Cardiology
Pulmonology
Nephrology
Endocrinology
Gastroenterology
Hem/Onc
Rheumatology
General Surgery
Orthopedics
Urology
Vascular Surgery
Neurosurgery
Obstetrics
DNA Viruses
Notes
Esophageal Disorders
When to do endoscopy Dysphagia/Odynophagia + Weight loss + Blood in stool + Anemia When to do manometry Motility dysphagia (Non-progressive) Achalasia Spasm Scleroderma Esophagitis Etiology Infectious → AIDS/↓Immune Candidiasis → 90% CMV HSV HIV Pill esophagitis NSAIDs Antibiotics Doxycycline Bisphosphonates Alendronate HAART KCL Eosinophilic Children with asthma, eczema, odynophagia Caustic Presentation...
Read moreOsteomyelitis
Etiology Children → Hematogenous Adults → Contiguous (nearby) Due to diabetes, vascular insufficiency Organisms Most common → Staph aureus Sickle cell → Salmonella Hip replacement → Staph epidermidis Foot puncture → Pseudomonas IVDU → Staph aureus, Pseudomonas Presentation Diabetic patient with ulcer Warmth, redness, swelling Draining sinus Afebrile Diagnosis Best initial → X-ray If Normal → Best...
Read moreSeptic Arthritis
Etiology Damaged joint DJD RA Prosthetic joint → Highest risk <3m → Perioperative → S. aureur, Pseudomonas 3-12m → Perioperative → S. epidermidis >12m → Not related to surgery → New S. aureus infection Blood spread Endocarditis IVDU Organism Staph (40%) Strep (30%) Gram ⊖ rod (20%) Staph epidermidis →...
Read moreOsteoporosis
Etiology ↓ Bone density Osteomalacia is mineralization defect due to severe ↓ Vit D Risk Factors Age Smoking Caffeine Alcohol Family history ↓ Estrogen in women Hypogonadism in men Hyperthyroidism Chronic inflammatory disease Corticosteroid Presentation Old woman Asymptomatic Spontaneous finding with routine DEXA scan in F>65y Vertebral fracture → ↓...
Read moreSeronegative Spondyloarthropathies
Ankylosing Spondylitis Etiology HLA-B27 association Can be associated with IBD → Enteropathic Spondylitis → Different from reactive arthritis Presentation Men <40y Low back pain/stiffness Worsen by rest Relieved by activity Radiate to buttocks Lumbar curvature flattening ⨁ Schober test → ↓ Spine flexion ↓ Chest expansion Enthesopathy → Achilles tendon...
Read moreSjögren Syndrome
Etiology Lymphoplasmacytic infiltration of exocrine glands Ab against lacrimal/salivary glands 90% women Causes Idiopathic RA SLE Primary biliary cirrhosis Polymyositis Hashimoto Presentation Dry eye Keratocunjunctivitis sicca Sand in eye Burning, itching Dry mouth Need to drink water constantly Difficult swallow Dental caries → Loss of teeth Parotid swelling Dry vagina →...
Read morePolymyositis / Dermatomyositis
Diseases Inclusion Body Myositis → T-cell mediated Polymyositis → T-cell mediated Dermatomyositis → Complex deposition Etiology Proximal muscle weakness Idiopahic Cancer (25%) Ovary Lung GI Lymphoma Presentation Muscle Getting up from chair Walking up stairs Pain/tenderness (25%) Dysphagia → Difficulty initiate swallowing Myocarditis Heart block ↑CK-MB but Cardio is normal! NO facial/ocular...
Read moreSystemic Sclerosis (Scleroderma)
Etiology Collagen deposition Presentation 80% → Limited → CREST Syndrome Calcinosis Raynaud Esophageal dysmotility Sclerodactyly Telangectasia Can also have primary pulmonary HTN NO damage to the lungs 20% → Diffuse → CREST + organ involvement Raynaud White → Blue → Red Precipitated by cold and stress Skin Fibrosis Telangectasia Pigmentation abnormality GI GERD Large-opening diverticula...
Read moreAntiphospholipid Syndrome
Etiology IgG or IgM against negatively charged phospholipids Lupus anticoagulant Anticardiolipin Ab Presentation Arterial and Venous thromboses Spontaneous abortion (1st and 2nd trimester) → Mostly with Anticardiolipin ↑aPTT → Mostly with lupus anticoagulant Normal PT and INR False positive VDRL/RPR → Lab reagent similar to cardiolipin Diagnosis Best initial → Mixing...
Read moreSLE
Systemic Lupus Erythematosus Etiology Autoimmune complex Women > Men Black > White Presentation DOPAMINE RASH (4 out of 12 criteria) Discoid rash Oral ulcer Photosensitivity Arthritis (90%) → Nondeforming! Malar rash Immunology Anti-dsDNA Anti-Smith (Sm) Antiphospholipid False positive VDRL/RPR Positive LE cell preparation → Phagocyte with nuclear material inside Neuro...
Read moreJuvenile Idiopathic Arthritis (JIA/JRA)
Etiology More common in girls 95% resolve by puberty Presentation Morning stiffness >6w is a <16y patient Subtypes Pauciarticular (Oligoarthritis) Most common ≤4 joints No systemic symptom Uveitis ANA⊕ RF⊖ ↑ESR Later → Uveitis Polyarthritis ≥5 joints Systemic symptoms rare Severe disease RF⊕ Reumatoid Nodules Young children → ANA⊕ Systemic (Still...
Read moreRheumatoid Arthritis
Etiology Unknown Women 35-50y HLA-DR4 Chronic synovitis → Overgrowth, Pannus → Damage everything Presentation Bilateral symmetric joints (≥3 joints) PIP (DIP is spared → Only in DJD) MCP Wrists Knees Ankles Morning stiffness ≥30 (>60) min → Key to diagnosis Skin → Rheumatoid nodule (20%) → Biopsy → Cholesterol Ocular → Episcleritis Lung → Pleural effusion, Nodules Vasculitis →...
Read more