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Notes
Skin Malignancies
Malignant Melanoma Etiology Sun exposure Presentation A → Asymmetry B → Border irregular C → Color irregular D → Diameter >5-6 mm E → Evolution over time → Worst prognostic Ugly Duckling sign → One lesion different from others Black lesion WITHOUT hair Pruritus in a changing skin lesion Diagnosis Excisional Biopsy Punch Biopsy if big...
Read moreHypersensitivity
Urticaria Type 1 hypersensitivity IgE-Mast cells Histamine Annular red papule Blanch with force If anaphylaxis → first Epinephrin IM If no anaphylaxis Steroid H1, H2 blockers Erythema Multiform Triggers Recurrent HSV Mycoplasma Coccidioidomycosis Can be a drug reaction Presentation Target lesions EM Minor → NO mucus membrane involvement EM Major Can involve mucus...
Read moreNephrotic Syndrome
Measure of severity of proteinuria Definition Proteinuria → >3.5 gr/24h Hypoproteinemia Hyperlipidemia Edema Etiology Diabetes Hypertension Any type of GN Associations Cancer → Membranous Children → Minimal change disease IVDU/AIDS → Focal-segmental NSAID → Minimal change disease, Membranous SLE → Any of them C3 nephritic factor → Membranoproliferative II/III Transient proteinuria → Common in boys →...
Read moreManeuvers
Valsalva → ⬇︎ Preload → ↓ All murmurs, ↑MVP/HOCM Standing → ⬇︎ Preload → ↓ All murmurs, ↑MVP/HOCM Diuretic → ⬇︎ Preload → ↓ All murmurs, ↑MVP/HOCM Squatting → ⬆︎ Preload → ↑ All murmurs, ↓MVP/HOCM Leg raising → ⬆︎ Preload → ↑ All murmurs, ↓MVP/HOCM Handgrip → ⬆︎ Afterload → ↑MR/AR, ↓AS/MVP/HOCM, MS not changed Amyl Nitrate → ⬇︎ Afterload → ↓MR/AR,...
Read moreHeat
Heat Cramps/Exhaustion Etiology Exertion High temp Presentation Normal body temp Normal CPK Normal K Treatment Oral fluids Oral electrolytes Heatstroke Etiology Exertion High temp Presentation ↑ body temp ↑CPK ↑K Treatment IV fluids Evaporation Benzodiazepine to prevent shaking Neuroleptic Malignant Syndrome Etiology Antipsychotics Presentation ↑ body temp ↑ CPK...
Read moreCardiac Rhythm Disorders
Cardiac Arrest Initial management Make sure truly unresponsive Call 911/EMS Airway Head tilt Chin lift Jaw thrust Breathing → Rescue breaths Circulation → Chest compression Precordial thumb → Only effective <10min (Witnessed) Defibrillation = Unsynchronized (120-200J Biphasic) Cardioversion → Synchronized Rhythms Asystole/PEA (Pulseless Electrical Activity) CPR Epinephrine/Vasopressin Simultaneously find underlying cause Tamponade Tension pneumothorax Hypovolemia...
Read moreHypothermia
Presentation Intoxicated person + ↓ Body Temp Unintoxicated people don’t fall sleep in cold! Diagnosis Best initial step → ECG → J waves Osborn wave Where QRS hits ST segment Complications Most common cause of death → Arrhythmia Treatment 32-35 → Passive external rewarming 28-32 → Active external rewarming <28 → Active...
Read moreBurns
Etiology 1st cause of death → Smoke inhalation, CO poisoning 2nd cause of death Airway injury present → Airway burn Airway injury NOT present → Volume depletion Most common cause of death several days after → Staph infection Treatment → TOPICAL silver sulfadiazine (NO IV) Degree 1st degree → Only epidermis Painful No blister 2nd degree → Epidermis...
Read moreHead Trauma
Diagnosis LOC ⇒ Best initial → CT without contrast Concussion → Normal CT NO focal NO lucid interval Treatment → 24h observe at HOME Contusion → Ecchymoses Rare focal NO lucid interval Treatment → 24h observe at HOSPITAL Subdural hematoma → Crescent (venous) Focal possible No lucid interval Treatment → Drain if LARGE Compression to...
Read moreUrinary incontinence
Stress Incontinence Presentation Old woman Painless leakage with ↑ abdominal pressure Coughing Laughing Lifting heavy objects Diagnosis Patient stand and cough → Leakage Treatment Kegel Estrogen cream Surgical tightening Urge Incontinence Presentation Sudden pain in bladder Immediate urge to urinate Diagnosis Pressure measurement in half-full bladder Manometry Treatment Bladder training...
Read morePotassium Disorders (K)
Hyperkalemia K >5 Etiology Pseudo ↑K Hemolysis Tourniquet Thrombocytosis Leykocytosis ↓ Excretion Renal failure ↓ Aldosterone RTA type 4 Addison disease Drugs ACEi ARB Aldosterone inhibitors Spironolactone Eplerenone K-sparing diuretics Triamterene Amiloride Tissue release Tissue destruction Hemolysis Rhabdomyolysis Tumor lysis ↓ Insulin → Insulin drives K into cells Acidosis → H...
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