FAMILY MED SHELF Flashcards
In SCD what is found on peripheral blood smear?
Howell- Jolly Bodies
What is a common symptom associated with Sickle Cell Trait?
Painless Gross Hematuria + Nocturia
What complications can arise from Sickle Cell Trait?
Kidney Dysfunctions: UTIs, CKD, Renal Papillary Necrosis, Renal Medullary Carcinoma
When does DDH (Developmental Dysplasia of the Hip) occur?
In Infancy
What is a common osteopathic complication in SCD?
Avascular Necrosis
Symptoms of Paroxysmal Nocturnal Hemoglobinuria (PNH)
Dark Urine in Morning Fatigue, Abdominal Pain, Jaundice Pancytopenia Intravascular Hemolysis Negative Coombs Test
What indicates Intravascular Hemolysis?
Unconjugated Hyperbilirubinemia
Elevated LDH
Low Haptoglobin
Hemaglobinuria
Indications of Autoimmune Hemolytic Anemia
Hemolytic Anemia
Positive Antiglobulin (Coombs) Test
PBS: RBC + Polychromasia
Symptoms of Intravascular Hemolysis
Reticulocytosis
Elevated LDH
Low Haptoglobin
HEMOGLOBINURIA
Symptoms of Extravascular Hemolysis
High LDH
Low Haptoglobin
NO HEMAGLOBINURIA
What is Pancytopenia?
Low counts in all blood cell lines
What Drugs can cause Aplastic Anemia
Sulfamethoxazole/Trimethoprim Carbamazepine Methimazole NSAIDs Chloramphenicol Propylthiouracil
How is Hep A Transmitted?
Fecal- Oral, Shellfish Tropical Environments
What Immunoglobulin indicates acute Hep A?
Anti-HAV IgM
Treatment of HPV-1 Plantar Warts?
Topical Salicylic Acid
Fluorouracil Cream
Clinical Presentation of HSV-2
Genital Ulcers
Fever
Tender Inguinal Lymphadenopathy
Clinical Presentation of Treponoma Pallidum
STI Syphyllis-
Primary- non-disappearing painless genital ulcer and inguinal lymphadenopathy
Clinical Presentation of Lymphogranuloma Venerum
Chlamydia
Small Painless Papule- disappears in 1 week
2-4 weeks later- painful suppurative bilateral inguinal lymphadenopathy
fever, malaise, chills, myalgia
Clinical Presentation of PID
Lower Abdominal Pain Dysuria Dyspareunia Purulent Vaginal Discharge Cervical Motion Tenderness
Initial Treatment of PID
Combo Antibiotic Therapy
IM Ceftriaxone (N. gonorrhoeae)
IM Doxycycline (Chalmydia Trachomatis)
Metronidazole (anaerobic bacteria)
Most common pathogens which cause Pelvic Inflammatory Disease (PID)?
Neisseria gonrrhoeae
Chlamydia Trachomatis
PID Follow up Test
HIV Test
Clinical Presentation of Herpangina?
Painful Oral Erosions with erythematous halo
On Palate, Posterior Pharyngeal Wall
Fever, Throat Pain
Cause of Herpangina?
Coxsackie A Virus
Dx and Tx: oral mucosal ulcers with regular margins, yellow fibrinous base in buccal or labial mucosa.
Dx: Apthous Stomatitis (Canker Sores)
Tx: Resolve without Treatment in 10-14 days
Local Chronic Muscle Pain, Restricted ROM, Local Palpable Mass with History of Overuse
Myositis Ossificans
Fx of Marijuana
Slurred Speech + conjunctival Injection (Eye Redness)
Ataxia, Poor Concentration, Euphoria
Acute Fx of Cocaine
Euphoria + Irritability (15-60 mins duration)
Withdrawal Symptoms of Cocaine
Depression, Anxiety, Increased Appetite
Chronic Fx of Cocaine Use
Change in Behavior Poor Concentration Decreased Appetite Chronic Rhinitis Perforation of Nasal Septum
Acute Fx of Phencyclidine
PCP (effects last for hours)
Bizarre Behavior, Irritability
Ataxia- diaphoresis, seizures
Violent Behavior + Hallucinations
Withdrawal symptoms of Phencyclidine
Anxiety and Irritability
Acute Fx of Aerosol Inhalant Use
Rapid Mood Swings, Irritability Poor Concentration, Slurred Speech Anorexia Conjunctival Injection Ataxia (Dysdiadochokinesia) Eczematous Rash in peri-oral area
Chronic/Severe Fx of Aerosol Inhalant Abuse
Cardiac Arrhythmias
CNS Toxicity (seizures, coma)
Death (via respiratory depression)
How to detect Legionella Pneumophila?
1st- Urine Antigen Assay
2nd- PCR
Tx of Legionella Pneumophila
1st- Fluoroquinolones (Levofloxacin)
2nd- Macrolides (Azithromycin)
Dx - Female- foul-smelling, frothy, vaginal discharge
yellow-green color; pH > 4.5
Trichomonas Vaginalis
Treatment of Trichomonas Vaginalis
Oral Metronidazole
Dx: Dyspnea, Dry Cough, Low-Grade Fever, Watery Diarrhea, Bilateral Patchy Infiltrates, Hyponatremia
Legionnaires’ Disease (Legionella Pneumophila)
Dx: Mild Fever, Headache Muscle Aches
Flu or Pontiac Fever
Dx: RUQ Pain + Fever + Hypoechoic Lesion + Liver Abscess
Amebiasis , Entamoeba Histolytica
Dx: Vaginal Discharge- Gray + malodorous, clue cells positive whiff test. pH >4.5
Gardenerella Vaginalis
Dx: Vaginal Discharge, odorless + purulent, positive nucleic acid amplification test
Chlamydia Trachomatis
Dx: Vaginal Discharge, Yellow-green, frothy, pH > 4.5, flagellated protozoa
Trichomonas Vaginalis
Dx: Vaginal Discharge- odorless, white, crumbly, pruritis, burning, pH < 4.5, pseudohyphae
Candida Albicans
Dx: vaginal discharge, odorless, purulent, creamy dysuria, dyspareunia, intermenstrual bleeding
Neisseria Gonorrheoeae
Dx: Bloody Stool + Rectal Pain + Perianal Discharge
Anal Fistula
Treatment of Anal Fistula
Tract Curettage
Treatment of Recurrent Anal Fissures
Anal Spincterotomy
Treatment of Anal Fissures
Sitz Bath (warm water buttocks bath) Topical Calcium Channel Blocker (nifedipine, diltiazem)
Dx: Pain + Paresthesias in distal extremities symmetrically, concurrent ascending flaccid muscle paralysis
Guillain-Barre Syndrome
Dx: Bilateral non-bloody nipple discharge, normal prolactin
Normoprolactinemia Galactorrhea
Common cause of hypogonadotropic hypogonadism
prolactinoma (pituitary adenoma)
hypogonadotropic hypogonadism symptoms
Blocks GnRH–> Low FSH + Low LH—> Low Testosterone
ED, decreased libido, low testicular volume, infertility, gynecomastia, loss of axillary hair
Chronic Hep C Symptom on Dorsal Hand
Porphyria Cutanea Tarda
Hep B and Hep C genetic Makeup
Hep B: DNA
Hep C: RNA
Treatment of Scabies
Topical Permethrin for 8-12 hours, Oral Histamines + Prophylatic Treatment for Contacts
Dx: Fever, Myalgia, Pharyngitis, Posterior Cervical Lymphadenopathy, Young Patient, Mononucleosis
Ebstein Barr Virus (EBV)
Diagnosis + Treatment of EBV
Dx: Heterophile Antibody Test
Tx: Symptomatic Analgesic + Antipyretics
Common Symptom of EBV?
Splenomegaly- Avoid Contact Sports to Avoid Splenic Rupture
Malignancies associated with EBV
Nasopharyngeal Carcinoma, Burkitt’s Lymphoma, Hodgkin Lymphoma
Dx: Epistaxis (bloody nose), painless cervical lymphadenopathy, recurrent otitis media
Nasopharyngeal Carcinoma
Virus associated with Kaposi Sarcoma
HHV-8
Dx: Multiple Nodular purplish submucosal painless skin plaques in AIDS patient
Kaposi Sarcoma
Dx: Fragile Bones, Blue Sclerae, Poor Hearing, Dental Abnormalities, Triangular Facial Structure, Short Child
Osteogenesis Imperfecta (Type I Collagen Defect)
Dx: Frontal Bossing, Nodular Deformities at Ribs (Beading at Ribs), Widened Wrists, Bowing Legs, Erosion of Tooth Enamel
Rickets (Vitamin D Deficiency–> Defective Growth Plate Mineralization)
Dx: Weakness, Fatigue, Mucosal Bleeding, Curly Hair, Poor Wound Healing, Severe Infections
Scurvy (Vitamin C deficiency)–> low cofactor of prolyl/lysyl hydroxylase)
Dx: Short stature/extremities, frontal prominence, microcephaly, scoliosis, trident hands
Achondroplasia (Fibroblast Growth Factor Receptor 3)
Dx: cranial nerve palsies, hip abnormalities, long bone fractures
Osteopetrosis (low osteoclast-mediated bone resorption
Dx: Low Calcium, Low Phosphates, Elevated PTH, Elevated ALPs
Vitamin D Deficiency
Dx: Normal Ca, Phosphates, PTH, Elevated ALPs
Paget’s Disease of the Bone
Dx: Low Calcium, Elevated Phosphate, Elevated PTH Elevated ALPs
Pseudohypoparathyroidism
Dx: Obesity, Round Face, Short Metacarpals, Soft Tissue Calfications, Dental Hypoplasia
Albright Hereditary Osteodystrophy (Pseudohypoparathyroidism)
Dx: Diarrhea, Bloating, Wt Loss, Microcytic Anemia
Celiac Disease
Dx: Bone Pain/Tenderness, Fractures, Waddle Gait, Myopathy, Hypocalcemia, Osteoporosis
Osteomalacia (Vit D deficiency + Hypocalcemia)
ACEi negative side effects
elevated bradykinin–> angioedema, edema of tongue/larynx, upper airway obstruction
Dx: fever, arthralgia, low C4
Serum Sickness
Drugs which can cause Serum Sickness
Bupropion, IVIG, Rituximab, Infliximad, Cefaclor, Cefprozil, Penicillin, Minocycline
Dx: angioedema, dyspnea, pruritis, urticaria
Anaphylactoid Reaction
Drugs which cause anaphylactoid reactions
IV radiocontrast, aspirin, vancomycin, opiates
Dx: flushing, severe diarrhea, cramps, dyspnea, increased serotonin, GI mass
serotonin syndrome via Carcinoid tumors
Dx: dull, persistent headache worsening in morning, gradual vision changes, mass in head
Meningioma
Dx: hypernatremia, hypokalemia, fatigue, muscle weakness, elevated aldosterone
Aldosteronoma
Dx: severe headache, hypertension, bradycardia, nausea, vomiting, acute onset
Intracranial Hemorrhage
Dx: episodic hypertension, excessive sweating, headache, tachycardia, palpitations
Pheochromocytomas
Adult presents with cough, dyspnea, whitish sputum for 5 days. What is first step in management
Supportive Treatment: Rest , Hydration, NSAIDs
Dx: dyspnea, orthopnea, decrescendo diastolic murmur, after S2, left midclavicular line, opening snap, carotid pulses diminished
Mitral Valve Stenosis
Dx: Dyspnea on Exertion, Orthopnea, holosystolic murmur, apex
Mitral Valve Regurgitation
Dx: lower extremity edema, hepatomegaly, holosystolic murmur, 4th intercostal space on left sternal border
Tricuspid Valve Regurgitation
Dx: exertional, nocturnal dyspnea, early diastolic decrescendo murmur, left sternal border, S3 gallop
Aortic Valve Regurgitation
Dx: fatigue, dyspnea, (can be asymptomatic), high frequency mid-systolic click, 5th intercostal mid clavicular line
Mitral Valve Prolapse
Dx: Dyspnea on exertion, orthopnea, crescendo-decrescendo systolic murmur, S4, delayed low carotid pulses
Aortic Valve Stenosis
Dx: Glass factory worker, dyspnea, dry cough, fatigue, fine crackles, calcifications of hilar lymph nodes (egg shell calcification), upper lobes
Silicosis
Complications of advanced silicosis
Pulmonary TB (silica disrupts phagolysosomes/macrophage function)—->Annual TB skin testing recommended Lung Cancer, Cor Pulmonale, RA
Complication of Asbestosis
Malignant Mesothelioma
Dx: Fungal Ball in Lungs, Repositions with Movement
Aspergilloma (Chronic Pulmonary Aspergillosis
Dx: mold spores, asthmatic, fever, chest pain, hemoptysis
Aspergillosis
Common Pneumonia in Immunosuppressed Patients
Pneumocystis Jirovecii
Biopsy of Kaposi Sarcoma
Abundant Lymphocytes
Dx: AIDS CD4<100, multiple cutaneous papules/nodules, red flesh color- bleed easily, diarrhea, wt loss, hepatosplenomegaly
Bartonella Henselae
Biopsy of Bartonella Henselae
Vascular Proliferation + Neutrophilic Infiltrate
Treatment of Bartonella Henselae
Abx: erythromycin or doxycycline
Dx Test for Acute HIV
HIV Viral Load
How long does HIV symptoms take to develop?
3-6 weeks
Tx of Postpartum Depression
Sertraline (SSRI)
Dx: mild-transient depression, episodes of sadness, insomnia, difficulty concentrating after birth
Post-partum blues
Dx: 2 weeks post-birth: depressed mood, anhedonia, significant wt loss, daily insomnia/hypersomnia, slowed down-psychomotor agitation, fatigue, feelings of worthlessness/guilty, difficulty concentrating, recurrent thoughts of death
Postpartum Depression
Tx of Adolescent MDD
Follow up within a month and start fluoxetine (or SSRI) on further evaluation
Dx: alopecia, scaly patches, inflammatory plaques, thick crusting, pustules, boggy feel
Kerion, tinea Capitis
Tx of Kerion
Oral griseofulvin, Oral Terbinafine
Decrease preload in Mitral Regurgitation Murmur
Standing or Valsalva Maneuver
Dx of Ascites SAAG > 1.1 g/dL
Portal Hypertension: cirrhosis, liver metastasis, portal vein thrombosis, alcoholic hepatitis, Budd-Chiari Syndrome, Heart Failure, Constrictive Pericarditis
Dx of Ascites SAAG <1.1g/dL
Pancreatitis Nephrotic syndrome TB Serositis Peritoneal carcinomatosis
Tx: CIN 2
LEEP (loop electrosurgical exicision) + Repeat Pap/HPV test in 12 months
Tx: of UTI and Uncomplicated Bacteriuria in pregnancy + uncomplicated cystitis
Nitrofurantoin
Contraindication for Rotavirus Vaccine
Increased Risk of Intussusception
Live Attenuated Vaccines
MMR Varicella Zoster Yellow Fever Rotavirus Influenza Small Pox Adenovirus Typhoid
Contraindications for administering Live attenuated vaccines
<9 months age (except rotavirus)
Pregnant individuals
Immunodeficient Individuals
Inactivated Whole Vaccines
Polio (Salk) Hep A Rabies Typhoid Influenze Pertussis Cholera Japanese Encephalitis Tick Borne Encephalitis
Inactived Fractionated Protein Vaccines
Hep B Influenza Pertussis HPV Anthrax Diptheria Tetanus
Inactivated Fractional Polysaccharide Vaccines
Hib
Pneumococcal
Meningococcal
Salmonella
Immunizations for Travel
Japanese Encephalitis- Southeast Asia- 2 doses month apart
Yellow Fever- Africa, Central/South America- 1 dose, 10 days before departure
Rabies- Everywhere- 3 does- month
Typhoid/Paratyphoid- developing countries- 1 or 4 doses
Meningococcal- Africa
Pathogens affecting unvaccinated children
Measles Rubella Varicella Zoster Mumps Diphtheriae HIb Strep Pneumo Meningitis Polio Tetanus Pertussis Hep A/B
Dx: High Fever, Erythematous Maculopapular Rash starts neck—> body, bluish-gray spots on buccal lining, generalized lymphadenopathy, malaise, cough, conjunctivitis
Measles
Dx: low grade fever, pink maculopapular rash head—>body, postauricular/suboccipital lympadenopathy, malaise, cough, conjunctivitis
Rubella
Dx: low fever, macules/papules/vesicles- hypopigmented lesions, rash starts at trunk—> moves out, severe itching
Varicella Zoster- Chicken Pox
Dx: fever, malaise, inflammation of salivary glands, unilateral parotitis, orchitis
Mumps
Dx: gray-white pseudomembranes, cervical lympadenopathy, bull neck, foul breath, inspiratory stridor
Diphtheriae
Dx: high fever, sore throat, dysphagia/odynophagia, drooling, muffled/hot-potato voice, respiratory distress
HIb
Dx: Fever, Headache, Neck-stiffness, photophobia, N/V, Altered mental status, seizures
Meningitis (Hib, Strep Pneumo, Neisseria, Polio)
Dx: Fever, headache, neck stiffness, pharyngitis
Hib Meningitis
Dx: Fever, Headache, Neck Stiffness, Sinusitis
Strep Pneumo Meningitis
Dx: Fever, Headache, Neck Stiffness, Myalgia, Petechial/purpuric rash
Neissseria Meningitidis
Dx: Fever, Headache, Neck Stiffness, Assymetric flaccid paralysis- legs, proximal muscles
Polio Meningitis and Poliomyelitis
HBsAg + Anti HBs - HBeAg - Anti- HBe + Anti- HBc IgM - Anti Hbc IgG +
Chronic Hepatitis with Low infectivity
Global Increase of Alveolar Surface Tension associated with
Cardiogenic Pulmonary Edema + CHF
Decreased Pulmonary Compliance Associated with?
Interstitial Lung Disease (Pulmonary Fibrosis, Pneumoconiosis, Sarcoidosis)
Local accumulation in kinins—> cough, What drug?
ACEi
Irreversible Inflammatory Widening of Bronchi
Bronchiectasis
Loss of Functional Residual Capacity (FRC)
Restrictive Lung Disease (Pneumonia)
Diagnostic Test for Lactose Intolerance
Hydrogen Breath Test >20 ppm
Dx: Dyspnea, productive cough, 4-6months/2years chronic smoker
Chronic Bronchitis
Diagnostic Test for Chronic Venous Insufficiency
Duplex Ultrasonography
What B blockers should be avoided in COPD/Asthma patients?
Non-selective Beta Blockers- abetolol, propranolol, nadolol, pindolol, timolol, carvedilol
High ALP (alphafetoprotein) in liver disease suggests?
Hepatocellular Carcinoma
Autoimmune hepatitis specific labs
Anti Smooth muscle antibodies (ASMA)
Anti Nuclear Antibody (ANA)
High Serum IgG
Specific Labs for Primary Biliary Cirrhosis
Anti Mitochondrial Antibodies (AMA)
Cholestatic process symptoms
Jaundice + Pruritis
Dx: low ceruloplasmin, neurlogic symptoms, brown rings around iris, hepatitis
Wilson Disease
Dx: Cirrhosis, HF, DM, bronze skin, arthralgias, high transferrin saturation >50%
Hemachromatosis
PSC (primary sclerosing cholangitis) specific test?
pANCA (perinuclear antineutrophil cytoplasmic antibodies)
Side FX of ARBs
hyperkalemia
Side Fx of non-selective B-blockers?
Bradycardia, hypotension, bronchospasm
Side Fx of ACEi
Dry Cough, Angioedema, Hyperkalemia
Side Fx of CCBs
Peripheral Edema, Headaches, Dizziness, Facial Flushing, Reflex Tachycardia
Complication of untreated group A strep tonsillopharyngitis?
Acute rheumatic fever
Dx: child with arthritis, involuntary irregular non-repetitive movements of limbs, subcutaneous nodules, pink rash on trunk and limbs, mitral regurgitation, post infection
Acute Rheumatic fever secondary to untreated group A streptococcal tonsillopharyngitis
Dx: dorsal side of each hand pressed together produces pain, tingling pain in thumb, index, and middle finger. Nerve and syndrome?
Median Nerve
Carpel Tunnel Syndrome
Dx: Back Pain, Fever, Leukocytosis, cortical destruction, bone marrow edema
Vertebral Osteomyelitis
Most common causative pathogen of vertebral osteomyelitis
Staphylococcus Aureus > Staphylococcus Epidermidis, Enterobacteriaceae, Pseudomonas, Streptococci
Dx: Oliguria, elevated Cr, elevated BUN, hyperkalemia, fractional excretion of Na > 2%
Acute Tubular Necrosis
WBC cast in urinary sediment—-> DDx
Pylonephritis and Acute Interstitial Nephritis (AIN)
Dx: dysuria, frequency, fever, costovertebral angle tenderness, flank pain WBC cast in urinary sediment
Pyelonephritis
Dx: hematuria, sterile pyuria, eosinophilia, flank pain, fever, rash, WBC cast in urinary sediment
Acute Interstitial Nephritis
Pigmented Casts —-> DDx
Rhabdomyolysis + Hemolysis
Dx: proteinuria >3.5g, edema, hyperlipidemia, fatty casts
Nephrotic syndrome
Dx: proteinuria > 3.5g, edema, hyperlipidemia, fatty casts
AKI secondary to Rhabdomyolysis or Hemolysis
Most common cause of intrinsic AKI
Acute Tubular Necrosis
Risk Factors of ATN (Acute Tubular Necrosis)
Advanced Age
History of sepsis
DM
Treatment with ACEi
Cast Cells associated with ATN (Acute Tubular Necrosis)
Muddy Brown Casts (Granular Casts)
Dx: red/cola colored urine, proteinuria < 3.5 g edema, RBC casts
Glomerulonephritis
Dx: persistent elevated BP despite treatment, bilateral carotid bruits, abdominal bruits, elevated plasma renin activity, hypokalemia
Renal Artery Stenosis secondary to atherosclerotic disease
Complication of RAS (Renal Artery Stenosis)
Unilateral Kidney Atrophy
Dx: Headache, depressed mood, fatigue, insomnia, nausea, sensory disturbances, irritability, ataxia, tremor, and myalgia within 4 days of stopping anti-depressant
Antidepressant Discontinuation Syndrome (ADS)
Dx: single genital lesion—> raised papule—> painless firm ulcer with indurated borders and smooth base + lymphadenopathy
Treponema Pallidum- Primary Syphillis
Dx and Tx: large painless vascular lesions on genitalia, no inguinal lymphadenopathy, appear up to 1 year after exposure.
Dx: Klebsiella granulomatis
Tx: Azithromycin until ulcers have completely healed
(Screen for otjer STIs)
Dx: grouped painful vesicles, pustules, and erosions on genitalia, painful inguinal lymphadenopathy within 2-7 days of exposure
HSV-2 (Herpes)
Dx: painful genital ulcers with gray necrotic base + painful inguinal lympadenopathy
Dx: Haemophilus ducreyi
chancre lesions
Dx: painless transient painless papule, then lymphadenopathy, fever, malaise, chills 2-6 weeks after.
Lymphogranuloma Venereum (L1-L3 serotypes of Chlamydia Trachomatis
Dx: fever, fatigue, productive cough with foul smelling sputum, lung cavity with air-fluid level o CXR
Lung Abscesses
Common causes Nosocomial (Hospital Acquired) of Lung Abscess
Aerobes- Pseudomonas Aeruginosa, Acinetobacter baumannii, Nocardia Species, Staphylococcus Aureus
Exposure to Bat droppings/ Cave exploration leading to pneumonia is most likely caused by what organism?
Histopasmosis
Lung abscesses or tricuspid valve by septic emboli in IV drug users is most commonly associated with which organism?
Staphylococcus aureus
Most common cause of lung abscesses
Periodontal diseases via anaerobic bacteria
Peptostreptococcus, Prevotella, Bacteroides, Fusobacterium
Dx: women 30-50 y/o- post URTI with fever, malaise, neck/jaw pain, painful swelling in front part of throat, anxious and sweaty state, elevated ESR, reduced radioiodine uptake
Subacute thyroiditis (De Quervain’s thyroiditis)
Tx of Subacute thyroiditis
Self-limiting: Triphasic—> initial hyperthyroidism (tachycardia, widened pulse pressure, sweating, resting tremor) then hypothyroidism (fatigue, bradycardia, cold intolerance, constipation, weight gain) back to euthyroidism
Most common lung cancer in non-smokers (and women)- located peripherally
Adenocarcinoma - CXR for initial evaluation, CT-guided transthoracic biopsy confirms diagnosis
Large peripheral mass on CXR in a smoker
Large cell carcinoma
Centrally located cavitary lesions on CXR in a patient who smokes
Squamous Cell Carcinoma
Dx: weight loss, fatigue, dry cough, peripheral lymphadenopathy, eye pain and redness, tender nodules and plaques bilateral hilar adenopathy
Sarcoidosis
Dx: diarrhea, flushing, wheezing, lesions in bronchial area
Carcinoid Tumor (Neuroendocrine Tumor)
Common Bacterial Infections with CD4+ count < 200
Pneumocystis, Mycobacterium Avium, Toxoplasmosis
Prevention of disease in CD4 < 200 patient
TMP-SMX + Azithromycin
Dx: Obesity, hepatic lipid accumulation, abnormal hepatic findings, no history of alcohol use, Hep A,B,C
NASH (Nonalcoholic Steatohepatitis)
Dx and Tx: Fever, Headache, Bilateral diffuse reddening of eyes, muscle ache, living in Hawaii
Leptospirosis (infection with Leptospira)]
1st line: doxycycline 2nd line: amoxicillin/azithromycin
Dx: inability to maintain pregnancy, no contractions, recurrent pregnancy losses/ preterm births
Cervical Insufficiency
Dx: constipation, nonpitting pretibial edema, hoarse boice, indurated cool dry skin, obese patient
Hypothydroidism (Hashimoto thyroiditis—> risk for primary thyroid lymphoma
Dx: nephritic sediment (hematuria, RBC casts, moderate proteinuria), elevated Cr + BUN, productive cough
Extra: chronic sinusitis, saddle nose deformity + cANCA positive
Pulmonary Renal Syndrome
Granulomatosis with Polyangitis (GPA or Wegener’s granulomatosis)
Dx: Toddler patient + multiple UTIs complications
Vesicoureteral reflux (VUR) (Dx with VCU)—-> renal scarring, pyelonephritis Tx: prophylatic antibiotics or surgical correction
Dx: Facial erythema, telangiectasia, papules, pustules
Rosacea
Triggers: stress, exercise, hot weather, sun exposure, alcohol consumption
Dx: dry, pruritic, erythematous skin rashes, beginning in childhood, improving in adolescence, worsening in adult hood in flexural creases
Filaggrin gene mutations-atopic dermatitis
Dx and etiology: fevers, fatigue, myalgias, arthritis
SLE
Complement Component 1q antibody deficiency
Complications of Carcinoid Tumors
Tricuspid Insufficiency + Pulmonary Stenosis
Dx: abdominal tenderness and cramps, nonbloody watery bowel movements, cutaneous flusing, telangiectasia, tachycardia, wheezing
Carcinoid Tumor
What is DAPT? When is it used?
Dual antiplatelet therapy (Aspirin + P2Y12 receptor inhibitor (clopidogrel, prasugrel, ticagrelor)
Post- MI after stent placement
Tx: asymptomatic Baker’s cyst vs. symptomatic baker’s cysts
Asymptomatic popliteal cyst - reassurance and observation- resolve spontaneously in 1-2 years
Symptomatic secondary popliteal cysts- underlying disease treatment, arthrocentesis + intraarticular glucocorticoid injection, arthroscopic excision
Dx: younger than 50 y/o shortness of breath, with barrel chest, diminished breath sounds,
Alpha-1-antitrypsin deficiency (A1AD)
A1AD Complications
Liver damage, cirrhoss, hepatocellular carcinoma (i.e. toxic accumulation of misfolded A1A protein in liver.
Which drug has prophylatic medication for malaria for pregnant patients?
Chloroquine, Mefloquine (chloroquine resistant countries), Proguanil,
Tuberculin skin test diagnoses what?
Latent TB
What does Sputum Culture diagnose in TB?
Active TB
What does CXR diagnose in TB?
Active TB in high risk patients
Sputum Microscopy in TB?
Moderate to high risk active TB
PCR of sputum in TB?
Rapid Diagnosis active TB
Interferon-𝛄 release assay
Diagnose exposure to TB
Tx of sleep onset insomnia
Short acting drugs (Triazolam)
Doxepin Drug Uses
Tricyclic antidepressant Sleep maintenance (long acting effect)
Flurazepam drug uses
Benzidiazepine—> sleep maintenance- long-acting effect
Trazodone Drug Uses
Atypical antidepressant— MDD
Sedative effect which can cause daytime drowsiness
Suvorexant drug uses
Orexin receptor antagonists—> insomnia treatment—> sleep onset + sleep maintenance
Causes next day sleepiness and impairs driving performance.
Dx: secondary sexual characteristics, advanced bone age in girl < 8 y/o
Precocious puberty
How to differentiate central and peripheral precocious puberty?
GnRH stimulation test
Increase LH concentrations > 5mIU - central
Increase LH concentrations < 5mIU- peripheral
Breast Mass Screening for women <30 y/o and > 40 y/o
Breast Ultrasound <30
Mammography > 40
Dx: prolonged HTN + progressive dyspnea, lower extremity swelling, JVD
Decompensated left heart failure
Dx:holosystolic murmur on left lower sternal border
Tricuspid regurgitation
Dx: infant with central cyanosis, Tall peaked p-waves, left axis deviation 3 parts
Tricuspid Atresia : Absent Tricuspid valve, Atrial septal defect, Ventricular septal defect
Lab Tests for newly diagnosed HTN
Renal Function Tests: Serum electrolytes, Creatinine, UA, Urine albumin/creatinine
Endocrine Tests- HbA1c, Lipid Profile, TSH
Cardiac- ECG, ECHO
Other: CBC, Uric Acid
Effects of Direct Renin Inhibitors (aliskiren for HTN)
Natriuresis, decreased serum angiotensin II, decreased aldosterone production
FX of ARBs
Act on angiotensin receptors—> do not decrease Angiotensin II , but cause natriuresis and decreased aldosterone production
Dx: murmur heard at the first right intercostal space, unequal carotid pulses, differential blood pressure in upper extremity, palpable thrill in suprasternal notch
Supravalvular aortic stenosis
Complications of Aortic stenosis
Left ventricular hypertrophy, coronary artery stenosis, subendocardial ischemia
Dx: HTN with 3 or more antihypertensive medications
Resistant Hypertension
Causes of Resistant Hypertension
Renovascular Hypertension
- serum Cr > 30% after starting ACEi/ARB
- flash pulmonary edema
- diffuse atherosclerosis
- assymetric kidney size- small atrophic unilateral kidney)
- abdominal bruit
Most important Risk factors for HFpEF
Chronic hypertension
Obesity and Sedentary Lifestyle
CAD and DM
Which non-pharmacologic intervention has the greatest impacts on reducing BP?
DASH diet- 11 mmHg Weight Loss- 6mmHg/10kg loss Aerobic exercise- 7mmHg Sodium intake changes- 5-8 mmHg Alcohol cessation- 5mmHg
Prevent DVT post surgery in high risk patients
Prophylatic low molecular weight heparin (Enoxaparin)- for at least 3 weeks post surgery
How do IgE mediated allergies present?
Immediate Anaphylaxis reaction in any age (<1hr) —> Urticaria (raised itchy rash), Vomiting/Wheezing, Angioedema (swelling underneath skin), hypotension
How do Non-IgE mediated food allergies present in infants <6 months?
Proctocolitis, Insidious onset— painless, bloody stools in a well appearing infant
How does non-IgE mediated food allergies present in infants <12 months?
Protein induced- enterocolitis syndrome- onset within hours- profuse vomiting, diarrhea (+/- blood), dehydration, lethargy, ill-appearing.
most common cause of protein-induced allergic proctocolitis?
Cow’s Milk
Labs of autoimmune hepatitis?
Elevated aspartate aminotransferase, alanine aminotransferase,
Normal alkaline phosphatase and bilirubin
High autoantibody —> serum globulins + 𝛄 gap
Positive serology
Chromium deficiency manifestation
Impaired glucose control in diabetes
Copper deficiency manifestations
Brittle hair Skin depigmentation Neurologic dysfunction (ataxia, peripheral neuropathy) Anemia Osteoporosis
Selenium Deficiency Manifestations
Thyroid dysfunction
Cardiomyopathy
Immune Dysfunction
Zinc Deficiency Manifestations
Alopecia Pustular Skin Rash (perioral region/extremities) Hypogonadism Impaired wound healing Impaired taste Immune dysfunction
What are patients on parenteral nutrition at risk for?
Trace mineral deficiency
Risk factors of trace mineral deficiency?
Malabsorption
bowel resection
poor nutritional intake
dependence on parenteral nutrition
Dx: Recurrent episodes of mild jaundice (provoked by stress aka fever, fasting, dehydration, exercise, menstruation, surgery), elevated unconjugated bilirubinemia (indirect hyperbilirubinemia)
Gilbert Syndrome
Constipated Infant + Ill appearing
Serious Organic causes: Hirschsprung disease, Cystic Fibrosis, Spinal Dysraphism, Hypothyroidism
Constipated + well appearing infant + loose stools +/- blood mucous
Food induced protein enterocolitis
Constipated Infant + Well appearing + Normal Stool consistency
Normal Infant dyschezia
Constipated Infant + Well-Appearing + Hard or Pellet-like Stools
Functional constipation (+/- anal fissure if blood present)
Dx: elderly patient, chronic antacid uses, subtle neurologic defects in lower extremity, dorsal column injury (diminished light touch/vibration sensation)
Vitamin B12 deficiency
Dx: elderly female, progressive abdominal pain, nausea/vomiting, high-pitched bowel sounds and distended, fullness in right groin area
Femoral hernia
Dx: Diarrhea post radiation, <8 weeks, mucus discharge, tenesmus, minimal bleeding, severe erythema/edema ulcerations on endoscopy
Dx: Acute radiation proctitis
Tx: Loperamide and Butyrate Enemas
Dx: > 3 years post radiation, severe bleeding +/- strictures with constipation & rectal pain, multiple telangiectasias, mucosal pallor/friability on endoscopy
Dx: Chronic radiation Proctitis
Tx: endoscopic thermal coagulation, sucralfate/glucocorticoid enemas
Dx: Loose, oily, non-bloody stools, bloating, flatulence, weight loss, decreased linear velocity, contaminated food/water,villous blunting—> malabsorption
Dx: Giardiasis
Diagnostic: stool antigen + PCR testing,
Tx: 1st line = tinidazole/ nitazoxanide or metronidazole
- pregnancy- paromomycin
- refractory/recurrent: evaluate for CF/CVID
Dx: New IDA in elderly patient
GI blood loss - Check colonoscopy/endoscopy
Dx and Tx: Child, ear pain, itch, pain with auricle manipulation, tympanic membrane spared
Otitis Externa- Pseudomonas/ Staph A/ Foreign Object
Tx: Remove Debris, Topical FQ (ciprofloxacin) +/- topical glucocorticoid, wick placement
Most concern with Parotid Masses
Cranial nerve dysfunction: facial droop, facial numbness
Presbycusis
Age related Hearing Loss (cochlear hair cell loss)
Nasopharyngeal Carcinoma is endemic where? Treatment
Asia
Radiation/Chemotherapy
EEG?
Test which detects abnormalities in brain waves or in electrical activity of your brain
Thyroid Nodules Management?
Fine-Needle Aspiration Bx
Complication of recurrent acute otitis media: fever, ear pain, infection behind ear, displacement of auricle
Acute Mastoiditis
Dx: painless, white lesions in mouth which cannot be scraped off, fatigue, unintentional weight loss, cervical adenopathy
Oral Hairy Leukoplakia (obtain HIV testing)
Dx and Tx: Nasal Drip (rhinorrhea), nasal congestion, sneezing, nasal itching, darkened circles under eyes, transverse nasal crease, pale bluish turbinates, pharyngeal cobblestoning, high arched breathing
Dx: Allergic Rhinitis (Allergic shiners, salute, facies)
Tx: intranasal corticosteroids
Dx + Tx: infant, middle ear effusion, tympanic membrane inflammation- fever, earache (otalgia), erythema.
Acute Otitis Media: Strep Pneumo, H. Flu, Moraxella,
Tx: amox, amox+clauv or penicillin allergy: clindamycin
Complications of acute Otitis Media
TM perforation
Conductive Hearing Loss
Mastoiditis
Meningitis
Dx and Tx: child, Respiratory Distress, Dysphagia, dysphonia, drooling, high fever, “thumb sign on X-ray,
Dx: Epiglottitis (H.Flu)
Tx: endotracheal intubation + antibiotics
Prevent: immunization against Hib
Dx: clear unilateral rhinorrhea increasing at times bending over/bowel movements, salty/metallic tast
CSF rhinorrhea- check for trauma- bed rest, elevation of head, avoid strain, lumbar drain placement, surgical repair
Dx and Tx: Child: Ear fullness/discomfort, tinnitus, conductive hearing loss, popping sensation
Retracted tympanic membrane—eustachian tube dysfunction predisposing factor for acute otitis media
Dx and Tx: ear pain, hearing loss associated with flying
Dx: Barotrauma to the ear
Tx: Reassurance and Follow-Up
Dx: asthma, bronchospasm, or bland taste for food, nasal congestion (nasal polyposis) with naproxen
AERD (Aspirin Exacerbated Respiratory Disease)
Dx + Tx
: chronic mass in hard palate, benign bony growth, congenital or develop later in life
Torus Palatinus
Tx: with Surgery if needed
Treatment of Bisphosphonate-related osteonecrosis of the jaw?
Oral Hygiene, Antibacterial Rinses, Antibiotics and debridement
Dx: Smoker or Drinker, White patches on Tongue that can’t be wiped off
Oral Leukoplakia
Dx and Tx: unilateral sensorineural hearing loss and imbalance, facial numbness or paralysis
Dx: Vestibular Schwannoma (CN8 and CN5 dysfunction)
Tx: Observation, Surgery, Radiation
DDx: Blood streaked stools in a well appearing infant <6 months old
DDx: Anal Fissure or Food-protein induced allergic proctocolitis (FPIAP)
Dx + Tx: Blood streaked stools in a well appearing infant <6 months old, normal rectal exam, hx of loose stools, presence of mucous in the stool,
Dx: food protein induced allergic proctocolitis
Dx: acute fever. nausea, right upper quadrant pain, hepatomegaly, jaundice elevated liver transanimases >1000
Acute Hep A infection
Dx: fatigue, pruritis, elevated Alk Phos, normal common bile duct
Test:
Test: antimitochondrial antibodies
Dx: PBC (primary biliary cholangitis
Dx: Fatigue, pruritis, elevated alk phos, elevated bilirubin
PSC (Primary Sclerosing Cholangitis)
Complications of Primary Sclerosing Cholangitis
Association with IBD, UC
Cholangiocarcinoma, Colon Cancer, Biliary Cancer
Dx: asymptomatic + high alk phos + high 𝛄- glutamyl transpeptidase
Primary Sclerosing Cholangitis
Unmodifiable Risk factors of Pancreatic Cancer
1st Degree Relative with Pancreatic Cancer
Hereditary Pancreatitis
Germline Mutations
Environmental Risk Factors of Pancreatic Cancer
Cigarette Smoking
Obesity
Nonhereditary Chronic Pancreatitis
Dx: Diarrhea (nausea, abdominal pain, loss of appetite), Dermatitis (rough, hyper pigmented scaly skin), Dementia (depressed mood, memory loss, psychosis)
Pellegra- Vitamin B3- Niacin Deficiency
Dx: metabolic syndrome, AST/ALT < 1, hyperechoic texture on ultrasound of liver
Non- Alcoholic Fatty Liver Disease + Insulin Resistance
When do use anoscopy?
Patients with no clinical features but minimal bleeding: hemorroids or anal fissures
F/U with cirrhosis
Diagnostic upper endoscopy- risk of hemorrhage
Esophageal Varices—-> variceal hemorrhage prevention
Non-selective beta blocker
What medications can cause medication induced esophagitis?
Tetracyclines (doxycycline)
Aspirin and NSAIDs
Bisphosphonates (Alendronate, Risendronate)
Potassium Chloride, Iron
dx: abrupt onset retrosternal pain with severe painful swallowing
Medication-induced esophagitis- clinical + endoscopy (ulcers with normal surrounding mucosa
Dx: female solitary well-circumscribed mobile mass on chest
Breast Cyst
Dx: female, multiple diffuse nodulocystic masses, premenstrual tenderness
Fibrocystic changes
Dx: solitary, firm, well-circumscribed and mobile mass, premenstrual tenderness
Fibroadenoma
Dx: female, after trauma/surgery, firm, irregular mass +/- ecchymosis, skin/nipple retraction
Fat Necrosis
Common sign of hyperandrogenism
Severe nodulocystic acne
Dx: Hirsutism, Nodulocystic acne, Androgenic alopecia, high serum testosterone, irregular menses in female
Dx: PCOS (polycystic ovaries on ultrasound)
When does Pap test start?
21 y/o
Dx & Tx: asymptomatic or vaginal/pelvic pressure, stress urinary incontinence, retention, constipation, incomplete defecation.
Dx: Pelvic Organ Prolapse- Bowel, Bladder, or uterus herniation into vagina
Tx: Asymptomatic- Observation, Symptomatic- Pelvic floor kegel exercises, vaginal pessary, surgical repair
Dx: chronic pelvic pain and adnexal mass, cellular metaplasia, retrograde menstruation, worsening pain with exercise, dysparenia,
Endometriosis
Screening Guidelines of Cervical Screening
<21—> No screening 21-29—> Cytology every 3 years 30-65—> Cytology plus HPV every 5 years >65—> no screening needed Hysterectomy—> no screening HIV—-> annual until >3 normal results Immunosuppressed > annual pap test + HPV
Tx of Menopause Symptoms (vasomotor symptoms, oligomenorrhea/amenorrhea, sleep disturbances, decreased libido, depression, cognitive decline, vaginal atrophy)
Tx: topical vaginal estrogen + systemic Hormone Replacement Therapy
Tx: asymptomatic uterine leiomyomas (fibroids)
Tx: observation
Dx + Tx: heavy, prolonged menses, pelvic pain, constipation, urinary frequency, irregular ultrasound (heavy, prolonged menses, chronic pelvic pain, bulk symptoms, recurrent pregnancy loss)
Dx: uterine leiomyomata
Tx: Hormonal contraception, Surgery
Dx, Tx, Cx: chronic constipation and vaginal bulge
Dx: pelvic organ prolapse
Tx: pelvic floor muscle exercises, vaginal pessary placement, possible surgical correction
Cx: levator ani muscle complex damage
Dx and Tx: female, sudden strong urge to urinate and urine leakage
Dx: urgency urinary incontinence
Tx: lifestyle behavior pelvic floor exercises
2nd- pharmacotherapy—> oxybutynin (systemic antimuscurinic) or mirabegron (fewer systemic side effects)
Dx and Tx: urine leaks with laughing, sneezing, coughing, exercising
Dx: Stress Urinary Incontinence
Tx: Midurethral Slings
Contraindications for SERMs
Thromboembolism
Annual Screening for sexually active females <25
Clamydia and Gonorrhea- NAAT is best (nucleic acid amplification testing)
Most important risk factors for Breast Cancer
- Age
- Increased estrogen Exposure
- Family History
What is the follow up test if a pap smear test is unsatisfactory?
Endocervical curettage
Dx and Tx: pain in first 2-3 days of menses, N/V/D, normal pelvic examination
Primary Dysmenorrhea
Tx: NSAIDs (inhibit prostaglandin) in non-sexually active patients
Oral contraceptives in sexually active patients
Unilateral firm tender mass posterior to the nipple in girl (8-10
First sign of puberty- physiologic thelarche
Tx: of Chlamydia Trachomatis
Doxycycline
Azithromycin in pregnant patients
Dx + Tx: >40 woman, multiparity, prior uterine surgery with dysmenorrhea, heavy menstrual bleeding, chronic pelvic pain, diffuse uterine enlargement, uterine tenderness
Adenomyosis- thickened myometrium + MRI/US + Pathology confirmation
Treatment: Hysterectomy
Dx + Tx: Young woman, strenous exercise, relative caloric defiiciency, stress fractures, amenorrhea, infertility
Dx: Exercised Induced Hypothalamic Amenorrhea
Tx: Increase Caloric Intake, Estrogen, Calcium + Vit D
Chronic Abnormal uterine bleeding in obese patient, no menstrual cycles
Anovulation - obesity contributes to increased overall estrone levels —> disrupt Hypothalamic- pituitary- ovarian axis- anovulation and uterine bleeding.
Dx + Tx: Maculopapular Rash, Fever, New Drug exposure +/- arthralgias. Labs: pyuria, hematuria, WBC cast
Dx: Acute Interstitial Nephritis
Tx: Discontinue new drug, +/- systemic glucocorticoids
Dx: malar rash/discoid rash + hypertension, mild proteinuria + RBC casts
Dx: Lupus Nephritis
Dx: hematuria, mild proteinuria, RBC casts, fluid retention, hypertension, periorbital edema, 1-2 weeks after episode of streptococcal pharyngitis/skin infection
Dx: Postinfectious glomerulonephritis
Dx, Cx, and Tx: Night time urinary incontinence + Boys 5-8,
Nocturnal Enuresis - self-resolves, behavioral modifications, enuresis alarms, desmopressin therapy
Cx: constipation (leaky stool)- treat with laxatives
diagnostic test for post-renal diseases
Renal ultrasound
Dx , Cx, Tx: < 50 y.o. Asymptomatic, renal stones, moans, groans, bones, hypercalcemia, elevated PTH, elevated 24 hr urinary calcium excretion,
Dx: Primary Hyperparathyroidism
Cx: Osteoporosis, Nephrolithiasis, CKD
Tx: parathyroidectomy
Dx, Diagnostic, and Tx: episodic headache, sweating, tachycardia or resistant HTN
Dx: Pheochromocytoma
Diagnostic: urine/plasma metanephrines + confirmatory abdominal imaging
Tx: pre-operative alpha blockade prior to beta blockade, laparoscopic/open surgical resection
Dx: Asymptomatic, renal stones, moans, groans, bones, hypercalcemia, elevated PTH, elevated 24 hr urinary calcium excretion, Pituitary Tumors (prolactin, visual defects), Pancreatic tumors (gastrinomas)
MEN Type 1
Dx: Asymptomatic, renal stones, moans, groans, bones, hypercalcemia, elevated PTH, elevated 24 hr urinary calcium excretion,
Medullary Thyroid Cancer (Calcitonin elevated)
Pheochromocytoma (Episodic Headache, tachycardia, Sweating or Resistant HTN)
MEN Type 2A
Dx: Asymptomatic, renal stones, moans, groans, bones, hypercalcemia, elevated PTH, elevated 24 hr urinary calcium excretion,
Medullary Thyroid Cancer (Calcitonin elevated)
Mucosal Neuromas/Marfanoid Habitus
MEN Type 2B
Difference between pseudogynecomastia and gynecomastia
Pseudo: Excessive deposition of fat without distinct margin
True: margin of glandular tissue
Squamous Cell Carcinoma with elevated calcium, low phosphorus
Hypercalcemia of malignancy = PTHrP —> low PTH —-> mimics PTH— high calcium low phosphorus
Findings associated with T2DM
Obesity, HTN, dyslipidemia, aconthosis nigricans
Dx: oligomenorrhea (inconsistent menses), hirsutism (excess terminal hair growth), virilization (clitoromegaly), obesity, T2DM, dyslipidemia, hypertension
PCOS
Dx: PCOS (oligomenorrhea, hirsutism, hyperandrogenism, obesity) + elevated serum 17-hydroxyprogesterone
21- hydroxylase deficiency
Dx: rapidly progressive hirsutism with virilization + high serum androgens, post menopausal
Androgen-secreting ovarian tumors, ovarian hyperthecosis
Or high androgen secreting neoplasm
Dx: Diarrhea (steatorrhea), Wt Loss, Ab Pain, Flatulence/Bloating
Dermatitis herpetiformis, atrophic glossitis,
Vit D deficiency, secondary hyperparathyroidism (Low Ca, Low Phos, High PTH)
Osteomalacia/Osteoporosis/Rickets
IDA
Peripheral Neuropathy/ Depression Anxiety
Can have ulcerative jejunitis, enteropathy- associated T-cell lymphoma
Celiac Disease
Best Management of DKD
Reduce BP to <130/80 with ACE/ARB
Reduce HBA1c <7.0 with SGLT2i , GLP-1 agonist
Dx + Diagnostic + Tx: hyperpigmentation, athropathy (joint pain), hepatomegaly, cirrhosis (HCC), diabetes mellitus, hypopituitarism, hypogonadism, cardiomyopathy
Dx: Hereditary Hemochromatosis
Diagnosis: Elevated Liver Transaminases (ALT, AST), elevated serum ferritin, transferrin saturation
Tx: Therapeutic phlebotomy (urgent if ferritin >1000
Dx, Diagnostics, and Tx: Fatigue, Weakness, Anorexia/Wt loss, N/V/ Ab Pain, Salt Craving, Postural Hypotension, Hyperpigmentation
Dx: Primary Adrenal Insufficiency
Labs: Hyponatremia, hyperkalemia, eosinophilia, low morning cortisol, high ACTH
Tx: Glucocorticoids (hydrocortisone, prednisone), Mineralocorticoids (fludrocortisone)
Dx: elevated free T4, supressed TSH, tachycardia, anxiety, wt loss, low RAIU, non-tender, enlarged thyroid gland
Self-limiting painless thyroiditis
Tx: propranolol—> control palpitations, tremulousness
Hypothyroid features, diffuse goiter, TPO antibody, variable RAIU
Chronic autoimmune thyroiditis (Hashimoto thyroiditis)
Mild brief hyperthyroid phase, hypothyroid phase, small non-tender goiter, spontaneous recovery, positive TPO, low RAIU
Painless (silent Thyroiditis)
Post-viral URTI, prominent fever, hyperthyroid symptoms (painful/tender goiter), elevated ESR + CRP, Low RAIU
Subacute thyroiditis- de Quervain thyroiditis)
Dx: arthralgias (joint pain), jaw widening (increased interdental spaces), macroglossia (enlarged tongue)
Headache, visual field defect, cranial nerve defects, skin thickening, hyperhidrosis,
Hypogonadism, DM, hypertriglyceridemia
Joint involvement in axial and appendicular skeleton, joint space widening
Acromegaly: excessive growth hormone
Hypertension hypokalemia + elevated renin/ aldosterone
Secondary hyperaldosteronism (renovascular hypertension, malignant hypertension, renin-secreting tumor, diuretic use
Hypertension, hypokalemia, low renin high aldosterone
Primary hyperaldosteronism (aldosterone producing tumor, bilateral adrenal hyperplasia)
Hypertension + hypokalemia + low renin, low aldosterone
Non-aldosterone causes- congenital adrenal hyperplasia, deoxycorticosterone producing adrenal tumor, Cushing Syndrome, Exogenous Mineralocorticoids
Hyperprolactin symptoms > prolaction 25-100 mg
Medication related -Hyperprolactinemia- gynecomastia, galactorrhea, menstrual dysfunction, decreased libido most- likely risperidone
Hyperprolactinism- > 200ng/ml
Prolactinomas- headaches, visual disturbances
Mechanism of diabetic neuropathy- large fiber neuropathy
- pressure, proprioception, balance, numbness, poor balance, diminished ankle reflexes, reduced vibration to light tough, axonopathy of large nerve fibers
Mechanism of diabetic neuropathy- small fiber neuropathy
Pain and temperature, burning/stabbing pain, reduced pinprick sensation, ankle reflexes reserved
Diabetic Nephropathy —> > 30 mg/g- albuminuria, decreased glomerular filtration
Also proliferative diabetic retinopathy
What does that CHA2DS2VASC score assess?
Whether a patient should be on anticoagulant therapy
Male > 2 , Female > 3
Choice of HTN drug in Angina Pectoris?
B-blocker (-olols) or CCB (amlodipine)
HTN drug of choice in post MI
ACEi (lisinopril) or ARB (losartan) or B-blocker (-olols)
HTN drug of choice in HFrEF?
ACEi (lisinopril) or ARB (losartan), B-blocker (-olols), diuretic (-thiazide), aldosterone agonist (spironolactone, eplerenone)
HTN drug of choice in Afib?
Beta blocker (-olol), nondihydropyridine CCB (diltiazem)
HTN drug of choice in CKD?
ACEi (lisinopril) or ARB (losartan)
HTN drug of choice in gout
Losartan, other ARB, CCB, avoid diuretics
HTN drug of choice in osteoporosis
Thiazide diuretic
HTN drug of choice with migraine
B-blocker (olols), CCB (amlodipine)
Screening for abdominal aortic aneurysm
One time abdominal duplex US
Absolute Contraindication of Hormonal Contraception
Active Breast Cancer Migraines with Aura Uncontrolled HTN Active Hepatitis, Cirrhosis, Liver Cancer Age > 35 and 1.5 packs smoking daily Ischemic Heart Disease, Stroke <3 weeks post partum Prolonged immobilization Thrombophilia (Factor V Leiden, Antiphospholipid antibody syndrome) Venous Thromboembolism
What is recurrent UTI?
> 2 infections in 6 months
> 3 infections in 1 year
Risk factors for Reccurent UTIs
History of cystitis <15 years old
Spermicide Use
New Sexual Partner
Postmenopausal status
Dx of UTI
UA + Urine Culture, Clean Catch
Prevention of UTI
Behavior modification- Contraception,
Postcoital/Daily Antibiotic prophylaxis
Topical Vaginal Estrogen for Post menopausal patients
Cx of candida albicans
Erythematous beefy red plaques, mirror image, satellite regions - intertrigo- happens in impaired immunity, obesity, tight fit clothing
Tx: Topical azoles (clotrimazole)
Tx of Recurrent UTI in postmenopausal patients
Topical Vaginal Postmenopausal patients
Dx: Woman Breast feeding, fever, firm red, tender, swollen quadrant of unilateral breast, myalgia, chills, malaise
Frequent Breastfeeding/ Pumping + Antibiotics, analgesia
Postmenopausal bleeding causes
Endometrial hyperplasia or cancer (older women and obesity)
Approach to menopausal bleeding
Endometrial biopsy or TVUS endometrium <4mm observe, >4 mm biopsy (benign - observe) Atypia neoplasia (progestins)
Pelvic organ prolapse is
Abnormal herniation of uterus, bladder, rectum through the vaginal wall
Weakened pelvic floor muscles
Most common risk factor is Multiparity
Vaginal mass worsening with valsalva
Dx: pelvic pressure, obstructed voiding, urinary retention, urinary urgency/incontinence, constipation, fecal urgency/incontinence, sexual dysfunction
Pelvic organ prolapse:
Anterior prolapse: bladder (cystocele) - pelvic pressure, obstructed voiding, urinary retention/urgency, incontience
Posterior prolapse: Rectum (rectocele- fecal urgency/incontinence
enterocele- small intestine
Apical prolapse: uterus/ vaginal vault
Procidentia: complete herniation
Ovarian cyst <4cm with thin walls
Physiologic ovarian cysts
Dx + Tx: Acute unilateral lower abdominal pain in reproductive age women- thin-walled ovarian cysts with pelvic free fluid
Ovarian cyst Rupture
Tx: observation and reassurance if hemodynamically stable, no infection
If infected and hemodynamically unstable- surgery
Abnormal uterine bleeding in obese female
Increased peripheral conversion/aromatization of androgens to estrone—> chronic anovulation—-> endometrial hyperplasia
Contraindications for using a IUD
Heavy menstrual bleeding
Contraception method <1 month post partum + breast feeding
Subdermal progestin-releasing implant
Bilateral breast soreness, weight gain, increasing fatigue
Early Pregnancy
Dx with Urine Pregnancy Test
Dx: hyperpigmentation on sun-exposed areas of face in pregnancy, symmetric centrofacial, mandibular, malar distribution
Dx: Melasma
Tx: self-resolving, use sunscreen
Causes of Oligohydramnios
Early: dependent on fetal urine production- aneuploidy, renal agenesis, posterior urethral valves
Late: uteroplancental insufficiency: fetal growth restriction,
Maternal causes: dehydration rupture of membranes
Amniotic fluid <5cm
Oligohydramnios
Dx: late term oligohydramnios + increased clear vaginal discharge + asymptomatic
Spontaneous rupture of membranes
Dx: late term oligohydramnios + fetal growth restriction + abnormal U/S findings
congenital infections (CMV)
What vaccines are recommended during pregnancy?
Tdap
Inactivated Influenza
Rho (D) Immunoglobulin
What vaccines are indicated for high risk pregnant patients?
Hep B, Hep A Pneumococcus Haemophilus Influenza (HiB) Meningococcus Varicella-Zoster immunoglobulin
What vaccines are contraindicated in pregnant patients?
HPV
MMR
Live-Attenuated Influenza
Varicella
Absolute Contraindications for Exercising during Pregnancy
Amniotic Fluid Leak Cervical Insufficiency Multiple Gestation Placenta Abruption/ Previa Premature Labor Pre-eclampsia/ Gestational Hypertension Severe Heart and Lung Disease
Unsafe Activities for Pregnant Women
Contact Sports
High Fall Risk
Scuba Diving
Hot Yoga
Exercise Recommendations for Pregnant Women
Moderate- Intensity Exercise- Most/All Days - 20-30 mins
Causes of Fetal Tachycardia (>160/min)
Maternal Fever
Medication Side Effect (B-agonist)
Fetal hyperthyroidism
Fetal Tachyarrhythmia
Causes of Fetal Bradycardia (<110/min)
Maternal hypothermia
Medication side effect (B-blockers)
Fetal hypothyroidism
Fetal Heart Block
Lab Test in initial Prenatal Visit
Rh(D) type + antibody screening - autoimmune attack of fetus HgB, Hct, MCV, ferritin - IDA, anemia HIV, VDRL/RPR, HbsAg, anti-HCV Ab - HIV, syphilis, Hep A and C Rubella + Varicella Immunity Urine Culture Urine Dipstick for Protein Clamydia PCR Pap test (if indicated)
Lab Tests in 24-28 weeks gestation
HgB/ Hct- anemia
Antibody screen if Rh(D) negative- autoimmune attack of fetus
1-hr 50g GCT - gestational diabetes
Lab Tests in 36-38 weeks gestation
Group b Streptococcus Rectovaginal Culture
Anemia in Pregnancy HgB <
11.0
Appropriate Weight Gain in Pregnancy
<18.5 BMI =28-40 lbs
18.5-24.9 BMI = 25-35lbs
25-29.9 BMI = 15-25lbs
>30 BMI = 11-20lbs
Harmful Substances to avoid in Pregnancy
Recreational Substances
High Mercury Levels
Alcohol
Caffeine
Food Safety in Pregnancy
Avoid undercooked meat, fish, eggs
Clean Raw fruits/veggies
Avoid unpasteurized dairy
Complications of inadequate weight gain in pregnancy
Low birth weight
Pre term delivery
Complications of Excessive weight gain in pregnancy
Gestational Diabetes
Fetal Macrosomia
Cesarean Delivery
Contraindications of DTaP vaccinations
Anaphylaxis
Unstable Neurologic Disorders (infantile spasms, uncontrolled epilepsy)
Encephalopathy (coma, decreased level of consciousness, prolonged seizures)
Dx and Tx: Young patient, recurrent sinpulmonary infections, chronic lung disease, non-smoker, progressive cough/dyspnea
CVID
Diagnostics: Quantitative Immunoglobulin Assay low IgG low Iga low IgM
Tx: Immunoglobulin replacement therapy
Tx of Infant constipation (infrequent defecation, hard painful stools, large-caliber or pellet like stools, anal fissures)
Add undigestable, osmotically active carbohydrate (prune/apple juice/puree
Dx and Tx: diarrhea, mucus discharge, tenesmus, minimal bleeding, <8 weeks post radiation therapy, endoscopy: severe erythema, edema + ulcerations
Acute Radiation Proctitis
Tx: Antidiarrheals (loperamide) and butyrate enemas
Dx and Tx: severe bleeding, strictures with constipation and rectal pain, >3 months radiation endoscopy: multiple telangiectasias, mucosal pallor/friability
Dx: Chronic radiation proctitis
Tx: Endoscopic thermal coagulation, sucralfate or glucocorticoid enemas
Dx diagnostic Tx: 40s, osmotic diarrhea, abdrominal cramps, bloating, no steatorrhea, flatulence with dairy ingestion
Dx: lactose intolerance
diagnostic: Lactose hydrogen breath test, positive stool test for reducing substances, low stool pH, increased stool osmotic gap,
Dx, diagnostics, Tx:
General: Bulky, foul smelling, floating stools
Fat/Protein: loss of muscle mass, loss of subQ fat, fatigue
Iron: Pallor (anemia), fatigue
Calcium + Vit D- bone pain + fracture
Vitamin K- easy bruising
Vitamin A- hyperkeratosis
Celiac Disease
Diagnostic: IgA anti-tissue transglutaminase, IgA anti-endomysial antibodies
Dx, Diagnostic, Tx: difficulty swallowing (dysphagia), bad breath (hallitosis), history of regurgitating undigested food, gurgling sound, recurrent aspiration pneumonia
Zenker Diverticulum
Diagnostic: contrast swallow study
Tx: surgical -cricopharyngeal myotomy, diverticulectomy, diverticulotomy
Dx and Tx: tender papulopustular eruption on lower extremeties after swimming in heated hotel pool, low grade fever,
Pseudomonas aeruginosa folliculitis (hot tub folliulitis
Tx: self-limited
Dx, Diagnostic, TX: child, fever, irritability, limited function of a limb, bony tenderness, swelling, elevated ESR, CRP, WBC
Osteomyelitis
X-ray, MRI, bone biopsy, blood culture, ESR, CRP WBC count elevated
Tx: vancomycin
Risk Factors: sickle cell, immunodeficiency
Features of Viral Upper Respiratory Syndrome
Slow onset
Rhinorrhea, Coryza, sneezing, mild pharyngitis
Mild Systemic Symptoms
Nasal Edema, slightly erythematous pharynx
Influenza Clinical Features
Abrupt dramatic onset
respiratory symptoms mild
high fever, myalgias, headaches
Streptococcal pharyngitis clinical features
Variable onset of symptoms
pharyngeal symptoms
might be fever and myalgias
pharyngeal erythema, tonsillar hypertrophy/exudates, tender cervical lymph nodes
Stages of Lyme Disease (Borrelia Burgdorferi
Early Localized (days- months)- erythema migrans, fatigue, myalgias, arthralgias Early Disseminated (weeks-months)- multiple erythema migrans, CN VII palsy, meningitis, carditis (AV block), migratory arthralgias Late- arthritis, encephalitis, peripheral neuropathy
Treatment of Borrelia burgdorferi (Ixodes Scapularis Tick)
Doxycycline
Dx and Tx: Traveler’s Diarrhea < 2 weeks, watery diarrhea, crampy abdominal pain, ingestion of contaminated water, food
ETEC- Enterotoxigenic Escherichia Coli
Tx: supportive
Dx, Diagnostic, Tx: Traveller’s Diarrhea > 2weeks, bloody mucid diarrhea, liver abcess
Dx: Entamoeba Histolytica
Diagnostic: Stool Analysis: cysts + trophozoites
Tx: Metronidazole or Tinidazole
Dx, DGx, Tx: traveller’s diarrhea > 2 weeks, watery/oily, foul-smelling stools, bloating, fat malabsorption, weight loss (fatigue, N/V)
Dx: Giardia Lamblia
DGx: Stool analysis: cysts + multinucleated trophozoites, Immunoassay, PCR
Tx: Metronidazole or Tinidazole
Dx, DGx, Tx: Traveller’s Diarrhea > 2 weeks, watery diarrhea, immunosuppressed patient ( CD4 <100)
Dx: Cryptosporidium
DGx: Stool test: acid fast cysts in stool
Tx: ORT + consider nitazoxanide
Dx: Traveller’s Diarrhea > 2 weeks, watery/blood diarrhea, waxing/waning symptoms
Dx: Cyclospora
DGx: Stool Test
Tx: TMP- SMX
Guidelines for PPSV23 vaccine administration
Recommended for all adults > 65
<65 with chronic liver disease, lung disease, heart disease, diabetes mellitus, smoking history
Requirements for Hep A Prophylaxis
Hep A Vaccine or Ig for close personal contacts of Hep A infected patients, Child care center contacts, food prep workers
< 2 weeks
younger patients <40 should take vaccine, > 40 Hep A Ig
Bug with itchy (pruritic), small puncta/ maculopapules in linear groups on unclothed skin
Beg Bug
Bug with widespred itching of hair, body or genitalia with visible louse
Lice (pediculosis)
Bug with itchy burrows, hemorrhagic crusts in interriginous areas
Scabies
Bug with Solitary papule/pustule or wheal and itching
Spider
Bug with Painless red papule, itchy during spring/summer
Tick
dry scaly flat papules with red base in sun exposed areas
Actinic Keratosis
tan, brown, round lesion, well demarcated border, stuck on appearance, benign lesions
Seborrheic keratosis
skin tag
acrochordon
slow growing papule, nodule, pearly, rolled border, overlying telangiectasias
Basal Cell Carcinoma
enlarging non-healing ulcer, bleeding on contact
Squamous Cell Carcinoma secondary to chronic wounds
Tx of HPV plantar warts
salicylic acid cream
5-fluoro uracil cream
persistent itchy plaque with lichenification, fissuring
Chronic Allergic Contact Dermatitis (type IV mediated hypersensitivity
Tx: of Allergic Contact Dermatitis
avoidance + topical/systemic corticosteroid
Dx, DGx, Tx: Scaly plaques + Ulceration, well demarcated patches/plaques
Dx: Squamous Cell Carcinoma in Situ
DGx: Punch, Shave, Excisional Biopsy
Tx: Excision 4-6mm margins, Mohs Micrographic Surgery, Cryotherapy, Topical 5-FU, imiquimod
Pathology of Parkinson Disease
Accumulation of alpha synuclein within neurons of the substantia nigra pars compacta
Dx DGx and Tx: elderly, tremor, rigidity in movements, akinesia/bradykinesia, postural instability
Parkinson Disease
DGx: Clinical Diagnosis
Tx: levodopa
Adverse Effects of Benzos in elderly
Increased risk of confusion, falls, baseline cognitive impairment,
Recurrent episodes of confusion, aggression, disinhibition within an hour of taking benzos in elderly
Paradoxical agitation
Abortive Migraine Therapy
Triptans (Sumatriptan)
NSAIDs (Naproxen or Acetominophen)
Antiemetics (metoclopramide, prochlorperazine)
Ergotamines (dihydroergotamine)
Preventive Migraine Therapy
Topiramate
Divalproex Sodium
Tricyclic Antidepressants (Nortriptyline, Desipramine)
Beta Blockers- Propranolol
Dx: newborn with diffuse (crosses suture lines) fluctuant scalp swelling and blood loss (pallor, anemia, tachycardia)
Dx: subgaleal hemorrhage (via sugaleal vein shearing)- massive blood accumulation between periosteum and galea aponeurotica
Essential coagulation factor in carboxylation that activate coagulation factors
Vitamin K
Dx: infancy, bleeding in joints (hemarthrosis), intracranial hemorrhage, prolonged PTT
Hemophilia A - X linked bleeding disorder
Dx: venipuncture site oozing, thrombocytopenia, prolonged PT and PTT
Disseminated intravascular coagulation (DIC)
Dx: newborn bleeding between skull and periosteum, subperiosteal vessel rupture, firm nonfluctuant swelling that does not cross suture lines
Cephalohematoma
Dx, DGX, Tx: Elderly, Wide based Gait with falls, cognitive dysfunction, urinary urgency/incontinence, depressed affect, upper motor neuron signs in lower extremeties
Dx: Normal Pressure Hydrocephalus
DGx: improvement of gait with Miller Fisher Lumbar Tap Test (removal of spinal fluid), MRI enlarged ventricles out of proportion to underlying brain atrophy on MRI
Tx: Ventriculoperitoneal shunting
Generalized Seizure Triggers
Lack of Sleep, Flashing Lights, Emotional Stress
Generalized Seizure Event Features
Preceding Aura, Loss of Consciousness and Loss of Postural Tone, Tonic-Clonic Convulsions
Generalized Seizure Post Event Features
Delayed Return to Baseline
Vasovagal Syncope Triggers
Prolonged Standing + Physical/Emotional Stress
Vasovagal Syncope Event Features
Presyncope- Light- headedness, pallor, diaphoresis
Vasovagal syncope post event features
Immediate return to baseline
Cardiogenic Syncope Triggers
Exertion, Dehydration
Cardiogenic Event Features
Sudden Loss of Consciousness without prodrome
Cardiogenic Syncope Post event features
Immediate Return to Baseline
Dx and Tx: child, pulsatile throbbing headache lasting hours-days, photophobia,phonophobia, N/V, autonomic symptoms (facial sweating, tearing, nasal congestion, preceding aura, normal neurologic examination
Dx: Migraine in Children
Tx: Acetominophen, NSAIDs, Triptans (sumatriptan), antiemetics (promethazine, prochlorperazine), Ergots (Dihydroergotamine)
Dx: encephalopathy (confusion), oculomotor dysfunction (horizontal nystagmus), gait ataxia, anorexia or chronic alcohol use
Dx: Wernicke Syndrome or Alcohol Withdrawal Syndrome (Thiamine Deficiency)
Tx: Thiamine Replenishment
Dx, DGx, Tx: adult, unilateral severe stabbing pain in jaw line, triggered by chewing, talking, brushing teeth, light touch)
Dx: Trigeminal Neuralgia
DGx: MRI/MRA of brain with contrast, nerve conduction
Tx: Carbamezapine or Oxcarbazepine or Surgery for severe medically refractory cases
Dx, DGx, Tx: Facial pain with jaw motion, ear pain/ tinnitus, unilateral headache, jaw dysfunction
Dx: temporomandibular joint disorder
DGx: clinical, tenderness of mastication muscles, tooth wear/grinding (bruxism), crepitus or clicking with TMJ
Tx: Education: avoid triggers, soft foods, dental splints, NSAIDs
Dx, DGx, Tx: inattentive, hyperactive symptoms for >6months before age 12, in at least 2 settings
Dx: ADHD
DGx: behavioral rating scales from school
Tx: Stimulants (Methylphenidate, amphetamines), Non stimulants (atomoxetine), Behavioral therapy
SIGECAPS
Sleep Disturbance Loss of Interest Guilt Energy Low Concentration Impaired Appetite Change Psychomotor Retardation/Agitation Suicidal Thoughts
Dx: Excessive Fears of having a serious illness
Illness Anxiety Disorder
Dx: bloating, fatigue, headaches, breast tenderness, mood swings, anxiety, difficulty concentrating, decreased libido, irritability lasting for a week, recurring in female
Dx: PMS
Dx: prominent irritability, hopelessness, depressed mood, self-critical thoughts, anger, recurrent in a female
PMDD (premenstrual dysphoric disorder)
Why avoid citalopram in depressive patients with cardiac disorders?
Dose dependent QT prolongation
Dx and Tx: Avoidance of reminders of trauma, emotional detachment, negative mood, decreased interest in activities, sleep disturbance, hypervigilance, irritability
Dx: PTSD
Tx: trauma focused cognitive behavioral therapy, antidepressants (SSRIs, SNRIs)
Dx: Chronic anemia following subtotal gastrectomy
B12 Deficiency
B12 is required cofactor for?
DNA synthesis
Increased intramedullary hemolysis causes
Release of heme—-> indirect hyperbilirubinemia and elevating LDH, total RBC/reticulocyte count will be low, thrombocytopenia, leukopenia
Tx of Rheumatoid Arthritis
Methotrexate, Hydroxychloroquine, TNF- inhibitors (infliximab, etanercept)
Most common malignancy in upper cervical node
Head and neck squamous cell carcinoma
Dx: elderly patients with painless cervical waxing and waning lymphadenopathy, leukocytosis
Dx: CLL (Chronic Lymphocytic Leukemia
Dx: glomerulonephritis, pulmonary nodules, ear pain, subcutaneous nodules
Granulomatous polyangitis
Dx: fever, night sweats, weight loss, painless cervical lymphadenopathy
Dx: Hodgkin Lymphoma
Dx: fever, pharyngitis, fatigue, bilateral multiple lymphadenopathy, young patients
Infectious Mononucleosis (EBV)
Dx: Dry cough, malaise for long term + bilateral hilar adenopathy
Sarcoidosis
DGx: radiographic + clinical findings
Dx: mid 40s patient, non smoking, dyspnea, cough, sputum production, CXR: hyperinflation
Alpha-1- antitrypsin deficiency
Dx: adult, fever, weight loss, rhinosinusitis, CXR: pulmonary nodules and alveolar consolidation
Necrotizing pulmonary vasculitis (granulomatosis with polyangitis)
Dx: CHF patient, cardiomegaly, cephalization of pulmonary vessels, prominent vascular markings, pleural effusions
Pulmonary venous congestion
Risk Factors for Pulmonary Fibrosis
Microscopic alveolar epithelial injury (smoking, GERD, silent aspiration)
Inappropriate repair by fibrosis
Male, >60y.o., smoking,
Dx and Tx: Chronic progressive dyspnea, non productive cough, fatigue, velcro inspiratory crackles, digital clubbing,
HRCT: UIP (subpleural honey combing, reticular opacities, restrictive pattern PFTs
Dx: Pulmonary Fibrosis
Tx: Antifibrotic Therapy (pirfenidone, nintedanib), smoking cessation, GERD treatment, supplemental oxygen, lung transplant
Tx of asthma exacerbation
- SABA: albuterol
- SAMA: ipratropium
- IV Magnesium
- F/U with systemic glucocorticoids: prednisone/dexamethasone
Dx, Tx, Px: Infant, Inspiratory Stridor, Harsh Cough, Hoarseness
Parainfluenza viral infection of larynx and trachea
Tx: mild (no stridor at rest)- humidified air + corticosteroids,
Moderate/severe (stridor at rest)- corticosteroids + nebulized epinephrine
Px: handwashing, decontamination of surfaces, proper ventilation
MCC of Mitral Stenosis in adults
Rheumatic Heart Disease
Dx: exertional dyspnea, cough, orthopea, left atrial dilation, elevation of left main stem bronchus, atrial fibrilliation, acute decompensated heart failure
Mitral Stenosis in the setting of Rheumatic Heart Disease
Dx: acute onset SOB, hypoxia, unilaterally decreased breath sounds in COPD patient, chest pain, hyper-resonance on percussion
Dx: large alveolar bleb ruptures- leak air into pleural space- secondary spontaneous pneumothorax
Tx of lumbosacral radiculopathy
Activity Modification
First 1-2 weeks: NSAIDs
After 2 weeks: consider Physical Therapy, Oral Glucocorticoids (Prednisone)
After 4-6 weeks: obtain MRI and assess for surgical indication
Dx and Tx: most asymptomatic, headache, hearing loss, spinal stenosis/radiculopathy, bowing, fracture, arthritis of adjacent joints
Labs: Ca, Phos = normal, alk phos: elevated
X- ray: osteolytic or mixed lesions, DEXA: focal increase in uptake
Paget’s Disease of Bone
Tx: Bisphosphonates
Dx and Tx: obese with heavy panniculus, diabetes, or pregnancy, numbness and tingling (pins/needles on lateral thigh, no motor deficits
Dx: Meralgia Paresthetic
Tx: avoid tight garments, weight loss, gabapentin or nerve block (if necessary)
Dx and Tx: Swelling, heaviness, discomfort
Early: soft skin, pitting edema
Late: firm, dry and thickened skin, non-pitting edema
Dx: lymphedema
Tx: weight loss, limb elevation, compression bandages and physiotherapy, do not use diuretics
Indications for preoperative ECG?
Hx of CAD or arrhythmia, MACE risk >1%
Indications for preoperative Chest Radiograph
Hx of Cardiopulmonary disease, under going upper abdominal/thoracic surgery
Indications for preoperative CBC
Hx of anemia, expected significant blood loss, under going major surgery
Indications for coagulation and platelets preoperatively
Hx of abnormal bleeding, anticoagulant use, liver disease, malignancy, planned spinal anesthesia
Indications for CMP preoperatively
Hx of Kidney disease, ASCVD risk, predisposing medications (diuretic, ACEi, ARB)
Developmental Milestones for 2 month infants
Gross Motor: Lifts head when prone
Fine Motor: Opens hands briefly
Language: reacts to loud sounds, makes noises
Social/Cognitive: Social Smile, Calms when spoken to, tracks past midline
Developmental Milestones of 4 month infants
Gross Motor: Holds head steady, pushes up on forearms
Fine Motor: Brings hands to midline/mouth, holds to if put in hand
Language: Coos, turns to voice
Social Cognitive: Seeks attention (smiles/sounds), Enjoys looking at hands
Development Milestones for 6 month old infants
Gross Motor: Rolls over, Leans on hands to support seated position
Fine Motor: Reaches for toy, puts things in mouth
Language: Blows raspberries, squeals
Social/Cognitive: Laughs, Recognizes Familiar Faces
Development Milestones at 9 months infant
Gross Motor: Gets to sitting unassisted, Sits without support
Fine Motor: Transfers object between hands, raking grasp
Language: Babbles, Turns to Name
Social/Cognitive: Stranger Anxiety, Separation Anxiety
Developmental milestones 12 month infant
Gross Motor: Pulls to stand, cruises
Fine Motor: Pincer grasp
Language: says mama, dada, understands no
Social/Cognitive: Plays pat-a-cake, Looks for hidden object
Raising the cut off point for a test will do what to specificity and sensitivity?
Increase specificity
Decrease sensitivity
Simple vs. Malignant Renal Cysts
Thin, smooth regular wall vs. thick irregular wall
Unilocular vs. multilocular
No septae vs. multiple septae thick and calcified
Homogenous content vs. heterogenous content
Asymptomatic vs. may cause pain hematuria or hypertension
No follow up vs. requires follow up imaging and urological eval for malignancy
Dietary Prevention measures for recurrent nephrolithiasis
Increased fluids (produce > 2L urine/day)
Reduced Sodium
Reduced Protein
Normal calcium intake (1200 mg/day)
Increased Citrate (fruits/veggies)
Reduced oxalate diet (dark roughage, vitamin C)
Drug therapy prevention for recurrent nephrolithiasis
Thiazide diuretic
Potassium Citrate/Bicarbonate Salt
Allopurinol (hyperuricuria related stones)
Dx, DGx, and Tx: night time bed wetting age > 5 w/o prolonged period of continence
Dx: Primary nocturnal enuresis
DGx: UA
Tx: Reassurance, Behavioral Modifications, Bedwetting Alarm
Dx, DGx, Tx: Night time incontinence >5 y.o. After prolong period of continence
Dx: secondary nocturnal enuresis via UTI, DM, psychological stress
DGx: UA
Tx: treat underlying disease, behavioral modifications
MC bacteria in UTI
E. Coli, Klebsiella, Proteus
Medication used for passing distal ureteral stone
Alpha 1 antagonists: tamsulosin
Drugs that can induce interstitial nephritis (fever, rash, arthralgias, eosinophilia, hematuria, sterile pyuria, eosinophiluria
Penicillins, cephalosporins, sulfonamides
Mitral Stenosis —> Atrial Fibrilliation how?
Left atrial dilation
DGx and Tx of aortic stenosis
Aortic jet velocity >4.0 or mean transvalvular pressure > 40mm Hg
Indications for valve replacement: angina, syncpe, LVEF <50%, CABG
Dx and Tx: Leg Edema, Fatigue, Pain, Superficial venous dilation, often worse at the end of the day, no thrombus on US
Dx: Post thromboTic syndrome- chronic venous insufficiency following DVT
Tx: exercise: ankle flexion, walking), Compression (bandages or stockings)
Common side effect of CCB (amlodipine)
Peripheral Edema
Dx: enlarged globular cardiac silhouette on chest X-ray, diminished heart sounds and maximal impulse difficult to palpate
Pericardial Effusion
Diagnostic Criteria for Orthostatic Hypotension
Postural decrease of blood pressure by 20 mgHG systolic or 10 mmHg diastolic
Dx, Tx, and Cx: rapidly growing nodule with ulceration and keratin plug, spontaneous regression
Dx: Keratoacanthoma
Tx: excisional biopsy with complete removal of lesion
Cx: can progress to squamous cell carcinoma
Dx DGx, and Tx: Scaly, erythematous, pruritic patch with centrifugal spread, subsequent central clearing with annular border
Dx: Tinea Corporis (ringworm)
DGx: KOH preparation
Tx: topical antifungal (clotrimazole, terbinafine or oral antifungals (terbinafine, griseofulvin)
Dx: numerous, ring like widespread plaques with annular or serpinginous border and central clearing, transient, non-pruritic, child associated with rheumatic fever
Dx: erythema marginatum
Dx: target shaped rash associated with Lyme Disease
Erythema migrans
Dx: Chronic, relapsing, coin shaped patches on extremities, erythematous, pruritic, scant exudate
Nummular eczema
Viral prodrome, christmas tree pattern Numerous oval, scaly plaques with large initial lesion, resolves in 6 weeks
Pityriasis Rosea
Tx: Reassurance, antihistamines
erythematous target lesions with a dusky center, worse with infections
Erythema Multiforme
Dx and Tx: non-inflammatory, hyperkeratinization spots on face
Dx: acne vulgaris (Cutibacterium acnes)
Tx: topical retinoid (salicylic, azelaic, glycolic acid)
Dx and Tx: scaling, lichenification, fissuring on hands
Dx: contact dermatitis
Tx: emollients, topical corticosteroids, and irritant avoidance
Dx: itchy (pruritic), scaly patches on palms or annular plaques raised on dorsum, usually unilateral,
Dx: tinea Manuum
Dx and Tx: onset in early childhood, diffuse scaly skin with mild pruritus, worse on extensor extremities
Dx: Ichthyosis Vulgaris
Tx: long baths to remove scales, moisturization, keratolytics (urea, alpha-hydroxy acid, salicylic acid)
Dx, Tx, Cx: pruritic, erythematous patches and papules, extensor surfaces, trunk or facez
Dx: atopic dermatitis (eczema)
Tx: emollients, topical corticosteroids
2nd line- pimecrolimus (topical calcineurin inhibitors
Cx: impetigo (Staph A) or Eczema herpeticum (HSV)
Dx and Tx: papules, pustules, vesicles, golden crusting, weeping, purulence, painful/itch
Dx: Impetigo
Tx: topical mupirocin or oral cephalexin (local vs. widespread)
Child abuse scald wounds typically have:
Spare flexural creases, sharp line of demarcation, uniform burn depth, absence of splash marks
Tx of Vitiligo
Limited: topical corticosteroids
Extensive: oral corticosteroids, topical calcineurin inhibitors, PUVA
Dx: unilateral/bilateral eye, eye stuck shut, watery, scant, stringy discharge not reappearing after wiping, burning, gritty sensation, prodromal, diffuse injection, follicular or bumpy, rhinorrhea, sore throat, cough
Adenovirus conjunctivitis
Dx: unilateral/bilateral eye involvement, eyes stuch shut, purulent thick discharge reappearing after wiping, unremitting discharge, diffuse injection, non-follicular, in adult vs. child
Adult: Staph Aureus Conjunctiviitis
Child: Hib, Moraxella Catarrhalis, Strep Pneumo
Dx: intensely pruritic erythematous papules, vesicles, and bullae occur symmetrically in grouped clusters on extensor surfaces associated with diarrhea/wt loss (celiac disease
Dx: dermatitis herpetiformis
Tx: dapsone, gluten free diet
Characteristics of right sided colon tumors
Occult bleeding and Iron deficiency anemia
Characteristics of left sided colon cancer?
Obstruction of flow of stool, crampy—> colicky pain, constipation, hematochezia (blood in stool)
Rectal tumor characteristics
Hematochezia (blood in stool, frank red blood, narrowed stools, tenesmus, sensation of mass in rectum.
Dx: headache, female, family history of headaches, variable onset, unilateral, pulsatile and throbbing, 4-72 hours, Auras, photophobia, phonophobia, nausea
Migraines
Dx and Tx: headache, males, no family history, occurs during sleep, behind one eye, excruciating sharp and steady, 15-90 mins, sweating facial flushing, nasal congestion, lacrimation, pupillary changes
Cluster Headache
Tx: prophylatic verapamil, subq sumatriptan + 100% oxygen
Dx: Headache female > male, No family history, onset under stress, band like pattern around the head (bilateral), dull tight and persistent, 30 mins-7 days,muscle tenderness in head,neck and shoulders
Tension Headaches
Dx: facial pain, rhinorrhea, fever, anosmia
Acute maxillary sinusitis
Dx: erythema, edema, tenderness, impaired extraocular movement
Dx: Orbital Cellulitis
Dx: sudden onset eye pain, nausea, diminished vision with halos around lights, fixed mid-dilated pupil
Angle Closure Glaucoma
Dx: progressive headache, morning nausea, focal neurological deficits
Dx: brain tumor
Dx: pure motor hemiparesis, ataxic hemiparesis, dysarthria
Lacunar infarct
Dx: sudden onset, persistent, severe headache with vomiting, seizure, decreased level of consciousness
Subarachnoid Hemorrhage
Dx: recurrent stabbing pain along mandible and Maxilla, triggered by anything,
Dx: trigeminal neuralgia
Complication of Long Term Metformin Use
Vitamin B12 deficiency in terminal ileum
Minority neurological manifestations of B12 deficiency
Impaired vibratory/proprioception/sensory ataxia
Positive babinski sign
Lower extremity paresthesias
Irritation/mood changes
Mytonia, pain, weakness in distal facial muscles, cardiac arrhythmias, hypogonadism
Myotonic dystrophy- AD CTG repeatexpansion in DMPK
Dx and Tx: small vascular tumor <1cm, abnormal capillaries/granulation tissue, friable, dome shaped nodules on hands/trunk, oral mucosa, common in pregnancy, bleed with minor trauma
Pyogenic granuloma or lobular capillary hemangioma
Tx: surgical excision, laser therapy, silver nitrate, can regress post-partum
Dx: HIV patient, multiple reddish purple papules that evolve into friable nodular lesions with fever, malaise, night sweats
Dx: Bacillary Angiomatosis (Bartonella Infection)
Dx: rapid growing-volcano like nodule with central keratotic plug, non friable
Dx: Keratoacanthoma
Dx/ Tx: firm domed, papule with central umbilication in adult, genital or extensive
Dx: Mollusca Contagiosum
Tx: cryotherapy, curettage, topical therapy (cantharidin, podophyllotoxin)
Tx of tinea pedis
DGx: clinical + KOH prep
Tx: Topical Antifungals: miconazole, terbinafine, tolnaftate
Dx and Tx: infant, erythematous papules, plaques, spares skinfolds
Dx: irritant contact dermatitis
Tx: topical barrier: petrolatum, zinc oxide
Dx and Tx: Infant,Beefy-red confluent plaques, involves skin folds, satellite lesions
Dx: Candida Dermatitis
Tx: Topical Antifungal (Nystatin)
Microblastic anemia serum iron study findings
IDA: low iron, high TIBC, low ferritin
Thalassemias: normal/high iron and ferritin
Anemia of Chronic Disease: normal iron, normal ferritin low TIBC
Sideroblastic anemia: normal iron, ferritin
Dx, Dgx, Tx: small papule/pustule—> rapidly progressive painful ulcer with purulent base, violaceous border, ulceration (common in RA or AML)
Dx: pyoderma gangrenosum
DGx: Dx of exclusion, mixed inflammation on biopsy
Tx: local/systemic glucocorticoids
Dx: hemorrhagic pustules —> necrotic ulcers with neutropenia/bacteria, fever, little pain
Dx: ecthyma gangrenosum- pseudomonas aeruginosa
Dx: acute panniculitis, tender erythematous nodules/plagues on lower extremeties, no ulceration, resolve after 2-8 weeks
Dx: Erythema Nodosum
Dx: small papule/nodule from rose bushes/plants
Dx: Sporotrichosis
Dx and Tx: papules and pustules with honey crusted lesions
Dx: nonbullous impetigo (Staph A, or Group A strep (pyogenes)
Tx: topical mupirocin (antibiotics) or oral antibiotics (cephalexin)
Dx and Tx: enlarging flaccid bullae with yellow fluid
Dx: Staph A- Bullous Impetigo
Tx: Oral Cephalexin
Dx: bilateral non-tender, non pruritic maculopapular or vesicular rash on palms and soles
Dx: Coxsackie Virus (Hand-Foot-and- Mouth Disease
Dx: clusters of painful vesicles on lips, fingers, do not enlarge rapidly
Dx: HSV
Dx and Tx: fever, chest pain, hemoptysis in Immunocompromised, Pulmonary nodules with halo sign, positive cultures/cell wall biomarkers
Acute Aspergillosis
Tx: Voriconazole + Caspofungin
Dx and Tx: lung disease/damage previous: > 3months weight loss, hemoptysis, fatigue, cavity lesion/fungus ball
Dx: Chronic pulm aspergillosis
Tx: Resect aspergilloma, Voriconazole, Embolization
Dx and Tx: poorly localized shoulder pain pain and stiffness, decreased ACTIVE and PASSIVE ROM, atrophy of shoulder may occur
Dx: Adhesive Capsulitis
DGx: Clinical, X-ray, MRI rule out
Tx: ROM exercises, NSAIDs, Corticosteroid Injections, Surgical Release
Dx, DGx, Tx: epigastric pain + dark stools (melena) + improves with food
Dx: Duodenal Ulcer- H.Pylori or NSAIDs,
DGx: endoscopic biopsy or urea breath test
Tx: Antisecretory therapy: PPI (omeprazole/pantoprazole) + Antibiotic eradication + Amoxicillin + Clarithromycin
Dx: multiple paracentesis with blood ascites
Dx: Malignancy: MC Hepatocellular Carcinoma
Dgx: Cytologic analysis- for underlying tumor should be done
Obstructive and Restrictive Lung Disease PFTs
Restrictive
- Obesity- Hypoventilation Syndrome- decreased FEV1,TLC and preserved DLCO
- Interstitial Disease- normal FEV1, reduced TLC, decreased DLCO
Obstructive
- Asthma- decreased FEV1, increased TLC, increased DLCO
-COPD- decreased FEV1, increased TLC, decreased DLCO
Dx and Tx: Infant, increased tearing, eyelash crusting, clear conjunctivae
Dx: congenital dacryostenosis (congenital nasolacrimal duct obstruction
Tx: observation, lacrimal sac massages, probing of duct
Dx: infant, purulent eye drainage, erythema, warmth, tenderness and swelling over lacrimal sac
Dacryocystitis (NLD infection)
Dx: infant, 2-5 days old, profuse, purulent eye drainage, conjunctival injection (bloodshot eyes), eyelid swelling
Dx: Gonococcal eye infection
Px: erythromycin eye ointment
Dx: clear mucoid eye discharge, erythematous conjunctivae, viral prodrom (fever, congestion)
Dx: viral conjunctivitis
Tx of fibromyalgia
Amitriptyline
Side effects of amitriptyline (treatment for Fibromyalgia, depression, insomnia)
Anticholinergic symptoms: dry mouth, constipation, urinary retention
Histamine symptoms: lethargy
Alpha-adrenergic receptors: orthostatic hypotension
Dx and Tx: erythematous (red), pruritic (itchy) plaques with greasy scales—-> scalp, central face, ears, chest
Dx: Seborrheic Dermatitis
Tx: Topical Antifungals (selenium sulfide, ketoconazole), topical glucocorticoids, topical calcineurin inhibitors (pimecrolimus)
Dx and Tx: erthymatous, scaly, annular plaques
Dx: tinea
Tx: oral antifungals (terbinafine, itraconazole)
Dx & Tx: dry scaly skin on extremities and trunk
Dx: xerosis
Tx: Topical Emollients
Dx, DGx, & Tx: episodic dyspnea and noisy breathing during exercise, inspiratory stridor
Dx: Paradoxical Vocal Fold Motion (PVFM)
DGx: Laryngoscopy
Tx: therapy with speech-language pathologist
IBS DGx criteria
Rome IV diagnostic criteria
- Recurrent abdominal pain >1/day for 3 months
- Related to defecation
- Changes in stool frequency
- Change in stool form
IBS alarms
> 50 age of onset GI bleed Nocturnal diarrhea Worsening pain Unintended weight loss IDA Elevated CRP Positive fecal lactoferrin or calprotectin
Dx and Tx: lower extremity edema, varicose veins, skin discoloration, medial skin ulceration
Dx: Chronic Venous Insufficiency
Tx: leg elevation, exercise, compression therapy
Dx & Tx: well-defined erythematous plaques with silvery scale, extensor surfaces
Dx: plaque psoriasis
Tx: topical: glucocorticoids, Vit-D analogs, tar, retinoids, calcineurin inhibitors, tazarotene
Systemic: methotrexate, calcineurin inhibitors, retinoids, apremilast, biologics
Dx DGx, & Tx: painless bright red rectal bleeding,
Dx: hemorhoids
DGx: mucosal bulges on anoscopy
Tx: increase fluid/ fiber intake, reduce fat intake, moderate EtOH intake, limit sitting on toilet, limit defecation to 1x/day, avoid straining,
Topical agents: benzocaine, witch hazel, hydrocortisone
Dx & Tx: itchy (pruritic), purple/pink, polygonal, papules and plaques on skin or white papules/plaques, erythema,mucosal atrophy, ulcers in oral mucosa
Dx: Lichen Planus
Tx: high potency glucocorticoids: betamethasone, widespread: systemic glucocorticoids, phototherapy
antipsychotic medications (Risperidone) block dopamine- SFX?
Hyperprolactinemia, gynecomastia, galactorrhea, menstrual dysfunction, decreased libido
Tx of Somatic Symptom Disorder
Regular primary care follow-up that targets coping skills, provides reassurance, and avoids unnecessary tests
Dx: hypertension, hypokalemia, elevated bicarb, urine acidification
Hyperaldosteronism
DGx: Serum Renin low, Aldosterone high
Dx: hypotension, hyponatremia, hyperkalemia, hypoglycemia, metabolic acidosis
Dx: Addison’s disease (AI failure of adrenal glands
Dx, DGx, Tx: Linear white scaly areas with moist raw skin between toes
Dx: Trichophyton Rubrum- Tina pedis
DGx: KOH prep- hyphae
Tx: topical antifungal: clotrimazole, terbinafine, ketoconazole
Dx, DGx, Tx: adult, fatigue, shortness of breath after fever, sore throat, rhinitis, distended veins, basilar crackles, s3 gallop, arrythmia, exercise intolerance, syncope, hypotension, tachypnea, tachycardia
Dx: Viral Endocarditis (Coxsackie B, Parvovirus B19, HHV-6, Adenovirus, HIV
DGx: normal ECG, CXR
Tx: supportive, resolves in time
Dx, DGx, Tx: Child, migratory polyarthralgia, pancarditis, subcutaneous nodules, erythema marginatum, involuntary movements (sydenham chorea) 1-5 weeks after infection
Dx: Acute Rheumatic Fever
DGx: strep titers
Tx: Penicillin V, or Ceftriaxone
Dx, Dgx, Tx: teenager, sore throat, fatigue, malaise, fever, chills, pharyngitis, cervical lymphadenopathy and tenderness, hepatosplenomegaly
Labs: atypical lymphocytes, negative strep test
Dx: EBV- Mono
DGx: Monospot Test
Tx: supportive- no sports, lidocaine gargle
Do not use amox—> generalized maculopapular rash
Dx and Tx: sore throat, erythema and exudates, cervical lymphadenopathy, oral sex
Gonococcal pharyngitis
IM ceftriaxone
Nausea, vomiting, altered mental status, seizures, hepatomegaly in child
Reye Syndrome- oral aspirin in child
Depressed mood + cognitive defects in a elderly person,rapid onset, poor cooperation/effort, apathy, normal neurologic findings
Pseudodementia
Tx: SSRIs
Dx: rapid progressive dementia with myoclonus (involuntary twitches), ataxia, nystagmus
Creutzfeldt-Jakob disease
Dx and Tx: confusion, horizontal/vertical nystagmus, opthalmoplegia, ataxia
Dx: Wernicke’s Encephalopathy- Chronic Alcohol Abuse
Tx: fluids and thiamine repletion (B1 deficiency)
Dx: encephalopathy, cognitive dysfunction, interstitial nephritis, vomiting, abdominal pain, constipation, anemia in infant,
Dx: lead poisoning
DGx: serum lead
Dx; delays in speech, language, cognitive development, reciprocal interactions, normal eye contact
Hearing Deficit
DGx: aural stimuli
Cx of Down Syndrome
Alzheimer’s Dementia ALL/AML Cardiac Septal Defects Duodenal Atresia Hirschsprung Disease
Dx: delayed communication and social skills, impaired non-verbal communication (no eye contact/facial expressions)
Dx: Autism Spectrum Disorder
DGx: Clinical
Tx: CBT
Dx and Cx: HIV patient, fever pharyngitis, atypical leukocytes, retinitis (visual disturbances, flashing lights, blurred vision), esophagitis, pneumonia
Dx: CMV or HHV-5
Cx: retinal necrosis, edema, detachment
Dx: HIV pateint, immunocompromised, dyspnea, pulmonary infiltrate, meningitis, encephalitis
Cryptococcus Neoformans
Dx: HIV immunocompromised, self-limiting watery diarrhea, wt loss and dehydration
Cryptosporidium Parvum
Dx: HIV immunocompromised, pneumonia, choreoretinitis (decreased visual acuity, eye pain, hepatitis (elevated AST/ALT)
Toxoplasma Gondii
Dx and Tx: depressive, anxiety, behavioral changes <6 months with identifiable stressor
Dx: Adjustment Disorder
Tx: CBT + SSRI
Dx and Tx: increase tolerance to alcohol intake, palpitations, sweating, anxiety, insomnia, tremor, headaches, tonic-clonic seizures on cessation to alcohol (6-24 hrs)
Dx: Alcohol Dependence and AWS
Tx: Acute: Benzos (IV if seizures, PO- oxazepam, lorazepam), Haloperidol, IV fluids, thiamine and folate, glucose
Chronic: CBT + Pharmacotherapy
Dx: 7-9 year old, avoiding school, can’t separate from father, mother, grandmother, guardian,etc
Separation Anxiety Disorder
Dx: child/adolescent—> persistent aggression towards people/animals, lying, serious rule violations (destruction of property, deceitfulness < 18 y/o
Dx: Conduct Disorder
Tx: CBT
Dx, DGx, Tx: malabsorption, flatulence, abdominal bloating, fat in stools (steatorrhea), nutritional deficiencies, iron deficiency anemia, grouped pruritic bilateral subepidermal vesicles (Dermatitis Herpetiformis)
Dx: celiac disease
DGx: serum antigliadin antibody assay, Bx: intraepithelial lymphocytosis, villous atrophy, crypt hyperplasia
Tx: gluten free diet (no wheat, rye, barley, spelt)
Dx, DGx, Tx: cramp pain, relieved with BM, intermittent diarrhea/constipation, associated with stress or fibromyalgia
Dx: IBS
DGx: Clinical
Tx: Reassurance, Exercise + Diet Modifications
Dx, DGx, & Tx: infant > 1 yr, fever, headache, vomiting, sore throat, myalgias in leg, lethargy, confusion, <1day high fever, flexes hip when neck flexed, nonblanch, pinpoint trunk on lower extremities
Dx: N. Meningitidis (strep pneumo)
DGx: Clinical + CSF culture
Tx: Ceftriaxone or Vanc
Cx: Shock, DIC, Adrenal Hemorrhage
Dx, DGx, & Tx: infant > 1 yr, fever, headache, vomiting, sore throat, myalgias in leg, lethargy, confusion, <1day high fever, flexes hip when neck flexed, unvaccinated
Dx: HiB meningitis
DGx: Clinical + CSF Culture
Tx: Ceftriaxone
Meningitis Infections in infants by age
<1 months - Listeria Monocytogenes
<3 months- group B streptococcus
> 1 year- N. Meningitis, Strep pneumo
> 1 year + unvaccinated - HiB
Dx, DGx, Tx: >45 y/o, progressive loss of vision over a year, sensitivity to glare, halos around lights, opacifcation of lens
Dx: Cataracts
Tx: Surgery
Early onset in DMII trauma, steroid
Dx: unilateral loss of central vision, fluffy granualar retinal with yellow white fluffy lesions, photpsia (flashing light sensitvity), scotomata (blind spots)
CMV retinitis
Dx, DGx, Tx: unilateral ocular pain, redness, tearing, with branching/dendritic corneal ulcers
Dx: HSV retinitis
DGx: fluoroscein
Dx, DGx, Tx: Fever, Low ROM in Joint, Non-weight bearing, acute, elevated WBC,ESR, C-reactive protein
Dx: Septic Arthritis
DGx: Arthrocentesis purulent synovial fluid > 50K
Tx: operative + Vancomycin + Cefriaxone
Dx: slow onset hip pain, child, no fever, leukocytosis
Legg-Calve-Perthes
Dx: 10-15y/o- overweight + fracture of hip growth plate
Slipped Capital Femoral Epiphysis
Dx, DGx, Tx: young males, unilateral painless testicular nodule/swelling, dull lower abdominal ache, dyspnea, neck mass, low back pain
Dx: Testicular Cancer
DGx: scrotal US, tumor markers (AFP, B-hCG, CT scan
Tx: radical orchiectomy, chemotherapy
Dx and Tx: itchy (pruritic), purple, polygonal papules/plaques on flexural surfaces assx with Hep C (IV users)
Dx: Lichen Planus
Tx: resolves spontaneously use betamethasone (topical high-potency glucocorticoids
