Medicine

Soduim Disorders (Na)

Hypernatremia Na >145 Etiology Free water loss (6 Ds) Diuresis Dehydration Sweating Burns Fever Diarrhea Doctors (Iatrogenic) Disease Pneumonia → Hyperventilation Sickle cell Diabetes Insipidus Central DI → ↓ADH CNS disorder Very high Na → No thirst Nephrogenic DI → ↑ but ineffective ADH Na not very high → Patient is...

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Hypertension

SBP >140 DBP >90 Most common disease in US Most common risk factor for MI Etiology 90% → Essential hypertension Other causes Renal artery stenosis Glomerulonephritis Coarctation of aorta Acromegaly Obstructive sleep apnea Pheo Hyperaldosteronism Cushing syndrome Congenital adrenal hyperplasia Presentation Majority asymptomatic → Found on screening Renal artery stenosis → Continuous...

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Nephrolithiasis

Etiology Ca oxalate Alkaline urine Ca overexcretion ↓Ca intake → Ca in gut will not bind oxalate ⇒ ↑Oxalate absorption Crohn disease → ↑ Oxalate absorption Fat malabsorption Metabolic acidosis/RTA 2 → Remove Ca from bone ↓Citrate → Citrate will not bind to Ca in urine and Ca will deposit ↑Oxalate Struvite...

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PCKD

Cyst Complexity Simple cyst → Do NOT aspirate Echo free Smooth, thin wall Sharp demarcation No debris inside Complex cyst → Potential cancer → Aspirate Mixed echogenicity Irregular, thick walls Lower density on back wall Debris in cyst Polycystic Kidney Disease ADPKD Etiology Familial ADPKD1, ADPKD2 gene Presents >30y Presentation Pain Hematuria...

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TTP/HUS

TTP/HUS Etiology ↓ Metalloproteinase ADAMTS 13 ADAMTS 13 is vWF-cleaving enzyme ⇒ Large vWF multimers PLT mictothrombi → Block off small vessels → End-organ damage TTP → Adults Hereditary HIV Cancer SLE Drugs Cyclosporine Ticlopidine Clopidogrel HUS → Children E. coli 157:H7 Shigella Presentation ↓PLT Intravascular hemolysis → Most important, Always present Microangiopathic hemolytic anemia...

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CKD/ESRD

CKD = GFR <60 for >3m Kidney damage DM Hypertension Glomerulonephritis PCKD ESRD = Uremia (GFR <30) Etiology Leading cause → DM → Basement membrane thickened, Mesengial expansion, fibrosis HTN → Nephrosclerosis, Glomerulosclerosis Tubular damage Glomerular damage RPGN Presentation Uremia Anorexia N/V Uremic frost → Urea crystals on face Indications for Dialysis...

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Analgesic Nephropathy

Etiology NSAIDs Presentation ATN AIN Membranous glomerulopathy Vascular insufficiency NSAIDs inhibit prostaglandins → Constrict afferent artriole Papillary necrosis Papillary Necrosis Etiology Sloughing off renal papillae NSAIDs Sudden vascular insufficiency Presentation Sudden flank pain Fever Hematuria Extra NSAIDs in the setting of Sickle cell Diabetes Urinary obstruction Chronic pyelonephritis Diagnosis Best...

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Acute Kidney Injury

AKI (ARF) Etiology Prerenal azotemia Hypotension Sepsis Anaphylaxis Bleeding Dehydration Hypovolemia Diuretics Burns Pancreatitis CHF ↓Albumin Cirrhosis NSAIDs ACEi Renal artery stenosis Postrenal azotemia BPH Nephrolithiasis Cervical cancer Neurogenic bladder Retroperitoneal fibrosis Bleomycin Methylsergide → Migraine/Cluster Radiation Intrinsic renal disease ATN Toxins NSAIDs Aminoglycoside Amphotericin Cisplatin Cyclophosphamide Prolonged ischemia...

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Lung Cancer

Small Cell (SCLC) Etiology Notes Histology Paraneoplastic Small Cell Smoking myc oncogene Central Undifferentiated Aggressive Metastasis → LABBs Liver Adrenal Brain Bone Kulchitsky cells Small, dark blue Neuroendocrine Chromogranin A ⨁ Cushing → ACTH SIADH → ADH → ↓Na Lambert-Eaton Peripheral neuropathy Subacute cerebellar degeneration Non-Small Cell (NSCLC) Etiology Notes...

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Cirrhosis Causes

VW Happens Viral Hepatitis (Chronic) Presentation Cirrhosis Liver cancer PAN Diagnosis Hep B → ⨁ Surface Ag (DNA PCR) >6m Biopsy has no significance Only treat if ⨁ E-Ag OR DNA polymerase Hep C → PCR RNA viral load Treat anyone with ↑ RCR RNA viral load Treat anyone...

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Pancreas Disorders

Insulinoma MEN 1 Whipple triad Hypoglycemia on blood test Associated symptoms Sweating Palpitation Anxiety Tremor Headache Confusion Resolution of symptoms with correction glucose Best initial test → Fasting insulin + C-peptide Most accurate → 72-hour fasting test Localize tumor and resect VIPoma VIP-producing malignant tumor Presentation Classic triad Watery...

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Colon Cancer

Colon Cancer Second cause of cancer mortality in US Etiology Polyps >2 cm Sessile > Pedunculated Villous > Tubular Presentation Right-sided Anemia → Chronic blood loss ↓ Weight Anorexia Diarrhea Vague abdominal pain Left-sided Obstruction → Apple-core Bowel habit change Constipation ↓ Caliber Blood-streaked stool Rectal Bright red blood...

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