Notes

Upper Limb Injuries

Upper Limb Injuries Anterior Shoulder Dislocation Etiology Strain of glenohumeral ligaments >95% of shoulder dislocations Presentation Arm held to side Forearm externally rotated Severe pain Diagnosis Best initial → X-ray Most accurate → MRI Complications Axillary artery injury Axillary nerve injury Treatment Shoulder relocation Immobilization Weak pulse/sensation → Surgery Posterior...

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Fractures

Fractures Presentation Pain Swelling Deformity Diagnosis → X-ray Treatment rules Closed reduction Mild fracture No displacement Open reduction + internal fixation Severe fracture Displacement or misalignment Surgery and debridement Open fracture Types Comminuted fracture Bone broken into multiple pieces Cause → Crush injuries Stress fracture Cause → Repetitive insult to bone Most...

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Doctor and Society

Elder Abuse CAN report without consent of the patient Domestic Violence Can NOT report without consent of patient Impaired Drivers Suggest that the patient finds another method of transportation Not allowed to Confiscate keys Report to police Hospitalize Avoid them to get into the car Execution of Prisoners Never...

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Labs

Fishbone SERUM Na (sodium) 136 – 145 mEq/L K (potassium) 3.5 – 5.0 mEq/L Cl (chloride) 95 – 105 mEq/L Ca (calcium) 8.4 – 10.2 mg/dL Mg (magnesium) 1.5 – 2.0 mEq/L P (phosphorus) 3.0 – 4.5 mg/dL HCO3 (bicarbonate) 22 – 28 mEq/L Glucose – Fasting 70 –...

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Abbreviations

IF → Immunofluorescence

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COVID-19

Global pandemic 2020-2021 Etiology SARS-CoV-2 virus Presentation Fever Maiais Flu like symptoms SOB Diagnosis test Best initial → test Subtitle 2 Subtitle 3 Most accurate → test Subtitle 2 Subtitle 3 Complications Thrombosis Myocarditis Treatment test Best initial → test drug Subtitle 2 Subtitle 3 Most accurate → test drug Subtitle 2...

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Test Note

This is a test note to see if I can transfer colors using the online Evernote UI This is a Disease Etiology Diagnosis Best initial -> First test Treatment

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Testicular Cancer

Testicular Cancer Etiology Germ cell (95%) Seminoma → ↑ Placental ALP, LDH Yolk sac (Endodermal sinus) → ↑AFP Choriocarcinoma → ↑hCG Teratoma → ↑ AFP/hCG Non-Germ cell (5%) Leydig → ↑ Testosterone/Estrogen Sertoli Lymphoma → Metastasis Presentation Painless lump Does NOT transilluminate History of cryptorchidism History of Kleinfelter syndrome Retroperitoneal LAP Diagnosis Needle biopsy...

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Prostate Cancer

Prostate Cancer Presentation Asymptomatic Obstructive symptoms similar to BPH Palpable mass Diagnosis Best initial → Biopsy Most accurate → Biopsy U/S to guide biopsy PSA → Controversial Corresponds to volume of cancer No mortality benefit NOT routinely offered → Only if patient asks or first degree relative history >75y do NOT...

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Bladder Cancer

Bladder Cancer Transitional cell carcinoma Etiology Smoking Meat/fat diet Schistosomiasis Cyclophosphamide Aniline dye exposure Presentation Gross Hematuria Frequency Urgency Dysuria Diagnosis Best initial/Most accurate → Cystoscopy + biopsy U/A → Hematuria Cytology → Dysplastic cells Staging → MRI/CT Treatment Carcinoma in situ → Intravesicular chemo Superficial lesion TURBT Intravesicular...

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Renal Cell Carcinoma

Renal Cell Carcinoma Adenocarcinoma Etiology Male Smoking Obesity Cysts due to ESRD von-Hippel-Lindau Angiomatosis Visceral cysts RCC CNS tumors Presentation Triad Hematuria Flank pain Flank mass LEFT-SIDED varicocele Fever Malaise ↓ Weight Anemia 5-10% → Polycytemia Diagnosis Best initial → CT Scan Most accurate → Histology on nephrectomy specimen...

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Autonomy

Advanced Directives Order of decision making Patient Proxy/Agent Proxy must be completely clear on what to do, what not to do! Living will Person clearly familiar with his wishes Test should clearly state that a friend knows and can prove he knew the patient wishes Family Spouse Adult children...

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