OnlineMedEd-QuickTables-Preview.pdf

Index: 1.

CARDIOLOGY

a.  b. c. d. e. f. g. h. i. 2.

Gallbladder Disease Esophagitis Esophageal Disorders Peptic Ulcer Disease Misc. Gastric Disorders Acute Diarrhea Chronic Diarrhea Cirrhosis and Ascites Cirrhosis Etiologies Malabsorption Diverticular Disease Colon Cancer Gi Bleed Acute Pancreatitis

Inammatory Bowel Disease Jaundice Viral Hepatitis

12 13 14 15 15 16 16 17 18 19 19 20 21 22 22 23 23

Acute Kidney Injury Sodium Calcium Potassium Kidney Stones Cysts and Cancer Acid Base

24 25 25-26 27 27 28 28

HEMATOLOGY O NCOLOGY

a.  b. c. d. e. f. g. 6.

8 8 9 9 10 10 11

NEPHROLOGY

a.  b. c. d. e. f. g. 5.

Asthma Lung Cancer Pleural Effusion DVT PE COPD ARDS Interstitial Lung Disease

GASTROENTEROLOGY

a.  b. c. d. e. f. g. h. i.  j. k. l. m. n. o.  p. q. 4.

1 2 3 4 4 5 5 5 6

PULMONARY

a.  b. c. d. e. f. g. 3.

Coronary Artery Disease Congestive Heart Failure Valve Disease Cardiomyopathy Pericardial Disease Syncope Hypertension Cholesterol ACLS

Macrocytic Anemia Microcytic Anemia Normocytic Anemia Leukemia Lymphoma Plasma Cell Dyscrasia Bleeding, Thrombocytopenia

30 30 31 32 32 33 34

I NFECTIOUS DISEASE

a.  b. c. d.

Antibiotics HIV TB Sepsis

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36 36 37 37

Index: e. f. g. h. i.  j. k. l. 7.

Anterior Pituitary Posterior Pituitary Thyroid Nodules Men Syndromes Thyroid Disorders Adrenals Diabetes

42 43 43 43 44 45 46

NEUROLOGY

a.  b. c. d. e. f. g. h. i. 9.

Lung Infection UTI Genital Ulcers Skin Infections Endocarditis Antibiotics Surgery

38 38 39 39 40 41 41 41

E NDOCRINOLOGY

a.  b. c. d. e. f. g. 8.

Brain Inammation

Stroke Dizziness Seizure Tremor Headache Back Pain Dementia Coma Weakness

48 48 49 50 50 51 52 52 53

R HEUMATOLOGY

a.  b. c. d. e. f.

Approach To Joint Pain Lupus Rheumatoid Arthritis Other Connective Tissue Dz Monoarticular Athropathies Seronegative Arthropathies

54 55 55 56 56 57

10. DERMATOLOGY

a.  b. c. d. e. f. g. h.

Blistering Disease Papulosquamous Dermatoses Eczematous Dermatoses Hypersensitivity Reactions Hyperpigmentation Hypopigmentation Skin Infections Alopecia

58 58 59 59 60 61 61 62

11. PEDIATRICS

a.  b. c. d. e. f. g. h. i.  j. k. l. m. n.

Constipation Neonatal Jaundice Vomiting Seizures Gi Bleed Allergies Peds Rash Peds Preventable Trauma Vaccinations ENT Pediatrics CT Upper Airway / Stridor Lower Airway

Immunodeciencies

64 64 65 65 66 66 67 68 68 69 70 71 71 72

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Index: o.  p. q. r. s.

Ortho Peds Pediatric Ophtho Urology Peds Sickle Cell Abuse

73 74 75 76 76

12. PSYCHIATRY

a.  b. c. d. e. f. g. h. i.  j. k. l. m. n. o.

Defense Mechanisms Anxiety Disorders Impulse Control Disorders Eating Disorders Mood Disorders I And II Delusional Disorders Personality Disorders Peds Psych Dissociative Disorders Addiction Drugs of Addiction: Intoxication and Withdrawal Sleep I And II Psych Pharm Psych Cognition Psych Somatoform – DSM-IV

78 79 80 80 81 82 83 84 85 85 86 87 88-89 90 90

13. GYNECOLOGY

a.  b. c. d. e. f. g. h. i.  j. k. l. m. n.

Gynecologic Cancers Gestational Trophoblastic Disease Incontinence Adnexal Mass Pelvic Anatomy Gyn Infections Vaginal Bleeding 1: Premenarche Vaginal Bleeding 2: Reproductive Years Vaginal Bleeding 3: Reproductive Age Primary amenorrhea Secondary Amenorrhea Infertility Menopause Virilization

92 93 93 94 95 96 97 97 98 99 100 101 101 102

14. OBSTETRICS

a.  b. c. d. e. f. g. h. i.  j. k. l. m. n. o.  p. q. r.

Physiology Of Pregnancy 1st Visit Labs And Initial Care Quad Screen Third Trimester Labs Medical Disease Normal Labor Abnormal Labor Third Trimester Bleeding L&D Pathology Advanced Early Testing Eclampsia Multiple Gestation Post-Partum Hemorrhage Early Antenatal Testing Isoimmunization Perinatal Infections OB Operations Contraception

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104 104 105 105 106 107 108 108 109 110 110 111 111 112 112 113 114 115

Index: 15. SURGERY: GENERAL

a.  b. c. d. e. f. g. h. i.  j. k. l. m. n. o.  p.

Pre-op Evaluation Post-op Fever Chest Pain Altered Mental Status Abdominal Distention Wound Fistula Decreased Urinary Output Obstructive Jaundice Esophagus Small Bowel Pancreas Leg Ulcers Colorectal Breast Cancer Pediatrics First Day

116 116 117 117 118 118 119 119 120 121 121 122 122 123 124 125

15. SURGERY: SPECIALTY

a.  b. c. d. e. f. g. h. i.  j. k. l. m. n. o.  p. q.

Pediatrics Weeks To Months Surgical Hypertension Endocrine CT Surgery Pediatrics CT Vascular Adult Ophtho Skin Cancer Pediatric Ophtho Neurosurgery Bleeds Neurosurgery Tumors Urologic Cancer Urology Peds Urologic Miscellaneous Ortho Injury Ortho Hand Ortho Peds

126 126 127 128 129 130 131 132 133 134 134 135 136 137 138-139 140 141

15. SURGERY: TRAUMA

a.  b. c. d. e. f. g. h.

Shock Head Trauma Neck Trauma Chest Trauma Abdominal Trauma Burns Bites Toxic Ingestion

142 143 143 144 145 146 146 147

16. PREVENTATIVE  MEDICINE

a.  b. c. d. e. f.

Biostats Prevention

Condence Interval Bias Vaccines Screening

148 149 149 149 150 150

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 C 

CARDIOLOGY

Coronary Artery Disease MYOCARDIAL INFARCTION

ACUTE TREATMENT  OPTIONS

Path:

Occlusion of a coronary vessel

ASA

FIRST drug to give

Pt:

Chest pain that is worse with exertion,  better with rest, relieved with nitrates in a hypertensive, diabetic, dyslipidemic smoker, who is old

 Nitrates

Second

Angioplasty

No Clopidogrel needed, only in single-vessel disease

Bare-Metal Stent

Clopidogrel x 1 month, only in single-vessel disease

Drug-Eluting Stent

Clopidogrel x 1 year, only in single-vessel disease

CABG

Left Mainstem equivalent or multi-vessel disease

tPA

No PCI is available within 60 minutes transport time

Door-to balloon

90 minutes

Dx:

Tx:

ST segment changes = STEMI Biomarker Elevation = NSTEMI Stress Test = CAD Coronary Angiogram = best test Morphine, Oxygen, nitrates, Aspirin (MONA) Beta-Blocker, Ace-inhibitor, Statin, Heparin (BASH) Coronary Angiography with Stent (single vessel disease) CABG (multi-vessel disease) tPA if no transport available (60 minutes) R IS K  F ACTORS

Prasugrel = Clopidogrel CHRONIC T REATMENT  OPTIONS

AN D  G OALS

Beta-Blocker

BP < 140 / < 90, HR < 70

Hypertension

40, better > 60

Statins

LDL < 100 (prefer < 70)

Age

Woman > 55 Man > 45 STORY

STRESS TESTING

Imaging EKG

Test of choice, no baseline abnormality

PHYSICAL

Left sided / Substernal

Nonpositional

Echo

EKG abnormalities, no CABG

Worse with exertion

Nonpleuritic

 Nuclear

Better with rest

Nontender  

CABG, Baseline wall defects, LBB Testing

STABLE

UNSTABLE NSTEMI

STEMI

ANGINA

ANGINA

Pain

Exercise

@ rest

@ rest

@ rest

Relief 

Rest +  Nitrates

Ø

Ø

Ø

Trops

Ø

Ø

↑

↑

ST ∆s

Ø

Ø

Ø

↑

Exercise

Test of choice, no contraindication to exercise with feet

Pharm

Any reason why they can’t get on a treadmill, of any kind. Dobutamine and Adenosine essentially identical COMPLICATIONS OF MI

RV Failure

Right Sided ECG  No Nitrates

Aneurysm

Diagnosed by Echo

Arrhythmia

Vtach / Vb – ventricular ectopy from dying cells Brady / Blocks – AV nodal dysfunction

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A R D I     O

CHAPTER  1 :

CARDIOLOGY

ACLS R HYTHMS

TO TREATMENT

Rhythm

Drug

Electricity

Vb Vtach

Amio Amio

Shock   Shock  

Torsades

Mag

Shock  

SVT 1° Block

Adenosine Atropine

Shock   Pace

2° Type 1

Atropine

Pace

2° Type 2 3° Block

Vb

Vtach

Torsades

Pace Pace SVT CODES

 No pulse

CPR 

Shock delivered Anything

CPR   CPR  

All codes

Epi

VT/VF Codes PEA, Asystole

Epi, Amio Epi AFIB

Stach

WITH RVR 

Path:

Underlying stressor  Ischemia, Infection, Structural heart

Pt:

Palpitations, Asymptomatic

Dx: Tx:

ECG NO HEART FAILURE: BB or CCB HEART FAILURE: Dig, Amio Shock: Shock  AFIB

Path:

Sbrady

Pt:

PIRATES mnemonic Ischemia, Infection, Structural heart Palpitations, Asymptomatic

Dx:

ECG

Tx:

Rate control = Rhythm Control (AFFIRM) Rhythm: Cardioversion after TTE, TEE, one month of anticoagulation Rate: BB, CCB Rate: Anticoagulate with CHADS2 C CHF H HTN A Age > 75 D Diabetes S Stroke S Stroke Score 0 – Aspirin Score 1 – Rivaroxaban, Apixaban Score 2 + Coumadin or -axabans

1 ° Block 

2 ° Type 1

2 ° Type 2

3 ° Block 

Ab

Autter 

Idioventricular 

Asystole

6

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CHAPTER  3 :

GASTROENTEROLOGY

Cirrhosis Etiologies WILSON’S DISEASE

Path:

Copper secretion deciency, deposits in

PRIMARY  BILIARY CIRRHOSIS

Path:

Women, Intrahepatic, Microductal disease

eyes, basal ganglia, and liver Pt:

Chorea, Kaiser-Fleischer Rings, Cirrhosis

Pt:

Asymptomatic 40 year old female who gets cirrhosis

Dx:

Multiple tests available.  NEVER: Serum Copper Option: Ceruloplasmin low Option: Urine Copper high 1st: Slit Lamp looking for eye ndings Best: Biopsy

Dx:

Serology = AMA Biopsy shows disease

Tx:

Transplant

Tx:

Penicillamine → Transplant

Path:

Women with autoimmune disease

Free:

Picture of an eye + question about cirrhosis

Pt:

May be insidious, or may be acute with AST, ALT in the 1000s

Dx:

Serology = Anti Smooth Muscle, Anti-LKM Biopsy = best test

Tx:

Steroids initially Transplant

AUTOIMMUNE HEPATITIS

HEMOCHROMATOSIS

Path:

No “off” signal for iron absorption

Pt:

Bronze Diabetes = Diabetes, Cirrhosis, and Hyperpigmentation.

♂: Amenorrhea, ♀ Dx:

Iron Tests First Test: Ferritin – very elevated Best: Biopsy showing elevated iron

Tx:

NASH/NAFL

Path:

Fatty liver from Fatty People

Pt:

Diabetes, Dyslipidemia, Obesity, and cirrhosis without evidence of another disease causing cirrhosis

Dx:

Ultrasound 1st Biopsy best

Tx:

Weight loss, diabetes control, transplant

Deferoxamine (Desferal) or phlebotomy Transplant will result in recurrence ALPHA-1 ANTITRYPSIN DEFICIENCY

Path:

Elastase goes unchecked because Antitrypsin is trapped in liver. Genotype PiMM normal, PiZZ worst form

Pt:

Cirrhosis and Emphysema

Dx: Tx:

Pt: Dx:

Tx:

18

“VW HAPPENS” V

Viral Hepatitis (B, C)

Biopsy = PAS positive macrophages Best: genotype

W

Wilson’s Disease

Protease (emphysema) Transplant (liver)

H

Hemochromatosis

A

Alpha-1 Antitrypsin

P

Primary Sclerosing Cholangitis

P

Primary Biliary Cirrhosis

E

Ethanol

PRIMARY  SCLEROSING CHOLANGITIS

Path:

ETIOLOGY ADVANCED ORGANIZER 

Autoimmune disease in men, extrahepatic disease, macroductal disease Biliary stasis and cirrhosis, may also have ulcerative colitis, men Serology = p-ANCA ERCP = Beads on a string Biopsy = Onion Skinning Fibrosis Cholestyramine symptomatic relief  Stents maybe, make transplant harder  Transplant , but may/will recur 

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 N S

Non-Alcoholic Steatohepatitis Something else… fulminant diseases Autoimmune Hepatitis

Aa-toxin Acetaminophen Budd-Chiari Shock Liver Portal Vein Thrombosis

CHAPTER  7 :

E NDOCRINOLOGY

Anterior Pituitary 3 LEVELS OF FEEDBACK  AND ENDOCRINE R EG

Hypothalamus Portal Circulation

GnRH

TRH

CRH

GHRH

↓

↓

↓

↓

FSH/LH

TSH

ACTH

GH

↓

↓

↓

↓

Ovaries Estrogen Progesterone Ovulation

Thyroid T3 T4 Metabolism

Adrenals Cortisol

Liver  ILGF

Stress

Growth

Pituitary Systemic Circulation Target Organ Metabolic Effect

OF THE ANT PITUITARY

PROLACTINOMA

CUSHING’S SYNDROME

Path:

Autonomously secreting prolactin Most common pituitary lesion

See Adrenal

Pt:

Women: Galactorrhea, Amenorrhea, Microadenomas, No Vision Change Men: Decreased libido, Gynecomastia, Macroadenomas, Vision Changes,

Dx:

Medication list 1st: TSH Then: Prolactin Levels Best: MRI

Tx:

Bromocriptine or Cabergoline Surgery

f/u:

Surgery is NOT rst line therapy for

ACUTE P AN HYPOPITUITARISM

Path:

Infection, Infarction, Surgery, Rads

Pt:

TSH: Lethargy, Coma ACTH: Hypotension, Tachycardia GH/LH/FSH: Irrelevant

Dx:

Clinical Hormone (Cortisol and T4)

Tx:

Replace end hormones

f/u:

Sheehan’s: Pregnancy, bloody delivery Apoplexy: Tumor outgrows blood supply and dies, necrosis

 prolactinomas; it is for all other secreting pituitary tumors and macroadenomas ACROMEGALY

Path:

Growth hormone = things that can grow Child = Long bones (Gigantism) Adult = visceral organs

Path:

Diabetes Wide-spaced teeth Hat/ring/shoe size increases Coarse features, CARPAL TUNNEL Big hands Dx:

Tx:

Autoimmune, Deposition, Cancer 

GH / FSH / LH sacriced so that TSH and ACTH can persist Pt:

↓ Libido, changes in menstruation ↓ Growth

Dx:

Insulin Stimulation Test ˗ Growth Hormone fails to rise MRI

Tx:

Reverse underlying cause Replace hormones as needed

Cardiomegaly → DIA heart failure

Pt:

Growth Hormone ILGF-1 Glucose Suppression Test MRI

Path:

Normal variant

Surgery rst

Pt:

Asymptomatic

Dx:

MRI

Tx:

Reassurance

Octreotide or Cabergoline (adjunct) f/u:

Glucose Suppression Test = give glucose, test is positive (abnormal) if the GH does not change

Wait

Carpal tunnel is more associated with RA than Acromegaly… don’t be tricked

42

CHRONIC P AN HYPOPITUITARISM

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EMPTY SELLA SYNDROME

CHAPTER  9 :

R HEUMATOLOGY

Approach To Joint Pain SINGLE JOINT

MULTIPLE JOINTS

VS

Septic Crystals

Osteoarthritis, Lupus, Rheumatoid Scleroderma, Myositis, Seronegatives ACUTE

CHRONIC

VS

Septic, Trauma, Crystal, Reactive

Osteo, Lupus, Rheumatoid, Scleroderma, Myositis, Seronegatives

ISOLATED

SYSTEMIC MANIFESTATIONS

VS

Septic Crystal

Seronegative (IBD) Lupus (Face, CNS, Renal, Heart, Lung) Rheumatoid (Nodules, Serositis) Reactive (Oral + Genital Ulcer) DEGENERATIVE

INFLAMMATORY

VS

Osteoarthritis

Everything Else

NORMAL

Appearance

NONINFLAMMATORY

INFLAMMATORY

SEPSIS

Clear

Clear

Yellow, White

Opaque

WBC

16 weeks: Genetic > 24 weeks: Anemia > 36 weeks: L:S

> 16 weeks

AFP, Genetic Material

Chorionic Villus Sampling

10-12 weeks

Genetic Screens, Karyotypes, ?? Abortion

1/100

Elective abortion still possible in 1st tri

PUBS

> 20 weeks

Fetal Anemia

1/30

Access for transfusion

Amniocentesis

Eclampsia DISEASE

Chronic HTN

BP

> 140 / > 90

TIMING

U/A

Sustained BEFORE 20 weeks

Ø

Sustained AFTER 20 weeks

Ø

SXS

Ø

TREATMENT

α-methyldopa Hydralazine Labetalol

Ø

α-Methyldopa,

Transient HTN

> 140 / > 90

Mild PreE

> 140 / > 90

Sustained AFTER 20 weeks

> 300mg/dL

Ø

> 36: Mg + deliver   < 36 Develop

Severe PreE

> 160 / > 110

Sustained AFTER 20 weeks

> 5g/dL

+

Mag + Deliver (C/S)

Eclampsia

----

-----

----

Seizing

Mag + Deliver (C/S)

HELLP

Hemolysis

Elevated Liver Enzymes

Low

Platelets

Mag + Deliver (C/S)

Hydralazine, Metoprolol Returns to normal 12 weeks after 

Path: ?? Vasoconstriction Alarm Sxs:

Hemoconcentration, Edema Epigastric / RUQ Abdominal Pain Headache, Vision Δs

→ 3 rd Spacing → Glisson’s Capsule Stretch → Vasospasm

Labs: CBC, LFT, U/A

˗ Proteinuria → Eclampsia ˗ HELLP → HELLP Syndrome Seizing

→ Eclampsia

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CHAPTER  1 5:

SURGERY: GENERAL

Breast Cancer  BREAST CANCER 

Path:

Estrogen - Obesity, Nulliparity, Early Menarche, Late Menopause, HRT Genes – BRCA ½, Radiation

Pt:

Asymptomatic Screen Breast Lump, Breast Mass

Dx:

Mammogram Core Needle Biopsy

Tx:

Lumpectomy + radiation = Mastectomy Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection if  positive Chemo ˗ Her 2 Neu + ˗ Trastuzumab ˗ ER/PR + ˗ Tamoxifen (pre-menopausal) ˗ Anastrozole (post-menopausal) ˗ All ˗ Doxorubicin or Daunorubicin (anthracycline) based regimen BREAST CANCER  SCREEN

PICK THE

TREATMENT

Local Surgical Therapy Disease: Lumpectomy + Radiation OR Mastectomy Sentinel Lymph Node Biopsy and then Axillary Lymph Node Dissection if + Spread Systemic Therapy Disease: Chemo: Doxorubicin, Paclitaxel Her2neu: Trastuzumab ER/PR: SERMS (Pre-Menopausal) ER/PR: Aromatase-I (PostMenopausal) K NOW YOUR  TREATMENTS

Tamoxifen:

Better, ↑ DVT, ↑ Endo Ca

Raloxifene:

Worse, ↓ DVT, ↓ Endo Ca

Trastuzumab:

Heart Failure, Reversible, EARLY

Doxorubicin:

Heart Failure, Irreversible, LATE

USPTF:

50q2, start at 50, every 2 years

Daunorubicin:

The other Doxorubicin

ACS:

40q1, start at 40, every 1 year 

ALND:

Sentinel Lymph Node First

All:

Mammogram → Core Needle Biopsy

BRCA:

MRI

DIAGNOSTIC DILEMMA: THE YOUNG WOMAN

< 30 gets a different set of rules Then Then Then

OR  OR  OR 

< 30 = Reassurance x 2-3 cycles < 30 + persists = Ultrasound < 30 + cyst on ultrasound = FNA < 30 + cyst resolves = reassurance Mammogram and Core Needle Biopsy if… > 30 Ultrasound shows mass Aspirate is bloody Cyst recurs after aspiration

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PREVENTATIVE  MEDICINE

Prevention

Bias

LEVELS

Primary

Prevent onset of dz Vaccines, diet/exercise

Secondary Tertiary

OF PREVENTION

Prevent progression of dz Screening, hypertension meds

BIAS

Lead Time

Condence Interval

Length Time

CI includes 1

Effect Size

Furthest from 1

Power

Narrowest range

Deadly dz is found less often,

 bias that assumes nding dz means it’s less dangerous,

articially makes screening ↑ Overdiagnosis Diagnosis is ↑ but has Ø effect on mortality, is meaningless.

Articially ↑ survival stats Selection

Pt group isn’t chosen at random, can’t get meaningful comparisons, skews outcome

ASSOCIATIONS

 Null

Pt of diagnosis changes, but no

effect on outcome, articially ↑ survival time

Prevent complications of dz Surgery, rehab

All medicine falls under 1 of these 3.

IN STUDIES/SCREENS

Measurement Using different tools to measure same thing, can’t get meaningful comparisons, skews outcome Information

Pts know something that affects their actions, skews outcome

Publication

Null/negative results less likely to be published, skews available data

Confounding

3rd variable that has a noncasual relationship with exposure AND outcome, why correlation doesn’t = causation

METHODS

TO ELIMINATE  BIAS

Randomization

Blinding

Standardization

Statistical Controlling

**Bias is addressed in study design.**

P 

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