ranitidine) or PPI normal: air conduction is 2x > bone conduction
#1 Rx: modafinil (psychostimulant) ---------------------------------------------------------------- bone conduction > air conduction on Rinne test
alt Rx: methylphenidate, amphetamines atypical antipsychotics (olanzapine, clozapine) suggests conductive hearing loss
is a/w weight gain, hyperglycemia, dyslipidemia
Weber test to confirm Dx fever, localized back pain, neurologic deficits ----------------------------------------------------------------
otosclerosis causes conductive hearing loss in (motor weakness, paresthesia, bowel/bladder): sarcoidosis causes hypercalcemia by extra-renal
females age 20s 30s; autoimmune process spinal epidural abscess conversion of 25(OH) VitD to 1,25(OH) VitD in
radicular pain below the knee, +straight leg test, granulomatous tissue
Interpretation of Rinne & Weber tests pain improves with rest: herniated disk intestinal Ca++ absorption
Rinne result Weber result chronic back pain, fatigue, weight loss, anemia, ----------------------------------------------------------------
normal air > bone midline hypercalcemia, elevated Cr: MM Approach to hypercalcemia
conduction B/L low back pain radiates to buttocks & thighs, first: confirm by repeat testing
Conductive BC > AC affected lateralizes neuro deficits, worse with walking or standing: next: measure PTH
hearing loss AC > BC unaffected toward lumbar spinal stenosis o high/normal PTH (PTH-dependent): 10 or 30
affected ear low back pain, claudication of hip muscles, hyperPTH, familial hypercalcemic
Sensorineura AC > BC both ears lateralize to impotence: iliac artery thrombosis hypocalciuria, Lithium, teriparatide
l hearing loss (diminished AC & unaffected ear, age > 50, pain worse at night, point tenderness, o suppressed PTH (PTH-independent)
BC in both) away from cauda equina syndrome, Hx of malignancy: measure PTHrP, 25(OH)D, 1,25(OH)D
affected ear cancer mets to bone malignancy, Vit D toxicity, sarcoidosis
local tenderness to palpation after minor trauma, ----------------------------------------------------------------
sensorineural hearing loss: involves inner ear, in elderly with Hx of osteoporosis: vertebral fatigue, anxiety, depression, tetany
cochlea, or auditory nerve compression fracture Approach to hypocalcemia
o MCC ototoxic ABX, Menieres chronic progressive pain, local point tenderness, always confirm with repeat Ca++ measurement
conductive hearing loss: decreased movement low-grade fever, ESR/CRP, soft tissue infection: correct serum albumin or measure ionized Ca++
of small ear bones, otitis media, otosclerosis vertebral osteomyelitis evaluate Mg++, medications (Ca++ chelators,
---------------------------------------------------------------- ---------------------------------------------------------------- bisphosphonates, phenytoin), recent transfusion
Manifestations of sarcoidosis tenderness to gentle percussion over spinous o correct underlying cause
non-caseating granulomatous inflammation processes of involved vertebrae, not relieved next: measure serum PTH
pulmonary B/L hilar adenopathy, with rest, ESR: vertebral osteomyelitis
interstitial infiltrates MCC: S. aureus normal/low PTH high PTH
ophthalmic anterior uveitis MC in IVDA or recent distant infection (UTI) radical neck surgery, Vit D deficiency, CKD
reticuloendothelia peripheral lymphadenopathy, initial tests: CBC, blood cultures, ESR/CRP, parathyroidectomy,
l hepatosplenomegaly spine XR thyroidectomy
MSK acute polyarthritis (ankles) Dx: spinal MRI autoimmune pancreatitis, sepsis
chronic arthritis confirm Dx: CT-guided aspiration & Bx Wilsons, tumor lysis syndrome
CNS central DI, hypercalcemia Rx: long-term IV ABX +/- surgery hemochromatosis
Lofgren o erythema nodosum complications: epidural abscess, paralysis genetic: PTH gene, Ca+ PTH resistance
syndrome (painful shin lesions) ---------------------------------------------------------------- +- sensing Rc gene (pseudo-hypoPTH)
o hilar adenopathy hyperplastic polyp: MC non-neoplastic polyp in
o migratory polyarthralgia the colon; no CRC risk; no further work-up hypoMg++ causes hypoCa++ in alcoholics; due
o fever hamartomatous polyp: juvenile & Peutz-Jegher to decreased PTH release & PTH resistance
polyps; non-malignant not a/w hyperphosphatemia
mostly asymptomatic adenomatous polyp: premalignant potential ----------------------------------------------------------------
cough, dyspnea, fever, malaise, weight loss sessile villous adenoma, > 2.5 cm total serum Ca++ varies with albumin levels
elevated ACE & hypercalcemia ---------------------------------------------------------------- o 50% of Ca++ is albumin bound
Dx: mediastinoscopy/bronchoscopy tissue Bx fevers, chills, malaise, cough, dyspnea, tachypnea ----------------------------------------------------------------
Rx: systemic corticosteroids if symptomatic & diffuse fine crackles; diffuse reticular or hypophosphatemia coexists with hypoMg++ in
---------------------------------------------------------------- ground-glass opacities on CXR: hypersensitivity alcoholics
reaction or pneumonitis GI absorption & renal loss of phosphate
---------------------------------------------------------------- inhibin is made by granulosa cells of ovarian deficient anterior pituitary hormones only:
Prolactinoma follicles causes feedback inhibition on FSH ACTH, GH, FSH, LH, TSH
premenopausal: oligo/amenorrhea, infertility, ---------------------------------------------------------------- posterior pituitary (ADH, oxytocin) is unaffected
galactorrhea, hot flashes, bone density CXR: pulmonary venous congestion, cardiomegaly, no effective Rx to restore lactation
postmenopausal: mass effect (headache, vision) cephalization of pulmonary vessels, Kerley B lines, ----------------------------------------------------------------
men: infertility, impotence, libido, gynecomastia & pleural effusion: CHF non-pitting edema seen in Turners is due to
due to hypogonadotropic hypogonadism ---------------------------------------------------------------- congenital lymphedema from dysfunctional
**serum prolactin > 200 ng/mL (diagnostic) CHF exacerbation causes tachypnea as LV dysFx development of lymphatic network
r/o renal insufficiency & hypothyroidism results in pleural effusion, hypoxemia, hypocapnia o leads to webbed neck, cystic hygroma
brain MRI & respiratory alkalosis ----------------------------------------------------------------
Rx: cabergoline, transphenoidal surgery dry cough, exertional dyspnea, bibasilar crackles progressive dysphagia of solids & liquids, weight
cardiomegaly, S3, S4 loss, regurgitation, nighttime cough: achalasia
prolactin inhibits GnRH production & release Dx: BNP, PCWP CXR: widened mediastinum
low LH, low/normal TSH DDx: COPD (respiratory acidosis, hypoxia), PE ( barium studies: dilated esophagus with smooth
detected early in premenopausal due to associated A-a gradient) tapering of distal esophagus
endocrine symptoms ---------------------------------------------------------------- Dx: manometry shows aperistalsis, LES tone
---------------------------------------------------------------- diffuse esophageal spasm due to dysFx of Dx: endoscopy to r/o malignancy
pituitary tumor < 10 mm = microadenoma inhibitory neurons cause chest pain & dysphagia Rx: surgical pneumatic dilatation or myotomy
MC prolactin-only secreting tumor manometry: periodic high-amplitude, non-peristaltic ----------------------------------------------------------------
o amenorrhea & galactorrhea in women ---------------------------------------------------------------- polymyositis: idiopathic inflammatory muscle
o hypogonadism in men Features of systemic sclerosis (scleroderma) disease; progressive proximal muscle weakness
Rx: cabergoline (fewer A/E) if symptomatic systemic fatigue, arthralgia weakness is prominent than pain or tenderness
---------------------------------------------------------------- skin telangiectasia, sclerodactyly, dysphagia due to weakness of striated muscles
non-functional pituitary adenoma: large mass digital ulcers, calcinosis cutis in upper esophagus; regurgitation, aspiration
effect; low TSH & LH, mild prolactin elevation vascular Raynauds Dx: muscle biopsy
hypogonadism & hypothyroidism cardiac myocarditis, pericarditis DDx: MG, MS, polymyalgia rheumatica,
2/2 compression of thyrotrophs & gonadotrophs, pericardial effusion Guillain-Barre, ACE-I (hyperkalemia)
& compression of dopaminergic pathway pulmonary pulmonary fibrosis, pulmonary HTN ----------------------------------------------------------------
---------------------------------------------------------------- GI esophageal dysmotility, dyspepsia, postpartum > 8 wks with chest pain, dyspnea, &
primary hypothyroidism can cause mild/moderate dysphagia, angiodysplasia of stomach multiple nodules on CXR: choriocarcinoma
hyperprolactinemia due to TRH-induced (watermelon stomach), metastatic gestational trophoblastic disease
lactotroph (prolactin) stimulation malabsorption (bacterial growth) (GT neoplasia is only locally invasive)
---------------------------------------------------------------- scleroderma renal crisis can occur after molar or normal prego, abortion
child with acute bacterial sinusitis; congestion, o acute oliguric renal failure with enlarged uterus, pelvic pain
nasal drainage, & cough for 10 30 days without malignant HTN irregular vaginal bleed > 8 wks post-partum
improvement; high fever, purulent nasal drainage o thrombocytopenia
MC site of mets: lungs
MC predisposing factor: viral URI Rx: ACE-I o microangiopathic hemolytic anemia
confirm Dx: quantitative -hCG
due to impaired mucociliary clearance lower esophagus smooth muscle atrophy &
----------------------------------------------------------------
Dx: clinical fibrosis, causes peristalsis & LES tone severe headache, vomiting, B/L periorbital edema:
Rx: augmentin o dysphagia, heartburn, hoarseness
cavernous sinus thrombosis
---------------------------------------------------------------- ---------------------------------------------------------------- 2/2 uncontrolled infection of skin, sinuses, or
menopause symptoms are similar to hyperthyroid failure of postpartum lactation, amenorrhea,
orbit (insect bite on the face)
Dx: measure TSH & FSH hyponatremia, loss of sexual hair, anorexia, CN 3, 4, 5, 6 deficits, intracranial HTN
---------------------------------------------------------------- weight loss, lethargy, delayed DTRs: Sheehan
MC is severe headache
prolactin deficiency
fundoscopy: papilledema, dilated tortuous veins CSF removal reduce volume & pressure low glucose in empyema is due to high metabolic
Dx: MRI with venography activity of leukocytes/bacteria in pleural fluid
Rx: IV ABX 3 distinct brain compartments: parenchyma, CSF, ----------------------------------------------------------------
DDx: brain abscess, cluster headache, migraine, cerebral blood flow (CBF) fever, leukocytosis, parenchymal infiltrates:
preseptal cellulitis CBF is regulated by BP, paO2 & paCO2 aspiration pneumonia
---------------------------------------------------------------- paCO2 is a potent regulator of CBF ----------------------------------------------------------------
dacryocystitis: infection of lacrimal sac o as cerebral paCO2 , also CBF GB carcinoma is Dx incidentally during or after
acute onset pain & redness in medial canthal, ---------------------------------------------------------------- cholecystectomy
sometimes purulent drainage FSH in the setting of 3 months of amenorrhea in o sufficient Rx if confined to GB mucosa
normal visual acuity women < 40 = premature ovarian failure ----------------------------------------------------------------
MC in infants & adults > 40 primary hypogonadism estrogen, FSH, Bacillus cereus: preformed toxin
MCC: S. aureus LH (FSH: LH > 1.0; slower FSH clearance) o 1 6 hrs after contaminated rice ingestion
Rx: systemic ABX causes: chemotherapy, radiation, autoimmunity, S. aureus: preform toxin
---------------------------------------------------------------- Turners, Fragile X o dairy, salad, meat, eggs
episcleritis: between conjunctiva & sclera all secondary amenorrhea require a pregnancy test, C. perfringens: spore-forming
o acute mild/moderate discomfort, photophobia, prolactin & FSH level o meat, poultry, gravy
watery discharge; bulbar conjunctival injection ---------------------------------------------------------------- o watery diarrhea, 8 14 hr after ingestion
hordeolum: abscess over upper/lower eyelid transudate is due to systemic factors; B/L effusion ----------------------------------------------------------------
o localized red, painful eyelid swelling (hypoalbuminemia, hydrostatic pressure) scatter plots are used for crude analysis of data;
o MCC: S. aureus o pleural fluid pH 7.4-7.55 (normal pH: 7.6) can show a linear association, used to calculate
o #1 Rx: warm compress o MCC: CHF, cirrhosis the correlation coefficient
o Rx: I&D if not resolved in 48 hrs o no further workup; Rx underlying cause 0 = no association
stye: external hordeolum of Zeis or Moll gland exudate is due to inflammation (pH 7.3 7.45) -1 or +1 = strong correlations closer to margins
chalazion: chronic, granulomatous inflammation results in capillary permeability does not imply causal relationships, nor account
of Meibomian gland o requires further diagnostics for cofounders
o hard, painless lid nodule o MCC: infection, pneumonia, TB, malignancy, ----------------------------------------------------------------
o Rx: incision & curettage PE, sarcoidosis, lymphoma, RA during fasting, glycogen reserves drop within the
orbital cellulitis: posterior to orbital septum ---------------------------------------------------------------- first 12 hrs & gluconeogenesis begins
Lights criteria for exudative effusion (Excess) main substrates of gluconeogenesis: alanine,
o unilateral; abrupt onset of fever, proptosis,
at least one of the following glutamine, lactate, glycerol-3-phosphate
restricted EOM movement, swollen eyelids
pleural fluid/serum protein ratio > 0.5 alanine & lactate are converted to pyruvate
o MC predisposing factor: bacterial sinusitis
pleural fluid/serum LDH ratio > 0.6 glycerol-3-phosphate is released during
----------------------------------------------------------------
traumatic deceleration injury resulting in pleural fluid LDH > 2/3 upper limit of normal breakdown of adipose
Next determine if effusion is ----------------------------------------------------------------
vegetative state: diffuse axonal injury
CT: numerous minute punctate hemorrhages, uncomplicated Manifestations of hemochromatosis
blurring of gray-white matter interface complicated: persistent bacterial invasion, AR inheritance; mutated HFE gene
---------------------------------------------------------------- which pleural fluid glucose & LDH; intestinal iron absorption & deposition
Interventions to lower ICP culture is negative, easily cleared with ABX general weight loss, weakness, polydipsia,
head elevation increase venous outflow from brain empyema: low pH < 7.2 (or glucose < 60) are polyuria, decreased libido, ED
sedation decrease metabolic demand & indications for chest tube drainage skin hyperpigmentation (bronze diabetes)
control HTN o low pleural glucose also indicates exudate MSK arthralgia, arthropathy,
IV mannitol osmotic diuresis (free water) (complicated parapneumonic effusion, empyema, chondrocalcinosis (pseudogout)
hyperventilatio cerebral vasoconstriction RA, malignancy, TB, drug-induced lupus, or GI elevated LFTs, hepatomegaly,
n (CO2 washout) esophageal rupture) cirrhosis, risk of HCC
endocrine DM, secondary hypogonadism
hypothyroidism Rx: ursodeoxycholic acid relieves symptoms & hyperpigmentation due to increased ACTH &
cardiac dilated cardiomyopathy, systolic dysFx, slows disease progression melanocyte-stimulating hormone
conduction defect (sick sinus syndrome) o definitive Rx: liver transplant ketoconazole can precipitate adrenal insufficiency
infection Listeria, Vibrio vulnificus, Yersinia ---------------------------------------------------------------- by inhibiting adrenal steroid synthesis
post-partum adrenal insufficiency can be a/w other autoimmune disorders
transferrin & serum ferritin, TIBC primary (adrenal) or secondary (pituitary) Rx: hydrocortisone
o if elevated in absence of an inflammatory hyperpigmentation & signs of mineralocorticoid ----------------------------------------------------------------
condition, genetic testing should be done deficiency suggests an adrenal cause Secondary (central) adrenal insufficiency
---------------------------------------------------------------- weakness, fatigue, abdominal pain, anorexia, loss of only glucocorticoid & adrenal androgen
cervicofacial actinomycosis presents in the mild hyponatremia, postural hypotension, secretion; preserved mineralocorticoid production
mandibular region as a slowly growing, nontender hyperkalemia aldosterone is regulated by RAA system
mass with yellow pus (sulfur granules) ---------------------------------------------------------------- no hypotension, hyperK+, or hyperCl- acidosis
Actinomyces: anaerobic Gram+ branching Adrenal insufficiency MCC: lymphocytic hypophysitis & Sheehan
filamentous bacilli; not acid-fast 10 (adrenal) 20 (pituitary) ----------------------------------------------------------------
colonizes the oral cavity MCC autoimmune chronic screen for Cushings: 24-hr urine free cortisol &
risk factors: poor dental hygiene, irradiation, glucocorticoid Rx low-dose dexamethasone suppression test
malnutrition, immunosuppression, DM ACTH ----------------------------------------------------------------
complication: abscess, fistula, draining sinus tract cortisol ursodeoxycholic acid: Rx primary biliary cirrhosis
Dx: tissue culture; can take 3 wks to grow aldosteron normal & primary sclerosing cholangitis
Rx: high-dose PCN (12 wks) e ----------------------------------------------------------------
---------------------------------------------------------------- features severe symptoms less severe
skin infection, fever & purulent crusting lesions hyperpigmenttn no hyperpigment,
or ulcers following puncture wound (gardening): hyperkalemia no hyperkalemia,
Nocardia hyponatremia possible
aerobic, Gram+ weakly acid fast, filamentous rod hypotension hyponatremia
subacute pneumonia that mimics TB glucocorticoid > 3 wks suppress secretion of
Rx: TMP-SMX CRH & ACTH central adrenal insufficiency
---------------------------------------------------------------- screening: morning basal cortisol, ACTH, &
acute ischemic stroke due to atherosclerotic cosyntropin stimulation test
thrombosis or emboli: ASA within 48 hr basal cortisol: low basal cortisol: low
o risk of recurrent stroke & mortality ACTH: high ACTH: high
---------------------------------------------------------------- cosyntropin: minimal cosyntropin: suboptimal
10 adrenal insufficiency 20 or 30 adrenal insuff. recurrent oral & genital ulcers, anterior uveitis,
pruritus, jaundice, steatorrhea, hepatosplenomegaly,
chronic central AI develop adrenal gland atrophy, erythema nodosum: Behcet syndrome
ALP & bilirubin, anti-mitochondrial antibodies:
thus a suboptimal response to cosyntropin MC in Turkish, Asian, Middle Eastern
primary biliary cirrhosis
---------------------------------------------------------------- immune-mediated small-vessel systemic vasculitis
nocturnal pruritus can be severe
weakness, fatigue, weight loss, anorexia, Dx: triple-symptom complex: recurrent aphthous
autoimmune destruction of intrahepatic bile ducts
depression, hypotension, hyperpigmentation, ulcers, genital ulcers, anterior uveitis
leads to cholestasis & cirrhosis
eosinophilia, hyponatremia, hyperkalemia o also erythema nodosum
ability to absorb fat-soluble vitamins can lead to
Primary adrenal insufficiency (Addisons) Rx: high dose corticosteroids
osteoporosis
MCC: autoimmune adrenalitis humoral & complications: aneurysm, dementia, & blindness
a/w xanthomas & xanthelasmas
cell-mediated destruction of adrenal cortex ----------------------------------------------------------------
a/w Sjogrens, Raynauds, scleroderma, Celiacs
loss of glucocorticoid, mineralocorticoid, & Tamoxifen: SERM
Dx: anti-mitochondrial antibodies in serum
adrenal androgens 2/2 adrenal cortex destruction antagonist on breast
hyperchloremic acidosis o Rx breast cancer & prevention in other breast
agonist on endometrium soltalol causes prolonged QT & TdP o tearing, hyperacusis, loss of taste over
endometrial cancer risk ---------------------------------------------------------------- anterior 2/3 of tongue
o uterine sarcoma risk adenosine: Rx PSVT forehead muscle sparing suggests intracranial
agonist on osteoclasts (inhibits turnover) amiodarone: Rx hemodynamically stable atrial & lesion brain imaging for ischemia or tumor
o risk of osteoporosis ventricular wide-complex tachycardia; also a-fib o lesion above facial nucleus
venous thrombosis risk atropine: symptomatic sinus brady, AV block o C/L hemiparesis, hemianesthesia, dysarthria
---------------------------------------------------------------- sodium bicarbonate: TCA overdose, hyperK+, ----------------------------------------------------------------
Raloxifene: SERM ASA overdose Vit K deficiency in newborns result from poor
antagonist on breast & endometrium ---------------------------------------------------------------- placental transfer, absent gut flora, immature
o breast cancer risk small, rubbery lymph nodes < 1 cm are commonly liver function, inadequate levels in breast milk
does not increase risk of endometrial cancer benign in children & young adults bruising, bloody stools, intracranial hemorrhage
agonist in bone o asymptomatic, soft lymph nodes can be initially prolonged PT, followed by aPTT
o #1 Rx prevents osteoporosis observed for growth or symptoms Rx: Vit K replenishes in 8 10 hrs
A/E: risk of VTE; C/I if Hx of DVT cancerous nodes are firm & immobile, > 2 cm FFP for acute hemorrhage
---------------------------------------------------------------- hard cervical nodes in adults or smokers suggest ----------------------------------------------------------------
early decelerations: due to fetal head compression metastatic cancer or oropharyngeal neoplasia ACTH does not affect aldosterone production,
leading to a vagal response ---------------------------------------------------------------- which is regulated by RAA system
o does not indicate fetal distress Peripheral facial palsy Central facial palsy ----------------------------------------------------------------
o normal finding of active labor (Bells palsy) Muscular dystrophy
variable & late decelerations indicate risk for loss of forehead & brow preservation of forehead Duchenne Becker Myotonic
fetal hypoxemia & acidosis movement & brow movement XR deletion of dystrophin, Xp21 AD inheritance,
o variable: cord compression or prolapse, inability to close eye & C/L lower face weakness CTG repeats,
drooping eyelids DMPK gene
oligohydramnios; abrupt drop in fetal HR
o late: uteroplacental insufficiency loss of nasolabial folds, drooping lower lip onset: age 2 3 age 5 15 age 12 - 30
---------------------------------------------------------------- progressive mild weakness facial weakness,
Alcohol withdrawal syndrome weakness, Gower, (*decreased hand grip
pseudohypertroph dystrophin*) myotonia,
features last drink
y dysphagia (asp.
mild anxiety, tremulousness, 6 hrs
pneumonia),
withdrawal sweating, palpitations
foot drop
withdrawal single or multiple in short 12 48 hr
scoliosis, cardiomyopath arrhythmias,
seizures period of time
cardiomyopathy; y cataracts, bald,
alcohol auditory, visual, tactile 12 24 hr
wheelchair-bound testicular
hallucinosis hallucination; normal vitals resolves
by adolescence atrophy/infertilit
& intact sensorium in 24 48
y
hr
death by 20 30; death by 40 - respiratory or
delirium fever, HTN, tachycardia,
respiratory or 50 heart failure
tremens diaphoresis, hallucinations, 48 96 hr
heart failure heart failure
disorientation
----------------------------------------------------------------
DMD: absent dystrophin on immuno staining
polymorphic ventricular tachycardia in the setting
CPK & aldolase are elevated before manifestations
of congenital or acquired prolonged QT interval:
----------------------------------------------------------------
Torsades de Pointes (TdP)
medullary thyroid cancer: calcitonin secretion
can resolve spontaneously or degenerate to V-fib
follicular & papillary cancers: a/w Hurthle cells
Rx hemodynamically unstable: defibrillation Bells: CN VII neuropathy, lesion below the pons
----------------------------------------------------------------
Rx hemodynamically stable: Mg++ sulfate
follicular thyroid cancer: invasion of tumor Dx/Rx: arthrocentesis, blood & synovial cultures aldosterone adrenal adenoma
capsule & blood vessels; encapsulated before empiric IV ABX (vancomycin) B/L adrenal hyperplasia
early hematogenous spread to lung, brain, bone o ABX can interfere with cultures Dx: adrenal CT
---------------------------------------------------------------- Rx: synovial fluid aspiration & drainage Secondary
papillary thyroid cancer: MC thyroid malignancy prevents long-term disability & joint destruction renin, diuretics, cirrhosis, CHF,
slow, infiltrative spread to thyroid gland & DDx: transient synovitis, acute rheumatic fever, aldosterone renovascular HTN,
regional lymph nodes; unencapsulated osteomyelitis (ratio > 20) renin-secreting tumor,
Dx: psammoma bodies ---------------------------------------------------------------- malignant HTN,
FNAB: large cells with ground-glass cytoplasm, malaria causes cyclical fever, nonspecific GI & coarctation of aorta
pale nuclei with inclusion bodies & central groove constitutional symptom, anemia & thrombocytopenia Other
Px: excellent cyclical fever coincides with RBC lysis renin, CAH, Cushings,
---------------------------------------------------------------- up to 2 wks after mosquito bite aldosterone glucocorticoid resistance,
Neuroimaging in psychiatric disorders Dx: thin & thick peripheral blood smears exogenous mineralocorticoids
autism: increased brain volume protective: hemaglobinopathies (HbS, HbC,
OCD: abnormal Orbitofrontal Cortex & striaDum thalassemia, sickle cell trait, Hx of malaria) easily induced hypokalemia after starting a
pAnic disorder: decreased Amygdala volume ---------------------------------------------------------------- thiazide suggests primary hyperaldosteronism
PTSD: decreased hippocampal volume Dengue fever: leukopenia is common metabolic alkalosis (loss of H+)
schizophrenia: enlarged cerebral ventricles ---------------------------------------------------------------- mild hypernatremia only (aldosterone escape)
---------------------------------------------------------------- cholestyramine: bile acid sequestrant ----------------------------------------------------------------
chemotherapy can cause rapid tumor cell lysis, o fecal loss of bile salts & cholesterol recurrent episodes of flash pulmonary edema
releasing uric acid (DNA by-product), Rx: hypercholesterolemia, pruritus a/w liver failure, screen for renovascular HTN: abdominal CT
predisposing to gout attacks bile acid diarrhea, absorb C. difficile toxins A & B angiography
Rx: allopurinol decreases uric acid production ---------------------------------------------------------------- MCC: renal artery stenosis, fibromuscular dysplasia
---------------------------------------------------------------- fever, jaundice, hepatomegaly, dark urine, ----------------------------------------------------------------
Rx gout attacks: NSAIDs, steroids, colchicine pruritus, acholic stools: Hep A acute, painless vision loss, fundoscopy: optic disk
gout prevention: allopurinol ( production), incubation: 30 days swelling, retinal hemorrhages, dilated & tortuous
probenecid ( excretion) ---------------------------------------------------------------- veins, & cotton wool spots: central vein occlusion
---------------------------------------------------------------- headache, abdominal pain, vomiting, diarrhea, blood & thunder appearance
Mesna: prevents hemorrhagic cystitis caused by salmon rose spots, bradycardia: typhoid fever monocular loss of vision caused by thrombosis
cyclophosphamide ---------------------------------------------------------------- Dx: fluorescein angiography
---------------------------------------------------------------- inhaled albuterol & systemic steroids Rx acute Rx: conservative, observation
chronic liver disease immunized for Hep A & B asthma attacks DDx: angle closure glaucoma, anterior uveitis,
risk for acute hepatic failure or cirrhosis high-dose 2-agonists can cause hypokalemia, amaurosis fugax, optic neuritis
---------------------------------------------------------------- resulting in weakness, arrhythmias, EKG changes ----------------------------------------------------------------
cirrhosis causes intravascular volume depletion check serum electrolytes acute, severe eye pain, blurred vision, N/V,
& salt retention ---------------------------------------------------------------- steamy cornea with non-reactive, dilated pupils:
Rx: low-salt diet decreased ascites & edema muscle cramps, weakness, palpitations, HTN after acute angle-closure glaucoma
Rx: furosemide prevents hypervolemia initiating a thiazide acute, severe eye pain, unilateral vision loss,
---------------------------------------------------------------- HTN & hypokalemia: suspect hyperaldosteronism afferent pupillary defect: optic neuritis
child refuse to bear weight, knee pain & swelling, test: plasma renin & aldosterone ----------------------------------------------------------------
high fever: septic arthritis fever > 390C (102.20F) in any child age < 3 should
preceded by skin or URI; MCC is S. aureus Causes of HTN & hypokalemia prompt evaluation for UTI
leukocytosis, ESR & CRP renin, Primary Dx tests for UTI
serum BUN/Cr, urine dipstick, U/A, urine culture
children in diapers require straight catheter for IVDA with fever, aortic vegetation, cerebral infarct: Acute Chronic
sterile specimen native valve endocarditis with cardioembolic stroke feature fever, chills, malaise, no fever, dysuria,
---------------------------------------------------------------- high risk of TIA or stroke due to septic emboli s myalgia, perineal pain, frequency,
chronic productive cough of mucopurulent sputum ischemic stroke: Rx underlying cause cloudy urine recurrent UTI
(> 100 mL/day), dyspnea, hemoptysis, fatigue, Rx: IV ABX reduces risk of septic cardioemboli Dx **mid-stream urine sample**
weight loss, clubbing: bronchiectasis in native valve IE pyuria, tender prostate, pyuria,
due to damage of bronchial walls from infection Rx: aortic valve surgery for severe cases +urine culture (E. coli) +urine culture
or inflammation IV heparin is a/w risk of intracranial hemorrhage Rx empiric TMP-SMX for fluoroquinolones
diffuse ronchi & wheezes, bibasilar crackles ---------------------------------------------------------------- 4 6 wks
Dx: high-resolution CT bronchial dilation, evidence of acute pericarditis & renal failure: complication: prostatic abscess (CT scan)
bronchial wall thickening uriemic pericarditis ----------------------------------------------------------------
Dx: sputum analysis & bronchoscopy inflammation of visceral & parietal membranes all present with irritative voiding symptoms
Rx: underlying cause, corticosteroids, macrolides, of pericardial sac; BUN > 60 (frequency, urgency, suprapubic or perineal pain)
chest PT no evidence of pericarditis on EKG acute bacterial prostatitis: very tender prostate
DDx: chronic bronchitis (less sputum, nonpurulent) definitive Rx: hemodialysis
---------------------------------------------------------------- ---------------------------------------------------------------- Prostatitis
acute adrenal crisis: post-op complication in acute viral or idiopathic pericarditis Rx: NSAIDs feve U/A prostatic secretions
patients with chronic glucocorticoids-induced & colchicine r leukocyte bacteria
HPA-axis suppression (SLE, RA) ---------------------------------------------------------------- acute bacterial + + +
daily prednisone > 3 wks can cause central adrenal hypertensive BP 180/120 mmHg chronic bacterial - nrml +
insufficiency: ( ACTH & cortisol) urgency without symptoms or end-organ damage chronic _ nrml _
N/V, hypoglycemia, hypotension hypertensive headache, dyspnea, blurred vision, inflammatory
Rx: pre-op stress-dose glucocorticoids emergency + acute, end-organ complications chronic _ nrml nrml _
patients with Cushingoid features are also at risk (BP > 220/120) malignant HTN: exudates, non-inflammatory
for HPA suppression retinal hemorrhage, papilledema ----------------------------------------------------------------
o Rx: short-term stress-dose of glucocorticoids Rx: hypertensive encephalopathy: Glasgow Coma Scale
---------------------------------------------------------------- nitroprusside: cerebral edema, neuro symptoms, eye opening (4), verbal (5), motor (6)
femoral nerve: hip flexion, knee extension SAH or ICH not used to Dx coma
o innervates anterior thigh ---------------------------------------------------------------- o Dx coma: impaired brainstem activity, motor
o sensation to anterior thigh & medial leg via most intussusceptions before age 2 following dysfunction, impaired LOC
saphenous branch viral illness have no identifiable lead point ----------------------------------------------------------------
tibial nerve: supplies posterior thigh & leg, o gastroenteritis hypertrophied Peyer patches hypoglycemic episodes can occur with pre-meal
plantar foot muscles pathological lead point should be suspected in insulin administration in diabetic gastroparesis
o sensation to the leg (except medial side) & older children with recurrent intussusception metoclopramide: Rx N/V & gastroparesis
plantar foot o MCC: Meckels o DA receptor antagonist; prokinetic & antiemetic
obturator nerve: innervated medial thigh other risk factors: Henoch-Schonlein, rotavirus monitor for drug-induced EPS, dystonic reaction
o thigh adduction vaccination rarely, NMS may occur
o sensation to medial thigh ---------------------------------------------------------------- Rx: discontinue; benztropine or diphenhydramine
common peroneal: supplies anterior & lateral leg ventilator-associated pneumonia occurs 48 hr alt Rx: erythromycin (prokinetic)
o sensation to anterolateral leg & foot dorsum after intubation ----------------------------------------------------------------
o superficial peroneal: foot eversion MCC: P. aeruginosa, E. coli, Klebsiella, MRSA fibrocystic disease of the breast: B/L tenderness
o deep peroneal: sensation bwtn 1st & 2nd toe Dx: CXR, lower respiratory tract culture & palpable mass during luteal phase
---------------------------------------------------------------- Rx: empiric ABX (after obtaining sample) ----------------------------------------------------------------
----------------------------------------------------------------
Prostatitis overview
weight loss, anorexia, fatigue, recent onset DM, ---------------------------------------------------------------- large head, prominent forehead & jaw, protruding
migratory superficial thrombophlebitis (Trousseau): PVCs are common post-MI; a/w worse prognosis ears, joint laxity, macroorchidism: Fragile X
pancreatic adenocarcinoma no Rx unless symptomatic (-blockers) hyperactivity, short attention, autism
important risk factor: Hx of smoking ---------------------------------------------------------------- FMR1 gene with CGG repeats
insidious, gnawing abdo pain, worse at night initial Rx of acute & chronic anal fissures: diet, ----------------------------------------------------------------
Dx with jaundice: USS (head tumor) stool softener, local anesthetic Breastfeeding
Dx w/o jaundice: CT scan (body & tail tumors) chronic or refractory cases: lateral sphincterotomy Benefits Contraindications
---------------------------------------------------------------- ---------------------------------------------------------------- Maternal
connective tissue thickening 2/2 product of MCC of esophagitis in HIV breast & ovarian ca active untreated TB
myofibroblast proliferation, collagen & ground Candida white plaques, oral thrush risk (not endometrial) (resume feeds after 2 wks
substance production: systemic sclerosis Rx: empiric fluconazole, of anti-TB therapy)
a/w HTN, GERD, right heart failure endoscopy if no improvement rapid uterine involution, maternal HIV infection
Dx: ANA, anti-topoisomerase antibodies HSV small, round/ovoid ulcers post-partum bleeding, herpetic breast lesions
Rx scleroderma renal crisis: ACE-I Rx: acyclovir rapid return to pre-partum varicella infection (< 5
---------------------------------------------------------------- CMV large, linear ulcers in distal esophagus weight, days prior or 2 days after
anti-smooth Ab: autoimmune hepatitis Rx: IV ganciclovir delivery)
---------------------------------------------------------------- improved child spacing, chemotherapy/radiation
anti-psychotics mainly block DA D2 receptors MC when CD4 < 100 maternal-infant bonding drug or alcohol abuse
o can cause hyperprolactinemia odynophagia without dysphagia: MCC is viral Infant
o breast tenderness, amenorrhea, galactorrhea Dx: esophagoscopy immunity, GI function,
acyclovir is not effective Rc for CMV due to its preventionotitis media,
risperidone also binds 5-HT receptors
lack of thymidine kinase to convert to active form respiratory/GI illness, UTI galactosemia
o improves negative symptoms of schizophrenia
---------------------------------------------------------------- risk of childhood ca,
& Rx depression Type I DM, NEC
o most likely atypical to cause EPS at high dose dysphagia, heartburn, refractory to GERD Rx:
Rx: benztropine eosinophilic esophagitis
comorbid asthma, seasonal allergies exclusively breastfed infants require Vit D suppl
aripiprazole: partial DA D2 agonist until age 6 months
o does not cause galactorrhea manometry shows hypercontractility
---------------------------------------------------------------- mastitis & Hep B or C are not C/I to breastfeeding
---------------------------------------------------------------- ----------------------------------------------------------------
rigidity, bradykinesia, tremor, akathisia: EPS acute odynophagia, retrosternal chest pain,
epigastric burning: pill esophagitis Indications for cytoscopy
---------------------------------------------------------------- gross hematuria with no glomerular disease
carbamazepine A/E: aplastic anemia, SIADH direct mucosal injury due to prolonged contact
result in discrete ulcers on endoscopy microscopic hematuria without evidence of
o monitor with routine CBC glomerular disease, but risk for malignancy
MCC: KCl, tetracycline, aldendronate, NSAIDS,
lamotrigine A/E: rash, SJS/TEN recurrent UTIs
quinidine, iron
---------------------------------------------------------------- obstructive symptoms (strictures, stones)
----------------------------------------------------------------
well-circumscribed pale white patches around irritative symptoms without infection
alcoholic with altered mental status, gait instability,
acral area & body orifices: vitiligo abnormal bladder imaging or urine cytology
nystagmus, conjugated gaze palsy: Wernickes
autoimmune destruction of melanocytes ----------------------------------------------------------------
no labs or radiological studies necessary
peaks @ age 20 - 30 risk of bladder cancer: smoking, chronic cystitis,
can be induced iatrogenically by giving glucose
a/w Graves, Type I DM, hypopituitarism, cyclophosphamide, pelvic radiation, occupational
without thiamine
pernicious anemia, 10 adrenal insufficiency, screening is not recommended, even those at risk
----------------------------------------------------------------
alopecia areata ----------------------------------------------------------------
apathy, irreversible amnesia, confabulation,:
---------------------------------------------------------------- severe ear pain especially at night, exacerbated
Korsakoffs
Babinski is the only primitive reflex that may by chewing, purulent drainage with fullness, &
----------------------------------------------------------------
persist up to age 2 yrs conductive hearing loss; ESR
malignant otitis externa: MCC P. aeruginosa orthostatic hypotension is a common cause of no antidote for major hemorrhage
risk factors: elderly with uncontrolled DM syncope in elderly due to impaired baroreceptor Rx: recurrent or refractory DVT
otoscopy: granulation tissue & edematous sensitivity &/or volume depletion ----------------------------------------------------------------
external auditory canal ---------------------------------------------------------------- thrombolytics are reserved for
complications: osteomyelitis of skull base or TMJ long-standing progressive heartburn, weight loss, hemodynamically unstable PE
Rx: empiric anti-psuedomonal (IV ciprofloxacin) fatigue, smoking Hx: esophageal cancer IVC filter: Rx lower extremity DVT when
alt Rx: piperacillin, ceftazidime 2 histologic types anticoagulation is C/I (hemorrhagic stroke,
DDx: cholesteatoma: keratinized epithelial growth SCC: a/w smoking & alcohol active bleeding) or anticoagulation failure
& discharge in the middle ear; Rx: surgical adenocarcinoma: a/w Barretts, obesity ----------------------------------------------------------------
---------------------------------------------------------------- Dx: barium swallow followed by EGD & Bx, ventricular tachycardia: wide QRS
cholesteatoma: abnormal squamous epithelium in & PET scan (disease staging) hemodynamically stable IV amiodarone
middle ear; continuous ear drainage despite ABX ---------------------------------------------------------------- hemodynamically unstable synch cardioversion
o 2/2 chronic middle ear disease; MC in children maternal hyperglycemia fetal hyperglycemia &
granulation tissue & skin debris accumulation fetal hyperinsulinemia metabolic demand Hemodynamic instability
damage to ossicles result in conductive hearing loss fetal hypoxia erythropoiesis polycythemia hypotension
otoscopy: granulation tissue & skin debris within ---------------------------------------------------------------- altered mental status
retraction pockets of tympanic membrane young patient with cataracts, tinnitus hearing loss: signs of shock
Rx: surgery neurofibromatosis II ischemic chest discomfort
---------------------------------------------------------------- acoustic neuroma Dx: MRI with gadolinium acute heart failure
anovulation as a cause of infertility can be ---------------------------------------------------------------- ----------------------------------------------------------------
evaluated with serum progesterone performed IV diuretics: Rx symptomatic relief of SVT with aberrancy (PSVT): narrow complex
in mid-luteal phase decompensated CHF hemodynamically stable: vagal maneuvers
---------------------------------------------------------------- ---------------------------------------------------------------- (carotid massage, rate control) or IV adenosine can
MVP = MCC of chronic MR in developed countries dyspnea, JVD, clear lungs, cardiac silhouette: slow SA & AV node
2/2 myxomatous degeneration of leaflets & chordae early cardiac tamponade 2/2 pericardial effusion o #2 Rx: CCB (verapamil) slow AV conduction
o chronic severe MR can cause LA dilation, MCC recent viral URI hemodynamically unstable synch cardioversion
& lead to a-fib non-palpable PMI; Becks triad (hypotension, JVD, ----------------------------------------------------------------
infective endocarditis can cause MR due to muffled heart sounds), pulsus paradoxus cyclophosphamide: Rx SLE with renal
inadequate leaflet coaptation or leaflet perforation CXR: enlarged/globular silhouette, water bottle hydroxychloroquine: Rx SLE with isolated skin
---------------------------------------------------------------- EKG: electrical alternans, low voltage QRS & joint involvement
immunocompromised with lung nodules, seizures, Dx if hemodynamically stable: echo A/E: retinopathy (eye exam every 6 months)
Gram+, partially acid-fast, aerobic filamentous hemodynamically unstable Rx: pericardiocentesis ----------------------------------------------------------------
branching rod: Nocardia ---------------------------------------------------------------- HTN, bradycardia, & respiratory depression
weight loss, fever, night sweats healthy, young patient with CHF, & recent URI: (Cushings reflex): intracranial pressure
causes seizures 2/2 brain abscess (disseminated) viral myocarditis due to Coxackie B ----------------------------------------------------------------
CXR: pulmonary nodules, with cavitation dyspnea, JVD, cardiomegaly, S3, bibasilar rales Prader-Willi: paternal 15q11 deletion
Rx: TMP-SMX CXR: pulmonary vascular congestion o maternal uniparental disomy
DDx: TB ---------------------------------------------------------------- o poor suck & feeding in infancy
---------------------------------------------------------------- bisferiens pulse: a/w aortic insufficiency with or w/o o binge-eating & obesity
Actinomyces Rx: PCN aortic stenosis, severe aortic insufficiency, HOCM Angelman: maternal 15q11 deletion
anaerobic, G+ filamentous bacilli (not acid-fast) ---------------------------------------------------------------- o paternal unilateral disomy
yellow pus with sulfur granules rivaroxaban: direct factor Xa inhibitor
o hand flapping, ataxia, seizures
---------------------------------------------------------------- oral anticoagulant with rapid onset (2 4 hrs)
----------------------------------------------------------------
similar efficacy to LMWH & warfarin for acute
DVT & PE
changing a drug regimen, prodrome viral illness acute onset lower abdominal pain, followed by child with sore throat, dysphagia, odynophagia,
or diuretic use can cause digoxin toxicity bloody diarrhea within 12 24 hr, fever, N/V: pharyngeal/tonsillar erythema: pharyngitis
o neuro (lethargy, confusion, disorientation) ischemic colitis o cough, rhinorrhea, conjunctivitis, oral ulcers
o vision (color vision, scotomas, blindness) a/w complication of procedures on the aortoiliac = viral pharyngitis Rx: symptomatic
o cardiac (life-threatening arrhythmias) vessels (AAA) o exudates, edema, palatal petechiae, absence
o GI (anorexia, N/V, abdominal pain) MC sites: splenic flexure & recto-sigmoid junction of viral symptoms rapid antigen test &
risk factors: hypokalemia (diuretics) 2/2 impaired flow through inferior mesenteric artery throat culture (gold std)
amiodarone, verapamil, quinidine, propafenone dull abdominal pain overlying ischemic bowel & negative viral pharyngitis
can serum digoxin levels hematochezia positive Strep pharyngitis (GAS)
o Rx: digoxin dose by 25 50% CT scan: thickened bowel wall Rx: oral PCN or amoxicillin
evaluation: digoxin level, EKG, PT/INR Dx: colonoscopy discrete ischemic segment of reduces risk of rheumatic fever
---------------------------------------------------------------- cyanotic mucosa with ulcerations Group A Strep is MC in age 5 15 yrs
atrial tachycardia with AV block is specific for DDx: acute diverticulitis, radiation proctitis, o tender anterior cervical lymph nodes, tonsillar
digitalis toxicity IBD, C. difficile colitis erythema & exudates, palatal petechiae
digitalis ectopy atrial tachycardia ---------------------------------------------------------------- all negative rapid Strep antigen test must be
digitalis vagal tone disrupts AV conduction diarrhea, rectal bleeding, tenesmus, incontinence: confirmed with throat culture (high sensitivity)
---------------------------------------------------------------- radiation proctitis ASO antibodies peak 1 month after infection, not
child with sudden-onset abdominal pain, bloody strictures & fistulae may form useful in Dx acute pharyngitis
diarrhea, anemia, thrombocytopenia, uremia: HUS ---------------------------------------------------------------- ----------------------------------------------------------------
MCC: E. coli O157:H7 BUN & Cr are decreased in pregos due to MCC of cirrhosis: alcohol abuse, viral hepatitis,
Rx: supportive, plasmapheresis; dialysis, steroids increased renal plasma flow & GFR non-alcoholic fatty liver disease
---------------------------------------------------------------- ---------------------------------------------------------------- evaluate family Hx, alcohol Hx, Hep B/C serology,
lactose intolerance Dx: hydrogen breath test macroglossia, hemihyperplasia, umbilical hernia iron studies/HFE protein for hemochromatosis
---------------------------------------------------------------- overgrowth disorder & predisposed to neoplasms Clinical features of cirrhosis
fever, chills, deep abdominal pain after blunt non-specific: anorexia, weight loss, weakness,
abdominal trauma: retroperitoneal abscess 2/2 Beckwith-Wiedemann syndrome fatigue, muscle cramps, jaundice, pruritus
pancreatic laceration pathogenesis dysregulation of imprinted gene GI bleeding, caput medusa, palmar erythema
early findings: normal abdominal CT expression encephalopathy (sleep disturbance, confusion)
devitalized tissue or pseudocyst becomes infected features fetal macrosomia, rapid growth, women: amenorrhea/anovulation
Dx: serial CT omphalocele or umbilical hernia, men: hypogonadism decreased libido, ED,
macroglossia, hemihyperplasia gynecomastia, testicular atrophy
Rx: percutaneous drainage catheter, culture of
complication Wilms nephroblastoma, synthesis of thyroxine-binding globulins
drained fluid, & surgical debridement
s heptapoblastoma total T3/T4 (normal TSH)
----------------------------------------------------------------
surveillance abdominal/renal USS & AFP ----------------------------------------------------------------
duodenum is mostly retroperitoneal, vulnerable
to crush injury overlying vertebral bodies adrenal insufficiency: fatigue, weakness,
monitor newborns for hypoglycemia anorexia, weight loss
duodenal hematoma & obstruction can occur
---------------------------------------------------------------- women: androgen production occurs in adrenals
----------------------------------------------------------------
EPS (dystonia, choreoathetosis), mental retardation, axillary & pubic hair, loss of libido
transtentorial herniation due to head trauma,
self-mutilation: Lesch-Nyhan men: androgens produced in testes; no findings
leads to uncus compression against the tentorium
---------------------------------------------------------------- ----------------------------------------------------------------
I/L CN III I/L down-&-out gaze, mydriasis,
lymphadenopathy, hepatosplenomegaly jaundice, aortic coarctation Rx: balloon angioplasty +/- stent
& ptosis
rash, rhinitis: early congenital syphilis a/w Takayasu arteritis: large vessel granulomatous
I/L PCA C/L homonymous hemianopsia
saber shin, Hutchinsons teeth, saddle-nose,
o I/L hemiparesis & altered mentation vasculitis with massive intimal fibrosis & vascular
keratitis, deafness: late manifestations (2 yrs) narrowing; young Asian females
---------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------
gait instability, truncal ataxia, nystagmus, acute renal failure (Cr > 1.5) with severe cirrhosis rifampin, phenytoin, & carbamazepine
intention tremor, dysmetria: cerebellar dysRx 2/2 systemic & renal hypoperfusion increase hepatic clearance of thyroid hormones
common in chronic alcoholism does not respond to fluid resuscitation** by enzyme metabolism (deiodination)
hypotonia leads to pendular knee reflex complication of cirrhosis ----------------------------------------------------------------
---------------------------------------------------------------- Idiopathic intracranial HTN
Type I collagen mutation: Osteogenesis imperfecta Hepatorenal syndrome (aka pseudomotor cerebri)
recurrent fractures, hearing loss, joint laxity, risk factors advanced cirrhosis with portal HTN impaired CSF absorption by arachnoid villi
short stature, scoliosis, blue sclera precipitating renal perfusion: GI bleed, vomiting, risk obese women of child-bearing age, OCPs,
---------------------------------------------------------------- factors sepsis, excessive diuretics, SBP factors tetracycline, isotretinoin, excess Vit. A
mood disturbances (depression, apathy), dementia, glomerular pressure & GFR: NSAIDs symptom o headache (holocranial, pulsatile)
chorea, writhing, facial grimace, ataxia, dystonia: (constricts afferents) s worse at night, awakens from sleep
Huntingtons Dx renal hypoperfusion: FeNa < 1% o transient vision loss, diplopia
---------------------------------------------------------------- prerenal azotemia o pulsatile tinnitus (whooshing)
Ascites fluid SAAG absence of tubular injury exam papilledema, peripheral vision defect,
(serum-to-ascites albumin gradient) (no RBC, protein, or granular casts) CN VI palsy (lateral rectus)
1.1 g/dL portal HTN does not respond to fluid resuscitation Dx MRI: normal (may see empty sella)
2/2 cirrhosis, Budd-Chiari, Rx address precipitating factors, LP: normal CSF analysis
cardiac ascites splanchnic vasoconstrictors opening pressure > 250 mmHg
< 1.1 g/dL absence of portal HTN (midodrine, octreotide, NE), (communicating hydrocephalus)
2/2 malignancy, pancreatitis definitive Rx: liver transplant Rx stop offending medication, weight loss,
nephrotic syndrome, TB ---------------------------------------------------------------- acetazolamide (if weight reduction fails)
portal HTN: capillary hydrostatic pressure progressive worsening back pain, focal tenderness, definitive Rx: surgery
non-portal HTN: capillary permeability increased radionuclide uptake in lumbar region complication: blindness
---------------------------------------------------------------- radiation therapy: Rx bone pain a/w Hx of DDx: migraine, cluster headache, viral encephalitis,
Management of ascites prostate cancer & bone mets after orchiectomy MS, NPH
Na+ & water restriction ----------------------------------------------------------------
spironolactone (up to max dose) patients with hypothyroidism have in increased papilledema is not C/I to LP unless evidence of
furosemide (not > 1 L/day diuresis; risk of requirement for levothyroxine after starting obstructive hydrocephalus or mass lesion
hepatorenal syndrome or encephalopathy) estrogen (estrogen replacement, OCPs) acetazolamide inhibits choroid plexus carbonic
paracentesis (monitor renal function) oral estrogen decrease clearance of TBG anhydrase, thus CSF production
---------------------------------------------------------------- elevated TBG levels, thus free T4 & TSH ----------------------------------------------------------------
nephrotic syndrome with palpable kidneys, Rx: higher dosing of levothyroxine protracted vomiting a/w pyloric stenosis results in
hepatomegaly, recurrent pulmonary infections, ---------------------------------------------------------------- hypochloremic hypokalemic metabolic alkalosis
ventricular hypertrophy: secondary amyloidosis pregnancy is a/w up-regulation thyroid hormone Rx: IV rehydration & normalize electrolytes
2/2 chronic inflammation (RA, IBD, TB, due to TBG by estrogen & stimulation of TSH prior to pyloromyotomy
lymphoma bronchiectasis) receptors by -hCG alkalosis risk of post-op apnea
extracellular deposition of fibrils in tissues/organs ----------------------------------------------------------------
Dx: abdominal fat pad Bx Thyroid hormones during pregnancy acute appendicitis: peri-umbilical pain is referred
Rx: underlying inflammatory disease Total T4 -hCG stimulates TH production & visceral; RLQ pain involves parietal peritoneum
Rx: colchicine (Rx & prophylaxis) 1.5x & estrogen stimulates TBG is somatic pain
---------------------------------------------------------------- Free T4 slight increase ----------------------------------------------------------------
flutamide: non-steroidal anti-androgen that TSH suppressed by age 12 months, weight should triple, &
binds DHT receptors; Rx: prostate cancer ---------------------------------------------------------------- height should double
no benefit for those underwent orchiectomy ----------------------------------------------------------------
----------------------------------------------------------------
Dx ureteral stones: USS or non-contrast spiral CT Trimethoprim (TMP) causes hyperkalemia 2/2 ----------------------------------------------------------------
of abdomen & pelvis blockade of epithelial Na+ channels in collecting Preconception counseling
USS for pregos tubule @ high doses initial screening of hemaglobinopathies for
IV pyelogram: old test for stones serial K+ monitoring required non-African American: CBC of the female only
---------------------------------------------------------------- also competitively inhibits tubular Cr secretion, o further testing if anemic & reduced MCV
Parkinsons is a clinical Dx: at least 2/3 results in artificial increase of serum Cr African Americans: CBC & Hb electrophoresis
o resting tremor, rigidity, bradykinesia without affecting GFR ----------------------------------------------------------------
no imaging or labs needed to confirm Dx ---------------------------------------------------------------- iron level, TIBC, & ferritin are normal in
---------------------------------------------------------------- glomerular hyperfiltration is the earliest renal thalassemia; abnormal with iron deficiency
chronic acid suppression with PPI or H2 blocker abnormality in diabetic nephropathy ----------------------------------------------------------------
is a risk factor for o detectable several days after DM Dx ceftriaxone use is a/w cholestasis
C. difficile o creates intraglomerular HTN & progressive C/I in newborns at high risk of cholestasis
o Dx: stool PCR assay for toxin A & B glomerular damage ----------------------------------------------------------------
o osteoporosis 2/2 impaired Ca++ absorption Rx: ACE-I reduces intraglomerular HTN Skin conditions & associated diseases
o pneumonia 2/2 upper GIT colonization first quantified change: glomerular BM thickening, acanthosis nigricans insulin resistance
---------------------------------------------------------------- followed by mesangial expansion, nodular sclerosis (PCOS, obesity, DM),
suspected community-acquired pneumonia or ---------------------------------------------------------------- GI malignancy
atypical pneumonia (Mycoplasma) rapid onset respiratory failure, severe hypotension, multiple skin tags insulin resistance,
Dx: clinical & CXR & DIC during labor or immediately post-partum: pregnancy,
Rx: empiric ABX amniotic fluid embolism Crohns (perianal)
---------------------------------------------------------------- cardiogenic shock, seizures, or coma porphyria cutanea tarda &
TSH-secreting pituitary adenoma: macroadenoma risk factors: adv maternal age, high gravida palpable purpura 2/2 Hep C
Dx: clinical cryoglobulinemia
causes central hyperthyroidism
Rx: respiratory & hemodynamic support dermatitis herpetiformis Celiacs
symptoms MC due to mass effect
DDx: eclampsia, peripartum cardiomyopathy, PE sudden onset psoriasis,
presents with goiter, but no Graves findings recurrent herpes zoster, HIV
---------------------------------------------------------------- ----------------------------------------------------------------
severe aortic stenosis can cause anginal chest pain molluscum contagiosum
Hashimotos: lymphocytic infiltration of thyroid severe seborrheic dermatitis HIV,
anti-TPO Abs, elevated TSH, low T4 due to myocardial O2 demand
accompanying prolonged myocardial contraction Parkinson
enlarged, rubbery goiter explosive, itchy seborrheic GI malignancy
can cause transient hyperthyroidism 2/2 initial & impaired diastole coronary blood flow
dermatitis
inflammatory destruction of thyroid follicles ----------------------------------------------------------------
HCM: murmur @ LLSB; dual upstroke carotids pyoderma gangrenosum Crohns
---------------------------------------------------------------- erythema nodosum sarcoidosis, UC, TB,
thyroid lymphomas: MC a/w Hashimotos aortic stenosis: murmur located in 2nd IC space
coccidiomycosis,
rapid thyroid gland enlargement with compressive with radiation to carotids
histoplasmosis, Bechet
symptoms (dysphagia, voice changes) ----------------------------------------------------------------
reduced RAIU myocardium meets increased O2 demand by
DDx of hyperpigmentation: Addisons, pellagra,
---------------------------------------------------------------- inducing dilation of coronary vessels
hemochromatosis
TMP-SMX: prophylactic Rx for toxoplasmosis, o unable to increase O2 extraction
----------------------------------------------------------------
----------------------------------------------------------------
PCP, community-acquired skin MRSA, nocardia, pyoderma gangrenosum: neutrophilic ulcerative
& uncomplicated UTI anti-tissue transglutaminase Ab: Dx Celiacs
skin disease; purulent base, violaceous borders
prophylaxis for all post-transplant patients ----------------------------------------------------------------
a/w underlying systemic disorder (IBD, RA, AML)
heparin inactivates antitrhombin III, which
o vaccines: influenza, pneumococcus, Hep B Dx: skin biopsy
---------------------------------------------------------------- inactivates thrombin, factor IXa & Xa
Rx: local or systemic corticosteroids
----------------------------------------------------------------
mean values are extremely sensitive to outliers ----------------------------------------------------------------
ecthyma gangrenosum: hemorrhagic pustule Dx: abdominal CT (detects radiolucent stones) Rx: do not treat hyperCa++, no parathyroidectomy
with surrounding erythema necrotic ulcers ileus resolves when ureterolithiasis is treated ----------------------------------------------------------------
o MCC: P. aeruginosa ---------------------------------------------------------------- pRBC transfusion can O2-carrying capacity
---------------------------------------------------------------- sudden onset epigastric pain, N/V, hematemesis, for severe anemia
erythema nodosum: painful, discrete, pretibial peritoneal signs (guarding, rigidity, rebound tender), when to transfuse pRBCs
subcutaneous nodules pneumoperitoneum: perforated peptic ulcer o stable patients, no comorbidities: Hb < 7 g/dL
MCC: recent Strep pharyngitis gastric content released into peritoneal cavity, o unstable, symptomatic anemia: Hb < 9 g/dL
a/w sarcoidosis, UC, TB, coccidiomycosis, results in peritonitis, rebound tenderness, guarding ----------------------------------------------------------------
histoplasmosis, Behcet surgical emergency!!! eczematous rash on the nipple, Bx: large cells
evaluation: CXR, PPD, ASO titers DDx: acute cholecystitis, gallstone pancreatitis, surrounded by halo-like areas invading epidermis:
---------------------------------------------------------------- aortic dissection, biliary colic breast Pagets
hidradenitis suppurativa: chronic inflammatory ---------------------------------------------------------------- localized to the nipple, ulcerating eczematous
occlusion of skin follicles acute onset focal neurologic findings (confusion, appearance with underlying adenocarcinoma
o nodules or abscess with purulent drainage ataxia, hyperreflexia, seizures), fever, headache, ----------------------------------------------------------------
scar tissue @ axilla, groin, perineum, scalp behavior changes: herpes encephalitis FFP: contains all clotting factors & plasma proteins
result in linear rope-like bands & sinus tracts MCC of fatal sporadic encephalitis: HSV-1 from 1 unit of blood
o risk factors: family Hx, smoking, obesity, damages the temporal lobe Rx: active bleeding with severe coagulopathy
mechanical stress on skin CSF: marked lymphocytic pleocytosis, proteins, (liver disease, DIC, supratherapeutic warfarin)
o Dx: clinical; no skin biopsy or cultures erythrocytes (2/2 hemorrhagic destruction of ----------------------------------------------------------------
---------------------------------------------------------------- temporal lobes), normal glucose cryoprecipitate contains insoluble products from
well-defined erythematous plaques with satellite Dx: CSF shows HSV DNA on PCR cold FFP (fibrinogen, vWB factor, factor VIII,
vesicles or pustules in interigenous & occluded Rx: empiric IV acyclovir after LP factor XIII)
skin areas (axilla, groin, skin folds): intertrigo ---------------------------------------------------------------- Rx: replacement therapy
MCC: Candida albicans bacterial meningitis CSF: polymorphonuclear ----------------------------------------------------------------
---------------------------------------------------------------- leukocytes, glucose PLT transfusion: Rx PLT < 10,000
hyperpigmented plaques in flexural & interigenous ---------------------------------------------------------------- o or PLT < 50,000 with active bleeding
areas with hyperkeratosis: acanthosis nigricans hyperCa++, hypophosphatemia, urinary Ca++, ----------------------------------------------------------------
risk factors: family Hx, diabetes, obesity, PCOS, PTH: primary hyperPTH kleptomania: impulse control disorder to steal
Cushings Dx: 24 hr urine Ca++ Rx: CBT
---------------------------------------------------------------- Rx: parathyroidectomy criteria for ----------------------------------------------------------------
erythematous papules & pustules in central face: asymptomatic hypercalcemia abdo pain, palpable mass, jaundice, dark urine,
acne (papulopustular) rosacea o serum Ca++ 1 mg/dL above upper limit age < 10 yrs: congenital biliary cyst
not acne vulgaris, no comedones o young age < 50 yrs o no fever, N/V, or anorexia
---------------------------------------------------------------- o bone mineral density < 2.5 single, extrahepatic cystic dilation of bile duct
biliary colic: increased intra-GB pressure against o reduced renal function (GFR < 60) Dx: USS (or ERCP for biliary obstruction)
an obstructed cystic duct DDx: familial hypocalciuric hypercalcemia, Rx: surgical resection reduces malignancy risk
referred pain; exacerbated by fatty meals hypercalcemia of malignancy complications: cholangiocarcinoma
spontaneous resolution within 4 -6 hrs ---------------------------------------------------------------- DDx: biliary atresia (early infancy, acholic stools),
no fever, TTP, or leukocytosis; no inflammation hypercalcemia without polyuria, polydipsia, or cholangitis (fever), pancreatic pseudocyst
DDx: cholecystitis (pain > 6 hrs, Murphys sign) constipation: familial hypocalciuric hyperCa++ ----------------------------------------------------------------
---------------------------------------------------------------- abnormal Ca++-sensing receptor on parathyroid chronic diarrhea, short stature, gingivitis, recurrent
intestinal ileus can be due to a vagal reaction cells & renal tubules; excess Ca++ reabsorption lymphadenitis, osteomyelitis at multiple sites,
caused by uereteral colic (renal stone) AD inherited, benign, asymptomatic hypercalcemia catalase+ infections: chronic granulomatous dz
RLQ pain, constipation, no flatus high/normal PTH, low urine Ca++ o S. aureus, Aspergillus, Serratia, Klebsiella
U/A: needle-shaped crystals (uric acid stones)
not susceptible to catalase-negative (S. o moon facies, bruises o emphysema COPD: DLCO due to alveolar
pyogenes, S. pneumo, H. influenza) GI hamartomatous polyps, mucocutaneous destruction
underweight, dermatitis, lymphadenopathy, pigmentation: Peutz-Jeghers ----------------------------------------------------------------
hypergammaglobulinemia, hepatic abscesses, sporadic phakomatosis, mental retardation, DLCO = function of alveolar-capillary membrane
hepatosplenomegaly, anemia of chronic disease seizures, visual impairment: Sturge-Weber DDx based on DLCO
Dx: nitroblue tetrazolium test ---------------------------------------------------------------- obstructive restrictive normal
Rx: daily TMP-SMX, gamma-INF 3x/wk MCC of secondary digital clubbing: CF, pattern pattern spirometry
---------------------------------------------------------------- lung malignancies, right-to-left shunts DLCO emphysema interstitial anemia, PE,
lethargy, bradycardia, AV block, hypotension, 2/2 trapping of megakaryocytes in distal (COPD) lung disease, pulmonary
diffuse wheezing: -blocker overdose fingertips, releasing PDGF & VEGF sarcoidosis, HTN
wheezing is hallmark hypertrophic osteoarthropathy: clubbing & asbestosis,
hypoglycemia, bronchospasm, delirium, seizures painful joint enlargement, synovial effusions, heart failure
initial Rx: isotonic fluid bolus, IV atropine periostosis of long bones; a/w lung cancer normal chronic MSK
Rx: IV glucagon ( intracellular cAMP) for ---------------------------------------------------------------- DLCO bronchitis deformity,
refractory hypotension MC complication of PUD: hemorrhage (COPD), neuromuscula
---------------------------------------------------------------- ---------------------------------------------------------------- asthma r disease
prematurity & LBW infants are risk factor for Obstructive Restrictive DLCO severe morbid pulmonary
intraventricular hemorrhage lung disease lung disease asthma obesity hemorrhage,
Dx: transfontanelle USS of all newborns with FEV1 < 80% < 80% polycythemi
FEV1/FVC < 70% () > 70% a
predisposing risk factors
(normal) Causes of DLCO (look at FEV pattern)
----------------------------------------------------------------
FVC normal or < 80% restrictive pattern: interstitial fibrosis, bleomycin,
Parinaud syndrome: due to pineal gland tumor
idiopathic pulmonary fibrosis
(pineal produces melatonin)
obstructive pattern: emphysema COPD
MCC: germ cell tumors
normal spirometry: PE, anemia, pulmonary HTN
central precocious puberty: -hCG
Causes of DLCO
pressure on pretectal midbrain region near
due to pulmonary blood volume
superior colliculus & CN II
limited upward gaze (sun-setting sign), ptosis, exercise, supine position, pulmonary hemorrhage,
B/L eyelid retraction (Colliers sign) severe asthma, smoking, polycythemia
pseudo-Argyll-Robertson (minimally reactive) ----------------------------------------------------------------
DLCO in emphysema due to "adjoining
obstructive hydrocephalus: headache, vomiting,
capillary beds" (decreased surface area)
papilledema
DLCO in asthma due to "increased pulmonary
Dx: MRI, AFP & -hCG
blood volumes"
----------------------------------------------------------------
----------------------------------------------------------------
ecchymosis on areas exposed to repeated minor
chronic bronchitis: COPD subtype a/w smoking
trauma (extensors) in elderly: senile purpura
productive cough 3 months in 2 successive yrs
age-related loss of elastic fibers in perivascular
hypersecretion of mucus & structural changes to
connective tissue positive bronchodilator response (> 12% FEV1),
incidence & severity a/w anticoagulants, tracheobronchial tree; normal DLCO
normal DLCO, dyspnea, wheezing, cough: asthma CXR: prominent bronchovascular markings
NSAIDs, & corticosteroids COPD & asthma both show airflow obstruction
normal labs; no further evaluation ----------------------------------------------------------------
only asthma shows complete reversible Evaluation of hyperthyroidism
---------------------------------------------------------------- airway obstruction with bronchodilators Dx: measure TSH & free T4
precocious puberty, pigmentation, polyostotic o asthma: normal or DLCO (if severe) o TSH, free T4 20 hyperthyroidism
fibrous dysplasia (3 Ps): McCune Albright
o Dx: MRI pituitary adenoma
o caf au lait spots, multiple bone defects
o TSH, free T4 10 hyperthyroidism ---------------------------------------------------------------- aldosterone/renin > 20:1
o goiter, ophthalmopathy Graves fatigue, malaise, fever, night sweats, anorexia, pheochromo- headache, palpitations, diaphoresis
o Dx: radioactive iodine uptake (RIU) weight loss, pallor, abdominal pain: CML cytoma paroxysmal elevated BP
RIU = de novo hormone synth leukocytosis with left shift, basophilia, anemia, adrenal incidentaloma
RIU = preformed or exogenous thrombocytosis, splenomegaly Cushings central obesity, facial plethora,
high RIU: diffuse Graves myelocytes > metamyelocytes proximal weakness, striae,
high RIU: nodular adenoma, multi-nodular goiter reciprocal t(9, 22) form Philadelphia Xome amenorrhea/erectile dysfunction
low RIU thyroglobulin low exogenous TH containing the BCR/ABL fusion gene causes hypothyroidis fatigue, dry skin, cold intolerance,
low RIU thyroglobulin high thyroiditis dysregulated tyrosine kinase activity m constipation, weight gain
LAP score (leukocyte alkaline phosphatase) primary hypercalcemia, renal stones
----------------------------------------------------------------
Rx: tyrosine kinase inhibitors (imatinib) hyperPTH polyuria, polydipsia
thyroglobulin: produced by follicular cells of
inhibit BCR/ABL tyrosine kinase activation confusion, depression, psychosis
the thyroid; used only within the thyroid gland
---------------------------------------------------------------- aortic differential HTN, headache,
----------------------------------------------------------------
leukocyte alkaline phosphatase (LAP) score: coarctation epistaxis, blurred vision,, LVH
fever, neck pain, tender thyroid, elevated ESR:
leukemoid reaction, polycythemia vera brachial-femoral delay, rib notching
subacute thyroiditis (de Quervain) continuous to-&-fro machine-like
self-limited < 8 wks due to depletion of LAP score: CML (Dx: Philadelphia Xome)
---------------------------------------------------------------- murmur (posterior chest) due to
preformed thyroid hormone large collateral circulation
---------------------------------------------------------------- acute promyelocytic leukemia (APL) is a/w
upper GI bleed Rx: supplemental O2, IV fluids, retinoic acid receptor
+Auer rods, +myeloblasts hypercalcemia: bones, stones, moans, groans
NPO, monitor CBC & vitals for ongoing bleeding hyperPTH can cause HTN, arrhythmias, ventricular
---------------------------------------------------------------- no fever, no splenomegaly
Rx: all-trans retinoic acid (ATRA) hypertrophy, vascular & valvular calcifications
Manifestations of SLE significant HTN & 10 hyperPTH; MEN syndrome
feature constitutional: fever, fatigue, weight loss ----------------------------------------------------------------
MC thyroid malignancy: papillary carcinoma ----------------------------------------------------------------
s non-deforming migratory arthritis
Acute decompensated heart failure
butterfly rash & photosensitivity best prognosis
feature acute dyspnea, orthopnea, PND, HTN,
serositis: pleurisy, pericarditis, peritonitis MC mets to local lymph nodes
s accessory muscle use, tachycardia,
thromboembolic events (antiphospholipid) risk factors: childhood head/neck irradiation,
tachypnea, bibasilar crackles, JVD, S3,
cognitive dysfunction & seizures family Hx of thyroid ca peripheral edema
labs hemolytic anemia, thrombocytopenia, ---------------------------------------------------------------- Rx stable: supplemental O2,
leukopenia follicular thyroid carcinoma: hematogenous IV furosemide, IV vasodilator (nitro)
proteinuria, elevated Cr anaplastic thyroid ca: rapidly enlarging mass;
hypocomplementemia (C3, C4) hypotension or shock: supplemental O2,
worst prognosis (months) IV furosemide, IV vasopressor (NE)
ANA, anti-dsDNA, anti-Smith ----------------------------------------------------------------
false-positive RPR test for syphilis resistant HTN: despite 3 anti-hypertensives
acute decompensated HF can present with acute
Secondary causes of HTN
SLE joint Rx: NSAIDs, low-dose glucocorticoids, pulmonary edema
renal serum Cr, proteinuria, RBC casts
hydroxychloroquine ----------------------------------------------------------------
parenchymal
---------------------------------------------------------------- disease Tetanus prophylaxis
cough & wheezing with ASA-exacerbated renovascular continuous abdominal bruit, wound clean, minor dirty, severe
respiratory disease is preceded by refractory disease severe HTN ( 180/120), 3 tetanus tetanus toxoid if tetanus toxoid if
chronic rhinosinusitis a/w nasal polyposis (MCC) diffuse atherosclerosis (PAD, PVD) toxoid doses last dose was last dose was
---------------------------------------------------------------- recurrent flash pulmonary edema 10 yrs ago 5 yrs ago
child with morning headaches, seizures, irritable, serum Cr (after starting ACE-I) no TIg no TIg
decorticate posturing, space-occupying lesion primary HTN, mild hyponatremia, unimmunized, tetanus toxoid tetanus toxoid
infratentorial, benign astrocytomas: MC in kids aldosteronism easily provoked hypokalemia uncertain, or vaccine only, vaccine + TIg
< 3 tetanus doses no TIg 5-HT is synthesized in carcinoid cells from Nephrotic histopathology
---------------------------------------------------------------- tryptophan, also used for niacin crescent formation: focal segmental GN
diastolic dysfunction = heart failure with o 5-HT production pellagra thick BM & subepithelial spikes: membranous
preserved LV ejection fraction (contractility) DDx: right-sided IE (fever, malaise, arthralgias) mesangial hypercellularity: membranoproliferative
elevated diastolic pressure reduced C.O. ---------------------------------------------------------------- ----------------------------------------------------------------
---------------------------------------------------------------- folic acid depletion: 4 5 months parents are not allowed to refuse life-saving Rx
Drugs/supplements that affect elderly on a tea & toast diet for a child, including religious reasons
warfarin metabolism Vit B12 stores: 3 4 yrs obtain court order to proceed with intervention
p450 acetaminophen* NSAIDs ---------------------------------------------------------------- ----------------------------------------------------------------
inhibitors ABX/antifungals thyroid hormone perifollicular hemorrhage, poor wound healing, adolescents can receive confidential care w/o consent
(metronidazole) SSRI swollen gums: Vit C deficiency for contraception, pregnancy, & STDs
warfarin amiodarone cranberry juice RBC fragility, hyporeflexia, muscle weakness, ----------------------------------------------------------------
( bleed risk) cimetidine Gingko biloba blindness: Vit E deficiency presbyopia: age-related lens elasticity
omeprazole Vit E ---------------------------------------------------------------- prohibits accommodation, thus loss of near vision
p450 inducers carbamazepine phenobarbital unilateral pulsatile headache, vomiting, peaks at age 40, Hx of eye problems
ginseng rifampin photophobia, 4 72 hrs duration: migraine ----------------------------------------------------------------
warfarin spinach (greens) St. Johns wort Rx acute attacks: IV anti-emetics (chlorpromazine, weakness, postprandial epigastric pain, +FOBT:
effects/efficacy OCPs prochlorperazine, metoclopramide), esp. w/ N/V gastric cancer
---------------------------------------------------------------- o monotherapy or adjunct to NSAIDs & triptans Dx: endoscopy/Bx positive for adenocarcinoma
lupus anticoagulant: causes artificially migraine prophylaxis: amitriptyline, propranolol Staging gastric adenocarcinoma
prolonged aPTT by binding phospholipids ---------------------------------------------------------------- initial staging: abdomen & pelvis CT
risk of thrombosis most effective in reducing UTI risk a/w limited stage surgical resection
---------------------------------------------------------------- neurogenic bladder: intermittent catheterization advanced stage chemotherapy +/- laparotomy
episodic flushing, secretory diarrhea, wheezing, indwelling catheters can acquire a biofilm ----------------------------------------------------------------
tricuspid regurgitation ---------------------------------------------------------------- nocturnal wheezing & cough: GERD
Nephritic syndrome Nephrotic syndrome ----------------------------------------------------------------
Carcinoid syndrome
HTN, oliguria, edema, hypoalbuminemia, Esophageal perforation
feature episodic flushing, telangiectasias, periorbital edema hyperlipidemia, VTE etiology Boerhaaves, endoscopy, esophagitis
s cyanosis, secretory diarrhea, cramping, hematuria, RBC casts no hematuria, fatty casts (infectious/pill/caustic), ulcer
bronchospasm, tricuspid regurgitation, proteinuria < 3.5 g/day proteinuria > 3.5 g/day features chest/abdo pain, fever,
niacin deficiency (pellagra)
pediatric etiologies subcutaneous emphysema, crepitus
Dx 24 hr urine 5-HIAA
post-strep GN, HUS minimal change disease Dx CXR: wide mediastinum, pneumoTx,
CT/MRI abdomen/pelvis localizes tumor
adult etiologies pneumomediastinum
OctreoScan (detect mets), echo
IgA nephropathy, focal segmental GN, CT: esophageal wall thickening,
Rx octreotide only if symptomatic & prior to
crescentic GN membranous nephropathy, mediastinal air-fluid level
surgery for liver mets
(rapidly progressive GN) membranoproliferative, water soluble contrast esophagogram
lupus nephritis, amyloidosis, Rx ABX, parenteral nutrition, supportive care
carcinoid tumors can secrete histamine, 5-HT,
Alports diabetic glomerularnepho surgical repair
VIP that are metabolized in the liver
----------------------------------------------------------------
o liver mets results in hormone release into Hep B is a risk factor for membranous nephropathy -blockers can exacerbate severe reactive airway
systemic circulation o immunofluorescence: granular disease, but safe with mild/moderate COPD/asthma
hallmark: plaque-like deposits of fibrous tissue
membranoproliferative glomerulonephritis is o Rx: use cardioselective -blockers
on endocardium tricuspid regurgitation & right
a/w Hep C infection ----------------------------------------------------------------
heart failure
o can cause nephritic or nephrotic syndrome
----------------------------------------------------------------
MCC of sudden cardiac arrest is sustained Hep C can be asymptomatic or nonspecific valproate A/E: weight gain & acute pancreatitis
ventricular tachycardia or fibrillation due to ALT can be normal or 2x normal lamotrigine: Rx of bipolar depressive episodes;
acute MI or ischemia consideration for Rx requires liver biopsy as the A/E: SJS
survival rated depends on effective CPR, prompt best clinical predictor of disease progression & ----------------------------------------------------------------
rhythm analysis & defibrillation for V-fib assess response to treatment post-menopausal asymptomatics with adnexal mass
o #1 Rx: compression-only CPR liver biopsy determines staging & guide Rx require transvaginal USS, then CA-125
Rx: epinephrine for asystole, PEA, or refractory Rx: peginterferon & ribavirin elevated CA-125 in post-menopause
ventricular arrhythmias after defibrillation HHC surveillance for cirrhosis: USS every 6 months suggests ovarian cancer
---------------------------------------------------------------- ---------------------------------------------------------------- if simple cyst < 10 cm & normal CA-125: follow
hereditary non-polyposis CRC (HNPCC): aka early phase of acute pneumonia with consolidation conservatively with periodic USS
Lynch Syndrome can have persistent blood flow to areas of impaired needle aspiration is C/I
MC a/w endometrial carcinoma ventilation (V/Q mismatch) leads to physiologic ----------------------------------------------------------------
---------------------------------------------------------------- intrapulmonary (right-to-left) shunting & arterial Rx emergency reversal of warfarin-induced
MCC of osteomyelitis hypoxemia (deoxygenated blood to left heart) anticoagulation: FFP
children & adults: S. aureus (coagulase+) laterally positioning the affected lung in the ----------------------------------------------------------------
sickle cell disease: Salmonella & S. aureus dependent (lowest) position will worsen the shunt desmopressin can be used pre-operatively for
neonates: E. coli & group B strep ---------------------------------------------------------------- mild hemophilia A to prevent excess bleeding
age < 1 yr: group B strep conditions that cause decreased perfusion of o indirectly increases factor VIII by causing
diabetics: Pseudomonas well-ventilated alveoli (PE) amount of vWF release from endothelial cells
foot puncture: Pseudomonas physiologic dead space, resulting in wasted ----------------------------------------------------------------
o Rx: fluoroquinolones & surgical debridement ventilation, but not hypoxemia paraplegia, bladder/fecal incontinence, sensation
vertebral body: S. aureus poor ventilation of well-perfused alveoli absent from nipple downward: upper thoracic
---------------------------------------------------------------- (consolidated lung) leads to hypoxemia cord lesion
recent onset confusion, fever, muscle rigidity, ---------------------------------------------------------------- absent sensation from umbilicus downward:
diaphoresis, CK: NMS monthly bloating, headaches, breast tenderness, lower thoracic cord lesion
o drug-induced idiosyncratic reaction irritability decreased libido, anxiety: PMS ----------------------------------------------------------------
MCC: haloperidol, some atypicals occurs 1 2 wks before menses ipratropium: anti-muscarinic
o within 2 wks of initiation resolves with onset of menses Rx acute COPD exacerbation, combined with
---------------------------------------------------------------- DDx: hypothyroid, perimenopause, migraine, short-acting -agonists (albuterol)
Features of compartment syndrome somatization ----------------------------------------------------------------
o pain on passive stretching ---------------------------------------------------------------- Rx proven to prolong COPD survival: cessation of
o pain out of proportion to injury bipolar: not required to have depressive episode smoking, supplemental O2, lung reduction surgery
o antipsychotics have rapid onset of action, ----------------------------------------------------------------
o rapidly increasing & tense swelling
best for Rx acute mania Hep A is the MC vaccine-preventable disease of
o paresthesia
o mood stabilizers require gradual titration travelers, especially developing countries
reperfusion of a limb following arterio-occlusive
Bipolar disorder Rx yellow fever vaccine
ischemia > 4 6 hr can lead to intracellular &
mild/mod monotherapy with atypicals o sub-Saharan Africa, S. America
interstitial edema
(risperidone, olanzapine, aripiprazole) ----------------------------------------------------------------
increased pressure muscle & nerve ischemia
alternative lithium or valproate as monotherapy alcohol cessation & low purine diet can prevent
Rx: elevated compartment pressures that do not
severe mania atypical + lithium or valproate acute gouty arthritis
show rapid improvement fasciotomy
Maintenance Rx ethanol is metabolized to lactate; competes with
DDx: necrotizing fasciitis, gas gangrene,
lithium aripiprazole risperidone urate for renal excretion
embolic occlusion, DVT (vague pain)
lamotrigine olanzapine ziprasadone also avoid diuretics & pyrazinamide
complication: Volkmann contracture
valproate quetiapine Rx: NSAIDs, colchicine
----------------------------------------------------------------
haloperidol can Rx acute mania, not maintenance ----------------------------------------------------------------
headache, N/V, abdominal discomfort, confusion, large anterior mediastinal mass, -hCG, AFP: features asymptomatic, firm abdominal mass,
pink-red skin: carbon monoxide poisoning non-seminomtous germ cell tumor does not cross midline
Dx: carboxyHb level young males, locally invasive Dx USS, then contrast-enhanced CT
o pulse oximetry may be normal; unreliable most are primary tumors Rx excision or nephrectomy,
Rx: 100% O2 CO half-life from 5 hr to 1 2 hr Dx: testicular USS (r/o primary tumor) chemotherapy +/- radiation
or hyperbaric O2 DDx: seminoma ( -hCG only), benign teratoma, prognosis 5 yr survival with Rx: 90%
---------------------------------------------------------------- bronchogenic cyst, Hodgkins MC site of mets: lungs
Causes of inadequate response to anti-hypertensives ----------------------------------------------------------------
o NSAIDs, decongestants, glucocorticoids choriocarcinoma: -hCG DDx: neuroblastoma
o excess alcohol seminoma: -hCG only o arises from neuro crest cells (precursor of
o screen for secondary causes non-seminomtous tumor: -hCG, AFP sympathetic chain & adrenal medulla)
---------------------------------------------------------------- benign teratoma: no markers o can arise anywhere in sympathetic NS, but
sudden onset syncope without warning signs, HCC: AFP typically the adrenals
structural heart disease, ectopic beats: arrhythmia ---------------------------------------------------------------- firm, nodular mass that crosses midline
thiazides can predispose to ventricular arrhythmia #1 testicular sex cord stromal tumor: leydig cell tumor o metastatic sites: long bones, bone marrow,
DDx: vasovagal, autonomic dysFx, postural gynecomastia, precocious puberty skull, liver, lymph nodes, skin
---------------------------------------------------------------- estrogen due to aromatase expression with o urine HVA, VMA catecholamines
methadone is for pregos addicted to heroin to secondary inhibition of LH & FSH o XR: calcifications & hemorrhages
prevent uncontrolled withdrawal in the fetus undetectable -hCG & AFP ----------------------------------------------------------------
prenatal exposure to heroin & methadone ---------------------------------------------------------------- relative risk can be calculated from cohort studies
increases risk of IUGR, macrocephaly, SIDS subacute combined degeneration: neurologic by comparing incidence
Neonatal abstinence syndrome complication of Vit B12 deficiency odds ratio measures association in case-control
irritability, high-pitched cry, poor sleep, tremors, progressive symmetric polyneuropathy (legs) studies; compares the odds of exposure
seizures, sweating, sneezing, vomiting, diarrhea degeneration of dorsal spinal column, gait ataxia o if outcome/disease is uncommon, odds ratio
o heroin withdrawal: within 48 hr corticospinal disease (UMN signs) is a close approximation of relative risk
o methadone withdrawal: 48 72 hr peripheral neuropathy, memory loss, dementia (rare disease assumption)
Rx: symptomatic, morphine (systematically wean) if low incidence OR approximates RR
Dx: elevated methylmalonic acid
---------------------------------------------------------------- ----------------------------------------------------------------
----------------------------------------------------------------
penile fracture: due to crush injury Thoracic aortic aneurysm
Toxoplasmosis Rx: empiric sulfadiazine &
tearing of tunica albuginea, forms a hematoma ascending aortic aneurysm: cystic medial necrosis
pyrimethamine
Rx: retrograde urethrogram to r/o urethral injury, (aging) or connective tissue disorders (Marfan)
prophylaxis: TMP-SMX
then surgical exploration descending aortic aneurysm: atherosclerosis
----------------------------------------------------------------
---------------------------------------------------------------- o HTN, hypercholesterolemia, smoking
large sample size: decreases p-value & narrows CI
o phenytoin: Rx partial seizures CXR: wide mediastinum, increased aortic knob,
----------------------------------------------------------------
o carbamazepine: Rx trigeminal neuralgia tracheal deviation
Wilms tumor (nephroblastoma)
fetal hydantoin syndrome: nail/digit hypoplasia, Dx: contrast-enhanced CT
epidemiolog arise from metanephros
cleft lip/palate, MR, cardiac defects, microcephaly y (precursor of renal parenchyma) ----------------------------------------------------------------
o phenytoin rate of fetal Vit K degradation MC renal malignancy of childhood De Quervain tenosynovitis: inflammation of
o pregos on phenytoin during last trimester peak @ age 2 5 yrs; sporadic, abductor pollicis longus & extensor pollicis brevis
should receive prophylactic Vit K to prevent associated syndromes MC in new mothers holding infants
neonatal bleeding o WAGR (Wilms, Aniridia, GU Finkelstein test (grasps thumb & ulnar deviate
---------------------------------------------------------------- anomalies, mental Retardation) the wrist)
fetal exposure to valproate: risk of NTDs, o Beckwith-Wiedemann ----------------------------------------------------------------
cardiac anomalies, dysmorphic facies o Denys-Drash acute, severe retro-orbital pain, same time of day,
---------------------------------------------------------------- wakes patient from sleep, male: cluster headache
attacks occur in clusters: daily for 6 8 wks, Vit B12 supplements for exclusively breastfed etiology COPD, interstitial lung disease,
then remission for up to 1 yr infants born to strict vegetarian mothers pulmonary vascular disease, OSA
redness, I/L tearing, rhinorrhea, I/L Horners ---------------------------------------------------------------- symptom dyspnea on exertion, fatigue, lethargy,
acute Rx: 100% O2, subcutaneous sumatripan acute confusion, fluctuating LOC, inability to s exertional syncope, exertional angina
prophylaxis Rx: verapamil, lithium, ergotamine sustain attention: delirium exam peripheral edema, loud S2,
---------------------------------------------------------------- ---------------------------------------------------------------- JVD + prominent a wave, RV heave,
Iron deficiency anemia in age < 2 yr epinephrine (Rx asthma, croup) tricuspid regurgitation
risk factors prematurity** -agonist effect: reduces bronchial secretions & imaging EKG: partial/complete RBBB, RAD,
lead exposure mucosal edema RVH, RA enlargement
infants who consume -agonist effect: smooth muscle relaxation echo: pulmonary HTN, dilated RV,
o low-iron formula ---------------------------------------------------------------- tricuspid regurgitation
cow, soy, or goat milk fibromuscular dysplasia: non-inflammatory, right heart catheterization (gold std Dx):
introduced before age 1 yr non-atherosclerotic condition; women age < 50 RV dysfunction, pulmonary HTN,
o exclusive breastfeeding after abnormal development of arterial wall absence of left heart disease
age 6 months primarily affect renal arteries HTN ----------------------------------------------------------------
toddlers who consume involvement of carotid or vertebral arteries cause constrictive pericarditis is an important cause
o 24 oz/day milk (> 3 glasses) TIA, amaurosis fugax, stroke, headache, dizziness of right heart failure
o < 3 servings/day iron-rich food secondary hyperaldosteronism 2/2 decreased ----------------------------------------------------------------
adrenal vein sampling: Dx adrenal hyperplasia
universal CBC in all age 9 12 months perfusion to kidneys (aldosterone: renin ratio < 20)
screening Dx: abdominal CT angiography or duplex USS vs. adenoma (primary hyperaldosteronism)
aldosterone > 15; aldosterone:renin ratio > 20
Rx empiric iron supplementation, Rx: angioplasty with stent placement
recheck Hb in 4 wks, ----------------------------------------------------------------
o Rx: ACE-I if poor surgical candidate
start cow milk @ age 1 yr symptoms of CAD can be unmasked or worsened
ACE-I is C/I in B/L renal artery stenosis
with thyrotoxicosis
----------------------------------------------------------------
term infants have adequate iron stores for 6 months Cardiovascular effects of thyrotoxicosis
painful non-itchy pustules & honey-crust lesions
excess cow milk is low in iron & causes occult rhythm sinus tachycardia, PACs, PVCs
on mouth, nose, & neck: non-bullous impetigo
a-fib
intestinal blood loss MCC: S. aureus, group A Strep (S. pyogenes)
hemodynamics systolic HTN, pulse pressure,
goat milk is folate deficient risk factors: eczema, abrasion, insect bites contractility & C.O., SVR,
---------------------------------------------------------------- no fever, no systemic symptoms myocardial O2 demand
all pregos without C/I: influenza vaccination Rx: topical mupirocin heart failure high-output failure
o @ any trimester complications: post-strep GN angina coronary vasospasm,
---------------------------------------------------------------- DDx: HSV (orolabial region), VZV, erysipelas anginal symptoms in pre-existing
cough, erythema nodosum, anterior uveitis, arthritis: ---------------------------------------------------------------- coronary atherosclerosis
sarcoidosis 3+ proteinuria, hematuria, dense intramembranous
most are asymptomatic, incidental CXR findings deposits staining for C3: membranoproliferative systolic HTN in thyrotoxicosis is due to
DDx: acute HIV, TB, histoplasmosis, Hodgkins glomerulonephritis hyperdynamic circulation from contractility
---------------------------------------------------------------- caused by IgG against C3 convertase of hypothyroidism causes HTN due to SVR
primary CNS lymphoma Rx: irradiation alternative complement pathway, leads to ----------------------------------------------------------------
suspected if no response to ABX persistent complement activation thiazide A/E: hyperglycemia, LDL & TGs,
---------------------------------------------------------------- ---------------------------------------------------------------- hyponatremia, hypokalemia, hypercalcemia,
all exclusively breastfed infants should start on cor pulmonale: RV failure from pulmonary HTN uric acid retention (risk of acute gout)
VitD daily within 1st month of life due to COPD, PVD, or OSA ----------------------------------------------------------------
solid foods @ < 6 months risk of GI infections
Findings of cor pulmonale
arrest of labor in stage 1: 6 cm with ROM & ---------------------------------------------------------------- Rx for a single episode of major depression:
no cervical changes for 4 hr despite adequate, Antiphospholipid antibody syndrome continue for 6 months following patient response
OR no change 6 hr & inadequate contractions clinical arterial/venous thrombosis (VTE, PE) multiple episodes Rx: maintenance therapy
o Rx: c-section pregnancy ----------------------------------------------------------------
protracted labor: slower than expected progress o 3 consecutive unexplained fetal loss Asbestosis
Stages of labor before 10th wk occupational (shipyard, construction, mining, pipes)
1 latent 0 6 cm dilated o 1 unexplained fetal loss after 10th latency period: > 20 yrs
active 6 10 cm dilated (complete) wk progressive dyspnea (months), clubbing,
2 10 cm dilated delivery o 1 premature birth of normal neonate bibasilar end-expiratory crackles
3 delivery placenta expulsion before 34th wk due to preeclampsia, (no cough, sputum, or wheezing)
---------------------------------------------------------------- eclampsia or placental insufficiency risk for lung cancer & malignant mesothelioma
bloody/purulent nasal discharge, oral ulcers, labs lupus anticoagulant CXR: benign pleural plaques, interstitial fibrosis
sinusitis, dyspnea, hemoptysis, renal insufficiency, anti-cardiolipin antibody DLCO, PFT: restrictive pattern
microscopic hematuria, RBC casts: Wegeners anti-2-glycoprotein 1 antibody complication: cor pulmonale (RV heave)
granulomatosis with polyangiitis Dx 1 clinical & 1 lab criterion ----------------------------------------------------------------
URI & lower respiratory infections & RPGN Enzyme deficiencies
CXR: nodular densities & alveolar/pleural opacities lupus anticoagulant: prolongs PTT in vitro 21-hydroxylase (CAH)
Dx: c-ANCA & tissue Bx ---------------------------------------------------------------- cortisol & aldosterone ambiguous genitalia (girls)
Rx: high-dose corticosteroids & cyclophosphamide young female, decreased visual acuity in one eye, testosterone salt waste ( Na+, K+)
---------------------------------------------------------------- pain on eye movement, change in color perception: 17-OH-progesterone hypotension
unilateral, intermittent bloody nipple discharge: optic neuritis 11- hydroxylase
intraductal papilloma afferent pupil defect & central scotoma cortisol & aldosterone ambiguous genitalia (girls)
benign, no palpable masses (too small) DDx: orbital cellulitis, anterior uveitis testosterone fluid & Na+ retention,
MC in perimenopausal ---------------------------------------------------------------- 11-deoxycorticosterone HTN
---------------------------------------------------------------- anterior uveitis: unilateral eye is painful & red (weak mineralocorticoid)
painful, rubbery, firm breast mass with cyclic blurred vision, perilimbal injection 17-hydroxylase
symptoms with menstruation: fibrocystic change keratic precipitates & corneal stromal edema cortisol & testosterone all phenotypic female
o premenopausal women ---------------------------------------------------------------- mineralocorticoids fluid & Na+ retention,
o Dx/Rx: aspiration shows clear fluid, mass splenomegaly, pruritus with hot baths due to corticosterone HTN
disappears, observe for 4 6 wks histamine release: polycythemia vera (weak glucocorticoid) hypogonadism @ puberty
o biopsy if the mass recurs myeloproliferative disorders are common causes
painless, firm, mobile, solitary breast lump in of uric acid overproduction; purine catabolism classic CAH Dx: 17-OH-progesterone
women age 15 25: fibroadenoma o gouty arthritis is a common manifestation partial deficiency of 21-hydroxylase present in
nipple discharge, breast mass, or incidental finding ---------------------------------------------------------------- childhood: non-classic CAH
on mammography: DCIS Vasovagal syncope o precocious puberty, hirsutism/virilism,
o postmenopausal inciting age < 60: emotional stress, orthostatic stress medication-resistant acne, accelerated growth
eczematous nipple changes & discharge: Pagets events (prolonged standing, venipuncture) o Dx: cosyntropin stimulation test (gold std)
---------------------------------------------------------------- age > 60: micturition, cough, defecation licorice is known to inhibit 11- hydroxylase;
scleroderma renal crisis: acute onset renal failure feature prodrome pallor, dizziness, nausea, sweating chronic consumption can result in
(w/o previous kidney disease) & malignant HTN s short duration of syncope (minutes) pseudohyperaldosteronism
(headache, blurry vision, nausea) symptoms improve in supine position ----------------------------------------------------------------
microangiopathic hemolytic anemia with Dx mainly clinical post-operative pneumonia deteriorating into
schistocytes & thrombocytopenia upright tilt table test if uncertain septic shock with lactic acidosis 2/2 tissue hypoxia
Rx: ACE-I Rx self-limited; avoid triggers Rx: IV normal saline, ABX
---------------------------------------------------------------- ----------------------------------------------------------------
external validity: how generalizable are results monosymptomatic (isolated) enuresis: urinary CPK is a/w acute tubular necrosis due to
to other populations? incontinence > 2x/wk in age 5 yrs myoglobinuria
internal validity: are results in this specific workup: U/A; imaging for +daytime symptoms U/A: +blood, but no RBCs on microscopy
cohort valid? (design, method, analysis) or recurrent UTIs Rx: hydration, mannitol, urine alkalinization
---------------------------------------------------------------- #1 Rx: behavior modification, enuresis alarm o avoid -blockers: unopposed activation
Vaccines for adults with HIV #2 Rx: (short-term) desmopressin; alt Rx: TCAs worsens HTN & causes coronary vasospasm
HAV chronic liver disease (HBV, HCV) ---------------------------------------------------------------- ----------------------------------------------------------------
men/men sex, IVDA acute onset severe liver injury with encephalopathy aseptic meningitis MCC: Coxsackie or Echovirus
HBV all unimmunized to HBV & INR > 1.5, without cirrhosis or underlying liver ----------------------------------------------------------------
HPV all age 9 26 disease: fulminant hepatitis Management of acute STEMI
influenza all annually (IM inactivated) acute liver failure: MCC are acute viral hepatitis, o supplemental O2 (if O2 Sat < 90%)
all age 11 18 acetaminophen toxicity, ischemic hepatopathy o chewed ASA
meningococcu large groups in close quarters, (shock liver), Wilsons o clopidogrel
s asplenia or complement deficiency o concurrent alcohol use increases propensity o sublingual nitrate (not for RV infarct,
pneumococcus PCV13 once, then of hepatotoxicity from acetaminophen hypotensive, severe aortic stenosis)
PPSV23, 8 wks later & every 5 yrs RUQ pain, pruritus, jaundice, encephalopathy o metoprolol (not for hypotensive, bradycardia,
Td, Tdap Tdap once, then Td every 10 yrs acute AST & ALT (1000s), PTT, bilirubin decompensated CHF, heart block)
Tdap for each pregnancy decreasing aminotransferases & worsening PT/INR, o high-dose statin
indicates progressive liver failure o LMWH or unfractionated heparin
live vaccines (MMR, varicella, intranasal influenza, PT is the most important prognostic indicator persistent pain, HTN, or heart failure: IV nitro
zoster) are C/I for CD4 < 200 ---------------------------------------------------------------- (not for hypotension, RV infarct, severe AS)
MMR should be given if CD4 > 200 & no evidence Intrapartum fetal HR monitoring persistent severe pain: IV morphine
of immunity Early fetal head compression (anxiolytic & preload reduction)
o HIV+ are at increased risk for measles can be normal unstable sinus bradycardia: IV atropine
---------------------------------------------------------------- Late uteroplacental insufficiency acute pulmonary edema: IV furosemide
vaccinate 14 days before or after splenectomy Variable cord compression, cord prolapse, (not for hypotensive or hypovolemic)
Vaccines for asplenic adults oligohydramnios reperfusion: PCI within 90 min; thrombolysis if
pneumococcus sequential PCV13, then PPSV23; PCI not available within 120 min
PPSV23 again in 5 yrs & age 65 intermittent variable decelerations (< 50%) are ----------------------------------------------------------------
H. influenza 1x Hib vaccine well tolerated by the fetus; does not require a Guidelines for primary PCI of acute STEMI
meningococcu quadrivalent vaccine every 5 yrs change in management within 12 hr of symptom onset, AND
s recurrent variable decelerations (> 50%) are within 90 min of first medical contact to device
influenza IM inactivated vaccine annually concerning for fetal academia; prompt intervention time at PCI-capable facility, OR
others HAV, HBC, Tdap 1x, Td every 10 yr o #1 Rx: O2 & change maternal position o within 120 min at non-PCI-capable facility
S. pneumo is MCC of sepsis post-splenectomy o discontinue uterotonic drugs ----------------------------------------------------------------
---------------------------------------------------------------- o #2 Rx: artificial ROM & amnioinfusion fibrinolytics is a/w recurrent MI, ICH, mortality
late-term pregnancies (41 42 wks) risk for o #3 Rx: c-section compared to PCI
uteroplacental insufficiency ---------------------------------------------------------------- ----------------------------------------------------------------
antenatal fetal surveillance begin @ 41 wks: BPP terbutaline: 2-agonist tocolytic headaches worse at night, N/V, LOC, cognitive
diffuse placental calcifications on USS are Rx tachysystole (> 5 contractions in 10 min) dysFx, vision changes, worse with maneuvers that
common in late-term; indicates a mature placenta ---------------------------------------------------------------- ICP (leaning forward, Valsalva, coughing):
---------------------------------------------------------------- Rhabdomyolysis intracranial HTN
D-dimer: product of cross-linked fibrin degradation MCC: cocaine overdose, tonic-clonic seizures Cushing reflex: HTN, bradycardia, resp depressn;
---------------------------------------------------------------- rhabdomyolysis releases K+, CPK, & myoglobin suggests brainstem compression
DDx: sinusitis (purulent nasal discharge), acute rapidly progressive GN o nephrosclerosis = hypertrophy & intimal
angle closure glaucoma, temporal arteritis thin BM disease medial fibrosis of renal arterioles
---------------------------------------------------------------- lupus nephritis (low complement) o glomerulosclerosis = progressive loss of
oliguria, azotemia & BUN/Cr > 20:1 in post-op: post-streptococcal GN (low complement) glomerular capillary surface area with
acute prerenal failure from hypovolemia membranoproliferative GN (low complement) glomerular & peritubular fibrosis
#1: rule out urinary catheter obstruction mixed cryoglobulinemia (low complement) ----------------------------------------------------------------
Dx: IV fluid challenge ---------------------------------------------------------------- diabetic nephropathy: #1 cause of ESRD
---------------------------------------------------------------- atypical presentations of ACS: N/V, dyspnea, 1st year: GFR, glomerular hyerperfusion, renal
low-dose dopamine infusion can dilate renal epigastric pain; MC in women, elderly, diabetics hypertrophy
arterioles GFR & urine output (temporary) initial evaluation: EKG extracellular matrix, BM thickening, mesangial
---------------------------------------------------------------- DDx: acute cholecystitis, pancreatitis, PUD expansion, & fibrosis
Chronic Hep C strongly a/w ---------------------------------------------------------------- 5 10 yrs: microalbuminuria, overt nephropathy
porphyria cutanea tarda (photosensitivity, hilar mass, mediastinal adenopathy, cough, ----------------------------------------------------------------
vesicles/erosions on dorsum hand) dyspnea, weight loss: small cell lung cancer hypoparathyroidism (PTH deficiency): hypoCa++,
essential mixed cryoglobulinemia (circulating hyperphosphatemia, normal renal function
immune complexes deposit in small/med vessels) Paraneoplastic syndromes a/w lung cancer hypoCa++: perioral tingling/numbness, tetany,
o IgM complexes with anti-hepatitis C IgG endocrine SIADH** cramps, carpopedal spasm, seizures
o vasculitis of skin, kidney, nerves, joints PTHrP (hypercalcemia) causes: post-surgical, autoimmune, DiGeorge,
membranoproliferative GN ACTH (Cushings)** defective Ca++-sensing receptors, irradiation
---------------------------------------------------------------- hematologic hypercoagulability (Trousseaus) ----------------------------------------------------------------
Chronic Hep C features neurologic Lambert-Eaton** phenytoin, carbamazepine, rifampin can cause
fatigue, arthralgia, Raynauds ataxia, autonomic/sensory neuropathy Vit D deficiency by inducing p450
low complement MSK hypertrophic osteoarthropathy resulting in secondary hyperparathyroidism:
intermittent elevations of AST/ALT, RF (a/w adenocarcinoma) hypoCa++, hypophosphatemia
Dx: viral hepatitis serology dermatomyositis & polymyositis ----------------------------------------------------------------
confirm Dx: kidney/skin Bx **a/w small cell lung cancer CKD impairs 1--hydroxylase, which converts
Rx: plasmapheresis (cryoglobulins), 25-OH Vit D to 1,25-OH Vit D Vit D deficiency
glucocorticoids & cyclophosphamide Trousseau's: spontaneous recurrent or migratory resulting in secondary hyperparathyroidism:
complications: cirrhosis & HCC venous thromboses, arterial emboli caused by hypoCa++, hyperphosphatemia
---------------------------------------------------------------- non-bacterial thrombotic endocarditis ----------------------------------------------------------------
MCC of nephrotic syndrome ---------------------------------------------------------------- inadequate Ca++ intake 20 hyperparathyroidism
focal segmental African-Am & Hispanics, shoulder pain & weakness with arm lifting: bone resorption Ca++
glomerulosclerosis obesity, HIV, heroin use rotator cuff pathology (tendonitis or tear) 25-OH Vit D to 1,25-OH Vit D, which
membranous adenocarcinoma (breast, limited mid-arc abduction & external rotation stimulates gut Ca++ absorption
nephropathy lung), NSAIDs, Hep B, SLE Dx: lidocaine injection renal phosphate loss hypophosphatemia
membranoproliferativ Hep B & C o improvement = tendonitis/impingement ----------------------------------------------------------------
e glomerulonephritis o no improvement = tear weight loss, anorexia, constipation, easy fatigue,
minimal change adults: NSAIDs, lymphoma Dx rotator cuff tear: drop arm test, shoulder MRI dry mucous membranes, confusion, polyuria
disease (Hodgkins) o MCC: fall on outstretched hands hypercalcemia induces urinary Na+ wasting,
IgA nephropathy upper URI ---------------------------------------------------------------- resulting in volume depletion, further impairing
nephrosclerosis 2/2 HTN renal clearance of Ca++
secondary: diabetes & primary amyloidosis (MM) atherosclerotic lesions of afferent & efferent
---------------------------------------------------------------- arterioles & glomerular capillary tufts Management of hypercalcemia
MCC of nephritic syndrome nephrosclerosis glomerulosclerosis severe short-term: aggressive hydration;
IgA nephropathy (Ca++ > 14) normal saline & calcitonin
or symptomatic long-term: shifting the cutoff point to the left: & FP will ----------------------------------------------------------------
bisphosphonate (zoledronate) decrease PPV (PPV = TP/ (TP + FP)) excess androgens in PCOS suppress ovulation by
moderate no immediate Rx unless ---------------------------------------------------------------- suppressing GnRH & FSH by feedback inhibition
(12 14) symptomatic (same as above) selective survival bias occurs in case-control ----------------------------------------------------------------
mild (< 12) or no immediate Rx studies; cases are selected from the entire disease inhibin B: use to determine ovulatory reserve;
asymptomatic avoid thiazides, lithium, volume population instead of newly diagnosed (cancer) with declining reserves
depletion & prolonged bed rest ---------------------------------------------------------------- ----------------------------------------------------------------
saline hydration restores intravascular volume & strongest predictor of AAA expansion & rupture: MCC of acute pancreatitis: alcohol, gallstones
promotes urinary Ca++ excretion active smoking others: hypertriglyceridemia, hypercalcemia,
loop diuretics only if volume overloaded other risks: large diameter & rate of expansion recent ERCP, trauma, viral infection, medications
o avoid diuretics if volume-depleted o HTN has a weak association eruptive xanthomas Dx: fasting lipid profile
---------------------------------------------------------------- indications for AAA repair o triglycerides > 1000 causes pancreatitis
hyperthyroidism-related tachysystolic a-fib o > 5.5 cm ----------------------------------------------------------------
Rx: propranolol o expansion rate > 1 cm/yr club foot Rx: stretching, manipulation, serial casts
---------------------------------------------------------------- o symptomatic (regardless of size) surgery if conservative management fails
atypical community-acquired pneumonia with ---------------------------------------------------------------- ----------------------------------------------------------------
CNS & GI features: Legionnaires MC complication of AAA repair: bowel ischemia acute urticaria (< 6 wks)
fever with relative bradycardia due to inadequate colonic collateral perfusion to well-circumscribed, raised erythematous plaques
intracellular G-negative rod left colon & sigmoid 2/2 loss of IMA perfusion with central pallor; intense pruritus
CXR: unilateral patchy infiltrates presents with abdominal pain & bloody diarrhea worsen over minutes hrs; resolve within 24 hr
Dx: urine antigen testing & culture Rx: check sigmoid perfusion after graft placement mast cell activation in superficial dermis, which
Rx: fluoroquinolone or macrolide ---------------------------------------------------------------- histamine release pruritus & swelling
morphine contributes to post-op ileus by angioedema can occur in deep dermal & SC tissues
Suspicion of Legionella pneumonia decreasing GI motility MCC: IgE mediated, direct mast cell activation,
exposure recent travel within previous 2 wks o post-op ileus: hypoactive/absent bowel sounds NSAIDs, infection, idiopathic
(cruise ships, hotel) mechanical obstruction: hyperactive BS ----------------------------------------------------------------
nosocomial (hospital, nursing home) ---------------------------------------------------------------- atopic dermatitis (eczema): pruritic erythematous,
features fever > 39 (102.20 F) with bradycardia, child with meningeal signs & erythematous scaly patches on extensor surfaces
confusion (CNS), watery diarrhea (GI), petechial/purpuric rash: N. meningitides epidermal dysfunction of stratum corneum synthesis
unilateral lung diffuse crackles (meningococcal meningitis) MC in infancy; cheeks, scalp, extensor limbs
labs hyponatremia, mild hepatitis, rash appears within 24 hr of infection MC site (adults): flexural areas, face, wrist, forearm
hematuria, proteinuria ---------------------------------------------------------------- o lichenified plaques on flexural creases
CXR: unilateral interstitial infiltrates HSV causes temporal lobe encephalitis in risk factors: low humidity, stress, overheating,
Gram stain: neutrophils, no organisms neonates & infants; presents with seizures excessive bathing, irritants
Dx urine antigen testing & culture ---------------------------------------------------------------- complication: eczema herpeticum, cellulitis/abscess
Rx: fluoroquinolones causes of anatomic defects in the uterus or ----------------------------------------------------------------
Legionella stains poorly; intracellular fallopian tubes: Hx of PID, in utero DES, eczema herpeticum: HSV superinfection in areas
DDx: influenza, mycoplasma, PCP, TB endometriosis, congenital malformations of severe atopic dermatitis (eczema)
---------------------------------------------------------------- Dx: hysterosalpingogram o numerous umbilicated vesicles over
amoxicillin/clavulanate: Rx sinusitis, otitis media ---------------------------------------------------------------- erythematous skin
ceftriaxone: Rx pneumococcus, H. influenza elevated serum prolactin suppresses ovulation by o a/w fever & adenopathy
clindamycin: Rx aspiration pneumonia inhibiting GnRH release amenorrhea o Rx: acyclovir
vancomycin: Rx nosocomial pneumonia (MRSA) ---------------------------------------------------------------- erysipelas: red, indurated, tense, shiny plaque
---------------------------------------------------------------- mid-luteal serum progesterone tests for ovulation with raised, sharply demarcated margin
PPV & NPV depend of prevalence of a disease ovulation corpus luteum produces progesterone
o a/w fever & chill ---------------------------------------------------------------- COPD: chronic bronchitis +/- emphysema
o MCC: Group A strep congenital syphilis: transplacental transmission long-term supplemental O2 prolongs survival
---------------------------------------------------------------- XR: metaphyseal dystrophy & periostitis indications: PaO2 < 55, SaO2 < 88%, Hct > 55%,
contact dermatitis: direct skin exposure to irritant initially asymptomatic or evidence of cor pulmonale or pulmonary HTN
erythematous papules & vesicles; indistinct margins early sign: cutaneous palm/sole lesions, survival benefits if used for 15 hrs/day
Type IV hypersensitivity rhinorrhea, hepatosplenomegaly, jaundice, anemia ----------------------------------------------------------------
vesicular fluid can be 20 infected by Strep or Staph late findings (age > 2 yr): frontal bossing, cellulitis MCC: -hemolytic strep & S. aureus
---------------------------------------------------------------- Hutchinson teeth, high arched palate, saddle nose, systemic signs: high fever, chills, malaise,
chronic follicular occlusive disease on interstitial keratitis, perioral fissures fatigue, confusion
intertriginous skin (axilla, groin) with painful ---------------------------------------------------------------- Rx (+systemic signs): IV nafcillin or cefazolin
nodules & sinus tracts: suppurative hidradenitis scaphoid fx: MCC is fall on outstretched arm Rx (no systemic signs): oral dicloxacillin
---------------------------------------------------------------- proximal fragment vulnerable to avascular necrosis chronic fungal foot infections (tinea pedis) can
erythema multiforme: target lesions with XR can take up to 10 days to show abnormalities be a nidus for recurrent bacterial cellulitis
erythematous, iris-shaped macules Rx: thumb spica 6 10 wks, repeat XR in 1 wk o Rx: itraconazole, terbinafine
painful, pruritic, symmetrical on extensors, ---------------------------------------------------------------- ----------------------------------------------------------------
including palm/soles glucosuria, phosphaturia, aminoaciduria: acyclovir nephrotoxicity: acyclovir accumulation
a/w HSV, coccidiomycosis, Mycoplasma Fanconi syndrome in collecting ducts exceed solubility crystalluria
---------------------------------------------------------------- ---------------------------------------------------------------- MC with high-dose IV acyclovir
pityriasis rosea: self-limited, cutaneous reaction 2 day Hx of periorbital swelling, skin infection Rx: adequate hydration & dosage adjustment
following a viral etiology 3 wks ago (Rx: dicloxacillin), dark urine, HTN ----------------------------------------------------------------
papulosquamous rash of oval-shaped lesions whose U/A: RBC casts & mild proteinuria hypothyroidism can cause
long axes are oriented along skin folds ('Christmas labs: low C3 o hyperlipidemia & hypercholesterolemia
tree' pattern); trunk & proximal extremities Dx: post-strep GN o hyponatremia ( free water clearance)
initial lesion: pink to salmon-colored 'herald' patch ---------------------------------------------------------------- o asymptomatic creatinine kinase, ALT/AST
plaque with raised margin & collarette scale, with hematuria 5 days after URI, normal C3: IgA ----------------------------------------------------------------
eruption into scaly & ovoid papules & plaques on nephropathy hypothyroidism & adrenal insufficiency must be
the back or flexor surfaces ---------------------------------------------------------------- ruled out before Dx of SIADH
---------------------------------------------------------------- fever, rash, arthralgia; hematuria, sterile pyuria, ----------------------------------------------------------------
infant with failure to thrive, normal anion gap peripheral eosinophilia, medication use (NSAIDs, thyrotoxicosis can cause hypercalcemia due to
acidosis, & alkalotic urine: renal tubular acidosis sulfonamides, PCN, cephalosporins, diuretics): bone resorption
o Type I RTA: poor K+ & H+ excretion acute interstitial nephritis ----------------------------------------------------------------
a/w nephrolithiasis U/A: WBC casts, eosinophiluria, mild proteinuria bulimia: binging at least 2x/wk, 3 months
o Type II RTA: poor HCO3 resorption ---------------------------------------------------------------- o no amenorrhea
a/w Fanconis likely PE based on modified Wells criteria binge-eating disorder: no compensatory behavior
o Type IV RTA: aldosterone resistance o confirm Dx: CT angiography: filling defect to prevent weight gain (purging)
a/w CAH (hyperkalemic, hyperchloremic unlikely PE criteria evaluate with D-dimer ----------------------------------------------------------------
metabolic acidosis) o D-dimer < 500 excludes PE Interstitial cystitis (painful bladder syndrome)
labs: low serum HCO3 & hyperchloremia, leads o D-dimer > 500 CT angiography epidemiolog women, a/w psychiatric disorders
to normal anion gap metabolic acidosis ---------------------------------------------------------------- y (anxiety) & fibromyalgia
Rx: oral sodium bicarbonate COPD: progressive in expiratory flow rate; features pain with filling, relief with voiding
---------------------------------------------------------------- FEV1/FVC < 0.7 chronic pelvic pain
fluphenazine: typical antipsychotic, injection air trapping & airflow obstruction TLC, frequency, urgency, dyspareunia
A/E: hypothermia by inhibiting autonomic vital capacity Dx bladder pain, no other cause 6 wks
thermoregulation destruction of alveolar-capillary membrane normal U/A
Rx: avoid prolonged cold exposure ----------------------------------------------------------------
Rx not curative; focus on quality of life, o MC in liver disease DDx: malignant melanoma, dysplastic nevi,
behavior modification, avoid triggers, Howell-Jolly: basophilic remnants of nuclei BCC, actinic keratosis
amitriptyline o Hx of splenectomy or functional asplenia ----------------------------------------------------------------
analgesics for exacerbations Target cells: bulls eye RBC Hx of recurrent unexplained DVTs
DDx: cystocele, PID, stress incontinence, UTI o thalassemia, chronic liver disease, alcoholics Dx: factor V Leiden mutation is resistant to
---------------------------------------------------------------- ---------------------------------------------------------------- protein C inactivation
Acetaminophen intoxication medication-induced torticollis: metoclopramide, ----------------------------------------------------------------
first 24 hrs, can be asymptomatic typical antipsychotics, prochlorperazine increased dead space ventilation in COPD
single dose 7.5 g & 4 hr since ingestion ---------------------------------------------------------------- worsens respiratory acidosis
o Rx: activated charcoal & check serum levels MCC of acquired torticollis: URI, minor trauma, chronic hypercapnic respiratory failure in COPD
nomogram showing hepatotoxic levels cervical lymphadenitis, retropharyngeal abscess maintains a normal pH due to renal compensation
o Rx: N-acetylcysteine Dx: XR to r/o cervical fx or dislocation ( HCO3 retention)
o non-toxic levels repeat levels in 2 hr ---------------------------------------------------------------- ----------------------------------------------------------------
---------------------------------------------------------------- erectile dysfunction in diabetics can be due to MCC euvolemic hypernatremia: diabetes insipidus
cough with blood-tinged sputum: TB autonomic neuropathy, medications, circulation, dilute urine, elevated serum osmolality
highest risk: emigration from endemic area or hypogonadotropic hypogonadism ----------------------------------------------------------------
---------------------------------------------------------------- o gynecomastia, testicular atrophy isolated systolic HTN: elasticity
ARPKD: infant with large flank mass, respiratory Dx: early-morning total testosterone; all diabetics increases CV risk in elderly
distress from pulmonary hypoplasia, Potter facies Dx: serum prolactin Rx: monotherapy with low-dose thiazide, ACE-I,
ADPKD: asymptomatic in childhood excess prolactin suppresses GnRH or long-acting CCB
---------------------------------------------------------------- Rx: sildenafil (diabetics, normal testosterone) ----------------------------------------------------------------
Management of severe hematochezia (lower GI bleed) ---------------------------------------------------------------- circulating BNP correlates with severity of LV
initial evaluation: NGT aspiration acquired hypogonadotropic hypogonadism 2/2 filling pressure & mortality; a/w S3
o +blood, +/- bile upper endoscopy hypothalamic dysfunction ----------------------------------------------------------------
o no blood, +bile colonoscopy insufficient GnRH pulses, LH & FSH only +Anti-HBs, +Anti-HBc, -HBsAg: resolved HBV
if bleed continues Technitium-99 labeled RBC amenorrhea, irregular menses +Anti-HBs only: HBV vaccinated
scintigraphy is less invasive, more sensitive than MCC: significant stressor, eating disorder, +IgM anti-HBc: window phase
arteriogram excessive exercise HBsAg: first marker; precedes symptoms
o if RBC scan identifies bleed, follow up with #1 Rx: reduce stress & exercise intensity HBcAg: not detectable
angiography or repeat colonoscopy #2 Rx: pulsatile GnRH +HBsAg, +IgG anti-HBc > 6 months: chronic HBV
capsule endoscopy: Dx chronic GI bleed with ---------------------------------------------------------------- ----------------------------------------------------------------
negative upper & lower endoscopy respiratory distress, tachycardia, tachypnea, fever, B/L proptosis & impaired extraocular motion
---------------------------------------------------------------- upper petechial rash, sub-conjunctival hemorrhage, (decreased convergence, diplopia), exophthalmos:
vesicoureteral reflux Dx: voiding cystourethrogram multiple long bone fx,: fat embolism Graves ophthalmopathy
screen for hydronephrosis: renal USS 12 72 post-injury also gritty/sandy sensation, photophobia, tearing
long-term eval for scarring: renal scintigraphy CNS: confusion, agitation stupor, coma infiltrative ophthalmopathy from accumulation of
evaluate renal function: serial Cr Dx: fat droplets in urine or intra-arterial fat globules glycosaminoglycans in retro-orbital muscles, leads
---------------------------------------------------------------- on fundoscopy to proptosis (specific to Graves)
Hep C is a risk factor for cirrhosis, HCC, Rx: respiratory support risk factors: females, advanced age, smoking
cryoglobulinemia, membranoproliferative GN ---------------------------------------------------------------- anti-thyrotropin receptor auto-antibodies directly
---------------------------------------------------------------- chronic non-healing wound (burns) with scarred cause retro-orbital tissue expansion
Burr cells (echinocytes): speculated, serrated RBCs or inflamed skin: squamous cell ca ----------------------------------------------------------------
o MC in liver disease & ESRD SCC arising within burn wounds: Marjolin ulcer bacterial meningitis Rx: IV ceftriaxone & vanco
Spur cells (acanthocytes): irregular RBC projections Dx: Bx to r/o malignancy CSF: WBC (neutrophil predominance), low
glucose, elevated protein
---------------------------------------------------------------- congenital aganglionic megacolon (Hirschsprung) MCC of isolated aortic regurgitation in young adults
MCC of atrial flutter: reentrant circuit around may be a/w Downs in developed countries: bicuspid aortic valve
tricuspid annulus, slows the impulse through the delayed passage of meconium > 48 hr MCC of aortic regurgitation in developing country:
cavotricuspid isthmus XR: dilated loops of small & large bowel rheumatic heart disease
MC location of ectopic foci causing a-fib: Dx: rectal biopsy show absence of ganglion cells ----------------------------------------------------------------
pulmonary veins (myocardial sleeve) ---------------------------------------------------------------- GVHD is common after bone marrow transplant
AVNRT: reentrant circuit by 2 separate pathways diffuse bronchial obstruction & purulent sputum: due to activation of donor T lymphocytes
within the AV node acute exacerbation of COPD maculopapular rash on palms & soles, face
AVRT: reentry circuit via accessory bypass tract o diffuse rhonchi & wheezing, PaCO2 occult-positive diarrhea, abnormal LFTs, jaundice
---------------------------------------------------------------- Dx: spirometry FEV1/FRC < 0.70 pulmonary: bronchiolitis obliterans
lung cancer & malignant melanoma can present ---------------------------------------------------------------- ----------------------------------------------------------------
with multiple brain metastases dullness to percussion, decreased breath sounds, activation of host T lymphocytes mediates graft
MC site of brain metastases: lung cancer B/L coarse crackles: CHF rejection, resulting in depression of myelopoiesis
Dx: chest CT o due to transudative pleural effusion severe neutropenia for several days risk of
---------------------------------------------------------------- ---------------------------------------------------------------- infection
mitral regurgitation: murmur with squatting immobility is MCC of decubitus ulcers ----------------------------------------------------------------
MVP: murmur intensity with squatting MC over bony prominences; ischemic necrosis Reye syndrome: children age < 15 yrs
---------------------------------------------------------------- ---------------------------------------------------------------- vomiting & agitation, progressing to lethargy,
preoccupation with a slight or imagined defect, lesions on skin & viscera, abdo pain, fever, stupor, restlessness
significant impairment: body dysmorphic disorder malaise, weight loss: bacillary angiomatosis hyperammonemia, hypoglycemia, prolonged PT,
related to OCD, with repeated thoughts & o large, pedunculated exophytic papules bilirubin, ALP, AST/ALT, & LDH
compulsive behavior to hide or treat the defect CT: nodular, contrast-enhanced intrahepatic lesions liver Bx: microvesicular steatosis
Rx: therapeutic alliance, psychotherapy, SSRI Dx: tissue biopsy; prone to hemorrhage Rx: supportive
---------------------------------------------------------------- Rx: ABX ----------------------------------------------------------------
COPD patient with catastrophic worsening of ---------------------------------------------------------------- troponin T is most sensitive & specific for MI,
respiratory symptoms: spontaneous pneumoTx pleuritic chest pain, dyspnea, tachypnea, but slow to return to normal (10 days)
risk factor: smoking leads to chronic destruction tachycardia, hypoxemia after immobilization CK-MB normalizes within 1 2 days; reinfarction
of alveolar sacs, forming large alveolar blebs Approach to suspected PE ----------------------------------------------------------------
which eventually rupture & leak into pleural space stabilize with O2 & IV fluids C. difficile colitis
---------------------------------------------------------------- contraindications to anticoagulation? IVC filter risk factors recent ABX, advanced age, PPIs
Evaluation of bilious emesis assess with Modified Wells (pretest probability) pathogenesis Enterotoxin A: watery diarrhea
#1 Rx: stop feeds, IV fluids, NG tube Cytotoxin B: colonic epithelial cell
PE likely IV heparin, then order diagnostics
#2 Rx: abdominal XR necrosis & fibrin deposition
o PE unlikely CT angiogram (or V/Q scan)
if pneumoperitonium, hematemesis, unstable vitals presentation fever, watery diarrhea, leukocytosis
+PE anticoagulate
surgery fulminant colitis with toxic megacolon,
-PE stop anticoagulation
if dilated loops of bowel contrast enema white/yellow pseudomembranes
early empiric anticoagulation should be initiated
o microcolon meconium ileus a/w CF Dx stool toxin via PCR
prior to pursuing confirmatory diagnostics in
o rectosigmoid transition zone Hirschsprung patients with likely PE Rx metronidazole or oral vancomycin
if NG tube misplaced upper GI contrast series anticoagulation prevents further clotting, but does ----------------------------------------------------------------
(barium) shows Ligament of Treitz on right side & not lyse existing clots Causes of normal anion gap metabolic acidosis
corkscrew pattern malrotation/volvulus ---------------------------------------------------------------- diarrhea, laxative abuse
o Rx: Ladd procedure (fixed bowel) MCC of isolated aortic stenosis in elderly: fistulas (pancreatic, ileocutaneous)
if double bubble sign duodenal atresia age-dependent idiopathic sclerocalcific changes carbonic anhydrase inhibitors
---------------------------------------------------------------- renal tubular acidosis (RTA)
ureteral diversion somatostatin & octreotide act by reducing congenital long QT syndrome increases risk for
iatrogenic splanchnic blood flow, inhibiting gastric acid syncope, TdP, & sudden death
---------------------------------------------------------------- secretion, & gastric cytoprotective effects Rx: refrain from vigorous exercise, avoid meds
non-anion gap metabolic acidosis & hyperkalemia Rx upper GI bleed when endoscopy is that prolong QT, monitor electrolytes
with mild renal dysfunction: renal tubular acidosis unsuccessful, C/I, or unavailable; or adjunct Rx: propranolol
aldosterone resistance retention of H+ & K+ ---------------------------------------------------------------- symptomatics Rx: propranolol & pacemaker
MC in poorly controlled diabetes asthma-like symptoms for several days, diffuse C/I: sotalol (class III) prolongs QT
---------------------------------------------------------------- wheezes, fine inspiratory crackles, peripheral ----------------------------------------------------------------
diarrhea/laxatives cause hypokalemia due to K+ loss eosinophilia: eosinophilic pneumonia electrolyte imbalances causing prolonged QT:
in stool & aldosterone from volume depletion ---------------------------------------------------------------- hypoCa++, hypoK+, hypoMg++
---------------------------------------------------------------- iatrogenic esophageal rupture (recent endoscopy) ----------------------------------------------------------------
Aldosterone Saves Sodium & Pushes #1 Dx: CXR may show left-sided pleural effusion, greatest risk factor for cerebral palsy: prematurity
Potassium pneumomediastinum, & pneumoTx o comorbidities: intellectual disability,
---------------------------------------------------------------- confirm Dx: water-soluble contrast esophagram epilepsy, strabismus, scoliosis
renal artery stenosis 20 hyperaldosteronism due Rx: surgical closure of esophagus & drainage of ----------------------------------------------------------------
to low kidney perfusion mediastinum within 6 hrs GAD: 3 symptoms, at least 6 months
o hypokalemia, metabolic alkalosis, HTN complications: mediastinitis o impaired sleep, poor concentration, irritability,
---------------------------------------------------------------- ---------------------------------------------------------------- easy fatigue, muscle tension, restlessness
GERD can be the primary trigger of asthma bullous pemphigoid: autoimmune blistering, #1 Rx: CBT & SSRI/SNRI
all patients with asthma-like symptoms should be triggered by medications (furosemide, NSAIDs, #2 Rx: benzos, buspirone
inquired about reflux symptoms captopril); MC in elderly o benzos: adjunct for acute anxiety
Dx & Rx: oral PPI pruritus, tense bullae & urticarial plaques with an o buspirone: monotherapy or with SSRIs
---------------------------------------------------------------- erythematous or urticarial base ----------------------------------------------------------------
most effective non-pharmacologic measure to IgG & C3 linear deposits @ dermal-epidermal Jx systemic vasculitis, upper & lower airway
decrease BP: weight loss ---------------------------------------------------------------- granulomatous inflammation, glomerulonephritis:
also DASH diet, low Na+, moderate alcohol pemphigus: autoantibodies against desmogleins Wegeners (granulomatosis with polyangiitis)
---------------------------------------------------------------- superficial, flaccid blisters; +Nikolsky sign epistaxis, chronic purulent rhinorrhea, otitis,
supracondylar humerus fx: outstretched hand fall MC on skin & oral mucous membranes sinusitis, saddle nose deformity
MC complication: entrapment of brachial artery IgG deposits between epidermal cells painful subcutaneous nodules, palpable purpura,
or median nerve antibodies against desmoglein ulcerative lesions
---------------------------------------------------------------- Rx: prednisone, MTX; azathioprine labs: +c-ANCA, CRP
proximal humerus fx: axillary nerve injury ---------------------------------------------------------------- U/A: RBC casts, proteinuria, sterile pyuria
---------------------------------------------------------------- selegiline: MAO-B inhibitor Rx: cyclophosphamide & corticosteroids
fibrates decrease triglycerides & increase HDL if taken with SSRI or TCA serotonin syndrome ----------------------------------------------------------------
no improvement in CV outcome or mortality agitation, confusion, tachycardia, muscle rigidity Osteoporosis risk factors
---------------------------------------------------------------- ---------------------------------------------------------------- excess alcohol causes a dose-dependent risk
surreptitious vomiting causes hypokalemic, FRC prevents post-op atelectasis modifiable: low estrogen, malnutrition, low Ca++,
hypochloremic metabolic alkalosis atelectasis is a common complication 24 hr post-op; low Vit D, glucocorticoid or anticonvulsant use,
o hypokalemia due to aldosterone caused reduces vital capacity & FRC immobility, smoking, excess alcohol, low BMI
by volume depletion moving from supine to sitting increases FRC non-modifiable: advanced age, small body size,
---------------------------------------------------------------- o also chest physiotherapy, incentive spirometry, female, late menarche or early menopause,
newborns of mothers with active HBV should be coughing, repositioning, & ambulation Caucasians & Asians, family Hx
passively immunized: HBV Ig & HBV vaccination opioid analgesics suppress respiratory drive ----------------------------------------------------------------
o HBV Ig provides temporary protection ----------------------------------------------------------------
----------------------------------------------------------------
child with chronic back pain, neurologic dysFx mild Rx: topical retinoid + benzoyl smoking
(urinary incontinence), & palpable step-offs in peroxide locatio upper 1/3 wall of upper 1/3 wall of
lumbosacral area: spondylolisthesis moderate Rx: add topical ABX n posterior vagina anterior vaginal
forward slippage of vertebrae (L5 over S1) (erythromycin, clindamycin) features malodorous vaginal discharge,
DDx: lumbosacral strain, herniated disk, severe Rx: add oral ABX postmenopausal or post-coital bleeding,
ankylosing spondylitis, epidural abscess, tumor nodular large (> 5 cm) nodules, may form irregular vaginal mass, plaque, or ulcer
---------------------------------------------------------------- (cystic) acne sinus tracts & scarring Dx lesion biopsy
daily alcohol intake ( 3 men, 2 women) can severe Rx: add oral ABX
raise BP, causing refractory HTN unresponsive: oral Isotretinoin risk factors for SCC are similar to cervical cancer:
---------------------------------------------------------------- (diminishes sebum excretion) smoking & HPV 16 or 18
exogenous testosterone use: gynecomastia, ----------------------------------------------------------------
erythrocytosis, hepatotoxicity, LDL, HDL benzoyl peroxide: Rx inflammatory features neutrophilic crypttis is seen in UC & Crohns
DDx: autologous blood transfusion & EPO do isotretinoin A/E: teratogenic, hyper-TG-emia bimodal age: 20s & 60s
not cause gynecomastia ---------------------------------------------------------------- ----------------------------------------------------------------
---------------------------------------------------------------- diabetic retinopathy: microaneurysms, fever, colicky abdo pain, chronic diarrhea with
diarrhea in HIV+ patients requires stool culture, exudates, hemorrhages, macular edema bloody stool, weight loss: UC
exam for ova & parasites, & test for C. difficile non-proliferative: cotton-wool spots crypt abscesses
for Dx prior to ABX proliferative: neovascularization ----------------------------------------------------------------
---------------------------------------------------------------- Rx: laser photocoagulation dyspnea, orthopnea, LE edema, B/L crackles,
follicular conjunctivitis, corneal neovascularization ---------------------------------------------------------------- displaced apical impulse: decompensated CHF
with concurrent nasopharynx infection & discharge sudden, unilateral visual impairment noted upon due to LV systolic dysfunction
trachoma: major cause of blindness worldwide waking, disc swelling, venous dilation & hyponatremia parallels disease severity &
Chlamydia trachomatis serotypes A C tortuosity, retinal hemorrhages, cotton-wool spots: independent predictor of adverse clinical outcomes
Dx: Giemsa stain of conjunctival scrapings central retinal vein occlusion 2/2 renin, NE, & ADH free water retention &
Rx: topical tetracycline or oral azithromycin ---------------------------------------------------------------- dilutional hyponatremia
complication: corneal scarring smoking increases risk of macular degeneration Rx: fluid restriction, furosemide, & ACE-I
---------------------------------------------------------------- primary risk factor: age o furosemide enhances K+ excretion
eye pain, photophobia, decreased vision, grid test: straight lines appear wavy ----------------------------------------------------------------
dendritic ulcer: herpes simplex keratitis atrophic form: multiple sores in macular region anaphylaxis usually have prior exposure to the
abrupt fever, proptosis, swollen eyelids, exudative form: new blood vessels may leak, offending substance from preformed IgE to
restricted EOM movements: orbital cellulitis bleed, & scar the retina cause Type I hypersensitivity
---------------------------------------------------------------- ---------------------------------------------------------------- Rx: IM epinephrine
female athletes have GnRH & LH, resulting in myasthenia gravis: normal reflexes, sensory, & o alpha-1 increases vasoconstriction
estrogen deficiency coordination o beta-2 relax bronchial smooth muscles &
o secondary amenorrhea, infertility, symptoms seen on exertion, resolves with rest decrease vascular permeability
osteopenia, vaginal & breast atrophy nasal speech, difficulty chewing or swallowing ----------------------------------------------------------------
---------------------------------------------------------------- ---------------------------------------------------------------- reversible cholinesterase inhibitors (donepezil,
Treatment of acne vulgaris vegans are at risk for low Vit D & bone loss rivastigmine, galantamine) slows cognitive decline
comedonal closed/open comedones on face; ---------------------------------------------------------------- a/w Alzheimers
acne minimal inflammation Vaginal cancer ----------------------------------------------------------------
Rx: topical retinoid; or add Squamous cell Clear cell Thyroid nodule evaluation
salicylic, azelaic, or glycolic acid adenocarcinoma initial evaluation: TSH & USS
inflammatory inflamed papules (< 5 mm), onset age > 60 age < 20 cancer risk factors: family Hx, childhood radiation
acne pustules, erythema risk HPV 16 or 18, in utero exposure exposure, cervical lymphadenopathy
factors cervical dysplasia Hx, to DES
suspicious USS findings: hypoechoic, diverticula: high intraluminal pressure causes Rx: azithromycin or doxycycline
microcalcifications, internal vascularity mucosa & muscularis mucosa to herniate DDx: gonococcal urethritis (G-negative cocci),
abnormal USS & +risk factors require FNA do not include all bowel layers: false diverticula acute bacterial cystitis
normal USS, no risk factors, nrml/ TSH FNA MC risk factor: chronic constipation ----------------------------------------------------------------
low TSH iodine-123 scintigraphy MC site: sigmoid; bleeds occur from right colon erythematous & edematous cutaneous plaque with
o uptake = hyperfunctional hot nodule = low ---------------------------------------------------------------- peau d orange overlying breast mass with
cancer risk Rx for hyperthyroidism discrete skin nodule containing normal epidermis, spontaneous discharge & axillary lymphadenopathy:
o uptake = hypofunctional cold nodule = produces keratin: epidermal inclusion cyst inflammatory breast carcinoma
high cancer risk FNA dome-shaped, firm, freely mobile with a central Dx: biopsy for histology
---------------------------------------------------------------- punctum ----------------------------------------------------------------
AV block in patients with infective endocarditis Rx: resolves spontaneously, but can recur child with macrocytic anemia, low reticulocyte count,
is suspicious for perivalvular abscess extending Rx: excision for cosmetic reasons & congenital abnormalities: Diamond-Blackfan
into adjacent cardiac conduction tissues ---------------------------------------------------------------- syndrome (congenital hypoplastic anemia)
aortic valve endocarditis & IVDA is a/w risk of benign, painless subcutaneous mass with o intrinsic defect of erythroid progenitor cells
periannular extension of endocarditis overlying epidermis; soft/rubbery & irregular: result in increased apoptosis
---------------------------------------------------------------- lipoma macrocytic: no hypersegmentation of nucleus
mitral valve perforation is a complication of ---------------------------------------------------------------- congenital abnormalities: short stature, webbed
mitral endocarditis episodes of apnea precipitated by emotional trigger neck, cleft lip, shield chest, triphalangeal thumb
presents as acute CHF & mitral regurgitation in age 6 months 2 yrs: breath-holding spell Rx: corticosteroids
---------------------------------------------------------------- cyanotic-type: crying followed by breath-holding ----------------------------------------------------------------
insoluble renal crystal deposition resulting in in forced expiration, apnea, limpness, LOC caf-au-lait spots, microcephaly, microphthalmia,
acute renal failure: hyperuricemia, indinavir, o brief episodes with rapid return to baseline short stature, horseshoe kidney, absent thumbs,
acyclovir, sulfonamides pallid-type: triggered by minor trauma followed progressive pancytopenia & macrocytosis in a
---------------------------------------------------------------- by LOC, breath-holding, pallor, diaphoresis child: Fanconis anemia
SPIKES for delivering bad news o brief episode, then confusion & sleepiness ----------------------------------------------------------------
Set up situation: privacy, include participants a/w iron deficiency anemia cancer-related anorexia/cachexia syndrome:
Perception: open-ended questions to assess Dx: CBC, serum ferritin hypercatabolic state a/w accelerated loss of skeletal
patient perception of the situation Rx: reassurance; no long-term sequelae & adipose tissue
Invitation: ask how much info is wanted Rx: progesterone analogs (megestrol acetate,
----------------------------------------------------------------
Knowledge: give bad news in simple, HBV Treatments medroxyprogestone acetate)
straightforward language interferon-alpha: short-term Rx; young patients o appetite, weight gain, & well-being
Empathy: use empathetic statements with compensated liver disease o alt Rx: mirtazapine (TCA)
Strategy: summarize & make a plan lamivudine: increasing drug resistance ----------------------------------------------------------------
---------------------------------------------------------------- entecavir: use in decompensated cirrhosis; lower seizures, mental retardation, port wine stain or
secondary malignancy is common in patients with rate of drug resistance nevus inflammeus along trigeminal nerve:
Hx of Hodgkins treated with chemotherapy & tenofovir: most potent, limited drug resistance Sturge-Weber
radiation within 20 yrs hemianopia, hemiparesis, hemisensory loss,
----------------------------------------------------------------
MC secondary solid tumor: lung pegylated interferon & ribavirin: Rx HCV ipsilateral glaucoma
o cough, hemoptysis, chest pain, dyspnea skull XR: tramline intracranial calcifications
add teleprevir for chronic Hep C
also risk of subsequent acute leukemia & non-HL DDx: tuberous sclerosis (adenoma sebaceum)
----------------------------------------------------------------
---------------------------------------------------------------- male with dysuria, pyuria, urinary frequency & ----------------------------------------------------------------
aspergilloma: a/w pre-existing lung cavity 2/2 Indications for urgent dialysis (AEIOU)
urgency, mucopurulent urethral discharge:
TB, sarcoidosis, bronchial cysts, & neoplasms chlamydial urethritis Acidosis metabolic acidosis (pH < 7.1)
mobile, intra-cavitary mass with air crescent negative Gram stain & culture: C. trachomatis Electrolytes symptomatic hyper-K+,
---------------------------------------------------------------- Dx: nucleic acid testing of first-catch urine severe hyper-K+ (> 6.5)
Ingestion methanol, ethylene glycol, flattens the top & bottom of a flow-volume curve hyperplasia of squamous epithelium
salicylate, lithium,, carbamazepine Rx: epinephrine, systemic corticosteroids, reactive precancerous lesion for SCC
Overload volume overload refractory to diuretics antihistamines resolves with cessation of tobacco
Uremia symptomatic encephalopathy, ---------------------------------------------------------------- development of induration or ulceration Bx
bleeding, pericarditis asthma causes airflow during effort-independent ----------------------------------------------------------------
---------------------------------------------------------------- phase of exhalation, causing the flow-volume loop white plaques on oral mucosa, oropharynx, or
functional hypothalamic amenorrhea: to have a scooped out exhalation pattern, smaller, tongue with underlying erythema; can scrape off:
suppression of hypothalamic-pituitary-ovarian axis & shifted to the left (obstructive pattern) oral candidiasis
without a anatomic or metabolic cause flow-volume look remains normal in panic attacks localized, shallow, painful oral ulcers on gray base:
GnRH, LH/FSH, estrogen pneumoTx & pulmonary edema causes reduced aphthous stomatitis
causes: excess physical training, anorexia nervosa, lung compliance; increased expiratory flow rates, multiple vesicular lesions with erythematous border
marijuana use, starvation, stress, depression, smaller, shifted to the right (restrictive pattern) within oral cavity & perioral area: gingivostomatitis
chronic illness (HSV-1)
risk of bone mineral density due to estrogen persistent, nodular, erosive/ulcerative lesion with
progestin challenge: no withdrawal bleeding surrounding erythema or induration: SCC
---------------------------------------------------------------- ----------------------------------------------------------------
Risk factors for cholelithiasis fever, painful enlargement of testes, & irritative
40, Fat, Fertile, Females voiding symptoms (urinary frequency & urgency):
rapid weight loss, bariatric surgery acute epididymitis
HRT, OCPs, pregos as STD: a/w urethritis, pain, urethral discharge
---------------------------------------------------------------- o MCC: chlamydia & gonococcus
monomorphous pink papules on face, arms, trunk, as non-STD: elderly, a/w UTI
in absence of comedones 2/2 prednisone use for o MCC: E. coli
SLE: steroid-induced folliculitis ----------------------------------------------------------------
DDx: adolescent acne, androgen abuse, PCOS, SLE bright red, firm, friable, exophytic nodules in HIV:
---------------------------------------------------------------- bacillary angiomatosis (Bartonella)
wound site with abundant cloudy-gray discharge Rx: oral erythromycin
& dusky, friable subcutaneous tissue, decreased ---------------------------------------------------------------- ----------------------------------------------------------------
sensation at wound edges: necrotizing SSI microangiopathic hemolytic anemia (DIC, HUS, weakness, fatigue, muscle cramps: hypokalemia
fever, hypotension, tachycardia TTP) & artificial mechanical valves schistocytes: EKG: broad, flat T-waves, U-waves, ST depression,
dishwasher drainage, crepitus serum haptoglobin, LDH, indirect bilirubin, &
& PVCs
MC in diabetics, MCC is polymicrobial urinary urobilinogen MCC: HCTZ, diarrhea, anorexia, hyperaldosteronism
Rx: early surgical exploration, IV ABX urine urine
----------------------------------------------------------------
---------------------------------------------------------------- bilirubin urobilinogen
most accurate estimate of gestational age:
invasive ductal carcinoma: determine Px & Rx normal none low
crown-rump length via 1st trimester USS
by overexpression of HER2 oncogene via FISH hemolytic negative increased
pregnancy dating by LMP assumes a normal
or immunohistochemical staining disease
28-day cycle with fertilization on day 14
HER2/neu overexpression = worse prognosis hepatic + or - increased
----------------------------------------------------------------
disease
+HER2 Rx: trastuzumab & anthracycline karyotyping of fetal tissue is not indicated after
biliary positive low
o trastuzumab + chemotherapy can lead to one spontaneous abortion, but after recurrent
obstruction
cardiotoxicity pregnancy loss, or loss in 2nd trimester
----------------------------------------------------------------
obtain baseline echocardiogram ----------------------------------------------------------------
white granular patch/plaque over the buccal mucosa
---------------------------------------------------------------- abdominal pain after traumatic injury with
that cannot be scraped off, Hx of alcohol & tobacco:
fixed upper-airway obstruction (laryngeal edema vertebral fracture & retroperitoneal hemorrhage:
oral leukoplakia
2/2 food allergy) inspiratory & expiratory airflow paralytic ileus
also 2/2 abdominal surgery redistribution of coronary blood flow from Strep pharyngitis
XR: air-fluid levels & distended gas-filled loops diseased segments to non-diseased segments ----------------------------------------------------------------
in small & large intestines = coronary steal subdural hematoma is MC in elderly &
Rx: bowel rest, supportive care ---------------------------------------------------------------- alcoholics due to tearing of bridging veins 2/2
DDx: mesenteric ischemia, SBO secondary bacterial pneumonia: prodrome brain atrophy
---------------------------------------------------------------- viral URI, high fever, blood-streaked sputum ruptured aneurysm results in subarachnoid
Evaluation of chest pain MCC: S. aureus hemorrhage
assess pre-test probability of CAD CXR: B/L mid-field infiltrates, thin-walled abscess headache, confusion, somnolence, focal neural
low risk: men < 40, women < 50, atypical chest cavities suggesting necrotizing bronchopneumonia deficits within hours of trauma: epidural hematoma
pain & no cardiac risk factors no Dx testing with secondary pneumatoceles ----------------------------------------------------------------
intermediate risk: able to exercise? ---------------------------------------------------------------- tumor of arachnoid granulation = meningioma
o yes & normal EKG exercise EKG test high PaCO2 & low PaO2 is a/w hypoventilation ----------------------------------------------------------------
o yes & abnormal EKG exercise imaging test MCC: COPD, OSA, obesity, scoliosis episodic numbness, weakness, spastic paraparesis,
o no pharmacologic stress imaging test hypoventilation & reduced inspired O2 is a/w paresthesia, gait abnormalities, vision loss: MS
any positive result coronary angiography normal A-a gradient ----------------------------------------------------------------
high risk: coronary angiography evaluation & ---------------------------------------------------------------- middle ear effusion without signs of acute infection,
pharmacologic Rx for CAD PE, atelectasis, pleural effusion, PCP, pulmonary + conductive hearing loss: serous otitis media
---------------------------------------------------------------- edema cause V/Q mismatch & A-a gradient due to auditory tube dysfunction 2/2 HIV
fever, fatigue, pharyngitis, exudative tonsillitis, A-a gradient: any process that results in lymphadenopathy or obstructing lymphomas
& polymorphous rash after taking amoxicillin: impaired gas exchange hypoxia dull tympanic membrane & hypomobile
infectious mono ---------------------------------------------------------------- ----------------------------------------------------------------
posterior cervical lymphadenopathy Meningococcal vaccination boy with gout, hypotonia & persistent vomiting:
Rx: supportive management for several weeks primary all adolescents age 11 12; Lesch-Nyhan
---------------------------------------------------------------- vaccine optional at age 19 21 for high risk deficiency of HPRT for purine metabolism
Common oropharyngeal lesions in children & 1st year college students uric acid accumulates in peripheral tissue
aphthous recurrent ulcers on anterior oral booster age 16 21 (if primary vaccine given MC @ age 6 months
stomatitis mucosa vaccine before age 16) mental retardation, choreoathetosis, spasticity,
(canker sore) no fever or systemic symptoms age > 21 considered if @ high risk dystonia, self-mutilation, gouty arthritis & tophi
herpangina vesicles & ulcers on posterior ---------------------------------------------------------------- Rx: allopurinol
oropharynx & hard palate, Live-attenuated vaccines ----------------------------------------------------------------
MCC: fever, pharyngitis oral polio intranasal knee pain, adolescent male athlete: Osgood-Schlatter
Coxackie A Rx: supportive; self-limited in 1 wk MMR influenza traction apophysitis @ tibial tubercle\
gingivostomatitis vesicles & ulcers on anterior oral rotavirus yellow fever absence of knee swelling
mucosa & perioral area, fever, varicella pain reproduced by knee extension with resistance
MCC: HSV-1 pharyngitis, erythematous gingiva avoid in patients on TNF antagonists ----------------------------------------------------------------
Rx: oral acyclovir ---------------------------------------------------------------- anterior knee pain that worsens with descending
Group A Strep tonsillar exudates, fever, MCC of macrocytic anemia in sickle cell disease steps or hills; MC overuse injury in runners:
pharyngitis anterior cervical lymphadenopathy is folate deficiency patellofemoral stress syndrome
infectious mono tonsillar exudates, sickle cell disease is a chronic hemolytic anemia ----------------------------------------------------------------
posterior cervical adenopathy with an appropriate reticulocyte response MC predisposing factor for aortic dissection: HTN
+/- hepatosplenomegaly RBC turnover & consumption of folate in bone ----------------------------------------------------------------
---------------------------------------------------------------- marrow folate deficiency intermittent vision loss with changes in head
dipyridamole (& adenosine) is a coronary ---------------------------------------------------------------- position: papilledema
vasodilator used in myocardial perfusion scanning fever, pharyngitis, tonsillar exudates, absent cough, ----------------------------------------------------------------
to reveal areas of restricted perfusion & tender, anterior cervical lymphadenopathy:
most significant factor in suicide risk assessment: ---------------------------------------------------------------- Rx: prenatal counseling for subsequent pregnancy
previous attempts & clear plan Acute HIV infection ----------------------------------------------------------------
presents 2 4 wks after exposure Pertussis in infants & children
Assessment of suicidality mononucleosis-like syndrome (fever, night sweats, Catarrhal phase mild cough, rhinitis
SAD PERSONS diarrhea, weight loss, lymphadenopathy, arthralgia) (1 2 wks)
Sex, Age, Depression, generalized macular rash Paroxysmal phase coughing paroxysms with
Previous attempt, EtOH use, Rational thought painful mucocutaneous ulcerations (2 6 wks) inspiratory whoop,
loss (psychosis), Social support (lack of), GI: diarrhea, abdominal distension, flatulence posttussive emesis,
Organized plan, No spouse or significant other, Dx: low threshold for HIV testing; viral load; apnea & cyanosis (infants)
Sickness/injury negative HIV Ab, normal CD4 Convalescent symptom resolution
---------------------------------------------------------------- Rx: combination anti-retrovirals phase
colicky abdominal pain & distension, N/V, DDx: IBD, connective tissue disease, lymphoma, (wks months)
obstipation, diffuse tenderness: SBO Whipples, hyperthyroidism, Celiacs
mild leukocytosis & modest amylase ---------------------------------------------------------------- total duration if untreated: 3 months
XR: multiple air-fluid levels Rx chronic stable angina lymphocyte predominant leukocytosis
Rx #1: bowel rest, NG tube decompression, pain antianginals -blocker (#1; improves survival) Dx: Pertussis PCR or culture of nasopharyngeal
control, fluids CCB (peripheral & coronary vasodilation) secretions
fever, tachycardia, leukocytosis, metabolic acidosis nitrates (long-acting) Rx on clinical suspicion: empiric macrolides
risk of strangulation prevention ASA, statin (azithromycin, erythromycin, clarithromycin)
o Rx: surgical exploration smoking cessation, exercise, weight loss, o respiratory isolation at home for 1st 5 days
---------------------------------------------------------------- BP & diabetes control prevention: acellular pertussis vaccine
Indications for prophylactic anti-D immune globulin o 5 doses of DTaP between age 2 months 6 yrs
for unsensitized Rh-negative prego avoid -blockers if hypotensive or bradycardic o Tdap booster once at age 11 18 & pregos
no antepartum prophylaxis if father is Rh-negative ---------------------------------------------------------------- o does not provide lifelong immunity
@ 28 32 wk gestation reddish nodule that later ulcerates @ site of injury, complications: pneumonia, weight loss,
within 72 hr of delivery of Rh+ infant; spreads along lymphatics forming subcutaneous pneumoTx, subconjunctival hemorrhages,
spontaneous, threatened, or induced abortion nodules & ulcers: sporotrichosis respiratory failure, death (infants)
ectopic pregnancy ----------------------------------------------------------------
hydatidiform molar pregnancy leprosy: chronic granulomatous disease that Pertussis Rx & post-exposure prophylaxis
CVS or amniocentesis affects peripheral nerves & skin; MC in Asians age < 1 azithromycin x5 days
abdominal trauma MCC: Mycobacterium leprae month
2nd or 3rd trimester bleeding early: insensate, hypopigmented plaque age 1 azithromycin x5 days, or
external cephalic version peripheral nerve damage & muscle atrophy with month clarithromycin x7 days, or
---------------------------------------------------------------- crippling deformities erythromycin x14 days
anti-D immune globulin binds D antigens on face, ears, wrists, buttocks, knees, eyebrows ABX prophylaxis for all close contacts
fetal RBCs in the mothers circulation to prevent Dx: skin biopsy (acid-fast bacilli) regardless of vaccination status
formation of anti-D alloimmunization ---------------------------------------------------------------- ----------------------------------------------------------------
if mother is sensitized (elevated antibody titers), child with unsteady wide-based gait & weakness Indications for renal & bladder USS
Rx: fetal monitoring for hemolytic disease of lower limbs, decreased vibratory & position age < 2 yrs with a first febrile UTI to evaluate
---------------------------------------------------------------- sense, absent B/L ankle jerks, high plantar arches: for anatomic abnormalities
intravascular hemolysis: RBC breakdown in Friedreich Ataxia any age child with recurrent febrile UTI
blood vessels; schistocytes AR inheritance, excess trinucleotide repeats UTI in a child of any age with family Hx of
o prosthetic valves, DIC, TTP, HUS, PNH a/w necrosis & degeneration of cardiac muscle renal or urologic disease, HTN, or poor growth
extravascular hemolysis: a/w spleen & RES fibers myocarditis, fibrosis, cardiomyopathy child does not respond to appropriate ABX
o autoimmune hemolytic anemia in CLL MCC of death: arrhythmia & CHF
persistent or worsening symptoms to assess for invasive clusters of spindle cells surrounded by o lymphadenopathy, hepatosplenomegaly
renal abscess palisaded basal cells: BCC ----------------------------------------------------------------
---------------------------------------------------------------- elevated or rolled border with central ulceration new-onset a-fib should have TSH & T4 screening
voiding cystourethrogram: newborns < 1 month, Rx low-risk & superficial: 5-FU or imiquimod for hyperthyroidism
children age < 2 yrs with recurrent UTI, or first UTI Rx low-risk lesions on trunk or extremities: ----------------------------------------------------------------
from organism other than E.coli electrodessication & curettage (ED&C) Rx uncomplicated diverticulosis: dietary fiber
---------------------------------------------------------------- Rx high-risk nodular BCC on face: Mohs surgery o resultant large, bulky stools colon width
Screening for average risk patients ---------------------------------------------------------------- Rx uncomplicated diverticulitis: bowel rest & ABX
Breast cancer 50 -75 mammogram (2 yrs) shallow, fibrin-coated ulcerations with underlying o fever, leukocytosis, peritoneal inflammation
Cervical cancer 21 65 Pap every 3 yrs mononuclear infiltrates: aphthous ulcer ----------------------------------------------------------------
Colon cancer 50 75 annual FOBT or Rx: topical corticosteroids Maternal estrogen effects on newborns
colonoscopy (10 yrs) ---------------------------------------------------------------- o breast hypertrophy (boys & girls)
HIV 15 65 HIV antibody 1x hoarding disorder Rx: CBT & SSRI o swollen labia
Hyperlipidemi men 35+ lipid panel every 5 yrs ---------------------------------------------------------------- o physiologic leukorrhea (non-purulent)
a DDx of T-wave inversion: MI, old pericarditis, o uterine withdrawal bleeding
HTN 18+ BP every 2 yrs myocarditis, myocardial contusion, digoxin toxicity Rx: routine care & observation
Osteoporosis female 65+ DEXA scan ---------------------------------------------------------------- ----------------------------------------------------------------
---------------------------------------------------------------- adult with palpable purpura, proteinuria, hematuria: uncomplicated pyelonephritis Rx: urine culture
chronic, intermittent, painful eyelid swelling that mixed cryoglobulinemia & empiric oral ABX against G-
regresses with hot compresses: chalazion also hepatosplenomegaly, peripheral neuropathy, o Rx: oral fluoroquinolone or TMP-SMX
nodular, rubbery lesion; no redness or discharge arthralgia, hypocomplementemia hypotensive patients require hospitalization &
chronic granulomatous obstruction of a MC a/w Hep C blood cultures, fluids, & empiric IV ABX
Meibomian gland Dx: circulating cryoglobulins abdominal & pelvic CT if symptoms persist
recurrent lesions histology to r/o malignancy DDx: Henoch-Schonlein (normal complement) despite 48 -72 hr of Rx, Hx of nephrolithiasis,
(Meibomian gland carcinoma) ---------------------------------------------------------------- gross hematuria, urinary obstruction or
DDx: BCC, hordeolum (stye) ranolazine: late Na+ channel blocker complicated pyelonephritis
---------------------------------------------------------------- Rx stable angina with recurrent symptoms, complicated pyelonephritis: progression to
acute infection of an eyelid gland: hordeolum already on -blocker, CCB, or nitrates renal abscess or papillary necrosis, sepsis with
Rx: anti-staphylococcal ABX o not for initial therapy multi-organ failure, shock, renal failure
---------------------------------------------------------------- ---------------------------------------------------------------- o MC with immunosuppression, diabetes,
retinoblastoma: MC intraocular tumor of children Klumpke palsy: excessive traction of C8 & T1 renal stones, anatomic abnormalities
inactivation of Rb suppressor gene during delivery; intact Moro & biceps reflexes o Rx: IV ceftriaxone, cefepime,
strabismus, decreased vision, ocular inflammation, Claw hand, Horners (ptosis, miosis) fluoroquinolones
glaucoma, orbital cellulitis Rx: gentle massage & PT to prevent contractures ----------------------------------------------------------------
Dx: USS or CT of a mass with calcifications ---------------------------------------------------------------- acute pyelonephritis in pregos: hospitalization
MCC of death: liver & brain mets D-xylose test of proximal small bowel absorption Rx: IV ceftriaxone +/- gentamicin, aztreonam
---------------------------------------------------------------- normal: D-xylose excretion in urine ----------------------------------------------------------------
MCC of bronchiolitis in age < 2 yrs: RSV abnormal: high fecal D-xylose excretion, diabetics with acute pyelonephritis are managed
fever, rhinorrhea, cough, mild respiratory distress minimal D-xylose in urine (MCC: Celiacs) with IV ABX for 48 72 hrs, then switched to oral
---------------------------------------------------------------- false+: bacterial overgrowth, urinary retention, fluoroquinolone or TMP-SMX; 10 14 days
solitary, non-healing ulcer in the keratinized delayed gastric emptying, renal dysfunction, ascites non-diabetics with mild/moderate pyelonephritis,
epithelium of the vermillion zone of lower lip & ---------------------------------------------------------------- Rx: oral ABX only
Hx of sun exposure, immunocompetent: SCC anemia of lymphoproliferative disorders is due gentamicin: Rx UTI with severe infection or risk
invasive cords of squamous cells & keratin pearls to bone marrow infiltration with cancerous cells for drug-resistant organisms
---------------------------------------------------------------- ----------------------------------------------------------------
post-operative fever, leukocytosis, parotitis: symmetrical distal sensorimotor polyneuropathy octreotide: Rx active variceal bleeding by
acute bacterial parotitis is MC type of diabetic neuropathy causing splanchnic vasoconstriction & reduced
MCC: S. aureus stocking glove sensory loss portal blood flow by inhibiting glucagon release
MC in elderly & post-op dehydration neuropathic pain is present at rest, worse at night ----------------------------------------------------------------
purulent saliva from parotid duct Rx: TCAs (amitriptyline), gabapentin, NSAIDs molar pregnancy: abnormal trophoblastic
prevention: adequate hydration & oral hygiene o TCAs may worsen urinary symptoms & proliferation following abnormal fertilization
---------------------------------------------------------------- orthostatic hypotension; Rx: gabapentin o Rx: D&C
young woman with a breast lump: return after o NSAIDs: C/I in renal dysfunction o F/U: serial -hCG post-evacuation
menstrual period, if no signs of malignancy ---------------------------------------------------------------- o complication: gestational trophoblastic neoplasia
---------------------------------------------------------------- pronator drift assess UMN damage complete mole: 2 sperm + 1 empty ovum
left-sided weakness, +Babinski, Hx of HTN & o seen in some stroke patients o no fetal tissue (completely empty)
DM Type II: acute ischemic stroke Rombergs assess proprioception o symptomatic: theca lutein ovarian cysts,
Dx: head CT without contrast to r/o hemorrhage ---------------------------------------------------------------- -hCG, hyperemesis graviarum
Rx: fibrinolytics (IV alteplase (tPA)) any patient with an acute, severe illness can have partial mole: 2 sperm + 1 haploid ovum (triploid)
ASA should be held for 24 hrs abnormal thyroid function tests: euthyroid sick o abnormal placenta + fetal tissue
Rx with ASA is indicated if fibrinolytics are C/I syndrome (aka low T3 syndrome) ----------------------------------------------------------------
heparin would increase risk of IC hemorrhage total & free T3, normal T4 & TSH Manifestations of hyperthyroidism
---------------------------------------------------------------- thyroid function tests are not recommended in symptom o anxiety, insomnia
well-appearing infant that regurgitates milk, eczema, acutely ill patients; unreliable s o palpitations
painless bloody stools: milk protein allergy DDx: subclinical hypothyroidism ( TSH, o heat intolerance
infants age 2 8 wks normal T4) o perspiration
family Hx of allergies, eczema, or asthma ---------------------------------------------------------------- o weight loss
non-IgE-mediated rectal & colonic inflammation Non-allergic rhinitis Allergic rhinitis o goiter
Rx: eliminate dairy & soy protein from maternal nasal congestion, watery rhinorrhea, findings o HTN, tachycardia
diet if breastfed; hydrolyzed formula rhinorrhea, postnasal sneezing, eye itching o tremors of fingers/hands
o resolves within 2 wks of diet modification drainage (dry cough) early age of onset o hyprreflexia
o can resume/tolerate dairy & soy by age 1 yr late age onset (> 20) allergen or seasonal o proximal muscle weakness
---------------------------------------------------------------- no allergic triggers pale/blue nasal o lid lag
failure to thrive, irritability, Sandifer syndrome: perennial symptoms mucosa o a-fib
infantile GERD erythematous nasal a/w asthma, eczema chronic thyrotoxic myopathy: inability to comb
Sandifer syndrome: periodic opisthotonic posturing mucosa hair, difficulty holding arms up, muscle atrophy
Rx: thickened feeds, PPI, esophageal pH probe mild Rx: intranasal Rx: intranasal ----------------------------------------------------------------
monitoring, upper endoscopy antihistamine spray or glucocorticoids or Suspected hyperthyroidism
---------------------------------------------------------------- intranasal glucocorticoids antihistamines initial Dx test: plasma TSH
somatic & parasympathetic fibers of CN III have mod/severe Rx: combo if plasma TSH is low measure free T4
separate blood supplies ---------------------------------------------------------------- o elevated free T4 clinical hyperthyroidism
in diabetics, CN III neuropathy is ischemic; all cirrhotic patients require diagnostic endoscopy
24-hr RIU scan to differentiate Graves from
affect somatic fibers only to asses risk for variceal hemorrhage
toxic adenoma
o down & out gaze & ptosis only small, non-bleeding varices Rx: propranolol
next test: EKG to r/o arrhythmia
nerve compression affects BOTH somatic & as primary prophylaxis, results in unopposed
initial Rx: propranolol for symptomatic relief
parasympathetic fibers alpha-mediated vasoconstriction
endoscopic band ligation is an alternative Rx definitive Rx: radioactive iodine
o down & out gaze, ptosis, fixed & dilated complications if untreated: rapid bone loss 2/2
pupil, loss of accommodation endoscopic sclerotherapy is for active bleeding
direct osteoclastic bone resorption, & a-fib
---------------------------------------------------------------- ----------------------------------------------------------------
cobalamin deficiency can result in peripheral workup pelvic USS, thyroid function, rhythm control with digoxin: Rx patients unable
neuropathy or posterior column defects due to electrolytes, U/A, BUN, Cr, to achieve rate control, recurrent symptoms, or
defective myelin synthesis Rx dietary modification, hydration, ginger LV systolic dysfunction
folate supplementation can improve the anemia, Vit B6 +/- doxylamine all patients require CHA2DS2-VASc score to
but may precipitate or worsened neuro deficits ---------------------------------------------------------------- assess thromboembolic risk
folate & Vit B12 are cofactors in homocysteine to hypocapnia is a normal phenomenon of late ----------------------------------------------------------------
methionine conversion pregos due to direct stimulation by progesterone narrow-complex SVT with abrupt onset/offest:
---------------------------------------------------------------- on central respiratory center PSVT
autoimmune hemolysis: IgG autoantibodies respiratory drive & relative hyperventilation o includes AVRNT, AVRT, atrial tachycardia,
bind to RBC membrane & promotes removal in ---------------------------------------------------------------- & junctional tachycardia
the spleen reticuloendothelial system fever, cough, abdo pain, diarrhea, night sweats, Rx: IV adenosine or vagal maneuvers if
---------------------------------------------------------------- weight loss, splenomegaly & ALP, CD4 < 50: hemodynamically stable
OCD in a child after recent group A Strep disseminated Mycobacterium avium complex o temporarily slow AV node conduction to
infection: pediatric autoimmune Dx: blood cultures unmask hidden P waves with a-flutter or
neuropsychiatric disorders a/w streptococcal Rx: azithromycin or clarithromycin atrial tachycardia
infections (PANDAS) CD4 < 50 prophylaxis: azithromycin o terminates PSVT by interrupting AV nodal
OCD #1 Rx: CBT & high-dose SSRI DDx: TB, CMV reentry circuit
---------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------
acalculous cholecystitis: MC in critically ill Solitary pulmonary nodule B/L digital clubbing with sudden onset arthropathy
o extensive burns, severe trauma, prolonged TPN rounded opacity, < 3 cm, surrounded by & tenderness affecting wrist & hand joints, Hx of
or fasting, mechanical ventilation pulmonary parenchyma, no lymphadenopathy smoking: hypertrophic osteoarthropathy
presents similar to calculous cholecystitis step #1: determine if low, intermediate or high screening: CXR to r/o malignancy
due to cholestasis & GB ischemia, leading to probability for malignancy ----------------------------------------------------------------
secondary infection by enteric organisms o low risk no follow-up HIV+: HSV & VZV can cause severe, acute
no prior Hx of GB disease o intermediate risk FDG-PET scan retinal necrosis a/w pain, keratitis, uveitis
Dx: CT shows GB wall thickening & distension o high risk surgical resection o most cases due to reactivation
with pericholecystic fluid step #2: FDG-PET scan for nodules 0.8 cm & initially: keratitis & conjunctivitis with pain,
Rx: ABX & percutaneous cholecystostomy, then intermediate risk followed by rapid progressive visual loss
cholecystectomy once stable o suspicious for malignancy surgical resection fundoscopy: central retinal necrosis & pale
complications: sepsis & death if undetected o negative results serial CT scans peripheral lesions
---------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------
severe N/V during 1st trimesters, a/w ketonuria & Chronic HBV infection CMV retinitis: painless
metabolic alkalosis: hyperemesis gravidarum immune tolerance phase: high levels of HBV fundoscopy: fluffy or granular lesions around
volume depletion causes contraction metabolic replication, normal ALT; can last 10 30 yrs retinal vessels & associated hemorrhages
alkalosis & R-A-A system activation immune clearance phase causes immune-mediated o no keratitis or conjunctivitis
destruction of infected hepatocytes & fluctuating ----------------------------------------------------------------
Hyperemesis gravidarum ALT levels untreated complete heart block can lead to
risk HG in a prior pregnancy, inactive carrier state: measure 3 normal ALT ventricular arrhythmias or asystole
factors multifetal gestation, & 2 3 normal HBV DNA levels; 3 6 months symptomatic 3rd degree heart block Rx:
gestational trophoblastic disease (molar) ---------------------------------------------------------------- temporary pacemaker & ID reversible causes
features severe, persistent N/V in 1st trimester, a-fib with rapid ventricular response: rate control permanent pacemaker if no reversible causes
enlarged uterus than expected, should be attempted with -blocker or CCB ----------------------------------------------------------------
abnormally elevated -hCG, (diltiazem) Niemann-Pick Tay-Sachs
> 5% loss of pre-pregnancy weight, hemodynamically unstable: synch cardioversion Sphingomyelinase def. -hexosaminidase A def.
ketonuria, metabolic alkalosis AR inheritance; MC in Ashkenazi Jews
onset: age 2 6 months o severe Rx: Dimercaprol + Ca++ EDTA involuntary contraction of perineal musculature,
loss of motor loss of motor also for acute encephalopathy at least 6 months: vaginismus
milestones milestones ---------------------------------------------------------------- pain with intercourse or attempted penetration
hypotonia hypotonia easy fatigue, difficulty concentrating, insomnia, underlying cause is psychologic
feeding difficulties feeding difficulties muscle weakness, clumsiness, memory loss, Rx: relaxation, Kegels, dilators to desensitize
cherry red macula cherry red macula peripheral neuropathy: chronic lead exposure ----------------------------------------------------------------
hepatosplenomegal hyperreflexia o inquire about occupation Hx Varenicline: partial agonist at nicotinic ACh Rc,
y microcytic anemia, basophilic stippling more effective than bupropion
hypo-/areflexia ---------------------------------------------------------------- all meds are enhanced by nicotine replacement Rx
---------------------------------------------------------------- nasopharyngeal carcinoma presents with recurrent ----------------------------------------------------------------
constitutional growth delay: normal birth otitis media, epistaxis, & nasal obstruction sudden cardiac death 2/2 CVD is MCC of death
weight & height, but between age 6 mo 3 yrs, a/w EBV, smoking, nitrosamine consumption in dialysis & renal transplant patients
height velocity slows, then regains normal ---------------------------------------------------------------- ----------------------------------------------------------------
growth velocity at 5th 10th percentile V-fib & sustained V-tach are complications of MI nocturnal respiratory symptoms can occur as
delayed puberty & growth spurt, but Rx: early defibrillation before epinephrine or GERD can exacerbate asthma
eventually occurs, reaching normal adult height amiodarone GERD exacerbates airflow obstruction by
bone age is delayed in unwitnessed cardiac arrest or witnessed arrest vagal tone, bronchial reactivity, &
Rx: F/U in 6 months after puberty has occurred; occurring > 5 min before defibrillator arrival, a microaspiration of gastric contents
no supplement with testosterone or GH cycle of CPR should precede defibrillation initial Rx of GERD: lifestyle modification
---------------------------------------------------------------- ---------------------------------------------------------------- (elevation of bed head, diet, weight loss)
oropharyngeal dysphagia: difficulty initiating MCC of thyrotoxicosis with reduced RIU uptake Rx: PPI improves peak expiratory flow,
swallowing; a/w coughing, choking, nasal is subacute lymphocytic (painless) thyroiditis nocturnal respiratory symptoms, & GERD
regurgitation o leakage of thyroid hormone due to ----------------------------------------------------------------
esophageal dysphagia initially with solids, then inflammatory damage of thyroid follicles MCC of vulvovaginitis in pre-pubertal kids:
liquids is MC mechanical obstruction ---------------------------------------------------------------- vaginal foreign bodies; MC is toilet paper
o Hx of prior radiation, caustic injury, MCC of thyrotoxicosis with low RIU uptake o foul-smelling discharge, intermittent bleeding
complex stricture, or surgery for laryngeal subacute painless thyroiditis (painless) or spotting, urinary complaints
or esophageal cancer subacute granulomatous thyroiditis (de Quervain, Rx small foreign body: Ca++ alginate swab or
Dx: barium swallow, then upper endoscopy painful) irrigation with warm fluids after topical anesthetic
esophageal dysphagia for both solids & liquids is iodine-reduced thyroid toxicosis sedation or general anesthesia may be required
MC motility disorder levothyroxine overdose never perform bimanual exam in a child
Dx: barium swallow, confirm with manometry struma ovarii ----------------------------------------------------------------
---------------------------------------------------------------- ---------------------------------------------------------------- Serum sickness-like reaction
folate deficiency is MCC of megaloblastic anemia Aromatase deficiency etiology ABX (PCN, -lactams, TMP-SMX),
in chronic alcoholics by impairing enterohepatic in utero: no placental estrogen masculinization Type III hypersensitivity reaction
cycle & absorption of mother that resolves after delivery features fever, urticarial rash, polyarthralgia
---------------------------------------------------------------- gestational androgens results in virilized XX child, (1 2 wks after first exposure);
Approach to childhood lead poisoning normal internal genitalia, ambiguous externally; headache, edema, lymphadenopathy,
risk factors: home built before 1978, pica, delayed puberty, 10 amenorrhea, clitoromegaly, splenomegaly (less common)
sibling with lead poisoning, low socioeconomics, osteoporosis, polycystic ovaries labs hypocomplementemia, ESR & CRP
immigrant or international adoptee undetectable estrogens, high LH/FSH Rx avoid offending agent; resolves with 48 hrs,
no risk factors no further testing DDx: CAH (virilized female, normal internals), steroids for severe cases
+risk factors draw venous lead levels Kallman (delayed puberty, absent LH/FH)
o mild Rx: no meds, repeat level in < 1 month ---------------------------------------------------------------- DDx: untreated Strep pharyngitis, arthritis, fever,
o moderate Rx: DMSA, oral succimer erythema marginatum (acute rheumatic fever)
---------------------------------------------------------------- antiviral Rx for influenza: oseltamivir
dizziness, headache, pruritus after shower, & o must be started within 48 hrs for efficacy VIP binds intestinal epithelial cells to increase
splenomegaly: polycythemia vera confirm Dx: nasal swab for influenza antigens fluid & electrolyte secretion into intestinal lumen
high histamine release also cause peptic ulcers ---------------------------------------------------------------- maybe a/w MEN Type I
o hypercellular bone marrow fever, leukocytosis, LUQ pain: splenic abscess ----------------------------------------------------------------
o production of all three cell lines, esp. RBCs left pleuritic chest pain, left pleural effusion, steatorrhea, hepatomegaly, PUD: systemic
o risk of thrombosis & bleeding due to elevated splenomegaly mastocystosis
PLT count & impaired PLT function MCC: Staph, Strep, Salmonella o pruritus, facial flushing, urticaria
o low serum iron due to iron utilization MC risk factors: infective endocarditis with ----------------------------------------------------------------
primary polycythemia: low erythropoietin hematogenous spread striatal neuro-degeneration: Huntingtons
o polycythemia vera Rx: ABX + splenectomy spongiform encephalopathy: CJD
o primary familial & congenital polycythemia percutaneous drainage for poor surgical candidate loss of nigrostriatal DA neurons: Parkinsons
secondary: high/normal erythropoietin DDx: malaria, Hodgkins, infectious mono, TB selective loss of cholinergic neurons: Alzheimers
o hypoxemia, congenital, hepatic or renal tumors, ---------------------------------------------------------------- neurodegeneration of frontal/temporal lobes: Picks
post-renal transplant, testosterone supp/abuse anorexia, constipation, thirst, easy fatigue, ----------------------------------------------------------------
---------------------------------------------------------------- hypercalcemia, smoking Hx: SCC of lung rationalization: excusing an unacceptable
SCC of the mucosa of head & neck is common o sCa++mous cell carcinoma behavior/emotion in a false, but logically rational
with a Hx of alcohol & tobacco use PTHrP Ca++ resorption from bone & renal Ca+ way to avoid the true reason for a behavior, to
firm, non-tender, palpable solitary cervical node + resorption from distal tubule prevent anxiety & protect self-esteem
Dx: panendoscopy (laryngoscopy, bronchoscopy, CXR: hilar mass can result in a delay in care or difficult Rx course
esophagoscopy) to detect primary tumor DDx: small cell carcinoma (a/w ACTH or SIADH), ----------------------------------------------------------------
o F/U lymph node biopsy for histologic Dx adenocarcinoma (a/w hypertrophic osteoarthropathy) repression: blocking upsetting ideas/impulses
---------------------------------------------------------------- ---------------------------------------------------------------- from entering consciousness; blocking inner states
MCC of Vit B12 deficiency: pernicious anemia OTC cold meds containing acetaminophen & denial: blocking external sensory data
1. anti-intrinsic factor antibodies functional IF for phenylephrine can provoke warfarin-associated ----------------------------------------------------------------
Vit B12 absorption IC hemorrhage acute dyspnea, pleuritic chest pain, tachycardia,
2. chronic atrophic gastritis IF production by acetaminophen potentiates warfarin effects follwed by hypotension, syncope: acute massive PE
parietal cells & risk of gastric cancer phenylephrine elevates BP accompanied by RV dilation & hypokinesis 2/2
periodically monitor for gastric cancer Rx: prothrombin-complex concentrate (rapid & occlusion of the pulmonary artery, which RA, RV,
---------------------------------------------------------------- short-term warfarin reversal) & IV Vit K & pulmonary artery pressure
Vit B12 deficiency is common after total or partial (promotes clotting factor synthesis; 12 24 hr) can cause RBBB & right axis deviation
gastrectomy or chronic gastritis alt Rx: FFP if PCC not available; FFP takes longer septal deviation toward LV results in LV preload
o 2/2 loss of intrinsic factor to prepare/administer & more volume infusion & cardiac output
Vit B12 is a cofactor in purines & DNA synthesis ---------------------------------------------------------------- PCWP & SVR are not affected
ineffective erythropoiesis megaloblastic anemia VIPoma ----------------------------------------------------------------
total RBC count & reticulocyte count are low feature watery diarrhea, weight loss, lethargy, hypovolemic shock: RA, RV, pulmonary artery,
shiny tongue (glossitis) & pale palmar creases s facial flushing, N/V, muscle weakness & PCWP; SVR to maintain organ perfusion
---------------------------------------------------------------- labs hypokalemia ( intestinal K+ secretion), cardiogenic shock: PCWP & SVR, C.O.
ineffective erythropoiesis is a hallmark of both acholrhydria ( gastric acid secretion), o cardiac index, RA pressure
Vit B12 & folate deficiency hypercalcemia ( bone resorption), septic shock: peripheral vasodilation & SVR,
delayed nuclear maturation # of megaloblasts hyperglycemia ( glycogenolysis), RA, pulmonary artery, & PCWP, C.O.
ineffective erythropoiesis due to transition to secretory diarrhea: Na+, osmolal gap o mixed venous O2 saturation
mature RBC & death of immature precursors Dx watery diarrhea, VIP > 75 pg/mL ----------------------------------------------------------------
total RBC count & reticulocyte count are low abdominal CT (usually pancreatic tail) acute mitral regurgitation as a complication of
---------------------------------------------------------------- Rx IV fluids, octreotide to decrease diarrhea MI can result in cardiogenic shock
o flash pulmonary edema & crackles low/normal fibrinogen may indicate early signs of unvaccinated pregos with confirmed rubella
---------------------------------------------------------------- consumptive coagulopathy if a/w PLT count, exposure are offered termination of pregnancy
MCC of 20 HTN in children, to-&-fro bruit @ CVA: PT, PTT, or fibrin split products or Rx prego with IV Ig
fibromuscular dysplasia o fibrinogen is usually higher in pregos serology not needed if documentation of vaccine
angiogram: sting of beads if any coagulation derangements prompt delivery ----------------------------------------------------------------
---------------------------------------------------------------- if normal coagulation parameters Evaluation of nipple discharge
viral meningitis: self-limited inflammation of o watchful expectancy or labor induction unilateral likely malignant
leptomeninges cause by viral infection o expectant management complications: Dx: mammogram +/- USS, surgical evaluation
MCC: echovirus or coxsackie virus chorioamnionitis & DIC bilateral color of discharge??
MC in infants; incidence decreases with age ---------------------------------------------------------------- o bloody or serous mammogram
prodrome constitutional & URI symptoms; next Congenital hypothyroidism o milky, non-bloody
36 48 hrs high fever, headache, irritability, & etiology thyroid dysgenesis (MCC) palpable mass or skin changes??
nuchal rigidity features most are asymptomatic, yes mammogram
WBC (lymphocyte predominance), normal jaundice, lethargy, hoarse cry, dry skin, no likely physiologic discharge
glucose, mildly elevated protein poor feeding, constipation, large tongue physiologic galactorrhea
Rx: supportive; resolves in 7 10 days Dx TSH, free T4, via newborn screening o painless, B/L milky-brown-gray-green
DDx: bacterial (neutrophils, protein, glucose), Rx levothyroxine o MCC: hyperprolactinemia
TB meningitis (lymphocytes, protein, glucose) ---------------------------------------------------------------- Dx: pregnancy test, TSH & prolactin
---------------------------------------------------------------- maternal Graves: transplacental passage of o Dx: pituitary MRI if prolactin is elevated
hemolytic anemia, cytopenias, hypercoagulability: TSH receptor antibodies congenital Graves: ----------------------------------------------------------------
PND poor feeding, jitteriness, tachycardia, weight loss frequent exposure to ototoxic agents
Dx: RBC CD55 & CD59 testing ---------------------------------------------------------------- (aminoglycosides for P. aeruginosa) for CF Rx
---------------------------------------------------------------- synchronized cardioversion: Rx a-fib, a-flutter, can cause sensorineural deafness
oral corticosteroids: Rx acute asthma exacerbation stable monomorphic v-tach ----------------------------------------------------------------
---------------------------------------------------------------- temporary transvenous pacemaker: sick sinus back pain, constipation, anemia, renal dysfunction,
Management of GERD syndrome, 2nd or 3rd degree heart block ESR: MM
no cancer risk factors or alarm symptoms PPI ---------------------------------------------------------------- o hypercalcemia causes polyuria,
o if refractory, try another PPI or to 2x daily duodenal hematoma: MCC direct blunt abdominal constipation, confusion, or acute pancreatitis
male, age > 50, symptoms for > 5 yrs, or cancer risk trauma; MC in children ----------------------------------------------------------------
factors or alarm symptoms upper endoscopy Dx: CT with oral contrast acute onset polyarticular & symmetric arthritis
o if no evidence of esophagitis manometry #1 Rx: NG suction & parenteral nutrition; that resolves within 2 wks: viral arthritis 2/2
spontaneous resolution in 1 2 wks Parvovirus B19
GI alarm symptoms #2 Rx: surgical removal if conservative Rx fails o adults in frequent contact with children
hematemesis, persistent vomiting, anemia, ---------------------------------------------------------------- morning stiffness < 30 min, no joint swelling
melena, weight loss, dysphagia/odynophagia Vaccines for pregos o MCP, PIP, wrist, knees, ankles
---------------------------------------------------------------- all pregos Tdap & inactivated influenza transient aplastic anemia
intrauterine fetal demise: in utero fetal death special Hep A & B (high risk) Dx: anti-B19 IgM antibodies
after 20 wks gestation, before labor onset circumstances Pneumococcus (2nd & 3rd trimester Rx: resolves spontaneous in 2 3 wks, no Rx
o Dx: USS if high risk),
DDx: RA (arthritis > 6 wks), SLE, rheumatic fever
next: coagulation profile to detect incipient DIC H. influenza (if asplenic),
----------------------------------------------------------------
o retention of dead fetus can cause chronic Meningococcus (if high risk),
progressive dyspnea, tricuspid regurgitation,
consumptive coagulopathy due to gradual Anti-D Ig (if Rh-negative mother)
not HPV, MMR, Varicella, smallpox, peripheral edema: pulmonary HTN due to LV
release of thromboplastin from the placenta systolic dysfunction
recommended intranasal influenza
**avoid conception for 4 wks
mean pulmonary arterial pressure 25 mmHg @ secondar diffuse rash (+ palms/soles), hepatitis, DM Type II, HTN
rest (normal 20 mmHg) y condyloma lata, lymphadenopathy feature livedo reticularis, blue toe syndrome,
#1 initial Rx: furosemide & ACE-I Rx: IM PCN G 1x s acute kidney injury, amaurosis fugax,
---------------------------------------------------------------- PCN-allergic: oral doxycycline x 14 days Hollenhorst plaques, intestinal ischemia
Impetigo latent asymptomatic Dx Cr, eosinophilia, hypocomplementemia,
Non-bullous Bullous-type Rx: IM PCN G 3x doses eosinophiluria
MCC S. aureus or S. aureus PCN-allergic: doxycycline x 28 days confirm Dx: skin or renal Bx (biconcave,
Group A Strep tertiary Tabes dorsalis, Argyll-Robertson pupil, needle-shaped clefts within occluded vessel)
feature localized painful, rapidly enlarging dementia, aortic insufficiency, gummas ----------------------------------------------------------------
s non-itchy pustules flaccid bullae with Rx: IV PCN G x14 days patient undergoing coronary angiography are at
& honey-crusted yellow fluid, PCN-allergic: ceftriaxone x 14 days risk for contrast-induced nephropathy
lesions; collarette of scale @ pregos intrapartum transmission U/A: muddy-brown granular & epithelial casts
lymphadenopathy periphery of lesion Rx: PCN G Rx: benign, resolves in 3 5 days
Rx topical mupirocin oral ABX (cephalexin, PCN-allergic: desensitize to PCN ----------------------------------------------------------------
dicloxacillin, clinda) pseudocyesis is a form of conversion disorder
congenital syphilis: failure to thrive, meningitis, normal endometrial stipe, pregnancy test negative
predisposing factors: warm, humid climates, seizures, congenital defects Rx: psych evaluation
poverty, crowding, pre-existing skin trauma, ---------------------------------------------------------------- DDx: missed abortion (intrauterine collapsed
atopic dermatitis MCC of complicated influenza pneumonia: S. aureus gestational sac, +pregnancy test), ectopic
prevention: hand-washing MC in hospitalized, nursing homes, IVDA, CF (adnexal mass & empty uterus, +pregnancy test)
complications: post-strep GN, rheumatic fever Gram+ cocci in clusters ----------------------------------------------------------------
---------------------------------------------------------------- Rx: anti-staphylococcal ABX neoadjuvant therapy: given before standard Rx
melena, episodic gnawing, nocturnal abdominal ---------------------------------------------------------------- adjuvant therapy: given in addition to standard Rx
pain relieved by eating: duodenal ulcer TNM staging is most important prognostic factor induction therapy: initial dose of treatment to
unopposed acid enters duodenum causing pain in breast cancer rapidly kill tumor cells & induce remission
high a/w H. pylori infection ---------------------------------------------------------------- consolidation therapy: given after induction Rx
Rx H. pylori-associated PUD: triple therapy with depressed patients must be closely monitored for with multi-drug regimen to further reduce tumor
PPI + amoxicillin + clarithromycin suicidality within the first few weeks of initiating maintenance therapy: given after consolidation Rx
Rx PUD only: PPI or H2 blocker pharmacotherapy; more likely to act on impulses to kill residual tumor cells; keep patient in remission
DDx: gastric ulcer (pain worse with eating) as motivation & initiative improve before a salvage therapy: Rx for a disease when standard
---------------------------------------------------------------- depressed outlook Rx fails (radiation for PSA recurrence after
CHF 2/2 restrictive cardiomyopathy, bibasilar rales, ---------------------------------------------------------------- radical prostatectomy)
right-sided pleural effusion: hemochromatosis tachypnea, retractions, grunting, nasal flaring, & ----------------------------------------------------------------
LV volume is normal with symmetric thickening cyanosis @ birth: respiratory distress syndrome cirrhosis increases risk for HCC, but HCC does
Rx of hemochromatosis (phlebotomy) can MCC are immature lungs & surfactant deficiency not risk of cirrhosis
reverse the cardiac dysfunction risk factors: prematurity, maternal diabetes, Management of cirrhosis
DDx: amyloidosis, sarcoidosis, & scleroderma cesarean without labor periodic surveillance of LFTs, INR, albumin, etc
all cause non-reversible cardiac dysfunction maternal diabetes delays surfactant maturation compensated: asymptomatic or vague symptoms
---------------------------------------------------------------- due to fetal hyperinsulinemia, which antagonizes USS for HCC +/- AFP; every 6 months
Stages of syphilis cortisol, thus blocks sphingomyelin maturation decompensated: jaundice, pruritus, upper GI bleed;
primary painless chancre CXR: ground glass opacities, air bronchograms assess complications
Dx: spirochetes on darkfield microscopy ---------------------------------------------------------------- o varices: start non-selective -blockers,
Rx: IM benzathine PCN G 1x Cholesterol embolism (atheroembolism) repeat EGD annually**
PCN-allergic: oral doxycycline x14 days risk cardiac catheterization or angiography; o ascites: dietary Na+ restriction, diuretics,
factors with comorbid hypercholesterolemia, paracentesis, abstain from alcohol
o hepatic encephalopathy: lactulose, Rx fever, odynophagia, dysphagia, drooling, stiff neck, red, demarcated plaques that blanch
underlying cause muffled voice, inability to extend neck & widened grows rapidly in first 1 2 yrs of life, then
---------------------------------------------------------------- prevertebral space: retropharyngeal abscess spontaneously regress in childhood
childhood Hx of recurrent renal stones, +family Hx, MC in age 6 months 6 yrs Rx: propranolol if at risk for complications
+urinary cyanide nitroprusside screening test, & prodrome URI direct spread of infection ----------------------------------------------------------------
hexagonal crystals on U/A: cystinuria polymicrobial (Group A Strep, S. aureus, anaerobes) spider angiomas are estrogen dependent
defective transport of dibasic amino acids (Lys, Arg) Dx: CT with contrast MC in pregos, OCP use, cirrhosis (hyperestrogen)
poor solubility of cysteine leads to renal stones complications: airway compromise, bacteremia, dilated cutaneous arterioles with a central papule
---------------------------------------------------------------- carotid artery rupture, jugular venous thrombosis & radiating blanching capillaries
persistent abdo pain or dyspepsia post-op or years ---------------------------------------------------------------- ----------------------------------------------------------------
after cholecystectomy: post-cholecystectomy young adult with cirrhosis, neuropsych symptoms, recurrent sinopulmonary & GI bacterial infections
syndrome & Kayser-Fleischer rings: Wilsons (aka in adults may indicate humoral immunity defect
due to biliary or extra-biliary causes hepatolenticular degeneration) o a/w food allergies & autoimmune disease
elevated ALP, mildly abnormal ALT/AST, & AR inheritance Dx: quantitative serum Ig levels
dilated common bile duct on USS resting tremor, muscle rigidity, slurred speech, ----------------------------------------------------------------
MCC: common bile duct stones or sphincter dysFx depression, paranoia, catatonia NSAIDs can cause SIADH
Dx: endoscopic USS, then ERCP or MRCP impaired ceruloplasmin secretion, thus decreased o NSAIDs potentiate the action of ADH
---------------------------------------------------------------- secretion of copper in biliary system hypotonic hyponatremia with euvolemia
Management of Cushings Cu++ deposition in liver, basal banglia, cornea Dx: r/o hypothyroidism & adrenal insufficiency
#1 test: ACTH levels & urinary cortisol also a/w Fanconis, hemolytic anemia, neuropathy Dx: urine & plasma osmolality
low ACTH adrenal CT Dx: liver biopsy, low ceruloplasmin, slit lamp, low plasma osmolality with high urine osmolality
o MCC: exogenous glucocorticoids urinary Cu++ excretion serum uric acid is low due to urinary excretion
o exclude adrenal adenoma & hyperplasia #1 Rx: D-penicillamine or trientine & hemodilution
normal/high ACTH pituitary MRI o oral zinc prevents copper absorption ----------------------------------------------------------------
o mass > 6 mm dexamethasone supp test #2 Rx: liver transplant mineralocorticoid deficiency: hypotonic
no mass or < 6 mm inferior petrosal ---------------------------------------------------------------- hyponatremia with hypovolemia; elevated K+
sinus sampling (invasive) liver disease, hyperpigmentation, arthropathy, ----------------------------------------------------------------
MCC: ACTH-producing pituitary adenoma, diabetes, impotence, dilated cardiomyopathy: nephrotic syndrome & advanced renal failure:
ectopic ACTH, or ectopic CRH hemochromatosis hypotonic hyponatremia with hypervolemia
ectopic ACTH: rapid onset HTN, hypokalemia, ---------------------------------------------------------------- ----------------------------------------------------------------
proximal muscle weakness, metabolic alkalosis, productive cough, hemoptysis, recurrent fevers, incidence of carpal tunnel syndrome in pregos
hyperglycemia; less likely to have central obesity, recent travel: pulmonary TB 2/2 estrogen-mediated depolymerization of ground
moon facies chest CT: upper lobe cavitary lesions with substance, causing interstitial edema
---------------------------------------------------------------- surrounding alveolar infiltrates initial Rx: wrist splinting
Prevention of recurrent nephrolithiasis ---------------------------------------------------------------- #2 Rx: NSAIDS (risk of miscarriage), local
dietar fluids (produce > 2 L urine/day) MC benign cutaneous vascular tumor in adults: corticosteroid injection, surgical decompression
y reduce Na+, reduce protein, reduce oxalate, cherry angioma (aka senile hemangioma) ----------------------------------------------------------------
normal Ca++ intake, increase citrate age 3rd 4th decade, increases with age Urinary incontinence
Rx thiazides (passive Ca++ reabsorption), sharply circumscribed areas of congested capillaries Stress loss of urethral support, intraabdominal
potassium citrate (urine alkalization), pressure exceeds urethral sphincter
& post-capillary venules in papillary dermis
allopurinol (for uric acid stones) leaking with cough, sneeze, laugh, lifting
benign, no Rx required
reduced dietary Ca++ leads to oxalate Urge detrusor overactivity
----------------------------------------------------------------
absorption in the gut excreted into urine & MC benign vascular tumor in children: sudden, overwhelming, frequent need
binds urinary Ca++ Ca++ oxalate stones Overflow impaired detrusor contractility,
superficial infantile (strawberry) hemangioma
---------------------------------------------------------------- bladder outlet obstruction
constant involuntary dribbling & dermatomyositis is an idiopathic inflammatory academia alone does not lead to CNS depression,
incomplete emptying myopathy with immune-mediated muscle injury but the underlying cause results in lethargy &
that can be due to a paraneoplastic syndrome altered mental status
epidural anesthesia: block afferent & efferent from malignancy (lung cancer) CO2 retention due to underlying COPD can lead
nerves from the bladder; can cause overdistension Dx: muscle biopsy to CO2 narcosis (PaCO2 > 60 mmHg)
post-partum urinary retention: indwelling catheter ---------------------------------------------------------------- ----------------------------------------------------------------
for 24 hr to decompress the bladder Achilles tendon reflex can be decreased or DIC depletes clotting factors & 20 fibrinolysis
---------------------------------------------------------------- absent with age thrombocytopenia, prolonged PT & PTT,
ankylosing spondylitis & IBD (UC) are a/w lower extremity weakness, rectal tone, decreased fibrinogen, schistocytes
HLA-B27; may occur together bowel/bladder incontinence, & brisk LE DTRs: ----------------------------------------------------------------
both are +p-ANCA, despite absence of vasculitis possible spinal cord compression predominant unconjugated hyperbilirubinemia
---------------------------------------------------------------- ---------------------------------------------------------------- o bilirubin production (hemolysis)
infantile colic: crying 3 hr/day, 3 days/wk, ovulatory phase: cervical mucus is profuse, o bilirubin uptake (portosystemic shunt)
for 3 wks; typically evenings clear & thin, stretches 6 cm, exhibits ferning, o abnormal conjugation (Gilberts)
o resolves spontaneously by age 4 months & pH > 6.5 (more basic than usual) predominant conjugated hyperbilirubinemia
Rx: calming techniques, reassurance o ideal for spermatozoa entering uterus o hepatocellular injury
---------------------------------------------------------------- pre- & post-ovulatory: scant, opaque, & thick mucus o bilirubin excretion in bile canaliculi
misoprostol: synthetic prostaglandin, used with ---------------------------------------------------------------- (Dubin-Johnson)
mifepristone to terminate pregnancies 49 days Hx of pelvic surgery or irradiation can develop a o intrahepatic cholestasis (10 biliary cirrhosis)
---------------------------------------------------------------- urinary fistula o extrahepatic cholestasis (biliary obstruction)
cyanosis & respiratory distress immediately after Dx: intravenous pyelography normal transaminases & ALP suggest inherited
birth, scaphoid-abdomen: congenital ---------------------------------------------------------------- bilirubin metabolism disorders
diaphragmatic hernia young male with lower abdominal pain, tenesmus, elevated transaminases & normal ALP suggest
XR: displaced cardiac silhouette, gasless abdomen bloody diarrhea with acutely worsening fever, intrinsic liver disease (viral, hemochromatosis)
---------------------------------------------------------------- leukocytosis, hypotension, & tachycardia: elevated ALP suggest intrahepatic cholestasis or
acute gout Rx: NSAIDs (indomethacin), ulcerative colitis complicated by toxic megacolon biliary obstruction
colchicine, corticosteroids may be the first presentation of UC ----------------------------------------------------------------
prophylactic Rx: allopurinol Dx: abdominal XR with colonic distension > 6 cm painless jaundice, fatigue, weight loss, pruritus,
---------------------------------------------------------------- + 3 signs acholic stools with dark urine, ALP, GGT:
male pubertal gynecomastia resolves within a few o fever > 380C, HR > 120, leukocytosis, anemia malignant biliary obstruction
months 2 yrs without intervention; reassurance Rx: bowel rest, NG tube, steroids (if UC), ABX MCC: adenocarcinoma, cholangiocarcinoma
---------------------------------------------------------------- o sigmoidoscopy is used to confirm UC, but Dx: USS or CT; ERCP if non-diagnostic
antiphospholipid antibody syndrome promotes risk of perforation in toxic megacolon DDx: acute choledocholithiasis (acute RUQ pain),
arterial/venous thromboses & recurrent severe cases: subtotal colectomy & end-ileostomy chronic autoimmune hepatitis, chronic pancreatitis
spontaneous abortions ---------------------------------------------------------------- ----------------------------------------------------------------
o thrombocytopenia & prolonged PTT sulfasalazine: Rx Crohns, UC, RA elderly patient with hip fracture should undergo
prophylactic Rx: LMWH & low-dose ASA ---------------------------------------------------------------- definitive surgical correction
---------------------------------------------------------------- fever, malaise, productive cough, eosinophilia, surgery can be delayed up to 72 hrs to evaluate
leukopenia & thrombocytopenia in SLE is due to hemoptysis: allergic bronchopulmonary surgical risk & address unstable comorbidities
peripheral immune-mediated destruction aspergillosis (ABPA) ----------------------------------------------------------------
o pancytopenia is common with SLE hypersensitivity reaction to Aspergillus Ovarian & adnexal torsion
---------------------------------------------------------------- MC a/w asthma & CF risk factors ovarian mass 5 cm, reproductive age,
alcoholic hepatitis: AST:ALT > 2; < 300 IU/L ---------------------------------------------------------------- infertility Rx with ovulation induction
o also GGT & ferritin (acute phase reactant) features sudden onset unilateral pelvic pain,
---------------------------------------------------------------- tender adnexal mass, N/V,
vaginal bleeding is uncommon ---------------------------------------------------------------- absence of language delay distinguishes
Dx -hCG to exclude ectopic pregnancy, defective mineralization of organic bone matrix: Aspergers from autism
USS with color Doppler osteomalacia 2/2 Vit D deficiency ----------------------------------------------------------------
Rx laparoscopy with detorsion defective mineralization of growth plates in kids: sensorineural deafness, cataracts, purpura,
rickets hepatosplenomegaly: congenital rubella
rotation of ovary around infundibulopelvic ---------------------------------------------------------------- ----------------------------------------------------------------
(suspensory ligament) & utero-ovarian ligaments Rickets young female with fever, rash that started on face
adnexal torsion: includes fallopian tube risk skin pigmentation, that spreads to body that spares palms & soles,
MC right-side: longer ligament factors exclusive breastfeeding, joint pain, B/L conjunctival injection, cervical
DDx: appendicitis, ruptured ovarian cyst, inadequate sun exposure, lymphadenopathy: rubella
endometriosis, tubo-ovarian abscess maternal Vit D deficiency polyarthritis is MC in young females
---------------------------------------------------------------- feature craniotabes (ping-pong ball skull), Rx: supportive
gradual onset fever, chills, lower abdominal pain, s delayed fontanelle closure, frontal bossing, complication: post-infectious encephalitis
vaginal discharge: tubo-ovarian abscess costochondral hypertrophy (rachitic rosary) DDx: measles (high fever > 104), RMSF (starts on
risk factors: multiple partners, young age, Hx of PID genu varum wrist & ankles, involve palms/soles)
---------------------------------------------------------------- XR metaphyseal cupping & fraying, ----------------------------------------------------------------
ovarian hyperstimulation syndrome: ovarian epiphyseal widening, osteopenia liver transplant is the only effective Rx of
enlargement from multiple cysts with fluid shifts labs Ca++ & phosphorus, ALP & PTH fulminant hepatic failure (Hep B infection)
out of the intravascular space Rx Vit D fortified baby food or formula; or fulminant hepatic failure: hepatic encephalopathy
o results in ascites & hypovolemia supplementation that develops within 8 wks of acute liver failure
complication of gonadotrophin Rx for infertility ---------------------------------------------------------------- high mortality rate, high priority for transplant
---------------------------------------------------------------- Vit D deficiency causes marked hypophosphatemia, ----------------------------------------------------------------
major depressive disorder (MDD): persistent & ALP, normal Ca++, secondary hyperPTH interferon & lamivudine: Rx acute Hep B infection
pervasive sadness, self-critical ruminations, & XR: bone density with thin cortex, codfish ----------------------------------------------------------------
suicidality a/w feeling worthlessness & hopeless vertebral bodies, & pseudofractures (Looser zones) cross-sectional study = prevalence study
2 wks ---------------------------------------------------------------- simultaneous measure of exposure & outcome
can be diagnosed anytime during acute grief; large anterior fontanelle, lethargy, poor feeding, calculate odds ratio
bereavement period is not an exception macroglossia: congenital hypothyroidism ----------------------------------------------------------------
Rx: SSRI & psychotherapy frontal bossing, anterior shin bowing, saddle-nose, case-control study: selects patient with/without
---------------------------------------------------------------- notched/gap teeth: congenital syphilis outcome, & determine previous exposure status
electroconvulsive Rx: refractory to antidepressants bucket-handle fx = classic metaphyseal lesion: ----------------------------------------------------------------
o #1 Rx if not eating/drinking; acutely suicidal, child abuse iron stores must be evaluated prior to starting
catatonic, or psychotic ---------------------------------------------------------------- supplemental erythropoietin for CKD/ESRD
---------------------------------------------------------------- large tender, soft-tissue mass with localized pain o Rx: IV iron if on dialysis
first-time DVT with a reversible inciting incident MC primary malignant bone tumor in children, A/E: worsening HTN, headache, flu-like syndrome,
(surgery) MC @ metaphysis of long bones: osteosarcoma red cell aplasia
Rx: unfractionated or LMWH within 48 72 hrs o distal femur, proximal tibia & humerus ----------------------------------------------------------------
if hemodynamically stable XR: sunburst periosteal rxn, Codman triangle rapid testing for Strep pharyngitis for those with
o prevents extension of the clot & future clots ALP, LDH, ESR (inflammation) 2 Centor criteria: fever, tonsillar exudates,
rather than lysis of the present clot risk factors: Pagets, radiation & chemotherapy tender anterior cervical adenopathy, absent cough
o streptokinase & tPA: only Rx STEMI Rx: tumor excision, chemotherapy ----------------------------------------------------------------
---------------------------------------------------------------- ---------------------------------------------------------------- pagophagia: pica for ice; iron deficiency anemia
low bone mass with normal mineralization: deficits in reciprocal social communication, ----------------------------------------------------------------
osteoporosis limited play, poor eye contact, speech delay,
normal serum Ca++, phosphorus, PTH, & ALP repetitive behaviors: autism
influenza: sudden & dramatic onset with ---------------------------------------------------------------- first indicators of hypovolemia: pulse rate &
systemic symptoms out of proportion to mild Raynauds causes finger ischemia, progressing peripheral vascular constriction to maintain BP
nasal & respiratory symptoms from pallor cyanosis erythema ----------------------------------------------------------------
self-limited 3 10 days MC due to cold exposure or stress acute pain & swelling of mid-line sacrococcygeal
Rx: oseltamivir (neuraminidase inhibitor) for all ---------------------------------------------------------------- skin & subcutaneous tissue: pilonidal cyst
confirmed or suspected cases within 48 hrs & drug-induced immune hemolytic anemia is a MC in young males with body hair
those at high risk for complications rare complication of ibuprofen infection of hair follicles form an abscess that
Rx > 48 hrs: rest, analgesics, cough suppressants gastric ulcers, GI bleeding, epigastric pain ruptures, forming a pilonidal sinus tract
---------------------------------------------------------------- ---------------------------------------------------------------- Rx: drainage & excision of sinus tracts
post-exposure prophylaxis of animal bites from corneal abrasion: absence of eye pain suggests DDx: perianal abscess, perianal fistula
a healthy-appearing domesticated animal can be trigeminal nerve (V1) dysfunction, which ----------------------------------------------------------------
observed for 10 days, without PEP controls corneal sensation unexplained CHF with diastolic dysfunction,
o animals that become sick should be euthanized ---------------------------------------------------------------- ventricular wall thickness with normal LV size,
& brain tested for rabies start PEP peak airway pressure = airway resistance + proteinuria, easy bruising: cardiac amyloidosis
low-risk animal bite (squirrel, chipmunk): no PEP plateau pressure waxy skin, macroglossia, hepatomegaly, CTS
exposure to high-risk wild animal (raccoon, bat, plateau pressure = elastic pressure + PEEP AA amyloidosis 2/2 RA, Crohns, osteomyelitis,
skunk) PEP if animal is unavailable for testing PEEP is calculated with end-expiratory hold TB, lymphoma, vasculitis
o if available for testing, start PEP, then maneuver Dx: abdominal fat pad biopsy with amyloid deposits
discontinue if test is negative ---------------------------------------------------------------- ----------------------------------------------------------------
PEP: receive both active & passive immunization incidence of a disease is not changed by any Rx Causes of hyponatremia
rabies vaccine & human rabies Ig prevalence may be affected by Rx of disease hypovolemic volume depletion (acute blood loss),
o if previously vaccinated revaccination only ---------------------------------------------------------------- hyponatremia primary adrenal insufficiency,
---------------------------------------------------------------- hypercalcemia of immobilization: osteoclastic GI loss (diarrhea, vomiting, bleed),
symptomatic sinus bradycardia (fatigue, bone resorption; pre-existing high bone turnover renal loss (diuretics)
syncope, dizziness, hypotension, angina, CHF) median onset: 4 wks after immobilization euvolemic SIADH (drugs, malignancy),
#1 Rx: identify & Rx reversible causes prevention: hydration & bisphosphonates hyponatremia psychogenic polydipsia,
#2 Rx: IV atropine ---------------------------------------------------------------- secondary adrenal insufficiency,
alt Rx: IV epinephrine, dopamine, MCC of respiratory alkalosis: hyperventilation 2/2 hypothyroidism
transcutaneous or transvenous pacing pneumonia, high altitude, salicylate intoxication hypervolemi CHF, cirrhosis,
---------------------------------------------------------------- ---------------------------------------------------------------- c CKD, nephrotic syndrome
adenosine: transient block of impulse conduction Obesity & precocious sexual development hyponatremia
@ AV node; Rx PSVT adiposity can stimulate sexual hormone production
---------------------------------------------------------------- centrally & peripherally hypovolemic hyponatremia has appropriate ADH,
IV glucagon: Rx - blocker or CCB toxicity adipocytes cause insulin & leptin also renin, angiotensin, & aldosterone,
---------------------------------------------------------------- insulin stimulates resulting in hypokalemic metabolic alkalosis
although depressive symptoms can develop in adrenal androgens peripheral adrenarche Rx: isotonic saline repletion suppresses ADH &
response to a stressor, meeting full criteria for (body odor, pubic & axillary hair, acne) allow kidneys to excrete excess water
major depressive episode rules out adjustment risk factor for PCOS, DM Type II ----------------------------------------------------------------
disorder & grief reaction DHEA-S & low testosterone radial head subluxation (nursemaids elbow):
symptoms cause significant functional impairment o ovarian estrogen peripheral thelarche axial traction on forearm with elbow extended
---------------------------------------------------------------- leptin stimulates activation of arm held extended & pronated
symmetric duskiness & coolness of fingertips/toes: o hypothalamic-pituitary-gonadal axis & pulsatile no swelling or deformity
norepinephrine-induced vasospasm GnRH central precocious puberty LH/FSH Dx: clinical, radiographs are normal
o -1 agonist vasoconstriction results in stimulation thelarche Rx: closed reduction with forearm supination &
ischemia & necrosis of distal fingers & toes ---------------------------------------------------------------- elbow flexion, OR forearm hyperpronation
---------------------------------------------------------------- ---------------------------------------------------------------- sexual contacts of +HCV should be screened
Trendelenburg sign: weakness of gluteus medius duodenal atresia 2/2 to Down syndrome ----------------------------------------------------------------
& minimus; or superior gluteal nerve impingement requires surgical repair suspected acute appendicitis during pregnancy
---------------------------------------------------------------- pre-op cardiac assessment is essential (VSD, ASD) MC symptom: RLQ pain
MCC of acute abnormal uterine bleed in adolescent: ---------------------------------------------------------------- Dx: USS with graded compression
immature hypothalamic-pituitary-ovarian axis, repeated vomiting causes hypokalemic, ----------------------------------------------------------------
resulting in anovulatory cycles hypochloremic metabolic alkalosis acute pancreatitis: most patients recover with
anovulation cause persistent endometrial proliferation loss of H+ as HCl results in HCO3- retention & conservative management in 3 5 days
followed by heavy menses no stimulus for HCO3- release by pancreas severe acute pancreatitis: +organ failure
#1 Dx: r/o pregnancy & bleeding disorders ECV loss decreases renal perfusion activates local release of activated pancreatic enzymes into
Rx for acute abnormal uterine bleeding if the R-A-A system aldosterone causes the vascular system & vascular permeability,
hemodynamically stable hypokalemia & contraction alkalosis leads to systemic hypotension, capillary leak,
#1 Rx: high-dose IV or oral conjugated equine Rx: IV normal saline & K+ shock, & end-organ damage
estrogen (rapid endometrium regrowth) ----------------------------------------------------------------
Rx: high-dose combined OCPs anion gap = Na+ - (HCO3- + Cl-) Severe pancreatitis
high-dose progestin o normal anion gap: 6 12 mEq/L risk factors age > 75, obesity, alcoholism,
tranexamic acid (anti-fibrinolytic) ---------------------------------------------------------------- CXR: infiltrates or pleural effusion
estrogen promotes regrowth of endometrium over MCC of anion gap metabolic acidosis features fever, hypotension, tachycardia,
the denuded epithelium from heavy bleeding lactic acidosis (hypoxia, poor tissue perfusion) tachypnea, basilar crackles,
---------------------------------------------------------------- ketoacidosis (DKA, starvation, alcoholism) abdominal tenderness or distension,
hypoventilation causes respiratory acidosis in the methanol ingestion worsening BUN, low urine output
post-ictal state ethylene glycol ingestion (oxalate accumulation) Cullen sign: periumbilical bluish
post-ictal state can be complicated by lactic acidosis salicylate poisoning (with respiratory alkalosis) discoloration; hemoperitoneum
2/2 prolonged, forceful skeletal muscle activity uremia (ESRD) Grey-Turner sign: reddish-brown
o manifest as metabolic acidosis ---------------------------------------------------------------- around flanks; retroperitoneal bleed
---------------------------------------------------------------- venous blood that contains a similar O2 content Dx CT or MRCP to look for
MCC cause of aplastic anemia in kids: Fanconis as arterial blood may indicate cyanide poisoning pancreatic necrosis & extrapancreatic
short stature, microcephaly, abnormal thumbs, ---------------------------------------------------------------- inflammation
hypogonadism, caf-au-lait spots, low-set ears osmolar gap: calculated for suspected ethanol, Rx supportive, IV fluids to replace lost
macrocytic anemia, thrombocytopenia methanol, or ethylene glycol toxicity intravascular volume
Dx: chromosomal breaks on genetic analysis ---------------------------------------------------------------- complications pseudocyst, necrotizing pancreatitis,
Rx: stem cell transplant HIV screening test: p24 antigen & HIV antibodies peripancreatic fluid collection, ARDS,
---------------------------------------------------------------- o +result: confirm Dx with HIV-1/HIV-2 acute renal failure, GI bleeding
prolactin is stimulated by TRH & 5-HT; antibody differentiation immunoassay
inhibited by DA initial HIV screen: 1x scene for age 15 65 pancreatic pseudocyst: fluid collection
hypothyroidism TRH/TSH prolactin regardless of risk factors surrounded by a necrotic or fibrous capsule
prolactin inhibits GnRH LH/FSH result in o Rx for TB, Rx for another STD o complication of acute pancreatitis; 3 4 wks
hypogonadism annual screening for high-risk groups: IVDA, ----------------------------------------------------------------
o amenorrhea, libido, bone density tick bite, acute febrile illness, altered mental status,
MSM, sex workers, sex partner of +HIV, STD Hx,
---------------------------------------------------------------- homeless shelter living, correctional facility no rash: Ehrlichiosis (lone star tick)
malaria chemoprophylaxis in areas with HIV testing with each pregnancy o RMSF without spots
chloroquine-resistant P. falciparum ---------------------------------------------------------------- SE & south central US
o sub-Saharan Africa, south & southeast Asia Hep C screening criteria: elevated ALT, +HIV leukopenia & thrombocytopenia, LFTs & LDH
Rx: mefloquine (safe for pregos) status, HCV risk factors (IVDA Hx, blood Rx: empiric doxycycline
alt Rx: doxycycline, atovaquone-proguanil transfusion before 1992, chronic hemodialysis) ----------------------------------------------------------------
ceftriaxone: Rx neuro & cardiac manifestations long-term Rx asthma: inhaled corticosteroids Rx: supportive; ABX may risk of HUS
of Lyme disease long-term Rx COPD: inhaled long-acting ----------------------------------------------------------------
---------------------------------------------------------------- anticholinergic abdominal pain, N/V, Hx recent travel, myositis,
furosemide can cause hypoK+ & hypoMg++, ---------------------------------------------------------------- periorbital edema, eosinophilia: Trichinellosis
leading to V-tach Ebsteins anomaly causes atrialization of the RV fever, diarrhea, splinter hemorrhages
hypoK+ also potentiates effects of digoxin risk factor: lithium exposure in 1st trimester ingestion of undercooked meat; up to 4 wks
---------------------------------------------------------------- ---------------------------------------------------------------- MC in Mexico, China, Thailand
PSVT: MCC is re-entrant pathway into AV node child with fever, preceding acute diarrheal illness, ----------------------------------------------------------------
sudden onset palpitations & generalized weakness pallor, purpura, acute renal failure: HUS Evaluation of chest pain in the ER
MCC of paroxysmal tachycardia without microangiopathic hemolytic anemia if unstable: stabilized, & assess underlying causes
structural heart disease o LDH, reticulocytosis, thrombocytopenia (PE, pericarditis, aortic dissection)
Rx: IV adenosine or vagal maneuvers AV node schistocytes & giant platelets if stable: O2, IV access, EKG, CXR
conduction to unmask hidden P-waves within U/A: hemosiderin, albumin, RBC & WBC casts o possible ACS & low risk of aortic dissection
QRS to clarify Dx of a-flutter or atrial tachycardia ---------------------------------------------------------------- Rx ASA
o carotid massage, cold water face immersion, elderly patients with iron deficiency anemia ----------------------------------------------------------------
Valsalva, eyeball pressure require colonoscopy & endoscopy despite a premature newborn with poor feeding, abdominal
---------------------------------------------------------------- single negative FOBT; MCC is GI blood loss distension, bloody stools: necrotizing enterocolitis
pulseless electrical activity (PEA) Rx: CPR & ---------------------------------------------------------------- CXR: pneumatosis intestinalis (extravasation of
vasopressor (epinephrine every 3 5 min) PSA screening: case-by-case basis by physician bowel gas into damaged bowel wall)
continue CPR & identify reversible causes & patient discussion Necrotizing enterocolitis
Reversible causes of asystole/PEA ---------------------------------------------------------------- risk factors prematurity, very low birth weight,
5 Hs 5 Ts severe aortic stenosis is a/w GI angiodysplasia mesenteric perfusion (hypotension,
hypovolemia tension pneumoTx resulting in occult GI bleed congenital heart disease),
hypoxia tamponade ---------------------------------------------------------------- enteral feeding (formula > breast)
H+ ions (acidosis) toxins (narcotics,benzos) acute mediastinitis: complication of cardiac surgery features poor feeding, vomiting, blood stools,
hypo- or hyperK+ thrombosis 2/2 intraoperative wound contamination abdominal distension
hypothermia trauma chest pain, fever, tachycardia, leukocytosis, & CXR pneumatosis intestinalis,
no role for synch. cardioversion or defibrillation sternal wound drainage or purulent discharge portal venous gas, pneumoperitoneum
---------------------------------------------------------------- within 14 days post-op Rx supportive, bowel rest,
synchronized cardioversion: Rx symptomatic CXR: widened mediastinum empiric IV ABX, parenteral nutrition,
or sustained monomorphic VT & hemodynamic Rx: surgical debridement & prolonged ABX +/- surgery
unstable a-fib with rapid ventricular response Dx: surgical evidence of pus in mediastinum complications septic shock, intestinal strictures,
---------------------------------------------------------------- ---------------------------------------------------------------- short bowel syndrome, death
DDx of asthma vs COPD: spirometry before/after a-fib is common within days after CABG & DDx: intussusception, milk-protein enterocolitis
inhaled bronchodilator challenge (albuterol) resolution within 24 hrs; self-limited ----------------------------------------------------------------
Spirometry Rx: rate control with -blocker or amiodarone child with mild/moderate dehydration: oral fluids
low FEV1/FVC obstructive disease hemodynamic unstable a-fib with rapid ventricular child with moderate/severe dehydration: IV bolus
o after bronchodilator challenge response Rx: synchronized cardioversion o IV isotonic crystalloids only
FEV1 > 12% = asthma Rx a-fib > 24 hr after CABG: anticoagulation or ----------------------------------------------------------------
no change = COPD cardioversion Rx for ischemic stroke
normal/high FEV1/FVC, low VC restrictive ---------------------------------------------------------------- symptom onset within 3 4.5 hrs, IV alteplase
normal DLCO = chest wall weakness, OSA MCC of bloody diarrhea without fever: E. coli no C/I
DLCO = interstitial lung disease EHEC produces Shiga toxin, causing within 24 hr of stroke onset, ASA
(asbestosis) inflammatory diarrhea with bloody stools no prior anti-platelet Rx
---------------------------------------------------------------- Dx: stool assay for Shiga toxin recurrent stroke, already on ASA ASA +
clopidogrel Dx: suspected malignancy & opportunistic infection fever, progress to abdominal pain & salmon-colored
stroke, with a-fib (CHADS2) warfarin Dx: suspected PCP pneumonia rash, then hepatosplenomegaly with intestinal bleed:
o non-productive cough, progressive dyspnea, typhoid fever
ASA reduces risk of early recurrence of ischemic weight loss, tachypnea ----------------------------------------------------------------
stroke; continue indefinitely to prevent future strokes o CXR: B/L interstitial alveolar infiltrates gout begins with asymptomatic hyperuricemia &
clopidogrel: not for ASA-nave patients with stroke o Dx sputum induction with hypertonic saline progression to monoarticular arthritis
unfractionated heparin/LMWH: should be avoided o Dx: bronchoalveolar lavage if sputum is o swelling & pain in great toe due to
in acute stroke; risk of bleeding not diagnostic deposition of monosodium urate = podagra
---------------------------------------------------------------- ---------------------------------------------------------------- uric acid in renal tubules = nephrolithiasis
Evaluation of suspected gastrinoma proximal deep veins (iliac femoral, popliteal) of chronic urate deposits in soft tissues = tophi
initial test: endoscopy shows thickened gastric folds LE are the MC sources of symptomatic PE risk factors: HCTZ enhance uric acid reabsorption
& stomach/duodenal ulcers ---------------------------------------------------------------- ----------------------------------------------------------------
next: fasting serum gastrin (off PPI for 1 wk) adolescent female with hirsutism, irregular menses, Dx panic disorder
if gastrin < 100 pg/mL = no gastrinoma acne, 17-hydroxyprogesterone: CAH 2/2 partial 1 unexpected full-symptom panic attack
if gastrin > 1000 check gastric pH deficiency of 21-hydroxylase Dx: clinical; drug screen, monitor vital signs,
o pH < 4 requires testing to localize gastrinoma precocious puberty in boys EKG, & cardiac enzymes
o pH > 4 = no gastrinoma concomitant aldosterone deficiency results in Rx panic disorder
if gastrin is 110 1000 secretin stimulation test salt wasting immediate: benzo, then tapered
o secretin stimulates gastrin release by gastrinoma androgen excess impairs hypothalamic sensitivity long-term: SSRI/SNRI &/or CBT
normal G-cells are inhibited by secretin to progesterone, resulting in GnRH secretion, ----------------------------------------------------------------
---------------------------------------------------------------- LH/FSH gonadal steroids Water-soluble vitamin deficiencies
Turners is prone to osteoporosis 2/2 low estrogen DDx: classic CAH 2/2 21-hydroxylase deficiency Wernicke-Korsakoff, B1 (thiamine)
due to gonadal dysgenesis (infant virilization & salt wasting), Cushings peripheral neuropathy (dry),
Rx: HRT (hypercortisolism), PCOS (amenorrhea) dilated cardiomyopathy (wet)
---------------------------------------------------------------- ---------------------------------------------------------------- angular cheilosis, stomatitis, B2 (riboflavin)
Hx of nocturnal teeth grinding, pain with chewing, diastolic rumble at the apex may be heard in a glossitis, seborrheic dermatitis,
referred ear pain: TMJ dysfunction large VSD due to flow across mitral valve normocytic anemia
Rx: nighttime bite guard or surgery Dx: echo to determine location & size of defect pellagra (dermatitis, diarrhea, B3 (niacin)
---------------------------------------------------------------- complications: pulmonary HTN & Eisenmengers dementia, death) glossitis
non-glomerular hematuria: gross hematuria ---------------------------------------------------------------- cheilosis, stomatitis, glossitis, B6 (pyridoxine)
infant with meningitis, nuchal rigidity, lethargy, irritability, confusion, depression
with normal-appearing RBCs, no proteinuria
glomerular hematuria: microscopic hematuria, large purpuric lesions, hypotensive: adrenal megaloblastic anemia, NTDs B9 (folate)
hemorrhage 2/2 meningococcemia megaloblastic anemia, B12 (cobalamin)
MC due to glomerulonephritis or BM disease;
(Waterhouse-Frederickson syndrome) confusion, paresthesia, ataxia
proteinuria, dysmorphic RBCs or RBC casts
---------------------------------------------------------------- sudden vasomotor collapse & purpuric skin rash scurvy (punctate hemorrhage, C (ascorbic acid)
proteinuria, transient gross hematuria following MCC of death: adrenal gland failure gingivitis, corkscrew hair),
---------------------------------------------------------------- ecchymosis, petechiae
acute pharyngitis: IgA nephropathy
hematuria within 5 days of URI (synpharyngitic) Features of hypopituitarism
central hypothyroidism angular cheilosis: fissures at corners of lips
----------------------------------------------------------------
MCC of papillary necrosis: NSAID amenorrhea, infertility, loss of libido, small testes glossitis: hyperemic tongue
o NSAIDs, Sickle cell disease, Analgesic abuse, ACTH/cortisol deficiency (20 adrenal insufficiency): stomatitis: hyperemic/edematous oropharyngeal
Infection (pyelonephritis), Diabetes pale skin, fatigue, hyponatremia, hypoglycemia, mucous membranes, sore throat
---------------------------------------------------------------- eosinophilia ----------------------------------------------------------------
bronchoalveolar lavage: samples lung cells normal aldosterone, normal serum K+
----------------------------------------------------------------
hard, unilateral, non-tender solitary submandibular pressures in post-capillary venules damages Hx of blunt trauma or MVA, CXR with left
or cervical lymph nodes in an older patient with capillaries causing loss of fluids, plasma proteins, lower lung opacity, elevated hemidiaphragm, &
smoking Hx: SCC head & neck cancer & RBCs into tissues mediastinal deviation: diaphragmatic rupture
Dx: panendoscopy & biopsy RBC extravasation cause hemosiderin deposition confirm Dx: abdominal & chest CT
---------------------------------------------------------------- & discoloration; MC @ above medial malleolus ----------------------------------------------------------------
painful, fluctuant cervical lymphadenopathy: Rx: leg elevation, exercise, compression stocking hemineglect: right (non-dominant) parietal lobe
bacterial infection o if refractory venous duplex USS ----------------------------------------------------------------
---------------------------------------------------------------- o Rx: endovenous ablation provoked seizure 2/2 severe hyponatremia
DDx of hyperandrogenism in females ---------------------------------------------------------------- Rx: 3% saline, corrected @ 0.5 mEq/L/hr to avoid
PCOS Ludwigs angina: infection of submandibular & osmotic demyelination or central pontine
non-classic CAH sublingual glands 2/2 tooth infection myelinosis 2/2 rapid correction of hyponatremia
ovarian/adrenal tumors rapidly progressive B/L cellulitis, firm induration with excess water moving intra- extracellularly
hyperprolactinemia of submandibular space DDx: rapid correction of hypernatremia results
Cushings syndrome dysphagia, drooling, fever, palpable crepitus in cerebral edema
acromegaly MCC of death: asphyxiation 2/2 airway constriction ----------------------------------------------------------------
---------------------------------------------------------------- Rx: ABX & tooth removal MCC of death from acromegaly: cardiovascular
H1-antihistamines (diphenhydramine, ---------------------------------------------------------------- o excess IGF-1 risk of coronary heart disease,
chlorpheniramine, hydroxyzine) have significant fever, acute monoarthritis, hot, swollen joint with cardiomyopathy, arrhythmias, LVH, &
anticholinergic effects 2/2 inhibition on ROM, ESR & CRP: septic arthritis diastolic dysfunction
muscarinic receptors risk factors: underlying joint abnormality (RA, ----------------------------------------------------------------
urinary retention results from detrusor inactivity OA, gout, prosthetic joint), intra-articular brain death is a clinical Dx
controlled by pelvic splanchnic nerves glucocorticoid joint injections o absent cortical & brain stem functions
---------------------------------------------------------------- Dx: synovial fluid analysis show leukocytosis HR does not accelerate after atropine injection
midazolam: induce conscious sedation during >50,000, +Gram stain, culture due to absence of vagal control
medical procedure Rx G+ cocci: IV vancomycin spinal cord may be intact: DTRs present
---------------------------------------------------------------- Rx G- rod: IV 3rd gen cephalosporin ----------------------------------------------------------------
young boy with headache, vomiting, bitemporal Rx negative microscopy: vancomycin newborn with tachycardia, warm/flushed skin,
hemianopsia, & calcified lesion above sella: ---------------------------------------------------------------- poor feeding, irritability, low birth weight,
craniopharyngioma most significant risk factor for stroke = HTN maternal Hx of Graves: neonatal thyrotoxicosis
located suprasellar & inferior to optic chiasm 4x increased risk for all stroke types transplacental passage of maternal anti-TSH Rc
a/w diabetes insipidus; growth failure 2/2 ---------------------------------------------------------------- antibodies that bind to infants TSH receptors
hypothyriodism or GH deficiency can occur despite maternal Rx for Graves
Dx: MRI; cystic calcified parasellar lesion Dx: maternal anti-TSH Rc antibodies
Rx: surgical removal self-limited in 3 months
---------------------------------------------------------------- o Rx: methimazole + -blocker to prevent
Brown-Sequard: damage to lateral spinothalamic A/E on developing nervous system
C/L loss of pain & temp, 2 levels below lesion ----------------------------------------------------------------
I/L motor weakness, spasticity, loss of vibration long-term tobacco use, chronic cough, JVD,
& proprioception 1 2 levels below the lesion barrel-shaped chest, & hepatomegaly: COPD
I/L loss of all sensation at the lesion level with cor pulmonale
---------------------------------------------------------------- cor pulmonale: RV dysfunction caused by
B/L lower extremity edema, stasis dermatitis, & standard deviation of normal distribution pulmonary HTN due to underlying lung disease
venous ulcerations 2/2 venous insufficiency ---------------------------------------------------------------- (COPD), OSA, or pulmonary arterial HTN
dyspnea, angina, syncope, peripheral edema, RV S3
Dx: clinically & echo
definitive Dx: right heart catheterization showing ---------------------------------------------------------------- acute ASA poisoning: tinnitus, fever, hyperpnea
pulmonary artery systolic pressure (> 25) progressively worsening dyspnea, bibasal crepitus. (respiratory alkalosis), & metabolic acidosis
---------------------------------------------------------------- S3, cardiomegaly, macrocytosis, AST > ALT: ----------------------------------------------------------------
portal HTN: portal venous resistance dilated cardiomyopathy 2/2 alcoholism, resulting acute Vit A overdose: N/V, blurry vision, dry skin
2/2 cirrhosis or extrahepatic portal vein thrombosis in CHF chronic Vit A toxicity: pseudomotor cerebri
palmar erythema, spider angiomata, caput medusae, Rx: abstinence from alcohol reverses disease process ----------------------------------------------------------------
gynecomastia Rx: ACE-I slows progression abrupt onset B/L flaccid paralysis, loss of pain &
complications: ascites, SBP, variceal bleeding Rx: digoxin for systolic dysFx & rapid ventricular temp sensation below the lesion
---------------------------------------------------------------- rates due to a-fib or a-flutter anterior cord syndrome 2/2 spinal cord infarct
Rx acute psychosis: 2nd gen antipsychotic ---------------------------------------------------------------- MC due to thoracic aortic aneurysm repair
o lorazepam as adjunct only for agitation young healthy female with recent upper URI with anterior spinal artery is dependent on blood supply
---------------------------------------------------------------- sudden onset CHF: dilated cardiomyopathy 2/2 from radicular arteries of thoracic aorta
recent cardiac catheterization, anticoagulation with acute viral myocarditis UMN signs develop over days to weeks
heparin, sudden onset hypotension, tachycardia, MCC Coxackie B virus vibration & proprioception are intact
flat neck veins, & back pain: retroperitoneal Dx: echo shows dilated ventricles & diffuse ----------------------------------------------------------------
hematoma 2/2 bleeding from arterial access site hypokinesia, resulting in low EF sudden, painless loss of vision in one eye, with
arterial puncture sites above the inguinal ligament Rx: supportive, manage CHF symptoms pallor of optic disc, cherry red fovea, & boxcar
can extend into retroperitoneal space ---------------------------------------------------------------- segmentation of blood in retinal veins: central
Dx: non-contrast CT concentric hypertrophy: 2/2 chronic pressure retinal artery occlusion
Rx: supportive, bed rest, IV fluids, transfusion overload (valvular stenosis) ----------------------------------------------------------------
avoid strenuous activity for one week eccentric hypertrophy: 2/2 chronic volume premature atrial contractions (PACs)
---------------------------------------------------------------- overload (valvular regurgitation) Rx if symptoms cause stress or SVT: -blocker
preterm fetus with severe congenital anomalies ---------------------------------------------------------------- avoid precipitating factors: alcohol, tobacco, stress
incompatible with life (B/L renal agenesis) chronic mitral stenosis can cause RV hypertrophy ----------------------------------------------------------------
Rx: spontaneous vaginal delivery & RV heave 2/2 pulmonary HTN post-MI secondary prevention; mortality benefits
---------------------------------------------------------------- ---------------------------------------------------------------- o ASA, -blocker, ACE-I, statin
unilateral breast pain with isolated, firm, tender, young female with chronic anterior knee pain, add clopidogrel for unstable angina/NSTEMI,
erythematous area, & fever: mastitis worse with climbing stairs on knee extension: & post-PCI
Rx: frequent breastfeeding or pumping, analgesia, patellofemoral syndrome clopidogrel is an ASA alternative
anti-Staph ABX a/w chronic overuse clopidogrel + ASA for post-PCI is more effective
DDx: breast abscess, plugged ducts, engorgement Dx: patellofemoral compression test than ASA alone; prevents subacute stent thrombosis
---------------------------------------------------------------- Rx: exercises to stretch & strengthen thigh muscles clopidogrel for STEMI with primary PCI
Iron poisoning ---------------------------------------------------------------- ----------------------------------------------------------------
elemental iron is corrosive to GI mucosa MC renal stones: calcium LMWH: only Rx post-MI for 48 hrs or until
free radical production & lipid peroxidation high protein diet is a/w calcium stones angiography is performed
feature 30 min 4 days: abdominal pain, increased Na+ intake enhances Ca++ excretion o not necessary after hospital discharge
s hematemesis, melena, hypotensive shock Dx: CT without contrast detects radiopaque & ----------------------------------------------------------------
within 2 days: hepatic necrosis radiolucent (uric acid) stones Lung cancer types
within 2 8 wks: pyloric stenosis 2/2 Rx: dietary protein, oxalate, & Na+ location associations
gastric scarring o fluids & dietary Ca++ adenocarcinom peripheral, clubbing,
Dx anion gap metabolic acidosis, serum iron, hypercalciuria & recurrent stones Rx: HCTZ a solitary hypertrophic
XR: radiopaque tablets ---------------------------------------------------------------- (non-smokers) osteoarthropathy
Rx whole bowel irrigation, IV deferoxamine acute acetaminophen overdose: N/V or SCC central,
(binds ferric iron urinary excretion) asymptomatic for 24 hr (squ-Ca++mous) necrosis & hypercalcemia
pre-natal vitamins appear as radiopaque on XR cavitation
small cell central Cushings, SIADH, ---------------------------------------------------------------- initial menstrual cycles in pubertal females are
carcinoma Lambert-Eaton lactose intolerance Dx: hydrogen breath test usually irregular & anovulatory 2/2 immaturity
large cell peripheral gynecomastia, indicates bacterial CHO metabolism of the hypothalamic-pituitary-gonadal axis
carcinoma galactorrhea ---------------------------------------------------------------- endometrium builds up under estrogen influence
resting pill-rolling tremor in Parkinsons in absence of progesterone
large, peripheral, irregular pulmonary nodule a/w starts in one hand, progress to other extremities o progesterone is produced by corpus luteum
hemoptysis & weight loss: adenocarcinoma more pronounced with distractibility (mental tasks) following ovulation; withdrawal of
---------------------------------------------------------------- ---------------------------------------------------------------- progesterone as corpus luteum degenerates
painless, monocular vision loss, photopsia (light physiologic tremor: benign postural tremor results in menses
flashes), floaters, & curtain coming down over (holding arms ourstretched); usually not visible; menstrual-like bleeding occurs due to estrogen
my eyes: retinal detachment low amplitude, high frequency break-through bleeding
grey, elevated retina o worsens with emotions, stress, caffeine ----------------------------------------------------------------
Rx: laser therapy & cryotherapy ---------------------------------------------------------------- acute severe anemia with low/absent reticulocytes
---------------------------------------------------------------- anterior urethra injury: distal to urogenital in patient with sickle cell disease: aplastic crisis
sudden loss of vision & onset of floaters: diaphragm o transient arrest of erythropoiesis results in a
vitreous hemorrhage MCC: straddle injuries, urethra instrumentation severe drop in Hb
MCC: proliferative diabetic retinopathy perineal tenderness or hematoma, bleeding urethra, MCC: parvovirus B19
fundoscopy: loss of fundus detail, floating debris, normal prostate Rx: blood transfusion
dark red glow ---------------------------------------------------------------- DDx: aplastic anemia (pancytopenia),
---------------------------------------------------------------- posterior urethra injury: contains prostatic & hyperhemolytic crisis (appropriate reticulocytosis),
mask-like, immobile facial expression, bradykinesia, membranous urethra splenic sequestration (persistent reticulocytosis &
resting tremor, & fenestrating, hypokinetic gait: MC a/w pelvic fractures rapidly enlarging spleen)
Parkinsons high-riding prostate, suprapubic pain, blood at ----------------------------------------------------------------
substantia nigra degeneration & DA activity urethral meatus, scrotal hematoma, inability to neonatal tetanus: MC in infants of unimmunized
with anticholinergic activity void, distended bladder mothers, following umbilical stump infection
---------------------------------------------------------------- ---------------------------------------------------------------- within 1st 2 wks of birth
waddling gait: muscular dystrophy long-term prognosis of STEMI: duration of time poor suckling, fatigue, rigidity, spasm, opisthotonus
spastic gait: UMN lesions (cerebral palsy) before restoration of coronary blood flow MCC of death: apnea or septicemia
wide-based, high-stepping gait: sensory ataxia, o PTCA door-to-balloon time: < 90 min ----------------------------------------------------------------
loss of proprioception o fibrinolysis door-to-needle time: < 30 min pulmonary contusion is not clinically evident
staggering gait: vestibular ataxia, a/w vertigo & ---------------------------------------------------------------- immediately after injury; hypoxia & respiratory
nystagmus androgens are produced in adrenals distress develops hours later as pulmonary edema
broad-based gait: multiple system atrophy estrogens are formed through conversion of sets in
---------------------------------------------------------------- androgens by aromatase in granulosa cells of IV fluids may exacerbate hypoxia
non-tender ulcer on penis shaft with raised border the ovary in child-bearing women CXR: patchy, irregular alveolar infiltrates
& smooth base, B/L inguinal lymphadenopathy: o aromatase activity in ovaries ceases after DDx: myocardial contusion ( PCWP)
primary syphilis (chancre) menopause ----------------------------------------------------------------
Dx: dark field microscopy peripheral fat tissue also contains aromatase Screen for developmental dysplasia of hips (DDH)
o also HIV screening with ELISA conversion of adrenal androgens to estrogen by age 0 12 months serial hip exam at each visit
---------------------------------------------------------------- adipose tissue alleviates menopausal symptoms until walking
first-degree heart block: no further evaluation & mild hot flashes +Barlow or +Ortolani refer to orthopedics
a/w risk of heart failure, a-fib, & mortality estrogen is not produced in peripheral fat asymmetric inguinal folds extending beyond
first-degree heart block with prolonged QRS ---------------------------------------------------------------- the anal aperture, & negative Barlow/Ortolani
likely have conduction delays below AV node hip laxity at birth resolves by age 2 wks
o Dx: electrophysiology testing age 2 wks 6 months hip USS
age 4 6 months hip XR QRS narrow narrow or wide inadequate alveolar clearance at birth results in
Rx: Pavlik hip harness for infants < 6 months exercise or improves worsens mild pulmonary edema
complications of delayed Dx: Trendelenburg gait, atropine AV block AV block CXR: B/L perihilar linear streaking
scoliosis, arthritis, avascular necrosis vagal maneuvers worsens improves resolves by day 2; no long-term sequelae
---------------------------------------------------------------- risk of complete low risk, high risk; ----------------------------------------------------------------
Barlow method identifies a loose hip that can be heart block benign pacemaker persistent pulmonary HTN of the newborn
pushed out of the socket with gentle pressure AV node blockers: digoxin, -blockers, CCB should be suspected in all term & post-term
Ortolani method identifies a dislocated hip that ---------------------------------------------------------------- neonates with cyanosis
can be reduced into the socket; audible clunk; unexplained syncope evaluation: EKG high pulmonary vascular resistance result in
confirms Barlow prolonged PR & QRS suggests intermittent right-to-left shunting of deoxygenated blood
B comes before O bradyarrhythmia or high-grade AV block through foramen ovale & ductus arteriosus
o Barlow: we are going out tonight; hip can isolated PVCs with normal EF is not a/w syncope tachypnea & severe cyanosis
be popped out ---------------------------------------------------------------- CXR: clear lungs, vascularity
o Ortolani: Oh, its time to gO home; femoral Rx symptomatic ureteral stone < 1 cm ----------------------------------------------------------------
head is reduced hydration dry cough, weight loss, right arm pain, smoking Hx:
---------------------------------------------------------------- pain control superior sulcus tumor
screening occult spina bifida: lumbosacral USS -blocker (tamsulosin) facilitate stone passage compressive symptoms: Horners, hoarse voice,
abnormal USS spinal MRI ---------------------------------------------------------------- SVC syndrome, Pancoast syndrome (brachial
---------------------------------------------------------------- bethanechol: cholinergic agonist; Rx urinary plexus invasion @ C8, T1)
early pregnancy: N/V, bloating, constipation retention, atonic bladder shoulder pain radiating in ulnar distribution
serum quantitative pregnancy test can be oxybutynin: anticholinergic; Rx overactive bladder ----------------------------------------------------------------
positive within 4 days of implantation (detrusor instability) swelling of head, neck, & arms upon waking;
urine pregnancy test may take one week imipramine: TCA with anticholinergic activity; plethoric face, engorged chest veins, smoking Hx:
Dx: pelvic USS for intrauterine vs. ectopic Rx childhood enuresis superior vena cava syndrome
---------------------------------------------------------------- ---------------------------------------------------------------- MCC: small cell lung cancer, non-Hodgkins
sensitivity determines how well a test identifies Mg++-sulfate toxicity: depression of DTRs & Dx: CXR with F/U CT & histology
people with disease (to rule it out; SNOUT) respiratory depression ----------------------------------------------------------------
specificity determines how well a test identifies o Mg++ blocks neuromuscular transmission & painful, red corneal opacification & ulceration
people without disease (to rule it in; SPIN) cause CNS depression a/w contact lens use: contact lens keratitis
---------------------------------------------------------------- Rx: Ca++ gluconate, stop Mg++-sulfate, o medical emergency!!
tick-borne paralysis: absence of prodrome fever, monitor DTRs MCC: Pseudomonas
rapidly ascending paralysis, normal CSF ---------------------------------------------------------------- Rx: topical ABX
Rx: meticulous search for tick results in Neonatal respiratory distress syndrome DDx: anterior uveitis, viral conjunctivitis, episcleritis
spontaneous improvement tachypnea (RR > 60/min), grunting, nasal flaring, ----------------------------------------------------------------
DDx: Guillain-Barre (ascending symmetrical intercostal retractions, cyanosis MC benign primary intracardiac tumor in LA:
paralysis, albuminocytologic dissociation) surfactant deficiency results in alveolar cardiac myxoma
---------------------------------------------------------------- collapse & diffuse atelectasis fever, weight loss, Raynauds
2nd degree AV block risk factors: prematurity, very low birth weight mimics mitral valve disease; obstruction of blood
Mobitz I Mobitz II CXR: diffuse, reticulogranular (ground-glass) flow across mitral valve, early diastolic rumble
blockage AV node below AV node opacities, bronchograms complication: systemic embolization (stroke, TIA)
EKG progressive PR PR & R-R Rx: continuous PAP ventilation Dx: TEE
prolongation remain constant ---------------------------------------------------------------- Rx: surgical resection
leads to a unpredictable MCC of respiratory distress in full-term infants: ----------------------------------------------------------------
nonconducted nonconducted transient tachypnea of the newborn
P-wave P-wave
chest pain, fever, chills, cough, purulent sputum, non-traumatic subarachnoid hemorrhage is Crohns or fat malabsorption are predisposed to
bronchial breath sounds, dullness to percussion, MC due to ruptured saccular or berry aneurysm hyperoxaluria 2/2 oxalate gut absorption,
TVF, & egophony: lobar pneumonia #1 Dx: non-contrast CT shows hyperdense regions leads to oxalate stone formation
---------------------------------------------------------------- suspected SAH with negative CT requires fatty acid absorption & bile salt recycling are
unregulated spontaneous bladder contractions lumbar puncture reduced in Crohns
that are unresponsive to cortical inhibition: urge o opening pressure & xanthochromia normally, Ca++ binds oxalate in the gut, thus
incontinence (detrusor instability) overactive Rx: cerebral angiography & surgical clipping preventing its absorption
---------------------------------------------------------------- ---------------------------------------------------------------- in fat malabsorption, Ca++ preferentially binds fat,
cirrhosis & portal HTN is a/w ascites & night terrors occur during non-REM sleep leaving oxalate unbound & absorbed in the gut
peripheral edema 2/2 low albumin episodes of fear, screaming, crying, child cannot also, failure to absorb bile salts damages colonic
hepatic hydrothorax can cause transudative be fully awakened; no recollection of the incident mucosa, contributing to oxalate absorption
pleural effusion 2/2 cirrhosis without underlying triggered by acute stress, sleep deprivation, ----------------------------------------------------------------
cardiac or pulmonary disease illness, medications affecting CNS first unprovoked VTE: age-appropriate screening
#1 Rx: salt restriction & diuretics DDx: nightmares (during REM, does not cry, (colonoscopy, mammogram) & CXR can identify
#2 Rx: TIPS for refractory cases scream, or tachycardic; can recall incident) occult malignancy
definitive Rx: liver transplant ---------------------------------------------------------------- unprovoked & recurrent VTE (thrombophlebitis,
---------------------------------------------------------------- hypokalemia, hypochloremia, metabolic alkalosis, DVT), smoking Hx, back pain, & weight loss
pleurodesis: prevents recurrent pleural effusion & normotensive: surreptitious vomiting requires further workup: CT chest/abdomen/pelvis
or pneumothorax DDx: diuretic abuse (high urine chloride) ----------------------------------------------------------------
o pleural space is artificially obliterated by ---------------------------------------------------------------- osteonecrosis is a common complication of
adhesion of the two pleurae meningococcal meningitis: highly contagious sickle cell anemia 2/2 vaso-occlusion
---------------------------------------------------------------- Rx: isolation, IV ABX, ICU setting MC sites: humeral & femoral heads
sickle cell trait patients are generally asymptomatic ---------------------------------------------------------------- ----------------------------------------------------------------
MC complication: painless hematuria hCG is secreted by syncytiotrophoblast Charcot arthritis: joint destruction 2/2
isosthenuria: impaired concentrating ability doubles every 48 hr, peaks @ 6 8 wks gestation deterioration of proprioception, pain & temp
presents as nocturia & polyuria maintains corpus luteum, which maintains MC a/w diabetic neuropathy, syringomyelia,
---------------------------------------------------------------- progesterone secretion until placenta takes over spinal cord injury, Vit B12 def, tabes dorsalis
halo around lights also promotes male sexual differentiation ----------------------------------------------------------------
gradual onset blurred vision, difficulty with infection can precipitate DKA due to systemic
also stimulates maternal thyroid
nighttime driving & fine print, glare: cataract release of insulin counterregulatory hormones:
----------------------------------------------------------------
oxidative damage with aging causes progressive catecholamines & cortisol
progesterone inhibits uterine contractions during
lens thickening & loss of transparency o resultant excess glucagon causes
pregnancy
risk factors: advancing age, diabetes, smoking, hyperglycemia, ketnonemia, & osmotic diuresis
estrogen induces prolactin during pregnancy
chronic sun exposure, glucocorticoid use depletion of total body K+ stores
----------------------------------------------------------------
---------------------------------------------------------------- osmotic diuresis activates the R-A-A system,
S4 can be heard during acute phase of MI due
iron deficiency anemia is common in elderly thus accelerates K+ loss
to ischemia induced myocardial dysfunction
taking NSAIDs & ASA, resulting in chronic GIT osmotic diuresis urinary excretion of glucose,
can be normal in healthy older adults
blood loss ketones, Na+, Mg++, & phosphate
----------------------------------------------------------------
elderly have low-grade chronic anemia at baseline; ----------------------------------------------------------------
paradoxical splitting of S2 seen with myocardial
idiopathic anemia of aging tumor lysis syndrome MC a/w Burkitts, ALL
ischemia/infarction due to delayed myocardial
evaluation: CBC, iron studies, FOBT Ca++, phosphate, K+, uric acid
relaxation & delayed aortic valve closure
definitive Dx: upper GI endoscopy ---------------------------------------------------------------- o K+ & phosphate are intracellular ions
Rx: withhold NSAIDS & ASA, initiate PPI pulsus paradoxus seen with cardiac tamponade, o released phosphate binds Ca++
---------------------------------------------------------------- severe asthma, COPD, hypovolemic shock Rx: allopurinol reduces acute urate nephropathy
---------------------------------------------------------------- ----------------------------------------------------------------
dry beri beri: symmetric peripheral neuropathy Methotrexate: single-dose IM injection
with sensory & motor impairments o Rx unruptured ectopic pregnancy
wet beri beri: neuropathy + cardiac involvement o hemodynamic stability, normal baseline
(cardiomegaly, cardiomyopathy, CHF) liver & renal function
---------------------------------------------------------------- Laparoscopy: last resort Dx of ectopic
denial: behaving as if an aspect of reality does not ----------------------------------------------------------------
exist; block acceptance of external sensory data Sodium bicarbonate therapy
repression: blocking upsetting feelings from Rx TCA overdose by alleviating depressant action
entering consciousness; blocking inner states on myocardial sodium channels when QRS > 100
dissociation: disrupting memory, identity, & Rx salicylate/ASA overdose by alkalinizing urine
consciousness to cope with an event Rx severe hyperK+ by driving extracellular K+
isolation of affect: separating a though from its into cells
emotional component ----------------------------------------------------------------
---------------------------------------------------------------- child with acute, U/L cervical lymphadenitis,
sublimation: channeling impulses into socially tender, rapidly enlarging & fluctuant
acceptable behaviors MCC: Strep pyogenes, S. aureus
suppression: putting unwanted feelings aside to Rx: I&D + clindamycin (covers Strep & Staph)
cope with reality ----------------------------------------------------------------
---------------------------------------------------------------- child with U/L cervical lymphadenitis & Hx of
transabdominal USS cannot visualize periodontal disease or dental caries
gestational sacs when -hCG < 6,500 MCC: anaerobes
tension (closed) pneumoTx: air within pleural transvaginal USS can visualize an intrauterine Rx: clindamycin or amoxicillin/clavulanate
space pushes mediastinum to the opposite side, gestational sac when -hCG @ 1500+ ----------------------------------------------------------------
obstructing venous return o #1 Dx: r/o ectopic pregnancy amoxicillin covers streptococcal infections, but
Rx: needle thoracostomy (2nd IC, mid-clavicular) o failure to detect intrauterine or adnexal sac, not S. aureus, which produce -lactamase
before CXR or IV access for fluid resuscitation serial -hCG is required in 48 hrs ----------------------------------------------------------------
---------------------------------------------------------------- normal pregos, -hCG doubles every 48-72 hrs dyspnea on exertion, weakness, fatigue, chest pain,
dry eyes, photophobia, difficulty adapting to until 10,000 - 20,000 IU/mL hemoptysis, clear lungs: pulmonary HTN
darkness, dry scaly skin, follicular hyperkeratosis ectopic pregnancies, -hCG levels increase less mean pulmonary artery pressure > 25 at rest
on extensors: Vit A deficiency ---------------------------------------------------------------- CXR: prominent pulmonary arteries with rapid
MC @ age 2 3 yrs respiratory alkalosis causes H+ dissociation from tapering of distal vessels (pruning) & enlarged
keratomalacia (wrinkled, cloudy cornea) albumin albumin-Ca++ ionized Ca++ right heart border
Bitot spots (dry, silver-gray plaques on bulbar total Ca++ is unchanged untreated complication: cor pulmonale
conjunctiva) crampy pain, paresthesia, carpopedal spasm ----------------------------------------------------------------
---------------------------------------------------------------- DDx: acidosis ionized Ca++ severe persistent bronchial asthma requiring
sore throat, cheilitis, hyperemic & edematous ---------------------------------------------------------------- multiple medications, recent weight gain, HTN,
oropharyngeal mucous membranes, stomatitis, stool sample with oocysts on modified acid-fast bruising, acne, proximal muscle weakness:
glossitis, photophobia, normocytic anemia, staining: Cryptosporidium parvum Cushings 2/2 excess systemic corticosteroids
seborrheic dermatitis: riboflavin (B2) deficiency severe diarrhea with malaise, nausea, anorexia hypokalemia due to corticosteroids which have
---------------------------------------------------------------- MC seen in HIV CD4 < 180 mineralocorticoid activity that bind aldosterone Rc
ecchymosis, petechiae, hyperkeratosis, Sjogrens, ---------------------------------------------------------------- Rx: spironolactone
arthralgias, depression, neuropathy, coiled hair: Management options of ectopic pregnancy ----------------------------------------------------------------
Vit C deficiency Expectant: asymptomatic & no evidence of morning stiffness, deformities, enthesitis,
---------------------------------------------------------------- rupture or hemodynamic instability dactylitis sausage digits @ DIP joints,
o demonstrates declining -HCG levels onycholysis, & nail pitting: psoriatic arthritis
Rx: NSAIDs, methotrexate, anti-TNF agents #1 Rx: DMARDs ASAP MTX presents with hypovolemia, leading to ADH &
DDx: tophi (gout), enterohepatic arthritis (UC, o MTX not for pregos, severe renal insufficiency, hyponatremia, thus concentrated urine
Crohns), Gottrons papules (dermatomyositis), liver disease, or excess alcohol intake ----------------------------------------------------------------
Charcot joint (diabetes), osteoarthritis, RA NSAIDs, COX-2 inhibitors, & glucocorticoids are central & nephrogenic DI decreases ADH action,
---------------------------------------------------------------- adjuncts for symptomatic relief, but do not reduce thus renal water reabsorption, hypernatremia,
urethritis, asymmetric oligoarthritis, conjunctivitis, disease progression or joint destruction thus dilute urine
mouth ulcers, & enthesitis (Achilles pain): persistent symptoms > 6 months ----------------------------------------------------------------
reactive arthritis o Step-up therapy with biological DMARDs primary polydipsia is common with psychiatric
seronegative spondyloarthropathy (etanercept, infliximab, adalimumab) + MTX conditions (schizophrenia) 2/2 central defect in
synovial fluid analysis is sterile if inadequate response switch to an alternate thirst regulation
Rx: NSAIDs TNF- inhibitor & continue MTX ----------------------------------------------------------------
DDx: gonococcal septic arthritis ---------------------------------------------------------------- fever, productive cough, foul-smelling sputum
---------------------------------------------------------------- chronic abdominal pain, diarrhea, weight loss, after upper GI endoscopy: anaerobic infection
enthesitis: pain @ tendon & ligament insertion sites Hx of daily alcohol intake Rx: clindamycin
MC a/w ankylosing spondylitis, psoriatic arthritis, Chronic pancreatitis ----------------------------------------------------------------
& reactive arthritis etiology alcohol, CF, duct obstruction, autoimmune ventricular remodeling occurs weeks months
---------------------------------------------------------------- features chronic epigastric pain, malabsorption, DM post-MI, causing LV dilatation with thinning of
pain with eye movement, proptosis, diplopia, labs amylase/lipase can be normal, ventricular walls, resulting in CHF
ophthalmoplegia: orbital cellulitis dilated ducts, enlarged pancreas Rx: ACE-I within 24 hr post-MI to limit
MC predisposing factor: bacterial sinusitis Dx CT scan show calcifications ventricular remodeling
complications: cavernous sinus thrombosis, Rx pain management, ----------------------------------------------------------------
subperiosteal abscesses alcohol & smoking cessation, Late-term & post-term complications
---------------------------------------------------------------- pancreatic enzyme supplements Fetal Maternal
heel pain & tenderness, recent UTI on cipro: ---------------------------------------------------------------- oligohydramnios cesarean delivery
Achilles tendinopathy 2/2 fluoroquinolone use glycosylated Hb (HbA1c) is dependent on plasma meconium aspiration infection
complication: tendon rupture glucose concentration, reflective of blood glucose macrosomia postpartum
Rx: stop medication, avoid exercise over the average RBC lifespan (3 months) convulsions hemorrhage
---------------------------------------------------------------- hemolytic anemia causes a falsely low HbA1c stillbirth perineal trauma
child with tachycardia, tachypnea, muffled heart ----------------------------------------------------------------
sounds 1 wk after cardiac surgery, with new confusion, lethargy, psychosis, seizures aging placenta has decreased fetal perfusion
cardiomegaly on CXR: pericardial effusion Evaluation of hyponatremia oligohydramnios is an indication for delivery
with progression to cardiac tamponade 2/2 test #1: serum osmolality > 290 risk factors: nulliparity, Hx of postterm pregnancy,
post-pericardiotomy syndrome o marked hyperglycemia obesity, fetal anomalies
inflammation from surgical intervention leads to o advanced renal failure ----------------------------------------------------------------
reactive pericarditis, pericardial effusion, &/or if serum osmolality < 290 fever, diaphoresis, malaise, jaundice, dark urine
tamponade (Becks triad: distant heart sounds, test #2: urine osmolality < 100 following a tick bite: Babesiosis
JVD, hypotension) o primary polydipsia MC in NE U.S.; MC in post-splenectomy
Rx: pericardiocentesis or pericardiectomy if urine osmolality > 100 parasite enters RBCs hemolytic anemia
---------------------------------------------------------------- test #3: urine sodium < 25 no rash
classic CAH: ambiguous genitalia (clitoromegaly) o volume depletion, CHF, cirrhosis Dx: Giemsa stain thick & thin
& salt-wasting if urine sodium > 25 Rx: quinine-clindamycin or atovaquone-azithromycin
nonclassic CAH: premature pubarche, hirsutism, o SIADH (concentrated urine), hypothyroid, ----------------------------------------------------------------
severe acne adrenal insufficiency shoulder pain with passive internal rotation &
---------------------------------------------------------------- ---------------------------------------------------------------- flexion @ shoulder: subacromial bursitis 2/2
Management of RA adrenal insufficiency lack of aldosterone microtrauma to supraspinatus tendon
---------------------------------------------------------------- varicocele: worsens with standing & Valsalva, RCA occlusion a/w inferior wall MI can lead to
gaze abnormalities, limb ataxia, sensory loss, decreases when supine hypotension, AV block, & sinus bradycardia
vertigo, Horners: Wallenberg syndrome spermatocele: painless, fluid-filled cyst @ head of ----------------------------------------------------------------
(lateral medullary infarct) epididymis; mass outside the testes that contains Rx pheochromocytoma: always -blocker first,
---------------------------------------------------------------- non-viable sperm; no change with position then -blocker
dizziness, inability to walk, stabbing facial pain, ---------------------------------------------------------------- -blockers first lead to unopposed stimulation of
topples over when sitting, reduced corneal reflex, flank pain, hematuria, left-sided varicocele that vascular -receptors by catecholamines, results
ptosis, horizontal nystagmus: Wallenberg syndrome fails to empty when recumbent: renal cell ca in rapid, catastrophic BP
MC site: lateral medulla 2/2 vertebral artery or also anemia or polycythemia, thrombocytosis, o -blockers decrease BP
PICA occlusion fever, hypercalcemia, cachexia o -blockers Rx tachycardia & tremors
Dx: MRI obstruction of gonadal vein results in varicocele labetalol can be used as initial Rx
Rx: IV thrombolytics (tPA) Dx: abdominal CT ----------------------------------------------------------------
---------------------------------------------------------------- SSRI A/E: anorexia & sexual dysfunction
Wallenberg syndrome Effect of intensive glycemic control in DM Type II ----------------------------------------------------------------
(lateral medullary syndrome) macrovascular complications (acute MI, stroke): personal Hx or family Hx of febrile seizures is
vestibulo- vertigo, falling TOWARD the lesion, no change NOT a C/I to immunization (DTaP)
cerebellar difficulty sitting upright, microvascular (nephropathy, retinopathy) o febrile seizure are benign; no sequelae
nystagmus (horizontal & vertical), complications: reduces risk immediate anaphylaxis following DTaP is the
sensory abnormal facial sensation/pain, target HbA1c: 6 7%; no change in mortality only C/I for avoiding all vaccine components
pain/temp loss on I/L face & C/L body ---------------------------------------------------------------- unstable neurologic disorders or encephalopathy
bulbar dysphagia, aspiration, dysarthria, non-productive cough a/w ACE-I is due to within a week of DTaP are C/I to pertussis
hoarseness, diminished gag reflex accumulation of kinins, which are normally component of the vaccine
autonomic I/L Horners (ptosis, miosis, anhidrosis) degraded by ACE ----------------------------------------------------------------
motor function of face & body are spared ---------------------------------------------------------------- fever, lower abdo pain, adnexal tenderness,
---------------------------------------------------------------- Hx of wheezing with ASA or NSAIDs, rhinitis, purulent discharge, cervical motion tenderness,
medial medullary syndrome: C/L hemiparalysis, post-nasal drainage: ASA-exacerbated leukocytosis, ESR: PID
tongue deviates toward lesion, C/L loss of tactile, respiratory disease (AERD) MCC of infertility in age < 30
vibration & position sense asthma, chronic rhinosinusitis with nasal polyps, N/V is an indication for hospitalization
---------------------------------------------------------------- & bronchospasm or nasal congestion following Rx: IV ABX before cultures
lateral mid-pontine lesion: affect motor & sensory ingestion of ASA or NSAIDs o cefoxitin, or cefotetan/doxycycline, &
nuclei of I/L trigeminal nerve B/L glistening mucoid masses in nasal cavities clindamycin/gentamicin
weak muscles of mastication, jaw jerk reflex, nasal polyps tend to recur untreated complications: tubo-ovarian abscess,
impaired tactile & position sense in the face ---------------------------------------------------------------- pelvic peritonitis, sepsis
---------------------------------------------------------------- MI infarction location ----------------------------------------------------------------
medial mid-pontine lesion: C/L ataxia & vessel EKG MS neurologic deficits can be exacerbated by
hemiparesis of face, trunk, & limbs anterior LAD lead V1 V6 exercise or hot weather
---------------------------------------------------------------- inferior RCA or ST elevation in II, III, aVF internuclear ophthalmoplegia is caused by
infant develops weakness, lethargy, poor appetite, LCX demyelination of the MLF
constipation, macroglossia, umbilical hernia: posterior LCX or ST depression in V1 V3 ----------------------------------------------------------------
congenital hypothyroidism RCA ST elevation in I & aVL (LCX) fever, acute RUQ pain, jaundice, confusion,
MCC: thyroid dysgenesis ST depression in I & aVL (RCA) hypotension: acute ascending cholangitis
infants appear normal at birth due to maternal lateral LCX, ST elevation in I, aVL, V5 & V6 infection of common bile duct 2/2 obstruction by
hormones in circulation diagonl ST depression in II, III, aVF gallstones or stricture or bacterial contamination
screening: T4 & TSH RV RCA ST elevation in V4R V6R ALP & WBC
---------------------------------------------------------------- Dx: USS
#1 Rx: supportive & IV ABX ---------------------------------------------------------------- ----------------------------------------------------------------
refractory cases: ERCP biliary decompression Prosthetic joint infection vague abdominal pain, fatigue, microcytic anemia,
---------------------------------------------------------------- MCC early onset: S. aureus, Pseudomonas positive FOBT, hepatomegaly with a firm edge:
Medications a/w pancreatitis MCC delayed onset (> 3 months): S. epidermidis colon cancer with mets to liver
o valproic acid ---------------------------------------------------------------- liver is MC site of mets for colon cancer
o diuretics Unprovoked first seizure Dx: abdominal CT with contrast
o sulfasalazine, 5-ASA (Rx IBD) Dx: brain CT without contrast if unstable ----------------------------------------------------------------
o azathioprine o identify intracranial/subarachnoid hemorrhage Werdnig-Hoffman (spinal muscular atrophy):
o metronidazole Dx: MRI if stable/non-emergency situations autosomal recessive degeneration of anterior horn
CT scan: swelling of pancreas with o identify structural causes of epilepsy, TBI, & motor nuclei
peripancreatic fluid & fat-stranding cerebral infarct, CNS tumors, infections symmetric proximal weakness & hyporeflexia
Rx: resolves with supportive care ---------------------------------------------------------------- does not affect pupils (vs. botulism)
---------------------------------------------------------------- Hemorrhagic stroke sub-categories floppy baby syndrome (also infant botulism)
cirrhosis, heart failure, diabetes, hypogonadism, 1. subarachnoid hemorrhage: sudden onset severe ----------------------------------------------------------------
libido, pseudogout: hemochromatosis headache, N/V, meningismus Hyperandrogenism in pregnancy
AR inheritance 2. intracerebral hemorrhage: acute focal neurologic Luteoma of pregnancy
intestinal iron absorption & deposition in tissues deficits that worsen over minutes hrs o B/L, solid ovarian masses of large lutein cells
o headache, vomiting, altered mental status o benign, MC in A-A
leads to oxidative damage
initial evaluation: serum iron studies Dx: head CT without contrast to r/o hemorrhage o new onset hirsutism & acne
o serum iron, ferritin, & transferrin, TIBC ---------------------------------------------------------------- o Rx: spontaneous regression after pregnancy
child with lethargy, altered mental status, N/V; o high risk of female fetus virilization
Dx: genetic testing for mutated HFE gene
Hx of fever, malaise, headache, cough, coryza, & Theca luteum cyst
o liver biopsy for staging
sore throat treated with ASA: Reye syndrome o B/L multi-septated ovarian cysts on USS
Rx: phlebotomy relieves iron overload
pediatric ASA Rx: juvenile idiopathic arthritis
complications: hepatic fibrosis, cirrhosis, HCC o arise from high -hCG levels a/w molar
& Kawasaki s
---------------------------------------------------------------- pregnancy or multiple gestation
Reye syndrome o Rx: spontaneous regression after pregnancy;
hemochromatosis is a/w Ca++ pyrophosphate
pathophysiolog microvesicular fatty infiltration & suction curettage for complete moles
dihyrate (CPPD) deposition in joints, leading to y on liver Bx hepatic mitochondrial dysfunction
chondrocalcinosis (calcified articular cartilage), o low risk of female fetus virilization
etiology pediatric ASA use for influenza or
which is a/w pseudogout Krukenberg tumor
VZV infection
---------------------------------------------------------------- o B/L solid ovarian masses on USS
features o hepatomegaly
MCC of male infertility o new onset hirsutism
o acute liver failure
anabolic steroid use (testicular atrophy) o mets from primary GIT cancer
o encephalopathy
Klinefelters (testicular fibrosis) o high risk of female fetus virilization
mumps (orchitis) labs o transaminitis
DDx: PCOS (hyperandrogenism in non-pregos)
myotonic dystrophy (testicular atrophy) o PT/INR, PTT
----------------------------------------------------------------
o hyperammonemia
CF (B/L absence of vas deferens) ADHD
5--reductase deficiency ---------------------------------------------------------------- 6 inattentive &/or 6 hyperactive/impulsive
macrovascular fatty infiltration: alcoholic hepatitis symptoms, 6 months in at least 2 setting
Prolactinoma (hypogonadism)
& nonalcoholic fatty liver disease (NAFLD) functional impairment, before age 12 yrs
----------------------------------------------------------------
asymptomatic subtypes: inattentive, hyperactive/impulsive, or
urine dipstick
---------------------------------------------------------------- combined type
o leukocyte esterase indicates pyuria
NAFLD is MC due to peripheral insulin resistance ----------------------------------------------------------------
o nitrites indicate Enterobacteraceae (E. coli)
with peripheral lipolysis & hepatic FA uptake
negative dipstick & +UTI symptoms require a
o a/w metabolic syndrome, obesity, DM
urine culture
Rx: diet/exercise, bariatric surgery for BMI 35
impaired social interaction & communication, Hx of painful, itchy, red streaks on chest, then o moderate: active external rewarming (warm
restricted interests, insistence on routine, arms; Hx smoking: superficial migratory blankets, heating pads, warm bath)
delayed language: autism spectrum disorder thrombophlebitis 2/2 Trousseaus syndrome o severe: active internal rewarming (warmed
can occur without language impairment Trousseaus: hypercoagulable disorder with pleural or peritoneal irrigation, warmed
---------------------------------------------------------------- recurrent, migratory superficial venous thrombosis humidified oxygen)
risk factors for cholesterol gallstones: Caucasian, at unusual sites (arms, chest); Dx prior to or during ----------------------------------------------------------------
obesity, female, rapid weight loss, OCPs, GB occult visceral malignancy; MC pancreas TBI of any severity can lead to post-concussive
hypomobility (fasting, prolonged TPN, pregnancy) evaluate: abdominal CT r/o pancreatic carcinoma syndrome
protective factors: low-CHO diet, exercise, ---------------------------------------------------------------- headache, confusion, amnesia, mood alteration,
caffeinated coffee, ASA or NSAID use oliguria s/p renal transplant, HTN, BUN & Cr, difficulty concentrating, vertigo, sleep disturbance
---------------------------------------------------------------- renal Bx: lymphocytic infiltration & vascular resolves with symptomatic treatment within
female with joint pain, fatigue, ankle edema, involvement with intima swelling: acute rejection weeks to months following TBI
facial rash, proteinuria, & decreased C3: SLE Rx: IV steroids DDx: delayed subdural hematoma (neuro deficits)
2/2 immune complex-mediated kidney damage, ---------------------------------------------------------------- ----------------------------------------------------------------
resulting in complement activation ( C3) Late presentation of aortic coarctation hypochromic, microcytic anemia unresponsive to
DDx: cytotoxic antibodies (Goodpastures) features asymptomatic HTN, chest pain, iron supplementation: thalassemia
---------------------------------------------------------------- claudication, headache, epistaxis, 2/2 reduced Hb synthesis
thalamic stroke involving VPL nucleus, which heart failure ----------------------------------------------------------------
transmits sensory info from C/L body exam brachial-femoral delay, acute bleeding with liver failure Rx: FFP to
C/L hemianesthesia with transient hemiparesis, continuous cardiac murmur from large replace clotting factors
athetosis, or ballistic movements collaterals o liver failure hepatocytes cannot utilize Vit K
dysesthesia in areas affected by sensory loss: studies EKG: LVH ----------------------------------------------------------------
thalamic pain phenomenon CXR: rib-notching, 3 sign Aspiration syndromes
DDx: internal capsule strokes (motor symptoms) confirm Dx: echo pneumonia pneumonitis
---------------------------------------------------------------- Rx balloon angioplasty +/- stent pathophy lung parenchyma lung parenchyma
Causes of urinary incontinence in elderly associatio bicuspid aortic valve, VSD, Turners s infection, inflammation,
GU detrusor contractility, n aspiration of oral aspiration of
detrusor overactivity, ---------------------------------------------------------------- cavity anaerobes gastric contents
bladder/urethra obstruction (tumor, BPH) Hypothermia with acid injury
urogenital fistula mild: tachycardia, tachypnea, ataxia, dysarthria, onset days after aspiration hours after
neurologic dementia (Alzheimers, Parkinson, NPH), shivering aspiration
MS, SCI, disk herniation moderate: bradycardia, lethargy, hypoventilation, features fever, cough, sputum range from
potentially DIAPPERS shivering asymptomatic to
reversible Delirium severe: coma, CV collapse, v-fib, acidosis non-prod cough,
Infection (UTI) ---------------------------------------------------------------- hypoxemia,
Atrophic urethritis/vaginitis bradycardia a/w hypothermia is refractory to Rx resp distress
Pharma (-blockers, anticholinergics) with atropine & cardiac pacing, but improves CXR infiltrate in dependent infiltrates in one
Psych (depression) with correction of hypothermia lung (RLL) or both lower
Excess urine output (diuretics, DM, CHF) Rx hypothermia lobes; resolves
Restricted mobility (post-op) warmed crystalloid IV fluids for hypotension without ABX
Stool impaction intubation if comatose Rx ABX: clindamycin, supportive,
Dx: U/A with culture rewarming techniques to improve or -lactams & no ABX
---------------------------------------------------------------- hemodynamic status -lactams inhibitors
o mild cases: passive external rewarming
(cover with blankets)
aspiration pneumonitis: acute lung injury 2/2 aspiration pneumonia: infection by ----------------------------------------------------------------
chemical burn from gastric contents oropharyngeal secretions 2/2 impaired
consciousness (overdose, seizure, anesthetics)

UWorld 2 CK Notes 2 PDF

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

UWorld 2 CK Notes 2 PDF

Hochgeladen von

Copyright:

Verfügbare Formate

UWorld Notes: Step 2 CK avoidant personality disorder: shyness, feelings maternal infection may be asymptomatic

of inferiority with a desire for friends, but intense ----------------------------------------------------------------

Das könnte Ihnen auch gefallen