Cardiology
Pulmonology
Nephrology
Endocrinology
Gastroenterology
Hem/Onc
Rheumatology
General Surgery
Orthopedics
Urology
Vascular Surgery
Neurosurgery
Obstetrics
DNA Viruses
Rheumatology
Antiphospholipid Syndrome
Etiology IgG or IgM against negatively charged phospholipids Lupus anticoagulant Anticardiolipin Ab Presentation Arterial and Venous thromboses Spontaneous abortion (1st and 2nd trimester) → Mostly with Anticardiolipin ↑aPTT → Mostly with lupus anticoagulant Normal PT and INR False positive VDRL/RPR → Lab reagent similar to cardiolipin Diagnosis Best initial → Mixing...
Read moreSLE
Systemic Lupus Erythematosus Etiology Autoimmune complex Women > Men Black > White Presentation DOPAMINE RASH (4 out of 12 criteria) Discoid rash Oral ulcer Photosensitivity Arthritis (90%) → Nondeforming! Malar rash Immunology Anti-dsDNA Anti-Smith (Sm) Antiphospholipid False positive VDRL/RPR Positive LE cell preparation → Phagocyte with nuclear material inside Neuro...
Read moreJuvenile Idiopathic Arthritis (JIA/JRA)
Etiology More common in girls 95% resolve by puberty Presentation Morning stiffness >6w is a <16y patient Subtypes Pauciarticular (Oligoarthritis) Most common ≤4 joints No systemic symptom Uveitis ANA⊕ RF⊖ ↑ESR Later → Uveitis Polyarthritis ≥5 joints Systemic symptoms rare Severe disease RF⊕ Reumatoid Nodules Young children → ANA⊕ Systemic (Still...
Read moreRheumatoid Arthritis
Etiology Unknown Women 35-50y HLA-DR4 Chronic synovitis → Overgrowth, Pannus → Damage everything Presentation Bilateral symmetric joints (≥3 joints) PIP (DIP is spared → Only in DJD) MCP Wrists Knees Ankles Morning stiffness ≥30 (>60) min → Key to diagnosis Skin → Rheumatoid nodule (20%) → Biopsy → Cholesterol Ocular → Episcleritis Lung → Pleural effusion, Nodules Vasculitis →...
Read moreSports Medicine
Rotator Cuff Injury Etiology Damage to muscle, tendon, bursae Presentation Flexion/Abduction impaired Shoulder pain → Worse at night Tenderness → Supraspinatus insertion Diagnosis Most accurate → MRI Treatment NSAIDs Rest Physical therapy Steroid injection Surgery Patellofemoral Syndrome Etiology Trauma Quadriceps strength imbalance Meniscal tear Presentation Anterior knee pain In front...
Read moreCarpal Tunnel Syndrome
Peripheral neuropathy Median nerve compression under flexor retinaculum Etiology Overuse Pregnancy Diabetes RA Acromegaly Amyloidosis Hypothyroidism Presentation Pain in hand Palm Thumb Index Ring finger (radial half) Worse at night Thenar atrophy Tinel sign → Tapping median nerve reproduces pain Phalen sign → Flexing wrist 90º reproduces pain First sensory signs;...
Read moreFibromyalgia
Etiology Unknown Presentation Young woman Chronic MSK pain Neck Shoulder Back Hip Trigger point tenderness Trapezius Knee medial fat pad Lateral epicondyle Stiffness Numbness Fatigue Headache Sleep disorder Diagnosis No test All labs normal Painful areas 11-18 → Fibromyalgia <11 → Myofascial Pain Syndrome Treatment First → Aerobic exercise and...
Read moreLow Back Pain
Lumbosacral Strain Etiology Heavy lifting Straining Presentation Just back pain Diagnosis No test needed Treatment NSAIDs Disk Herniation (Sciatica) Etiology Heavy lifting Straining Presentation Pain/numbness of medial calf/foot ⊖ Knee/ankle reflex ⊕ SLR → 95% sensitive, 50% Specific Roots L4 root (L3/L4 disk puts pressure on it but exits between L4/L5)...
Read moreGout / Pseudogout (CPPD)
Gout Etiology 90% in Men Uric acid metabolism defect ↑Production Idiopathic Cell turnover Cancer Hemolysis Psoriasis Chemotherapy Enzyme deficiency Lesch-Nyhan Syndrome (HGPRT def.) Glycogen storage disease ↓Excretion Renal insufficiency Ketoacidosis Lactic acidosis Drugs Thiazides Aspirin Presentation Acute Attack Man Sudden pain, redness, tenderness of big toe At night After...
Read moreOsteoarthritis (DJD)
Definition Degenerative Joint Disease Chronic Articular cartilage loss No inflammation Etiology Age Trauma Contact sports Obesity Presentation Weight-bearing joints → Knee, Hip, Ankle DIP > PIP > MCP Pain Worsens with use Crepitation No effusion Stiffness <15 min Heberden nodes → DIP enlargement Bouchard nodes → PIP enlargement Diagnosis Labs ALL normal...
Read moreDupuytren 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 more