Cardiology
Pulmonology
Nephrology
Endocrinology
Gastroenterology
Hem/Onc
Rheumatology
General Surgery
Orthopedics
Urology
Vascular Surgery
Neurosurgery
Obstetrics
DNA Viruses
Medicine
GI Cancers
Esophageal Cancer Etiology SCC Most common worldwide Upper/Middle third Alcohol Tobacco Nitrosamines Adenocarcinoma Most common in US Lower third GERD Barrett Esophagus Presentation >50y PROGRESSIVE dysphagia → From solid to liquid ↓Weight GI bleeding Vomiting Diagnosis Best initial → Barium esophagram (might be) Asymmetric stricture Most accurate → Endoscopy and...
Read moreGallbladder
RUQ pain Jaundice Fever Best Initial Most Accurate Cholelithiasis ✓ ✖︎ ✖︎ U/S U/S Cholecystitis ✓ ✖︎ ✓ U/S HIDA scan Choleducolithiasis ✓ ✓ ✖︎ U/S MRCP Cholangitis ✓ ✓ ✓ U/S ERCP Cholelithiasis Etiology Cholesterol stone → Radiolucent Pigmented stone Black → Hemolysis Brown → Infection Presentation Fat...
Read moreThyroid Cancer
Thyroid Nodule Etiology Palpable in 5% of women and 1% of men 95% benign Radiation to neck Presentation Benign Adenoma Colloid nodule Cyst Malignant Papillary Radiation to neck Papillary cell tumor Branching papillae Lymphadenopathy Orphan Annie nuclei Psammoma bodies Positive prognosis Lymphatic spread Follicular Follicular cell tumor Hematologic spread...
Read moreMultiple Endocrine Neoplasia (MEN Syndromes)
Syndrome MEN 1 (3P) MEN 2A MEN 2B Tumors Pituitary Functioning or NOT Parathyroid ↑Ca Pancreas Zollinger Ellison Insulinoma VIPoma Parathyroid ↑Ca Thyroid (Medullary) Calcitonin → ↓Ca Pheo Neuronal Tumors Intestinal ganglioma Thyroid (Medullary) Calcitonin → ↓Ca Pheo Notes MEN gene Ret oncogene Ret oncogene Marfanoid habitus
Read moreGenetic Syndromes
Bartter Syndrome → Genetic salt loss in loop of Henle Metabolic alkalosis Not volume-responsive NOT hypertensive ↓K ↑ Urine Cl Gitelman Syndrome → Problem with thiazide-sensitive Na/Cl symporter in the distal convoluted tubule Metabolic alkalosis Not volume-responsive NOT hypertensive ↓K ↓Mg ↑ Urine Cl Conn’s Syndrome → Primary hyperaldosteronism Metabolic alkalosis...
Read morePleural Disease
Pleural Effusion Etiology Transudate CHF Cirrhosis Nephrotic syndrome Exudate Pneumonia → Parapneumonic effusion TB Malignancy PE Collagen vascular RA SLE Pancreatitis Trauma Presentation Dyspnea Pleuritic chest pain Cough ↓ Breath sounds Dullness to percussion Diagnosis Best initial → CXR AP → Costophrenic angle blunting Lateral Decubitus → To assess loculation...
Read moreGastriesophageal Reflux Disease
GERD Etiology Inappropriate relaxation of LES Worsened by Nicotine Alcohol Caffeine Chocolate Peppermint Late-night meals Obesity Scleroderma Gasteroparesis Hiatal hernia Presentation Heartburn Epigastric burning pain 30-90m after meals Radiate → Up into chest Worsened by → Reclining Improved by → Sitting, standing, antacids Sore throat → Water brash Bad metallic...
Read moreNephrotic Syndrome
Measure of severity of proteinuria Definition Proteinuria → >3.5 gr/24h Hypoproteinemia Hyperlipidemia Edema Etiology Diabetes Hypertension Any type of GN Associations Cancer → Membranous Children → Minimal change disease IVDU/AIDS → Focal-segmental NSAID → Minimal change disease, Membranous SLE → Any of them C3 nephritic factor → Membranoproliferative II/III Transient proteinuria → Common in boys →...
Read moreManeuvers
Valsalva → ⬇︎ Preload → ↓ All murmurs, ↑MVP/HOCM Standing → ⬇︎ Preload → ↓ All murmurs, ↑MVP/HOCM Diuretic → ⬇︎ Preload → ↓ All murmurs, ↑MVP/HOCM Squatting → ⬆︎ Preload → ↑ All murmurs, ↓MVP/HOCM Leg raising → ⬆︎ Preload → ↑ All murmurs, ↓MVP/HOCM Handgrip → ⬆︎ Afterload → ↑MR/AR, ↓AS/MVP/HOCM, MS not changed Amyl Nitrate → ⬇︎ Afterload → ↓MR/AR,...
Read moreUrinary incontinence
Stress Incontinence Presentation Old woman Painless leakage with ↑ abdominal pressure Coughing Laughing Lifting heavy objects Diagnosis Patient stand and cough → Leakage Treatment Kegel Estrogen cream Surgical tightening Urge Incontinence Presentation Sudden pain in bladder Immediate urge to urinate Diagnosis Pressure measurement in half-full bladder Manometry Treatment Bladder training...
Read morePotassium Disorders (K)
Hyperkalemia K >5 Etiology Pseudo ↑K Hemolysis Tourniquet Thrombocytosis Leykocytosis ↓ Excretion Renal failure ↓ Aldosterone RTA type 4 Addison disease Drugs ACEi ARB Aldosterone inhibitors Spironolactone Eplerenone K-sparing diuretics Triamterene Amiloride Tissue release Tissue destruction Hemolysis Rhabdomyolysis Tumor lysis ↓ Insulin → Insulin drives K into cells Acidosis → H...
Read more