UWorld Notes: Step 2 CK
destruction of property, deceitfulness or theft, or
 malingering: intentional production of false
physical symptoms for secondary gain
 factitious disorder: intentional production affects
physical or psychological signs or symptoms to
assume the sick role; no secondary gain
 Hypochondriais: fear of disease and
preoccupation with the body, manifests through
multiple somatic complaints; at least six months
 conversion disorder: unexplained serious
neurological symptoms preceded by an obvious
emotional trigger; symptoms are not artificially
produced, unexplained by any medical condition,
can cause social and functional impairment
----------------------------------------------------------------
 prolonged hypotension from any cause can lead
to acute tubular necrosis. Hallmark findings on
urinalysis are muddy brown granulomatosis
consisting of renal tubular epithelial cells. Also
seen are serum BUN:creatinine ratio < 20:1,
urine osmolality 300 to 350 mOsm per liter
(never <300), urine sodium > 20 mEq per liter,
FE Na greater than 2%
 broad casts are seen in chronic renal failure, due
to dilated tubules enlarged nephrons that have
undergone compensatory hypertrophy in
response to the reduced renal mass
 waxy casts are shiny and translucent, also seen in
chronic renal disease
 RBC casts are indicative of glomerular disease
or vasculitis; glomerulonephritis
 WBC casts are evidence that urinary WBCs
originate in the kidney; seen in interstitial
nephritis and pyelonephritis
 fatty casts: nephrotic syndrome
 hyaline casts are composed of protein and pass
unchanged along the urinary tract; seen in
asymptomatics and prerenal azotemia
----------------------------------------------------------------
 antisocial personality disorder is diagnosed at
age 18 years or older; often display evidence of
conduct disorder as minors
 conduct disorder diagnosis requires at least three
symptoms from the following categories:
aggression towards people or animals:  topical silver nitrate: prophylaxis against
penicillinase-producing strains of N. gonorrhea
a serious violation of rules (not available in the US)
 borderline personality disorder called shortly  nasolacrimal duct obstruction presents with
pattern of instability relationships, impulsive and unilateral tearing & minimal conjunctival
or reckless; have identity disturbance, recurrent injection; Rx massage nasolacrimal ducts
suicidal or self-mutilating behavior, feelings of ----------------------------------------------------------------
emptiness  hypotension, tachycardia, flat neck veins,
 histrionic personality disorder: excessively labile confusion, and cold extremities despite IV fluids
emotions and attention seeking behavior resuscitation: hypovolemic/hemorrhagic shock
----------------------------------------------------------------  cardiogenic shock: decreased cardiac output
causes elevated venous filling pressures and JVD
common etiologies of neonatal conjunctivitis  loss of vascular tone occurs in septic &
Type Onse Findings Treatment neurogenic shock
t age ----------------------------------------------------------------
Chemical ˂24 Mild conjunctival Eye  meniscal and ligamentous tears can both be a/w a
hours irritation/injectio lubricant popping sensation following a precipitating
n and tearing injury
after silver nitrate  meniscal injuries cause gradual joint swelling
ophthalmic over 12 to 24 hours
prophylaxis  ligamentous injuries (ACL) cause rapid joint
Gonococca 2 - 5 Eyelid swelling; IV or IM swelling due to hemarthrosis (ligaments have
l days profuse purulent ceftriaxone greater vascular supply than menisci, which rely
discharge; or on diffusion for nourishment)
corneal cefotaxime  MRI provides definitive diagnosis
ulceration ----------------------------------------------------------------
Chlamydial 5 - eyelid swelling; oral  Ulcerative colitis occurs more frequently in
14 chemosis; bloody erythromyci females, Ashkenazi Jews, with a peak incidence
days or mucopurulent n at ages 15 to 25
discharge  UC is confined to the mucosal layer, while
Crohn’s disease is transmural
 gonococcal conjunctivitis is the most destructive;
 UC causes bloody diarrhea, tenesmus, cramping
resulting in corneal perforation and permanent
 severe disease is marked by weight loss, fever,
blindness
anemia
 ceftriaxone should be avoided in infants with
 diagnosis is confirmed by friable mucosa on
hyperbilirubinemia has it results in displacement
colonoscopy and biopsy demonstrating mucosal
of bilirubin from albumin-binding sites,
inflammation
increasing the risk of kernicterus
 extraintestinal compliations include sclerosing
 oral erythromycin is the treatment of choice for
cholangitis, uveitis, erythema nodosum, and
both chlamydial conjunctivitis and pneumonia;
spondyloarthropathy
increased risk of infantile hypertrophic pyloric
 severe complications include toxic megacolon
stenosis
and colorectal carcinoma
 topical erythromycin: neonatal prophylaxis
 routine surveillance with yearly colonoscopies is
against gonococcal conjunctivitis
recommended beginning 8 to 10 years after
 diagnosis for prevention and/or early detection of Hysterectomy no screening if no history of risk with ASA use, causing life-threatening
colon cancer without cervix high-grade lesions, cervical hepatic encephalopathy)
---------------------------------------------------------------- cancer, or exposure to DES  complications: coronary artery aneurysms,
 adjustment disorder: emotional or behavioral ---------------------------------------------------------------- leading to MI & ischemia
symptoms developing within 3 months of  weight loss in obese patients is the most effective  perform a baseline echocardiography in all
exposure to an identifiable stressor that rarely lifestyle intervention for reducing blood pressure suspected cases; repeat to monitor changes
lasts more than 6 months after the stressor ends  DASH diet for is the next most effective ----------------------------------------------------------------
 patient experiences marked distress in excess of approach in preventing and treating hypertension  complication of untreated streptococcal
what would be expected from exposure to the especially in nonobese individuals, then exercise, pharyngitis: Scarlet fever
stressor dietary sodium, alcohol intake  presents with tonsillar exudates, sandpaper-like
 treatment of choice is cognitive or  cigarette smoking causes a transient rise in BP rash that spares palms & soles
psychodynamic psychotherapy to develop coping ----------------------------------------------------------------  perform throat culture
mechanisms, response to and attitude about  maternal risk factors for fetal macrosomia:  Rx: amoxicillin
stressful situations advanced maternal age, obesity, diabetes,
 SSRIs can be adjunctive therapy for depressive ----------------------------------------------------------------
multiparity  Rheumatoid arthritis
symptoms  African & Hispanic males are at increased risk
---------------------------------------------------------------- o morning stiffness >30 min, improves with
for fetal macrosomia, a risk factor for shoulder activity
 atypical squamous cells, cannot rule out high-
dystocia o tenosynovitis of palms (“trigger finger”)
grade squamous epithelial lesion (ASC-H) is a/w
 excessive traction on the neck during delivery o cervical joint involvement can lead to
premalignant lesions
can result in Erb-Duchenne palsy subluxation  spinal cord compression
 atypical squamous cells of undetermined
o involves 5th, 6th, 7th CN o positive anti-cyclic citrullinated peptide
significance (ASC-US) is the most common
o most infants recover arm function (anti-CCP)
cervical cytological abnormality, but the risk of
spontaneously within 3 months o CRP & ESR elevation correlate with disease
invasive cervical cancer is low
o Rx: gentle massage & PT to prevent o XR: soft-tissue swelling, joint space
 ASC-US or LSIL for women age 21 – 24: repeat
contractures narrowing, bony erosions
pap smear in 1 year
----------------------------------------------------------------  greatest risk for osteoporosis
o colposcopy only if ASC on 3 consecutive
 cephalohematoma: subperiosteal bleed, does not  Rx: physical activity, optimize Ca++ & Vit D
paps or any ASC-H, atupical glandular cells,
or HSIL cross suture lines; resolves spontaneously intake, minimize corticosteroids, consider
---------------------------------------------------------------- bisphosphonates
 ASC-US in women age ≥ 25: HPV testing
 Kawasaki disease (mucocutaneous lymph node ----------------------------------------------------------------
o HPV positive = colposcopy
syndrome) is a clinical diagnosis  avascular necrosis is common with systemic
o HPV negative = repeat pap & HPV in 3 yrs
o common in age < 5 corticosteroid therapy, heavy alcohol, SLE, or
o fever ≥ 5 days sickle cell disease
Cervical cancer screening
o irritability  Paget disease of bone = osteitis deformans is due
Immunocompromised  Onset of sexual
(HIV, SLE, organ o B/L non-exudative conjunctivitis to osteoclast overactivity, leading to replacement
intercourse
transplant on  every six months x2 o cervical lymphadenopathy > 1.5 cm of lamellar bone with abnormal woven bone
immunosuppressants) o mucositis (injected/fissured lips or  osteosarcoma risk factors: Paget disease,
than annually
strawberry toungue) radiation & chemotherapy exposure
Age ˂ 21 No screening
o polymorphous rash ----------------------------------------------------------------
21 to 29 cytology every 3 years
o coronary artery aneurysm  Osteitis fibrosa cystica (Von Recklinghausen
30 to 65  cytology every 3 years
o swelling/erythema of palms/soles disease) presents with bony pain
 OR cytology + HPV
 Rx: ASA & IV immunoglobulin within 10 days  excessive osteoclastic resorption, leads to
testing every 5 years
of fever to prevent cardiac complications, but replacement with fibrous tissue (brown tumors)
≥ 65 No screening if negative  a/w parathyroid carcinoma
prior screens & not high-risk usually self-limited (caution: Reye syndrome
----------------------------------------------------------------
  Bronchiolitis: commonly caused by RSV  avoid interventions that provoke vomiting (milk, ----------------------------------------------------------------
 older children causes self-limited URI activated charcoal, vinegar, NG lavage)  erythema chronicum migrans is hallmark of early
 age < 2 involves lower respiratory tract ---------------------------------------------------------------- localized Lyme disease (Borrelia burgdorferi)
 wheezing/crackles & respiratory distress with  Pinworm infection can present with  also a/w headache, malaise, fatigue, fever
waxing/waning peaking at 5-7 days erythematous vulvovaginitis in prepubertal  early diagnosis is based on the trademark rash &
 Rx: supportive care females; absence of vaginal discharge recent travel to Lyme-endemic areas
 prophylaxis: Palivizumab for high risk cases  recurrent episodes of nocturnal itching should be  Rx: oral doxycycline (age > 8)
 complications: apnea & respiratory failure; examined with the “Scotch tape” test  Rx: oral amoxicillin (age < 8 & pregnancy) or
develops recurrent wheezing  empiric Rx: mebendazole cefuroxime
 increased risk of acute otitis media; rarely ---------------------------------------------------------------- ----------------------------------------------------------------
bacterial pneumonia or sepsis  B/L, nontender, upper abdominal masses;  chemotherapy-induced peripheral neuropathy
---------------------------------------------------------------- progressive renal insufficiency, early-onset HTN from vincristine (also cisplatin, paclitaxel)
 alpha-1-antitrypsin counteracts neutrophil begins after several weeks, presents as
elastase ADPKD symmetric paresthesia in fingers/toes, spreads
 AAT deficiency: uninhibited elastase causes symptoms most are asymptomatic proximally in stocking-glove pattern
bullous, panlobular emphysematous changes of hematuria  early loss of ankle jerk reflexes, pain & temp
the lower lobes flank pain (due to renal calculi, cyst sensation, occasional motor neuropathy
 centrilobular changes occur with smoking- rupture, hemorrhage, or upper UTI) ----------------------------------------------------------------
induced emphysema clinical signs early onset HTN  sudden onset C/L lower extremity motor &
 AAT deficiency can cause liver disease: b/l upper abd. masses sensory deficits with UMN signs: anterior
cirrhosis, neonatal hepatitis, or liver failure proteinuria cerebral artery occlusion
---------------------------------------------------------------- chronic kidney disease ----------------------------------------------------------------
Caustic ingestion extrarenal cerebral aneurysm Spinal cord compression
features hepatic/pancreatic cysts Causes spinal injury
Features Chemical burn or liquefaction
cardiac valve disorders (MVP, AR) malignancy
necrosis results in:
diverticulosis infection (epidural abscess)
 hoarseness, stridor, orofacial
ventral/inguinal hernias Signs & gradual severe local back pain
inflammation (laryngeal damage)
diagnosis abdominal USS Symptoms pain worse when recumbent & at night
 dysphagia, odynophagia
(esophageal damage) management monitor BP & renal Fx, potassium early: symmetric weakness, hypoactive/
 epigastric pain, bleeding (gastric control cardiovascular risk factors absent DTRs
ACE-inhibitors for HTN late: B/L Babinski, decreased rectal
damage)
ESRD: dialysis, renal transplant tone, paraparesis with increased DTRs,
Management  secure ABCs
sensory loss
 remove contaminated clothing, Manage emergency MRI
 central obesity, facial plethora, proximal muscle
irrigate exposed skin IV glucocorticoids
weakness, abdominal striae, ecchymosis:
 CXR if respiratory symptoms
Cushing’s syndrome
 upper endoscophy within 24 hr  sensory ataxia, brief stabbing pains, Argyll-
 headaches, palpitations, diaphoresis a/w
 barium contrast (2-3 weeks) Robertson pupils (“accommodate but do not
paroxysmal BP elevations: pheochromocytoma
Complication  perforation  measure urinary vanillylmandelic acid & react”): Tabes dorsalis, a manifestation of late
s  esophageal strictures metanephrines neurosyphilis
 pyloric stenosis ---------------------------------------------------------------- ----------------------------------------------------------------
 ulcers  primary manifestations of Chagas disease: recent  recurrent pneumonias in the same anatomic
 cancer immigrant from Latin America with chronic region suggest bronchial obstruction;
megacolon/megaesophagus & cardiac disease bronchogenic carcinoma is most concerning with
(CHF: pedal edema, JVD, S3, cardiomegaly) a smoking history
  chest CT is indicated initially
o central masses or negative CT: bronchoscopy
o peripheral lesions: CT-guided biopsy
 recurrent pneumonias in different regions:
o sinopulmonary disease (CF, immotile cilia)
o immunodeficiency (HIV, leukemia)
o vasculitis, bronchiolitis obliterans
 recurrent aspiration, same lung region
o seizures
o ethanol/drug use
o GERD, dysphagia, achalasia
----------------------------------------------------------------
 hypotension, tachycardia, poor skin turgor,
lethargy, confusion: hypovolemic hypernatremia
 IV normal saline (0.9%) is preferred for
symptomatic hypovolemic hypernatremia until
euvolemic, then 5% dextrose
 serum Na+ should be corrected by 0.5 mEq/dL/hr,
as cerebral edema can result if too rapid
 high serum & low urine osmolality due to
inadequate ADH response is most likely due to
lithium-induced nephrogenic DI
 Lithium induces ADH resistance, resulting in
acute-onset nocturia, polyuria, & polydipsia
 Rx: discontinue lithium; or salt restriction &
diuretics (amiloride)
 hemodialysis is indicated for serum lithium level
˃ 4 mEq/L or ˃ 2.5 mEq/L + signs of significant
toxicity or renal disease
----------------------------------------------------------------
 secondary effects provoked by nitroglycerin like
increased contractility & reflex tachycardia are
due to changes in baroreceptor activity in
response to decrease BP from venodilation
----------------------------------------------------------------
 polyarthralgia, tenosynovitis, and painless
vesiculopustular skin lesions suggest
disseminated gonococcal infection
 lesions can number from 2 - 10 and appear
similar to furuncles or pimples
 the person chills may be present
 history of recent unprotected sex with a new
partner
 all patients should undergo HIV screening
----------------------------------------------------------------
 petechial rash, fever, headache, nausea\vomiting,
stiff, and photophobia: meningococcemia
 fever, arthralgia, sore throat, lymphadenopathy,
mucocutaneous lesions, diarrhea, weight loss:
acute HIV infection
 migratory arthritis of large joints, erythema
marginatum (raised ring-shaped lesions over
trunk and extremities), subcutaneous nodules,
carditis, Sydenham chorea: acute rheumatic fever
o an episodes of pharyngitis precedes the
onset of ARF by 2 - 4 weeks
----------------------------------------------------------------
 best method of reducing maternal-fetal
transmission of HIV infection: triple HAART
therapy for the mother throughout pregnancy
 HAART: dual NRTI + NNRTI or protease
inhibitor
 test viral load monthly until undetectable, then
every 3 months
 CD4 cell count every 3 months
 avoid amniocentesis until viral load undetectable
 mothers with undetectable viral loads at delivery
have ˂ 1% risk for transmission
 intrapartum mother not on HAART: Zidovudine
 intrapartum viral load > 1000 copies/mL:
Zidovudine + C-section
 infants: Zidovudine for ≥ 6 wks & serial HIV
PCR testing
----------------------------------------------------------------
 blunt abdominal trauma iscommonly caused by
MVAs; most common organs injured are the
liver and spleen
 free peritoneal fluid should raise suspicion for
liver or splenic laceration
 hemodynamically unstable patients with
evidence of free intraperitoneal fluid on
ultrasound need emergency laparotomy
 splenic lacerations that are hemodynamically
stable with no evidence of other intra-abdominal
injuries may be managed nonoperatively
----------------------------------------------------------------
PDA-dependent congenital heart disease
 Ductus arteriosus coarctation of the aorta
 transposition of the great arteries
 hypoplastic left lung syndrome
 total anomalous pulmonary venous connection
 tricuspid atresia
 Normal ductus arteriosus constricts around day 3
of life
 prostaglandin E1 is a vasodilator used to prevent
ductus arteriosus closure
 inspired O2 stimulates PDA constriction
 indomethacin is a potent prostaglandin inhibitor,
stimulating PDA closure
---------------------------------------------------------------
 ventricular free wall rupture is a mechanical
complication occurring within 5 days to 2 weeks
after an acute MI (usually anterior); presents
with acute onset chest pain & profound shock,
with rapid progression to pulseless electrical
activity (PEA) and death
 abrupt LV rupture leads to hemopericardium and
eventual cardiac tamponade
 LV free wall rupture should be suspected in
patients with PEA after the recent first line no
signs of heart failure
----------------------------------------------------------------
 acute peri-infarct pericarditis can occur within 1
to 3 days after an MI; pericardial friction rub
with or without chest pain
o self-limited, resolves with supportive care
 posted-MI pericarditis occurring weeks to
months after an MI: Dressler syndrome
o improves with NSAIDs
----------------------------------------------------------------
 interventricular septum rupture occurs 3 to 5
days after MI; causes a VSD, not pericardial
tamponade
 sudden onset hypotension, CHF, holosystolic
murmur heard best at lower left sternal border
----------------------------------------------------------------
 papillary muscle rupture occurs 3 to 5 days after
infarction, causing hypotension secondary to
severe acute mitral regurgitation and pulmonary
edema will
----------------------------------------------------------------
 acute massive PE can cause hypotension
&syncope, leading to pulseless electrical activity
in some cases of
---------------------------------------------------------------- rupture days pain, effusion  strabismus after age 4 months is abnormal and
 ventricular aneurysm occurs as a late to 2 JVD, with requires treatment to prevent amblyopia (vision
complication (weeks to months) of acute STEMI wee distant tampon loss from disuse of deviated eye)
 scarred or fibrotic myocardial wall resulting ks heart ade  intermittent strabismus can be expected in
from healed transmural MI sounds infants < 4 months due to immaturity of
 can present as heart failure, refractory angina, extraocular muscles; reassurance & observation
ventricular arrhythmias, or systemic arterial ----------------------------------------------------------------  esotropia beyond infancy must be treated to
embolism due to mural thrombus formation  Sarcoidosis diagnosis is based on compatible Hx, prevent amblyopia
---------------------------------------------------------------- CXR: hilar adenopathy with/without  first 5 years of life are critical to development of
 hypotension or shock, JVD, clear lungs, reticulonodular infiltrates, & biopsy of visual acuity, a time of visual cortex maturity
Kussmaul sign: right ventricular infarction noncaseating granulomas; elevated serum ACE  the deviated eye can be strengthened by patching
 EKG: inferior MI &/or ST elevation in leads also supports the diagnosis the normal eye (occlusion therapy) or blurring
V4R –V6R  no definitive diagnostic test the normal eye with cycloplegic drops
----------------------------------------------------------------  presents with cough, dyspnea, erythema (penalization)
nodosum, anterior uveitis, acute polyarthritis  new onset strabismus can be a sign of
Mechanical complications of acute MI  asymptomatics are followed without treatment retinoblastoma if accompanied by white reflects
Tim Coron Clinical echo due to high rate of spontaneous remission  acute onset strabismus can result from
e ary findings  symptomatic disease Rx: systemic glucocorticoid intracranial hemorrhage, brain abscess, or
artery ---------------------------------------------------------------- encephalitis; performed brain MRI
involv  Rx for SLE, malaria prophylaxis, acute malaria, ----------------------------------------------------------------
ed rheumatoid arthritis: hydroxychloroquine  encephalopathy, ocular dysfunction, gait ataxia:
Right Acut RCA Hypotens Prokinet  Rx for inflammatory bowel disease, ankylosing Wernicke encephalopathy
ventricular e ion ic RV spondylitis, rheumatoid arthritis: infliximab  giving IV fluids containing glucose prior to
failure social (TNF-alpha blocker) thiamine can precipitate or worsen WE
lungs  Rx for histoplasmosis: itraconazole  thiamine should be given along with or before
Kussmau o sarcoidosis & histoplasmosis present with glucose
l sign similar symptoms & CXR; biopsy reveals ----------------------------------------------------------------
Papillary Acut RCA acute, Severe yeast forms in histoplasmosis  flumazenil: competitive antagonists of
muscle e, 3 severe MR  Rx for SLE with renal involvement: GABA/benzodiazepine receptor; Rx
rupture to 5 pulmonar with cyclophosphamide benzodiazepine overdose (slurred speech, ataxia,
days y edema flail ---------------------------------------------------------------- hypotension, depressed mental status)
new leaflet  sudden onset abdominal pain a/w vaginal bleed,  labetalol: Rx hypertensive encephalopathy (BP ≥
holosysto fetal HR abnormalities, & loss of fetal station 180/120 mmHg, headache, N/V, confusion)
lic during active labor: uterine rupture ----------------------------------------------------------------
murmur o risk factors: pre-existing uterine scar,  acute onset back pain after physical exertion,
Interventric Acut LAD  Shock & left to abdominal trauma paravertebral tenderness, absence of radiation,
ular septum e, 3 apical chest right o prior low transverse c-section: < 1% risk negative straight leg raise test, normal
rupture/def to 5 RCA  pain, shunt neurological exam: lumbosacral strain
o prior vertical c-section: as high as 9%
ect days basal holosysto o Rx: NSAIDs, early mobilization
 HTN & cocaine use: risk for placental abruption
lic
 sinusoidal fetal HR pattern: vasa previa  acute intense pain, local spinal tenderness:
murmur,
 fever, tender uterus, foul-smelling lochia, vertebral compression fracture
biventric
progression to sepsis: endometritis o risk factors: postmenopausal or senile
ular
failure ---------------------------------------------------------------- osteoporosis, steroid treatment
Ventricular first LAD Shock Pericard ----------------------------------------------------------------
free wall 5 and chest ial Cryptococcal meningoencephalitis
Features headache, fever, malaise, altered mental  lactation alone causes anovulation, thus some (preload
status degree of contraception due to high prolactin )
develops over 2 weeks (subacute) levels which inhibit GnRH release, but not Cardiac 2-4   
more acute & severe in HIV (CD4 considered a reliable form of birth control index L/min/
˂100/ μL ---------------------------------------------------------------- (pump m2
Diagnosis CSF features…  Eikenella corrodens: G-negative anaerobe part of function
 high opening pressure normal oral flora )
 low glucose, high protein o infective endocarditis due to E. corrodens is Systemi   
 WBC ˂ 50/μL (mononuclear seen in poor dentition, periodontal infection, c
predominant) or manipulative dental procedures vascular
 transparent capsule on India ink  E. corrodens belongs to the HACEK group resistanc
 cryptococcal antigen positive  congential heart lesions (bicuspid aortic valve, e
 culture on Sabouraud agar PDA, ToF, VSD) predisposes to risk of IE (afterloa
 ulcerative colon lesions due to colonic neoplasia d)
Treatment Initial: amphotericin B with flucytosine
maintenance: fluconazole or inflammatory bowel disease predisposes to IE Mixed   
due to Strep gallolyticus (S. bovis type I) venous
 S. aureus is the MCC of IE among IVDA O2
 serial lumbar puncture may be required to
 Enterococci (E. faecalis) commonly cause saturatio
reduce increased ICP
n
 initiation of retroviral therapy for HIV in the endocarditis a/s nosocomial UTIs
setting of acute infection is not recommended ----------------------------------------------------------------
 acute pancreatitis can cause ARDS  intravascular volume loss  decreases LV
due to risk of immune reconstitution syndrome
 mechanical vent.: FiO2 improves oxygenation, preload  decreased C.O. & systemic BP 
 antiretroviral therapy should be deferred at least
increased HR & peripheral vasoconstriction
2 weeks after completing induction antifungal PEEP prevents alveolar collapse
(systemic vascular resistance)
therapy for cryptococcal meningitis  arterial pO2 measures oxygenation, influenced
o pulmonary capillary wedge pressure
 itraconazole does not cross the BBB by FiO2 & PEEP
(PCWP) is a measure of LA pressure & LV
 sulfadiazine–pyrimethamine: Rx cerebral  arterial pCO2 measures ventilation, affected by
end-diastolic pressure, are decreased
toxoplasmosis (headache, focal neurologic respiratory rate & tidal volume
 cardiogenic shock leads to decreased C.O. & BP 
deficits, &/or seizures); multiple ring-enhancing  initial ventilator management is decrease FiO2
increased HR & SVR maintains organ perfusion 
brain lesions with edema to non-toxic values (< 60%); goal = paO2 ≥ 60
increased PCWP due to heart failure
----------------------------------------------------------------  PEEP can be increased to maintain oxygenation
 vasodilatory/distributive shock due to sepsis,
 Baker cysts: excessive fluid production by an o decreasing PEEP lowers oxygenation by
anaphylaxis, SIRS, or CNS injury  significant
inflamed synovium accumulates in popliteal decreasing availability of alveoli decease in SVR & BP, with compensatory HR &
busa, results in a tender mass; common with ---------------------------------------------------------------- C.O. increase
rheumatoid arthritis, osteoarthritis, cartilage tears Hemodynamic measurements in shock o O2 saturation increases due to high flow rate
 DDx: subcutaneous abscess, lymphedema Normal Hypovole Cardioge Septic & decreased organ perfusion
 Baker cysts may burst and release contents into mic shock nic shock shock o as sepsis progresses  vasoconstriction with
the calf, presenting similar to DVT RA 4   normal, rise in SVR & decline of C.O.
---------------------------------------------------------------- pressure mmHg or  ----------------------------------------------------------------
 prostaglandin-only oral contraceptives are (preload  dizziness described as spinning sensation
preferred for hormonal contraception for )
accompanied by nausea: vertigo
lactating mothers Pulmona 9   normal,
 vertigo classification: central or peripheral
o does not affect volume or composition of ry mmHg or 
o peripheral vertigo has a shorter interval
milk produced, or risk of venous thrombosis capillary
wedge o ear fullness suggests peripheral vertigo
a/w combination pills
pressure o CN VIII lesions lead to central vertigo
 vertigo with a sensation of ear fullness suggests  transesophageal echo (TEE) is preferred over ----------------------------------------------------------------
Meniere’s disease, from abnormal accumulation chest CT with contrast in patients with kidney  constrictive pericariditis is a complication of
of endolymph in the inner ear disease or contrast-induced nephropathy mediastinal irradiation (from Hodgkin lymphoma)
o may cause hearing loss & tinnitus  patients should not receive antiplatelets (ASA, & cause of right heart failure (hepatomegaly,
---------------------------------------------------------------- clopidogrel) or anticoagulation without first progressive peripheral edema, JVD, ascites)
 gaze abnormalities, limb ataxia, sensory loss, excluding aortic dissection  can present 10 – 20 yrs after irradiation or
vertigo, Horner’s syndrome: Wallenberg ---------------------------------------------------------------- anthracycline therapy
syndrome (lateral medullary infarct) Lithium therapy  results from scarring & inelastic pericardium
---------------------------------------------------------------- Indications mania due to bipolar  CXR: pericardial calcifications
 > 2 weeks of persistent, high-volume, non-bloody Contraindication  chronic kidney disease  echo confirms Dx: pericardial thickening,
watery diarrhea after recent travel; no fever,  cardiovascular disease abnormal septal motion, bi-atrial enlargement
tenesmus or vomiting: Cryptosporidium parvum  hyponatremia or diuretic use  Rx: diuretics for temporary relief;
 travel-associated diarrhea > 2 weeks: parasistic Baseline studies  BUN/creatinine, U/A pericardiectomy for refractory symptoms
(cryptosporidium cystoisospora, microsporidia,  Ca++
Giardia)  Thyroid function Constrictive pericarditis
 diarrhea < 1 week: viral or bacterial  EKG if coronary risk factors Etiology idiopathic or viral
o rotavirus/norovirus: vomiting cardiac surgery
Adverse effects Acute
o ETEC/EPEC: contaminated food/water  tremor, ataxia, weakness radiation therapy
o Campylobacter: abd pain, blood diarrhea, tuberculosis
 polyuria, polydipsia
“pseudoappendicitis” Features fatigue, dyspnea on exertion
 vomiting, diarrhea, weight gain
o Samonella: frequent fever peripheral edema, ascites
 cognitive impairment
o Shigella: fever blood diarrhea, abd pain JVD, Kussmaul sign
Chronic hepatojugular reflux
 Entamoeba histolytica causes amibiasis,  nephrogenic DI
resulting in abdominal pain & bloody diarrhea pericardial knock (mid-diastolic sound)
 thyroid dysfunction pulsus paradoxus
----------------------------------------------------------------
 hyperparathyroidism with Diagnosi EKG: nonspecific, a-fib, or low voltage
 extertional dyspnea, syncope, angina: aortic
hypercalcemia s QRS complexes
stenosis
o systolic ejection murmur radiating to apex & pericardial calcification & thickening
 Lithium has a narrow therapeutic window, thus prominent x & y descents
carotid arteries
monitor every 6 – 12 months or 5 – 7 days after ----------------------------------------------------------------
o peripheral pulse: pulsus parvus et tardus
dose changes or possible drug interactions  spontaneous esophageal rupture after severe
(rises gradually & delayed peak)
(diuretics, NSAIDs, SSRIs, ACE-I, phenytoin, retching/vomiting: Boerhaave syndrome
 exaggerated decrease (> 10 mmHg) in systemic
carbamazepine)  CXR: left-sided pleural effusion with/without
arterial BP with inspiration: pulsus paradoxus;  during pregnancy may cause Ebstein’s anomaly,
suggests cardiac tamponade pneumothorax, subcutaneous emphysema, &
polyhydramnios, DI, floppy infant syndrome widened mediastinum
 pulmonary edema, a-fib, late diastolic murmur
 no effect on liver function, lipids, or glucose  pleural fluid: exudative, low pH, high amylase
with opening snap: mitral stenosis
---------------------------------------------------------------- (>2500 IU)
----------------------------------------------------------------
 long-acting injectable antipsychotics (depot) are  confirm Dx: CT or contrast esophagography with
 sudden severe chest pain radiating to back,
useful for chroni noncompliance, but have Gastrografin
severe HTN, decrescendo diastolic murmur of
previously responded to oral antipsychotics Mallory-Weiss Boerhaave
aortic regurgitation: acute aortic dissection
o 1st & 2nd generations available as depot Etiology mucosal tear transmural tear
o also weak or absent peripheral pulses, &
o given as IM every 2 – 4 wks forceful forceful retching
systolic BP > 20 mmHg between arms
 treatment-resistant schizophrenia: clozapine retching esophageal air/fluid
o heard better at right sternal border
o requires routine monitoring: CBC submucosal leakage
 CXR & EKG to exclude other Dx
o risk of agranulocytosis arterial or
 serum creatinine, contrast allergy?
 venule plexus o pain, tenderness, erythema in nasal vestibule 
bleeding o potentially life-threatinging if spread to ----------------------------------------------------------------
Features vomiting, vomiting, retching cavernous sinus 
retching chest/upper abd pain ---------------------------------------------------------------- 
epigastric pain odynophagia, fever,  blunt abdominal trauma can cause splenic injury, ----------------------------------------------------------------
hematemesis dyspnea, or septic shock presenting as delayed onset hypotension, LUQ 
subcutaneous emphysema pain radiating to left shoulder due to 
Imaging confirm Dx CT or contrast diaphragmatic irritation (Kehr sign) ----------------------------------------------------------------
with EGD esophagography with  Dx: abdominal CT with contrast if 
Gastrografin hemodynamically stable 
CXR: pneumomediastinum  hemodynamic instability despite IV fluids ----------------------------------------------------------------
& pleural effusion requires laparotomy 
pleural fluid: exudative, ---------------------------------------------------------------- 
low pH, high amylase  hypotension, tachycardia, distended neck veins, ----------------------------------------------------------------
Treatment self-limited conservative: cervical electrical alternans: cardiac tamponade 
endoscopic perforations ----------------------------------------------------------------
therapy as surgery: thoracic 
 stress fractures are common in the anterior ----------------------------------------------------------------
needed perforations middle third of the tibia in jumping sports & 
posteromedial distal third of the tibia in runners 
----------------------------------------------------------------  XR is typically normal initially
 acute pancreatitis can cause unilateral, left-sided ----------------------------------------------------------------
 Dx with MRI or bone scan 
pleural effusion with high amylase concentration, ----------------------------------------------------------------
but not widened mediastinum 
 cephalohematoma: subperiosteal hemorrhage
 cocaine use predisposes to aortic dissection with ----------------------------------------------------------------
limited to one cranial bone, presents several 
wide mediastinum & unilateral pleural effusion, hours after birth; resorbs spontaneously
but not high amylase content 
 Caput succedaneum: diffuse, ecchymotic
 aspiration pneumonia is common in the right ----------------------------------------------------------------
swelling of the scalp that crosses suture lines
lower lobe & unilateral pleural effusion due to 
----------------------------------------------------------------
parapneumonic effusion or empyema  infant with failure to thrive, B/L cataracts, 
o pleural fluid shows elevated WBCs, protein, ----------------------------------------------------------------
jaundice, hypoglycemia: glactosemia
& LDH, but not amylase  glactose-1-phosphate uridyl transferase deficiency 
---------------------------------------------------------------- 
 also vomiting, hepatomegaly, convulsions
 complications following rhinoplasty: ----------------------------------------------------------------
 increased risk for E.coli neonatal sepsis
dissatisfaction, nasal obstruction, epistaxis 
 early Dx & Rx: eliminating galactose from diet
 nasal septum has poor blood supply & 
 complications: cirrhosis, mental retardation
regenerating capacity, thus trauma or surgery ----------------------------------------------------------------
may result in septal perforation ----------------------------------------------------------------

 presents as a whistling during respiration due to  galactokinase deficiency: cataracts only

a septal hematoma following rhinoplasty ----------------------------------------------------------------
----------------------------------------------------------------
----------------------------------------------------------------  solitary, painful, lytic long bone lesion with

 allergic rhinitis: rhinnorhea, nasal pruritis, overlying tender swelling & hypercalcemia in a

cough; nasal mucosa is edematous & pale, child: Langerhans histiocytosis
 locally destructive, but resolves spontaneously ----------------------------------------------------------------
polyps may be present 
 nasal furunculosis results from staphylococcal  benign, Rx conservative

folliculitis due to nose-picking or hair plucking ----------------------------------------------------------------
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