Cardiology
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Notes
Sports Medicine
Rotator Cuff Injury Etiology Damage to muscle, tendon, bursae Presentation Flexion/Abduction impaired Shoulder pain → Worse at night Tenderness → Supraspinatus insertion Diagnosis Most accurate → MRI Treatment NSAIDs Rest Physical therapy Steroid injection Surgery Patellofemoral Syndrome Etiology Trauma Quadriceps strength imbalance Meniscal tear Presentation Anterior knee pain In front...
Read moreCarpal Tunnel Syndrome
Peripheral neuropathy Median nerve compression under flexor retinaculum Etiology Overuse Pregnancy Diabetes RA Acromegaly Amyloidosis Hypothyroidism Presentation Pain in hand Palm Thumb Index Ring finger (radial half) Worse at night Thenar atrophy Tinel sign → Tapping median nerve reproduces pain Phalen sign → Flexing wrist 90º reproduces pain First sensory signs;...
Read moreFibromyalgia
Etiology Unknown Presentation Young woman Chronic MSK pain Neck Shoulder Back Hip Trigger point tenderness Trapezius Knee medial fat pad Lateral epicondyle Stiffness Numbness Fatigue Headache Sleep disorder Diagnosis No test All labs normal Painful areas 11-18 → Fibromyalgia <11 → Myofascial Pain Syndrome Treatment First → Aerobic exercise and...
Read moreLow Back Pain
Lumbosacral Strain Etiology Heavy lifting Straining Presentation Just back pain Diagnosis No test needed Treatment NSAIDs Disk Herniation (Sciatica) Etiology Heavy lifting Straining Presentation Pain/numbness of medial calf/foot ⊖ Knee/ankle reflex ⊕ SLR → 95% sensitive, 50% Specific Roots L4 root (L3/L4 disk puts pressure on it but exits between L4/L5)...
Read moreGout / Pseudogout (CPPD)
Gout Etiology 90% in Men Uric acid metabolism defect ↑Production Idiopathic Cell turnover Cancer Hemolysis Psoriasis Chemotherapy Enzyme deficiency Lesch-Nyhan Syndrome (HGPRT def.) Glycogen storage disease ↓Excretion Renal insufficiency Ketoacidosis Lactic acidosis Drugs Thiazides Aspirin Presentation Acute Attack Man Sudden pain, redness, tenderness of big toe At night After...
Read moreOsteoarthritis (DJD)
Definition Degenerative Joint Disease Chronic Articular cartilage loss No inflammation Etiology Age Trauma Contact sports Obesity Presentation Weight-bearing joints → Knee, Hip, Ankle DIP > PIP > MCP Pain Worsens with use Crepitation No effusion Stiffness <15 min Heberden nodes → DIP enlargement Bouchard nodes → PIP enlargement Diagnosis Labs ALL normal...
Read moreAplastic Anemia
Etiology BM invasion Infection Cancer Myelofibrosis Myelophthisic anemia Etiology BM fibrosis Extramedullary hematopoiesis Spleen Liver Presentation Pancytopenia symptoms Diagnosis Pancytopenia Blood smear Tear-drop cells Nucleated RBC Treatment TNF inhibitors Thalidomide Lenalidomide <50y → BM transplant Ruxolitinib → JAK2 inhibitor → Suppress myelofibrosis Disease SLE PNH B12/Folate deficiency Renal failure (↓EPO) Thymic...
Read moreHemolytic Anemia
Seen in all hemolytic anemias Sudden ↓HCT ↑LDH ↑Indirect bilirubin → Bilirubin gallstones (in chronic hemolysis) ↑Retic → ↑MCV ↓Haptoglobin ↑K ↓Folate Sickle Cell Disease Etiology AR Beta globin chain 6th position → Point mutation → Valine replaces Glutamic acid Presentation African American First presentation → Dactylitis in children Acute crisis Billirubin gallstones...
Read moreMacrocytic Anemia
Etiology ↓B12 Pernicious anemia Parietal cell atrophy → No intrinsic factor ↑ Risk of gastric cancer Pancreatic insufficiency → B12 not freed from R-protein Dietary (vegan) Terminal illeum Crohn Celiac → Also causes Iron deficiency Tropical sprue Radiation Blind loop syndrome Diphyllobotrium latum HIV Alcoholism ↓Folate Dietary (goat milk) Alcoholism...
Read moreMicrocytic Anemia
MCV <80 fL Etiology Iron deficiency Blood loss Menstruation GI bleeding Iron need Normal → 1-2 mg/day Menstruating → 2-3 mg/day Pregnancy → 5-6 mg/day Duodenum absorption → 4 mg/day Chronic disease Iron locked in cells, macrophages and ferritin Renal failure → ↓Erythropoietin ⬆︎Hepcidin Sideroblastic Iron cannot incorporate into heme Alcohol Lead poisoning Isoniazid...
Read moreHypercoagulable States
Factor V Leiden mutation Etiology Factor 5 resistant to inactivation by protein C Presentation Young caucasian with family history of thrombosis DVT PE MI Stroke Treatment First event → Heparin to Warfarin until INR 2-3 for 6m Second event → Heparin to Warfarin until INR 2-3 for 12m Third event...
Read moreBleeding Disorders
Hemophilia Etiology XR Factor 8 → A (80%) Factor 9 → B Factor 11 → C Presentation Male child with delayed joint/muscle bleeding Normal BT Normal PT ↑aPTT Diagnosis Best initial → Mixing study → Corrects aPTT Most accurate → Factor assays for 7, 8, 9, 11, 12 Treatment...
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