‘o2 g cu THE MOST ENTERTAINING WAY TO STUDY MEDICINE JORGE MUNIZ, PA-CEPISTAXIS ANTERIOR NOSEBLEEDS ARE MOST COMMON COMMONLY CAUSED BY TRAUMA, INCLUDING NOSE-PICKING KIESSELBACH’S ——— PLEXUS MORE COMMON IN CHILDREN AND ADOLESCENTS WWW. MEDCOMIC.COM. WOODRUFF'S PLEXUS POSTERIOR BLEEDING \S LESS COMMON ASSOCIATED WITH HYPERTENSION AND ATHEROSCLEROSIS USUALLY SEEN \N THE ELDERLY © 2018 JORGE MUNIZEpistaxis may be classified as anterior or posterior nosebleeds, Anterior nosebleeds are most common, usually occurring at Kiesselbach’s plexus in the anterior nasal septum. © Klesselbach’s plexus consists of the anterior ethmoid, greater palatine, sphenopelatine, and superior labial arteries. © More comman in children and adolescents, © Commonly caused by trauma, including nose picking Approximately 10% if epistaxis occurs In the posterior nasal cavity, In an area known as Woodruffs plexus. © Woodruffs plexus mainly consists of the the posterior nasal, sphenopalatine, and ascending pharyngeal arteries. © Usually seen in the elderly. © Associated with hypertension and atherosclerosis. Initial management of epistaxis involves positioning the patient leaning forward and applying manual pressure to the anterior nose for 15-20 minutes. Other treatment options include topical decongestants (oxymetazoline), topical anesthetics (lidocaine), cautery (siver nitrate, electrocautery), packing, and surgery consisting of arterial ligation for intractable bleeding.PTERYGIUM FLESHY TRIANGULAR MASS THAT EXTENDS TO THE CORNEA MAY INTERFERE WITH VISION WWW. MEDCOMIC.COM BOTH ARE CONJUNCTIVAL GROWTHS THAT MAY RESULT FROM CHRONIC ACTINIC IRRITATION, REPEAT TRAUMA, OR EXPOSURE TO DRY/WINDY CONDITIONS MAY CAUSE IRRITATION OR COSMETIC BLEMISH PINGUECULA YELLOWISH ELEVATED BUMP OR PATCH THAT DOES NOT GROW ACROSS THE CORNEA TREATMENT IS NOT USUALLY NECESSARY BUT CAN BE RESECTED © 2018 JORGE MUNIZPrerygium: fleshy triangular mass that extends to the comea. ® May interfere with vision. Pingueculat yellowish elevated bump or patch that does not grow across the cornea, © Treatment is nat usually necessary but can be resected Both are conjunctival growths that may result from chronic actinic irritation, repeat trauma, or exposure to drywindy conditions. Typically occur on the nasal side. ‘They may cause irritation or cosmatic blemish.coe RATORY ott NORMAL PCOz 35-45 MMHg 2 oO Cc RESPIRATORY WWW.MEDCOMIC.COM HIGH PH > 7.45 CALKALOSIS) agsRATORY OPPOSITE METABOLIC Equa, LOW PH < 7.35 (ACIDOSIS) METABOLIC of t NORMAL HCO3 22-26 MEQ/L METABOLIC S| { © 2018 JORGE MUNIZRespiratory Alkalosis, Respiratory Acidosis Metabolic Alkalosis Metabolic Acidosis, pH Pco2z HCO ‘Common Causes Hyperventilation (e.g. in response to hypoxia, metabolic acidosis, increased metabolic demands, pain, or anxiety). Impaired respiration or airflow obstruction which can be caused by a multitude of disorders, Volume depletion (e.g. vomiting) and diuretic use. High anion gap: ketoacidosis, lactic acidosis, renal failure, toxic ingestions. Normal anion gap: Gl or renal HCO3 loss.TRANSUDATIVE OCCURS. DUE TO INCREASED HYDROSTATIC PRESSURE OR LOW PLASMA ONCOTIC PRESSURE E.G., CHF, CIRRHOSIS, NEPHROTIC SYNDROME, PE, HYPOALBUMINEMIA LOW IN PROTEIN AND LDH WWW. MEDCOMIC.COM PLEURAL EFFUSION ACCUMULATION OF FLUID WITHIN THE PLEURAL SPACE CCC EXUDATIVE OCCURS DUE TO INFLAMMATION AND INCREASED CAPILLARY PERMEABILITY E.G., PNEUMONIA, CANCER, TB, VIRAL INFECTION, PE, AUTOIMMUNE © 2018 JORGE MUNIZClassifying Pleural Effusions A pauraletusion can accumulation of fuchthin te purl space [betermning the unsering cau efaclitates by thoracantesic ae pleura Aud analy ‘The pleural fd may be classed as 2 transudate or an exudate. depending on the enlogy “Transudates occur secondary to conditions which cause an increase in the pulmonary capilary hydrostatic pressure ora decreacein the caplaryoncote pressure ‘© Leads t accumulation of protein poor pleural uid ‘© Cemmen causes include: CHF. nephrotic syndrome, crzhosis,hypeleuminemia, pulmonary embolism xudates occur secondary to conditions which cause inflammation or Increased pleural vascular permeability © Leads to accumulation of protein rich pleural flld and cali ‘© Common causes include: pneumonia, cancer tubereulosis pulmonary embelsm ‘According to Lights criteria 2 east one ofthe following criteria is present then the Rud is determined tobe an exudate: (Pleural fluid proten to serum protein rato greater than 0S © Pleural Fuld LOM to serum Los rate gresterthan 08 ‘9 Pleural Muid LH greater than two-thirds the upp limit for normal serum LOHPresentation + often agymptomate but can present with dyspnea, pleuatic chest pain. and cough + Physical examination may demonstrate decreased breath sounds on te side ofthe effusion, dunes to percussion, and decreased ‘este fremitus Imaging + Chest xray: blunting of cestophrenic angles freeflowing effusions will sulin layering of fluid on the decubitus view 1+ Chas CT sometmer used forfurtnerevalustion Treatment + Treatunderying cause + Thoracentesisis diagnostic and therapeutic + Pleurodesisorindeling catheter for recurrentmalignantefusions|PORCELAIN GALLBLADDER CHRONIC CHOLELITHIASIS AND CHOLECYSTITIS CAUSES CALCIFIED SCARRING CALCIFIED GALLBLADDER ON ABDOMINAL wy RADIOGRAPH * ‘ees CHOLECYSTECTOMY “DUE TO ASSOCIATION WITH GALLBLADDER WWW. MEDCOMIC.COM. COURVOISIER'S GALLBLADDER ENLARGED, PALPABLE NONTENDER GALLBLADDER WITH JAUNDICE ASSOCIATED WITH CANCER OF THE HEAD OF THE PANCREAS © 2018 JORGE MUNIZ‘+ Porcelain gallbladder: calefied gallbladder on abdominal radiograph due to scarring caused by chronic choelthisisieholecystti, © Requires crolecjstectomy due to association with gallbladder carcinoma, ‘= courvasers galsladder enlarge. palpable nantender gallbladder with jaundice. ‘© Assodated with cancer of the head ofthe pancreasPREECLAMPSIA: PATHOPHYSIOLOGY DEFECTIVE SPIRAL ARTERY REMODELING PLACENTAL HYPOPERFUSION WWW. MEDCOMIC.COM SYSTEMIC VASOCONSTRICTION AND ENDOTHELIAL DYSFUNCTION = CAN'T... BREATHE... DISEASED | WANT PLACENTA RELEASES A BELLY PROINFLAMMATORY BUTTON! PROTEINS INTO MATERNAL CIRCULATION CURATIVE TREATMENT IS DELIVERY HYPERTENSION AND END-ORGAN DAMAGE HEMOLYSIS ELEVATED LIVER ENZYMES LOW PLATELETS © 2018 JORGE MUNIZGeneral Features 1 reaelampsia is classically defined a= the new onset athypertanion and pratauria ftar 20 weeks of gestation. 18 New onset hypertension with sign‘icant end-organ dysfunction (wth or without protelnuria) ater 20 weeks of gestation also salistes the diagnosis of preedlampsia, 1 Severe headache, enigastic or right upper quadrant pan, visual disturbances thrombocytopenia, impaired iver function, renal insufcincy, pulmonary edeme 1 HELLP syndrome: Hemolyis, Elevated Livor enzymes, Low Plateete ‘© Edema may o may not be present 1 Eclampsia= preeclampsia ~ seizures ‘Risk factors induce nulipanty, past history of preeclampsia, preexisting hypertension or renal sense autoimmune disease very young or abvanced maternal age diabetes and obesity. + curatwe treatments deliveryPathophysiology 1 Genetic and immunclegcal factors ‘Defective spiral artery remodeling during pregnancy © During normal pregnancy trophoblast cls invade the myometrial segment of the spiral arteries to cause transformation and iavon ofthe arenes. © In preeclampsia there is insuffitent trophoblast calli placental hypapertusion sion. which causes the spiral arteries to remain narrow and leads to Diseased placenta releases proinflammatory proteins © ypertnion © vasoconstnction © Endothelial cll dystunction * Formation of thrombi © End-organ damageACUTE \ ) SINUSITIS \ ‘K} THE PARANASAL SINUSES Teal Ae DURATION LESS THAN 4 WEEKS WWW.MEDCOMIC.COM 4 OBSTRUCTION PAIN AND PRESSURE OVER THE AFFECTED SINUSES. © 2018 JORGE MUNIZGeneral Features 1 excess 2 otamnation of te paral suse uly eto 2a rect, second batt Infecion an oc ‘+ onen reepea oy an upperrespracry neon 1 commen acer garages incude 5 preumante, Hinzurze sre Moro corona Symptoms and Signs + Poin and pressure verafees Sruses + Worse anes vending towers 1 ns corgeson araosructon 1 raneuminsten ane ances ances may sermons psenestonDiagnosis + Unayaingrnes inet ‘+ xs scl soul be conser wth psa symp ling ge the 10 ey vere se ofsymatos if symone 1 CTscaniteamptacors ae suspect orn rerecaey case. feet nae oro nenement Treatment + Supportive ray ASAD wasn corprenen secangetnt nua nine ngmion saws setcomecsise + kotiosesit simp prs er 10-4 dc or severe symone are presen.OSTEOARTHRITIS DEGENERATIVE DISEASE MORNING STIFFNESS LASTING LESS THAN 30 MINUTES HEBERDEN'S WWW. MEDCOMIC.COM INFLAMED SYNOVIUM SYMMETRICAL RHEUMATOID ARTHRITIS AUTOIMMUNE DISEASE MORNING STIFFNESS LASTING MORE THAN 30 MINUTES EXTRA- ARTICULAR INVOLVEMENT © 2018 JORGE MUNIZConcetta eversens nsec tony prominese oct tte itl oterpningen (Dot ouch redes 2 late te proximal nepaengeal OS. "ypcay ates joc asym, suayaegnovenormal zo rigs. fssogsen nincnansia aieans ameopyeas sno acenouing mieten nent moet chnchint in noes roc commen buna presen, ‘oily ates ein ymca tigi prep ter ines pereeexnatdong bhakadsHPA AXIS pOTHAL Amar WE HAVE THREE EXAMS THIS WEEK! BINGE- WATCHING WAS A BAD CHOICE! You Two SHUT UP!? ACTH STRESS CAUSES j STIMULATES THE THE HYPOTHALAMUS \ RELEASE OF CORTISOL TO RELEASE CRH, WHICH \ ; / FROM THE ADRENAL STIMULATES THE ANTERIOR CORTEX PITUITARY TO RELEASE ACTH WWW. MEDCOMIC.COM. © 2018 JORGE MUNIZThe Adrenal Glands 1 Te scenal gic are angular stapes gestation cop othe anes + baer aren gan ecompones ato ute soron cles he cove anien er gorten sled ne es 6 The serna cone secre rineocrtcals aucecrtais, an aneregers. 1 Theconenistunser avoea no vee nes orzares gomeruom cueriaye seuss (mse ige) an eters ner, Thelen sntian ttn agree sacra esl sues ataonimne ans unr ne Sracinhuens st ‘mesymeamescnencus yer. 1 Geecoumines spine anc rorepnestine The Adrenal Cortex (G--R) ‘ona Postion Hormone Class Hormones z aye Feecnists Wise Guctconeass cont sige aye Rescues Inowiger dosragen DHEA ONES anceteesne SexHypothalamic-pituitary-adrenal Axis + The typotatemicptanceren (PH) ana ajar ontzoencrine system ha ce the hyptnalamu pea garded svescren ame + orctopcesing hormone (CR seesressence Re rem peter + Sumustes tne elect ot sreneconicgicharmone ACH elects tom anor star) = lsses om sorens gana c7s eccust or serene cone) © Provide nage feeseck ecgan hehypalara and tery mgr RH and ACTH prcACOUSTIC NEUROMA mM WEAKNESS IF TUMOR Hi GROWS TO AFFECT \/ BENIGN SCHWANN CELL-DERIVED TUMOR OF THE EIGHTH CRANIAL NERVE aw we) SENSORINEURAL HEARING LOSS IMAGING OF CHOICE IS MRI TINNITUS, aA , VERTIGO, : = TREATMENT OPTIONS c HEADACHE — INCLUDE SURGERY AND UNILATERAL FOCUSED RADIATION WWW. MEDCOMIC.COM © 2018 JORGE MUNIZ| MONTEGGIA == “mucetR" = GALEAZZI GENAIFRACTURE fo. oe RADIUS FRACTURE WITH DISLOCATION OF SE WITH DISLOCATION OF THE THE RADIAL HEAD DISTAL RADIOULNAR JOINT MONTEGGIFA ae ~ caveazZ ‘A’ IS PROXIMAL: Fy ‘Z' IS DISTAL: BONES AFFECTED PROXIMALLY i _ BONES AFFECTED DISTALLY WWW. MEDCOMIC.COM © 2018 JORGE MUNIZDefinitions + ANoneesgafactureis fracture ofthe prover ue tn dscston ofthe radia ness, + Tare st fou pas utes one drecton rato radal pads places Bato casei. 4+ Acaennitemure tea ramure ttn tal oust sieeton ote ci regu ohwion) Fracture-dislocation Mnemonic ‘+ usa prenources HUGGER: eran tne ramus one. 2M NoneagitUne 9 wicpredral vonage) s+ fade mens dscentor an pow une tnire + Teewancrez) + op mscunerjamatsoeman area rosuetemureSYSTOLIC DYSFUNCTION SYSTOLIC AND DIASTOLIC DYSFUNCTION CAN APPEAR IN COMBINATION IMPAIRED CONTRACTILITY SYSTOLIC ETIOLOGIES: ISCHEMIC HEART DISEASE, CHRONIC HYPERTENSION, DILATED CARDIOMYOPATHY, AND MYOCARDITIS DIASTOLIC ETIOLOGIES: HYPERTENSION WITH LV HYPERTROPHY, RESTRICTIVE AND HYPERTROPHIC CARDIOMYOPATHIES, FIBROSIS, AMYLOIDOSIS, SARCOIDOSIS, CONSTRICTIVE PERICARDITIS, HEMOCHROMATOSIS, VALVULAR DISEASE, ——\ 93 GALLOP AND AGING Low - ) ) go if EJECTION 7 AND WATER RETENTION WE NEED PULMONARY AND — SYSTEMIC VENOUS CONGESTION WE'RE GETTING CARDIAC DILATION ‘ INCREASED BACKED UP. DO AND HYPERTROPHY PRELOAD ‘YOUR JOB! WWW. MEDCOMIC.COM © 2018 JORGE MUNIZGeneral Features and Pathophysiology 1+ ene ture hte athe nabity fhe hes te provide utican puta mae he metabolic demand 2 Bae © Mosc oten 2 everic conto, bu may ako be acute 1+ esr falure encom sue rypopertsion a ala pulmonary are systemic venous congesven + There ore mary pars tclgies. Low extput faire occurs wth conditions aseained with impaired canine contrac, imped didn ig meer evan or ttn gh emp fre descTaesa cern whic resi! re coma ctor {allure ocarin the senng ofincresed carcac ouput reduced systemic vascular resistance, and increased metabolic dear. {agi esr Dake nck nace ay en Fagen arbaty, pericardial disease, hyenas, and val disease. + biampies ofconanons oes high output hen fre ines severe anemia sysotoiae's Paget eeose of bone. rps oye eitinteran shumjarc bet! + Compensatory mechanisms develop ro improve cardiac ouput butin me these responses only serve tw exacerbate the underlying ‘cardia prolem. Examples of compensatory mechan smsinude + snreasedsympashexc nervous ays acy cats ineresced myocardial contac and peripheral vasocontaon 1+ Aaivason ofthe erin engotensneisemerone sytem leads te sodlum answerer retention. 1 Vasoprestin/ADH secreon causes perchera vesocorurcson and ater rein ‘+ Neurohorrnoral acchaion helps mainain systemic arterial pressures, bualzoconuibutes an increaced workload on reheat © Carelaccllaion and hypervophyHODGKIN LYMPHOMA OP DIAGNOSIS: EXCISIONAL LYMPH NODE BIOPSY IT'S SPREADING TO YOU NEXT! SPREADS IN AN I ORDERLY FASHION THERE'S J ‘ TO ADJACENT NODES ¢ SOMETHING b a = WRONG WITH WWW. MEDCOMIC.COM © 2018 JORGE MUNIZHodakn rnphome (Hl) is «lal Ball malignancy thet esespredorina in thelymghaticzyzem: HL ends to develop thin single lymph node region and spreads in an orderly fashion wo adiacent mph nodes, defining charecersticof HL isthe presence of ‘the Rees Stenberg cal ngs ce wh 2 bobed mulevs and prominent nace eng the appearance oF oa "s een ‘Theresa bimodal age distcbuson, peaking among patents inthe 20s and in those greater than 30 years of age. HL comment presents wth pines yrnphasenopathy series suprscaviely, spe mesasina. Other nisl man fetatons cue consenons Se ayosare fever, denching night meats, ane igh ns) printus ane nepatarlensmagay A suggestive symptoms pain he sffeceshnph node afer alcohol conumption Hz azocate with Epstein Beer vue infor, ‘The sagross ie mode by excional npn nade biopsy, Naser scone ene mostcommon hinbowic np of. The tne ssluation includes CT ears (chest, abdomen pei ardaometimes nec), PET scan, end sometimes bane marrow bcpsy f chances casease is suspeced. The Arn Arbor system is used o stage HL with ’A’ and" modifers. Stage Arepresems HL without symptoms [shins = Asymtomanie) Sage ® represent Hl uth corsttuiona symptoms winch ie assonate with 3 poorer prognosis thine fla Treatnert cles rdistion therapy and/or cniination chractheopy.| TYPICAL COMMUNITY ACQUIRED PNEUMONIA ACUTE INFECTION OF THE LUNG PARENCHYMA ACQUIRED OUTSIDE OF THE HOSPITAL OR LESS THAN 48 HOURS AFTER HOSPITAL ADMISSION MOST COMMON CAUSE OF TYPICAL CAP IS STREPTOCOCCUS PNEUMONIAE WWW. MEDCOMIC.COM FEVER, COUGH, SPUTUM PRO! PLEURITIC CHEST PAIN, DYSPNEA, TACHY¢ BRONCHIAL BREATH SOUNDS AND CRACKLES ON AUSCULTATION TaG INFILTRATE ON CHEST RADIOGRAPH © 2017 JORGE MUNIZCommurty aquired preunoni (CA2)s an acute infeaion of thelung parenchyma squid ouside of ce hosp ress han 48 hoursafer hosp admission. CAP casafedinte pal and apical ubypes,ifferencate by thelr presentation and causanve pathogens. Thi hisraton fuses onthe loss feaires ofp CAP. “ne most common cause of spiel CAPs Soepracoccus pneumoniae. ts an encapsulated gram-positive, ancershaped diplococcus bactanum, Other commen susatve pathogens incuee Hoenophite mfuerzoe, Meraxal carta, grem-reganve bail (eg eps) ona Seotyocoesuoureve Corman wr agers nce Infuena vous, eaprmony syrqrilvrue FSV. aderovrus 2nd eerie “Typical CAP is characterised bythe acute onset of fever. cough, sputum producon igs perc ches pain, dyspnea, and achyeardl, Sragtocaccveaneurtonige nfecion ‘sense arsactes wh she procueron of usr elares sputum, Broncrilarath sous ane cocks toy be bean ter eten‘SpecelRncngs dic wo ler oration cre phony (Et A uttered peceslagey, ai ers tate inte CAP rth tro plea Eon oy Seta trend te re ene ase percussion. Chast radiegrphy is mporcancin exablzhing te diagnose, which may revel aber concoldaton, patchy airspace fopacnies orinterntilopsees.Trastmentnvoher empire snares ar aganimspeefeantbianes fone pathogen is serieVISUAL RELEASE HALLUCINATIONS AKA CHARLES BONNET SYNDROME (CBS) VISUAL HALLUCINATIONS THAT OCCUR DUE TO VISION LOSS FROM ANY UNDERLYING CAUSE 1 CAN'T SEE! CAN EXAMPLES OF UNDERLYING CAUSES: MACULAR DEGENERATION, GLAUCOMA, DIABETIC RETINOPATHY, OPTIC NEURITIS, SURGERY, STROKE WWW. MEDCOMIC.COM HALLUCINATIONS MAY BE SIMPLE OR COMPLEX MORE COMMON IN ELDERLY PATIENTS PATIENTS UNDERSTAND THAT THE HALLUCINATIONS ARE NOT REAL © fv, SA THE DIAGNOSIS IS MADE IN THE ABSENCE OF PSYCHIATRIC DISORDERS OR OTHER CAUSES OF HALLUCINATIONS © 2017 JORGE MUNIZ‘Visual lease hallucinations sto kn oun as Charles Bonnet syndrome CBS, efers to symptoms of usual halucrations sha: occu due ‘ovine loss from ary uncaring enuse. The underying consti nny alee: me ye, spre nerve or she brn Evargles oFuncerying aks cee teatory lec it retort carey ond ac 85 etroughero occur due othe nverrupion or dastucton ofthe atferenscannetons of rerv callin the vival system leading 0 “srniorionoftre sul cate: The subsequent spantanenus fing of neurons cnuses mllsnaions, Patients vith CES have ieight nro the unreal nature of he halludnaton. isnot #yrnptom of xchat tnes or ny other cause ‘sf cements, CBS can oesurin all Ee groups bute more common in sléerypasents Patent my expenience simple halucinavons such 8 flshes fight or shapes or they con be complex halluanation, such as images of people animals. lardscapes, or cartoons. The hallucinaians are commenly eaters, but may cause aniety he duration af se hllucinatons general depen cr the underying cause. Insome cases they may ony ast day weeks, ven other cues the halcnations may parse over veverl years Se ee ee ee (C85 managed by vesting te undering condition causing the visual dei and providing reassuance to pate ef ther sant. Some cases anicanulsa or ancpsyonc therapy may provide relet ram C85,AN ACUTE ERUPTION OF OVAL, SCALY PAPULES AND : PLAQUES THAT BEGINS WITH : I oa VIRAL A SINGLE HERALD PATCH V7) ] etiovoey is PROBABLE [ax = SUNLIGHT OR UVB (HHV-G AND y PHOTOTHERAPY MAY HHV-7) HELP THE LESIONS DISAPPEAR FASTER CONDITION RESOLVES 1-2 WEEKS LATER THE ERUPTION ve MAINLY SEEN IN SPONTANEOUSLY IN APPEARS ON THE TORSO INA Vv TEENAGE AND YOUNG ABOUT 6 WEEKS CHRISTMAS TREE PATTERN ADULT FEMALES : WWW. MEDCOMIC.COM © 2017 JORGE MUNIZPieyriasis rosea Is an acute sef-limited eruption of eval, scaly papules and plaques wrth a disunctve morphology. Females are affected ‘nore often than males it croscomnan in eenagers and young ans. Pyles roses ness ne sanng.nd fo seosons The snort probable cause hes heen atributed to rescoweson afhuman herpenis (HVS and HEV) Paytests rosea begins with 2 single lesion krown as “herald” patch, usually located on he wrk. Th incl lesan san enthematous, “valoinque wien eosveme of ele nse the hover: Appeosreataly | Dweske afer he sppesrance oftne hesis path > “horacerinicrashappesrs onthe tose tnt tolls the ines of cemiage na "Chemas ree" paern Piynas rose ay De compares by puri: ‘The condsion resohe: spontaneously In about 6 wets often requres n restart. Sunlight r WE phototherapy may help she lesions “sspsenrforerifsares surng the freee af eruption Lotions, or aathuarnnes, anaer apes slncartcnie may be een or iting.CLOSTRIDIUM DIFFICILE INFECTION _ FEVER, CRAMPY ABDOMINAL PAIN, C., DIFFICILE CONTAINS ENDOSPORES THAT CAN SURVIVE THE ACIDITY OF THE STOMACH iC. DIFFICIVE HLOURISHES AND REACH THE LARGE INTESTINE WITHIN THE COLON THE NORMAL GUT FLORA IS ALTERED BY BROAD-SPECTRUM ANTIBIOTICS, MOST NOTABLY CLINDAMYCIN, CEPHALOSPORINS, AMPICILLIN, AMOXICILLIN, AND FLUOROQUINOLONES WWW. MEDCOMIC.COM DIARRHEA ; MOST COMMON INFECTIOUS CAUSE OF NOSOCOMIAL DIARRHEA TOXINS A&B CAUSE MUCOSAL PSEUDOMEMBRANOUS COLITIS: YELLOWISH PLAQUES FORM OVER DAMAGED EPITHELIUM © 2017 JORGE MUNIZ(Cosma afin sa gram postive anaerobic bells hich scretes nin ans) ser ens sarhen ons peeudomembeenous eC ise alee eee et sown rf Trane fe cai aes is eceaaet eh contaminated humars and fomites. he organism catains endospore hat can suvvethe ai of he stomach and eech the lage life colorizes the neni tact fer he normal gut flora hes been altered by eros here, tcanScurish ar any asibiate therapy, but mos nocebly occurs wih Broze-pecrum ancblouc suc a Cindanycincephslosorins, ampicin amoxilin, nd Aaroquinalones Pesudamemranou coi a7iammator noel scorer nynich yelowen plagues Forn overone darnnze0 Intestinal mucas. The plaque son execs hat resembles « membrane, hence the tem pseudomembranous” “The signs and symptoms nude ever crampy abdominal pair, and darthea.Progesion ef he condion can lead leukcyto, eryerason an roe megacsion The disgrose econfrrved wien a t00|seenyforCsifcfetow, Pzeusomembranes canbe seen on semassoesepy Tresoment includes daconcinuing the causative ager, Oral mecronidazle the estmencof choice pavents that de notrezponds2 conseryanye measures Arnel, very severe cases may require oa wareomycin. Rarely, 350s complicate by toxic megacolon er pe etary par chalkOBSESSIVE-COMPULSIVE DISORDER RECURRENT, INTRUSIVE, UNDESIRED THOUGHTS (OBSESSIONS) AND/OR UNCONTROLLABLE REPETITIVE ACTS (COMPULSIONS) WASH YOUR 10 TIMES, OBSESSIONS AND COMPULSIONS ARE TIME CONSUMING AND CAUSE SIGNIFICANT DISTRESS IN ad Nile) WWW. MEDCOMIC.COM. © 2017 JORGE MUNIZCbsessve-compusvecsorder (OCD is characterize by recuren, nase undesired thoughts (known as obsession) aralor uncontrollable repetove as tknown as compulsions Obsessions and compulsions are e-coneursing (| hour na da and cause “ipnfcantleversins psvert= olf, The prevalences 2-15, th mean onset mane scone deca Obsessions cause grief and ara. These hugh are urcessorable ard ate rot worses about reali protlems, Carrying out ‘ompusons may x mporary relieve hearer caused by obsesions. ompusons can incude physical acts (eg, fequenchand- aching. repeatedly checan she stove or door lock, aeranging objecs in 3 spec corer] or marsal ac (eg. courting. repestng certain prrases Teestmers options inde cognitive behavioral therapy ard pharmacotherapy, end combining thetwo may be best SSRs may reed be tivated higher doses han those wed o west other corde Clomipremin alo effecve buthas mary ie ects ‘Anupaychodcs may be helpfid asa thir ne agent in reotment-restcont caseOVARIAN CYCLE THE MENSTRUAL CYCLE CORPUS LOW fg , | Li \ LUTEUM CORPUS ESTROG! ( ‘ \ i. ‘J ene en cue: ZH ALBICANS AT THE END OF Z MENSES MENSES “y € — UTERINE CYCLE PROLIFERATIVE PHASE: INFLUENCED BY ESTROGEN, SECRETORY PHASE: INFLUENCED BY PROGESTERONE, THE THICKNESS OF THE ENDOMETRIUM RAPIDLY INCREASES. THE LINING BECOMES HIGHLY VASCULAR AND EDEMATOUS WWW. MEDCOMIC.COM © 2017 JORGE MUNIZ‘The menstrual cycle is coordinated by @ series of hormones that regulate the growth of the endometrium, the development of an o2cite,teleace and porsible implantation ofan ovum, ali pregnancy doesnot acu, sloughing af the eromatum and menses to allow arepeac ofthe same process. The fat day af the mensirval ees represenced by te frat day of menses, The mensrual ces ‘then sles intothe fica ane lune] phaees ofthe ovens gee which correspon with he prosferatve and secretary pases oF ‘eines ‘The folleuar phase inkaced by low estrogen levels atthe end of merce: Fale stimulating hormone (FSH) fromthe anterior priory sumulates he flictesin the ovate grow ane produce enrogen T's =age roughly sorresponds wn she proliferative pha tf the uterine ode thch the tices ofthe trcometiam rapid erzaex: The dominance (reaian folie] emerges by day Tei is eR Me ea PS Lind etic EM tied ike pene amounts of esrogen from the mature folie, Ora ovum ie relaaced 369 42 hour from tne onaet ofthe LA surge. ‘The uteaprase sso med neceuse centers ante ae af the corpus ute, the ermnant ofthe ovario ile, yc serene progesterone to rey sh users fora posible pregrancy, Tis sage roughly correspond with she seretary shes ef the uterine cycle Inch he lining ofthe uterus becomes highly vascular and edemacous he gg not feline, the corpus kteum volutes apd becomes the corpus albicans (Reraus sear tesue) and menstuaton occuPULMONARY HYPERTENSION Mm caer ONLY GROUP 1 IS CALLED CATCH) PULMONARY "ARTERIAL" HYPERTENSION, BUT ALL 5 GROUPS MAY BE REFERRED TO ELEVATED MEAN ARTERIAL AS PULMONARY HYPERTENSION (PH) PRESSURE > 25 MMHg AT REST ASSESSED BY RIGHT HEART CATHETERIZATION GROUP 3: PH DUE TO LUNG A. DISEASE AND/OR CATEGORIZED é HYPOXEMIA INTO FIVE GROUPS ie BY THE WORLD HEALTH ORGANIZATION (WHO) é GROUP 4: PH DUE CHRONIC THROMBOEMBOLISM GROUP 1: PULMONARY ARTERIAL HYPERTENSION (PAH) PAH EXAMPLES: IDIOPATHIC, INHERITED, DRUG AND TOXIN INDUCED, ss HEART DISEASE PH WITH UNCLEAR CAUSED BY CONNECTIVE TISSUE KS i (MOST COMMON) MULTIFACTORIAL DISEASE, HIV, SCHISTOSOMIASIS MECHANISMS PH DUE TO LEFT cr OOe WWW. MEDCOMIC.COM © 2017 JORGE MUNIZPulmanary hypertension (PH refers to increased pressure inthe pulmonary crculation. = develops wihen aulmonary vessels became “consmict sna/orobmrueted heh con sur in 9 wide variety of conainone. The ncenseim pressure empennures by rare catbeeriznion ards defied axe mean pulmonary eri prsaure25 om H a lasceco ight venmiulshypartophy ans enlagemnentae tne vertrle pump agnnstineresse renctance Fight ade hear re (cor pulmonale) cn evensuly develop. Signs and nynptome of PH ince depres one or gue inter chest py acne hepatomegaly, neck ein diterion, and ing edema. Narran splizing ofS2 wih an accertusted pulmoris component (P2) may behead on avecultation, fcroceriograshy «helpline test testimete the mean arterial pressure arc may sa demonstvate enlargement the rah verre ang atrium, wth trcuspdregurghatin, Echocardiography azo allons for an assassmen of eft varia funcon velar “Ssesze ans congenneartazeace, Te mean aren pressure neefntay iagnoeea win nght near extherersaton ‘The Wer Heeh Orgenizeion (WHO) categorizes PH into groupe and she mana smentof BH depends onthe eiclogy- Posse underyng causes shouldbe identi and weaved. Treaomen: opsons indude oxygen therapy, conc aricoaglatn, calcu channel Dockers. prostecjsn luneosioter PDES nhbtars ana near hang vanssienMEDULLOBLASTOMA MOST COMMON MALIGNANT BRAIN TUMOR IN CHILDREN HEADACHE, NAUSEA, VOMITING, 2 DIZZINESS, VISUAL DISTURBANCES IMAGING MODALITY OF CHOICE IS MRI WWW. MEDCOMIC.COM. TUMOR CAN COMPRESS 4TH VENTRICLE, CAUSING HYDROCEPHALUS \__7 MAJORITY ARISE IN THE CEREBELLUM TRUNCAL ATAXIA, SEIZURES, SENSORY TREATMENT USUALLY RECS CONSISTS OF SURGERY, RADIATION, AND CHEMOTHERAPY © 2017 JORGE MUNIZMedullablastama is the most common type of malignant brain tumer in childhood. It is an aggressive solid tumor malignancy that sic the ster fi ic connie rns ey andere Bey ine oli wits Repel ten ads wih sual occuring between 5 and 9 years of age Sigrsane atoms are relates to cerebeliar ystinston anainerense ntnerani!presure deo biskage ofthe fourth vermice compression may ature unc Patan common pratentaithhaade=ne,nauses vorsingmslence Sheu inursances, Nan es ars Thelmsging mec of calc Wl vin ga nim contac, Trestmenc usualy consis of surgery essen and chemotnersoy.TESTICULAR TORSION SURGICAL EMERGENCY THAT REQUIRES INTERVENTION WITHIN G6 HOURS WWW. MEDCOMIC.COM ACUTE PAIN AND SWELLING TWISTING OF THE TESTIS AND SPERMATIC CORD RESULTS IN ISCHEMIA DOPPLER ULTRASOUND DEMONSTRATES DECREASED BLOOD FLOW © 2015 JORGE MUNIZ“Ts etn er tether ees na he tne vgn esr chats the pera ‘ess. Testicular torsion may occur in he absence ofa preceding eventor after minor wauma, Patents sypcally experience acu severe ‘ann choc may be accompanied ay nauses and orm, ‘On physical examination, se affect venus ic edemaious tender to palpation, anytnematous, and sigh elevate, Teves i ao ‘equertl found tobe ying boroncly, dplacng the epdidyis so that i’ ratfoundn the normal posterlaterl pose. The ‘unio ebsence of he cremastere efx ietne mos senate pric expansion fring in temieuintoron Doppler ultrasound may be helpful nthe agnosis when there ae equivocal nical ndings, but should not delay westment. Imecace surgical ircerverion can salvage an ischemic tests if performed within sx hours, but he succes rae dereaces signcaly beyond 12 hours Manan esorsion say a0 e gerormesin 9 sinlar manner so ozening.® Book presales] monAORTIC STENOSIS TESTS: + ECG: LVH, ST-T WAVE CHANGES THREE MAIN CAUSES: * ECHO: CHECK STRUCTURES * CALCIFIC DISEASE OF A TRILEAFLET VALVE NARROWING AND CALCIFICATION AND PRESSURE GRADIENT * CALCIFICATION OF A BICUSPID VALVE OF THE AORTIC VALVE RESULTS IN LEFT * CARDIAC CATH: ASSESS VALVE + RHEUMATIC VALVE DISEASE VENTRICULAR OUTFLOW OBSTRUCTION AREA AND.CORONARY ARTERIES INTERVENTION: + SURGICAL AORTIC VALVE REPLACEMENT, + TRANSCATHETER AORTIC VALVE REPLACEMENT + BALLOON VALVULOPLASTY IN YOUNG PATIENTS OR POOR SURGICAL CANDIDATES SYSTOLIC EJECTION MURMUR AT RIGHT SECOND POSSIBLE HEART FAILURE, INTERCOSTAL SPACE ANGINA, AND SYNCOPE WWW. MEDCOMIC.COM © 2017 JORGE MUNIZCauses of aortic stenosis (AS) include degenerative sclerosis with calcification of trieefiet aortic valve, calcification of a congenital aortic rapid vee, sheurasc fever. Nerrowing af the aoe vale obstructs blood fow fram the ef venie tothe azarding aorta ring yeoe Left unneate, patents nithAS may develop hearfalrs, angina, ayncope, exerlona zones, and anthyehmias. (hci es air cto ght car nec pe ic cite a par oh ‘arcu seen nsevere AS, n which here 2 weak ac celayed arid ups ok. Testing includes CAR, ECG, echocarcography, end cardiac eatherrzation to assess vale area ard coronary ates for atherosclerauc csease eymtometie dts it 4S do oot cay requis intervention. Severe As treated with valve replacement or balloon veinsonlty In young patients or poor surgical canchdates.