Cardiology
Pulmonology
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Notes
Dupuytren Contracture
Etiology Men >40y Genetic predisposition Alcoholism Cirrhosis Hyperplasia of palmar fascia → Constriction Presentation Nodule formation Contracture of 4th and 5th finger Hand flexed Can no longer be properly extended Diagnosis Clinical Treatment Cosmetic concern Triamcinolone Lidocaine Collalgenase injection Impaired function → Surgery
Read moreVasculitis
General Presentations Fever Fatigue/Malaise Weight loss Arthralgia Myalgia LARGE VESSEL Giant Cell (Temporal) Arteritis Risk Factors Polymyalgia Rheumatica Age >50y Female Presentation Headache Scalp pain Temporal tenderness Visual symptoms → Amaurosis fugax Jaw claudication Other arteries involvement ↓ Arm pulses Bruit near clavicle Aortic regurgitation Diagnosis ↑ ESR (>50)...
Read moreDiagnostic Tests in Nephrology
Best initial test → Urinalysis (UA) + BUN + Cr Cast RBC → Glomerulonephritis WBC → Pyelonephritis Eosinophil → Acute interstitial nephritis Hyalin → Dehydration (Tomm-Horsfall accumulation) Borad/Waxy → CRF Granular (Muddy-brown) → ATN (dead tubular cells) Protein UA Dipstick → Only detects albumin 0 = <300mg → Normal (microalbuminuria) Microalbuminuria 30-300 mg/24h Important in diabetics Treatment → ACEi/ARB...
Read moreGlomerulonephritis (Nephritic Syndrome)
General Rules Etiology → Not from toxins/drugs Presentation Proteinuria <1.5 g/d Hematuria Oliguria Uremia Edema Hypertension Chronic All can progress to → Nephrotic syndrome Diagnosis Most accurate → Biopsy UA Hematuria RBC cast Dysmorphic RBC Proteinuria ↓Na ↓Na fractional excretion Treatment Steroids Cyclophosphamide Mycophenolate Goodpasture Syndrome Etiology Antibody to Collagen IV...
Read moreSigns in Radiology
Cardiac findings in CXR Pear-shaped → Pericardial effusion Boot-shaped → TOF Jug handle → Primary pulmonary hypertension “3”/Rib notching → Coarctation of aorta Egg on string → TOGV Globular-shaped → Hypoplastic left heart syndrome “8”/Snowman → TAPVR Miscellaneous Signs String sign → Pyloric stenosis Shoulder sign → Pyloric stenosis Mushroom sign → Pyloric stenosis Railroad track sign → Pyloric stenosis Doughnut sign (Target...
Read morePeripheral Vascular Disease
Etiology DM Hyperlipidemia Hypertension Smoking Presentation Leg pain (calves) on exertion → Intermittent claudication Both walking UP and DOWN hill Spinal stenosis is worse walking DOWN hill Smooth shiny skin Loss of Hair follicle Sweat gland Sebaceous gland Diagnosis Best initial → Ankle-brachial index (ABI) → <0.9 Most...
Read moreOrthopedics
Hand 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...
Read moreAcute Abdomen
RLQ Pain Appendicitis Etiology Lymphoid hypertrophy Fecalith Foreign body Tumor Parasite Presentation M > F 10-30y Periumbilical pain 1-12h THEN → RLQ pain → MacBurny point N/V Anorexia Fever ↑WBC with left shift RLQ tenderness Signs Rovsing sign → LLQ palpation causes RLQ pain Psoas sign → Pain with hip...
Read moreAbdomen Surgery
Ischemic Bowel Disease Chronic → Chronic Mesenteric Ischemia Etiology ↓ Blood flow to mesentery Progressive from mild ischemia to full occlusion Sloughing of mucosa Analogous to angina Presentation Abdominal pain after eating → Intestinal Angina Bloody diarrhea Diagnosis Best initial → CT abdomen → vs acute mesenteric ischemia in which you get AXR...
Read moreTrauma
ABC Assessment Airway No airway No facial trauma No cervical spine injury → Orotracheal tube Cervical spine injury → Flexible bronchoscopy → Orotracheal tube Facial trauma → Cricothyroidotomy Breathing Proper ventilation → O2Sat >90% Circulation 2 large IV lines Aggressive fluid resuscitation Abdominal Trauma Signs Cullen sign → Bruising around umbilicus Hemarrhagic pancreatitis AAA...
Read morePeds – Orthopedics
Congenital Hip Dysplasia Etiology Infants Presentation Found in newborn screen exam Click and clunk in the hip Diagnosis Barlow maneuver → Dislocates (Clunk) Ortolani maneuver → Fixes (Click) Allis (Galeazzi) sign → Knees have different height in supine position when flexed Asymmetric inguinal skin folds Best initial <4m →...
Read morePeds – Pulmonology
Bronchiolitis Organisms RSV → Most common Parainfluenza 1, 2 Influenza virus Metapneumovirus Etiology <2y Small airways of lower respiratory tract Fall/winter Presentation Day 1-3 Fever Rhinorrhea Cough Infants with RSV → Risk of Apnea Day 4-6 Tachypnea → Earliest sign Respiratory distress Hypoxia Intercostal retraction Washing machine sounds Crackles...
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