Notes

Tuberculosis (TB)

Etiology Previous BCG has no effect on management Risk factors Recent immigrant (5y) Homeless Prisoners HIV Heath care worker Close contact with TB Steroid use Hematologic malignancy Alcoholic Diabetes Presentation Risk factor + >3w of Fever Cough Sputum Fatigue Weight loss Hemoptysis Night sweats Lymphadenopathy FUO Ghon Complex Cavitary...

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Pneumonia

Community-Acquired Pneumonia Pneumonia before or <48h after admission Etiology Most common → Strep pneumoniae → Can cause in anybody COPD → H. influenza Recent viral influenza → S. aureus Alcoholism/Diabetes → Klebsiella Poor dentition/Aspiration → Anaerobes Young and healthy → Mycoplasma Hoarseness → Chlamidophylia pneumoniae Contaminated water/AC → Legionella Legionnaire’s Disease...

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Cystic Fibrosis

Etiology Autosomal Recessive CFTR gene (Chromosome 7) Thick mucus Presentation <1y → Meconium ileus, Cough, Wheezing, Recurrent URI >1y → Pancreatic insufficiency → FTT Young adult Respiratory Chronic sinopulmonary disease Chronic lung disease Cough, sputum, hemoptysis, bronchiectasis, wheezing, dyspnea Recurrent infection Sinus pain Polyps GI History of Meconium ileus Pancreatic...

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Eosinophilic Pulmonary Syndromes

Eosinophilic Pulmonary Syndromes General Dyspnea, cough, blood-tinged sputum, fever Peripheral eosinophilia Pulmonary infiltrates Treat underlying cause Corticosteroids may help Allergic Bronchopulmonary Aspergillosis (ABPA) Etiology Fungal antigens in bronchial tree Only in asthma patients History of atopic disorders Presentation Asthma history Atopy history Recurrent episodes of brown-flecked sputum + Transient...

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Bronchiectasis

Etiology Permanent anatomic abnormality → Dilated bronchi Most common cause → Cystic fibrosis (50%) Infection → TB, Pneumonia, Abscess Hypogammaglobulinemia, Immune deficiency Foreign body Tumor ABPA Collagen-Vascular disease RA Presentation Key → Recurrent episodes of high volume purulent sputum Hemoptysis Dyspnea Wheezing Weight loss Anemia of chronic disease Crackles NO clubbing...

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COPD

COPD Definition Appearance Nickname Acid-Base Chronic Bronchitis Productive cough >3m/year 2y Overweight Edematous Blue bloater Early Hypercapnia hypoxia Emphysema Terminal airway Obstruction Dilation Thin Wasted Pursed lips Minimal cough Pink puffer Late Hypercapnia Hypoxia Etiology Chronic Bronchitis Tobacco smoke Emphysema Tobacco smoke → Centrilobular Alpha-1 antitrypsin deficiency → Panlobular...

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Asthma

PND → First-gen antihistamine Reversible airway obstruction Etiology Unknown Family history Atopic disorders Obesity Exacerbation causes Allergens → Pollen, Dust mite, Cockroaches, Cat dunder Infection Cold air Emotional stress Exercise Catamenial → Related to menses Drugs → Aspirin, NSAID, Beta blocker, Histamine, Nebulized meds Tobacco smoke GERD Presentation Wheezing Acute onset SOB Cough...

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Primary Amenorrhea

First pregnancy test! Definition No 2º sexual characteristics by 13y 2º sexual characteristics present but no menses by 15y Etiology 2º sexual characteristics ABSENT Gonadal dysgenesis Turner syndrome Swyer syndrome Premature ovarian failure Radiation/Chemo to ovary Central hypogonadism Hypothalamic/Pituitary insufficiency Constitutional growth delay Undernourishment Stress Hyperprolactinemia Exercise Cranial radiation...

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Diabetes

Etiology Type 1 DM Insulin deficient Childhood onset HLA-DR3, HLA-DR4 Insulin dependent from beginning Not related to obesity Type 2 DM Insulin resistant Adult onset Related to obesity Presentation Polyurea Polyphagia (Type 1>2) Polydipsia ↓ Wound healing DKA (Type 1>2) Diagnosis 2x FBS >125 (two separate occasions) 1x Glucose >200...

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Adrenal Disorders

Hypercortisolism Etiology ↑ ACTH Pituitary source → Cushing Disease (70%) Ectopic source → Cushing Syndrome Small cell lung cancer, Carcinoid (10%) Unknown (5%) Adrenal source (15%) Presentation Fat redistribution Moon face Truncal obesity (↑ abdominal fat) Buffalo hump Thin extremities Skin Striae Easy bruising ↓ Wound healing Thin skin Osteoporosis...

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Calcium Disorders

Hypercalcemia Etiology Primary hyperpara Cancer Vit D intoxication Granulomatous disease (Sarcoidosis) Thiazide diuretics Hyperthyroidism Bone metastasis Multiple myeloma Presentation Stones → Nephrolithiasis Bones → Osteoporosis Groans Constipation Abdominal pain Moans Confusion Stupor Lethargy Short QT Syndrome Hypertension Diabetes insipidus Renal failure Treatment Ca >14 or Symptomatic → Saline at high volume...

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Thyroid Disorders

Hypothyroidism Etiology Hashimoto Thyroiditis Autoimmune Thyroid burnout Subacute Thyroiditis Postpartum Thyroiditis Postviral Thyroiditis Secondary Hypothyroidism Pituitary compromise Congenital Hypothyroidism FTT Hypotonia Umbilical hernia Prolonged jundice Generalized thyroid hormone resistance Iatrogenic → After surgery ↓ Iodine intake Lithium Amiodarone Presentation Bradycardia Constipation ↑Weight Fatigue, Lethargy, Coma ↓DTR Cold intolerance Hypothermia...

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