Cardiology
Pulmonology
Nephrology
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Hem/Onc
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DNA Viruses
Notes
Malabsorption
Malabsorption Etiology Celiac disease → Gluten-sensitive enteropathy IgA mediated Whipple disease → Treponema whippli Tropical sprue → Infection Lactose intolerance Chronic pancreatitis Presentation Steatorrhea Fat malabsorption → Weight loss ADEK deficiency D → ↓Ca, Osteoporosis K → Bleeding, Easy bruising B12 deficiency → Anemia, Hypersegmentd PMN, Neuropathy Celiac Dermatitis herpetiformis (10%) Iron deficiency Osteoporosis Whipple...
Read moreGI Cancers
Esophageal Cancer Etiology SCC Most common worldwide Upper/Middle third Alcohol Tobacco Nitrosamines Adenocarcinoma Most common in US Lower third GERD Barrett Esophagus Presentation >50y PROGRESSIVE dysphagia → From solid to liquid ↓Weight GI bleeding Vomiting Diagnosis Best initial → Barium esophagram (might be) Asymmetric stricture Most accurate → Endoscopy and...
Read moreGallbladder
RUQ pain Jaundice Fever Best Initial Most Accurate Cholelithiasis ✓ ✖︎ ✖︎ U/S U/S Cholecystitis ✓ ✖︎ ✓ U/S HIDA scan Choleducolithiasis ✓ ✓ ✖︎ U/S MRCP Cholangitis ✓ ✓ ✓ U/S ERCP Cholelithiasis Etiology Cholesterol stone → Radiolucent Pigmented stone Black → Hemolysis Brown → Infection Presentation Fat...
Read moreThyroid Cancer
Thyroid Nodule Etiology Palpable in 5% of women and 1% of men 95% benign Radiation to neck Presentation Benign Adenoma Colloid nodule Cyst Malignant Papillary Radiation to neck Papillary cell tumor Branching papillae Lymphadenopathy Orphan Annie nuclei Psammoma bodies Positive prognosis Lymphatic spread Follicular Follicular cell tumor Hematologic spread...
Read moreMultiple Endocrine Neoplasia (MEN Syndromes)
Syndrome MEN 1 (3P) MEN 2A MEN 2B Tumors Pituitary Functioning or NOT Parathyroid ↑Ca Pancreas Zollinger Ellison Insulinoma VIPoma Parathyroid ↑Ca Thyroid (Medullary) Calcitonin → ↓Ca Pheo Neuronal Tumors Intestinal ganglioma Thyroid (Medullary) Calcitonin → ↓Ca Pheo Notes MEN gene Ret oncogene Ret oncogene Marfanoid habitus
Read moreGenetic Syndromes
Bartter Syndrome → Genetic salt loss in loop of Henle Metabolic alkalosis Not volume-responsive NOT hypertensive ↓K ↑ Urine Cl Gitelman Syndrome → Problem with thiazide-sensitive Na/Cl symporter in the distal convoluted tubule Metabolic alkalosis Not volume-responsive NOT hypertensive ↓K ↓Mg ↑ Urine Cl Conn’s Syndrome → Primary hyperaldosteronism Metabolic alkalosis...
Read morePleural Disease
Pleural Effusion Etiology Transudate CHF Cirrhosis Nephrotic syndrome Exudate Pneumonia → Parapneumonic effusion TB Malignancy PE Collagen vascular RA SLE Pancreatitis Trauma Presentation Dyspnea Pleuritic chest pain Cough ↓ Breath sounds Dullness to percussion Diagnosis Best initial → CXR AP → Costophrenic angle blunting Lateral Decubitus → To assess loculation...
Read moreBites
Snake bite 30% → Local wound Death from Hemolytic toxin Hemolysis DIC Neurotoxin Respiratory paralysis Ptosis Dysphagia Diplopia Treatment Pressure Immobilization Antivenom WRONG choices Torniquet blocking artery Compression bands are OK Ice Incision and suction by mouth Spider bite Stepped on a nail, piece of glass in shoe Etiology Black...
Read moreToxic Ingestion
Unknown Substance Alert patient Stomach empties after 1 hour. Emptying not useful after 2 hours Most common overdose death Acetaminophen Aspirin Charcoal Benign, not dangerous, given in any overdose Removes toxins even after absorption NOT effective for Lithium Iron Lead Hydrocarbons Toxic alcohols Gastric lavage 1h → 50% removal 2h →...
Read moreSubstance Abuse
Alcohol Intoxication Presentation Talkative, Sullen, Gregarious, Moody, Disinhibited Treatment Severe → Mechanical ventilation Withdrawal Presentation 6-12h → Tremors Within 48h Tachycardia Hypertension Agitation Seizure 2-7d Hallucination Delirium Tremens Confusion, Agitation Autonomic instability Fever Tachycardia, HTN Diaphoresis Delirium Hallucinations Lasts 5 days 5% Death Treatment Benzodiazepines Thiamine Multivitamins Folic acid Haloperidol...
Read moreAnxiolytics
Buspirone → Treats GAD, Non-addictive Partial 5-HT1A agonist Side effects Headache Nausea Dizziness Benzodiazepines Drugs/Indication Diazepam Lorazepam Emergency → IM Alcohol withdrawal Liver SAFE Clonazepam → Long half-life → Less addiction Alprazolam → Panick attack, Panick disorder Oxazepam → Alcohol withdrawal, Liver SAFE Chlordiazepoxide → Alcohol withdrawal Temazepam → Hypnotic Flurazepam → Hypnotic Triazolam → Hypnotic Side effects Sedation...
Read moreAntipsychotics
Atypical Antipsychotics → All need to monitor FBS and lipids ALL CAUSE QTc prolongation → Baseline ECG IF history of heart problem -PINEs → Weight gain, Metabolic syndrome, Diabetes Quetiapine → NO movement disorders Psychosis + Insomnia Psychosis + Mania (Bipolar) Olanzapine → Diabetes, ↑Weight, Metabolic syndrome Clozapine Agranulocytosis → Monitor CBC weekly...
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