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A concise overview of various medical conditions and their management, covering topics from pediatric milestones to adult health issues. It includes key points on diagnosis, treatment, and important clinical considerations. The notes are structured to aid quick review and recall, making it a valuable resource for medical students and healthcare professionals. It covers a wide range of topics, including pediatric development, gastroenteritis, osteoporosis, hematuria, pneumonia, depression, and various other medical conditions. The document emphasizes key diagnostic criteria, treatment options, and potential complications, offering a practical guide for clinical practice. It also includes mnemonics and memory aids to facilitate retention of critical information.
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Dr. High Yield FM
● Triple A screening ○ Men aged 65 who have ever smoked ○ Abdominal ultrasound ● Lung cancer screening ○ HE SAYS: 55 or older with 30 pack year hx of smoking who currently smokes or who have quit within the last 15 years ○ UPDATED GUIDELINES: annual screening for lung cancer with low dose CT in adults aged 50 to 80 with a 20 pack year history and currently smoke or who quit in the last 15 yrs ● Advice ○ Review USPSTF guidelines ○ Many questions are based off these ● Colonoscopy ○ HE SAYS: start at 50 then q10 yrs ○ UPDATED: age 45 then q10 years, or 10 years before first degree relative was diagnosed if they were diagnosed before age 60, whichever is earlier ■ Say a first degree relative had colon cancer at 45, then start at 35 ● Paps ○ Age 21 years old then every 3 years ○ Can stop at age 65 if all screenings were clear ○ MORE DETAILED GUIDELINES that he does not mention: it is every 3 years above age 21 with just Pap alone, but can be every 5 years with Pap + HPV testing. ■ The pap + HPV option q5 years can begin at age 30 ● Mammograms ○ Start age 40 and every year or 2 (my FM attending does yearly but honestly idk the right answer on an exam) ● Osteoporosis screening ○ 65 with DEXA scan of lumbar spine ● Zoster vaccine at 60 yrs ● HPV vaccine ages 9- ● Chlamydia and gonorrhea in females who are sexually active and less than 24 yrs old ● HIV screenings ages 15- ● COPD classification ○ Mild, moderate, severe, very severe → categories ○ This depends on FEV1, which is also the main metric for prognosis ○ FEV1 > 80 give albuterol (mild) ○ Between 50-80 (moderate) add LABA (salmeterol) ○ Between 30-50 add ICS (severe) ○ Below 30 (very severe) add oxygen ○ Indications for home oxygen ■ O2 sat <88% or PaO2 <55 mmHg
● Gout ○ Acute abrupt onset of severe pain in MTP joint (base of big toe), swollen, red, extremely painful, may wake them up ○ Filled with uric acid (negatively birefringent, we all know) ○ Best next step: aspirate, will find the crystals ○ Pseudogout ■ Calcium pyrophosphate crystals ■ Blue rhomboid shape ○ Treatment for gout ■ Acute gout → indomethacin, colchicine (pick indomethacin FIRST, unless they have CKD, then cannot give NSAID!!!) → then give steroid injection ■ Note: any hot swollen joint needs to be aspirated, because it could be septic arthritis ■ Chronic gout and prevention of flares → probenecid or allopurinol ● Check uric acid in urine → if low, issue with excretion and use probenecid ● If high, too much uric acid in the body and use allopurinol (stops body from making so much uric acid) ● Septic arthritis ○ Commonly in knee or hip 2/2 systemic infections (bacteremia) ○ Extremely tender, swollen joint, will not be able to bear weight on hip or bend the knee ○ Fever, leukocytosis ○ Best next step: arthrocentesis, on analysis it will have >50,000 WBC (if there is an inflammatory issue like rheumatoid, the WBC won’t be as impressive), also neutrophils ● Initial prenatal care ○ Initial visit ■ CBC, urinalysis, STD, HIV, Hep B, Pap, blood typing, rubella ○ Week 28 ■ CBC (anemia), diabetes testing, Rhogam if mother is Rh- ● Diabetes - 50 g GTT then 100 g GTT ○ 50 g test- after 1 hr if greater than 140, advance to 100 g GTT ○ 100 g GTT- measure at hours 1, 2 and 3 ○ Hours 1, 2, 3 greater than 180, 160, 140 → if 2 out of 3 are high can diagnose gestational diabetes ● My note on Rhogam bc it’s confusing ○ If mom is Rh- and hypothetically baby is Rh+ from dad, we don’t want her anti D antibodies to switch from IgM to IgG because this is bad for the second baby (IgM cannot cross placenta, but IgG can) ○ Week 35- ■ GBS testing swab of vagina and rectal/perianal area
■ Supportive care, only give abx if young, old or immunosuppressed ■ DO NOT TREAT WITH ANTIDIARRHEALS - traps bacteria ■ Main complication with EHEC: if give abx, can cause HUS ○ Chronic diarrhea (more than a month) do stool ova and parasite analysis ○ C diff ■ Broad spectrum abx ■ Clindamycin ■ Diarrhea, abdominal pain after taking abx ■ Fever, leukocytosis ■ Toxin stool analysis A and B → if confirmed c diff, treat with ORAL VANCO (high yield) b/c more active in the colon ○ Viral watery diarrhea ■ Rotavirus, norovirus ■ Cruise ships or classrooms, acute onset ■ Kids should stay home until completely resolved ● Osteoporosis ○ T score less than -2.5 diagnosed as OP ○ First line treatment: bisphosphonates ○ He didn’t say it but we all remember the jaw necrosis issue (maybe watch prescribing this in someone with a huge dental history) ● Ottawa ankle rules ○ Posterior malleolar tenderness or inability to bear weight immediately after injury → get x ray ● Hematuria ○ Microscopic hematuria (invisible to naked eye) ○ Proteinuria ○ If first time it has been detected on dipstick, next step is to repeat urinalysis ○ On repeat, have to also order microscopic analysis (RBC casts, dysmorphic RBC) → gives more information ○ What if urinalysis w/ lots of blood on dipstick but no RBC? → rhabdo (will have myoglobin detected as blood) ● Thyroid disorders ○ Hyperthyroid ■ PTU and methimazole → risk of agranulocytosis (baso, eosino, neutrophils) ■ Sore throat or signs of infection → think of the meds! ○ If preggo ■ INCREASE LEVO DOSE!!!! If high E levels, this increases thyroid binding globulin which essentially “sucks up all the medication” and you essentially need more thyroid hormone to replace what is bound to protein ■ This can also happen with a woman on OCPs
■ I had an endo professor say once “I tell women after they become pregnant, to tell me before their partner” (he was trying to say it’s truly that important to increase the levothyroxine while pregnant) ■ Can cause cretinism! Better to be hyperthyroid than hypo while pregnant ○ Nodules ■ Best next step is TSH and ultrasound ■ Assess how many nodules there are, if cystic or cancerous, and measure it ■ TSH determines if they are eu or hyperthyroid ● Most of the time, hot nodules are benign (low TSH) ● Cold nodules (euthyroid) are more likely to be malignant ● So, if hyperthyroid, do radioactive iodine uptake ● If graves, treat with PTU and methimazole ● If toxic adenoma or multinodular goiter, do ablative therapy ● If a cold nodule > 1 cm, do FNA and assess for cancer. If less than 1 cm, 6 month f/u ● Fetal HR tracings ○ Normal is 110-160 bpm ○ Fetal tachy → look for infection in mom ○ Sinusoidal → anemia ○ Lupus → congenital fetal heart block ○ Acceleration - this is a good thing! HR raises by 15 for at least 15 sec, want to see 2 of those in 20 min ○ Non stress test- do when mom feels reduced fetal movement ■ Check for accels ■ If no accels (as mentioned before) then do biophysical profile ■ If BPP less than 4, deliver ● Hypercalcemia ○ More than 10 ○ Can lead to arrhythmia ○ First line tx- IV FLUIDS ● Hyponatremia algorithm ○ Check serum Osm ■ Hypertonic (elevated glucose) ■ Isotonic (elevated protein or fat) ■ Hypotonic (gets tricky) ○ Hypotonic hyponatremia ■ Honestly just look at the chart lol ○ Shortcuts ■ Hypovolemic hyponatremia without symptoms- use normal saline ■ If severe hyponatremia with symptoms (lethargy, coma) with a sodium of like 120- hypertonic saline 3% ■ Euvolemic - SIADH and treat with water restriction first ● Hypo/hyperkalemia
○ CKD BP goal is less than 140/ ● Women with DM are more likely to get vaginal candidiasis (sugar in urine) ○ Also think of candida in someone who just took abx ● Asymptomatic gardnerella (BV) in a pregnant woman- treat with metronidazole because can cause preterm labor ● Hematochezia / GI bleeding ○ Unstable → colonoscopy ○ Stable → fluids and EGD ● Diverticulitis ○ Fluoroquinolones and metronidazole ○ LLQ pain, fever, leukocytosis, dx with CT abdomen ● UC ○ A/w colon cancer, toxic megacolon, primary sclerosing cholangitis ○ Pt presents with microcytic anemia (MCV <80 and Hb low) → GET COLONOSCOPY (HY) ● Legionella → diarrhea, PNA, hyponatremia ○ Elderly smokers who hang out in areas with dirty ACs/contaminated water ● Inpatient complicated PNA → fluoroquinolone ○ When to admit? CURB-65, if 2 or more, admit ● Outpatient uncomplicated typical PNA– > amoxicillin ● Outpatient atypical - azithromycin (macrolide) ○ Mycoplasma, chlamydia, legionella ○ Typical vs atypical is based on CXR (lobar consolidation vs interstitial) ● Depression- SIGECAPS → if 5 or more, they are depressed, start SSRI ○ Takes 4-6 weeks for SSRI to start working ○ If feel better, continue for at least 9 months and reassess ○ People who have MI or stroke with depression after that are 3x/likely to die ● Lochia ○ The endometrium keeps shedding after giving birth ○ This is normal for at least a month ● CI to breastfeeding - HIV and chemo ○ Otherwise breastfeeding is good good good, exclusive up to 6 months ● Lactational mastitis vs breast abscess ○ Erythema over the breast, can look like cellulitis, treat with dicloxacillin ○ Breast abscess- FLUCTUANCE, treat with abx and I and D ● CHF classifications- 4 classes ○ Class I- no symptoms ■ ACEi ○ Class II- sx with activity ■ ACEi + BB ○ Class III- ok resting but barely any physical exertion causes symptoms ■ ACEi + BB + diuretic (spiro) ○ Class IV- symptoms at rest ■ ACEi + BB + spiro + inotrope (digoxin)
○ Remember the 3 drugs that can improve mortality in CHF- ACEi, BB, spironolactone (K sparing diuretic) ■ Now SGLT2i do too ○ CHF is dx by an ECHO - NOT AN EKG (I’ve gotten questions about this) ■ Acute onset SOB with pulmonary edema- give a loop diuretic to get fluid out of the lungs ■ Also presents with PND and orthopnea ● OCPs ○ CI in migraines with aura, smokers 35 or older b/c estrogen can increase risk of DVT/PE/stroke (prothrombotic) ○ Protect against ovarian/endometrial cancer but slightly increased risk of breast cancer ● Copper IUD ○ Most effective form of emergency contraception (can be used within 5 days of unprotected sex) ○ Can cause heavy periods so contraindicated in pts with menorrhagia ● First line for hypertension ○ CCBs, ACEi, thiazides ○ In African Americans, thiazides or CCBs are first line because African Americans are at higher risk for angioedema ● Proteinuria → give ACEi because they cause vasodilation of EA, which reduces pressure on the glomerulus and reduces the GFR ● Hypertension ○ Greater than 140/90 on 3 consecutive visits, want to start anti hypertensives ○ If not at goal (<140/90) after 1 month, increase dose or add second drug ● Insussusception (telescoping of ileum into cecum) ○ Currant jelly stools (due to sloughing off of inflamed/irritated bowel and possible ischemia), RLQ, colicky intermittent pain ○ Do abdominal x ray to r/o perforation ○ Treat with air enema ● Midgut volvulus ○ Embryonic pathology- the intestines do not rotate CC 270 degrees and twists around SMA so cecum is in the RUQ and predisposes it to twisting around SMA ○ Bilious vomiting and CONSTANT pain ○ Do abdominal XR → upper GI series (XR with barium swallow) which will show double bubble sign or corkscrew sign ● Jejunal atresia ○ Vascular accident in utero (like maternal cocaine use) ○ Triple bubble sign ● Double bubble → a/w Down syndrome and duodenal atresia (duodenum fails to rencanalize) ● Pneumomediastinum ○ Air in the mediastinum ○ Esophageal perforation (like Boerhaave)
why they recommend/do not recommend a statin for them. It’s very helpful ● Niacin is best at increasing HDL ● Fibrates are best at decreasing TGs ○ Neither of these are first line, consider fibrates if super high TGs ● MCC pancreatitis → gallstones and alcohol abuse ● Child abuse ○ Bruising in weird places at various healing stages ○ Posterior rib or metaphyseal fractures ○ Spiral fractures ○ If suspect, talk to child alone and separate child from parents and admit to hospital for workup ■ Funduscopy, skeletal survey, call CPS ■ Some comments on the YouTube video discussed that admitting to the hospital isn’t always correct, if “call CPS immediately” is there choose that, but if that isn’t there, you want to choose admit inpatient as a way to separate them from their parents ● Hips in kids ○ SCFE → obese 11-12 y/o where epiphysis has slipped off, next step is SURGERY ■ My note: don’t always look for obesity, I’ve gotten UWorld questions about kids that were not obese, just athletic and it happened ○ Legg Calve Perthes → idiopathic avascular necrosis of hip joint, treat conservatively, younger thin kid (6-7 y/o) ○ Septic arthritis → CANNOT bear weight, warm and erythematous → next step is ASPIRATE JOINT ■ Staph aureus and strep pyo are MCC ○ FABER test can test for ankylosing spondylitis (AS) ■ Irritates SI joint ■ If suspect AS on FABER test, do lumbar and sacral XR (will show the bamboo pattern) ● Malignant hyperthermia (I do not know what this has to do with FM lol) ○ Caused by Ca accumulation in the muscles due to halothane or succ ○ Supportive tx or dantrolene ○ C/w neuroleptic malignant syndrome and serotonin syndrome ■ Just look at the history to help determine the cause ■ In questions I see serotonin syndrome as presenting with hyperreflexia rather than rigidity but in a comment on the video he says it can also present with rigidity (he’s a legend so idk) ● Aspiration PNA ○ At risk → people who can’t control their swallow/gag reflex/secretions ○ Seizures, dementia, strokes, alcoholics, mechanical ventilation ○ Infiltrates in RLL that can progress to abscesses (air fluid levels) ○ Cover for anaerobes!!! Zosyn or clindamycin
■ Clindamycin above diaphragm, metronidazole below ● DVT ○ tender/swollen calf, if suspect DVT START HEPARIN and bridge to warfarin, or rivaroxaban ● Skin wound infection ○ Redness around sutures, open wound and let it drain → antibiotics ● RSV ○ Common pediatric respiratory disease in kids under 2 ○ Upper respiratory sx progressing to wheezing and cough ○ Supportive treatment ○ Can also be really bad in the elderly, there is a vaccine now ● Normal breathing ○ In adults: 12-20 breaths per min ○ In kids: greater than 40 is tachypnea ● Epiglottitis ○ H flu, vaccine prevewntable ○ Drooling, hard to breathe, tripoding, sticking tongue out ○ INTUBATE!!!! ● Croup ○ Parainfluenza ○ Bark cough, stridor ○ Treat with corticosteroids and racemic epi if they have stridor at rest with respiratory distress ○ Can progress to bacterial tracheitis!!! Life threatening, want to intubate (staph aureus) ● Peritonsillar abscess ○ Deviated uvlua, hard to swallow, muffled voice, fever, leukocytosis ○ Incision and drainage and abx ● IBS ○ Constipation and diarrhea with improvement after BM ○ Treatment depends on if constipation or diarrhea predominant ● Celiac ○ Diarrhea, abdominal pain, weight loss, usually a younger patient ○ BMs are loose and greasy due to fat malabsorption ○ Villous atrophy on biopsy ○ Antibodies: anti tissue transglutaminase, anti gliadin, anti endomysial ○ Avoid gluten ● Cocaine overdose/toxicity with chest pain ○ DO NOT GIVE BETA BLOCKER (unopposed alpha vasoconstriction) ○ Give benzos! ● Quitting alcohol ○ Acamprosate and naltrexone ● Quitting smoking ○ Patches and gum → bupropion → varenicline
● Bilirubinuria ○ Can only be found in its conjugated form ● Hyperbilirubinemia- bili greater than 1 ○ Know direct vs indirect/means conjugated vs unconjugated ● Painless jaundice- sign of pancreatic cancer ● GERD/ulcer stuff ○ If someone comes in with GERD, start empiric PPIs but if they are from a foreign country, think H pylori and start with a breath test ○ If from US, start with a PPI and see if better. If not, test for H pylori or do endoscopy ○ If ALARM symptoms: dysphagia, microcytic anemia, weight loss → proceed with endoscopy first to look for cancer ○ Spicy foods do not cause ulcers- they just make GERD symptoms worse ■ But H pylori and NSAIDs can directly cause ulcers! ○ High yield atypical pt: if an older diabetic woman ℅ upper abdominal pain, this can be atypical sign of an MI so need EKG! ○ Chronic PPI use linked to C diff and osteoporosis ● Fever less than 30 days old → suspect meningitis or PNA ○ Treat empirically with amp and gent ○ Bugs in babies → GBS, e coli and listeria ○ In adults, meningitis is strep pneumo h flu and neisseria men →tx empirically with ceftriaxone and vanc ● Smallpox vs chicken pox ○ Smallpox has same stage of development all over the skin, chickenpox has lesions of different stages ● Measles vs rubella ○ Both have rash on head down to LE ○ Measles has 4 Cs, rubella does not and has arthralgias ○ Vaccine - MMR ○ Measles can progress to PNA or SSPE (brain infection about a decade later, treat with vitamin A ) ■ He says B6 but it’s vitamin A ● Roseola vs parvo B ○ Roseola is high fever that breaks → then rash ○ Parvo is slapped cheek rash in kids ■ I got a question wrong once about parvo in an adult- typically no cheek rash, described the rash as “patchy” and she also had diarrhea and arthralgias/arthritis resembling RA and she worked with kids ■ Parvo is BAD IN PREGNANT WOMEN → can lead to hydrops ● Breast stuff ○ Under 30 → ultrasound, over 30 → mammogram ○ Any breast mass needs to be biopsied regardless of imaging ○ Unilateral nipple bleeding → intraductal papilloma and do mammogram ○ Mammograms start at age 40
○ Breast cysts → aspirate and drain. If yellow and completely drains, follow up in a month, but if not, biopsy ■ If fluid is bloody, send to cytology! ● PCOS ○ Get a pregnancy test first ○ Anovulation, hirsutism, obesity ○ Sometimes can see cystic follicles on ovary ○ If they have trouble getting pregnant, suggest weight loss ● Diabetes ○ Diagnosed by: ■ Fasting glucose 126+ ■ Random glucose 200+ with symptoms (polyuria, polyphagia, polydipsia, weight loss, dehydration) ■ Hb A1c 6.5+ ○ Controlled diabetes: blood pressure control less than 140/90, A1c less than 7, LDL less than 100 ○ Metformin is contraindicated in kidney disease and CHF (lactic acidosis) ○ He doesn’t go that much into it but obviously diabetes and its complications/pharm is huge in FM ● Low back pain/cauda equina ○ Usually muscular ○ RED FLAGS: nighttime pain unrelenting, pain at rest, or more than 6 weeks ○ My note: if they have red flags/history of malignancy (like pt with hx breast cancer) GET IMAGING ○ Disc herniation vs spinal stenosis ■ Herniation is worsened with sneezing/coughing and improved with extension, worse with bending forward, pain radiating down leg ● Diagnosed clinically, treat conservatively x 1 month but if no improvement → get MRI ■ Stenosis is better with flexion (shopping cart sign) ○ Cauda equina ■ Bowel and bladder incontinence, paresthesias, paralysis ■ Do MRI!!!! ○ Lumbar muscle strain ■ NEVER CHOOSE bed rest ■ Treat conservatively with exercise, PT ● Essential tremor ■ Worsened with movement, better with rest and with alcohol, runs in families, treat with propranolol ● Tourette’s syndrome → treat with clonidine or guanfacine (alpha 2 agonists) or atypical antipsychotics ○ My note: Uworld says that first line are VMAT2 inhibitors (tetrabenazine) and atypical antipsychotics before a2 agonists ○ Both motor and vocal tics for > 1 yr
● Pediatric umbilical hernia ○ Self resolves so usually reassure, unless the pt is over 5 yrs old (then do surgery) ● Colon polyps ○ If find polyp, he says the next one should be in 3 years but I think it depends on what they find (what kind, how many, size) ■ If small tubular adenomas it’s 5-10 years ■ If higher risk adenomas, 3 years ■ Also depends on family history, etc. Highly doubt they will go into that much specifics ○ Worse polyp is villous (villain)