SoCal's UW Step 2 CK EOs (UTD 10 Nov)

Currently Available Questions On UWorld 1 O
Medicine Obstetric Pediatrics PsychiatrySurgery

Allergy & 6 21 27 0.74% Allergy &
Biostatist 91 1 1 93 2.54% Biostatist
Cardiovas 203 4 28 58 293 7.99% Cardiovas
Dermatolo 65 1 23 20 109 2.97% Dermatolo
Ear, Nose 14 27 32 73 1.99% Ear, Nose
Endocrine 112 8 23 1 17 161 4.39% Endocrine
Female Re 5 209 19 10 243 6.63% Female Re
Gastrointes 128 13 51 160 352 9.60% Gastrointes
General Pr 2 14 11 27 0.74% General Pr
Hematolog 101 5 54 22 182 4.96% Hematolog
Infectious 136 12 87 37 272 7.42% Infectious
Male Repr 14 7 1 25 47 1.28% Male Repr
Miscellane 1 1 13 3 18 0.49% Miscellane
Nervous S 226 3 74 10 45 358 9.77% Nervous S
Ophthalmo 26 17 9 52 1.42% Ophthalmo
Poisoning 33 11 6 50 1.36% Poisoning
Pregnancy, Childbir 228 7 1 1 237 6.46% Pregnancy,
Psychiatri 9 6 26 300 3 344 9.38% Psychiatri
Pulmonary 140 2 30 60 232 6.33% Pulmonary
Renal, Uri 111 9 34 36 190 5.18% Renal, Uri
Rheumatol 113 2 49 79 243 6.63% Rheumatol
Social Sci 34 9 8 6 6 63 1.72% Social Sci
1570 513 624 319 640 3666
42.83% 13.99% 17.02% 8.70% 17.46% 3666
Objectives Available On This Sheet
Medicine Obstetric PediatricsPsychiatrySurgery
6 20 26 0.69%
100 1 1 102 2.70%
200 4 28 1 59 292 7.73%
66 1 24 22 113 2.99%
14 27 33 74 1.96%
115 8 23 1 17 164 4.34%
5 217 19 11 252 6.67%
128 13 53 162 356 9.42%
2 14 11 27 0.71%
102 5 56 22 185 4.90%
136 12 89 37 274 7.25%
14 8 1 25 48 1.27%
1 1 14 3 19 0.50%
231 3 80 10 45 369 9.76%
26 17 9 52 1.38%
35 12 1 6 54 1.43%
242 7 1 1 251 6.64%
11 7 26 309 3 356 9.42%
148 2 33 63 246 6.51%
114 9 35 35 193 5.11%
116 2 50 81 249 6.59%
45 10 8 6 8 77 2.04%
1615 537 644 330 653 3779
44.05% 14.65% 17.57% 9.00% 17.81% 3779
QID Subject System Topic
Common Variable Objective
Recurrent sinopulmonary infections and evidence of
19993 Medicine Allergy & I Immunodeficiency deficiency
Irritant contactsuchdermatitis
as common canvariable
be triggeredimmunodeficien
by a variet
11177 Medicine Allergy & I Contact Dermatitis contact dermatitis with pruritus,
Infections are common in patients who undergo erythema, local swell
liver
7494 Medicine Allergy & I Liver
CommonAbscess
Variable month
Recurrent bacterial infections in an adult should raisem
are due to bacterial causes; infections during
4301 Medicine Allergy & I Immunodeficiency the diagnosis.
Calcineurin inhibitors (e.g. tacrolimus, cyclosporine) h
3980 Medicine Allergy & I Calcineurin Inhibitors control.
ACE inhibitors are the most common cause of acquir
2770 Medicine Allergy & I Ace Inhibitors
Measures Of the
Themedication.
odds ratio (OR) Otherisadverse
a measure effects of ACE inhibito
of association calc
20563 Medicine Biostatistic Association
Measures Of OR = ad / bc.
The odds ratio (OR) is a measure of association calc
Sensitivity And bc.
20541 Medicine Biostatistic Specificity The accuracyisof
A percentile thea value
diagnostic test is the
in a normal probability
distribution thatthh
20538 Medicine Biostatistic Normal DistributionAnd
Pretest Probability 68-95-99.7
In a clinical rule to identify
setting, the pretestthe percentiles
probability that corresp
of disease
20537 Medicine Biostatistic Odds Pretest odds
Blinding is theofconcealment
disease = Pretest probability
of intervention / (1 - Pr
assignme
20533 Medicine Biostatistic Bias blind as many individuals as possible in a clinical stud
20507 Medicine Biostatistic Bias Observer
In ecological biasstudies,
occurs thewhen unitobservers
of observation(e.g. research
is the po
20503 Medicine Biostatistic Study Designs Therefore, results about associations
In ecological studies, the unit of observation is the po at the populatio
20502 Medicine Biostatistic Study Designs determined.
The odds ratio Results
(OR) isabout associations
a measure at the popula
of association used
20466 Medicine Biostatistic Case Control Studies always 1 (i.e. OR = 1).
Analysis of variance (ANOVA) is used to compare the
20464 Medicine Biostatistic Anova used
A cohortto determine
study begins which
by group means
identifying differ. A as
individuals confid
ex
20435 Medicine Biostatistic Study Designs
Measures Of cohort design, the study begins before
Attributable risk percentage (ARP) describes the perc the outcome h
20430 Medicine Biostatistic Association between
Relative riskthe reduction
exposed and (RRR) unexposed
measures groups
how much divided a
20426 Medicine Biostatistic Risk
Measures Of relative risk (RR) as follows: RRR =
Relative risk (RR) is a measure of association betwee ARR / Rate[contr
Number Needed To statistically
The interpretationsignificant.
of theAdjusted
numberRRs needed minimize
to treat confou
(NN
20401 Medicine Biostatistic Treat
Number Needed To outcome.
The number needed to harm (NNH) is the number tre
NNT values for the same intervention or of
20398 Medicine Biostatistic Harm the NNH, the absolute risk increase
Confounding bias occurs when an extraneous (i.e. co (ARI) between th
20371 Medicine Biostatistic Study Designs And
Life Expectancy (i.e.
The outcome,
Kaplan-Meier disease of interest).
survival curve is Ita maycommonlylead toused false
20331 Medicine Biostatistic Survival Statistics of > 2
The study groups
external validitycan be compared; they
(or generalizability) of aare statis
study is
20328 Medicine Biostatistic Validity And Reliability very
A specific population
randomized controlledoftrial patients
is used are to generalizable
estimate and
20318 Medicine Biostatistic Study Designs common
The measure
correlation of association
coefficient is relative
(r) describes the risk.
direction
20317 Medicine Biostatistic Statistical Tests causality.
A chi-square test evaluates the relationship between
20289 Medicine Biostatistic Statistical Tests participants into 2 groups and a categorical depende
20283 Medicine Biostatistic Study Designs The case-control study
A cross-sectional study is is the most appropriate
an observational study analycom
20279 Medicine Biostatistic Study Designs and
A case-control study is used to compare the exposurd
disease. However, exposure to risk factors and
Measures Of of association
greater risk foristhe theoutcome
odds ratio. in the treatment group. A
20214 Medicine Biostatistic Association null value (i.e. RR = 1.0) is statistically
Negative predictive value (NPV) is the probability significant. tha
20188 Medicine Biostatistic Predictive
Measures Values
Of negative).
there is no association between exposure and diseas
20103 Medicine Biostatistic Association OR = 1.0) indicate
Confounding that thewhen
bias occurs association
an extraneousis not statistic
(i.e. co
20094 Medicine Biostatistic Bias (i.e. outcome, disease of interest).
The independent samples t-test compares the mean It may lead to false
20062 Medicine Biostatistic Statistical Tests groups.
The analysis of variance test compares the mean of >
20059 Medicine Biostatistic Statistical Tests exposure,
Phase III trialsrisk factor).
evaluate the efficacy, risks, and benef
20058 Medicine Biostatistic Clinical Trials
Risk, Rate, Prevalence the disease of interest).
Absolute risk reduction (ARR) Most phasedescribes III trials
the are rand
differenc
20057 Medicine Biostatistic And Incidence (Rate[control] - Rate [treatment]). The rate of an unfa
Number Needed To The number needed to treat (NNT) is the number of p
Risk, Rate, Prevalence The lowerrisk
Relative thereduction
NNT, the(RRR) more effective
measuresthe treatment
how much a
20035 Medicine Biostatistic And Incidence relative risk (RR): RRR = ARR / Risk[control] = (Risk[
20033 Medicine Biostatistic Power And Sample Size Studies
A regressionwith larger
analysissample sizes have
is a statistical greater power
technique used t
20021 Medicine Biostatistic Statistical Tests quantitative dependent variable (i.e. outcome).
12685 Medicine Biostatistic Bias Reporting
Cross-sectional bias may occur
studies areif examples
subjects over- or under-r
of observationa
Synthesis Of Concepts generate hypotheses.
12674 Medicine Biostatistic With
Number RealNeeded
Data) To Stratification
The number needed can helptoclarify
treat isthetheassociation
reciprocalbetween
of the a
12673 Medicine Biostatistic Treat to patients.
Continuity of care for medications at the time of trans
9634 Medicine Biostatistic Adverse Event
Sensitivity And Interventions that target pharmacy
proportion of false-positive personnel results
and true-negative and hig
7712 Medicine Biostatistic Specificity
Colorectal Polyps And positive
A shift inandthe negative predictive characteristic
receiver operating values. curve u
7711 Medicine Biostatistic Cancer
Number Needed To specificity.
The number needed to treat (NNT) is defined as the
Synthesis Of Concepts absolute risk reduction (ARR).
7708 Medicine Biostatistic With Real Data) When comparing
result. the effects
To avoid selection biasofina studies,
treatment on a com
patients are
7691 Medicine Biostatistic Bias analysis, which compares the initial randomized
Hazard ratios are the ratio of an event rate occurring treat
Randomized Clinical ratios > 1 indicate that the treatment group had a hig
7689 Medicine Biostatistic Trial
Randomized Clinical Factorial
Hazard ratiosdesign arestudies
the ratioinvolve
of an randomization to diffe
event rate occurring
7688 Medicine Biostatistic Trial
Kalaxin Drug ratios higherrandomization
Successful than one indicate the treatment
in a clinical arm ahad
trial allows st
7687 Medicine Biostatistic Advertisement
Kalaxin Drug treatment and control group sizes, and
Hazard ratios are proportions that indicate the chanc achieves a low
7686 Medicine Biostatistic Advertisement
Risk, Rate, Prevalence drug advertisement,
A cohort study designit is is best
important to criticallythe
for determining read al
incid
4686 Medicine Biostatistic And Incidence
Synthesis Of Concepts calculation of relative risk.
4315 Medicine Biostatistic With RealOperating
Receiver Data) Scatter plots operating
The receiver are useful characteristic
for crude analysis curveofofdata.
a quanTh
4262 Medicine Biostatistic Characteristic
Pre- And Post-Test cutoff point to increase the true-positive rate (directly
4189 Medicine Biostatistic Probabilities
Value PPV, Negative If
NPVa test result
is the is negative,
probability the probability
of being of having
free of a disease th
if the
4184 Medicine Biostatistic Predictive Value
Modification, NPV having
Bias, Matching a disease will have
is frequently usedain low NPV, and astudies
case-control patientbw
4182 Medicine Biostatistic Errors the
Lossstudy (e.g., age,
to follow-up race). Cases
in prospective and controls
studies createsarea potth
4178 Medicine Biostatistic Bias
Prevalence And overestimate or underestimate the association betwe
4172 Medicine Biostatistic Incidence An increasing
ARP represents prevalence
the excess butrisk
stable
in theincidence
exposedofpopu a di
4157 Medicine Biostatistic Risk
Randomized Control 1) / RR.
4121 Medicine Biostatistic Trials In clinical trials, randomization is said to be successfu
4109 Medicine Biostatistic Risk In a case-control study, if the outcome is uncommon
4107 Medicine Biostatistic Accuracy AndBias,
Modification, Precision Precision is the measure of random error. The tighter
4100 Medicine Biostatistic Errors A confounder
Risk is an extraneous
is the probability of gettingfactor that has
a disease overproper
a cert
4095 Medicine Biostatistic Risk people at risk).
4079 Medicine Biostatistic Statistical
P-Value And Tests The chi-square
increases test isofused
the power a study to compare proportions.
and consequently narA
4019 Medicine Biostatistic Confidence Interval
(Mean, Median, Mode, with p-values.
An outlier is defined as an extreme and unusual valu
4002 Medicine Biostatistic Outliers)
Modification, Bias, resistant to outliers.
4001 Medicine Biostatistic Errors Randomization is used to control for confounders dur
3998 Medicine Biostatistic Statistical Tests The two-sample t test is a statistical method that is co
3992 Medicine Biostatistic Normal Distribution A normal distribution is symmetric and bell-shaped. A
3989 Medicine Biostatistic Correlation Coefficient
(Mean, Median, Mode, The correlation coefficient (r) shows the strength and
3982 Medicine Biostatistic Outliers) The median is the value that is located in the middle
3961 Medicine Biostatistic Hypothesis Testing The null hypothesis
Generalizability is the statement
or external of no relationshi
validity pertains to the app
3960 Medicine Biostatistic Validity And Reliability
Modification, Bias, applicable to elderly men).
Effect modification results when an external variable
3947 Medicine Biostatistic Errors variable
The concept is a confounder
of a latencyor an effect
period can be modifier.
applied to bo
P-Value And sometimes occur years before clinical
The p-value is the probability of observing a given (or manifestations
3934 Medicine Biostatistic Confidence Interval significant
A case-control whenstudyp < 0.05.
is used to compare the exposur
3931 Medicine Biostatistic Odds Ratio the exposure odds ratio.
In a cross-sectional study, risk factor and outcome ar
3922 Medicine Biostatistic Study Designs exposure from the outcome.
3915 Medicine Biostatistic Bias Observer
Confidence bias occursand
intervals when the investigator's
p values are interrelateddecisio an
3909 Medicine Biostatistic Risk confidence interval that does not include
In a normal (bell-shaped) distribution: 68% of all valu the null valu
3904 Medicine Biostatistic Standard
Prevalence Deviation
And values
Know the aredifference
within 3 standard
betweendeviations
incidence from the mea
and prevalen
3897 Medicine Biostatistic Incidence
Value PPV, Negative of cases
Both theatpositive
a particular point value
predictive in time. (PPV) and negative
3886 Medicine Biostatistic Modification,
Predictive Value NPV
Bias, PPV increases
Know the concept andofNPV decreasesDistinguish
confounding. with an increasebetwee
3885 Medicine Biostatistic Errors relationship is
Understand themixed
concept withofthe effect ofbias
lead-time extraneous
in screenin fac
3880 Medicine Biostatistic Bias changing the prognosis of the disease.
3708 Medicine Biostatistic Risk Know how to interpret the strength of association and
3653 Medicine Biostatistic Bias Consider
The critical the natural history
distinction between of acase
disease when
control andevalu retro
3650 Medicine Biostatistic Study Designs first and then look for associated risk
Know the different kinds of bias, which can decrease factors; retrospe
Sensitivity And they are being studied.
Value PPV, Negative Know how to calculate the sensitivity and specificity o
Sensitivity Value
And NPV Know how to calculate the predictive values of a test.
Sensitivity And False
Changing negatives will increase
the cutoff point of awhen the cut-off
quantitative level o
diagnostic
Sensitivity And negatives)
Changing the andcutoff
decreasepoint specificity (more false
of a quantitative diagnosticposit
Value PPV, Negative and
Unlikedecrease
sensitivity sensitivity (more false
and specificity, negatives).
positive and negativ Scre
Value PPV,Value NPV
Negative an increase in the number of false positives and true
2135 Medicine Biostatistic Predictive Value NPV Raising the cut-off
Right ventricular point (e.g.infarction
myocardial increasing the inclusion
commonly pres
20480 Medicine CardiovascuMyocardial Infarction should be obtained to confirm the diagnosis.
19991 Medicine CardiovascuMyocardial Infarction Because
Dual elderly patients
antiplatelet therapy with with aspirin
acute myocardial
and a P2Y12 infarc
inh
19950 Medicine CardiovascuMyocardial Infarction early to all patients
ST-segment elevationin the absenceinfarction
myocardial of contraindication
(STEMI)
19934 Medicine CardiovascuMyocardial Infarction leads. Patients with STEMI should
hyperkalemia-induced ECG changes should be urgen undergo emergen
19929 Medicine CardiovascuHyperkalemia
Carbon Monoxide acting
Carbontherapies
monoxide topoisoning
remove potassium from the
disrupts oxygen body
delivery
19888 Medicine CardiovascuPoisoning diagnosis.
Peri-infarction Severe cases require
pericarditis hyperbaric
(PIP) results from oxygen
localized t
19724 Medicine CardiovascuAcute Pericarditis
Secondary prevented
medications, by but
early coronaryofreperfusion
treatment the underlying therapyOSAto(e. m
17858 Medicine CardiovascuHypertension pulmonary
Stress-induced hypertension,
(Takotsubo) right-sided heart failure,
cardiomyopathy mostcor co
17651 Medicine CardiovascuStress Cardiomyopathy emotional stress. It is characterized
suspected PIP should undergo echocardiography to by left ventricular
17567 Medicine CardiovascuAcute Pericarditis wall rupture). statin therapy can reduce the risk of m
High-intensity
17515 Medicine CardiovascuStatins high-intensity
and suggestive statin,
clinical switching
featuresto(e.g.a different
dyspnea,high-inten
tachyc
16102 Medicine CardiovascuPulmonary Embolism pulmonary angiography.
Epileptic seizure can present similarly to a number of
16031 Medicine CardiovascuSeizures
Secondary specific
Onset offor epileptic seizure
hypertension and can
at a young agebe(i.e.
helpful
age < in30)
con
15974 Medicine CardiovascuHypertension epistaxis
Conventional and β tremor.
blockers A urine
(e.g. drug screen atenolol,
metoprolol, should beprc
15973 Medicine Cardiovascuβ Blockers reduced insulin sensitivity.
hemoglobin/hematocrit, andTherefore,
urinalysis.these drugs are
In addition, pa
15971 Medicine CardiovascuPrimary Hypertension A1c.
due to dilation of the mitral valve annulus and lateral
15761 Medicine CardiovascuMitral Regurgitation LVEDV, resulting in disappearance of the associated
15759 Medicine CardiovascuMitral Regurgitation Patients
arrhythmia with severe
(i.e. mitral tachycardia,
ventricular regurgitationventricular
develop leftfibv
15758 Medicine CardiovascuVentricular Tachycardia indicated in these
surge in jugular patients.
venous pressure that occurs due to r
15757 Medicine CardiovascuVentricular Tachycardia dissociation (e.g. ventricular
Aortic stenosis (AS) is a common tachycardia,
cause ofcomplete
angina, sy a
15750 Medicine CardiovascuAortic Stenosis In
anpatients
increasewith mild tovolume
in stroke moderate AS, anginal
to maintain sympto
cardiac outp
15740 Medicine CardiovascuAortic Regurgitation decompensated heart failure.
Carotid sinus hypersensitivity involves an exaggerate
14019 Medicine CardiovascuSyncope > 50 mm Hg
Estimated drop in systolic
atherosclerotic blood pressure,
cardiovascular leading
disease (AS
12535 Medicine CardiovascuDyslipidemia recommended for primary prevention
Masked hypertension describes normal blood pressu in patients with
12534 Medicine CardiovascuPrimary Hypertension monitoring
alcohol intake.in patients
In patientswithwithclinical
mildevidence of hypert
hypertriglyceridem
12522 Medicine CardiovascuDyslipidemia pharmacologic
Dobutamine is atherapy. Fibrates and
potent inotropic agent niacin
with reduce
a strongtr
12520 Medicine CardiovascuAcute Heart Failure to improvedsyncope
Vasovagal ejectionisfraction,
typicallyreduced
preceded leftby
ventricular
a prodro
12501 Medicine CardiovascuSyncope parasympathetic
Patients with acute activity.
viral (orCardiac monitoring
idiopathic) immedia
pericarditis sh
12374 Medicine CardiovascuAcute Pericarditis lowers the rate
Pericarditis is the of most
recurrentcommon pericarditis.
cardiacCorticosteroi
manifestatio
Ventricular Septal changes accompanied by other manifestations
Rupture of the interventricular septum typically occur of act
12340 Medicine CardiovascuDefect
Peripartum failure, and cardiomyopathy
Peripartum a new harsh holosystolic is an uncommon murmur with cause pao
12118 Medicine CardiovascuCardiomyopathy
Pulmonary Arterial following delivery.
Left ventricular systolic or diastolic dysfunction is a co
11252 Medicine CardiovascuHypertension
Gastroesophageal blockers).
Gastroesophageal reflux disease (GERD) and esoph
11126 Medicine CardiovascuReflux Disease include prolonged
Constrictive episodes
pericarditis is anlasting
important morecausethan an hou
of right
10764 Medicine CardiovascuConstrictive Pericarditis (mid-diastolic
Cyanide toxicity sound),
can occurand pericardial
in patients calcifications
treated with nit on
10763 Medicine CardiovascuCyanide Poisoning
Calcium Channel status, lactic
Peripheral acidosis,
edema is a seizures,
common side and coma.
effect of dihydro
10179 Medicine CardiovascuBlocker
Coronary Artery inhibitor or angiotensin receptor
Single photon emission CT scan is a useful blocker) cantool
reduce
to ev
9648 Medicine CardiovascuDisease
Peripheral Vascular Antiplatelet therapy is the preferred
A supervised exercise program should be recommen treatment to prev
Peripheral Vascular percutaneous
20% 5-year risk orofsurgical
nonfatal revascularization
myocardial infarction shouldand be
8927 Medicine CardiovascuDisease limb ischemia of
Development with risk of limb amputation.
atrioventricular block in a patient with
8879 Medicine CardiovascuEndocarditis valve endocarditis is associated
Coarctation of the aorta is a potential with increased
cause of secon risk o
8819 Medicine CardiovascuAortic Coarctation pulsesfibrillation
Atrial to assessisfor mostbrachial-femoral
commonly caused delay,byand bilat
ectopic
8472 Medicine CardiovascuAtrial Fibrillation nodalinitial
The re-entry
therapy tachycardia
of patients results
with from
pulmonarya re-entrant
edemac
6945 Medicine CardiovascuAcute HeartVascular
Peripheral Failure possibly assisted
Peripheral ventilation.
artery disease is a manifestation of ASCV
4928 Medicine CardiovascuDisease attack.
Use dependence refers to enhanced pharmacologic
4922 Medicine CardiovascuAtrial Fibrillation
Supraventricular antiarrhythmic
conduction delay, agents.
or can Class
cause IC aagents
transient cause
blocka prog
in A
4920 Medicine CardiovascuTachycardia tachycardia. It can also terminate paroxysmal
Mitral regurgitation classically results in a holosystolic suprav
4911 Medicine CardiovascuMitral Regurgitation atrial
Aorticfibrillation,
regurgitation andproduces
signs of heart an earlyfailure.
diastolic murm
4910 Medicine CardiovascuAortic Regurgitation peripheral pulses.
The fourth heart sound (S4) is a low frequency sound
4909 Medicine CardiovascuChronic Heart Failure hypertension.
The third heart sound (S3) is a low frequency diastoli
4908 Medicine CardiovascuAcute Heart Failure
Wolff-Parkinson-White patients with decompensated
Wolff-Parkinson-White (WPW)heart pattern failure.
refers to the c
4894 Medicine CardiovascuSyndrome the QRS complex with ST/T wave
Pulsus paradoxus is defined as an exaggerated changes. WPW fallisin
4771 Medicine CardiovascuPulsus Paradoxus conditions
Aspirin andwithout
β blockers pericardial
are common effusion such as severe
medications that
4742 Medicine CardiovascuAsthma
Coronary Artery mild-to-moderate
The primary anti-ischemic and antianginal effects ofbn
asthma, but all β blockers should
4741 Medicine CardiovascuDisease end-diastolic
elevated left atrialvolume, andreducing
ventricular wall stress
filling and myoca
pressures an
4740 Medicine CardiovascuMitral Regurgitation compliance.
Progressively decreasing baroreceptor sensitivity and
4728 Medicine CardiovascuAging elderly.
Pulseless electrical activity (PEA) or asystole should
4725 Medicine CardiovascuCardiac
Secondary Arrest coronary perfusion. Potentially
Hyperparathyroidism is a causereversible
of secondary causes of P
hyperte
4722 Medicine CardiovascuHypertension neuropsychiatric
Ascending aortic symptoms. dissection can Other cardiovascular
propagate proximallyma
4720 Medicine CardiovascuAortic Dissection another
effectivepotential
resuscitation complication
with adequate of ascending
bystander aortic dis
cardi
4719 Medicine CardiovascuVentricular Fibrillation
Supraventricular fibrillation).
4709 Medicine CardiovascuTachycardia Patients
Patients withwith persistent
heart failure tachyarrhythmia
with preserved(narrow- ejection orfracw
4707 Medicine CardiovascuChronic Heart Failure (LV) ejection fraction
Renovascular and objective
hypertension is the most evidence
common of diasto
and
4682 Medicine CardiovascuRenal Artery Stenosis hypertension. The presence of a
The renin-angiotensin-aldosterone system is integrallsystolic-diastolic ab
4681 Medicine CardiovascuACE Inhibitors
Polycystic Kidney blockers,
Most patients angiotensin-converting
with autosomal dominant enzyme inhibitors,kid
polycystic a
4680 Medicine CardiovascuDisease are typically palpable
An abnormal fourth heart on physical examination,
sound (atrial gallop) can andofth
4679 Medicine CardiovascuMyocardial Infarction ischemia.
Atrial fibrillation (AF) presents with electrocardiogram
4676 Medicine CardiovascuAtrial Fibrillation
Hypertrophic should
Syncope have
in aTSHyoung and free T4
patient withlevels measured to scr
a crescendo-decresc
4673 Medicine CardiovascuCardiomyopathy HOCM
In Mobitz is often
type I multifactorial
atrioventricular andblock,
can be dueistoprogre
there outflo
4660 Medicine CardiovascuHeart Block best appreciatedpresents
Costochondritis by measuring PR intervals
with tenderness of just befo
> 1 costo
4650 Medicine CardiovascuCostochondritis localized chest pain that is reproducible
Anticoagulation agents, such as non-vitamin K antag with palpatio
4649 Medicine CardiovascuAcute Limb Ischemia with atrialwho
patients fibrillation and a high
are overweight risk of thromboembol
or obese should be advi
4646 Medicine CardiovascuPrimary Hypertension effective non-pharmacologic
systems stimulate vasoconstriction and sodium intervention for lowering
reten
4594 Medicine CardiovascuAcute Heart Failure maladaptive as they further decrease
jugular venous pressure; Right ventricular 3rd heart s cardiac output
4593 Medicine CardiovascuCor Pulmonale
Chronic Venous Echocardiogram will show signs
Chronic venous insufficiency is aofcommon
increased rightofhe
cause lo
4592 Medicine CardiovascuInsufficiency includes conservative measures with
The primary risk factors for abdominal aortic aneurys leg elevation, e
4532 Medicine CardiovascuAortic Aneurysm condition with a one-time
elevated jugular abdominal
venous pressure, ultrasound in an
hepatomegaly, me
4524 Medicine CardiovascuConstrictive Pericarditis pressure
Elevated brainon inspiration),
natriureticand a pericardial
peptide levels and knock (mid
an audib
4518 Medicine CardiovascuAcute Heart Failure ventricular systolic dysfunction.
Aortic root disease is the predominant cause of morb
4484 Medicine CardiovascuAortic Dissection chronic aortic regurgitation
Warfarin is a vitamin K antagonist or type that A aortic dissection
prolongs INR.
4473 Medicine CardiovascuAnticoagulants intake
(AF) and moderate to high risk of thromboembolicuse
of green leafy vegetables. Acetaminophen ev
4469 Medicine CardiovascuAtrial Fibrillation is not indicated.
(e.g. anorexia, nausea, vomiting, abdominal pain). Ch
4463 Medicine CardiovascuDigoxin (e.g. changes
High-output in color
heart vision,
failure usuallyscotomas,
results fromblindness).
increase
4459 Medicine CardiovascuChronic Heart Failure circulation
ECG is useful(evidenced by widened
in identifying cardiogenicpulsesyncope
pressureand and
4456 Medicine CardiovascuSyncope includestenosis
Aortic sinus bradycardia,
can presentsinus pauses, atrioventricu
with decreased exercise
4455 Medicine CardiovascuAortic Stenosis soft second heart sound, and mid-
Digoxin has a narrow therapeutic window and toxicity to late-peaking sy
4454 Medicine CardiovascuChronic Heart Failure toxicity
T3. It alsoinclude gastrointestinal
can increase synthesis disturbances (e.g. ano
of thyroid hormone
4453 Medicine CardiovascuHypothyroidism hormone.
Anticoagulation (e.g. warfarin, direct oral anticoagula
4452 Medicine CardiovascuAtrial Fibrillation CHA2DS2-VASc
pulmonary edemascore who haveis recommended
normal or elevated for assessmbloo
4451 Medicine CardiovascuAcute Heart Failure
Supraventricular therapy (e.g. nitroglycerin, nitroprusside).
of a dual electrical pathway (slow and fast pathway) i
4450 Medicine CardiovascuTachycardia an increase in
Intravenous drugtheusers
AV node are at refractory
increased period,
risk forleading
bacte
4398 Medicine CardiovascuEndocarditis endocarditis and can be distinguished
The most common signs and symptoms of pulmonar from other mu
4396 Medicine CardiovascuPulmonary
Coronary ArteryEmbolism sensitivity
intermediate andprobability
specificityoffor pulmonary
CAD embolism,
should receive approan
4395 Medicine CardiovascuDisease therapy,
Electricalwith expertwith
alternans evaluation to consider iscoronary
sinus tachycardia a highlya
4390 Medicine CardiovascuPericardial Effusion beat variation in QRS axis and amplitude. Patients w
4377 Medicine CardiovascuSyncope
Gastroesophageal Orthostatic
laryngopharyngeal hypotensionirritationis characterized by a drop in
(e.g. cough, hoarseness)
4346 Medicine CardiovascuReflux Disease inhibitor
Patients (e.g. omeprazole).
with cardiac tamponade usually have clinica
4345 Medicine CardiovascuCardiac Tamponade shift of the interventricular septum toward the left ven
Patients presenting to the emergency department wit
4334 Medicine CardiovascuMyocardial Infarction therapy
Hypovolemic with aspirin
shock is reduces the rate by
characterized of low
myocardial
cardiac in o
4326 Medicine CardiovascuHypovolemia pressure are low due to decreased
Dual antiplatelet therapy (aspirin and a P2Y12 recept intravascular bloo
4298 Medicine CardiovascuMyocardial Infarction with non-STfor
Counseling elevation MI. It also reduces
nonpharmacologic therapythe risk ofm
(lifestyle s
4291 Medicine CardiovascuPrimary Hypertension restrict
Patientsdietary salt intake;
with severe aortichave a diet
stenosis canrich in fruit,
have veg
angina
4277 Medicine CardiovascuAortic Stenosis soft and single
Elevated plasma S2, andnatriuretic
brain a late-peaking,peptide crescendo-de
levels have
4270 Medicine CardiovascuAcute Heart Failure crackles, elevated jugular venous
Congestive heart failure due to left ventricular pressure, lower ext
systolic
4243 Medicine CardiovascuChronic Heart Failure left ventricular end-diastolic
Tachycardia-mediated volume (LVEDV).
cardiomyopathy can develop i
4238 Medicine CardiovascuAtrial Fibrillation at
Septic shock leads to a decrease in systemiccontrol
restoration of sinus rhythm or aggressive vascula o
4237 Medicine CardiovascuSepsis normal
Myocardial or decreased
infarction can pulmonary
lead to capillary
cardiogenic wedge shock pres (e
4235 Medicine CardiovascuCardiogenic Shock capillary wedge pressure (estimate
Anaphylaxis is an IgE-mediated hypersensitivity reac of left atrial press
4234 Medicine CardiovascuAnaphylaxis tachycardia,
Statins inhibiturticarial
intracellularrash,HMG-CoA
and wheezing, reductaseand theyenzym
4227 Medicine CardiovascuDrug Induced Myopathy decrease coenzyme
Hyponatremia Q10 with
in patients synthesis, whichheart
congestive is involved
failure
4190 Medicine CardiovascuAcute Heart Failure of renin,
heart norepinephrine
failure have elevated andjugular
antidiuretic
venous hormone.
pressureTra
4133 Medicine CardiovascuChronic Heart Failure jugular venous pressure and negative
Most thoracic aortic aneurysms are due to age-relate hepatojugular
4129 Medicine CardiovascuAortic Aneurysm
Coronary Artery Chest
β blockersx-rayareoften demonstrates
first-line therapy for a widened
alleviating mediastin
sympto
4127 Medicine CardiovascuDisease and myocardial contractility, leading
Several systemic and cardiac manifestations of hype to a reduction in
4126 Medicine CardiovascuHyperthyroidism hyperthyroidism
and aVF). ST-segment and should be continued
depression in leadsuntil V1 the
andpa V
4108 Medicine CardiovascuMyocardial Infarction block.
Diastolic and continuous murmurs are usually due to
4101 Medicine CardiovascuAortic Regurgitation Midsystolic murmurs inarrhythmias
Re-entrant ventricular otherwise young, asymptoma
(e.g. ventricular fib
4093 Medicine CardiovascuMyocardial Infarction myocardial infarction.
Viral myocarditis is a potential cause of dilated cardio
4061 Medicine CardiovascuDilated
Coronary Cardiomyopathy
Artery by a viral prodrome.
Pharmacologic Echocardiography
vasodilator stress testingtypically
(e.g. adeno show
4054 Medicine CardiovascuDisease coronary
oxygen demand,arteries.and Thealleviate
difference in blood flowsympto
cardiovascular allows
4042 Medicine CardiovascuCocaine pain. β blockers idiopathic
Age-dependent are contraindicated.
sclerocalcific changes are
4003 Medicine CardiovascuAortic Stenosis hemodynamic significance,
Isolated systolic hypertension, butan sometimes
importantmay cause be ofse
3994 Medicine CardiovascuPrimary Hypertension increase in cardiovascular
electrocardiogram changesmorbidity
of pericarditisand mortality,
(e.g. diffus an
3979 Medicine CardiovascuChronic Kidney Disease effusion.
High-dose niacin therapy to treat lipid abnormalities f
3973 Medicine CardiovascuDyslipidemia and can treatment
General be reducedmeasures by low-dose aspirin.with vasovag
in patients
3962 Medicine CardiovascuSyncope and to use physical
Transesophageal counterpressure
echocardiogram hasmaneuvers
excellent sens duri
3956 Medicine CardiovascuAortic Dissection instability or renal insufficiency. CT
Cholesterol embolization should be suspected in pati angiography and
3950 Medicine CardiovascuAtheroembolism
Coronary Artery syndrome), cerebral or intestinal
Sublingual nitroglycerin is used as ischemia,
a first-line and Holle
agent fo
Secondary with a decrease in left ventricular end-diastolic
elevation in serum creatinine > 30% from baseline af volum
3933 Medicine CardiovascuHypertension bruit has a high
Coarctation of thespecificity
aorta is for the presence
a narrowing of the ofdescen
renova
3924 Medicine CardiovascuAortic Coarctation femoral
Situational pulses
syncopewith brachial-femoral
is a form of vasovagal delay.(neurally
Chest x-rm
3921 Medicine CardiovascuSyncope
Calcium Channel autonomic
Dihydropyridine responsecalcium andchannel
can precipitate
blockersa can predomina
cause
3920 Medicine CardiovascuBlocker heart failure, renal disease, and venous
Patients with an arrhythmic cause of syncope usually insufficiency
3881 Medicine CardiovascuSyncope those
includewith vasovagal
oxygen, full-doseor neurocardiogenic
aspirin, platelet P2Y12 syncope recefr
3826 Medicine CardiovascuMyocardial Infarction STEMI patientsiswho
Statin therapy cannotforundergo
indicated primaryPCI but is assoc
prevention of a
3823 Medicine CardiovascuDyslipidemia Cohort Equations cardiovascular risk
(ASCVD). In general, moderate-intensity statin therap calculator.
3822 Medicine CardiovascuDyslipidemia cardiovascular
Pulmonary toxicity disease.
is a serious adverse effect of long
3769 Medicine CardiovascuInterstitial Lung Disease amiodarone presents
should be managed with withtemporary
progressive dyspnea,inser
pacemaker nonp
3768 Medicine CardiovascuHeart Block reversible causes of heart block are found.
Degeneration of the sinus node and replacement with
3767 Medicine CardiovascuSick Sinus Syndrome leading to fatigue,
Mobitz type dyspnea on
I atrioventricular exertion,
block lightheadedn
has progressive p
3766 Medicine CardiovascuHeart Block arrhythmia.
Most cases of first-degree atrioventricular (AV) blockin
Treatment usually involves observation
3765 Medicine CardiovascuHeart Block block and prolonged
cardioversion QRS for
is indicated duration
patients likelywithhave a cond
persistent
3763 Medicine CardiovascuVentricular Tachycardia or hemodynamically
Immediate synchronized unstable (hypotension,
cardioversion is thesigns
initialoftre
3699 Medicine CardiovascuAtrial Fibrillation instability
Patients with (hypotension,
ventricular cardiogenic
fibrillation orshock, pulselesssigns of is
ventri
3698 Medicine CardiovascuVentricular Fibrillation narrow
In atrial or wide QRS
fibrillation complex
(AF) with rapid tachyarrhythmia
ventricular respons (e.g. a
3697 Medicine CardiovascuAtrial Fibrillation cardioversion
overload. Common is indicated
etiologies in hemodynamically
in the United States unstab
inc
3635 Medicine CardiovascuConstrictive Pericarditis countries and endemic areas such as
All patients with carotid artery stenosis should receive Africa, India, a
3529 Medicine CardiovascuCarotid Artery Stenosis patients
Acute limb with high-grade
ischemia after(80%-99%)
myocardialstenosis.infarctionHowev sugge
3526 Medicine CardiovascuAcute Limb Ischemia aneurysm and/or residual LV thrombus.
Post-cardiac injury syndrome (Dressler syndrome) pr
3521 Medicine CardiovascuMyocardial Infarction are the treatment
Pulmonary toxicityofischoice
a serious andadverse
are usually administe
effect of long
3506 Medicine CardiovascuAtrial
ChronicFibrillation
Venous and pulmonary
Stasis dermatitisfunction testing should
is characterized obtained
by scaling, prior
weeping
3455 Medicine CardiovascuInsufficiency ulcers. The
Cocaine acts diagnosis is primarily based
as a sympathomimetic agent on that
clinical fin
leads
3188 Medicine CardiovascuCocaine formation; and increases the risk of
Digitalis toxicity causes increased ectopy and increas myocardial ische
3096 Medicine CardiovascuChronic Heart Failure digitalis toxicity. All patients should be encouraged to
obese patients.
3094 Medicine CardiovascuPrimary Hypertension exercise
Congenital to bicuspid
maintain aorticnormal bodyisweight,
valve the most and limit alc
common
3093 Medicine CardiovascuAortic Regurgitation valvular
wide pulse butpressure,
can also be duehammer'
'water to aortic pulse,
root dilation.
and LV e
3092 Medicine CardiovascuAortic Regurgitation sensation and increased awareness
Patients with aortic outflow obstruction from supraval of the heartbeat
3090 Medicine CardiovascuAortic Stenosis
Wolff-Parkinson-White increased myocardial
Atrioventricular oxygen demand
nodal blockers such asduring exercis
β blockers, ca
3069 Medicine CardiovascuSyndrome pathway.
Chagas disease is a chronic disease that can cause
3065 Medicine CardiovascuChagas Disease responsible.
Intravenous β blockers (e.g. labetalol, esmolol) are th
3056 Medicine CardiovascuAortic Dissection pressure and reduce left ventricular contractility.
3046 Medicine CardiovascuSarcoidosis Cardiac sarcoidosisand
Prompt recognition is a restoration
disease of of noncaseating
coronary blood gra
2745 Medicine CardiovascuMyocardial Infarction ST-elevation myocardial infarction.
2744 Medicine CardiovascuAtrial Premature Beats Tobacco
Diuretics and alcohol are reversible
are recommended for acute risk factors forede
pulmonary pr
2743 Medicine CardiovascuMyocardial Infarction
Coronary Artery decompensated congestive heart failure or bradycard
2742 Medicine CardiovascuDisease Exercise
Viral stress ECG
myocarditis is recommended
is a common cause ofas an initial
dilated te
cardio
2741 Medicine CardiovascuDilated Cardiomyopathy dyspnea,
The orthopnea,
medications shown peripheral
to improve edema).
long-term surviva
2740 Medicine CardiovascuChronic Heart Failure mineralocorticoid receptor antagonists.
Electrical alternans is when the amplitudes of the QR
2739 Medicine CardiovascuCardiac Tamponade seen
Acuteon chest x-ray
coronary syndromeas well. dueEchocardiogram
to unstable angina can moor
2738 Medicine CardiovascuMyocardial Infarction statins. Fibrinolytic therapy is not
Not taking dual antiplatelet therapy (DAPT) is the moused in patients wit
2737 Medicine CardiovascuMyocardial Infarction importance of taking DAPT,
Systemic hypertension is theboth mostatimportant
the time of riskstent
fact
2735 Medicine CardiovascuAortic Dissection dissection, but it is rare in older patients
Following myocardial infarction (MI), deleterious card with dissecti
2732 Medicine CardiovascuMyocardial Infarction (e.g. metoprolol),
Ventricular aneurysm and occurs
aldosterone antagonists
as a late complication (e.g. os
2731 Medicine CardiovascuMyocardial Infarction deep Q waves.
Patients Progressive pericarditis
with peri-infarction left ventricular enlargeme
typically have
2729 Medicine CardiovascuAcute Pericarditis Treatment is usually supportive.
hypotension, jugular vein distension, and clear lung fi
2726 Medicine CardiovascuMyocardial Infarction
Coronary Artery nitrates and diuretics
Vasospastic angina resultsshouldfrom be avoided.
hyperreactivity of int
Coronary Artery coronary artery vasodilation
Vasospastic angina is characterized and are by therecurrent
preferredche ph
Hypertrophic phenomenon
The primary mitral mainly affects
valve the digitalinarteries
abnormality patientsand withoc
2711 Medicine CardiovascuCardiomyopathy leaflets toward
restrictive the interventricular
cardiomyopathy that may septum. Contacttob
later progress
2707 Medicine CardiovascuAmyloidosis confirmed by tissue biopsy (e.g. abdominal fat pad).
Mitral stenosis leads to an increase in pulmonary pre
2701 Medicine CardiovascuMitral Stenosis also causes left
consequent left atrial
atrial stretching.
enlargement, predisposing
In the setting of MS, to a
2700 Medicine CardiovascuMitral Stenosis fibrillation.
Amyloid cardiomyopathy should be suspected in pati
2699 Medicine CardiovascuAmyloidosis hypertension.
The 3 most common causes of aortic stenosis in the
2698 Medicine CardiovascuAortic Stenosis cause
Cardiacofauscultation
aortic stenosis in the majority
in patients with mitralof patients
valve prolaag
2696 Medicine CardiovascuMitral Valve Prolapse increases
Patients with preload
severe and left ventricular
leaflet dysfunction volume, decrea
and prolapse
2695 Medicine CardiovascuMitral Valve Prolapse enlargement
Complete cessation leadingof toalcohol
atrial fibrillation,
consumption left ventricula
is the ma
2692 Medicine CardiovascuDilated Cardiomyopathy
Hypertrophic function over time.
cardiac sarcomere. Mutations in the cardiac myosin b
2687 Medicine CardiovascuCardiomyopathy
Hypertrophic with HCM.inotropic agents (e.g. β blockers, verapamil
Negative
2686 Medicine CardiovascuCardiomyopathy β
β blockers are preferred
blocker overdose presentsfor initial therapy, and hypote
with bradycardia, verap
2663 Medicine Cardiovascuβ Blocker Poisoning treatment
Torsades de options.
pointes Intravenous
(TdP) refers glucagon should be
to polymorphic ven a
2659 Medicine CardiovascuVentricular Tachycardia hemodynamically
livedo reticularis), unstable
cerebral or patients
intestinalwithischemia,
TdP, while acuin
2310 Medicine CardiovascuAtheroembolism of recurrent
Uremic cholesterol
pericarditis resultsembolism.
from inflammation of the v
Secondary present hypertension.
causes with pleuritic chest pain andofathe
Involvement pericardial
cerebrovasc frict
2172 Medicine CardiovascuHypertension or nonspecific symptoms (e.g. headache, pulsatile tin
2164 Medicine CardiovascuVentricular Tachycardia Loop diuretics cause hypokalemia
hemoglobin/hematocrit, and urinalysis. and hypomagnese
In addition, pa
2159 Medicine CardiovascuPrimary Hypertension A1c.
Patients with right ventricular myocardial infarction ca
2156 Medicine CardiovascuCardiogenic Shock intravenous
An echocardiogram saline bolus should to increase
be obtained rightinventricular
all patients
2153 Medicine CardiovascuAortic Stenosis without specific neurological symptoms.
2148 Medicine CardiovascuMyocardial Infarction Abdominal
Patients with pain and nausea/vomiting
symptomatic sinus bradycardia are atypicalshould preb
2141 Medicine CardiovascuBradycardia epinephrine
Oral isotretinoin or dopamine,
is indicated or for
transcutaneous
severe nodulocystic pacing.a
20422 Medicine DermatologyAcne Vulgaris test
Oral(if female)
lichen should
planus (LP)be obtained
presents prior
with to and
white duringa
papules
17676 Medicine DermatologyLichen Planus hepatitis
(follicularC. Treatment includes
miniaturization). topical
Hair loss canhigh-potency
be seen in wg
17187 Medicine DermatologyHair Loss minoxidil.
Many chemotherapeutic agents preferentially target r
17186 Medicine DermatologyHair Loss temporary,
Alopecia areata reversible cessation of
is characterized byhair growth
patchy, and ra
nonscarr
17185 Medicine DermatologyHair Loss intralesional corticosteroids.
Psoriasis is characterized byAerythematous,
recurring course scalyis com
pla
17063 Medicine DermatologyPsoriasis and trunk
Tinea (e.g. gluteal
versicolor cleft) as small
is a superficial fungalplaques. Whenc
skin infection
16963 Medicine DermatologyTinea Versicolor worse during theissummer
Onychomycosis a chronic months. The diagnosis
dermatophyte infection cano
16901 Medicine DermatologyOnychomycosis discoloration
contact, contactof the
withnails. The diagnosis
animals, or via fomites. is confirmed
The diag
16890 Medicine DermatologyTinea treatment is a topical antifungal (e.g.
mutations of proteins involved in intraepidermal and terbinafine, mico d
16853 Medicine DermatologyEpidermolysis Bullosa
Pseudofolliculitis microscopy and genetic testing. Treatment
hair. Complications include hyperpigmentation, secon is support
16849 Medicine DermatologyBarbae techniques.
Nummular eczema is an idiopathic inflammatory diso
16843 Medicine DermatologyNummular Eczema diagnosis
Dyshidroticiseczema
based primarily on clinical findings.
(acute palmoplantar eczema) Trea
is
16841 Medicine DermatologyDyshidrotic Eczema
Discoid Lupus based on clinical features, and treatment
Discoid lupus erythematosus presents with scaly, ery includes hig
16840 Medicine DermatologyErythematosus and neck. tinea cruris is common and suggests re-ex
Recurrent
16839 Medicine DermatologyTinea tinea
Tineacorporis,
cruris (i.e.onychomycosis).
jock itch) presents Patients shouldannula
as pruritic, have
16838 Medicine DermatologyTinea clinical
Patientsfindings
with tineaandcorporis
can be confirmed
are at risk with potassium
for developing
16837 Medicine DermatologyTinea due to diabetes
flaking. A potassiummellitus, systemic
hydroxide glucocorticoid
preparation of skinther sc
16835 Medicine DermatologyTinea
Nonmelanoma Skin tolnaftate).
Squamous cell carcinoma (SCC) in situ of the skin (B
16708 Medicine DermatologyCancer and
Whereasis usually not associated
idiopathic lichen planus with occurs
pain ormost itching.
comm Bec
16405 Medicine DermatologyLichen Planus glucocorticoids
Lichen planus presents and discontinuation
with pruritic,ofpurple/pink,
the suspected poly
16404 Medicine DermatologyLichen Planus genitalia. Lichen planus is often associated with hepa
Acne mechanica is an acneiform eruption caused by
15380 Medicine DermatologyAcne Vulgaris padding,
Erythemahelmets,
nodosumand is aheavy
delayed backpacks.
hypersensitivity reac
15365 Medicine DermatologyErythema Nodosum inflammatory bowel disease,
Tuberous sclerosis is an autosomal dominant sarcoidosis, and neuroc
malign
14193 Medicine DermatologyTuberous Sclerosis behavioral/cognitive
Telogen effluvium causes disorders)acute, findings.
diffuse, noninflamm
13530 Medicine DermatologyHair Loss trauma. Patients have widespread
Erythema multiforme is an acute inflammatory thinning of hair bu
disord
12348 Medicine DermatologyErythema Multiforme with certain
Factors that infections
can lead to (especially
worseningherpes simplex)
of psoriasis as
includ
12332 Medicine DermatologyPsoriasis indomethacin,
psoriasis includes propranolol). In addition, glucocorticoid
topical high-potency certain infect
12329 Medicine DermatologyPsoriasis require
Plantar phototherapy
warts are dueor to systemic treatment.
human papillomavirus (HPV
10485 Medicine DermatologyWarts papules on the sole of the foot that
Dermatofibromas are nontender, firm, hyperpigmente can be painful wh
10402 Medicine DermatologyDermatofibroma extremities. The lesions
direct (e.g. narcotics, have a fibrous
radiocontrast component
medium) mast ce th
10298 Medicine DermatologyUrticaria plaques
Acanthosis withnigricans
a centralispallor, along with
characterized byintense prurit
symmetrical
8821 Medicine DermatologyAcanthosis Nigricans polycystic
patients with ovarian syndrome)rosacea
papulopustular in younger (i.e.patients
papulesand an
7019 Medicine DermatologyRosacea acid, and ivermectin.
Drug-induced acne is a common side effect of system
4812 Medicine DermatologySteroid Acne acne does not respond
Toxicodendron to typical
plants (poison acne treatment
ivy/oak/sumac) arebut
a fr
4732 Medicine DermatologyContact Dermatitis skin has brushed against the plant leaves.
Herpes zoster is a painful reactivation of the varicella
4693 Medicine DermatologyHerpes
Molluscum Zoster duration
Molluscum of disease
contagiosum and the incidence of post-herpeti
is characterized by firm, fles
4685 Medicine DermatologyContagiosum severe, widespread disease.
Actinic keratosis is characterized by scaly papules or
4410 Medicine DermatologyActinic Keratoses keratosis can progress to squamous cell carcinoma,
4403 Medicine DermatologyCherry Angioma Cherry hemangiomas
Senile purpura usuallyare small, with
presents red, ecchymoses
cutaneous papu in e
4355 Medicine DermatologySenile Purpura
Porphyria Cutanea related loss of elastic fibers in perivascular
The porphyrias are disorders of heme synthesis. Por connectiv
4314 Medicine DermatologyTarda ingestion
Vitiligo is anof ethanol
autoimmune or estrogens
condition and is frequentlyby
characterized as
4296 Medicine DermatologyVitiligo pernicious
Drug-induced anemia,
type 1autoimmune
hypersensitivity thyroid disease,
reactions aretype
im
4267 Medicine DermatologyDrug Allergy without systemic symptoms) are usually
Inflammatory acne is treated with topical retinoids an treated with
4091 Medicine DermatologyAcne Vulgaris isotretinoin are usually
Topical retinoids reserved
are first-line for severe
treatment or recalcit
for noninflam
4076 Medicine DermatologyAcne Vulgaris Benzoyl
Herpetic peroxide,
whitlow isan antibacterial
a viral infection agent,
of the handmay be use
cause
4011 Medicine DermatologyHSV Infection secretions.
Condylomata Spontaneous resolution iswarts)
acuminata (anogenital the norm but re
are verru
3831 Medicine DermatologyWarts common
Nickel sexually
allergy is a transmitted disease in the
type IV hypersensitivity Unitedtha
reaction S
3811 Medicine DermatologyContact
Skin AndDermatitis
Soft Tissue lichenification.
Cellulitis is a skinMost patients
infection of respond
the deeptodermis low- orand mid-p
su
3080 Medicine DermatologyInfections
Stevens-Johnson typically develop asyndrome
Stevens-Johnson slowly spreading rash that is react
is an inflammatory warm
2780 Medicine DermatologySyndrome Systemic signs include fever, hemodynamic
Vitiligo is caused by regional destruction of melanocy instabilit
2779 Medicine DermatologyVitiligo
Toxic Epidermal progressive.
syndrome (SJS) Theare diagnosis
similar is made ondistinguished
disorders clinical ground b
2777 Medicine DermatologyNecrolysis involves 10-30%.
Erythematotelangiectatic rosacea causes erythema in
2776 Medicine DermatologyRosacea alcohol,
Pemphigus heat, emotion,
vulgaris is aand other causes blistering
mucocutaneous of rapid bod dis
2775 Medicine DermatologyPemphigus Vulgaris in adherence between epidermal
Dermatitis herpetiformis is an autoimmune dermal rekeratinocytes. Biops
2774 Medicine DermatologyDermatitis Herpetiformis on the elbows,are
Tetracyclines knees, back, and
an important buttocks.
cause Managem
of phototoxic dr
2771 Medicine DermatologyAdverse Drug Reaction areas.
Malignant melanoma may occur wherever there are p
2765 Medicine DermatologyMelanoma factors.
Seborrheic Findings
keratosisthat issuggest
a benign melanoma
epidermal include
tumorasy tha
2764 Medicine DermatologySeborrheic Keratosis
Nonmelanoma Skin appearance.
Basal cell carcinoma is the most common skin maligna
Diagnosis is based primarily on clinical
2762 Medicine DermatologyCancer
Molluscum metastasizes,
Molluscum contagiosumit may invade is alocal
benign tissues and should
condition charac
2761 Medicine DermatologyContagiosum topical therapies (e.g. cantharidin).
Seborrheic dermatitis causes pruritic, erythematous p
2755 Medicine DermatologySeborrheic Dermatitis and can bevulgaris
Ichthyosis associated with Parkinson
is a chronic, inherited disease and H
skin disorde
2754 Medicine DermatologyIchthyoses Treatment options include emollients, keratolytics, an
Bullous pemphigoid is an autoimmune disorder chara
2751 Medicine DermatologyBullous Pemphigoid confirmed with skinand
have excoriations biopsy. First-line
crusted, treatment
red papules is aaffe
in the h
2750 Medicine DermatologyScabies treatment in adults.
Tinea versicolor is a superficial nondermatophyte fun
2747 Medicine DermatologyTinea Versicolor diagnosis is confirmed
Tinea corporis is a cutaneous with potassium
dermatophytehydroxide prep
infection
2746 Medicine DermatologyTinea elsewhere
Continuouson the body,
positive airway hands, groin,(CPAP)
pressure or feet. predisp
Those w
16968 Medicine Ear, Nose & Epistaxis CPAP-associated epistaxis. by pain, erythema, ede
Otitis externa is characterized
15993 Medicine Ear, Nose & Otitis Externa is Pseudomonas
Acute otitis externaaeruginosa.
('swimmer's ear') presents with p
15991 Medicine Ear, Nose & Otitis Externa retention in the external
Herpes zoster oticus (Ramsay auditory Huntcanal.
syndrome) is cau
14828 Medicine Ear, Nose & Herpes Zoster
Vestibular spread to cranial nerve VIII. Primary
Vestibular neuritis is a self-limited disorder manifestations
of the vesin
12455 Medicine Ear, Nose & Neuritis/Labyrinthitis loss is termed labyrinthitis.
Glucocorticoid nasal sprays are the most effective sin
12123 Medicine Ear, Nose & Allergic Rhinitis antihistamines,
Necrotizing (malignant)antihistamine or cromolyn
otitis externa nasal spray
is a severe infe
4282 Medicine Ear, Nose & Otitis Externa frequently in elderly patients with diabetes
Méniére disease is a disorder of the inner ear charac mellitus. In
3449 Medicine Ear, Nose & Méniére Disease sensorineural
Oral leukoplakia hearing
presents loss,asandwhitetinnitus
patchesor aural fullne
or plaque
2844 Medicine Ear, Nose & Leukoplakia squamous cell carcinoma
Aspirin-exacerbated (tobacco
respiratory and alcohol
disease use).c
is a clinical
2842 Medicine Ear, Nose & Nasal Polyps inflammatory drugs, and chronic rhinosinusitis
Loop diuretics can cause hearing loss that may be ei with na
2838 Medicine Ear, Nose & Hearing Loss failure, or thosehearing
Sensorineural also being loss treated
that occurswith with
otheraging
known is co
2836 Medicine Ear, Nose & Hearing Loss inner ear. (malignant) otitis externa represents oste
Necrotizing
2828 Medicine Ear, Nose & Otitis Externa
Temporomandibular severe ear pain and ear drainage; granulation tissue
2194 Medicine Ear, Nose & Disorders Temporomandibular
Although acromegalyjoint disorder
typically can result
presents in referr
with characte
20453 Medicine Endocrine, DAcromegaly macroglossia, thyromegaly, thickening
Hereditary hemochromatosis can causeofsecondary
skinfolds, a h
19597 Medicine Endocrine, DHemochromatosis serum iron, serum ferritin, and transferrin
anxiety, palpitations, sweating). Frequent or severe h saturation.
19235 Medicine Endocrine, DHypoglycemia management, which may impair
patients with long-standing diabetesglycemic
reduces control.
the gluc
19233 Medicine Endocrine, DHypoglycemia progressively worsening hypoglycemic
Chronic pancreatitis or pancreatic resection can caus episodes.
19231 Medicine Endocrine, DHypoglycemia glucagon-secreting
Hypoglycemia can occur α cellsinand are atwith
patients riskcritical
for rapid an
illnes
19227 Medicine Endocrine, DHypoglycemia renal insufficiency,
characterized likely duefalsification
by intentional to decreased renal gluc
of illness in th
19222 Medicine Endocrine, DHypoglycemia controlled environment (e.g. hospital)
phase (i.e. the patient understands the need for chan may confirm th
18637 Medicine Endocrine, DObesity scientifically
Urine osmolalityvalidand
assessment of the can
specific gravity prosbe and cons
used to on
18019 Medicine Endocrine, DDiabetes Insipidus seen in diabetes
osmotic diuresis and insipidus.
insulinHigh urine osmolality
deficiency, total bodyand pot
18006 Medicine Endocrine, DDiabetic Ketoacidosis intravenoushormone.
antidiuretic fluids, potassium repletion
Unlike patients should
with primarybe give
adr
17863 Medicine Endocrine, DAdrenal Insufficiency hyperkalemia or skin hyperpigmentation.
Bisphosphonates (e.g. alendronate, risedronate) are
17597 Medicine Endocrine, DOsteoporosis 2 years to
Patients assess
with primaryresponse
adrenaltoinsufficiency
therapy. Treatmenthave gluco is
17445 Medicine Endocrine, DAdrenal Insufficiency mineralocorticoid
diagnosis can be presumed (e.g. fludrocortisone)
in patients activity.
with renal dys
17317 Medicine Endocrine, DDiabetes Mellitus correlates with the presence of DN.
ACE inhibitors (ACEIs) for secondary prevention of o
17316 Medicine Endocrine, DDiabetes Mellitus
Male Sexual normal
Secondary albumin excretion. in men presents with low l
hypogonadism
17231 Medicine Endocrine, DDysfunction common
breast canceradverse effectductal
Invasive of opioids, which issuppress
carcinoma the mostG
17229 Medicine Endocrine, DKlinefelter Syndrome include
Milk-alkalimammography.
syndrome is characterized by hypercalcem
16966 Medicine Endocrine, DMilk Alkali Syndrome of calcium
cotransporter carbonate
2 (SGLT-2) takeninhibitors,
for heartburn
whichorreduceosteopor ca
16507 Medicine Endocrine, DDiabetes Mellitus thiazolidinediones.
Pheochromocytoma should be suspected in patients
15097 Medicine Endocrine, DPheochromocytoma tachycardia).
Anorexia nervosa Measurement
is characterized of urinebyoraplasma
distorted metan
bod
15090 Medicine Endocrine, DAnorexia Nervosa hypotension, edema, gastroparesis,
Hypothyroidism disrupts the hypothalamic-pituitary-ov cardiac atrophy,
14025 Medicine Endocrine, DHypothyroidism stimulates
Radioiodineanterior
therapypituitary
for Graves production
diseaseofleads
both to TSH reso a
12399 Medicine Endocrine, DRadioactive Iodine patients. This therapy can also acutely worsen Grave
Patients with diabetes mellitus who have an elevated
12366 Medicine Endocrine, DDiabetes Mellitus acting basal insulinoutcomes
on macrovascular (to control(e.g. fasting glucose)
stroke, and a
myocardial
11367 Medicine Endocrine, DDiabetic Retinopathy increased
Thyroid storm cardiovascular mortality.thyrotoxicosis
is a life-threatening Therefore, the rec
usua
11277 Medicine Endocrine, DHyperthyroidism inadequately
Postpartum adrenal treatedinsufficiency
hyperthyroidism. Patients
(AI) may be due cantod
11270 Medicine Endocrine, DAdrenal Insufficiency primary rather than
Hypopituitarism withsecondary AI.
a mild to moderate increase in p
8918 Medicine Endocrine, DHypopituitarism but are frequently asymptomatic until
Chronic gastrointestinal disease (e.g. steatorrhea, the adenomace b
8901 Medicine Endocrine, DVitamin D Deficiency elevated parathyroid hormone.
Primary hyperaldosteronism Patients can be
is characterized byasym
hype
8897 Medicine Endocrine, DHyperaldosteronism baseline but can be severe with diuretic
Vitamin D deficiency can lead to hypocalcemia with a use. Clinicall
8876 Medicine Endocrine, DHypocalcemia malabsorptive
Patients takingdisorders.
exogenous Evaluation
insulin forincludes
diabetesmeasur
are vu
7010 Medicine Endocrine, DHypoglycemia levels. Patients with chronic kidney
Cushing syndrome is characterized by hypertension, disease are at inc
4721 Medicine Endocrine, DCushing Syndrome
Male Sexual ectopic
CirrhosisACTH production.
can cause hypogonadism due to primary go
4635 Medicine Endocrine, DDysfunction increased conversion
In hyperthyroidism, increased from androgens.
radioactive iodine upta
4588 Medicine Endocrine, DHyperthyroidism
Hyperosmolar exogenous hormone
Hyperosmolar intake. Thyrotoxicosis
hyperglycemic state in type 2due to ex
diabetes
4516 Medicine Endocrine, DNonketotic Syndrome high plasma osmolality. Common precipitating factors
4471 Medicine Endocrine, DHypothyroidism Hypothyroidism
syncope. Most patients is an important cause of reversible
have hyponatremia due to re ch
4420 Medicine Endocrine, DAdrenal Insufficiency the setting
Cushing of aldosterone
syndrome deficiency.by weight gain, m
is characterized
4419 Medicine Endocrine, DCushing Syndrome of cortisol
Graves on connective is
ophthalmopathy tissue.
due to Women can have
the effects fea
of activa
4415 Medicine Endocrine, DHyperthyroidism iodine
Chronic(RAI) treatmentmyopathy
hyperthyroid can raiseistiters of TRAB and
characterized by pw
4382 Medicine Endocrine, DHyperthyroidism Treatment of hyperthyroidism usually improves the m
4336 Medicine Endocrine, DDyslipidemia Statin therapy
and cortisol is indicated
levels and a normalfor thealdosterone
primary prevention
level. In
4325 Medicine Endocrine, DHypopituitarism hyperkalemia, hyponatremia).
TSH-secreting pituitary adenomas cause hyperthyroi
4324 Medicine Endocrine, DHyperthyroidism macroadenomas
Acromegaly is caused and can be associated
by excessive with mass
secretion of growe
4323 Medicine Endocrine, DAcromegaly and is the preferred
Hyperthyroidism from initial
toxictest in suspected
adenoma is due acromega
to autono
4318 Medicine Endocrine, DHyperthyroidism only in the hyperactive nodule, with
calcium levels. It is due to secretion of PTH-relatedsuppression of up
p
4308 Medicine Endocrine, DHypercalcemia production of 1,25-dihydroxyvitamin D,
Untreated hyperthyroid patients are at risk for rapid b and increased
4307 Medicine Endocrine, DHyperthyroidism tachyarrhythmias,
Autoimmune adrenalitis includingis theatrial
most fibrillation.
common cause o
4306 Medicine Endocrine, DAdrenal Insufficiency are the
(e.g. hyperpigmentation
primary hypothyroidism, andvitiligo).
hyperkalemia
Clinicalseenmanifein
4305 Medicine Endocrine, DAdrenal Insufficiency and hyperpigmentation
Primary hyperparathyroidism of the is skin and mucousbymem
characterized auto
4304 Medicine Endocrine, DHyperparathyroidism asymptomatic
followed hypercalcemia,
by a hypothyroid phase butorpotential
return toclinical
a euthyrfe
4286 Medicine Endocrine, DHyperthyroidism palpitations, tremulousness).
Hypoparathyroidism (parathyroid hormone deficiency
4254 Medicine Endocrine, DHypocalcemia include
values are postsurgical,
often normal autoimmune
or elevated. and
Thisnonautoimmun
finding is du
4247 Medicine Endocrine, DDiabetic Ketoacidosis uptake of potassium.
Insulin resistance typical for patients with central-type
4164 Medicine Endocrine, DMetabolic
MenopausalSyndrome
Hormone dyslipidemia). *Extremely high
Oral estrogen preparations yield question
increase levels of for the U
thyroxin
4154 Medicine Endocrine, DTherapy sites.
Humoral hypercalcemia of malignancy is characterize
4134 Medicine Endocrine, DHypercalcemia increased bone resorption
Estrogen increases the level and of reabsorption of calciuT
T4-binding globulin.
4132 Medicine Endocrine, DHyperthyroidism levels are elevated,isbut
Hypomagnesemia an patients
important with normal
cause hypotha
of hypocalce
4082 Medicine Endocrine, DHypocalcemia
Polycystic Ovary Hypoparathyroidism
Polycystic ovary syndrome induced mayby low magnesium
present is no
with irregula
3996 Medicine Endocrine, DDisease estrogen and progestin to regulate menstrual cycles.
3981 Medicine Endocrine, DChronic Kidney Disease Hypocalcemia, hyperphosphatemia, and increased p
3952 Medicine Endocrine, DHyperthyroidism Systolic
Moderately hypertension
increased in thyrotoxicosis
albuminuria (urineis albumin-cre
caused by h
3902 Medicine Endocrine, DDiabetic Nephropathy receptor
osmolalityblockers.
< 1/2 plasmaTheseosmolality)
agents reduce glomerular h
and hyponatremi
3899 Medicine Endocrine, DDiabetes Insipidus (decreased antidiuretic hormone [ADH] release from
Hypothyroid myopathy is characterized by myalgias,
3878 Medicine Endocrine, DHypothyroidism (e.g. fatigue,
diagnosis, and delayed
positivereflexes).
tests require Initialfurther
diagnostic testiim
adrenal
3832 Medicine Endocrine, DHyperaldosteronism patients
Patients without discrete unilateral
with hypertension should be adrenal
screened massfor ondiaim
3807 Medicine Endocrine, DDiabetes Mellitus advised for patients
Initial treatment agefor
options 40-70 withdiabetic
painful a BMI >neuropath
25.
3800 Medicine Endocrine, DDiabetic Neuropathy pain by inhibiting
Diabetic gastroparesisthe release of excitatory
(i.e. delayed gastricneurotrans
emptying)
3797 Medicine Endocrine, DGastroparesis prokinetic agent that can relieve
Sensorimotor polyneuropathy in diabetes is charactegastroparesis sympt
3795 Medicine Endocrine, DDiabetic Neuropathy causes numbness,
Risk factors loss of
for diabetic footproprioception
ulcers includeand vibratio
diabetic n
3781 Medicine Endocrine, DDiabetic Neuropathy factor and is found in > 80% of patients
water deprivation can distinguish between central and with ulcers. M
3729 Medicine Endocrine, DDiabetes Insipidus desmopressin
Acromegaly causes acetate tablets; patients
concentric myocardial withhypertroph
nephroge
3634 Medicine Endocrine, DAcromegaly hypertension,
Rapidly progressive obstructive
hirsutismsleepwith apnea, and valvular
virilization suggesh
3598 Medicine Endocrine, DHirsutism
Male Sexual androgen-producing
Patients should haveadrenal measurementtumors.of serum prolacti
3595 Medicine Endocrine, DDysfunction
Multiple Endocrine effect
which symptoms, very low with
are also associated testosterone levels, or disrP
pheochromocytoma.
3520 Medicine Endocrine, DNeoplasia assay.
Antithyroid peroxidase (anti-TPO) antibodies are pres
3496 Medicine Endocrine, DHypothyroidism
Multiple Endocrine to overt
Type 2Bhypothyroidism.
multiple endocrine High titers of anti-TPO
neoplasia (MEN2B) are is ch a
3494 Medicine Endocrine, DNeoplasia with MEN2B is often very aggressive,
Prolactin-producing lactotroph adenoma (prolactinom and thyroidecto
3493 Medicine Endocrine, DProlactinoma ng/mL
Patients are essentially
with diagnostic. (> 1 cm) or a sym
a macroprolactinoma
3492 Medicine Endocrine, DProlactinoma levels and reduce
Osteomalacia is due tumor size.
to defective mineralization of the
3490 Medicine Endocrine, DVitamin D Deficiency phosphorus
weakness. Laboratory findings includesecondary
absorption with resultant hypocalcemia hype
3489 Medicine Endocrine, DVitamin D Deficiency concave
Subacutevertebral
(de Quervain) bodies,thyroiditis
and pseudofractures.
is characterized b
3488 Medicine Endocrine, DHyperthyroidism hypothyroidism and eventual recovery
Graves disease can be treated with antithyroid of thyroiddrugsfunc
3487 Medicine Endocrine, DHyperthyroidism Patients
Euthyroiddeveloping
sick syndrome sore is throat and fever by
characterized should
low T3 stople
3486 Medicine Endocrine, DHypothyroidism Treatment is generally not recommended unless abn
3484 Medicine Endocrine, DThyroid Nodules Thyroid nodules can
Hypothyroidism shouldcause be evaluated
elevated levels by serum TSH
of total ch
3483 Medicine Endocrine, DHypothyroidism with
antagonists (e.g. spironolactone, eplerenone) is recon
levothyroxine can improve lipid levels, although
3231 Medicine Endocrine, DHyperaldosteronism surgical candidates.
3230 Medicine Endocrine, DHyperaldosteronism Patients
Causes of with mild primary should
hypercalcemia hyperaldosteronism
be categorized mayon nt
3102 Medicine Endocrine, DHypercalcemia PTH-dependent hypercalcemia (elevated or inapprop
3100 Medicine Endocrine, DHypocalcemia Patients with
Increased hypoalbuminemia
extracellular pH (e.g. can have decreased
respiratory alkalosis)
3099 Medicine Endocrine, DHypocalcemia Ionized calcium
Milk-alkali syndrome is theisphysiologically
caused by excessive active form,
intakeand o
3083 Medicine Endocrine, DHypercalcemia symptomatic hypercalcemia, metabolic
Primary hyperaldosteronism (Conn syndrome) cause alkalosis, and
2725 Medicine Endocrine, DHyperaldosteronism renin
muscle and elevated aldosterone
weakness/cramps (due levels.
to hypokalemia), and
2649 Medicine Endocrine, DVIPoma pg/mL confirms VIPoma diagnosis.
manifestations include diabetes mellitus, weight loss,
2645 Medicine Endocrine, DGlucagonoma
Multiple Endocrine and
Typeevaluate
1 multiple forendocrine
metastases. neoplasia is characterized
2630 Medicine Endocrine, DNeoplasia complications include symptomatic
The initial step in the evaluation of Cushing hypercalcemiasyndrome an
2592 Medicine Endocrine, DCushing
PolycysticSyndrome
Ovary low-dose
Polycysticdexamethasone
ovary syndrometest. (PCOS) If hypercortisolism
may present with is c
2414 Medicine Endocrine, DDisease type 2 diabetes
Carcinoid tumorsmellitus
are rare and should be screened
neuroendocrine tumorswith tha
2220 Medicine Endocrine, DCarcinoid Tumors production of serotonin from tryptophan
glucagon-like peptide-1 (GLP-1) agonists and sodium (required for
2192 Medicine Endocrine, DDiabetes Mellitus patients
Painlesswith cardiovascular
thyroiditis disease. is characterized
(silent thyroiditis)
2191 Medicine Endocrine, DHyperthyroidism uptake.
Strict blood pressure control, particularly using ACE i
2190 Medicine Endocrine, DDiabetic Nephropathy target
The most hemoglobin
accurateA1c < 7%indicating
markers also can prevent
resolution progre
of d
2189 Medicine Endocrine, DDiabetic Ketoacidosis concentration in the blood and returns
Hypoglycemia is associated with multiple differential to normal with
2188 Medicine Endocrine, DHypoglycemia levels. Hypoglycemia secondary to insulinoma is ass
Hyperosmolar Hyperosmolar hyperglycemic state is characterized b
2186 Medicine Endocrine, DNonketotic
Hyperosmolar Syndrome deficits
However, in total
serum body water; therefore,
potassium levels maytreatment
be normal shou
or
2185 Medicine Endocrine, DNonketotic Syndrome potassium levels, leading to hypokalemia.
Essential measures in diabetic ketoacidosis include:
2184 Medicine Endocrine, DDiabetic Ketoacidosis hyperglycemia
Graves diseaseand canketosis
be treatedwith with
intravenous
antithyroid regular
drugsin
2179 Medicine Endocrine, DHyperthyroidism remission.
Fever and sore Theythroat
are also used
in any in preparation
patient for treat
taking antithyroid
2178 Medicine Endocrine, DHyperthyroidism in patients takingisantithyroid
Hypopituitarism characterized drugs byisglucocorticoid
not cost effectiv de
2175 Medicine Endocrine, DHypopituitarism libido. In contrast to primary adrenal
The evaluation of adrenal insufficiency should include insufficiency, ald
2174 Medicine Endocrine, DAdrenal Insufficiency primary
Myopathy adrenal insufficiency
in Cushing syndrome (andis most patients with
characterized by p
2173 Medicine Endocrine, DCushing Syndrome cortisol on skeletal muscle, leading
Diabetic ketoacidosis can be the initial manifestationto muscle atrophy
2171 Medicine Endocrine, DDiabetic Ketoacidosis altered
Rapid-onset mentation. Fingerstick blood
hyperandrogenism, glucose with
particularly can virili
rapi
2170 Medicine Endocrine, DHirsutism the site of androgen
A complication production.
of Crohn diseaseElevated
is perianal testosteron
disease (
12137 Medicine Female ReprR ectovaginal
Fibrocystic Fistula
Breast a
Fibrocystic breast changes are a common cause oftan
rectovaginal fistula typically have a malodorous, c
11970 Medicine Female ReprChanges no nipple
Acute discharge
urinary or lymphadenopathy.
incontinence in elderly patients may ha
11063 Medicine Female ReprUrinary Incontinence present with urinary
Trastuzumab is usedtract infections
for the treatment limited to the lowe
of patients wit
2608 Medicine Female ReprBreast Cancer should be assessed with echocardiography at baselin
2605 Medicine Female ReprBreast Cancer Tumor burden is
Celiac disease thepresent
can single most
with aimportant
diverse array prognostic
of sy
20396 Medicine GastrointestiCeliac Disease peripheral neuropathy, atrophic glossitis).
the causation or falsification of illness in another pers
20389 Medicine GastrointestiFactitious Disorder by notifying
Celiac disease,protective services.
an immune-mediated disorder trigger
20387 Medicine GastrointestiC eliac Disease
Colorectal Cancer common, which increases
Childhood cancer survivors treated with the risk for osteoporosis.
abdominopeD
20070 Medicine GastrointestiScreening increased
that affect risk for developing
the intestinal brushcolorectal
border (e.g. adenocarcino
infectious
19782 Medicine GastrointestiLactose Intolerance oral lactose, can be diagnostic.
Hepatitis A causes fever, vomiting, jaundice, hepatom
19702 Medicine GastrointestiHepatitis A increased
confirmed risk, as arefor
by testing day
HFE care workers,
genetic homeless
mutations, butsh
p
19593 Medicine GastrointestiHemochromatosis waiting for genetic testing results.
Gonococcal proctitis typically occurs in adolescents o
19169 Medicine GastrointestiGonococcal Infection spread from the
and/or sitting butvagina. Manifestations
often occur without an include
obvioustenesstim
19111 Medicine GastrointestiProctalgia Fugax are normal.
disease process, whereas bilirubin and alkaline phos
18705 Medicine GastrointestiHepatitis A contaminated
and bilirubin), as water
wellorasfood,
highas well of
levels asautoantibodies
to overcrowde
18690 Medicine GastrointestiAutoimmune Hepatitis antinuclear
count, serum antibodies)
chemistry,orand hypergammaglobulinemia
stool studies (e.g. c
18552 Medicine GastrointestiIrritable
Chemotherapy
Bowel loperamide).
Irritable bowel syndrome is characterized by recurren
17993 Medicine GastrointestiSyndrome modification,
In patients with and fiber supplementation
alcoholic cirrhosis, cessation (in constipati
of alcoh
17860 Medicine GastrointestiCirrhosis improved
the renin-angiotensin-aldosterone system andbe
survival. Alcohol abstinence should reco
promo
17856 Medicine GastrointestiAscites cavity while with
All patients low oncotic
new-onset pressure
ascites(i.e. hypoalbuminem
require diagnostic
17852 Medicine GastrointestiAscites color
Autoimmune atrophic gastritis is an autoimmuneand
assessment and measurement of albumin diso
16898 Medicine GastrointestiAtrophic Gastritis intrinsic factor (resulting in B12 deficiency).
Stress ulceration is common in patients in the intensi Common
16716 Medicine GastrointestiStress Gastric Ulcer ventilation,
Sarcoidosistraumatic spinal cord/brain
is characterized by multisystem injury,inflamma
burns, a
16539 Medicine GastrointestiS arcoidosis
Small Intestinal demonstrate
Small intestinal a mixed cholestatic
bacterial overgrowth andpresents
hepatocellular
with blop
16528 Medicine GastrointestiBacterial
ClostridiumOvergrowth
Septicum chronic
Clostridium opiate use) and
septicum is diagnosed
bacteremia with carbohydra
is strongly associate
16386 Medicine GastrointestiInfection group D streptococci, particularly
Anorexia nervosa (AN) is characterized by low body Streptococcus bovis w
16342 Medicine GastrointestiAnorexia Nervosa signs and symptoms
gastrojejunal (e.g. constipation,
anastomosis, leading to symptoms cold intoleran
of n
16274 Medicine GastrointestiBariatric Surgery and treatment.
Splenic infarction usually presents with acute pain an
16255 Medicine GastrointestiSplenic Infarct (SLE), malignancy),
insufficiency embolic disease,
with associated abdominal or pain
hemoglobino
from pa
16247 Medicine GastrointestiChronic Pancreatitis insufficiency and pain.
Most cases of acute pancreatitis are related to gallsto
16222 Medicine GastrointestiAcute Pancreatitis once these more common etiologies are ruled out, es
reveals grossly normal-appearing colonic mucosa; ho
16212 Medicine GastrointestiM icroscopic
Irritable Colitis
Bowel Risk factors include
movements. Furtherconcurrent
workup is not autoimmune condition
typically required u
16211 Medicine GastrointestiSyndrome
Irritable Bowel loss, iron deficiency anemia, elevated
presence of alarm features requires further workup; t inflammatory m
16210 Medicine GastrointestiSyndrome abnormal
Eosinophilic laboratory
esophagitis testscommonly
(e.g. iron affects
deficiencyyounganemi me
16192 Medicine GastrointestiEsophagitis heartburn. More than 50% of patients
Acute cholangitis leads to right upper quadrant pain, have a history
16167 Medicine GastrointestiC holangitis Difficile
Clostridium gap metabolicdifficile
Clostridioides acidosis may beshould
infection present bedue to lacticina
suspected
16106 Medicine GastrointestiInfection difficile toxin is generally
Fecal impaction is common diagnostic. Other establishe
in older patients with imp
16093 Medicine GastrointestiFecal Impaction cause
insufficiency. Pancreatic exocrine insufficiencyaround
backup of stool; passage of liquid stool is cha
14940 Medicine GastrointestiChronic Pancreatitis diagnostic.
extremity paresthesias and signs of dorsal column re
Treatment involves pancreatic enzyme in
13853 Medicine GastrointestiVitamin B12 Deficiency homocysteine testing may be required for confirmatio
12514 Medicine GastrointestiEsophageal Varices Non-selective β blockers
Patients with cirrhosis suchundergo
should as propranolol
screeningor nado
end
12513 Medicine GastrointestiCirrhosis hemorrhage.
Lactose is processed into glucose and galactose by i
12406 Medicine GastrointestiLactose Intolerance intolerance,
Peptic ulcer which
disease is can
characterized
be complicated by chronic, cramp
by perforatio
12142 Medicine GastrointestiClostridium
Perforated Viscus
Difficile Upright x-ray
Clostridium of theischest
difficile and abdomen
a common cause ofcan confirm
nosocomia
11067 Medicine GastrointestiInfection proton-pump inhibitors). Diagnosis
Pill esophagitis is due to a direct effect of certainis typically made med w
4934 Medicine GastrointestiE sophagitis
Gastrointestinal common
Patients withcauses.
upper Patients experience
gastrointestinal sudden-onset
bleeding who hav
4927 Medicine GastrointestiHemorrhage
Inflammatory Bowel stabilization and resuscitation. Prompt
Crohn disease can involve any component of the gas endoscopic tre
4903 Medicine GastrointestiDisease focal ulcerations
In evaluating with transmural
ascites, inflammation.
a serum-to-ascites albumin gra
4747 Medicine GastrointestiA scites
Gastroesophageal portal hypertensive etiologies (e.g.
circumferential narrowing of the involved esophagus malignancy, panc
4694 Medicine GastrointestiReflux Disease caustic
Ischemic ingestions.
hepatic injury occurs in the setting of hypote
4648 Medicine GastrointestiIschemic Hepatitis alkaline phosphatase.
Management of chronic Inliver
patients
diseasewhoinvolves
survive thebothinc tr
4626 Medicine GastrointestiH epatitis C
Hepatic vaccination).
Treatment of hepatic encephalopathy involves identif
4625 Medicine GastrointestiEncephalopathy lowering
Peptic ulcer serum ammonia.
disease (PUD) may present with epigast
4623 Medicine GastrointestiPeptic Ulcer Disease buffer (e.g. 2-5 hours
Acute pancreatitis complicated after meals, by on an empty is
hypotension stoma
tho
4603 Medicine GastrointestiAcute Pancreatitis increased vascular permeability, and plasma
steatohepatitis, or hepatitis C. In the setting of cirrhos leak into
4602 Medicine GastrointestiA scites Bowel
Irritable common.
Irritable bowel syndrome is a functional disorder of th
4595 Medicine GastrointestiSyndrome
Colorectal Cancer with the ROME
Patients at averageIII criteria
risk ofand no alarmcolon
developing features
cancer do ns
4504 Medicine GastrointestiScreening
Inflammatory Bowel 10 years). colitis
Ulcerative Patients (UC)with an affected
presents with first-degree
bloody diarrhea, relati
4492 Medicine GastrointestiDisease Biopsy shows
Herpes zoster mucosal
(shingles)inflammation and crypt of
is due to reactivation absce
vari
4431 Medicine GastrointestiHerpes Zoster may precede the rash by several
Achalasia commonly presents with chronic dysphagia days, during which
4405 Medicine GastrointestiA chalasia Liver
Metastatic esophagus
The most common and failure siteof ofthe
colonlower esophageal
cancer metastasis sphinis
4389 Medicine GastrointestiDisease diagnosis is confirmed by CT of the
Treatment of actively bleeding esophageal varices in abdomen.
4386 Medicine GastrointestiE sophageal Varices
Gastrointestinal Coagulopathy,
Packed red blood anemia, and thrombocytopenia
cell transfusions are recommended are co
4385 Medicine GastrointestiHemorrhage unstable
Duodenalpatients
ulcer (DU) withisacute coronary by
characterized syndrome
epigastric or pa
w
4363 Medicine GastrointestiPeptic Ulcer Disease Management
Chronic pancreatitisof H. pylori-associated
is a progressive ulcer requires dis
inflammatory ac
4362 Medicine GastrointestiC hronic Pancreatitis
Nonalcoholic Fatty Liver established
Nonalcoholicbyfatty the liver
presencedisease of pancreatic
resembles calcificatio
alcohol-ind
4321 Medicine GastrointestiDisease
Gastrointestinal range from bland steatosis to steatohepatitis
Patients with upper gastrointestinal bleeding often to fibrosha
4303 Medicine GastrointestiHemorrhage intestinal breakdown of hemoglobin)
Alcoholic hepatitis (AH) is most commonly seen in pa and increased u
4278 Medicine GastrointestiA lcoholic
Diffuse Liver Disease
Esophageal laboratory results showing
Diffuse esophageal spasm an aspartate aminotransfe
is characterized by uncoo
4226 Medicine GastrointestiSpasm simultaneous
produced by VIPomas), congenital disorders lower
contractions of the middle and of ion es tr
4150 Medicine GastrointestiChronic Diarrhea typical.
Diverticulosis is associated with chronic constipation.
4086 Medicine GastrointestiDiverticular Disease increased intake of fruit and vegetable fiber; it is high
Gastrointestinal Angiodysplasia is characterized by dilated submucos
Inflammatory Bowel on colonoscopy,
A number of features although it is frequently
are helpful missed. Asy
in differentiating ulce
4074 Medicine GastrointestiDisease presence of noncaseating granulomas,
prompt a thorough evaluation for the cause as early and fistula forl
3936 Medicine GastrointestiIColorectal
ron Deficiency
PolypsAnemia
And may not tolerate
Adenomatous additional
polyps carry blood
increased loss.malignant pote
3918 Medicine GastrointestiCancer features
Giardiasis carry an even greater
is characterized malignantdiarrhea
by persistent potential.and
3887 Medicine GastrointestiG iardia
Gastrointestinal test is a rectal
Minimal stool antigen
bleeding assay. Metronidazole
is usually is the firs
due to hemorrhoids
3857 Medicine GastrointestiHemorrhage features suggesting
metronidazole). malignancy
An abdominal CT should undergo
scan can reveal colodif
3833 Medicine GastrointestiAcute Pancreatitis supportive care.
Acute erosive gastropathy is characterized by the de
3704 Medicine GastrointestiPeptic Ulcer Disease cocaine).
Lactose intolerance is characterized by a positive hyd
3605 Medicine GastrointestiLactose Intolerance steatorrhea.
Celiac disease should be suspected in any patient wi
3602 Medicine GastrointestiCeliac Disease celiac
Laxative disease
abusebut may be absentbyif frequent,
is characterized there is concurre
watery,
3593 Medicine GastrointestiLaxative Abuse coli (dark brown discoloration with
Helicobacter pylori is a urease-producing organism pale patches of tha
lym
3588 Medicine GastrointestiDyspepsia bleeding; worsening
ultrasound to rule out pain during
cancer fasting
in the head andofnocturnal
the pancr
3585 Medicine GastrointestiChronic Pancreatitis scan.
Whipple disease is a multi-systemic illness character
3582 Medicine GastrointestiWhipple Disease is a classical
Pellagra is due biopsy
to niacinfinding of Whipple
deficiency anddisease.
is characteriz
3087 Medicine GastrointestiNiacin Deficiency occasionally cause pellagra.
Body stores of folate are minimal, and deficiency may
3086 Medicine GastrointestiFolic Acid Deficiency megaloblastic
Survival without anemia with insufficiency
liver transplantation reticulocytos
is low in patients
2986 Medicine GastrointestiAcute Liver Failure undergo early consideration for liver
ischemia, acute pancreatitis) complications. Acute pa transplantation.
2982 Medicine GastrointestiAcute Pancreatitis intravenous
In addition tofluids.leukocytosis with left shift, laboratory st
2978 Medicine GastrointestiCholangitis aminotransferases.
Dubin-Johnson syndrome is a benign, hereditary con
2977 Medicine GastrointestiJaundice conjugated
Elevated serum bilirubin.
alkaline phosphatase levels are indic
2975 Medicine GastrointestiGallstone Disease assess for intrahepatic
Hepatic hydrothorax generally or extrahepatic
results incauses of bilia
transudative
2969 Medicine GastrointestiCirrhosis and
Acute testing to exclude
pancreatitis is mostother causes. due to chronic a
commonly
2965 Medicine GastrointestiA cute Pancreatitis
Hepatic xanthomas.
Patients withThe diagnosis
hepatic can be confirmed
encephalopathy with acan
on diuretics fa
2953 Medicine GastrointestiEncephalopathy
Primary Biliary hypokalemia.
Ursodeoxycholic Treatment
acid (UDCA) includes is thevolume
drug ofresuscitatio
choice in
2950 Medicine GastrointestiCholangitis UDCA should be initiated as soon
In evaluating the asymptomatic elevation of aminotra as the diagnosis o
2937 Medicine GastrointestiAbnormal LFTs travel outside
diagnosing of the
acute country, blood
pancreatitis. transfusions, high
Contrast-enhanced co
2934 Medicine GastrointestiAcute Pancreatitis conservative
Individuals management.
with resolved hepatitis Abdominal ultrasound
B infection ma
are pos
2926 Medicine GastrointestiHepatitis B anti-HBs
Gilbert but negative
syndrome for HBsAg
is caused and anti-HBc.
by reduced bilirubin glucu
2923 Medicine GastrointestiGilbert Syndrome or consumption of a fat-free diet,
varices as well as the risk of variceal hemorrhage. physical exertion,En fe
2921 Medicine GastrointestiE sophageal
Primary Varices
Sclerosing therapy.
colitis. The diagnosis is confirmed with magnetic reso
2920 Medicine GastrointestiCholangitis
Drug Induced Liver beaded appearance).
2917 Medicine GastrointestiInjury Isoniazid
Acute livercausesfailureidiosyncratic liver injury by
(ALF) is characterized with histolog
elevated
2914 Medicine GastrointestiAcute Liver Failure chronic
HBsAg and alcohol use. are the most appropriate diagno
anti-HBc
2912 Medicine GastrointestiHepatitis B during
Alcoholic thehepatitis
window is period.
generally characterized by a rati
2911 Medicine GastrointestiA lcoholic LiverFatty
Nonalcoholic Disease
Liver The absolute values
Nonalcoholic fatty liver disease of AST andisALT are almostby
characterized alwahe
2910 Medicine GastrointestiDisease (e.g. alcohol). It is most common
Workup of ascites includes ultrasonography and a dia in patients with obe
2908 Medicine GastrointestiCirrhosis etiology
Cirrhosisand shouldrule be outsuspected
spontaneous in anybacterial
patientperitonitis
with evid
2907 Medicine GastrointestiC irrhosis
Spontaneous Bacterial nonalcoholic fatty liver disease, and
Spontaneous bacterial peritonitis (SBP) should be su hemochromatos
2901 Medicine GastrointestiPeritonitis The
Acute Reitan trail test,
liver failure a timedas
is defined connect-the-numbers
acute onset of severe te
2900 Medicine GastrointestiAcute Liver Failure liver disease. Drug toxicity and acute viral hepatitis ar
2899 Medicine GastrointestiCirrhosis Hyperestrinism in cirrhosis leads to gynecomastia, te
Primary Biliary ducts. It presents in middle-aged women with fatigue
2898 Medicine GastrointestiCholangitis titers.
Wilson disease is characterized by the combination o
2895 Medicine GastrointestiW ilson Disease
Primary Biliary function abnormalities
Primary biliary cholangitis to cirrhosis. Neuropsychiatric
is a progressive autoimmus
2759 Medicine GastrointestiCholangitis xanthelasmas.
Carcinoid syndrome Othertypically
complicationspresents include malabsorf
with episodic
2625 Medicine GastrointestiCarcinoid Tumors can
(MALT))confirm
of thethestomach.
diagnosisAll in patients
most patients.
with MALT lymp
2596 Medicine GastrointestiM ALT Lymphoma pylori eradication therapy (e.g.
Familial Adenomatous Patients with familial adenomatous polyposis quadruple therapy).
have a
2586 Medicine GastrointestiPolyposis proctocolectomy are the standard
Lynch syndrome causes colorectal cancer and impar of care.
2585 Medicine GastrointestiL ynch Syndrome
Inflammatory Bowel hysterectomy, is recommended
Patients with ulcerative colitis are toatprevent
increased endometri
risk fo
Inflammatory Bowel years after the initial diagnosis and
There appears to be a bimodal distribution of ulceratirepeated every 1-
Gastrointestinal incontinence.
Diverticulosis is Endoscopy
the most commondemonstrates causecontinuous
of gross low in
Spontaneous Bacterial instability.
Spontaneous Diverticular
bacterialhemorrhage
peritonitis can usually
have resolves
a subtle ps
2217 Medicine GastrointestiPeritonitis
Diffuse Esophageal status.
Episodes Paracentesis
of dysphagia, is the test of choice,
regurgitation, withchest
and/or the ma pa
2213 Medicine GastrointestiSpasm Manometry establishes
Oropharyngeal dysphagia thepresents
diagnosis asofdifficulty
diffuse initiat
esop
2212 Medicine GastrointestiAspiration Pneumonia The videofluoroscopic
most commonmodified cause ofbarium swallow to
iron deficiency evaluat
anemia in
2210 Medicine GastrointestiIInflammatory
ron Deficiency Anemia
Bowel blood test does not exclude the possibility
Crohn disease is characterized by chronic abdominal of gastroin
Clostridium Difficile the
shouldgastrointestinal
be sent to confirmtract from mouth to anus.
the diagnosis. Treatment o
2202 Medicine GastrointestiInfection
Gastroesophageal megacolon) should be treated
bleeding, or recurrent vomiting) or are men agewith high-dose oral va
> 50
2200 Medicine GastrointestiReflux Disease pump inhibitor therapy
pseudoachalasia include and further evaluation
significant weight loss, if refrac
rapid
2199 Medicine GastrointestiAchalasia suspected achalasia.
D-xylose is a monosaccharide that is absorbed in the
2198 Medicine GastrointestiCeliac Disease will
Thehave impaired
diagnosis absorption
of chronic of D-xylose.
mesenteric ischemia Patients
shouldw
2149 Medicine GastrointestiMesenteric Ischemia atherosclerotic
Chronic lymphedema changes of thecommonly
is most celiac or superior
caused by mes a
12527 Medicine General PrinLymphedema one or more extremities. Patients
The US Preventive Services Task Force recommend usually have pitting
3863 Medicine General PrinBreast Cancer recommended
Sickle cell disease but can be considered
patients are at highon riskanofindividua
delayed
19721 Medicine Hematology Sickle Cell and can cause hemolytic anemia. Diagnosis
iron available for erythrocytosis. Anemia with reticulo is confirm
19159 Medicine Hematology Hemolytic Anemia autoimmune
Celiac disease hemolytic
causes smallanemia. bowel villous atrophy, le
19037 Medicine Hematology Celiac Disease hyperparathyroidism, and premature
due to the massive release of intracellular osteoporosis.
tumor prod In
18770 Medicine acid and calcium-phosphate.
Hematology Tumor Lysis Syndrome channels on enterocytes and Renal injury can often
reticuloendothelial macb
17386 Medicine Hematology Anemia Of Inflammation The reticulocyte
adrenalresponse.
glands are a common site of metastatic
17146 Medicine Hematology Non-Hodgkin
Adrenal Insufficiency include hypotension/orthostasis,
Follicular lymphoma is a commonhyponatremia, form of non-Hodgk hype
16854 Medicine Hematology Lymphoma
Non-Hodgkin and laboratory abnormalities are rare,
Patients with chronic autoimmune diseases are at inc but mediastina
16777 Medicine Hematology Lymphoma
Non-Hodgkin dysregulation,
Patients with HIV andareuseatofsignificantly
immunosuppressive increased agents risk of
16776 Medicine Hematology Lymphoma Hodgkin
Hodgkin lymphoma is generally treated with combinao
lymphoma, which is due to the reactivation
16590 Medicine Hematology Hodgkin Lymphoma notably
Peripheral secondary malignancyB(e.g.
lymphadenopathy, solid organ,
symptoms, hem
pruritus,
16586 Medicine Hematology Hodgkin Lymphoma dehydrogenase
Hodgkin lymphoma andoften
eosinophilia.
presents with painless perip
16585 Medicine Hematology Hodgkin Lymphoma and pruritus. Diagnosis
trait). Although patients with is usually
sicklemade
cell traitwithareexcision
gener
16278 Medicine Hematology Sickle Cell air travel or dehydration. Diagnosis
A positron emission tomography scan using a radiola of most hemoglob
15628 Medicine Hematology Pet Scan
Antiphospholipid healthy
Patientsorgans with high glucose
with antiphospholipid requirements
antibodies such a
(e.g. lupus
15112 Medicine Hematology Syndrome
Waldenström antiphospholipid antibodies are asymptomatic,
Waldenström macroglobulinemia is a B-cell neoplasm but a
12473 Medicine Hematology Macroglobulinemia
Acute Promyelocytic vertigo,
high riskdizziness, ataxia),hemorrhage
for catastrophic peripheral neuropathy,
due to tumor-in cry
12465 Medicine Hematology Leukemia abnormal
Von Willebrand promyelocytes
disease isinto maturedisorder
a genetic myelocytes and
associa
12461 Medicine Hematology VonAcute Willebrand
Myeloid Disease Patients are usually
Acute myeloid leukemia asymptomatic
(AML) is the butmost maycommon
have prola
12425 Medicine Hematology Leukemia leukemia is a unique form of AML that often presents
back pain or functional impairment (e.g. motor weakn
12403 Medicine Hematology Prostate Cancer phosphatase,
Aplastic anemia andis radiographic
an acquired deficiencyevidence of offocal, scl
pluripote
12394 Medicine Hematology Aplastic Anemia infection,
Scleroderma andrenal
mucocutaneous
crisis typically bleeding,
presents arewithdueacute
to p
10767 Medicine Hematology Systemic Sclerosis show mild proteinuria.
iron studies require furtherPeripheral
testingblood smear can sh
with hemoglobin e
8894 Medicine Hematology Thalassemia testing.
Salvage therapy is defined as treatment for a disease
4940 Medicine Hematology Chemotherapy prostate cancer.
4861 Medicine Hematology Hemophilias Hemophilia is an X-linked recessive
Idiopathic thrombocytopenia purpurableeding
is usually disorde
diagn
4860 Medicine Hematology Thrombocytopenia
Heparin Induced thrombocytopenia may be the initial
Heparin-induced thrombocytopenia (HIT) is an immun presentation of H
4859 Medicine Hematology Thrombocytopenia patients must be placed on alternate forms of anticoa
4736 Medicine Hematology Anticoagulants Warfarin
Anaphylactic is antransfusion
anticoagulant agentisthat
reaction functions by
characterized byi
4672 Medicine Hematology Blood
Venous Transfusion shock.
Oral directAcute management
factor Xa inhibitors includes immediate transf
(e.g. rivaroxaban, apix
4647 Medicine Hematology Thromboembolism complications.
Patients These drugs
with asplenia are atdo risknot
forrequire
fulminant laboratory
infectio
4633 Medicine Hematology Splenectomy
Heparin Induced antibody-mediated
Heparin-induced phagocytosis/complement
thrombocytopenia should be activat
suspec
4616 Medicine Hematology Thrombocytopenia platelet count
Patients from baseline
with multiple myeloma 5-10 aredays after the initiat
at increased risk
4466 Medicine Hematology Multiple Myeloma
Obstructive Sleep hypogammaglobulinemia.
Obstructive sleep apnea (OSA) can present without s
4448 Medicine Hematology Apnea
Hereditary Hemorrhagic erythropoietin, which canhemorrhagic
Patients with hereditary result in erythrocytosis.
telangiectasia (O
4447 Medicine Hematology Telangiectasia shunt physiology. This diagnosis must be entertained
4446 Medicine Hematology Polycythemia Carbon
Thalassemia monoxide minorpoisoning
is usuallyshould be considered
asymptomatic and nointr
4440 Medicine Hematology Thalassemia smear,
Drug-inducedand disproportionately
hemolytic anemia high red blood
is often cell (RB
triggered by
4437 Medicine Hematology Hemolytic Anemia splenomegaly, dark urine, and jaundice.
Pancytopenia (decreased red blood cells, white blood Discontinuat
4416 Medicine Hematology SLE
Antiphospholipid mediated destruction(LA),
lupus anticoagulant of allanticardiolipin
3 cell lines. antibody, and
4412 Medicine Hematology Syndrome serum
thrombotic(mixing test).
thrombocytopenic purpura) and due to ery
4406 Medicine Hematology Mechanical Valve well
Patients who have received the equivalent ofand
as an increased lactate dehydrogenase more biliru
th
4402 Medicine Hematology Hypocalcemia
Venous substance added to stored blood).
Vitamin B6, folate, and vitamin B12 are involved in th Citrate chelates ca
4384 Medicine Hematology Thromboembolism synthase, which metabolizes
Immune thrombocytopenia is homocysteine
an autoimmune into cysta
disorde
4383 Medicine Hematology ITP glycoproteins.
Competitive athletes Patients mayexogenous
using have mucocutaneous
androgens, ble au
4374 Medicine Hematology Polycythemia suggesting
serum iron, exogenous
decreased total androgens include
iron-binding gynecoma
capacity, de
4358 Medicine Hematology Anemia Of Inflammation anemia.
individuals with pernicious anemia, marked by antibo
4356 Medicine Hematology Vitamin B12 Deficiency Vitamin
the risk of B12 gastric cancer.
deficiency is common after a total or par
4350 Medicine Hematology Vitamin B12 Deficiency results
Anemia of chronic kidney disease ispresenting
in ineffective erythropoiesis, due to erythropoas me
4349 Medicine Hematology Chronic Kidney Disease most common cause of inadequate response to ESA
4348 Medicine Hematology Iron Deficiency Anemia Pica is an appetite for dehydrogenase
Glucose-6-phosphate non-nutritive substances deficiencysuch cau
4347 Medicine Hematology G6PD Deficiency especially dapsone, antimalarials,
The 2 most common causes of microcytic anemia, iro and nitrofurantoin.
4343 Medicine Hematology Thalassemia
Thrombocytopenic the hemoglobin
Thrombotic globin subunits.
thrombocytopenic Thalassemia
purpura (TTP) isminor cause i
4339 Medicine Hematology Purpura
Thrombocytopenic TTP is life threatening
Thrombotic thrombocytopenicand requires purpura emergent
should treatme
be sus
4338 Medicine Hematology Purpura
Hereditary failure
Hereditary spherocytosis is an inherited defect inbloo
are often present at diagnosis. Peripheral the
4333 Medicine Hematology Spherocytosis gallstones is a common complication.
Glucose-6-phosphate dehydrogenase deficiency is a
4331 Medicine Hematology G6PD Deficiency drugs,
Folate andinfections,
cobalaminor certain
deficiencyfoodsboth(e.g.result
fava beans).
in megalH
4330 Medicine Hematology Vitamin
Chronic B12 Deficiency changes
Myeloid Anemia can of cobalamin
be due to deficiency.
decreased red It is blood
important to dis
cell (RBC
4329 Medicine Hematology Leukemia
Heparin Induced infiltration
the surfacewith cancerous
of platelets, cells. in platelet activation
resulting
4316 Medicine Hematology Thrombocytopenia patients previously exposed
Febrile non-hemolytic transfusionto heparin.
reaction (FNHTR) i
4160 Medicine Hematology Blood Transfusion develop within 1-6 hours and include transient fever,
Graft Versus Host GVHD is caused by recognition of host major and mi
4151 Medicine Hematology Disease the skin, intestine,
Phenytoin commonly andcauses
liver. megaloblastic anemia a
4147 Medicine Hematology Folic Acid Deficiency effects. Calcium and vitamin D supplementation are a
4081 Medicine Hematology Iron Deficiency Anemia Gastrointestinal blood lossinispatients
Iron studies are indicated the most who common
presentoccu wit
4069 Medicine Hematology Iron Deficiency Anemia microcytic/hypochromic anemia, and
Sideroblastic anemia usually manifests as microcytic in ruling out oth
4037 Medicine Hematology Sideroblastic Anemia total iron bindingiscapacity.
Hypercalcemia common In in patients
patients withwith an identifia
multiple m
4013 Medicine Hematology Multiple Myeloma hypercalcemia.
Factor V Leiden is the most commonly inherited hype
3999 Medicine Hematology Inherited Thrombophilia unprovoked
Erythropoietin first-time thrombusofinchoice
is the treatment young for (age < 45) rp
anemia
3978 Medicine Hematology Chronic Kidney Disease experience
Multiple myelomaa rapidisrise in hemoglobin
a plasma concentration
cell neoplasm. It is chaa
3943 Medicine Hematology Multiple Myeloma Approximately 50% of patients with multiple myeloma
3930 Medicine Hematology Folic Acid Deficiency Heavy alcohol
Hereditary use is a common
hemochromatosis cause
should beofconsidered
nutritional in f
3890 Medicine Hematology Hemochromatosis associated
A mechanical with oraseverely
significantly increased
calcified aortic risk
valve forcan
hepaca
3610 Medicine Hematology Hemolytic Anemia platelet
show injury. An
hemolytic echocardiogram
anemia (e.g. elevated should be perform
lactate dehydr
3609 Medicine Hematology Venous
G6PD Deficiency made
The by G6PD
proximal deepactivity level,are
leg veins but the
sensitivity
most common is low insa
3597 Medicine Hematology Thromboembolism
Venous upper extremity veins, and right heart.
3596 Medicine Hematology Thromboembolism
Superior Vena Cava Noninvasive
mediastinitis evaluation
(secondarywith compression ultrasonogr
to histoplasmosis or Tb infec
3508 Medicine Hematology Syndrome chest x-ray is warranted.
with other autoimmune conditions. Patients generally
3067 Medicine Hematology Vitamin B12 Deficiency paresthesia, subacute combined
Vitamin B12 deficiency should bedegeneration).
suspected in strict
3066 Medicine Hematology Vitamin B12 Deficiency
Hereditary leads to rapid progression of neurologic
Hereditary spherocytosis is usually an autosomal complication dom
3062 Medicine Hematology Spherocytosis corpuscular hemoglobin concentration
Budd-Chiari syndrome, a condition marked by obstru is elevated du
2988 Medicine Hematology Polycythemia
Chronic Myeloid and hepatosplenomegaly.
Chronic myeloid leukemia (CML) Polycythemia
is driven vera,
by aarecipr
chro
2894 Medicine Hematology Leukemia kinase.
Bone pain Tyrosine kinase inhibitors
is a common presentingsuch symptomas imatinib ar
in multip
2889 Medicine Hematology Multiple
Chronic Myeloma
Lymphocytic tests of choice for MM are serum protein electrophore
2887 Medicine Hematology Leukemia Infections
Leukemoidare a common
reaction complication
(LR) occurs of chronictolym
as a response sev
2886 Medicine Hematology Leukemoid Reaction
Chronic Myeloid presence of a high alkaline phosphatase
Chronic myeloid leukemia (CML) is marked by drama score, a gre
2885 Medicine Hematology Leukemia the leukocyte alkaline
Polycythemia vera is aphosphatase
myeloproliferative score,disorder
a marker ma o
2884 Medicine Hematology Polycythemia Erythropoietin
Facial plethoralevels tend to be loware
and splenomegaly (unlike
common moston caus
ph
2883 Medicine Hematology Polycythemia added
Iron if there isanemia
deficiency a high usually
risk of thrombosis.
demonstrates a low se
2877 Medicine Hematology Iron Deficiency Anemia men is usually
Macrocytic anemiadue tocan chronic
be duegastrointestinal
to megaloblastic blood
(e.g.lo
2872 Medicine Hematology Vitamin B12 Deficiency etiologies. Peripheral smear, reticulocyte
Hairy cell leukemia is a chronic B-cell neoplasm that count, and
2868 Medicine Hematology Hairy Cell
Chronic Leukemia
Lymphocytic atypical lymphocytes with 'hairy' cytoplasmic projectio
2865 Medicine Hematology Leukemia Chronic lymphocytic
Multiple myeloma (MM)leukemia is seen
is a plasma almost
cell neoplasm exclusiv
tha
2864 Medicine Hematology Multiple Myeloma anemia,
Warfarin-induced skin necrosis typically occurs withing
renal insufficiency, and an elevated protein
2658 Medicine Hematology Anticoagulants
Cancer Anorexia protein C deficiency.
Progesterone analogues Treatment involves
(megestrol acetate immediate
and med w
2646 Medicine Hematology Cachexia Syndrome anorexia/cachexia
into the serum, leading syndrome. Progesterone
to hyperuricemia, analogue
hyperkalem
2641 Medicine Hematology Tumor Lysis Syndrome acute renal injury (uric acid/calcium phosphate tubula
2623 Medicine Hematology Chemotherapy Serotonin (5HT) antagonists that block 5HT3 recepto
2599 Medicine Hematology Bone Metastasis
Waldenström Bisphosphonates (e.g. zoledronic (WM)
Waldenström macroglobulinemia acid, pamidronate)
is a lymphopl
2597 Medicine Hematology Macroglobulinemia
Paroxysmal Nocturnal marrow biopsy. Hyperviscosity
Paroxysmal nocturnal hemoglobinuria should syndrome, neuropath
be susp
2258 Medicine Hematology Hemoglobinuria venous thrombosis). Flow cytometry
underlying condition (e.g. HIV, hepatitis C). Testing tests are used foto
2251 Medicine Hematology ITP disorders
Autoimmune (e.g. systemicanemia
hemolytic lupus erythematosus)
(AIHA) and hereditary are pr
2248 Medicine Hematology Hemolytic Anemia positive family history and negative Coombs test sug
Venous appropriate screening (e.g. colonoscopy, mammogra
2208 Medicine Hematology Thromboembolism findings
Group Aconcerning
Streptococcus for malignancy
(GAS) pharyngitis or for recurrent
is characte or
19914 Medicine Infectious D Pharyngitis common in viral pharyngitis.
relapse: induction with amphotericin PatientsBatand lowflucytosine
risk for G
19819 Medicine Infectious D Cryptococcal Infections CD4
ongoingcounts recover toor> concurrent
inflammation 100/mm3 for > 3 months
infection; it canona
19429 Medicine Infectious D Tuberculosis medications
tuberculosis (e.g.require glucocorticoids).
empiric 4-drug treatment with iso
19425 Medicine Infectious D Tuberculosis supports
Pulmonary tuberculosis several
the diagnosis, is common samples
in olderareindividua
required
19418 Medicine Infectious D Tuberculosis
Skin And Soft Tissue anorexia;
Impetigo iscavitation
a superficialis seen skinless often that
infection on chestcommonlyx-ray.
19395 Medicine Infectious D Infections varicella,
Meningococcalherpesmeningitis
simplex, scabies), and inflammation
is a potentially fatal infectio
18591 Medicine Infectious D Meningitis suspicion is high, empiric vancomycin
Early meningococcal infection is often nonspecific and ceftriaxone(e.
18590 Medicine Infectious D Meningococci perfusion (e.g. mottled skin, cold hands/feet).
Early meningococcal meningitis presents with nonspe Positive
18589 Medicine Infectious D Meningococci
Rocky Mountain status. Signs of poor
Rocky Mountain spottedperfusion
fever isand severe myalgias
a tick-borne illness t
17311 Medicine Infectious D Spotted Fever Thrombocytopenia and hyponatremia are characteris
17242 Medicine Infectious D HIV Patients with
Bacterial HIV should
conjunctivitis be started
should on antiretroviral
be suspected in patient
17172 Medicine Infectious D Conjunctivitis occur
A syphilitic chancre (nonexudative, painless genital ua
after direct contact with an infected individual,
16921 Medicine Infectious D Syphilis shaft).
CellulitisPenicillin is the gram-positive
occurs when first-line treatment. skin flora gain ac
16833 Medicine Infectious D Tinea cellulitis, causes fissuring, erosions,
positive HCV RNA have chronic HCV infection and ulceration and thsh
16592 Medicine Infectious D Hepatitis C positive HCV antibody testing.
Gonococcal urethritis in men typically presents with d
15915 Medicine Infectious D Urethritis a urethral often
Pertussis swab occurs
or urineinsample. The recommended
adolescents and adults. It g
14068 Medicine Infectious D Pertussis of the classic paroxysmal cough.
The Jarisch-Herxheimer reaction is an acute, Adults often febrile
do not r
12471 Medicine Infectious D Syphilis rigors,
outbreaks sweating, hypotension,
have occurred andwho
in those worsening
trade sex of syph
for d
12470 Medicine Infectious D Chancroid erythematous base, well-demarcated
Pharyngitis, fever, and lower abdominal pain in a sex borders, purule
12427 Medicine Infectious D Gonococcal Infection to
as orogenital
painless red contact.
macules, quickly progress to pustules
12321 Medicine Infectious D Pseudomonas antibiotics are required.
Chlamydia trachomatis is a common sexually transmit
12308 Medicine Infectious D Urethritis Treatment
The most commonwith a one-time
cause ofdose of azithromycin isbac
community-acquired alm
12240 Medicine Infectious D Meningitis mental status. prophylaxis
Postexposure Concurrent with pneumococcal
either hepatitis pneumonia
A vacc
12070 Medicine Infectious D Hepatitis A sexual
Chikungunya fever is a mosquito-borne viral illnesspa
contacts, household contacts) with infected th
11228 Medicine Infectious D Chikungunya Fever edema, and cervical
HIV-associated Kaposi lymphadenopathy.
sarcoma (KS) is an AIDS-defi
11108 Medicine Infectious D Kaposi Sarcoma and genitalia.
with complement Thedeficiency
lesions usually appearmilitary
or asplenia, as multiplerecru
10904 Medicine Infectious D Immunizations patients receiving
Patients with HIV who tumor havenecrosis factor antagonists.
subacute-onset of low-gr
9885 Medicine Infectious D Meningitis established by detection of the
Infectious esophagitis is a common complicationcryptococcal antigenseeo
8959 Medicine Infectious D Esophagitis herpes simplex,
Amphotericin B iscytomegalovirus)
required in patients beingwith more HIVlikely
who in d
4939 Medicine Infectious D Histoplasmosis oral itraconazole for > 1 year of maintenance
Histoplasma capsulatum rarely causes illness in immu therapy
4938 Medicine Infectious D Histoplasmosis
Community Acquired the norm (> 90%).
improvement. Urine or serum
Streptococcus pneumoniaeHistoplasma
4867 Medicine Infectious D Pneumonia pneumonia with hightypically
Miliary tuberculosis risk of death.
presents with subacute o
4669 Medicine Infectious D Tuberculosis (millet seed). The most common
Infective endocarditis can cause acute, behavioral risk facto
subacute, or
4668 Medicine Infectious D Endocarditis (e.g. glomerulonephritis, Osler node),
trunk and extends to the extremities, including the pa and embolic. L
4656 Medicine Infectious D Syphilis penicillin G benzathine
Chronic hepatitis C virus is (HCV)
the standard
infection treatment.
is associate
4654 Medicine Infectious D Hepatitis C fragile, photosensitive skin that
prevents active infection; TMP-SMX is generally develops vesiclesgive and
4611 Medicine Infectious D Toxoplasmosis in preventing
Because Pneumocystis
hepatitis C virus may pneumonia.
spontaneously clear in
4547 Medicine Infectious D Hepatitis
Community C Acquired test and a confirmatory molecular
occur in patients age > 65, but community-acquired test for the presenc m
4517 Medicine Infectious D Pneumonia progressive, necrotizing pneumonia with
pallidum (syphilis), and hepatitis B virus. Patients sho high fever, p
4488 Medicine Infectious D Syphilis counseling on safe sexual practices.
In addition, all patients with HIV should receive vaccin
4478 Medicine Infectious D HIV Streptococcus pneumoniae
Patients with chronic liver should
diseasealso be given.
require the same i
4476 Medicine Infectious D Immunizations 23-valent pneumococcal polysaccharide
Tuberculin skin testing is used to identify patients with vaccine.
4470 Medicine Infectious D Tuberculosis considered
Influenza is negative
usually a(i.e. > 15 mminfection
self-limited is considered
markedposi by
4418 Medicine Infectious D Influenza symptoms. Complications (e.g. pneumonia)
Nocardia is a filamentous, aerobic, gram-positive bacte are comm
4417 Medicine Infectious D Nocardiosis treatment
Intravenous of drug
choiceusers
is trimethoprim-sulfamethoxazole.
are more prone to developing
4388 Medicine Infectious D Endocarditis characteristic nodular infiltrate
Bartonella henselae and Bartonella with cavitation.
quintana
4373 Medicine Infectious D Bartonella
Infectious symptoms, and sometimes organ involvement (liver, ce
4354 Medicine Infectious D Mononucleosis Infectious
Patients withmononucleosis
influenza abruptly causes prolonged
develop fever,(fev
systemic ph
4284 Medicine Infectious D Influenza absence of risk
Legionnaires' factorscan
disease (e.g. age > 65,
present chronic
similarly medica
to other
4233 Medicine Infectious D Legionella Legionnaires'. Diagnosis canwho
Patients with pyelonephritis be confirmed
are vomiting, withofurine
olde
4169 Medicine Infectious D Urinary Tract Infection intravenous therapy. Most hospitalized patients can b
4163 Medicine Infectious D Endocarditis Mitral valve
Vertebral disease, usually
osteomyelitis usually mitral valve with
presents prolapsefever,witb
4120 Medicine Infectious D Osteomyelitis
Pneumocystis and C-reactive
develop in patientsprotein). Magnetic
with AIDS, but resonance
acute respiratoryimaging f
4115 Medicine Infectious D Pneumonia chest x-ray.
Nocardia most commonly causes pulmonary disease
4012 Medicine Infectious D Nocardiosis
Pneumocystis diagnosed
dehydrogenase,by culture and the presence
and bilateral interstitial of filamentou
infiltrates. Tri
3938 Medicine Infectious D Pneumonia Hg, alveolar-arterial gradient > 35 mm
Viridans group streptococci colonize the oral mucosa Hg, or pulse o
3928 Medicine Infectious D Endocarditis subacute
suspectedpresentation
in those withwith severalsmall-volume,
frequent, weeks of fatigue blooa
3917 Medicine Infectious D Cytomegalovirus requires
Vaccinationocular
for examination
hepatitis A isto rule out concurrent
recommended ret
for adults
3888 Medicine Infectious D HIV is
Theprevalent.
varicellaItvaccine
is also isrecommended
a live attenuated for adults who ca
virus that h
3873 Medicine Infectious D HIV attenuated virus and
There is a strong should not
association receiveinfections
between vaccination. with
3825 Medicine Infectious D Endocarditis colonoscopy to look for underlying occult
dysentery (i.e. amebic colitis). Patients typically deve malignancy
3819 Medicine Infectious D Liver Abscess metronidazole, tinidazole)
increased intracranial followed
pressure by paromomycin
(vomiting, headachest
3808 Medicine Infectious D Neurocysticercosis enhancement/edema
Malaria is a very common on brain
cause MRI).
of fever in the return
3675 Medicine Infectious D Malaria
Cutaneous Larva thrombocytopenia.
contaminated sand or soil. Symptoms include a pruri
3674 Medicine Infectious D Migrans given to erythema
Multiple speed resolution
migransand areclearance.
pathognomonic for ea
3636 Medicine Infectious D Lyme Disease be present.
Patients whoDoxycycline
receive a solid is the treatment
organ of choice.
transplant are at r
3613 Medicine Infectious D Cytomegalovirus patients who present with a systemic illness involving
3590 Medicine Infectious D Chronic Diarrhea Cryptosporidium
Acute HIV infection parvum
ofteniscauses
a majora cause of chronic d
mononucleosis-lik
3583 Medicine Infectious D HIV ulcerations and a transient
include a chronic, slow-growing, rash (oval, red, macular
nontender mass at le o
3561 Medicine Infectious D Actinomycosis Penicillin is the preferred therapy; surgery
reserved for patients with persistent clinical symptom is sometim
3475 Medicine Infectious D Urinary Tract Infection hematuria,
Leprosy is asuspicion for urinary obstruction).
chronic granulomatous disease of the sk
3425 Medicine Infectious D Leprosy with peripheral nerve involvement
Herpes zoster causes a dermatomal rash characteriz(nodular/painful ne
3422 Medicine Infectious D Herpes Zoster virus; decreased
Patients cell-mediated
with significant puncture immunity
wounds(e.g. whoolderhave an
3325 Medicine Infectious D Tetanus patients with significant
Disseminated gonococcal or infection
dirty wounds whohigh
causes have no
fever
3320 Medicine Infectious D Gonococcal Infection considered
Trichinellosis when risk factors
typically presents forwith
gonococcal infectionc
gastrointestinal
3267 Medicine Infectious D Trichinellosis (hallmark of the enterotoxin
Bacillus cereus disease). Other formsfindings
in starch include
products feve (e
3264 Medicine Infectious D Foodborne Illness
Skin And Soft Tissue within 1-6 hours. Vomiting is the primary
Erysipelas is a superficial skin infection that manifest manifestatio
3263 Medicine Infectious D Infections raised,
Proteus sharply
mirabilisdemarcated borders. The
is a urease-producing majority tha
bacterium of e
3262 Medicine Infectious D Urinary Tract Infection the
tick solubility
bite. Earlyofdisease
phosphate, dramatically
typically manifests increasing
with erythe th
3261 Medicine Infectious D Lyme Disease most
Malariacommonly causes atrioventricular
chemoprophylaxis is recommended block. for most
3259 Medicine Infectious D Malaria atovaquone-proguanil, doxycycline, or mefloquine. M
3257 Medicine Infectious D Lyme Disease Pregnant patients
syphilis should have with early localized
pretreatment Lymewith
serology disease
a non a
3256 Medicine Infectious D Syphilis treatment
by fluconazolesuccess.
for consolidation and maintenance the
3254 Medicine Infectious D Cryptococcal Infections for at least 2
Kaposi sarcoma (KS)weeks after
is aantifungal
vascular tumor therapy dueis to
started
hum
3253 Medicine Infectious D Kaposi Sarcoma will often regress if the underlying HIV
longer required. No other primary prophylaxis is routi disease is trea
3252 Medicine Infectious D HIV itraconazole.
Postexposure HIV prophylaxis with 3-drug antiretrovi
3251 Medicine Infectious D HIV individual. Therapy that
Travelers' diarrhea should be started profuse,
is prolonged, as soon as andpos wa
3249 Medicine Infectious D Cryptosporidiosis typically self-limited in otherwise healthy
Enterohemorrhagic Escherichia coli (EHEC) is a food individuals (
3248 Medicine Infectious D Acute Diarrhea
Ehrlichiosis & EHEC is suspected,
Ehrlichiosis should beempiric suspected antibiotic therapyfrom
in a patient should an
3247 Medicine Infectious D Anaplasmosis aminotransferases. Rash is uncommon,
mm is considered positive in this population. In the ab and the drug
3246 Medicine Infectious D Tuberculosis isoniazid
regimen of and pyridoxine
choice or 12 weeks of weekly
for immunocompromised rifape
patients
3245 Medicine Infectious D Meningitis show an organism
Early localized Lyme other than should
disease Streptococcus pneumoni
be suspected in
3243 Medicine Infectious D Lyme Disease because serology
Parvovirus B19 can is cause
negative an in earlysymmetric
acute disease; doxycarthrit
3172 Medicine Infectious D Parvovirus
Infectious with anti-parvovirus
Infectious mononucleosis B19 IgM. The syndrome
typically presents with is usual
prolo
3131 Medicine Infectious D Mononucleosis hemolytic anemia and thrombocytopenia up to 2-3 we
3107 Medicine Infectious D Bartonella
Pneumocystis Bright red, firm, friable, exophytic nodules
Oral trimethoprim-sulfamethoxazole is the in an HIVagi
primary
3105 Medicine Infectious D Pneumonia require cytomegalovirus
burgdorferi, prophylaxis with ganciclovir
Anaplasma phagocytophilum
3104 Medicine Infectious D Babesiosis and thrombocytopenia.
inclusions; it is treated with Diagnosis is made
ganciclovir. primarily
Herpes simplb
3103 Medicine Infectious D Cytomegalovirus acyclovir.
3068 Medicine Infectious D Endocarditis Enterococci, especially Enterococcus
Legionella pneumophila faecalis,
is an intracellular, are a co
gram-negat
3054 Medicine Infectious D Legionella Extrapulmonary
Blastomycosis issymptomsa pulmonary suchfungal
as confusion,
infectionataxia,
endem o
3037 Medicine Infectious D Blastomycosis to pulmonary
viridans groupmanifestations.
streptococci is Broad-based
commonly encountered budding y
3014 Medicine Infectious D Endocarditis biopsy of theendocarditis
Right-sided respiratory tract. should be considered in pati
3013 Medicine Infectious D Endocarditis toward methicillin-resistant Staphylococcus aureus
3012 Medicine Infectious D Endocarditis Blood
normalcultures
to slightlyfrom separate
elevated venipuncture
protein sites shou
concentration. Ear
3003 Medicine Infectious D HSV Infection until confirmatory tests return.
Rabies postexposure prophylaxis (PEP) for mammali
3002 Medicine Infectious D Rabies Available,
forms asymptomatic
at the inoculation site, animals
which canmay either be obser
ulcerate and
3000 Medicine Infectious D Sporotrichosis and lymph nodes
Blastomycosis is aare usually
fungal spared,
infection and systemic
endemic to the ce s
2999 Medicine Infectious D Blastomycosis individuals.nodosum,
erythema Cutaneous andblastomycosis
erythema multiforme.manifestsSymp as w
2998 Medicine Infectious D Coccidioidomycosis immunocompromised)
Histoplasmosis closely mimics the presentation of giv
for dissemination are often sa
2995 Medicine Infectious D Histoplasmosis endemic regions, dimorphic fungi
Mucormycosis is an invasive fungal infection most co(e.g.
2994 Medicine Infectious D Mucormycosis debridement,
mellitus). Symptoms antifungal medication
include (e.g. liposomal
acute fever, nasal conge am
2993 Medicine Infectious D Mucormycosis with tissue sampling.
Approximately 10%-20% Rhizopus is the on
of patients most common
isoniazid willc
2981 Medicine Infectious D Tuberculosis without
Among intervention.
healthy adults, acute hepatitis B virus infectio
2961 Medicine Infectious D Hepatitis B provides immunity),
patients (ocular, mucous IgG hepatitis
membrane, B core antibody,
or skin) should an
2927 Medicine Infectious D Hepatitis B as possible.
Hepatitis A virus infection commonly presents with fe
2905 Medicine Infectious D Hepatitis
InfectiousA tender
Clinical manifestationsand
hepatomegaly significantmononucleosis
of infectious elevations in tra in
2869 Medicine Infectious D Mononucleosis heterophile antibodies, while specific
Patients with febrile neutropenia should be started on for Epstein-Barr
2616 Medicine Infectious D Febrile Neutropenia
Pneumocystis antipseudomonal
Pneumocystis jirovecii agent (e.g. cefepime,
organisms meropenem,
in respiratory secreti
2304 Medicine Infectious D Pneumonia
Community Acquired with bronchoalveolar lavage.
Mycoplasma pneumoniae causes atypical pneumonia w
2296 Medicine Infectious D Pneumonia reveals
Patientsinterstitial
with HIV have infiltrate with or
a much without
higher riskaofsmall,
reactivaser
2295 Medicine Infectious D Tuberculosis weight loss, night sweats). Upper lobe cavitary lesion
In patients with fever and a cough productive of foul-s
2292 Medicine Infectious D Aspiration
ProgressivePneumonia
Multifocal antibiotic
Progressive options for anaerobic
multifocal coverage include
leukoencephalopathy met
is cause
2277 Medicine Infectious D Leukoencephalopathy subacute neurologic
generally treated withchanges
empiric oral (e.g.fluconazole.
mental status cha
Those
2274 Medicine Infectious D Esophagitis
Pneumocystis to clarify the diagnosis.
Pneumocystis pneumonia is common in patients with a
2273 Medicine Infectious D Pneumonia added for those
blood smear. Unlike with Epstein-Barr
pulse oximetry < 92%,
virus, CMVPaO2 usually<7
2270 Medicine Infectious D Cytomegalovirus heterophile
HIV-associated antibody
diarrheatest hasis negative, and CMV
many potential IgM s
causes.
2269 Medicine Infectious D Acute Diarrhea involves sending
intracellulare. the stool
Patients usually for several tests including
have nonspecific symp
2268 Medicine Infectious D HIV
Community Acquired blood culture or bone marrow aspirate; treatment with
2267 Medicine Infectious D Pneumonia Patients
Syphilis is with HIV are with
diagnosed at increased
a combination risk of of
community-
nontrepon
2265 Medicine Infectious D Syphilis (> 97%) in patients with primary syphilis.
Toxoplasmosis causes headache, fever, focal neurol
2264 Medicine Infectious D Toxoplasmosis
Rocky Mountain ring-enhancing
Rocky Mountainlesions.spottedTreatment is with sulfadiazine
fever is a tick-borne illness c
2263 Medicine Infectious D Spotted Fever rash
Patients with malnutrition, pregnancy, or certainempir
that may involve the palms/soles. Without com
2262 Medicine Infectious D Tuberculosis tuberculosis ascending
obstruction; with isoniazid (INH).organisms
coliform This helpssuch prevent
as I
2239 Medicine Infectious D Epididymitis infections with Chlamydia
In the absence of identifiable trachomatis
bacteriaor on culture or G
2236 Medicine Infectious D Urethritis amplification testing confirms the
mucosa. The diagnosis is based primarily on examinadiagnosis.
17493 Medicine Male ReprodLichen Planus limited and typically
Acute bacterial resolves
prostatitis within
usually 2 years. with a flu
manifests
15936 Medicine Male ReprodProstatitis tenderness and swelling.
Klinefelter syndrome (47,XXY) is characterized by a e
12376 Medicine Male ReprodKlinefelter Syndrome seminiferous
Absent sperm concentration withazoospermia,
tubule dysgenesis, normal FSH, LH, hypog
an
8952 Medicine Male ReprodInfertility obstructive azoospermia, is highly
Management of acute retention includes bladder dec associated with cy
4232 Medicine Male ReprodUrinary Retention
Male Sexual reductase inhibitorsfor
First-line treatment (e.g. finasteride),
erectile dysfunctionand possibly
in diabetic su
4191 Medicine Male ReprodDysfunction
Male Sexual in patients
Erectile who are taking
dysfunction is common α blockers or nitrates.
in patients with cardio
4161 Medicine Male ReprodDysfunction contraindicated in patients taking
Priapism refers to an unwanted, persistent, and nitrates or α blocke
often
3916 Medicine Male ReprodPriapism
Male Sexual sickle cell disease, perineal trauma)
Persistence of nocturnal and early-morning penile ere may precipitate p
3860 Medicine Male ReprodDysfunction
Benign Prostatic vascular and lower
Patients with nerve urinary
functiontract in the penis. (e.g. urina
symptoms
3481 Medicine Male ReprodHyperplasia
Benign Prostatic also be obtained
The preferred in symptomatic
initial treatment forpatients to assess
uncomplicated benth
3477 Medicine Male ReprodHyperplasia an alternative or in addition to α blockers but have a m
3369 Medicine Male ReprodAndrogenic Steroids Anabolic steroid
pronounced use by
systemic a man can
symptoms produce
(e.g. fever, infertility
chills, ac
2246 Medicine Male ReprodProstatitis pathogen.
Chronic prostatitis/chronic pelvic pain syndrome is a
2238 Medicine Male ReprodProstatitis genital pain;
Failure modeand andpain or blood
effects analysis on ejaculation.
(FMEA) is aUrine prospc
19553 Medicine MiscellaneouPatient Safety may arise, with the goal of ensuring
Central herniation occurs when the diencephalon and safe outcomes. F
20496 Medicine Nervous SysBrain Herniation brainstem, whichwith
Patients treated results in Cushing
multiple triad, unconsciou
anticholinergic medicati
20443 Medicine Nervous SysAnticholinergics findings not typical of acute anticholinergic
Patients with intracerebral hemorrhage can have rap toxicity. R
20194 Medicine Nervous SysHemorrhagic Stroke Breathing,
marked by Circulation) should be reassessed
subacute, progressive headache, vomitingbecaus
19821 Medicine Nervous SysCryptococcal
Guillain-BarréInfections protein elevation,
Guillain-Barré and lowpresents
syndrome glucose.with rapidly progre
19805 Medicine Nervous SysSyndrome peripheral
Transversenerves,
myelitisMRI is anof immune-mediated
the spinal cord is often nor
disorder
19740 Medicine Nervous SysTransverse Myelitis sensory
Transverse disturbances
myelitis is (characterized
an immune-mediated, by a distinct
rapidlysenp
19736 Medicine Nervous SysTransverse Myelitis spinal cord onphysiologic
An enhanced MRI. First-line tremormanagement
is typicallyisa thefine,adm
fas
19547 Medicine Nervous SysTremor reuptake inhibitors, β-agonists) can
Essential tremor most often presents as an action tre cause enhanced
19545 Medicine Nervous SysTremor
Guillain-Barré effects due to peripheral
Guillain-Barré syndrome β-adrenergic receptor blocka
(GBS), an immune-mediate
19489 Medicine Nervous SysSyndrome is the same as
Tuberculous non-HIV-associated
meningitis is typically marked GBS; nerve cond
by subacu
19421 Medicine Nervous SysTuberculosis enhancement, hydrocephalus,
Tuberculous meningitis is generally and stroke
marked dueby to vas
subac
19419 Medicine Nervous SysTuberculosis lymphocytosis, moderate increase in white blood cell
L5 radiculopathy often presents with low back pain th
19325 Medicine Nervous SysRadiculopathy extension
Radiculopathiesand foot dorsiflexion,
result in deficitsinversion,
that affectand parteversi
of an
19323 Medicine Nervous SysRadiculopathy deficits from the forearm to the fourth
Progressive sensory loss in a distal, symmetric, stock and fifth fingers
19267 Medicine Nervous SysPeripheral Neuropathy
Amyotrophic Lateral toxin or medication
Amyotrophic lateral such as metronidazole.
sclerosis can present with bulbar
19242 Medicine Nervous SysSclerosis
Amyotrophic Lateral and lower motor neuron
Amyotrophic lateral sclerosis leads signs (e.g. to tongue fasciculato
degeneration
Amyotrophic Lateral signs. Electrodiagnostic
Amyotrophic lateral sclerosis studies canoftencause show character
respiratory in
19212 Medicine Nervous SysSclerosis life.
18962 Medicine Nervous SysMedian Nerve Injury Because the median nerve lies directly adjacent to th
18895 Medicine Nervous SysDiaphragmatic Paralysis Botulism
Polyarteritis presents
nodosa with symmetric,
often descending motor
causes mononeuritis multip
18608 Medicine Nervous SysPolyarteritis Nodosa manifestations; the lungs are generally
Giant cell arteritis is characterized by new headache spared.
18576 Medicine Nervous SysGiant Cell
SubarachnoidArteritis obtained
Subarachnoid with temporal
hemorrhage artery biopsy; however,
classically presents to withreda
18570 Medicine Nervous SysHemorrhage head.
AutonomicCharacteristic
dysfunction findings
is commoninclude an Parkinson
with elevated ope dis
18528 Medicine Nervous SysParkinson
SubarachnoidDisease disorder cranial
Isolated is typicallynerve recognized
palsies can by bea >suggestive
20 mm Hgof dro
a
18517 Medicine Nervous SysHemorrhage indicate
HIV an aneurysm
neuropathy of thesymmetrical
is a distal, posterior communicating
polyneuropat
Temporomandibular controlled HIV are at greatest risk.
Temporomandibular joint disorder can present with Antiretroviral treath
18480 Medicine Nervous SysDisorders as well as pain, crepitus, and/or
neck pain, shoulder/arm pain, weakness, paresthesia audible clicks from th
18469 Medicine Nervous SysRadiculopathy
Subarachnoid and therapeutic.
Subarachnoid hemorrhage (SAH) results in sudden-o
18417 Medicine Nervous SysHemorrhage urgent noncontrast
delayed speech, and CTincoordination
scan of the head; if results
are also common are
18412 Medicine Nervous SysConcussion they
Crossedremain asymptomatic,
signs (e.g. ptosis, impairedpotentially returning
pupil to ful
constriction
18335 Medicine Nervous SysIschemic Stroke results in Weber
diaphoresis, and syndrome,
nausea. More which is characterized
severe cases are ma by
18287 Medicine Nervous SysAlcohol Withdrawal
Demyelinating benzodiazepines,
Chronic inflammatory which dampen CNS
demyelinating excitation.
polyneuropathy
17500 Medicine Nervous SysPolyneuropathy proximal and distal muscles,
Vertigo accompanied by loss sometimes
of sensationwith over distal
the seip
17492 Medicine Nervous SysIschemic Stroke dissection after minor neck trauma.
accompanied by aura (focal, reversible neurologic sy
17490 Medicine Nervous SysMigraine with aura due
Dystonias are to the increased
involuntary muscle riskcontractions
of ischemic that stroke of
17119 Medicine Nervous SysDystonia occur as extrapyramidal symptoms
Vascular air embolism can occur due to decompress of a high-potency
17007 Medicine Nervous SysAir Embolism shock,
Myotonic whereas
dystrophy arterial
is anairautosomal
embolismdominant can causedisord conf
16818 Medicine Nervous SysMyotonic Dystrophy
Benign Paroxysmal adulthood
Benign with facialpositional
paroxysmal and distalvertigomuscle weakness
causes brief and(<
16583 Medicine Nervous SysPositional Vertigo maneuvers
spinal (e.g. Dix-Hallpike)
cord segments, leading is to diagnostic.
a rapidly progressiv
16473 Medicine Nervous SysTransverse Myelitis distinct sensory
Sarcoidosis is a level.
systemic granulomatous disorder tha
16472 Medicine Nervous SysSarcoidosis include lymphadenopathy,
Long-term (> 5 years) metformin hypercalcemia,
therapy can andcause
parotiv
16313 Medicine Nervous SysVitamin B12 Deficiency Although
fluconazole) megaloblastic
or that displace anemia is oftenfrom
phenytoin seen,plasma
a minop
16291 Medicine Nervous SysAntiepileptics nystagmus,
the acute form ataxia, and nausea/vomiting,
(myoclonus status epilepticus and[MSE])
signific
16265 Medicine Nervous SysAnoxic Brain Injury limb, and facial muscles.
Blepharospasm is a form Prolonged
of focal dystonia MSE ischaracteri
a marker
16229 Medicine Nervous SysDystonia skin around the
Postherpetic eye may
neuralgia is terminate
characterized the spasm.
by burning Mildpa c
16204 Medicine Nervous SysHerpes Zoster or severe neuropathy
Alcoholic rash. First-line is atreatment includesthat
toxic neuropathy anticonv
typica
Guillain-Barré ataxia. Loss of distal deep tendon
Miller-Fisher syndrome (MFS) is a variant of Guillain- reflexes (e.g. ankle
16196 Medicine Nervous SysSyndrome
Cervical Artery ophthalmoplegia,
Internal carotid artery ataxia, and areflexia;
dissection strength
is a common is oft
cause
16169 Medicine Nervous SysDissection syndrome
headaches,(ptosis and miosis without
nausea/vomiting, anhidrosis),
and confusion. In a unil
min
16124 Medicine Nervous SysCryptococcal Infections generally made using lumbar puncture
Non-pupil-sparing oculomotor nerve (CN III) palsies a with CSF ana
16119 Medicine Nervous SysCranial Nerve Palsy are
Spinalmost commonly
epidural abscess, caused by microvascular
a bacterial infection of ischem
the e
16085 Medicine Nervous SysEpidural Abscess fever,
The initial workup of suspected dementia should neur
malaise, focal back pain, and progressive inclu
16082 Medicine Nervous SysAlzheimer Disease metabolic panel, TSH, vitamin B12), and neuroimagin
thoracic levels). Patients generally develop acute bla
16079 Medicine Nervous SysAnterior Cord Syndrome touch
risk forsensation
cognitive are generallywhich
impairment, preserved because athe
may produce m
16032 Medicine Nervous SysAlzheimer Disease
Normal Pressure complex medication regimen with
Normal pressure hydrocephalus is a potentially rever new-onset or worse
15951 Medicine Nervous SysHydrocephalus ventriculomegaly
Prosthetic valve thrombosisout of proportion(PVT) to is athe sulci. comp
potential
15833 Medicine Nervous SysMechanical Valve (stenosis)
Huntingtonordisease regurgitation, or a thromboembolic
is an autosomal dominant diseas even
15787 Medicine Nervous SysHuntington Disease with preferential
Vascular dementia degeneration
(VaD) is caused of GABA-producing
by large or small ne
15783 Medicine Nervous SysVascular Dementia should
Multipleundergo
sclerosisneuroimaging to evaluate demyelinat
is an immune-mediated for cerebro
15402 Medicine Nervous SysMultiple Sclerosis D
REMdeficiency, geographic
sleep behavior location,
disorder (RBD) genetic predisposi
is characterized
15146 Medicine Nervous SysREM Behavior Disorder neurodegeneration,
Cervical spondylotic most commonly
myelopathy Parkinson
is common diseaa
in older
14697 Medicine Nervous SysCervical
MedicationMyelopathy
Overuse weakness,
disorder. Commondiminished reflexes),
features includeandheadache
upper motor thatneuis
14457 Medicine Nervous SysHeadache medication.
benzodiazepines (e.g. lorazepam, diazepam) should
14370 Medicine Nervous SysSeizures
Wernicke-Korsakoff seizure
associated recurrence; recommended
with long-standing alcohol medications
abuse; howeve includ
14369 Medicine Nervous SysSyndrome thiamine.
Bell palsy is a peripheral neuropathy of the facial nerv
14333 Medicine Nervous SysBell Palsy Lateral
Amyotrophic reactivation
and lower motor of neurotrophic
neurons (e.g. viruses
cranial(e.g. herpes
nerves, simp
spinal
Carbon Monoxide Examination shows both upper motor
and usage of oxygen, leading to clinical manifestation neuron and low
14195 Medicine Nervous SysPoisoning permanent hypoxicnerve
Bell palsy (cranial brainVII injury canpresents
palsy) occur. with acut
14156 Medicine Nervous SysBell Palsy Therapy is with glucocorticoids,
from underlying cervical spondylosis. and some studies
Patients rec
usually
13878 Medicine Nervous SysCervical Spondylosis extremity dermatome.
Chronic, excessive noiseMRIexposure
of the cervical
can lead spine is the
to senso
13790 Medicine Nervous SysHearing Loss high-risk occupations
Major depressive (e.g. may
disorder manufacturing,
occur in uptransporta
to 20% of
12486 Medicine Nervous SysParkinson Disease PD, the presence of depressed mood,
constipation. It can lead to hypertension, nephropath anhedonia, ho
12396 Medicine Nervous SysLead Poisoning involves chelation
constipation. It cantherapy
lead to with an agent such
hypertension, as calc
nephropath
12395 Medicine Nervous SysLead Poisoning
Subclavian Steal history including
asymptomatic butpotential
may have sources
symptoms of lead of exposure.
upper extre
Tricyclic worsened by upper extremity exercise.
Amitriptyline is commonly used for depression, insom
12302 Medicine Nervous SysAntidepressants symptoms
Tetanus is (e.g. dry mouth,
a presynaptic constipation, junction
neuromuscular urinary retendiso
12265 Medicine Nervous SysTetanus synaptic cleft, leading to fever, painful
avoiding unnecessary medications, treating infections muscle spasm
12248 Medicine Nervous SysDelirium
Cerebellar patients
Alcoholicrecover
cerebellar more quickly.
degeneration is caused by dama
12247 Medicine Nervous SysDegeneration difficulties, including wide-based gait and postural ins
12246 Medicine Nervous SysAlzheimer Disease Neurocognitive
Common fibulartesting
neuropathy shouldis be obtained
typically the in patients
result of le
12243 Medicine Nervous SysFootdrop sensory changes
Tension-type over thecan
headaches dorsal
occur footdueandtolateral
stress shin
and
12241 Medicine Nervous SysTension
Increased Intracranial Headaches that are new or differ in character frommo
Headache treated with analgesics (e.g. ibuprofen), but when pr
12228 Medicine Nervous SysPressure concerning
Central vertigo presents with nonfatigable nystagmuss
for a pathological cause. These patients
12215 Medicine Nervous SysVertigo in patients
Patients withwho have
large or persistent,
embolic ischemicnew-onset central
strokes andve t
12214 Medicine Nervous SysHemorrhagic Stroke
Transient Ischemic stroke
Neurological deficits related to an acute demyelinatins
and often manifests with deteriorating mental
12180 Medicine Nervous SysAttack hours. The initial treatment
Late neurosyphilis can manifest of TIA is modifying
years risk fa
after untreated
12125 Medicine Nervous SysSyphilis Argyll-Robertson
Foodborne botulism pupils
is a(normal
potentiallypupillary constriction
life-threatening ill
12120 Medicine Nervous SysBotulism Symptoms typically occur within 36
Phenytoin is an antiepileptic drug with known teratog hours of ingestion
12044 Medicine Nervous SysSeizures discontinue
The diagnosis phenytoin if considering
of myasthenia gravis can becoming pregn
be supported
12028 Medicine Nervous SysMyasthenia Gravis ptosis. Patients with positive test results should unde
11996 Medicine Nervous SysHearing Loss Presbycusis is common
The initial diagnostic in theofelderly
workup and presents
a first-time seizure inw
11982 Medicine Nervous SysSeizures
Post-Concussion liver function
headache, tests) and
confusion, a toxicology
amnesia, screen
difficulty to evalua
concentratin
11557 Medicine Nervous SysSyndrome treatment
Intravenous within a few weeks
antibiotics decrease to months
the riskfollowing
of septic TB em
10972 Medicine Nervous SysIschemic Stroke valvular dysfunction, persistent/difficult to treat infecti
Asterixis is a flapping movement of the hands that oc
10776 Medicine Nervous SysAcute Kidney Injury encephalopathy,
subacute combined anddegeneration).
hypercapnia. Treating
A vitaminthe B12 unde
lev
10499 Medicine Nervous SysVitamin B12 Deficiency cases.
Chemotherapy-induced peripheral neuropathy typica
10477 Medicine Nervous SysPeripheral Neuropathy include
Vascularplatinum-based
dementia presents medications,
as a suddentaxanes, and vin
or stepwise
10448 Medicine Nervous SysVascular Dementia findings
Vascularon examination
dementia (e.g.presents
typically hemiparesis, pronator
as a sudden ord
10348 Medicine Nervous SysVascular Dementia
Acute Intermittent examination,
pain, peripheral andneuropathy
neuroimaging withclassically
proximal muscledemonstra we
6913 Medicine Nervous SysPorphyria porphyrin levels confirm the diagnosis.
mater and skull. CT scan of the head typically reveals
4923 Medicine Nervous SysEpidural Hematoma evacuation.
Embolic strokes usually have sudden onset with max
4921 Medicine Nervous SysIschemic Stroke fibrillation, endocarditis). Patients with atrial fibrillation
4914 Medicine Nervous SysTremor First-line
Essential treatment for essential tremor
tremor is characterized by a fineis propranolo
tremor tha
4913 Medicine Nervous SysTremor
Idiopathic Intracranial but is highly variable and may affect
Papilledema is caused by increased intracranial any part of the
presb
4900 Medicine Nervous SysHypertension
Increased Intracranial evaluation
The symptoms (e.g.of ophthalmologic examination,
intracranial hypertension neuroim
include he
4708 Medicine Nervous SysPressure examination.
Heat stroke isCushing reflex (hypertension,
characterized by core temperature bradycard>4
4703 Medicine Nervous SysHeat Related Illness while performing
immediately extreme activities.
on noncontrast CT as whiteComplications
hyperdense inc
4702 Medicine Nervous SysHemorrhagic Stroke event.
Wernicke encephalopathy is due to thiamine (vitamin
4700 Medicine Nervous SysDelirium
Spinal Cord ocular
Neoplasticdysfunction,
epidural and gait
spinal ataxia.
cord Patients should
compression presents b
4691 Medicine Nervous SysCompression
Restless Legs late
worse findings. In the acute phase
in the evening/night. of spinal
Treatment cord injury,
includes iron s
4687 Medicine Nervous SysSyndrome δ calcium channel ligands (e.g. gabapentin).
Thrombolytic therapy (e.g. intravenous alteplase) imp
4657 Medicine Nervous SysIschemic Stroke
Normal Pressure thrombolytics
Normal pressure are hydrocephalus
administered, aisnoncontrast
characterized headby Cg
4651 Medicine Nervous SysHydrocephalus result from decreased CSF absorption
Common precipitating causes of delirium include infe with increased
4644 Medicine Nervous SysDelirium disturbances.
Acute exacerbations of multiple sclerosis should be tr
4641 Medicine Nervous SysMultiple Sclerosis glucocorticoids.
Toxic-metabolic and infectious etiologies are the mos
4622 Medicine Nervous SysDelirium in the hospital.
Alzheimer Typical
disease, the and
mostatypical
common antipsychotics
type of demen are
Dementia With Levy bodies, frontotemporal dementia, and vascular deme
4619 Medicine Nervous SysBodies
Cerebellar Dementia
Cerebellarwith Lewy bodies
dysfunction causesamong
is common cognitive fluctuat
chronic alc
4618 Medicine Nervous SysDegeneration tremor.
The 3 cardinal signs of Parkinson disease are rest tre
4563 Medicine Nervous SysParkinson Disease this
2 disease.
most commonly isolated organisms. Headache, fev
4513 Medicine Nervous SysBrain Abscess lesion with central
vegetations, leading necrosis.
to cerebral ischemic infarction, c
4483 Medicine Nervous SysSeptic Emboli glomerulonephritis.
Lacunar strokes occur due to microatheroma formatio
Guillain-Barré hemiparesis.
Guillain-BarréHypertension,
syndrome is an hyperlipidemia,
acute or subacute diabetes,
asc
4465 Medicine Nervous SysSyndrome dissociation).
that typically presents with fluctuating and fatigable e
4464 Medicine Nervous SysMyasthenia Gravis of the neck
obvious and extremities
corneal trauma. Patients(uppertypically
more than lower).
develop se
4461 Medicine Nervous SysInfectious Keratitis
Benign Paroxysmal suggests trigeminal nerve dysfunction
Benign paroxysmal positional vertigo causes brief (< as the ophthal
4457 Medicine Nervous SysPositional Vertigo intermittent
extremities. arrhythmia)
There is no is usually
muscle due to global
inflammation orcereb
tende
4443 Medicine Nervous SysGiant Cell Arteritis once the offending medication is discontinued.
Unilateral foot drop is characterized by a 'steppage' g
4427 Medicine Nervous SysPeroneal Neuropathy neuropathy.
Ischemic oculomotor (CN III) palsy is commonly asso
4408 Medicine Nervous SysCranial Nerve Palsy more peripheralManifestations
spontaneously. parasympathetic fibers.the
include This manifes
sudden on
4401 Medicine Nervous SysParkinson Disease patients with acute ACG can develop
Resting tremor is often the presenting symptom of Pa permanent visio
4400 Medicine Nervous SysParkinson Disease tongue,
Torticollis andis alips.
common form of focal dystonia involvin
4399 Medicine Nervous SysDystonia agent(s) may improve
Vasovagal (neurocardiogenic) symptoms. syncope occurs due to
4397 Medicine Nervous SysSyncope of nausea, diaphoresis, and pallor.
Elderly patients are at higher risk for subdural hemato
4394 Medicine Nervous SysSubdural Hematoma injury with headache, somnolence, confusion, and fo
Hypokalemia is a common electrolyte abnormality tha
4393 Medicine Nervous SysHypokalemia
Cauda Equina waves,
are dueflat and broad
to epidural T waves,
tumor and premature
or abscess or inflammationventri
Spinal Cord activity in the
Spinal cord lower extremities,
compression bowel/bladder/sexua
is characterized by signs an
4391 Medicine Nervous SysCompression extensor plantar response. Cord compression
Pronator drift is a relatively sensitive and specific is asign
me
4381 Medicine Nervous SysMultiple Sclerosis the arms
Spinal with the
epidural palms may
abscess up and eyes closed.
present with fever,In patie
foca
4372 Medicine Nervous SysEpidural Abscess spectrum intravenous antibiotics
eye pain, nausea, and decreased visual acuity. Exam and prompt drainag
4367 Medicine Nervous SysGlaucoma diagnosis
Parkinsonism is confirmed
is causedbybygonioscopy
overactivityand/or tonome
of cholinergic
4322 Medicine Nervous SysParkinson Disease chasing
Patients his withcenter of gravity)mass
an intracranial is characteristic
often have headac of the d
4311 Medicine Nervous SysBrain Tumors positioning that increases
changes. Symptomatic intracranial
patients pressure.
(i.e. transient An M
ischem
4287 Medicine Nervous SysCarotid Artery Stenosis
Brown-Séquard Hemi considered
Hemisectionfor ofcarotid
the spinal endarterectomy
cord can cause to reduce
Brown-Séq futu
4274 Medicine Nervous SysCord Syndrome and light touch
ipsilateral face andat the level of thebody,
contralateral spinalipsilateral
cord injury an
bulb
4269 Medicine Nervous SysIschemic Stroke body is typically
internal capsule.spared. Lacunar infarcts are most commonly
4268 Medicine Nervous SysIschemic Stroke cerebral arteries.
4255 Medicine Nervous SysCraniopharyngiomas Craniopharyngiomas
Cluster headaches usually are benign
present suprasellar
with acute, tumors
unilatet
4253 Medicine Nervous SysCluster Headache rhinorrhea, and ipsilateral ptosis
Hemineglect syndrome is characterized by ignoring oand miosis.
4206 Medicine Nervous SysIschemic Stroke handed individuals).
upper extremity sensory, motor, and/or reflex abnorm
4205 Medicine Nervous SysCervical Spondylosis osteophytes.
Lacunar stroke of the posterolateral thalamus typicall
4203 Medicine Nervous SysIschemic Stroke later, patients
Essential tremor canmost develop
oftenthalamic
presentspain as asyndrome,
tremor of tc
4179 Medicine Nervous SysTremor movements.
The ulnar nerve It isisoften hereditary
vulnerable and can
to injury wherebe itassocia
runs p
4170 Medicine Nervous SysUlnar Nerve Neuropathy and weakness of intrinsic hand muscles.
Brain death is a clinical diagnosis. The characteristic
4159 Medicine Nervous SysBrain Death be present. fluid findings are lymphocytic pleocytos
cerebrospinal
4139 Medicine Nervous SysHSV Infection diagnosis.
4130 Medicine Nervous SysMultiple System Atrophy Always
Recent consider
studies have multiple systemthat
suggested atrophy
a brainwhen thatahas
pati
4089 Medicine Nervous SysSeizures laminar
Surgicalnecrosis
resectionisisthe hallmark of prolonged
recommended for solitaryseizure
brain
4072 Medicine Nervous SysBrain Tumors whole brain radiation therapy is typically
Depression-related cognitive impairment may be so s used.
4060 Medicine Nervous SysDepression choice for elderly
A detailed history patients with depression
and neurologic examination andoffreque
a pa
4022 Medicine Nervous SysIschemic Stroke is characterized
Huntington disease by contralateral
(HD) presents motor
with or sensory de
psychiatric sy
3954 Medicine Nervous SysHuntington Disease expansion disorder with no known disease-modifying
3935 Medicine Nervous SysCluster
Normal Headache
Pressure Providing
Normal 100% oxygen
pressure by facemask
hydrocephalus is an effective
is characterized by ta
3923 Medicine Nervous SysHydrocephalus demonstrates enlargement of the
In older patients, cognitive impairment caused by depventricles out of pro
3919 Medicine Nervous SysDepression depression
weakness. Most and usually
patientsimproves with treatment
with acetylcholine of th
receptor
3891 Medicine Nervous SysMyasthenia Gravis imaging.
Lambert-Eaton Hypertension
Lambert-Eatonincreases myasthenic the syndrome
risk of stroke more thanasa
is frequently
3837 Medicine Nervous SysMyasthenic Syndrome gated calcium
Myasthenic channels
crisis in the presynaptic
is a life-threatening motor nerv
complication of
3809 Medicine Nervous SysMyasthenia Gravis preceded by increasing generalized
Management options for acute pain (including opioids or bulbar muscle
3804 Medicine Nervous SysAcute Pain
Amyotrophic Lateral opioid analgesics
Amyotrophic lateral may need close
sclerosis presentsfollow-up careuppe
with both to a
3771 Medicine Nervous SysSclerosis edaravone
Dominant frontal (an antioxidant),
lobe lesionswhich improves
can cause survival (
expressive
Acute Intracerebral involvement
Patients whoofdevelop the supplementary
serious bleeding motor(e.g.cortex.
intracere
3737 Medicine Nervous SysHemorrhage intravenous
The basal ganglia (putamen) is a common site ofconc
vitamin K and prothrombin complex hyp
3728 Medicine Nervous SysHemorrhagic Stroke leading to contralateral hemiparesis,
The management of myasthenic crisis with respirator contralateral sen
3727 Medicine Nervous SysMyasthenia Gravis corticosteroids.
ipsilateral hemiataxia. There is usually no hemiparesi
3726 Medicine Nervous SysAcute Cerebellar Ataxia saving.
loss of pain/temperature sensation but not vibratory/p
3724 Medicine Nervous SysSyringomyelia extremities.
Intracranial hemorrhage classically presents with acu
3723 Medicine Nervous SysHemorrhagic Stroke intracranial
myasthenic pressure
sneer), and (e.g. headache,
proximal (e.g.vomiting,
difficulty altere
holdin
3722 Medicine Nervous SysMyasthenia Gravis choice.
Parkinson disease (PD) should be suspected in patie
3718 Medicine Nervous SysParkinson Disease Trihexyphenidyl is an anticholinergic medication som
3715 Medicine Nervous SysParkinson Disease Medications
Aspirin is theused only in the treatment
antiplatelet agentofthat
Parkinson
is effectivediseain
3712 Medicine Nervous SysIschemic Stroke stroke. Aspirin plus dipyridamole OR
When multiple sclerosis is suspected but clinical exam clopidogrel is re
3644 Medicine Nervous SysMultiple Sclerosis bands in 85%-95%
considered in patients of patients. Opening pressure,
who are refractory to corticoste pr
3643 Medicine Nervous SysMultiple Sclerosis
Idiopathic Intracranial secondary,
for patients progressive
refractory to forms medical of multiple
therapy. sclerosis.
Corticoster
3637 Medicine Nervous SysHypertension therapies for patients awaiting definitive
Huntington disease (HD) presents with psychiatric surgical treat
sy
3631 Medicine Nervous SysHuntington
Subarachnoid Disease associated with preferential atrophy
Nontraumatic subarachnoid hemorrhage is most com of the caudate nu
3622 Medicine Nervous SysHemorrhage irritation
Migraine(e.g.should nuchal rigidity, photophobia,
be suspected in patients with nausea).
unilateN
3619 Medicine Nervous SysMigraine
Spinal Cord have frequent
Acute spinal cord attacks or disabling
compression cansymptoms
present with thatlossdo
3560 Medicine Nervous SysCompression neuroimaging,
Cerebral amyloid andangiopathy
possibly intravenous
is the most glucocorticoi
common ca
3537 Medicine Nervous SysHemorrhagic Stroke walls of small- to medium-size cerebral
diagnosis. The most common etiology is retinal ische arteries and i
3528 Medicine Nervous SysAmaurosis Fugax receive
Trigeminal a duplex
neuralgia ultrasound of the neck.
is characterized by recurrent an
3462 Medicine Nervous SysMultiple Sclerosis sclerosis should be suspected when trigeminal neura
3461 Medicine Nervous SysTrigeminal Neuralgia Carbamazepine
Trigeminal neuralgia can be used to treat trigeminal
is characterized by recurrent neura
se
3460 Medicine Nervous SysTrigeminal Neuralgia stimuli. This condition is usually treated
When multiple sclerosis is suspected, magnetic reson with carbama
3446 Medicine Nervous SysMultiple Sclerosis subcortical white matter
Multiple sclerosis shouldlesions
be suspectedlocatedininyoung
periventric
wom
3431 Medicine Nervous SysMultiple Sclerosis painful
Creutzfeldt-Jakob disease is characterized by rapidlym
eye movement) and transverse myelitis (e.g.
3374 Medicine Nervous SysPrion Disease encephalopathy
Cholinesterase inhibitors is causedsuch by aas prion. Most patients
donepezil, rivastigm d
3373 Medicine Nervous SysAlzheimer
CavernousDisease
Sinus Alzheimer
Because the disease; however, these
facial/ophthalmic venous medications
system is have valv
3327 Medicine Nervous SysThrombosis bilateral
Anterior cord syndrome usually occurs when there isV
periorbital edema; and cranial nerve III, IV,
3300 Medicine Nervous SysAnterior Cord Syndrome with diminished pain and temperature sensation bilat
3299 Medicine Nervous SysTraumatic Brain Injury CT scan of a diffuse
Fibromyalgia is a pain axonal
syndromeinjurythatshows numerous
occurs most com
3205 Medicine Nervous SysFibromyalgia Amitriptyline
Giant is an (GCA,
cell arteritis effective or initial
temporal therapy. Pregabalin
arteritis) presen
3164 Medicine Nervous SysGiant Cell Intracranial
Idiopathic Arteritis optic neuropathy,
Idiopathic intracranial which can lead to typically
hypertension blindness. Threa
presents
3162 Medicine Nervous SysWernicke-Korsakoff
Hypertension lumbar puncture
Thiamine deficiency showing elevated
can cause opening
Wernicke pressure
encephalop
3082 Medicine Nervous SysSyndrome patients
Alzheimer disease, the most common causeand
(e.g. anorexia, chronic alcohol use) of dememay
3074 Medicine Nervous SysAlzheimer Disease develop
Hypertensivelater in the course hemorrhages
intracerebral of the disease.occur most
3060 Medicine Nervous SysHemorrhagic Stroke progress
Alzheimertodiseasesigns ofinitially
elevated intracranial
presents pressure.
with memory impB
Idiopathic Intracranial medial temporal
neuroimaging andlobes.
elevated CSF pressure. The treatm
3044 Medicine Nervous SysHypertension blindness.
Creutzfeldt-Jakob disease should be suspected in old
2990 Medicine Nervous SysPrion Disease electroencephalogram,
Wilson disease presentsand/or elevatedneurologic,
with hepatic, 14-3-3 protei and
2938 Medicine Nervous SysWilson Disease rings on slit-lamp examination.
2861 Medicine Nervous SysRetinal Artery Occlusion Central retinalisartery
Optic neuritis usually occlusion is a monocular
characterized by the acute painleson
2856 Medicine Nervous SysOptic Neuritis movement. There is a strong association between op
2837 Medicine Nervous SysAminoglycoside
Spinal Cord Aminoglycosides
ankle reflexes; motor can findings
be ototoxic maytobe both the manifest
a late cochlea
2679 Medicine Nervous SysCompression
Subarachnoid suggestive
Vasospasmofisan theupper
majormotorcauseneuron process.
of delayed morbidity a
2678 Medicine Nervous SysHemorrhage nimodipine.
2677 Medicine Nervous SysMultiple Sclerosis A multiple sclerosis plaque in the upper thoracic spin
Amyotrophic Lateral
2674 Medicine Nervous SysSclerosis Amyotrophic
peripheral lesions lateral(e.g.
sclerosis (ALS)cause
Bell palsy) is characterized
weakness th b
2673 Medicine Nervous SysBell Palsy sensation
include theover basal theganglia
anterior tongue. cerebellar nucle
(putamen),
2672 Medicine Nervous SysHemorrhagic Stroke of the adjacent
intracranial internal capsule.
or subarachnoid bleed) that might require
2671 Medicine Nervous SysSeizures the neuroimaging modality
proximal (e.g. difficulty rising from of choice in elective
sitting), ocularsituat
(e.g
2667 Medicine Nervous SysMyasthenia Gravis developing the disease.
are highly specific. Those with an established diagno
2634 Medicine Nervous SysMyasthenia Gravis thymectomy
Mild to moderate is associated with long-term
cancer-related pain can clinical
usuallyimpr be
2621 Medicine Nervous SysChronic Pain should be offered. If the pain requires
Lung cancer is the most common neoplasm to metas frequent dosing
2620 Medicine Nervous SysBrain Tumors typically
exacerbationreveals of legmultiple,
symptoms well-circumscribed
with walking (similar lesionstow
2316 Medicine Nervous SysSpinal Stenosis
Guillain-Barré relieved by flexion
gastrointestinal of the (especially
infection spine. Diagnosis is made ba
Campylobacter je
2290 Medicine Nervous SysSyndrome plasmapheresis.
Tick-borne paralysis is characterized by rapidly progr
2289 Medicine Nervous SysTick Paralysis examination.
unable to adduct Ticks must
and thefeed for 4-7 days
contralateral eye and are ty
abducts w
2285 Medicine Nervous SysMultiple Sclerosis
Frontotemporal classically
The seenvariant
behavioral in multiple sclerosis.
of frontotemporal dementia (F
2281 Medicine Nervous SysDementia develop later
Patients in the disease
with advanced AIDScourse. FTD has an
are at increased early
risk fo
2276 Medicine Nervous SysCNS Lymphoma oncogenes, which can often be identified
Anterior uveitis often occurs in association with syste in the cereb
19495 Medicine OphthalmoloAnkylosing Spondylitis ankylosing
Open-anglespondylitis
glaucoma (e.g. can be chronic
treated backwithpain, enthes
topical age
18671 Medicine OphthalmoloGlaucoma which increases drainage of aqueous
volume leads to a hyperosmolar state on the surface humor in the an
17227 Medicine OphthalmoloSjögren Syndrome infection,
the adjacent corneal ulceration,
conjunctiva mayand alsocorneal perforation.
be inflamed. Comm
17171 Medicine OphthalmoloBlepharitis infestation.
hazy 'flare' in the aqueous humor, and hypopyon. An
13351 Medicine OphthalmoloUveitis infections, sarcoidosis, spondyloarthritis,
Contact lens-associated infectious keratitis and is inflamm
a medic
8926 Medicine OphthalmoloInfectious Keratitis organisms but can also be due to Gram-positive
Viral conjunctivitis is a self-limited condition associate orga
8925 Medicine OphthalmoloConjunctivitis caregivers in late summer
Macular degeneration is theandmostearly fall. Nocause
common specific of t
4901 Medicine OphthalmoloMacular Degeneration condition
necrosis. may report that
In contrast, CMVstraight
retinitisgrid lines appear
is painless, not uscu
4099 Medicine OphthalmoloHSV Infection lesions
Sympatheticaround the retinalisvessels.
ophthalmia characterized by damage
4021 Medicine OphthalmoloOcular Trauma
Subconjunctival recognition of 'hidden' antigens.
3779 Medicine OphthalmoloHemorrhage Spontaneous
Acute angle-closure subconjunctival
glaucomahemorrhage
is characterized is a benign
by ac
3429 Medicine OphthalmoloGlaucoma is the gold standard
Presbyopia is a common for diagnosis.
age-related Ocular tonometry
decrease in lenc
3332 Medicine OphthalmoloPresbyopia read3ismain
The classic.
categories of diabetic retinopathy are bac
3330 Medicine OphthalmoloDiabetic Retinopathy
Central Retinal Vein or malignant
Central retinal(neovascularization).
vein occlusion presents Visual impairment
with acute or s
3328 Medicine OphthalmoloOcclusion swelling, retinal hemorrhages, dilated veins, and cotto
2863 Medicine OphthalmoloDiabetic Retinopathy Vitreous hemorrhage typically presents as a sudden
2862 Medicine OphthalmoloRetinal Detachment Retinal detachment usually presents with a sudden o
2860 Medicine OphthalmoloInfectious Keratitis
Dacryostenosis & Herpes simplex keratitis is characterized by corneal v
2858 Medicine OphthalmoloDacryocystitis Dacryocystitis
(sensation of flashingpresents with inflammatory
lights). changes in
The major complication
2855 Medicine OphthalmoloCytomegalovirus in severe cases, intravitreal injections. All patients sh
2854 Medicine OphthalmoloHerpes Zoster Herpes zoster
It is typically ophthalmicus
associated with is characterized
increased by dend
intraocular pre
2852 Medicine OphthalmoloGlaucoma asymptomatic until the condition
Angle closure glaucoma occurs predominantly in peois advanced.
2851 Medicine OphthalmoloGlaucoma Examination reveals aisred
Allergic conjunctivitis an eye
acute with steamy cornea
hypersensitivity reacan
2849 Medicine OphthalmoloConjunctivitis conjunctiva and eyelids.
2375 Medicine OphthalmoloMacular Degeneration Age-related macular degeneration
An external hordeolum is an acute is usually seendiso
inflammatory in
2374 Medicine OphthalmoloHordeolum
Decompression with Staphylococcus
Decompression aureusinbut
sickness can is
divers becaused
sterile. by Initial tre
rapid
20364 Medicine Poisoning & Sickness definitive treatment is hyperbaric oxygen therapy.
Acute mountain sickness can progress to high-altitud
20203 Medicine Poisoning & High Altitude Illness rapid ascent
Bites from to high fire
imported altitude.
ants Early
causetreatment of HACE
sterile pustules th
20097 Medicine Poisoning & Insect Bites And Stings can be treated successfully with
Patients with mild snake bite envenomation should be antihistamines and t
19728 Medicine Poisoning & Snake Bite medically
Characteristicssignificant
of acutesnakebites
and chronic in North America
salicylate can
toxicity
19677 Medicine Poisoning & Salicylate Poisoning indicated
β blocker in patientspresents
overdose with altered withinmental status,
6 hours pulmo
of ingesti
19181 Medicine Poisoning & β Blocker Poisoning seen. Treatment consists
Exercise-associated postural of airway management,
hypotension occurs in gac
19085 Medicine Poisoning & Heat Related Illness
Organophosphate cardiac
Management demand. It is characterized
includes by collapseinhibito
atropine, a competitive (with
17903 Medicine Poisoning & Poisoning
Organophosphate agent that has
(mnemonic: both nicotinic
DUMBELS) as wellandas muscarinic activity (
muscle fasciculati
Organophosphate acetylcholinesterase
Organophosphates are activity.
acetylcholinesterase inhibitor
17312 Medicine Poisoning & Poisoning bronchospasm, muscle
Opioid intoxication is commonly fasciculations/weakness,
characterized by diar me
12503 Medicine Poisoning & Opioids also be present.
Arsenic toxicity should be suspected in a patient with
12397 Medicine Poisoning & Arsenic Poisoning lesions
Endurance (hypo- and hyperpigmented,
athletes are at risk for thermal hyperkeratotic),
illness, bot
11466 Medicine Poisoning & Accidental Hypothermia aggressive
Primary treatment,
therapy including
for moderate active external
hypothermia (heate
includes a
11417 Medicine Poisoning & Accidental Hypothermia withprevent
To atropine and cardiac pacing,
cardiorespiratory arrestbutandit usually
permanent improv ne
10146 Medicine Poisoning & Cyanide Poisoning hydroxocobalamin or sodium thiosulfate,
Cyanide binds to ferric iron in cytochrome oxidase a3 or with nitrit
10145 Medicine Poisoning & Cyanide Poisoning causing lacticisacidosis.
Lead toxicity usually due to lead exposure at work
4862 Medicine Poisoning & Lead Poisoning peripheral neuropathy),
acidosis. Treatment involves or gastrointestinal
administrationmanifestat
of fomep
4511 Medicine Poisoning & Toxic Alcohols acidosis and/or end-organ damage.
Decreased respiratory rate is the most reliable and p
4510 Medicine Poisoning & Opioids be absentsymptoms
Common due to co-ingestions).
of opioid withdrawalManagement include should
nau
4509 Medicine Poisoning & Opioids
Tricyclic tachycardia, mydriasis, piloerection,
airway, breathing, and circulation; in patients with evi and hyperactive
4487 Medicine Poisoning & Antidepressants
Carbon Monoxide prevent
cerebralarrhythmia.
hypoxia (e.g. headache, confusion, seizure,
Tricyclic is with 100% oxygen. overdose can present with ce
Tricyclic antidepressant
4035 Medicine Poisoning & Antidepressants characterized
Initial management by prolonged
of frostbite QRS duration
is based on(> 100 rewa
rapid mse
3876 Medicine Poisoning & Accidental Hypothermia be attempted
A caustic if there
ingestion is a possibility
causes injury to theof refreezing
upper aerodig befo
3856 Medicine Poisoning & Caustic Ingestion alterations
Exertional heat in consciousness.
stroke is characterized by temperatur
3691 Medicine Poisoning & Heat Related Illness immersion.
Nonexertional (classic) heat stroke most commonly a
3689 Medicine Poisoning & Carbon
Heat Related Illness
Monoxide common
All patientsmanifestations
with smoke inhalation include tachycardia, tachypn
should be suspecte
3223 Medicine Poisoning & Poisoning CO poisoning
The most severe areconsequences
typically neurological and include
of methanol intoxicaa
3161 Medicine Poisoning & Tricyclic
Toxic Alcohols reveal anion gap
characterized metabolic acidosis.
by prolonged QRS durationAn increased
(> 100 mse os
3138 Medicine Poisoning & Antidepressants
Acetaminophen depressant action on sodium channels.
For patients who present soon after a single, potentia
Substance Use acetaminophen
Clinical featureslevels. Patients
of marijuana can be asymptomatic
intoxication include incr
3129 Medicine Poisoning & Disorders concentration,
Slurred speech, unsteady gait, and drowsiness canthb
and coordination; and can increase
2664 Medicine Poisoning & Benzodiazepines respiratory
Diphenhydramine depression overdoseand the lacktoofantihistaminic
leads pupillary const (e
2662 Medicine Poisoning & Anticholinergics retention) effects. Physostigmine,
Caustic alkali ingestion causes immediate esophagea a cholinesterase in
2377 Medicine Poisoning & Caustic Ingestion 24 hours
fluid; to assess thesuggests
hyperosmolality severity addition
of the injury and guid
of concentrat
20233 Medicine Psychiatric/ Factitious Disorder osmotic
incorrectgap (osmoticreconciliation
medication laxatives cause a high
during osmotic
transfers of
20151 Medicine Psychiatric/ Patient Safety involvement and enhanced interprovider
Elderly, depressed patients can have significant cogn communicat
15896 Medicine Psychiatric/ Depression
Somatic Symptom impairment is reversible with treatment of the underly
15093 Medicine Psychiatric/ Disorder Illness anxiety disorder
HIV-associated is characterized
neurocognitive disorder is bydueexcessive
to repl
13371 Medicine Psychiatric/ HIV
Substance Use are
and increased blood pressure are often present. HIV
common. The risk increases with duration of In co
11815 Medicine Psychiatric/ Disorders intoxication may take up to a week
Delayed sleep-wake phase disorder is a circadian rhy to subside.
8823 Medicine Psychiatric/ Insomnia daytime sleepiness. Patients sleep normally if allowe
Poor sleep hygiene is a common cause of insomnia.
8822 Medicine Psychiatric/ Insomnia avoiding late afternoon
The antiemetics naps and and
metoclopramide exposure to electro
prochlorperazin
4366 Medicine Psychiatric/ Dystonia
Somatic Symptom akathisia,
to general and parkinsonism.
measures may benefit from pharmacother
3845 Medicine Psychiatric/ Disorder treatment.
Alcoholic hallucinosis usually presents in the first 24 h
2661 Medicine Psychiatric/ Alcohol Withdrawal
Central Venous autonomic
placement hyperactivity).
and may be recognizedTreatmentbyconsists of benz
bright red, bris
20310 Medicine Pulmonary &Catheter ensure successful CVC placement and
Aspiration of fluid during drowning can cause broncho minimizes co
20241 Medicine Pulmonary &Drowning drowning are managed with supportive care, which m
20200 Medicine Pulmonary &Drowning
Emergent Airway Patients
Capnography who are is theasymptomatic
measurement after nonfataldioxide
of carbon drowni
20145 Medicine Pulmonary &Management method
Major risk forfactors
verifyingforendotracheal tube (ETT)asthma
severe, life-threatening placem
19743 Medicine Pulmonary &Asthma with
Normalaccessory
physiologic muscle use, hypoxia,
changes in pregnancy tachypnea,
includeand ap
19704 Medicine Pulmonary &Dyspnea Of Pregnancy Basilar lung compression by the gravid
The risk of pulmonary hypertension is increased in pa uterus decrea
19694 Medicine Pulmonary &Sickle Cell exertional
second [FEV1],dyspnea andvital
forced signs of right-sided
capacity [FVC] with hearta failu
nor
19687 Medicine Pulmonary &Diaphragmatic Paralysis respiratory
monoxide, asymptoms.
measurement of alveolarincludes
Management gas exchange
antibiot
19680 Medicine Pulmonary &Community
Sickle Cell Acquired trigger.
Congestive heart failure (CHF) frequently causes bila
19650 Medicine Pulmonary &Pneumonia
Community Acquired patients
despite signsCHF
with can have rapid
and symptoms resolution
that localize theofinfectio
chest
19649 Medicine Pulmonary &Pneumonia pulmonary
(sometimes) infiltrate.
pleural effusion. Suspicion should be rai
19417 Medicine Pulmonary &Tuberculosis
Hypersensitivity (e.g. pneumonia)
gradually progressive doesdyspnea,
not improve cough,symptoms.
weight loss, a
19243 Medicine Pulmonary &Pneumonitis
Hypersensitivity inflammation or fibrosis.
Acute hypersensitivity pneumonitis classically presen
19241 Medicine Pulmonary &Pneumonitis to an inhaled pulmonary
High-altitude antigen. The condition
edema (HAPE) is often mistaken
typically pres
19068 Medicine Pulmonary &High Altitude Illness pneumonia include recent ascent to
High-altitude pulmonary edema (HAPE) typically pres high altitude, the
19067 Medicine Pulmonary &High Altitude Illness pneumonia
Acetazolamide include
helps recent
prevent ascent
and to high
treat altitude,
high altitudenori
18939 Medicine Pulmonary &High Altitude Illness ventilatory response.
Hyperventilation syndrome presents with acute onset
18915 Medicine Pulmonary &Respiratory Alkalosis reassurance with breathing retraining.
18888 Medicine Pulmonary &Respiratory Acidosis Acute benzodiazepine
An annual low-dose CTintoxication
scan of thecauses chest isdecreased
recomme
18420 Medicine Pulmonary &Lung Cancer generally begin at age 55 and continue
Anaphylaxis is a life-threatening, multisystem disorde to age 80 or u
17054 Medicine Pulmonary &Anaphylaxis manifestations include gastrointestinal,
Large-volume atelectasis can result from neurologic,
airway obst an
16928 Medicine Pulmonary &Atelectasis decreased or
Pulmonary absenttests
function breath sounds are
in patients withexpected
sarcoidosis- ove
16540 Medicine Pulmonary &Sarcoidosis FEV1/FVCand
headache ratio, reduced total lung
hypersomnolence withcapacity,
mild to and dec
modera
16406 Medicine Pulmonary &Perioperative
COPD comadisease
Medical lung (CO2 narcosis)
(e.g. chronicor seizures.
obstructive pulmonary dise
16402 Medicine Pulmonary &Management
Acute Respiratory postoperative pulmonary complications.
gas findings will show a primary respiratory acidosis.
16113 Medicine Pulmonary &Failure volume.
The initial criteria for extubation readiness include pH
16112 Medicine Pulmonary &Mechanical Ventilation
Acute Respiratory meet these resulting
weakness, criteria should undergo a spontaneous
in diaphragmatic impairment and br
16109 Medicine Pulmonary &Failure pregnancy or childbirth. Elective
Acute nitrofurantoin-induced intubation
pulmonary should
injury is duebe
14827 Medicine Pulmonary &Interstitial Lung Disease 9 days fromasthma
New-onset medication initiation.asBilateral
can present an acute basilar opa
exacerba
13933 Medicine Pulmonary &Asthma and a systemic
Treatment of anglucocorticoid
acute asthma(e.g. prednisone)
exacerbation to red
includes
13800 Medicine Pulmonary &Asthma late-phase inflammation
Idiopathic pulmonary and prevent
fibrosis symptombyrelaps
is characterized slow
12459 Medicine Pulmonary &Interstitial Lung Disease profile
Pulmonary arterial hypertension (PAH) is a common f
and reduced diffusion capacity on pulmonary
12136 Medicine Pulmonary &Systemic Sclerosis disease
Pulmonary andarterial
normalhypertension
FEV1 and FEV1/FVC is a common ratiomanife
help d
12135 Medicine Pulmonary &Systemic Sclerosis right-sided
Acute bronchitisheart is failure.
a self-limited illness usually cause
12069 Medicine Pulmonary &Acute Bronchitis from an inhaled bronchodilator
Asthma may present with chronic (e.g. albuterol).
cough that is Antibi
predo
10982 Medicine Pulmonary &Chronic Cough of chronic cough include upper airway
Although asthma is usually diagnosed in childhood or cough syndrom
8905 Medicine Pulmonary &Asthma testing. Reversible airway obstruction (> 12% increas
Pleural effusion insulates sound and vibration origina
8818 Medicine Pulmonary &Pleural Effusion decreased tactile fremitus,
upper respiratory infection, and initialdullness
empiricto percussio
treatment in
8815 Medicine Pulmonary &Chronic Cough and pseudoephedrine).
Early septic shock is associated with a hyperdynamic
6942 Medicine Pulmonary &Sepsis to an increase
Pulmonary airwayin stroke
disease volume, heart rate,
(e.g. chronic and pulse
bronchitis, br
4864 Medicine Pulmonary &Hemoptysis chronic productive cough for > 3 months
normal or an increased FEV1/FVC ratio). The diffusio in 2 success
4863 Medicine Pulmonary &Interstitial Lung Disease physiology.
An acute massive pulmonary embolism can present i
4772 Medicine Pulmonary &Pulmonary Embolism
Acute Respiratory normal
Alveolarpulmonary
consolidation capillary wedge pressure.
in pneumonia causes hypoxem
4770 Medicine Pulmonary &Failure ventilation/perfusion mismatch, increase intrapulmon
4753 Medicine Pulmonary &Pleural Effusion Empyemas
All patients withare exudative effusions with
acute exacerbation a low glucos
of chronic obstru
4730 Medicine Pulmonary &COPD addition,
Supplemental oxygen in patients with advancedventil
supplemental oxygen, antibiotics, and chro
4718 Medicine Pulmonary &COPD
Community Acquired ventilation-perfusion mismatch, decreased
Pneumonia causes hypoxemia due to right-to-left intr affinity of
4717 Medicine Pulmonary &Pneumonia intrapulmonary
Patients with massive shunting, the resulting
pulmonary hypoxemia
embolism usuallymap
4716 Medicine Pulmonary &Pulmonary Embolism thrombus
Peak airwayincreases
pressure pulmonary
is the sumvascularof airwayresistance
resistance a
4713 Medicine Pulmonary &Mechanical Ventilation calculated
Patients by severe
with performingasthma the exacerbation
end-inspiratory hold ma
should rec
4706 Medicine Pulmonary &Asthma carbon dioxide suggests failure of
Pulmonary emboli classically present with sudden-on medical therapy an
4690 Medicine Pulmonary &Pulmonary Embolism wedge-shaped
Patients with Hodgkin infarction is virtually
lymphoma whopathognomonic
are treated with fo
4689 Medicine Pulmonary &Lung Cancer in the lung
Acidosis (especially inbysmokers),
accompanied hypercarbia breast,
and and gastro
a normal o
4677 Medicine Pulmonary &Respiratory Acidosis may occur in the postictal state.
Inhaled antimuscarinic agents such as ipratropium ar
4667 Medicine Pulmonary &COPD adrenergic
Decreased agonists for greater
alveolar elasticity in symptom relief.
chronic obstructive pu
4665 Medicine Pulmonary &COPD volume, as well as diaphragmatic flattening. The flatt
Obesity Hypoventilation The bodywith
Patients compensates for chronic
combined obesity hypercapniasyndr
hypoventilation by in
4663 Medicine Pulmonary &Syndrome secondary erythrocytosis,
COPD is characterized by pulmonary
progressivehypertension,
expiratory airfa
4645 Medicine Pulmonary &COPD compared
Pulmonaryto VC.
pathology may lead to the syndrome of in
4643 Medicine Pulmonary &SIADH
Acute Respiratory Infusion
absent breath sounds on may
of normal saline worsen
the left hyponatremia
side on auscultationi
4632 Medicine Pulmonary &Failure
Parapneumonic problem.
complicated. Uncomplicated parapneumonic effusion
4631 Medicine Pulmonary &Effusion & Empyema
Upper Airway well as relatively low leukocyte and lactate dehydroge
4630 Medicine Pulmonary &Obstruction A fixed
For upper-airwayunfractionated
anticoagulation, obstruction willheparin decrease the air
is preferr
4629 Medicine Pulmonary &Pulmonary Embolism glomerular
A filtrationresult
normal D-dimer rate < is 30 mL/min/1.73
useful in excludingm2)pulmon
as red
4628 Medicine Pulmonary &Pulmonary Embolism patients
Mild with likely
persistent pretest
asthma probability. Anbyelevated
is characterized symptoms D-
4617 Medicine Pulmonary &Asthma (e.g. inhaled corticosteroid) in addition
Most cases of active tuberculosis in the United States to an as-need
4614 Medicine Pulmonary &Tuberculosis Vietnam,
Sudden-onset India,dyspnea,
Dominican chestRepublic, andtachycardia
pain, and Haiti), with
4613 Medicine Pulmonary &Pleural Effusion exudative,
Evaluation and of a bloody).
solitary pulmonary nodule detected o
4596 Medicine Pulmonary &Lung Nodule decision to observe,
Patients with ankylosing biopsy, or surgically
spondylitis resect the
can develop n
restr
4575 Medicine Pulmonary &Ankylosing Spondylitis reduced
ventilation.vital capacity and
Tachypnea causes totalhypocapnia
lung capacity andbutrespir
nor
4570 Medicine Pulmonary &Acute Heart Failure lungs.
Acute exacerbation of chronic obstructive pulmonary
4569 Medicine Pulmonary &COPD respiratory
Acute bronchitisinfection. Examination
is a common cause often revealsthat
of cough wheema
4566 Medicine Pulmonary &Acute Bronchitis self-limiting. Symptomatic treatment
Oxygenation in mechanically ventilated patients may and close clinica
4562 Medicine Pulmonary &ARDS levels (> 60%)
Mechanical of FiO2 improves
ventilation are required to maintain
oxygenation byoxyge
prov
4536 Medicine Pulmonary &ARDS as possible below levels that predispose
patients are unable to meet. Respiratory muscle fatig to oxygen to
4535 Medicine Pulmonary &Respiratory Acidosis respiratory
Anaphylaxisacidosis).
is commonly characterized by an acute
4523 Medicine Pulmonary &Anaphylaxis as asthma. Medications
hypoxemia) does not cause suchdigital
as nonsteroidal
clubbing, and anti-inf
the
4521 Medicine Pulmonary &Lung Cancer with painful joint enlargement, periostosis of long bon
The 3 most common causes of chronic cough are up
4519 Medicine Pulmonary &Chronic Cough
Obesity Hypoventilation syndrome is confirmed by
Obesity hypoventilation the elimination
syndrome is definedof nasal
by obes dis
4489 Medicine Pulmonary &Syndrome hypercapnia,
Transudative hypoxemia,
effusions areand respiratory
commonly acidosis
caused by dec as
4467 Medicine Pulmonary &Pleural Effusion
Obstructive Sleep increased
Obstructivecapillary
sleep apnea or pleural membrane
is caused permeability
by episodic obstru
4413 Medicine Pulmonary &Apnea
Community Acquired daytime sleepiness, snoring, and a choking or gaggin
4387 Medicine Pulmonary &Pneumonia Lung consolidation
Pulmonary embolism (e.g. lobar pneumonia)
typically presents withpresentsdyspneaw
4344 Medicine Pulmonary &Pulmonary Embolism pain and hemoptysis.
Comorbid gastroesophageal reflux disease (GERD) i
4335 Medicine Pulmonary &Asthma and/or symptoms
Cor pulmonale refers suggestive
to isolated of comorbid
right-sided GERD, pro
heart fail
4297 Medicine Pulmonary &Cor Pulmonale venous distension, increased intensity of P2 (pulmon
4263 Medicine Pulmonary &Chronic Cough Chronic
Chronic nonproductive cough is amanifests
pulmonary aspergillosis common with side>effec3m
4210 Medicine Pulmonary &Aspergillosis 1 apical cavitary lesions with or without
Obesity and malignancy are important risk factors for an aspergillom
4208 Medicine Pulmonary &Pulmonary Embolism gradient
testing isisnotcommonly
necessary seen
prior in to
patients with
initiating PE. trea
empiric
4201 Medicine Pulmonary &Nonallergic Rhinitis glucocorticoids,
Sarcoidosis or combination
typically affects young therapy.
adults and is more
4200 Medicine Pulmonary &Sarcoidosis
Pulmonary Arterial adenopathy.
Primary The underlying
pulmonary hypertension histopathologic
can be seen lesion
in midd is
4177 Medicine Pulmonary &Hypertension
Community Acquired enlargement of the pulmonary arteries
Streptococcus pneumoniae is the most common cause with rapid tape
4166 Medicine Pulmonary &Pneumonia and chestwith
Patients x-ray evidence
chronic of a lobar
obstructive infiltrate.disease w
pulmonary
4131 Medicine Pulmonary &COPD home oxygen treatment. Those with signs of right he
4119 Medicine Pulmonary &Aspiration Pneumonia Patients withfor
Risk factors impaired
aspiration consciousness,
pneumonia include advanced dem
altered
4118 Medicine Pulmonary &Aspiration Pneumonia present
capacitywith indolent
of the lung for symptoms,
carbon monoxide foul-smelling(DLCO) sputumis n
4116 Medicine Pulmonary &COPD marked by a decreased DLCO, but
Histoplasma capsulatum is prevalent in the central, mi the FEV1/FVC ra
4114 Medicine Pulmonary &Histoplasmosis droppings.
Patients with Infections
an acuteare usually
asthma subclinical in
exacerbation immun
usually h
4105 Medicine Pulmonary &Asthma
Community Acquired important finding that suggests impending
The diagnosis of community-acquired pneumonia req respiratory
4097 Medicine Pulmonary &Pneumonia typically not required in the outpatient setting as emp
4087 Medicine Pulmonary &Pleural Effusion Undiagnosed
with a history of pleural
asthma effusion
or chronicis best evaluated with
rhinosinusitis witht
4065 Medicine Pulmonary &Asthma avoidance
Congestiveofheart nonsteroidal anti-inflammatory
failure commonly drugs (N
causes transudat
4053 Medicine Pulmonary &Pleural Effusion fluid usually has
Theophylline a pleural
toxicity fluid pH of
can manifest as7.4-7.55.
central nervous
4048 Medicine Pulmonary &COPD (arrhythmia).
The Inhibition of
use of noninvasive the cytochrome ventilation
positive-pressure oxidase sys(
4040 Medicine Pulmonary &COPD intubation, are
Antibiotics hospital length
indicated foroftreatment
stay, andof incidence
acute exace of n
4039 Medicine Pulmonary &COPD mechanical ventilation. Antibiotics are not indicated in
4036 Medicine Pulmonary &Leukocytosis
Community Acquired Glucocorticoids
azithromycin) orcause a leukocytosis
fluoroquinolone (e.g. mainly throughF
moxifloxacin).
4024 Medicine Pulmonary &Pneumonia tendon rupture,
obstruction by theand aortic dissection.
bronchodilator suggests asthma. P
4017 Medicine Pulmonary &Asthma out.
Hypovolemia is a common cause of orthostatic hypot
3958 Medicine Pulmonary &Hypovolemia angiotensin-aldosterone system, decreased urine sod
3944 Medicine Pulmonary &Chronic Cough ACE inhibitors
by elevation of commonly
the left main cause
stemchronic
bronchus cough and s
on chest
3874 Medicine Pulmonary &Mitral Stenosis compensated patients.
3846 Medicine Pulmonary &Asthma The most common
Vasopressors (e.g. adverse effect of which
norepinephrine), inhaledcausecorticost
pro
3777 Medicine Pulmonary &Acute Limb Ischemia is usually bilateral and symmetric.
Superior pulmonary sulcus (Pancoast) tumors arise i
3776 Medicine Pulmonary &Lung Cancer arm
Earlydueandtoeffective
invasionanticoagulation
of adjacent structures decreases (e.g.thebrach
mo
3717 Medicine Pulmonary &Pulmonary Embolism likely probability of acute PE, especially those in mod
Granulomatosis With Smoking cessation
Granulomatosis withispolyangiitis
associated is with a mortality
a vasculitis ben
affecti
3580 Medicine Pulmonary &Polyangiitis Diagnosis
dysmorphicisred made by antineutrophil
cells/red cell casts on cytoplasmic
urinalysis).antib Sys
3579 Medicine Pulmonary &Anti-GBM Disease membrane.
Impaired immune defense contributes to the develop
3474 Medicine Pulmonary &Bronchiectasis upper
The firstlobe.
step in evaluation of solitary pulmonary nodu
3453 Medicine Pulmonary &Lung Nodule not available,
The management a CTofshould
acute be performed
respiratory to further
distress syndroch
3433 Medicine Pulmonary &ARDS ventilation
Anaphylaxis (LTVV). LTVV results
is a widespread, in lower pulmonary
IgE-mediated responsep
3400 Medicine Pulmonary &Anaphylaxis
Multifocal Atrial development
Multifocal atrial of tachycardia
life-threatening is a complications
supraventricular (e.g.
tachhy
3053 Medicine Pulmonary &Tachycardia usually
Short-actingprecipitated
β-adrenergicby acute respiratory
agonists illness in10-2
administered pat
3050 Medicine Pulmonary &Asthma
Granulomatosis With (less than daily).with
Granulomatosis Inhaled corticosteroids
polyangiitis or antileukot
is a systemic vascul
3049 Medicine Pulmonary &Polyangiitis progressive.
Ventilation is defined as the product of the respiratory
3048 Medicine Pulmonary &Respiratory Alkalosis alkalosis
and residual in the settingwith
volume) of an appropriate
preserved tidal volume,
or increased for
3045 Medicine Pulmonary &Interstitial Lung Disease capacity of carbon monoxide and increased alveolar-
3042 Medicine Pulmonary &COPD Long-term
Bronchiectasis supplemental
is a disease oxygen therapythickening
of bronchial has been an pr
3038 Medicine Pulmonary &Bronchiectasis
Obstructive Sleep dyspnea are common.
Patients involved in motorThevehicle
diagnosis is made
collisions dueusing
to dra
3033 Medicine Pulmonary &Apnea
α1 Antitrypsin is frequently
α1 antitrypsinimplicated
(AAT) deficiencyin drowsy driving
should bemotor vehic
considered
3031 Medicine Pulmonary &Deficiency
Community Acquired basilar-predominant
Lung malignancy is adisease). potentialDiagnosis is confirmed
cause of localized airw
3029 Medicine Pulmonary &Pneumonia whom there is suspicion for lung
Intermittent asthma is characterized by symptoms < 2 malignancy.
3027 Medicine Pulmonary &Asthma Patients with intermittent asthma are managed with a
3026 Medicine Pulmonary &Asthma High doses of β2-agonists
and symptoms. Pulmonaryused function in asthma
tests show treatment
a rest
3022 Medicine Pulmonary &Asbestos plaques on imaging are the hallmark
Asbestos exposure increases the risk of pulmonary fi of asbestosis.
3021 Medicine Pulmonary &Asbestos Smoking acts synergistically
Acute respiratory distress syndrome with asbestos to further
is associated wi
3020 Medicine Pulmonary &ARDS
Hypersensitivity lung compliance, and pulmonary
within 4-6 hours of antigenic exposure. Chronic expo hypertension.
3016 Medicine Pulmonary &Pneumonitis responsible antigen. primarily affects immunocompr
Invasive aspergillosis
2997 Medicine Pulmonary &Aspergillosis
α1 Antitrypsin nodules with surrounding
α1 antitrypsin deficiency isground-glass
a genetic disease opacities that('ha
res
2919 Medicine Pulmonary &Deficiency COPD but lack typical risk factors
Primary adrenal insufficiency (PAI) is a potential com or who have a fam
2817 Medicine Pulmonary &Adrenal Insufficiency and can help
Findings differentiate
of acute respiratory PAIdistress
from secondary
syndromeadrena (ARD
2702 Medicine Pulmonary &ARDS imaging, all of which are not completely
Hyponatremia due to the syndrome of inappropriate explained bya
2636 Medicine Pulmonary &SIADH asymptomatic
Smoking is theor mildlygreatest
single symptomatic patients.
risk factor for lung can
2615 Medicine Pulmonary &Lung Cancer nevermanifestations
The smoked mostof often developembolism
pulmonary adenocarcinoma,are nons
2300 Medicine Pulmonary &Hypertrophic
Pulmonary Embolism shortness
The of breath,
development pleuritic chest
of clubbing pain, low-grade
and sudden-onset jointfe
2298 Medicine Pulmonary &Osteoarthropathy and therefore
Know a chest x-ray
the complications is indicated to rule
of positive-pressure out ma
ventilatio
2297 Medicine Pulmonary &Pneumothorax
Benign Prostatic tachycardia, tracheal deviation,
Benign prostatic hypertrophy can cause an obstructiv and unilateral absenc
20536 Medicine Renal, UrinaHyperplasia for creatinine
Hematuria in aelevation
setting of orurinary
chronictract kidney disease,
infection typ
should
20166 Medicine Renal, UrinaHematuria hematuria
Renal tubular is still present,
acidosis (RTA)a workup
involves is indicated.
a net loss of H
18881 Medicine Renal, UrinaRenal Tubular Acidosis and can be recognized by abnormally
Chronic lithium therapy is commonly associated high urine with
pH (
18520 Medicine Renal, UrinaDiabetes Insipidus from lithium accumulation
Hyperventilation during panic in the renal results
attacks collecting ducts
in respir
16513 Medicine Renal, UrinaRespiratory Alkalosis dissociation of hydrogen
Calcineurin inhibitors (e.g.ions from albumin,
tacrolimus, allowingh
cyclosporine)
16485 Medicine Renal, UrinaKidney Transplantation impaired hepaticisclearance
Lupus nephritis caused byofdeposition
the drug and presents
of anti-double
16359 Medicine Renal, UrinaSLE insufficiency,
Alcohol bingeing hypertension,
can lead toperipheral
acute alcohol edema) or nep
myopathy
16358 Medicine Renal, UrinaRhabdomyolysis kidney
Some drugs injury (e.g.
due to both intravascular
statins, colchicine) are volume
directly deplet
myo
16353 Medicine Renal, UrinaRhabdomyolysis urinalysis
Manifestations of renal infarction include flank pain, m
in the absence of red blood cells on urine n
16317 Medicine Renal, UrinaRenal Infarction scan is diagnostic. Renal infarctions
disease characterized by proteinuria and nephrotic sy can occur as a s
16296 Medicine Renal, UrinaAmyloidosis hyaline material
Acute tubular that stains
necrosis resultswithinCongo
limited red.
resorptive ca
16044 Medicine Renal, UrinaMultiple Myeloma results in hypocalcemia; the presence of hypercalcem
Calciphylaxis (calcific uremic arteriolopathy) is charac
15372 Medicine Renal, UrinaChronic Kidney Disease patients
Prerenalwithacute longstanding
kidney injury end-stage
(AKI) canrenaloccur disease.
in volumR
13932 Medicine Renal, UrinaAcute Kidney Injury elevated
The kidneys central
playvenous
a role inpressure leading to aforreduct
the compensation prima
13842 Medicine Renal, UrinaMetabolic Acidosis urinary chloride (Cl) excretion. Most
Hypovolemia stimulates the renin-angiotensin system of the excreted H
12290 Medicine Renal, UrinaPrerenal Azotemia sodium and water reabsorption.
Exercise-associated hyponatremia occurs due to a co
12222 Medicine Renal, UrinaHyponatremia severe cases, patients
First-line treatment for urgency may experience seizures, proi
urinary incontinence
12033 Medicine Renal, UrinaUrinary Incontinence treated
Prolonged withinfusion
antimuscarinic
of sodium medications
nitroprusside (e.g. atoxybuty
high ra
11566 Medicine Renal, UrinaCyanide Poisoning arrhythmias, flushing, and respiratory
Hematuria (gross or microscopic) can be due to glom depression.
10287 Medicine Renal, UrinaGlomerular Disorders dysmorphic
Trimethoprimred canblood
causecells (RBCs) or RBC
hyperkalemia due to casts.
blockad
8331 Medicine Renal, UrinaHyperkalemia and may cause an artificial increase
Hypovolemic hyponatremia occurs due to nonosmoti in serum creatin
7722 Medicine Renal, UrinaHyponatremia angiotensin II). Restoration
Renal vein thrombosis, which of can
blood volume
present withshuts
hema off
6969 Medicine Renal, UrinaGlomerular Disorders membranous
The pathogenesis nephropathy
of metabolic in particular,
alkalosisisrequires
associated gen
4866 Medicine Renal, UrinaMetabolic Alkalosis involves addressing
Hypokalemia may bethe underlying
caused cause and
by increased promo
intracellul
4760 Medicine Renal, UrinaHypokalemia (e.g. hyperaldosteronism,
Hepatorenal diuretics).
syndrome is characterized by a decreas
4752 Medicine Renal, UrinaHepatorenal Syndrome volume resuscitation. It occurs due to
Initial hematuria suggests urethral damage, terminal splanchnic arte
4751 Medicine Renal, UrinaHematuria usually
Diabeticseen with renaliscauses
nephropathy of hematuria
characterized (e.g. glo
by glomerular
4750 Medicine Renal, UrinaDiabetic Nephropathy diabetes and poorly controlled hypertension should ra
4749 Medicine Renal, UrinaRenal Calculi Obstructive uropathy presents with flank pain, low-vo
4739 Medicine Renal, UrinaRespiratory Alkalosis The kidney compensates
First-generation for respiratory
H1-antihistamines have alkalosis
potent antich by
4733 Medicine Renal, UrinaUrinary Retention prostatic hyperplasia,
opioids). Affected elderly
patients men aredevelop
commonly at increased acuteris k
4683 Medicine Renal, UrinaRhabdomyolysis protein released from lysed skeletal muscle
Nephritic glomerulonephritis usually presents with uri cells.
4591 Medicine Renal, UrinaGlomerular Disorders is
Thedue primarily
elderly can to bedecreased
especially glomerular
susceptiblefiltration
to intravascrate
4567 Medicine Renal, UrinaPrerenal Azotemia (e.g. diarrhea).
Diabetic Laboratory
nephropathy, results typicallyglomerular
a microangiopathic demonstra
4515 Medicine Renal, UrinaDiabetic Nephropathy blood pressure control, and other systemic microvasc
4506 Medicine Renal, UrinaBladder Cancer Bladder
The risk tumors
of bladder are cancer
a common cause of
is greatest painless
in those withhemch
4502 Medicine Renal, UrinaBladder Cancer increased risk. However, screening for
disease are at increased risk. Preventive measures in bladder cance
4491 Medicine Renal, UrinaContrast
PolycysticNephropathy
Kidney contrast
The media.
clinical manifestations of autosomal dominant po
4474 Medicine Renal, UrinaDisease hypertension,
Patients polyuria,
with chronic flank pain,pulmonary
obstructive and renal disease
dysfuncto
4435 Medicine Renal, UrinaPrerenal Azotemia
Central Pontine administered
Acute, to treathyponatremia
symptomatic cor pulmonale(impaired symptoms but ms
mental
4430 Medicine Renal, UrinaMyelinolysis saline at a rate of no more than 0.5 mEq/L/hr to avoid
4425 Medicine Renal, UrinaDiabetes Insipidus Lithium
Patientsiswith
a common cause of nephrogenic
chronic alcoholism often present diabetes
with m
4423 Medicine Renal, UrinaHypokalemia hypokalemia due to removal of inhibition
cardiac membrane and insulin plus glucose to shift of renal pota
se
4422 Medicine Renal, UrinaHyperkalemia and/or blood (e.g. hemodialysis) should
Aminoglycosides are antibiotics used to treat serious then be initia
4379 Medicine Renal, UrinaAcute Kidney Injury therapy.
Ureteral calculi may cause flank or abdominal pain ra
4361 Medicine Renal, UrinaRenal Calculi are the imaging modalities of choice to confirm the di
4337 Medicine Renal, UrinaAcute Kidney Injury Metformin should notβ-adrenergic
include nonselective be given to acutely blockers, ill patients
potassium w
4288 Medicine Renal, UrinaHyperkalemia inflammatory
manifestation.drugs. Complications of nephrotic syndrome
4266 Medicine Renal, UrinaGlomerular Disorders deficiency.
Gastric contents are rich in hydrogen, chloride, and p
4236 Medicine Renal, UrinaMetabolic Alkalosis hydrogen loss and activation
Diabetic autonomic neuropathy of can
the renin-angiotensin
affect the genitou
4228 Medicine Renal, UrinaUrinary Incontinence incontinence (e.g. dribbling, poor
significant survival benefit over any form of urinary stream)
chronic with
d
4211 Medicine Renal, UrinaChronic Kidney Disease complications (e.g. anemia, impaired
Simple renal cysts are almost always benign and do bone metabolis
4181 Medicine Renal, UrinaRenal Cysts septae, and contrast enhancement.
Unfavorable metabolic side effects of thiazide diuretic
4171 Medicine Renal, UrinaPrimary Hypertension be induced
Acute renal by thiazide
allograft diuretics
rejection is include
predominantlyhyponatremia
T-cell
4152 Medicine Renal, UrinaTransplant Rejection rise
Measures to prevent urinary calcium stone formationb
in serum creatinine. The diagnosis is confirmed
4058 Medicine Renal, UrinaRenal Calculi diuretics
Sepsis leads to lower urinary calcium
to hypotension excretion.
and intravascular volum
4034 Medicine Renal, UrinaPrerenal Azotemia mEq/L), low fractional excretion of
Uric acid stones are often radiolucent but may be see sodium (< 1%), an
4027 Medicine Renal, UrinaRenal Calculi
Coronary Artery citrate
likely due is theto antreatment
increased of choice.
prevalence of traditional ca
4026 Medicine Renal, UrinaDisease
Acute Interstitial stress related to dialysis).
Analgesic nephropathy is the most common form of d
4007 Medicine Renal, UrinaNephritis Patients with chronic analgesic abuse are also more
4006 Medicine Renal, UrinaHematuria
Acute Interstitial Rifampin
Long-termcauses analgesic red use
to orange
with 1 discoloration
or more analgesics of body(e
4004 Medicine Renal, UrinaNephritis hematuria
and demonstrate due to papillary
apple-green necrosis.
birefringence under po
3997 Medicine Renal, UrinaAmyloidosis AA amyloidosis.
High-dose intravenous acyclovir can cause crystallur
3987 Medicine Renal, UrinaAcute Kidney Injury injury.
gradual progression of DN. ACE inhibitors and angiot
3986 Medicine Renal, UrinaDiabetic Nephropathy the rate of DN progression.
HIV-associated nephropathy is thought to be caused
3984 Medicine Renal, UrinaFSGS and edema.
Patients withItsickle
is most cellcommon in patients
trait, a carrier of sub-Sah
mutation, do no
3967 Medicine Renal, UrinaSickle Cell oxygen tension, dehydration, acidosis),
Muddy brown granular cast - Acute tubular necrosis; leading to ren
3955 Medicine Renal, UrinaAcute Kidney Injury syndrome;
DDAVP is usually Broad and waxy castsof- choice,
the treatment Chronicifrenal
needed.failu
3951 Medicine Renal, UrinaChronic Kidney Disease indicated because the transfused platelets quickly be
3946 Medicine Renal, UrinaMPGN
Hypertensive Membranoproliferative
Hypertensive nephrosclerosis glomerulonephritis, type 2, iswi
develops in patients
3942 Medicine Renal, UrinaNephropathy
Polycystic Kidney features
Autosomal include
dominant progressive,
polycystic irreversible
kidney disease renal insuffi
is com
3939 Medicine Renal, UrinaDisease both impaired vascular integrity
Systemic lupus erythematosus is an autoimmune dis caused by the underl
3898 Medicine Renal, UrinaSLE Nephrotic syndrome may also occur.
3895 Medicine Renal, UrinaRenal Calculi The
ACEdietary
inhibitors recommendations
or angiotensin receptor for patients with renal
blockers are in
3894 Medicine Renal, UrinaRenal Artery Stenosis revascularization is reserved for patients
The increased incidence of urinary tract infections in with resistan
3884 Medicine Renal, UrinaUrinary Tract Infection intercourse,
Dipsticks arerecent antibioticavailable
commercially use, thekits usethatof spermici
detect t
3693 Medicine Renal, UrinaUrinary Tract Infection significant pyuria and positive nitrites
Rapid treatment with calcium gluconate is necessary indicate the pre
3648 Medicine Renal, UrinaHyperkalemia exchange
Patients with resin,
severe dialysis)
bladdermeasures to reduce serum
outlet obstruction due to
3336 Medicine Renal, UrinaAcute Kidney Injury those with
Always suspectworsening kidney function.
surreptitious vomiting as a cause of h
3228 Medicine Renal, UrinaHypokalemia syndrome)
Diuretic abuse using the to
leads urine chlorideexcretion
increased concentration.
of water
3085 Medicine Renal, UrinaHypovolemia
Acute Interstitial Urinary sodiuminterstitial
Drug-induced and potassiumnephritis willisbe elevated.
usually causedPatie b
3061 Medicine Renal, UrinaNephritis present
Loop diuretics are frequently administered to cirrhoticf
with a fever, maculopapular rash, and renal
2826 Medicine Renal, UrinaMetabolic Alkalosis injury.
Postictal lactic acidosis commonly occurs following a
2821 Medicine Renal, UrinaMetabolic Acidosis resolution
chloride depletionof seizure activity.
include severe vomiting and diuret
2819 Medicine Renal, UrinaMetabolic Alkalosis responsive).
Recurrent vomiting causes depletion of fluid, acid, an
2813 Medicine Renal, UrinaMetabolic Alkalosis potassium
Type 4 renal loss. Volume
tubular resuscitation
acidosis (hyperkalemic with normal
renal tubsal
2810 Medicine Renal, UrinaRenal Tubular Acidosis insufficiency.
Acute salicylate It commonly
intoxication occurs
should in be
patients
suspectedwith poo
in p
2803 Medicine Renal, UrinaSalicylate Poisoning acidosis with arterial pH often within
Ethylene glycol and methanol intoxication cause meta the normal range
2799 Medicine Renal, UrinaToxic Alcohols with ethylene glycol (antifreeze) poisoning. Ethylene
2798 Medicine Renal, UrinaMetabolic Acidosis The anion gapby
accompanied must always be calculated
compensatory respiratoryinalkalosis
patients (
2796 Medicine Renal, UrinaMetabolic Acidosis levels
The anion but never
gap (AG) fullyrepresents
corrects. the concentration of u
2793 Medicine Renal, UrinaMetabolic Acidosis in the serum.
Mixed acid-base disorders involve > 2 primary disturb
2790 Medicine Renal, UrinaMetabolic Acidosis common
In any patient, causethe of mixed
pH andmetabolic
PaCO2 are andthe respiratory
two lab val ac
2787 Medicine Renal, UrinaPhysiological Buffers Hasselbalch equation.
Pneumonia triggers hyperventilation that can lead to
2786 Medicine Renal, UrinaRespiratory Alkalosis because
conditionsfull renal
(e.g. compensationpossibly
schizophrenia), requiresdue several
to a cenday
2657 Medicine Renal, UrinaPrimary Polydipsia with
Initialsignificant
treatmenthyponatremia
includes saline can developtoconfusion,
hydration restore in
2633 Medicine Renal, UrinaHypercalcemia administration of saline.
Patients with nephrotic syndrome have increased risk
2244 Medicine Renal, UrinaGlomerular Disorders hypercoagulability increase the risk for stroke and my
2243 Medicine Renal, UrinaRenal Vein Thrombosis
Acute Interstitial Renal
70% ofveincases thrombosis is an important
with interstitial nephritis are complication
caused byo
2242 Medicine Renal, UrinaNephritis allopurinol.
Uncomplicated Discontinuing the offending
cystitis commonly occurs agent is the tr
in otherwise
2235 Medicine Renal, UrinaUrinary Tract Infection culture, whichand
involvement, mayrenal
be done laterItinisthose
disease. whoassocia
strongly fail init
2232 Medicine Renal, UrinaCryoglobulinemia rheumatoid factor.
infection (synpharyngitic presentation). IgA nephropa
2230 Medicine Renal, UrinaIgA Nephropathy glomerulonephritis and
induced acute renal insufficiency.normal serum
Becausecomplement
urinalysis le
2229 Medicine Renal, UrinaRhabdomyolysis urinalysis in the absence
Calcium oxalate stones are of the
RBCs moston common
urine microscop
type o
2228 Medicine Renal, UrinaRenal Calculi dehydration,
the most common causes of nephrotic syndrome inoba
excess sodium or oxalate in the diet,
2223 Medicine Renal, UrinaFSGS use, and HIV.
Unilateral varicoceles that fail to empty when a patien
2221 Medicine Renal, UrinaRenal Cell Carcinoma scan of the abdomen
Hepatorenal syndromeis isthe most
seen in sensitive
patients with and severe
specif
2219 Medicine Renal, UrinaHepatorenal Syndrome low urine sodium level, typically < 10 mEq/L,
testing is the most sensitive test to detect early eleva and an
2183 Medicine Renal, UrinaDiabetic Nephropathy diagnosis.
Patients with the syndrome of inappropriate antidiure
2181 Medicine Renal, UrinaSIADH symptoms
The syndrome require treatment with
of inappropriate hypertonichormone
antidiuretic (3%) sal
2180 Medicine Renal, UrinaSIADH (> 100treatment
Initial mOsm/kg), and ansaline
includes elevated urine sodium
hydration to restore conin
2169 Medicine Renal, UrinaHypercalcemia administration
include nonselective of saline.
β-adrenergic blockers, potassium
2167 Medicine Renal, UrinaHyperkalemia anti-inflammatory drugs.
inappropriately normal parathyroid hormone levels, a
2165 Medicine Renal, UrinaHypercalcemia excretion,
Pes anserine by the urinepresents
bursitis calcium/creatinine
as a swelling clearance
over ther
20190 Medicine RheumatologBursitis strengthening
Osteoarthritis of exercises
the hands to optimize
presents strength,
with hard,flexibilit
periar
20186 Medicine RheumatologOsteoarthritis carpometacarpal joint and distal and
Initial management of hand osteoarthritis includes strproximal interph
20185 Medicine RheumatologOsteoarthritis patients; oral nonsteroidal
modification, NSAIDs are also effective but carry
anti-inflammatory drugs,gre an
20089 Medicine RheumatologBursitis fluid aspiration.
Fracture of a bone containing abundant marrow (e.g.
20065 Medicine RheumatologFat Embolism (e.g.
Plantarrespiratory
fasciitis isdistress,
caused neurologic
by degeneration dysfunction, pete
of the plan
19844 Medicine RheumatologPlantar Fasciitis secondary
activity. pathology (e.g.
Management of acutefracture) is suspected
AT includes activityormif
19778 Medicine RheumatologAchilles Tendinopathy emphasizing
extension. eccentric
Initial treatmentresistance
includes exercises is recom
activity modificat
19763 Medicine RheumatologLateral Epicondylitis rather than
Meralgia inflammation.
paresthetica is caused by compression of th
19757 Medicine RheumatologMeralgia Paraesthetica without weakness. Patients are usually treated
wrists; and presence of chondrocalcinosis. Managemconse
19599 Medicine RheumatologHemochromatosis
Polymyalgia minimize
diagnosisother systemicbycomplications
is suggested the presenceofofHH (e.g. liva
elevated
18676 Medicine RheumatologRheumatica low-dose
Suprascapularglucocorticoid therapy. presents with shoul
nerve entrapment
18416 Medicine RheumatologRotator Cuff suprascapular notch (e.g. use ofdrugs
Nonsteroidal anti-inflammatory a heavy backpack),
(NSAIDs) are fi
18018 Medicine RheumatologBack Pain muscle
The evaluation of reduced bone density is aimed atcan
relaxant (e.g. cyclobenzaprine, tizanidine) r
17681 Medicine RheumatologOsteoporosis myeloma.
Scleroderma renal crisis is characterized by the acute
17145 Medicine RheumatologSystemic Sclerosis (typically captopril),
A photosensitive which
rash, along reduce renin-angiotensin-a
with multisystemic symp
16384 Medicine RheumatologSLE antibody assay is highly sensitive
characterized by excessive monosodium urate deposfor SLE.
16277 Medicine RheumatologGout involvement
Rheumatoid may alsocan
arthritis occur.
cause exudative pleural effu
16239 Medicine RheumatologRheumatoid Arthritis disease.
peptide antibodies (high specificity) are the primary s
16237 Medicine RheumatologRheumatoid Arthritis
Complex Regional Pain prognosis.
Complex regional pain syndrome typically follows loc
16199 Medicine RheumatologSyndrome associated
Methotrexate with edema,
therapy forerythema,
rheumatoid and trophicisskin,
arthritis assoc h
16184 Medicine RheumatologRheumatoid Arthritis methotrexate, including hepatotoxicity, can be mitiga
characteristic findings in RA include periarticular eros
16181 Medicine RheumatologRheumatoid Arthritis modifying
Carpal tunnel antirheumatic
syndrome drugs (e.g. methotrexate)
is a common manifestationslo o
16179 Medicine RheumatologRheumatoid Arthritis erythrocyte sedimentation rate, C-reactive
Psoriatic arthritis is common in those with long-stand protein), s
16158 Medicine RheumatologPsoriasis arthritis). Important
Osteoarthritis diagnostic
is common clues are
in patients withthe involvem
prior joint in
15631 Medicine RheumatologOsteoarthritis disorders, bony deformities, and neuromuscular
Drug-induced lupus erythematosus should be suspec wea
15620 Medicine RheumatologSLE strongly
Claw toeassociated
and hammer with
toedrug-induced lupus erythem
deformities reflect an imba
15224 Medicine RheumatologDiabetic Neuropathy deformities may suggest underlying diabetic
medications can also contribute. Sjögren syndrome is peripher
12268 Medicine RheumatologSjögren Syndrome and is associated
nonsteroidal with a positive
anti-inflammatory antinuclear
drugs can be antibody
used int
12059 Medicine RheumatologBack Pain relaxants are not advised.
occlusive symptoms, blood pressure discrepancies, a
12057 Medicine RheumatologTakayasu Arteritis glucocorticoids.
The initial treatment of ankylosing spondylitis include
11989 Medicine RheumatologAnkylosing Spondylitis whose conditions
Antinuclear antibody do (ANA)
not respond
is a veryto less aggressive
sensitive, but not
11988 Medicine RheumatologSLE stranded DNA) can
Felty syndrome is a confirm the diagnosis.
complication of seropositive rheu
11980 Medicine RheumatologRheumatoid Arthritis citrullinatedand
Heberden peptide antibodies
Bouchard nodes(both of which
represent bony are usu
enlar
11923 Medicine RheumatologOsteoarthritis primarily
with a clinical
diabetes diagnosis;
mellitus, thyroidimaging
disorders,(e.g. x-ray)imm
chronic is le
11254 Medicine RheumatologAdhesive Capsulitis motion in multiple planes. X-ray findings
Raynaud phenomenon (RP) is abnormal vasoconstric are normal.
9939 Medicine RheumatologRaynaud Phenomenon especially
attacks withoutautoimmune
evidencedisorders.
of peripheralPatients with disea
vascular suspe
9906 Medicine RheumatologRaynaud Phenomenon amlodipine) and avoiding
Acute gout presents as anaggravating factors. usual
acute monoarthritis,
8933 Medicine RheumatologGout
Patellofemoral neutrophils)
Patellofemoral and monosodium
pain syndrome urate crystals,cause
is a common whichofa
8886 Medicine RheumatologSyndrome quadriceps contraction
the drug. Patients should(e.g.
stopsquatting).
the drug at Treatment
onset of inc sy
8866 Medicine RheumatologAchilles Tendinopathy fluoroquinolone antibiotic.
7006 Medicine RheumatologSLE Systemic
toes. The lupus
pain iserythematosus
often reproduced is a by
multisystem
lateral compresinflam
4933 Medicine RheumatologMorton Neuroma Treatment
Paget disease is conservative with metatarsal
of bone is characterized by support
osteoclast or
4659 Medicine RheumatologPaget Disease Of Bone bone pain, and fractures. Involvement of cranial bone
4590 Medicine RheumatologGonococcal Infection Disseminated gonococcal
Osteoarthritis causes infection
chronic oftenand
joint pain presents
is mostwit c
4586 Medicine RheumatologOsteoarthritis with movement, and painful or decreased
deposition of fibrils into tissues and organs. Patients range of m
4585 Medicine RheumatologAmyloidosis inflammatory
Pseudogout isdisease.an acute inflammatory arthritis caused
4582 Medicine RheumatologPseudogout synovial fluid
Psoriatic showing
arthritis occursrhomboid-shaped,
in 5%-30% of patients positively
withbip
4581 Medicine RheumatologPsoriasis and nail involvement
Fibromyalgia presentsare common.inCurrent
commonly young to treatment
middle-
4580 Medicine RheumatologFibromyalgia index and symptom
rheumatoid factor orseverity score,
antinuclear which titer.
antibody emphasize
Howe
4579 Medicine RheumatologParvovirus course.
Patients with long-standing ankylosing spondylitis can
4578 Medicine RheumatologAnkylosing Spondylitis patients
Reactivecan increase
arthritis the risk of vertebral
is a seronegative fracture, wh
spondyloarthropa
4577 Medicine RheumatologReactive Arthritis lesions, enthesitis and asymmetric oligoarthritis. Not
4576 Medicine RheumatologAnkylosing Spondylitis Enthesitis is characterizedjoints
proximal interphalangeal by inflammation
of the fingers, and pain
metatar
4574 Medicine RheumatologRheumatoid Arthritis compression.
folate depletion and leads to impaired DNA synthesis
4573 Medicine RheumatologRheumatoid Arthritis administration of folic acid,
Patients with rheumatoid which are
arthritis does atnot reduce ris
increased the
4572 Medicine RheumatologRheumatoid Arthritis calcium and vitamin
Septic arthritis D intake, minimization
is characterized of glucoco
by acute monoarthriti
4571 Medicine RheumatologSeptic Arthritis should be performed
Osteoarthritis presents promptly
in adultstoage confirm
> 40the withdiagnos
progre
4564 Medicine RheumatologOsteoarthritis region and can radiate to the lower thigh or knee. The
4460 Medicine RheumatologGiant Cell Arteritis Aortic aneurysms can occur in patients with giant cel
4449 Medicine RheumatologGout Gout is a common
Inflammatory back complication of myeloproliferative
pain is characterized by the gradu
4370 Medicine RheumatologBack Pain typically
Lumbar spinal stenosis is a common cause ofankylosi
suggests spondyloarthropathy (e.g. back p
4369 Medicine RheumatologSpinal Stenosis standing still. Vascular claudication is exertion-depen
and inflammatory markers (e.g. erythrocyte sediment
4368 Medicine RheumatologBack Pain initial
Systemictests, significant
sclerosis canneurologic
cause atrophy deficits, andorfibrosis
caudaof eq
4328 Medicine RheumatologSystemic Sclerosis sphincter.
Methotrexate Typical symptoms include antirheumatic
is a disease-modifying heartburn anddr d
4295 Medicine RheumatologRheumatoid Arthritis (including hepatotoxicity)
Lifestyle modifications, can be alcohol
including mitigated by the adm
cessation an
4259 Medicine RheumatologGout
Carpal Tunnel with repeated attacks of gouty arthritis
Compression of the median nerve at the wrist causes or complicated
4173 Medicine RheumatologSyndrome
Polymyositis And diagnosis is usually
Dermatomyositis is anmade on clinical
idiopathic grounds, but
inflammatory ne
myopa
4123 Medicine RheumatologDermatomyositis
Vertebral Compression symmetrical proximal muscle
A vertebral compression weakness
fracture is a common and erythemcompl
4083 Medicine RheumatologFracture minimal
Lumbosacral strain is the most common cause ofExam
trauma (e.g. bending, coughing, lifting). acu
4078 Medicine RheumatologBack Pain lumbar paraspinal area, but pain
Osteonecrosis is a common complication of systemic may radiate to the b
4047 Medicine RheumatologOsteonecrosis worsened by activity.
Systemic sclerosis (SS)Early examination
is divided findings
into diffuse and
cutane
4014 Medicine RheumatologSystemic Sclerosis internal
Lumbosacralorganradiculopathy
involvement (e.g. interstitial
(sciatica) is duelung disea
to nerve
4000 Medicine RheumatologBack Pain management
Behcet syndrome is focused primarily on
is a multisystem short-term relief
inflammatory cond
3815 Medicine RheumatologBehcet Disease morbidity. It is most common in patients of Turkish, M
3778 Medicine RheumatologGout In chronic
Lateral tophaceous
epicondylitis gout, elbow)
(tennis urate crystals
is painful can be dep
noninfla
3575 Medicine RheumatologLateral Epicondylitis reveals
Patients with symptomatic Paget disease of bonepain
tenderness at the lateral epicondyle and and
3518 Medicine RheumatologPaget Disease Of Bone decrease the risk of complications.
Paget disease of bone is characterized by disordered Bisphosphonates
3516 Medicine RheumatologPaget
Mixed Disease Of Bone
Connective turnover.
manifestationsSeruminclude
calcium will usually
Raynaud be normal swelli
phenomenon, in the
3324 Medicine RheumatologTissue Disease specificity.
dysfunction (e.g. Raynaud phenomenon). Extraderm
3322 Medicine RheumatologSystemic Sclerosis specific serologic
The diagnosis marker and
of Sjögren is associated
syndrome requireswith exten
evidenc
3321 Medicine RheumatologSjögren Syndrome infiltration
choice in most of thepatients
salivarywith glands
activeor serum autoantiboda
RA. Nonsteroidal
3318 Medicine RheumatologRheumatoid
Polymyalgia Arthritis therapy.
Polymyalgia rheumatica (PMR) affects patients age >
3317 Medicine RheumatologRheumatica
Inflammatory Bowel sedimentation
Inflammatory bowel rate. The diseasetreatment of choice
is frequently for uncom
complicated
3312 Medicine RheumatologDisease inflammatory
Whipple disease drugs is amay exacerbate
multisystem the underlying
disorder with a vari d
3311 Medicine RheumatologWhipple Disease loss,
The mostmigratory
common non-deforming
cause of anarthritis,
asymptomatic lymphadenop elevati
3304 Medicine RheumatologPaget Disease Of Bone tests. X-rays will show osteolytic or
mellitus, knee osteoarthritis, and angular deformity of mixed lytic-sclero
3303 Medicine RheumatologBursitis quadriceps
features may strengthening
include neurologic exercises and nonsteroidal
deficits, unexpected
3211 Medicine RheumatologPolymyositis
Back Pain And thyroid, and non-small
Polymyositis is characterized cell lung bycancer,
chronicas well aswe
proximal no
Polymyositis And are present in most
Dermatomyositis cases. Muscleby
is characterized biopsy
classic is cutaneou
the most
Carpal Tunnel most commonly
Carpal tunnel syndromeovarian, islung, causedpancreatic,
by compressionstomach,oo
3203 Medicine RheumatologSyndrome and associated with motor features.
such as the mid trapezius, lateral epicondyle, costoch Pain may radiate
3202 Medicine RheumatologFibromyalgia tricyclic
Sarcoidosisantidepressants)
is diagnosed reserved in the setting for patients
of a compatibwho fa
3177 Medicine RheumatologSarcoidosis Hypercalcemia
Hydroxychloroquine can be present
is used for due
patientsto granulomatous
with active sy
3173 Medicine RheumatologSLE should have a baseline ophthalmologic
Viral arthritis due to parvovirus B19 is characterized evaluation anb
3171 Medicine RheumatologParvovirus erythema infectiosum due to parvovirus B19 is more
3169 Medicine RheumatologBladder Cancer Long-term
characteristic CYC useplain
pain, is associated
x-rays showing with the increased
sacroiliitis ca
3167 Medicine RheumatologAnkylosing Spondylitis diagnosis.
First-line treatment options for ankylosing spondylitis
3165 Medicine RheumatologAnkylosing Spondylitis inhibit
Lumbar progression
spinal stenosis of theisdisease for long periods.
most commonly caused by
3157 Medicine RheumatologSpinal Stenosis dependent
Initial management of osteoarthritis of the kneeand
(exacerbated by lumbar extension) shou pe
3155 Medicine RheumatologOsteoarthritis inflammation
cause of septic and joint loading
arthritis in young, thatsexually
promoteactive degenerapati
3153 Medicine RheumatologGonococcal Infection tests.
Hyperparathyroidism with chronic hypercalcemia can
3151 Medicine RheumatologPseudogout (chondrocalcinosis)
Gout typically presents on x-ray
as anand acute rhomboid-shaped,
monoarticular artp
3150 Medicine RheumatologGout and certain medications (e.g. diuretics).
secondary infection of the joint. In patients with crysta
3149 Medicine RheumatologGout between attacks.
Physical examination in osteoarthritis shows crepitus
3148 Medicine RheumatologOsteoarthritis
Polymyositis And osteophytes, and subchondral
Polymyositis is characterized by sclerosis/cysts.
proximal muscle Patien
wea
3059 Medicine RheumatologDermatomyositis receive a glucocorticoid-sparing
Mixed cryoglobulinemia syndrome is an immune com agent (e.g. methotre
2958 Medicine RheumatologCryoglobulinemia disease,
Hereditary and peripheral neuropathies.
hemochromatosis is commonly Laboratory
associated stu
2880 Medicine RheumatologHemochromatosis
Antiphospholipid arthropathy.
Antiphospholipid Patients commonly
syndrome also have diabetes
is characterized by a throa
2450 Medicine RheumatologSyndrome β2-glycoprotein-I antibody, or lupus anticoagulant. It
2380 Medicine RheumatologOsteoporosis Screening for osteoporosis
Stress fractures are common with dual-energy
in patients whox-ray sudden ab
2329 Medicine RheumatologStress Fractures decreased
Erythema nodosumcaloric intake).
(EN) isTypicala conditionsymptoms include
of painful, red
2317 Medicine RheumatologSarcoidosis symptoms, chest x-ray should be
Systemic lupus erythematosus is a multisystem, infla performed in patien
2315 Medicine RheumatologSLE nonerosive
The finding with brief morning stiffness.
of chondrocalcinosis in a joint The knees,
with a typic c
2314 Medicine RheumatologPseudogout (pseudogout). Synovial fluid
The initial management analysis willshould
of osteoarthritis show an emph infl
2305 Medicine RheumatologOsteoarthritis are thedisease
Paget medication of choice
can cause focal forenlargement,
pain relief. weakne
2144 Medicine RheumatologPaget Disease Of Bone may cause
reduce frontal
errors, bossing,should
physicians headaches, cranial nerve
use a qualified inter
20591 Medicine Social ScienInterpreters to
management of complex medication regimen) by suc
repeat their understanding of new information, skil
20431 Medicine Social ScienHealthcare Quality
Principles Of Public maintaining patient independence, autonomy,
Health behaviors (e.g. diet, physical activity), a leadin and en
20321 Medicine Social ScienHealth to healthy become
providers food, physical activityto
desensitized opportunities).
all alerts, includingInequ
20288 Medicine Social ScienPatient Safety
Attributes Of High- settings to lower overall
Pay-for-performance alarm frequency
programs link financial andincentive
false al
20230 Medicine Social ScienQuality Health Care
Attributes Of High- value health
discharge care (i.e.
reduces care that optimizes
readmissions patient outc
rates by preventing
20229 Medicine Social ScienQuality Health Care coordination (effective of
laboratory monitoring) transition
chronic between
conditions. inpatient
Medicaid an
20225 Medicine Social ScienHealth Insurance
Attributes Of High- (including children
treatment (i.e. and pregnant
delivering high-value women)
care).and those w
Overutiliza
20153 Medicine Social ScienQuality Health Care
Attributes Of High- patient
Excessive outcomes.
medical treatment (overuse of resources)
20152 Medicine Social ScienQuality Health Care health care
Loss to follow-upresourceafteruse) by following
hospital discharge standards
can leadoftoe
19909 Medicine Social ScienPatient Safety of patient attendance,
compliance in health care completion
settingsof is pending
typically items
low. Ph (e
19801 Medicine Social ScienPatient Safety increases provider
improves health likelihood
literacy of hand hygiene
and adherence; complia
best practice
19788 Medicine Social ScienPatient Safety understanding
Preventable adverse of newdrug information
events (ADEs)or changes are ainmajor
treat
19787 Medicine Social ScienPatient Safety improves patientbreakdowns,
Communication health literacy and reduces
a leading causeADE of medrisk
19684 Medicine Social ScienPatient Safety Closed-looperrors
Diagnostic communication
are commonly increases
causedaccuracy
by cognitive of in
18797 Medicine Social ScienCognitive Error influences bias
Anchoring a provider's
occurs when judgment, resulting
a diagnosis is in failure t
premature
18796 Medicine Social ScienCognitive
Physician Error
Patient example
on known facts of the case. The degree of uncertainta
of anchoring bias is prematurely assigning
18785 Medicine Social ScienCommunication
Physician Patient allow the patient an of
their understanding opportunity
the illnesstoand askthequestions.
self-limited
18778 Medicine Social ScienCommunication The clinician should also discuss
Root cause analysis is a systematic approach the risks and thatadvers id
18751 Medicine Social ScienPatient
Against Safety
Medical Advice a team of professionals from different
patient insists on discontinuing treatment, the provide disciplines) imp
18702 Medicine Social ScienDischarge options.
Successful weight loss can be enhanced by incorpora
18657 Medicine Social ScienObesity associated
In cases in withwhich increased
a patientsuccess declinesrates. Self-monito
a recommended
18556 Medicine Social ScienInfluenza intervention,
Cognitive errors including
involvethe likely benefits,
heuristics (mentalrisks, and lim
shortcuts)
15835 Medicine Social ScienCognitive
Physician Error
Patient notable clinical is
Contemplation experiences
a stage of behaviorto bias subsequent
change in which clinic
13533 Medicine Social ScienCommunication considering
Accepting gifts behavioral change third
from interested should be assessed
parties can influe fo
11911 Medicine Social ScienProfessional Conduct the patient, such as unbiased educational material or
10661 Medicine Social ScienMedical Errors Checklists are an important tool to prevent undesired
10660 Medicine Social ScienMedical Errors Communication
According to ethical failures betweenpermission
guidelines, physiciansmust during be po
8957 Medicine Social ScienInformed Consent training purposes.
Hospice is a palliative, interdisciplinary model of care
8942 Medicine Social ScienEnd Of Life
Decision Care
Making bereavement care.
Patients with psychotic illness do not necessarily lack
7517 Medicine Social ScienCapacity regarding medical treatment,
When dealing with an angry patient,the patient has the
the most right
approp
4066 Medicine Social ScienProfessional Conduct question.
3805 Medicine Social ScienProfessional Conduct
Intimate Partner When
describedealing with difficult
their situation patients,
on their own the physician
terms. The firstmup
3792 Medicine Social ScienViolence
Complementary And Additional steps maytothen
The initial response be needed
patients to address
suggesting con
compleme
3749 Medicine Social ScienAlternative Medicine risks andhave
Patients benefits of complementary
the right and alternative
to refuse treatment except wha
3625 Medicine Social ScienRefusal
DecisionOf Treatment
Making public's health is no longer at risk.
3617 Medicine Social ScienCapacity
Directive/Surrogate When a patient refuses potentially life-saving treatme
3616 Medicine Social ScienDecision Maker In the absence
Patients of an
have the advance
right to knowdirective, a life-saving
their diagnoses. If fam
3615 Medicine Social ScienPatient Confidentiality how to proceed.
frequently have additional policies requiring written fo
3614 Medicine Social ScienPatient Confidentiality
Directive/Surrogate familiar with these rules and disclose only the minimu
3388 Medicine Social ScienDecision Maker A living will communicates the patient's own wishes if
3240 Medicine Social ScienMedical Errors A physician
medical has a in
condition moral
publicresponsibility
areas wheretocomments
act in the pa m
3238 Medicine Social ScienPatient Confidentiality rebuffed.
3237 Medicine Social ScienProfessional Conduct Physicians should respond politely but firmly to inapp
3232 Medicine Social ScienPatient Confidentiality
Physician Patient Medical information
When delivering should be
potentially badshared
news, with family mem
a physician sh
2197 Medicine Social ScienCommunication comprehensible manner.
infections and evidence of chronic lung disease (e.g. bronchiectasis, fibrosis/scarring) in a young adult are suspicious for an un
on
canvariable immunodeficiency.
be triggered by a variety of chemicals, solvents, cleaning products, or acidic/alkaline solutions. It is nonimmunologically me
uritus, erythema, local swelling,
patients who undergo and vesicles.Likely
liver transplantation. Chronic symptoms
etiology can beinclude excoriations,
discerned based on hyperkeratosis, and
the length of time fissuring
since of skin.
transplantation. M
lons
causes; infections during months 1-6 are usually caused by opportunistic pathogens (in the setting of high-dose
in an adult should raise suspicion for common variable immunodeficiency Quantitative measurement of serum immunoglob immunosuppr
. tacrolimus, cyclosporine) have a wide range of adverse effects, including nephrotoxicity, hypertension, neurotoxicity (e.g. trem
st common cause of acquired angioedema. It is important to note that angioedema from ACE inhibitors can occur at ANYTIME
erse effects
measure of ACE inhibitors
of association are as
calculated cough, hyperkalemia,
follows: OR = (oddsand precipitation
of exposure of acute
in cases) renalof
/ (odds failure in patients
exposure with bilateral
in controls). renal art
For a contingen
measure of association calculated as: OR = (odds of exposure in cases) / (odds of exposure in controls). For a correctly formatt
nstic test is the

a normal probability
distribution thatthat
hasana individual is correctly classified
specified percentage by the below
of observations test: Accuracy = (under
it (i.e. area True positives
the curve+toTrue negatives
the left ) / To
of the specif
the percentiles
etest probability that correspond
of disease is equalto values that are 1, 2,ofor
to the prevalence 3 standard
disease in thedeviations
populationfrom the mean.
of interest; it is used to calculate the pretest o
Pretest
nt probability
of intervention / (1 - Pretest
assignments probability)
from individuals involved in a clinical research study. The optimal strategy to maximize unbiased
as possible in a clinical study, especially those collecting and analyzing the data.
en
unitobservers (e.g. researchers,
of observation physicians)
is the population. Disease misclassify
rates anddata (e.g. treatment
exposures outcomes)
are measured in eachdueofto
a preconceived expectations
series of populations, regard
and their as
ssociations at the population level may not translate to the subject level.
unit of observation is the population, not the individual. Disease rates and exposures are measured in each of a series of popul
t associations
measure at the population
of association level may not
used in case-control translate
studies. to the individual
It quantifies level.
the relationship between an exposure and a disease; its null v
OVA) is used to compare the means of independent groups; it determines only whether at least 2 group means differ. Group com
group means
dentifying differ. A as
individuals confidence
exposedinterval for the to
or unexposed difference in group
a risk factor means
and ends bythat includesoutcome
comparing 0 indicates (i.e.no significant
disease) difference
rates betweeninth
geegins before
(ARP) the outcome
describes has occurred,
the percentage whereas
of disease in anin exposed
a retrospective cohort
group that candesign the study
be attributed begins
to the after the
exposure. outcome
It is has as
calculated occu
the
unexposed groups divided by the risk of disease in the exposed group: ARP = [(Risk[exposed]
RR) measures how much a treatment reduces the risk (i.e. rate) of an unfavorable outcome. RRR may be calculated using abs - Risk[unexposed]) / Risk[expo
ws:
asure RRRof =association
ARR / Rate[control]
between an = (Rate[control]
exposure and-an Rate[treatment])
outcome. Confidence / Rate[control];
intervalsRRR = 1 - RR.
that contain the null value (i.e. RR = 1.0) indic
justed RRs minimize confounding and provide better estimates of associations.
umber needed to treat (NNT) should always include information about the comparison group, the specific outcome, and the pe
the same intervention
arm (NNH) is the number or treatment
of people whowill vary
mustdepending
be exposed on to
thea outcome,
treatment the periodharm
to cause of observation,
to 1 personand whothe comparison
otherwise would group us
not ha
kwhenincrease (ARI) between
an extraneous the treatmentvariable
(i.e. confounding) and control masksgroupthemust be known:
relationship NNH an
between = 1independent
/ ARI. variable (e.g. risk factor, treatm
nterest). It may lead to false conclusions (i.e. statistically significant results that are truly invalid).
l curve is a commonly used graphic representation of the probabilities that subjects survive in a study without an event of intere
e compared; they
eneralizability) of aare statistically
study different only
is the applicability if the results
of study p-valuebeyond
is less the
thanspecific
0.05. population studied. Results from a randomized
frial
patients
is used areto generalizable
estimate and only to that
compare thespecific
incidence subgroup of the population.
of an outcome in groups of individuals randomly assigned to one of several
ociation is relative
(r) describes the risk.
direction (i.e. positive, negative) and strength of the linear relationship between 2 quantitative variables. It do
es the relationship between 2 categorical variables. It requires a categorical independent variable (e.g. exposure or intervention
and a categorical dependent variable (e.g. outcome).
the most appropriate
an observational studyanalytical
commonly design
usedtotostudy uncommon
estimate (rare) diseases
the prevalence and but
of disease, diseases
it may with
alsoabe long
usedlatent period. associations
to examine
xposure to risk factors
ed to compare and disease
the exposure statusstatus
of peopleare measured
with a disease simultaneously
(i.e. cases) atto athe
particular
exposure point in time
status (i.e. snapshot).
of people without the disease (i
ratio.
me in the treatment group. A confidence interval (CI) that includes the null value for RR (i.e. RR = 1.0) is not statistically significa
s(NPV)
statistically significant. that an individual does not have a disease given a negative test result. It is calculated as NPV = true ne
is the probability
tween exposure and disease. For OR > 1.0, the exposure increases the odds of disease (i.e. risk factor). Confidence intervals t
ewhen
association is not statistically
an extraneous significant.
(i.e. confounding) variable masks the association between an independent variable (e.g. risk factor, treatm
nterest). It may lead to false conclusions
s t-test compares the mean of 2 independent about the association
groups. (i.e. statistically
The test requires significant dependent
that a quantitative associations that are
variable truly
(e.g. invalid). be
outcome)
est compares the mean of > 3 groups. The test requires a quantitative dependent variable (e.g. outcome) and a categorical ind
he efficacy, risks, and benefits of a new treatment compared to current standard treatments (or placebo) in a large sample of aff
Most
RR)phase III trials
describes are randomized,
the difference blind,(orand
in the rate compare
risk) > 2 treatments.
of an unfavorable outcome between control and treatment groups. It is calcula
tment]). The rate of an unfavorable outcome is equal to the number of unfavorable outcomes in a group divided by the sample
eat (NNT) is the number of patients who need to receive a treatment to prevent 1 additional negative event. NNT is the inverse
ore effective
RR) measuresthe treatment
how much a because
treatmentfewer patients
reduces need
the risk of to
anbe treated to outcome.
unfavorable prevent 1 RRR
additional negative
may be event.
calculated using the absolute r
ARR / Risk[control] = (Risk[control] - Risk[treatment]) / Risk[control]; RRR = 1 - RR.
estatistical
sizes have greater power
technique used to(i.e. a falsethe
describe H0effect
is rejected)
of > 1 and thereforevariables
independent lower probability of a typerisk
(e.g. exposures, II error than do
factors), studies
which may with sma
be quan
riable (i.e. outcome).
reif examples
subjects over- or under-report
of observational exposure
studies. They history duerelatively
are often to perceived
quicksocial stigmatization.
and easy to perform, are useful in determining prevalence
ify is
eat thethe
association
reciprocalbetween 2 variables.
of the absolute risk reduction rate from an intervention. This number is used by some clinicians to present p
ications at the time of transitions of care, between inpatient and outpatient facilities and within inpatient facilities, is a potential s
harmacy personnel results
e and true-negative and high-risk patients
will change theappear to beAlterations
specificity. the most effective in improving
in test sensitivity the quality of
and specificity, as patient
well ascare.
changes in disease
dictive values.
rating characteristic curve upward for a given cutoff indicates increased sensitivity. A shift of the curve to the right for a given cu
eat (NNT) is defined as the number of people that need to receive a treatment to prevent 1 additional adverse event. It is calcula
RR).
cts
biasofina studies,
treatment on a composite
patients are randomly outcome,
assignedit is to
important
treatments to note any differences
to minimize potentialbetween the individual
confounding variables.endpoints.
Many studies also pe
the initial randomized treatment groups (the original intention) regardless of the eventual treatment.
o of an event rate occurring in the treatment group versus the non-treatment group. Ratios < 1 indicate that the treatment group
treatment group had a higher event rate.
nvolve
o of an randomization to different
event rate occurring in theinterventions
treatment arm with additional
versus study of 2 or more
the non-treatment variables.
arm. Ratios less than 1 indicate that the treatment ar
icate the treatment arm had a higher rate of events.
in a clinical trial allows a study to eliminate bias in treatment assignments. An ideal randomization process minimizes selection
up
onssizes, and achieves
that indicate a low of
the chance probability
an eventof confounding
occurring in thevariables.
treatment group compared to the chance of the event occurring in the
mportant to critically read all the presented information.
est for determining the incidence of a disease. Comparing the incidence of the disease in 2 populations, with and without a give
r crude analysis
aracteristic curveofofdata. They can diagnostic
a quantitative demonstrate testthe type of association
demonstrates (i.e. linear,
the trade-off non-linear),
between the test'sifsensitivity
any is present.
and specificity at var
e true-positive rate (directly proportional to sensitivity) will also increase the false-positive rate (inversely proportional to specific
the probability
being of having
free of a disease thetest
if the disease
resultisis1negative.
- negativeRemember:
predictive value.
the NPV will vary with the pretest probability of a disease. A pat
e
ed in case-control studies because it is an efficient method to control will
a low NPV, and a patient with a low probability of having a disease have a high
confounding. NPV.
Remember: matching variables should alway
.ective
Cases and controls are then selected based on the matching variables, such that both
studies creates a potential for attrition bias, a subtype of selection bias. When a substantial groups have a similar
number distribution
of subjects in act
are lost
mate the association between the exposure and the disease. Investigators try to achieve high rates of follow-up to reduce the p
ssbutrisk
stable incidence
in the exposedofpopulation
a diseasethat
cancan
be attributed to factors
be attributed that factor.
to the risk prolongIt the
canduration
be easilyofderived
the disease
from (e.g. improved
the relative riskquality of c
using the
ation is said to be successful when a similarity of baseline characteristics of the patients in the treatment and placebo groups is
the outcome is uncommon in the population, the odds ratio is a close approximation of the relative risk ('rare disease assumptio
of random error. The tighter the confidence interval, the more precise the result. Increasing the sample size increases precision
eous factor
etting that has
a disease overproperties linking of
a certain period it with
time.both the exposure
To calculate anddivide
the risk, the outcome of interest.
the number of diseased subjects by the total number
d to compare
study proportions.
and consequently A 2 x 2the
narrows table may be used
confidence to surrounding
interval compare thethe
observed values with
point estimate. the expected
Confidence values.
intervals express statistical
n extreme and unusual value observed in a dataset. The mean is very sensitive to outliers and easily shifts toward them. The m
control for confounders during the design stage of a study. It helps to control for known, unknown, and difficult-to-measure con
statistical method that is commonly employed to compare the means of two groups of subjects.
mmetric and bell-shaped. All its measures of central tendency are equal: mean = median = mode.
(r) shows the strength and direction (positive, negative) of linear association between 2 variables. It does not necessarily imply
hat is located in the middle of a dataset. It divides the right half of the data from the left half.
alstatement of no relationship
validity pertains betweenofthe
to the applicability exposure
study results and the outcome.
to other populations To (e.g.
statethe
theresults
null hypothesis
of a studycorrectly, the study
in middle-aged design
women sh
wou
.when an external variable positively or negatively impacts the effect of a risk factor on the disease of interest. Stratified analys
r an effect
period can bemodifier.
applied to both disease pathogenesis and exposure to risk modifiers. Exposure to risk factors and the initial steps
efore
ility of observing a given (or are
clinical manifestations moreevident.
extreme) In addition,
result due exposure
to chanceto risk
alone,modifiers
assumingmay need
the null to be continuous
hypothesis over
is true. a certain
A result period
is general
ed to compare the exposure of people with the disease (cases) to the exposure of the people without the disease (controls). Th
, risk factor and outcome are measured simultaneously at a particular point in time (snapshot study). In other study designs, a c
me.
en the investigator's
p values decision
are interrelated and is adversely
express the affected
statisticalby knowledgeofofathe
significance exposure
study. status. significant study, p should be < 0.05
In a statistically
oes not include
distribution: 68%theofnull value. are within 1 standard deviation from the mean; 95% of all values are within 2 standard deviations
all values
ard
eendeviations
incidence from the mean. Incidence is the measure of new cases, the rapidity with which they are diagnosed. Prevalence is
and prevalence.
nt in time.
e value (PPV) and negative predictive value (NPV) of a test depend on the prevalence of the disease of interest in the populati
decreases with an increase
ounding. Distinguish between in prevalence.
crude and adjusted measures of association. Confounding refers to the bias that can result when
the effect ofbias
f lead-time extraneous factors
in screening (i.e.,
tests. Theconfounders).
typical example of lead-time bias is prolongation of apparent survival in patients to who
the disease.
strength of association and dose-response relationship from a study.
ry of acase
ween disease when
control andevaluating the effectiveness
retrospective cohort studiesofisathe drug in aintrial.
order which outcomes and risk factors are assessed. Case control
of bias, which can decrease the validity of study results. Hawthornefactor
ociated risk factors; retrospective cohort studies first ascertain risk effect exposure and then
is the tendency determine
of the the outcome.
study population to affect the ou
e sensitivity and specificity of a test.

e predictive values of a test.
ase
of awhen the cut-off
quantitative level oftest
diagnostic a diagnostic test affect
will inversely is raised.
its sensitivity and specificity. Typically, lowering the cutoff value will increase
specificity (more false positives). Screening tests need
of a quantitative diagnostic test will inversely affect its sensitivity high sensitivity, and confirmatory
and specificity. Typically,tests need
raising thehigh specificity.
cutoff value will increase
more false negatives). Screening tests need high sensitivity; confirmatory tests need high specificity.
cificity, positive and negative predictive values depend on the prevalence of disease in the population being tested. A change in
r of false positives and true positives will decrease positive predictive value.
e.g. increasing
ial infarction the inclusion
commonly criteria)
presents withofepigastric
a screeningpaintest
andresults
nausea in an
andincrease in specificity
is commonly and with
associated decrease in sensitivity.
hypotension and bradycardi
firm the diagnosis.
with aspirin
with acute myocardial
and a P2Y12 infarctions
inhibitorfrequently report atypical
lowers morbidity symptoms,
and mortality anpatients
rates in ECG is with
oftennon-ST-segment
indicated on arrival to the myocardial
elevation emergency inf
de
absenceinfarction
ocardial of contraindications.
(STEMI) can present with atypical symptoms in elderly patients. Criteria for diagnosing STEMI include ST-se
MI
G changes should be urgentlycardiac
should undergo emergency treatedcatheterization and percutaneous
with calcium gluconate to stabilizecoronary intervention.
the cardiac membrane and insulin plus glucose to mo
engpotassium from the body can then be administered.
disrupts oxygen delivery and usage, which can cause clinical manifestations of myocardial ischemia. Elevated carboxyhemo
equire hyperbaric
(PIP) results from oxygen
localized therapy.
inflammation triggered by myocardial necrosis and can occur 2-4 days following transmural myoca
ary reperfusion therapy to minimize
nt of the underlying OSA (e.g. nocturnal the extent of myocardial
continuous necrosis.
positive airway pressure) often leads to resolution. Other cardiovascular com
right-sided heart failure, coronary heart disease, and arrhythmias.
o) cardiomyopathy most commonly affects postmenopausal women and is believed to result from a catecholamine surge broug
racterized by left ventricular
dergo echocardiography mid- and apical
to characterize segment hypokinesis
the presence and severity and basilar
of any segment
associated hyperkinesis
pericardial and and
effusion typically resolves
to rule on pit
out other
py can reduce the risk of myocardial infarction and ischemic stroke in patients with atherosclerotic cardiovascular disease. For
hing to(e.g.
atures a different
dyspnea,high-intensity
tachycardia,or tachypnea,
a moderate-intensity statin extremity
unilateral lower should beedema).
considered.
Patients with high pretest probability of PE are
ent similarly to a number of other conditions and can be especially difficult to differentiate from syncope. Tongue biting, especia
re and can
a young agebe(i.e.
helpful
age < in30)
confirming the diagnosis.
should raise suspicion for a secondary cause. In addition to hypertension, features suggesting intra
e.g. metoprolol, atenolol, propranolol) areaassociated
ine drug screen should be considered in young patient
withwith unexplained
impaired glucosehypertension.
control and increased weight gain, likely via effects
.ndTherefore,
urinalysis. In addition, patients should be screened for major atherosclerotic riskinfactors
these drugs are an unfavorable option for hypertension management patients with,
with or atpanel
a lipid high and
risk for, type
either 2 diab
fasting s
al valve annulus and lateral papillary muscle displacement with restricted movement of the chordae tendineae. The mitral regurg
pearance of the associated murmur.
rl tachycardia,
regurgitationventricular
develop leftfibrillation).
ventricularFollowing
volume overload
a trial of and an S3
optimal galloptherapy,
medical due to the large prevention
primary volume of regurgitant
with placementflow re-entering
of an impla
s.
ressure that occurs due to right atrial contraction against a closed tricuspid valve. These waves are indicative of a cardiac arrhy
lar
ommontachycardia,
cause ofcomplete atrioventricular
angina, syncope, and heart block).
failure; however, such symptoms are rare until the AS becomes severe (usually in
oderate
me to maintain cardiac output. This allows for aanother
AS, anginal symptoms are likely due to temporary cause, most commonly
asymptomatic period.obstructive
However, coronary arterywall
overwhelming disease.
stress eventually
ure.
vity involves an exaggerated vagal response that is often triggered by tactile stimulation. The exaggerated response causes a >
lic blood pressure,
cardiovascular leading
disease to a transient
(ASCVD) risk canreduction in cerebral
be calculated using perfusion
the Pooled that manifests
Cohort as syncope
Equations or presyncope.
cardiovascular risk calculator. Initia
prevention in patients with a 10-year ASCVD risk > 7.5%-10%.
cribes normal blood pressure readings in clinic but elevated average blood pressure throughout the day. The diagnosis is made
hwith
clinical
mildevidence of hypertension
hypertriglyceridemia (i.e.(e.g.
150-500left ventricular
mg/dL) who hypertrophy)
have known despite
or are normal
at high clinic blood
risk for pressure readings.
atherosclerotic cardiovascular disea
ibrates and niacin reduce triglyceride levels but have not been shown to improve cardiovascular outcomes.
otropic agent with a strong affinity for β1 receptors and a weak affinity for β2 and α1 receptors. Dobutamine stimulates increase
on, reduced
ically precededleftby
ventricular
a prodrome end-systolic
(e.g. nausea, volume, and symptomatic
diaphoresis, improvement of and
pallor, lightheadedness) decompensated heart
usually occurs duefailure.
to a cardioinhibitory r
Cardiac
or monitoring
idiopathic) immediately
pericarditis should bepreceding the syncope
initially treated with atypically showsofsinus
combination bradycardia
nonsteroidal and asystole due
anti-inflammatory drugs to (e.g.
sinusibuprofen)
arrest. a
nt pericarditis.
mmon cardiacCorticosteroids
manifestation of(e.g. prednisone)
systemic are second-line(SLE).
lupus erythematosus therapy for these
Patients patients.
typically have pleuritic chest pain, a pericardial fr
other manifestations of active SLE (e.g. joint pain, cytopenia).
cular septum typically occurs 3-5 days after an acute myocardial infarction and presents with sudden-onset cardiogenic shock w
holosystolic murmur with
hy is an uncommon cause palpable thrill
of dilated at the left sternal
cardiomyopathy border.
characterized by the development of heart failure during the last month of
diastolic dysfunction is a common cause of pulmonary hypertension. Initial management includes loop diuretics and ACE inhib
disease (GERD) and esophageal motility disorders are common causes of non-cardiac chest pain. Features suggestive of an e
es anlasting
importantmorecause
than an hour,heart
of right postprandial
failure and symptoms, associated
is characterized heartburn orperipheral
by progressive dysphagia, and relief
edema, of pain
ascites, by antireflux
elevated jugular therap
venou
pericardial calcifications on chest radiograph.
r in patients treated with nitroprusside who receive prolonged infusions, higher doses, or have underlying renal insufficiency. It p
zures,
mmon side and coma.
effect of dihydropyridine calcium channel blockers (CCBs). Addition of a renin-angiotensin system antagonist (angio
ceptor blocker)
T scan is a useful cantool
reduce CCB-associated
to evaluate for coronary peripheral edema.and indicates inducible ischemia when a reversible defect is note
artery disease
preferred
ogram should treatment to prevent coronary
be recommended as a partartery disease
of an initial in theseregimen
treatment patients.in all patients with intermittent claudication. Pharmacolo
revascularization
al myocardial infarctionshouldand be stroke
reserved andfora those
15%-30% with risk
persistent
of death symptoms despite adequate
due to cardiovascular supervised
causes. Only 1%-2%exercise therapy.with PA
of patients
limb
icularamputation.
block in a patient with infective endocarditis should raise suspicion for perivalvular abscess extending into the adjacent c
ciated with increased
a potential risk of periannular
cause of secondary hypertensionextension of endocarditis.
in young adults. Patients should be initially evaluated with simultaneous palpation
hial-femoral
ommonly delay,byand
caused bilateral
ectopic foci upper
within and lower extremity
the pulmonary veins.blood
Atrialpressure measurement
flutter commonly involves to assess for blood
a re-entrant pressure
circuit arounddifferentia
the tricus
ants results
with from a re-entrant
pulmonary edemacircuit formed by due
and hypoxemia 2 separate conducting
to acute decompensatedpathways within
heart theincludes
failure AV node. aggressive intravenous diuresis,
on.
is a manifestation of ASCVD, as is myocardial infarction, stable or unstable angina, coronary or other arterial revascularization,
o enhanced pharmacologic effects of a drug during faster heart rates and is seen with class I (especially IC) and class IV (calciu
ass
cause IC aagents
transient cause a progressive
block in AV node decrease
conduction. in impulse conduction
Intravenous adenosinewithcan
faster
be heart
usefulrates, leading P
in identifying to waves
an increase in the
to clarify QRS co
diagnosis
rminate
cally paroxysmal
results supraventricular
in a holosystolic murmur heardtachycardias
best at bytheinterrupting the AV nodal
apex with radiation to there-entry circuit. clinical features of MR include
axilla. Common
cesof heart
an earlyfailure.
diastolic murmur and can be associated with several physical signs caused by a hyperdynamic pulse, including bo
4) is a low frequency sound heard at the end of diastole just before S1 that is commonly associated with left ventricular hypertr
) is a low frequency diastolic sound heard just after S2 that is associated with left ventricular failure. Intravenous diuretics provid
WPW)heart
ated pattern failure.
refers to the characteristic ECG findings of a short PR interval (< 120 msec), slurred initial upstroke of the QRS co
/T wave changes.
ed as an exaggerated WPW fallisindue to an accessory
systemic blood pressure pathway
> 10that
mmbypasses
Hg duringthe atrioventricular
inspiration. It is a node andfinding
frequent directlyinconnects the atria
cardiac tampona
edial effusion
common such as severe
medications that canasthma
triggeror bronchoconstriction
chronic obstructive pulmonary
in patients disease.
with asthma. Short-term use of cardioselective β blocker
but all β blockers should be used with caution.
and antianginal effects of nitrates are due to systemic vasodilation rather than coronary vasodilation. Systemic venodilation low
ucing
ntricularwall stress
filling and myocardial
pressures and acute oxygen demand.
pulmonary edema. Unlike chronic MR, acute MR does not cause any significant change in le
baroreceptor sensitivity and defects in the myocardial response to this reflex are the main reasons for the increased incidence
y (PEA) or asystole should be managed with uninterrupted cardiopulmonary resuscitation along with vasopressor therapy to ma
tially reversible
cause causes
of secondary of PEA should
hypertension also bebe
and should investigated.
suspected in Defibrillation
patients who or have
synchronized cardioversion
hypertension associated has no hypercalcemia,
with role in the mana
ms. Other
on can cardiovascular
propagate manifestations
proximally from the siteofofhyperparathyroidism include
intimal tear to involve left ventricular
the aortic hypertrophy,
valve, causing arrhythmias,
acute aortic and and
regurgitation vascular
hearta
ation of ascending
h adequate aortic
bystander dissection that resuscitation,
cardiopulmonary can be differentiated
prompt from
rhythmacute aortic and
analysis, regurgitation by an
defibrillation absencefound
in patients of pulmonary
to be in aedem
shoc
chyarrhythmia
with preserved(narrow-
ejection or wide-complex)
fraction, often duecausing hemodynamic
to hypertensive instabilityhave
heart disease, should be managed
typical with immediate
manifestations synchronized
of congestive ca
heart failure
objective
on evidence
is the most commonof diastolic dysfunction.
and correctable cause Impaired myocardial
of secondary relaxationand
hypertension and/or increased
should LV wallinstiffness
be suspected patientsleads to an increa
with diffuse athe
ce of a systolic-diastolic abdominal bruit has high specificity for the presence of renal artery stenosis.
osterone system is integrally involved in the pathophysiology and treatment of hypertension. Numerous antihypertensives, inclu
verting
mal enzyme
dominant inhibitors,kidney
polycystic and direct renin
disease areinhibitors, affect until
asymptomatic this system.
age 30-40, when renal cysts become large and numerous. Bilat
physical examination, and hypertension is an early disease manifestation
sound (atrial gallop) can often be heard during the acute phase of myocardial that typically
infarctionprecedes a progressive
due to left decline inand
ventricular stiffening renal
dysf
ents with electrocardiogram findings such as irregularly irregular rhythm, varying R-R intervals, and no clearly discernible P wav
entT4 withlevels measured to screen formurmur
a crescendo-decrescendo occult hyperthyroidism
at the lower left as an underlying
sternal cause.
border is most likely due to hypertrophic obstructive cardiomy
ial andblock,
cular can be dueistoprogressive
there outflow obstruction,
prolongationarrhythmia, ischemia,
of PR interval andto
leading aaventricular baroreceptor
non-conducted P waveresponse that inappropriately
and a 'dropped' QRS complex. ca
uringtenderness
with PR intervals of just before and after
> 1 costochondral or the 'dropped' QRS
sternochondral complexes.
joints and is the most common cause of musculoskeletal chest pain. Pa
such
reproducible with palpation. Treatment involves reassurance
as non-vitamin K antagonist oral anticoagulants (e.g. apixaban) and symptomatic
and warfarin,pain management.
should be used to reduce the risk of systemic
high risk of thromboembolic events (i.e. CHA2DS2-VASc score > 2).
ght or obese should be advised to lose weight. Obesity is the single greatest contributing lifestyle risk factor for hypertension, an
gic intervention
nstriction for lowering
and sodium blood
retention to pressure.
maintain organ and tissue perfusion in the setting of reduced cardiac output. The compensat
er
Right ventricular 3rd heart sound; Tricuspidaregurgitation
decrease cardiac output and perpetuate downward spiral of clinical
murmur; decompensation.
Hepatomegaly with pulsatile liver; Lower-extremity edema, as
wncy signs of increased right heart pressures, and right heart catheterization
is a common cause of lower extremity edema that may be accompanied by varicose will show pulmonary
veins,systolic pressure > 25
skin discoloration, and mm Hg. sk
medial
orasures
abdominalwith leg elevation,
aortic aneurysmexercise,
includeand
malecompression therapy.history, and age > 65. The US Preventive Services Task Force rec
gender, smoking
abdominal ultrasound in and
ressure, hepatomegaly, menascites.
age 65-75Otherwho ever smoked.
findings include the presence of hepatojugular reflux, Kussmaul sign (lack of decrea
and a pericardial knock (mid-diastolic sound).
peptide levels and an audible third heart sound are signs of increased cardiac filling pressures and are noted in patients with co
ction.
predominant cause of morbidity and mortality in patients with Marfan syndrome. Most patients have aneurysmal aortic root dilat
ntagonist
or type thatA aortic dissection.
prolongs INR. ItsIf anticoagulant
dissection occurs it isare
effects usually prior toby
influenced age 40; it is a surgical
medications emergency
that affect that may be complicated
the gut microbiome/cytochrome P
tables. Acetaminophen use commonly prolongs INR in those on warfarin due to interruption of
h risk of thromboembolic events (CHA2DS2-VASc score > 2). Patients with lone AF (score 0) are at low risk of systemic emboli vitamin K recycling in the liver.
omiting, abdominal pain). Chronic digoxin toxicity presents with less pronounced gastrointestinal symptoms but more significant
on, scotomas,
usually blindness).
results from increased cardiac output in response to a reduction in systemic vascular resistance (e.g. arteriovenous fistu
widened pulsesyncope
g cardiogenic pressureand
andshould
brisk carotid upstroke)
be obtained in alland increased
patients cardiac venous
with unexplained returnECG
syncope. leading to peripheral
findings andan
suggesting pulmonary
arrhythmie
, sinus
nt pauses, atrioventricular
with decreased block, and
exercise tolerance, prolonged
exertional QTc interval.
dyspnea, angina, or syncope. Physical examination typically reveals a delayed
and mid- to late-peaking systolic murmur with maximal intensity
apeutic window and toxicity is common in elderly patients as they at are
the susceptible
second righttointercostal space
acute renal and radiation
dysfunction to the carotid
with decreased cle
stinal disturbances (e.g. anorexia, nausea, vomiting), neurologic disturbances (e.g. confusion, changes in color vision),
ynthesis of thyroid hormone in patients with nodular thyroid disease or latent Graves disease and can cause destructive thyroid and card
arin, direct oral anticoagulants) has been shown to significantly reduce the risk of embolization in patients at moderate to high r
recommended
ave for assessment
normal or elevated of stroke
blood pressure risk in patients
includes with nonvalvular
supplemental atrial fibrillation.
oxygen, assisted ventilation as needed, aggressive intravenous d
, nitroprusside).
ay (slow and fast pathway) in the AV node. Vagal maneuvers increase parasympathetic tone and result in a temporary slowing o
e at
e refractory period,
increased leading
risk for to termination
bacterial endocarditis of involving
AVNRT. the right-sided heart valves. Tricuspid regurgitation is commonly present
istinguished
and symptoms from other murmurs
of pulmonary by augmentation
embolism of intensity
include dyspnea, of holosystolic
pleuritic murmur with
chest pain, tachypnea, inspiration.
and tachycardia. Chest radiograph is f
or pulmonary embolism, and may be normal.
CAD should receive appropriate stress testing based on ECG findings and their ability to exercise. High-risk patients should be
ation to consider iscoronary
inus tachycardia a highlyangiography.
specific sign for large pericardial effusion. This is due to the swinging motion of the heart in the peri
s and amplitude. Patients with cardiac tamponade and hemodynamic compromise should have emergency pericardiocentesis.
sncharacterized by a drop in blood
(e.g. cough, hoarseness) pressure of
are suggestive after standing
GERD. and is typically
Appropriate preceded
treatment combines by alifestyle
lightheaded or presyncopal
changes sensation.
with a histamine 2 rece
).
ponade usually have clinical features of Beck triad: hypotension, distended neck veins, and muffled heart sounds. These sympt
septum toward the left ventricular cavity, which reduces left ventricular preload, stroke volume, and cardiac output.
emergency department with chest pain and suspected acute coronary syndrome (ACS) should be administered aspirin as soo
es the rate by
aracterized of low
myocardial
cardiac infarction
output and and overall mortality
a compensatory in patients
elevation with ACS.
in systemic vascular resistance. Central venous pressure and p
ecreased intravascular blood volume.
aspirin and a P2Y12 receptor blocker) leads to a reduction in recurrent myocardial infarction (MI) and cardiovascular death com
It also reduces
acologic therapythe risk ofmodification)
(lifestyle stent thrombosis should andbeispart
recommended
of the overall in all patients forofathypertension
management least 12 months following
at every officedrug-eluting ste
visit. All patien
chave a diet
stenosis canrich in fruit,
have vegetables,
angina, and low-fat dairy
syncope/presyncope, andproducts; engage
heart failure in regular
symptoms. aerobic
Physical exercise; lose
examination weight;
typically and limit
reveals alcoh
diminishe
late-peaking,
triuretic peptide crescendo-decrescendo
levels have high sensitivity systolic
for murmur best heard
the diagnosis at the right
of congestive upper
heart sternal
failure. border. clinical signs of congestive
In contrast,
uevenous
to leftpressure,
ventricular lower extremity
systolic edema,
dysfunction is third heart sound)
characterized have high cardiac
by decreased specificity but low sensitivity
output/index, increasedfor systemic
the diagnosis.
vascular resis
ic volume (LVEDV).
rdiomyopathy can develop in patients who have persistent or recurrent tachyarrhythmia with prolonged periods of rapid ventricu
thm or aggressive
ecrease in systemiccontrolvascularof ventricular
resistancerate and can
(cardiac lead todue
afterload) significant
to overall improvement in left ventricular
peripheral vasodilation. function. monitoring in th
Hemodynamic
monary
lead to capillary
cardiogenic wedgeshock pressure, low systemic
(e.g. hypotension, vascular
poor organresistance,
perfusion) dueincreased cardiac
to impaired leftoutput (at least
ventricular initially), and
contractility. high index
Cardiac mixedisv
(estimate
diated of left atrial pressure)
hypersensitivity is elevated
reaction that can resultduefrom
to failure
exposure of forward
to latexblood
(e.g.flow.
surgical gloves, Foley catheter). Patients typically pr
h,HMG-CoA
and wheezing, and they may develop life-threatening upper airway edema.
reductase enzyme, prevent conversion of HMG-CoA to mevalonic acid, and increase the number of cell membrane
synthesis,
with whichheart
congestive is involved
failure in musclethe
parallels cellseverity
energy of production andand
heart failure possibly
is an contributes
independenttopredictor
statin-induced myopathy.
of adverse clinical outcomes.
dndjugular
antidiuretic
venous hormone.
pressureTreatment
and positive involves fluid restriction,
hepatojugular angiotensin-converting
reflux. Those with peripheral edema enzyme inhibitors,
from primary and loopdisease
hepatic diuretics.and cir
and negative hepatojugular reflux.
rysms are due to age-related degenerative changes that lead to disruption of the aortic medial layer, resulting in loss of elasticit
tratesfor
erapy a widened
alleviating mediastinum,
symptoms and enlarged aorticexercise
improving knob, and trachealindeviation.
tolerance patients with stable angina. They help prevent angina by de
ty, leading to a reduction in myocardial oxygen demand.
diac manifestations of hyperthyroidism are due to an increase in sympathetic Calcium channel blockers and
activity. long-acting
β blockers arenitrates are also as
recommended used.
initial the
ld be continued until the patient becomes euthyroid with thionamides, radioiodine, and/or surgery.
epression in leads V1 and V2 in this setting usually suggests a posterior wall MI. Inferior MI is also associated with hypotension,
murmurs are usually due to an underlying pathologic cause, and their presence should prompt further evaluation with a transtho
herwise young,
hythmias asymptomatic
(e.g. ventricular adultsare
fibrillation) arethe
usually
mostbenign
common andcause
do notofrequire
suddenfurther
cardiacevaluation.
arrest in the immediate post-infarction peri
ntial cause of dilated cardiomyopathy in relatively young adults (e.g. age < 55). Patients usually present with decompensated h
rcardiography
stress testingtypically shows biventricular
(e.g. adenosine) enlargement
causes a marked increasewithindiffuse
blood ventricular
flow in normalwall coronary
hypokinesis.arteries and a relatively small incre
erence in blood flow allows for diagnosis of obstructive coronary artery disease
viate cardiovascular symptoms. Aspirin, nitroglycerin, and calcium channel blockers are also effective due to reduced uptakeinofthe
radioactive isotope in
initial management
aindicated.
sclerocalcific changes are the most frequent cause of isolated aortic stenosis in elderly patients. These changes are common a
e,
sion,butan
sometimes
importantmaycausebe of
severe.
hypertension in elderly patients, is caused by increased stiffness or decreased elasticity of the arter
r morbidity and mortality, and managementelevations).
es of pericarditis (e.g. diffuse ST-segment should be similar to that of
Hemodialysis primary
leads hypertension,
to rapid resolution of with lifestyle
chest pain modifications
and reduces the andsize
ph
to treat lipid abnormalities frequently produces cutaneous flushing and pruritus. This side effect is explained by prostaglandin-in
w-dose aspirin.with vasovagal syncope include reassurance and education about the benign nature of the condition. Patients sh
res in patients
erpressure
rdiogram hasmaneuvers during the and
excellent sensitivity prodromal phase
specificity for in
theorder to abort
diagnosis of or delay
aortic an episode
dissection andofissyncope.
the preferred diagnostic study in pa
ency. CT angiography and MR angiography should be avoided in patients with
should be suspected in patients with multisystem involvement with acute or subacute renal failure, moderate to severetypical
kidneyskin
disease.
manifestations (e
estinal ischemia, and Hollenhorst plaques after recent arteriography or cardiac catheterization.
used as a first-line agent for rapid relief of symptoms in patients with angina pectoris. The anti-ischemic effect of nitrates is me
ntricular
ine > 30%end-diastolic volume
from baseline afterand wall stress
starting resulting in decreased
an angiotensin-converting myocardial
enzyme oxygen
inhibitor demand.
or angiotensin-receptor blocker. The presenc
for the presence of renovascular hypertension.
a narrowing of the descending aorta that leads to a proximal arterial pressure load. Patients typically present with upper extrem
ial-femoral
orm of vasovagaldelay.(neurally
Chest x-ray usually syncope
mediated) demonstrates inferior
associated notching
with specificoftriggers
the third(e.g.
to eighth ribs due
micturition, to pressure-induced
defecation, cough). These enlarge
trigg
can precipitate a predominant cardioinhibitory, vasodepressor, or mixed response.
hannel blockers can cause peripheral edema and should always be considered in the differential diagnosis of this condition, alo
e, and venous
ic cause insufficiency.
of syncope usually have underlying structural heart disease and may not have any prodromal symptoms prior to the sy
eurocardiogenic syncope
aspirin, platelet P2Y12 receptorfrequently experience
blockers, a prodrome
nitroglycerin, with nausea,
β blockers, pallor, diaphoresis,
and anticoagulation. and generalized
Fibrinolysis sense of warmth
may be administered within
ot
for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in patients with an estimated 10-year ASCVD riskcom
undergo PCI but is associated with higher rates of recurrent myocardial infarction, intracranial hemorrhage, and mortality >
ascular risk calculator.
derate-intensity statin therapy is recommended for patients without known ASCVD, whereas high-intensity therapy is recommen
rious adverse effect of long-term amiodarone use and can occur months to several years after the initiation of therapy. Interstiti
progressive
emporary dyspnea,insertion
pacemaker nonproductive cough, andfurther
while undergoing new reticular
evaluationor ground-glass
to identify and opacities
correct on chest radiograph.
reversible causes. A permanent pace
block are found.
node and replacement with fibrous tissue is the most common cause of sick sinus syndrome. Elderly patients are typically affe
a
laron exertion,
block lightheadedness,
has progressive confusion,
prolongation and
of the PRsyncope
interval or presyncope.
leading ECG demonstrates
to a nonconducted sinusa bradycardia
P wave and 'dropped' QRS withcomplex.
delayed Itorisd
eually involves observation
atrioventricular (AV) blockinwithasymptomatic
normal QRS patients
durationand correction
are of reversible
due to delayed causes
AV nodal (e.g. holding
conduction medications
and require that evaluation
no further affect AV
duration
for patientslikely
withhave a conduction
persistent delay below
tachyarrhythmia whotheareAVseverely
node and should have
symptomatic electrophysiology
(altered mental status, testing
acute toheart
determine
failureitsornature.
pulmon
able (hypotension, signs of shock).
cardioversion is the initial treatment of choice in patients with persistent tachyarrhythmia (narrow or wide complex) associated w
ardiogenic
brillation orshock, signs
pulseless of ischemia,
ventricular acute heart
tachycardia (VT)failure).
should be managed with immediate defibrillation. In contrast, patients with he
plex tachyarrhythmia (e.g. atrial fibrillation, atrial
h rapid ventricular response, rate control should be attempted flutter, VT withinitially
a pulse) should
with be managed
β blockers with channel
or calcium synchronized cardioversion.
blockers. Immediate s
in hemodynamically unstable patients with rapid AF.
gies in the United States include viruses, cardiac surgery, chest radiation, and idiopathic causes. Tuberculosis is the most comm
eas
tery such as Africa,
stenosis shouldIndia,
receiveandmedical
China. therapy with antiplatelet agents and statins. Some evidence suggests benefit of carotid en
80%-99%)
myocardialstenosis.
infarctionHowever,
suggestsasymptomatic
embolization of patients with lower-grade
a left ventricular (< 80%) Transthoracic
(LV) thrombus. lesions are managed medically. should be perf
echocardiography
omeLV thrombus.
(Dressler syndrome) presents weeks after a myocardial infarction with chest pain that is improved by leaning forward. Nons
e and are usually
rious adverse administered
effect of long-termwith colchicine.use
amiodarone Anticoagulation
that can occurshould
months betoavoided
severaltoyears
prevent
afterdevelopment
the initiationofofaamiodarone
hemorrhagic pe
thera
esting
cterized should obtained
by scaling, prior tosuperficial
weeping, initiating therapy
erosions,with
andamiodarone.
pitting edema. Chronic findings include red/brown discoloration, woody in
rimarily
homimetic based on that
agent clinical findings,
leads although duplex
to hypertension, ultrasonography
tachycardia, can confirm
pupillary dilation, venous hypertension
and psychomotor agitation;and reflux.
causes coronary vasoco
the risk of myocardial ischemia and infarction.
creased ectopy and increased vagal tone. Atrial tachycardia with AV block occurs from the combination of these two digitalis ef
s should be encouraged to follow the DASH diet (rich in fruits, vegetables, and low-fat dairy products), restrict dietary salt intak
al bodyisweight,
valve the most and limit alcohol
common causeintake.
of aortic regurgitation (AR) in developed countries, with patients typically diagnosed in their 3
ue to aortic root dilation.
er hammer' pulse, and LV enlargement. The left lateral decubitus position brings the enlarged left ventricle closer to the chest w
awareness
w obstruction of from
the heartbeat.
supravalvular aortic stenosis develop left ventricular hypertrophy and can have exertional angina due to sube
gen demand during
ckers such as β blockers, exercise.
calcium channel blockers, digoxin, and adenosine should be avoided as they can cause increased co
nic disease that can cause megaesophagus, megacolon, and/or cardiac dysfunction. The protozoan Trypanosoma cruzi, endem
.g. labetalol, esmolol) are the treatment of choice for the initial medical management of patients with acute aortic dissection, as
ventricular contractility.
isease of of
estoration noncaseating
coronary blood granuloma
flow withinfiltration of the myocardium
primary percutaneous and canorresult
intervention in serious
fibrinolysis arrhythmia,
improves cardiomyopathy,
cardiovascular heart
and overall fa
long
nfarction.
reversible
ed for acute risk factors foredema
pulmonary premature
(acuteatrial contractions.
myocardial β blockers
infarction). are often
β blockers are a helpful in symptomatic
standard patients. infarction but shou
therapy in myocardial
ve heart failure or bradycardia.
commended
mon cause ofas an initial
dilated test for diagnosis
cardiomyopathy and riskyoung
in relatively stratification in most patients
adults. Patients typicallywith suspected
present stable
with signs andischemic
symptoms heart
of disease.
decompe
pheral
o improve edema).
long-term survival in patients with left ventricular systolic dysfunction include β blockers, ACE inhibitors, angiotensin I
r antagonists.
en the amplitudes of the QRS complexes vary from beat to beat. It is fairly specific for pericardial effusion. Enlargement of the c
ell.
dueEchocardiogram
to unstable angina can more definitely
or non-ST demonstrate
elevation myocardiala pericardial
infarction effusion.
is managed with antiplatelet and antithrombotic agents, β blo
y is not used in patients with non-ST elevation acute coronary syndrome.
et therapy (DAPT) is the most common cause of intracoronary stent thrombosis. Patients receiving an intracoronary stent should
T,
theboth
mostatimportant
the time of stent
risk placement
factor for aorticand in follow-up.
dissection, especially in older patients (age > 60). Marfan syndrome is common in youn
older patients with dissection.
rction (MI), deleterious cardiac remodeling is mostly driven by neurohormonal mechanisms. ACE inhibitors (e.g. enalapril, lisino
osterone
urs as a lateantagonists
complication(e.g. of
spironolactone)
acute ST-segment improve survival
elevation orfollowing
transmural MI,myocardial
likely due to inhibitionECG
infarction. of neurohormonal-mediated
often shows persistent ST-s card
ve left ventricular
n pericarditis enlargement
typically can cause
have pleuritic chestheart
pain, failure, refractory
a pericardial angina,
friction ventricular
rub, and diffuse arrhythmias,
ST-segment functional
elevationsmitral
on ECG regurgitation,
< 4 days f
ortive.
distension, and clear lung fields. Such patients are preload dependent and should be treated with intravenous fluids; preload-re
uld be avoided.
s from hyperreactivity of intimal smooth muscle, leading to intermittent coronary artery vasospasm. Calcium channel blockers (
on and
aracterized are by
therecurrent
preferredchestpharmacologic
discomforttreatment.
resulting from hyperreactivity of vascular smooth muscle, leading to intermittent coron
ts the digital arteries and occurs through
abnormality in patients with hypertrophic cardiomyopathy a similar mechanism. is the presence of systolic anterior motion of the mitral valve, leading t
ntricular septum. Contact between the mitral valve
y that may later progress to dilated cardiomyopathy. Other commonly and the thickened affected
septum during
organssystole
includeleads to leftkidneys,
the liver, ventricular
skin,outflow trac
and nervo
y (e.g. abdominal fat pad).
n increase in pulmonary pressures and pulmonary vascular congestion, manifesting as dyspnea, orthopnea, paroxysmal noctur
argement,
ching. In the predisposing to atrial
setting of MS, fibrillation
atrial and
fibrillation cansystemic thromboembolicheart
trigger decompensated complications
failure and (e.g.
alsostroke).
carries a higher thrombogenic risk
should be suspected in patients with unexplained congestive heart failure, proteinuria, and left ventricular hypertrophy in the ab
ses of aortic stenosis in the general population are senile calcific aortic stenosis, bicuspid aortic valve, and rheumatic heart dise
n the majority
atients of patients
with mitral age < 70.
valve prolapse typically shows a systolic click and/or mid-to-late systolic murmurs of mitral regurgitation. Squa
ventricular volume, decreasing
et dysfunction and prolapse can develop the intensity of the
severe MRmurmur.
and holosystolic murmur on physical examination. Chronic severe MR caus
rial fibrillation, left ventricular dysfunction, and
ohol consumption is the mainstay of therapy in patients with congestive heart failure.cardiomyopathy and is associated with improvement or n
alcoholic
ions in the cardiac myosin binding protein C gene and cardiac β-myosin heavy chain gene are responsible for about 70% of ide
(e.g. β blockers, verapamil, disopyramide) are recommended for the pharmacological management of symptomatic patients wi
or
ntsinitial therapy, and hypotension,
with bradycardia, verapamil or disopyramide can be useddelirium,
wheezing, hypoglycemia, as additional therapy
seizures, andincardiogenic
patients with persistent
shock. symptoms.
Intravenous fluids and a
nous glucagon should be administered in patients with profound or refractory hypotension.
P) refers to polymorphic ventricular tachycardia that occurs in the setting of a congenital or acquired prolonged QT interval. Imm
el or
patients withischemia,
intestinal TdP, while intravenous
acute magnesium
kidney injury, is the first-line
and Hollenhorst therapy
plaques. for stable
Treatment patients with
is supportive andrecurrent
includesepisodes of TdP.
statin therapy for ris
smbolism.
from inflammation of the visceral and parietal layers of the pericardium. Patients have advanced renal failure (blood urea nitro
st pain andofathe
olvement pericardial friction rub.
cerebrovascular The classic
arteries ECG finding
(e.g. carotid, of diffuse
vertebral) ST elevation
can cause symptoms is typically absent due
of brain ischemia to transient
(e.g. lack of myocardia
ischemic
(e.g. headache, pulsatile tinnitus, dizziness).
okalemia
nd urinalysis.and hypomagnesemia.
In addition, patientsThese shouldelectrolyte
be screenedabnormalities can cause ventricular
for major atherosclerotic tachycardia,
risk factors and
with a lipid also and
panel potentiate the sides
either fasting
ular myocardial infarction can experience profound hypotension due to inadequate right ventricular preload. These patients sho
od increase
be obtainedrightinventricular
all patientspreload and improve
with syncope due to cardiac output.
suspected structural heart disease. Neurological workup (e.g. brain CT scan) h
cal symptoms.
cea/vomiting are atypical
sinus bradycardia presentations
should of acute
be treated initially coronary
with syndrome.
intravenous In select
atropine. patients,
In patients withcardiac causes
inadequate must befurther
response, excluded prior to
treatment
ed or for
transcutaneous pacing.acne or milder acne that is producing scars or has failed less aggressive treatments. Liver function te
severe nodulocystic
obtained
esents withprior to and
white duringand
papules treatment.
plaques on the oral mucosa; variants may also show erythematous mucosal atrophy or ulceratio
ludes topical high-potency glucocorticoids.
Hair loss can be seen in women with hyperandrogenicUnlike cutaneous
states,LP,
butwhich is self-limited,
androgen oral LP
levels in most often with
women has a prolonged
FPHL courseThe
are normal. wit
agents preferentially target rapidly dividing cells, including hair follicle cells in the anagen phase. Impaired cellular reproduction i
sation of
terized byhair growth
patchy, and rapid hair
nonscarring shedding
loss. Itofishair shafts (anagen
an autoimmune effluvium).
disorder and is often associated with other autoimmune conditions
ds. A recurring course is common, but most patients have regrowth
by erythematous, scaly plaques. It is classically found on the extensor surfaces over time. of the knees and elbows (large plaque) but can
ft) as small
rficial fungalplaques. Whencharacterized
skin infection psoriasis occurs on the hands, it ishypopigmented,
by hyperpigmented, typically found on or the dorsal surface,
salmon-colored likely due
macules on theto frequent minor
upper trunk an
nicmonths. The diagnosis
dermatophyte canofbe
infection theconfirmed
nails mostwith potassium
commonly hydroxide
caused preparationrubrum
by Trichophyton of skin and
scrapings.
similar Treatment includes topical
fungi. It is characterized byset
The diagnosis
mals, is confirmed
or via fomites. by potassium
The diagnosis hydroxide
is generally microscopy
apparent of nailbut
on inspection scrapings.
can be confirmed with potassium hydroxide examinat
ungal (e.g. terbinafine, miconazole).
lved in intraepidermal and dermoepidermal adhesion complexes in the basement membrane zone. Diagnosis is based on biops
esting. Treatment is supportive.
e hyperpigmentation, secondary bacterial infection, and keloid formation. Management includes discontinuation of shaving or u
diopathic inflammatory disorder that presents with round, pruritic, scaly plaques, most commonly on the extremities. It is often a
eilypalmoplantar
on clinical findings.
eczema) Treatment includesby
is characterized topical glucocorticoids,
a recurrent, emollients,
pruritic, vesicular rashand avoidance
that primarily of harshthe
affects soaps.
palms, soles, and sides
,sus
andpresents
treatment includes high- and super high-potency topical corticosteroids.
with scaly, erythematous plaques, leading to atrophy, hypopigmentation, and scarring. It most commonly affects s
ommon and suggests re-exposure to an external source or autoinfection from a concurrent dermatophyte infection elsewhere o
cosis).
presents Patients shouldannular
as pruritic, have aplaques
thorough skin
with inspection,
a raised, and
scaly any other
border. sitesinofthe
It occurs infection should
groin but be treated.
usually spares the scrotum. The diag
es confirmed with potassium hydroxide preparation of skin scrapings. Topical antifungals (e.g. clotrimazole,
are at risk for developing additional foci of infection elsewhere on the body, toes, groin, or nails due to autoinoculation. tolnaftate) arePatien
usual
systemic glucocorticoid
oxide preparation of skintherapy,
scrapingsor HIV infection
showing can develop
branched, extensive,
segmented hyphaewidespread involvement.
is diagnostic. Treatment includes topical antifungals
(SCC) in situ of the skin (Bowen disease) presents as a slowly enlarging, scaly, erythematous patch or plaque. It most commo
ted with occurs
planus pain ormost
itching. BecauseatSCC
commonly in situand
the wrists canankles,
developdrug-induced
foci of invasive SCC,
lichen biopsy
planus is have
can recommended for confirmation.
a more diffuse presentation. Trea
ntinuation of the suspected medication.
ith pruritic, purple/pink, polygonal papules and plaques on the flexural surfaces of the wrists and ankles. Lesions may also occu
often associated with hepatitis C. The disorder is self-limited; treatment includes topical glucocorticoids.
neiform eruption caused by pressure-related damage to pilosebaceous follicles. It can result from pressure from crutches, bra s
avy
elayed backpacks.
hypersensitivity reaction characterized by 2- to 3-cm, tender, erythematous nodules, most often on the shins. Common
se, sarcoidosis,
autosomal dominant and neurocutaneous
malignancy. It can also becharacterized
disorder triggered by medications,
by typical skinsuch (e.g.asangiofibromas,
penicillins, sulfonamides, andand
ash-leaf spots) oralneurologic
contracept
ders)
acute, findings.
diffuse, noninflammatory hair loss. It is often triggered by a stressful event, such as weight loss, pregnancy, major illnes
despread thinning of hair
n acute inflammatory but the
disorder scalp and hair
characterized by shafts appear normal.
erythematous, It is a self-limited
round papules that evolvedisorder but lesions,
into target may take up to a the
although yearappea
to re
pecially
orseningherpes simplex)
of psoriasis as well
include as skin
local medications, malignancies,
trauma (Koebner and connective
phenomenon), tissuefrom
withdrawal diseases.
systemic glucocorticoids, and certain m
l).
high-potency glucocorticoids (e.g. betamethasone, fluocinonide) or vitamin D derivatives (e.g. trigger
In addition, certain infections, especially HIV and streptococcal pharyngitis (which can also guttate psoriasis),
calcipotriene). Patients witharemod
ass
ystemic treatment.
uman papillomavirus (HPV) infection and most commonly occur in young adults and immunocompromised individuals. The lesi
foot that can be painful
tender, firm, hyperpigmented whennodules
walking that
or standing.
are usually < 1 cm in diameter. They are due to fibroblast proliferation and most com
ave a fibrous component that causes
ocontrast medium) mast cell activation. Nearly 50% the central areaof to dimplehave
patients whenidiopathic
pinched. urticaria. Patients usually develop well-circumsc
lor, along with
haracterized byintense pruritus
symmetrical, and resolution of
hyperpigmented, individual
velvety skin in
plaques lesions within
the axilla, 24 hours.
groin, and neck. It is associated with insulin resistan
me) in younger patients and gastrointestinal malignancy in older individuals.
lar rosacea (i.e. papules and pustules on the central face) typically require pharmacologic treatment. First-line options include to
ommon side effect of systemic glucocorticoids and is characterized by monomorphic papules without associated comedones, cy
typical
son acne treatment
ivy/oak/sumac) arebut improves
a frequent rapidly
cause on discontinuation
of allergic of the The
contact dermatitis. offending agent. vesicular rash involves exposed skin and
erythematous,
he plant leaves.
reactivation of the varicella zoster virus that causes a vesicular rash in a dermatomal distribution. Acyclovir and other antivirals
he incidence of post-herpetic
s characterized neuralgia.dome-shaped, umbilicated papules. Patients with impaired cellular immunity (e.g. HIV dis
by firm, flesh-colored,
se.
cterized by scaly papules or plaques on the scalp, face, lateral neck, and dorsal surface of the hands. Chronic sun exposure is t
squamous cell carcinoma, but the likelihood of malignant progression of an individual lesion is low.
small, with
esents red, ecchymoses
cutaneous papules common
in elderly patients in in
aging
areas adults.
exposed Theytodo not regress
repeated minorspontaneously, but they surfaces
trauma (e.g. extensor are benign andhands
of the generallyand
rs in perivascular connective tissue. Senile purpura is not dangerous and requires no further
ers of heme synthesis. Porphyria cutanea tarda, the most common porphyria, is due to deficiency of uroporphyrinogen decarbo evaluation.
rogens and
condition is frequentlyby
characterized associated with hepatitis C.due
areas of depigmentation Manifestations
to destruction include photosensitivity
of melanocytes. It canwith blisters andwith
be associated skinother
fragility.
autoimm
mmune thyroid disease, type 1 diabetes mellitus, primary adrenal insufficiency, hypopituitarism,
rsensitivity reactions are immediate in onset and mediated by IgE and mast cells/basophils. Mild manifestations of a drug allerg and alopecia areata.
ms)
ted arewithusually
topical treated
retinoids with
andantihistamines
benzoyl peroxide. and discontinuation of the offending drug.
Moderate and moderate-to-severe cases will benefit from the addition of topical
served for severe or recalcitrant acne.
ine treatment for noninflammatory (comedonal) acne with the addition of organic acid preparations (e.g. salicylic, azelaic, or gly
bacterial
infection agent, may be
of the hand used by
caused for herpes
comedonal acne,
simplex but Most
virus. is preferred for inflammatory
adult infections acne.from contact with genital herpetic lesio
are acquired
resolution
anogenitaliswarts) the norm but recurrences
are verrucous are common.
papilliform lesions located in the anogenital region. These lesions are caused by human papillo
tted disease in the
hypersensitivity Unitedthat
reaction States. Certaincaused
is typically serotypes (especially
by jewelry 16 andfasteners.
or clothing 18) are associated with squamous
Chronic, low-level cell carcinoma
nickel exposure of the
can lead to
nntsof respond
the deeptodermis low- orand mid-potency
subcutaneoustopicalfatcorticosteroids.
that is usually caused by β hemolytic Streptococcus (nonpurulent) or
mespreading rash that is reaction
is an inflammatory warm, erythematous, and painful
to drugs or certain withand
infections flat,isindistinct borders.
characterized by coalescing erythematous macules, bullae, d
ver, hemodynamic instability, and altered level of consciousness.
nal destruction of melanocytes, most likely due to an autoimmune etiology. It is often associated with other autoimmune conditi
s is
ar made ondistinguished
disorders clinical grounds,by theand topical or systemic
percentage of involved corticosteroids
skin: SJS involvesare the most of
< 10% common
the body first-line
surfaceintervention.
area, TEN involves > 30,
rosacea causes erythema involving the central face, facial flushing, telangiectasias, and burning discomfort. Symptoms are typi
d other causes blistering
mucocutaneous of rapid body temperature
disease changes.
characterized The episodes
by flaccid aremucosal
bullae and usually intermittent butcaused
erosions. It is can lead
by to permanently against
autoantibodies flushed ds
sdermal keratinocytes.
an autoimmune dermalBiopsy shows
reaction dueintraepidermal cleavage,
to dietary gluten and immunofluorescence
and is commonly associated with studies show intercellular
celiac disease. It presentsIgGwithdeposits
cluster
ck, and buttocks. Management includes dapsone and a gluten-free diet.
rtant cause of phototoxic drug eruptions These eruptions manifest as exaggerated sunburn reactions with erythema, edema, a
occur wherever there are pigmented cells. Sunlight exposure, hereditary factors, fair skin, and a history of pre-existent dysplas
gest
benignmelanoma
epidermal include
tumorasymmetric
that presents shape, irregular border,
in middle-aged variability
or elderly of color,
individuals as adiameter > 6 mm,
tan or brown, and
round evolution
lesion with aofwell-demarcat
size and app
ebased
most primarily
common on clinical
skin appearance,
malignancy and treatment
in the United States. Itistypically
usually not required.
presents as a slow-growing nodule with pearly, rolled borders.
de local tissues and should be removed.
s a benign condition characterized by small papules with central umbilication. First-line therapy in adults includes cryotherapy w
tharidin).
ses pruritic, erythematous plaques with a greasy scale that predominantly affect the scalp and face. It is most common in the fi
th Parkinson
ronic, inherited disease and HIV.
skin disorder Topical antifungal
characterized agents
by diffuse are effective
dermal treatment.
scaling. The skin appears dry and rough with horny plates resemb
e emollients, keratolytics, and topical retinoids.
autoimmune disorder characterized by pruritus and tense bullae. A pre-bullous prodrome can present as urticarial or eczemato
y.
sted,First-line treatment
red papules in theis aaffected
high-potency
areas.topical glucocorticoid,
Diagnosis is confirmed which is effective
by light microscopy for even
of skinextensive
scrapings.disease.
Topical permethrin or ora
rficial nondermatophyte fungal skin infection caused by Malassezia species and characterized by salmon-colored, hyper- or hyp
hous potassium
dermatophytehydroxide preparation
infection of skin
that causes scrapings,
a pruritic rashand withtreatment is with topical border
a scaly, erythematous antifungals.
and central clearing. Patients often ha
ands,
y pressure (CPAP) predisposes users to recurrent epistaxis because of its drying effect on thecan
groin, or feet. Those with immunocompromising conditions (e.g. HIV, diabetes mellitus) have
nasal severeHumidification
mucosa. or widespreadisd
s. by pain, erythema, edema, and discharge. Loss of cerumen, trauma, and foreign materials in the ear canal increase the ris
ized
a.
mmer's ear') presents with pain, erythema, and discharge from the ear. It often occurs after disruption of the skin barrier and whe
uditory
msay Hunt canal. Pseudomonas
syndrome) is causedaeruginosa
by the is the most common
reactivation pathogen.
of varicella zoster virus in the geniculate ganglion, disrupting cranial nerve V
II. Primary manifestations include a painful, erythematous,
f-limited disorder of the vestibulocochlear nerve (CN VIII) that sometimes vesicular rash follows
on the auditory canalrespiratory
a viral upper or auricle and ipsilateral
infection. facial pn
Vestibular
ys . are the most effective single agent for allergic rhinitis, although maximal benefits may require continuous treatment for sever
mine or cromolyn
itis externa nasal sprays,
is a severe infection and
of leukotriene
the externalmodifiers can bethat
auditory canal considered
extends to based on the
the skull basepatient's
and is symptoms and drug
usually caused by toleranc
nts
rderwith diabetes
of the inner ear mellitus. Intravenous
characterized ciprofloxacin
by increased is theand/or
volume first-line therapy.
pressure of endolymph (endolymphatic hydrops). Clinical featur
s,asand tinnitus
white patchesor aural fullness.
or plaques over the oral mucosa that usually cannot be scraped off. The risk factors for development of leuko
(tobacco
ratory and alcohol
disease use).condition
is a clinical Development
definedof by
areas
the with
triadinduration
of asthma,and/or ulceration or
bronchospasm should
nasalprompt biopsy
congestion to rule out
following the malignant
ingestion o
chronic rhinosinusitis with nasal polyposis.
hearing loss that may be either temporary or permanent. Ototoxicity is more common in patients taking high doses of loop diure
gs treated with with
that occurs otheraging
known ototoxic
is called medicationsIt (e.g.
presbycusis. aminoglycosides).
presents with bilateral, high-frequency hearing loss and is related to damage to
itis externa represents osteomyelitis of the skull base and is most commonly caused by Pseudomonas aeruginosa
rainage; granulation tissue may be seen in the ear canal. Progression of the infection may lead to cranial neuropathies.
disorder
cally can result
presents in referred pain
with characteristic to the ear
changes that isand
in facial worse
limbwith
bones,chewing.
it should Patients
also be typically haveinapatients
suspected history of nocturnal
with teeth grin
constellations of
y, thickening of skinfolds, and obstructive sleep apnea. The initial test for acromegaly is a
osis can cause secondary hypogonadism due to iron deposition in the pituitary with deficient production of gonadotropins. Initial serum insulin-like growth factor-1 lev
and transferrin
ating). Frequent saturation. The diagnosiscan
or severe hypoglycemia is confirmed
encouragewith HFE genetic
behavioral changes testing. Treatment
to prevent includessuch
recurrence, therapeutic phlebotomy.
as increased caloric in
impair glycemic control.
g diabetes reduces the glucose-raising effects of epinephrine and suppresses the symptoms related to the catecholamine surg
hypoglycemic
ncreatic resection episodes.
can cause loss of insulin-producing β cells, leading to pancreatogenic diabetes; exogenous insulin is require
snand are at risk for
patients with critical rapid and due
illness severe hypoglycemia.
to increased use of glucose in the tissues and suppression of gluconeogenesis in the liver. Th
due to decreased renal gluconeogenesis and
al falsification of illness in the absence of external reward. reduced clearance of endogenous
Laboratory testing (e.g.insulin.
insulin/C-peptide levels, sulfonylurea screen
.g. hospital) may confirm the abnormal behaviors.
derstands the need for change but has not committed to a specific plan), the clinician should probe the patient's level of underst
ment of the can
ific gravity prosbe and
used cons to of the proposed
narrow the cause change.
of suspected polyuria. Low urine osmolality and low urine specific gravity (e.g. < 1.
.inHigh urine osmolality
deficiency, total bodyand high urine
potassium specific
is often gravitydespite
depleted suggestnormal
osmotic or diuresis from conditions
slightly elevated such as diabetes
serum potassium values. mellitus.
Therefore, in
ium repletion
ke patients should
with primarybe given
adrenal when serum potassium
insufficiency is < 5.3
(e.g. Addison mEq/L. patients with central (secondary or tertiary) adrenal insuffi
disease),
erpigmentation.
endronate, risedronate) are the first-line treatment for most women with postmenopausal osteoporosis. After initiation, bone den
se toinsufficiency
enal therapy. Treatment is usually discontinued
have glucocorticoid after 5 years
and mineralocorticoid due to a risk
deficiency. Mostofpatients
atypicalrequire
fracturereplacement
with prolonged use.glucocorticoid
of both
drocortisone)
ed in patients activity.
with renal dysfunction and either a prolonged history of diabetes (> 5 years for type 1 diabetes) or proliferative dia
ce of DN.
r secondary prevention of overt nephropathy. However, ACEIs are not indicated for primary prevention in patients with diabetes
m in men presents with low libido, erectile dysfunction, a low serum testosterone level, and a low or inappropriately normal LH. S
fctal
opioids, which issuppress
carcinoma the mostGnRH
commonandhistologic
LH secretion,
type,leading
and mostto reduced Leydig
tumors are cell testosterone
hormone synthesis.
receptor-positive. The initial evaluation of su
aracterized by hypercalcemia, acute kidney injury, and metabolic alkalosis. It is caused by excessive intake of calcium and abs
ninhibitors,
for heartburn
whichorreduce
osteoporosis.
cardiovascular mortality and morbidity. Both agents are associated with weight loss, an effect not seen
ld be suspected in patients with resistant hypertension, especially in the presence of other suggestive features (e.g. episodic an
nt of urinebyoraplasma
acterized metanephrine
distorted levels
body image and is the
fear initial step
of weight gain in evaluation.
despite an abnormally low BMI. Medical complications due to malnu
roparesis, cardiac atrophy, and decreased bone mineral density.
he hypothalamic-pituitary-ovarian axis. Low circulating thyroxine levels increase the excretion of hypothalamic thyrotropin-relea
y production
raves diseaseofleads
both to
TSH and prolactin.
resolution The resultinginhyperprolactinemia
of hyperthyroidism 6-18 weeks, but thesuppresses
dose needed ovulation, leadinggradually
for treatment to abnormal uterine
leads ble
to perm
also acutely worsen Graves ophthalmopathy due to increased titers of thyroid-stimulating autoantibodies.
llitus who have an elevated hemoglobin A1c despite normal fasting glucose levels may have postprandial hyperglycemia. A com
ntrol fasting
es (e.g. glucose)
stroke, and a infarction)
myocardial rapid-actingandmealtime insulin
mortality. Very(to control
strict postprandial
glycemic glucose)
control (e.g. goal can
A1c improve
< 6.5%) glycemic control.
is associated with increa
mortality. Therefore, the recommended target hemoglobin A1c for most nonelderly patients is 7.0%.
eatening thyrotoxicosis usually triggered by a specific event (e.g. surgery, trauma, infection, iodine contrast, childbirth) in patien
erthyroidism.
iciency (AI) may Patients cantodevelop
be due adrenalfever, hemodynamic
(primary instability,
AI) or pituitary cardiac
(secondary AI) arrhythmias, and congestive heart
disease. Hyperpigmentation failure.
and signs of mineraloco
dary AI.
d to moderate increase in prolactin suggests a nonfunctioning (gonadotroph) adenoma. Patients may develop symptomatic hyp
omatic until the
isease (e.g. adenomaceliac
steatorrhea, becomes very can
disease) largecause
and causes
vitaminaDmass effect due
deficiency on surrounding tissues.
to malabsorption. Patients usually develop hypoca
mone. Patients can be asymptomatic or complain of bone pain or tenderness, muscle
sm is characterized by hypertension, mild hypernatremia, metabolic alkalosis, and suppressed plasma weakness or cramps,
reninand gait abnormaliti
activity. Hypokalem
e with diuretic use. Clinically significant hypernatremia and edema are not seen due to aldosterone escape.
ead to hypocalcemia with an elevated parathyroid hormone level. Causes include inadequate dietary intake of vitamin D, inade
Evaluation
s insulin forincludes
diabetesmeasuring the serum
are vulnerable 25-hydroxyvitamin
to exercise-induced D level. because insulin continues to be released from the inject
hypoglycemia
nic kidney disease
racterized are at increased
by hypertension, risk due and
hyperglycemia, to delayed
weight clearance
gain. Commonof insulin by the
causes kidneys.
include excess glucocorticoid intake, ACTH-prod
gonadism due to primary gonadal injury or hypothalamic-pituitary dysfunction. Cirrhosis is also associated with elevated circulat
msedandrogens.
radioactive iodine uptake (RAIU) suggests de novo thyroid hormone synthesis, whereas decreased RAIU suggests release
ke.
micThyrotoxicosis
state in type 2due to exogenous
diabetes thyroid
mellitus is hormoneby
characterized is severe
characterized by low serum
hyperglycemia thyroglobulin levels.
and hyperosmolality without significant ketoacido
ommon precipitating factors include infection, medications (e.g. glucocorticoids), interruption of insulin therapy, trauma, and acu
ortant cause of reversible
ave hyponatremia changes
due to renal in memory
sodium loss andand mentation.
increased It will be
secretion accompanied
of antidiuretic by systemic
hormone. changes such
Hyperkalemia ascommon
is also weight gain,
due
deficiency.
racterized by weight gain, muscle weakness, and hypertension. Patients can experience easy bruisability, dermal atrophy, and
sissue.
due to Women can have
the effects features
of activated T of hyperandrogenism
cells due to co-secretion
and thyrotropin receptor of adrenal
antibodies (TRAB) androgens
on TSH withon
receptors cortisol.
retro-orbital fibroblasts
npathy
raiseistiters of TRAB and worsen the ophthalmopathy. Glucocorticoids and antithyroid drugs can
characterized by proximal muscle weakness in the setting of clinical features of hyperthyroidism. Objective be used to minimize the effec
findings ma
ism usually improves the myopathy.
for thealdosterone
normal primary prevention
level. In of atherosclerotic
contrast, patients cardiovascular
with primary Aldisease in all patients
have elevated ACTH, agelow > 40 with diabetes
aldosterone mellitus,
and cortisol, andregardless
significanto
mia).
denomas cause hyperthyroidism with elevated thyroid hormone and elevated or inappropriately normal TSH levels. Most TSH-s
be associated
excessive with mass
secretion effecthormone
of growth symptoms including
(GH), usuallyheadache, visual field
due to a pituitary defects, and
somatotroph impaired
adenoma. function ofgrowth
Insulin-like surrounding
factor 1pituita
med
test in suspected acromegaly. GH is not as sensitive due to wide fluctuations in circulating levels.
c adenoma is due to autonomous production of thyroid hormones from the hyperplastic thyroid follicular cells. The radioactive io
dule, with suppression
secretion of PTH-related of uptake
protein in
bythe rest of the
malignant gland.
cells. Other mechanisms of tumor-related hypercalcemia include osteolytic bone
oxyvitamin D, and increased interleukin-6 levels.
atients are at risk for rapid bone loss from increased osteoclastic activity in the bone cells. Untreated hyperthyroid patients are a
ngtheatrial
most fibrillation.
common cause of primary adrenal insufficiency (PAI) in developed countries. The key differentiating features of PAI f
nsm,andvitiligo).
hyperkalemia
Clinicalseen in PAI.
manifestations result from deficiency of mineralocorticoids, glucocorticoids, and androgens and include fati
the is
sm skin and mucousbymembranes.
characterized autonomous secretion of parathyroid hormone from parathyroid adenomas or parathyroid hyperplasia. M
mia,
phase butorpotential
return toclinical features
a euthyroid include
state. nephrolithiasis,
It does osteoporosis,
not require specific therapy,nausea,
but a β constipation,
blocker may be andprescribed
neuropsychiatric symptoms.
to control symptom
ss).
athyroid hormone deficiency) is characterized by hypocalcemia and hyperphosphatemia in the presence of normal renal function
immune
r elevated. and nonautoimmune
This finding is due parathyroid destruction,
to hyperosmolarity, whichand defective
draws watercalcium-sensing
and potassium into receptor.
the extracellular space, and insulin de
or patients with central-type obesity is the key pathogenic factor in the development of type-2 diabetes mellitus and associated
shigh yield question
increase levels of for the USMLE!!! globulin (TBG). Patients on thyroid replacement may need a higher dose to saturate the i
thyroxine-binding
f malignancy is characterized by severe, symptomatic hypercalcemia. It is due to the release of parathyroid hormone-related pr
nvel
andof reabsorption of calcium
T4-binding globulin. Thisineffect
the distal renal
is seen in tubule.
pregnancy and in patients on oral contraceptives or menopausal estrogen repla
atients with normal hypothalamic-pituitary-thyroid
mportant cause of hypocalcemia, particularly in alcoholics. function maintain a euthyroid
Hypomagnesemia state and
causes normal release
decreased TSH level.of parathyroid hormone
ced by low magnesium is not associated with elevated phosphorus levels (as seen with other causes of hypoparathyroidism).
e may present with irregular menses and signs of hyperandrogenism (e.g. hirsutism). Treatment involves weight loss and oral c
regulate menstrual cycles.
sphatemia, and increased parathyroid hormone levels are characteristic biochemical abnormalities of secondary hyperparathyro
hyrotoxicosis
uminuria (urine is albumin-creatinine
caused by hyperdynamic ratio ofcirculation
30-300 mg/g)resulting
is an from
earlyincreased myocardial
sign of diabetic contractility
nephropathy and and heart
should rate. therapy with
prompt
agents
smolality)reduce glomerular hydrostatic
and hyponatremia (sodium <pressure and are
137 mEq/L). clinically
Serum Na >proven to prevent
145 mEq/L progression
with dilute of proteinuria
urine excludes and
primary nephropathy.
polydipsia and f
ormone [ADH] release from pituitary) or nephrogenic (normal ADH level but with renal ADH resistance).
characterized by myalgias, proximal muscle weakness, and an elevated serum creatine kinase level. Patients often have additio
exes). Initialfurther
sts require diagnostic testing
adrenal includes
imaging. TSH venous
Adrenal and freesampling
T4 levels.is the most sensitive test for differentiating adrenal adenoma and
unilateral adrenal mass on imaging.
n should be screened for diabetes mellitus with either fasting blood glucose or hemoglobin A1c. Even in the absence of hyperte
0-70 withdiabetic
r painful a BMI >neuropathy
25. include tricyclic antidepressants, dual serotonin norepinephrine reuptake inhibitors, and anticonvu
ase of excitatory neurotransmitters.
e. delayed gastric emptying) presents with anorexia, nausea, vomiting, early satiety, postprandial fullness, and impaired glycem
relieve
athy gastroparesis
in diabetes symptoms but
is characterized is associated with axonopathy.
by length-dependent a small risk of extrapyramidal
Small side effects
fiber involvement causesand tardive
pain, dyskinesia.
paresthesia, and allody
f proprioception and vibration sense, and diminished ankle reflexes.
oot ulcers include diabetic neuropathy, previous foot ulceration, vascular disease, and foot deformity. Diabetic neuropathy is the
0% of patients
inguish between with ulcers.
central Monofilament
and nephrogenictesting predicts
DI. Patients thecentral
with risk of DI
future ulcers.
increase their urine osmolality by at least 50% following th
lets; patients with nephrogenic DI will not show much change. Desmopressin (intranasal
entric myocardial hypertrophy, diastolic dysfunction, left ventricular dilation, and global hypokinesis. form preferred) is the first-line treatme
This cardiomyopathy is ofte
sleep apnea, and valvular heart disease. Complications include heart failure and arrhythmias.
tism with virilization suggests very high androgen levels due to an androgen-producing neoplasm. Elevated dehydroepiandroste
nal tumors.of serum prolactin and screening for other pituitary hormone deficiencies. Pituitary imaging is indicated for patients w
asurement
w with
testosterone levels, or disruptions
pheochromocytoma. Patients in
withother
MTC pituitary
shouldhormones.
be screened for pheochromocytoma prior to thyroidectomy with a plasma
nti-TPO) antibodies are present in > 90% of patients with Hashimoto thyroiditis, and high titers of anti-TPO are associated with a
High titers of anti-TPO
ne neoplasia (MEN2B) are also associated
is characterized with increased
by medullary riskcancer
thyroid of miscarriage in both euthyroid and
(MTC), pheochromocytoma, hypothyroid
marfanoid women.
habitus, and mucos
aggressive, and thyroidectomy is often recommended in infancy.
roph adenoma (prolactinoma) is the most common primary pituitary tumor. Serum prolactin levels correlate with the size of prol
gnostic.
actinoma (> 1 cm) or a symptomatic prolactinoma should be treated with dopaminergic agonists (e.g. cabergoline, bromocriptin
ize.
efective mineralization of the organic bone matrix. It is most commonly due to severe vitamin D deficiency, which leads to decre
dings includesecondary
th resultant hypocalcemia,hyperparathyroidism.
hypophosphatemia, Typical laboratory
increased findings hormone,
parathyroid include hypophosphatemia,
and elevated alkaline hypocalcemia,
phosphatase. and elevate
X-ray find
and pseudofractures.
hyroiditis is characterized by fever, neck pain, and a tender goiter following an upper respiratory illness. Patients have a self-lim
ual recovery
eated of thyroiddrugs,
with antithyroid function. Treatment
radioactive is symptomatic
iodine with β blockersThe
therapy, or thyroidectomy. andmost
nonsteroidal anti-inflammatory
serious side drugs.drugs is ag
effect of antithyroid
throat and fever by
s characterized should
low T3stop the drug
levels with and seeTSH
normal a physician
and T4 into patients
check their
withwhite
acuteblood cellItcount.
illness. is due primarily to decreased peripher
t recommended unless abnormal thyroid function persists after the patient has returned to baseline health.
e evaluated
e by serum
elevated levels TSH
of total and ultrasound.
cholesterol, LDL, andA radionuclide
triglyceridesscan
and isis associated
indicated only
withforanpatients
increased withrisk
lowofTSH.
coronary atherosclerosis
prove lipid levels, although normalization may take several months.
actone, eplerenone) is recommended for patients with bilateral adrenal hyperplasia or with unilateral adrenal adenoma who eith
hyperaldosteronism
should be categorized mayon not
the have
basis spontaneous
of parathyroidhypokalemia,
hormone (PTH) but levels.
they are prone to developing
PTH-independent diuretic-induced
hypercalcemia hypokalemia.
(suppressed PTH) i
cemia (elevated or inappropriately normal PTH) is usually due to primary hyperparathyroidism.
nemia
H (e.g. can have decreased
respiratory alkalosis)total serum
causes calcium. However,
dissociation of hydrogen ionized calcium
ions from (physiologically
albumin, active form)
allowing increased is hormonally
binding of calciumregulated
and a dro
siologically
used active form,
by excessive intakeand decreased
of calcium andlevels can result
absorbable in clinical
alkali. manifestations
It can be seen in patientsof hypocalcemia.
taking calcium bicarbonate for osteoporos
mia, metabolic alkalosis, and acute kidney injury.
sm (Conn syndrome) causes hypertension, mild hypernatremia, hypokalemia, and metabolic alkalosis. The diagnosis of Conn s
erone
(due tolevels.
hypokalemia), and hypo- or achlorhydria (due to decreased gastric acid secretion). Stool studies are consistent with se
diagnosis.
abetes mellitus, weight loss, diarrhea, and anemia. A serum glucagon level > 500 pg/mL confirms the diagnosis, and abdominal
ses.
neoplasia is characterized by primary hyperparathyroidism, pituitary tumors, and gastrointestinal/pancreatic endocrine tumors
mptomatic hypercalcemia
uation of Cushing syndrome andisrecurrent peptic
to confirm ulcer.
hypercortisolism with a late-night salivary cortisol assay, 24-hour urine free cortisol m
e (PCOS) may present with androgenic alopecia (male-pattern hairtoloss),
test. If hypercortisolism is confirmed, ACTH levels are measured differentiate
irregularACTH-dependent from ACTH-independent
menses, and obesity. Patients with PCOSca ar
nd should be screened with an oral glucose tolerance test.
neuroendocrine tumors that cause episodic flushing, secretory diarrhea, bronchospasm, and cardiac valvular abnormalities. Ca
om
GLP-1)tryptophan
agonists(required for niacin synthesis),
and sodium-glucose resulting
cotransporter in niacin GLP-1
2 inhibitors. deficiency (i.e. pellagra,
agonists withsignificant
can induce dermatitis, diarrhea,
weight loss and
and dementia
are asso
ar disease.
thyroiditis) is characterized by acute thyrotoxicosis with mild thyroid enlargement and suppressed TSH. Thyroid scintigraphy sh
rol, particularly using ACE inhibitors or angiotensin II receptor blockers, can reduce the progression of diabetic nephropathy (DN
7% also can prevent
rs indicating progression
resolution of diabeticofketoacidosis
DN; further are
lowering is associated
the serum with
anion gap andanserum
increased risk of hypoglycemia
β-hydroxybutyrate and possibly
levels. The anion gapcard
es
and returns to normal with the disappearance of ketoacid anions.
ed with multiple differential diagnoses. Helpful tests used in the evaluation of hypoglycemic patients are measurements of C-pe
ondary to insulinoma is associated with elevated insulin, C-peptide and proinsulin levels.
mic state is characterized by severe hyperglycemia and hyperosmolarity, mental status changes, and normal anion gap. Osmo
r;
mtherefore,
levels maytreatment
be normal should begin
or mildly with immediate
elevated due to the intravenous fluid resuscitation
shift of potassium out of cellswith
intonormal saline.
the extracellular space. Insulin in these
to hypokalemia.
betic ketoacidosis include: 1. Hydration to restore intravascular volume, with 0.9% (normal) saline recommended in the first 1-2
s with with
eated intravenous
antithyroidregular
drugs, insulin; 3. Serial
radioactive assessment
iodine, of electrolytes,
or thyroidectomy. especially
Antithyroid drugspotassium;
are used for 4. Treatment of mild
patients with the underlying
disease who pre
used in preparation
ny patient for treatment
taking antithyroid drugswith radioactive
suggests iodine in patients
agranulocytosis. with significant
Antithyroid drugs shouldhyperthyroidism
be stopped and or who
WBC arecount
at increased
checked.riskRo
oid drugs is not cost effective.
erized by glucocorticoid deficiency, hypogonadism, and hypothyroidism. Typical features include fatigue, cold intolerance, hypo
ry adrenal insufficiency,
insufficiency aldosterone
should include an 8 AM isserum
normal in central
cortisol and adrenal insufficiency
plasma ACTH. due toan
In addition, hypopituitarism.
ACTH stimulation test (cosyntropin test)
ncy
drome is characterized by progressive painless muscle weakness predominantly involvinginitial
(and most patients with central adrenal insufficiency) and should be performed in the evaluation.
the proximal muscles. It is due to the
e,beleading to muscle atrophy.
the initial manifestation of type 1 diabetes mellitus. Typical symptoms include acute onset of weight loss, polydipsia, abdom
stick
enism, blood glucose with
particularly can virilization,
rapidly provide a presumptive
suggests diagnosis, andovarian
an androgen-secreting treatment should neoplasm.
or adrenal begin immediately with intravenous
Serum testosterone fluid
and DHE
uction.
iseaseElevated
is perianal testosterone
disease (e.g. with normal fissure,
abscess, DHEAS fistula),
suggests an ovarian
including source, whereas
rectovaginal fistula, dueelevated DHEAS inflammation
to transmural suggests an adrenal
of the ga
ally have a malodorous, tan vaginal discharge; passage of flatus through the vagina; and a posterior
s are a common cause of cyclic breast pain in women of reproductive age. Classic clinical findings are diffusely nodular breasts vaginal lesion.
mphadenopathy.
e in elderly patients may have atypical presentations. Consider reversible etiologies first, especially if new onset (remember: DI
nfections
he treatment limited to the lower
of patients urinary epidermal
with human tract. Initialgrowth
evaluation should
receptor includebreast
2-positive urinalysis with culture.
carcinoma and is associated with a risk of card
echocardiography at baseline and at regular intervals in patients treated with trastuzumab.
e most
nt with aimportant prognostic
diverse array consideration
of symptoms relatedintothe treatment of(e.g.
malabsorption patients with breast
diarrhea, cancer.
microcytic It is based
anemia, vitaminonDTNM staging.or autoimm
deficiency)
ophic
on glossitis).
of illness in another person, typically a family member, to obtain psychologic validation or facilitation of the sick/caregiver rol
vices.
e-mediated disorder triggered by gluten, causes inflammatory changes that decrease the small bowel’s ability to absorb nutrien
srsthe risk for
treated withosteoporosis.
abdominopelvic DXAradiation,
can be used to screen
patients for osteoporosis
with inherited in patients
colon cancer with celiac
syndromes, and disease.
patients with a history of inflamm
ing colorectal adenocarcinoma and should start colon cancer screening at an
ush border (e.g. infectious gastroenteritis, celiac disease, Crohn disease). Lactose breath testing, earlier age than the general population.
which detects hydrogen rele
ostic.
vomiting, jaundice, hepatomegaly, and severe elevations in hepatic transaminases (e.g. aminotransferase levels > 1,000 U/L).
FEcare workers,
genetic homeless
mutations, butshelter
patients residents,
with extremeinternational travelers, (e.g.
hyperferritinemia and men
serum who have>sex
ferritin with
1,000 men. should receive urgent ther
ng/mL)
results.
ally occurs in adolescents or young adults practicing unprotected sexual intercourse. Rectal infection can occur via receptive an
Manifestations
cur without an includeobvioustenesmus, mucopurulent
stimulus. Proctalgia fugax anal
is adischarge,
diagnosis and pruritus; rectal
of exclusion; physicalfullness, bleeding,
examination anorectal
(e.g. pain, and
digital rectal, const
prostate,
s bilirubin and alkaline phosphatase levels may increase several days later. The virus has fecal-oral transmission, and outbreak
od,
ighas well of
levels asautoantibodies,
to overcrowdedresulting
homelessin shelters.
elevated serum globulins and a γ gap. Positive serology (e.g. anti-smooth muscle, anti
hypergammaglobulinemia
nd confirmsdifficile,
stool studies (e.g. Clostridioides the diagnosis.
fecal occult blood) to rule out other etiologies. First-line therapy is oral hydration and
s characterized by recurrent abdominal pain related to defecation and changes in stool frequency or form. Management include
pplementation
cirrhosis, (in constipation-predominant
cessation of alcohol use can reduce disease) or antidiarrheal
liver inflammation, agents (inand
fibrogenesis, diarrhea-predominant disease).
portal pressure, which can lead to the resolu
l abstinence should be recommended in all patients with cirrhosis.
osterone system and promotes sodium and water retention. Hyperdynamic circulation and resistance to flow promote third spac
ressure
et ascites(i.e. hypoalbuminemia
require due to impaired
diagnostic paracentesis. Ascitic synthetic
fluid cellfunction)
count and reduces fluid resorption
differential should be from the interstitium.
performed to rule out spontaneous b
asurement of albumin and total protein are needed to determine the underlying etiology.
tritis is an autoimmune disorder resulting in the formation of antibodies toward parietal cells (resulting in hypochlorhydria and un
nonB12 deficiency).
in patients Common
in the manifestations
intensive care unit andinclude
can causepostprandial
occult or abdominal pain, bloating,
gross gastrointestinal elevated
bleeding. serum
Risk gastrin
factors levels,
include andsep
shock, m
al
edcord/brain injury,inflammatory
by multisystem burns, and high-dose corticosteroids.
noncaseating granuloma formation. Subclinical (asymptomatic) hepatic involvement is common
estatic and hepatocellular pattern.
overgrowth presents with bloating, diarrhea, and mild abdominal pain. It can develop in patients with altered small bowel motility
diagnosed
eremia with carbohydrate
is strongly associated withbreath testing. colon
underlying Treatment
cancer.is with antibiotics
Therefore, (e.g. with
patients rifaximin, neomycin).
C. septicum bacteremia require screening co
icularly Streptococcus bovis, is also strongly linked to colon cancer.
characterized by low body weight, distorted body image, and avoidance of weight gain. Because patients with AN often try to h
s,constipation, cold intolerance,
leading to symptoms bradycardia,
of nausea, postprandial hypotension) are important diagnostic
vomiting, gastroesophageal clues.
reflux, and dysphagia. Esophagogastroduodenosco
presents with acute pain and tenderness in the left upper quadrant. Most cases arise in those with hypercoagulable states (e.g.
olic
ed disease,
abdominal or pain
hemoglobinopathy.
from pancreatic hyperstimulation. Pancreatic enzyme supplementation (i.e. lipase, protease, amylase) is us
reatitis are related to gallstones or alcohol abuse, and hypertriglyceridemia is the third most common cause. Drug-induced pan
n etiologies are ruled out, especially in patients taking a known offending agent (e.g. furosemide, hydrochlorothiazide).
pearing colonic mucosa; however, biopsy demonstrates a mononuclear infiltrate within the lamina propria, and a subepithelial c
urrent autoimmune
up is not conditions,
typically required cigarette
unless alarm smoking, andpresent,
features are certain medications
which include (e.g. nonsteroidal
older age of onset, anti-inflammatory
gastrointestinaldrugs).
bleeding, noctu
mia, elevated inflammatory markers, or a family history of early colon cancer.
s requires further workup; these include older age of onset (> 50 years), nocturnal diarrhea, gastrointestinal bleeding, worsenin
(e.g. iron affects
ommonly deficiency anemia,
young elevated
men and inflammatory
is frequently markers),
associated with or a family
other atopichistory of inflammatory
disorders. It can present bowel
withdisease or early
intermittent solidcolon
foodc
%right
of patients have a history
upper quadrant pain, of foodand
fever, impaction.
jaundiceThe diagnosis
(e.g. is confirmed with biopsies
direct hyperbilirubinemia); demonstrating
hypotension and alteredeosinophilic
mental statusinfiltration
can occuof
ay
tionbeshould
present
bedue to lacticinacidosis
suspected recentlyinhospitalized
severe sepsis. Common
patients bile ductvoluminous
who develop dilation is typically visible onlow-grade
watery diarrhea, right upperfever,
quadrant abdo
and leuko
diagnostic.
on Other established
in older patients with impairedrisk mobility,
factors include
chronicantibiotic use, severe
constipation, comorbid
or decreased illness of
sensation (e.g. inflammatory
stool in the rectalbowel
vault.disease),
Obstruction ando
ssage ofinsufficiency
exocrine liquid stool around the impaction
is characterized can lead
by protein andtofat
incontinence.
malabsorption, Initial management
steatorrhea, includes
weight loss, manual disimpaction
and fat-soluble vitamin and enem
deficie
olves
d signspancreatic
of dorsalenzyme replacement.
column injury (e.g. diminished light touch/vibration sensation). A serum vitamin B12 test is usually diagnostic,
y be required for confirmation in inconclusive cases.
suchundergo
ould as propranolol or nadolol
screening endoscopyand endoscopic varicealindicate
to exclude varices, ligation the
are risk
the of
mainstays of primary prophylaxis
variceal hemorrhage, for esophageal
and determine strategiesvaricea
for pri
glucose and galactose by intestinal lactase that is present on the brush border of the duodenum. Lactase enzyme deficiency c
acterized
be by chronic,
complicated crampy, postprandial
by perforation, which typicallyabdominal pain, bloating,
causes acute-onset, and watery
severe pain; adiarrhea.
systemic inflammatory response (e.g. fever, t
and abdomen
mmon cause ofcan confirm the
nosocomial anddiagnosis
outpatientof infectious
perforationdiarrhea.
by revealing
Majorsubdiaphragmatic free
risk factors include air. antibiotic use, age > 65, and ga
recent
Diagnosis
a direct effect of certain medications on esophageal mucosa. Tetracyclines, potassium chloride,reaction.
is typically made with stool assay for C. difficile exotoxin genes via polymerase chain bisphosphonates, and nonstero
experience sudden-onset odynophagia and retrosternal pain that can sometimes
ointestinal bleeding who have a depressed level of consciousness and ongoing hematemesis should cause difficulty swallowing.
be intubated to protect the
e any component of the gastrointestinal tract from the mouth to the anus, such as aphthous ulcers and bleeding.
tion. Prompt endoscopic treatment with ligation or sclerotherapy should then be performed to stop the perianal skin tags and fi
smural inflammation.
erum-to-ascites albumin gradient (SAAG) > 1.1 g/dL indicates portal hypertensive etiologies (e.g. cardiac ascites, cirrhosis) whil
gies (e.g.
of the malignancy,
involved pancreatitis,
esophagus nephrotic
with dysphagia forsyndrome,
solids but tuberculosis).
typically no weight loss. Other causes of peptic strictures include radia
curs in the setting of hypotension and manifests as acute, massive increases in the transaminases with milder associated incre
patients
ver disease whoinvolves
survive the
bothinciting condition
treatment of the(e.g. hypotension),
underlying cause and liverstrategies
enzymesto typically
preventreturn
furtherto liver
normal within(e.g.
damage a fewalcohol
weeks.avoidan
ephalopathy involves identifying the underlying precipitant and lowering serum ammonia. Nonabsorbable disaccharides (e.g. lac
D) may present with epigastric pain, nausea, and/or early satiety in association with food. Symptoms of duodenal ulcer classical
r meals,
cated by on an empty is
hypotension stomach,
thought or to at night).
arise fromMelena is a manifestation
intravascular volume lossofsecondary
upper gastrointestinal bleeding,vascular
to local and systemic with PUDendothelial
being oneinj
o
sability,
C. In and plasmaofleak
the setting into thestigmata
cirrhosis, retroperitoneum,
of chronicresulting in systemic
liver disease hypotension.
(e.g. spider angiomas, palmar erythema, asterixis, jaundice) an
s a functional disorder of the gastrointestinal tract characterized by chronic abdominal pain with diarrhea and/or constipation. P
fand no alarmcolon
developing features
cancerdo not require
should begin extensive
screening workup
at agefor
50diagnosis.
with high-sensitivity stool-based testing or direct visualization techn
nsents
affected
with first-degree relative
bloody diarrhea, should
often with begin
weightscreening at ageUC
loss and fever. 40 invariably
or 10 years before the
involves the rectosigmoid
age of the relative's
but candiagnosis (whichevin
have continuous
slammation and crypt of
due to reactivation abscesses. The risk
varicella zoster of colorectal
virus from a dorsal cancer
rootisganglion.
elevatedPatients
in UC, and surveillance
experience paincolonoscopy is advised.
and a vesicular rash in a der
several days, during which the diagnosis may not be apparent.
ents with chronic dysphagia to both solids and liquids, regurgitation, difficulty belching, and weight loss. Achalasia is caused by
the lower
colon esophageal
cancer metastasissphincter to relax
is the liver. when
Liver food boluses
metastases reach
manifest asit.right
Manometry is key topain,
upper quadrant diagnosis.
mildly elevated liver enzymes, an
CT of the abdomen.
ding esophageal varices involves hemodynamic support, pharmacologic treatment (e.g. octreotide), endoscopic therapy, and p
nd thrombocytopenia
nsfusions are common
are recommended in acute complications and bleeding
gastrointestinal may alsofor require
patientscorrection.
with hemoglobin < 7 g/dL. A higher threshold of hemo
ute coronary syndrome or with active bleeding and hypovolemia.
aracterized by epigastric pain that improves with eating. The majority of DUs are caused by Helicobacter pylori or nonsteroidal
progressive ulcer
associated requires disorder
inflammatory acid suppression and antibiotic
of the pancreas eradication
characterized therapy. bouts of upper abdominal pain, diarrhea/steatorrh
by recurrent
ce of pancreatic
sease resembles calcifications
alcohol-induced on CT
liverscan or plain
disease but film.
occurs in patients with minimal or no alcohol history. It is associated with ins
s to steatohepatitis to fibrosis and cirrhosis.
ointestinal bleeding often have an elevated blood urea nitrogen (BUN) and elevated BUN/creatinine ratio, possibly due to increa
emoglobin)
most commonly and increased urea reabsorption
seen in patients with a history(dueof to hypovolemia).
chronic heavy alcohol use. AH is characterized by fever, jaundice, anorexia,
g an aspartate aminotransferase to alanine aminotransferase
m is characterized by uncoordinated contractions of the esophagus ratio of and> 2:1.
presents with chest pain and dysphagia. Esophageal m
songenital
of the middle and lower esophagus. Esophagram may show a 'corkscrew'
disorders of ion transport (e.g. cystic fibrosis), or unabsorbed bile acids pattern. First-line
(e.g. due to treatment includes
postsurgical calcium
changes). chann
A low stoo
d with chronic constipation. It is usually asymptomatic, but potential complications include hemorrhage and diverticulitis. The ris
nd vegetable fiber; it is higher with heavy meat consumption, aspirin or nonsteroidal anti-inflammatory drug use, obesity, and sm
erized by dilated submucosal veins and arteriovenous malformations. It is a common cause of recurrent, painless gastrointestin
it is frequently
helpful missed. Asymptomatic
in differentiating ulcerative colitispatients do not
(UC) and require
Crohn treatment.
disease Those with
(CD), including anemia orofbleeding
involvement multiplecan be treated
portions of thewith cau
gastroi
granulomas,
tion for the causeand asfistula formation,
early low-gradeallbleeding
of whichcan
areherald
more suggestive of CD than
later catastrophic UC.
hemorrhage. Elderly patients often have a low-grad
aly blood loss.
increased malignant potential and warrant enhanced colonoscopic surveillance. Large polyps (> 1 cm) and adenomas with hi
eater malignantdiarrhea
d by persistent potential.and abdominal cramps, and is most commonly transmitted via water in rural areas and developing coun
ay. Metronidazole
usually is the first-line
due to hemorrhoids treatment.
or other benign conditions. Evaluation depends on the patient's presentation and risk factors. Patie
nancy should undergo colonoscopy.
minal CT scan can reveal diffuse or focal For parenchymal
younger patients (age <edema,
changes, 40) andnecrosis,
no otheror
risk factors, office-based
liquefaction. anoscopy
Drug-induced may be
pancreatitis is up
y is characterized by the development of hemorrhagic lesions after ischemia or the exposure of gastric mucosa to various injurio
aracterized by a positive hydrogen breath test, positive stool test for reducing substances, low stool pH and increased stool osm
suspected in any patient with malabsorption and iron deficiency anemia. IgA anti-endomysial and anti-tissue transglutaminase
eerized
absent byif frequent,
there is concurrent selective
watery, nocturnal IgA deficiency.
diarrhea. The diagnosis is suggested by a positive laxative screen or colonoscopy with ch
tion with pale patches of lymph follicles).
ease-producing organism that can cause peptic ulcer disease. Symptoms of peptic ulcers include dyspepsia, postprandial fullness and
during
cer in thefasting
headand
ofnocturnal pain can
the pancreas. also occur.
Patients without jaundice are likely to have cancer in the body and tail of the pancreas, and sh
i-systemic illness characterized by arthralgias, weight loss, fever, diarrhea, and abdominal pain. PAS-positive material in the lam
g of Whipple
eficiency anddisease.
is characterized by the '3 Ds': dermatitis, diarrhea, and dementia. Prolonged isoniazid therapy can interfere with n
ra.
minimal, and deficiency may occur quickly in the setting of significant alcohol abuse. Folate and cobalamin (vitamin B12) deficie
h insufficiency
splantation reticulocytosis,
is low butacute
in patients with folateliver
deficiency
failure is
andassociated
indications with normal
that (not high)
the disease methylmalonic
is worsening acidtolevels.
or failing improve. When app
on for liver transplantation.
tis) complications. Acute pancreatitis from uncorrectable causes (e.g. ischemia, atheroembolism) can be conservatively manag
with left shift, laboratory studies reflect biliary stasis and demonstrate direct hyperbilirubinemia, elevated alkaline phosphatase
is a benign, hereditary condition resulting in chronic or fluctuating conjugated hyperbilirubinemia and intermittent jaundice due
hosphatase levels are indicative of cholestasis. These patients (with or without hyperbilirubinemia) should be evaluated with rig
extrahepatic
rally results incauses of biliary
transudative obstruction.
pleural effusions and is thought to occur due to small defects in the diaphragm. Diagnosis involves
er causes.
commonly due to chronic alcohol use and gallstones. Marked hypertriglyceridemia (> 1,000 mg/dL) can lead to acute pancreat
s can be confirmed
ephalopathy with acan
on diuretics fasting serum
develop lowlipid profile. volume despite having total volume overload, leading to a metabolic alka
intravascular
ncludes
CA) is the volume
drug ofresuscitation and repletion
choice in primary of hypokalemia
biliary cholangitis (PBC).in addition
It delaystohistologic
serum ammonia-lowering
progression and may medications (e.g. lactulose).
improve symptoms and
as soon as the diagnosis of PBC is made. Patients with advanced disease require liver transplantation.
matic elevation of aminotransferases, the first step is to take a thorough history to rule out the more common hepatitis risk facto
ry, blood
titis. transfusions, high-risk
Contrast-enhanced computed sexual practices).
tomography scan of the abdomen may be performed in patients with unclear diagnosis or th
t. Abdominal
hepatitis ultrasound
B infection may identify
are positive gallstones
for anti-HBs andas the cause
anti-HBc but of pancreatitis.
negative for HBsAg. Individuals who are immunized with the hep
HBsAg
ed and anti-HBc.
by reduced bilirubin glucuronidation and results in intermittent jaundice due to a mild, unconjugated hyperbilirubinemia. Jaun
ee diet, physical exertion,Endoscopic
of variceal hemorrhage. febrile illness, stress,ligation
variceal or menstruation.
can be used Management involves
as an alternate primaryreassurance
preventiveand supportive
therapy care.with co
in patients
onfirmed with magnetic resonance cholangiopancreatography demonstrating multifocal bile duct strictures alternating with segm
ratic liver injury by

characterized with histological
elevated features similarencephalopathy,
aminotransferases, to those seen in and patients
INR with viral
> 1.5. hepatitis.
Acetaminophen toxicity is a common cause of A
he most appropriate diagnostic tests for acute hepatitis B (HBV) infection as they are both elevated during initial infection and a
rally characterized by a ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) > 2, elevated γ-glutamyltr
ST
seaseandisALT are almostby
characterized always < 500 IU/Lwith
hepatomegaly, in alcoholic liver disease.
mild elevations in liver transaminase levels in the absence of other causes of sec
ommon
s ultrasonography and a diagnostic paracentesis (i.e. serum-ascites weight
in patients with obesity and diabetes. Management includes albuminloss and control
gradient, of metabolic
cell count risk factors.
and differential, total protein) t
taneous bacterial peritonitis. Initial management of ascites from cirrhosis includes spironolactone and
ected in any patient with evidence of chronic liver disease (e.g. ascites, spider angiomata, gynecomastia, splenomegaly). furosemide, sodiumViral
restrh
ease, and
ritonitis hemochromatosis
(SBP) are theinmost
should be suspected any common causes
patient with of cirrhosis
cirrhosis in thewho
and ascites United States.
presents with low-grade fever, abdominal disc
ed connect-the-numbers test, helps detect subtle mental status changes sometimes
ed as acute onset of severe liver injury with encephalopathy and impaired synthetic function (defined present in patients with >SBP.
as INR 1.5) in a patient
y and acute viral hepatitis are the most common causes.
s leads to gynecomastia, testicular atrophy, decreased body hair, spider angiomas, and palmar erythema.
e-aged women with fatigue, pruritus, hepatomegaly, and elevated alkaline phosphatase. The diagnosis is confirmed with serum
erized by the combination of liver disease and neuropsychiatric symptoms that present in patients age 5-35. Liver dysfunction r
cirrhosis. Neuropsychiatric
is a progressive autoimmune symptoms
diseaseinclude parkinsonism,
characterized dysarthria,
by destruction choreoathetosis,
of intrahepatic ataxia,
bile ducts. personality
It can changes,
be associated withand depre
severe h
plications include malabsorption, metabolic bone disease (e.g. osteoporosis, osteomalacia),
ally presents with episodic flushing, secretory diarrhea, wheezing, and murmur of tricuspid regurgitation. Elevated 24-hour urina and hepatocellular carcinoma.
Allin patients
most patients.
with MALT lymphomas should be tested for H. pylori infection, and those with a positive result and early-stage MALT
(e.g. quadruple
nomatous polyposis therapy).
have a significantly increased risk of colorectal cancer. Consequently, frequent colonoscopic screening star
tandard of care.
colorectal cancer and imparts an extremely high risk of endometrial carcinoma for female carriers. An annual endometrial biops
ended
olitis aretoat
prevent
increasedendometrial cancer. cancer. Screening colonoscopy with mucosal sampling should be offered to patients wit
risk for colorectal
nosis and
modal repeated
distribution of every 1-3 years
ulcerative colitisthereafter.
with a second peak at age 50-80. Patients commonly experience abdominal pain, bloody d
demonstrates continuous involvement
common cause of gross lower gastrointestinal with erythematous
bleeding in and friable
adults. mucosa
Bleeding and ulcers.
is typically painless but may be associated with light
morrhage usually resolves spontaneously but occasionally requires
ritonitis can have a subtle presentation and should be considered in any patient with cirrhosisendoscopic or surgical intervention.
and ascites accompanied by eith
e test of choice, with the main diagnostic criteria being a positive ascites fluid
egurgitation, and/or chest pain precipitated by emotional stress should raise the suspicion for esophageal culture and neutrophil countmotility
of > 250/mm3.
disorder such
epresents
diagnosis asofdifficulty
diffuse initiating
esophageal spasm. associated with coughing, choking, aspiration, or nasal regurgitation. Typically, patie
swallowing
dofbarium swallow to
iron deficiency evaluate
anemia swallowing
in the elderly ismechanics, degree
gastrointestinal of dysfunction,
blood loss. The next and severity
step of aspiration.
in evaluation would be colonoscopy and en
de the possibility of gastrointestinal bleeding.
erized by chronic abdominal pain, diarrhea, weight loss, and evidence of inflammation (e.g. anemia, elevated inflammatory mark
rom mouth to anus.
the diagnosis. Treatment options for the initial episode include oral vancomycin or oral fidaxomicin. Patients with fulminant dise
ated with high-dose
miting) or are men age oral vancomycin
> 50 with chronic and(>intravenous metronidazole;
5 years) symptoms and cancerif ileus is factors
risk present,(e.g.
vancomycin may be
tobacco use). All given
other rectally.
patients can
d further evaluation if refractory to therapy.
significant weight loss, rapid symptom onset, and presentation at age > 60. Consequently, endoscopy is recommended to exclu
aride that is absorbed in the proximal small intestine without degradation by pancreatic or brush border enzymes. Patients with
tion of D-xylose.
mesenteric Patients
ischemia shouldwith
bemalabsorption due to enzyme
suspected in patients deficiencies
with unexplained will have
chronic normal pain,
abdominal absorption
weightofloss,
D-xylose.
and food aversion.
f the celiac or superior mesenteric arteries.
most commonly caused by an acquired disruption of the lymphatic system (e.g. chronic inflammation, malignancy) and typically p
Patients
es Task usually have pitting edema
Force recommends biennialthat later2progresses
(every to nonpitting
years) screening edema accompanied
mammography for women age by firm, thickened
50-74. Screeningskin.
at age 40-49 a
considered on an individual basis.
s are at high risk of delayed hemolytic transfusion reactions due to alloimmunization from frequent transfusions. Reactions dev
anemia.
ytosis. AnemiaDiagnosis withisreticulocytosis
confirmed with is acommonly
newly positive
seen Coombs test.
in acute bleeding conditions and hemolysis. Chronic lymphocytic leukemia
emia.
mall bowel villous atrophy, leading to malabsorption of iron and iron deficiency anemia. Vitamin D deficiency can also occur, lead
epremature
of intracellularosteoporosis. Initial screening
tumor products for celiac disease
into the circulation. can be performed
Major manifestations includewithelectrolyte
tissue transglutaminase
abnormalities and autoantibody testin
renal insufficien
ate.
and Renal injury can often
reticuloendothelial be prevented
macrophages. with
This intravenous
limits fluids toforflush
iron availability the kidneys which
erythropoiesis, and uric acid inhibitors
causes to reduce
a normocytic serum
or slightly uric
microc
common site of metastatic cancer spread, and extensive metastatic involvement can lead to primary adrenal insufficiency (PAI
stasis,
ommonhyponatremia, hyperkalemia,
form of non-Hodgkin lymphoma. and hypoglycemia. Diagnosis
It generally presents in anisolder
made by cosyntropin
patient with months stimulation
or years testing.
of waxing and waning ly
ies are rare, but mediastinal/hilar lymphadenopathy is sometimes seen.
immune diseases are at increased risk for lymphoproliferative disorders such as non-Hodgkin lymphoma (NHL) due to chronic
immunosuppressive
gnificantly increased agents. NHL often presents
risk of malignancy with painless
due to immune lymphadenopathy
dysregulation and Bofsymptoms.
and reactivation oncogenic viruses. One of the most co
nerally treated with combination chemotherapy and radiation therapy. Although > 75% of patients with
h is due to the reactivation of the Epstein-Barr virus in B-lymphocytes. Patients generally present diffusetreatment
are cured, lymphadenopathy
can lead
ancy (e.g. solid organ, hematologic) and cardiovascular disease.
thy, B symptoms, pruritus, and worsened pain with exposure to alcohol may be present. Laboratory evaluation often reveals ele
nophilia.
presents with painless peripheral lymphadenopathy (LAD) in the cervical and/or supraclavicular chains. Patients may also have
usually
ith sicklemade withare
cell trait excisional
generally lymph node biopsy
asymptomatic, (Reed-Sternberg
they cells). splenic infarction and intravascular hemolysis in the se
occasionally develop
Diagnosis
graphy scan of most
usinghemoglobinopathies
a radiolabeled glucose is made
analogbycan
hemoglobin electrophoresis.
identify areas of enhanced metabolic activity (e.g. cancer, infection). How
glucose
lipid antibodies (e.g. lupus anticoagulant) have prolonged PTT that failalso
requirements such as the brain, liver, and kidneys; uptake will be seen
to correct within athe urinary
mixing testcollecting system
(combination withdue to radio
normal pl
es are asymptomatic, but a minority develop antiphospholipid-antibody syndrome (thromboembolism,
linemia is a B-cell neoplasm associated with elevated monoclonal IgM. High levels of IgM may cause hyperviscosity syndrome fetal loss).
,hemorrhage
peripheral neuropathy, cryoglobulinemia,
due to tumor-induced consumptive and/or renal insufficiency.
coagulopathy. Diagnosis
Therefore, requires
patients requireserum
urgentprotein electrophoresis
treatment with all-transand bon
retinoi
snto maturedisorder
a genetic myelocytes and rapidly
associated with reduces
impairedbleeding risk.
activity/quantity of von Willebrand factor, leading to poor platelet-endothelial bindin
AML) is the most common acute leukemia in adults and is typicallybruising,
ptomatic but may have prolonged mucocutaneous bleeding, easy associated andwith
prolonged
fatigue PTT.
and symptoms related to > 1 cytopen
of AML that often presents with life-threatening coagulopathy due to disseminated intravascular coagulation.
pairment (e.g. motor weakness, incontinence). Prostate cancer usually causes osteoblastic bone lesions with normal or low cal
aphic deficiency
uired evidence ofoffocal, sclerotic
pluripotent stemlesions.
cells that can result from certain exposures, viral infections, or autoimmune conditions. The
eous
ypically presents with acute renal failure Cellular
bleeding, are due to pancytopenia. (without morphology is normal
previous kidney andand
disease) splenomegaly is absent.
malignant hypertension (e.g. headache, blurry v
ripheral blood smear can show microangiopathic hemolytic anemia with fragmented red blood cells (e.g.
r testing with hemoglobin electrophoresis. Based on these results, patients may be offered genetic counseling, schistocytes) and throm
hematology con
d as treatment for a disease when standard therapy fails, such as radiation therapy for prostate-specific antigen recurrence afte
recessive
nia purpurableeding
is usuallydisorder
diagnosedthat after
can present
excludingwith recurrent
other hemarthrosis
possible and skeletal muscle
causes of thrombocytopenia. hematoma
These after
patients minor
should betrauma.
tested fo
ecytopenia
the initial (HIT)
presentation of HIV infection (up to 5%-10% of patients). Treatment of the underlying infection can
is an immune-mediated process that causes thrombocytopenia several days after initiation of heparin therapy. affect the platelet
n alternate forms of anticoagulation due to the risk for arterial and venous clots.
ant agentisthat
eaction functions by
characterized byinhibiting the synthesis
a rapid onset (secondsoftovitamin K-dependent
minutes) factors
of respiratory II, VII,
distress and IX,hypotension,
and X, protein C, and
which protein
quickly S.
progresse
nt includes
itors immediate transfusion
(e.g. rivaroxaban, apixaban) cessation andefficacy
have similar administration of epinephrine.
to warfarin IgA-deficient
in the treatment patientsthromboembolism
of acute venous are at increased risk.
and do no
gsatdo not
risk forrequire laboratory
fulminant infectionmonitoring or overlapbacteria
with encapsulated therapy(e.g.
with Streptococcus
heparin and are becomingHaemophilus
pneumoniae, preferred agents for the treatment of
influenzae
cytosis/complement
cytopenia should be activation.
suspected in patients receiving heparin anticoagulation who have thrombocytopenia, thrombosis (arterial o
ne 5-10
eloma aredays after the initiation
at increased of treatment.
risk for infection due to bone marrow infiltration by neoplastic cells, which alters the normal leukocyte po
OSA) can present without symptoms of snoring or witnessed apneic events. OSA causes transient periods of hypoxemia. The
result in erythrocytosis.
emorrhagic telangiectasia (Osler-Weber-Rendu syndrome) can develop pulmonary arteriovenous malformations associated wit
agnosis must be entertained in a patient with recurrent nose bleeds and oral lesions.
ng
allyshould be considered
asymptomatic and nointreatment
patients with environmental
is required. Patientsrisk factorshave
typically whomild
present with low
anemia, headache, nausea, and
mean corpuscular dizziness.
volume (55-75 µm3
ately high red blood cell (RBC) count. Iron deficiency anemia is associated with low RBC count and no microcytosis
nemia is often triggered by penicillin and cephalosporin medications. It is marked by evidence of extravascular hemolytic until hemog
anem
and jaundice. Discontinuation of the offending drug usually results in complete resolution of symptoms within days. No
red blood cells, white blood cells, and platelets) is common in patients with systemic lupus erythematosus. It usually indicatesaddition
lanticardiolipin
3 cell lines. antibody, and/or β2-glycoprotein-I antibody is diagnostic. Those with LA have prolonged PTT that does not impro
enic purpura) and due to erythrocyte destruction by prosthetic cardiac valves. Hemolytic anemias are characterized by a decrea
ed te the
dehydrogenase
equivalent ofand morebilirubin.
than one blood volume of blood transfusions or packed red blood cells over 24 hours may develop ele
damin
blood). Citrate chelates calcium
B12 are involved in the metabolism and magnesium and mayVitamin
of homocysteine. reduce B6their plasma
lowers levels, causing
homocysteine paresthesias.
levels by acting as a cofactor for th
zes homocysteine into cystathionine.
a is an autoimmune disorder with increased platelet destruction and inhibition of platelet production due to IgG autoantibodies a
ay have mucocutaneous
g exogenous androgens, bleeding
autologous with isolated
blood thrombocytopenia
transfusions, and no hepatosplenomegaly.
or erythropoietin to enhance athletic performance can develop an elev
drogens
al include
iron-binding gynecomastia,
capacity, decreasedtesticular atrophy, mood
iron saturation, disturbances, and
and normal/elevated hepatotoxicity.
serum ferritin. Treating the underlying inflammatory dis
s anemia, marked by antibody-mediated destruction of intrinsic factor and gastric parietal cells. Damage to the stomach results
common after a total or partial gastrectomy. Vitamin B12 is a necessary cofactor in purine synthesis, and its deficiency causes
ropoiesis,
disease ispresenting as megaloblastic
due to erythropoietin anemia.
deficiency; treatment is with erythropoiesis-stimulating agents (ESAs) (e.g. erythropoietin, darb
adequate response to ESAs in patients on dialysis.
n-nutritive substances
hydrogenase deficiencysuch
causesas ice, clay, dirt,
hemolytic and paper
anemia due toproducts.
oxidativePica,
injuryespecially for ice,
to red blood cells.can be indicative
Hemolytic of iron
episodes deficiency.
can be precipita
malarials, and nitrofurantoin.
ses of microcytic anemia, iron deficiency and thalassemia, are differentiated by iron studies. Thalassemia is a hemoglobin defec
bunits. Thalassemia
enic purpura (TTP) isminor
caused is minimally symptomatic.
by autoantibodies to plasma protease ADAMTS13 and is marked by microangiopathic hemolytic
denic
requires emergent treatment with plasma exchange.
purpura should be suspected in patients with laboratory evidence of thrombocytopenia and intravascular hemolytic anemia
tisdiagnosis.
an inherited Peripheral
defect inblood
the redsmear
bloodiscell
crucial in the diagnostic
membrane workup,
that presents with demonstrating
hemolytic anemia, signsjaundice,
of intravascular hemolysis (e.g.
and splenomegaly. Acutesch
c
omplication.
hydrogenase deficiency is an X-linked disorder commonly seen in African American men. It is characterized by episodic hemoly
n foodsboth
ciency (e.g.result
fava beans). Heinz bodies
in megaloblastic, and biteanemia.
macrocytic cells are characteristically
Folate supplementation seencan
on peripheral
improve the blood smear.
anemia of either disorder but
iciency. It is important to distinguish between the two prior to initiating therapy.
creased red blood cell (RBC) production, increased RBC destruction, and frank blood loss. The anemia of lymphoproliferative d
cells. in platelet activation, thrombocytopenia, and a prothrombotic state. Type 2 HIT typically occurs 5-10 days after heparin
esulting
ed to heparin.
nsfusion reaction (FNHTR) is the most common adverse reaction and is caused by release of cytokines from leukocytes in the s
and include transient fever, chills, and malaise. Leukoreduction of donor blood helps prevent FNHTR.
gnition of host major and minor HLA-antigens by donor T-cells and consequent cell-mediated immune response. The organs tha
er. megaloblastic anemia and gingival hyperplasia due to impaired folic acid absorption in the jejunum. Supplementation with fo
ses
min D supplementation are also usually given to counter alterations in bone mineral metabolism that impair bone density.
sinispatients
the most common
who presentoccult cause of iron deficiency anemia.
with microcytic/hypochromic anemia, These
especially in patients
are useful age > 50.the
in confirming Referral to a of
diagnosis gastroenterologist fo
iron deficiency an
nemia,
ally and in as
manifests ruling out other causes.
microcytic/hypochromic anemia simulating iron deficiency anemia, but iron studies reveal elevated serum iron
.n In patients with an identifiable cause of vitamin
in patients with multiple myeloma. It is caused by B6osteolytic
deficiencybone
(alcohol, medications),
destruction. theconstipation,
Fatigue, administration
andofdepression
pyridoxine are
cancomm
easil
st commonly inherited hypercoagulable disorder in the Caucasian population, leading to increased risk of thrombosis. Testing s
ment ofinchoice
mbus young for
(age < 45) related
anemia patientstoorchronic
those with an disease.
kidney unusual site of thrombus.
Hypertension is a common side effect of erythropoietin; patients w
hemoglobin concentration are at highest risk.
sma cell neoplasm. It is characterized by the excessive production of monoclonal protein that can accumulate in the kidneys an
ients with multiple myeloma have renal insufficiency at diagnosis.
mmon
osis cause
should beof nutritional in
considered folate deficiency
patients in the
who have United liver
elevated States and would
enzymes, causemellitus,
diabetes megaloblastic anemia.
and skin hyperpigmentation. It can pr
antly increased risk for hepatocellular carcinoma.
calcified aortic valve can cause hemolytic anemia due to erythrocyte shearing. Patients also frequently have mildly low platelet
rdiogram
e.g. should
elevated be performed
lactate to assess the valvular
dehydrogenase/bilirubin, function. and peripheral blood smear typically demonstrates bite cells and
low haptoglobin),
vel, but the
ns are sensitivity is low insource
most common acute hemolytic crises;pulmonary
of symptomatic therefore, embolism.
this test cannot
Otherbe relied
less on to rule
common out the
sources condition
of emboli in thethe
include acute
calf sv
d right heart.
ith compression ultrasonography
o histoplasmosis or Tb infection) or is recommended as an initial
thrombosis secondary test in patients
to indwelling centralwith moderate
venous or high
devices. When probability
the historyof and
deepphysical
venous
nditions. Patients generally have megaloblastic anemia, atrophic glossitis (smooth, shiny tongue), and/or neurologic abnormalit
mbined
ould bedegeneration).
suspected in strict vegetarians with anemia and neurologic complications. Folic acid supplementation may correct the a
nisofusually
neurologic complications.
an autosomal dominant disorder characterized by hemolytic anemia, jaundice, splenomegaly, and spherocytes on pe
oncentration is elevated
condition marked by obstruction due to red blood cell
of hepatic dehydration
venous outflow,and membrane
often presents loss. Pigment gallstones
with subacute are asuch
manifestations common complication
as vague, progre
Polycythemia vera, a chronic myeloproliferative neoplasm associated with increased red blood
(CML) is driven by a reciprocal translocation of chromosomes 9 and 22 forming the BCR-ABL fusion gene. This gene creates cell mass, is particularly likelyat
nhibitors
resentingsuch as imatinib
symptom are a myeloma
in multiple key therapy in the
(MM). treatment
In an elderly of CML.with evidence of osteolytic lesions on x-ray, MM should alwa
patient
e serum protein electrophoresis, urine protein electrophoresis, and free light chain analysis. Diagnosis can be confirmed with bo
complication
occurs of chronictolymphocytic
as a response severe infection leukemia
and is (CLL).
markedCLLbyisleukocyte
diagnosedcounts
by flow cytometry (clonality
> 50,000/mm3. of mature
Compared B cells).
to chronic myeloid leuke
e(CML)
phosphatase
is marked by dramatic leukocytosis, absolute basophilia, and a shift towards very early neutrophil precursor cells basop
score, a greater proportion of late neutrophil precursors (metamyelocytes, bands), and a lack of absolute (prom
osphatase score, a marker of neutrophil activity, typically is low.
yeloproliferative disorder marked by erythrocytosis. It is a form of primary polycythemia, almost always caused by a mutation of
to be loware
omegaly (unlike
commonmoston causes
physicalof secondary
examination. polycythemia).
Treatment is primarily serial phlebotomy; bone marrow suppressive drugs (e.g.
k of thrombosis.
ually demonstrates a low serum iron, low ferritin, elevated total iron-binding capacity (TIBC), and low transferrin saturation (i.e.
onic
e duegastrointestinal
to megaloblastic blood
(e.g.loss.
impaired DNA synthesis due to B12 or folate deficiency) or nonmegaloblastic (e.g. alcohol use, hyp
ear, reticulocyte count, and B12
hronic B-cell neoplasm that infiltrates and folate levels
the bone can aidspleen,
marrow, diagnosis
andand distinguish
peripheral blood, between B12
resulting in and folate deficiency.
cytopenias, splenomegaly, and
'hairy' cytoplasmic projections. Hepatomegaly, lymphadenopathy, and B symptoms are uncommon. Diagnosis is made with bo
emia is seen
a plasma almost
cell exclusively
neoplasm in elderly
that infiltrates thepatients. Peripheral
bone marrow smear
and may is characterized
cause a monoclonal byprotein
a marked leukocytosis
elevation withMM
(M-spike). mature lym
is assoc
y, andtypically
crosis an elevated protein
occurs withingapthe(>first
4 g/dL).
few days of warfarin therapy. It is caused by a rapid decline in protein C levels, usually in p
(megestrol acetate and medroxyprogesteroneand
tment involves immediate warfarin cessation administration
acetate) of protein C
and corticosteroids concentrate.
have been shown to increase appetite and weight ga
me. Progesterone analogues are preferred over corticosteroids due
hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia (due to calcium phosphate to their decreased incidence of side effects.
binding in the renal tubules).
d/calcium phosphate tubular injury) and cardiac arrhythmia. Prophylaxis with intravenous fluids and uric acid inhibitors reduces
sts that block 5HT3 receptors are the drugs of choice for treating and preventing chemotherapy-induced nausea and vomiting.
ledronic acid, pamidronate)
linemia (WM) are the drugs
is a lymphoplasmacytic of choice
neoplasm for stabilizing
characterized by bony metastatic
excessive lesionsIgM,
monoclonal to prevent
end-organhypercalcemia
damage, and of malignan
> 10% c
osity syndrome, neuropathy, and cryoglobulinemia are common consequences of elevated
moglobinuria should be suspected in patients who have a combination of hemolytic anemia, cytopenias, and hypercoagulable serum IgM in patients with WM. s
cytometry
HIV, tests
hepatitis C).are used for
Testing to confirm
HIV andthe diagnosis
hepatitis by assessing
C virus for absence
is recommended for allofpatients
the CD55 and
with CD59
ITP; proteins
additional on the
testing is surface
needed of wh
upus erythematosus) are present.
nemia (AIHA) and hereditary spherocytosis (HS) can cause extravascular hemolytic anemia. A negative family history and posit
negative Coombs test suggest HS. The peripheral blood smear in both conditions may show spherocytes without central pallo
g. colonoscopy, mammogram) and chest x-ray in most patients with a first episode of unprovoked VTE. More detailed testing is
alignancy
GAS) or for recurrent
pharyngitis or multiple-site
is characterized (e.g. cerebral,
by exudative pharyngitis, hepatic
fever, vein)
tenderVTE.anterior cervical lymphadenopathy, and absence of co
is. Patients at low risk for GAS pharyngitis based on these
mphotericin B and flucytosine for ~2 weeks, consolidation with high-dose oral clinical criteria do fluconazole
not require rapid
for ~8antigen
weeks,testing or empiric antibio
and maintenance with lo
100/mm3 for > 3 months on antiretroviral treatment.
oncurrent infection; it can also occur when there is minimal response to control mitogens due to lymphocyte suppression from
rticoids).
ric 4-drug treatment with isoniazid, rifampin, pyrazinamide, and ethambutol while awaiting culture results. Although rapid testing
everal
common samples
in olderareindividuals
required towith achieve adequate(e.g.
comorbidities sensitivity.
renal failure) due to waning cell-mediated immunity. Older patients often h
en less often on chest x-ray.
kin infection that commonly presents with honey-crusted papules and pustules on the face and extremities. Pre-existing trauma
scabies), and inflammation
is a potentially fatal infection (e.g.
thateczema)
presentsare withrisk factors.
rapidly progressive symptoms (e.g. fever, headache, nuchal rigidity, petechiae)
vancomycin and ceftriaxone should be administered
ction is often nonspecific (e.g. fever, pharyngitis) but should as soonbeassuspected
possible; in lumbar puncture
a patient shouldprogressive
with rapidly not delay treatment.
illness, severe m
n, cold hands/feet). Positive cerebrospinal fluid culture obtained via lumbar puncture is diagnostic.
ingitis presents with nonspecific symptoms that rapidly progress over 12-24 hours and may include a petechial/purpuric rash, n
usion
ever isand severe myalgias
a tick-borne should
illness that promptwith
presents a lumbar puncture toand
fever, headache, evaluate for Neisseriaor
a maculopapular meningitidis infection.
petechial rash on the wrists and ankles
yponatremia are characteristic laboratory findings. Prompt treatment with doxycycline decreases the risk of progressive disease
be
ould started on antiretroviral
be suspected in patients therapy regardless oferythema
with conjunctival CD4 count andtothick,
reduce HIV-related
purulent morbiditythat
eye discharge andreaccumulates
death. within a few min
with an infected individual, and one or both eyes may be affected. S. aureus is the most common
xudative, painless genital ulcer) can result from direct sexual contact with an infectious lesion in an exposed area despite condetiology in adults.
t-line treatment.
m-positive skin flora gain access to the subcutaneous space via breaks in the skin. Tinea pedis, one of the most common risk f
,hronic
erosions, and ulceration
HCV infection and that allow
should be bacterial
referred forentry into the tissue.
treatment. Negative HCV RNA indicates no current infection; these individuals
ting.
men typically presents with dysuria and a purulent urethral discharge. The diagnosis is confirmed with urethral culture or with nu
ample. The recommended
adolescents treatmentmanifests
and adults. It generally includes a assingle dose of
a stepwise ceftriaxone
illness and azithromycin,
that begins with 1-2 weeks and
of empiric treatment
nonspecific of sexual
symptoms co
and th
cough. Adults
eaction often febrile
is an acute, do not reaction
have thethat
classic post-tussive
commonly occursemesis.
< 12 hoursMostafter
cases resolve
initial withinof3 early
treatment months.
syphilis. Symptoms include
sion, and worsening of syphilitic rash (if present). Manifestations are self-limited
in those who trade sex for drugs or money. Manifestations include the development of > 1 painful papules and typically resolve spontaneously within
that convert 48 h
to pustu
demarcated
wer abdominal borders,
pain inpurulent
a sexuallyexudate). Inguinal
active patient arelymphadenitis is common.pharyngitis and associated pelvic inflammatory diseas
caused by gonococcal
quickly progress to pustules/bullae, and then form 'punched-out' gangrenous ulcers. Patients are usually febrile and ill. Blood cu
a common sexually transmitted infection that is often asymptomatic but may cause urethritis in men. Symptoms include mucoid
eofdose of azithromycin isbacterial
community-acquired almost always curative;
meningitis however, current
is Streptococcus sexualMost
pneumoniae. partners musthave
patients receive
> 2 testing
symptoms and oftreatment
headache,to preven
fever,
pneumococcal pneumonia may or may not be present.
with either hepatitis A vaccine or hepatitis A immune globulin should be considered in a number of groups, including those with
ld contacts) with
osquito-borne infected
viral illnesspatients.
that typically presents with flulike illness, symmetric polyarthralgias, macular or maculopapular rash o
hadenopathy.
rcoma (KS) is an AIDS-defining malignancy due to human herpesvirus 8. Cutaneous KS develops most commonly on the lowe
cy usually appearmilitary
or asplenia, as multiple violaceous
recruits, college papules.
studentsDiagnosis is made clinically
living in dormitories, but may
and travelers torequire biopsy.Africa. Live-attenuated vacc
sub-Saharan
veecrosis factor antagonists.
subacute-onset of low-grade fever, headache, and signs of increased intracranial pressure should be evaluated for cryptococ
ofcommon
the cryptococcal
complicationantigen
seenor in
isolation
patientsofwith
the advanced
organism in cerebrospinal
HIV fluid. with oral thrush most likely have Candida
disease. Patients
alovirus)
d in patients being more
with HIVlikely
who in the setting
develop of severe
progressive odynophagia
disseminated without dysphagia
histoplasmosis (PDH).or After
thrush.1-2The diagnosis
weeks is confirmed
of clinical with up
improvement, pa
ear of maintenance therapy. Antiretroviral therapy should be initiated in all patients with HIV who
arely causes illness in immunocompetent patients; however, in patients with advanced HIV (CD4 < 100/mm3), progressive disse develop PDH (usually 2 weeks
or
usserum Histoplasma
pneumoniae antigen assay
and Staphylococcus is a rapid,
aureus sensitive
are the test for diagnosing
most common PDH.
etiologic organisms. S. aureus pneumonia tends to cause rapid-
of death.
lly presents with subacute or chronic fevers, weight loss, fatigue, and pulmonary symptoms. Chest x-ray classically reveals a d
ommon behavioral
cause acute, risk factor
subacute, for tuberculosis
or chronic symptoms.inManifestations
the United States are isoften
substance abuse.
nonspecific (e.g. fever, fatigue, myalgia, arthralgia), car
Osler node), and embolic. Laboratory studies usually show normocytic anemia
extremities, including the palms and soles. Diagnosis is made with serology (using both a treponemal and dramatic elevationsand
in erythrocyte
a nontreponemalsedimenta
test
the standard treatment.
HCV) infection is associated with many extrahepatic manifestations, including fatigue, arthralgias, and porphyria cutanea tarda
nTMP-SMX
that develops vesiclesgiven
is generally and bullae with trauma
to patients with AIDS or sun
whoexposure.
have CD4All patients
counts with PCTand
< 100/mm3 should be screened
positive Toxoplasmafor HCV.
gondii IgG sero
tis pneumonia.
may spontaneously clear in up to half of affected patients, the diagnosis of chronic infection is a 2-step process that requires b
olecular test for the presence
, but community-acquired of circulating hepatitis
methicillin-resistant C virus RNA.
Staphylococcus aureus has a predilection for young patients with recent influenza.
neumonia with high fever, productive cough (often with hemoptysis),
epatitis B virus. Patients should be screened for these infections in addition leukopenia, and multilobar
to receiving cavitary
appropriate infiltrates.
antibiotics (usually ceftriaxo
l practices.
h HIV should receive vaccinations for hepatitis A, hepatitis B, and zoster (unless they have documented immunity); immunizatio
should
diseasealso be given.
require the same immunizations as the general population and additional disease-specific vaccines, including hepatitis
polysaccharide vaccine.
used to identify patients with latent tuberculosis (TB) infection and a high risk of reactivation TB. In the United States, an indura
>limited
15 mminfection
is considered
markedpositive) in healthy
by < 1 week patients(fever,
of systemic with amalaise,
low likelihood of TB
myalgias, infection. and respiratory (rhinorrhea, sore throat,
headache)
(e.g. pneumonia)
aerobic, gram-positiveare bacteria
commonthat in patients withacid-fast.
is partially advanced age and
It causes chronic illness.
pulmonary or disseminated disease (particularly to the brain) in
ethoprim-sulfamethoxazole.
e more prone to developing tricuspid endocarditis caused by Staphylococcus aureus. Fragments of the vegetation can embolize
trate with cavitation.
Bartonella quintana can cause bacillary angiomatosis in immunocompromised individuals (e.g. advanced HIV). Patients develop vasc
organ involvement (liver, central nervous system, bone). Treatment requires antimicrobials (e.g. doxycycline, erythromycin) and an
causes
ruptly prolonged
develop fever,(fever,
systemic pharyngitis,
malaise,fatigue, and headache)
myalgia, lymphadenopathy and is diagnosed
and upper/lower by (rhinorrhea,
respiratory the heterophile
soreantibody (Monospot) t
throat, nonproductive
ng. age > 65,
present chronic
similarly medical
to other conditions)
atypical for influenza complications,
community-acquired pneumonias. most adultsconcurrent
However, do not require testing andand
gastrointestinal are central
treated nervous
symptom
can be confirmed
is who are vomiting,withofurine
olderantigen
age, ortesting
septic orin combination
who have certainwith culture.
comorbidities (e.g. diabetes mellitus, urinary obstruction) typica
t hospitalized patients can be transitioned to culture-guided oral antibiotics if symptoms are improved at 48 hours.
ally mitral
ually valve with
presents prolapse
fever,with
back coexisting
pain, andmitral
focal regurgitation, is the Evaluation
spinal tenderness. most common valvular
includes abnormality
blood detected
cultures and in patients
inflammatory with
markers
Magnetic
IDS, but resonance imaging
acute respiratory is theusually
failure modality of choice
develops for diagnosis,
in those receivingfollowed
chronicby computed tomography-guided
immunosuppressive bone biopsy.
therapy. Bilateral, diffuse inte
causes pulmonary disease in an immunocompromised host, with or without extrapulmonary manifestations (e.g. skin, central n
the presence
eral interstitial of filamentous,
infiltrates. gram-positive, weakly acid-fast
Trimethoprim-sulfamethoxazole rods
is the on Gram
first-line stain. Trimethoprim-sulfamethoxazole
treatment. Concomitant corticosteroids areisadministere
the treatme
ent > 35 mm
ci colonize theHg, or mucosa
oral pulse oximetry
and can< cause
92% on room air
infective to reduce risk
endocarditis of aofstructurally
respiratoryabnormal
decompensation.
heart valve following dental procedu
h several weeks of fatigue and low-grade fever.
equent, small-volume, bloody stools and abdominal pain. Diagnosis is confirmed by colonoscopy with biopsy. Any patient with H
A isto
on rule out concurrent
recommended retinitis.
for adults who are at increased risk of contracting the virus such as men who have sex with men and travele
ommended
live attenuated virus that causeschronic
for adults who have liver disease.
a low virulence infection after inoculation. Patients with HIV with CD4 counts < 200/mm3 may
uld not receive vaccination. Those with CD4
ion between infections with Streptococcus gallolyticus counts > 200/mm3 who have
(S. bovis biotype I) andlowcolonic
titers should receive
neoplasms, the
and allvaricella vaccine.
such patients should ha
nderlying occult malignancy.
itis). Patients typically develop fever, right upper quadrant pain, anorexia, elevated liver enzymes, and leukocytosis. Treatment
followed
ssure by paromomycin
(vomiting, headaches, topapilledema)
eradicate intestinal
monthscolonization.
or years after inoculation. Diagnosis is made largely by clinical and radiograp
brain MRI).
cause of fever in the returning traveler. Classic findings include cyclical fever with nonspecific constitutional and gastrointestina
. Symptoms include a pruritic, papular lesion at the portal of entry and intensely pruritic, migrating, serpiginous reddish-brown tr
sandareclearance.
pathognomonic for early disseminated Lyme disease, even without a known history of a tick bite. Systemic symptoms (e.g
slid the treatment
organ of choice.
transplant are at risk for opportunistic infections, most notably Pneumocystis pneumonia and cytomegalovirus (CMV). I
a systemic illness involving multiple organ systems (e.g. pneumonitis, hepatitis, gastroenteritis) should be tested for CMV.
scauses
a majora cause of chronic diarrhea
mononucleosis-like in patients
syndrome with of
consisting HIV who night
fever, have sweats,
CD4 counts < 180/mm3. arthralgias, and diarrhea. Importan
lymphadenopathy,
t rash (oval,
owing, red, macular
nontender mass at lesions). Providers
or near the mandible. should havesinus
Multiple a lowtracts
threshold
to thefor HIVmay
skin testing
draineven whenfluid
purulent traditional HIV granules
with sulfur risk factors
(di
herapy; surgery is sometimes required for severe cases.
persistent clinical symptoms despite 48-72 hours of therapy, history of nephrolithiasis, complicated pyelonephritis, or unusual u
rinary
ulomatous obstruction).
disease of the skin and peripheral nerves that is found primarily in developing regions. Symptoms include chronic, an
lvement (nodular/painful
ermatomal rash characterized nerveby deformations
small papules withthat
diminished
evolve into sensory/motor
vesicles or bullaeactivity).
withDiagnosis
ulcerationusually requiresIt aisbiopsy
and crusting. causedfrom
by rt
iated immunity
uncture wounds(e.g.whoolder
have age, HIV) increases
not received the risk.forIt tetanus
revaccination is treated with 5antiviral
within agentsbe
years should (e.g. acyclovir,Infamciclovir,
vaccinated. valacyclovir
addition, tetanus immu
dirty wounds who have not previously received at least 3 doses of tetanus vaccine or whose vaccine
infection causes high fever, chills, tenosynovitis, polyarthralgia, and pustular lesions on the trunk and extremities. Disseminate status is uncertain.
ors
sents forwith
gonococcal infectioncomplaints
gastrointestinal are present.(e.g.Routine bloodpain,
abdominal and nausea,
pustule cultures
vomiting) can be negative
followed by thedue to the fastidious
characteristic triad ofnature of e
periorbital
nOther
formsfindings
in starchinclude
productsfever,
(e.g.subungual splinter
rice) that have beenhemorrhages, and conjunctival
left at room temperature or retinalperiods
for extended hemorrhages.
or reheated. Symptoms begin rap
is the primary manifestation.
skin infection that manifests with the acute onset of systemic symptoms (fever, chills), regional lymphadenitis, and a warm, ten
ed borders. The
se-producing majority that
bacterium of erysipelas
commonly cases
causes areurinary
causedtractby group A Streptococcus.
infections. Urease generates ammonium, resulting in urine alkaliniz
e, dramatically increasing the risk of urinary calculi with struvite
pically manifests with erythema migrans (EM), but patients may also present with multiple stones (magnesium ammonium phosphate).
EM lesions, carditis, and/or neurologi
trioventricular block.
s is recommended for most travelers who visit malaria endemic countries. In areas with high rates of chloroquine resistance, pa
xycycline, or mefloquine. Measures for avoiding mosquito bites (e.g. protective clothing, insecticide, insecticide-treated bed net
rly localized
eatment Lymewith
serology disease are typically treated
a nontreponemal with
test (e.g. amoxicillin.
rapid This treatment
plasma reagin) is generally
to quantitate curative
antibody titers. and doesdecrease
A 4-fold not poseina antibod
risk to
dation and maintenance therapy. Serial lumbar punctures may be required to reduce increased intracranial pressure. Antiretrov
antifungal therapy
vascular tumor dueis to
started.
human herpesvirus-8 that typically occurs in advanced HIV disease. Typical lesions appear as violet pap
derlying HIV disease is
primary prophylaxis is routinely treated with highly
given; activepatients
however, antiretroviral therapy.
in Histoplasma-endemic areas with CD4 counts < 150/mm3 are somet
laxis with 3-drug antiretroviral therapy for 4 weeks is recommended following high-risk occupational exposure to blood or body
dprolonged,
be started profuse,
as soon as andpossible,
watery ispreferably
often dueintothe first few pathogen
a parasitic hours. such as Cryptosporidium parvum. C. parvum
erwise healthy individuals (resolving spontaneously in 10-14
erichia coli (EHEC) is a food-borne pathogen that causes acute watery to bloody days). Patients whodiarrhea.
are immunocompromised
Diagnosis can be(e.g. AIDS)with
confirmed are at ri
a st
ric antibiotic
spected therapyfrom
in a patient should be avoided
an endemic as itwith
region mayaincrease
history ofthe risk
tick of hemolytic
bite, uremic
febrile illness withsyndrome.
systemic symptoms, leukopenia and/or
is uncommon, and the drug of choice is doxycycline.
e in this population. In the absence of active TB manifestations (positive chest x-ray, fever, night sweats, cough), treatment of LT
r 12 weeks of weekly
munocompromised rifapentine,
patients high-dose
with suspected isoniazid,
bacterial and pyridoxine
meningitis. is curative.
Corticosteroids should be started at the same time as antibiotics
han Streptococcus pneumoniae.
ase should be suspected in individuals in Lyme-endemic areas who develop a flat, annular rash with or without central clearing.
etive
an in earlysymmetric
acute disease; doxycycline
arthritis of the is usually curative.
hands (metacarpophalangeal, proximal interphalangeal, and wrist), knees, and ankle joints
gM. The syndrome
typically presents withis usually
prolongedself-limited and doesexudative
fever, malaise, not require specific treatment.
pharyngitis, splenomegaly, and generalized lymphadenopathy. Pati
ombocytopenia up to 2-3 weeks after the onset of initial symptoms.
ophytic nodules
ethoxazole is the in an HIVagent
primary infected
usedpatient are most likely
for prophylaxis bacillary angiomatosis.
for Pneumocystis pneumonia in patients who have had solid organ transplan
rophylaxis with ganciclovir or valganciclovir.
agocytophilum) is possible. Symptoms are often flu-like (fever, chills, malaise), and laboratory studies usually show anemia with
hagnosis is made
ganciclovir. primarily
Herpes by identifying
simplex esophagitis organisms on peripheral
is characterized by small,blood smear ('Maltese cross').
well-circumscribed, round/ovoid ulcers and intranuclear inc
nterococcus faecalis,
an intracellular, are a common
gram-negative causecommonly
organism of endocarditis
spread associated
by aerosols with nosocomial
or droplets fromurinary tract infections.
contaminated water supplies. A history of
snary
suchfungal
as confusion, ataxia, or diarrhea are suggestive of Legionnaires' disease. Treatment options
infection endemic to the Great Lakes, and Mississippi and Ohio River basins. Systemic Blastomycosis include macrolides ormay fluoroquino
cause s
ns. Broad-based budding yeast grown from the sputum confirm the diagnosis. Itraconazole or amphotericin
ci is commonly encountered after dental procedures involving manipulation of the gingival tissue or oral mucosa and with proce B may be used to t
ract.
hould be considered in patients with presumed history of intravenous drug use. Empiric antibiotic treatment of native-valve end
t Staphylococcus aureus, streptococci, and enterococci. Vancomycin is the most appropriate empiric antibiotic for these patients
date venipuncture
protein sites should
concentration. be obtained
Early empiric therapyover a specified
with intravenous period in all patients
acyclovir should be with suspected
initiated infective
as soon endocarditis
as possible prior to in
for suspected h
urn.
phylaxis (PEP) for mammalian bites includes rabies vaccine and rabies immune globulin. PEP is indicated when the animal is u
animals
te, which can
may either be observed
ulcerate and drain(pets, for 10 days)
nonpurulent, or tested
odorless fluid.(wild animals)
Additional, to determine
proximal papular thelesions
need for
mayPEP.
form along lines of lymph
ally spared,
infection and systemic
endemic spreadUnited
to the central is rare.States. It usually causes a mild pulmonary illness, but disseminated infection may occu
astomycosis
erythema manifestsSymptoms
multiforme. as well-circumscribed
may last weeks verrucous nodules
to months. Mostand plaqueshealthy
otherwise that progress
patientstodo microabscesses.
not require antifungal therapy. P
dissemination are often given ketoconazole or fluconazole.
mics the presentation of sarcoidosis and should be considered when a patient with suspected sarcoidosis deteriorates after imm
hic
ivefungi
fungal(e.g. Histoplasma,
infection Blastomyces,
most commonly seen Coccidioides)
in patients should be excluded
with poorly controlledbefore immunosuppression
diabetes mellitus (especially is initiated.
in ketoacidosis). Treatm
medication (e.g. liposomal amphotericin B), and the elimination of promoting factors (e.g.
de acute fever, nasal congestion, purulent nasal discharge, headache, and sinus pain. Local, necrotic spread hyperglycemia, ketoacidosis).
is common. Diag
opus is the most common cause.
of patients on isoniazid will develop mild aminotransferase elevation within first few weeks of treatment. This hepatic injury is ty
ute hepatitis B virus infection is self-limited in > 95% of cases. In the recovery phase, serology typically demonstrates hepatitis
epatitis B core
membrane, antibody,
or skin) and
should hepatitis
receive B e antigen prophylaxis.
post-exposure antibody. Unvaccinated individuals should receive both the HB vaccine an
commonly presents with fever, nausea, vomiting, and abdominal pain followed by jaundice and pruritus. Physical examination
significantmononucleosis
infectious elevations in transaminases,
include fatigue,bilirubin, and fever,
sore throat, alkaline phosphatase. Most
lymphadenopathy, andpatients completely
splenomegaly. recover
Atypical in 3-6 weeks.
lymphocytes on per
hile specific for Epstein-Barr virus infection, may be negative early in the illness.
openia should be started on empiric broad-spectrum antibiotics as soon as possible after blood cultures are obtained. Empiric m
e.g.
anismscefepime, meropenem,
in respiratory piperacillin-tazobactam)
secretions using microscopy with is recommended for initial
specialized stains. Samplesmanagement.
are obtained using induced sputum or, if this
ge.
auses atypical pneumonia with indolent symptoms of headache, malaise, low-grade fever, incessant cough, and nonexudative
emuch
with or without
higher riskaofsmall, serous tuberculosis
reactivation pleural effusion.
thanEmpiric oral antibiotics
the general population.(e.g. azithromycin)
Patients usually
typically have resolveor
subacute the infection
chronic comple
symptoms
. Upper lobe cavitary lesions are common on chest x-ray.
a cough productive of foul-smelling sputum after instrumentation of the upper airway or esophagus, an anaerobic lung infection
robic coverage include
koencephalopathy metronidazole
is caused withreactivation
by JC virus amoxicillin,and
amoxicillin-clavulanate, and clindamycin.
occurs primarily in patients with advanced HIV (CD4 count < 200/mm
ges (e.g. mental status change, motor deficits, ataxia) and imaging evidence of multiple
piric oral fluconazole. Those who do not respond to fluconazole or have no evidence of thrush nonenhancing brainfurther
often require lesionsevaluation
with no maw
s common in patients with advanced AIDS (CD4 counts < 200/mm3). Trimethoprim-sulfamethoxazole is the first-line treatment;
e oximetry
ein-Barr < 92%,
virus, CMVPaO2
usually< 70 mm Hg,
causes mildorpharyngitis,
alveolar-arterial gradient > 35 mm
lymphadenopathy, and Hg on room air(or
splenomegaly to reduce risk of worsened
these symptoms may be hypoxia
absent)
s negative, and CMV IgM serology is positive.
has many potential causes. CD4 count, chronicity, and the presence or absence of symptoms of colitis help narrow the different
for several
ually tests including
have nonspecific culture,(e.g.
symptoms ovadiarrhea,
and parasites,
weightacid-fast
loss), anstain, and alkaline
elevated Clostridium difficile antigen.
phosphatase level, and lymphadenopathy. D
row aspirate; treatment with macrolide-based combination therapy is curative, but antiretroviral therapy should be initiated to pr
ncreased risk of of
a combination community-acquired
nontreponemal andpneumonia.
treponemalStreptococcus pneumoniae
serologic testing. is thetests
Treponemal most(e.g.
commonly implicated
fluorescent organism.
treponemal antibody abs
rimary syphilis.
eadache, fever, focal neurologic deficits, and altered mental status in patients with advanced AIDS (CD4 count < 100/mm3). An
reatment is with sulfadiazine
ever is a tick-borne and pyrimethamine.
illness caused by Rickettsia rickettsii. Classic symptoms include a few days of fever and headache, followed
palms/soles. Without empiric antibiotic
pregnancy, or certain comorbid conditions treatment (e.g. doxycycline),
(e.g. diabetes noncardiogenic
mellitus) should be startedpulmonary
on pyridoxine edema and shock can
supplementation occur.
when treat
dliform
(INH).organisms
This helpssuch
prevent INH-induced
as Escherichia coliperipheral
are the mostneuropathy, which is Patients
likely pathogens. due to INH-mediated
age < 35 are pyridoxine deficiency.
far more likely to have epididymi
trachomatis
ble bacteria oronNeisseria
culture or gonorrhoeae.
Gram stain, a mucopurulent urethral discharge in a patient who is sexually active suggests chlamydia
rms the diagnosis.
based primarily on examination, but biopsy can be performed for confirmation. Treatment includes topical high-potency glucoc
ves within
usually 2 years. with a flu-like illness and lower urinary symptoms. The diagnosis is generally confirmed when digital rectal ex
manifests
XXY) is characterized by a eunuchoid habitus, gynecomastia, small testes, and decreased virilization. It can lead to infertility du
enesis,
on withazoospermia,
normal FSH, LH, hypogonadism, and elevated
and testosterone suggestsFSH and LH
infertility duelevels.
to obstructive azoospermia. Congenital absence of the bilate
is highly associated with cystic fibrosis and may be the only feature
ention includes bladder decompression with urethral or suprapubic catheterization; in mild, atypicaldefinitive
disease.treatment includes α blockers (e.g.
finasteride),
ectile and possibly
dysfunction in diabeticsurgery.
patients consists of phosphodiesterase-5 inhibitors (e.g. sildenafil). However, these medications ca
α blockers or nitrates.
mmon in patients with cardiovascular disease. First-line treatment includes phosphodiesterase-5 (PDE-5) inhibitors (e.g. sildena
santed,
takingpersistent,
nitrates orand
α blockers as concomitant
often painful useconstitutes
erection that can causeaseveremedicalhypotension.
emergency. Certain medications (e.g. trazodone, prazos
al trauma) may precipitate priapism.
and early-morning penile erections helps differentiate psychogenic from organic causes of male erectile dysfunction. Normal no
on in the
y tract penis. (e.g. urinary frequency, nocturia, hesitancy) should have a urinalysis to evaluate for hematuria and infection. P
symptoms
omatic
ment forpatients to assess
uncomplicated the risk
benign for prostate
prostatic cancerincludes
hyperplasia unless predicted life which
α1 blockers, expectancy is <10 rapid
can provide years.relief of symptoms. 5-α-redu
n to α blockers but have a much slower onset of action.
man can
mptoms produce
(e.g. fever, infertility by suppressing
chills, acute illness), andthe production
a tender, of GnRH,
swollen LH,
prostate onand FSH.
digital rectal examination. Urine culture is required to
c pelvic pain syndrome is a common disorder of uncertain etiology, characterized by irritative voiding symptoms (e.g. frequency,
blood
analysis on ejaculation.
(FMEA) is aUrine culture is
prospective, sterile. Treatment
systematic, team-based includes antibiotics,
approach α blockers,
that consists and 5-α-reductase
of identifying steps in a inhibitors.
process and finding s
fwhen
ensuring safe outcomes. FMEA can be performed before any problems are identified.
the diencephalon and midbrain are displaced caudally due to increased intracranial pressure (e.g. intracranial hemorrhag
npleCushing triad, unconsciousness,
anticholinergic medications (e.g. mid-sized and fixed pupils,
elderly psychiatric andare
patients) abnormal posturing
at risk for chronic (decorticate
anticholinergicvs.toxicity,
decerebrate).
which often prese
te anticholinergic toxicity. Removal of the anticholinergic medication leads to resolution of symptoms.
l hemorrhage can have rapid clinical deterioration, especially when brain herniation is present. When a change in clinical status
ould
gressive be reassessed because intubation
headache, vomiting, fever, and and mechanical
nuchal ventilation may
rigidity. Cerebrospinal be typically
fluid necessary (e.g.lymphocytosis
shows airway protection).
with a mildly elevated
glucose.
presents with rapidly progressive ascending motor weakness due to immune-mediated demyelination of peripheral nerve fibers.
the spinal cord is often
immune-mediated normal.
disorder that causes a rapidly progressive myelopathy characterized by motor weakness (with upper and/or
aracterized by a distinct sensory
immune-mediated, rapidly progressive level), myelopathy
and autonomic thatdysfunction (including
typically causes motorbowel or bladder
and sensory dysfunction).
deficits, a distinct sensory level, and
ine management is the administration of high-dose intravenous glucocorticoids.
tremor is typically a fine, fast, symmetric action tremor of the hands that increases with sympathetic activity. Certain medication
nists)
en presentscan cause
as anenhanced physiologic
action tremor tremor,
of the hands which
that generally
is not improves
associated with neurologic
with other dose reduction or medication
symptoms. cessation.
First-line treatment include
β-adrenergic receptor blockade, and primidone, a centrally acting anticonvulsant.
GBS), an immune-mediated polyneuropathy, can be associated with early HIV infection. The clinical presentation and diagnost
ssociated GBS; nerve
typically marked conduction
by subacute studiesof
symptoms (e.g. showingirritation
meningeal demyelination) can help
(e.g. vomiting, confirm the
headache, diagnosis.
nuchal rigidity) and imaging findings o
alus, and stroke due to vasculitis. Risk is increased with immunocompromise (e.g. HIV).
generally marked by subacute symptoms of meningeal irritation with or without cranial nerve palsy and stroke. Cerebrospinal fl
increase in white blood cells, mildly elevated protein, low glucose, and elevated adenosine deaminase.
esents with low back pain that radiates down the leg associated with sensory loss over the lateral thigh, calf, and dorsal foot, an
exion,
deficitsinversion,
that affectandparteversion.
of an extremity and follow a dermatomal/myotomal pattern; lancinating pains are common. C8 nerve roo
o the fourth and fifth fingers, and weakness
in a distal, symmetric, stocking-glove of theisfingers
distribution and thumb.
characteristic of a length-dependent axonal polyneuropathy. If it occurs acu
as metronidazole.
osis can present with bulbar symptoms (e.g. dysphagia, dysarthria) with examination revealing both upper motor neuron signs (e
ignsleads
osis (e.g. to
tongue fasciculations
degeneration and
of cells in atrophy).
the anterior horn of the spinal cord. It is characterized by often asymmetric weakness with
tudies often show characteristics of
osis can cause respiratory insufficiency due both acute and chronic
to respiratory denervation.
muscle weakness. Noninvasive positive-pressure ventilation prolongs
e lies directly adjacent to the brachial artery in the distal upper arm, it can be injured (e.g. laceration, compression) as a result o
mmetric, descending motor
causes mononeuritis paresis
multiplex, that can progress
a neuropathy to involve the peripheral
of > 2 noncontiguous diaphragm,nerves.
causing hypoventilation
Patients and respiratory
also frequently have skin,acidosi
renal
are generally spared.
acterized by new headache and elevated inflammatory markers in patients age > 50; complications include permanent vision los
tery biopsy; however,
e classically presents to reduce
with the risk of blindness,
a sudden-onset, treatmentLumbar
severe headache. with systemic
punctureglucocorticoids
is warranted ifshould
clinicalnot be delayed
suspicion whilehigh
remains await
d
ngs include an elevated opening pressure, xanthochromia, and an elevated red blood cell count that does
common with Parkinson disease and can lead to neurogenic orthostatic hypotension, with patients experiencing lightheadedne not decline with succe
nizedcan
sies by be
a >suggestive
20 mm Hgof drop in systolic
a ruptured blood pressure
or enlarging withaneurysm
saccular standing with
and an absence
active of the expected
or impending increase
subarachnoid in heart rate.
hemorrhage. Isolat
he posterior communicating
, symmetrical polyneuropathy artery.
that typically begins with numbness/tingling/pain in the feet and progresses proximally. Older pat
test risk. Antiretroviral treatment
disorder can present with headaches, reduces the risk
muscle of progression.
spasms, Gabapentin
jaw fatigue, and facial is first-line
pain. for symptomatic
Physical examination management.
can reveal tenderness
and/or audible clicks from the joint.
pain, weakness, paresthesia, and diminished reflexes. Improvement of radicular symptoms when the hand is placed on the top
e (SAH) results in sudden-onset, severe headache; nausea/vomiting, brief loss of consciousness, and meningismus are commo
an of the head;
ordination if results
are also are negative
common. and a high suspicion
After a concussion, average-riskfor adults
SAH still exists,
should lumbar
rest for > 24puncture should gradually
hours before be performed.
increasing acti
c, potentially returning to full contact sports in 1 week.
s, impaired pupil constriction, down-and-out eye) raise suspicion for a brainstem stroke. A midbrain infarction due to occlusion o
e,
Morewhich is characterized
severe by oculomotor
cases are marked nerve
by delirium (CN III)
tremens dysfunction
(e.g. autonomic accompanied by contralateral
instability, delirium), hemiparesis.
hallucinations, and/or seizures. The p
ampen CNS excitation.
myelinating polyneuropathy causes immune-mediated destruction of myelin in a non-length dependent manner; this results in pr
es,
oss sometimes
of sensation with distal
over the sensory
ipsilateralloss.
face and contralateral body is concerning for a posterior circulation stroke that can be preci
k trauma.
cal, reversible neurologic symptoms that precede or accompany the headache). Estrogen-containing contraceptives are contrai
ased
muscleriskcontractions
of ischemic that
stroke.
often involve the small muscles of the head and neck; oculogyric crisis results in a forced upward gaz
ymptoms of a high-potency,
n occur due to decompression first-generation antipsychotic
sickness following (e.g. haloperidol,
deep underwater fluphenazine).
diving. Venous Management
air embolism can cause includes benztropine
skin cyanosis, a
respir
r embolismdominant
autosomal can causedisorder
confusion, gait by
caused ataxia, dysarthria,ofand
the expansion stroke.
cytosine-thymine-guanine trinucleotides. The disease typically presen
distalvertigo
onal musclecauses
weakness
brief and
(< 1myotonia (delayed
min) episodes muscletriggered
of vertigo relaxation
by after contraction);
changes cataracts,
in head position. testicularan
Triggering atrophy,
episode and
bysleep
usingdis
pro
pike)
ding is
to diagnostic.
a rapidly progressive myelopathy characterized by motor weakness, autonomic dysfunction (e.g. bowel/bladder dysfunc
granulomatous disorder that can involve the nervous system, presenting as facial nerve palsy. Other common extrapulmonary
,tformin
hypercalcemia,
therapy can andcause
parotid glandB12
vitamin swelling.
deficiency due to alterations in calcium homeostasis, leading to impaired absorption of v
nemia is often seen, a minority of patients
ce phenytoin from plasma proteins (e.g. valproic have isolated neurologic
acid) increase the findings (e.g.toxicity.
risk of drug paresthesias,
Common sensory ataxia,
symptoms of neuropsychiatric
acute phenytoin
ausea/vomiting, and significant toxicity can result in altered mental status, coma, and death.
s status epilepticus [MSE]) occurs while patients are still unconscious and is characterized by generalized (often symmetric) my
Prolonged MSE ischaracterized
of focal dystonia a marker of poor prognosis.
by recurrent forceful contraction of the eyelid muscles. Bright lights may trigger symptoms, wher
erminate the spasm. Mild cases may be managed
characterized by burning pain and hyperesthesia lasting with trigger avoidance,
> 4 months but acute
following botulinum toxin
zoster. The injection may be needed
risk is greatest in thosefor more
with ad
reatment includes anticonvulsants (e.g. gabapentin) and tricyclic antidepressants (e.g. amitriptyline).
toxic neuropathy that typically results in a symmetric distal polyneuropathy (i.e. stocking and glove pattern) characterized by pa
p
MFS)tendon
is a reflexes
variant of(e.g. ankle) and syndrome,
Guillain-Barré light touch and vibratory
a group sense are common.
of immune-mediated polyneuropathies that are caused by molecular mimi
and areflexia; strength is often preserved. It is highly associated
section is a common cause of stroke in young patients and can occur spontaneously with anti-GQ1b antibody.
or after mild trauma or illness. It is typically
sis without anhidrosis), unilateral headache and neck pain, and cerebral ischemia
ing, and confusion. In a minority of patients, elevated ICP compresses the 6th cranial nerve and (transient ischemic attack,
results stroke).
in diplopia and lateral g
bar puncture with CSF analysis and India ink stain or capsular polysaccharide antigen testing.
otor nerve (CN III) palsies are concerning for aneurysmal compression. MR or CT angiography should be performed immediate
ed by microvascular
a bacterial ischemia
infection of associated
the epidural space,with diabetes
typically arisesmellitus, hypertension,
in the setting and hyperlipidemia.
of bacteremia from intravenous drug use or distant infec
pain, and progressive neurologic findings (e.g. sensory, motor, reflex deficits).
ected dementia should include neuropsychological testing (e.g. Montreal Cognitive Assessment), selected laboratory testing (co
amin B12), and neuroimaging (e.g. MRI). Patients in specific risk groups may warrant additional targeted testing.
generally develop acute bladder paralysis, lower extremity paresis, crude touch/pain sensation loss, and diminished reflexes (in
rallywhich
ent, preserved because athese
may produce are carried in the
medication-induced posteriorthat
syndrome columns
mimics and receive some
dementia. Review blood flow from the
of medications intact
is an posterior
important spinal
first step
men with new-onset or worsening cognitive impairment.
phalus is a potentially reversible cause of dementia characterized by cognitive decline, gait impairment, and urinary incontinenc
oportion
sis (PVT) to is athe sulci. complication of both mechanical and bioprosthetic valves. Patients can have a new murmur, heart failure
potential
, or a thromboembolic
autosomal dominant disease event (e.g.
of CAG transient ischemic
trinucleotide attack).
repeat Suspected
expansion PVT should
characterized bybe promptly symptoms,
psychiatric evaluated with echocardiograp
cognitive impairme
ation of GABA-producing neurons in the caudate nucleus and putamen.
is caused by large or small artery ischemia or infarction and presents with executive dysfunction and focal neurologic findings.
ging to evaluate demyelinating
mune-mediated for cerebrovascular disease disease.
of the central nervous system. The disease is most common in Caucasian women age <
ocation, genetic predispositions
der (RBD) is characterized by dream enactment (HLA-DRB1), andduring
smoking. REM sleep atonia. Most patients with idiopathic RBD eventually develo
commonly Parkinson disease.
opathy is common in older adults and generally presents with progressive neck pain, gait disturbances, lower motor neuron sig
esexes),
includeandheadache
upper motor thatneuron
is presentsigns in the
upon lower extremities
awakening and brief (e.g.
symptomincreased
relief reflexes,
followed byspasticity).
rebound pain. Management involves
azepam, diazepam) should be administered for seizure termination. In addition, a nonbenzodiazepine antiepileptic medication s
mmended
ding alcohol medications
abuse; however,include itfosphenytoin,
may be caused phenytoin, levetiracetam,
by any disorder or valproic
that causes chronicacid.
malnourishment (e.g. short-gut syndrome).
neuropathy of the facial nerve (cranial nerve VII) characterized by facial weakness that involves both the upper and lower face.
ic viruses
(e.g. cranial(e.g. herpes
nerves, simplex
spinal virus),
nerves). resulting
Because anyin inflammation,
motor neuron edema, and degeneration
can be involved, patients mayof thehavemyelin sheath.
a variety of symptoms, incl
upper motor neuron and lower motor neuron signs.
ding to clinical manifestations of cerebral hypoxia (e.g. headache, confusion, seizure, coma). Laboratory results may demonstra
njury
VII canpresents
palsy) occur. with acute-onset, progressive, unilateral facial weakness involving the upper and lower face. A prodrome of a
coids,
pondylosis.and somePatientsstudies recommend
usually have painthe in addition
the neckof acyclovir
radiating toorthevalacyclovir.
shoulder/arm, weakness in an upper extremity myotome, and
RIexposure
of the cervical spine is the first test of choice.
can lead to sensorineural hearing loss due to the irreversible death of hair cells in the cochlea. Hearing screening pro
r may occur in uptransportation).
. manufacturing, to 20% of patients with Parkinson disease (PD). Although the diagnosis of major depression may be difficult d
essed mood, anhedonia,
o hypertension, nephropathy, hopelessness,
hyperuricemia, and/or and suicidality
microcytic often suggests
anemia major depression.
with basophilic stippling seen on peripheral smear. Treatme
with an agent such as calcium disodium EDTA.
o hypertension, nephropathy, hyperuricemia, and microcytic anemia with basophilic stippling seen on the peripheral smear. Diag
sources
ve symptoms of leadof exposure.
upper extremity ischemia (e.g. pain, fatigue, paresthesias) or vertebrobasilar insufficiency (e.g. dizziness, atax
mity exercise.
used for depression, insomnia, and pain disorders but is frequently associated with side effects including orthostatic hypotensio
h, constipation, junction
neuromuscular urinary retention).
disorder causedDiscontinuing the medication
by the Clostridium tetaniusually
toxin, resolves
which blocksthesethe
symptoms.
release of the inhibitory neurotransmitt
ever, painful muscle spasms, and trismus (lockjaw). It is usually
dications, treating infections and metabolic disturbances, and encouraging regular activity duringseen only in those who are unvaccinated or incompletely
the day while minimizingimmu distu
ckly.
neration is caused by damage to the Purkinje cells of the cerebellar vermis. Manifestations typically include the slowly progress
-based gait and postural instability. Truncal coordination (e.g. tandem gait) is impaired, but limb coordination (e.g. finger-nose te
ould
hy is be obtained
typically the in patients
result of leg with cognitive impairment
immobilization, leg crossing,to establish a diagnosis.
or protracted squatting. Manifestations are usually transient (lasting
candorsal
occur foot
due andtolateral
stress shin.
and are Physical
usually examination
bilateral, dull,showsand impaired
nonthrobbing anklewithout
dorsiflexion and great
associated toe extension
symptoms with preserved
(e.g. nausea, vomiting). pl
.g. ibuprofen), but when more disabling, prophylactic medication (e.g. amitriptyline) should
or differ in character from prior, that are present on awakening, and that are associated with frequent nausea and vomiting as w be considered.
ical nonfatigable
with cause. Thesenystagmus,patients should whichbe evaluated
cannot early with an
be suppressed by MRI
visual offixation.
the brain.Head imaging should be performed to evaluate for
istent, new-onset central vertigo and vascular risk factors, neurologic
bolic ischemic strokes and those treated with thrombolytics are at high risk for hemorrhagic signs/symptoms, or accompanying
transformation. headache.
This condition usual
s with deteriorating mental status. Diagnosis requires emergent noncontrast CT scan of
ed to an acute demyelinating plaque of multiple sclerosis usually last for days to weeks whereas transient ischemic attack (TIA) the head.
nt of TIA
anifest is modifying
years risk factors,
after untreated startingpallidum
Treponema aspirin and statin,
infection andtabes
with improving
dorsalisblood pressure
(sensory control.
ataxia, lancinating pains, reduced/absen
normal pupillary constriction with accommodation but not with light). Intravenous
potentially life-threatening illness caused by the ingestion of food (e.g. improperly canned fruits/vegetables, penicillin is the treatment ofcuredchoice.
fish) contamin
within 36 hours of ingestion and begin with bilateral cranial neuropathies followed
tic drug with known teratogenic effects (e.g. fetal hydantoin syndrome). Women of childbearing age who have a low risk by symmetric descending muscle weakness.
of seiz
onsidering becoming pregnant; however, the medication should be slowly tapered as rapid
nia gravis can be supported with the bedside ice pack test. In this test, an ice pack is applied over the eyelids for several minut withdrawal may result in seizure rec
ve test results should undergo confirmatory testing for acetylcholine receptor antibodies (highly specific).
nup theofelderly and presents
a first-time seizure inwith bilateral,
an adult symmetric,
should sensorineural
include basic blood tests hearing
(e.g. loss.
serum electrolytes, glucose, calcium, magnesium, co
nesia, difficulty concentrating or with multitasking, vertigo, mood alteration, seizures
toxicology screen to evaluate for metabolic and toxic causes. Unprovoked generally require
sleep disturbance, furtherThese
and anxiety. evaluation with neu
symptoms typ
eks to months following TBI; however, some patients may have persistent symptoms lasting
crease the risk of septic embolic events in patients with native valve infective endocarditis. Surgery can be considered in some > 6 months.
istent/difficult to treat infection, or recurrent embolism.
vement of the hands that occurs when the wrist is extended with the arms outstretched. Common causes include hepatic encep
ercapnia. Treating
neration). A vitamintheB12underlying
level is the cause
initialwill improve
test neurological
of choice, but serumstatus and resolve
methylmalonic asterixis.
acid and homocysteine testing should be ord
eripheral neuropathy typically presents as a symmetric, distal, sensory neuropathy that progresses in a stocking-glove pattern.
edications,
nts taxanes,
as a sudden and vinca
or stepwise alkaloids.
decline in executive function after stroke, which interferes with activities of daily living. Patients typi
e.g. hemiparesis, pronator drift, Romberg
ly presents as a sudden or stepwise decline sign).
in executive function with mild memory loss early in the disease. Patients can have
maging classically demonstrates a cerebral
hy with proximal muscle weakness, autonomic dysfunction, infarction and/or and
deepneuropsychiatric
white matter changes from chronic
manifestations. ischemia. levels are typical
Urobilinogen
he diagnosis.
of the head typically reveals a hyperdense biconvex lesion that does not cross suture lines. Symptomatic patients require emer
ave sudden onset with maximal symptoms at the beginning. They occur more commonly in patients with a history of structural c
Patients with atrial fibrillation PLUS existing structural heart disease have an increased risk of cardioembolic strokes.
sential tremor
cterized is propranolol,
by a fine tremor that isespecially
typically ifsuppressed
the patient at is rest
also and
hypertensive.
exacerbated Alternate medications
at the end include movements.
of goal-directed primidone and topirama
It is most c
may affect any part of the body. It is usually not associated with other neurologic symptoms.
increased intracranial pressure and presents with transient vision loss lasting a few seconds with changes in head position. It r
ologic examination,
nial hypertension neuroimaging,
include headacheand/or (worselumbar puncture)
at night), as persistent
nausea/vomiting, andpapilledema canchanges.
mental status lead to vision loss.
Papilledema and focal neuro
ex
ed (hypertension,
by core temperaturebradycardia,
> 40 C respiratory
(104 F) withdepression) is a worrisome
CNS dysfunction finding
(e.g. altered suggestive
mental status).ofIt brainstem
occurs most compression.
commonly in those exp
activities.
st Complications
CT as white hyperdense include
regions rhabdomyolysis, disseminated
in the brain parenchyma, intravascular
whereas coagulation,
many ischemic and do
strokes end-organ dysfunction.
not become evident (hypoden
y is due to thiamine (vitamin B1) deficiency and is most commonly seen in malnourished patients with underlying alcoholism. Fe
ait ataxia.
cord Patients should
compression presents be with
treated empirically
worsening focalwith
back thiamine prior tolower-extremity
pain, bilateral or along with glucose administration.
weakness, sensory loss, and gait ataxia. B
phase of spinal cord injury, patients can develop spinal shock with absence of reflexes and
t. Treatment includes iron supplementation for iron deficiency, conservative measures, and pharmacotherapy flaccid paraplegia with
as a dopamine
result. ag
(e.g. gabapentin).
. intravenous alteplase) improves neurologic outcomes in patients with acute ischemic stroke when given within 4.5 hours of sy
phalusaisnoncontrast
tered, characterized head
by CT
gaitshould be performed
abnormalities, to rule
cognitive out hemorrhagic
impairment, stroke,
and urinary and the patient
incontinence should
that often be screened
presents for othe
as urgency in e
F absorption with increased ventricular compliance, allowing for ventricular enlargement without chronically increasing
uses of delirium include infections (e.g. urinary tract infection), polypharmacy, medication side effects, volume depletion, and ele intracran
ultiple sclerosis should be treated with high-dose intravenous glucocorticoids. Plasma exchange is reserved for patients who do
tious etiologies are the most common causes of delirium in a hospitalized patient. Patients with dementia have an increased ris
ostatypical
d common antipsychotics are useful
type of dementia in thefor treating
United acute
States, is agitation in elderly
characterized patients
by early and with dementia.
prominent memoryBenzodiazepines
impairment. The are differentia
typically n
mentia, and vascular dementia, as well as nondementing syndromes such as normal pressure hydrocephalus.
es causesamong
common cognitive fluctuations,
chronic visual hallucinations,
alcohol abusers. and parkinsonism.
Symptoms include Cognitive
gait instability, truncal symptoms may precede,
ataxia, difficulty with rapidoralternating
appear along
movemw
arkinson disease are rest tremor, rigidity, and bradykinesia. The presence of at least 2 of these 3 on physical examination is gro
d organisms. Headache, fever, focal neurologic deficits, and seizure may be present. Brain imaging (CT scan, MRI) typically rev
s.
rebral ischemic infarction, cerebral abscess, and/or bacterial meningitis. Renal injury may also occur due to embolic infarction o
e to microatheroma formation and lipohyalinosis in the small penetrating arteries of the brain. They often affect the internal caps
sn,anhyperlipidemia,
acute or subacutediabetes, and smoking
ascending are major Cerebrospinal
flaccid paralysis. risk factors. fluid analysis shows an elevated protein level with normal ce
h fluctuating and fatigable extraocular (e.g. diplopia, ptosis) and bulbar (e.g. dysarthria, dysphagia) muscle weakness as well as
s (uppertypically
Patients more than lower).
develop severe eye pain, photophobia with reluctance to open the eye, and a sensation of a foreign body in th
dysfunction as the ophthalmic
onal vertigo causes brief (< 1 min) branch (V1) of
episodes of the trigeminal
vertigo nerve
triggered (cranial nerve
by changes V) position.
in head controls corneal
Dizzinesssensation.
related to cardiovascula
muscle inflammation or tenderness, and creatine kinase level and erythrocyte sedimentation rate are normal. true
usually due to global cerebral hypoperfusion and presents as lightheadedness or near-syncope rather than vertigo.
Glucocorticoid-indu
ation is discontinued.
racterized by a 'steppage' gait: exaggerated hip and knee flexion while walking. Common causes include L5 radiculopathy and
III) palsy is commonly associated with poorly controlled diabetes mellitus and is characterized by damage to the inner somatic
pathetic fibers.the
tions include This manifests
sudden onsetwith ptosis,eye
of severe 'down-and-out'
pain, nausea, gaze, diplopia,
vomiting, and normal
unilateral pupillary
conjunctival response.
injection, and a dilated pupil with po
can develop permanent vision loss within 2-5 hours of symptom onset. Urgent ophthalmologic
e presenting symptom of Parkinson disease. It is usually a 'pill-rolling' tremor that starts in one hand and can consultation is progress
required. to involve
rm of focal dystonia involving the sternocleidomastoid muscle. It can occur idiopathically but is very often medication-related. D
mptoms.
enic) syncope occurs due to excessive vagal tone that can be triggered by emotional stress, pain, or prolonged standing. Episo
nd
herpallor.
risk for subdural hematoma due to increased fall risk and cerebral atrophy. Chronic subdural hematoma often presents insi
mnolence, confusion, and focal neurologic deficits.
n electrolyte abnormality that causes weakness, fatigue, and muscle cramps. When severe, it can lead to paralysis and arrhyth
aves, and premature
or abscess ventricular
or inflammation in thebeats.
region. Suspicion should be raised when a patient has severe, radicular lower back pain plus
mities, bowel/bladder/sexual dysfunction,
s characterized by signs and symptoms of and/or
uppersaddle
motoranesthesia.
neuron dysfunction distal to the site of compression. These include wea
e.y sensitive
Cord compression is a medical emergency requiring prompt
and specific sign for upper motor neuron or pyramidal diagnosis by spinal
tract disease MRI. the upper extremities. It is performed b
affecting
p and
may eyes closed.
present In patients
with fever, withpain,
focal back pyramidal lesions, the
and neurologic affected arm
dysfunction. drifts downward
Evaluation and theMRI
includes urgent palmof turns (pronates)
the spine. toward th
Most patients
biotics and
creased prompt
visual drainage/surgery.
acuity. Examination findings include conjunctival injection, corneal edema, palpable firmness of the eyeball, and
gonioscopy and/or tonometry.
y overactivity of cholinergic neurons and underactivity of dopaminergic neurons in the substantia nigra. A shuffling gait (i.e., the
ity) is characteristic
al mass of the disease.
often have headache associated with nausea and vomiting and/or focal neurologic deficits. Symptoms are often worse
intracranial pressure. An MRI
atients (i.e. transient ischemic attackof the or
brain is usually
ischemic diagnostic.
stroke in the distribution of the affected vessel) with high-grade carotid stenosi
darterectomy to reduce future stroke risk.
cord can cause Brown-Séquard syndrome, which is characterized by the following: Ipsilateral hemiparesis and diminished prop
llateral
of thebody,
spinalipsilateral
cord injury and below;
bulbar muscleContralateral diminished pain and
weakness, vestibulocerebellar temperature
impairment sensation
(e.g. 1-2 levels distal
vertigo, nystagmus), andtoHorner
the cord injury
syndrom
infarcts are most commonly associated with chronic hypertension, which leads to arteriolar sclerosis and occlusion of deep pen
ybenign suprasellar
present with acute,tumors that present
unilateral, with visual defects,
severe retro-orbital pain that headache,
awakens and symptoms
patients of pituitary
from sleep. Thesehormonal
headachesdeficiencies.
may be accompan
ptosis and miosis.
characterized by ignoring one side of a space (the left side in right-handed individuals) and involves the nondominant parietal l
motor, and/or reflex abnormalities in a dermatomal distribution. Spine imaging generally shows abnormal facet joints, including
terolateral thalamus typically presents with sudden-onset contralateral sensory loss involving all sensory modalities (i.e. pure se
enthalamic
p presentspain
as asyndrome, characterized
tremor of the hands thatby severe paroxysmal
is suppressed at rest, burning pain over
exacerbated the affectedarms,
by outstretched area that
and is exacerbated
more pronounced by light
at th
reditary and can be associated with a head tremor, but it is not associated with other neurologic symptoms. The diagnosis
able to injury where it runs posterior to the medial epicondyle at the elbow. Features include decreased sensation in the medial is cli
hand muscles.
agnosis. The characteristic findings are absent cortical and brain stem functions. The spinal cord may still be functioning; theref
s are lymphocytic pleocytosis, an increased number of erythrocytes, and elevated protein. HSV polymerase chain reaction ana
systemthat
gested atrophy when
a brain thatahas
patient withfor
seized Parkinsonism
> 5 minutes experiences orthostatic
(status epilepticus) is at hypotension,
increased riskimpotence, incontinence,
of developing permanentorinjury
otherdue
auton
to
llmark of prolonged seizures and can lead to persistent neurologic deficits and recurrent seizures.
mmended for solitary brain metastasis in patients with good performance status and stable extracranial disease. In patients with
apy is typically used.
ive impairment may be so severe in elderly patients that they appear to have dementia. Psychotherapy and/or antidepressant m
with depression
urologic examination andoffrequently
a patient result
with ainstroke
reversal
canofoften
cognitive deficits.
localize the region of brain dysfunction and the involved vasculature. An
lateral motor
presents with or sensory deficits,
psychiatric symptomswhich are
(e.g. more pronounced
depression, in the
irritability), lower limb
cognitive than theand
impairment, upper limb. HD
chorea. Urinary
is anincontinence can al
autosomal domina
o known disease-modifying treatment.
y facemask
phalus is an effective
is characterized andsymptom
by the rapid method
triad used
of gaittodisturbance,
abort an acute cluster headache
dementia, and urinarywithout major side
incontinence; effects.
upper motor neuron signs
nt of the ventricles out of proportion to the sulci.
e impairment caused by depression often mimics other neurocognitive disorders, such as Alzheimer disease. However, it is acc
mproves with treatment
with acetylcholine of the
receptor underlying
antibodies depressive
have disorder.
thymic abnormalities (e.g. thymoma, thymic hyperplasia), which appear as an anter
he risk of stroke
c syndrome more thanassociated
is frequently any other risk
with factor includingmalignancy
an underlying hypercholesterolemia, diabetes
(e.g. small cell mellitus,Itsmoking,
lung cancer). is causedand sedentary lifes
by autoantibodies
nthreatening
the presynaptic motor nerve
complication terminal leading
of myasthenia gravis to symmetric
that proximalbymuscle
is characterized severeweakness
respiratory with depressed
muscle deepleading
weakness tendontoreflexes.
respirato
eneralized or bulbar muscle weakness. The condition may be precipitated by infection, surgery, and certain medications
acute pain (including opioids) will be similar for all patients regardless of substance use history, although those with a history (e.g.offlu
ed close
osis follow-up
presents careupper
with both to avoid
andrelapse.
lower motor neuron signs; sensation is typically normal. Medical management includes riluzol
t), which improves survival and slows
ons can cause expressive (Broca) aphasia, disease progression.
contralateral hemiparesis due to involvement of the primary motor cortex, and cont
mentary motor cortex.
ous bleeding (e.g. intracerebral hemorrhage) due to excess anticoagulation with warfarin should have their anticoagulation imm
den)
prothrombin
is a common complex
site ofconcentrate
hypertensive to intraparenchymal
reduce the risk of brain
deathhemorrhage.
and permanentThedisability.
internal capsule that lies adjacent to the putame
emiparesis,
sthenic crisis with respiratory failure consists of endotracheal intubation followedside
contralateral sensory loss, and conjugate gaze deviation toward the of the lesion.
by treatment with plasmapheresis (or intraveno
ere is usually no hemiparesis or sensory loss. Early diagnosis with noncontrast head CT scan is important as emergency surgic
sensation but not vibratory/proprioceptive sensation), often in a 'cape' distribution, and may develop weakness that disproportio
lassically presents with acute focal neurologic deficits that gradually worsen over minutes to hours and can be associated with
headache,
roximal (e.g.vomiting,
difficulty altered
holding mental
up the status).
head or Patients
lifting thewith suspected
arms) muscles.acute stroke should
Pyridostigmine, initially receive
a long-acting oral a head CT without con
acetylcholinesterase in
hould be suspected in patients with a resting tremor of 5-7 Hz that is asymmetric and associated with rigidity. Tremor is often th
cholinergic medication sometimes used in the treatment of PD, generally in younger patients where tremor is the primary symp
eatment
elet agentofthat
Parkinson disease
is effective may cause
in reducing hallucinations.
the risk Dopamine
of early recurrence agonists and,
of ischemic stroke.to aIt lesser
shouldextent,
be givenlevodopa arehours
within 24 associated
to all paw
sdamole
suspected OR clopidogrel
but clinical is recommended
examination or MRIfor is
patients who have
not classic, recurrent
a lumbar stroke
puncture on aspirin
should therapy.for cerebrospinal fluid analys
be performed
oents. Opening pressure,
are refractory protein, and
to corticosteroids. cell count
Interferon β orare generallyacetate
glatiramer normal.can be used as chronic maintenance therapy in patients wi
rms of multiple
medical therapy. sclerosis.
Corticosteroids and serial lumbar punctures are not recommended as long-term primary treatments. However,
iting definitive surgical
presents with psychiatric treatment.
symptoms, cognitive impairment, and chorea. HD is an autosomal dominant CAG trinucleotide repeat
al atrophy of the caudate
id hemorrhage is most commonly nucleus and due putamen.
to ruptured saccular (berry) aneurysm and typically presents with thunderclap headache
ty, photophobia, nausea). Noncontrast
cted in patients with unilateral headaches CTwith
scana usually
pulsing reveals acutequality,
or throbbing bleeding around the
particularly brainstem andbybasal
if accompanied cisterns.
nausea/vomiting an
disabling
ssion cansymptomspresent withthatlossdo not respond
of motor andtosensory
abortivefunction,
treatment should
loss be considered
of rectal tone, and urinaryfor prophylactic
retention. treatment,
Management including topiram
includes eme
ly intravenous
thy is the most glucocorticoids.
common cause of spontaneous lobar (e.g. parietal, occipital) hemorrhage, particularly in the elderly. It occurs du
-size cerebral arteries
mon etiology is retinal ischemia and is associated with Alzheimeremboli
due to atherosclerotic dementia.
originating from the ipsilateral carotid artery; therefore, patients wi
nd of the neck.
aracterized by recurrent and sudden-onset severe, stabbing pain along the V2 (maxillary) and V3 (mandibular) branches of the
cted when trigeminal neuralgia presents bilaterally.
sed to treat trigeminal
aracterized by recurrent neuralgia.
severe painIt is an anticonvulsant
usually along the V2 that(maxillary)
can causeand nausea and vomiting
V3 (mandibular) as well as
branches of leukopenia.
the trigeminal nerve (CN
sually treated with carbamazepine.
s suspected, magnetic resonance imaging should be performed to support the diagnosis. T2-weighted imaging usually demonst
esions
be suspectedlocatedininyoung
periventricular,
women with juxtacortical,
neurologicinfratentorial, or spinal in
deficits disseminated cord areas.
space and time. Common presentations include optic ne
nd transverse myelitis (e.g. motor and sensory loss below the
e is characterized by rapidly progressive dementia, myoclonus, and sharp, triphasic, level of the lesion, incontinence).
synchronous discharges on electroencepha
dsuch
by aas prion. Most patients die within one year of symptom onset.
donepezil, rivastigmine, and galantamine may provide moderate symptomatic relief of cognitive symptoms and tempora
ver, these
almic venous medications
system is have not been
valveless, shown toinfection
uncontrolled alter theofdisease
the skincourse.
can result in cavernous sinus thrombosis. Red-flag symptom
a; and cranial nerve III, IV, V, and VI deficits.
sually occurs when there is injury to the anterior spinal artery from trauma. It is characterized by bilateral motor function loss at
temperature sensation bilaterally that begins 1-2 levels below the cord injury, whereas proprioception, vibratory sensation, and
al injurythat
ndrome shows numerous
occurs minute punctate
most commonly in young hemorrhages
to middle-aged withwomen
blurringand
of the gray-white interface.
is characterized by fatigue, widespread pain, and cogn
e initial
or temporal therapy. Pregabalin,
arteritis) presentsduloxetine,
with headache and milnacipran
and systemic are alternate (e.g.
symptoms therapies
fatigue,for fever)
patients in not responding
patients to tricyclic
age > 50. Potentialantidepre
compli
an lead to typically
ertension blindness. Threatened
presents (e.g.obese
in young, vision women
change)with or confirmed
headache,vision
visionloss in GCApapilledema,
changes, requires high-dose intravenous
and abducens nerveglucocort
(CN VI)
elevated
ause Wernicke opening pressure and normal
encephalopathy, which cell counts.
is characterized by encephalopathy, oculomotor dysfunction, and gait ataxia. This is ge
hronic alcohol use) and may be induced iatrogenically
ost common cause of dementia, is characterized by insidious by the administration of glucose
memory loss followed bywithout
behavioralthiamine.
changes. Psychotic symptom
el hemorrhages
of the disease.occur most commonly in the basal ganglia, thalamus, pons, and cerebellum. Patients tend to present initially wit
ted intracranial
presents pressure.
with memory Brain CT confirms
impairment. hemorrhage
Neuroimaging anddemonstrates
generally excludes other causes.lobe atrophy, which is most prominent in th
temporal
ed CSF pressure. The treatment includes weight reduction and acetazolamide. Shunting or optic nerve sheath fenestration may
e should be suspected in older adult patients (age 50-70) with rapidly progressive dementia, myoclonus, periodic sharp-wave co
nd/or elevatedneurologic,
with hepatic, 14-3-3 proteins in cerebrospinal
and psychiatric fluid. The diagnosis is supported by low serum ceruloplasmin, increased urinary
symptoms.
ation.
usion is a monocular
haracterized painless
by the acute onsetacute vision loss
of monocular mostloss
vision commonly caused
with central by an embolized
scotoma, atherosclerotic
afferent pupillary plaque from
defect, changes the percep
in color ipsilate
ong association between optic neuritis and multiple sclerosis.
ototoxic
ngs maytobeboth the manifestation
a late cochlea (resulting in sensorineural
in severe hearing loss)
disease. Hyperactive and the
reflexes andvestibular
an upgoingsystem (resulting
plantar in imbalance).
reflex are inconsistent with dia
otor neuron process.
ause of delayed morbidity and mortality in subarachnoid hemorrhage and can result in cerebral infarction. Vasospasm can bes
e in the upper thoracic spinal cord can result in paraplegia, bladder incontinence, and absent sensation below the level of the le
osis (ALS)cause
ell palsy) is characterized
weakness thatby the presence
affects of both
the entire upper
side of the(e.g. spasticity,
face. Bell palsyhyperreflexia) andinlower
may also result (e.g. fasciculations,
decreased atrophy)
eye lacrimation, hyper
or tongue.
(putamen), cerebellar nuclei, thalamus, and pons. Putaminal hemorrhage often produces contralateral hemiparesis and contral
psule.
oid bleed) that might require urgent intervention. Magnetic resonance imaging is more sensitive than CT in identifying most struc
ying
of from
choice in elective
sitting), ocularsituations.
(e.g. diplopia, ptosis), and bulbar (e.g. dysarthria, dysphagia) muscles. Pregnant and postpartum patien
with an established diagnosis should subsequently undergo chest imaging (e.g. CT scan, MRI) to evaluate for thymoma and fo
with long-term
elated pain can clinical
usuallyimprovement
be managed in both
with patientsanalgesics.
nonopioid with and without thymoma.
However, if initial interventions are not effective, intermittent do
ain requires frequent dosing or if bedtime dosing does not
ommon neoplasm to metastasize to the brain and may present with headache, focal provide relief through the night, a long-acting
neurologic opioid
dysfunction, may be change,
cognitive added.
well-circumscribed
oms with walking (similar lesionstowith vasogenic
peripheral edema
vascular at the gray
disease andHowever,
[PVD]). white matter
unlikejunction.
PVD, the symptoms are positional and remain
spine. Diagnosis is made based on clinical history and classic findings on spinal MRI.
especially Campylobacter jejuni). Cerebrospinal fluid analysis shows albuminocytologic dissociation. Treatment of GBS includes
aracterized by rapidly progressive ascending paralysis (which may be asymmetrical), absence of fever and sensory abnormaliti
eed for 4-7 days
contralateral eye and are typically
abducts found onUnilateral
with nystagmus. patients after
MLFmeticulous
lesions cansearching.
occur withRemoval of the tick
lacunar stroke results
in the pontinein spontaneous imp
artery distribution
efrontotemporal
sclerosis. dementia (FTD) is characterized by early personality changes, compulsive behaviors, and executive dysfunction
se
IDScourse.
are at FTD has an
increased early
risk age of onset Primary
for malignancy. (i.e. 50s-60s) and a strong
CNS lymphoma hereditary
is an component.
AIDS-defining malignancy associated with the expressi
en be identified in the cerebrospinal fluid. MRI of the brain generally shows a
urs in association with systemic inflammatory disorders, in particular spondylarthritis (e.g. ankylosing solitary, irregular, nonhomogenous
spondylitis). ring-enhancing
Patients with u
g. chronic back pain, enthesitis) should undergo x-ray of the pelvis/sacroiliac joints (and maybe
n be treated with topical agents that lower intraocular pressure. The first-line agent for most patients is a topical prostaglandinhuman lymphocyte antigen B27(
of aqueous
smolar state humor
on the in the anterior
surface of the chamber. If prostaglandins
eye, resulting are ineffective,
in irritative symptoms topical βan
and promoting blockers (e.g. timolol)
inflammatory can be
response. added.
Complications
on, and
may alsocorneal perforation.
be inflamed. Common contributors include seborrheic dermatitis, rosacea, allergic disorders, bacterial infection, viral in
s humor, and hypopyon. Anterior uveitis is most often idiopathic or traumatic but can be associated with systemic inflammatory
ondyloarthritis,
nfectious keratitisand is inflammatory bowel disease.
a medical emergency that causes a painful, red eye and opacification and ulceration of the cornea. Most ca
ef-limited
due to Gram-positive
condition associated with adenoviruscertain
organisms as well as fungiviral
and other andupper
amoebas. Most cases
respiratory require
illnesses. It is topical
common broad-spectrum antibiotics.
in sporadic outbreaks, es
and early fall. No specific treatment is needed, although some patients may develop a bacterial
he most common cause of blindness in industrialized nations. Activities that require fine visual acuity are usually the first affectesuperinfection which requires
Vstraight
retinitisgrid lines appear
is painless, curved.associated with keratitis or conjunctivitis, and characterized by funduscopic findings of hemorrh
not usually
svessels.
characterized by damage of one eye (the sympathetic eye) after a penetrating injury to the other eye. It is due to an immunolo
igens.
tival hemorrhage
coma is characterized is a benign
by acute finding, and headache,
eye pain, does not require any treatment.
and nausea. Signs include conjunctival erythema, corneal opacification, an
agnosis.
age-related Ocular tonometry
decrease can
in lens be helpful
elasticity thatifleads
urgenttoophthalmologic
difficulty with nearconsultation
vision. A is unavailable.
history of a middle-aged individual who has to h
diabetic retinopathy are background or simple (microaneurysms, hemorrhages, exudates, retinal edema), pre-proliferative (cott
rization).
ion presentsVisual impairment
with occurs with
acute or subacute the development
painless of macular
monocular visual loss. edema. Argonexamination
Funduscopic laser photocoagulation is performed
shows a 'blood for the
and thunder' app
ges, dilated veins, and cotton wool spots.
cally presents as a sudden loss of vision and onset of floaters. Vitreous hemorrhage occurs in patients with diabetic retinopathy
ly presents with a sudden onset of photopsia and floaters.
s characterized by corneal vesicles and dendritic ulcers.
ith inflammatory
ts). changes in the
The major complications aremedial canthal
vision loss region of
(including the eye. and
blindness) Staphylococcus aureus and
retinal detachment. β-hemolytic
Treatment Streptococcus
necessitates are the
antiviral mediu
al injections. All patients should also be started on antiretroviral treatment to prevent recurrence and progression.
us
ith is characterized
increased by dendriform
intraocular pressure,corneal
but thisulcers
findingand a vesicular
is not rash in the
highly sensitive trigeminal
or specific. OAGdistribution.
usually has an insidious course, and p
ndition is advanced.
occurs predominantly in people aged 55-70 years. It presents with an acute onset of severe eye pain and blurred vision associa
d
n eye
acutewith steamy cornea
hypersensitivity and moderately
reaction caused bydilated pupil thatexposure
environmental is nonreactive to light. It is characterized by intense itching, hyperem
to allergens.
eneration
an acute is usually seendisorder
inflammatory in patients age
of the > 50. Itfollicle
eyelash presents withgland
or tear progressive and bilateral
and presents loss of central vision.
as an erythematous, tender Navigational
nodule at thevision
lid m
but can be sterile. Initial treatment includes warm compresses.
in divers is caused by rapid ascent to the surface that leads to formation of nitrogen bubbles in the tissues and bloodstream. It
erbaric oxygen therapy.
can progress to high-altitude cerebral edema (HACE), a life-threatening condition characterized by ataxia and declining mental
de.
nts Early
causetreatment of HACE
sterile pustules thatwith dexamethasone
should be left intact can improve
to prevent symptoms;
secondary definitivePustules
infections. treatment requires
and immediate
small local descent.
reactions require n
ly with antihistamines and topical steroids.
bite envenomation should be observed closely for 12-24 hours following the event. Repeat wound examinations and laboratory
ebites in North
nd chronic America
salicylate can be
toxicity treated
include appropriately
vomiting, tinnitus,with antivenom
pulmonary if symptoms
edema, progress.
hyperthermia, tachypnea, and an anion gap metaboli
altered mental status, pulmonary edema, renal failure, and persistent acidosis.
nts within 6 hours of ingestion with bradycardia, hypotension, cardiogenic shock, bronchospasm, altered mental status, and sei
of airway
ural management,
hypotension occurs ingastric decontamination,
conditioned athletes and intravenous
is caused by fluids,
the intravenous
sudden decrease atropine, and intravenous
in venous return afterglucagon.
cessation of exerc
acterized by collapse (with no loss of consciousness) immediately after completion of exercise.
opine, a competitive inhibitor of acetylcholine at the muscarinic receptor (reverses muscarinic symptoms), followed by pralidoxim
nic andas
as well muscarinic activity (reverses
muscle fasciculations, neurotoxicity).
weakness, and paralysis. Organophosphate poisoning can be confirmed with the measuremen
ity.
cetylcholinesterase inhibitors that are commonly used as agricultural pesticides. Toxicity is characterized by signs of cholinergic
sciculations/weakness,
monly characterized by diarrhea, vomiting,
mental status lacrimation).
changes, respiratory First-line therapy
depression, andis atropine, a competitivebradycardia,
miosis. Hypotension, inhibitor of acetylcholine
hypothermia, at
an
suspected in a patient with possible environmental exposure (e.g. pressure-treated wood, pesticides) who has painful sensorim
pigmented, hyperkeratotic),
risk for thermal illness, both pancytopenia, and mild transaminase
hyper- and hypothermia. elevation.
Mild hypothermia Diagnosis
is generally is confirmed
managed with elevated
with passive urine arsenic
rewarming. More se
uding
rate active external
hypothermia (heated
includes blankets)
active and
external internal (heated
rewarming peritoneal
and warmed irrigation)
intravenous rewarming.
fluids. Bradycardia associated with hypothermia
pacing,
ory arrestbut it usually
and permanentimproves with correction
neurologic disability, of hypothermia.
victims of smoke inhalation injury should be treated empirically for cyanide toxici
um thiosulfate, or with nitrites to induce methemoglobinemia.
n in cytochrome oxidase a3 in the mitochondrial electron transport chain. This activity blocks oxidative phosphorylation and pro
e to lead exposure at work or home. Patients may present with nonspecific (e.g. fatigue, irritability, insomnia), neuropsychiatric
rves
gastrointestinal
administrationmanifestations.
of fomepizole or ethanol to inhibit alcohol dehydrogenase, sodium bicarbonate to alleviate the acidosis, and h
nedamage.
is the most reliable and predictive sign of opioid intoxication, which also frequently presents with altered mental status, hypoth
stions). Management
ioid withdrawal should
include focus
nausea, on airway
cramps, protection,
diarrhea, improving
restlessness, ventilation,
rhinorrhea, and prompt
lacrimation, administration
myalgias, of naloxone.
and arthralgias. Examination
oerection, and hyperactive bowel sounds. Low-dose methadone with adjunctive medications is the treatment of choice.
culation; in patients with evidence of cardiac toxicity, sodium bicarbonate should then be administered to improve blood pressur
adache, confusion, seizure, coma, death). Diagnosis is made by co-oximetry of arterial blood gas showing an elevated carboxyh
verdose can present with central nervous system, cardiac, and anticholinergic findings. Sodium bicarbonate is used to treat car
ed QRS
stbite duration
is based on(> 100 rewarming
rapid msec) andof ventricular arrhythmias
affected tissues (e.g. ventricular
in a 37-39 tachycardia,
C (98.6-102.2 ventricular
F) water bath. Hot airfibrillation).
rewarming is not recomme
possibility of refreezing before definitive care can be provided.
s injury to the upper aerodigestive tract and most commonly presents with pain, dysphagia, and oropharyngeal erythema and u
ess.
haracterized by temperature > 40 C (104 F) and CNS dysfunction (e.g. altered mental status, seizure). First-line treatment is ra
eat stroke most commonly affects elderly patients and is characterized by body temperature > 40 C (104 F) with CNS dysfunctio
nclude
halationtachycardia, tachypnea,tohypotension,
should be suspected and end-organ
have acute carbon monoxide dysfunction (e.g. diffuse
(CO) poisoning intravascular
and treated with 100% coagulopathy,
oxygen via apulmonary ed
nonrebreath
y neurological
uences and include
of methanol agitation,
intoxication confusion,
are vision and coma.
loss and somnolence.
Physical examination in methanol intoxication reveals optic disc hype
edc acidosis.
QRS durationAn increased osmolar
(> 100 msec) andgap is often arrhythmias.
ventricular seen as well.Sodium bicarbonate increases serum pH and extracellular sodium,
um channels.
soon after a single, potentially toxic ingestion (> 7.5 g) of acetaminophen, the first step in management is gastric decontaminati
tients
ana can be asymptomatic
intoxication duringappetite,
include increased the first 24 hours aftertachypnea,
tachycardia, ingestion. dry mouth, and conjunctival injection. Marijuana use slows
nation;
gait, andanddrowsiness
can increase canthe
be risk
seenofinmotor vehicle collisions.
the overdose of multiple drugs. Benzodiazepine overdose can be distinguished from opioi
d the lack of pupillary constriction.
se leads to antihistaminic (e.g. drowsiness, confusion) and anticholinergic (e.g. dry mouth, dilated pupils, blurred vision, reduce
tigmine, a cholinesterase
uses immediate esophagealinhibitor,
injury can
withcounteract
liquefactivethese anticholinergic
necrosis. effects. with no evidence of perforation, endoscopy sho
In stable patients
verity addition
gests of the injury and guide further
of concentrated management.
fluid (e.g. urine)), stool electrolytes (elevated magnesium or phosphate suggests use of saline os
atives cause a high osmotic gap diarrhea).
nciliation during transfers of care (e.g. discharge from the hospital to another facility) and can be prevented through interdiscipli
d interprovider
ts communication.
can have significant cognitive impairment that may be mistaken for a dementing syndrome. However, unlike most dementias
with treatment of the underlying depression.
characterized
nitive disorder isbydue
excessive concern
to replication of about
HIV inhaving
the CNS a serious, undiagnosed by
and is characterized disease despite
a chronic minimal
decline or no somatic
in multiple cognitivesymptoms.
domains. M
reases with duration of HIV infection and is greatest in patients age and those with CD4 counts < 200/mm3.
sure are often present. In contrast to other stimulants and hallucinogens, which have a much shorter duration of effect, the effe
oe adisorder
week toissubside.
a circadian rhythm disorder characterized by the inability to fall asleep at traditional bedtimes, resulting in sleep-on
nts sleep normally if allowed to follow their internal circadian rhythm and sleep until late morning.
ommon cause of insomnia. Strategies to improve sleep hygiene include maintaining a regular sleep schedule and a quiet, dark,
aps and and
ramide exposure to electronicare
prochlorperazine devices before
dopamine bedtime; and
antagonists, avoiding
which, alongnicotine,
with mostcaffeine, alcohol, and
antipsychotics, can heavy
cause meals in the evening
extrapyramidal symp
sm.
benefit from pharmacotherapy with antidepressants and cognitive-behavioral therapy. Selective serotonin reuptake inhibitors a
ally presents in the first 24 hours after the last drink and is typically associated with other symptoms of alcohol withdrawal (e.g.
Treatmentbyconsists
cognized of benzodiazepines
bright red, brisk-flowing blood;to control agitation
resistance and prevent
to catheter progression
flushing; and bloodofgas
withdrawal.
analysis consistent with arterial blood
acement and minimizes complications.
drowning can cause bronchospasm, alveolar collapse, and pulmonary edema, leading to impaired ventilation and hypoxemia. P
th supportive care, which may include supplemental oxygen, bronchodilators, and ventilatory support.
omatic
urement after nonfataldioxide
of carbon drowning should undergo
concentration prolonged
over time. It can(i.e. > 8 hr)
provide observation
valuable due toabout
information the risk of delayed pulmonary
ventilation/perfusion and complica
metaboli
tracheal tube (ETT) placement. Patients with abnormal waveforms should be assessed for proper ETT placement.
re, life-threatening asthma include a history of prior intubation and recent poor asthma control. Impending respiratory failure sh
e,
eshypoxia,
in pregnancytachypnea,
includeand hypercarbia.
a progesterone-induced sensation of dyspnea and an increase in minute ventilation that is driven most
by the gravid uterus decreases residual volume
pertension is increased in patients with sickle cell disease and functional
due toresidual
chroniccapacity. Vital hemolysis
intravascular capacity and FEV1pulmonary
causing are unchanged fromre
vascular
gns
al of right-sided
capacity hearta failure
[FVC] with normal(e.g. hepatomegaly,
or increased FEV1/FVCedema).ratio), with reduced maximal inspiratory and expiratory pressure. The d
nt of alveolarincludes
anagement gas exchange, is preserved.
antibiotics (e.g. ceftriaxone and azithromycin) because pneumonia is clinically indistinguishable from ACS a
CHF) frequently causes bilateral pulmonary infiltrates on chest x-ray. In contrast to bacterial or viral pneumonia, which causes p
ve
msrapid resolution
that localize theofinfection
chest x-ray findings
to the lungs. following diureticshould
These patients administration.
undergo additional pulmonary imaging with high-resolution CT
on. Suspicion should be raised in those who reside in high-risk settings or have impaired immunity, particularly when treatment
tpnea,
improve symptoms.
cough, weight loss, and fatigue over several months, and lung biopsy demonstrates lymphocytic infiltrate, non-necrotizing
eumonitis classically presents with recurrent episodes of abrupt-onset fever, dyspnea, nonproductive cough, and fatigue that co
edema
condition
(HAPE)is often mistaken
typically for bacterial
presents pneumonia
with shortness but self-resolves
of breath, within a and
cough, hypoxemia, few bilateral
days after removal
lung of antigen
crackles. exposure.
Characteristics that fa
ascent to high altitude, the absence of leukocytes > 15,000/mm3, and rapid improvement with supplemental
dema (HAPE) typically presents with shortness of breath, cough, hypoxemia, and bilateral lung infiltrates. Characteristics that f oxygen.
ascent
ent and to high
treat altitude,
high normal
altitude illnessprocalcitonin
by increasing with no more
renal HCO3than mild leukocytosis,
excretion and pH
to reduce blood rapid
andimprovement of hypoxemia
alleviate central with sui
chemoreceptor
e presents with acute onset of deep breathing and/or tachypnea often accompanied by neurologic symptoms. Lung examinatio
g retraining.
oxication
can of thecauses
chest isdecreased
recommended centralforrespiratory
patients withdrive,
a >leading to hypoventilation
30-pack-year and respiratory
smoking history acidosis. and mortality from lung
to reduce morbidity
and continue
tening, to agedisorder
multisystem 80 or until > commonly
that 15 years ofinvolves
smokingthe cessation.
skin or mucosa in association with the cardiovascular or respiratory sy
strointestinal, neurologic, and ocular symptoms. Management
can result from airway obstruction (e.g. mucus plug) and lead to includes the prompt
mediastinal administration
displacement towardoftheintramuscular epinephrine.
side of alveolar collapse.
th sounds are
n patients withexpected over the area of
sarcoidosis-associated atelectasis.
lung disease typically follow a restrictive pattern: normal or reduced FEV1, normal or red
total lung
nolence capacity,
with mild to and decreased
moderate diffusionhigher
hypercapnia; capacity for carbon
levels monoxide.
of hypercapnia (e.g. PaCO2 > 75-80 mm Hg) can cause delirium, con
eizures.
obstructive pulmonary disease). Smoking cessation is recommended > 4-8 weeks prior to elective surgery as it has been show
complications.
rimary respiratory acidosis. Correction of the hypercapnia requires increased ventilation, which can be accomplished via increa
bation readiness include pH > 7.25, adequate oxygenation on minimal ventilator settings, and sufficient mental alertness to prot
undergo a spontaneous
phragmatic impairment and breathing trial failure;
respiratory to help bulbar
confirmweakness
candidacymayfor successful extubation.
also be a prominent feature. Precipitants include infection
lective intubation should be performed in patients with evidence of impending respiratory failure.
ed pulmonary injury is due to a hypersensitivity that can present with fevers, shortness of breath, dry cough, and erythematous
itiation.
esent asBilateral
an acute basilar opacitieswith
exacerbation andcough,
pleuralwheezing,
effusions are
andcommon.
shortnessTreatment
of breath. involves
Treatment cessation
includesofalbuterol
nitrofurantoin.
(inhaled short-act
coid (e.g. prednisone) to reduce airway inflammation.
hma exacerbation includes a short-acting β-agonist (e.g. albuterol) to manage immediate bronchoconstriction and a glucocortic
nd
sis prevent symptombyrelapse.
is characterized slowly progressive dyspnea, dry cough, and fine crackles and commonly occurs in patients age 50-70. I
ension (PAH) is a common function
on capacity on pulmonary testing.
manifestation of systemic sclerosis that results from intimal hyperplasia of the pulmonary arteries. A
1ension
and FEV1/FVC ratio help differentiate
is a common manifestation of systemic PAH from pulmonary
sclerosis hypertension
that typically due with
presents to lung disease or
progressive left-sided
dyspnea andheart
oftenfailure.
leads to righ
imited illness usually caused by a viral infection. Treatment is supportive, although patients with associated wheezing due to un
ilator (e.g.
chronic albuterol).
cough that is Antibiotics are not
predominantly helpful These
nocturnal. and should be avoided.
patients should be evaluated with spirometry to assess bronchodilator re
upper airway cough syndrome, gastroesophageal reflux disease,
y diagnosed in childhood or early adulthood, in some cases it presents and ACE inhibitors.
for the first time in late adulthood. The diagnosis is conf
obstruction (> 12% increase in FEV1) with normal diffusion capacity for carbon monoxide suggests asthma regardless of age.
sound and vibration originating within the lung parenchyma. Physical examination of patients with a pleural effusion typically sh
n,, and
initialdullness
empiricto percussion
treatment over the
includes oraleffusion.
first-generation antihistamine (e.g. chlorpheniramine) or combined antihistamine-decong
ciated with a hyperdynamic cardiovascular state that occurs in response to peripheral vasodilation with capillary leak and intrav
olume, heart rate,
e (e.g. chronic and pulse
bronchitis, pressure, which
bronchogenic resultsbronchiectasis)
carcinoma, in bounding peripheral pulses.
is the most common cause of hemoptysis in adults. Chronic
for > 3 months in 2 successive years, with cigarette smoking as the leading cause.
EV1/FVC ratio). The diffusion capacity of the lung for carbon monoxide is decreased in ILD but remains normal in extrinsic caus
ary embolism can present initially with syncope and shock. Right heart catheterization will show elevated right atrial and pulmo
y wedge pressure.
pneumonia causes hypoxemia due to right-to-left intrapulmonary shunting. Positional changes that make the consolidation more
match, increase intrapulmonary shunting, and lead to worsened hypoxemia.
effusions with
acerbation a low glucose
of chronic concentration
obstructive pulmonary due to the
disease high metabolic
should activitybronchodilators
receive inhaled of leukocytes and bacteria within
(β2-agonists the pleural fluid.a
and anticholinergics)
ygen, antibiotics,
patients with advancedand ventilatory support should
chronic obstructive be administered
pulmonary disease canwhenworsenindicated.
hypercapnia due to a combination of increased dead
match, decreased affinity of oxyhemoglobin for CO2, and reduced alveolar
emia due to right-to-left intrapulmonary shunting, an extreme form of ventilation/perfusion ventilation. The goal oxyhemoglobin
mismatch. Depending saturation in the
on how much
the resulting
monary hypoxemia
embolism usuallymay be difficult
present to correct
with signs of lowwith an increase
arterial perfusionin(e.g.
the fraction of inspired
hypotension, oxygen.
syncope) and acute dyspnea, pleuritic c
onary
he sumvascular resistance
of airway resistance and
andright ventricular
plateau pressure,
pressure. causingpressure
The plateau right ventricular
is the sum hypokinesis andpressure
of the elastic dilation and
andhypotension.
positive end-exp
ma he exacerbation
end-inspiratory hold maneuver.
should PEEP
receive inhaled is calculated
short-acting with the end-expiratory
β2-agonists, hold maneuver.
inhaled ipratropium, and systemic corticosteroids. Elevated or
ally present with sudden-onset pleuritic chest pain, cough, and dyspnea. Hemoptysis can occur as intubation
ailure of medical therapy and impending respiratory collapse. These patients require endotracheal a result of and mechanical
pulmonary v
infarct
sphoma
virtuallywhopathognomonic
are treated with forchemotherapy
pulmonary embolism.
and radiation are at high risk for secondary malignancy later in life (generally > 10 y
mokers),
hypercarbia and a normal or elevated serum (e.g.
breast, and gastrointestinal system colorectal,
bicarbonate esophageal,
is diagnostic of agastric tumors)
respiratory are most
acidosis. common.
Hypoventilation is a major cau
state.
ents such as ipratropium are the mainstay of symptom management in COPD. These anticholinergic medications may be comb
eater
city in symptom relief.
chronic obstructive pulmonary disease causes lung hyperinflation, which results in increased total lung capacity, function
agmatic flattening. The flattened diaphragm has more difficulty contracting to expand the thoracic cavity, resulting in increased
or chronic
besity hypercapniasyndrome
hypoventilation by increasingand renal bicarbonate
obstructive retention
sleep apnea canand creating
develop a compensatory
chronic hypoxia andmetabolic
hypercapniaalkalosis.
(with a compensato
pulmonary hypertension, and cor pulmonale.
y progressive expiratory airflow limitation which causes air trapping, decreased VC and increased total lung capacity. FEV1 is d
y lead to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is characterized by hypotonic hyponatrem
may worsen
the left hyponatremia
side on auscultation.in Repositioning
patients with SIADH.
the endotracheal tube by pulling back slightly will move the tip between the carina an
ed parapneumonic effusions involve increased flow of sterile exudate into the pleural space and demonstrate pH and glucose l
ocyte and lactate dehydrogenase levels.
ruction
ctionatedwillheparin
decrease the airflow
is preferred ratelow-molecular-weight
over during inspiration and expiration,
heparin, flattening both
fondaparinux, the top and bottom
and rivaroxaban of the
in patients flow-volume
with loop
severe renal in
s 30 mL/min/1.73
useful m2)pulmonary
in excluding as reducedvenous
renal clearance increases(VTE)
thromboembolism anti-Xa activity levels
in patients and bleeding
with unlikely pretestrisk.
probability. However, a normal
probability. Anbyelevated
characterized symptoms D-dimer result
> 2 days perinweek
any patient is not diagnostic
or 3-4 nightly awakenings of VTE and must
per month. be followed
Patients by persistent
with mild more specific studies.
asthma requi
d) in addition to an as-needed short-acting β2-agonist (e.g. albuterol).
rculosis in the United States occur in foreign-born individuals who have recently emigrated from endemic areas (especially Mex
nhest
Republic, andtachycardia
pain, and Haiti), with the
withhighest rates for those
no consolidation arriving
on chest in thesuggests
imaging last 5 years.
a pulmonary embolism (PE). PE can cause pleural
lmonary nodule detected on chest x-ray includes comparison with old imaging studies, if available, followed usually by chest co
sy, or surgically
pondylitis resect the
can develop nodule lung
restrictive is based on its
disease size
due to and characteristics
diminished as and
chest wall well spinal
as themobility.
patient'sPulmonary
age and smoking
functionhistory.
tests show
duses
totalhypocapnia
lung capacity but normal FEV1/FVC.
and respiratory alkalosis. Examination typically shows signs of fluid overload, S3 and S4 gallops, cardiomega
onic obstructive pulmonary disease (COPD), characterized by an acute worsening of symptoms in a patient with COPD, is com
mination
mon cause often revealsthat
of cough wheezes,
may betachypnea,
productive prolonged
of purulent,expiration,
blood-tingedandsputum.
use of accessory muscles.viral infection is the typical etio
Upper respiratory
treatment
ally andpatients
ventilated close clinical
may befollow-up
improved arebythe best management
increasing the fractionstrategies.
of inspired oxygen (FiO2) or increasing positive end-expirato
eproves
required to maintain oxygenation, PEEP levels should be increased
oxygenation by providing an increased fraction of inspired oxygen to allow forand
(FiO2) reductions
positiveinend-expiratory
the FiO2 as oxygenation improve
pressure (PEEP).
hat predispose muscle
et. Respiratory to oxygen toxicity
fatigue (e.g.
leads to <acute
60%). PEEP may
respiratory need recognized
failure, to be increased to maintain adequatePaCO2
by higher-than-expected oxygenation.
(i.e. mixed primary
characterized by an acute illness involving the skin/mucosa and either respiratory or cardiovascular compromise. Risk factors i
uch as nonsteroidal
se digital anti-inflammatory
clubbing, and the presence ofdrugs can should
clubbing worsenprompt
anaphylaxis by resulting
a search for occultinmalignancy.
nonimmunologic mast cellosteoarthropathy
Hypertrophic activation.
ment, periostosis of long bones, and synovial effusions.
ses of chronic cough are upper airway cough syndrome (postnasal drip), asthma, and gastroesophageal reflux disease. The dia
the elimination
yndrome of nasal
is defined discharge
by obesity (BMI and
> 30cough
kg/m2),with the usehypercapnia
daytime of H1 histamine receptor
(PaCO2 > 45 antagonists.
mm Hg), and alveolar hypoventilation. Arte
and respiratory acidosis as a result of altered lung mechanics due to obesity and hypoventilation.
e commonly caused by decreased intrapleural or plasma oncotic pressures or elevated hydrostatic pressure. Exudative effusion
ural membrane
s caused permeability
by episodic or disruptions
obstruction to lymphatic
of the upper airway dueoutflow.
to laxity of pharyngeal tissue, resulting in nocturnal hypoventilation. C
ng, and a choking or gagging sensation while sleeping.
obar
cally pneumonia)
presents withpresents
dyspnea,with dullness and
tachypnea to percussion,
tachycardia. increased
Occlusion intensity of breathpulmonary
of a peripheral sounds, and increased
artery tactile may
by thrombus fremitus.
cause pu
eal reflux disease (GERD) is common in patients with asthma and can worsen asthma symptoms as a result of microaspiration
ive of comorbid
olated right-sided GERD, proton-pump
heart failure (RHF) inhibitor therapy hypertension,
from pulmonary has shown benefitmostincommonly
improvingdue asthma symptoms
to chronic and peak
obstructive expiratory
pulmonary disefl
sed intensity of P2 (pulmonic component of the 2nd heart sound), right ventricular heave, hepatomegaly, dependent pitting ede
ugh is amanifests
gillosis common with side>effect of ACE
3 months inhibitors
of weight that
loss, is likely
cough, due to increased
hemoptysis, circulating
and fatigue levelswith
in patients of kinins, substance
a history P, prostaglan
of underlying lung dis
with or without an aspergilloma. Diagnosis is made with Aspergillus IgG serology in the setting
are important risk factors for deep venous thrombosis and pulmonary embolism (PE). Wheezing can occur in acute PE. An of characteristic symptoms and ra
elev
n in to
rior patients with
initiating PE. treatment. Depending on the severity of the symptoms, patients should be treated with an intranasal ant
empiric
nation
ts young therapy.
adults and is more common in African Americans. It is often discovered incidentally on routine chest x-ray by the pres
ng histopathologic
ension can be seen lesion is noncaseating
in middle-aged granulomas
patients, on tissue
and it presents withbiopsy.
exertional breathlessness. Lungs are generally clear to auscu
nary arteries with rapid tapering of the distal vessels (pruning)
is the most common cause of community-acquired pneumonia. Manifestations and enlargementtend of the
to right
beginventricle.
abruptly and include fever, chills, p
of a lobar infiltrate.
ructive pulmonary disease who have resting arterial oxygen tension (PaO2) < 55 mm Hg or pulse oxygen saturation (SaO2) < 8
Those with signs of right heart failure or hematocrit > 55% should be started on home oxygen if PaO2 < 59 mm Hg or SaO2 < 8
nsciousness,
pneumonia include advanced dementia,
altered and otherdue
consciousness neurologic disorders
to excessive areintake,
alcohol predisposed to aspiration
neurologic dysphagia, pneumonia due todisruption
or mechanical impaired swaof g
ptoms, foul-smelling sputum, and concurrent periodontal disease.
rbon monoxide (DLCO) is normal in chronic bronchitis-predominant COPD and decreased in emphysema-predominant COPD.
LCO, but the
prevalent FEV1/FVC
in the ratio is normal.
central, midwestern, and northeastern United States. Inoculation typically occurs when patients are exposed to
usually subclinical in immunocompetent
hma exacerbation usually have respiratory hosts; however,
alkalosis withsome
a low patients
PaCO2 due (especially with high dose
to hyperventilation. exposure)
A normal may have
or elevated subacut
PaCO2 is
gests impending respiratory failure.
ity-acquired pneumonia requires the presence of a lobar, interstitial, or cavitary infiltrate on chest imaging (e.g. chest x-ray). Sp
e outpatient setting as empiric oral antibiotics are almost always curative.
sion is best
r chronic evaluated with
rhinosinusitis withthoracentesis,
nasal polyposis.except
AERD in patients with clear-cut
is characterized evidence of congestive
by bronchospasm heart failure.
and nasal congestion *Extremely
following high
aspirin in
anti-inflammatory drugs (NSAIDs), desensitization if NSAIDs are required, and the use of leukotriene
ommonly causes transudative effusions (bilateral 61%, unilateral right-sided 27%, and unilateral left-sided 12%). Normal pleura receptor antagonists (e.g
fluid pH of
manifest as7.4-7.55.
central nervous system stimulation (e.g. headache, insomnia, seizures), gastrointestinal disturbances (e.g. nausea,
the cytochrome ventilation
ositive-pressure oxidase system(NPPV)by in
other medications,
patients with acute diet, or underlying
exacerbation diseaseobstructive
of chronic can alter itspulmonary
narrow therapeutic
disease haswindow.
been show
oroftreatment
stay, andof incidence of nosocomial
acute exacerbation infections.
of chronic Endotracheal
obstructive intubation
pulmonary with(COPD)
disease mechanical ventilation
in patients with is recommended
moderate for exace
to severe patien
ntibiotics are not indicated in patients with mild COPD exacerbation.
eukocytosis
nolone (e.g. mainly throughFluoroquinolones
moxifloxacin). mobilization of marginated neutrophils
should generally and an in
be avoided increase
elderly in the number
patients (whenofpossible)
circulating
dueneutrophils.
to the risk of
dissection.
odilator suggests asthma. Patients with COPD may have a partial bronchodilator response, but normal airflow after bronchodila
n cause of orthostatic hypotension and orthostatic syncope, especially in elderly patients. Due to decreased renal perfusion and
ystem, decreased urine sodium is usually present in patients with hypovolemia.
cause
in stemchronic cough
bronchus and should
on chest x-ray. be considered
Atrial fibrillationinisthe differential
a common diagnosis in
complication all can
and patients taking acute
precipitate the medication.
decompensated heart fa
se effect of which
nephrine), inhaledcause
corticosteroid
profoundtherapy is oropharyngeal
vasoconstriction, can alsothrush
cause(oral candidiasis).
ischemia of peripheral structures such as the distal digits. Th
mmetric.
s (Pancoast) tumors arise in the apical pleuropulmonary groove and typically present with shoulder pain, Horner syndrome, or n
acent structures
agulation decreases(e.g.the
brachial plexus,
mortality risk ofparavertebral sympathetic
acute pulmonary embolismchain).
(PE) and should be initiated prior to pursuing confirmatory d
PE, especially those in moderate to severe distress.
ociated is
angiitis with a mortality
a vasculitis benefit small-
affecting and reduced progression blood
and medium-sized of disease in patients
vessels with chronic obstructive
and is characterized pulmonary
by upper and disease. trac
lower respiratory
neutrophil
cell casts oncytoplasmic
urinalysis).antibody
Systemicpositivity
symptoms andare
tissue biopsy. Diagnosis is made by renal biopsy showing linear IgG antibodies
uncommon.
e contributes to the development of bronchiectasis. Impaired mucociliary clearance in cystic fibrosis typically leads to bronchiect
n of solitary pulmonary nodules is to obtain any previous radiographic lung images. Absence of growth over 2-3 years rules out
de be performed
respiratory to further
distress characterize
syndrome (ARDS) theinvolves
lesion. avoiding complications of mechanical ventilation by using lung protective strat
results in lower pulmonary
ad, IgE-mediated responsepressures, decreasing
to an allergen the likelihood
(e.g. medication). of overdistending
Rapid administrationalveoli. In addition,
of intramuscular it improvesismortality
epinephrine the best in pat
treat
ening
ia is a complications
supraventricular (e.g. hypotension, upper
tachyarrhythmia airway edema).
characterized by distinct P waves with > 3 different morphologies, atrial rate > 100/min,
ute respiratory illness in patients with underlying lung
agonists administered 10-20 minutes before exercise are the first-line disease. Treatment should be
treatment for directed at correcting
exercise-induced the underlying inciting
bronchoconstriction if req
corticosteroids or antileukotriene agents can be used in patients who exercise daily.
angiitis is a systemic vasculitis characterized by upper and lower respiratory tract granulomatous inflammation and glomerulone
he product of the respiratory rate and the tidal volume. Respiratory alkalosis results from hyperventilation. In mechanically venti
an appropriate
preserved tidal volume,
or increased theexpiratory
forced respiratoryvolume
rate should be lowered. vital capacity ratio. Patients have impaired gas exchange
in 1 second/forced
ide and increased alveolar-arterial gradient.
oxygen
se therapythickening
of bronchial has been and proven to prolong
dilation due tosurvival
recurrent in infection
patients with
and chronic obstructive
inflammation. Cough pulmonary disease and
with large-volume significant sputu
mucopurulent chron
evehicle
diagnosis is made
collisions dueusing a high-resolution
to drowsy driving should CT be
scan of the chest.
evaluated for high-risk behaviors, use of sedating medications, and sleep dis
drowsy
ency driving
should bemotor vehicleincollisions;
considered nocturnal
patients who polysomnography
lack typical risk factors forshould beobstructive
chronic ordered to pulmonary
confirm thedisease
diagnosis.
(e.g. age < 45) or
se). Diagnosis
ential is confirmed
cause of localized airwayby obstruction
measuring serumand may AAT levels.with episodes of recurrent pneumonia. CT scan of the chest should
present
or lung malignancy.
racterized by symptoms < 2 days per week, nighttime awakenings < 2 times per month, normal FEV1 and FEV1/FVC ratio, and
asthma are managed with an as-needed short-acting β2-agonist (e.g. albuterol) and do not require daily controller medication (e
syused in asthma
function tests showtreatment (e.g. albuterol)
a restrictive can cause
lung disease patternhypokalemia,
with decreased which
lungmay present
volume, with muscle
decreased weakness,
diffusion hyporeflexia,
lung capacity, and aan n
he hallmark of asbestosis.
ases the risk of pulmonary fibrosis and malignancy. Bronchogenic carcinoma is the most common malignancy diagnosed in pati
ally with asbestos
syndrome to further
is associated increase
with the risk
hypoxemia andofbilateral
lung cancer.
alveolar infiltrates not fully explained by volume overload. It results in imp
monary hypertension.
nic exposure. Chronic exposure may cause weight loss, clubbing, and honeycombing of the lung. The cornerstone of HP mana
marily affects immunocompromised patients and typically causes the triad of fever, pleuritic chest pain, and hemoptysis. CT sca
sground-glass
a genetic diseaseopacities
that('halo
resultssign'). Treatment
in symptoms of usually
chronic requires a combination
obstructive of voriconazole
pulmonary disease (COPD)and andan echinocandin
liver (e.g. caspo
disease. It should be c
kncyfactors or who have a family history of emphysema or liver disease.
(PAI) is a potential complication of miliary tuberculosis. Signs and symptoms of aldosterone deficiency (e.g. hypovolemia, h
PAI from secondary
ory distress syndromeadrenal
(ARDS) insufficiency.
include respiratory distress, diffuse crackles on lung examination, severe hypoxemia, and bilater
not completely explained by
syndrome of inappropriate antidiuretic volume overload.
hormone ARDS risk factors
secretion includecomplication
is a common infections, trauma,
of smalland
cellother
lung causes
cancer.(e.g.
Fluidmassive
restrictiontran
is
mptomatic patients.
atest risk factor for lung cancer in all patient populations. However, ~50% of women who develop lung cancer have no history o
developembolism
monary adenocarcinoma, which usually
are nonspecific arises The
and variable. in the lung periphery.
diagnosis should be suspected in any patient who presents with some com
itic chest
bing pain, low-grade
and sudden-onset fever,
joint and hemoptysis.
arthropathy in a chronic Tachypnea,
smoker istachycardia,
suggestive of and hypoxemiaosteoarthropathy.
hypertrophic are common examination findings.
This condition is oft
fypositive-pressure
is indicated to rule out malignancy
ventilation: Alveolar and/or otherpneumothorax,
damage, lung pathology.and hypotension. Pneumothorax presents with sudden-onset s
ation, and unilateral absence of breath sounds.
phy can cause an obstructive uropathy presenting as a slowly rising creatinine level. A renal ultrasound, which should be obtain
chronictract
urinary kidney disease,
infection typically
should not bereveals
solelyhydronephrosis
attributed to theand may help
infection. assess
A repeat the extent
urinalysis and reversibility
should be performed of in
kidney injury.
6 weeks to conf
a workup is indicated.
TA) involves a net loss of HCO3 and is a common cause of nonanion gap metabolic acidosis. Type 1 RTA results from impaired
abnormallyassociated
commonly high urine with
pH (e.g. > 5.5) in diabetes
nephrogenic the setting of acidosis.
insipidus (DI), presenting with polyuria and persistently dilute urine. Lithium-in
in the renal collecting ducts, which leads to antidiuretic
anic attacks results in respiratory alkalosis (elevated pH, low pCO2). hormone resistance and impaired
Ionized calcium renalwith
competes water reabsorption.
hydrogen ions to bind to alb
ons from albumin, allowing for increased calcium binding and a decrease in serum ionized (free) calcium.
. tacrolimus, cyclosporine) have vasoconstrictive properties that are responsible for much of their toxicity. Acute calcineurin inhi
ebyofdeposition
the drug and presents with hypertension
of anti-double-stranded DNA immuneand prerenal
complexesacuteinkidney injury.
the glomerulus, which leads to glomerulonephritis (e.g. hema
n,toperipheral
acute alcohol myopathy and rhabdomyolysis, especially when combined with cocainetiters
edema) or nephrotic syndrome. Serum anti-double-stranded DNA antibody abuse.correlate
Patientswith risk
with of nephritis. a
rhabdomyolysis
ntravascular
colchicine) are volume depletion
directly myotoxic and pigment-induced
and nephropathy.especially when used in combination. Rhabdomyolysis is sug
may cause rhabdomyolysis,
of red blood
arction cells
include on urine
flank pain, microscopy,
nausea, and and acute urinalysis
vomiting; kidney injury.
demonstrates hematuria and proteinuria without casts. A wedge-sha
infarctions can occur as a sequela of infectious
proteinuria and nephrotic syndrome; cardiac and gastrointestinalendocarditis, which typically
disease maypresents with The
also occur. recurrent fever,iscardiac
diagnosis confirmedmurmurs,
with biopan
s withinCongo
sults limited red.
resorptive capacity, leading to high urine sodium (> 40 mEq/L) and a normal blood urea nitrogen/creatinine ratio
he presence of hypercalcemia suggests multiple myeloma cast nephropathy.
mic arteriolopathy) is characterized by systemic arteriolar calcification and soft-tissue calcium deposition with local ischemia and
g
ury end-stage
(AKI) canrenal occur disease.
in volumeRisk factors include
overloaded states. hyperparathyroidism,
That occurring in anhyperphosphatemia, and hypercalcemia,
acute heart failure exacerbation although
is most likely due serum
to cardic
ressure leading to aforreduction
the compensation primary in renal perfusion.
metabolic acidosis Decreased
via increased renal
HCO3perfusion due to reduced
reabsorption cardiac output
and H excretion. also plays
The increased a role.
HCO3 reab
tion. Most of the excreted H is in the form of ammonium (NH4) or the titratable acid, dihydrogen
he renin-angiotensin system, which helps improve intravascular volume, glomerular filtration rate, and blood pressure via vasoc phosphate (H2PO4).
rption.
natremia occurs due to a combination of excessive fluid intake and nonosmotically mediated release of inappropriately high lev
ay
gency experience seizures, profound
urinary incontinence includes confusion, and even
bladder training anddeath.
pelvic floor muscle (Kegel) exercises. Patients whose condition does n
c medications (e.g. oxybutynin) to decrease detrusor
ium nitroprusside at high rates can lead to cyanide toxicity, especially contractions andinreduce thewith
patients sense of urgency.
chronic kidney disease. Typical findings in
respiratory depression.
oscopic) can be due to glomerular or non-glomerular causes. The source of hematuria is more likely to be glomerular if the urine
s (RBCs) or RBC
hyperkalemia due tocasts.
blockade of the epithelial sodium channel in the collecting tubule. Trimethoprim also competitively inhibits r
al increase in serum
ia occurs due to nonosmotic creatinine without affecting
stimulation the glomerular
of antidiuretic hormonefiltration rate.
(ADH) secretion in response to hypovolemia, hypotension, and
n of blood volume shuts off nonosmotic stimulation of ADH and corrects the hyponatremia.
hich can present with hematuria, flank pain, and scrotal edema (in men), is an important complication of nephrotic syndrome. N
y in particular,
abolic alkalosisisrequires
associated with theexcess
generating urinarybicarbonate
loss of several endogenous
(generation phase) anticoagulant
and preventingproteins, resulting
excretion in hypercoagulability.
of excess bicarbonate (ma
nderlying
sed cause and
by increased promotingentry
intracellular urinary bicarbonate
of potassium excretion.
(e.g. with insulin, β-adrenergic agents, hematopoiesis), gastrointestinal losses
diuretics).
characterized by a decrease in glomerular filtration in the absence of other causes of renal dysfunction, minimal hematuria, and
ccurs due to splanchnic
urethral damage, terminal arterial dilation,
hematuria decreased
indicates vascular
bladder resistance,
or prostatic and local
damage, and renal vasoconstriction
total hematuria reflectswith decreased
damage perfusio
anywhere in
uses of hematuria (e.g. glomerular diseases).
haracterized by glomerular hyperfiltration, basement membrane thickening, and mesangial nodules. Persistent proteinuria in a p
olled hypertension should raise suspicion for this diagnosis.
ents with flank pain, low-volume voids with or without occasional high-volume voids, and, if bilateral, renal dysfunction.
for respiratory
stamines have alkalosis by preferentially
potent anticholinergic excreting
effects and may bicarbonate
cause eyeinand the oropharyngeal
urine. The result is an alkalinized
dryness as well asurine (increased
urinary retention.urine
Due pto
serly men aredevelop
commonly at increased
acuterisk of urinary
kidney injury retention due to anticholinergic
due to decreased renal perfusion activity.
and direct renal tubular toxicity of heme pigment, whi
ed skeletal muscle cells.
tis usually presents with urinary sediment containing red blood cells, occasional white blood cells, and red cell or mixed cellular
sed
ally glomerular
susceptiblefiltration rate andvolume
to intravascular retention of sodium
depletion and water
leading by theacute
to prerenal kidneys.kidney injury. There is often a history of poor oral in
microangiopathic glomerular process suggested by persistent proteinuria, is moreanlikely
y results typically demonstrate a blood urea nitrogen/creatinine ratio > 20:1 and unremarkable
to occur inurine sediment.
the setting of long-standing d
nd other systemic microvascular damage (e.g. retinopathy). It is associated with increased risk of cardiovascular mortality.
mmon cause of
r is greatest painless
in those withhematuria in older adults,
chronic exposure particularly
to chemical in thoseinwho
carcinogens havesmoke,
tobacco used tobacco.
the workplace, or drinking water; family
screening for bladder cancer (e.g. urinalysis, urine cytology, tumor markers)
risk. Preventive measures include avoidance of nonsteroidal anti-inflammatory drugs, periprocedural has not been shown to conclusively improve
saline hydration, andoutco
using
s of autosomal dominant polycystic kidney disease generally correlate with the progression of cystic structural degeneration of t
nk pain,pulmonary
ructive and renal disease
dysfunction.
oftenExtrarenal manifestations
have chronic include
CO2 retention, liver cysts
resulting and cerebral
in respiratory aneurysms.
acidosis and compensatory metabolic alka
pulmonale symptoms
natremia (impaired but must
mental be used cautiously
status/seizures) as they
is a medical can lead toIt arequires
emergency. reduction in cardiac
a prompt outputinand
increase the subsequent
serum sodium developme
concent
e than 0.5 mEq/L/hr to avoid causing central nervous system osmotic demyelination syndrome.
se of nephrogenic
holism often presentdiabetes insipidus
with multiple (DI). Lithium-induced
electrolyte abnormalitiesnephrogenic DI is treated
(e.g. hypokalemia, with salt restriction
hypomagnesemia, and discontinuation
hypophosphatemia). of l
Hypoma
val ofplus
sulin inhibition
glucoseof renal potassium
to shift excretioninto
serum potassium andcells
should be suspected
is indicated. in patients
Definitive withofhypokalemia
removal potassium via that
theisstool
difficult to patiromer),
(e.g. correct with
alysis)used
biotics shouldto then
treat be initiated.
serious gram-negative infections. They are potentially nephrotoxic and drugs levels and renal function must
e flank or abdominal pain radiating to the perineum, often with nausea and vomiting. Ultrasonography or a noncontrast spiral CT
s of choice to confirm the diagnosis. Ultrasonography is preferred in pregnant patients to reduce radiation exposure.
given to acutely
renergic ill patients
blockers, with acute renal
potassium-sparing failure,
diuretics (e.g.liver failure, or
amiloride), sepsis as these conditions increase
angiotensin-converting-enzyme the risk
inhibitors, of lactic II
angiotensin acidosis.
recepto
ons of nephrotic syndrome include: protein malnutrition, iron-resistant microcytic hypochromic anemia, increased susceptibility t
n hydrogen, chloride, and potassium. Therefore, vomiting causes hypochloremic metabolic alkalosis and hypokalemia. Bicarbo
ion of can
pathy the renin-angiotensin system.
affect the genitourinary tract to cause a neurogenic bladder with urinary retention and distended bladder. Patients ca
g, poor urinary stream) with a high post-void
over any form of chronic dialysis. Further residual
benefits volume.
of renal transplantation over dialysis include better quality of life and improve
a, impaired bone metabolism).
most always benign and do not require further evaluation. Features concerning for malignant renal mass include a multilocular m
ancement.
de effects of thiazide diuretics include hyperglycemia, increased LDL cholesterol and plasma triglycerides, and hyperuricemia. E
uretics
tion is include hyponatremia,
predominantly hypokalemia,
T-cell mediated hypomagnesemia,
and usually occurs withinand
the hypercalcemia.
first 6 months following transplant. Affected patients typically
The diagnosis is confirmed by renal biopsy showing lymphocytic infiltration
ary calcium stone formation include increasing fluid intake, following a low-sodium, of the intima, and treatment
low-protein is with high-dose
diet, maintaining moderateintrave
calciu
calcium excretion.
on and intravascular volume depletion and is a common cause of prerenal acute kidney injury (AKI). Prerenal AKI is characteriz
retion of sodium
radiolucent (< 1%),
but may and elevated
be seen blood urea or
on renal ultrasound nitrogen/creatine
CT scan. They ratio (> 20:1).
are highly Urineinsediment
soluble is bland.
alkaline urine; alkalization of the urine
choice.
prevalence of traditional cardiovascular risk factors (e.g. hypertension, advanced age) and ESRD-related risks (e.g. anemia of
the most common form of drug-induced chronic renal failure. Papillary necrosis and chronic tubulointerstitial nephritis are the m
gesic abuse are also more likely to develop premature aging, atherosclerotic vascular disease, and urinary tract cancer.
ange1 discoloration
with of body(e.g.
or more analgesics fluids. 'Red urine'anti-inflammatory
nonsteroidal in a patient takingdrug
rifampin
suchisasusually a can
aspirin) benign drugchronic
cause effect.kidney disease due to tu
yeen
necrosis.
birefringence under polarized light. Multiple myeloma is the most common cause of AL amyloidosis, and rheumatoid arthrit
yclovir can cause crystalluria with renal tubular obstruction. Administering intravenous fluids concurrently with the drug can help
N. ACE inhibitors and angiotensin II receptor blockers decrease renal efferent arteriole vasoconstriction, reducing glomerular hy
n.
thy is thought to be caused by direct infection of the renal epithelial cells by HIV and typically presents with heavy proteinuria, ra
mmon in patients
ait, a carrier of sub-Saharan
mutation, African
do not typically have descent
specificwith advanced
symptoms of HIV
sickleinfection.
cell disease; however, sickling can occur in the setting o
on, acidosis), leading to renal papillary necrosis with hematuria
st - Acute tubular necrosis; Red blood cell casts - Glomerulonephritis; White blood and possibly flank pain.
cell casts - Interstitial nephritis and pyelonep
xy casts - Chronic renal failure; *Extremely high yield question for the USMLE!!!
atment of choice, if needed. DDAVP increases the release of factor VIII:von Willebrand factor multimers from endothelial storag
nsfused platelets quickly become inactive. *Extremely high yield question for USMLE!!!
omerulonephritis,
osis develops in patientstype 2, iswith
a unique glomerulopathy
chronically uncontrolled that is caused by
hypertension and persistent activation
is characterized byofhyaline
the alternative complement
arteriolosclerosis and pathw
ische
ve, irreversible renal insufficiency with mild proteinuria and small, atrophic kidneys.
cystic kidney disease is commonly associated with cerebral aneurysms that may rupture and lead to intracranial bleeding. This
egrity
osus iscaused by the underlying
an autoimmune disorderPKD genemultiple
affecting mutationorgan
as well as the Renal
systems. hypertension that ismay
involvement typically
presentpresent with the disease.
with nephritic syndrome with
also occur.
ionsreceptor
nsin for patients with renal
blockers calculi are:
are indicated for 1. Increased
initial therapyfluid intake; 2.
in patients withDecreased
renovascular sodium intake; 3. Normal
hypertension dietary
(due to renal calcium
artery intake.R
stenosis).
ved for patients
of urinary with resistant
tract infections hypertension
in women is due toortherecurrent
shorter flash
length pulmonary
of the femaleedema and/or
urethra refractory
compared toheart failure
males. Otherdue to severe hyp
predisposing fac
otic use, the use of spermicidal contraceptives, and a close proximity of the urethra to the anus.
y available kits that detect the presence of leukocyte esterase and nitrite in the urine of patients with suspected UTI. Positive le
itive nitrites indicate
um gluconate the presence
is necessary of Enterobacteriaceae.
in patients with hyperkalemia who develop significant ECG changes. Temporary (e.g. intravenous in
measures to reduce serum potassium should
der outlet obstruction due to benign prostatic hyperplasia follow calcium canadministration.
develop acute kidney injury. A renal ultrasound is advised for asse
ey function.
ous vomiting as a cause of hypokalemic alkalosis in a normotensive patient, and be able to distinguish it from other entities (e.g
ecreased
chlorideexcretion
concentration.
of water and electrolytes by the kidneys, resulting in dehydration, weight loss, orthostatic hypotension, hypon
sium willisbe
ephritis elevated.
usually Patients
caused sometimes
by antibiotics abuse
(e.g. diuretics
penicillins, to induce weight
cephalosporins, loss.
trimethoprim, rifampin), nonsteroidal anti-inflammatory
ulopapular rash, and renal failure. Urinalysis may reveal white blood cell
ntly administered to cirrhotic patients with volume overload and ascites. Potential side effects casts and, less frequently,
includeeosinophils.
hypokalemia, metabolic al
ommonly occurs following a tonic-clonic seizure. It is a transient anion gap metabolic acidosis that resolves without treatment wi
ity.
severe vomiting and diuretic overuse. These etiologies demonstrate low urine chloride (< 20 mEq/L), and the alkalosis corrects
s depletion of fluid, acid, and sodium chloride, leading to metabolic alkalosis, activation of the renin-angiotensin-aldosterone sys
esuscitation with normal
osis (hyperkalemic saline corrects
renal tubular acidosis)contraction alkalosis.
is characterized Hypokalemia
by non-anion gapshould be treated
metabolic as persistent
acidosis, well. hyperkalemia, and m
occurs in patients with poorly controlled diabetes.
on should be suspected in patients with the triad of tinnitus, fever, and tachypnea. It usually causes a mixed primary respiratory
ften within
anol the normal
intoxication causerange.
metabolic acidosis with both an anion gap and an osmolal gap. Calcium oxalate crystals (square, envelo
reeze) poisoning. Ethylene glycol intoxication can result in renal failure; methanol intoxication can cause blindness.
ys be calculated
satory respiratoryinalkalosis
patients (signified
with metabolic acidosisrespiratory
by increased in order torate
narrow
andthe differential
deep breathing)diagnosis.
leading to decreased PaCO2. The pH ca
ects.
sents the concentration of unmeasured serum anions. In anion gap metabolic acidosis, the AG is increased by the abnormal pr
s involve > 2 primary disturbances and can be recognized by inappropriate compensation for the initial primary disturbance. Se
metabolic
PaCO2 are andthe
respiratory acidosis.
two lab values that provide the best picture of acid-base status; the HCO3 can be calculated from these values
ventilation that can lead to primary respiratory alkalosis, which is indicated by high pH and low PaCO2. Serum HCO3 remains
nsation requiresdue
enia), possibly several days todefect
to a central complete.
in thirst regulation. Patients typically develop hyponatremia and dilute urine with urine os
mia can develop confusion, lethargy, psychosis,
saline hydration to restore intravascular volume and andcalcitonin
seizures. to inhibit bone resorption. Bisphosphonates further reduce calciu
ndrome have increased risk for atherosclerosis (due to hyperlipidemia) and arteriovenous thrombosis (due to loss of antithromb
se the risk for stroke and myocardial infarction.
an
tialimportant complication
nephritis are caused byofdrugsall causes of nephrotic
such as syndrome.
cephalosporins, However,
penicillins, it is most commonly
sulfonamides, associated
sulfonamide with
containing membranous
diuretics, NSAIDs,glo
the offending
mmonly occursagent is the treatment
in otherwise of drug-induced
healthy patients and hasinterstitial
a low risknephritis.
of treatment failure. Urinalysis confirms the diagnosis. Patients
ne later in those who fail initial therapy. Oral trimethoprim/sulfamethoxazole, nitrofurantoin,
sease. It is strongly associated with hepatitis C infection, and characteristic laboratory and fosfomycin
abnormalities includeare effective first-line
hypocomplementem
presentation). IgA nephropathy is differentiated from postinfectious glomerulonephritis based on earlier onset of upper respirato
ormal serum
iciency. complement
Because levels.
urinalysis bloodKidney
testingbiopsy can
detects alsorather
heme help differentiate
than actual these 2 processes.
red blood cells (RBCs), rhabdomyolysis is often sugg
of RBCs on urine microscopy.
re the most common type of kidney stone; patients may also have stones composed of a mixture of calcium oxalate and calcium
umof or oxalate syndrome
nephrotic in the diet,inobesity, hyperparathyroidism,
adults in and malabsorptive
the absence of a systemic disease. FSGSdisorders.
is moreCalcium-containing
common in Africanstones are patients
American radiopaque
an
fail to empty when a patient is recumbent raise suspicion for an underlying mass pathology, such as renal cell carcinoma (RCC
e most
seen in sensitive and severe
patients with specificliver
testcirrhosis
for diagnosing
secondaryRCC.to systemic and renal hypoperfusion. Patients have acute renal failure (cr
pically < 10 mEq/L, and an absence of blood,
ve test to detect early elevations in albumin excretion. casts, orThis
protein
testinshould
urine. be
Renal functionatdoes
performed leastnot improve
annually with intravenous
in patients with typefluid r
2 dia
e of inappropriate antidiuretic hormone secretion who are asymptomatic or have mild symptoms usually respond to fluid restric
ent
priatewith hypertonichormone
antidiuretic (3%) saline.secretion is characterized by hypotonic hyponatremia and euvolemia. Low serum osmolality (< 275
elevated urine sodium concentration
saline hydration to restore intravascular (>volume
40 mEq/L)and strongly
calcitonin suggest thebone
to inhibit diagnosis.
resorption. Bisphosphonates further reduce calciu
renergic blockers, potassium-sparing diuretics (e.g. triamterene), angiotensin-converting-enzyme inhibitors, angiotensin II recep
rathyroid hormone levels, and low urinary calcium excretion. It can be differentiated from primary hyperparathyroidism, which h
cium/creatinine
sents as a swelling clearance
over theratio.
upper medial tibial region. It is typically caused by overuse and poor knee mechanics. Treatment in
os optimize strength, flexibility,
presents with hard, periarticular and enlargement
stability of theofknees.
the joints; crepitus with range of motion; and mild tenderness. It most commo
d distal and proximal interphalangeal joints. X-ray
nd osteoarthritis includes stretching and strengthening exercises. reveals decreased joint nonsteroidal
Topical space, subchondral sclerosis, and
anti-inflammatory drugsperiarticular
(NSAIDS) osteop
(e.g. d
also effective but carry greater risk for toxicity (e.g. peptic ulcer).
anti-inflammatory drugs, and elbow padding. However, redness, warmth, or significant pain suggests an infectious or inflamma
ning abundant marrow (e.g. pelvis) can release fat into the venous circulation, resulting in fat embolism syndrome. Diagnosis is
neurologic
by degenerationdysfunction, petechial
of the plantar rash), and at
aponeurosis management
its insertionisonsupportive (e.g. due
the calcaneus supplemental
to overuse. oxygen).
The diagnosis is made clinically. Im
.cute
fracture) is suspected
AT includes activityormodification,
if the pain does coldnot improve after treatment.
compresses/icing, and nonsteroidal anti-inflammatory drugs. For chronic symptoms
sistance
t includes exercises is recommended.
activity modification and use of an elbow counterforce brace. NSAIDs are of limited value, given that the underlying p
aused by compression of the lateral femoral cutaneous nerve under the inguinal ligament and presents with localized pain and
ts are usually treated
hondrocalcinosis. conservatively
Management with weight
is primarily loss and(e.g.
symptomatic avoidance of tight garments.
acetaminophen, nonsteroidal anti-inflammatory drugs), but therap
omplications of HH (e.g. liver disease).
the presence of elevated acute-phase inflammatory markers (e.g. erythrocyte sedimentation rate, C-reactive protein), and the
herapy.
apment presents with shoulder pain and weakness of shoulder abduction and external rotation. It can be caused by external co
use ofdrugs
atory a heavy backpack),
(NSAIDs) a directdrug
are first-line blow,therapy
or repetitive motion
for acute, at the shoulder.
uncomplicated low back pain. If NSAIDs are ineffective, a short cours
obenzaprine, tizanidine) can provide additional pain relief.
d bone density is aimed at ruling out secondary causes of bone loss. Bone loss associated with anemia, renal insufficiency, and
s characterized by the acute onset of hypertension and acute kidney injury in patients with systemic sclerosis. The mainstay of
reduce
ng renin-angiotensin-aldosterone
with multisystemic system hyperactivity,
symptoms (e.g. arthralgias, pancytopenia,improve renal function,
splenomegaly), andconcern
raises normalize
forblood pressure.
systemic lupus erythemato
ensitive for SLE.
e monosodium urate deposition, leading to chronic inflammation and nodular deformity. Tophi commonly involve the joints of th
ur.
cause exudative pleural effusions characterized by low glucose, very high lactate dehydrogenase, and (often) low pH and is ass
pecificity) are the primary serologic markers for RA. Patients who have negative assays for both markers (seronegative RA) ma
ndrome typically follows local trauma or surgery and is characterized by severe burning or tingling pain in a regional (not derma
rythema, and
rheumatoid trophicisskin,
arthritis hair, orwith
associated nail hepatotoxicity.
changes. X-raySerum may show liver patchy
studiesdemineralization.
should be checked prior to initiation and periodically th
epatotoxicity, can be mitigated by concurrent administration of folic acid, which does not reduce the effectiveness of the drug.
RA include periarticular erosions on x-ray, elevated inflammatory markers, and positive cyclic citrullinated peptide antibodies or
srugs (e.g. methotrexate)
a common manifestationslow disease progression
of rheumatoid and should
arthritis involving be initiated
the wrist. on diagnosis.
Initial evaluation of rheumatoid arthritis should include infla
rate, C-reactive protein), serologic studies (e.g. rheumatoid factor, cyclic
on in those with long-standing psoriatic skin disease and usually presents with asymmetric citrullinated peptide antibodies),
oligoarthritis or and x-rays of
symmetric the sym
polyarthri
ostic clues are
in patients withthe involvement
prior joint injury of the distal anterior
(especially interphalangeal
cruciate joints
ligament(present
injury)inor~50%) andOther
surgery. characteristic
secondary nail changes
causes such as pit
of osteoarthriti
es, and neuromuscular
ematosus weakness.
should be suspected in patients developing acute onset of fever, arthralgia, and serositis after initiation of causative m
rug-induced
deformities reflect an imbalance inTreatment
lupus erythematosus. strength andincludes cessation
flexibility between of the
the flexor
causativeand medication
extensor muscle and symptom management.
groups. In a patient with lon
underlying
tribute. Sjögren syndrome is an autoimmune disorder of the exocrine glands that can also present with dry eyes andjoint
diabetic peripheral neuropathy. Other complications of diabetic neuropathy include callusing, ulceration, drysubluxa
mouth
ositive antinuclear antibody assay.
atory drugs can be used intermittently. Some patients may benefit from tricyclic antidepressants or duloxetine, but opioids, benz
d pressure discrepancies, and pulse deficits. CT and MRI can reveal aneurysm formation or narrowing of the arterial lumen. Tr
kylosing spondylitis includes regular exercise and nonsteroidal anti-inflammatory drugs. Tumor necrosis factor inhibitors and IL-
espond
A) to less
is a very aggressive
sensitive, treatment. marker for systemic lupus erythematosus. If ANA titers are elevated, more specific autoa
but nonspecific,
m the diagnosis.
lication of seropositive rheumatoid arthritis (RA) characterized by neutropenia and splenomegaly. Most patients have high-titer
odies
nodes(both of which
represent bonyare usually elevated
enlargement at theindistal
RA).and
Riskproximal
of recurrent bacterial infection
interphalangeal is significantly
joints and increasedfor
are pathognomonic due to neutropeni
osteoarthritis. O
sis;
roidimaging
disorders,(e.g. x-ray)immobility,
chronic is less sensitive
rotatorthan
cuffexamination
tendinopathy, findings and is of
and fracture usually unnecessary
the proximal humerus.for diagnosis or management.
Examination shows decreas
X-ray findings are normal.
P) is abnormal vasoconstriction of digital arteries in response to cold or emotional stress. It may be primary, or may occur in as
sorders.
of peripheral Patients with disease,
vascular suspected secondary
tissue injury, RP should benailfold
or abnormal tested capillary
for autoantibodies
examination. andTreatment
inflammatory markers.
involves mainly calcium chan
aggravating factors.
n acute monoarthritis, usually in the first metatarsophalangeal joint or knee. Synovial fluid analysis shows leukocytosis (2,000-1
dium
ome urate crystals,cause
is a common whichofare needle-shaped
chronic and pain
anterior knee negatively
in women. birefringent.
Diagnosis is based on clinical findings; symptoms are typically
.g.
stop the drug at onset of symptoms, avoid exercise and/or use of thehip
squatting). Treatment includes strengthening the quadriceps and abductors.
affected area, and seek medical care for symptom evalua
osus is a by
produced multisystem inflammatory
lateral compression disease
of the that can
metatarsal present
heads, andwith centralofnervous
palpation the thirdsystem findings
metatarsal such asduring
interspace a generalized tonic-m
compression
with metatarsal
characterized by support or padded
osteoclast shoewith
dysfunction inserts.
a focal increase in bone turnover. Most patients are asymptomatic, but symptoms
Involvement of cranial bones may lead to headaches and hearing loss.
infection
onic oftenand
joint pain presents
is mostwith a triadwith
common of polyarthralgias,
advanced age,tenosynovitis, and joint
obesity, and prior vesiculopustular skin lesions.
injury. Examination findings include bony enlarge
ul or decreased range of motion.
sues and organs. Patients can develop multi-organ dysfunction (e.g. kidneys, liver, gastrointestinal tract). Treatment usually inv
nflammatory arthritis caused by calcium pyrophosphate crystals. It often occurs in the setting of surgery or medical illness. Pseu
nmboid-shaped, positively
5%-30% of patients withbirefringent crystals
psoriasis. The and
classic radiographic
presentation evidence
involves theofdistal
chondrocalcinosis
interphalangeal (calcified articularstiffness,
joints. Morning cartilage).
deform
common.
mmonly inCurrent
young totreatment options
middle-aged for psoriatic
women arthritis include
with widespread nonsteroidal
pain, fatigue, anti-inflammatory
and cognitive/mood agents, methotrexate,
disturbances. Diagnosis isandmadeanti-t
cl
ity score,
uclear which titer.
antibody emphasize cognitive
However, RA and problems,
SLE are fatigue, and severity
significantly of somatic
less common, symptoms.
typically produce more obvious synovitis, and usual
g ankylosing spondylitis can develop bone loss due to increased osteoclast activity in the setting of chronic inflammation. In ad
risk of vertebral
onegative fracture, whichresulting
spondyloarthropathy often results
from from minimal
enteric trauma. infection. Findings in reactive arthritis may include urethrit
or genitourinary
ymmetric oligoarthritis. Not all extra-articular manifestations need be present to suspect the diagnosis. NSAIDs are the first line
doints
by inflammation and
of the fingers, pain at sites of tendon
metatarsophalangeal and
joints ofligament
the toes,attachment to bone.
and the wrists. It is a common
Involvement finding in
of the cervical ankylosing
spine can leadspondylitis
to atlanto
to impaired DNA synthesis. Side effects include oral ulcers, macrocytic anemia, and hepatotoxicity. Much of the toxicity of met
d, which are
arthritis doesatnot reduce risk
increased the effectiveness
of developing of the drug. osteoporosis, and bone fractures. Management includes adequate phys
osteopenia,
ake,
rizedminimization of glucocorticoid
by acute monoarthritis, often therapy,
with feverand
andbisphosphonate
restricted rangetreatment.
of motion. It is more common in patients with underlying joint
mptly to confirm the diagnosis.
adults age > 40 with progressive pain that is worsened by activity and relieved by rest. The pain is typically felt in the groin, but
the lower thigh or knee. The joint is not tender, and systemic symptoms are absent.
ur in patients with giant cell (temporal) arteritis due to the involvement of the branches of the aorta.
cation of myeloproliferative
characterized by the gradualdisorders
onset ofdue
paintoand
excessive
stiffnessturnover of purines
that begins and the
at a young ageresulting increase with
(< 40), worsens in uric acid
rest production.
(e.g. at night), an
loarthropathy (e.g. ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with
a common cause of back pain in patients age > 60. It is characterized by back pain radiating to the thighs that is worseinflammatory bowel disea
with lum
audication is exertion-dependent and resolves with standing still.
s (e.g. erythrocyte sedimentation rate) are recommended for patients with suspected malignant pain. MRI is indicated for patien
urologic
use atrophydeficits,
andorfibrosis
caudaof equina syndrome.
the smooth muscle in the lower esophagus. This leads to decreased peristalsis and decreased tone
ms include heartburn and dysphagia.
-modifying antirheumatic drug used for rheumatoid arthritis. Macrocytic anemia and hepatotoxicity are common adverse effects
can
cluding be alcohol
mitigated by the administration
cessation and weight loss, of folic
are acid, which does
recommended to not reduce
prevent the effectiveness
recurrent of the
gout attacks. drug.
Medications for lowering serum
outy arthritis or complicated disease (e.g. tophi, uric acid kidney stones).
an nerve at the wrist causes carpal tunnel syndrome, which is characterized by pain and paresthesia in the first 3 digits and the
on clinical
opathic grounds, but
inflammatory nerve conduction
myopathy studies can confirm
with immune-mediated muscle the diagnosis.
injury that can be due to a paraneoplastic syndrome in malignan
scle
racture is a common complication of advanced osteoporosis. Patients(Gottron
weakness and erythematous rash over the dorsum of the fingers sign) and/or
with osteoporosis canupper eyelids
develop (heliotrope eruption).
a compression fracture w
ding, coughing, lifting). Examination may show localized/point tenderness, although neurological examination
most common cause of acute back pain. It is often triggered by twisting, lifting, or physical exertion. The pain and tenderness is typically normala
ut pain may radiate to the buttocks, hips, and thighs. Straight-leg raising test and neurologic examination
on complication of systemic lupus erythematosus, and the risk is increased with chronic glucocorticoid use. It causes pain in the are typically normal.
sydivided
examination findings
into diffuse and x-rays
cutaneous andmay be normal,
limited cutaneous andsubtypes.
MRI is a more sensitive
Although theretest.
is considerable overlap in disease manifestatio
ty (e.g. interstitial lung disease) is more common and more extensive in diffuse
(sciatica) is due to nerve root compression, usually by a herniated disc or lumbar spondylosis. cutaneous SS, leading
Most to a worse
patients prognosis.spon
experience
rimarily on
ltisystem short-term relief
inflammatory of symptoms
condition with nonsteroidal
characterized by recurrentanti-inflammatory drugs Skin
oral and genital ulcers. or acetaminophen.
and ocular involvement is common. Th
mon in patients of Turkish, Middle Eastern, and Asian descent. The diagnosis is made based on clinical features.
ut, urate crystals
is elbow) is painful can be deposited inangiofibroblastic
noninflammatory the skin, resulting in the formation
tendinosis of tumors
at the common with a chalky
extensor white appearance.
origin caused by repetitive, forceful w
lateral epicondyle and pain with passive flexion or resisted extension at the wrist.
c Paget disease of bone and those with involvement of high-risk skeletal structures (e.g. skull, weight-bearing long bones) shou
lications. Bisphosphonates
characterized by disorderedinhibit osteoclasts
osteoclastic bone and suppress
resorption. bonealkaline
Serum turnoverphosphatase
and are the and
preferred
urine therapy.
hydroxyproline levels are incre
will usually be normal in the absence of other complicating factors.
ynaud phenomenon, swelling of the fingers and hands, inflammatory arthritis, and myositis. Autoantibodies for U1 ribonucleopr
d phenomenon). Extradermal manifestations include esophageal dysmotility, interstitial lung disease, and hypertension. Anti-top
and is associated
syndrome requireswith extensive
evidence disease.
of dry mouth and eyes (e.g. positive Schirmer test result for decreased lacrimation) with either his
glands or serum autoantibodies
th active RA. Nonsteroidal anti-inflammatoryagainst SSA (Ro)drugsand/or SSB (La). should be used for initial temporary symptomatic relief wh
or glucocorticoids
PMR) affects patients age > 50 and is characterized by pain and stiffness in the neck, shoulders, and pelvic girdle, along with a
eatment
se of choice
is frequently for uncomplicated
complicated PMR
by arthritis, is low-dose
which occurs inprednisone,
up to 45% which results
of patients incan
and rapid relief of
involve symptoms.
axial or peripheral joints. Treatm
exacerbate the underlying disease.
isystem disorder with a varied presentation caused by infection with the gram-positive bacillus Tropheryma whippelii
ming
of anarthritis, lymphadenopathy
asymptomatic elevation ofand a low-grade
alkaline fever are
phosphatase in anthe most patient
elderly common is presenting symptoms.
Paget disease of bone, which is frequently discov
eolytic or mixed lytic-sclerotic lesions, and radionuclide bone scan can fully stage the disease.
is, and angular deformity of the knee. The diagnosis is based on clinical features, although x-ray can exclude concurrent osteoa
exercises
rologic and nonsteroidal
deficits, unexpected weightanti-inflammatory drugs.
loss, and hypercalcemia. The most common cancers associated with vertebral metastasis in
l lung
zed bycancer,
chronicas well asweakness.
proximal non-Hodgkin lymphoma.
Muscle enzymes (e.g. creatine kinase) are elevated, and autoantibodies (e.g. antinuclear an
. Muscleby
cterized biopsy
classicis cutaneous
the most definitive
findings test and showsby
accompanied a mononuclear
proximal muscle infiltrate surrounding
weakness. Over 15%necrotic andpatients
of adult regenerating muscle
will have fib
or dev
sung, pancreatic,
caused stomach,oforthe
by compression colorectal
median cancers,
nerve at orthenon-Hodgkin lymphoma.
wrist. It initially Regular, age-appropriate
has an intermittent course, but withcancer screening
progression is esse
the sympto
r, features. Pain may radiate to the forearm or upper arm, but sensory loss in these areas is not seen.
lateral epicondyle, costochondral junction in the chest, and greater trochanter. Exercise is the foundation of management, with
reserved for patients
in the setting who fail initial
of a compatible measures.
history, chest x-ray findings of hilar adenopathy with or without reticulonodular infiltrates, and non
esent due to granulomatous production
ed for patients with active systemic lupus of erythematosus.
1,25-dihydroxyvitamin
However, D. Symptomatic disease
it can cause retinal is treated
toxicity with systemic
with prolonged use.glucocorticoid
Patients trea
phthalmologic evaluation and periodic reassessment.
virus B19 is characterized by acute, symmetric, small-joint arthralgias, mild joint swelling, and a benign, self-limited course. It is
to parvovirus B19 is more common in children.
sociated
x-rays with the
showing increased
sacroiliitis canincidence of acute
confirm the hemorrhagic
diagnosis. cystitis associated
AS is strongly and bladderwith carcinoma.
HLA-B27, but HLA-B27 is not specific for AS
s for ankylosing spondylitis include nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors, which provide substa
disease for long periods.
most commonly caused by degenerative changes in the spine and presents with low back and leg pain. The leg pain of neurog
by
eoarthritis of the kneeand
lumbar extension) persists
should includeeven while standing
regular, moderatestill. Vascular
activity claudication
and weight is exertion-dependent
loss, particularly and
in overweight resolves
and with standW
obese patients.
ding thatsexually
young, promoteactive
degeneration
patients. of the articular
Diagnosis cartilage by
is confirmed andGram
is associated with
stain of the decreased
synovial fluid,pain and
blood functional
cultures, andimpairment.
genital/pharynge
chronic hypercalcemia can cause pseudogout, presenting as acute, painful monoarthritis. Diagnostic findings include calcificat
ay
anand rhomboid-shaped,
acute positively
monoarticular arthritis thatbirefringent calcium to
quickly progresses pyrophosphate crystals
maximum intensity in synovial
within fluid. Triggers include alcohol use,
12-24 hours.
e.g. diuretics).
joint. In patients with crystal-induced arthritis (e.g. gout), the presence of crystals in the synovial fluid does not rule out septic a
steoarthritis shows crepitus, periarticular bony enlargement, and painful or decreased range of motion. X-ray findings include a
ndral
zed by sclerosis/cysts.
proximal muscle Patients
weaknesscan alsoand have a bland
elevated synovial
creatine effusion
kinase. Initial(no organisms,
treatment < 2,000
includes white glucocorticoids
systemic blood cells/mm3). (e.g. prednis
paring agent (e.g. methotrexate, azathioprine) to minimize the adverse effects of treatment.
yndrome is an immune complex deposition disorder commonly associated with chronic hepatitis C. It presents with fatigue, palp
europathies.
osis is commonlyLaboratory
associatedstudies
withshow serum
calcium cryoglobulins,
pyrophosphate hypocomplementemia,
dihydrate crystal deposition positive rheumatoid
in joints, leading tofactor, elevated transam
chondrocalcinosis, pse
monly also have diabetes and liver disease. Diagnosis is suggested by iron overload on serum iron
e is characterized by a thrombotic event or pregnancy morbidity in the setting of a positive autoantibody to 1 of 3 phospholipids studies and can be confirm
y, or lupus anticoagulant. It is very common in patients with systemic lupus erythematosus.
s with
mon dual-energy
in patients whox-ray absorptiometry
suddenly increase their is recommended
physical activity, in all women age
especially > 65 and
in female for younger
runners with thewomen
female who have
athlete an(oligomen
triad equivale
isTypical symptoms
a condition include
of painful, redlocalized
or violaceous,pain tosubcutaneous
palpation andnodules.
possibleItswelling.
can be a sign of a more serious disease process. Even in
ould be performed in patients with EN to assess for findings
osus is a multisystem, inflammatory disease that often presents with arthritis consistent with sarcoidosis.
and arthralgias. Joint involvement tends to be sym
ning
cinosis in a joint with a typical acute inflammatory arthritis establishes a diagnosis of affected.
stiffness. The knees, carpal joints, and joints of the fingers are most commonly probable calcium pyrophosphate dihydrate
uid analysis will show an inflammatory effusion and rhomboid-shaped,
f osteoarthritis should emphasize nonpharmacologic measures, including exercise, weight weakly positively birefringent
loss, and CPPD
activitycrystals.
modification. Nonst
ce forenlargement,
focal pain relief. weakness, or fracture of bone. Bowing of long bones, bone pain, and arthritis in adjacent joints are common
g,should
headaches, cranial nerve
use a qualified dysfunction,
interpreter, and hearing
communicate loss.
directly with the patient (rather than only addressing the interpreter), and apply
ing of new information, such as new medication instructions).
medication regimen) by skilled professionals (e.g. nurses, social workers). It improves safety (e.g. reducing fall risk in the elderl
endence,
t, physicalautonomy,
activity), aand engagement.
leading modifiable cause of chronic disease risk, are shaped by environmental factors, including social de
activity opportunities). Inequities
itized to all alerts, including those in indicating
social determinants
true adverse create health
events. disparities.
Alert fatigue (and alarm effectiveness) can be improved by ad
larm frequency and false alarm likelihood.
rams link financial incentives to provider actions (e.g. completing cancer screening). They can promote clinicians' delivery of ev
e that optimizes
issions patient outcomes
rates by preventing loss to and qualityincreasing
follow-up, while avoiding unnecessary
patient engagement treatment).
(proactively identifying and addressing potentially s
nsition between inpatient and outpatient care).
chronic conditions. Medicaid is a public health insurance program funded by federal and state governments that covers low-inco
egnant women)
high-value care).and those with disabilities.
Overutilization of imaging studies for acute, uncomplicated low back pain is associated with increased health c
ent (overuse of resources) lowers quality of care and may cause patient harm. Physicians are ethically obligated to promote res
by following
spital discharge standards
can leadoftoevidence-based,
adverse outcomes. medically necessary
High-quality care.
patient counseling that encourages early (< 4 weeks) primary care
mpletion of pending items (e.g. imaging studies), and management
settings is typically low. Physical environmental reengineering (e.g. improving of patient health
numberstatus
and(e.g. new diagnoses).
placement of hand hygiene stations
od of hand hygiene compliance.
nd adherence; best practices include plain-language communication and interactive methods such as teach-back (i.e. having p
rmation or changes
events (ADEs) are ainmajor
treatment plans).
patient safety concern; risk increases with vague prescription instructions (e.g. ‘as directed’). Plain-
eracy
wns, and reduces
a leading causeADE risk. error, are at increased risk of occurring when providers use abbreviations, verbal orders, or third
of medical
on
monlyincreases
causedaccuracy of information
by cognitive relay framing,
bias, including and interpretation
anchoring,between providers bias.
and confirmation and reduces
Framingrisk
biasofoccurs
medical error.
when contextual info
dgment, resulting
en a diagnosis is in failure to consider
prematurely swayed alternate diagnoses.
by immediate impressions (i.e. an anchor). This bias can preclude thoroughly evaluating
se.isThe
prematurely
degree of uncertainty should be acknowledged.chest
assigning a non-cardiac diagnosis to The pain associated
discussion shouldwith mental
also explainstress.
the need for further evaluation, inclu
tunity to ask questions.
illness and the self-limited nature of the infection. Referring to the illness as a ‘chest cold’ may alleviate patients' anxiety that th
discuss
systematic theapproach
risks and that
adverse effects
identifies of antibiotics.
fundamental, system-level factors causing error, in lieu of assigning individual blame. Interpr
om different disciplines) improve teamwork, communication,
nuing treatment, the provider should continue to act in the patient's and oversight, reducing
best interest, the risk
including of sentinel
offering events (even
appropriate such as wrong-p
if less effe
n be enhanced by incorporating behavioral strategies into the overall program. Detailed self-monitoring of dietary intake, exerci
tsuccess
declinesrates. Self-monitoring
a recommended is also
service associated
based with greater
on inaccurate long-term
or incomplete maintenance
information, the of weightshould
clinician loss. provide a balanced asse
likely benefits,
euristics (mentalrisks, and limitations.
shortcuts) incorrectlyGiving a more
influencing accurate
clinical and thorough resulting
decision-making, explanation can reinforce
in diagnostic patient
error. autonomy
Availability bias and imp
describ
es to bias subsequent
of behavior clinicalajudgment,
change in which and often
patient is willing causes excessive
to consider changes todiagnostic
maladaptiveworkup.
behaviors but has not yet decided to pursue
ange should be assessed for conviction (understanding importance
ested third parties can influence a physician's practice in subtle or subconscious ways. of change) and confidence (self-perceived
Only nonmonetary ability
gifts that aretoofchange
minim
sed educational material or drug samples, should be considered.
nt tool to prevent undesired medical outcomes that result from physician communication failures during the patient handoff proc
etween physiciansmust
lines, permission during
be patient
obtained handoffs
from the are a large
family (or contributor to medical
from the patient errors
prior to andbefore
death) adverse patient outcomes.
procedures can be performed on a
erdisciplinary model of care for patients with a prognosis of < 6 months. The focus is on symptom control; quality of life; and psy
ness do not necessarily lack decision-making capacity. If a patient's psychotic symptoms do not interfere with understanding or
ent,patient,
gry the patient has the
the most right to refuse
appropriate treatment,
response even ifnon-defensive,
is to remain it would be lifesaving.
acknowledge that the patient is upset, and begin the disc
t their
patients,
own the physician
terms. must
The first maintain
priorities are professional
to obtain an conduct
accurateand
andresponsibilities while addressing
thorough understanding their medical
of the abuse and takeandanypsychologic
necessary
be needed to address concurrent emotional symptoms and satisfy legal reporting requirements.
ients suggesting complementary and alternative medicine is to explore their reasons for requesting such treatment. Physicians
plementary and alternative
refuse treatment approaches
except when doing so to treatment
poses and threat
a serious be opento to integrating
public health. modalities with proven
In these cases, safety and
the physician efficacy.
is justified in restri
r at risk.
otentially life-saving treatment, it is important to fully discuss the specific reasons for the decision before honoring it.
ance
knowdirective, a life-saving
their diagnoses. blood
If family transfusion
members can be
request thatgiven to a Jehovah's
the diagnosis not beWitness
revealedwho lacks
to the decision-making
patient, capacity.
the underlying reasons shou
policies requiring written forms for release of information and procedures to verify the identity of phone callers. It is important th
nd disclose only the minimum necessary information.
s the patient's own wishes if he or she becomes incapacitated, and it overrules the wishes of the family.
cesponsibility
areas wheretocomments
act in the patient's
might bebest interests.
overheard. When a physician's
Inappropriate inquiries mistake is discovered,
from colleagues theabout
curious factsashould be medical
patient's clarified conditio
and the
d politely but firmly to inappropriate patient requests. Maintaining professional boundaries is an important component of the phy
dy be
badshared
news, with family members
a physician only
should first with the
assess thepatient's
patient'spermission.
comprehension, fears, and desire for information to deliver the news in
dult are suspicious for an underlying immunoglobulin
t is nonimmunologically mediated but can resemble allergic
s,
timeand fissuring
since of skin.
transplantation. Most infections within the first
of high-dose immunosuppression).
ment of serum immunoglobulin levels is needed to establish
ion, neurotoxicity (e.g. tremor), and impaired glucose
ors can occur at ANYTIME, not just within weeks of starting
tients with bilateral
in controls). renal artery table
For a contingency stenosis.
in the standard format:
ols). For a correctly formatted contingency table: OR = ad /
ves
urve+toTrue negatives
the left ) / Total value).
of the specific numberIt of
is individuals
possible to tested.
use the
ed to calculate the pretest odds of disease as follows:
ategy to maximize unbiased ascertainment of outcomes is to
nceived expectations
of populations, regarding
and their the treatment.
association is determined.
in each of a series of populations and their associations
ure and a disease; its null value (i.e. null hypothesis) is
oup means differ. Group comparisons are follow-up tests
e.no significant
disease) difference
rates betweeninthe
group means,
2 groups. In and vice versa.
a prospective
after
osure.the outcome
It is has as
calculated occurred.
the difference in risk of disease
sk[unexposed]) / Risk[exposed]]
ay be calculated using absolute risk x 100.
reduction (ARR) or
ull value (i.e. RR = 1.0) indicate that the association is not
pecific outcome, and the period of observation for the
nd the
who comparison
otherwise would group used.been harmed. To calculate
not have
able (e.g. risk factor, treatment) and a dependent variable
dy without an event of interest. The event-free survival rates
Results from a randomized controlled trial conducted in a
assigned to one of several treatments or placebo. A
quantitative variables. It does not necessarily imply
g. exposure or intervention) that is used to divide study
gsed
latent period. associations between potential risk factors
to examine
i.e. snapshot).
eople without the disease (i.e. controls). The main measure
0) is not statistically significant, and a CI that excludes the
calculated as NPV = true negative / (true negative + false
ctor). Confidence intervals that contain the null value (i.e.
able (e.g. risk factor, treatment) and a dependent variable
ons that are
t variable truly
(e.g. invalid). be evaluated in 2 independent
outcome)
come) and a categorical independent variable (e.g.
ebo) in a large sample of affected patients (i.e. patients with
atment groups. It is calculated as follows: ARR =
oup divided by the sample size of that group.
e event. NNT is the inverse of the absolute risk reduction.
ve event.
culated using the absolute risk reduction (ARR) or the
or than do
actors), studies
which may with smaller sample
be quantitative sizes.
or qualitative, on 1
in determining prevalence of an outcome, and can serve to
some clinicians to present probabilities regarding outcomes

ent facilities, is a potential source of medical error.
s patient
well ascare.
changes in disease prevalence, will affect the
ve to the right for a given cutoff point indicates a decrease in
l adverse event. It is calculated as the inverse of the
dual endpoints.
ables. Many studies also perform an intention-to-treat
.ate that the treatment group had a lower event rate and
ndicate that the treatment arm had a lower event rate while
process minimizes selection bias, results in near-equal
f the event occurring in the control group. When reviewing a
ons, with and without a given risk factor, allows for
ysitivity
is present.
and specificity at various cutoff points. Changing the
sely proportional to specificity).
obability of a disease. A patient with a high probability of
hing variables should always be the potential confounders of
e a similar
umber distribution
of subjects in accordance
are lost with
to follow-up, thethe variables.
study may
of follow-up to reduce the potential for attrition bias.
e (e.g.
m improved
the relative riskquality of care
using the and disease
following formula:management).
ARP = (RR -
ment and placebo groups is seen.

isk ('rare disease assumption').
ple size increases precision.
ubjects by the total number of subjects at risk (i.e. all the
ected values.
intervals express statistical significance and are interrelated
y shifts toward them. The median and mode are more
and difficult-to-measure confounders.
t does not necessarily imply causality.

orrectly, the study
in middle-aged design
women should
would notbe
beconsidered.
expected to be
of interest. Stratified analysis helps determine whether a
factors and the initial steps in disease pathogenesis
nuous over
s is true. a certain
A result period before
is generally influencing
considered the outcome.
statistically
ut the disease (controls). The main measure of association is
. In other study designs, a certain period separates the
nt study, p should be < 0.05. This corresponds to a 95%

within 2 standard deviations from the mean; 99.7% of all
e diagnosed. Prevalence is the measure of the total number
se of interest in the population in which the test is applied.
he bias that can result when the exposure-disease
t survival in patients to whom a test is applied, without
are assessed. Case control studies determine the outcome

nepopulation
dy the outcome.
to affect the outcome since they are aware that
the cutoff value will increase sensitivity (fewer false

high
e specificity.
cutoff value will increase specificity (fewer false positives)
.n being tested. A change in a test cutoff point that causes
ease in sensitivity.
hypotension and bradycardia. A right-sided precordial ECG
arrival
ent to the myocardial
elevation emergency infarction.
department. It should be administered
osing STEMI include ST-segment elevation in 2 contiguous
d insulin plus glucose to move potassium into cells. Longer-
mia. Elevated carboxyhemoglobin levels confirm the
ollowing transmural myocardial infarction. PIP is best
n. Other cardiovascular complications of OSA include
catecholamine surge brought on by acute physical or
and and
sion typically resolves
to rule on post-MI
out other its own within several weeks.
complications (e.g. free
ardiovascular disease. For patients who are intolerant of one
pretest probability of PE are best evaluated with CT
ope. Tongue biting, especially of the lateral tongue, is highly
n, features suggesting intranasal cocaine use include
eight gain, likely via effects on skeletal muscle that lead to
ridatpanel
high and
risk for, type
either 2 diabetes
fasting serummellitus.
glucose or hemoglobin
endineae. The mitral regurgitation resolves with reduction in
regurgitant
with placementflow re-entering the ventricle
of an implantable during diastole. is
cardioverter-defibrillator
ndicative of a cardiac arrhythmia involving atrioventricular
becomes severe (usually indicated by valve area < 1 cm2).
arterywall
lming disease.
stress eventually leads to symptomatic,
erated response causes a > 3 second ventricular pause and
or presyncope.
ascular risk calculator. Initiation of statin therapy is
day. The diagnosis is made by ambulatory blood pressure
sure
leroticreadings.
cardiovascular disease, statins are the first-line
comes.
utamine stimulates increased myocardial contractility leading
heart
s duefailure.
to a cardioinhibitory response from increased
ole due
ory drugsto (e.g.
sinusibuprofen)
arrest. and colchicine, as colchicine
c chest pain, a pericardial friction rub, and diffuse ECG
n-onset cardiogenic shock with hypotension, biventricular
ure during the last month of pregnancy or within 5 months
oop diuretics and ACE inhibitors (or angiotensin II receptor
Features suggestive of an esophageal origin of chest pain
of pain
ites, by antireflux
elevated jugular therapy.
venous pressure, pericardial knock
rlying renal insufficiency. It presents with altered mental
n system antagonist (angiotensin-converting enzyme
n a reversible defect is noted on stress and rest images.
nt claudication. Pharmacologic therapy with cilostazol and
ed exercise
1%-2% therapy.with PAD progress to develop critical
of patients
xtending into the adjacent cardiac conduction tissues. Aortic
with simultaneous palpation of the brachial and femoral
or blood
rant pressure
circuit arounddifferential.
the tricuspid annulus. Atrioventricular
essive intravenous diuresis, oxygen supplementation, and
er arterial revascularization, and stroke or transient ischemic
ially IC) and class IV (calcium channel blockers)
o waves
an increase in the
to clarify QRS complex
diagnosis of atrialduration.
flutter or atrial
nical features of MR include exertional dyspnea, fatigue,
dynamic pulse, including bounding or 'water hammer'
with left ventricular hypertrophy from prolonged
Intravenous diuretics provide symptomatic benefits to
itial upstroke of the QRS complex (δ wave), and widening of
dfinding
directlyinconnects the atria to but
cardiac tamponade the can
ventricles.
also occur in
of cardioselective β blockers is usually safe in patients with
n. Systemic venodilation lowers preload and left ventricular
e any significant change in left atrial or ventricular size and/or
or the increased incidence of orthostatic hypotension in the
h vasopressor therapy to maintain adequate cerebral and
sion
ciated has no hypercalcemia,
with role in the management of these
renal stones, patients.
abdominal pain, or
arrhythmias, and vascular and valvular calcification.
rtic regurgitation and heart failure. Cardiac tamponade is
bsence of pulmonary
atients found to be in aedema.
shockable rhythm (e.g. ventricular
nsimmediate synchronized
of congestive cardioversion.
heart failure with a normal left ventricular
stiffness leads to an increase
n patients with diffuse atherosclerosisin LV end-diastolic pressure.
and resistant
s.
ous antihypertensives, including angiotensin receptor
e large and numerous. Bilateral upper abdominal masses
rogressive decline inand
entricular stiffening renal function. induced by myocardial
dysfunction
no clearly discernible P waves. Patients with new-onset AF
rophic obstructive cardiomyopathy (HOCM). Syncope in
donse that inappropriately
a 'dropped' QRS complex. causes
The PRvasodilation.
interval prolongation is
sculoskeletal chest pain. Patients typically have sharp,
reduce the risk of systemic thromboembolism in patients
k factor for hypertension, and weight loss is the most
diac output. The compensatory mechanisms are ultimately
Lower-extremity edema, ascites, and/or pleural effusions.
c pressure > 25
discoloration, and mm Hg. skin ulceration. Initial treatment
medial
ve Services Task Force recommends screening for this
ussmaul sign (lack of decrease or increase in jugular venous
are noted in patients with congestive heart failure due to left
aneurysmal aortic root dilation that can progress to cause
cy that may be complicated
t microbiome/cytochrome by acute
P450 systemaortic
and regurgitation.
the dietary
min K recycling in the liver.
low risk of systemic embolization and anticoagulant therapy
mptoms but more significant neurologic and visual symptoms
nce (e.g. arteriovenous fistula). It involves hyperdynamic
peripheral
gs suggestingandanpulmonary
arrhythmia edema.
as the cause of syncope
typically reveals a delayed and diminished carotid pulse,
efunction
and radiation to the carotids.
with decreased clearance of the drug. Symptoms of
ges in color vision), and cardiac
n cause destructive thyroiditis with arrhythmias.
release of preformed
tients at moderate to high risk of thromboembolic events.
d, aggressive intravenous diuresis, and possible vasodilator
sult in a temporary slowing of conduction in the AV node and
tation is commonly present in patients with tricuspid valve
n.
ardia. Chest radiograph is frequently abnormal but has poor
High-risk patients should be started on appropriate medical
otion of the heart in the pericardial cavity causing a beat-to-
rgency pericardiocentesis.
or presyncopal
ges sensation.
with a histamine 2 receptor antagonist or proton-pump
heart sounds. These symptoms are due to an exaggerated
d cardiac output.
administered aspirin as soon as possible. Early antiplatelet
ntral venous pressure and pulmonary capillary wedge
nd cardiovascular death compared to aspirin alone in patients
hsevery
following
officedrug-eluting stent placement.
visit. All patients should be encouraged to
lose weight; and limit alcohol intake.
n typically reveals diminished and delayed carotid pulses, a
clinical signs of congestive heart failure (e.g. bilateral lung
for systemic
sed the diagnosis.
vascular resistance (SVR), and an increase in
ged periods of rapid ventricular rate. Initial treatment is aimed
ar function. monitoring in these patients reveals a low
emodynamic
st initially), and
ontractility. high index
Cardiac mixedisvenous
reduced,oxygen saturation.
and pulmonary
theter). Patients typically present with hypotension,
e number of cell membrane LDL receptors. Statins also
ced myopathy.
adverse clinical outcomes. It is caused by increased levels
rs, and
ary loopdisease
hepatic diuretics.and cirrhosis have reduced or normal
resulting in loss of elasticity and consequent aortic dilation.
y help prevent angina by decreasing exertional heart rate
nitrates are also as
recommended used.
initial therapy for atrial fibrillation due to
ssociated with hypotension, bradycardia, and atrioventricular
er evaluation with a transthoracic echocardiogram.
mediate post-infarction period in patients with acute
sent with decompensated heart failure that is often preceded
and a relatively small increase in blood flow in stenotic
ake
e inoftheradioactive isotope in ischemic
initial management myocardium. chest
of cocaine-associated
ese changes are common and usually have minimal
eased elasticity of the arterial wall. It is associated with an
st pain modifications
estyle and reduces the andsize
pharmacologic therapy.
of any associated pericardial
xplained by prostaglandin-induced peripheral vasodilatation
of the condition. Patients should be advised to avoid triggers
.
erred diagnostic study in patients with hemodynamic
kidney
ypical skindisease.
manifestations (e.g. livedo reticularis, blue toe
emic effect of nitrates is mediated by systemic vasodilation
ceptor blocker. The presence of a continuous abdominal
ly present with upper extremity hypertension and diminished
o pressure-induced
ecation, cough). These enlargement of thean
triggers cause intercostal
alterationarteries.
in the
agnosis of this condition, along with other causes, such as
mal symptoms prior to the syncopal episode. In contrast,
eneralized sense of warmth
may be administered withinprior to theofsyncopal
12 hours symptomepisode.
onset for
morrhage, and mortality compared to PCI.
ated 10-year ASCVD risk > 7.5%-10% based on the Pooled
ensity therapy is recommended for those with established
nitiation of therapy. Interstitial pneumonitis due to
adiograph.
causes. A permanent pacemaker is indicated if no
ly patients are typically affected and have bradycardia,
radycardia
dropped' QRS withcomplex.
delayed Itorisdropped
a benignP and
waves.
transient
grequire
medications that affect AV node conduction).
no further evaluation. Patients with first-degree AV
ng
cute heart failureitsornature.
to determine pulmonary edema, ischemic chest pain)
wide complex) associated with clinical or hemodynamic
In contrast, patients with hemodynamic instability due to a
nchronized
annel blockers.cardioversion.
Immediate synchronized electrical
berculosis is the most common cause in developing
uggests benefit of carotid endarterectomy in asymptomatic
d medically. should be performed to screen for LV
cardiography
ed by leaning forward. Nonsteroidal anti-inflammatory drugs
pment of
nitiation ofaamiodarone
hemorrhagic pericardial
therapy. effusion.
A baseline chest radiograph
own discoloration, woody induration, fibrosis, and chronic
n and
on; reflux.
causes coronary vasoconstriction; promotes thrombus
tion of these two digitalis effects, and is relatively specific for
s), restrict dietary salt intake, engage in regular aerobic
ypically diagnosed in their 30s or 40s. The AR is usually
entricle closer to the chest wall and causes a pounding
xertional angina due to subendocardial ischemia with
ey can cause increased conduction through the accessory
Trypanosoma cruzi, endemic to Latin America, is
acute aortic dissection, as they lower heart rate and blood
a, cardiomyopathy,
diovascular heart
and overall failure, and
long-term sudden
mortality cardiac death.
in patients with
patients.
yocardial infarction but should be avoided in patients with
ble
andischemic
symptomsheart
of disease.
decompensated heart failure (e.g.
ACE inhibitors, angiotensin II receptor blockers, and
usion. Enlargement of the cardiac silhouette can often be
antithrombotic agents, β blockers, nitrates, and high-intensity
n intracoronary stent should be counseled regarding the
ndrome is common in young patients (age < 40) with aortic
hibitors (e.g. enalapril, lisinopril), cardioselective β blockers
eurohormonal-mediated cardiac remodeling.
often shows persistent ST-segment elevation along with
nctional mitral regurgitation, or mural thrombus. infarction.
evations on ECG < 4 days following myocardial
travenous fluids; preload-reducing medications such as
Calcium channel blockers (e.g. diltiazem, amlodipine) cause
eading to intermittent coronary artery vasospasm. Raynaud
of the mitral valve, leading to anterior motion of mitral valve
oer,
leftkidneys,
ventricular
skin,outflow tract obstruction.
and nervous system. The diagnosis is
hopnea, paroxysmal nocturnal dyspnea, and hemoptysis. It
s a higher thrombogenic risk than nonvalvular atrial
cular hypertrophy in the absence of a history of
e, and rheumatic heart disease. A bicuspid aortic valve is the
of mitral regurgitation. Squatting from a standing position
on. Chronic severe MR causes left atrial and ventricular
iated with improvement or normalization of left ventricular
onsible for about 70% of identifiable mutations in patients
of symptomatic patients with hypertrophic cardiomyopathy.
persistent symptoms.
ck. Intravenous fluids and atropine are the first-line
prolonged QT interval. Immediate defibrillation is indicated in
ncludesepisodes
current of TdP.
statin therapy for risk factor reduction and prevention
nal failure (blood urea nitrogen > 60 mg/dL) and typically
nt due
mia to transient
(e.g. lack of myocardial inflammation.
ischemic attack, amaurosis fugax, stroke)
and also and

id panel potentiate the sideserum
either fasting effects of digoxin.
glucose or hemoglobin
preload. These patients should be managed initially with
orkup (e.g. brain CT scan) has low yield in most patients
es must befurther
esponse, excluded prior tooptions
treatment pursuing other intravenous
include etiologies.
treatments. Liver function tests, lipid panel, and pregnancy
mucosal atrophy or ulceration. It is often associated with
has a
with FPHLprolonged courseThe
are normal. withfirst-line
relapses over many
treatment years.
is topical
aired cellular reproduction in the anagen phase can lead to
ther autoimmune conditions. Treatment includes topical or
bows (large plaque) but can also occur on the scalp, hands,
likely
cules due on theto frequent minor
upper trunk andtrauma.
the extremities. It is often
reatment
ungi. includes topical
It is characterized byselenium
thickening, sulfide or ketoconazole.
roughness, and
assium hydroxide examination of skin scrapings. First-line
Diagnosis is based on biopsy with immunofluorescence
continuation of shaving or use of alternative shaving
the extremities. It is often associated with dry skin. The
hthesoaps.
palms, soles, and sides of the digits. The diagnosis is
It most commonly affects sun-exposed areas of the head
phyte infection elsewhere on the body (e.g. tinea pedis,
eated.
pares the scrotum. The diagnosis is often apparent based on
mazole, tolnaftate) arePatients
ue to autoinoculation. usually effective.
with compromised immunity
includes topical antifungals (e.g. miconazole, terbinafine,
h or plaque. It most commonly occurs on sun-exposed skin
ded
re for confirmation.
diffuse presentation. Treatment includes topical
kles. Lesions may also occur on the oral mucosa, nails, and
oids.
essure from crutches, bra straps, turtlenecks, sports
ten on the shins. Common triggers include infection,
amides, andand
-leaf spots) oralneurologic
contraceptives.
(e.g. seizures,
oss, pregnancy, major illness or surgery, or psychiatric
may take
lesions, up to a the
although yearappearance
to resolve completely.
can vary. It is associated
lucocorticoids, and certain medications (e.g. antimalarials,
rotriene).
guttate psoriasis), aremoderate
Patients with associatedto with psoriasis.
severe disease may
omised individuals. The lesions appear as hyperkeratotic
t proliferation and most commonly occur on the lower
ually develop well-circumscribed and raised erythematous
ociated with insulin resistance states (e.g. diabetes mellitus,
. First-line options include topical metronidazole, azelaic
t associated comedones, cysts, or nodules. Drug-induced
sh involves exposed skin and can form linear streaks where
cyclovir and other antivirals may be used to decrease the
llular immunity (e.g. HIV disease) are at risk for more
s. Chronic sun exposure is the major risk factor. Actinic
ey surfaces
or are benign andhands
of the generally
anddo not require
forearms). It istreatment.
due to age-
ion.
f uroporphyrinogen decarboxylase. It can be triggered by the
sters andwith
sociated skinother
fragility.
autoimmune conditions, such as
alopecia areata.
anifestations of a drug allergy (e.g. urticaria and pruritus
from the addition of topical antibiotics. Oral antibiotics and
(e.g. salicylic, azelaic, or glycolic acid) if initial therapy fails.
ct with genital herpetic lesions or infected orotracheal
re caused by human papillomavirus, which is the most
amous cell carcinoma
nickel exposure of the
can lead anus, genital
to itching, organs,
scaling, and and throat.
purulent) or Staphylococcus aureus (purulent). Patients
hematous macules, bullae, desquamation, and mucositis.
h other autoimmune conditions and is usually slowly
eceintervention.
area, TEN involves > 30, and SJS/TEN overlap syndrome
comfort. Symptoms are typically precipitated by hot drinks,
ad
by to permanently against
autoantibodies flushed desmogleins,
skin. which are involved
w intercellular IgG deposits in the epidermis.
ase. It presents with clusters of pruritic papules and vesicles
ns with erythema, edema, and vesicles in sun-exposed
story of pre-existent dysplastic nevi are important risk
d evolution
lesion with aofwell-demarcated
size and appearance over
border andtime.
'stuck-on'
e with pearly, rolled borders. Although it only rarely
dults includes cryotherapy with liquid nitrogen, curettage, or
It is most common in the first year of life and in middle age
gh with horny plates resembling fish or reptile scales.
nt as urticarial or eczematous lesions. The diagnosis is
isease.
s. Topical permethrin or oral ivermectin is the preferred
mon-colored, hyper- or hypopigmented macules. The
al clearing. Patients often have concurrent infection
ave severeHumidification
l mucosa. or widespreadisdisease.
often effective in preventing
he ear canal increase the risk. The most common pathogen
n of the skin barrier and when conditions cause moisture
n, disrupting cranial nerve VII motor fibers, with subsequent
uricle
atory and ipsilateral
infection. facial paralysis.
Vestibular neuritis with unilateral hearing
ntinuous treatment for several days or weeks. Oral
ymptoms
usually and drug
caused tolerances. aeruginosa. It is seen most
by Pseudomonas
atic hydrops). Clinical features include episodic vertigo,
rs for development of leukoplakia are similar to those for
iopsy
ion to rule out
following the malignant
ingestion of transformation of the lesion.
aspirin or nonsteroidal anti-
king high doses of loop diuretics, those with coexistent renal
and is related to damage to sensorineural structures in the
as aeruginosa. The characteristic presentation consists of
ranial neuropathies.
story
tientsof nocturnal
with teeth grinding.
constellations of less specific findings, such as
ulin-like growth factor-1 level.
ion of gonadotropins. Initial assessment should include
therapeutic
such phlebotomy.
as increased caloric intake or less rigorous insulin
d to the catecholamine surge, increasing the risk for
xogenous insulin is required. Patients typically also lose
oneogenesis in the liver. The risk is higher in patients with
levels, sulfonylurea screen) or close observation in a
he patient's level of understanding and provide a
ne specific gravity (e.g. < 1.006) suggest dilute urine, as
as diabetes
ssium values. mellitus.
Therefore, in addition to insulin and
ry or tertiary) adrenal insufficiency do not develop
is. After initiation, bone density is typically remeasured after
rolonged use.glucocorticoid (e.g. hydrocortisone) and
ment of both
diabetes) or proliferative diabetic retinopathy, which
on in patients with diabetes who are normotensive and have
nappropriately normal LH. Secondary hypogonadism is a
hesis.
. The initial evaluation of suspected breast cancer should
e intake of calcium and absorbable alkali, usually in the form
ight loss, an effect not seen with insulin, sulfonylureas, and
ve features (e.g. episodic anxiety, headaches, sweating,
complications due to malnutrition include bradycardia,
othalamic thyrotropin-releasing hormone, which in turn
ding to abnormal
ent gradually uterine
leads bleedinghypothyroidism
to permanent (e.g. oligomenorrhea).
in most
bodies.
andial hyperglycemia. A combined regimen including a long-
ve glycemic
%) control.
is associated with increased risk of hypoglycemia and
ontrast, childbirth) in patients with undiagnosed or
ive
on heart failure.
and signs of mineralocorticoid deficiency suggest
ay develop symptomatic hypogonadism or hypothyroidism
ents usually develop hypocalcemia, low phosphorus, and
ramps,
ma reninand gait abnormalities.
activity. Hypokalemia is not always present at
escape.
y intake of vitamin D, inadequate sunlight exposure, or
be released from the injection site despite falling glucose
corticoid intake, ACTH-producing pituitary adenoma, and
ciated with elevated circulating levels of estradiol due to
ased RAIU suggests release of preformed hormone or
vels. significant ketoacidosis. Altered sensorium is due to
without
lin therapy, trauma, and acute illness.
alemia such
anges is alsoascommon
weight gain, fatigue,
due to renal and constipation.
potassium retention in
ability, dermal atrophy, and striae due to the catabolic effects
sthon
cortisol.
retro-orbital fibroblasts and adipocytes. Radioactive
edism.
used Objective
to minimize the effects
findings of RAI. muscle atrophy.
may include
abetes mellitus,
and cortisol, andregardless
significantofelectrolyte
LDL level.abnormalities (e.g.
mal TSH levels. Most TSH-secreting tumors are
nction
lin-likeofgrowth
surrounding
factor 1pituitary
mediates tissue.
most of the effects of GH
ular cells. The radioactive iodine uptake scan reveals uptake
emia include osteolytic bone metastasis, increased
hyperthyroid patients are also at risk for cardiac
erentiating features of PAI from central adrenal insufficiency
androgens and include fatigue, weight loss, hypotension,
or parathyroid hyperplasia. Most patients have mild,
europsychiatric
escribed symptoms.
to control symptoms due to hyperthyroidism (e.g.
nce of normal renal function. Causes of hypoparathyroidism
ellular space, and insulin deficiency, which impairs cellular
tes mellitus and associated abnormalities (hypertension,
higher dose to saturate the increased number of TBG binding
athyroid hormone-related protein by tumor cells, leading to
menopausal estrogen replacement. Total thyroid hormone
Haselevel.
of parathyroid hormone (PTH) and PTH resistance.
solves
of hypoparathyroidism).
weight loss and oral contraceptives containing
f secondary hyperparathyroidism in chronic renal failure.

d and heart
should rate. therapy with ACE inhibitors or angiotensin-
prompt
roteinuria
es primaryand nephropathy.
polydipsia and favors DI. DI can be central
ce).
. Patients often have additional features of hypothyroidism
ating adrenal adenoma and bilateral adrenal hyperplasia in
n in the absence of hypertension, screening for diabetes is
ke inhibitors, and anticonvulsants. Pregabalin decreases
ness, and impaired glycemic control. Metoclopramide is a
d tardive
pain, dyskinesia.
paresthesia, and allodynia, whereas large fiber injury
. Diabetic neuropathy is the most important contributing
by at least 50% following the administration of
rred) is the first-line treatment
This cardiomyopathy for centralby
is often worsened DI.concurrent
levated dehydroepiandrosterone sulfate levels are seen in
g is indicated for patients with elevated prolactin, mass-
yroidectomy with a plasma fractionated metanephrine
i-TPO are associated with an increased risk of progression
ypothyroid women.
rfanoid habitus, and mucosal neuromas. MTC associated
orrelate with the size of prolactinoma, and levels > 200
g. cabergoline, bromocriptine), which can lower prolactin
iency, which leads to decreased intestinal calcium and
hypocalcemia,
ine phosphatase. and elevated
X-ray alkaline
findings phosphatase.
include cortical thinning,
ess. Patients have a self-limited thyrotoxic phase followed by
ammatory
ect drugs.drugs is agranulocytosis (0.3% of patients).
of antithyroid
marily to decreased peripheral conversion of T4 to T3.
health.
wofTSH.
coronary atherosclerosis. Treatment of hypothyroidism
adrenal adenoma who either refuse surgery or are poor
retic-induced
alcemia hypokalemia.
(suppressed PTH) is usually due to malignancy.
m) is hormonally
binding of calciumregulated and
and a drop in remains
unboundstable.
(ionized) calcium.
bicarbonate for osteoporosis. Clinical findings include
is. The diagnosis of Conn syndrome is suggested by low
udies are consistent with secretory diarrhea; a VIP level > 75
e diagnosis, and abdominal imaging can localize the tumor
ancreatic endocrine tumors (e.g. gastrinomas). Common
4-hour urine free cortisol measurement, and/or overnight
rom ACTH-independent
esity. Patients with PCOScauses.
are at increased risk of developing
ac valvular abnormalities. Carcinoid cells cause increased
itis,
nt diarrhea,
weight loss and
and dementia).
are associated with decreased mortality in
SH. Thyroid scintigraphy shows decreased radioiodine
of diabetic nephropathy (DN). Tight glycemic control with a
oglycemia and possibly
ate levels. The anion gapcardiac events.
estimates the unmeasured anion
are measurements of C-peptide, proinsulin and sulfonylurea
nd normal anion gap. Osmotic diuresis leads to marked
e.ular space. Insulin in these patients can rapidly lower
ecommended in the first 1-2 hours; 2. Correction of
atment
ents with of mild
the underlying
disease whoprecipitating factors.
are likely to have a permanent
or who are at increased risk of complications.
nd WBC count checked. Routine WBC count measurement
igue, cold intolerance, hypoglycemia, anorexia, and low
m.ation test (cosyntropin test) can identify patients with
uation.
mal muscles. It is due to the direct catabolic effects of
ght loss, polydipsia, abdominal pain, hyperventilation, and
iately with intravenous
erum testosterone fluids and
and DHEAS insulin.
levels are used to delineate
HEAS suggests an adrenal source.
mural inflammation of the gastrointestinal tract. Patients with
r vaginal
are lesion.
diffusely nodular breasts with non-focal tenderness and
f new onset (remember: DIAPPERS). Fever may not
associated with a risk of cardiotoxicity. Cardiac function
d onDTNM
min staging.or autoimmune inflammation (e.g.
deficiency)
ion of the sick/caregiver role. The victim must be protected
wel’s ability to absorb nutrients. Vitamin D deficiency is
se.ts with a history of inflammatory bowel disease are all at an
eneral population.
which detects hydrogen released from a standardized dose of
ferase levels > 1,000 U/L). Unvaccinated individuals are at
) should receive urgent therapeutic phlebotomy without
n can occur via receptive anal intercourse or proximal
g,e.g.anorectal pain, and
digital rectal, constipation
prostate, maylaboratory
pelvic) and also occur.analysis
transmission, and outbreaks have been linked to
g. anti-smooth muscle, anti-liver/kidney microsomal type 1,
herapy is oral hydration and antidiarrheal medications (e.g.
r form. Management includes reassurance, dietary
nt
whichdisease).
can lead to the resolution of ascites and, ultimately,
e to flow promote third spacing of fluids into the abdominal
dnterstitium.
to rule out spontaneous bacterial peritonitis, whereas fluid
g in hypochlorhydria and unchecked gastrin production) and
serum
k factors gastrin levels,
include andsepsis,
shock, macrocytic anemia. mechanical
coagulopathy,
patic involvement is common, and liver function tests
altered small bowel motility (e.g. uncontrolled diabetes,
.eremia require screening colonoscopy. Bacteremia with
tients with AN often try to hide their disorder, associated
Esophagogastroduodenoscopy is used for both diagnosis
ypercoagulable states (e.g. systemic lupus erythematosus
e, protease, amylase) is used to treat both exocrine
n cause. Drug-induced pancreatitis should be considered
drochlorothiazide).
ropria, and a subepithelial collagen band may be present.
ammatory
rointestinaldrugs).
bleeding, nocturnal diarrhea, unintended weight
ntestinal bleeding, worsening pain, unintended weight loss,
wel
withdisease or early
intermittent solidcolon
foodcancer.
dysphagia and refractory
ng
red mental status can occurthe
eosinophilic infiltration of esophageal
with mucosa.
severe disease. An anion
nlow-grade
right upperfever,
quadrant abdominal ultrasound.
and leukocytosis. Stool testing for C.
matory bowel disease),
e rectal vault. Obstructionandofadvanced
fecal flowage.
in the rectum can
anual disimpaction and enemas to clear
d fat-soluble vitamin deficiencies; low fecal the elastase
rectal vault.
is
2 test is usually diagnostic, but methylmalonic acid or
laxis for esophageal

determine strategiesvariceal hemorrhage.
for primary prevention of variceal
actase enzyme deficiency commonly causes lactose
atory response (e.g. fever, tachycardia); and peritonitis.
biotic use, age > 65, and gastric acid suppression (e.g.
ion.
hosphonates, and nonsteroidal anti-inflammatory drugs are
wallowing.
be intubated to protect the airway as a part of initial
he
nd bleeding.
perianal skin tags and fistulas. Biopsy typically reveals
diac ascites, cirrhosis) while a SAAG < 1.1 suggests non-
ptic strictures include radiation, systemic sclerosis, and
with milder associated increases in the total bilirubin and
l within(e.g.
amage a fewalcohol
weeks.avoidance, hepatitis A and hepatitis B
bable disaccharides (e.g. lactulose, lactitol) are preferred for
of duodenal ulcer classically occur in the absence of a food
ding, with PUDendothelial
emic vascular being oneinjury.
of the This
mostcauses
common causes.
vasodilation,
ema, asterixis, jaundice) and hepatosplenomegaly are also
rhea and/or constipation. Patients with symptoms consistent
or direct visualization techniques (e.g. colonoscopy every
elative's
d but candiagnosis (whichever
have continuous comes first).
involvement of the entire colon.
olonoscopy
nd a vesicularis advised.
rash in a dermatomal distribution. The pain
oss. Achalasia is caused by impaired peristalsis of the distal
elevated liver enzymes, and firm hepatomegaly. The
endoscopic therapy, and prophylactic antibiotics.
A higher threshold of hemoglobin < 9 g/dL is considered for
acter pylori or nonsteroidal anti-inflammatory drugs.
nal pain, diarrhea/steatorrhea, and weight loss. Diagnosis is
ory. It is associated with insulin resistance. Severity can
ratio, possibly due to increased urea production (from
y fever, jaundice, anorexia, and tender hepatomegaly with
d dysphagia. Esophageal manometry reveals multiple
ent includes
urgical calcium
changes). channel
A low blockers.
stool osmotic gap (< 50 mOsm/kg) is
ge and diverticulitis. The risk of complications is lower with
ry drug use, obesity, and smoking.
rent, painless gastrointestinal bleeding. Diagnosis is made
ding
ltiplecan be treated
portions of thewith cautery.
gastrointestinal tract, rectal sparing,
ients often have a low-grade chronic anemia at baseline and
cm) and adenomas with high-grade dysplasia or villous
areas and developing countries. The preferred diagnostic
ation and risk factors. Patients age > 50 or with clinical
e-based
ug-inducedanoscopy may be
pancreatitis performed
is usually mildfirst.
and resolves with
ric mucosa to various injurious agents (e.g. alcohol, aspirin,
pH and increased stool osmotic gap. There is no
nti-tissue transglutaminase antibodies are highly predictive of
een or colonoscopy with characteristic findings of melanosis
sia, postprandial fullness and nausea, and gastrointestinal
tail of the pancreas, and should undergo abdominal CT
S-positive material in the lamina propria of the small intestine
therapy can interfere with niacin metabolism and
alamin (vitamin B12) deficiencies both result in
ic acidtolevels.
ailing improve. When appropriate, these patients should
an be conservatively managed with analgesics and
vated alkaline phosphatase, and mildly elevated
d intermittent jaundice due to a defect in hepatic excretion of
should be evaluated with right upper-quadrant ultrasound to
hragm. Diagnosis involves documentation of the effusion
can lead to acute pancreatitis and can cause eruptive
, leading to a metabolic alkalosis with associated
medications (e.g. lactulose).
ay improve symptoms and possibly survival. Therefore,
ion.
common hepatitis risk factors (e.g. alcohol or drug use,
with unclear diagnosis or those who fail to improve with
are immunized with the hepatitis B vaccine are positive for
ed hyperbilirubinemia. Jaundice may be triggered by fasting
eand supportive
therapy care.with contraindications to β blocker
in patients
ctures alternating with segments of ductal dilation (e.g.
city is a common cause of ALF that may be potentiated by

during initial infection and anti-HBc will remain elevated
T) > 2, elevated γ-glutamyltransferase, and elevated ferritin.
ence of other causes of secondary hepatic fat accumulation
dbolic risk factors.
differential, total protein) to determine the underlying
nd furosemide, sodiumViral
astia, splenomegaly). restriction, and
hepatitis, alcohol
chronic abstinence.
alcohol abuse,
grade fever, abdominal discomfort, or altered mental status.
dents with >SBP.
as INR 1.5) in a patient without cirrhosis or underlying
hema.
osis is confirmed with serum antimitochondrial antibody
ge 5-35. Liver dysfunction ranges from asymptomatic liver
sonality changes,
be associated withand depression.
severe hyperlipidemia, leading to
patocellular carcinoma.
tion. Elevated 24-hour urinary 5-hydroxyindoleacetic acid
result and early-stage MALT lymphoma should undergo H.
colonoscopic screening starting in childhood and elective
n annual endometrial biopsy, as well as prophylactic
ld be offered to patients with ulcerative colitis beginning 8
ce abdominal pain, bloody diarrhea, tenesmus, and fecal
may be associated with lightheadedness and hemodynamic
on. accompanied by either fever or a change in mental
scites
countmotility
ageal of > 250/mm3.
disorder such as diffuse esophageal spasm.
egurgitation. Typically, patients are evaluated initially with
on.uld be colonoscopy and endoscopy. A single negative occult
elevated inflammatory markers). It can involve any part of
Patients with fulminant disease (e.g. hypotension, ileus,
may be
use). All given
other rectally.
patients can receive an empiric trial of proton-
py is recommended to exclude malignancy in all patients with
der enzymes. Patients with small intestinal mucosal disease
nhtofloss,
D-xylose.
and food aversion. Most cases are due to
, malignancy) and typically presents with pain and swelling in
thickened
4. Screening skin.
at age 40-49 and age > 75 is not routinely
ransfusions. Reactions develop > 24 hours after transfusion
hronic lymphocytic leukemia is associated with warm
iciency can also occur, leading to hypocalcemia, secondary
minaseand
malities autoantibody testing. due to the precipitation of uric
renal insufficiency
ibitors to reduce
normocytic serum
or slightly uric acidanemia
microcytic levels. with a low
y adrenal insufficiency (PAI). Clinical manifestations of PAI
on testing.
ars of waxing and waning lymphadenopathy. B symptoms
homa (NHL) due to chronic B-cell stimulation, immune
viruses. One of the most common malignancies is non-
h diffusetreatment
e cured, lymphadenopathy
can lead toand B symptoms.
long-term complications, most
evaluation often reveals elevated serum lactate
ins. Patients may also have mediastinal LAD, B symptoms,
vascular hemolysis in the setting of certain stressors such as
e.g. cancer, infection). However, the tracer will also pool in
llecting system
combination due
with to radiotracer
normal plasma). excretion.
Most patients with
,e fetal loss).
hyperviscosity syndrome (vision changes, headaches,
ein electrophoresis
atment with all-trans and bone acid,
retinoic marrow biopsy.
which differentiates the
or platelet-endothelial binding and reduced factor VIII levels.
ptoms related to > 1 cytopenias. Acute promyelocytic
agulation.
sions with normal or low calcium, elevated alkaline
utoimmune conditions. The manifestations, including fatigue,
ion (e.g. headache, blurry vision, nausea). Urinalysis may
(e.g. schistocytes)
counseling, and thrombocytopenia.
hematology consultation, and fetal diagnostic
cific antigen recurrence after radical prostatectomy for
atoma after
patients minor
should betrauma.
tested for hepatitis C and HIV as
ection can affect the plateletHIT
nitiation of heparin therapy. count.
is highly thrombogenic and
rotein
on, C, and
which protein
quickly S.
progresses to respiratory failure and
are at increased risk.
hromboembolism and do not increase the risk of bleeding
agents
us for thedue
influenzae) treatment of acute
to deficits venousresponse
in antibody thromboembolism.
and
penia, thrombosis (arterial or venous), or a > 50% drop in the
ers the normal leukocyte population and causes
periods of hypoxemia. The kidneys respond by increasing
alformations associated with hemoptysis and right-to-left
usea, and
uscular dizziness.
volume (55-75 µm3), target cells on peripheral
no microcytosis until hemoglobin
ravascular hemolytic anemia suchis as
< 10 g/dL. weakness,
fatigue,
oms within
atosus. days. No
It usually additional
indicates workup is
concurrent generallyimmune-
peripheral, required.
ed PTT that does not improve with 1:1 dilution with normal
e characterized by a decreased serum haptoglobin level as
er 24 hours may develop elevated plasma levels of citrate (a
esthesias.
by acting as a cofactor for the enzyme cystathionine β-
due to IgG autoantibodies against platelet membrane
mance can develop an elevated hematocrit. Clinical findings
underlying inflammatory disorder will often improve the
age to the stomach results in gastric atrophy and increases
s, and its deficiency causes defective DNA synthesis. This
s) (e.g. erythropoietin, darbepoetin). Iron deficiency is the
ccative of iron
episodes deficiency.
can be precipitated by infection or medications,
emia is a hemoglobin defect caused by alterations to > 1 of
microangiopathic hemolytic anemia and thrombocytopenia.
avascular hemolytic anemia. Neurologic changes and renal
vascular hemolysis (e.g.
and splenomegaly. Acuteschistocytes).
cholecystitis from pigmented
cterized by episodic hemolysis in response to oxidants,
demia
smear.
of either disorder but will not improve the neurologic
mia of lymphoproliferative disorders is due to bone marrow
urs 5-10 days after heparin initiation but may occur sooner in
nes from leukocytes in the stored blood product. Symptoms
R.
e response. The organs that are typically affected include
um. Supplementation with folic acid prevents these adverse
impair bone density.
ral to a of
gnosis gastroenterologist for endoscopy
iron deficiency anemia, which isisthe
usually
usualrequired.
cause of
reveal elevated serum iron level and normal or decreased
ation
n, andofdepression
pyridoxine are
cancommon
easily correct the problem.
symptoms of mild
isk of thrombosis. Testing should be considered for an
of erythropoietin; patients who receive large doses or
ccumulate in the kidneys and cause renal insufficiency.
mia.
hyperpigmentation. It can progress to cirrhosis and is
ntly have mildly low platelets due to concurrent mechanical
demonstrates bite cells and Heinz bodies. Diagnosis is
the condition
of emboli in thethe
include acute
calf setting.
veins, renal veins, pelvic veins,
enprobability
the history of and
deepphysical
venousexamination
thrombosis. are suggestive,
nd/or neurologic abnormalities (e.g. lower extremity
mentation may correct the anemia in these patients, but it
aly, and spherocytes on peripheral blood smear. Mean
are
ionsasuch
common complication.
as vague, progressive abdominal pain, ascites,
mass, is particularly
gene. This gene creates likelyatoconstitutively
cause Budd-Chiari syndrome.
active tyrosine
ns on x-ray, MM should always be suspected. The screening
is can be confirmed with bone marrow biopsy.
f mature
red B cells).
to chronic myeloid leukemia, LR is characterized by the
rophil precursor cells basophilia.
nd a lack of absolute (promyelocytes, myelocytes). In CML,
ys caused by a mutation of JAK2 in a myeloid precursor cell.
ow suppressive drugs (e.g. hydroxyurea) may sometimes be
w transferrin saturation (i.e. iron/TIBC). Iron deficiency in
lastic (e.g. alcohol use, hypothyroidism, drugs, liver disease)
dopenias,
folate deficiency.
splenomegaly, and peripheral smear evidence of
Diagnosis is made with bone marrow biopsy.
ukocytosis
ation withMM
(M-spike). mature lymphocytes
is associated withand smudge cells.
hypercalcemia,
protein C levels, usually in patients with underlying hereditary
ease appetite and weight gain in patients with cancer-related
side effects.
nding in the renal tubules). Major complications include
uric acid inhibitors reduces the risk of kidney injury.
uced nausea and vomiting.
hypercalcemia
rgan damage, and of malignancy
> 10% clonaland pathologic by
lymphocytes fractures.
bone
gM in patients with WM.
ias, and hypercoagulable state (intra-abdominal or cerebral
proteins
ditional on the
testing is surface
needed of red signs
when blood and
cells.symptoms of other
tive family history and positive Coombs test suggest AIHA; a
ocytes without central pallor.
TE. More detailed testing is indicated for patients with
nopathy, and absence of cough, features that are less
en
ks,testing or empiric antibiotic
and maintenance treatment.
with low-dose oral fluconazole until
mphocyte suppression from HIV or immunomodulatory
sults. Although rapid testing (e.g. acid fast bacilli stain)
unity. Older patients often have fatigue, weight loss, and
emities. Pre-existing trauma to the skin, infection (e.g.
e, nuchal rigidity, petechiae) over 12-24 hours. If clinical
ot delay treatment.
ogressive illness, severe myalgias (e.g. leg pain), and poor
a petechial/purpuric rash, nuchal rigidity, and altered mental
fection.
h on the wrists and ankles that spreads centrally.
risk of progressive disease and death.
ath.
cumulates within a few minutes after wiping. Most cases
ology in adults.
exposed area despite condom use (e.g. base of penile
e of the most common risk factors for lower extremity
infection; these individuals have resolved infection or false-
h urethral culture or with nucleic acid amplification testing of
mpiric treatment
nspecific of sexual
symptoms contacts
and then is also recommended.
progresses to several weeks
s.
syphilis. Symptoms include fever, headache, myalgias,
e spontaneously
apules within
that convert 48 hours.
to pustules and then to ulcers (painful,
d pelvic inflammatory disease. Gonococcal pharyngitis is due
ually febrile and ill. Blood cultures and empiric, intravenous
Symptoms include mucoid discharge and dysuria.
ing
mptoms and oftreatment
headache,to prevent reinfection.
fever, nuchal rigidity, and altered
groups, including those with close personal contact (e.g.
lar or maculopapular rash on the limbs and trunk, peripheral
most commonly on the lower extremities, face, oral mucosa,
Africa. Live-attenuated vaccines should be avoided in
d be evaluated for cryptococcal meningitis. Diagnosis is
ikely have Candida esophagitis, with viral causes (e.g.
sgnosis is confirmed
of clinical with upper
improvement, gastrointestinal
patients endoscopy.
are often transitioned to
velop PDH (usually 2 weeks after antifungal treatment).
00/mm3), progressive disseminated histoplasmosis (PDH) is
monia tends to cause rapid-onset, severe, necrotizing
x-ray classically reveals a diffuse reticulonodular pattern
ue, myalgia, arthralgia), cardiac (e.g. dyspnea), immunologic
alnsandin erythrocyte sedimentation
a nontreponemal test). Onerate.
intramuscular dose of
nd porphyria cutanea tarda (PCT). PCT presents with
reened
oxoplasma for HCV.
gondii IgG serology. TMP-SMX is also effective
tep process that requires both a positive serologic antibody
tients with recent influenza. This pathogen causes rapidly
itary infiltrates.
antibiotics (usually ceftriaxone plus azithromycin) and
nted immunity); immunization for Meningococcus and
vaccines, including hepatitis A and B vaccines as well as the
he United States, an induration size of < 15 mm is
ory (rhinorrhea, sore throat, nonproductive cough)
particularly to the brain) in immunocompromised hosts. The
he vegetation can embolize to the lungs, causing the
d HIV). Patients develop vascular cutaneous lesions, systemic
ycline, erythromycin) and antiretroviral initiation.
phile
a, soreantibody (Monospot) test.
throat, nonproductive cough) symptoms. In the
ing and are treated symptomatically.
estinal and central nervous system symptoms may suggest
, urinary obstruction) typically require hospitalization and
d at 48 hours.
tyand
detected in patients
inflammatory with infective
markers endocarditis.
(erythrocyte sedimentation rate
hy-guided bone biopsy.
erapy. Bilateral, diffuse interstitial infiltrates are common on
stations (e.g. skin, central nervous system). Nocardiosis is
amethoxazole
icosteroids areisadministered
the treatmentforofthose
choice.
with PaO2 < 70 mm
lve following dental procedures. Patients typically have a
th biopsy. Any patient with HIV who has active CMV disease
e sex with men and travelers to countries where hepatitis A
D4 counts < 200/mm3 may have difficulty clearing the
heallvaricella vaccine.
such patients should have further evaluation with
nd leukocytosis. Treatment includes a tissue agent (i.e.
ely by clinical and radiographic findings (> 1 cyst often with
titutional and gastrointestinal manifestations, anemia, and
erpiginous reddish-brown tracks. Ivermectin is typically
te. Systemic symptoms (e.g. malaise, headache, fever) may
d cytomegalovirus (CMV). In the absence of prophylaxis,
uld be tested for CMV.
gias, and diarrhea. Important diagnostic clues include oral
nfluid
traditional HIV granules
with sulfur risk factors are absent.
(discrete, yellow granules).
pyelonephritis, or unusual urinary findings (e.g. gross
ymptoms include chronic, anesthetic, hypopigmented lesions
ally requiresIt aisbiopsy
d crusting. causedfrom the active edge
by reactivation of the lesion.
of varicella zoster
vir, famciclovir, valacyclovir).
d. In addition, tetanus immune globulin should be given to
ne
nd status is uncertain.
extremities. Disseminated gonococcal infection should be
the fastidious nature of Neisseria
cteristic triad of periorbital edema,gonorrhoeae.
myositis, and eosinophilia
ges.
eheated. Symptoms begin rapidly after ingestion, usually
phadenitis, and a warm, tender, erythematous rash with
m, resulting in urine alkalinization (pH > 8). This decreases
sphate).
s, carditis, and/or neurologic manifestations. Lyme carditis
chloroquine resistance, patients typically receive
insecticide-treated bed nets) are also recommended.
and doesdecrease
A 4-fold not poseina antibody
risk to thetiters
fetus.
at 6-12 months indicates
acranial pressure. Antiretroviral therapy should be deferred
lesions appear as violet papules, nodules, or plaques. KS
unts < 150/mm3 are sometimes given prophylactic
exposure to blood or body fluids from an HIV-infected
m. C. parvum infections may be transiently severe but are
omised
can be(e.g. AIDS)with
confirmed are at risk for
a stool chronic
assay infection.
for Shiga toxin. If
mptoms, leukopenia and/or thrombocytopenia, and elevated
eats, cough), treatment of LTBI with 9 months of daily
the same time as antibiotics and discontinued if cultures
h or without central clearing. The diagnosis is made clinically
st), knees, and ankle joints. The diagnosis can be confirmed
zed lymphadenopathy. Patients may develop autoimmune
ve had solid organ transplantation. Many patients also

es usually show anemia with signs of intravascular hemolysis
d ulcers and intranuclear inclusions; it is treated with
fections.
water supplies. A history of recent travel is common.
de macrolides ormay
Blastomycosis fluoroquinolones.
cause skin and bone lesions in addition
hotericin B may be used to treat symptomatic
oral mucosa and with procedures disease.
involving incision and
eatment of native-valve endocarditis should be geared
antibiotic for these patients.
ctive endocarditis
as possible prior to initiating
for suspected antibiotic
herpes simplex therapy.
virus encephalitis
icated when the animal is unavailable or symptomatic.
ayPEP.
form along lines of lymphatic drainage. Deeper tissues
minated infection may occur even in immunocompetent
abscesses.
require antifungal therapy. Patients who are at high risk (e.g.
idosis deteriorates after immunosuppressive therapy. In
nally
is initiated.
in ketoacidosis). Treatment involves surgical
mia, ketoacidosis).
ic spread is common. Diagnosis requires sinus endoscopy
ent. This hepatic injury is typically self-limited and will resolve
ally demonstrates hepatitis B surface antibody (which
eive both the HB vaccine and HB immune globulin as soon
itus. Physical examination and laboratory analysis reveal
ly recover
Atypical in 3-6 weeks.
lymphocytes on peripheral smear are characteristic;
ures are obtained. Empiric monotherapy with an
ng induced sputum or, if this is unrevealing, bronchoscopy
t cough, and nonexudative pharyngitis. Chest x-ray often
esolve
acute or the infection
chronic completely.
symptoms (e.g. fever, fatigue, cough,
an anaerobic lung infection should be suspected. Common
HIV (CD4 count < 200/mm3). Manifestations include
ing brainfurther
require lesionsevaluation
with no mass
with effect
upper (edema).
endoscopy and biopsy
le is the first-line treatment; concomitant corticosteroids are
esymptoms
risk of worsened
may be hypoxia
absent).with treatment
In patients initiation.
with CMV, the
tis help narrow the differential diagnoses. Work-up typically
n.l, and lymphadenopathy. Diagnosis is typically made with
apy should be initiated to prevent future infection.
mplicated organism.
ent treponemal antibody absorption) have higher sensitivity
CD4 count < 100/mm3). An MRI of the brain reveals multiple
ver and headache, followed by a maculopapular or petechial
ma and shock can
supplementation occur.
when treated for latent or active
xinelikely
ore deficiency.
to have epididymitis due to sexually transmitted
y active suggests chlamydial urethritis. Nucleic acid
topical high-potency glucocorticoids. The disorder is self-
irmed when digital rectal exam reveals exquisite prostatic
n. It can lead to infertility due to testicular fibrosis with
enital absence of the bilateral vas deferens, a cause of
ent includes α blockers (e.g. terazosin, tamsulosin), 5-α
wever, these medications can cause hypotension, especially
DE-5) inhibitors (e.g. sildenafil). PDE-5 inhibitors are
ons (e.g. trazodone, prazosin) and medical conditions (e.g.
ctile dysfunction. Normal nocturnal erections indicate intact
or hematuria and infection. Prostate-specific antigen should
elief of symptoms. 5-α-reductase inhibitors can be used as
Urine culture is required to establish the underlying

symptoms (e.g. frequency, urgency, hesitancy); perineal or
ctase
s in a inhibitors.
process and finding solutions to any problems that
(e.g. intracranial hemorrhage). This causes damage to the
vs. decerebrate).
ic toxicity, which often presents with subtle and nonspecific
s.
n a change in clinical status occurs, the ABCs (Airway,
rotection).
tosis with a mildly elevated white blood cell count, mild
n of peripheral nerve fibers. Because it primarily affects
eakness (with upper and/or lower motor neuron signs),
unction).
a distinct sensory level, and focal T2 hyperintensity of the
activity. Certain medications (e.g. selective serotonin
dication cessation.
First-line treatment includes propranolol, which exerts its
l presentation and diagnostic workup of HIV-associated GBS
sis.
dity) and imaging findings of basilar meningeal
and stroke. Cerebrospinal fluid analysis generally reveals
se.
gh, calf, and dorsal foot, and weakness of great toe
are common. C8 nerve root compression results in sensory
neuropathy. If it occurs acutely, it is likely to be related to a
upper motor neuron signs (e.g. pathologic jaw jerk reflex)
asymmetric weakness with upper and lower motor neuron
ressure ventilation prolongs survival and improves quality of
, compression) as a result of brachial artery cannulation.

tion and respiratory
frequently have skin,acidosis.
renal, and gastrointestinal
nclude permanent vision loss. Definitive diagnosis can be
alnot be delayed
suspicion whilehigh
remains awaiting biopsy
despite results.
a normal CT scan of the
does not decline with successive samples.
experiencing lightheadedness or syncope on standing. The
d increase
achnoid in heart rate.
hemorrhage. Isolated oculomotor nerve palsy can
esses proximally. Older patients with long-standing, poorly
matic
ation management.
can reveal tenderness of the muscles of mastication,
e hand is placed on the top of the head is both diagnostic
nd meningismus are common. Patients should undergo an
uld be performed.
re gradually increasing activity level each 24-hour period
nfarction due to occlusion of the posterior cerebral artery
miparesis.
ons, and/or seizures. The primary treatment is with
nt manner; this results in progressive weakness of both
ion stroke that can be precipitated by vertebral artery
g contraceptives are contraindicated in patients with migraine
ults in a forced upward gaze deviation. Dystonias typically
ment
causeincludes benztropine
skin cyanosis, and diphenhydramine.
respiratory distress, and obstructive
The disease typically presents in late adolescence or early
cular
ring anatrophy,
episode and
bysleep
usingdisturbances are also
provocative head common.
positioning
(e.g. bowel/bladder dysfunction), and sensory deficits with a
er common extrapulmonary manifestations of sarcoidosis
g to impaired absorption of vitamin B12 in the terminal ileum.
ory ataxia,
mptoms of neuropsychiatric changes).
acute phenytoin toxicity include horizontal
alized (often symmetric) myoclonus that involves the axial,
may trigger symptoms, whereas touching or brushing the
on may be needed
is greatest in thosefor more
with significant
advanced age,symptoms.
severe initial pain,
.
pattern) characterized by paresthesia, burning pain, and
e caused by molecular mimicry. MFS is characterized by
uma or illness. It is typically characterized by partial Horner
ic attack,
ults stroke).
in diplopia and lateral gaze palsy. The diagnosis is
uld be performed immediately. Pupil-sparing CN III palsies
us drug use or distant infection. Manifestations include
lected laboratory testing (complete blood count, complete
eted testing.
and diminished reflexes (initially). Vibrioception and deep
mnsthe intact
is an posterior
important spinal
first step arteries.
in evaluating a patient on a
ent, and urinary incontinence. Neuroimaging demonstrates
a new murmur, heart failure due to valvular obstruction
mptoms,with
aluated echocardiography.
cognitive impairment, and chorea. It is associated
d focal neurologic findings. Patients with suspected VaD
in Caucasian women age < 50. Risk factors include vitamin
thic RBD eventually develop a disorder of α-synuclein
es, lower motor neuron signs in the upper extremities (e.g.
ain. Management involves cessation of the culprit
e antiepileptic medication should be administered to prevent
(e.g. short-gut syndrome). Treatment is with intravenous
h the upper and lower face. It is thought to be caused by
elin sheath.
a variety of symptoms, including bulbar muscle weakness.
atory results may demonstrate lactic acidosis, and
lower face. A prodrome of auricular pain may be present.
per extremity myotome, and sensory loss in an upper
hlea. Hearing screening programs are often mandated in
epression may be difficult due to overlapping symptoms with
n peripheral smear. Treatment for symptomatic patients
n the peripheral smear. Diagnosis hinges on a thorough
ciency (e.g. dizziness, ataxia, dysequilibrium) that are
uding orthostatic hypotension, lethargy, and anticholinergic
he inhibitory neurotransmitters glycine and GABA across the
nated or incompletely
e day while minimizingimmunized.
disturbances at night can help
include the slowly progressive onset of ambulation
rdination (e.g. finger-nose test) is relatively intact.
re usually transient (lasting hours) and include foot drop and
extension
ms with preserved
(e.g. nausea, plantar
vomiting). Whenflexion and reflexes.
infrequent, they can be
dered.
t nausea and vomiting as well as blurry vision are
e performed to evaluate for cerebellar stroke or hemorrhage
nying
mation. headache.
This condition usually occurs within 48 hours of the
nsient ischemic attack (TIA) symptoms usually last for < 24
ating pains, reduced/absent deep tendon reflexes) and
ment ofcured
tables, choice.
fish) contaminated with botulinum toxin.
scending muscle
who have a low risk weakness.
of seizure recurrence may safely
al may result in seizure recurrence.
he eyelids for several minutes, leading to an improvement in
cific).
se, calcium, magnesium, complete blood count, renal and
enxiety.
furtherThese
evaluation with neuroimaging
symptoms andwith
typically resolve EEG.symptomatic
nths.
can be considered in some patients with stroke, significant
uses include hepatic encephalopathy, uremic
steine testing should be ordered in borderline or inconclusive
n a stocking-glove pattern. Common causative agents
of daily living. Patients typically have abnormal neurologic
disease. Patients can have focal neurologic deficits on
ischemia.
obilinogen levels are typically elevated, and elevated urinary
matic patients require emergent neurosurgical hematoma
with a history of structural cardiac disease (e.g. atrial
embolic strokes.
ude primidone and
ted movements. topiramate.
It is most common in the upper extremities
hanges in head position. It requires urgent diagnostic
sion loss.
Papilledema and focal neurologic deficits may be seen on
m compression.
most commonly in those exposed to hot/humid environments
organ dysfunction.
t become evident (hypodense) until > 24 hours after the
h underlying alcoholism. Features include encephalopathy,
tration.
nsory loss, and gait ataxia. Bowel/bladder disturbances are
paraplegia as a dopamine
cotherapy with result. agonists (e.g. pramipexole) or α-2-
given within 4.5 hours of symptom onset. Before
hould
ten be screened
presents for other
as urgency contraindications
in early to therapy.
disease. It is thought to
onically increasing intracranial pressure.
s, volume depletion, and electrolyte or metabolic
eserved for patients who do not respond to high-dose
entia have an increased risk of developing agitated delirium
nzodiazepines are differential
impairment. The typically notincludes
recommended
dementia in with
this setting.
Lewy
ocephalus.
precede,
with rapidoralternating
appear along with, parkinsonian
movements, hypotonia,features.
and intention
physical examination is grounds for a clinical diagnosis of
(CT scan, MRI) typically reveals a single ring-enhancing
r due to embolic infarction or immune complex-mediated
often affect the internal capsule and result in pure motor
protein level with normal cell count (albuminocytologic
muscle weakness as well as symmetrical proximal weakness
ation of a foreign body in the eye. Absence of eye pain
l sensation.
ess related to cardiovascular causes (e.g. aortic stenosis,
her
normal. true
than vertigo.
Glucocorticoid-induced myopathy slowly improves
clude L5 radiculopathy and compression peroneal
amage to the inner somatic nerve fibers while sparing the
nse.
n, and a dilated pupil with poor light response. Untreated,
ltation
and can is progress
required. to involve other extremities, jaw, face,
often medication-related. Discontinuation of the causative
prolonged standing. Episodes typically involve a prodrome
matoma often presents insidiously weeks after the initial
ad to paralysis and arrhythmia. The ECG may show U
dicular lower back pain plus impaired motor/sensory/reflex
pression. These include weakness, hyperreflexia, and an
xtremities. It is performed by having the patient outstretch
mof turns (pronates)
the spine. toward the
Most patients floor.treatment with broad-
require
irmness of the eyeball, and a fixed, mid-dilated pupil. The
gra. A shuffling gait (i.e., the patient appears as if he was
Symptoms are often worse at night and with body
h high-grade carotid stenosis (70%-99%) should be
paresis and diminished proprioception, vibratory sensation,
evels
gmus), distal
andtoHorner
the cord injury and
syndrome. below.
Motor function of the face and
s and occlusion of deep penetrating branches of the major
monal deficiencies.
eadaches may be accompanied by redness and tearing,
the nondominant parietal lobe (the right lobe in right-
ormal facet joints, including the presence of sclerosis and
sory modalities (i.e. pure sensory stroke). Weeks to months
that
and is exacerbated
more pronouncedby light
at thetouch (allodynia).
end of goal-directed
mptoms. The diagnosis is clinical.
ed sensation in the medial hand, decreased grip strength,
ay still be functioning; therefore, deep tendon reflexes may
ymerase chain reaction analysis is the gold standard for
ncontinence,
ing permanentorinjury
otherdue
autonomic symptoms.
to excitatory cytotoxicity. Cortical
nial disease. In patients with multiple brain metastases,
apy and/or antidepressant medications are the treatment of
the involved vasculature. An anterior cerebral artery stroke
Urinary
HD is anincontinence can also CAG
autosomal dominant be seen occasionally.
trinucleotide repeat
e;side effects.
upper motor neuron signs may also occur. Neuroimaging
disease. However, it is accompanied by other symptoms of
), which appear as an anterior mediastinal mass on chest
moking,
s causedand sedentary lifestyle.
by autoantibodies directed against the voltage-
sed deep tendon reflexes.
eakness leading to respiratory failure. Symptoms are often
certain
ough medications
those (e.g.offluoroquinolones).
with a history opioid addiction who are given
management includes riluzole (a glutamate inhibitor) and
mary motor cortex, and contralateral apraxia due to
ve their anticoagulation immediately reversed with
lies adjacent to the putamen is almost always involved,
lasmapheresis (or intravenous immunoglobulins) and
ortant as emergency surgical decompression may be life-
weakness that disproportionately affects the upper
and can be associated with symptoms of elevated
ceive
oral a head CT without contrast
acetylcholinesterase to rule
inhibitor, is theout hemorrhage.
initial drug of
h rigidity. Tremor is often the presenting symptom of PD.
tremor is the primary symptom.
, levodopa
ven arehours
within 24 associated with thispresenting
to all patients adverse effect.
with ischemic
r cerebrospinal fluid analysis; this analysis shows oligoclonal
nance therapy in patients with relapsing-remitting or
mary treatments. However, they may be used as bridging
nt CAG trinucleotide repeat expansion disease that is
with thunderclap headache and symptoms of meningeal
m andbybasal
nied cisterns.
nausea/vomiting and photophobia. Patients who
treatment,
Management including topiramate,
includes emergency β blockers, or amitriptyline.
surgical consultation,
ly in the elderly. It occurs due to β-amyloid deposition in the
artery; therefore, patients with vascular risk factors should
mandibular) branches of the trigeminal nerve. Multiple
as
of leukopenia.
the trigeminal nerve (CN V), often triggered by minor
ed imaging usually demonstrates multifocal, ovoid,
esentations include optic neuritis (e.g. monocular blindness,
scharges on electroencephalogram. This spongiform
itive symptoms and temporarily improve functioning in
ombosis. Red-flag symptoms include severe headache;
teral motor function loss at and below the level of the injury
n, vibratory sensation, and light touch are unaffected.
, widespread pain, and cognitive/mood disturbances.
ponding to tricyclic
age > 50. Potentialantidepressants.
complications include anterior ischemic
-dose intravenous
nd abducens nerveglucocorticoids.
(CN VI) palsy. Diagnosis is confirmed by
, and gait ataxia. This is generally seen in malnourished
ine.
hanges. Psychotic symptoms (delusions, hallucinations) may
s tend to present initially with focal symptoms but can rapidly
hich is most prominent in the hippocampi and surrounding
ve sheath fenestration may be performed to prevent
nus, periodic sharp-wave complexes on
plasmin, increased urinary copper, and Kayser-Fleischer
roticchanges
ect, plaque from the perception,
in color ipsilateral carotid artery.
and pain with eye
ting in imbalance).
ex are inconsistent with diabetic neuropathy and are
rction. Vasospasm can best be prevented with initiation of
tion below the level of the lesion.

e.g.
asedfasciculations,
eye lacrimation,atrophy) motor neuron
hyperacusis, lesions.
and reduced taste
ral hemiparesis and contralateral sensory loss due to injury
CT in identifying most structural causes of epilepsy and is
nant and postpartum patients are at increased risk for
valuate for thymoma and for possible surgical planning, as
not effective, intermittent doses of short-acting opioids
ting opioid
function, may be change,
cognitive added. or seizure. An MRI of the brain
ms are positional and remain while standing still. Pain is
Treatment of GBS includes intravenous immunoglobulin or
ver and sensory abnormalities, and normal CSF
results
he pontinein spontaneous improvement
artery distribution; however,in bilateral
most patients.
lesions are
s, and executive dysfunction; memory difficulties tend to
ssociated with the expression of Epstein-Barr virus
homogenous
spondylitis). ring-enhancing mass.and features suggesting
Patients with uveitis
an
is alymphocyte antigen B27(e.g.
topical prostaglandin typing).
latanoprost, bimatoprost),
timolol) can be added.
ry response. Complications include decreased visual acuity,
s, bacterial infection, viral infection, and Demodex mite
with systemic inflammatory diseases such as certain
ation of the cornea. Most cases are due to Gram-negative
broad-spectrum
on antibiotics.
in sporadic outbreaks, especially among children and
perinfection which requires
y are usually the first affected, topical
and antibiotics.
patients with this
duscopic findings of hemorrhages and fluffy or granular
ye. It is due to an immunologic mechanism involving the
ma, corneal opacification, and a mid-dilated pupil. Gonioscopy

ged individual who has to hold books at an arm's length to
ema), pre-proliferative (cotton wool spots), and proliferative
ulation
ws is performed
a 'blood for the
and thunder' prevention
appearance of complications.
consisting of optic disk
nts with diabetic retinopathy.
lytic Streptococcus
necessitates are the
antiviral usual infecting
medication organisms. and,
(e.g. valganciclovir)
d progression.
s an insidious course, and patients frequently are
n and blurred vision associated with nausea and vomiting.
by intense itching, hyperemia, tearing, and edema of the
al
s, vision.
tender Navigational
nodule at thevision is preserved.
lid margin. It is often due to infection
issues and bloodstream. It is diagnosed clinically, and the
ataxia and declining mental function that can occur after
res immediate
all local descent.
reactions require no treatment. Large local reactions
xaminations and laboratory evaluation are important. Most
and an anion gap metabolic acidosis. Hemodialysis is
ered mental status, and seizures. Hypoglycemia is often
venous
urn afterglucagon.
cessation of exercise, which fails to meet increased
oms), followed by pralidoxime, a cholinesterase-reactivating
rmed with the measurement of red blood cell
ized by signs of cholinergic excess (e.g. miosis,
nhibitor
adycardia, of acetylcholine
hypothermia, at thedecreased
and muscarinic receptor.
bowel sounds may
s) who has painful sensorimotor polyneuropathy, skin
with
passive elevated urine arsenic
rewarming. levels.hypothermia requires
More severe
ssociated with hypothermia is often refractory to treatment
mpirically for cyanide toxicity with an antidote, such as
ve phosphorylation and promotes anaerobic metabolism,
nsomnia), neuropsychiatric (e.g. neurocognitive deficits,
alleviate the acidosis, and hemodialysis in cases of severe
ltered mental status, hypothermia, and miosis (which may
ation of naloxone.
nd arthralgias. Examination can show hypertension,
reatment of choice.
ed to improve blood pressure, narrow the QRS interval, and
owing an elevated carboxyhemoglobin level, and treatment
arbonate is used to treat cardiac toxicity, which is
ribrillation).
rewarming is not recommended, and rewarming should not
pharyngeal erythema and ulcerations. It does not cause
re). First-line treatment is rapid cooling with ice water
(104 F) with CNS dysfunction (e.g. encephalopathy). Other
%oagulopathy,
oxygen via apulmonary edema).
nonrebreather facemask. Early symptoms of
tion reveals optic disc hyperemia while laboratory studies
H and extracellular sodium, thereby alleviating the cardio-
ent is gastric decontamination and measurement of
ection. Marijuana use slows reaction time; impairs attention,
be distinguished from opioid overdose by the lack of severe
upils, blurred vision, reduced bowel sounds, urinary
perforation, endoscopy should be performed within the first
te suggests use of saline osmotic laxatives), and stool
vented through interdisciplinary (e.g. pharmacist)
ver, unlike most dementias, depression-related cognitive
or no somatic
ultiple cognitivesymptoms.
domains. Mood and behavior disturbances
0/mm3.
r duration of effect, the effects of synthetic cathinone
dtimes, resulting in sleep-onset insomnia and excessive
schedule and a quiet, dark, and comfortably cool bedroom;
heavy
cause meals in the evening.
extrapyramidal symptoms such as acute dystonia,
otonin reuptake inhibitors are generally used as first-line
of alcohol withdrawal (e.g. tremor, anxiety, diaphoresis,
onsistent with arterial blood. Ultrasound guidance helps
entilation and hypoxemia. Pulmonary complications of
rt.
elayed pulmonary
tion/perfusion and complications.
metabolic status and is the most reliable
TT placement.
ending respiratory failure should be considered in patients
entilation that is driven mostly by increased tidal volume.
FEV1pulmonary
using are unchanged fromremodeling.
vascular normal levels.
Symptoms include
d expiratory pressure. The diffusion capacity for carbon
ndistinguishable from ACS and may be the underlying
pneumonia, which causes prolonged chest x-ray findings,
ging with high-resolution CT scan of the chest to identify
particularly when treatment for common pulmonary diseases
ytic infiltrate, non-necrotizing granulomas, and interstitial
e cough, and fatigue that coincide with intermittent exposure
al of antigen
ckles. exposure.
Characteristics that favor HAPE over multifocal
plemental oxygen.
rates. Characteristics that favor HAPE over multifocal
ement of hypoxemia
ate central with supplemental
chemoreceptor oxygen.
inhibition of the hypoxic
ymptoms. Lung examination is normal. Initial treatment is
osis.
idity and mortality from lung cancer. Screening should
diovascular or respiratory system. Other common
heintramuscular epinephrine.
side of alveolar collapse. Dullness to percussion and
educed FEV1, normal or reduced FVC, normal or increased
Hg) can cause delirium, confusion, lethargy, and eventually
surgery as it has been shown to reduce the risk of
be accomplished via increased respiratory rate or tidal
ent mental alertness to protect the airway. Patients who
Precipitants include infection, medications, surgery, and
y cough, and erythematous rash. Symptoms usually begin 3-
ofalbuterol
nitrofurantoin.
(inhaled short-acting β-agonist) for bronchodilation
onstriction and a glucocorticoid (e.g. prednisone) to control
curs in patients age 50-70. It is associated with a restrictive
of the pulmonary arteries. Absence of alveolar airspace
t-sided
pnea andheart
oftenfailure.
leads to right ventricular enlargement and
ociated wheezing due to underlying asthma may benefit
to assess bronchodilator response. Other common causes
hood. The diagnosis is confirmed on pulmonary function
asthma regardless of age.
pleural effusion typically shows decreased breath sounds,
bined antihistamine-decongestant (e.g. brompheniramine
with capillary leak and intravascular hypovolemia. This leads
emoptysis in adults. Chronic bronchitis is defined as a
ains normal in extrinsic causes of restrictive pulmonary
vated right atrial and pulmonary artery pressures along with
make the consolidation more gravity dependent worsen
eria within
nists the pleural fluid.and systemic glucocorticoids. In
and anticholinergics)
mbination of increased dead space perfusion causing
emoglobin
. Depending saturation in these
on how much patients
of the lungsisare
90%-93%.
affected by
.d acute dyspnea, pleuritic chest pain, and tachycardia. The
lation and
essure andhypotension.
positive end-expiratory pressure (PEEP) and is
corticosteroids. Elevated or even normal partial pressure of
a result of and
ntubation mechanical
pulmonary ventilation.
infarction. Chest CT scan showing a
later in life (generally > 10 years after therapy). Solid tumors
common.
poventilation is a major cause of respiratory acidosis and
c medications may be combined with short-acting β-
total lung capacity, functional residual capacity, and residual
avity, resulting in increased work of breathing.
bolic alkalosis.
rcapnia (with a compensatory metabolic alkalosis),
al lung capacity. FEV1 is disproportionately decreased as
ed by hypotonic hyponatremia in a euvolemic patient.
he tip between the carina and vocal cords and solve the
monstrate pH and glucose levels near those of serum, as
ttom of the
patients flow-volume
with severe renalloop.
insufficiency (estimated
bability. However, a normal D-dimer result is not useful in
by persistent
mild more specific studies.
asthma require a daily controller medication
emic areas (especially Mexico, the Philippines, China,
(PE). PE can cause pleural effusions (typically small,
ollowed usually by chest computed tomography. The
e and smoking
monary functionhistory.
tests show a mildly restrictive pattern with
and S4 gallops, cardiomegaly, and bibasilar crackles in the
a patient with COPD, is commonly triggered by an upper
l infection is the typical etiology, and symptoms are usually
easing positive end-expiratory pressure (PEEP). If high
iO2 as oxygenation
xpiratory improves.
pressure (PEEP). FiO2 should be reduced as soon
te oxygenation.
d PaCO2 (i.e. mixed primary metabolic acidosis and
compromise. Risk factors include immune disorders such
certrophic
mast cellosteoarthropathy
activation. refers to digital clubbing along
geal reflux disease. The diagnosis of upper airway cough
veolar hypoventilation. Arterial blood gas will show
pressure. Exudative effusions are often the result of
nocturnal hypoventilation. Common manifestations include
reased tactile may

by thrombus fremitus.
cause pulmonary infarction with pleuritic
s a result of microaspiration. In asthma patients with signs
toms and peak
obstructive expiratory
pulmonary flow rate.
disease. Signs of RHF include jugular
galy, dependent pitting edema, and possible ascites.
ns, substance
istory P, prostaglandins,
of underlying lung disease.and thromboxane.
Imaging usually reveals >
racteristic symptoms and radiographic findings.
occur in acute PE. An elevated alveolar-arterial oxygen
eated with an intranasal antihistamine, intranasal
tine chest x-ray by the presence of bilateral hilar
are generally clear to auscultation. Chest x-ray would show
e.
ly and include fever, chills, productive cough, leukocytosis,
xygen saturation (SaO2) < 88% are candidates for long-term
2 < 59 mm Hg or SaO2 < 89%.
umonia due todisruption
r mechanical impaired swallowing and cough
of glottic closure. reflex.
Patients usually
ysema-predominant COPD. Interstitial lung disease is also
hen patients are exposed to soil contaminated by bird or bat
xposure) may have
ormal or elevated subacute
PaCO2 is anpulmonary illness.
alarming and extremely
aging (e.g. chest x-ray). Sputum and blood cultures are
art failure.
ngestion *Extremely
following high
aspirin yield question
ingestion. for USMLE!!!
Treatment includes
ne receptor antagonists (e.g. montelukast).
-sided 12%). Normal pleural fluid pH is 7.60. Transudative
disturbances (e.g. nausea, vomiting), and cardiac toxicity
w therapeutic
nary disease haswindow.
been shown to decrease mortality, rate of
nh is recommended
moderate for exacerbation
to severe patients who and
fail athose
trial ofneeding
NPPV.
circulating
possible) neutrophils.
due to the risk of Clostridium difficile infection,
mal airflow after bronchodilator administration rules COPD
creased renal perfusion and activation of the renin-
medication.
te decompensated heart failure in previously well-
such as the distal digits. The resulting digital tissue necrosis

pain, Horner syndrome, or neurologic manifestations in the
or to pursuing confirmatory diagnostic testing in patients with
rveand
pulmonary disease. tract disease and glomerulonephritis.
lower respiratory
owing linear IgG antibodies along the glomerular basement
typically leads to bronchiectasis located predominantly in the
wth over 2-3 years rules out malignancy. If previous films are
y using lung protective strategies such as low tidal volume
, it improvesismortality
epinephrine the best in patients to
treatment with ARDS. the
minimize
ogies, atrial rate > 100/min, and an irregular rhythm. It is
ecting the underlying inciting
ed bronchoconstriction disturbance.
if required only a few times a week
ammation and glomerulonephritis that can be rapidly
ation. In mechanically ventilated patients with respiratory
ve impaired gas exchange resulting in reduced diffusion
isease and
volume significant sputum
mucopurulent chronic hypoxemia.
production, hemoptysis, and
g medications, and sleep disorders. Obstructive sleep apnea
yedisease
diagnosis.
(e.g. age < 45) or those with atypical features (e.g.
CT scan of the chest should be used to evaluate patients in
V1 and FEV1/FVC ratio, and no limitation on daily activity.
daily controller medication (e.g. inhaled corticosteroid).
weakness, hyporeflexia,
sion lung capacity, and aand life-threatening
normal arrhythmias.
FEV1/FVC ratio. Pleural
alignancy diagnosed in patients exposed to asbestos.
me overload. It results in impaired gas exchange, decreased
he cornerstone of HP management is avoidance of the
n, and hemoptysis. CT scan often reveals pulmonary
n echinocandin
liver (e.g. caspofungin).
disease. It should be considered in patients who have
ciency (e.g. hypovolemia, hyperkalemia) are present in PAI
vere hypoxemia, and bilateral alveolar infiltrates on chest
ng causes
er cancer.(e.g.
Fluidmassive
restrictiontransfusion).
is the initial treatment of choice in
ng cancer have no history of smoking. Women who have
ho presents with some combination of sudden-onset
mon examination
opathy. findings.
This condition is often associated with lung cancer,
esents with sudden-onset shortness of breath, hypotension,
und, which should be obtained in all patients being evaluated
sibility of in
erformed kidney injury.
6 weeks to confirm resolution of hematuria; if
1 RTA results from impaired H excretion in the distal tubule
ently dilute urine. Lithium-induced nephrogenic DI results
er reabsorption.
hydrogen ions to bind to albumin; elevated pH causes
cium.
xicity. Acute calcineurin inhibitor toxicity is often triggered by
omerulonephritis (e.g. hematuria, proteinuria, renal
ate with
tients risk
with of nephritis. are at risk of developing acute
rhabdomyolysis
ion. Rhabdomyolysis is suggested by dark urine, blood on
without casts. A wedge-shaped cortical infarction on CT
nosis iscardiac
fever, confirmedmurmurs, and leukocytosis.
with biopsy demonstrating amorphous
ea nitrogen/creatinine ratio (~10-15:1). Usually, renal injury
ition with local ischemia and necrosis. It is primarily seen in
calcemia, although
n is most likely due serum calciumsyndrome,
to cardiorenal is often normal.
which involves
output also plays a role.
. The increased HCO3 reabsorption leads to increased
nd blood (H2PO4).
osphate pressure via vasoconstriction and kidney-mediated
e of inappropriately high levels of antidiuretic hormone. In
nts whose condition does not respond to these therapies are
disease. Typical findings include headache, confusion,
to be glomerular if the urine studies reveal proteinuria,
also competitively inhibits renal tubular creatinine secretion
ovolemia, hypotension, and decreased renal perfusion (via
n of nephrotic syndrome. Nephrotic syndrome, and
ulting in hypercoagulability.
of excess bicarbonate (maintenance phase). Treatment
sis), gastrointestinal losses, and renal potassium wasting
ion, minimal hematuria, and lack of improvement with
tion
lectswith decreased
damage perfusion.
anywhere in the urinary tract. Clots are not
Persistent proteinuria in a patient with long-standing
, renal dysfunction.
ed
asurine (increased
urinary retention.urine
Due pH).
to a high prevalence of benign
xicity of heme pigment, which is contained in the myoglobin
nd red cell or mixed cellular casts. Edema in these patients
ften a history of poor oral intake or excessive volume loss
ne sediment.
e setting of long-standing diabetes, suboptimal glycemic and
rdiovascular mortality.
ce, or drinking water; family history can also indicate
lconclusively improve
saline hydration, andoutcomes, so it is not
using the smallest recommended.
possible volume of
structural degeneration of the kidneys and include
s.
ompensatory metabolic alkalosis. Diuretics are often
and
the subsequent development
serum sodium of prerenal
concentration with 3%acute renal injury.
or hypertonic
tion and discontinuation

pophosphatemia). of lithium.
Hypomagnesemia can lead to refractory
a the stool (e.g. patiromer), kidneys (e.g.replacement.
hat is difficult to correct with potassium furosemide),
vels and renal function must be monitored closely during
hy or a noncontrast spiral CT scan of the abdomen and pelvis
iation exposure.
eitors,
the risk of lactic II
angiotensin acidosis.
receptor blockers, and nonsteroidal anti-
ia, increased susceptibility to infection, and vitamin D
s and hypokalemia. Bicarbonate levels rise as a result of
tended bladder. Patients can then develop overflow
er quality of life and improvement in ESRD-associated
mass include a multilocular mass, irregular walls, thickened
rides, and hyperuricemia. Electrolyte abnormalities that can
nt. Affected patients typically experience an asymptomatic
nt is with high-dose
maintaining moderateintravenous glucocorticoids.
calcium intake, and taking thiazide
. Prerenal AKI is characterized by low urinary sodium (< 20
bland.
ne; alkalization of the urine to pH 6.0-6.5 with oral potassium
elated risks (e.g. anemia of chronic kidney disease, oxidative
nterstitial nephritis are the most common pathologies seen.
urinary tract cancer.
ect.
nic kidney disease due to tubulointerstitial nephritis and
osis, and rheumatoid arthritis is the most common cause of
ently with the drug can help reduce the risk of acute kidney
ion, reducing glomerular hydrostatic pressure and slowing
nts with heavy proteinuria, rapidly progressive renal failure,
ng can occur in the setting of physiologic stress (e.g. low
titial nephritis and pyelonephritis; Fatty casts - Nephrotic
ers from endothelial storage sites. Platelet transfusion is not
ernative complement
arteriolosclerosis and pathway.
ischemic glomerulosclerosis. Clinical
o intracranial bleeding. This association is likely related to
sent with the disease.
with nephritic syndrome with low serum C3 and C4 levels.
emal dietary
to renal calcium
artery intake.Renal artery stenting or surgical
stenosis).
art
ales.failure
Otherdue to severe hypertension.
predisposing factors for UTIs include sexual
h suspected UTI. Positive leukocyte esterase signifies
mporary (e.g. intravenous insulin) and definitive (e.g. cation
trasound is advised for assessment of hydronephrosis in
sh it from other entities (e.g. diuretic abuse, Bartter’s
hostatic hypotension, hyponatremia, and hypokalemia.
nsteroidal anti-inflammatory drugs, and diuretics. Patients
eeosinophils.
hypokalemia, metabolic alkalosis, and prerenal kidney
solves without treatment within 90 minutes following
), and the alkalosis corrects with Cl- repletion (saline
angiotensin-aldosterone system, and increased urinary
l.
sistent hyperkalemia, and mild-to-moderate renal
a mixed primary respiratory alkalosis and primary metabolic
ate crystals (square, envelope-shaped) are seen in patients
ause blindness.
ecreased PaCO2. The pH can be restored to near-normal
creased by the abnormal presence of non-chlorinated acids
ial primary disturbance. Sepsis with respiratory failure is a
calculated from these values using the Henderson-
O2. Serum HCO3 remains near normal in the acute setting
nd dilute urine with urine osmolality < 100 mOsm/kg. Those
nates further reduce calcium levels and are given after initial
is (due to loss of antithrombin III). Atherosclerosis and
iated withdiuretics,
ntaining membranousNSAIDs,glomerulopathy.
rifampin, phenytoin, and
ms the diagnosis. Patients can be treated without a urine
omycin
includeare effective first-line treatment
hypocomplementemia, options.
polyclonal IgG, and
ier onset of upper respiratory tract infection-related
abdomyolysis is often suggested by positive blood on
calcium oxalate and calcium phosphate. Risk factors include
fricanstones
ning are patients
American radiopaque.and in those with obesity, heroin
s renal cell carcinoma (RCC), that obstructs venous flow. CT
have acute renal failure (creatinine > 1.5 mg/dL) with a very
ove with intravenous
ly in patients with typefluid resuscitation.
2 diabetes mellitus starting at
ually respond to fluid restriction. Patients with severe
w serum osmolality (< 275 mOsm/kg), high urine osmolality
nates further reduce calcium levels and are given after initial
hibitors, angiotensin II receptor blockers, and nonsteroidal
perparathyroidism, which has increased urinary calcium
ee mechanics. Treatment includes quadriceps and hamstring
tenderness. It most commonly involves the first
sis, and
tory periarticular
drugs (NSAIDS) osteophytes.
(e.g. diclofenac) are beneficial for most
ts an infectious or inflammatory etiology and warrants bursal
sm syndrome. Diagnosis is made based on clinical signs
agnosis is made clinically. Imaging is not required unless a
ugs. For chronic symptoms, a rehabilitation program
, given that the underlying pathology is chronic tendinosis
ents with localized pain and paresthesia in the lateral thigh
mmatory drugs), but therapeutic phlebotomy is necessary to
C-reactive protein), and the condition responds rapidly to
n be caused by external compression of the nerve at the
are ineffective, a short course of a nonbenzodiazepine
mia, renal insufficiency, and hypercalcemia suggests multiple
sclerosis. The mainstay of treatment is ACE inhibitors
blood
systemicpressure.
lupus erythematosus (SLE). The antinuclear
monly involve the joints of the hands and feet; soft tissue
nd (often) low pH and is associated with interstitial lung
rkers (seronegative RA) may have a more favorable
ain in a regional (not dermatomal) distribution. It is often
initiation and periodically thereafter. Much of the toxicity of
effectiveness of the drug.
nated peptide antibodies or rheumatoid factor. Disease-
arthritis should include inflammatory markers (e.g.
odies),
ritis or and x-rays of
symmetric the symptomatic
polyarthritis joints.rheumatoid
(resembling
tic
darynail changes
causes such as pitting
of osteoarthritis (present
include in > 90%).
infection, inflammatory
after initiation of causative medications. Hydralazine is
ymptom
groups. In management.
a patient with longstanding diabetes, these
ing,
ith dry eyes andjoint
ulceration, drysubluxation, and Charcot
mouth but occurs arthropathy.
in younger patients
duloxetine, but opioids, benzodiazepines, and muscle
ing of the arterial lumen. Treatment includes systemic
osis factor inhibitors and IL-17 inhibitors are used in patients
evated, more specific autoantibodies (e.g. anti-double-
ost patients have high-titer rheumatoid factor and anti-
ncreased
omonic for due to neutropenia.
osteoarthritis. Osteoarthritis of the hands is
agnosis or management.
Examination shows decreased active and passive range of
primary, or may occur in association with systemic disease,
ry markers.
volves mainly calcium channel blockers (e.g. nifedipine,
hows leukocytosis (2,000-100,000/mm3 with > 50%
ngs; symptoms are typically reproducible with isometric
cal care for symptom evaluation and changing to a non-
uch asduring
space a generalized tonic-clonic
compression seizure.
may reveal crepitus (Mulder sign).
ymptomatic, but symptoms may include skeletal deformities,
ons.
ndings include bony enlargement and tenderness, crepitus
tract). Treatment usually involves treating the underlying
ery or medical illness. Pseudogout is diagnosed with
fied articularstiffness,
ts. Morning cartilage).
deformity, dactylitis ('sausage digit'),
nts, methotrexate,
nces. Diagnosis isandmadeanti-tumor
clinicallynecrosis factor
using the agents. pain
widespread
obvious synovitis, and usually follow a chronic, protracted
chronic inflammation. In addition, spinal rigidity in these
arthritis may include urethritis, conjunctivitis, mucocutaneous
is. NSAIDs are the first line therapy.
ngal in ankylosing
spine can leadspondylitis and other
to atlantoaxial spondyloarthropathies.
subluxation and spinal cord
Much of the toxicity of methotrexate can be mitigated by the
ent includes adequate physical activity, optimization of
atients with underlying joint disease. Synovial fluid analysis
ypically felt in the groin, buttock, or lateral hip (trochanteric)
se with
in uric acid
rest production.
(e.g. at night), and improves with activity. It
hthighs
inflammatory bowel
that is worse disease).
with lumbar extension and persists while
. MRI is indicated for patients with abnormal findings on
istalsis and decreased tone in the lower esophageal
re common adverse effects. The toxicity of methotrexate
rug.
ications for lowering serum urate are indicated for patients
a in the first 3 digits and the radial half of the fourth. The
astic syndrome in malignancy. Patients typically have
pelids (heliotrope eruption).
a compression fracture with acute back pain following
mination is typically
The pain and tenderness normal.
are localized primarily to the
ation are typically normal.
oid use. It causes pain in the groin, thigh, or buttock that is
rlap in disease manifestations between the 2 subtypes,
ngst to a worse
patients prognosis.spontaneous resolution. Initial
experience
en.
nvolvement is common. Thrombosis is a major cause of
cal features.
e appearance.
sed by repetitive, forceful wrist extension. Examination
t-bearing long bones) should be treated to reduce pain and
erapy.
droxyproline levels are increased due to increased bone
ibodies for U1 ribonucleoprotein have high sensitivity and
, and hypertension. Anti-topoisomerase I (anti-Scl-70) is a
lacrimation) with either histologic evidence of lymphocytic
orary symptomatic relief while awaiting response to DMARD
d pelvic girdle, along with an elevated erythrocyte
mptoms.
or peripheral joints. Treatment with nonsteroidal anti-
heryma whippelii. Chronic malabsorptive diarrhea, weight
e, which is frequently discovered incidentally on routine blood
n exclude concurrent osteoarthritis. Management includes
with vertebral metastasis include prostate, breast, kidney,
ntibodies (e.g. antinuclear antibodies, anti-Jo-1 antibodies)
and regenerating
ult patients muscle
will have fibers. an internal malignancy,
or develop
ate
withcancer screening
progression is essentialmay
the symptoms in these patients.
become more persistent
n.
dation of management, with medications (e.g. duloxetine,
onodular infiltrates, and noncaseating granulomas on biopsy.
with systemic
prolonged use.glucocorticoids.
Patients treated with hydroxychloroquine
ign, self-limited course. It is usually seen in adults, whereas
LA-B27 is not specific for AS and not necessary for

bitors, which provide substantial relief of symptoms and may
pain. The leg pain of neurogenic claudication is position-
ent and
weight resolves
and with standing
obese patients. Weightstill.loss decreases the
functional
ltures, andimpairment.
genital/pharyngeal nucleic acid amplification
c findings include calcification of the articular cartilage
riggers include alcohol use, surgery/trauma, dehydration,
id does not rule out septic arthritis as these will be present
on. X-ray findings include a narrowed joint space,
blood cells/mm3).
glucocorticoids (e.g. prednisone), and most patients also
t presents with fatigue, palpable purpura, arthralgias, renal
ng tofactor,
oid elevated transaminases,
chondrocalcinosis, pseudogout,andandkidney injury.
chronic
studies
body to 1and
of 3can be confirmed
phospholipids by genetic tests.
- anticardiolipin antibody, anti-
omen
male who have
athlete an(oligomenorrhea,
triad equivalent risk ofosteoporosis,
osteoporotic fracture.
and
s disease process. Even in the absence of respiratory
nvolvement tends to be symmetric, migratory, and
m pyrophosphate dihydrate (CPPD) crystal arthritis
CPPD
activitycrystals.
modification. Nonsteroidal anti-inflammatory drugs
adjacent joints are common. Involvement of cranial bones
g the interpreter), and apply teach-back (e.g. asking patients
educing fall risk in the elderly) and health care quality while
l factors, including social determinants of health (e.g. access
ess) can be improved by adjusting sensitivity of alarm
mote clinicians' delivery of evidence-based care and high-
and addressing potentially serious concerns) and care
nments that covers low-income individuals and families living
ated with increased health care spending and suboptimal
ally obligated to promote resource stewardship (responsible
y (< 4 weeks) primary care follow-up increases the likelihood
entdiagnoses).
of hand hygiene stations) is a systems approach that
as teach-back (i.e. having patients describe their
ns (e.g. ‘as directed’). Plain-language medication teaching
ations, verbal orders, or third parties to relay messages.
medical
occurs error.
when contextual information (e.g. previous diagnosis)
clude thoroughly evaluating a differential diagnosis. An
for further evaluation, include a clear plan for follow-up, and
iate patients' anxiety that their infection requires antibiotics.
ng individual blame. Interprofessional rounds (i.e. involving
inel events (even
ppropriate such as wrong-patient
if less error. treatment
effective) alternate
ing of dietary intake, exercise, and daily weight is
s.
uld provide a balanced assessment of the recommended
e patient
ror. autonomy
Availability bias and improve
describes thedecision-making.
tendency for recent or
as not yet decided to pursue specific action. Patients
-perceived
netary ability
gifts that aretoofchange).
minimal value and that directly benefit
ing the patient handoff process.

ent outcomes.
dures can be performed on a newly deceased patient for
ontrol; quality of life; and psychosocial, spiritual, and
rfere with understanding or ability to communicate a choice
is upset, and begin the discussion with an open-ended
eir medical
use and takeandanypsychological needs.
necessary action to ensure patient safety.
such treatment. Physicians must be prepared to discuss the
en safety and
physician efficacy.
is justified in restricting individual liberties until the
fore honoring it.

on-making capacity.
he underlying reasons should be explored before deciding
one callers. It is important that health care providers be
mily.
sashould be medical
patient's clarified condition
and the truth toldbe
should to politely
the patient.
but firmly
ortant component of the physician-patient relationship.

mation to deliver the news in an empathetic yet
QID Subject System Topic Objective
Malignant pericardial effusions are often large and pr
20263 Surgery CardiovascuPericardial Effusion via
sideda pericardial
heart chambers, windowleading or prolonged catheter
to decreased draina
cardiac
20261 Surgery CardiovascuCardiac Tamponade increased
Malignancydue to lung
(e.g. compression.
cancer) is a common cause of
20254 Surgery CardiovascuPericardial Effusion to confirm the diagnosis,
Patients with blunt chest trauma evaluatemay for be
signs of subacu
at risk for se
19889 Surgery CardiovascuBlunt Thoracic Trauma hemodynamic
Essential elements discussed during the informediniti
stability, mechanism of injury, and co
19047 Surgery CardiovascuInformed
Venous Consent the risks of refusing treatment.
Post-thrombotic syndrome occurs in > 50% of patient
18775 Surgery CardiovascuThromboembolism of thrombus.
passive, It usually
resulting from presents
transmission with oflegelevated
pain, edema left a
18394 Surgery CardiovascuMitral Stenosis pulmonary arteriolar vasoconstriction
The increase in blood volume and cardiac output ass and remodeling
17968 Surgery CardiovascuMitral Stenosis risk
(e.g.conditions
myocardial during pregnancy;
infarction, coronary therefore, surgicalgrr
artery bypass
17566 Surgery CardiovascuAcute Pericarditis period of several
In patients weeks to chronic
with underlying months.adrenal insufficien
17169 Surgery CardiovascuAdrenal Insufficiency hypotension
Atrial flutter isoften refractory
recognized by to initial volume
saw-toothed resuscit
flutter wave
17090 Surgery CardiovascuAtrial Flutter similar
An risk of arterial
arteriovenous thromboembolization
fistula allows blood to bypass to atrial
the fib
h
17015 Surgery CardiovascuChronic Kidney Disease (preload), and
abdominal increased
pressure cardiac
stimulates output.
stretch A large arter
receptors on t
16712 Surgery CardiovascuAnesthesia atrioventricular block, and sometimes
Persistent tachycardia and new arrhythmia (e.g. prem asystole.
16349 Surgery CardiovascuBlunt Thoracic Trauma admitted for continuous
Pleural effusions occur incardiac almostmonitoring and echo
half of patients who
15921 Surgery CardiovascuCABG effusion is small to moderate in
pain, chest wall edema/crepitus, and purulent dischasize, begins within 1
15920 Surgery CardiovascuCABG imaging. Radiographic
and 'clicking' with chestfindingsmovement. includeThefluid collection
diagnosis ca
15919 Surgery CardiovascuCABG diagnosis. Management involves urgent surgical expl
15900 Surgery CardiovascuAcute Limb Ischemia Indications for lowercollateral
Due to pre-existing extremitycirculation,
amputationacute includelimbnois
15899 Surgery CardiovascuAcute Limb Ischemia Emergency
ovarian (e.g.intervention is still necessary.
infertility) disorders. Cardiovascular dise
15893 Surgery CardiovascuAortic Dissection further increased during pregnancy.
Type A dissections involve the ascending aorta and p
15889 Surgery CardiovascuAortic Dissection syncope,
Cocaine can stroke,
cause myocardial
rapid andinfarction,
transient or heart failure
hypertension
15888 Surgery CardiovascuAortic Dissection
Ehlers-Danlos tearing, and pleural
Ehlers-Danlos syndromeeffusion is amay occur of
collection due to hemot
genetic con
15873 Surgery CardiovascuSyndrome wound healing, and cigarette, paper-like
Pain is the most common manifestation of abdomina scarring.
15865 Surgery CardiovascuAortic Aneurysm back pain.regurgitation
Tricuspid In symptomatic, hemodynamically
is usually secondary (function stable p
15832 Surgery CardiovascuTricuspid Regurgitation V regurgitant
A wave in jugular murmurvenous overpulsation
a prosthetic is highly
valvespecific
suggesf
15831 Surgery CardiovascuMechanical Valve complications
rapid increase (e.g. in leftheart failure)end-diastolic
ventricular and should be prom
pressur
15767 Surgery CardiovascuMitral Regurgitation normal surgical
Timely or hyperdynamic
repair is the duebest
to atreatment
large amount of str
for chroni
15760 Surgery CardiovascuMitral Regurgitation overestimates the effective LVEF in
In patients with severe aortic stenosis, surgical aortic patients with sev
15749 Surgery CardiovascuAortic Stenosis fraction
Cardiac <catheterization
50% and those in undergoing
patients withother cardiac
cardiac tampo su
12533 Surgery CardiovascuCardiac Tamponade patients
Pulmonicwith valvesuspected
stenosiscardiac usually tamponade
occurs as afor defini
congenit
12532 Surgery CardiovascuPulmonary Stenosis crescendo-decrescendo
Transvenous lead placement systolic murmur
through the over the left
tricuspid va
12496 Surgery CardiovascuTricuspid Regurgitation should be suspected in patients presenting
Ventricular aneurysm occurs as a late complication (e with right
12410 Surgery CardiovascuMyocardial Infarction elevation
Patients with withperioperative
deep Q waves. Patients infarction
myocardial most common may
12335 Surgery CardiovascuCardiogenic Shock reveals
An arteriovenous fistula can develop as a complicatioc
a low cardiac index and elevated pulmonary
12282 Surgery CardiovascuAV Fistula accompanied
Acute type A aortic by a palpable
dissection thrill
canover the fistula
extend into the site.
pe
11104 Surgery CardiovascuAortic Dissection the initial diagnostic study of choice
The management of small to moderately sized (i.e. 3 in hemodynamica
4738 Surgery CardiovascuAortic Aneurysm minimize
Patients with AAAtrauma
progression.
from rapid deceleration are at ri
4696 Surgery CardiovascuBlunt Thoracic Trauma
Compartment ray
passive range of motion,for
findings concerning BTAI includeand
paresthesias, widened
sensory mea
4608 Surgery CardiovascuSyndrome fasciotomy.
Acute cardiac tamponade is due to rapid accumulatio
4556 Surgery CardiovascuCardiac Tamponade the cardiac silhouette can be normal on chest x-ray.
Patients with trauma following rapid deceleration are
4553 Surgery CardiovascuBlunt Thoracic Trauma (pseudocoarctation)
Although shock in theand/or trauma a hoarse
setting voice (left assum
is initially recur
4541 Surgery CardiovascuBlunt Thoracic
Peripheral Trauma
Vascular cardiogenic shock. Blunt
Aortoiliac occlusion (Leriche cardiac injury with
syndrome) myocardi
is characteriz
4508 Surgery CardiovascuDisease symmetric atrophy of the bilateral lower extremities d
4507 Surgery CardiovascuAcute Limb Ischemia
Retroperitoneal Sudden development
pain. Diagnosis of limb with
is confirmed ischemia in a previously
non-contrast CT sc
4501 Surgery CardiovascuHematoma
Peripheral Vascular intravenous fluids and/or blood transfusion.
Ankle-brachial index is a noninvasive test that is high
4494 Surgery CardiovascuDisease most cases. effusion appears as an enlarged, 'water
A pericardial
4445 Surgery CardiovascuCardiac Tamponade diminished heart sounds
Cardiac tamponade can occuron auscultation and a maxim
as a catastrophic com
4380 Surgery CardiovascuCardiac
PeripheralTamponade
Artery pulsus paradoxus who have sudden
Peripheral artery aneurysm manifests as a pulsatile m onset of severe
4241 Surgery CardiovascuAneurysms aneurysms are the
In patients with most common
hemodynamic peripheral
instability arteryan
and signs a
4212 Surgery CardiovascuAortic
ChronicAneurysm
Venous be performed.
Venous A CT scan
insufficiency (valvularis helpful in symptomatic
incompetence) is thepa m
4025 Surgery CardiovascuInsufficiency recumbent.
Ruptured abdominal aortic aneurysm presents with th
3551 Surgery CardiovascuAortic
CentralAneurysm
Venous umbilical hematomas.
Complications The onset of central
due to inappropriate hemodynamicvenous ins ca
3504 Surgery CardiovascuCatheter x-ray signs
Hard prior toofcatheter
vascularuse. injury include pulsatile bleedin
3354 Surgery CardiovascuGunshot Injury presence
limb ischemia). The tumorsinjury,
of a penetrating suchcause
may also signs position-
are almo
2713 Surgery CardiovascuAtrial Myxoma dyspnea,
As soon as syncope).
acute limb Constitutional symptoms
ischemia is clinically (e.g. fe
diagnose
2666 Surgery CardiovascuAcute Limb Ischemia propagation and distal thrombosis while the patient u
2371 Surgery CardiovascuAortic Aneurysm Bowel ischemia andcan
Acute mediastinitis infarction are possible
occur following earlysurge
cardiac com
2337 Surgery CardiovascuMediastinitis drainage, surgicalrupture
Papillary muscle debridement,
leading and prolonged
to acute mitral antibi
regur
2157 Surgery CardiovascuMyocardial Infarction infarct.
Superficial burns involve only the epidermis and are c
19258 Surgery DermatologyThermal Burn managed
second most withcommon
simple woundtype ofcare (e.g. cleansing,
melanoma, usually gro mo
16864 Surgery DermatologyMelanoma from other Evolving)
Diameter, lesions onrule; the lesions
patient ('ugly
with >duckling
1-2 of the sign')
AB
16863 Surgery DermatologyMelanoma sensory changes and for lesions that
standing, or large ulcers require foot imaging (e.g. x-rare significantly
16701 Surgery DermatologyDiabetic
Pyoderma Foot associated with elevated
underlying systemic erythrocyte
inflammatory sedimentation
disorders (e.g. rheu r
16067 Surgery DermatologyGangrenosum biopsy. Treatment ispresents
A keratoacanthoma with corticosteroids.
as a rapidly growing no
15575 Surgery DermatologyKeratoacanthoma
Nonmelanoma Skin keratoacanthomas
mm) margins. For the face andaother
often have benign course,
delicate orsome
cosm
14489 Surgery DermatologyCancer
Hidradenitis often performed.
Management of hidradenitis suppurativa initially invol
13917 Surgery DermatologySuppurativa
Nonmelanoma Skin retinoids, and surgical
Angiosarcoma excisiontumor
is a malignant may derived
be warranted.from the
12511 Surgery DermatologyCancer cancer) areinclusion
Epidermal at risk ofcyst
developing
is a benign secondary angiosar
nodule containin
10670 Surgery DermatologyEpidermoid
Pyoderma Cyst punctum.
Pyoderma gangrenosum causes a rapidly progressivin
The lesion can remain stable or gradually
10434 Surgery DermatologyGangrenosum
Hidradenitis bowel disease).
Hidradenitis Diagnosis
suppurativa is is made clinically
a chronic, relapsing after exc
condi
10152 Surgery DermatologySuppurativa presents
Prolongedaspressure
painful nodules
over a bony that can progresscan
prominence to absc
cau
4610 Surgery DermatologyPressure Induced Injury abnormal mental status, decreased
Severe burns are often complicated by wound infecti skin perfusion, an
4550 Surgery DermatologyThermal Burn Skin
Nonmelanoma injury;
Squamousgram-negative
cell carcinoma organisms and fungi
is the most common are more
maligc
4319 Surgery DermatologyCancer Biopsy is characterized by invasive cords of squamou
4312 Surgery DermatologyMelanoma
Nonmelanoma Skin On clinical examination,
Squamous cell carcinoma features
(SCC) of a lesion
is the mostthatcommonsugg
4033 Surgery DermatologyCancer patients is more
Risk factors aggressive,
for pressure withinclude
ulcers an increased
decreased risk mof
3472 Surgery DermatologyPressure
NonmelanomaInduced Injury
Skin pressure
Squamous ulcers include proper
cell carcinoma (SCC) positioning
is most often for pressur
assoc
3456 Surgery DermatologyCancer wounds tends to be more aggressive.
A mole may represent melanoma if it appears substa
2767 Surgery DermatologyMelanoma
Nonmelanoma Skin biopsy should painless,
A nonhealing, be obtained. bleeding skin ulcer associate
2604 Surgery DermatologyCancer
Nonmelanoma Skin of
Nodular basal cell carcinoma should
metastasis. The diagnosis has lowbe confirmedpote
metastatic wit
2603 Surgery DermatologyCancer thin layers are removed and inspected microscopical
An avulsed permanent tooth should be reimplanted a
20330 Surgery Ear, Nose & Dental Injury and
Bluntsocket
trauma with normal
to the saline.
ear can cause an auricular hema
20314 Surgery Ear, Nose & Ear Trauma required to avoid complications
Bisphosphonate-related osteonecrosis of infection,
of theavascula
jaw is c
18467 Surgery Ear, Nose & Osteonecrosis dental
Barotrauma to the ear occurs most commonly afteran
procedures. The course can be intractable, fl
18418 Surgery Ear, Nose & Ear Trauma spontaneously within a few weeks.
A septal hematoma presents after nasal trauma as flu
16961 Surgery Ear, Nose & Epistaxis
Cerebrospinal Fluid perforation,
Clear, unilateral and rhinorrhea
nasal deformities.
that increases at times of
16719 Surgery Ear, Nose & Rhinorrhea which is most often caused
A conductive hearing loss (CHL) by headmaytrauma and can
show improved
16535 Surgery Ear, Nose & Otosclerosis otosclerosis, which is characterized by bony overgrow
16433 Surgery Ear, Nose & Vertigo
Recurrent Respiratory A perilymphatic fistula can occur after head trauma a
16396 Surgery Ear, Nose & Papillomatosis Human papillomavirus
Thyroglobulin is produced canonly
causeby recurrent respirator
thyroid tissue (eith
16302 Surgery Ear, Nose & Thyroid Cancer thyroid tissue is removed.
16301 Surgery Ear, Nose & Thyroid Cancer Thyroid
Medullary nodules
thyroidthat havearises
cancer suspicious
from the sonographic
calcitonin-se fe
16293 Surgery Ear, Nose & Thyroid Cancer following surgery.
16292 Surgery Ear, Nose & Head
AirwayAndEmergency
Neck A postoperative neck hematoma should be recognize
16226 Surgery Ear, Nose & Cancers
Head And Neck A laryngeal ulcer in a smoker is likely squamous cell
Head And Neck Evolving leukoplakia in the oral cavity requires biopsy
Head And Neck A
Antonsil ulcer ulcerated
enlarged, in a smoker is likely
tonsil with due to squamous
ipsilateral cervicalca
Head And Neck absence
In a patient of traditional risk factors
with risk factors (smoking, ear
for malignancy, alcohol).
pain
16127 Surgery Ear, Nose & Cancers makes head and neck squamous cell
A branchial cleft cyst is a congenital neck mass that carcinoma the o
16058 Surgery Ear, Nose & Branchial Cleft Cysts the sternocleidomastoid
Unilateral sensorineural hearingmuscle. loss with imbalance
16039 Surgery Ear, Nose & Vestibular Schwannoma tumor of CN
ventilation VIII.
with 100% oxygen followed by endotrache
15962 Surgery Ear, Nose & Epiglottitis should prompt surgical
Epiglottitis should be suspected cricothyrotomy,
in patientswhichwithbypass
sore
15961 Surgery Ear, Nose & Epiglottitis
Nasopharyngeal respiratory infection. The diagnosis can
nasopharyngeal obstruction or invasion of adjacent ti be confirmed
12450 Surgery Ear, Nose & Carcinoma Early metastasis to the cervical lymph nodes is comm
11906 Surgery Ear, Nose & Salivary Gland Tumors Sialadenosis is a benign, noninflammatory enlargeme
4902 Surgery Ear, Nose & Otosclerosis Otosclerosis causes fixation of the stapes, which resu
4599 Surgery Ear, Nose & Salivary Gland Tumors Parotid masses are typically benign. Cranial nerve dy
4544 Surgery Ear, Nose & Nasopharyngeal
Acute Parotitis Suppurative parotitis
Nasopharyngeal presents
carcinoma with exquisitely
is associated with painful
the rea
3500 Surgery Ear, Nose & Carcinoma the Middle East. Manifestations include nasal conges
3428 Surgery Ear, Nose & Deviated Nasal Septum If a patient develops
asymptomatic, and the a whistling
diagnosisnoise duringclinically
is usually respiratie
3427 Surgery Ear, Nose & Bone Tumor
Retropharyngeal of dentures.
Retropharyngeal abscess presents with neck pain, od
2846 Surgery Ear, Nose & Abscess the superior mediastinum. Extension through the alar
2331 Surgery Ear, Nose & Sialolithiasis Salivary
intravenous stones occur therapy
antibiotic most often andinurgent
the submandibula
drainage of
2195 Surgery Ear, Nose & Peritonsillar Abscess epiglottitis.
synovial hypertrophy, which may be visible on x-ray a
20452 Surgery Endocrine, DAcromegaly resembling osteoarthritis.
The administration of desmopressin, an analogue of
18569 Surgery Endocrine, DHyponatremia hypotonic hyponatremia.
The initial evaluation of thyroid Laboratory
nodules studies, includin
includes a se
18539 Surgery Endocrine, DThyroid Nodules hyperfunctioning nodules are rarely
parathyroid hyperplasia and autonomous parathyroid malignant and do
18316 Surgery Endocrine, DHyperparathyroidism hyperphosphatemia,
Pheochromocytoma commonly and extremelypresentshigh serum PTH
with episodi
18171 Surgery Endocrine, DPheochromocytoma initial
tumors step
thatincan
diagnostic evaluation. or mass effect sy
lead to hemorrhage
17064 Surgery Endocrine, DPheochromocytoma tumors,
reduce this endolymphatic
risk, patientssac tumors
should of the
initiate middle ear,
preoperative
14028 Surgery Endocrine, DPheochromocytoma should
Thyroidneverstormbe is given in the absence
a life-threatening of α blockade
thyrotoxicosis oftend
10958 Surgery Endocrine, DHyperthyroidism hypertension, cardiac arrhythmias, high fever, tremor
hypoparathyroidism include postsurgical, autoimmun
8882 Surgery Endocrine, DHypoparathyroidism thyroidectomy.
Hypercalcemia can occur in prolonged immobilization
4309 Surgery Endocrine, DHypercalcemia reduce
High-volumethis hypercalcemia
blood transfusion and canpreventcause bone loss.
symptoma
4216 Surgery Endocrine, DHypocalcemia increased
Adrenal crisis risk primarily
due to decreased
presents with clearance of citrate
hypotension anb
4077 Surgery Endocrine, DAdrenal Insufficiency to aggressive volume are
Pheochromocytomas repletion.
catecholamine-producing tu
3976 Surgery Endocrine, DPheochromocytoma can
Surgical resection is the primaryprocedures,
be precipitated by surgical inductionf
treatment modality
3498 Surgery Endocrine, DThyroid
Euthyroid Cancer
Sick ablation
representand an suppressive
adaptive response doses of to thyroid
severe hormone.
illness. Th
3495 Surgery Endocrine, DSyndrome returned to baseline health.
Neuropathic ulcers are caused by repeated pressure
3451 Surgery Endocrine, DPeripheral Neuropathy Diabetes
patients with mellitus is the most
symptomatic common cause
hypercalcemia andof neuro
those w
2176 Surgery Endocrine, DHyperparathyroidism complications during their lifetime and should be offe
19469 Surgery Female ReprNipple Discharge Unilateral,
Lymphatic spontaneous,
drainage from bloody the breast nipple discharge
passes acc
primarily
19411 Surgery Female ReprBreast Cancer minor
Breastmuscle
conserving is thetherapy
landmark for distinguishing
typically the s
consists of partia
19290 Surgery Female ReprBreast Cancer cancer requires
Symptomatic negative
simple breastmargins.
cysts can be managed w
17510 Surgery Female ReprBreast Mass evaluate with
Patients for breast cancer.
a complete small bowel obstruction (e.g
15719 Surgery Female ReprIncisional Hernia laparotomy
A ruptured ovarian cyst canrisk
due to the high cause of life-threatening
hemoperitoneum, com
12160 Surgery Female ReprOvarian Cyst peritoneal
Palpable breast signs masses
require emergency
in women age surgery.
< 30 are initia
12115 Surgery Female ReprBreast Mass may require additional imaging (e.g. mammography)
12114 Surgery Female ReprBreast Mass An isolated,
Breast abscessesfirm, well circumscribed,
present with a unilateraland mobile brea
fluctuant,
12078 Surgery Female ReprBreast Abscess includes
Fat necrosis drainage
of the(e.g.
breast needle aspiration)
is a benign and empiri
condition with c
2362 Surgery Female ReprBreast Mass Biopsy
Mammography is the first-line imaging study for assei
will reveal fat globules and foamy histiocytes
2345 Surgery Female ReprB reast Mass
Colorectal Polyps And required
obstructive to confirm
symptoms theare
diagnosis.
uncommon, and any assoc
20075 Surgery GastrointestiCancer
Colorectal Polyps And bleeding
The liver is the most commonanemia.
and iron deficiency organ affected by meta
Colorectal Cancer stage, resection of the primary
Hyperplastic polyps are a non-neoplastic tumor is recommende
abnormality
20073 Surgery GastrointestiScreening
Colorectal Cancer continue
Although most patients with localized (e.g.intervals
colorectal screening at the usual stage 1) (e c
20072 Surgery GastrointestiScreening
Colorectal Polyps And colonoscopy should be performed
Obesity and type 2 diabetes are associated with an in 1 year after surgic
Compartment insulin-like
The increased growth factor-1, which
intra-abdominal andinhibits colorectal
intrathoracic prese
19960 Surgery GastrointestiSyndrome with increased
systemic central venous
inflammatory response pressure,
syndrome decreased
and evide v
19897 Surgery GastrointestiAcute Pancreatitis morbiditypancreatic
Infected and mortality and usually
necrosis shouldrequire intensive
be suspected in
19896 Surgery GastrointestiSepsis onset
Bile acidof acute
diarrhea necrotizing
is a common pancreatitis.
complicationCT scan of th
of chole
19449 Surgery GastrointestiChronic Diarrhea terminal
Enteral nutrition is the optimal form of nutrition forinpa
ileum and spills into the colon, resulting se
19257 Surgery GastrointestiThermal Burn has multiplewhereas
discharge, clinical benefits
chronic RP (e.g. maintenance
occurs months to of yea
gut
19168 Surgery GastrointestiProctitis and telangiectasias
Thrombosed external confined to the usually
hemorrhoids rectum.appear as
19164 Surgery GastrointestiHemorrhoids softeners, topical proctitis
Chronic radiation anti-inflammatories
is characterized and antispasmo
by oblitera
19163 Surgery GastrointestiFecal Incontinence
Gastrointestinal incontinence. Chronic tissue hypoxia
Angiodysplasias in the gastrointestinal (GI) tract results in neova
are a
19161 Surgery GastrointestiHemorrhage with low levels of von Willebrand factor
defecation, Valsalva). It is usually diagnosed in wome multimers; thi
19033 Surgery GastrointestiRectal Prolapse referred for surgical
renal infarction) and intervention.
gastrointestinal tract (e.g. mesen
18997 Surgery GastrointestiPolyarteritis Nodosa microaneurysms,
Cecal volvulus occurs whenluminal
irregular the cecum narrowing, and dis
and ascendin
18793 Surgery GastrointestiVolvulus nausea/vomiting,
Sigmoid volvulus often are typical.
presentsAbdominal
as slowlyx-ray may re
progressiv
18792 Surgery GastrointestiV olvulusSclerosing
Primary without
resonance perforation or peritonitis can undergo
cholangiopancreatography findingsflexible
of mul
18768 Surgery GastrointestiCholangitis
Primary Sclerosing time of diagnosis because many patients
Primary sclerosing cholangitis is characterized by fibr also have in
18763 Surgery GastrointestiCholangitis most
satiety,commonly
constipation).in men and is strongly
Therefore, associated
older women (e.g.wip
18053 Surgery GastrointestiOvarian Cancer considered.
Irritable Bowel Irritable bowel syndrome presents with recurrent abd
18052 Surgery GastrointestiSyndrome malignancy
pancreatic duct in patients age > of
with leakage 50pancreatic
with new-onset symp
juice into t
17865 Surgery GastrointestiAscites serum-ascites albumin gradient.
Persistently bloody ascites after multiple diagnostic p
17851 Surgery GastrointestiAscites ascites
Hemobilia can(bleeding
also occur with
into theperitoneal
biliary tract)metastases
is a rare cau fro
17640 Surgery GastrointestiHemobilia right upper quadrant
pneumonitis) pain,(e.g.
or intestinal jaundice,
abdominaland upper
pain, gastro
nause
17598 Surgery GastrointestiA scariasis
Tracheoesophageal pancreatitis). Treatment includes
Tracheoesophageal fistula with esophageal atresia albendazole or meb p
17593 Surgery GastrointestiFistula
Gastrointestinal confirmed by inserting a nasogastric
endoscopy; small bowel evaluation (e.g. video capsu tube, which enc
17514 Surgery GastrointestiHemorrhage endoscopic
phosphatase. evaluation.
Liver biopsy is diagnostic, demonstratin
17014 Surgery GastrointestiTransplant Rejection successfully
Impaired relaxationwith high-dose corticosteroids. muscle du
of the cricopharyngeus
16923 Surgery GastrointestiZ enker
Blunt Diverticulum
Abdominal the
Rapidesophagus.
compression Treatment
of the bowelis surgical
during with cricophary
blunt abdomi
16832 Surgery GastrointestiTrauma
Colorectal Polyps And symptoms and signs (e.g. fever, diffuse
Sigmoidoscopy is an effective tool for evaluating lesio abdominal pa
16715 Surgery GastrointestiCancer sigmoidoscopy
Refeeding syndrome have increased
occurs after risktheforreintroduction
synchronous on
16711 Surgery GastrointestiRefeeding Syndrome abnormalities,
Free perforation muscle
of the weakness,
gastrointestinal arrhythmias,
tract in the andset co
16622 Surgery GastrointestiPerforated Viscus temporary
(large size,relief
solid(decompression) and then generalize
components or calcifications, main p
16576 Surgery GastrointestiPancreatic Cancer possibly surgical resection.
16572 Surgery GastrointestiPerforated Viscus Small
Sigmoid bowel obstruction
volvulus occurs can when beacomplicated
segment of by bowe
sigmoid
16546 Surgery GastrointestiV olvulus
Compartment shaped
Decreased loopurine
('coffee
outputbean'
andsign).high Chronic constipation
peak inspiratory pre
16520 Surgery GastrointestiSyndrome hypertension
Enteral nutrition, when feasible, is the optimal formpre
causing organ dysfunction). Bladder o
16519 Surgery GastrointestiEnteral Nutrition initiated early (i.e. < 48 hr).
Gastric outlet obstruction presents with intractable na
16508 Surgery GastrointestiP ancreatic Cancer
Inflammatory Bowel adenocarcinoma
Patients with severe withCrohn
gastricdisease,
or duodenal invasion.
especially those P
16476 Surgery GastrointestiDisease with biologic
cardiac insults and/or
(e.g. immunomodulator
myocardial infarction, therapy.
unstableSmok a
16436 Surgery GastrointestiIschemic Hepatitis with
increase the risk of such disease progression. Fibrotife
bilirubin levels remaining unaffected or rising a
16414 Surgery GastrointestiB owel Obstruction
Inflammatory Bowel requires
diagnosissurgical
because removal of the strictured
it can distinguish between portion of s
charac
16413 Surgery GastrointestiDisease granulomas)
Sudden-onset, and thoseabdominal
severe of ulcerative pain colitis
and (e.g.
anioncontigap
16385 Surgery GastrointestiMesenteric Ischemia atrial fibrillation). Diagnosis is generally
(e.g. hypokalemia, hypomagnesemia) and factors tha made with CT
16350 Surgery GastrointestiOgilvie Syndrome made by CT
can occur scansetting
in the showing colonic
of poor dilation without
postoperative diet. anVi
16307 Surgery GastrointestiBariatric Surgery gingivitis;
Biliary platelet
atresia is a count,
neonatal prothrombin
disorder intime, which and partia
extrahe
16288 Surgery GastrointestiBiliary Atresia findings include
Anastomotic leakdirect hyperbilirubinemia,
is a serious postoperative normal
complica reti
16275 Surgery GastrointestiBariatric Surgery diagnosis
Splenic is best is
abscess confirmed by oral contrast-enhance
a rare, life-threatening complicatio
16253 Surgery GastrointestiSplenic Abscess fever
Atraumatic splenic rupture is an uncommonisbut
and tender splenomegaly. Diagnosis made w
life-th
16251 Surgery GastrointestiSpleen Rupture risk. Patients developfistula
A pancreaticopleural acute (between
abdominalthe pain, shock, ad
pancreatic
16248 Surgery GastrointestiChronic Pancreatitis chronic pancreatitis.
Approximately 25% of Management
pancreatic cancer includes bowel res
is heralded
16214 Surgery GastrointestiPancreatic Cancer new-onset
The most common diabetessymptommellitus, those who have
of pancreatic sympto
cancer is i
16213 Surgery GastrointestiPancreatic Cancer CT scan of the abdomen is the first-line
incontinence, constipation, and/or mucous discharge test for suspe
16209 Surgery GastrointestiRectal Prolapse dysfunction, chronic constipation
Esophageal dysphagia is characterized or straining, demen
by a sensatio
16191 Surgery GastrointestiEsophageal Cancer classically
stricture and presents with progressive
food impaction. Management solid-food dysph
includes d
16190 Surgery GastrointestiE sophagitis
Blunt Abdominal budesonide).
Blunt trauma that rapidly compresses the upper abdo
Blunt Abdominal trauma; persistent abdominal
Rapid compression of the duodenum discomfort or nausea,
against the verti
16188 Surgery GastrointestiTrauma the duodenal
Effort rupture lumen, causing a delayed
of the esophagus (Boerhaave (24-48 hr) pr
syndrom
16187 Surgery GastrointestiEsophageal Rupture esophagography
Blunt thoracic trauma or CTcan scancauseusing water-soluble
a sudden increase coni
16185 Surgery GastrointestiEsophageal Rupture space,
Esophagealpleural effusion results,
perforation and fluid analysis
is a life-threatening complica typi
16178 Surgery GastrointestiEsophageal Rupture chest x-ray. Water-soluble contrast esophagography
Acute cholangitis should be suspected in a patient wi
16166 Surgery GastrointestiCholangitis Endoscopic retrograde
Acute pancreatitis is thecholangiopancreatography
most common complication is
16151 Surgery GastrointestiERCP nausea, and vomiting.
Gastric cancer is common Lipase and amylase
in those from Eastern levelsAsiawill
16146 Surgery GastrointestiGastric Cancer can bleed
Gastric into the
cancer stomachtolumen,
is endemic Eastern leading
Asia, to iron def
Eastern E
16143 Surgery GastrointestiGastric Cancer typically include weight loss and chronic
epigastric pain, nausea, and vomiting; however, vital mid-epigastr
16131 Surgery GastrointestiGallstone Disease demonstrating
forming organisms the presence of gallstones.
such as Clostridium
16129 Surgery GastrointestiC holecystitisDifficile
Clostridium cholecystectomy.
tachycardia), leukocytosis, abdominal distension, and
16105 Surgery GastrointestiInfection having diarrhea and
Acute diverticulitis is symptoms
common inclinically worsen. and
older individuals
16100 Surgery GastrointestiDiverticular Disease bladder symptoms
colitis. Most (e.g. dysuria,
cases present frequency)
with subacute or upper
right sterile
16099 Surgery GastrointestiCholangiocarcinoma intrahepatic or common
Anorectal fistulas are most bileoften
duct.due to rupture of a p
16095 Surgery GastrointestiFistula In Ano Management
Thrombosis ofrequiresan externalsurgical intervention.
hemorrhoid manifests as e
16094 Surgery GastrointestiHemorrhoids management includes sitz baths,
Prolonged postoperative ileus, the delayed stool softeners,
return andof b
16080 Surgery GastrointestiParalytic Ileus examinations.
with decompensated liver failure, weight loss, and a p
16078 Surgery rule out the disease.
GastrointestiHepatocellular Cancer Hepatocellular carcinoma usually arises due to chron
16077 Surgery GastrointestiHepatocellular Cancer hepatitis B and
months is recommended.C virus infection,
Because suchHCC as often
Asia, presen
Africa
16076 Surgery GastrointestiHepatocellular Cancer evaluate
Young women for HCC. on prolonged oral contraception are a
16069 Surgery GastrointestiH epatic Adenomas
Focal Nodular malignant
Focal nodular hyperplasiaorisrupture
transformation a benign can occur.
liver lesionRuptu
due
16068 Surgery GastrointestiHyperplasia scar and radiating fibrous bands.
Femoral hernias are more common in elderly women
16035 Surgery GastrointestiGroin Hernias occur and typically
early elective herniapresents
repair. Inwith progressive
contrast, abdomi
asymptomatic
16034 Surgery GastrointestiG Dehiscence And pass
roin Hernias
Wound Deepthrough
(fascial)awound
wider orifice.
dehiscences can result in expo
16025 Surgery GastrointestiEvisceration with fascial dehiscence require emergency
phlebotonics, topical hydrocortisone, surgery.
astringents, and
16000 Surgery GastrointestiHemorrhoids prolapsed hemorrhoids that cannot be
hematogenous seeding of distal infection, particularly reduced manu
15723 Surgery GastrointestiLiver Abscess cultures,
radiography antibiotics,
typicallyaspiration, and drainage.
reveals a retrocardiac opacity (o
15710 Surgery GastrointestiHiatal Hernia whereas patients with gastroesophageal
organs. Manifestations include nausea and vomiting, reflux diseas
15709 Surgery GastrointestiH iatal Hernia Bowel
Inflammatory the
Mildthoracic
ulcerative cavity.
colitis (UC) is defined as < 4 bowel mo
14431 Surgery GastrointestiDisease
Inflammatory Bowel aminosalicylic
Erythema nodosummedications;
acid presents withsuppositories
tender, nonpruritic,or ene
14083 Surgery GastrointestiDisease inflammatory
cutaneous bowel(e.g.
findings disease (IBD),hyperkeratosis,
follicular especially Crohn perd
13534 Surgery GastrointestiVitamin C Deficiency healing. Diagnosis
Occlusion of an anal is crypt
madeglandwith plasma
can lead ortoleukocyte
a bacter
12457 Surgery GastrointestiIntra-Abdominal
Perianal Abscess and progressively
Patients who receive worsening pain. Anoreceptive
a laparoscopic appendectomy intera
12451 Surgery GastrointestiAbscess when fever and abdominal symptoms
with a BMI > 30 kg/m2 or those with a BMI 25-29.9 (e.g. pain, vom k
7553 Surgery GastrointestiO besity
Blunt Abdominal interventions may be pursued concurrently.
Patients with blunt abdominal trauma should be asse
4930 Surgery GastrointestiTrauma examination that can be
exocrine insufficiency performed
(loss of digestiveat the bedside.in p
enzymes)
4919 Surgery GastrointestiChronic Pancreatitis such patients.
4813 Surgery GastrointestiG allstone Disease
Retroperitoneal Total parenteral with
Anticoagulation nutrition causes
warfarin gallbladder
places patients stasis
at riskan fo
4697 Surgery GastrointestiHematoma hemodynamic compromise should raise suspicion for
4655 Surgery GastrointestiCholecystitis Acute
Pilonidalcholecystitis
disease most presents with right
frequently affectsuppermales quadran
age 1
4640 Surgery GastrointestiP ilonidal Disease
Metastatic Liver common presenting symptoms include
Multiple liver masses are much more likely to be the a painful, fluc
4612 Surgery GastrointestiDisease breast
Prolongedare the most common
postoperative ileusdiseases causingby
is characterized liver
nau m
4609 Surgery GastrointestiParalytic Ileus by decreasing
Patients gastrointestinal
on warfarin who require motility.
urgent surgery with
4601 Surgery GastrointestiAnticoagulants (PCC) and intravenous vitamin
Pancreatic cancer classically presents K. If PCC is unavailab
insidiously wit
Blunt Abdominal to extrahepatic biliary obstruction. A
Blunt abdominal trauma can cause gastrointestinal p peptic duodenal
4555 Surgery GastrointestiTrauma (e.g. intraperitoneal free air on imaging) should prom
Blunt Abdominal The liver is one of the most commonly injured organs
Gastric Outlet intraperitoneal free fluid oncan
Gastric outlet obstruction Focused
be causedAssessment
by many withdis
4486 Surgery GastrointestiObstruction ingestion, pyloric stricture is the most
Peptic ulcer disease can be complicated by perforatio likely cause.
4462 Surgery GastrointestiPerforated Viscus inflammatory
Biliary colic occursresponse.
due to increased intra-gallbladder
4433 Surgery GastrointestiGallstone Disease usually
Complete small bowel 6
lasts less than hours, andusually
obstruction resolves complet
presents w
4364 Surgery GastrointestiBowel Obstruction most common etiology.
widening) or pleural space (pleural effusion). Pleural
4360 Surgery GastrointestiEsophageal Rupture soluble
Patientscontrast
who presentshould prompt
with emergent
appendicitis > 5surgical
days aftercon
4251 Surgery GastrointestiAppendicitis patients
Diminished arerelaxation
otherwise of stable, they may be treated
the cricopharyngeus muscle wi
4188 Surgery GastrointestiZenker Diverticulum Zenker (pharyngoesophageal) diverticulum, which pr
4165 Surgery GastrointestiGastric Cancer In
Analgastric adenocarcinoma,
fissures present with pain tumorandstage
rectalatbleeding
the timeon o
4111 Surgery GastrointestiA nal Fissure
Zollinger-Ellison (e.g. nifedipine, nitroglycerin).
Zollinger-Ellison syndrome should be suspected in pa
4106 Surgery GastrointestiSyndrome these patients, inactivation
Ischemic colitis is characterized of pancreatic
by acuteenzymes
abdominal byp
4098 Surgery GastrointestiColonic Ischemia areas at the
Dumping splenic is
syndrome flexure
a common and rectosigmoid
postgastrectomy junction
co
4062 Surgery GastrointestiDumping Syndrome diaphoresis)
Ischemic symptoms.
colitis is a common The symptoms
complication can ofbe contro
vascula
3877 Surgery GastrointestiC olonic
Blunt Ischemia
Abdominal wall.
Rapid compression of the duodenum against thehemo
Colonoscopy shows cyanotic mucosa and vert
Inflammatory Bowel and emesis 24-48 hours postinjury
Patients with inflammatory bowel disease (IBD) are abecause the hem
3834 Surgery GastrointestiDisease TM
Riskshould
factorsreceive
for trace intravenous corticosteroids.
mineral deficiency include mala
3790 Surgery GastrointestiZinc Deficiency include hypogonadism, impaired taste,
Porcelain gallbladder is usually diagnosed on abdom impaired wou
3732 Surgery GastrointestiP orcelain
Small Gallbladder
Intestinal for gallbladderofadenocarcinoma
complication gastric bypass procedures.and usuallyCondition
requires
3603 Surgery GastrointestiBacterial Overgrowth
Zollinger-Ellison (e.g. atrophic(Zollinger-Ellison
Gastrinoma gastritis, chronicsyndrome) pancreatitis) also be
should preds
3591 Surgery GastrointestiSyndrome a fasting serum gastrin level > 1000
Colovesical fistula is most commonly due to diverticu pg/mL. Patients
3467 Surgery GastrointestiDiverticular Disease or rectal (not intravenous) contrast can confirm the di
3182 Surgery GastrointestiDiverticular Disease CT-guided
Psoas abscess percutaneous
commonlydrainage presentsissubacutely
recommended with ff
3181 Surgery GastrointestiPsoas Abscess detected
electrolyteonabnormalities.
examination. Signs CT scans and are requiredinclud
symptoms to c
3179 Surgery GastrointestiParalytic Ileus reveals uniformly distended, gas-filled loops of both t
3178 Surgery GastrointestiPerforated Viscus Sudden-onset,
The evaluation severe of patients abdominal pain withappendiciti
with suspected peritonitis
3064 Surgery GastrointestiAppendicitis perforated
Gilbert appendicitis)
syndrome, the most andcommon
direct management.
inherited disord CT
2983 Surgery GastrointestiGilbert Syndrome vigorous
or exercise,
epigastric region,surgery). With the exception
with corresponding elevations of ele
in
2973 Surgery GastrointestiGallstone Disease symptoms.
Pancreatic cancer can be due to hereditary (e.g. first
2966 Surgery GastrointestiPancreatic Cancer Cigarette
Pancreaticsmoking
cancer in is the
the most
body or consistent
tail of thereversible
organ may ri
2952 Surgery GastrointestiP ancreatic Liver
Metastatic Cancer back/neurologic examinations and radiographic imag
2951 Surgery GastrointestiDisease The most common malignancy of the liver is metasta
2946 Surgery GastrointestiCholecystitis Acute
retained acalculous
common cholecystitis
bile duct, cystic is an acute
duct inflammatio
stone) or extra
2943 Surgery GastrointestiGallstone Disease endoscopic retrograde cholangiopancreatography,
Emphysematous cholecystitis is a life-threatening for m
2940 Surgery GastrointestiCholecystitis due
oftentocause
infection of the gallbladder
abdominal pain without wall with gas-formin
jaundice. Althoug
2935 Surgery GastrointestiPancreatic Cancer nondiagnostic ultrasound or to evaluate
Gallstone pancreatitis should be suspected in patient for suspected
2933 Surgery GastrointestiAcute Pancreatitis patients with gallstone
Hepatic adenoma pancreatitis
is a benign tumorwho most are medically
often seen
2932 Surgery GastrointestiHepatic Adenomas rupture, and malignant transformation.
2930 Surgery GastrointestiGallstone Disease Asymptomatic
Gallstones andgallstones
chronic alcohol shouldabusenot beare treated.
the mostLapa c
2929 Surgery GastrointestiA cute Pancreatitis
Gastrointestinal should be performed in all patients with
The first step in the treatment of acute upper gastroin suspected ga
2922 Surgery GastrointestiHemorrhage fluids.
Acute cholecystitis usually presents with sudden onse
2904 Surgery GastrointestiCholecystitis cystic duct with subsequent inflammation and infectio
Gallstone ileus results from small bowel obstruction d
2903 Surgery GastrointestiGallstone Disease ultimately
Expectant causingmanagement complete obstruction.
is preferred Treatment
initially in patient in
2897 Surgery GastrointestiAcute Pancreatitis symptoms
Acute mesenteric (e.g. abdominal
ischemia pain, vomiting),
is commonly dueinfected
to abrup p
2822 Surgery GastrointestiMesenteric Ischemia more
Painless focal findingsindue
jaundice to infarction,
a patient perforation,
with conjugated or p
hyperb
2627 Surgery GastrointestiPancreatic Cancer cancer.
Trousseau Other common
syndrome is causes of biliary obstruction
a hypercoagulability disorderi
2624 Surgery GastrointestiPancreatic Cancer with an occult
Diagnosis visceral malignancy
of esophageal such asesophagea
cancer requires pancreatic
2601 Surgery GastrointestiEsophageal Cancer those who are age > 50 or with alarm symptoms (e.g
2476 Surgery GastrointestiUmbilical Hernia A congenital
Effort ruptureumbilical
of the esophagushernia is typically
(Boerhaave soft syndrom
and redu
2369 Surgery GastrointestiEsophageal Rupture evidenced
Esophagealbyperforation
suprasternal is acrepitus on examination.
life-threatening complicaC
2335 Surgery GastrointestiE sophageal
Blunt Rupture
Abdominal from leakedisesophageal
The spleen one of the contents.
most commonly Contrast esophago
injured orga
2327 Surgery GastrointestiTrauma intraperitoneal free fluid on Focused
Immediate surgical intervention is indicated for patien Assessment with
2322 Surgery GastrointestiBowel Obstruction and/or
Imagingdevelop
studiessymptoms
show gallbladder or signswallof ischemia
thickening or and
nec
2245 Surgery GastrointestiCholecystitis by cholecystectomy
Recurrent pneumonia when
in anthe medical
elderly condition
patient stab
with dysph
2214 Surgery GastrointestiZenker Diverticulum mass. A in
Tumors swallow
the head study withpancreas
of the contrast can esophagography
present with
Inflammatory Bowel dilation of both the intra- and extrahepatic
Diagnosis of toxic megacolon requires radiographic bile ductsea
2205 Surgery GastrointestiDisease hemodynamic instability).
2204 Surgery GastrointestiD iverticular Disease
Mallory-Weiss Abdominal
Mallory-Weiss CT tear
scanoccurs
is the best
due to diagnostic
a suddentest for dia
increase
2203 Surgery GastrointestiSyndrome endoscopy.
Acute mesenteric Bleeding stops spontaneously
ischemia classically presents in most withpaa
2143 Surgery GastrointestiM esenteric
Surgical Ischemia
Wound focal pain, peritoneal
undergoing clean proceduressigns, rectal(i.e. bleeding and sepsi
without infection or
17087 Surgery General PrinInfection cefazolin) or, alternatively, with
Hemorrhagic shock is the most common type of shoc vancomycin or clinda
16969 Surgery General PrinHypovolemia chest,
because abdomen,
it contains pelvis/retroperitoneum,
near-physiologic levels and of thigh.
electro
14484 Surgery General PrinThermal Burn
Blunt Abdominal development of hyperchloremic
For patients with blunt abdominal trauma who are hemetabolic acidosis.
4500 Surgery General PrinTrauma
Blunt Abdominal Assessment
Splenic injury,with oneSonography
of the most for Trauma
common (FAST) exa
intra-abdomi
4292 Surgery General PrinTrauma Hemodynamically
In cases of traumatic stable patients with
amputation, a negative part
the amputated ultra
3578 Surgery General PrinAmputation water.
Persistent Cooling of the amputated
pneumothorax and large partairprolongs
leak despitethe wintu
3503 Surgery General PrinBlunt Thoracic
Penetrating Trauma
Abdominal prior to operative repair.
3420 Surgery General PrinTrauma Patients with
Patients with cervical
penetrating spine abdominal
injuries are trauma
at riskandof hem
resp
3227 Surgery General PrinSpinal Cord Thoracic
Penetrating Injury management.
Any penetrating wound below the fourth thoracic derm
3221 Surgery General PrinTrauma following
All traumaindications
patients should - hemodynamic
be triaged instability,
using the Glasg perito
3213 Surgery General PrinTraumatic Brain Injury patient’s ability to open his/her eyes,
Blood products should be administered early in patien motor response
20002 Surgery Hematology Blood Transfusion cells/platelets)
Large-volume crystalloidto reduce coagulopathy, a leadingcoag
resuscitation increases con
20001 Surgery Hematology Hypovolemic Shock products to maintain
Blood transfusion a blood
should pressureearly
be initiated just in
sufficient
patientsf
19957 Surgery Hematology Hypovolemic Shock to
The beworkup
available. of a suspicious breast mass (e.g. unilate
19432 Surgery Hematology Breast
VenousMass first,
Spontaneous by
followed uppertissue sampling
extremity (e.g.
deep core biopsy).
venous thrombos
16545 Surgery Hematology Thromboembolism
Venous pitching a baseball game). It is marked
other hypercoagulable state. Manifestations include by acute arma
16544 Surgery Hematology Thromboembolism required.
16537 Surgery Hematology Von Willebrand Disease Insufficient
which triggers hemostasis
low-gradeiscoagulation
the most common cause of
and fibrinolysis.
16448 Surgery Hematology DIC and, to a lesser extent,
and phospholipids. mucocutaneous
Laboratory evaluationbleeding.
will reveal p
16437 Surgery Hematology DIC
Graft Versus Host and organ damage (e.g. renal insufficiency).
cells as foreign and initiate a strong inflammatory res
16148 Surgery Hematology Disease
Rectus Sheath and
Rectus signs of hepatobiliary
sheath hematomasinflammation.
are characterized by acut
15717 Surgery Hematology Hematoma rupture of the inferior epigastric
Transfusion-related acute lung injury arteryisfrom blunt trauf
a potentially
15679 Surgery Hematology Blood Transfusion Management involves transfusion cessation and resp
Acquired methemoglobinemia results from the oxidiza
12663 Surgery Hematology Methemoglobinemia
Heparin Induced characteristic
subcutaneously pulse
(e.g.oximetry
enoxaparin), reading of ~85%,
a classic and a
thrombot
6993 Surgery Hematology Thrombocytopenia
Venous alternate anticoagulant
anticoagulation as early(e.g. as 48-72 argatroban, fondaparinu
hours after surgery
Head And Neck temporarily causes a prothrombotic state. Low molec
4352 Surgery Hematology Cancers Nontender, solitary cervical
Vitamin K deficiency is usually lymphduenodes are concern
to inadequate die
4112 Surgery Hematology Vitamin K Deficiency
Spinal Cord K deficient in 7-10 days. Laboratory
Epidural spinal cord compression must be suspected studies usually s
3680 Surgery Hematology Compression
Venous dysfunction
Inferior venaare cavalatefilters
neurologic
are placed findings. Intravenous
to prevent clinica
Head And Neck those who have recurrent proximal deep venous thro
2614 Surgery Hematology Cancers
Extragonadal Germ Cell Squamous
may cause cell carcinoma
an elevated in a cervical
β-hCG, but the lymph
AFP isnode,essene
2590 Surgery Hematology Tumor
Heparin Induced elevated
Suspected β-hCG.
heparin-induced thrombocytopenia require
2250 Surgery Hematology Thrombocytopenia fondaparinux). Once the sepsis
Patients with suspected plateletrequire
count is > 150,000/m
early aggress
19283 Surgery Infectious D Sepsis of crystalloid fluid within
methicillin-resistant the first 3 hours
Staphylococcus aureusand broad-s
19256 Surgery Infectious D Thermal Burn are common first-line therapy.
19255 Surgery Infectious D Thermal Burn Patients with severe burn injuries are at high risk for
19246 Surgery Infectious D Thermal Burn In patients
Patients who with severesplenectomy
undergo burn injuries,are early
at excision
high risk of fo
19119 Surgery Infectious D Splenectomy
Skin And Soft Tissue of fever and then should be advised
Occlusion of an anal crypt gland can lead to the form to proceed direc
18712 Surgery Infectious D Infections
Animal And Human Bite recurrence
Puncture ofand the anorectal
thin soft tissuefistulaoverlying
formation, theshould
hand me be
18459 Surgery Infectious D Injuries
Catheter Related erythema,
fever, malaise,swelling,
chills)fluctuance, and painful
without localizing range ofTh
symptoms. m
18323 Surgery Infectious D Bloodstream
Skin And SoftInfection
Tissue catheter.
Pseudomonas folliculitis is a self-limited cutaneous eru
17300 Surgery Infectious D Infections have tender
Pyogenic liverpapules,
abscesses pustules,
typicallyor nodules
present and with low-gr
fever,
17223 Surgery Infectious D Liver Abscess
Community Acquired occur. Diagnosis requires abdominal
Fluoroquinolones (e.g. levofloxacin) increase collage imaging, and m
16619 Surgery Infectious D Pneumonia
Surgical Wound rupture.
SmokingWhen possible,with
is associated fluoroquinolone
an increaseduse riskshould
of surgib
16479 Surgery Infectious D Infection are
and still at increased
is usually due to risk.tissue Smoking
trauma,cessation
mismatched is recom
bloo
16043 Surgery Infectious D Postoperative Fever infections.
Acute infectious lymphangitis is marked by the forma
15977 Surgery Infectious D Lymphangitis fever).
PatientsMost
whocasesundergo are renal
caused by Streptococcus
transplantations arepyoge
at ris
12456 Surgery Infectious D Cytomegalovirus abdominal pain, vomiting, bloody diarrhea,
onset, severe, necrotizing fasciitis with hemorrhagic b and endos
12168 Surgery Infectious D Catheter
Vibrio Vulnificus
Related particularly high
Candidemia risk.
is common in patients hospitalized in the
12167 Surgery Infectious D Bloodstream Infection biopsy are usually
neurovascular required
bundle, for diagnosis.
especially the internal A positive
jugular b
11863 Surgery Infectious D Thrombophlebitis bacterialpresent
aureus) cause of LS. the first 3 months with acute pa
within
9111 Surgery Infectious D Septic Arthritis delayed onset and
Bacterial infection of present
a chronic withdiabetic
chronicfoot pain,ulcer
implant
may
7522 Surgery Infectious D Osteomyelitis osteomyelitis is greatly increased. Biopsy
effusion, and splenomegaly. Risk factors for splenic a and culture
4714 Surgery Infectious D Endocarditis endocarditis
receive bloodisproducts
most commonly associated
intraoperatively. Otherwithcauses
splen
4526 Surgery Infectious D Postoperative
Animal And HumanFeverBite anesthetic
Cat bites are medications.
at high risk of infection due to inoculatio
4317 Surgery Infectious D Injuries and is the first-line agent for antibiotic prophylaxis.
4257 Surgery Infectious D Osteomyelitis Patients with infections
Diabetic foot plantar punctureare common wounds in through
patients footw
with p
4168 Surgery Infectious D Osteomyelitis a mixture of gram-positive, gram-negative, and anaer
4167 Surgery Infectious D Urinary Tract
Necrotizing Infection
Soft Tissue Clean intermittent
Necrotizing surgical catheterization is an effective
infection is characterized bymea
inten
4102 Surgery Infectious D Infections surgical exploration is essential.
diarrhea, low-grade fever, abdominal pain, leukocytos
4092 Surgery Infectious D Acute Diarrhea
Healthcare Associated dehydrogenase
Ventilator-associated antigen and/or stool
pneumonia assay
occurs > 48forhours a
4071 Surgery Infectious D Pneumonia tract
watersampling
contaminated (Gramwith staindogand culture)
feces. and receive
Tapeworm eggse
3789 Surgery Infectious D Echinococcosis cysts
Toxic may
shock grow over time,
syndrome dueresulting in right upper
to Staphylococcus aureus qua
3743 Surgery Infectious D Toxic Shock Syndrome marked hypotension, and diffuse erythematous macu
Ludwig angina is a rapidly progressive cellulitis of the
3530 Surgery Infectious D Ludwig Angina with intravenous antibiotics
Coagulase-negative prevents
staphylococci areairway
the mostcomprom
frequ
3464 Surgery Infectious D Postoperative FeverBite
Animal And Human include fever, leukocytosis, hypotension,
Human bite wounds often result in polymicrobial infec and blood c
3011 Surgery Infectious D Injuries majority
In humans, of virulent
hepaticoral hydatidbacteria.
cysts are due to infection
2970 Surgery Infectious D Echinococcosis infection with this organism.
Entamoeba histolytica is a protozoan that can cause c
2968 Surgery Infectious D Liver Abscess
Necrotizing Soft Tissue characterized by right upper
radiographic evidence of gasquadrant
in the deep pain, fever, Wh
tissues. an
2749 Surgery Infectious D Infections
Benign Prostatic hypotension
Transurethralshould raiseofsuspicion
resection the prostate for necrotizing
is an effective fas
20504 Surgery Male ReprodHyperplasia causing
Most cases bladder outlet obstruction.
of priapism are idiopathic. Other common
However, co
it ca
19706 Surgery Male ReprodPriapism emissary
Priapism is veins. Commonpainful
a persistent, disorders include
erection sickle
in the absen cel
19696 Surgery Male ReprodPriapism and resulting
Neonatal venous obstruction.
circumcision is an elective Initial management
procedure assoc
17323 Surgery Male ReprodMale Circumcision cancer,
After initial stabilization, burn patients who requireCirc
and inflammatory disorders in adulthood. ag
16017 Surgery Male ReprodPenile Injury soon as possible.
Peyronie disease is an acquired disorder characterize
16016 Surgery Male ReprodPeyronie Disease oftengreatest
The include risk
penile pain,
factor forcurvature,
prostate cancerand/or is dorsal
advanc no
16012 Surgery Male ReprodProstate Cancer black ethnicity
Varicoceles and a present
typically diet highas in ameat and low
clustered in fruit
scrotal m
15997 Surgery Male ReprodVaricocele a reduced sperm count and decreased
Unilateral cryptorchidism can be monitored until age motility.
15990 Surgery Male ReprodCryptorchidism
Benign Prostatic testicular torsion, infertility, and testicular malignancy
15953 Surgery Male ReprodHyperplasia Benign
Chronicprostatic
bacterialhyperplasia
prostatitis often can gradually
presents with compress
symp
15939 Surgery Male ReprodProstatitis have
the urethra and entered the prostate via intraprostaticc
transient improvement of symptoms with short
15938 Surgery Male ReprodProstatitis sulfamethoxazole or a fluoroquinolone
Chronic bacterial prostatitis generally causes is generally
recurre re
15935 Surgery Male ReprodProstatitis prostate
Valsalva.from
The the urethra;is Escherichia
diagnosis confirmed with coli ultrasound.
15918 Surgery Male ReprodVaricocele
Necrotizing Soft Tissue patients
crepitus ofwith
thetesticular
affectedatrophy
region and or changes
significant in semen
system
15914 Surgery Male ReprodInfections imaging.
Acute epididymitis is associated with posterior testicu
15913 Surgery Male ReprodEpididymitis transmitted pathogens
Testicular torsion (e.g. Chlamydia
can present with acute testicular pa
15911 Surgery Male ReprodTesticular Torsion Doppler ultrasound of the scrotum
Testicular torsion is caused by twisting can confirm the di
of the sperma
15910 Surgery Male ReprodTesticular Torsion episodes
Testicularthat resolved
torsion presents without
withintervention.
abrupt onsetAofreactiv scrota
15908 Surgery Male ReprodTesticular Torsion patients may have recurring, transient
including low back pain (retroperitoneal lymphadenop symptoms due
12372 Surgery Male ReprodBenign
Testicular Cancer
Prostatic scrotal ultrasound
Cystoscopy and tumor markers
is recommended for patients to support
with gross the h
8929 Surgery Male ReprodHyperplasia smoking, certain occupational exposures (e.g. painte
4525 Surgery Male ReprodVaricocele A varicocele
Leydig is a dilation
cell testicular tumorsof the oftenpampiniform plexus th
cause feminization
3594 Surgery Male ReprodTesticular Cancer Serum tumor markers (e.g. β-hCG,
Penile fracture is most commonly caused by blunt AFP) are not usu tra
3352 Surgery Male ReprodPenile Injury repair, patients with evidence of urethral
A solid, firm, nontender testicular mass should be con injury (e.g. b
2589 Surgery Male ReprodTesticular Cancer
Blunt Abdominal markers, and blunt
Patients with radical inguinal orchiectomy.
abdominal trauma and suspected
19921 Surgery MiscellaneouTrauma managed according to their hemodynamic
Incisional hernias develop due to fascial closure status.breaHe
15718 Surgery MiscellaneouIncisional Hernia protruding abdominal
of the anterior aspect contents)
of the shoulder. that is X-rays
palpable showwhile lo
2372 Surgery MiscellaneouShoulder Dislocation dislocations are managed with closed
Subfalcine herniation, a type of brain herniation, occu reduction.
20493 Surgery Nervous SysBrain Herniation ipsilateral anterior cerebral
Cervical myelopathy artery compression
often causes both spinal cord that an le
19322 Surgery Nervous SysCervical Myelopathy symptoms (e.g. lower motor
Cervical radiculopathies occur neuron
due tosigns,
spinalpainnervein aroo d
19321 Surgery Nervous SysRadiculopathy pattern.
occur. The Lateral flexionisand
diagnosis rotation
usually made of clinically,
the neck worse
and m
19320 Surgery Nervous SysRadiculopathy activities.
Whiplash most commonly causes cervical strain with
19271 Surgery Nervous SysSpinal Cord Injury National
Traumatic Emergency
brain injuryX-Radiography
can cause damage Utilization Studya
to cortical
19024 Surgery Nervous SysTraumatic Brain Injury hyperactivity,
Osmotic therapy a syndrome characterized
(e.g. hypertonic saline, by rapid-ons
mannitol) is
18943 Surgery Nervous SysTraumatic Brain Injury draws water out of the edematous brain tissue, there
Acute traumatic coagulopathy, a state of hypocoagul
18942 Surgery Nervous SysTraumatic Brain Injury outcomes
The presence for patients
of a single withvertebral
moderate TBI if administe
fracture in a patien
18659 Surgery Nervous SysSpinal Cord Injury and accuracy.
CT scan is the preferred test to screen for cervical sp
18658 Surgery Nervous SysSpinal Cord
Subarachnoid Injury altered mental hemorrhage
Subarachnoid status, intoxication,typicallyorpresents
distracting
withinjur
as
18516 Surgery Nervous SysHemorrhage the brain is the best initial diagnostic
corresponding nerve root. The most commonly affect step.
18312 Surgery Nervous SysSpinal Cord Injury anterior
CT scansubluxation
is the preferred of thetest vertebral
to screen bodies.
for cervical sp
17426 Surgery Nervous SysSpinal Cord Injury altered mental status, intoxication,
of pituitary function; because cortisol helps maintain or distracting injurv
17181 Surgery Nervous SysPituitary Apoplexy hypotension
Symptoms include and distributive shock. myeloneuropat
slowly progressive
16772 Surgery Nervous SysCopper Deficiency depigmentation, hepatosplenomegaly, edema, and o
16718 Surgery Nervous SysOrbital Fracture An orbital floor fracture can result in entrapment of th
16699 Surgery Nervous SysNeurofibromatosis
Carpal Tunnel Vestibular
Carpal tunnel schwannomas
syndrome ispresent the most with hearingmonone
common loss a
16496 Surgery Nervous SysSyndrome
Carpal Tunnel symptoms
Carpal tunnel typically
syndrome worsen during dialysis
is common and are
in patients withmh
16491 Surgery Nervous SysSyndrome compression ofmedications.
antithrombotic the median nerve within theinclude
Manifestations carpal tusl
16481 Surgery Nervous SysEpidural Hematoma includes
by a lucidan urgent many
interval, MRI and neurosurgical
initially remain alert. decompre
Howeve
16480 Surgery Nervous SysEpidural Hematoma nausea/vomiting,
dysarthria, and nystagmus may occur. CT scanminute
altered mental status) within demo
16284 Surgery Nervous SysHemorrhagic Stroke or radiologic evidence of a hemorrhage
Symptoms of cervical myelopathy include a slowly > 3 cm, brain
pr
16182 Surgery Nervous SysRheumatoid Arthritis sign. Hoffman sign may also be positive.
also often cause neurogenic shock due to interruption
16089 Surgery Nervous SysSpinal Cord Injury heart
Central (bradycardia).
cord syndrome Hypothermia
is commonisafter alsowhiplash-typ
common du
16088 Surgery Nervous SysSpinal Cord Injury motor, sensory,
Spinal cord injuryand abovereflexT6abnormalities;
can be complicated sacral by(e.g.
au
16022 Surgery Nervous SysSpinal Cord Injury
Normal Pressure hypertension. A compensatory parasympathetic
cognitive impairment, and gait abnormalities; howeve resp
15950 Surgery Nervous SysHydrocephalus subarachnoid hemorrhage,
Malignant hyperthermia is atrauma,
genetic meningitis) that r
disorder associa
15653 Surgery Nervous SysMalignant Hyperthermia succinylcholine
Intracerebral hemorrhageor a volatile anesthetic.
(ICH) typicallyMost caseswit
presents a
14528 Surgery Nervous SysHemorrhagic Stroke commonly
symmetric,due to arteriovenous
descending neurologic malformation,
deficits (e.g.which
crani
14459 Surgery Nervous SysBotulism leukocytosis may be present. Urgent
include progressive gait instability and weakness in th treatment with e
12245 Surgery Nervous SysCervical Myelopathy
Cauda Equina the level of the saddle
accompanying lesion (legs).
anesthesia (sensory change in
12244 Surgery Nervous SysSyndrome followed by surgical decompression.
benign primary brain tumors; however, they can pres
11997 Surgery Nervous SysBrain Tumors recommended.
preserved touch, vibration, and proprioception) and m
4698 Surgery Nervous SysSyringomyelia
Normal Pressure surgical intervention.
demonstrates ventriculomegaly out of proportion to c
4652 Surgery Nervous SysHydrocephalus fluid removal.
Acute shoulderDefinitive
pain after treatment is ventricular
forceful abduction andshunt
exte
4604 Surgery Nervous SysShoulder Dislocation axillary nerve innervates the teres
Rapid hematoma (e.g. epidural) expansion after head minor and the delt
4552 Surgery Nervous SysBrain Herniation an ipsilateralorfixed
dislocation, iliacusandhematoma
dilated pupil andduecantosuffer
oculomoto
iatrog
4293 Surgery Nervous SysFemoral Neuropathy involving the femoral artery or vein.
Thoracic aortic aneurysm repair can cause spinal cor
4204 Surgery Nervous SysAnterior Cord Syndrome pain/temperature
Subdural hematoma andresults
crude from touchthe sensation;
rupture of and urin
bridg
4153 Surgery Nervous SysSubdural Hematoma well
sensoryas anticoagulant
changes, anduse. On non-contrast
bowel/bladder head CT—
dysregulation
3983 Surgery Nervous SysEpidural Abscess Epidural
In patients anesthesia
with traumatic is a common
spinal cord triggering event (du
injury, disruption
3784 Surgery Nervous SysSpinal Cord Injury prevent
The typicalbladder
CT/MRI distension
findingsand possible injury.
in high-grade (e.g. grade
3725 Surgery Nervous SysBrain Tumors butterfly appearance with central necrosis on neuroim
3226 Surgery Nervous SysTraumatic Brain Injury Short-term
Hyperextension hyperventilation
injury, especially helps in lower increased
elderly patientsintw
3072 Surgery Nervous SysCentral Cord Syndrome pain and temperature
Cataracts typically develop sensation in the age
in patients upper extremit
> 60 but m
18934 Surgery OphthalmoloCataract exposure.
Topical glucocorticoid eyedrops and systemic glucocr
Treatment for cataracts includes surgical
18673 Surgery OphthalmoloGlaucoma of peripheral
present vision,deformity,
with globe and someextrusion patients with steroid-in
of vitreous or
17224 Surgery OphthalmoloOcular Trauma visual acuity or afferent pupillary response, and reduc
Graves ophthalmopathy is characterized by ocular irr
4726 Surgery OphthalmoloHyperthyroidism (TSH)
obtainedreceptor autoantibodies,
with fluorescein leading
instillation. to expansion
In OGL, fluoresc
4015 Surgery OphthalmoloOcular Trauma yellow.
apraclonidine) is recommended. In addition, acetazol
3430 Surgery OphthalmoloGlaucoma provide definitive management.
3125 Surgery OphthalmoloOcular Trauma Chemical
Postoperativeburns to the eye are vision-threatening
endophthalmitis is the most common emefo
2853 Surgery OphthalmoloEndophthalmitis Examination reveals swollen eyelids and
A cataract is a vision-impairing opacification of the len conjunctiva,
2850 Surgery OphthalmoloCataract lens implantation
Patients is indicated
with a Loxosceles reclusawhen loss of
(brown vision imp
recluse) spid
20068 Surgery Poisoning & Insect Bites And Stings the application of cold packs and
Venomous snake bite should be managed with close local wound care.
19790 Surgery Poisoning & Snake Bite studies can be
High-voltage observed
electrical for 12-24
injuries hours.cause
frequently Patients morewi
19263 Surgery Poisoning & Electrical Injury complication that can
Severe burn injury oftenresult
leads in acute compartment sy
to a hypermetabolic re
16582 Surgery Poisoning & Thermal Burn and insulin resistance; and increased protein and lipid
3399 Surgery Poisoning & Insect Bites And Stings Brown recluse spider bites can cause a deep necrotic
3398 Surgery Poisoning & Wound
ThermalDehiscence
Burn Circumferential,
And Superficial wound full-thickness
dehiscence,(third degree)
separation of burns
the epid ca
16024 Surgery Pregnancy, C Evisceration contrast, tremens
Delirium deep (fascial)
is a late dehiscence
manifestation involves the fasci
of alcohol wi
15100 Surgery Psychiatric/ Alcohol Withdrawal tremens is associated with a mortality rate of 5% and
13693 Surgery Psychiatric/ Benzodiazepines Benzodiazepine
Delirium tremenswithdrawal
is a severemay be characterized
manifestation of alcoho by
12173 Surgery Psychiatric/ Alcohol Withdrawal
Parapneumonic sensorium.
Aspiration pneumonia leading to translocation of ana
20111 Surgery Pulmonary &Effusion & Empyema
Parapneumonic 2-3 weeks) with
Complicated weight loss and
parapneumonic similarinvolve
effusions signs and sym
bacter
20107 Surgery Pulmonary &Effusion & Empyema diagnostic
of swallowing of adysfunction
complicated oreffusion
impairedand is an indicat
consciousness
20098 Surgery Pulmonary &Lung Abscess recommended.
Bronchial carcinoid is the most common lung cancer
19924 Surgery Pulmonary &Carcinoid Tumors pneumonia in the same
Bronchial carcinoid tumors lobe areof the
the most
lung. common
Carcinoidlun sy
19922 Surgery Pulmonary &Carcinoid Tumors dyspnea,
and chestwheezing,
x-ray revealing pneumonia)
perihilaroropacities
hemoptysis. CT s
and inter
19293 Surgery Pulmonary &Lung Transplantation glucocorticoids) could markedly
Bronchiolitis obliterans is the major worsen an infection,
manifestation of c
19288 Surgery Pulmonary &Lung Transplantation based on a consistent clinical presentation
The phrenic nerve can be injured during cardiac surg (e.g. grad
18890 Surgery Pulmonary &Respiratory Acidosis inspiration).
central venous pressure (CVP), low pulmonary capilla
16919 Surgery Pulmonary &Obstructive Shock stenosis)
in the left leads
lateraltodecubitus
the samepositionfindingstoas cardiogenic
trap air on thesl
16527 Surgery Pulmonary &Penetrating
Air EmbolismNeck circulation. High-flow
neurosurgical), centraloxygen
venousiscatheter
also important to enc
manipulation,
16526 Surgery Pulmonary &Trauma hypoxemia, obstructive
Positive-pressure shock,
ventilation can and cardiac
rapidly arrest. t
exacerbate
16521 Surgery Pulmonary &Pneumothorax performed prior
Prophylactic to intubation does
anticoagulation for patients with TPthe
not eliminate who ri
16488 Surgery Pulmonary &Pulmonary Embolism angiography is the initial diagnostic test of choice in p
16455 Surgery Pulmonary &Blunt Thoracic Trauma Displaced fractures of ribs 9-12 can injure intra-abdo
16400 Surgery Pulmonary &Pneumonectomy FEV1 and diffusioninjury
Tracheobronchial capacity
should of the lung for carbon
be considered m
in patie
16316 Surgery Pulmonary &Blunt Thoracic
Penetrating Trauma the
Thoracic diagnosistrauma
Penetrating prior toaccompanied
operative repair. by shock (e.g. seve
16315 Surgery Pulmonary &Trauma 1,500 mL), which requires emergent thoracotomy to p
16314 Surgery Pulmonary &Blunt Thoracic Trauma Hypovolemic
Foreign body shockaspirationin the setting
should beofsuspected
blunt chest in traum
a chi
16267 Surgery Pulmonary &Foreign Body Aspiration
Acute Respiratory include a focal lung examination (e.g.
Positive-pressure ventilation improves gas exchange wheeze, decre
16110 Surgery Pulmonary &Failure
Healthcare Associated large pneumothorax often
Ventilator-associated demonstrate
pneumonia shouldrapid-onset
be suspecte ta
16061 Surgery Pulmonary &Pneumonia
Healthcare Associated requirement, increasedthe
secretions. Therefore, secretions),
risk is reduced and clinical signs
by elevating
16060 Surgery Pulmonary &Pneumonia acid suppression, unless patients are at high risk of s
15817 Surgery Pulmonary &Airway Emergency Ludwig anginasyndrome
Fat embolism is a rapidly can progressive
occur followingcellulitis of the
fracture
15656 Surgery Pulmonary &Fat Embolism
Transfusion Related dysfunction, and a petechial
pulmonary infiltrates. In contrast rash;tohowever,
patients withthe rash
trans
14706 Surgery Pulmonary &Acute Lung Injury distension.
Lung abscess is common in patients with periods of i
14378 Surgery Pulmonary &Lung Abscess presents
Aspirationwith indolent systemic
pneumonitis is an acute symptoms
lung injuryandsecond
cough
11669 Surgery Pulmonary &Aspiration Pneumonia aspiration of infected
Initial management inoropharyngeal
hemoptysis involves secretions.
establishin
4937 Surgery Pulmonary &Hemoptysis be placed with the bleeding lung
Patients with hemoptysis and high clinical suspicion in the dependent pof
4936 Surgery Pulmonary &Hemoptysis evaluation
Deep-breathing and treatment.
exercises and incentive spirometry c
4932 Surgery Pulmonary &Atelectasis of chest expansion
Postoperative atelectasis duringisrespiration.
common and typically ma
4931 Surgery Pulmonary &Atelectasis and hyperventilation
abdominal or thoracoabdominal leads to primary
surgery.respiratory
Adequate alka
p
4695 Surgery Pulmonary &Atelectasis postoperative atelectasis.
oropharyngeal inflammation/blistering, oropharyngea
4597 Surgery Pulmonary &Thermal Burn
Parapneumonic The presence
pleural space, of > 1 of these parapneumonic
a complicated indicators warrants earl
effusion
4568 Surgery Pulmonary &Effusion & Empyema tube)
Fracturein addition to prolonged
of > 3 contiguous ribsantibiotics.
in > 2 locations can re
4561 Surgery Pulmonary &Rib Fracture ineffective
Flail chest should be suspected incontusion,
ventilation, pulmonary patients with andrespi
atele
4559 Surgery Pulmonary &Blunt Thoracic Trauma respiratory
Positive-pressurefailure.mechanical ventilation causes an a
4551 Surgery Pulmonary &Hypovolemia
Postoperative mechanical
thoracic ventilationsurgery,
or abdominal can cause acutelasting
surgery loss of>right
3 hov
4545 Surgery Pulmonary &Pneumonia prevent such shock
Hypovolemic complications
involvesand improve
an initial outcomes
decrease b
in pre
4540 Surgery Pulmonary &Hypovolemia Hypotension, tachycardia, cold extremities,
Hypovolemic shock in the setting of blunt trauma is c and evide
4539 Surgery Pulmonary &Blunt Thoracic Trauma due to a spontaneous
Primary massive hemothorax. pneumothorax (PSP) occurs in
4538 Surgery Pulmonary &Pneumothorax clinically stable patients
Blunt thoracic trauma can includes
injure the observation
underlying and sup
lung.
4537 Surgery Pulmonary &Pulmonary Contusion hypoxemia.
may be present Irregular, nonlobular infiltrates
from hemorrhage preceding oncontainm
chest x
4527 Surgery Pulmonary &Blunt Thoracic Trauma death.
Secondary spontaneous pneumothorax should be su
4520 Surgery Pulmonary &Pneumothorax is the most
Solitary commonnodules
pulmonary cause in patients
< 0.6 cm are with chronictoob
unlikely b
4252 Surgery Pulmonary &Lung Nodule probability for malignancy (i.e. >
Diaphragmatic rupture can have a delayed presentat 5% probability) base
4229 Surgery Pulmonary &Blunt Thoracic Trauma organs into the
Even without thoracic
chest cavity. Chest
wall fracture, bluntx-ray maytraum
thoracic show
4145 Surgery Pulmonary &Pulmonary Contusion
Parapneumonic irregular
usually showsalveolar infiltrates.
loculation, and thoracentesis reveals fl
4073 Surgery Pulmonary &Effusion & Empyema empyemas require drainage (e.g. chest tube) in addit
4052 Surgery Pulmonary &Bronchogenic Cyst Bronchogenic
Lung abscess cysts are usually
is usually due to the found in the middle
aspiration of orop m
3901 Surgery Pulmonary &Lung Abscess high risk. Symptoms
The modified includecan
Wells criteria subacute
assessfever, night sw
the pretest po
3859 Surgery Pulmonary &Extragonadal
Pulmonary Embolism
Germ Cell Empiric
Germ anticoagulation
cell tumors typically in these
affect patients is oftenand
young patients appd
3775 Surgery Pulmonary &Tumor gonadotropin
Mucus plugging tumorcan markers.
lead to large-volume atelectasis
3734 Surgery Pulmonary &Atelectasis toward the siderupture
Diaphragmatic of atelectasis.
should be suspected in patien
3731 Surgery Pulmonary &Diaphragmatic Hernia
Acute Respiratory Delayed presentations
30-60 minutes). The etiology can occur is often aftermultifactorial,
progressive ex ho
3224 Surgery Pulmonary &Failure medication effect resulting in hypoventilation.
3220 Surgery Pulmonary &Rib Fracture Adequate pain control isisthe
Tension pneumothorax mainstay of rib condition
a life-threatening fracture m
3216 Surgery Pulmonary &Pneumothorax characterized by rapid-onset dyspnea, tachycardia, ta
2812 Surgery Pulmonary &Sepsis
Acute Respiratory Patients
Hypoxemia withcanseptic shock first
be caused require aggressive
by reduced inspired oxyge vol
2788 Surgery Pulmonary &Failure and
(duerespiratory
to parathyroid acidosis.
hormone-related protein release)
2632 Surgery Pulmonary &Lung Cancer inappropriate antidiuretic
Superior pulmonary sulcus hormone
tumors secretion),
are malignant andlung
ad
2602 Surgery Pulmonary &Lung
AcuteCancer
Respiratory pain, and/or handmuch
zero throughout weakness.
of the lungs and the hypoxemi
2303 Surgery Pulmonary &Failure arterial O2 gradient. It also causes stiffening of the lu
2145 Surgery Pulmonary &Pulmonary Embolism Massive
and Cl are pulmonary
low due to embolism
total body is depletion
likely in a andpostopera
aldost
18886 Surgery Renal, UrinaMetabolic Alkalosis responsive).
Nonanion gap metabolic acidosis (NAGMA) results fr
18882 Surgery Renal, UrinaMetabolic Acidosis
Blunt Abdominal volume fluid losses
Blunt trauma from blow
(e.g. direct the pancreas
to the flank) (e.g.canpancreat
cause
17450 Surgery Renal, UrinaTrauma of whether hematuria is present.
Blunt Abdominal Blunt trauma to a full bladder can cause it to rupture
17280 Surgery Renal, UrinaTrauma urinary
Patientsascites and increased
can develop respiratory blood urea nitrogen
alkalosis with a highan
16515 Surgery Renal, UrinaRespiratory Alkalosis tolerance
extrarenaland require
infection (e.g.increased
bacteremia)dosesinofthe opioids or m
prior 1-2
16340 Surgery Renal, UrinaUrinary Tract
Polycystic Infection
Kidney not in contact is
Hypertension with
one theofcollecting
the earliest ducts.
clinical manifestat
16338 Surgery Renal, UrinaDisease
Polycystic Kidney consequent increased renin
Autosomal dominant polycystic kidney disease production with activation
comm
16332 Surgery Renal, UrinaDisease although vasopressin-2 receptor
Acute renal vein thrombosis presents with hematuria antagonists (e.g. tol
16325 Surgery Renal, UrinaRenal Vein Thrombosis can be confirmed
pressure, decline in byrenal
CT orfunction
MR angiography or renalo
with the addition
16323 Surgery Renal, UrinaRenal Artery Stenosis imaging
and evidence(e.g. renal Doppler hyperaldosteronism
of secondary ultrasonography). (hypo
16321 Surgery Renal, UrinaRenal Artery Stenosis ultrasound
on imaging.with Doppler). of the post-stenotic kidne
Hypoperfusion
16320 Surgery Renal, UrinaRenal ArteryLindau
Von Hippel Stenosis hyperaldosteronism.
Von Hippel-Lindau disease Renin secretion
is an autosomalby the dominan
unaffecte
16249 Surgery Renal, UrinaDisease nervous systemisand
Bladder cancer retina. in
common Other
oldercommon
adults andmanifesta
often p
16046 Surgery Renal, UrinaBladder Cancer required to visualize the bladder
Bladder cancer often presents with painless hematur wall and to biopsy su
16045 Surgery Renal, UrinaBladder Cancer and to rule out infection/glomerulonephritis.
cardiopulmonary disease, obstructive sleep Those apnea).wiI
16042 Surgery Renal, UrinaRenal Cell Carcinoma carcinoma.
16040 Surgery Renal, UrinaRenal
UrinaryCell Carcinoma
Tract Renal cell carcinoma
incomplete emptying. is common
Postvoid in oldervolume
residual patientsis wh
inc
15906 Surgery Renal, UrinaObstruction urethroplasty.
mm in diameter) that are unlikely to pass without add
15697 Surgery Renal, UrinaRenal Calculi facilitate
Magnesium passage
ammonium (especially phosphatefor intermediate-sized
(struvite) causess
15682 Surgery Renal, UrinaRenal Calculi Klebsiella). Antibiotics
mellitus/metabolic alone dochronic
syndrome, not eliminate
diarrhea struvite
(due to
15674 Surgery Renal, UrinaRenal Calculi dissolves the stones.
whereas severe symptoms include seizure, coma, an
13446 Surgery Renal, UrinaHyponatremia therefore,
α1 receptor patients
blockers withsuch anyas symptoms
tamsulosin should
act on receive
the d
11109 Surgery Renal, UrinaRenal Calculi passage and reduce the need for
Patients with postoperative urinary retention often ha analgesics.
4701 Surgery Renal, UrinaUrinary Retention ultrasound
Acute urinary canretention
confirm (AUR) the diagnosis.
is common in elderly m
4615 Surgery Renal, UrinaUrinary Retention period.
Intravascular volume depletion isbladder
Diagnosis is made using a common ultrasound.
cause o
4607 Surgery Renal, UrinaPrerenal Azotemia unremarkable
Blunt lower abdominal trauma can rupture theofbladde
urine sediment. Administration intrav
4557 Surgery Renal, UrinaBladder Trauma tenderness, difficulty voiding,
Drugs with anticholinergic and associated
properties can cause pelvic
acute f
4432 Surgery Renal, UrinaUrinary Retention catheterization and discontinuing
In adults, fibromuscular dysplasia the mostmedication.
commonly aff
3866 Surgery Renal, UrinaRenal Artery Stenosis commonabsorption
Oxalate presentations. Accompanying
is increased in Crohn bruits mayand
disease be
3435 Surgery Renal, UrinaRenal Calculi hyperoxaluria
Blunt trauma can andcause
oxalate stone
renal formation.
injury. Concerning clini
3358 Surgery Renal, UrinaRenal Trauma mechanism
Pelvic fractures of injury,
in men should
may be prompt CT scanby
complicated ofposte
the a
3349 Surgery Renal, UrinaUrethral Injury retrograde urethrography.
Suprapubic pain and gross hematuria with associated
3348 Surgery Renal, UrinaBladder Trauma rupture
Bladdertypically
cancer often causes localized
causes (vs diffuse
hematuria, abdomin
voiding sym
3335 Surgery Renal, UrinaBladder Cancer symptoms require urgent workup
Most ureteral stones < 5 mm in diameter pass sponta with cystoscopy.
2227 Surgery Renal, UrinaRenal Calculi passage of larger
During a joint stones
or bursal (6-10 mm).
aspiration Urologic introdu
or injection, consul
20224 Surgery RheumatologBursitis Diagnostic
Gout can cause aspiration
acuteofbursal the joint(e.g.orprepatellar,
bursa is necessar
olecra
20191 Surgery RheumatologBursitis surrounding soft tissue and bones, which can result i
20117 Surgery RheumatologColles Fracture Distal
Septicradius fractures
prepatellar bursitis withisneurovascular
characterized compromis
by acute e
20114 Surgery RheumatologBursitis Staphylococcus).
Hip dislocation should be reduced within 6 hourstoofcon
Bursal fluid analysis is needed in
20034 Surgery RheumatologHip Fracture closed (i.e. nonoperative) reduction,
Patients with seemingly minor blunt chest trauma (BC whereas disloca
19966 Surgery RheumatologClavicle Fracture (e.g. chestcapsulitis
Adhesive x-ray) in results
stabilized from patients with BCT
contracture of the shou
gle
19930 Surgery RheumatologAdhesive Capsulitis includes gentle range of motion exercises;
the normal cortical contour, and irregular lucency at t adjunctive
19928 Surgery RheumatologHip Fracture
Tarsal Tunnel repair
Tarsal istunnel
indicatedsyndromefor most patients.
is caused by posterior tibial n
19927 Surgery RheumatologSyndrome posteromedial ankle, heel, sole, and toes, which is el
Dupuytren contracture results from progressive palm
19910 Surgery RheumatologDupuytren Contracture
Acromioclavicular contractures
Acromioclavicular that limit
(AC)extension
joint sprain at the metacarpopha
results from direct
19908 Surgery RheumatologInjuries arm across the torso. X-rays can assess the degree o
19907 Surgery RheumatologRotator Cuff Shoulder
increaseddislocation is commonly
risk for avascular necrosis, associated
and closed withredrot
19906 Surgery RheumatologShoulder Dislocation surgical
Patients repair.
who experience shoulder dislocation are ofte
19905 Surgery RheumatologShoulder Dislocation underlying multidirectional
at the anteromedial joint instability
heel. First-line treatments (i.e. excess
include
19845 Surgery RheumatologPlantar Fasciitis treatment.
painful, firm, mobile mass with local swelling. Alkaline
19830 Surgery RheumatologMyositis Ossificans radiolucent
Calcaneal stress zones.fracture is caused by repetitive micr
19793 Surgery RheumatologStress Fractures calcaneus,
Ganglion cyst andisthe diagnosis is
a connective confirmed
tissue outpouching with imagi aris
19776 Surgery RheumatologGanglion Cyst Most ganglion cysts resolve spontaneously,
The diagnosis of acute Achilles tendon rupture can b and asym
19676 Surgery RheumatologTendon Injury contraction.
Femoral neck Absent foot plantar flexion
and intertrochanteric in response
fractures are theto
17862 Surgery RheumatologHip Fracture and external
Posterior hip rotation
dislocation of the leg compared
commonly occurswith the co
in head-on
17564 Surgery RheumatologHip Fracture include
Initial sciatic nerve
treatment injury
of septic (e.g. impaired
arthritis includesdorsiflexion
intravenou
17513 Surgery RheumatologSeptic Arthritis Serial dislocation
Knee procedurescan arecause
often required to completely
limb-threatening injury cleto
17060 Surgery RheumatologKnee Dislocation vascular injury.
A dietary history to assess for anorexia nervosa shou
16620 Surgery RheumatologAnorexia Nervosa anorexia nervosa arepain
Greater trochanteric at risk for stress
syndrome fractures
presents withduelatt
16531 Surgery RheumatologBursitis nonsteroidal anti-inflammatory
Iliotibial (IT) band drugs. Patientsbywith
syndrome is characterized poor p
16530 Surgery RheumatologIliotibial Band Syndrome shows
Adolescenttenderness
idiopathicproximal
scoliosisto the joint line;
is defined aspressure
lateral cu
16389 Surgery RheumatologScoliosis prominence.
Pelvic fractures, especially those with pelvic ringofdisru
The first step in evaluation is x-ray the
16331 Surgery RheumatologPelvis Fracture pelvic volume and
A Salter-Harris typepromote tamponade
III (juvenile of bleeding.
Tillaux fracture) is ch
16330 Surgery RheumatologSalter-Harris Fracture when the physis is partially fused.
Upper Extremity Long Buckle fractures are common in children and typically Injury to the growth
16329 Surgery RheumatologBone Fracture cortex.
and impaired thumb abduction. In addition, if compre
16328 Surgery RheumatologColles Fracture sensation
to the lateral over the anterolateral
malleoli and the patient hand.can bear weight
16206 Surgery RheumatologAnkle Trauma appropriate.
Ankle pain after trauma may be caused by a sprain o
16205 Surgery RheumatologAnkle Trauma patients
Ganglionwith cystspain
areinmobile,
the malleolar
nontender region in associatio
swellings that o
16160 Surgery RheumatologGanglion Cyst transillumination of the mass. Most
Phantom limb pain is common following extremity am ganglion cysts res
16019 Surgery RheumatologAmputation consisting offittings
complicate pharmacotherapy
for amputational and prosthetics.
adjuvant therapie Inject
16018 Surgery RheumatologAmputation neuroma.
Plantar fasciitis is characterized by inflammation and
15967 Surgery RheumatologPlantar Fasciitis supportsosteomyelitis
Chronic the longitudinal may arch
leadoftothe foot. Itnonunion.
fracture presents
15669 Surgery RheumatologOsteomyelitis microbiologic
Paget disease of bone is associated with increasedsub
assessment, and treatment requires
15662 Surgery RheumatologBone Tumor hallmark
Osteosarcomaradiographic findings
is a primary bone (e.g.
tumordestructive
that is often bonea
15661 Surgery RheumatologBone TumorMuscle And Fraumeni
Quadriceps syndrome.
Sudden, forceful contraction of the quadriceps muscl
15657 Surgery RheumatologTendon
CompartmentInjuries actively extend the
reperfusion procedures; knee patients
against gravity.
who areInontears of th
anticoag
15654 Surgery RheumatologSyndrome weakness.
Management Diagnosis is confirmed
of osteoarthritis of thebyknee measuringshould com inclu
15632 Surgery RheumatologOsteoarthritis
Slipped Capital Femoral Slipped capital femoral epiphysis is most common ing
conservative management is inadequate, injectable
15479 Surgery RheumatologEpiphysis
Slipped Capital Femoral be the only
Slipped presenting
capital femoralsymptom.
epiphysis Supportive
occurs when examina
exces
15478 Surgery RheumatologEpiphysis Patients
Pediatric acute osteomyelitis is most commonly chron
are classically obese adolescents with caus
14963 Surgery RheumatologOsteomyelitis tenderness over the affected bone.
Initial management of osteoarthritis of the knee includ
14463 Surgery RheumatologOsteoarthritis strengthen
Osteoarthritis theofquadriceps muscles can reduce
the hip is characterized by chronic abnop
14202 Surgery RheumatologOsteoarthritis range
Plantaroffasciitis
motion.presents
X-ray reveals
with pain lossatofthe thesole normal of thejoinf
14026 Surgery RheumatologPlantar Fasciitis insertion of the aponeurosis
Patellar dislocation usually occurs on theaftercalcaneus
quick, with lateraldo
13974 Surgery RheumatologPatellar Dislocation malalignment, and patellar subluxation. Examination
Osteoporosis in a young or middle-aged man sugges
13742 Surgery RheumatologOsteoporosis
Patellofemoral asymptomatic
squatting) that osteopenia/osteoporosis
involve contraction of theorquadriceps osteomalaw
12060 Surgery RheumatologSyndrome strengthening
Prepatellar bursitis exercises.
is characterized by anterior knee
11976 Surgery RheumatologBursitis should be performed
Anterior cruciate ligament to exclude
injuriesinfection.
are common in spo
8895 Surgery RheumatologKnee Trauma swelling
is most common in patients with diabetic findings
with hemarthrosis. Examination neuropathy. inclu
4743 Surgery RheumatologCharcot Joint destruction,
Rotator cuff osteophyte
tears causeformation, and loss ofatjoint
pain and weakness the shsp
4605 Surgery RheumatologRotator Cuff can confirm(Baker)
A popliteal the diagnosis.
cyst is due to extrusion of synovia
4583 Surgery RheumatologBaker Cyst arthritis. Popliteal
Osteonecrosis (avascular cysts may presentofasthe
necrosis) a painless
femoral he bu
4565 Surgery RheumatologOsteonecrosis and jointtrochanteric
Greater instability. X-rays will often is
pain syndrome beannormal,
overuse andsyM
4546 Surgery RheumatologBursitis that
Stressis worsened
fractures of with
therepetitive
metatarsals hip are
flexion or lying on
associated wi
4485 Surgery RheumatologStress Fractures Initial treatment includes rest and
Succinylcholine is a depolarizing neuromuscular bloc simple analgesics.
4428 Surgery RheumatologHyperkalemia
Vertebral Compression receptors
Acute vertebral (e.g. skeletal
compression muscle trauma,
fracture canburn
be injury,
causeds
4375 Surgery RheumatologFracture osteoporosis
are unreliableor other conditions
findings. The erythrocyteassociated with decr
sedimentation
4371 Surgery RheumatologOsteomyelitis osteomyelitis
Most patients in patients
with acute,with a history of low
uncomplicated injection
back dru
pa
4264 Surgery RheumatologBack Pain activity. Nonsteroidal anti-inflammatory
Acute knee pain associated with catching or reduced drugs are pre
4250 Surgery RheumatologKnee Trauma MRI, and surgical
Osteonecrosis consultation
(aseptic necrosis) is advised for significa
of the femoral head
4038 Surgery RheumatologOsteonecrosis
De Quervain x-rays. It is due to occlusion of end
increased frequency during the postpartum period. E arteries supplying
3576 Surgery RheumatologTenosynovitis wrist
Tearswith of thethemedial
fingersmeniscus
closed over often theresult
thumb). from twistin
3572 Surgery RheumatologKnee Trauma effusion. Examination reveals palpable
Medial collateral ligament tear is caused by valgus locking or catst
3569 Surgery RheumatologKnee Trauma knee and valgus laxity. MRI is the
Tibial stress fractures are caused by repeated tensiomost sensitive test
3566 Surgery RheumatologStress Fractures Findings
Older patients include subacute,
with hip fracturelocalized,
shouldactivity-related
undergo defini
3564 Surgery RheumatologHip Fracture and ensure medical stability.
Arterial supply to the scaphoid enters at the distal po
3562 Surgery RheumatologScaphoid Fracture immediately
Clavicle fracture visible
canoninjure
x-ray.theIf initial x-raysbrachial
underlying are negat ple
3557 Surgery RheumatologClavicle FractureLong
Upper Extremity Soft signs of vascular injury (e.g.
Displaced supracondylar fractures of the humerus mo unexplained hypote
3556 Surgery RheumatologBone Fracture
Compartment anteriorly
Patients with displaced proximal
compartment humerushave
syndrome fragmentsevere canpa
3463 Surgery RheumatologSyndrome pulses
Displaced are scaphoid
uncommon findings.
fractures Compartment
should be considered pressu fo
3415 Surgery RheumatologUpper
Scaphoid Fracture
Extremity Long monitoredwith
resolves withappropriate
serial x-raymanagement
to rule out osteonecrosis
of the fracture o
3412 Surgery RheumatologBone Fracture fractures,
Fat embolism neurovascular
syndrome can compromise,
occur following and significant
the fract
3302 Surgery RheumatologFat Embolism distress;cuff
Rotator obstruction
tears occur in the cerebral
most commonly circulation may ca
in patients
3170 Surgery RheumatologRotator Cuff external rotation of the humerus.
Rotator cuff tendinopathy (RCT) is most common in MRI can confirm thep
3168 Surgery RheumatologRotator Cuff syndrome refers to compression
pain, swelling), but pulmonary metastasis and malignof soft tissue structu
2618 Surgery RheumatologBone Tumor biopsy,
hospitaland surgery is
admission). first-line treatment.
Prevention includes increasing c
19786 Surgery Social ScienPatient Safety (e.g.
Psychological safety strengthens safety verification
pharmacist review), and repeating culture by en p
19738 Surgery Social ScienPatient Safety by
Poorhigh-reliability
teamwork (includingorganizations (e.g. aviation), is
miscommunication) improv
a lea
19737 Surgery Social ScienPatient Safety improves
decrease human effort and facilitate correct action.situ
teamwork and safety culture, promoting E
19718 Surgery Social ScienPatient Safety using visual cues.
Communication breakdown during signout (e.g. omitt
19681 Surgery Social ScienPatient Safety standardized signout processes
Life-saving procedures (e.g. checklists,
(e.g. intubation) may be perfo mne
19110 Surgery Social ScienInformed Consent the same elements
An exception to the (e.g. diagnosis,
requirement proposedconsent
of informed proced
19060 Surgery Social ScienInformed Consent
Decision Making exception does not cover procedures for unrelated is
19048 Surgery Social ScienCapacity Incapacitated patients may regain capacity as their c
sions are often large and prone to recurrence. In addition to acute management with pericardiocentesis, they often require prev
r prolonged
ading catheter
to decreased drainage.
cardiac output and obstructive shock. Right atrial pressure and pulmonary capillary wedge pressure (a reflec
ssion.
cer) is a common cause of pericardial effusion, which may appear on chest x-ray as an enlarged cardiac silhouette with clear lu
evaluate
rauma may for signs of subacute
be at risk for serious tamponade,
intrathoracic andinjury.
guideEvaluation
pericardiocentesis.
includes chest x-ray and ECG. Additional tests/interventions ar
echanism of injury, and initial test findings.
ssed during the informed consent process include the patient's diagnosis, the risks and benefits of both the proposed treatment
ment.
e occurs in > 50% of patients with a history of acute deep venous thrombosis and is marked by the development of chronic ven
esents
nsmission with of
legelevated
pain, edema, fatigue,
left atrial superficial
pressure venous
backward dilation,
to the pulmonaryand/orcirculation.
ulcer. Treatment
There mayincludes exercise
also be and compression.
a reactive component invo
constriction and remodeling.
ume and cardiac output associated with pregnancy can be poorly tolerated in the setting of valvular disease. Symptomatic mitra
gnancy;
, coronary therefore, surgicalgraft
artery bypass repair, preferably
surgery, with percutaneous
percutaneous intervention, that
coronary intervention) should be performed
exposes the immunepriorsystem
to pregnancy.
to cardiac antige
o months.
g chronic adrenal insufficiency, acute stressors (e.g. procedure, illness, trauma) can trigger adrenal crisis, which presents with h
oryby to initial volume
saw-toothed resuscitation.
flutter waves on ECG; Treatment requires
the rhythm canrapid volumeorrepletion
be regular irregularand administration
depending on the of hydrocortisone
variability or dexametha
of the ventricular resp
mboembolization
llows blood to bypass to atrial
the fibrillation
high-resistance and should be similarly
systemic capillaries, managed
resulting with
in chronic
decreased anticoagulation.
systemic vascular resistance (afterload), i
cardiac output.
lates stretch A large arteriovenous
receptors on the peritoneum fistulathat
canrespond
lead to byhigh-output
triggeringheart failure. in vagal tone. Consequently, patients can dev
an increase
sometimes asystole.
d new arrhythmia (e.g. premature ventricular contractions) after blunt chest trauma are concerning for blunt cardiac injury. Patie
ardiac
almostmonitoring and echocardiography.
half of patients who undergo coronary artery bypass graft surgery. The majority of these effusions are small, asymptom
ate in size, begins within
epitus, and purulent discharge; 1 or 2 butdaysit ofcansurgery, and does
also present not cause
atypically. respiratory
Therefore, any symptoms,
patient withitcopious
can be drainage
managedfrom conservatively
the sternalw
dings
ovement. include
Thefluid collections
diagnosis can be or pneumomediastinum.
made radiographically (e.g. displaced sternal wire) or clinically; palpable rocking or clicking of t
nvolves urgent surgical exploration and repair.
mitycirculation,
eral amputationacute includelimbnonrevascularizable
ischemia in the setting limbofischemia, unsalvageable
chronic peripheral arterysoft-tissue damage,
disease (PAD) oftenand life-threatening
presents infectiontha
less dramatically (e
sorders.
still necessary.
Cardiovascular disease, including bicuspid aortic valve and aortic root dilation, places patients at an increased risk for a
regnancy.
e the ascending aorta and present with sudden-onset chest or back pain that is severe and described as sharp or tearing. They
ial infarction,
and transient or heart failureand
hypertension andisrequire
associated immediate surgical
with aortic intervention.
dissection in young patients. There is typically sudden-onset, severe ch
on may occur due to hemothorax.
s a collection of genetic connective tissue disorders. It is usually characterized by joint hypermobility/laxity, multiple joint disloca
ette, paper-likeof
manifestation scarring.
abdominal aortic aneurysm (AAA), and it can vary according to aneurysm location. Proximal AAA tends to cau
c, hemodynamically
usually secondary (functional), stable patients, the diagnosis
resulting from right is best made
ventricular by abdominal
cavity enlargement CT.in the setting of chronic right-sided volume or
rpulsation
a prosthetic is highly
valvespecific
suggests forprosthetic
tricuspid regurgitation.
valve dysfunction (PVD) in the form of a paravalvular leak or transvalvular regurgitation
ailure)end-diastolic
icular and should be promptly
pressure and evaluated
left atrialwith echocardiography.
pressure, resulting in pulmonary edema. Although forward blood flow is reduced, left
due
he bestto atreatment
large amount of stroke
for chronic volume
severe flowing
mitral backward(MR)
regurgitation into oftheprimary
left atrium through
etiology. Thethe low-resistance
measured regurgitant
left ventricular pathway.
ejection fraction
e LVEF in patients with severe MR; therefore, surgery is indicated for both symptomatic
rtic stenosis, surgical aortic valve replacement is indicated in all symptomatic patients. It is also indicated in asymptomatic and asymptomatic patients with LVEF
patie
undergoing other cardiac surgery.
patients with cardiac tamponade typically reveals elevated and equilibrated intracardiac diastolic pressures. Urgent echocardio
usually tamponade
ardiac occurs as afor definitivedefect
congenital diagnosis
and can and often
management.
remain asymptomatic until adulthood. Cardiac auscultation reveals an ejecti
ystolic murmur over the left second intercostal
ent through the tricuspid valve can cause severe tricuspid space and widened
regurgitation splitting
dueof toS2.
direct valve leaflet damage or inadequate leaflet
atients
urs as a late complication (e.g. several months) following transmural myocardial or
presenting with right-sided heart failure following implantable pacemaker cardioverter-defibrillator
infarction, and is suggestedplacement.
by ECG demonstr
ves. Patients most commonly have progressive left ventricular enlargement and
e myocardial infarction may lack chest pain and can develop cardiogenic shock due to left ventricular systolic dysfunction.dyskinetic wall motion leading to heart failure.
Pulm
x and elevated pulmonary capillary wedge pressure.
an develop as a complication of vascular access during cardiac catheterization. Patients typically have mild localized pain and s
le thrill
ction canover the fistula
extend into the site.
pericardial space, causing hemopericardium and rapidly progressing to cardiac tamponade and cardio
l to moderately sized (i.e. 3 cm stable
of choice in hemodynamically to 5.5 patients and reveals
cm) abdominal aortican intimal flap
aneurysms separating
(AAAs) the lifestyle
involves true andmodification,
false lumenswith in the ascending
smoking ces
n.rapid deceleration are at risk for blunt thoracic aortic injury (BTAI). All patients with blunt chest trauma require a chest x-ray aft
r BTAI includeand
paresthesias, widened
sensory mediastinum,
and motor deficits.abnormal The aortic contour,
diagnosis and/or left-sided
is confirmed effusioncompartment
by measuring (hemothorax). pressures. Definitive man
is due to rapid accumulation of a small amount of fluid within a stiff pericardium, causing a sudden rise in intrapericardial press
be normal on chest x-ray.
wing rapid deceleration are at risk for blunt thoracic aortic injury. Signs may include upper extremity hypertension with lower ext
or
umaa hoarse
setting voice (left assumed
is initially recurrent to
laryngeal nerve stretching).
be hypovolemic shock (from hemorrhage), elevated central venous pressure (CVP) is more c
cardiac
he syndrome) is characterized by the triad of bilateralcardiogenic
injury with myocardial dysfunction can cause shock
hip, thigh, and with elevated
buttock CVPimpotence;
claudication; and refractory
andhypotension.
absent or diminished
bilateral lower extremities due to chronic ischemia).
mb ischemia
ed with in a previously
non-contrast CT scanasymptomatic
of abdomen andpatient is most
pelvis consistentultrasonography.
or abdominal with embolic arterial occlusion.
Treatment Most supportive
is usually arterial emboli
withare
bedca
r
blood transfusion.
noninvasive test that is highly sensitive and specific for peripheral arterial disease in symptomatic patients. It is the preferred firs
ears as an enlarged, 'water bottle'-shaped cardiac silhouette on chest x-ray. Physical examination findings of effusion without c
on auscultation
ccur and a maximal
as a catastrophic apicalofimpulse
complication that isdissection.
acute aortic difficult to Itpalpate.
should be suspected in patients with hypotension, tachycardia,
ve sudden onset of severe tearing chest pain radiating to the back.
m manifests as a pulsatile mass that can compress adjacent structures (nerves, veins), and can result in thrombosis and ischem
common peripheral
amic instability arteryand
and signs aneurysms.
symptoms They are frequently
consistent with anassociated
abdominal with abdominal
aortic aneurysmaortic aneurysms.
(AAA) but without a known history, a foc
is helpful in symptomatic patients who are stable, while those who are unstable with
vular incompetence) is the most common cause of lower extremity edema. It classically worsens a known history of AAAthe
throughout should undergo
day and em
resolve
c aneurysm presents with the acute onset of severe abdominal or flank pain, sometimes accompanied by syncope, a pulsatile a
e onset of central
ppropriate hemodynamic
venous instability can be abrupt
catheter placement or delayed.
are common. With the exception of select cases, appropriate catheter tip placeme
. include pulsatile bleeding, bruits or thrills over the injury, an expanding hematoma, and signs of distal ischemia (e.g. absent
ury
rsinjury, suchcause
may also signs position-dependent
are almost universally predictiveofofthe
obstruction themitral
needvalve,
for urgent surgical
leading repair.
to a mid-diastolic murmur and symptoms of decre
titutional symptoms (e.g. fever, weight loss) may also be present.
hemia is clinically diagnosed (e.g. pallor, pulselessness), anticoagulation (e.g. intravenous heparin infusion) should be initiated.
ombosis while the patient undergoes further diagnostic procedures or awaits surgical intervention.
ctionfollowing
ccur are possible earlysurgery
cardiac complications of operation
and present on the
with fever, abdominal
chest aorta, suchand
pain, leukocytosis, as mediastinal
AAA repair. widening on chest x-ray. It is a s
ement,
eading and prolonged
to acute mitral antibiotic therapy.
regurgitation and cardiogenic shock is a mechanical complication of acute myocardial infarction and usua
only the epidermis and are characterized by erythema, pain, intact capillary refill, and lack of blistering or weeping. They do not
und
e ofcare (e.g. cleansing,
melanoma, moisturization).
usually grow vertically and have symmetric borders and a uniform, dark color. Suspicion should be raised when
patient ('ugly duckling sign')
esions with > 1-2 of the ABCDE or the lesionwarrant
criteria grows continuously, is elevated,
excisional biopsy. Biopsy or is firm.
is also recommended for lesions with inflammation; it
esions that are significantly different in appearance from other pigmented spots
equire foot imaging (e.g. x-ray, MRI) to assess for underlying osteomyelitis, even when on the same patient
no signs (ugly duckling
or symptoms of softsign).
tissue infe
erythrocyte sedimentation rate or C-reactive protein also require imaging.
mmatory disorders (e.g. rheumatoid arthritis, inflammatory bowel disease). The diagnosis is made clinically after excluding other
corticosteroids.
nts as a rapidly growing nodule with ulceration and a central keratin plug. It frequently regresses and may resolve spontaneous
have
e andaother
benign course,
delicate orsome lesions sensitive
cosmetically may progress
areas,toMohs
invasive squamoussurgery
micrographic cell carcinoma.
(sequential removal of thin skin layers with mic
tis suppurativa initially involves topical or oral antibiotics, depending on the severity. For severe or refractory disease, tumor ne
cision may derived
ant tumor be warranted.
from the lining of blood vessels and lymphatics. Patients who have received localized radiation therapy for ca
eloping
s a benignsecondary angiosarcoma
nodule containing of the skin.
squamous Breastthat
epithelium cancer survivors
produces with It
keratin. chronic
presentslymphedema are also atfirm,
as a dome-shaped, risk.freely movable c
remain stable or gradually increase in size but may produce a cheesy white discharge; it usually resolves
causes a rapidly progressive and painful ulcer with a purulent base and violaceous border. Most patients have associated syste spontaneously.
ss is made clinically
a chronic, after
relapsing excluding
condition other etiologies,
characterized usually withocclusion
by inflammatory skin biopsy.
of folliculopilosebaceous units. It most commonly occu
es
a bony prominence can cause ischemic necrosis of overlying tissues, leading toinclude
that can progress to abscesses that open to the skin surface. Complications sinus(decubitus)
a pressure tracts, comedones,
ulcer. Risk and scarring.
factors inclu
decreased skin perfusion, and reduced sensation.
omplicated by wound infections and sepsis. Risk is increased with large burns (> 20% body surface area). Gram-positive organi
anisms and fungi
is the most are more
common common
malignancy of after 5 days.
the lower lip. ARisk
change in burn
factors wound
include appearance
sun exposure, fairorskin,
the loss of skin
tobacco use,graft is often the first s
immunosuppression
y invasive cords of squamous cells with keratin pearls.
eatures
(SCC) of a lesion
is the mostthat suggest
common skinmelanoma
malignancy include Asymmetry,
in patients Border
on chronic irregularities, Color
immunosuppressive variation,
therapy for aDiameter
history of> organ
6 mm,transplan
and Evo
ve,
ulcerswithinclude
an increased
decreasedrisk mobility,
of local recurrence
malnutrition,and regionalmental
abnormal metastasis.
status, decreased skin perfusion, and reduced sensation. Inter
oper positioning for pressure redistribution, mobilization,
(SCC) is most often associated with ultraviolet (sun) exposure but maycareful skin care, moisture
also arise incontrol, and wounded,
chronically maintenance of nutrition.
scarred, or inflamed
aggressive.
lanoma if it appears substantially different from others ('ugly duckling sign'), itches or bleeds, or develops nodularity. If melanom
d.eeding skin ulcer associated with a chronic scar suggests squamous cell carcinoma (SCC). SCC arising within a scar or chroni
sis should
ma has lowbe confirmedpotential
metastatic with biopsy.
but should be removed with either electrodessication and curettage or surgical excision. Mohs
nd inspected microscopically to ensure clear margins, is used for high-risk lesions in delicate or cosmetically sensitive areas.
oth should be reimplanted as soon as possible. The tooth can be briefly stored in cold milk or saliva and manually reimplanted a
aline.
an cause an auricular hematoma, which is a collection of blood between the perichondrium and cartilage of the outer ear. Promp
ations of infection,
steonecrosis of theavascular necrosis, and
jaw is characterized by permanent cauliflower
chronic swelling, ear deformity.
mild pain, and exposed, necrotic bone. It is often triggered by tooth
ourse can be intractable, and treatment is largely supportive with careful
curs most commonly after flying and can result in injury (e.g. ear pain, hearing oral hygiene
loss) toand
the antibacterial rinses. (TM). Most baro
tympanic membrane
wntsweeks.
after nasal trauma as fluctuant swelling of the nasal septum. It should be recognized and promptly drained to avoid complic
ormities.
a that increases at times of relatively increased intracranial pressure (e.g. bending over, bowel movements) is suspicious for ce
d(CHL)
by head
maytrauma and can result
show improved speechin meningitis.
understanding in background noise. CHL in a young woman with a positive family history o
racterized by bony overgrowth of the stapes that causes stiffening of the ossicular chain.
n occur after head trauma and result in episodic vertigo triggered by sudden pressure changes (e.g. Valsalva maneuvers) or lou
nonly
cause
by recurrent respiratory
thyroid tissue (either papillomatosis, whichorresults
normally functioning in hoarseness
malignant). due to wartlike
Serum thyroglobulin growths on the
measurements aretrue vocal
used as acords.
tumor mark
earises
suspicious sonographic
from the features should
calcitonin-secreting undergoCfine-needle
parafollicular aspiration
cells. Serum calcitoninbiopsy,
levels even if thewith
correlate patient is pregnant.
the risk of metastasis and recurr
matoma should be recognized promptly and drained to avoid potentially lethal upper airway obstruction.
oker is likely squamous cell carcinoma. Persistent hoarseness should always be evaluated by laryngoscopy to ensure no delay
e oral cavity requires biopsy (even if previously biopsied). Tobacco use is the most important risk factor for oral cavity squamou
is likely
nsil with due to squamous
ipsilateral cervical cell carcinoma.
adenopathy is likely oropharyngeal (head and neck) squamous cell carcinoma. Human papillomaviru
factors (smoking, alcohol).
rs for malignancy, ear pain with a normal ear examination may be referred from the base of the tongue or hypopharynx/larynx.
uamous
congenital cellneck
carcinoma the often
mass that most presents
likely diagnosis.
in later childhood after an upper respiratory tract infection. It is typically located inferio
muscle.
earing loss with imbalance (CN VIII dysfunction) and decreased facial sensation (CN V dysfunction) are concerning for a vestib
gen followed by endotracheal intubation with advanced equipment (e.g. video laryngoscope). A single failed attempt at video-as
cothyrotomy,
pected which
in patients bypasses
with the epiglottal
sore throat, swelling
hoarseness, and
stridor, potential
pooled oralobstruction.
secretions, and drooling. Risk factors include diabetes mellit
on or invasion of adjacent tissues and include nasal congestion withusing
diagnosis can be confirmed (in those with stable respiratory status) lateral
epistaxis, neck radiograph.
headache, diplopia, cranial nerve deficits (e.g. fa
rvical lymph nodes is common.
noninflammatory enlargement of the salivary glands, often caused by chronic alcohol use.
on of the stapes, which results in conductive hearing loss. It often presents in young women and may progress during pregnanc
ally benign. Cranial nerve dysfunction (facial droop, facial numbness) increases concern for malignancy.
ents
ma with exquisitely
is associated with painful swelling of
the reactivation of the parotid gland.
Epstein-Barr virusThis
and postoperative complication
occurs most commonly can be
in those prevented
from with adequate
Asia (particularly fluid
southern
ations include nasal congestion with epistaxis, headaches, cranial nerve palsies, and otitis media. Early spread to the cervical ly
istling noise
agnosis duringclinically
is usually respiration following
evident. rhinoplasty,
Surgery oneifshould
is indicated suspect
the mass nasalsymptomatic,
becomes septal perforation likelywith
interferes resulting from
speech or aeating,
septalorhe
presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx. Infection within the retr
. Extension through the alar fascia into the 'danger space' can transmit infection into the posterior mediastinum and result in acu
st often
apy andinurgent
the submandibular glands
drainage of the and can
abscess. present
Deviation of with recurrent
the uvula and sialadenitis due to obstruction
unilateral lymphadenopathy of be
can thehelpful
duct. in distinguishing
ch may be visible on x-ray as widening of the joint space. However, in later stages, degeneration of the cartilage may lead to cli
mopressin, an analogue of antidiuretic hormone (ADH), can induce the syndrome of inappropriate ADH secretion. Urinary wate
Laboratory
yroid nodules studies, including
includes a serumserum
TSHelectrolytes, urine osmolality,
assay and thyroid ultrasound.and urine sodium,
Patients are the firstTSH
with a suppressed stepshould
in establishing
undergo the diagno
thyroid sci
are rarely malignant and do not usually require fine-needle aspiration.
nd autonomous parathyroid hormone (PTH) secretion. The net effect, termed tertiary hyperparathyroidism, is characterized by h
extremely
monly high serum
presents PTH levels.
with episodic headaches and hypertension and can cause unexplained hyperglycemia. Measurement of urine o
valuation.
emorrhage or mass effect symptoms in the brain and spinal cord. Other manifestations include clear cell renal cell carcinoma, p
c tumors
should of the
initiate middle ear, α-adrenergic
preoperative and pheochromocytomas.
blockade 7-14 days prior to surgery, followed by β-adrenergic blockade 2-3 days prior
he absence of α blockade due to the risk
eatening thyrotoxicosis often triggered by thyroidof precipitating hypertensive
or non-thyroid surgery,crisis.
trauma, infection, iodine contrast, or childbirth. It is cha
hythmias, high fever, tremor, altered mentation, and lid lag.
de postsurgical, autoimmune parathyroid destruction, and defective calcium-sensing receptor. Hypocalcemia is the most commo
in prolonged immobilization due to increased osteoclastic activity, especially in individuals with a high baseline rate of bone turn
a
usion and can preventcause bone loss.
symptomatic hypocalcemia due to chelation of ionized calcium by citrate in transfused blood. Patients with imp
eased clearance of
esents with hypotension and shock citrate by the liver.
that is refractory to initial volume resuscitation. Treatment requires intravenous hydrocortiso
etion.
catecholamine-producing tumors arising from chromaffin cells of the adrenal medulla. Paroxysms of severe hypertension in pat
gical procedures,
rimary inductionfor
treatment modality ofpapillary
anesthesia, andcarcinoma.
thyroid a number of medications.adjuvant therapies for patients at increased risk of recu
Postoperative
doses
ponse of to thyroid
severe hormone.
illness. Thyroid hormone supplementation is not indicated for these patients, and follow-up testing should be d
h.
used by repeated pressure, friction, or trauma due to lack of sensation in the local tissues. They typically occur at weight-bearin
ost common cause
hypercalcemia andof neuropathic
those ulcers.
with complications (e.g. nephrolithiasis) or at increased risk for complications. Younger patients (age
lifetime and should be offered surgery.
bloody
the breast nipple discharge
passes accompanied
primarily to the axillaryby alymph
palpable
nodes,breastwithmass is concerning
drainage traveling forfrommalignancy.
lateral to medial, posterior to the pectoralis
mark for distinguishing the surgical levels of axillary lymph
y typically consists of partial mastectomy and axillary sentinel lymph node biopsy, followed nodes during axillary lymph nodebydissection.
whole breast radiation therapy. A
margins.
st cysts can be managed with fine-needle aspiration. Breast cysts that contain bloody fluid or that do not resolve with aspiration
r.
small bowel obstruction (e.g. obstipation, no air in the rectum on abdominal x-ray) require nasogastric tube insertion for gastric
h risk
an cause of life-threatening
hemoperitoneum, complications
which presents (e.g. with
bowel ischemia,rigidity,
abdominal perforation).
rebound, guarding, and referred shoulder pain. Hemodynam
mergency surgery.
n women age < 30 are initially evaluated with breast ultrasound due to increased density of breast tissue. Solid or complex-app
aging (e.g. mammography) or biopsy to exclude malignancy.
tumscribed,
with a unilateral and mobile
fluctuant,breast masspalpable
tender, in women age mass
breast < 30 iswith commonly a benign fibroadenoma.
fever, surrounding erythema/pain, and associated axillary lympha
eedle aspiration) and empiric antibiotics (e.g. dicloxacillin, cephalexin).
is a benign condition with clinical and radiographic findings similar to breast cancer, including skin or nipple retraction and calc
ules
-line and imaging foamy histiocytes
study in fat necrosis.
for assessing a palpable Nobreast
furthermassworkup is indicated
in women age >for30.excised lesions.
Ultrasound may be added for better characterizat
agnosis.
uncommon, and any associated bleeding can be diluted by stool and is less likely to be visible; therefore, right-sided colon can
monanemia.
cy organ affected by metastatic colon adenocarcinoma. Surgical resection can be curative when metastatic colon cancer is co
mary tumor is recommended
non-neoplastic abnormality commonly for patients with on
found obstruction
screeningorcolonoscopy.
threatened obstruction of the colonic
Small hyperplastic polypslumen.
do not increase the risk for c
ning at the usual intervals (e.g. repeat colonoscopy in 10 years for individuals
th localized (e.g. stage 1) colon adenocarcinoma are cured after surgical resection, some develop recurrent at otherwise average risk). neoplastic lesions
erformed 1 year after surgical resection and every 3-5 years thereafter.
es are associated with an increased risk of colorectal adenocarcinoma, likely due to hyperinsulinemia. Hyperinsulinemia results
1,
minal which andinhibits colorectal
intrathoracic epithelial
pressure seen cell
in apoptosis
abdominaland promotes neoplastic
compartment syndrome progression.
can cause significant cardiovascular consequences
nous
sponse pressure,
syndrome decreased
and evidence venous return
(e.g. to the blood
elevated heart urea
(decreased
nitrogen cardiac preload),ofand
or hematocrit) decreasedvolume
intravascular cardiacdepletion.
output. Patients wit
d usually
sis shouldrequire intensive
be suspected monitoring.
in patients who develop worsening abdominal pain, unstable vital signs, or signs (e.g. fever, leukocytos
mmon pancreatitis.
complicationCT scan of the abdomen and
of cholecystectomy demonstrating
occurs duegas within
to the the rapid
overly pancreatic
release necrotic
of bile collection is diagnostic.
into the intestines, where it overwhelm
nto the colon, resulting in secretory (fasting) diarrhea. Bile-acid binding resins (e.g.
imal form of nutrition for patients with moderate to severe burn injuries. Early initiation helps offset the hypermetabolic cholestyramine, colestipol, colesevelam) are
response
its
ic RP(e.g. maintenance
occurs months to of years
gut integrity, reducedresulting
after radiation, rate of sepsis, decreased mortality).
in hematochezia, anemia, and possibly strictures. Colonoscopy demons
ned to the rectum.
morrhoids usually appear as purple or blue anal bulges below the dentate line and may cause severe pain. Although conservativ
ammatories
is characterized and antispasmodics) is usually indicated,
by obliterative endarteritis and submucosalpatientsfibrosis,
with severewhichpain should
stiffens theundergo hemorrhoidectomy
rectum and under local
impairs its compliance, resua
ue hypoxia results
strointestinal in neovascularization
(GI) tract are a common source and telangiectasia
of GI bleeding.formation,
Bleeding from whichangiodysplasias
are prone to hemorrhage.
may be triggered by underlying aor
ebrand factor multimers; this glycoprotein is often destroyed when
usually diagnosed in women age > 40 with risk factors that include multiparity, vaginal delivery, andit passes through the damaged valve at high
chronic velocity. Symp
constipation.
ention.
ointestinal tract (e.g. mesenteric ischemia, bowel perforation) are often affected. Mesenteric angiography typically reveals multi
renluminal narrowing,
the cecum and ascending and distalcolon occlusions.
twist on their mesentery, forming a closed-loop obstruction. Progressive abdominal pain and
cal. Abdominal x-ray may reveal a large,
esents as slowly progressive abdominal discomfort/distension dilated loop of colon. in an elderly patient and a 'coffee bean'-shaped dilated loop of co
tonitis
reatography can undergo
findingsflexible sigmoidoscopy
of multifocal intrahepatic to reduce the twistedbiliary
and extrahepatic segment and avoid
strictures with emergency surgery. are diagnostic. A colon
segmental dilations
egitismany patients also have
is characterized inflammatory
by fibrosis bowel disease.
and stricturing of the medium and large intra- and extrahepatic bile ducts, promoting cholestasi
nd is strongly associated with ulcerative colitis.
refore, older women (e.g. postmenopausal, age > 50) with new-onset abdominal pain and/or concerning gastrointestinal sympt
presents with recurrent abdominal pain related to defecation associated with episodes of diarrhea and/or constipation. Colonosc
e > of
age 50pancreatic
with new-onset symptoms
juice into and in those
the peritoneal space. with alarm features
Paracentesis (e.g.include
findings gastrointestinal bleeding,
serosanguinous or iron deficiency
yellow fluid withanemia).
high amylase
adient.
s after multiple diagnostic paracenteses is concerning for an underlying malignancy. Hepatocellular carcinoma is the most com
h peritoneal
he biliary tract)metastases from distant
is a rare cause of upper primary sites (e.g. bleeding
gastrointestinal ovaries, prostate).
that usually Cytologic
occurs as analysis of the ascitic
a complication fluid can
of hepatic help identif
or biliopancrea
jaundice,
(e.g. abdominaland upper
pain, gastrointestinal
nausea/vomiting, bleeding.
malnutrition) manifestations. Complications include obstruction of the small bowel or he
ncludes albendazole or mebendazole.
a with esophageal atresia presents shortly after birth with copious oral secretions and choking, coughing, and/or vomiting with f
asogastric(e.g.
valuation tube, which
video encounters
capsule resistance
endoscopy, deepatenteroscopy)
the proximal may esophageal
be requiredpouch.
if initial tests are unrevealing. The presence of he
y is diagnostic, demonstrating mixed inflammatory infiltration of the portal tracts, interlobular bile duct destruction, and endotheli
se corticosteroids. muscle during swallowing may lead to the formation of a Zenker diverticulum, which is seen on contrast swall
cricopharyngeus
tbowel
is surgical
during with cricopharyngeal
blunt abdominal trauma myotomy with orawithout
can cause diverticulectomy.
perforated viscus. When viscus perforation occurs within the retroperitoneum
fever, diffuse abdominal pain) may be delayed. Retroperitoneal
ctive tool for evaluating lesions in the distal colon but does not visualize free airthemay be present
right on abdominal
colon. Patients imaging.adenomas or ad
with left-sided
eased
urs after risktheforreintroduction
synchronous of neoplasia
nutritionon the right with
in patients side chronic
and require visualization Clinical
malnourishment. of the entire colon with include
manifestations colonoscopy.
hypophosphatem
akness,
strointestinalarrhythmias,
tract in theandsetting
congestive heart failure.
of ongoing inflammation (e.g. diverticulitis) often causes a classic pain sequence: sudden, seve
ession)
ents and then generalized,
or calcifications, constant
main pancreatic pain
duct (peritonitis).thickened
involvement, Abdominal or imaging
irregulartypically
cyst wall) shows
require intraperitoneal
further evaluationfree air.
with endosco
n.
an beacomplicated
when segment of sigmoidby bowelcolon
perforation.
twists on Free air on x-ray forming
its mesentery, and clinical signs of peritonitis
a closed-loop obstruction should
that prompt emergent
often appears on surgical
abdominal explo
x-
'ndsign). Chronic constipation and colonic dysmotility are risk factors.
high peak inspiratory pressures in the setting of a tensely distended abdomen are concerning for abdominal compartment sy
an dysfunction).
asible, is the optimal Bladder
formpressure
of nutritionmeasurement
for critically can estimate
ill patients and intra-abdominal pressure.
has multiple clinical benefits (e.g. reduction in infections, maint
).
presents with intractable nausea and vomiting, early satiety, and weight loss. Most cases are caused by malignancy, most com
tric or duodenal
n disease, invasion.
especially thosePancreatic
who haveadenocarcinoma
required intestinal can also cause
surgery in theunexplained hyperglycemia
past, are at high risk for futureresulting from isletand
complications celloften
destrun
nomodulator therapy. Smoking is strongly associated with increased severity and progression
ardial infarction, unstable arrhythmias), respiratory failure, hypovolemia, and septic shock. Patients immediately develop severe of Crohn disease and should be
ning
disease unaffected or rising
progression. a fewstricture
Fibrotic days later.with SBO presents with bilious emesis, severe abdominal pain, and inability to pass flatus
of the strictured portion of small bowel.
distinguish between characteristic findings of Crohn disease (e.g. cobblestone appearance, skip lesions, deep ulcerations, trans
ulcerative
dominal pain colitis
and (e.g.
anioncontinuous,
gap metabolic shallow ulcerations
acidosis should limited to the mucosa/submucosa,
raise suspicion for acute mesenteric pseudopolyps).
ischemia. Most cases arise in the se
sagnesemia)
is generallyand made with CT mesenteric angiography.
factors that lead to autonomic disruption of the colon (e.g. major surgery, neurologic disease, anticholinergic m
gpoor
colonicpostoperative diet. anatomic
dilation without Vitamin Cobstruction,
deficiency isand treatmentwith
associated involves bowel rest
ecchymosis, and colonic
petechiae, poor decompression, sometimes aided
wound healing, perifollicular hem
alrothrombin
disorder intime, which and partial thromboplastin
extrahepatic time willprogressive
bile ducts develop be normal. fibrosis. Patients have jaundice, pale stools, and a small or abs
perbilirubinemia,
ous postoperative normal reticulocyte
complication that count, and elevated
can present with fever, γ-glutamyl
abdominal transpeptidase.
pain, tachypnea, and tachycardia, usually within the first
edlife-threatening
by oral contrast-enhanced
complication imaging (eitherfrom
of bacteremia abdominal
a distant CTinfection
scan or (e.g.
upperinfective
gastrointestinal series),
endocarditis, and treatment
cholecystitis). requires urgen
Manifestations ge
egaly. Diagnosis is made with CT scan of the abdomen; antibiotic therapy and splenectomy
e is an uncommon but life-threatening complication of hematologic malignancy, infection, and systemic inflammatory disease, a are generally required.
te abdominalthe
a (between pain, shock, and
pancreatic ductanemia.
and the Peritonitis
pleural space) and left shoulder
resulting in anpain may also be
amylase-rich present.pleural effusion occurs most com
exudative
agementcancer
ncreatic includes bowel restbytoapromote
is heralded recent (<fistula
2 years)closure; endoscopic
diagnosis retrograde
of diabetes cholangiopancreatography
mellitus. Although screening for pancreatic may be required.
cancer is n
us, those who have symptoms (e.g. constant abdominal pain, weight loss) of pancreatic
om of pancreatic cancer is insidious, continuous midepigastric pain that often radiates to the flanks or back and is sometimescancer should undergo abdominal CTw
n,s and/or
the first-line
mucous testdischarge.
for suspected
Rectal pancreatic
prolapsecancer.
is most common in women age > 40. Risk factors include multiparity, vaginal deliv
tipation or straining, dementia, and stroke.
characterized by a sensation of food 'sticking' in the esophagus; in older patients, esophageal malignancy is a common cause.
on.rogressive
Management solid-food dysphagia;
includes dietary retrosternal
therapy (e.g.pain and weight
allergen loss are
avoidance, also common.
elimination Upper endoscopy
diet), proton-pump is theand
inhibitors, testtopical
of choice to e
glucoco
compresses the upper abdomen against the vertebral column can injure the pancreas. Pancreatic injury can be difficult to diagn
inal discomfort
duodenum or nausea,
against increasing
the vertebral amylase,
column duringor peripancreatic
blunt fluid collection
abdominal trauma may resultshould
in araise suspicion
duodenal for an undiagnosed
hematoma. injur
Hematoma expan
ing a delayed
hagus (24-48
(Boerhaave hr) presentation
syndrome) of with
can occur worsening emesis.
vomiting CT cause
and may scan confirms
unilateralthe diagnosis.
pleural effusion from leaked esophageal conten
can using water-soluble contrast should prompt emergent surgical consultation.
cause a sudden increase in intraesophageal pressure sufficient to rupture the esophagus. If gastrointestinal contents leak from
sults, and fluid analysis
a life-threatening typicallyofreveals
complication unusual
esophageal color (e.g. green),
instrumentation. low presentation
Clinical pH, and highmay amylase.
include severe chest/back pain, fever,
e contrast esophagography can confirm the diagnosis.
be suspected in a patient with gallstone pancreatitis who also has fevers, right upper quadrant pain, jaundice, altered mental sta
olangiopancreatography
most common complication is after
required to relieveretrograde
endoscopic the biliarycholangiopancreatography,
obstruction and prevent serious infectious
and typically complications.
presents with abdominal pain w
ase and amylase levels will rise several hours after symptom onset whereas CT scans
n in those from Eastern Asia, Eastern Europe, and South America. It generally presents with progressive epigastric can be normal for up to 48 hours.
pain and we
h lumen, leading to iron deficiency anemia. Metastasis to the liver can result in hepatomegaly
c to Eastern Asia, Eastern Europe, and the Andean portions of South America due to diets high in salt-preserved food and nitro and elevated transaminases and
ss ndand chronic
vomiting; mid-epigastric
however, pain white
vital signs, that worsens
blood cellwith eating.
count, andEsophagogastroduodenoscopy
liver function studies remain normal. is the initial test of choice
The diagnosis to establiw
is confirmed
ce of gallstones.
s Clostridium infect damaged or ischemic tissue but, unlike uncomplicated acute cholecystitis, it is a surgical emergency and w
, abdominal distension, and significant colonic distension on abdominal radiograph. Suspicion is often raised when a patient wi
ptoms
mon inclinically worsen. and typically presents with dull, left lower quadrant pain; nausea and vomiting; alteration in bowel habits
older individuals
ysuria, frequency)
t with subacute or upper
right sterile quadrant
pyuria. pain, weight loss, and signs of biliary obstruction such as jaundice, cholestatic liver enzym
stileoften
duct.due to rupture of a perianal abscess with formation of a persistent sinus tract. Symptoms include pain with defecation an
lgical intervention.
hemorrhoid manifests as excruciating anorectal pain exacerbated by sitting. Examination demonstrates a bluish (or purplish) b
zleus,baths, stool
the delayedsofteners,
return and topical
of bowel anesthetics.
function > 72 hours after surgery, is typically self-resolving; therefore, management is conserv
failure, weight loss, and a palpable liver lesion. α-fetoprotein is elevated in ~50% of cases; therefore, it can be a useful diagnos
usually arises due to chronic liver inflammation from viral hepatitis, alcoholism, or environmental toxins. Incidence is greatest in
ection,
Because suchHCC as often
Asia, presents
Africa, and theliver
with Middle East. Approximately
decompensation 50% of HCC
(e.g. new-onset cases
ascites, are associated
variceal bleeding),withthis dramatic
conditionelevations
should prom in
ed oral contraception are at greatest risk for hepatic adenoma. Although most lesions are benign and asymptomatic, life-threat
oris rupture
a benigncan occur.
liver Rupture
lesion due to should be suspected
an aberrant congenital in artery.
the setting
It is of sudden-onset,
usually severe right
found incidentally upperwomen
in young quadrantandpain and signs
is marked by to
ebands.
common in elderly women and are more likely than inguinal hernias to develop complications (e.g. incarceration, strangulation
ntsr. Inwith progressive
contrast, abdominal
asymptomatic pain, nausea/vomiting,
inguinal high-pitched
hernias (hernia located above bowel sounds
inguinal on examination,
ligament) can usually be andmanaged
distended loops
with of bowe
watchful wa
ce.
iscences can result in exposure or herniation (i.e. evisceration) of intra-abdominal organs (e.g. bowel), resulting in possible stra
quire emergency
ocortisone, surgery.
astringents, and local anesthetics. Rubber band ligation and surgical hemorrhoidectomy are advised only for patien
at cannot be reduced manually.
f distal infection, particularly those involving the portal system (e.g. diverticulitis). Diagnosis requires abdominal imaging, and m
ation, and drainage.
als a retrocardiac opacity (often with an air/fluid level) within the thoracic cavity. Asymptomatic sliding hiatal hernias do not requ
stroesophageal reflux
clude nausea and vomiting, disease should be medically
postprandial managed. and epigastric and/or chest pain. Chest imaging typically reveals a
fullness, dysphagia,
) is defined as < 4 bowel movements a day, intermittent hematochezia, normal inflammatory markers, and no anemia. First-line
ations;
nts withsuppositories or enemas
tender, nonpruritic, are preferred
erythematous, in patients with
or violaceous nodulesUC limited to the
measuring 2-3rectosigmoid,
cm and usually whereas
locatedoral
ontherapy
the shins.is used
It hasfor
a sm
se (IBD),hyperkeratosis,
ollicular especially Crohn disease, and
perifollicular its presence
hemorrhage, correlates petechiae),
ecchymosis, with the degree of IBD
gingivitis activity.
(e.g. recessed gums that bleed easily, den
tegland
with plasma
can lead ortoleukocyte
a bacterial vitamin C levels.
infection and perianal abscess formation. Perianal abscesses often present as tender, fluctuant,
ing pain. Anoreceptive
paroscopic appendectomy intercourse
are at much and greater
chronic risk
constipation are amongabscess
for intra-abdominal the risk factors for perianal
than those receiving abscess development.
laparotomy. Intra-abdomin
althose
symptoms (e.g. pain, vomiting) return several days after an abdominal operation.
with a BMI 25-29.9 kg/m2 and weight-related complications. Medication failure is not required for patients to qualify for ba
ued concurrently.
inal trauma should be assessed for intra-abdominal injury, beginning with Focused Assessment with Sonography for Trauma (F
serformed at the
of digestive bedside.in patients with chronic alcoholic pancreatitis. Alcohol cessation and pancreatic enzyme supplementati
enzymes)
causes
arin gallbladder
places patients stasis
at riskand predisposes to
for hemorrhage. gallstone formation
Retroperitoneal and bile
hematoma maysludging, bothwithout
occur even of which may lead to cholecystitis.
a supratherapeutic INR. Back pa
e should raise suspicion for retroperitoneal hematoma.
nts with right
quently upper
affects quadrant
males pain,particularly
age 15-30, fever, and leukocytosis. Patients
obese individuals, thosewith acute
with cholecystitis
sedentary should
lifestyles be treated with
or occupations, andlaparoscopic
those with d
toms include a painful, fluctuant mass 4-5 cm cephalad to the anus in the intergluteal region with associated
much more likely to be the result of metastatic disease than infectious causes or primary liver malignancy. Primary tumors mucoid, purulent,
of th
mon diseases causing liver metastases.
leus is characterized by nausea, abdominal distension, obstipation, and hypoactive bowel sounds that persist postoperatively. O
tinal motility.
require urgent surgery with a high risk of bleeding, or those who are experiencing significant hemorrhage, should receive prothr
amin K. If PCC
ally presents is unavailable,
insidiously fresh frozen plasma
with a combination can and
of constant be given.
gnawing epigastric pain that is frequently worse at night, anorexia w
truction. A peptic duodenal ulcer typically causes periodic epigastric
an cause gastrointestinal perforation in an acute or a delayed (e.g. progression pain relievedof by meals.
bowel contusion, mesenteric ischemia) fashio
ir on imaging) should prompt emergent surgical exploration.
st commonly injured organs in blunt abdominal trauma. Patients with severe liver laceration causing intra-abdominal hemorrhag
ncanFocused Assessment
be caused by many with Sonography
disease processes forand
Trauma.
is characterized by early satiety, nausea, nonbilious vomiting, and weight loss.
is the most likely cause.
be complicated by perforation, revealed as intraperitoneal free air. Emergent surgical exploration is indicated for patients with se
increased intra-gallbladder pressure that is created when the gallbladder contracts against an obstructed cystic duct. The pain
ours,
structionandusually
resolves completely
presents betweenvomiting,
with nausea, episodes.abdominal
There is no fever, abdominal
bloating, and dilatedtenderness
loops of bowelon palpation, or leukocytosis.
on abdominal x-ray. Adhesions
e (pleural effusion). Pleural fluid analysis may show low pH and very high amylase (> 2500 IU/L). Confirmation with esophagogr
ompt emergent
appendicitis > 5surgical consultation.
days after the onset of symptoms have a high incidence of perforation with abscess formation. They often hav
ble, they may be treated
he cricopharyngeus muscle during with intravenous
swallowinghydration,
resultsantibiotics,
in increased bowel rest, andpressure
intraluminal interval appendectomy.
in the hypopharynx. This may cause th
geal) diverticulum, which presents in patients age > 60 with dysphagia, halitosis, and regurgitation of undigested food.
a,pain
tumorandstage
rectalatbleeding
the timeon of defecation.
diagnosis determines
Treatmentprognosis and treatment
includes increased options.
fiber and fluidAintake,
CT scan stoolis softeners,
the initial staging modality.
sitz baths, and top
rin).
e should be suspected in patients with multiple duodenal ulcers refractory to treatment or ulcers distal to the duodenum or asso
n of pancreatic
erized by acuteenzymes
abdominal bypain
increased
and lowerproduction of stomach
gastrointestinal acid may
bleeding. lead to malabsorption.
It typically follows an episode of hypotension and most com
e and rectosigmoid
ommon postgastrectomy junction. CT scan may
complication show a thickened
characterized bowel wall.(e.g.
by gastrointestinal Colonoscopy can confirm
nausea, diarrhea, the diagnosis.
abdominal cramps) and vasomo
he symptoms
mon complication canofbe controlled
vascular with dietary
surgery, modification
as patients are oftenand usually
older diminish
and have over time.
extensive underlying atherosclerosis. CT imaging can
cyanotic mucosa and hemorrhagic ulcerations.
duodenum against the vertebral column during blunt abdominal trauma may result in a duodenal hematoma. Affected patients
postinjury because
y bowel disease the are
(IBD) hematoma
at highest expands
risk of to obstruct the
developing toxicduodenal
megacolon lumen.(TM)CT scaninconfirms
early the diagnosis.
the disease, sometimes at initial presenta
nous corticosteroids.
eral deficiency include malabsorption, bowel resection, poor nutritional intake, and dependence on parenteral nutrition. Clinical m
mpaired taste, impaired
sually diagnosed wound healing,
on abdominal imagingalopecia,
showing and skin rash
a calcified rimwith perioral
in the involvement.
gallbladder wall with a central bile-filled dark area. It is as
inoma and usually requires cholecystectomy.
pass procedures. Conditions that alter intestinal motility (e.g. systemic sclerosis, diabetes mellitus), anatomy (e.g. strictures), or
ronic pancreatitis)
son syndrome) also be
should predispose
suspected to in
SIBO.
patients with multiple stomach ulcers and thickened gastric folds on endoscopy. The dia
vel > 1000 pg/mL. Patients with nondiagnostic
commonly due to diverticular disease and presents serumwithgastrin levels should
pneumaturia, be evaluated
fecaluria, withconsistent
or findings a secretin with
stimulation
urinary test.
tract infectio
contrast can confirm the diagnosis by showing contrast material in the bladder with thickened colonic and vesicular walls.
ydrainage
presentsissubacutely
recommended for complicated
with fever diverticulitisorwith
and lower abdominal flankabscess formation.
pain radiating Surgical
to the groin. drainage
The ‘psoas cansign’,
be attempted
abdominalif pain
percutane
with
CT scans are required to confirm the diagnosis, and drainage with antibiotics is the mainstay
Signs and symptoms include nausea, vomiting, abdominal distension, obstipation, and hypoactive or absent bowel sounds. Abd of therapy.
ed, gas-filled loops of both the small and the large intestines.
dominal pain withappendicitis
with suspected peritonitis and (e.g.subdiaphragmatic
modified Alvarado free air on
score > 4)upright chest x-ray
now includes is a classic
imaging, which presentation
can visualizeofthe perforated
appendixviscus
(e.g. n(
ndcommon
st direct management. CT scan
inherited disorder of the abdomen
of bilirubin and pelvis
glucuronidation, is the recommended
is characterized imaging
by recurrent study in
episodes of nonpregnant
mild jaundiceadults.
precipitated by
y). With the exception
corresponding elevationsof elevated unconjugatedand
in aminotransferases bilirubin,
alkalineliver function testOpioid
phosphatase. resultsanalgesics
and complete (e.g.blood countsmay
morphine) are cause
normal. sphinc
due to hereditary (e.g. first-degree relative with pancreatic cancer, hereditary pancreatitis) or environmental (e.g. cigarette smo
most
body or consistent
tail of thereversible
organ may riskpresent
factor for
withpancreatic
constant, cancer.
progressive back pain that is worse at night and when supine. Because this
ions and radiographic imaging are generally normal. An abdominal CT scan is usually diagnostic.
nancy of the liver is metastasis from another primary source.
stitis is an
t, cystic acute
duct inflammation
stone) of the(e.g.
or extra-biliary gallbladder in thepeptic
pancreatitis, absence of disease)
ulcer gallstones that is Abdominal
causes. most commonly seen
imaging in hospitalized
(e.g. and cr
ultrasound) followe
olangiopancreatography,
stitis is a life-threatening formmagnetic resonance
of acute cholangiopancreatography)
cholecystitis that occurs more commonlycan establish thewith
in patients diagnosis and guide therapy
immunosuppression (e.g. towar
diabe
bladder wall with gas-forming bacteria and requires emergency cholecystectomy.
in without jaundice. Although ultrasound is the imaging test of choice to evaluate a jaundiced patient, a CT scan of the abdome
ouldtobe
or evaluate
suspectedfor suspected
in patients malignancy in a nonjaundiced
who have evidence patient.
of pancreatitis with alanine aminotransferase levels > 150 U/L. Early cholecys
ncreatitis who are medically stable enough to undergo surgery.
nign tumor most often seen in young and middle-age women who take oral contraceptives. Possible long-term complications inc
nsformation.
shouldabuse
cohol not bearetreated. Laparoscopic
the most common causescholecystectomy is the treatment
of acute pancreatitis. of choice
Abdominal for symptomatic
ultrasound is the most gallstone
sensitivedisease.
and specific imagin
l patients with suspected gallstone-induced pancreatitis.
ment of acute upper gastrointestinal bleeding is to establish vascular access with 2 large-bore intravenous catheters to initiate re
y presents with sudden onset of right upper quadrant abdominal pain, fever, vomiting, and leukocytosis. The primary inciting eve
nt inflammation and infection.
m small bowel obstruction due to a gallstone that has passed through a biliary-enteric fistula. As the stone advances it may cau
stepreferred
obstruction. Treatment
initially involves
in patients surgicalorremoval
with minimal of the stone
no symptoms and cholecystectomy.
and without complications. Endoscopic drainage is typically reserve
ala pain, vomiting), infected pseudocyst, or evidence of pseudoaneurysm.
is commonly due to abrupt arterial occlusion from cardiac embolic events (e.g. ventricular thromboembolism). If ischemia is p
infarction, perforation,
ient with conjugated or peritonitis. Laboratory
hyperbilirubinemia studies
and markedly typically
elevated show leukocytosis,
alkaline phosphatase elevated hemoglobin,
should raise elevated
concern for biliary amylase, a
obstruction
auses of biliary obstruction
hypercoagulability disorderinclude choledocholithiasis
presenting and migratory
with recurrent and benign biliary strictures.
superficial thrombophlebitis at unusual sites (e.g. arm, ches
lignancy such as pancreatic (most common), stomach, lung, or prostate carcinoma.
cancer requires esophageal endoscopy with biopsy. Young, low-risk patients with undetermined esophageal symptoms may sta
r with alarm symptoms (e.g. weight loss, gross or occult bleeding, early satiety) should proceed directly to endoscopy.
nia is typically
hagus (Boerhaave soft syndrome)
and reduciblecanand
occurdoes not
with require intervention.
vomiting. These hernias
Leakage of esophageal usually close
air through spontaneously
the full-thickness by age 5.
perforation may ca
lacrepitus on examination. Confirmation with esophagography or CT scan using water-soluble contrast should
life-threatening complication of endoscopy. Clinical presentation may include severe chest/back pain, systemic inflammatory prompt emergen
ontents.
most commonly Contrast esophagography
injured organs in blunt is the best testtrauma.
abdominal to confirm the diagnosis.
Patients with severe splenic laceration causing intra-abdominal hemo
n Focused Assessment with Sonography for Trauma.
ention is indicated for patients with intestinal obstruction who develop clinical or hemodynamic instability, fail to improve after ini
or signswall
bladder of ischemia
thickening or and
necrosis.
distension and pericholecystic fluid. The emergency treatment of choice is antibiotics and percutan
anthe medical
elderly condition
patient stabilizes.and regurgitation of undigested food raises concern for a Zenker diverticulum, which may occa
with dysphagia
thpancreas
contrast canesophagography can beloss,
present with weight usedjaundice,
to confirm thea diagnosis.
and nontender, distended gallbladder (e.g. Courvoisier sign) on examinatio
and extrahepatic bile ducts as well as the pancreatic
olon requires radiographic evidence (e.g. abdominal CT scan) duct (i.e. double ductdilation
of colonic sign). > 6 cm, along with manifestations of systemic t
s best diagnostic
due to a suddentest for diagnosing
increase acute diverticulitis
in intra-abdominal pressureand(e.g.differentiating it fromtoother
retching), leading causestear
a mucosal of abdominal pain.
and hematemesis. The diagno
s spontaneously in most patients, but those with ongoing bleeding can be treated endoscopically.
a classically presents with acute-onset, severe, midabdominal pain out of proportion to physical examination findings. Progress
s,
uresrectal
(i.e. bleeding and sepsis.
without infection or viscus entry) should receive coverage against gram-positive skin flora, ideally with a first- or secon
,most
with vancomycin or clindamycin.
common type of shock in trauma patients. Areas where large amounts of blood can be lost (or hidden) are ‘the floor’ (exte
troperitoneum,
physiologic levels andof thigh.
electrolytes and includes a buffer that helps correct acidosis and maintain normal blood pH. Normal saline
remic metabolic acidosis.
dominal trauma who are hemodynamically unstable, emergent laparotomy is indicated in the presence of peritonitis or intraperit
aphy
most for Trauma
common (FAST) examination.
intra-abdominal complications of blunt abdominal trauma (BAT), should be suspected in any patient with BAT an
patients
utation, the amputated part should evaluation
with a negative ultrasound but high-risk
be transported features
by wrapping should undergo CT
it in saline-moistened imaging.
gauze, sealing it in a plastic bag, and plac
utated part prolongs the window for replantation.
and large air leak despite tube thoracostomy in the setting of blunt chest trauma suggest tracheobronchial rupture. Bronchosco
abdominal
e injuries aretrauma
at riskand
of hemodynamic instability, Orotracheal
respiratory compromise. peritonitis, evisceration, or impalement
intubation with should undergo
manual stabilization immediate
of the cervical exploratory
spine is recomm
elow the fourth thoracic dermatome (i.e. nipple level) can involve the intra-abdominal organs. Patients with penetrating abdomin
modynamic
d be triaged instability, peritonitis,coma
using the Glasgow evisceration - should
scale (GCS), undergo
which immediate
can predict exploratory
the severity laparotomy.
and prognosis of coma, during the primary su
s/her eyes, motor response, and verbal response.
administered early in patients with signs of hemorrhagic shock. They should be administered in a ratio of 1:1:1 (fresh frozen pla
coagulopathy, a leadingcoagulopathy,
esuscitation increases contributor to mortality in trauma
hypothermia, patients.in trauma patients. Balanced resuscitation, which restricts cry
and mortality
od initiated
be pressureearly
just in
sufficient
patientsfor tissue
with perfusionshock.
hemorrhagic (i.e. permissive
Group O,hypotension)
Rh D-negative until hemorrhage
blood (universalisdonor)
controlled,
shouldcan
bedecrease
transfusedthese
whi
us breast mass (e.g. unilateral, firm, fixed, causing nipple retraction) is the same in men as in women: imaging (e.g. mammogra
mpling
mity (e.g.
deep core biopsy).
venous thrombosis most often occurs in young, athletic men who lift weights or engage in activities that have repetitiv
. It is marked by acute
ate. Manifestations include armarm
swelling, heaviness,
swelling, erythema,andand
pain. Treatment
pain. generally
The diagnosis requires
is made withthrombolysis and/or 3 months
duplex ultrasonography. of antico
Treatment wi
the most common

coagulation cause of Patients
and fibrinolysis. postoperative hematoma
frequently in patients
have normal withcounts
platelet no personal or family history
and coagulation times of
buteasy bleeding
are at or bruising.
increased risk for v
ucocutaneous bleeding.
atory evaluation will reveal prolonged PT/PTT and thrombocytopenia. Patients usually develop signs of bleeding (e.g. oozing fro
eenal insufficiency).
a strong inflammatory response. Patients usually manifest symptoms within 100 days of transplant, including a maculopapula
inflammation.
s are characterized by acute abdominal pain with a palpable abdominal wall mass, often associated with anemia and leukocyto
astric arteryisfrom
lung injury blunt trauma
a potentially fatal or forceful abdominal
transfusion contractions
reaction, presenting (e.g.
with severe
acute coughing),
dyspnea particularly
and hypoxia, in those
bilateral receiving
pulmonary anticoa
infiltrates,
nsfusion cessation and respiratory supportive care.
emia results from the oxidization of iron in hemoglobin, which is most commonly due to topical anesthetic agents or dapsone. It
etry reading
xaparin), of ~85%,
a classic and a large
thrombotic oxygen saturation
complication gap. at the abdominal injection site. HIT is treated by discontinuing all hep
is skin necrosis
.g. argatroban,
s 48-72 fondaparinux).
hours after surgery. Patients started on warfarin must be started on an additional anticoagulant (e.g. heparin) at the sa
hrombotic state. Low molecular weight heparin is not recommended in end-stage renal disease.
al lymph
ually duenodes are concerning
to inadequate dietary for mucosal
intake, headmalabsorption,
intestinal and neck squamous cell carcinoma,
or hepatocellular especially
disease. in anilladult
An acutely patient
patient with with a smok
underlying
Laboratory
pression studies
must usually show
be suspected prolonged
in any prothrombin
patient with a history time followed by
of malignancy prolonged
who develops partial
backthromboplastin
pain with motortime.and sensory abnorm
ologic findings. Intravenous glucocorticoids should be given without delay. MRI is then recommended.
re placed to prevent clinically significant pulmonary emboli in patients with contraindications to or complications from anticoagu
proximal deep venous thrombosis who failed anticoagulation.
in a cervical
hCG, but the lymph
AFP isnode, especially
essentially in anormal.
always smoker, likely has a mucosal
Nonseminomatous head
germ celland neckoften
tumors primary
havesite
anand requires
elevated AFP,examination of
with a consid
ed thrombocytopenia requires immediate cessation of all forms of heparin and initiation of anticoagulation with an alternate agen
platelet count is
epsis require > 150,000/mm3,
early aggressive fluidmost patients can
resuscitation andbebroad-spectrum
switched safelyantibiotic
to warfarin.therapy. Patients should receive rapid infusion o
he first 3 hours
ylococcus and
aureus) andbroad-spectrum
gram-negativeempiric
organismsantibiotics within
(including 1 hour. aeruginosa). Piperacillin-tazobactam or a carbapenem, i
Pseudomonas
apy.
injuries are at high risk for sepsis. Acute enteral feeding intolerance may be an early sign of sepsis, indicating end-organ hypop
rn injuries,are
enectomy early excision
at high risk of
fornecrotic
fulminanttissue andwith
sepsis wound closure (e.g.
encapsulated skin grafting)
organisms. They reduces
should be theprescribed
risk of burn wound infections.
amoxicillin-clavulanate
be advised
t gland canto proceed
lead to the directly to the
formation of annearest emergency
anorectal abscess.department.
Primary treatment is prompt incision and drainage. Systemic antibioti
fistula formation, should be given to patients with high-risk
ssue overlying the hand metacarpophalangeal joints (e.g. clenched-fist features (e.g.punch
systemic illness,
to the humandiabetes)
mouth) and considered
can result for all
in septic patie
arthritis
ance, and painful
out localizing range ofThe
symptoms. motion. Treatment
catheter requiresappears
site frequently urgent surgical
normal.irrigation and debridement
Initial therapy and antibiotics,
usually includes antibiotic therapy.
fluid resuscitat
a self-limited cutaneous eruption that develops within hours or a few days following exposure to inadequately chlorinated pools
tules, or nodules
typically present and
with low-grade
fever, rightfever.
upperNo treatment
quadrant is usually
pain, necessary,
hepatomegaly, but swimming
leukocytosis, and in the contaminated
elevated liver enzymes;wateranshould be av
associated
abdominalincrease
vofloxacin) imaging,collagen
and management
degradation includes blood
and are cultures,
associated antibiotics,
with adverse and drainage.
effects, including Achilles tendon rupture, retinal deta
uoroquinolone use should be avoided in patients with a known aortic aneurysm or substantial
h an increased risk of surgical site infection and poor wound healing. Current smoking is associated risk factors for aortic
with greater aneurysm.
risk than past
Smoking cessation is recommended prior to elective surgery, especially if cessation can be achieved at least
e trauma, mismatched blood products, or drug reactions. Acute (1-7 days postoperatively) and subacute (7-28 days postopera 4-6 weeks before
gitis is marked by the formation of proximal, tender, erythematous streaks at the site of skin wound with regional lymphadenopa
used by Streptococcus
al transplantations arepyogenes
at risk fororcytomegalovirus
methicillin-sensitive Staphylococcus
reactivation aureus;
with viremia therefore,
and/or treatment
end-organ with Gastrointestinal
disease. cephalexin is generally
manifest c
bloody
fasciitisdiarrhea, and endoscopic
with hemorrhagic bullous evidence
lesions and of multiple, large,Patients
septic shock. shallowwith
ulcers.
liverBiopsy
diseaseis the
such gold
as standard
cirrhosis, for
viraldiagnosis
hepatitis,ofand
tissue
he
n patients hospitalized in the intensive care unit with intravascular catheters. Manifestations include fever, sepsis, and/or multior
d for diagnosis.
pecially A positive
the internal jugular blood culture for Candida
vein. Thrombosis should
of this vein never
allows be considered
dissemination a contaminant.
of septic emboli to distal sites. Fusobacterium necr
first 3 months with acute pain, fever, and local signs of infection. Infections due to less virulent organisms (e.g. coagulase-nega
nt
ronicwithdiabetic
chronicfoot
pain,ulcer
implant
mayloosening,
be minimally gaitsymptomatic
impairment, and or sinus tractspecific
requires formation.
assessment. When the bone can be palpated with
creased. Biopsy and culture of affected bone is critical to confirming
ly. Risk factors for splenic abscess include hematogenous spread, immunosuppression, the diagnosis and guiding management.
intravenous drug use, trauma, and hem
monly associated with splenic abscess.
raoperatively. Other causes of immediate postoperative fever include prior infection or trauma, inflammation due to surgery, ma
of infection due to inoculation of bacteria into deep puncture wounds. Amoxicillin with clavulanate has activity against
or antibiotic prophylaxis.
eture wounds
common in through
patients footwear
with poorare at risk control,
glycemic for Pseudomonas
neuropathy, aeruginosa osteomyelitis.
and peripheral vascular disease. Most deep, long-standing diabe
e, gram-negative, and anaerobic organisms. Underlying osteomyelitis is common due to contiguous spread from the wound.
rization
ion is an effective
is characterized bymeasure for reducing
intense pain the risk
in the wound, of catheter-associated
decreased urinary
sensitivity at the edgestract infection
of the wound, in cloudy-gray
patients withdischarge,
neurogenic bla
and
ential.
abdominal pain, leukocytosis) to fulminant colitis with toxic megacolon. Diagnosis is confirmed with stool studies for
nd/or
umonia stool assay
occurs forhours
> 48 C. difficile
afterexotoxin
intubation genes.
and usually presents with fever, purulent secretions, and abnormal chest x-ray. Patie
n and culture) and receive empiric antibiotics.
dog feces. Tapeworm eggs hatch in the small intestine and spread to the viscera (e.g. liver, lung), causing hydatid cysts. Sympt
,eresulting in right upper
to Staphylococcus aureus quadrant pain, nausea,
is associated vomiting, and
with menstruation hepatomegaly.
(tampons), Imagingand
nasal packing, typically reveals infections.
post-surgery a large, smooth
Patientscyst, oft
usua
diffuse erythematous macular rash (erythroderma) that can progress to multiorgan involvement.
progressive cellulitis of the submandibular and sublingual spaces. The source of infection is most commonly an infected mand
s prevents
hylococci areairway compromise
the most frequent in mostofcases.
cause nosocomial bloodstream infection in patients with intravascular devices. Factors favori
s,result
hypotension, and blood culture growth
in polymicrobial infections with aerobic in > 2and
bottles (both aerobic
anaerobic and anaerobic)
oral organisms. Empiricwith the same
treatment withorganism and drug suscepti
amoxicillin-clavulanate pro
cteria.
d cysts are due to infection with Echinococcus granulosus. Dogs are the definitive host. A cystic hepatic lesion with eggshell calc
m.
protozoan that can cause colitis or extraintestinal (liver, pleura, brain) illness in patients who live in or travel to developing coun
per
gasquadrant
in the deep pain, fever, When
tissues. and (usually) a single subcapsular
skin or soft-tissue infection islesion in the rapid
suspected, right lobe. Diagnosis
progression is made examination
of physical with serology; needleorasp
findings se
suspicion for necrotizing fasciitis.
the prostate is an effective treatment for benign prostatic hyperplasia. However, this procedure does not preclude the prostate
struction. Other
e idiopathic. common
However, complications
it can be seen inof this procedure
hematologic are urinary
disorders incontinence
that cause and urethral
altered blood viscosity stricture.
or local microthrombi, leading
disorders include sickle cell disease, hematologic malignancies (e.g. chronic myelogenous leukemia),
ainful erection in the absence of ongoing sexual stimulation. Sickle cell disease is associated with an increased thalassemia,
risk and multipl
of priapism
ruction.
an Initial
elective management
procedure of priapism
associated includes
with several aspiration
medical of blood
benefits, from reduced
including the corpora
riskcavernosa, ofteninfections
of urinary tract followed in
bythe
intracaverno
first year
disorders in adulthood. Circumcision also decreases the risk of acquiring some, but not all, sexually transmitted
urn patients who require aggressive fluid resuscitation (e.g. due to burns covering a large total body surface area) should under infections.
quired disorder characterized by fibrosis of the tunica albuginea of the penis, which restricts tissue expansion and flexibility dur
curvature, and/or is
r prostate cancer dorsal nodules/plaques;
advanced distortion
age; approximately of the normal
30%-80% of menerectile
age >shape
70 have of the penis may
histologic makeofsexual
evidence intercourse
prostate diffi
cancer. Less
highas
ent in ameat and low
clustered in fruits
scrotal mass and vegetables.
above the testis. Men with a varicocele can have reduced fertility, possibly due to increased scr
nd decreased motility.
can be monitored until age 6 months, after which spontaneous descent is unlikely. In such a case, orchiopexy is indicated befor
y, and testicular malignancy.
sia can gradually
is often compress
presents with symptomsthe prostatic urethra,
of recurrent leading
urinary tract to incomplete
infection, bladder
painful emptying
ejaculation, and an
and/or increased
prostatic risk for recurrent
tenderness ur
in young or
ent of symptoms
he prostate with short courses
via intraprostatic urinaryof antibiotics.
reflux. Six weeks
Urine culture of a fluoroquinolone
is required to define the is generallypathogen,
underlying required for
buteradication.
6 weeks of therapy w
oroquinolone is generally required to ensure eradication.
is generally causes recurrent urinary tract infection symptoms and prostatic swelling and tenderness. Most cases arise when co
s Escherichia coli is
confirmed with the leading
ultrasound. pathogen.
Initial interventions include scrotal support and simple analgesics. Varicoceles are associated with
ophy or changes in semen analysis,
gion and significant systemic symptoms surgical
(e.g.venous ligationhigh
hypotension, canfever).
improve fertility.
Rapid surgical intervention is required to prevent death
ciated with posterior testicular pain/swelling, improvement of pain with testicular elevation, and normal cremasteric reflex. Most
g.
sentChlamydia,
with acuteNeisseria)
testicularinpain
patients age < 35after
and swelling and mild
by colonic
trauma. pathogens (e.g. Escherichia
The diagnosis may be made coli)clinically;
in those however,
age > 35.inTreatment
patients inwith
who
scrotum can confirm the diagnosis and exclude other etiologies.
ed by twisting of the spermatic cord and may result in testicular necrosis and nonviability. Patients have severe scrotal pain and
thout
s withintervention.
abrupt onsetAofreactive
scrotal,hydrocele
inguinal, or may be visible
abdominal on ultrasound;
pain, heterogeneous
which classically echotexture
does not resolve indicates of
with elevation testicular necrosis.
the testicle. Torsi
ng, transient symptoms due to intermittent torsion.
etroperitoneal lymphadenopathy) and dyspnea/cough (pulmonary nodules). Testicular examination showing a firm, ovoid testicu
mor
ded markers to support
for patients the hematuria
with gross diagnosis. or with microscopic hematuria and other risk factors for bladder cancer. Risk factors for bl
onal exposures (e.g. painters, metal workers), chronic cystitis, iatrogenic causes (e.g. cyclophosphamide), and pelvic radiation
of the
ors pampiniform
often plexus that
cause feminization presents
(e.g. as an irregular
gynecomastia) due toscrotal mass that
the production of increases
estrogen byin size
tumor with Valsalva
cells. maneuvers
This frequently and does
causes seconn
g. β-hCG, AFP) are not usually elevated.
mmonly caused by blunt trauma (e.g. sexual intercourse) to an erect penis. Although penile fracture is a urologic emergency th
nce of urethral
sticular injury (e.g.
mass should blood at the
be considered meatus,cancer
testicular dysuria, urinary
until provenretention)
otherwise.should undergo workup
A diagnostic retrograde urethrography
generally includes prior to sur
bilateral sc
nal orchiectomy.
inal trauma and suspected intra-abdominal hemorrhage (e.g. free intraperitoneal fluid) on Focused Assessment with Sonograp
eirdue
hemodynamic status.breakdown
to fascial closure Hemodynamicallyand maystable
have apatients
delayedcan tolerate further
presentation imaging andPatients
(months-years). should undergo contrast
typically have CT scan
a slowly of
enlarg
tents)
he that is X-rays
shoulder. palpable while
show losssupine
of theand enlarges
normal withbetween
relation the Valsalva maneuver.
the humeral head and glenoid and internal rotation of the humera
with closed reduction.
ype of brain herniation, occurs when the cingulate gyrus is displaced under the falx cerebri. This typically does not cause pupilla
al artery compression
n causes both spinal cordthat and
leads to contralateral
spinal leg weakness.resulting in myelopathic symptoms (e.g. upper motor neuron signs
nerve root compression,
or neuron
ccur due tosigns,
spinalpain in aroot
nerve dermatomal/myotomal pattern).
compression and typically Lhermitte
causes necksign
pain(electric shock-like
associated pain with sensorimotor
upper extremity neck flexion) may occur.
deficits that
d rotation of the neck worsens compression of the nerve root, worsening pain and/or paresthesia.
sually made clinically, and most patients improve with symptomatic treatment, including nonsteroidal anti-inflammatory drugs an
causes cervical strain without associated cervical spine fracture. Patients with cervical trauma should be evaluated using valid
adiography Utilization
n cause damage Studyareas
to cortical [NEXUS] low-risk for
responsible criteria) to determine
inhibiting whether cervical
lower sympathetic centers.spine
This imaging
disruptedisinhibition
needed. may result in par
characterized
ertonic by rapid-onset
saline, mannitol) episodes
is part of tachycardia,
of the initial treatment ofhypertension, and tachypnea
elevated intracranial pressureoften accompanied
in patients by feverbrain
with traumatic and diaphores
injury. It
ematous brain tissue, thereby reducing parenchymal volume and overall intracranial pressure.
athy, a state of hypocoagulability and hyperfibrinolysis, can complicate traumatic brain injury (TBI). Antifibrinolytic therapy (i.e. t
hvertebral
moderate TBI if administered
fracture in a patient with within thetrauma
blunt first 3 is
hours after injury.
an indication to image the entire spine. CT scan is the screening modality of c
est to screen for cervical spine injury. Indications include high-energy mechanism of injury or any of the following findings: neur
exication,
typicallyorpresents
distracting
withinjury
a sudden-onset, severe headache that may be accompanied by vomiting, neck stiffness, fever, and los
diagnostic step.
The most commonly affected vertebral bodies are C5/C6, which lead to C6 radiculopathy, and C6/C7, which lead to C7 radicu
eest
vertebral bodies.
to screen for cervical spine injury. Indications include high-energy mechanism of injury or any of the following findings: neur
xication, or distracting
use cortisol helps maintain injury.
vascular tone, the absence of ACTH-induced cortisol production can lead to adrenal crisis (acute ad
ve shock.
progressive myeloneuropathy similar to that of vitamin B12 deficiency (e.g. distal extremity paresthesia, numbness, sensory ata
plenomegaly, edema, and osteoporosis.
n result in entrapment of the inferior rectus muscle, which presents with vertical diplopia and restriction of upward eye moveme
spresent
the most with hearingmononeuropathy
common loss and imbalance. Bilateral,
in patients hereditary
with end-stage schwannomas
renal diseaseare
on most often
dialysis. It isassociated with by
characterized neurofibromatosis
pain and parest
n during dialysis and are more severe in the arm with vascular access.
s common in patients with hypothyroidism and is frequently bilateral. Hypothyroidism causes soft tissue thickening and mucinou
n nerve
s. within theinclude
Manifestations carpal tunnel.
slowly progressive motor and sensory dysfunction and localized back pain; bowel and bladder dysfun
nd neurosurgical
nitially remain alert.decompression.
However, hematoma expansion results in neurologic decompensation with signs of elevated intracranial pre
mental
s may occur. CT scanminutes
status) within to hours.
demonstrates a posterior fossa hyperdensity. Urgent surgical decompression is indicated in patients with
a hemorrhage > 3 cm, brainstem compression,
elopathy include a slowly progressive, spastic paraparesis or obstructive hydrocephalus.
involving the upper and lower extremities, hyperreflexia, sensory cha
lso be positive.
nic shock due to interruption of the descending sympathetic fibers, which results in unopposed parasympathetic stimulation of t
thermia
commonisafteralsowhiplash-type
common due to a lackinofolder
injuries peripheral
adults vasoconstriction.
with underlying cervical spondylosis. Damage to the central cervical spinal
x abnormalities; sacral (e.g. bowel/bladder)
T6 can be complicated by autonomic dysreflexia, in which and lower extremity
noxious function
stimuliisbelow
generally preserved.
the injury level trigger an unregulated sympathe
atory parasympathetic response above the lesion typically causes bradycardia.
gait abnormalities; however, all symptoms may not be present in early disease. NPH can be idiopathicManagement includes removing
or occur noxious
secondarystimul
to n
e,atrauma, meningitis) that result in scarring of the arachnoid granulations responsible for cerebrospinal
genetic disorder associated with sudden-onset tachypnea, tachycardia, myoglobinuria, and masseter/generalized muscle rig fluid resorption.
le
(ICH) typicallyMost
anesthetic. caseswith
presents arise during or shortly
progressive headache,afternausea/vomiting,
induction, but symptoms are mental
and altered sometimesstatus delayed
over auntil justofafter
period anesthesi
minutes to ho
enous malformation, which may also present with recurrent headache, seizure, or focal neurologic deficits.
eurologic deficits (e.g. cranial nerve palsy), respiratory compromise, and autonomic dysfunction. In contrast to foodborne and in
ent. Urgent
nstability andtreatment
weakness with equine
in the botulinum
extremities. antitoxin is usually
Examination requiredshows
and should not beneuron
lower motor delayedsignsfor diagnostic
at the levelevaluation.
of the lesion (arms)
s).
esthesia (sensory change in the genitals/perineum) and/or bladder, bowel, or sexual dysfunction. An urgent lumbosacral spine M
mpression.
ors; however, they can present with headache, seizure, and focal neurologic deficits due to mass effect. In such cases, complet
n, and proprioception) and may affect motor fibers in the ventral horns (flaccid paralysis). The diagnosis is confirmed by MRI, an
egaly out of proportion to cerebral atrophy. The diagnosis is confirmed with high-volume lumbar puncture demonstrating improv
eatment is ventricular
forceful abduction andshunt placement.
external rotation at the glenohumeral joint suggests an anterior shoulder dislocation, which may cause in
he teres minor and the deltoid,
idural) expansion after head injury can and injury can result
abruptly in weakened
increase shoulder
intracranial abduction
pressure, compressandthe
decreased
temporalsensation
lobe, andover theuncal
cause lateral
he
ated pupil due to oculomotor nerve (CN III) compression. Contralateral hemiparesis is often seen due to direct
atoma and can suffer iatrogenic injury during prolonged maintenance of the dorsal lithotomy position (e.g. hip/pelvic surgery, ch compression of t
ryrepair
or vein.
can cause spinal cord ischemia, especially of the anterior cord. Anterior cord syndrome typically presents with distal, bila
de touch
ts from the sensation;
rupture of and urinaryveins,
bridging retention.
most commonly from head trauma. Risk factors include advanced age and chronic alcoho
wel/bladder dysregulation —9 paralysis.subdural
On non-contrast head CT scan, acute Suspected hematoma appears
cases require as aMRI
urgent crescent-shaped
spine; treatmenthyperdensity that crosses
generally includes suture
surgical lin
deco
ommoncord
spinal triggering event (dueoftothe
injury, disruption direct inoculation).
autonomic tracts involved in bladder control can lead to urinary retention. Therefore, cathete
n and possible injury.
gs in high-grade (e.g. grade IV) astrocytoma are heterogenous and serpiginous contrast enhancement. Glioblastoma (grade IV
central necrosis on neuroimaging.
n helps in
pecially lower increased
elderly patientsintracranial
with cervicalpressure by causing cerebral
spine degenerative changes washout of CO2,
(i.e. cervical leading to vasoconstriction
spondylosis), can cause central and decreased
cord syndrom
sation in the upper extremities and disproportionate upper extremity weakness.
p in patients age > 60 but may be seen in younger individuals due to HIV infection, diabetes mellitus, ocular trauma, glucocortic
ataracts
drops and includes
systemic surgical removal ofcan
glucocorticoids theraise
lens intraocular
with implantation of a(IOP),
pressure prosthetic lens.
leading to open-angle glaucoma (OAG). OAG is usua
mity, extrusion of vitreous or iris, or a visible entry wound. Other manifestations include aedema.
ome patients with steroid-induced OAG may develop central blurriness due to corneal peakedIOP can be measured
or teardrop with tonom
pupil, asymmetric a
upillary response, and reduced intraocular pressure.
s characterized by ocular irritation, impaired extraocular motion, and proptosis. It is caused by T cell activation and stimulation o
odies, leading
instillation. to expansion
In OGL, of orbital
fluorescein tissues.
may reveal extrusion of fluid through the laceration; in corneal abrasion, fluorescein stains the c
ended. In addition, acetazolamide rapidly reduces further production of aqueous humor. Subsequently, laser iridotomy can facil
ment.
emitis
are vision-threatening
is the most common emergencies. The most important
form of endophthalmitis. and
It usually urgentwithin
occurs step 6inweeks
management is copious
of surgery. Patients irrigation
usually to normalize
present with the
pa
en eyelids and conjunctiva, hypopyon, corneal edema and infection.
airing opacification of the lens. Patients usually have painless blurred vision, glare, and often halos around lights. Treatment wit
ted when
reclusa loss of
(brown vision impairs
recluse) activities
spider bite initiallyofhave
dailyaliving.
small, red papule that can progress to form a larger necrotic wound (loxoscel
cks and local wound care.
ould be managed with close observation and frequent coagulation studies and wound evaluations. Patients with mild envenoma
or 12-24
uries hours.cause
frequently Patients withsevere
more abnormal
damage laboratory results,
to internal progressing
structures symptoms,
(e.g. muscle) thanorexternal
signs of structures
systemic toxicity should
(e.g. skin). receive
Skeletal mua
ult
eadsin acute compartment syndrome,
to a hypermetabolic rhabdomyolysis,
response characterized by aand heme pigment-induced
hyperdynamic acute kidney
circulatory response, injury.
causing tachycardia and hypertensio
d increased protein and lipid catabolism, causing elevated basal body temperature.
s can cause a deep necrotic ulcer at the bite site. The ulcer can progress over days to an eschar.
ness
ence,(third degree)
separation of burns can result
the epidermis in eschar
and/or formation tissue
subcutaneous that restricts
with anvenous and lymphatic
intact fascia, drainage,
is typically managed leading to acute compartm
conservatively with reg
ehiscence involves
manifestation the fascia
of alcohol and is athat
withdrawal surgical emergency.by delirium, hyperthermia, hypertension, and tachycardia 48-96 hours
is characterized
h a mortality rate of 5% and requires aggressive intensive care unit-level supportive management in addition to benzodiazepine
al may
ere be characterized
manifestation by agitation,
of alcohol withdrawal tremors,
usually perceptual
presenting changes,
48-96 hourspsychosis,
after theelevated vital
last drink. signs,
It is delirium,
defined and seizures.
by autonomic excitation,
ding to translocation of anaerobic oral flora into the intrapleural space is likely the most common cause of empyema, commonly
ss
nicand similarinvolve
effusions signs and symptoms
bacterial to uncomplicated
invasion into the pleuralpneumonia.
space and Putrid
requireordrainage
foul-smelling pleuraltofluid
in addition is diagnostic
antibiotic therapy.ofPositive
anaerobic
pleu
ed effusion and is an indication for chest tube placement.
or impaired consciousness. Sputum culture should be obtained but is rarely useful; empiric treatment with ampicillin-sulbactam
most common lung cancer in adolescents and young adults. It typically presents with proximal airway obstruction, leading to dy
sbe of the
are the most
lung. common
Carcinoidlung syndrome is much
malignancy less common
in young patients than
who with gastrointestinal
do not smoke. They carcinoid tumors.
typically arise in the proximal airway and c
monia)
perihilar opacities and interstitial edema. Because pulmonary infection can have a similar clinical presentation component.
or hemoptysis. CT scan with contrast usually reveals an avidly enhancing mass with an endobronchial and the treatmen
rkedly worsen an infection, bronchoalveolar lavage and lung biopsy should be performed in the diagnostic
the major manifestation of chronic lung transplant rejection and is common in lung transplant recipients > 5 years post-transpla workup of ALTR.
nical presentation
injured (e.g. gradually
during cardiac progressive
surgery. Patients can dyspnea
have dyspneaand nonproductive cough) andand
on exertion, orthopnea, pulmonary
paradoxicalfunction testing
breathing showing an
movement (i.e.oba
CVP), low pulmonary capillary wedge pressure (PCWP), and low cardiac output. Post-pulmonary obstructive shock (e.g. due to
me findingstoastrap
s position cardiogenic
air on theshock
lateralwith
righthigh CVP, high
ventricular wallPCWP,
and help and low cardiac
prevent output.
right ventricular outflow tract obstruction and embolizat
gen
nousiscatheter
also important to encourage
manipulation, absorption
or pulmonary of the air The
barotrauma. embolus.
air can obstruct blood flow in the right ventricular outflow tract or pu
hock,
on can and cardiac
rapidly arrest. tension pneumothorax (TP) and cause cardiovascular collapse. Therefore, decompression (e.g. nee
exacerbate
on does
on for patients with TPthe
not eliminate who also
risk need airway
of acute pulmonary protection
embolism- an(PE),
important exception
especially to the typical
in high-risk patientorder.
populations (e.g. postoperative
diagnostic test of choice in patients with likely pretest probability of acute PE.
s 9-12 can injure intra-abdominal organs, including the spleen. Bleeding that irritates the diaphragm may cause referred pain (e
ity of the
hould lung for carbon
be considered monoxide
in patients with(DLCO)
thoracicare the best
trauma and predictors of postoperativeair
extensive extrapulmonary outcomes
(e.g. chestfollowing lungpersistent
tube with resectionlarge
surgery.
air
rative repair.
mpanied by shock (e.g. severe hypotension) is attributed to hemorrhage until proven otherwise. Intrathoracic hemorrhage can c
s emergent thoracotomy to prevent exsanguination.
setting
hould beofsuspected
blunt chest in trauma is concerning
a child with for intrathoracic
abrupt-onset hemorrhage.
cough and wheeze (with orRib fractures
without (with intercostal
a choking vessel
episode) that injury) are a com
is unresponsive to a
ination (e.g. wheeze, decreased breath sounds, hyper-resonance) and/or unilateral lung hyperinflation
on improves gas exchange but poses the risk of pulmonary barotrauma, leading to alveolar rupture and subsequent pneumotho with mediastinal shift on
demonstrate
umonia shouldrapid-onset
be suspected tachycardia, tachypnea,
when an intubated hypoxemia,
patient develops andnew
decreased
pulmonary or absent breath
infiltrates sounds
on chest on the
x-ray, affected
worsened side.
respirator
ecretions), and clinical
risk is reduced signs of
by elevating theinfection
head of(e.g. fever,
the bed to leukocytosis).
30-45 degrees,Confirmation requires the
suctioning subglottic identification
secretions, of an
limiting organism intube
endotracheal a lom
patients are at high risk of stress ulcers.
yan progressive cellulitis
occur following of theofsubmandibular
fracture and sublingual
large, marrow-containing bonesspaces.
(e.g. Airway obstruction
femur, pelvis). can occur
Patients due to
classically displacement
have the triad ofofrespirato
the ton
ial rash;tohowever,
ontrast the rash
patients with is present in less than
transfusion-associated half of cases.
circulatory overload, those with TRALI typically have normal brain natriuretic pep
in patients with periods of impaired consciousness (e.g. alcohol/drug abuse, seizure disorder) or swallowing dysfunction (e.g. P
temic
an acutesymptoms andsecondary
lung injury cough productive of foul-smelling
to a chemical burn from sputum.
aspiratedChest
sterilex-ray usually
gastric reveals
contents. In a cavitaryaspiration
contrast, infiltrate inpneumonia
a dependent is ap
pharyngeal
moptysis secretions.
involves establishing adequate patent airway, maintaining adequate ventilation and gas exchange, and ensuring hemo
ng lung in the dependent
and high clinical suspicion position (lateral position).
for pulmonary Bronchoscopy
tuberculosis is the in
should be placed procedure of choice
respiratory to to
isolation identify
preventthethesitespread
and attempt earl
of infection
and incentive spirometry can help prevent postoperative atelectasis. Adequate postoperative pain control can also help by min
isrespiration.
common and typically manifests 2-5 days following surgery. Hypoxemia results from localized intrapulmonary shunting and v
s to
ominal primary
surgery.respiratory
Adequate alkalosis with low
pain control, PaCO2 and high
deep-breathing pH. directed coughing, early mobilization, and incentive spirometr
exercises,
on/blistering, oropharyngeal carbon deposits, carbonaceous sputum, stridor, carboxyhemoglobin level > 10%, or history of conf
ese indicators warrants
ted parapneumonic earlyor
effusion intubation
empyema to can
prevent upperEmpyemas
develop. airway obstruction
have frank by pus
edema.or bacteria (by Gram stain) in the pleural spa
ged antibiotics.
s ribs in > 2 locations can result in flail chest, with paradoxical movement of the fractured flail segment during respiration. Flail c
monaryincontusion,
pected patients with andrespiratory
atelectasis.distress and multiple rib fractures. Flail chest increases work of breathing and may injure the u
nical ventilation causes an acute increase in intrathoracic pressure. In the setting of decreased central venous pressure (e.g. hy
ngery,
cause acutelasting
surgery loss of>right ventricular
3 hours, and poorpreload,
generalloss of cardiac
health. output, and
Postoperative cardiac arrest.
measures such as incentive spirometry and deep breath
nsesand improve
an initial outcomes
decrease by promoting
in preload lung expansion.
and cardiac output followed by a compensatory increase in systemic vascular resistance, hear
, setting
cold extremities, and evidence of hypovolemia
of blunt trauma is concerning for hemorrhage. (e.g. decreased
Decreasedjugular
breathvenous
soundspressure)
and dullnessshould be present. with contralateral
to percussion,
orax.
umothorax (PSP) occurs in patients without a history of lung disease and is most common in tall, thin men in their early 20s. M
cludes
injure the observation
underlying and supplemental
lung. The resultingoxygen,
alveolarwhich enhancesand
hemorrhage theedema
speed -ofoften
resorption.
worsened by fluid resuscitation - can cause d
lobular infiltrates on chest x-ray or CT scan are classic for pulmonary contusion.
orrhage preceding containment (e.g. hematoma). Strict blood pressure control and emergent surgical intervention are necessa
pneumothorax should be suspected in patients with underlying lung disease presenting with rapid worsening of respiratory symp
ese in patients
< 0.6 cm are with chronictoobstructive
unlikely be malignant,lungwhereas
disease.those > 0.8 cm require additional management or surveillance. Nodules that a
n(i.e.
have > 5% probability)
a delayed based on
presentation clinical
after bluntfactors (e.g. nodule size,
thoracoabdominal traumapatient
due to age, smoking history)
progressive should
enlargement ofbethebiopsied or surgically
diaphragmatic defec
avity. Chest x-ray may show elevation of the hemidiaphragm or abdominal organs (e.g. stomach)
acture, blunt thoracic trauma can cause pulmonary contusion. Tachypnea and hypoxemia are classic symptoms, and imaging o in the thorax.
s.
and thoracentesis reveals fluid that is exudative with low glucose (< 60 mg/dL) and low pH (< 7.2). Most complicated parapneum
ge (e.g. chest tube) in addition to antibiotics.
sually
ue to the found in the middle
aspiration mediastinum.
of oropharyngeal Thymoma
anaerobic is usually
bacteria. foundwith
Patients in the anterior mediastinum.
dysphagia or episodes ofAll neurogenic
impaired tumors are (e.g.
consciousness locat
adecan subacute
assessfever, night sweats,
the pretest weight
possibility loss,pulmonary
of acute and coughembolism
with putrid sputum.
(PE). X-ray reveals
CT angiography cavitary
is the infiltrates,
test of choice inoften with air-fluid
clinically stable p
these
affect patients is oftenand
young patients appropriate, but clinicalbiologic
display aggressive judgment is needed
behavior. regarding clinicalgerm
Nonseminomatous stability
cell and
tumorscontraindications.
typically produce both α-f
ers.
to large-volume atelectasis (lung collapse) due to airway obstruction. Chest x-ray demonstrates opacification of the affected lun
asis.
ould be suspected in patients with prior blunt thoracoabdominal trauma and abnormal chest x-ray findings (e.g. bowel loops in t
n occur
ogy aftermultifactorial,
is often progressive expansion
however; the of the diaphragmatic
presence defectfailure
of respiratory and abdominal organ
(e.g. low pH, herniation.
elevated pCO2, CTlowscan of the
pO2), chest andand
bradypnea, abdb
g in hypoventilation.
he mainstay of ribcondition
a life-threatening fracture management
caused by airtowithin
prevent
the the associated
pleural complications
space that of atelectasis
displaces mediastinal and pneumonia.
structures and compromises cardi
set dyspnea, tachycardia, tachypnea, hypotension, and distension of the neck veins. Treatment should be initiated immediately
dfirst require aggressive
by reduced inspired oxygenvolume resuscitation
tension, with intravenous
hypoventilation, diffusion0.9% salineshunt,
limitation, prior to
andtheV/Q
initiation of vasopressors
mismatch. Hypoventilationto restore adeq
is associa
one-related protein release). In contrast, small cell carcinoma of the lung causes other paraneoplastic syndromes (e.g. ACTH pr
hormone
s tumors aresecretion), andlung
malignant adenocarcinoma
neoplasms thatof arise
the lung typically
in the causes
superior peripheral
portion lungThey
of the lung. lesions.
most commonly present with shoulde
ess.
he lungs and the hypoxemia does not correct with supplemental O2. As with any type of V/Q mismatch, pulmonary edema lead
o causes stiffening of the lungs and decreased lung compliance.
llism is depletion
body likely in a and
postoperative patient with hypotension,
aldosterone-mediated jugular venousRepletion
renal tubular reabsorption. distension, and new-onset
of volume rightnormal
and Cl with bundlesaline
branch block. t
corrects
acidosis (NAGMA) results from the loss of bicarbonate (HCO3). Because exocrine pancreatic secretions are high in HCO3, NAG
he pancreas
blow (e.g.can
to the flank) pancreatic ductinjury.
cause renal leak) or small intestine
Concerning (e.g.
clinical high ileostomy
findings (e.g. flankoutput, enterocutaneous
pain/ecchymosis) shouldfistula).
prompt CT scan of the
resent.
der can cause it to rupture at the weakest point, the dome. Diversion of urine from the urinary tract (e.g. inability to void) into th
sed blood
piratory urea nitrogen
alkalosis andrespiratory
with a high creatinine rate
fromand
peritoneal
normalreabsorption.
oxygen saturation due to inadequate pain control. Patients who take op
bacteremia) in the prior 1-2 months. In most cases, the urinalysis control
eased doses of opioids or multimodal strategies to appropriately acute pain.
demonstrates pyuria, bacteriuria, and proteinuria, but it may re
ecting ducts.
e earliest clinical manifestations of autosomal dominant polycystic kidney disease. It likely results from cyst expansion leading to
nin production
cystic with activation
kidney disease commonly of the renin-angiotensin-aldosterone
presents system.
with hypertension, hematuria, Therefore,
and recurrentthe hypertension
flank is best
pain in patients in treated
their 30swith ACE
or 40s.
eceptor antagonists
sis presents (e.g. tolvaptan)
with hematuria, may slow
renovascular disease progression
congestion, in some
and flank pain. patients.
The most common causes are nephrotic syndrome, malig
rfunction
MR angiography or renal venography.
with the addition of ACE inhibitors, a lateralizing abdominal bruit, and recurrent flash pulmonary edema. The diagnosis
er ultrasonography).
y hyperaldosteronism (hypokalemia, elevated serum bicarbonate); urinalysis is typically bland. The diagnosis is confirmed with
n of the post-stenotic kidney results in increased local renin secretion, leading to activation of the renin-angiotensin-aldosterone
n
e secretion by the dominant
is an autosomal unaffecteddisorder
kidney is suppressed.
resulting in benign and malignant multiorgan tumors. The most common tumors are hema
a. Other common manifestations include renal
n in older adults and often presents with hematuria, cell carcinoma (often preceded
voiding symptoms by the frequency),
(e.g. dysuria, formation ofand/or
premalignant renal cysts)
hydronephrosis withand
fla
ladder wall and to biopsy suspicious masses.
ents with painless hematuria that lasts throughout micturition in an adult age > 40. Urinalysis should be performed to confirm h
omerulonephritis.
obstructive sleep Those
apnea).with no clear with
Individuals cause for hematuria
secondary require urgent
polycythemia and noevaluation
evidence of with cystoscopy
hypoxia shouldtoundergo
visualizeabdominal
the bladderCTfo
ommon in oldervolume
tvoid residual patientsis who smoke.The
increased. It often presents
diagnosis with weight
is confirmed on loss, hematuria,orfirm/nontender
urethrography flank mass,
cystourethroscopy; and/or
treatment intermitten
includes ureth
unlikely to pass without additional intervention (e.g. lithotripsy). Most stones < 5 mm pass spontaneously, and α blockers (e.g. t
ally for intermediate-sized
hosphate (struvite) causesstones 6-10 mm).
large kidney stones in patients who have recurrent upper urinary tract infection with urease-producin
ne do not eliminate struvite stones,
me, chronic diarrhea (due to acidification of which cantheharbor
urine),bacteria, leadingsystemic
and increased to furtheruric
infection. Stone removal
acid production. is usually
Alkalization required.
of the urine wit
s include seizure, coma, and respiratory arrest. Acute hyponatremia (< 48 hr duration) is poorly tolerated, and patients are at e
nyas symptoms
tamsulosin should
act on receive hypertonic
the distal 3% saline.
ureter, lowering muscle tone and reducing reflex ureteral spasm secondary to stone impaction.
need for analgesics.
e urinary retention often have suprapubic discomfort and fullness, along with hypertension and tachycardia (i.e. sympathetic sti
eUR)
diagnosis.
is common in elderly men, especially in the setting of underlying benign prostatic hyperplasia. The risk of AUR is further in
eetion
usingisbladder
a common ultrasound.
cause of prerenal acute kidney injury (AKI). Patients typically have an elevated blood urea nitrogen/creatinin
ment.
uma can rupture theofbladder
Administration intravenous fluid restores
at its weakest renaldome),
part (i.e. perfusion andurine
spilling corrects
into the
the AKI.
intraperitoneal cavity. Common clinical finding
ng, and associated pelvic fracture.
properties can cause acute urinary retention by preventing detrusor muscle contraction and urinary sphincter relaxation. The tr
ntinuing
ysplasia the mostmedication.
commonly affects women. Headaches due to internal carotid artery stenosis and secondary hypertension due to
ccompanying
eased in Crohn bruits mayand
disease be found in the
all other neck and
intestinal abdomen.
diseases causing fat malabsorption. Increased absorption is the most common c
stone
enal formation.
injury. Concerning clinical findings include flank pain and ecchymosis, costovertebral area tenderness, and hematuria. The
uld
ay beprompt CT scanby
complicated ofposterior
the abdomen andinjury.
urethral pelvis.Patients with suspected urethral injury (e.g. blood at the urethral meatus, high-rid
s hematuria with associated pelvic fracture are concerning for bladder injury. Because of urine containment within adjacent tiss
ocalized
ses hematuria,(vs diffuse abdominal)
voiding symptoms symptoms and a urgency,
(e.g. dysuria, negative frequency),
examinationand/or
with Focused
suprapubic Assessment with Sonography
pain. Patients who have nofor Trauma.
clear sourc
workup with cystoscopy.
mm in diameter pass spontaneously; increased oral fluid intake is recommended to ensure adequate flow of dilute urine. α block
(6-10
pirationmm). Urologic introduction
or injection, consultation of is skin
recommended for stones
flora may result > 10bursitis
in septic mm and or for refractory
septic pain,
arthritis, anuria, acute
presenting kidney injury,
as worsening or sig
pain severa
hesaljoint
(e.g.orprepatellar,
bursa is necessary
olecranon) to assess for infection.
inflammation, chronic bursal swelling, or tophus deposition in the bursa. Tophus induces chron
d bones, which can result in erosions and overhanging edges of cortical bone on imaging.
hisneurovascular
characterized compromise (e.g. absent
by acute erythema, warmth, radial
andpulse, diminished median
pain accompanying bursalnerve sensation)
swelling. shouldcaused
It is usually undergo byimmediate reductio
skin breakage tha
id analysis is needed to confirm the diagnosis. Treatment includes systemic antibiotics.
reduced within 6 hours of injury to minimize the risk of osteonecrosis of the femoral head. Dislocation without associated fractu
reduction,
minor whereas
blunt chest dislocation
trauma with clavicular
(BCT) (e.g. fracture warrants
fracture)open
can (i.e.
haveoperative) reduction. injury (e.g. subclavian vessel injury). Abn
serious intrathoracic
szed
frompatients with BCT
contracture of theshould prompt additional
glenohumeral studies
joint capsule and(e.g. CT scan
presents withof the chest)
gradual onsettoshoulder
evaluate pain
for intrathoracic
and reducedinjuries.
active and pas
motion exercises; adjunctive measures include nonsteroidal anti-inflammatory drugs and corticosteroid
r, and irregular lucency at the fracture plane. Femoral neck fractures have a significant risk of complications (e.g. secondary ins injections.
tcaused
patients. by posterior tibial nerve compression beneath the flexor retinaculum in the medial ankle. It presents with burning pain
, sole, and toes, which is elicited by tapping on the nerve (i.e. Tinel sign).
sults from progressive palmar fascia fibrosis, leading to puckering of the skin and fibrotic nodule and cord formation along the fle
ension at the
nt sprain metacarpophalangeal
results from direct trauma and proximal
to the superiorinterphalangeal joints.Examination
or lateral shoulder. The diagnosis is made
shows clinically;
maximal no imaging
tenderness over is
theneeded.
AC join
ays can assess the degree of sprain and evaluate for concomitant clavicular or humeral fractures.
mmonly
ar associated
necrosis, withreduction
and closed rotator cuff
mayinjury
lead(RCI), which
to further presents as of
displacement shoulder pain and
the fracture. difficultydislocation
Therefore, with abduction. RCI can
associated withcause
humew
shoulder dislocation are often at increased risk for recurrent dislocation due to labral tears (i.e. Bankart lesion), ligamentous lax
l joint instability
First-line treatments (i.e. excessive,
include activity symptomatic,
modification, andphysical
involuntary laxity(stretching),
therapy of the joint capsule
and padded in > 1heel
direction).
inserts. Calcaneal spurs are in
with local swelling. Alkaline phosphatase and inflammatory markers (e.g. erythrocyte sedimentation rate) may be elevated. X-r
is caused by repetitive microtrauma to the calcaneus (e.g. abrupt increase in running). On examination, the pain is elicited by m
osis
tive is confirmed
tissue outpouching with imaging
arising(x-ray or MRI).sheaths and joint structures. It presents as a rubbery, mobile, transilluminating nod
from tendon
ve spontaneously,
chilles tendon rupture andcan asymptomatic
be easily missed cysts andcan isbebestobserved.
evaluated on physical examination with the calf squeeze test, which sim
lantar
chanteric fractures are the most common hip fractures with
flexion in response to calf squeeze is consistent Achilles
in older adults tendon
and most rupture.
typically occur due to mechanical falls. Examin
e leg compared with the contralateral side.
ommonly occurs in head-on motor vehicle collisions in which the knee strikes the dashboard. The leg appears shortened and in
y (e.g. impaired
arthritis includesdorsiflexion)
intravenous and arterialand
antibiotics injury with avascular
adequate drainage necrosis
of purulent of the femoralvia
material head.
needle aspiration, arthroscopic irrigation
en
se required to completely
limb-threatening injury clear
to thethe infection.
popliteal artery. Meticulous vascular examination, including measurement of the ankle-brachial
s for anorexia nervosa should be obtained in any patient with a stress fracture, low body weight, and distress at having to limit p
sk for stress
syndrome fractures
presents withdue to decreased
lateral hip pain and bone mineral density.
tenderness over the greater trochanter during flexion. Initial treatment includes hea
me is characterized by poorly localized lateral knee pain. It isfrom
atory drugs. Patients with persistent symptoms may benefit common local corticosteroid
in inexperienced injection.
runners starting a new or more strenuou
al to the joint line; pressure over the IT band just proximal to
iosis is defined as lateral curvature of the spine without a known etiology in a child age > 10. the lateral femoral epicondyle during
Forwardflexion
bendof the
testknee reproduce
reveals an asy
py in evaluation is x-ray of the spine to determine the degree of curvature and assess
those with pelvic ring disruption, can cause life-threatening hemorrhage from vascular (e.g. venous plexus) injury. Pelvic bind skeletal maturity.
e tamponade
venile of bleeding.
Tillaux fracture) is characterized by fracture of the distal tibial epiphysis and lateral physis (i.e. growth plate) and most co
y fused. Injury to the
mon in children and typically occur growth plate canat thecause
distalgrowth
radiusarrest
and/orand ulnaleadduetotopersistent
a fall ontolimb-length discrepancy.
an outstretched hand. X-ray is diagnostic an
ction. In addition, if compression occurs proximal to the tunnel, the palmar cutaneous branch of the median nerve may be affec
lateral
the patient hand.can bear weight, conservative management (e.g. compression bandage or brace, ice packs, crutches to reduce wei
ay be caused by a sprain or fracture. The Ottawa ankle rules are used to help determine which patients require imaging. X-ray
malleolar
e, nontender region in association
swellings that occur withmost
either 1) bony tenderness
commonly at the dorsal atsurface
the posterior
of the margin
wrist. Theor tip of the lateral
diagnosis or medial
is usually malleolus
obvious or 2
on inspecti
ass.
monMost ganglion
following cysts amputation.
extremity resolve spontaneously
The neuropathic and require no treatment.
pain, which is perceived in the absent portion of the limb, is best manage
erapy and prosthetics.
putational adjuvant therapies. Injection of a local anesthetic can provide transient pain relief and confirm the diagnosis. Management ty
erized by inflammation and degeneration of the plantar aponeurosis (deep plantar fascia), a thick, fibrous band that extends fro
arch
y leadoftothe foot. Itnonunion.
fracture presents with chronic
Common pain at the
symptoms sole of
include the foot that
intermittent pain is and
worse with weight
swelling bearing.
and sinus tract formation. Open bone bio
,associated
and treatment requires surgical debridement of the infected and necrotic bone.
with increased bone remodeling, which dramatically increases the risk of osteosarcoma. Most cases present with pa
ings (e.g. destructive
y bone tumor that is often boneassociated
lesion, sunburst periosteal
with inherited reaction,
genetic Codman
mutations triangle).
to the RB1 gene, which causes retinoblastoma, and the
on of the quadriceps muscle can cause rupture of the quadriceps-patellar tendon complex. Symptoms include an audible pop, r
against
atients gravity.
who areInontears of the quadriceps
anticoagulation or have tendon
a bleeding(proximal to theare
diathesis patella) the patella
at increased risk.rides low,features
Clinical with a palpable defectparesthesia
include pain, above the
onfirmed
ritis of thebyknee measuringshould compartment
include weightpressures.loss, regular activity, and exercises to strengthen the quadriceps muscle. Simple analges
t is inadequate, injectable
piphysis is most common in obese adolescents glucocorticoids may andrelieve symptoms.
occurs when the Total knee arthroplasty
proximal is indicated
femur is displaced for to
relative those who fail less
the epiphysis agg
along
mptom. Supportive
piphysis occurs when examination findings include
excessive shearing limited hip
at the proximal flexionphysis
femoral and internal
weakens rotation.
the growth plate, causing displacement of the
bese adolescents with chronic, dull pain along the
itis is most commonly caused by hematogenous spread of bacteria to the metaphysis thigh or knee that worsens with activity.
of long bones. Patients have fever, refus
ted bone.
eoarthritis of the knee includes weight loss, regular moderate activity, and topical or oral nonsteroidal anti-inflammatory drugs. I
s characterized
muscles can reduce by chronic abnormal
pain inloading
the groin,on the joint and
buttock, protect
or lateral hipthe articular
that is worse cartilage from further
with activity stress.
and weight bearing. Examination oft
veals loss of the normal joint space, periarticular osteophytes, and sclerosis of the
with pain at the sole of the foot that is worse with prolonged weight bearing or with the first steps of the day. The pain may be re acetabular surface.
sis on theafter
y occurs calcaneus
quick, with lateraldorsiflexion
movements of on
theatoes.
flexed X-ray
knee.may showdislocation
Lateral calcifications in thecommon.
is most proximal Risk
fascia (heel include
factors spurs), age
but this is jo
< 20, ne
r subluxation. Examination shows reduced range of motion and lateral displacement of the patella out of the trochlea.
or middle-aged man suggests a secondary cause. Bone loss is common in celiac disease due to malabsorption of vitamin D. Ma
/osteoporosis
ntraction of theorquadriceps
osteomalacia withwith bone in
the knee pain, muscle
flexion. weakness,
Initial management and impaired
includes ambulation.
activity modification, nonsteroidal anti-inflamma
racterized by anterior knee pain, tenderness, erythema, and localized swelling and is common in occupations requiring repetitiv
xclude
injuriesinfection.
are common in sports requiring rapid direction changes or twisting movements of the lower extremity. They usually pre
s.
ts with diabetic findings
Examination neuropathy. include laxity
It can of anterior
cause impaired motion of the tibia
ambulation, relative
but pain to the femur.
is typically mild. Examination shows deformity of the foo
rmation, and loss of joint spaces.
ain and weakness at the shoulder. With the arm abducted over the head, the patient may be unable to lower the arm smoothly
.due to extrusion of synovial fluid from the knee joint into the gastrocnemius or semimembranosus bursa, and is most common
ay presentofasthe
necrosis) a painless
femoral headbulgeisinathe popliteal
common space, but of
complication cyst rupture can use.
glucocorticoid cause It acute pain in theby
is characterized calf.
progressive hip pain, leadi
ssyndrome
will often is bean normal, and MRI is a more sensitive test.
overuse syndrome involving the tendons of the gluteus medius and minimus at the greater trochanter. It presen
etitive hip flexion
tatarsals are associated or lying on withthe affectedincrease
a sudden side. Physical examination
in activity shows local
and are common tenderness
in athletes over therecruits;
and military greater the
trochanter.
second metata
est
arizing neuromuscular blocker that can cause life-threatening hyperkalemia in patients with a condition leading tomore
and simple analgesics. Stress fractures of the fifth metatarsal are at increased risk for nonunion and warrant aggressi
upregulation
uscle trauma,
ion fracture canburn
be injury,
causedstroke). Nondepolarizing
by twisting, lifting, or trauma neuromuscular
and presents blocking agents
with back pain (e.g.
andvecuronium, rocuronium)
vertebral point tenderness. should be us
It typically
ditions associated
e erythrocyte with decreased
sedimentation rate isbone
grosslymineral density.
elevated. MRI is the most sensitive diagnostic study. There should be a very high in
with a history of low
uncomplicated injection
back drug
pain use or recent
experience distant site resolution
spontaneous infection (e.g. urinary
of their tract infection).
symptoms in the first few weeks. Patients should be a
inflammatory drugs are preferred as initial management.
ed with catching or reduced range of motion suggests a meniscal tear. Persistent symptoms in patients with suspected menisca
ation is advised
ecrosis) for significant
of the femoral head is tears.
a common complication of sickle cell disease and presents with hip pain, reduced range of motio
on of end arteries supplying
ng the postpartum period. Examination the femoralshowshead,tenderness
leading to necrosis and side
at the radial collapse
of theofwrist
the periarticular
and a positive bone and cartilage.
Finkelstein test (reproduct
ed over the thumb).
scus often result from twisting injuries with the foot in a fixed position. Associated symptoms can include reduced extension, a s
eals
tear palpable
is causedlockingby valgusor catching
stress orwhen severethetwisting
joint is rotated
injury and or extended while under
can be associated withload.
injuryDiagnosis is confirmed
to the medial meniscus. withFindings
MRI or arth
inc
RI is the most sensitive test, and most patients are managed nonoperatively.
caused by repeated tension or compression without adequate rest and occur most commonly in athletes or others who sudden
e,cture
localized,
shouldactivity-related
undergo definitive pain;surgical
swelling; and pointastenderness
correction on palpation.
soon as reasonably X-raysHowever,
possible. are frequently normal.
surgery may be delayed up to 72
ity.
phoid enters at the distal pole; fracture can disrupt flow to the proximal segment, leading to avascular necrosis and nonunion. N
ay.
e the If initial x-raysbrachial
underlying are negative,
plexus CT andscan or MRI artery.
subclavian is recommended,
Hard signs or of the wristinjury
arterial should(e.g.beabsent
immobilized and
pulses, x-rays
distal repeated
ischemia) after
require
ry (e.g. unexplained
fractures of the humerus hypotension,
most commonlystable hematoma,
present after reduced pulse)
a fall onto an warrant CT angiography
outstretched for further
hand with posterior evaluation. of the distal
displacement
mal
nt humerushave
syndrome fragment
severe canpain,
entrappainthe brachial
with passive artery
range andof median
motion, nerve, which passSensory
and paresthesia. anterior and to the humerus.
motor deficits occur in later sta
dings. Compartment pressures must be measured immediately if the index of suspicion
res should be considered for surgical intervention. Wrist immobilization with a cast can be considered for nondisplaced is very high. Fasciotomy is the treatmen
fracture
ymanagement
to rule out osteonecrosis
of the fracture. of the
Many proximal
midshaft segment
humeral and nonunion
fractures canofbe the fracture.
treated nonsurgically. Indications for open reduction and
compromise,
an occur following and significant
the fracture displacement.
of large, marrow-rich bones (e.g. the femur). Microvascular obstruction in the pulmonary circulat
e cerebral
most commonly circulation may cause
in patients age > 40, neurologic
often afterdysfunction,
a fall on an including confusion
outstretched arm.and focal
These deficits.
injuries are characterized by pain and weak
merus. MRI can confirm the diagnosis.
(RCT) is most common in patients who perform repetitive arm movement above shoulder height. It presents with subacute pain
ession
nary metastasisof soft tissueand structures between the humeral
malignant transformation may occur. headX-ray
and acromion
shows anand is a characteristic
eccentric lytic lesion, feature of RCT. soap bubbles
often resembling
t-line treatment.
ention includes increasing checkpoints (i.e. redundancy) by having at least 2 providers independently reconcile all medications,
ngthens safety verification
and repeating prior to continuing
culture by enabling team members hometo medications.
express questions and concerns without fear and regardless of status. Tea
ations (e.g. aviation), improve communication
miscommunication) is a leading root cause of retained foreign skills and psychological
objectssafety by encouraging
in surgical collaborative
settings. Simulation discussion
training, adoptedand bymonit
high
afety culture, promoting situational awareness, reduced hierarchical barriers, and closed-loop
d facilitate correct action. Examples include environmental design changes separating look-alike medications, standardizing an communication.
wn during signout (e.g. omitted information during handoff between providers) is a leading cause of transfer-of-care errors and c
esses
.g. (e.g. checklists,
intubation) mnemonics)
may be performed and redundancy
without informed consent (e.g. separate documentation
in emergencies, of cross-coverage
when obtaining consent isevents).
not possible. Informed re
diagnosis, proposed procedure, risks/benefits, alternatives, risks of refusal) required
ement of informed consent is extension of an authorized procedure if an unexpected complication arises that demands immedi for informed consent.
procedures for unrelated issues that are not imminently life-threatening.
y regain capacity as their condition improves. These patients should be reassessed for capacity before health care decisions a
esis, they often require prevention of reaccumulation, either
ary wedge pressure (a reflection of left atrial pressure) are
rdiac silhouette with clear lungs. Echocardiography is used
tional tests/interventions are based on the patient's
oth the proposed treatment and treatment alternatives, and
development of chronic venous insufficiency distal to the site
ercise and compression.
a reactive component involving endothelin-mediated
disease. Symptomatic mitral stenosis is among the highest-
riorsystem
ne to pregnancy.
to cardiac antigens and typically has a latency
crisis, which presents with hypoglycemia and severe
ydrocortisone or dexamethasone.
ability of the ventricular response rate. Atrial flutter carries a
ular resistance (afterload), increased venous return
sequently, patients can develop severe bradycardia,
or blunt cardiac injury. Patients with these findings are
usions are small, asymptomatic, and benign. When the
se drainage
managedfrom conservatively
the sternalwith observation.
wound should undergo chest
pable rocking or clicking of the sternum confirms the
life-threatening
esents infectionthan
less dramatically (e.g.ininfected
patientsgangrene).
without PAD.
nts at an increased risk for aortic dissection; this risk is
ed as sharp or tearing. They may be complicated by
ally sudden-onset, severe chest or back pain that is sharp or
y/laxity, multiple joint dislocations, tissue fragility, poor
Proximal AAA tends to cause upper abdominal, flank, or
ronic right-sided volume or pressure overload. A prominent
r transvalvular regurgitation. PVD can lead to serious
d blood flow is reduced, left ventricular ejection fraction is
nce regurgitant
ventricular pathway.
ejection fraction (LVEF) significantly
tomatic patients
cated in asymptomaticwith LVEF < 60%.
patients with left ventricular ejection
essures. Urgent echocardiography should be performed in
uscultation reveals an ejection click, followed by a
amage or inadequate leaflet coaptation. This complication
brillator placement.
uggested by ECG demonstrating persistent ST-segment
on leading to heart failure.
r systolic dysfunction. Pulmonary artery catheterization
ve mild localized pain and swelling and a continuous bruit
diac tamponade and cardiogenic shock. CT angiography is
se lumenswith
dification, in the ascending
smoking or descending
cessation as the bestaorta.
intervention to
ma require a chest x-ray after initial trauma survey. Chest x-
ax).
nt pressures. Definitive management includes urgent
rise in intrapericardial pressure. Unlike subacute tamponade,
hypertension with lower extremity hypotension
s pressure (CVP) is more consistent with obstructive or
ctory
e; andhypotension.
absent or diminished femoral pulses (often with
Most supportive
sually arterial emboli
withare
bedcardiac in origin.monitoring, and
rest, intensive
tients. It is the preferred first step to confirm the diagnosis in
ndings of effusion without cardiac tamponade include
h hypotension, tachycardia, distended neck veins, and
ult in thrombosis and ischemia. Popliteal and femoral artery
ms. a known history, a focused bedside ultrasound should
thout
y of AAAthe
oughout should undergo
day and emergent
resolves repair.
overnight when the patient is
ed by syncope, a pulsatile abdominal mass, and/or flank or
opriate catheter tip placement should be confirmed by chest
distal ischemia (e.g. absent pulses, cool extremities). In the
mur and symptoms of decreased cardiac output (e.g.
nfusion) should be initiated. This prevents thrombus
ning on chest x-ray. It is a serious condition that requires

ocardial infarction and usually occurs 3-5 days after the
ng or weeping. They do not require debridement and can be
icion should be raised when the lesion appears different
lesions with inflammation; itching, crusting, or bleeding; or
tsymptoms
(ugly duckling
of softsign).
tissue infection are present. Ulcers
nically after excluding other etiologies, usually with skin
d may resolve spontaneously over several months. Although
l of thin skin layers with microscopic inspection) is more
efractory disease, tumor necrosis factor-α inhibitors, oral
ized radiation therapy for cancer treatment (e.g. breast
also atfirm,
aped, risk.freely movable cyst or nodule with a small central
olves spontaneously.
ients have associated systemic disease (e.g. inflammatory
nits. It most commonly occurs in intertriginous skin areas and
comedones,
us) ulcer. Risk and scarring.
factors include impaired mobility, malnutrition,
area). Gram-positive organisms are common soon after
fcoskin graft
use, is often the first sign
immunosuppression, of chronic
and a burn wound infection.
inflammation.
aDiameter
history of> organ
6 mm,transplant.
and Evolution
SCCinincolor, size, or shape.
immunosuppressed
nd reduced sensation. Interventions that can prevent
intenance
unded, of nutrition.
scarred, or inflamed skin. SCC arising in chronic
elops nodularity. If melanoma is suspected, an excisional
ising within a scar or chronic wound carries an increased risk
or surgical excision. Mohs micrographic surgery, in which
metically sensitive areas.
and manually reimplanted after gentle rinsing of the tooth
lage of the outer ear. Prompt evacuation of the hematoma is
It is often triggered by tooth extractions or other invasive
ial rinses. (TM). Most barotraumatic TM injuries heal
membrane
tly drained to avoid complications of infection, septal
ements) is suspicious for cerebrospinal fluid rhinorrhea,
h a positive family history of hearing loss likely represents
Valsalva maneuvers) or loud noises (Tullio phenomenon).

sthe
aretrue vocal
used as acords.
tumor marker once the normally functioning
sskpregnant.
of metastasis and recurrence, and are measured serially
on.
oscopy to ensure no delay in diagnosis of possible cancer.
ctor for oral cavity squamous cell carcinoma.
noma. Human papillomavirus is the likely etiology in the
gue or hypopharynx/larynx. Associated cervical adenopathy
It is typically located inferior to the mandible and anterior to
are concerning for a vestibular schwannoma, a benign
le failed attempt at video-assisted endotracheal intubation
ctors include diabetes mellitus, obesity, and preceding upper
ranial nerve deficits (e.g. facial numbness), and otitis media.
ay progress during pregnancy.

ncy.
evented with adequate
Asia (particularly fluidChina)
southern hydration
andand oral
parts of hygiene.
Africa and
arly spread to the cervical lymph nodes is common.
ely resulting
s with speechfrom
or aeating,
septalorhematoma.
causes problems with the fitting
ynx. Infection within the retropharyngeal space can drain into
ediastinum and result in acute necrotizing mediastinitis.
nf be
thehelpful
duct. in distinguishing a peritonsillar abscess from
the cartilage may lead to clinical and radiographic findings
DH secretion. Urinary water excretion is impaired, leading to
pshould
in establishing
undergo the diagnosis.
thyroid scintigraphy. Small,
oidism, is characterized by hypercalcemia,
ia. Measurement of urine or plasma metanephrines is the
cell renal cell carcinoma, pancreatic neuroendocrine
gic blockade 2-3 days prior to surgery. β-blocker therapy
ntrast, or childbirth. It is characterized by tachycardia,
calcemia is the most common complication seen post
gh baseline rate of bone turnover. Bisphosphonates can
sed blood. Patients with impaired hepatic function are at
es intravenous hydrocortisone or dexamethasone in addition
f severe hypertension in patients with pheochromocytoma
nts at increased risk of recurrence include radioiodine
ollow-up testing should be delayed until the patient has
ically occur at weight-bearing sites on the sole of the foot.
ions. Younger patients (age < 50) are likely to have
l, posterior to the pectoralis minor muscle. The pectoralis

on.
breast radiation therapy. Adequate surgical excision of the
o not resolve with aspiration require core needle biopsy to
ic tube insertion for gastric decompression plus emergency
shoulder pain. Hemodynamically unstable patients with
ssue. Solid or complex-appearing masses on ultrasound
d associated axillary lymphadenopathy. Management

or nipple retraction and calcifications on mammography.
dded for better characterization of the mass. Tissue biopsy is
refore, right-sided colon cancer often presents with occult
metastatic colon cancer is confined to the liver. Regardless of
men.
do not increase the risk for colon cancer, and patients may
isk).
ecurrent neoplastic lesions of the colon. Therefore, a
ia. Hyperinsulinemia results in increased circulating levels of
ardiovascular consequences, including venous compression
ardiac output. Patients with SAP have increased risk of
lume depletion.
signs (e.g. fever, leukocytosis) of infection 7-10 days after
sestines,
diagnostic.
where it overwhelms the resorptive capacity of the
colestipol, colesevelam)
he hypermetabolic are first-line
response therapy.
present after burn injury and
ures. Colonoscopy demonstrates mucosal pallor, friability,
e pain. Although conservative management (e.g. fiber, stool
orrhoidectomy
mpairs under local
its compliance, anesthesia.
resulting in urgency and fecal
ge.
triggered by underlying aortic stenosis, which is associated
alve at high
d chronic velocity. Symptomatic patients should be
constipation.
raphy typically reveals multiple arteries with
gressive abdominal pain and distension, along with
n'-shaped dilated loop of colon on abdominal x-ray. Patients
gery.
tions are diagnostic. A colonoscopy is recommended at the
ducts, promoting cholestasis and acute cholangitis. It occurs
rning gastrointestinal symptoms, ovarian cancer should be
nd/or constipation. Colonoscopy is required to rule out
n deficiency
ellow fluid withanemia).
high amylase, high total protein, and low
carcinoma is the most common cause, although bloody
ascitic
on fluid can
of hepatic help identify theprocedures.
or biliopancreatic primary tumor.
It presents with
on of the small bowel or hepatobiliary tree (e.g. cholangitis,
hing, and/or vomiting with feeding. Diagnosis can be
vealing. The presence of hemorrhoids should not preclude
t destruction, and endotheliitis. Most patients can be treated
ch is seen on contrast swallow study as a pouch posterior to
rs within the retroperitoneum (e.g. duodenal tear), classic
nal imaging.adenomas or adenocarcinomas detected on
left-sided
th include
ns colonoscopy.
hypophosphatemia and other electrolyte
ain sequence: sudden, severe pain (perforation) followed by
ritoneal
her free air.
evaluation with endoscopic ultrasound-guided biopsy and
mptappears
en emergent on surgical
abdominal exploration.
x-ray as a dilated, inverted, U-
abdominal compartment syndrome (i.e. intra-abdominal
eduction in infections, maintenance of gut integrity) when
d by malignancy, most commonly from pancreatic
esulting from isletand
re complications celloften
destruction.
need aggressive management
ohn
mmediately develop severeavoided
disease and should be in these patients.
aminotransferase elevations
n, and inability to pass flatus and/or stool. Treatment usually
ons, deep ulcerations, transmural inflammation,
a.yps).
Most cases arise in the setting of thromboembolism (e.g.
ic disease, anticholinergic medication). The diagnosis is
mpression, sometimes aided
d healing, perifollicular by intravenous
hemorrhage, neostigmine.
coiled hairs, and
e stools, and a small or absent gallbladder. Laboratory
ardia, usually within the first week after bariatric surgery. The
nd treatment
ecystitis). requires urgent
Manifestations surgical
generally repair.persistent high
include
erally required.
mic inflammatory disease, and anticoagulation increases the
l effusion occurs most commonly as a result of acute or
raphy may be required.
g for pancreatic cancer is not recommended for patients with
uld undergo abdominal
or back and is sometimes CTworse
scan. with eating and lying down.
de multiparity, vaginal delivery, pelvic surgery, pelvic floor
nancy is a common cause. Esophageal malignancy
opy is theand
hibitors, testtopical
of choice to evaluate (e.g.
glucocorticoids dysphagia.
fluticasone,
jury can be difficult to diagnose immediately following
on for an undiagnosed
ematoma. injury.
Hematoma expansion can progressively obstruct
m leaked esophageal contents. Confirmation with
ntestinal contents leak from the esophagus into the pleural
vere chest/back pain, fever, and a widened mediastinum on
jaundice, altered mental status, and hypotension.
complications.
sents with abdominal pain with radiation to the back,
al
ssiveforepigastric
up to 48 hours.
pain and weight loss. Friable tumor vessels
levated transaminases and alkaline
alt-preserved food and nitroso phosphatase.
compounds. Manifestations
itial test of choice to establish the diagnosis.
he diagnosis is confirmed with an abdominal ultrasound
surgical emergency and warrants immediate
en raised when a patient with C. difficile infection stops
ng; alteration in bowel habits; and (sometimes) irritative
dice, cholestatic liver enzyme pattern, and dilation of the
lude pain with defecation and chronic discharge.
rates a bluish (or purplish) bulge at the anal verge. Initial
ore, management is conservative with bowel rest and serial
e, it can be a useful diagnostic clue but cannot be used to
xins. Incidence is greatest in regions that have high rates of
,with
this dramatic
conditionelevations in α-fetoprotein.
should prompt abdominal ultrasound to
nd asymptomatic, life-threatening complications such as
erwomen
quadrantandpain and signs
is marked of hemorrhagic
by the presence of shock.
a stellate central
incarceration, strangulation). Small bowel obstruction can
nd distended
e managed loops
with of bowel
watchful withbecause
waiting air-fluid levels
herniaon x-ray.
contents
el), resulting in possible strangulation. Therefore, patients
are advised only for patients with refractory symptoms or
abdominal imaging, and management includes blood
g hiatal hernias do not require further workup or intervention
t imaging typically reveals a retrocardiac air-fluid level within
s, and no anemia. First-line treatment is with 5-
as
ated oral
ontherapy is used
the shins. It hasfor more extensive
a strong associationdisease.
with
gums that bleed easily, dental caries), and impaired wound
esent as tender, fluctuant, erythematous masses with fever
abscess
g development.
laparotomy. Intra-abdominal abscess should be suspected
for patients to qualify for bariatric surgery; both
h Sonography for Trauma (FAST), a rapid, noninvasive
atic enzyme supplementation can improve symptoms in
ay lead to cholecystitis.
pratherapeutic INR. Back pain and signs and symptoms of
e treated with
cupations, andlaparoscopic cholecystectomy
those with deep gluteal clefts.within 72 hours.
The most
sociated
nancy. mucoid,
Primary purulent,
tumors orgastrointestinal
of the bloody drainage. tract, lung, and
hat persist postoperatively. Opiates compound this problem
hage, should receive prothrombin complex concentrate
y worse at night, anorexia with weight loss, and jaundice due
mesenteric ischemia) fashion. Confirmation of perforation
intra-abdominal hemorrhage may have shock and
s vomiting, and weight loss. In a patient with a history of acid
ndicated for patients with severe symptoms and a systemic
ucted cystic duct. The pain is exacerbated by fatty meals,
ation, or leukocytosis.
abdominal x-ray. Adhesions, typically postoperative, are the
onfirmation with esophagography or CT scan using water-
s formation. They often have a contained abscess. If the
my.
pharynx. This may cause the mucosa to herniate, forming a
f undigested food.
e initial staging
ofteners, modality.
sitz baths, and topical anesthetics and vasodilators
al to the duodenum or associated with chronic diarrhea. In
hypotension and most commonly affects arterial watershed
he diagnosis.
ominal cramps) and vasomotor (e.g. palpitations,
rosclerosis. CT imaging can show thickening of the bowel
ematoma. Affected patients commonly have epigastric pain
agnosis. at initial presentation. Patients with IBD-induced
ometimes
arenteral nutrition. Clinical manifestations of zinc deficiency
bile-filled dark area. It is associated with an increased risk
anatomy (e.g. strictures), or gastric/pancreatic secretions
olds on endoscopy. The diagnosis is strongly suggested by
etin stimulation
ent with urinary test.
tract infection. Abdominal CT scan with oral
nic and vesicular walls.
ansign’,
be attempted
abdominalif pain
percutaneous drainage fails.
with hip extension, can often be
rapy.
r absent bowel sounds. Abdominal radiography classically
tation ofthe
sualize perforated
appendixviscus (e.g. perforated
(e.g. normal peptic ulcer).
vs nonperforated or
onpregnant
mild jaundiceadults.
precipitated by stressors (e.g. infection, fasting,
od countsmay
orphine) are cause
normal.sphincter contraction and precipitate
nmental (e.g. cigarette smoking, obesity) risk factors.
when supine. Because this is a referred pain,
seen
ing in hospitalized
(e.g. and critically
ultrasound) followed ill patients.
by direct visualization (e.g.
sis
unosuppression (e.g. diabetes) or vascular factor.
and guide therapy toward the causative disease. It arises
t, a CT scan of the abdomen is indicated for those with a
s > 150 U/L. Early cholecystectomy is indicated in all
long-term complications include progressive growth,
lstone
ensitivedisease.
and specific imaging study to detect gallstones and
enous catheters to initiate resuscitation with intravenous
sis. The primary inciting event is a gallstone obstructing the
stone advances it may cause 'tumbling' obstruction before
drainage is typically reserved for patients with significant
oembolism). If ischemia is prolonged, patients may develop
globin, for
oncern elevated
biliary amylase, and
obstruction metabolic
due acidosis.
to pancreatic or biliary
unusual sites (e.g. arm, chest area). It is usually associated
phageal symptoms may start with barium esophagram, but
ctly to endoscopy.
ntaneously
ickness by age 5.
perforation may cause pneumomediastinum,
ast should prompt emergent surgical consultation.
pain, systemic inflammatory response, and pleural effusion
using intra-abdominal hemorrhage may have shock and
bility, fail to improve after initial conservative measures,
e is antibiotics and percutaneous cholecystostomy, followed
verticulum, which may occasionally present with a palpable
rvoisier sign) on examination. Imaging can demonstrate
manifestations of systemic toxicity (e.g. fever, leukocytosis,
dominal pain.
hematemesis. The diagnosis can be confirmed on
mination findings. Progression to bowel infarction causes
deally with a first- or second-generation cephalosporin (e.g.
r hidden) are ‘the floor’ (external bleeding) ‘and 4 more’:
al blood pH. Normal saline is associated with the
ce of peritonitis or intraperitoneal free fluid on Focused
d in any patient with BAT and evidence of hemorrhage.
g it in a plastic bag, and placing the bag in a bath of ice
onchial rupture. Bronchoscopy can confirm the diagnosis
ergo immediate
he cervical spineexploratory laparotomy.
is recommended for initial airway
s with penetrating abdominal trauma and any of the
oma, during the primary survey. The GCS assesses the
atio of 1:1:1 (fresh frozen plasma/packed red blood
scitation, which restricts crystalloid use and uses blood
trolled,
r) shouldcan
bedecrease
transfusedthese
whileadverse
waitingeffects.
for type-specific blood
n: imaging (e.g. mammography, ultrasound) is performed
activities that have repetitive overhead arm motions (e.g.
sasonography.
and/or 3 months of anticoagulation.
Treatment with 3 months of anticoagulation is
futeasy bleeding
are at or bruising.
increased risk for venous and arterial thrombosis
s of bleeding (e.g. oozing from venipuncture/surgical sites)
t, including a maculopapular rash; profuse, watery diarrhea;
with anemia and leukocytosis. They usually occur due to
y in those
ateral receiving
pulmonary anticoagulation
infiltrates, therapy.
and possible hypotension.
hetic agents or dapsone. It presents with hypoxia, a
ated by discontinuing all heparin products and initiating an
lant (e.g. heparin) at the same time because warfarin
an
y illadult patient
patient with with a smoking
underlying liverhistory.
disease can become vitamin
astin time.
motor and sensory abnormalities. Bowel and bladder
d.
omplications from anticoagulation (e.g. active bleeding) and
and requires
elevated AFP,examination of the laryngopharyngeal
with a considerable mucosa.
number also having an
lation with an alternate agent (e.g. argatroban,
ould receive rapid infusion of large volumes (e.g. 30 mL/kg)
obactam or a carbapenem, in combination with vancomycin,
indicating end-organ hypoperfusion and dysfunction.

fbed
burn wound infections.
amoxicillin-clavulanate to take immediately in the setting
drainage. Systemic antibiotic therapy, which may decrease
and considered
can result for all
in septic patients.
arthritis, presenting with joint pain,
d antibiotic therapy.
s antibiotics, fluid resuscitation, and removal of the dialysis
dequately chlorinated pools or hot tubs. Patients generally
minated
er enzymes;water anshould be avoided.
associated right-sided pleural effusion may
s tendon rupture, retinal detachment, and aortic aneurysm
actors for aortic
with greater aneurysm.
risk than past smoking, but patients who quit
d at least 4-6 weeks before surgery.
acute (7-28 days postoperatively) fever is generally driven by
with regional lymphadenopathy and systemic symptoms (e.g.
th Gastrointestinal
e. cephalexin is generally curative.are common and include
manifestations
dard
osis, for diagnosis
viral hepatitis,ofand
tissue-invasive disease.
hereditary hemochromatosis are at
ever, sepsis, and/or multiorgan failure. Blood cultures or
tal sites. Fusobacterium necrophorum is the most frequent
nisms (e.g. coagulase-negative staphylococci) have a
bone can be palpated with a probe, the risk of underlying
agement.
s drug use, trauma, and hemoglobinopathies. Infective
mmation due to surgery, malignant hyperthermia, and
s activity against Pasteurella multocida and oral anaerobes
t deep, long-standing diabetic wounds are polymicrobial with

spread from the wound.
patients withdischarge,
cloudy-gray neurogenic bladder.
and sometimes crepitus. Early
stool studies for C. difficile toxin and glutamate
abnormal chest x-ray. Patients should have lower respiratory
ausing hydatid cysts. Symptoms are initially rare, but hepatic
als infections.
ery a large, smooth cyst,
Patients often develop
usually with internal septations.
fever, myalgias,
ommonly an infected mandibular molar. Early intervention
ular devices. Factors favoring infection over contamination
organism and drug susceptibility.
amoxicillin-clavulanate provides adequate coverage for the
tic lesion with eggshell calcification is highly suggestive of
or travel to developing countries. Amebic liver abscess is
de with serology;
al examination needleoraspiration
findings is usually
severe systemic unnecessary.
signs such as
es not preclude the prostate tissue from growing back and
ure.
local microthrombi, leading to decreased outflow through the
a), thalassemia,
n increased risk and multipledue
of priapism myeloma.
to altered blood viscosity
en followed by intracavernous injection of phenylephrine.
t infections in the first year of life and penile phimosis,
transmitted infections.
surface area) should undergo urethral catheterization as
expansion and flexibility during erections. Manifestations
make
nce ofsexual intercourse
prostate difficult.
cancer. Less-prominent risk factors include
ossibly due to increased scrotal temperatures that can cause
rchiopexy is indicated before age 1 to reduce the risk of
creased risk for recurrent

atic tenderness urinary
in young or tract infections.
middle-aged men. Patients often
dn,for eradication.
but 6 weeks of therapy with trimethoprim-
s. Most cases arise when coliform pathogens enter the
oceles are associated with increased risk for infertility; for
s required to prevent death and should not be delayed for
mal cremasteric reflex. Most cases are caused by sexually
e however,
age > 35.inTreatment
patients inwith
whomantibiotics is required.
the diagnosis is unclear, a
ave severe scrotal pain and swelling and may report prior
dicates of
evation testicular necrosis.
the testicle. Torsion can occur after exercise, and
showing a firm, ovoid testicular nodule should prompt a
er cancer. Risk factors for bladder cancer include cigarette
mide), and pelvic radiation exposure.
alva maneuvers
his frequently and does
causes not transilluminate.
secondary inhibition of FSH and LH.
is a urologic emergency that requires urgent operative
e urethrography
enerally includes prior to surgery.
bilateral scrotal ultrasound, serum tumor
Assessment with Sonography for Trauma examination are
ndergo have
ypically contrast CT scan
a slowly of the abdominal
enlarging abdomen and pelvis.
mass (i.e.
ernal rotation of the humeral head. Most posterior
cally does not cause pupillary involvement but may cause
g. upper motor neuron signs below the lesion) and radicular
th sensorimotor
ty neck flexion) may occur.
deficits that follow a dermatomal/myotomal
anti-inflammatory drugs and avoidance of triggering
uld be evaluated using validated clinical decision rules (e.g.
dsinhibition
needed. may result in paroxysmal sympathetic
nied
ith by feverbrain
traumatic and diaphoresis.
injury. It creates an osmolar gradient that
Antifibrinolytic therapy (i.e. tranexamic acid) can improve
the screening modality of choice because of its sensitivity
the following findings: neurologic deficit, spinal tenderness,
neck stiffness, fever, and loss of consciousness. CT scan of
C7, which lead to C7 radiculopathy. Imaging demonstrates
the following findings: neurologic deficit, spinal tenderness,
d to adrenal crisis (acute adrenal insufficiency) with severe
esia, numbness, sensory ataxia), anemia, hair fragility, skin
ion of upward eye movement.

ated with by
cterized neurofibromatosis type ll.in the lateral hand;
pain and paresthesia
sue thickening and mucinous infiltration, which can lead to
; bowel and bladder dysfunction may occur. Management
s of elevated intracranial pressure (e.g. headache,
is indicated in patients with signs of neurologic deterioration
, hyperreflexia, sensory changes, and a positive Babinski
sympathetic stimulation of the vessels (hypotension) and
the central cervical spinal cord causes upper extremity
er an unregulated sympathetic response, leading to severe
es
thicremoving
or occur noxious
secondary stimuli and treating
to neurologic the (e.g.
insults hypertension.
nal fluid resorption.
eter/generalized muscle rigidity following exposure to
ed until just after
er a period of minutes anesthesia
to hours.cessation.
ICH in young patients is
eficits.
ontrast to foodborne and infant botulism, fever and
he levelevaluation.
nostic of the lesion (arms) and upper neuron signs below
urgent lumbosacral spine MRI is required for diagnosis,
ect. In such cases, complete surgical resection is
osis is confirmed by MRI, and management usually requires
ncture demonstrating improvement of gait with cerebrospinal
ocation, which may cause injury to the axillary nerve. The
dralsensation
lobe, andover
causetheuncal
lateral shoulder.The first sign is typically
herniation.
ne (e.g.
to direct compression
hip/pelvic surgery,ofchildbirth)
the ipsilateral cerebral
or vascular peduncle.
procedures
ally presents with distal, bilateral flaccid paralysis; loss of
ced age and chronic alcoholism (due to brain atrophy), as
nsity that crosses
rally includes suture
surgical lines.
decompression and antibiotics.
etention. Therefore, catheterization should be performed to
ent. Glioblastoma (grade IV astrocytoma) has a classic
constriction
cause centraland decreased
cord syndrome.cerebral blood flow.
This classically causes loss of
s, ocular trauma, glucocorticoid use, or external radiation
ucoma (OAG). OAG is usually characterized by insidious loss
can be measured
eardrop with tonometry.
pupil, asymmetric anterior chamber depth, loss of
activation and stimulation of orbital fibroblasts by thyrotropin
ion, fluorescein stains the corneal defect and appears
tly, laser iridotomy can facilitate aqueous outflow and
snts
irrigation
usually to normalize
present with the
painpH.
and decreased visual acuity.
around lights. Treatment with lens extraction and artificial
er necrotic wound (loxoscelism). Most cases will resolve with
atients with mild envenomation and normal laboratory
mic
restoxicity should
(e.g. skin). receive
Skeletal antivenom.
muscle necrosis is a frequent
y.
tachycardia and hypertension; increased gluconeogenesis
, leading
ged to acute compartment
conservatively syndrome.
with regular dressing changes. In
nd tachycardia 48-96 hours after the last drink. Delirium
addition to benzodiazepine therapy.
delirium, and seizures.
ed by autonomic excitation, agitation, tremor, and altered
use of empyema, commonly presenting insidiously (e.g. over
is diagnostic
ibiotic therapy.ofPositive
anaerobic empyema.
pleural fluid Gram stain or culture is
nt with ampicillin-sulbactam or a carbapenem is
ay obstruction, leading to dyspnea, wheezing, and recurrent
ns.the proximal airway and cause airway obstruction (e.g.
obronchial
esentation component.
and the treatment for ALTR (i.e. high-dose
nostic workup of ALTR.
nts > 5 years post-transplant. The diagnosis is usually made
ction testing showing an obstructive
breathing movement (i.e. abdomen moving pattern. inward on
bstructive shock (e.g. due to aortic dissection or severe aortic
t obstruction and embolization of air into the pulmonary
entricular outflow tract or pulmonary arterioles, leading to
e, decompression (e.g. needle thoracostomy) should be
r.
ulations (e.g. postoperative cancer resection). CT pulmonary
may cause referred pain (e.g. to the left shoulder).

wing lungpersistent
be with resectionlarge
surgery.
air leak). Bronchoscopy can confirm
thoracic hemorrhage can cause massive hemothorax (>
stalthat
de) vessel injury) are a common
is unresponsive cause
to albuterol. of hemothorax.
Supportive findings
on with mediastinal shift on x-ray.
and subsequent pneumothorax formation. Patients with a
nds on the
x-ray, affected
worsened side.
respiratory status (e.g. increased oxygen
ation of an organism in a lower
limiting endotracheal tube movement, respiratory
and tract sample.
avoiding gastric
elyto displacement
have the triad ofofrespiratory
the tonguedistress,
posteriorly.
neurologic
normal brain natriuretic peptide and no jugular venous
wallowing dysfunction (e.g. Parkinson disease). It usually
t,ryaspiration
infiltrate inpneumonia
a dependent portion
is an of thedisease
infectious lung. caused by
change, and ensuring hemodynamic stability. Patients should
ify thethe
event sitespread
and attempt earlybefore
of infection therapeutic
furtherintervention.
diagnostic
control can also help by minimizing pain-induced restriction
apulmonary shunting and ventilation-perfusion mismatch,
on, and incentive spirometry decrease the incidence of
el > 10%, or history of confinement in a burning building.
ram stain) in the pleural space and require drainage (chest
nt during respiration. Flail chest can cause hypoxia due to
eathing and may injure the underlying lung, often leading to
al venous pressure (e.g. hypovolemic shock), initiation of
spirometry and deep breathing exercises are used to
ic vascular resistance, heart rate, and ejection fraction.
present. with contralateral tracheal deviation, is most likely
rcussion,
n men in their early 20s. Management of small PSP in
resuscitation - can cause dyspnea, tachypnea, and
al intervention are necessary to prevent rebleeding and
orsening of respiratory symptoms. Rupture of alveolar blebs
surveillance. Nodules that are intermediate or high
ldof be
thebiopsied or surgically
diaphragmatic defectexcised.
and herniation of abdominal
the thorax.
c symptoms, and imaging often demonstrates patchy,
Most complicated parapneumonic effusions and all
neurogenic tumors are (e.g.

paired consciousness located
drugin or
thealcohol
posterior mediastinum.
abuse) are at
nfiltrates, often with air-fluid levels.
f choice in clinically stable patients in whom PE is likely.
ontraindications.
s typically produce both α-fetoprotein and human chorionic
cification of the affected lung area and mediastinal shifting
ndings (e.g. bowel loops in the thorax, mediastinal shift).
Tlow
scan of the
pO2), chest andand
bradypnea, abdomen confirms
bradycardia the diagnosis.
suggests prolonged
pneumonia.
res and compromises cardiopulmonary function. It is
uld be initiated immediately with needle thoracostomy.
asopressors to restore
. Hypoventilation adequatewith
is associated tissue perfusion.
a normal A-a gradient
c syndromes (e.g. ACTH production, syndrome of
mmonly present with shoulder pain, Horner syndrome, arm
atch, pulmonary edema leads to an increase in the alveolar-
rightnormal
with bundlesaline
branch block. the metabolic alkalosis (saline
corrects
ions are high in HCO3, NAGMA is expected with large-
us fistula).
ould prompt CT scan of the abdomen and pelvis, regardless
e.g. inability to void) into the peritoneal cavity can cause
ontrol. Patients who take opioids chronically often develop
and proteinuria, but it may remain normal if the abscess is
m cyst expansion leading to localized renal ischemia and
on is best
patients in treated
their 30swith ACETreatment
or 40s. inhibitors (e.g. lisinopril).
is mostly supportive,
e nephrotic syndrome, malignancy, and trauma. Diagnosis
nary edema. The diagnosis is made with renal vascular
diagnosis is confirmed with renal imaging (e.g. renal
nin-angiotensin-aldosterone system and secondary
t common tumors are hemangioblastomas of the central
emalignant
d/or renal cysts)
hydronephrosis withand
flankpheochromocytoma.
pain. Urgent cystoscopy is
d be performed to confirm hematuria (> 3 red blood cells/hpf)
y toundergo
uld visualizeabdominal
the bladderCTforscan
lesions.
to evaluate for renal cell
ank
py; mass, and/or
treatment intermittent
includes fever.
urethral dilation or surgical
ously, and α blockers (e.g. tamsulosin) can be used to
ection with urease-producing organisms (e.g. Proteus,
moval is usually
Alkalization required.
of the urine with potassium citrate effectively
rated, and patients are at elevated risk of brain herniation;
condary to stone impaction. These agents facilitate stone
ycardia (i.e. sympathetic stimulation); portable bladder
The risk of AUR is further increased during the postoperative
lood urea nitrogen/creatinine ratio (> 20:1), oliguria, and
ity. Common clinical findings include hematuria, suprapubic
sphincter relaxation. The treatment involves urinary
ondary hypertension due to renal artery stenosis are
ption is the most common cause of symptomatic
erness, and hematuria. These findings, or a concerning
he urethral meatus, high-riding prostate) should undergo
ainment within adjacent tissues, extraperitoneal bladder
h Sonography
ts who have nofor Trauma.
clear source (e.g. cystitis) for these
e flow of dilute urine. α blockers can be used to facilitate
a, acute
ng kidney injury,
as worsening or signsdays
pain several of urosepsis.
following the procedure.
ursa. Tophus induces chronic inflammation in the
undergo
aused byimmediate reduction.
skin breakage that allows entry of skin floras (e.g.
on without associated fracture is usually managed with
bclavian vessel injury). Abnormalities on screening tests
ntrathoracic
and reducedinjuries.
active and passive range of motion. Treatment
oid injections.
lications (e.g. secondary instability, malunion), and surgical
presents with burning pain or numbness in the
cord formation along the flexor tendons. Patients develop
cally; no imaging
tenderness over is
theneeded.
AC joint and pain with adduction of the
abduction.
ation RCI can
associated withcause
humeralweakness but notrequires
neck fracture sensoryopen
loss.
art lesion), ligamentous laxity due to overuse, and
on).
erts. Calcaneal spurs are incidental and do not require
n rate) may be elevated. X-ray may show calcification with
ion, the pain is elicited by medial-lateral squeezing of the
obile, transilluminating nodule, most commonly at the wrist.
alf squeeze test, which simulates gastrocnemius
o mechanical falls. Examination findings include shortening
g appears shortened and internally rotated. Complications
ation, arthroscopic irrigation, or open surgical drainage.
ement of the ankle-brachial index, is necessary for ruling out
d distress at having to limit physical activity. Patients with
nitial treatment includes heat, activity modification, and
ing a new or more strenuous training regimen. Examination
exion
rd bendof the
testknee reproduces
reveals the pain.
an asymmetric thoracic or lumbar
y.
s plexus) injury. Pelvic binder application can decrease
. growth plate) and most commonly occurs in adolescents
pancy.
hand. X-ray is diagnostic and shows bulging of the bony
median nerve may be affected, leading to decreased
cks, crutches to reduce weightbearing) without imaging is
ents require imaging. X-ray of the ankle is indicated for
ral or medial
usually malleolus
obvious or 2) inability
on inspection and can to be
bear weight. on
confirmed
of the limb, is best managed with a multimodal pain regimen
diagnosis. Management typically involves excision of the
brous band that extends from the calcaneus to the toes and
ct formation. Open bone biopsy is recommended for
Most cases present with pain, soft tissue swelling, and
es retinoblastoma, and the TP53 gene, which is linked to Li-
ms include an audible pop, rapid swelling, and inability to
aespalpable defectparesthesias,
include pain, above the patella.
loss of sensation, and motor
eps muscle. Simple analgesics may also be helpful. If
d for to
ative those who fail less
the epiphysis aggressive
along the growth measures.
plate. Knee pain may
causing displacement of the proximal femur diaphysis.
. Patients have fever, refusal to bear weight, and point
al anti-inflammatory drugs. In addition, exercises to
ress.
ht bearing. Examination often shows decreased rotational
e.
he day. The pain may be reproduced by palpation of the
a (heel include
factors spurs), age
but this is joint
< 20, neither sensitive
laxity, lower nor specific.
extremity
ut of the trochlea.
labsorption of vitamin D. Manifestations may include
nonsteroidal anti-inflammatory drugs, and stretching and
cupations requiring repetitive kneeling. Bursal fluid analysis
extremity. They usually present with rapid onset of pain and
n shows deformity of the foot, and x-ray reveals bony
e to lower the arm smoothly (drop arm test). An MRI scan
ursa, and is most common in patients with underlying
alf.
y progressive hip pain, leading to reduced range of motion
greater trochanter. It presents with chronic lateral hip pain
erecruits;
greater the
trochanter.
second metatarsal is most commonly injured.
ion leading tomore
and warrant aggressive
upregulation treatment. acetylcholine
of postsynaptic
m,
point rocuronium)
tenderness. should be used
It typically with these
occurs patients.
in patients with
ere should be a very high index of suspicion for vertebral
weeks. Patients should be advised to continue moderate
nts with suspected meniscal injury should be evaluated by
ain, reduced range of motion, and normal findings on initial
eone and cartilage.
Finkelstein test (reproduction of pain on adduction of the
ude reduced extension, a sensation of instability, and a knee
s
edialconfirmed
meniscus. withFindings
MRI or arthroscopy.
include tenderness at the medial
hletes or others who suddenly increase their activity.
normal.
ry may be delayed up to 72 hours to evaluate surgical risk
r necrosis and nonunion. Nondisplaced fractures may not be
des,and x-rays
distal repeated
ischemia) after 7-10
require days. surgical intervention.
immediate
orher evaluation. of the distal humerus fragment. The
displacement
humerus.
tor deficits occur in later stages. Pallor and loss of limb
ed Fasciotomy is the treatment
for nondisplaced fractures,of choice.
but patients should be
ons for open reduction and surgical exploration include open
on in the pulmonary circulation can lead to respiratory
racterized by pain and weakness with abduction and
presents with subacute pain on abduction. Impingement
ure of RCT. soap bubbles. The diagnosis is confirmed with
n resembling
y reconcile all medications, involving interprofessional staff
nd regardless of status. Team-based safety briefings, used
rative discussion
n training, adoptedand bymonitoring.
high-reliability organizations,
munication.
edications, standardizing and simplifying processes, and
ransfer-of-care errors and can be prevented with
eisevents).
not possible. Informed refusal requires discussion of all
nsent.
rises that demands immediate treatment. However, this
ore health care decisions are made.

Antipsychotic agents (e.g. haloperidol) can cause QT
19685 Psychiatry CardiovascuAntipsychotics arrhythmia (e.g. torsade
adrenal insufficiency de pointes).
presents with clinical manifestat
17156 Psychiatry Endocrine, DAdrenal Insufficiency
Male Sexual reduced secondary sexual characteristics
Premature ejaculation is characterized by uncontrolle in women).
19025 Psychiatry Male ReprodDysfunction ejaculatory latency.
Multiple sclerosis (MS)Patients may also benefit from
is an immune-mediated inflamlo
19661 Psychiatry Nervous SysMultiple Sclerosis brain MRI showing
Functional (psychogenic) demyelinating
tremors plaques
often presentdissemina
abrup
19546 Psychiatry Nervous SysTremor with known tremor syndromes.
to-side head or body movements, memory recall of th
15124 Psychiatry Nervous SysConversion Disorder demonstrating
Parkinson disease lack dementia
of epileptiform(PDD)activity.
is characterized b
14962 Psychiatry Nervous SysParkinson Disease with
Antipsychotics cause hyperprolactinemia byonset:
Lewy bodies by the timing of symptom blocking If p
4899 Psychiatry Nervous SysAntipsychotics gynecomastia,
naps, and avoidance and sexual dysfunction.
of alcohol and drugs that cause
3470 Psychiatry Nervous SysNarcolepsy preferred.
3383 Psychiatry Nervous SysBenzodiazepines Benzodiazepines
Absence seizuresshould typically beoccur
used in with extreme
children agecautio
4-10
2681 Psychiatry Nervous SysSeizures Automatisms
Sleep (e.g. blinking,
disturbances are commonlylip smacking)
seen inare commo
depression
2350 Psychiatry Nervous SysDepression
Dementia With Lewy disorder.
Dementia with Lewy bodies is characterized by fluctu
2282 Psychiatry Nervous SysBodies antipsychotics
Serotonin syndrome (dopamine antagonists)
is precipitated is a supportive
by medications th
20110 Psychiatry Poisoning & Serotonin Syndrome excitability. Sustained muscle contraction
All women should be assessed for depression at thei and autono
12617 Psychiatry Pregnancy, C Depression
Somatic Symptom Selective
patient thatserotonin
there is reuptake
no evidence inhibitors
of seriousare used
medicalas fir
il
20545 Psychiatry Psychiatric/ Disorder somatic symptom disorder and contributing
Serotonin syndrome is characterized by the acute on psycholo
20356 Psychiatry Psychiatric/ Serotonin Syndrome within 24 hours
medications, of stopping
hydration, all serotonergic
cooling, medicatioc
and blood pressure
20355 Psychiatry Psychiatric/ Serotonin Syndrome serotonergic activity.
Factitious disorder is characterized by intentional fals
20217 Psychiatry Psychiatric/ Factitious Disorder
Post-Traumatic Stress stressors or desire
Post-traumatic stress fordisorder
validation. may Patients with factitio
not develop imme
20019 Psychiatry Psychiatric/ Disorder
Post-Traumatic Stress serotonergic antidepressants are first-line
Life-threatening medical events may be experienced treatments
19983 Psychiatry Psychiatric/ Disorder treatment.
The initial management of stimulant intoxication invol
19662 Psychiatry Psychiatric/ Cocaine of GABA.syndrome is characterized by multiple moto
Tourette
19552 Psychiatry Psychiatric/ Tourette Syndrome
Mild Cognitive dopamine
Hearing loss depleters, or α-adrenergic
in the elderly is commonreceptor and mayagonis
prese
19477 Psychiatry Psychiatric/ Impairment testing
Patients with a family history of Alzheimer diseaseman
can help confirm the diagnosis and direct ar
19472 Psychiatry Psychiatric/ Alzheimer Disease cardiovascular
Exploring gender riskexpression
factors (e.g. is ahypertension,
normal part of diabete
child
19057 Psychiatry Psychiatric/ Gender Dysphoria that is incongruent with assigned gender.
18708 Psychiatry Psychiatric/ Stimulants
Body Dysmorphic Stimulant
Body misuse should
dysmorphic disorderbeisconsidered
characterized in patients
by preocc wi
18495 Psychiatry Psychiatric/ Disorder camouflaging the perceived defect. Accurate
Inhalant abuse typically begins in childhood or early a diagnos
18320 Psychiatry Psychiatric/ Inhalants abdominal cramps
Brief psychotic and neurological
disorder is characterized dysfunction.
by the acuteChr
17716 Psychiatry Psychiatric/ Brief Psychotic Disorder It can be triggered
Dependent personality by a disorder
marked stressor such asby
is characterized thea
16828 Psychiatry Psychiatric/ Personality Disorders anxiety or depression
Schizotypal personalityindisorder
the context of a breakup by
is characterized or ol
16825 Psychiatry Psychiatric/ Personality Disorders and avoidance.
Patients FrankII delusions
with bipolar and hallucinations
disorder experience at least 1 ar
16698 Psychiatry Psychiatric/ Bipolar Disorder antipsychotics lurasidone
Binge eating disorder and quetiapine.
is characterized by repeated ep
16490 Psychiatry Psychiatric/ Bulimia Nervosa
Normal Child psychotherapy.
Young children often prefer particular foodsselective
Medication options include or food g
16438 Psychiatry Psychiatric/ Development weight loss, or developmental delays,
Histrionic personality disorder presents with attention further evaluat
16310 Psychiatry Psychiatric/ Personality Disorders adulthood and acrossdisorder
Paranoid personality multipleiscontexts.
characterized by a lo
16309 Psychiatry Psychiatric/ Personality Disorders establishing rapport and creating
Depression, weight loss, and new-onset a therapeutic
diabetes allianc
me
16219 Psychiatry Psychiatric/ Pancreatic Cancer evaluation.
Psychosis may develop in Parkinson disease as a re
16164 Psychiatry Psychiatric/ Parkinson Disease
Post-Traumatic Stress the two. In patients
Trauma-focused treated with anti-Parkinson
cognitive-behavioral therapy ismedicthe f
16157 Psychiatry Psychiatric/ Disorder process the trauma and decrease avoidance behavio
Post-Traumatic Stress Early intervention for acute stress disorder is indicate
Generalized Anxiety behavioral
Generalized therapy
anxietyisdisorder
recommended presents aswith
first-line treat
excessive
16153 Psychiatry Psychiatric/ Disorder commonly
Early-onsetexperience
schizophrenia somatic(onsetsymptoms.
age < 18) is associa
16128 Psychiatry Psychiatric/ Schizophrenia decline
mistakenly diagnosed with primarypsychotic
prior to the onset of active psychiatric symptom
disord
16122 Psychiatry Psychiatric/ Depression dexamethasone suppression test.
16115 Psychiatry Psychiatric/ Clozapine The antipsychotic
findings is required. clozapine
Negativeissymptoms
associatedare with an inc
a core d
16114 Psychiatry Psychiatric/ Schizophrenia relationships. These symptoms may
Borderline personality disorder is characterized by m be mistaken for
16104 Psychiatry Psychiatric/ Personality
Normal Child Disorders Patients may havefriends
Having imaginary transient psychotic symptoms
is developmentally appropriin t
16103 Psychiatry Psychiatric/ Development competence,
Tardive dyskinesia as well is as providing comfort
characterized in timesinvo
by abnormal of
16066 Psychiatry Psychiatric/ Tardive Dyskinesia medication. If feasible, the causative medication shou
16065 Psychiatry Psychiatric/ Schizophrenia Antipsychotic
Family therapymedication should
is an effective be maintained
adjunct indefi
to antipsychotic
16064 Psychiatry Psychiatric/ Schizophrenia about the symptoms,
Delusional disorder is course, and treatment
characterized by one or of more
the dis d
16063 Psychiatry Psychiatric/ Psychosis delusion.
Parkinson disease presents with bradykinesia, resting
16051 Psychiatry Psychiatric/ Psychosis
Substance-Induced antipsychotic (e.g.
Glucocorticoid quetiapine,
therapy may cause pimavanserin).
psychosis, anxiety
16049 Psychiatry Psychiatric/ Psychotic Disorder discontinuation, is indicated
Alcohol withdrawal should be considered whenever possible.
in patients w
16048 Psychiatry Psychiatric/ Alcohol Withdrawal hours
Lithium toxicity presents with neurologic (e.g.are
following admission. Benzodiazepines indic
altered
15986 Psychiatry Psychiatric/ Lithium hemodialysis.
15985 Psychiatry Psychiatric/ Lithium Certain
Bipolar IImedications
disorder is (e.g. lithium) can
characterized enhanceepisode
by distinct a phy
15982 Psychiatry Psychiatric/ Bipolar Disorder
Substance Induced more
Cocainerapidly.
intoxication can produce manic symptoms, i
15981 Psychiatry Psychiatric/ Mood Disorder
Substance Induced diaphoresis,
Evaluation ofmydriasis,
new-onsettachycardia,
mood symptoms hypertension)
requires ca th
15980 Psychiatry Psychiatric/ Mood Disorder depression, hypomania or mania,
Mania in adolescence may be confused with normal and psychosis.
15930 Psychiatry Psychiatric/ Bipolar Disorder decreased need for sleep, distractibility, excessive go
15929 Psychiatry Psychiatric/ Bipolar Disorder Patients with aofmanic
Core features a manicepisode
episode of bipolar
includeI disorder
elevated ma or
15928 Psychiatry Psychiatric/ Bipolar Disorder getting very little or no sleep.
Atypical features of major depressive disorder include
15925 Psychiatry Psychiatric/ Depression events).
Sleep disturbance is a core symptom of depression.
15924 Psychiatry Psychiatric/ Depression REM sleep duration
Depression and REMinfarction
after myocardial sleep density.
can increase t
15923 Psychiatry Psychiatric/ Antidepressants The selective serotonin reuptake inhibitor sertraline is
15904 Psychiatry Psychiatric/ Depression Major depressive disorder is frequently recurrent. Lon
15898 Psychiatry Psychiatric/ Depression Psychotherapy is the preferred treatment approach fo
15897 Psychiatry Psychiatric/ Suicide
Obsessive Compulsive 5-hydroxyindoleacetic
Treatment of obsessive-compulsiveacid (5-HIAA) disorderis a metabolite
consists o
Obsessive Compulsive reuptake inhibitors are first-line
Obsessive-compulsive disorder medications.
is characterized by in
Child And Adolescent to the obsessions. Patients
Post-traumatic stress disorder in childrentypically have may prominent
presen
15861 Psychiatry Psychiatric/ Mental Health memories.
Options for pharmacological management of an acutd
This is often accompanied by emotional
Attention Deficit often used to
In addition due to its rapid
inattention and onset of action and
hyperactivity, intram
patients w
15853 Psychiatry Psychiatric/ Hyperactivity Disorder ADHD
Language disorder becomes evident in the early deva
may be mistaken for willfully defiant behavior
15852 Psychiatry Psychiatric/ Language Disorder negatively impact later academic
The second-generation antipsychotics achievement.
quetiapine and
15849 Psychiatry Psychiatric/ Bipolar Disorder due to the risk of inducing mania.
15844 Psychiatry Psychiatric/ Bipolar Disorder Bipolar
Patientsdisorder
with > 1ismanic characterized
episode are by depressive
diagnosed with and m b
15843 Psychiatry Psychiatric/ Bipolar Disorder symptoms, often with grandiose themes.
Bipolar disorder is a highly recurrent illness. Maintena
Autism Spectrum maintained
High functioning in patients
autismwhose condition
in children may iscomestable
to and
atten
15827 Psychiatry Psychiatric/ Disorders
Child And Adolescent fixated
guilt/feelings of worthlessness; and suicidal ideation.e
interests, and unusual responses to sensory
15825 Psychiatry Psychiatric/ Mental Health behavior.
Diagnosing major depressive disorder in patients with
15824 Psychiatry Psychiatric/ Depression treatment. If these symptoms are associated with dep
15823 Psychiatry Psychiatric/ Antidepressants An antidepressant
Nonresponders to antrialadequate
is at leasttrial 4-6ofweeks at a ther
a selective ser
15822 Psychiatry Psychiatric/ Depression inhibitor
Major depressive disorder with psychotic features isa c
that does not cause sexual side effects, is
15814 Psychiatry Psychiatric/ Depression Treatment
Postpartuminvolves
depression combinedshouldantidepressant
be differentiated andfroman
15813 Psychiatry Psychiatric/ Depression depression
Adjustment is diagnosed
disorder usingsymptoms
involves the same occurring
diagnosticwit c
15812 Psychiatry Psychiatric/ Adjustment Disorders diagnostic criteria therapy
Electroconvulsive for another is amental
safe and disorder.
effective first
15811 Psychiatry Psychiatric/ Depression who refuse to eat and drink or
Major depressive disorder can be differentiated are acutely suicidal.
from
15810 Psychiatry Psychiatric/ Depression that do not decrease in severity
Patients with depression should be carefully assesse over time should rais
15809 Psychiatry Psychiatric/ Depression
Autism Spectrum plan and access to means are at increased risk and s
15801 Psychiatry Psychiatric/ Disorders Autism
Catatonia spectrum disorder is
is characterized bycharacterized
immobility, mutism, by deficitsneg
15791 Psychiatry Psychiatric/ Catatonia treated with benzodiazepines (e.g.
Creutzfeldt-Jakob disease presents with rapidly progr lorazepam).
15786 Psychiatry Psychiatric/ Prion Disease cerebrospinal fluid. Itreduced
Unresponsiveness, is untreatable and generally
respirations, shallow bre fata
15774 Psychiatry Psychiatric/ Opioids rule out opioid
Tourette syndrome intoxication due to possible
is characterized coingestan
by multiple moto
15763 Psychiatry Psychiatric/ Tourette Syndrome distraction and teasing in the school
Neurobehavioral manifestations of fetal alcohol syndr setting.
15753 Psychiatry Psychiatric/ Fetal
Anxiety Due To Another dysmorphism
Alcohol Syndrome Hyperthyroidism (short andpalpebral fissures, have
anxiety disorders thin upper
consider lip,
15166 Psychiatry Psychiatric/ Medical
SelectiveCondition
Serotonin in management
Prior to prescribing of patients
selectivewith new-onset
serotonin anxiety
reuptake an
inhib
15149 Psychiatry Psychiatric/ Reuptake Inhibitors dysfunction,
Gender dysphoria weightisgain) should beby
characterized discussed.
persistentPatiendistr
15147 Psychiatry Psychiatric/ Gender Dysphoria
Due To Another Medical development of unwanted secondary sexual characte
15145 Psychiatry Psychiatric/ Condition
Body Dysmorphic Multiple sclerosis is frequently associated with depres
Impulse Control Treatment
Intermittentofexplosive
body dysmorphic disorder is disorder consistsbyofrec
characterized se
15122 Psychiatry Psychiatric/ Disorders provocation.
A combination of psychosocial interventions and pha
15104 Psychiatry Psychiatric/ Alcohol Use Disorder
Wernicke-Korsakoff medication options. is a potential complication of We
Korsakoff syndrome
15102 Psychiatry Psychiatric/ Syndrome
Anxiety Due To Another confabulation,
Pheochromocytoma lack ofisinsight,an adrenal and apathy.
tumor that Korsakoff
presents
15101 Psychiatry Psychiatric/ Medical Condition attacks.
In patientsGiven
withthe liverrisks associated
disease, with a missed me
the benzodiazepines lo
15099 Psychiatry Psychiatric/ Alcohol Withdrawal longer half-lives and active metabolites,
A mild rash may develop in up to 10% of those treate such as chlo
15098 Psychiatry Psychiatric/ Bipolar Disorder occurrence
Caffeine is aofstimulant
rash during that,thewhentreatment
used inofexcessive
lamotrigina
15096 Psychiatry Psychiatric/ Stimulants typically contain
First-line treatment large amounts
options of caffeine
for major and should
depressive diso
15095 Psychiatry Psychiatric/ Depression interpersonal psychotherapy
Dermatological complicationshave the bestnervosa
of anorexia evidence (A
15089 Psychiatry Psychiatric/ Anorexia Nervosa Most medical complications of AN
Major depressive disorder with psychotic features is a (e.g. hair loss) imp
Selective Serotonin antidepressant
Activating effects plus (e.g.an anxiety,
antipsychotic or electroconvu
insomnia) are possibl
15087 Psychiatry Psychiatric/ Reuptake Inhibitors more
Persistent complex bereavement disorder isand
sensitive to activating adverse effects may
characte
15085 Psychiatry Psychiatric/ Depression and behaviors.dysphoric
Premenstrual Psychotherapy disorder is is
thecharacterized
treatment of by cho
15084 Psychiatry Psychiatric/ Premenstrual Syndrome premenstrual mood symptoms represent an exacerba
15083 Psychiatry Psychiatric/ Antidepressants Venlafaxine
Approximately is a25% serotonin-norepinephrine
of patients treated withreuptake lithium wiin
15082 Psychiatry Psychiatric/ Lithium
Dissociative Identity hypothyroidism
Dissociative identity is generally
disordertreated with T4 suppleme
is characterized by swit
15078 Psychiatry Psychiatric/ Disorder important
Major depressive disorder with seasonal patternassoc
personal information. The disorder is (sea
15074 Psychiatry Psychiatric/ Depression remission). Treatment consists of
Bipolar II disorder is characterized by hypomanic and bright light therapy
15073 Psychiatry Psychiatric/ Bipolar Disorder features,
Borderlineand no need disorder
personality for hospitalization.
is characterizedFunctioning
by m
15072 Psychiatry Psychiatric/ Personality Disorders related paranoia and dissociation may be mistaken fo
15071 Psychiatry Psychiatric/ Personality
GeneralizedDisorders
Anxiety Dialectical
Generalized behavioral
anxiety disorder therapyisischaracterized
the treatment by of mult
cho
15065 Psychiatry Psychiatric/ Disorder disturbance.
Adjustment disorder is characterized by the developm
15064 Psychiatry Psychiatric/ Adjustment Disorders not Major meet the criteria
depressive for another
disorder is often mental disorder.
a recurrent illness.
15056 Psychiatry Psychiatric/ Depression for lifelong antidepressant treatment.
All patients who have a major depressive episode sh
15055 Psychiatry Psychiatric/ Antidepressants prescribed antidepressants due to the risk of antidep
Physician Patient All
Dhat antidepressants
syndrome is a are associated syndrome
culture-bound with a riskof ofSouth
induc
15042 Psychiatry Psychiatric/ Communication syndromes,
Schizophrenia it isisimportant
characterized to take by adelusions,
patient-centered
hallucin
15035 Psychiatry Psychiatric/ Psychosis disorders with psychotic features,
Substance-induced psychosis should be considered other primary psyc
Dementia With Levy onset psychosisdysfunction.
and autonomic includes obtaining a urine toxicology
If DLB-associated psych
14991 Psychiatry Psychiatric/ Bodies
Frontotemporal undertaken.
Behavioral-variant frontotemporal dementia presents
14990 Psychiatry Psychiatric/ Dementia disease,
Binge eating memory disorderimpairment is normally
is characterized by mild early of
episodes in
14982 Psychiatry Psychiatric/ Bulimia Nervosa recurrent,
Self-induced unhealthy
vomitingcompensatory
in bulimia nervosa behaviors
results (e.g. se
in de
14981 Psychiatry Psychiatric/ Bulimia Nervosa Symptoms may occur
Selective serotonin as a result
reuptake of volume
inhibitors contractio
and serotonin-
14970 Psychiatry Psychiatric/ Panic Disorder require immediate relief and should be avoided in tho
14968 Psychiatry Psychiatric/ Brief Psychotic
Prescription DrugDisorder Standard
Brief psychoticurine disorder
drug screens involvestest the
for presence
opioid useofby> m 1
14738 Psychiatry Psychiatric/ Misuse
Attention Deficit hydrocodone, hydromorphone, oxycodone)
Stimulant medication is a first-line treatment for most and synth
14348 Psychiatry Psychiatric/ Hyperactivity Disorder
Prescription Drug the
Therisks
mostoffrequently
drug misuse usedand addiction.
standard urine drug screen
13573 Psychiatry Psychiatric/ Misuse
Prescription Drug phencyclidine result. Most
Risk factors for prescription opioid misuse UDS detect natural opioids
include ag
13547 Psychiatry Psychiatric/ Misuse drug-monitoring
Pediatric depression can present with symptoms ofscir
program data, random urine drug
Child And Adolescent choice.
Suicide-risk assessment in adolescents should includ
12547 Psychiatry Psychiatric/ Mental Health promised
Fluoxetinebecauseis first-line it cannot be maintained
pharmacotherapy for ifbulimia
the patie ne
12542 Psychiatry Psychiatric/ Bulimia Nervosa rehabilitation.
Naltrexone is a first-line pharmacotherapy for alcohol
12541 Psychiatry Psychiatric/ Alcohol Use Disorder who
Majorare still drinking.
depressive disorder with psychotic features is a
Substance-Induced and/or
Over-the-counter cold typically
hallucinations, and cough withmedications
depressive often themec
12484 Psychiatry Psychiatric/ Psychotic
SeparationDisorder
Anxiety cautiously in youngon
Transient distress children, with recommended
initial separation from majordose att
12483 Psychiatry Psychiatric/ Disorder Children with persistent anxiety and
Factitious disorder involves the intentional falsification distress at separ
12482 Psychiatry Psychiatric/ Factitious Disorder physical examination,
Benzodiazepine overdose and can
laboratory results.
result in altered menta
12481 Psychiatry Psychiatric/ Benzodiazepines
Acute Intermittent sedative-hypnotics/central
Acute intermittent porphyrianervous should system depressa
be suspected in p
12469 Psychiatry Psychiatric/ Porphyria
Drug Induced Liver a family history of similar episodes. Elevated urine po
12468 Psychiatry Psychiatric/ Injury The anticonvulsant
Abrupt discontinuation mood of astabilizer valproatecan
benzodiazepine canresul
cau
12466 Psychiatry Psychiatric/ Benzodiazepines patients
Patients with unhealthy alcohol use are frequently seb
with anxiety disorders, mild withdrawal may
12432 Psychiatry Psychiatric/ Alcohol Use Disorder Findings
Concurrent of increased
use of thiazide liver enzymes
diuretics -and macrocytosi
as well as ACE
12431 Psychiatry Psychiatric/ Lithium lead to symptoms of lithium toxicity,
Well-balanced vegetarian diets can meet the nutrition including gastroi
12430 Psychiatry Psychiatric/ Anorexia Nervosa be
It isevaluated
a physician's for eating
duty todisorders.
use clinical judgment when
Generalized Anxiety harm
Generalized anxiety disorder is must
remains high, the patient be hospitalized
characterized by exce (
Substance Induced physical
Althoughsymptoms
physical symptoms related to are muscular
typicallytension.
minor, coca
12384 Psychiatry Psychiatric/ Mood
Due To Another Medical Diagnosis of primary mood disorders (e.g. intense
Disorder hyperphagia, impaired concentration, and major dep dru
12383 Psychiatry Psychiatric/ Condition symptoms
Cocaine use that overlapcan
disorder with depression
present (e.g. lowirritab
with anxiety, moo
12380 Psychiatry Psychiatric/ Cocaine system
Patientsactivation
with bipolar candisorder
help differentiate
may exhibit cocaine-induc
distractibilit
12369 Psychiatry Psychiatric/ Bipolar Disorder course and prominent mood symptoms
Learning disorders present in school-age children are more cha as
12304 Psychiatry Psychiatric/ Learning Disorders characterized by an inability to
The addition of nonsteroidal anti-inflammatory drugsdecode words, resultin
12287 Psychiatry Psychiatric/ Lithium symptoms of toxicity, including gastrointestinal sympt
12275 Psychiatry Psychiatric/ Depression Major depressive disorder is associated with hyperac
Post-Traumatic Stress The initial approach to patients with acute stress diso
12270 Psychiatry Psychiatric/ Disorder patients with severe
Gender dysphoria is and persistent
diagnosed when symptoms.
a persistent, in
12253 Psychiatry Psychiatric/ Gender Dysphoria support, assessing the patient's
Rapid eye movement (REM) sleep behavior safety, and offering
disordere
12208 Psychiatry Psychiatric/ REM Behavior
Attention DeficitDisorder and recall their dreams. In older patients, these beha
12207 Psychiatry Psychiatric/ Hyperactivity Disorder Behavioral
In the primary therapy
care is the preferred
setting, patientsinitial treatment foo
with depression
12205 Psychiatry Psychiatric/ Suicide screened
receptors.for TDsuicidal ideation. by abnormal involunta
is characterized
12204 Psychiatry Psychiatric/ Tardive Dyskinesia reduction
Neuroleptic or malignant
discontinuation. syndrome (NMS) is characteriz
12203 Psychiatry Psychiatric/ Antipsychotics cell count may also
Normal, age-related sleep be elevated.
changes Dopamine antagonis
include decrease
12195 Psychiatry Psychiatric/ Aging daytime
Cyclothymicsomnolence
disorder (napping).
is a chronic mood disturbance c
12191 Psychiatry Psychiatric/ Bipolar Disorder depressive or hypomanic/manic
condition begins several days postpartum episodes. and typica
Post-Traumatic Stress postpartum
Trauma-focused depression.
cognitive-behavioral psychotherapy
Post-Traumatic Stress traumatic stress disorder.
Acute stress disorder is a severe anxiety response ch
12185 Psychiatry Psychiatric/ Disorder after exposure
Psychosis to a traumatic
is common event.disease, occurring
in Parkinson
12152 Psychiatry Psychiatric/ Parkinson Disease be treated
Specific with antiparkinson
phobia is a common anxiety medication dosecharac
disorder reduct
12147 Psychiatry Psychiatric/ Specific Phobia behavioral therapy is the treatment
Switching antidepressants to or from a monoamine o of choice.
12146 Psychiatry Psychiatric/ Serotonin Syndrome antidepressants
Catatonia is a syndrometo an MAOI seen requires
in severe a 2-week washa
psychiatric
12145 Psychiatry Psychiatric/ Catatonia
Substance Use treatments of choice.
Chronic methamphetamine use can cause psychotic
12140 Psychiatry Psychiatric/ Disorders signs include marked weight loss, severe tooth decay
12003 Psychiatry Psychiatric/ Narcolepsy Narcolepsy is characterized
Nightmare disorder involves by excessive
recurrent daytime sle
awakenings fro
12002 Psychiatry Psychiatric/ Nightmare
To AnotherDisorder
Medical characterized by partial arousals, unresponsiveness,
The sudden onset of psychosis in a child or adolesce
11967 Psychiatry Psychiatric/ Condition
Physician Patient medical
Poststroke conditions
depression to rule out include
is common, systemic lupus
underdiagnosed,
11959 Psychiatry Psychiatric/ Communication inhibitor
Compared antidepressants.
with first-generation antipsychotics, secon
11958 Psychiatry Psychiatric/ Schizophrenia
Selective Serotonin Clozapine and olanzapine
Abrupt discontinuation carrytaper
or rapid a high of risk
shortof half-life
metabo
11957 Psychiatry Psychiatric/ Reuptake Inhibitors antidepressant.
have become much more common than HIV-associa
11954 Psychiatry Psychiatric/ Alzheimer
SeparationDisease
Anxiety untreated
SeparationHIV-infected
anxiety disorder patients.
is most commonly seen i
Physician Patient of separation from a loved one
Effective brief interventions for alcohol and mayabuse present as s
require
11936 Psychiatry Psychiatric/ Communication acknowledge
effects the problem,
and a favorable the physician's
side-effect profile (noroleweight
is to ing
11935 Psychiatry Psychiatric/ Depression of sexual
Opioid side effects.
withdrawal is characterized by myalgias, gastr
11933 Psychiatry Psychiatric/ Opioids
Oppositional Defiant is uncommon.defiant disorder is characterized by a pe
Oppositional
11921 Psychiatry Psychiatric/ Disorder basic rights of others
Delirium-induced seen inisconduct
psychosis disorder.
differentiated from prim
11905 Psychiatry Psychiatric/ Delirium offending medications.
Serotonin and norepinephrine reuptake inhibitors (e.g
11903 Psychiatry Psychiatric/ Antidepressants painful
Akathisiadiabetic
shouldneuropathy.
be considered if a patient becomes
Neuroleptic Malignant changing to an antipsychotic
Neuroleptic malignant syndrome withisless potential to ca
a life-threatening
11897 Psychiatry Psychiatric/ Syndrome elevated creatine
Patients with panickinase,
disorder andmayleukocytosis.
be misdiagnosed wi
11894 Psychiatry Psychiatric/ Panic Disorder
Attention Deficit recurrent abrupt onset of characteristic physical symp
11887 Psychiatry Psychiatric/ Hyperactivity Disorder
Autism Spectrum Stimulants are first-line
Early intervention for autismtreatment
spectrumfor attention
disorderdeficit
(ASD
11886 Psychiatry Psychiatric/ Disorders thorough screening and evaluation
Second-generation antipsychotics (e.g. quetiapine, lushould be underta
11884 Psychiatry Psychiatric/ Bipolar Disorder bipolar I disorder.
Postpartum psychosis is a medical emergency chara
11876 Psychiatry Psychiatric/ Postpartum Psychosis
Attention Deficit risk for suicide/infanticide, most patients require hosp
11857 Psychiatry Psychiatric/ Hyperactivity
Substance Use Disorder Stimulant medications (methylphenidate, amphetamin
MDMA (3,4-methylenedioxy-methamphetamine) is a
11853 Psychiatry Psychiatric/ Disorders Intoxication may lead to hypertension,
Electroconvulsive therapy is an evidence-based treat tachycardia, h
11827 Psychiatry Psychiatric/ Depression features and appropriate for severely depressed elde
Post-Traumatic Stress Patients with post-traumatic stress disorder (PTSD) c
Substance Use symptoms,
Inhalant abuse and usually
increased occursstartle response
in boys are clues
age 14-17 and
Substance-Induced Inhalant intoxication is characterized
Medication-induced psychotic disorder is characterize by a rapid onse
11790 Psychiatry Psychiatric/ Psychotic Disorder Glucocorticoids,
Medications that particularly
block the dopamineat high doses, are often(e
(D2) receptor
10780 Psychiatry Psychiatric/ Antipsychotics tardive dyskinesia. Drug-induced parkinsonism typica
Physician Patient A
Theteenager
loss of a with active
fetus is a suicidal
traumatic ideation
experiencemust forbe pare
hosp
10753 Psychiatry Psychiatric/ Communication stay in the room
Physicians and tend
are ethically to emotions
obligated that arise
to protect witho
patient co
10162 Psychiatry Psychiatric/ Patient
PhysicianConfidentiality
Patient without the patient's consent.
Help-rejecting patients who are hopeless about treatm
10065 Psychiatry Psychiatric/ Communication
Homicide And Other expression
Access to firearmsof empathy is the and a collaborative
greatest approachh
risk in completing
9841 Psychiatry Psychiatric/ Violence adolescents
Cognitive-behavioralshould be advised
therapy to limiton
focuses access to firea
reducing au
8938 Psychiatry Psychiatric/ Depression medication for a wide range of psychiatric disorders.
8915 Psychiatry Psychiatric/ Sexual Abuse Patients
Patients who experiencemood
with underlying sexualdisorders
assaultsfrequently
are at highco
8913 Psychiatry Psychiatric/ Depression about mood
Social anxiety and ability (SAD)
disorder to enjoy is usual activities.by a fe
characterized
8909 Psychiatry Psychiatric/ Social Anxiety Disorder related situations. SAD should be differentiated from
8875 Psychiatry Psychiatric/ Hoarding Disorder Hoarding
When major disorder is characterized
depression fails to respondby difficulty discars
to an initial
8841 Psychiatry Psychiatric/ Depression different SSRI, a serotonin-norepinephrine reuptake i
7957 Psychiatry Psychiatric/ Schizophrenia Clozapine
Patients with is the medication
factitious disorder of choice for treatment-re
intentionally produce
7728 Psychiatry Psychiatric/ Factitious Disorder which sickness is feigned for an external incentive.
Child And Adolescent Medically
The slightly ill increased
patients who riskdevelop comorbid depressio
of antidepressant-related s
7289 Psychiatry Psychiatric/ Mental Health risk of completed suicide in depression.
Panic disorder is characterized by recurrent, unexpec Patients shou
6978 Psychiatry Psychiatric/ Panic Disorder agoraphobia, which is the avoidance of > 2 situations
6931 Psychiatry Psychiatric/ Bipolar Disorder Lithium, valproate, quetiapine, and lamotrigine are fir
4905 Psychiatry Psychiatric/ Specific Phobia Specific
Delusional phobia is characterized
disorder involves oneby or marked fear of aa
more delusions
Physician Patient function.
Acutely psychotic patients with no insight are unable
4896 Psychiatry Psychiatric/ Communication and distress without
Antipsychotic endorsing
medications specific
are the delusions
first-line treatment or h
4895 Psychiatry Psychiatric/ Schizophrenia established on oral medications.
Neuroleptic malignant syndrome Clozapine should
is a potentially be
life-th
4887 Psychiatry Psychiatric/ Antipsychotics rigidity, altered may
Antipsychotics mental causestatus, and autonomic
drug-induced instabil
parkinsonism
4886 Psychiatry Psychiatric/ Antipsychotics amantadine, or switching
Second-generation to another
antipsychotics antipsychotic
cause metabolicwit s
4885 Psychiatry Psychiatric/ Antipsychotics effects is recommended
Bupropion is an antidepressant in patientswithtaking second-ge
mild stimulant pr
4884 Psychiatry Psychiatric/ Depression gain. It can also be used to aid smoking
Patients with situationally triggered depressive sympt cessation.
4883 Psychiatry Psychiatric/ Adjustment Disorders and
Majorabsence
depressive of marked
disorder distress
can beordiagnosed
significantiffunctio
depre
Monoamine Oxidase depression is associated with more persistent and pe
4879 Psychiatry Psychiatric/ Inhibitors
Physician Patient Patients
Patients taking
may bemonoamine
reluctant tooxidasediscuss inhibitors
sensitive such
issues a
4878 Psychiatry Psychiatric/ Communication physicians
Patients who alone.
are an acute threat to themselves shou
4877 Psychiatry Psychiatric/ Suicide parental or guardian
Sleep terrors are a common consent.and usually benign para
4869 Psychiatry Psychiatric/ Parasomnias event. The diagnosis
Antipsychotic medicationsis made clinically.
exert Parents
their effects shou
through
4848 Psychiatry Psychiatric/ Antipsychotics and infertility.
Persistent The second-generation
depressive antipsychotic
disorder is characterized by chri
4816 Psychiatry Psychiatric/ Dysthymia can improve symptomspersonality
Obsessive-compulsive and qualitydisorder
of life. involves a
4815 Psychiatry Psychiatric/ Personality Disorders compulsive
Cognitive deficits disorderthatbyinterfere
the lackwith of clear obsessionsina
independence
4675 Psychiatry Psychiatric/ Alzheimer Disease Patients with dementia have functional impairments t
4674 Psychiatry Psychiatric/ Aging Normal age-related cognitive
Anabolic-androgenic steroids changes
are used include
to improveoccasiph
4670 Psychiatry Psychiatric/ Androgenic Steroids dysfunction, altered lipid profiles, virilization, testicula
Neuroleptic malignant syndrome (NMS) typically pres
4522 Psychiatry Psychiatric/ Antipsychotics critical intervention.
Panic disorder involves recurrent unexpected panic a
4285 Psychiatry Psychiatric/ Panic Disorder include triggered
Patients with cannabis panic intoxication
attacks and typically
ruling out medicaw
present
4215 Psychiatry Psychiatric/ Cannabis occur, especially
Delusional disorder at higher doses. by at least 1 pers
is characterized
4195 Psychiatry Psychiatric/ Delusional
GeneralizedDisorder
Anxiety markedly
Serotonin impaired.
reuptake inhibitors and serotonin-norepine
4141 Psychiatry Psychiatric/ Disorder major depression.
Antipsychotic medication Benzodiazepines
nonadherence shouldis abe reserv
common
Obsessive Compulsive who have responded to oral antipsychotics but relaps
4063 Psychiatry Psychiatric/ Disorder Serotonergic
Schizoaffective antidepressants
disorder is diagnosed(e.g. selective
when major serotoni
de
4055 Psychiatry Psychiatric/ Schizoaffective Disorder absence of mood symptoms.
Persistent depressive disorder (dysthymia) refers to a
4051 Psychiatry Psychiatric/ Dysthymia major depressive episodes.
4046 Psychiatry Psychiatric/ Antipsychotics Weight
Patientsgain,
with dyslipidemia,
cancer may have and hyperglycemia
somatic symptoms are coth
4045 Psychiatry Psychiatric/ Depression such as persistent sadness, guilt, loss of
Bipolar I disorder is a highly recurrent illness that req interest, and
4043 Psychiatry Psychiatric/ Bipolar Disorder should be continued unless significant side effects or
4041 Psychiatry Psychiatric/ Cocaine
Generalized Anxiety Cocaine abuse
Generalized should
anxiety be suspected
disorder in an individual
is characterized by exce
3995 Psychiatry Psychiatric/ Disorder poor
Family psychosocial interventions are indicatedand
concentration, irritability, muscle tension, for im
pa
3844 Psychiatry Psychiatric/ Schizophrenia the home decreases the risk of relapse
Patients with a single episode of major depressive dis in patients wi
3843 Psychiatry Psychiatric/ Depression with recurrent, chronic,
pharmacological treatment or severe episodes
is a selective should be
serotonin re
3839 Psychiatry Psychiatric/ Social Anxiety Disorder nonpharmacological treatment.
Displacement is an immature defense mechanism in
3806 Psychiatry Psychiatric/ Defense Mechanisms situation.
3798 Psychiatry Psychiatric/ Defense Mechanisms Reaction formation is a defense mechanism that invo
3794 Psychiatry Psychiatric/ Schizophrenia Indications for psychiatric hospitalization include bein
3762 Psychiatry Psychiatric/ Benzodiazepines Abrupt cessation is
Active suicidality of associated
alprazolam,with a short-acting
intent and plan benzofo
Body Dysmorphic (involuntarily, if necessary).
procedures. The initial approach should focus on the
Somatic Symptom be educated
Patients with about
somatic BDD and treatment
symptom disorderfor it withfrom
benefit cog
3750 Psychiatry Psychiatric/ Disorder subspecialty referrals.
Conversion disorder is characterized by the sudden o
3719 Psychiatry Psychiatric/ Conversion Disorder disorder is often precipitated by stress.
3702 Psychiatry Psychiatric/ Antidepressants Bupropion
Patients is associated
with psychiatric with an increased
diagnoses can give risk of seiz
informed
3638 Psychiatry Psychiatric/ Informed Consent time of treatment.
3536 Psychiatry Psychiatric/ Defense Mechanisms Physicians
Intellectualization
shouldisexplore
the transformation
nonadherence of aindistressin
an empa
3535 Psychiatry Psychiatric/ Treatment Adherence
Impulse Control facilitate development of a united plan.
Gambling disorder is characterized by persistent and
Impulse Control relationships are common consequences.
3385 Psychiatry Psychiatric/ Disorders Kleptomania is an impulse
Adjustment disorder involves control disorder
symptoms character
causing mar
3382 Psychiatry Psychiatric/ Adjustment Disorders for another specific disorder (e.g. major depressive d
3378 Psychiatry Psychiatric/ Schizophrenia Enlargement
The diagnosisofofthe lateral cerebral
schizoaffective ventricles
disorder is theasm
requires
3376 Psychiatry Psychiatric/ Schizoaffective Disorder absence of a mood episode. Schizoaffective disorder
3372 Psychiatry Psychiatric/ Dissociative Amnesia Dissociative
Phencyclidine amnesia
intoxication involves isolated
presents withimpairment
severe agita in
3191 Psychiatry Psychiatric/ Phencyclidine disorientation. Agitation and
Amphetamine intoxication canaggression
present with are psychiatr
managed
3190 Psychiatry Psychiatric/ Stimulants diaphoresis,
Heroin withdrawaland mydriasis.
should be suspected in patients wi
3189 Psychiatry Psychiatric/ Opioids often severe but generally
Patients with a history of alcohol not life-threatening.
use who develop tre
3187 Psychiatry Psychiatric/ Alcohol Withdrawal Lorazepam, an intermediate-duration
Avoidant personality disorder is characterized benzodiazepine
by a pe
3147 Psychiatry Psychiatric/ Personality Disorders adulthood.
Individuals with schizoid personality disorder are soci
3146 Psychiatry Psychiatric/ Personality Disorders relationships but avoid them due to fears of rejection.
3145 Psychiatry Psychiatric/ Personality Disorders Dependent personality disorder is characterized by e
3144 Psychiatry Psychiatric/ Personality Disorders Narcissistic
Schizotypal personality
personality disorder
disorder is is characterized
characterized by by aa
3143 Psychiatry Psychiatric/ Personality Disorders magical
Signs of thinking,
self-induced unusualvomitingthoughts,
include and perceptual
parotid glanddh
3140 Psychiatry Psychiatric/ Anorexia
Tricyclic Nervosa of
and anorexia
dry skin,nervosa
intestinal can be differentiated
ileus). QRS duration from> 100bulimi
ms
3126 Psychiatry Psychiatric/ Antidepressants bicarbonate.
Patients who have decision-making capacity have the
2665 Psychiatry Psychiatric/ Patient Autonomy refuses, services
Phencyclidine is ashould be offered
dissociative if the patient
anesthetic reco
that charac
2653 Psychiatry Psychiatric/ Phencyclidine hyperthermia.
Malingering is the intentional production or exaggerat
2522 Psychiatry Psychiatric/ Malingering
Somatic Symptom examined or treated
Somatic symptom and there
disorder is a discrepancy
involves excessive preocc betw
2521 Psychiatry Psychiatric/ Disorder utilization.
Borderline personality disorder is characterized by a
2520 Psychiatry Psychiatric/ Personality Disorders psychotherapy
Tardive dyskinesia withoccurs
a behavioral focus (e.g.exposure
after prolonged dialecticat
2518 Psychiatry Psychiatric/ Tardive Dyskinesia When antipsychotic dose reduction or discontinuation
2517 Psychiatry Psychiatric/ Suicide The greatest
Bipolar risk factor
I disorder includes for manic
suicideepisode(s)
is a historywith of suic
or w
2510 Psychiatry Psychiatric/ Bipolar Disorder functional impairment,
Schizophreniform disorderno psychotic symptoms)
is differentiated from andschiza
2508 Psychiatry Psychiatric/ Psychosis diagnosis of schizophrenia requires
Clozapine is indicated for the treatment of psychotic p symptoms to per
2507 Psychiatry Psychiatric/ Antipsychotics
Obsessive Compulsive the risk oftreatments
First-line neutropenia forand agranulocytosis. disord
obsessive-compulsive
2506 Psychiatry Psychiatric/ Disorder inhibitors.
Acute dystonia is a type of extrapyramidal symptom a
2505 Psychiatry Psychiatric/ Antipsychotics treated with anticholinergics
Methylphenidate is a central (benztropine)
nervous system or antihista
stimulan
2504 Psychiatry Psychiatric/ Stimulants appetite, weight loss, and insomnia.
reuptake inhibitor bupropion is an activating antidepre
2503 Psychiatry Psychiatric/ Depression gain, hypersomnia,
Performance anxietyorissexual dysfunction.
classified as performance-on
2502 Psychiatry Psychiatric/ Social Anxiety Disorder
Neuroleptic Malignant Neuroleptic malignant syndrome isaapersonal
should be avoided in patients with or fami
rare but potentia
2501 Psychiatry Psychiatric/ Syndrome of the antipsychotic antipsychotics
Second-generation and intensive supportive
(SGAs) arecare can
seroto
2499 Psychiatry Psychiatric/ Antipsychotics likelihood
Antipsychoticof extrapyramidal
medications can adverse
causeeffects.
hyperprolactine
2497 Psychiatry Psychiatric/ Hyperprolactinemia antipsychotics, prolactinomas are
Benzodiazepines provide rapid relief of anxiety capable of produci
and a
2496 Psychiatry Psychiatric/ Panic Disorder cognitive-behavioral therapy are preferred
Bipolar disorder is a highly recurrent illness that requ for long-te
2495 Psychiatry Psychiatric/ Bipolar Disorder a second-generation
Adequate duration of antipsychotic
an antidepressant is used trialasisfirst-line
gener
2494 Psychiatry Psychiatric/ Depression considering
Conduct the next
disorder step in treatment.
is characterized by a repetitive patt
2482 Psychiatry Psychiatric/ Conduct Disorder repercussions,
symptoms that and
occur initiating
in the week physicalpriorfights with other
to menses and
2419 Psychiatry Psychiatric/ Premenstrual Syndrome menstrual cycle phase.
2387 Psychiatry Psychiatric/ Smoking Cessation Nicotine replacement
All depressed patientstherapy,
should be varenicline,
screened and bupro
for suicida
2360 Psychiatry Psychiatric/ Depression maintain
Antisocialtheir safety. disorder involves a pervasive p
personality
2358 Psychiatry Psychiatric/ Personality Disorders disorder
Lithium and symptoms
valproate before age 15. options for bipolar
are first-line
2357 Psychiatry Psychiatric/ Bipolar Disorder renal
Lithium dysfunction
is indicated duebothto the risktreatment
for the of systemic of toxicity
acute ma
2356 Psychiatry Psychiatric/ Hypercalcemia nephrogenic
Managementdiabetes of patients insipidus,
who arechronic
agitated kidney
and havediseaa
2355 Psychiatry Psychiatric/ Bipolar Disorder Patients experiencing severe mania often require a c
2354 Psychiatry Psychiatric/ Bulimia Nervosa Bulimia nervosa involves recurrent binge eating and c
2353 Psychiatry Psychiatric/ Anorexia Nervosa Indications for hospitalization
Bereaved patients who develop in patients
moderate with anorexim
to severe
2351 Psychiatry Psychiatric/ Depression for patients
Alcoholic with marked
hallucinosis is aninsomnia
alcoholand weight loss
withdrawal syndrodu
2349 Psychiatry Psychiatric/ Alcohol Withdrawal tends to present
The informed in patients
consent process whoforare fully oriented
procedures and
or trea
19054 Psychiatry Social ScienInformed Consent for a nonemergency
Manifestations surgical
of physical procedure
abuse or treatment
in the elderly may in
13465 Psychiatry Social ScienElder Abuse & Neglect
Assisted Suicide And financial exploitation, psychological
The initial response to a request for physician-assisteabuse, sexual ab
11922 Psychiatry Social ScienEuthanasia provider can optimize palliative care interventions to a
Decisions about whether to accept gifts from patients
7504 Psychiatry Social ScienProfessional Conduct experiencing a mood episode potentially affecting the
3742 Psychiatry Social ScienPatient Confidentiality
Physician Patient Under the Health Insurance Portability and Accounta
2642 Psychiatry Social ScienCommunication Delivering bad news is optimally done in a face-to fac
haloperidol) can cause QT-interval prolongation; therefore, an ECG should be obtained prior to administering these agents to
e
entspointes).
with clinical manifestations of deficiency of mineralocorticoids (eg. dietary salt craving), glucocorticoids (e.g. fatigue, depre
l characteristics in women). ejaculation and decreased ejaculatory latency. Most patients respond to selective serotonin reupt
characterized by uncontrolled
nts may also benefit from
an immune-mediated local anesthetics
inflammatory and/or psychotherapy
demyelinating to address
disease that typically concurrent
presents in young anxiety,
womenmood
with disorders,
episodes ofand
CNSrelational
dysfun
elinating plaques disseminated in time and space can help confirm the diagnosis.
tremors often present abruptly with significant disability. They often decrease with distraction, have changeable or inconsistent
mes.
ements, memory recall of the event, and lack of postictal confusion. The gold standard for diagnosis of PNES is video-electroen
ntia (PDD)activity.
eptiform is characterized by executive and visuospatial dysfunction with relatively mild memory impairment at first. PDD may b
erprolactinemia byonset:
ming of symptom If parkinsonism
blocking predates
dopamine activity cognitive
in the impairmentpathway.
tuberoinfundibular by > 1 year, PDDeffects
Clinical shouldofbehyperprolactinemia
diagnosed. include a
lcohol
dysfunction.
and drugs that cause drowsiness. When medications are needed to decrease daytime somnolence, wakefulness-promot
be used in
y occur with extreme
children agecaution in the
4-10 and areelderly due to increased
characterized risk of episodes
by < 20-second cognitive of
impairment, falls, and paradoxical
impaired concentration agitation.
(e.g. pause, blank stare)
g, lip smacking)
ommonly seen inare common, New-onset
depression. and ethosuximide
insomniais in
theelderly
first-line treatment.
patients who have associated symptoms of depression should rais
es is characterized by fluctuating cognitive impairment, recurrent visual hallucinations, REM sleep behavior disorder, and parkin
antagonists)
ecipitated is a supportive
by medications thatclinical
increasefeature.
serotonergic activity in the CNS, which results in altered mental status, autonomic instab
scle contraction and autonomic dysfunction
essed for depression at their postpartum follow-up can lead to rhabdomyolysis,
visits. Treatment options acute kidney injury,
for postpartum and disseminated
depression intravascular co
include psychotherapy a
ake inhibitors are used as first-line therapy.
dence of serious medical illness. The distressing and real nature of the symptoms should be acknowledged first, followed by a
raracterized
and contributing
by the psychologic
acute onset factors.
(within hours) of altered mental status, neuromuscular excitability, and autonomic dysregulation.
g all serotonergic medications.
ooling, and blood pressure control. Benzodiazepines are used to decrease agitation and muscle contractions. Cyproheptadine i
acterized by intentional falsification of illness in the absence of external reward. Patients appear to be motivated by internal fac
dation.
order Patients
may with factitious
not develop immediately disorder may a
following have hypoglycemia
trauma due toas
and is specified the surreptitious
‘with intake of sulfonylureas
delayed expression’. or insulin.
Trauma-focused cognitive-
ants are first-line treatments.
events may be experienced as traumatic and result in post-traumatic stress disorder. Trauma-focused cognitive-behavioral thera
f stimulant intoxication involves controlling agitation and reducing sympathetic hyperactivity with benzodiazepines, medications
racterized by multiple motor tics and at least one vocal tic. Treatment options include habit reversal training and pharmacothera
adrenergic
is commonreceptor
and mayagonists.
present with social isolation and cognitive decline. Careful history-taking and a whispered voice test shou
he
ory of Alzheimer diseasemanagement.
diagnosis and direct are at increased risk of developing the disease but can mitigate risk by addressing modifiable risk fact
sion(e.g.
is ahypertension,
normal part of diabetes,
child andobesity/physical inactivity), especially
adolescent development. in mid-life,
Nonconformity can help
with typical reduce
gender risk.should be differentiated from
norms
ssigned gender.
be
r isconsidered
characterized in patients with psychomotor
by preoccupation agitation
with slight and signs
to nonexistent of sympathetic
appearance flawshyperactivity. Benzodiazepines
and related repetitive behaviorsare theas
such treatmen
checkin
ed defect. Accurate diagnosis is critical to prevent patients from pursuing inappropriate cosmetic or surgical
egins in childhood or early adolescence. Perioral dermatitis involving the nasolabial folds is characteristic. Presenting features i treatments.
eurological
characterized dysfunction.
by the acuteChroniconsetuseofcan result in
psychotic long-term(e.g.
symptoms neurocognitive
disorganized impairment.
speech and behavior, delusions, hallucinations) las
arked stressor such as the loss of a loved one.
sorder is characterized by a need to be taken care of, leading to submissive and clingy behavior with a fear of separation. Indivi
he context
sorder of a breakup by
is characterized or odd
loss,beliefs/magical
with an urgent thinking,
need to seek out another
eccentric relationship.
behavior, and a reduced capacity for intimacy. Paranoid ideat
usions and hallucinations are absent.
order experience at least 1 episode of hypomania and > 1 major depressive episodes. First-line treatment of bipolar depressive
and quetiapine.
haracterized by repeated episodes of excessive eating accompanied by a loss of control and subsequent distress. The most ef
er particular foodsselective
n options include serotonin
or food groups, reuptake
which inhibitors
is consistent with(e.g. sertraline),
normal lisdexamfetamine,
development. and topiramate.
However, when picky eating is accompanied b
ental delays, further evaluation is indicated.
rder presents with attention seeking, inappropriately provocative behavior, and dramatic emotions and actions. These behavior
tipleiscontexts.
rder characterized by a long-standing pattern of suspicion and mistrust of others' intentions. In the physician-patient relations
reating a therapeutic
and new-onset diabetes alliance.
mellitus may occur as early manifestations of pancreatic cancer. CT of the abdomen is indicated as pa
n Parkinson disease as a result of the underlying disease process, treatment with anti-Parkinson medications (e.g. levodopa, pr
d with anti-Parkinson
e-behavioral therapy ismedications
the first-linewho develop
treatment of psychotic symptoms,
post-traumatic stress dose reduction
disorder. shouldcognitive
It combines be considered.
therapy and exposure tech
ecrease avoidance behaviors.
e stress disorder is indicated to reduce the severity of symptoms and prevent progression to post-traumatic stress disorder. Tra
mmended
der presents aswith
excessive concern about a range of issues, which can result in irritability, poor sleep, and trouble concentratin
matic symptoms.
a (onset age < 18) is associated with a more severe and impairing course. Youth commonly have a prodromal phase marked by
hofprimary
active psychotic
psychiatricsymptoms.
disorders.Hallucinations
Initial diagnosticaretests
common and24-hour
include need tourinary
be differentiated from imaginary
cortisol excretion, friends.
late-night salivary cortisol assa
ion test.
ne
tiveissymptoms
associatedare with an increased
a core domain of risk of seizure. and include apathy, avolition, lack of facial expression, alogia, social withdra
schizophrenia
ptoms
order ismay be mistaken
characterized byfor aspects
mood of personality
instability, or depressive
inappropriate disorders. and unstable relationships. Self-injury is common bu
anger, impulsivity,
ent psychotic symptoms
s developmentally in timesinofpreschool
appropriate stress. and school-aged children. It represents a form of creative play, aiding in the develo
roviding comfort
racterized in timesinvoluntary
by abnormal of distress.movements of the face, lips, tongue, trunk, or extremities that develop as a result of prolong
e causative medication should be tapered and discontinued.
should be maintained
tive adjunct indefinitely
to antipsychotic in patients
medication with schizophrenia,
in patients including
with schizophrenia andthose with a
has been first episode
shown of psychosis.
to reduce the risk of relapse. It focu
rse, and treatment of the disorder, and it helps to promote a supportive family environment.
racterized by one or more delusions. Other prominent psychotic symptoms are absent, and the individual is still able to function
nts with bradykinesia, resting tremor, and rigidity. It may be complicated by visual hallucinations, which can be treated with a low
pine, pimavanserin).
ay cause psychosis, anxiety, and mood symptoms. Restlessness, sleep disturbances, and memory loss may also occur. Glucoc
edbewhenever possible.
considered in patients who are newly admitted to supervised settings and develop tremor, agitation, and elevated pulse an
with neurologic (e.g.are
. Benzodiazepines indicated
altered forstatus,
mental the treatment
seizure,of alcohol withdrawal.
fasciculations, tremor) and gastrointestinal (e.g. vomiting, diarrhea) signs. T
lithium) can
acterized enhanceepisodes
by distinct a physiologic tremor,
of major which isand
depression typically a fine, In
hypomania. symmetric
contrast, action tremor
the labile of states
mood the hands
seenthat increases person
in borderline with sy
produce manic symptoms, including elevated or irritable mood, hyperactivity, agitation, and pressured speech. Signs of sympath
chycardia,
mood hypertension)
symptoms requires can
that assist
medical in and
differentiating cocaine intoxication
substance-induced causes be from
ruledbipolar
out. Thedisorder and other primary
neuropsychiatric psychiatric
side effects dis
of glucoco
rymania, and psychosis.
be confused with normal adolescent moodiness, defiance, overconfidence, and risk taking. However, an abrupt change from
, distractibility, excessive goal-directed activity, and grandiosity, should raise suspicion for a manic episode.
sode
episodeof bipolar
includeI elevated
disorder may have an
or irritable irritable
mood, rather than
increased euphoric mood,
energy/activity, and awhich can manifest
decreased need foras uncharacteristic
sleep. angry
Manic patients may outbur
feel
ep.
depressive disorder include hypersomnia, hyperphagia, heavy feelings in limbs, hypersensitivity to rejection, and mood reactiv
re symptom of depression. Polysomnographic findings in major depressive disorder include decreased REM latency and slow-w
REM sleep density.
ial infarction can increase the overall risk of cardiac mortality. Psychotherapy and antidepressant treatment (especially in comb
uptake inhibitor sertraline is considered a first-line treatment.
r is frequently recurrent. Long-term maintenance antidepressant therapy is indicated for patients with > 2 major depressive epis
erred treatment approach for patients with adjustment disorders.
d (5-HIAA) disorder
ompulsive is a metabolite
consists ofof
serotonin. Low antidepressants
serotonergic cerebrospinal fluid and5-HIAA is associated
exposure with prevention
and response suicidal behavior.
based cognitive-behaviora
st-line medications.
sorder is characterized by intrusive, recurrent, and persistent unwanted thoughts (obsessions) and repetitive behaviors or menta
s typically
order have may
in children prominent
present anxiety symptoms dreams
with distressing that must bevague
with differentiated
content from those of primary
and re-enactment anxiety disorders.
of traumatic themes in play, rather t
ccompanied by emotional dysregulation and behavioral difficulties.
cal management of an acutely agitated patient include the administration of a benzodiazepine and/or an antipsychotic agent. Th
dndonset of action and
hyperactivity, intramuscular
patients formulation.
with attention deficit hyperactivity disorder (ADHD) may display impulsive blurting out of thoughts and
or willfully defiant behavior and causes
mes evident in the early developmental period whendifficulties in asocial
child relationships.
has difficulty acquiring and/or using language appropriately. It can re
ademic achievement.
ntipsychotics quetiapine and lurasidone are first-line medications for the treatment of acute bipolar depression. Antidepressant m
mania.
terized are
pisode by depressive and manic
diagnosed with bipolarepisodes.
I disorder.IfDepressive
psychotic symptoms
episodes are occur,
notthey are only
required present inbut
for diagnosis theare
context of a manic
common. Manic or majo
episod
ndiose themes.
y recurrent illness. Maintenance treatment is recommended to decrease the risk of recurrent manic or depressive episodes. Lith
ose
children may iscome
condition stable
to and who are
attention onlytolerating the demands
when social medication. reveal their social-emotional deficits during school-age years. Featu
sual responses to sensory experiences.
ness; and suicidal ideation. The severity of symptoms and related impairment can help differentiate depression from adjustmen
sive disorder in patients with cancer is difficult because somatic symptoms of depression (e.g. fatigue, weight loss) may overlap
oms are associated with depressed mood or loss of interest, major depressive disorder should be considered.
at leasttrial
quate 4-6ofweeks at a therapeutic
a selective dose. Physicians
serotonin reuptake should should
inhibitor (SSRI) continuebeantidepressants for atantidepressant.
switched to another least 4-6 weeksBupropion,
before considering
a norepin
se sexual side effects, is a preferred choice in patients with SSRI-related sexual dysfunction.
r with psychotic features is characterized by an episode of major depression accompanied by delusions and/or hallucinations, o
ned antidepressant
hould be differentiated andfromantipsychotic
postpartummedication or electroconvulsive
blues, a milder and self-limited therapy.
form of depression that peaks at 5 days and resolves wi
using the same diagnostic criteria for a major depressive episode
ves symptoms occurring within 3 months of an identifiable stressor that cause outside the postpartum period. and/or impairment. It is not di
significant distress
her
is amental
safe and disorder.
effective first-line treatment for major depressive disorder with psychotic features. It is particularly appropriate for
nk or are acutely
r can be differentiatedsuicidal.
from adjustment disorders and normal grief reactions by the persistence and severity of symptoms. Perv
everity over time should
should be carefully assessed raise for
suspicion
suicidalfor major depression.
thoughts and behavior to determine the appropriate treatment setting. Patients with ac
s are at increased risk and should be hospitalized.
d isbycharacterized by deficits
immobility, mutism, in social and
negativism, interaction, restricted interests,
echophenomena. repetitive
It most often behaviors,
presents and abnormal
in the context of bipolarsensory
disorderperception. Fo
or major dep
enes (e.g. lorazepam).
presents with rapidly progressive dementia, myoclonus, mood symptoms, and hypersomnia. This disease is associated with h
ntreatable and generally
ed respirations, fatal withinand
shallow breathing, 1 year of diagnosis.
decreased bowel sounds are signs of opioid intoxication. Miosis is usually present as we
nracterized
due to possible coingestants.
by multiple motor ticsFor andemergency
at least onemanagement, naloxone
vocal tic, which may waxshould
andbe administered
wane toItreverse
in intensity. commonlyrespiratory
presentsdepressio
in childr
the school setting.
ations of fetal alcohol syndrome include intellectual disability, emotional dysregulation, inattention, and social skill deficits. Acco
ebral fissures, have
ety disorders thin upper lip, smooth
considerable philtrum)
symptom and growth
overlap, retardation.
including sleep disturbances, palpitations, and sweating. Measurement of th
s with new-onset anxiety and physical symptoms to prevent
ive serotonin reuptake inhibitors, common early side effects (e.g. headache, misdiagnosis andnausea,
provideinsomnia/sedation,
appropriate treatment.
anxiety, dizziness) and
acterized by persistent distress due to the incongruence between gender identity and assigned gender. It is oftentypically
should be discussed. Patients should be advised to avoid abrupt discontinuation and be informed that response requir
accompanied
secondary sexual characteristics.
ently associated with depression. Treatment, which includes psychotherapy and antidepressants, can alleviate suffering and im
rphic is
order disorder consistsbyofrecurrent
characterized selectiveepisodes
serotoninofreuptake
impulsiveinhibitors
verbal or and/or cognitive-behavioral
physical therapy. Cosmetic
aggression. The aggressive treatments
behaviors and
are unplanne
ocial interventions and pharmacotherapy is indicated for patients with moderate to severe alcohol use disorder. Acamprosate a
potential complication of Wernicke encephalopathy that is characterized by retrograde and anterograde amnesia with preserved
ght, and apathy.
adrenal tumor thatKorsakoff
presents syndrome is caused
with episodic by thiamine
headache, deficiency
hypertension, and develops more frequently
tachycardia/palpitations, in alcoholand
and diaphoresis usemay
disorder tha
be acco
ssociated with a missed medical
se, the benzodiazepines lorazepam, diagnosis,
oxazepam,physicians must maintain
and temazepam are apreferred
high index dueoftosuspicion for underlying
their shorter half-life andmedical
lack ofcauses o
active m
en metabolites,
up to 10% ofsuch thoseastreated
chlordiazepoxide and diazepam,
with lamotrigine, place patients with
whereas life-threatening hepatic dysfunction
Stevens-Johnson at risk
syndrome or for toxic
toxic drug buildup.
epidermal necrolys
at,the treatment
when used inofexcessive
lamotrigine requirescan
amounts, immediate discontinuation
cause sympathetic of the drug.
hyperactivity, leading to anxiety, jitteriness, insomnia, palpitations,
ounts of caffeine
s for major and should
depressive disorder be include
considered as a cause ofpsychotherapy,
antidepressants, stimulant intoxication.
or a combination of both. Among psychotherapies, cog
apy
onshave the bestnervosa
of anorexia evidence (AN)for include
efficacy.dry, scaly skin; hair loss; and lanugo. First-line treatment for AN consists of nutritional reh
ns of AN (e.g. hair loss) improve
r with psychotic features is a subtype with weight restoration.
of depression characterized by severe depression and delusions and/or hallucinations. Fir
tipsychotic or electroconvulsive therapy.
xiety, insomnia) are possible early adverse effects of selective serotonin reuptake inhibitors but frequently improve with time. Pa
ng adverse
vement effectsisand
disorder may benefit
characterized byfrom a temporary
prolonged dose reduction
grief, difficulty acceptingor initiation
the death, at persistent
a lower-than-normal
yearning for dose.
the deceased, and m
erapy is the treatment of choice.
isorder is characterized by cyclical mood swings, irritability, appetite changes, and physical discomfort that resolve after mense
toms represent an exacerbation of an underlying disorder in which symptoms are not limited to the premenstrual phase.
-norepinephrine
ients treated withreuptake
lithium will inhibitor
develop that can cause dose-dependent
hypothyroidism, requiring that hypertension.
all patients have Blood pressure
regular TSH should
monitoringbe monitored
every 6-12regularly
months
ly treated with T4 supplementation rather than discontinuation of lithium.
der is characterized by switching among two or more distinct personality states that take control of the patient's behavior and by
ration. The disorder
with seasonal patternis associated
(seasonal with severe
affective childhood
disorder) trauma and treated
is characterized with long-term
by seasonal onset andpsychotherapy.
remission (most commonly fall-win
nsists of bright light therapy alone or with an antidepressant.
acterized by hypomanic and major depressive episodes with no history of manic episodes. Hypomania is distinguished from ma
hospitalization.
order Functioning
is characterized by mood in hypomania is either improved
instability, recurrent or only mildly
suicidal behavior, impaired.
unstable relationships, inappropriate anger, impulsivity, a
ociation may be mistaken for primary psychosis. A history of childhood trauma is common.
apyisischaracterized
der the treatment by of multiple
choice for borderline
worries lastingpersonality
> 6 months disorder. Pharmacotherapy
with symptoms is usedfatigue,
of restlessness, as an adjunct
difficultytoconcentrating,
psychotherapyirrita
or
aracterized by the development of emotional or behavioral symptoms in response to an identifiable stressor. The diagnosis is a
nother mental
r is often disorder.
a recurrent illness. Patients with > 3 lifetime depressive episodes, severe episodes (e.g. suicide attempts), or episodes
treatment.
ajor depressive episode should be screened for a history of hypomanic/manic episodes to rule out bipolar disorder. This is espe
ts due to the risk of antidepressant-induced mania.
ssociated with a riskof
e-bound syndrome ofSouth
inducing
Asiamania in susceptible
that manifests with patients. The first
psychological andstep in management
somatic is discontinuation
symptoms that of loss
are attributed to the offending
of semen.m
to take
rized by adelusions,
patient-centered approach
hallucinations, and allow the
disorganized patient
speech andtobehavior,
explain the cultural
and explanations,
negative symptoms manifestations, and consequenc
of > 6 months duration. The diffe
eatures, other primary psychotic disorders, and substance and medical causes of psychosis.
osis should be considered in the differential diagnosis of all patients who come to the emergency department with acute psycho
obtaining a urine toxicology
n. If DLB-associated screen.
psychotic symptoms are functionally impairing, a trial of a low-potency second-generation antipsychotic (e
emporal dementia presents with behavioral changes (e.g. disinhibition), compulsive behavior, hyperorality, apathy, and executiv
ent is normally
haracterized by mild early of
episodes in binge
the disease.
eating associated with distress and a sense of loss of control. It is differentiated from bulimia
pensatory behaviors (e.g. self-induced
ulimia nervosa results in dehydration and vomiting,
volume fasting, excessive
depletion, exercise).
resulting in secondary hyperaldosteronism and a hypokalemic, hyp
ake inhibitors and serotonin-norepinephrine reuptake inhibitors are first-lineabnormalities
a result of volume contraction (e.g. dizziness, orthostasis) and electrolyte pharmacotherapy(e.g. arrhythmias, weakness,
for panic disorder. muscle cr
Benzodiazepin
nd should be avoided in those with substance abuse.
volves
ens test the
for presence
opioid useofby> measuring
1 psychoticmorphine,
symptomsa lasting > 1 days
breakdown and of
product <1 allmonth,
natural,with full return to
nonsynthetic the previous
opioids level of
(e.g. heroin, functionS
codeine).
hone, oxycodone) and synthetic (e.g. fentanyl, meperidine, methadone, tramadol) opioids are not detected
first-line treatment for most adults with ADHD. The nonstimulant atomoxetine, however, is preferred in patients with history on standard testing.
of s
nd addiction.
standard urine drug screens (UDS) test for amphetamine, cocaine, cannabis, opioids, and phencyclidine. Dextromethorphan m
tonUDS detect
opioid natural
misuse opioids
include age (e.g.
< 45,morphine,
psychiatricheroin, codeine)
disorder, but or
personal notfamily
semi-synthetic or syntheticdisorder,
history of substance opioids. or a legal history. Revi
data, random
present urine drugofscreens,
with symptoms irritabilityand regular
rather thanfollow-up
depressed aremood.
all associated
Treatment with risk reduction
options for long-term prescription
include psychotherapy opioid m
and/or pharmacoth
n adolescents should include direct and nonjudgmental questions to determine the nature and intensity of suicidal thoughts. Co
ot be maintained
rmacotherapy for ifbulimia
the patient is at Best
nervosa. high results
risk for are
self-harm.
achieved as part of a multimodal therapy that includes cognitive-behavioral
harmacotherapy for alcohol use disorder that decreases craving and heavy drinking. It can be initiated in opioid-free patients wi
r with psychotic features is a severe subtype of unipolar major depression. It is characterized by an episode of major depression
dcally withmedications
cough depressive oftenthemes.
contain ingredients that can have unwanted side effects, including confusion and hallucinations. The
en, with recommended
al separation from major attachmentdoses not exceeded
figures is nor
ageused in combination.
appropriate in children age 9-18 months and then again at times of transition
nxiety and distress at separation, repeated somatic
es the intentional falsification of symptoms with the goal of assuming complaints, or school refusal
the sick role.warrant
Clues tofurther assessment.
factitious disorder include inconsiste
d canlaboratory results.
result in altered mental status, ataxia, and slurred speech. When vital sign derangements or respiratory depression are se
lianervous
should system depressants
be suspected should
in patients withbesudden-onset
suspected. abdominal pain, neuropsychiatric symptoms (e.g. neuropathies, anxiety,
episodes. Elevated urine porphobilinogen during an attack is diagnostic.
astabilizer valproatecan
benzodiazepine canresult
causein elevated aminotransferases
a potentially life-threatening and in rare cases
withdrawal syndrome,hepatic failure, most
characterized bycommonly in the firsttremors,
anxiety, insomnia, 6 mont
ders, mild withdrawal may be difficult to distinguish from re-emergence of the underlying disorder.
cohol use are frequently seen in the primary care setting for insomnia and/or anxiety. These patients should be carefully screen
re enzymes
diuretics -and macrocytosis
as well can also tetracyclines,
as ACE inhibitors, assist in screening.
metronidazole, and nonsteroidal anti-inflammatory drugs - and lithium can i
m toxicity, including gastrointestinal symptoms,
diets can meet the nutritional needs of adolescents. However, confusion, ataxia, tremor,
patients and
with lowseizures.
BMI, evidence of excessively restrictive diets, o
sorders.
use clinical judgment when assessing suicide risk. Even if a patient denies a suicide attempt, when a likely attempt has been m
atient
der is must be hospitalized
characterized (involuntarily
by excessive if necessary)
and persistent worrytoabout
ensure safety.issues. Patients frequently come to their primary care pro
multiple
dms to are
muscular tension.
typically minor, cocaine withdrawal can cause acute depression with suicidal ideation. Other features include fatigue, hy
ncentration,
d disorders (e.g. intense
and drug craving.
major depressive disorder) requires exclusion of medical and substance-induced causes. Untreated obstructiv
thpresent with anxiety, irritability, mood sleep
depression (e.g. low mood, fatigue, swings, disturbance,
grandiosity,impaired concentration).
and psychotic symptoms such as paranoia and hallucinations. Phys
pder differentiate
may exhibit distractibility and hyperactivity that are difficult to distinguish disorders.
cocaine-induced symptoms from primary mood and psychotic from symptoms of attention deficit hyperactivity dis
od symptoms are more characteristic of bipolar disorder.
nt in school-age children as difficulties in acquiring and using academic skills (reading, writing, and/or mathematics). Dyslexia is
ity to
dal decode words, resulting
anti-inflammatory drugs (orinthiazide
problems in reading
diuretics, ACEfluency andtetracyclines,
inhibitors, spelling. and metronidazole) to lithium can increase serum
uding gastrointestinal symptoms, confusion, ataxia, and tremor.
r is associated with hyperactivity of the hypothalamic-pituitary-adrenal axis, resulting in increased cortisol levels.
tients with acute stress disorder is to educate them on the range of reactions to trauma. Trauma-focused cognitive-behavioral th
persistent
nosed when symptoms.
a persistent, intense desire to be another gender is accompanied by distress or impairment. The initial approach in
tient's safety,
M) sleep behaviorand offering
disorderevaluation with a enactment
involves dream multidisciplinary team of
that occurs specialists
during in order
REM sleep duetototailor treatment
absence to theatonia.
of muscle individual's me
If awake
n older patients, these behaviors may be a sign of neurodegeneration.
preferred
g, patientsinitial treatment for
with depression preschool-aged
often have somaticchildren with Any
symptoms. attention deficit
patient who hyperactivity disorder
reports feelings or problematic
hopeless, even if thehyperactive beh
initial symptom
tion. by abnormal involuntary movements of the mouth, tongue, trunk, and extremities and can first appear during treatment or
rized
on.
drome (NMS) is characterized by severe muscular rigidity, mental status changes, autonomic instability, and high fever. Serum
evated.
p changesDopamine antagonism,
include decreased which
total occurs
sleep time;with the usenighttime
increased of most antipsychotics, has beenearlier
awakenings; sleepiness implicated
in theasevening
a primary
with cause
earlyof NM
morn
ping). mood disturbance characterized by > 2 years of numerous periods of hypomanic and depressive symptoms that are su
chronic
manic
days episodes. and typically resolves within 2 weeks. Women with more severe depressive symptoms lasting for > 2 weeks sh
postpartum
e-behavioral psychotherapy and selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are firs
severe anxiety response characterized by re-experiencing of trauma, dissociation, negative mood, avoidance, and hyperarous
atic event.disease, occurring at a higher rate in those treated with dopamine agonists than in those treated with carbidopa-levod
Parkinson
son anxiety
mon medication dosecharacterized
disorder reduction and/or
by athe addition
clinically of a low-potency
significant fear of aantipsychotic (e.g.
specific object quetiapine,
or situation, pimavanserin).
leading to avoidance behavior.
reatment of choice.
s to or from a monoamine oxidase inhibitor (MAOI) must be done cautiously as drug-drug interactions can cause serotonin synd
OI requires
seen a 2-week
in severe washout.
psychiatric and medical illness and is characterized by immobility, mutism, and posturing. Lorazepam and electr
e use can cause psychotic symptoms, including paranoid delusions and auditory, visual, and tactile hallucinations (e.g. bugs cr
ght loss, severe tooth decay, and excoriations due to skin picking.
ed
es by excessive
recurrent daytime sleepiness,
awakenings cataplexy,
from REM sleep and REM
associated with sleep-related
full alertness phenomena (e.g. hypnagogic/hypnopompic
and dream recall. It should be differentiated hallucinatio
from non-R
rousals, unresponsiveness, and lack of dream content.
hosis in a child or adolescent is rare, and it is important to search for potentially reversible conditions such as medical disorders
out include
common, systemic lupus and
underdiagnosed, erythematosus,
associated withthyroiditis, metabolic
increased or electrolyte
morbidity disorders,
and mortality. PatientsCNS
caninfection, andearly
benefit from epilepsy.
treatment with
ration antipsychotics, second-generation antipsychotics cause fewer extrapyramidal symptoms but are associated with metabol
carrytaper
rapid a highofrisk of half-life
short metabolic side effects,
serotonergic whereas ziprasidone,
antidepressants can resultaripiprazole, and lurasidone
in antidepressant are associated
discontinuation withTreatment
syndrome. the lowestconris
common than HIV-associated dementia in these patients. HIV-associated dementia is a severe form of subcortical dementia fo
tients.
er is most commonly seen in infants and toddlers but can occur at any age and is often associated with transition or change. It
nsone
d and mayabuse
for alcohol present as school
require or work absences.
an understanding of the patient's level of awareness of the problem and readiness to change. When
, the physician's
de-effect roleweight
profile (no is to increase the patient's
gain or sexual awareness
side effects), thatitalcohol
making a gooduse mayfor
choice bepatients
interfering
whowith
arepersonal
on SSRI goals.
therapy but have
acterized by myalgias, gastrointestinal symptoms, piloerection, pupillary dilation, irritability, yawning, and lacrimation. Temperatu
der is characterized by a pervasive pattern of argumentative and defiant behavior toward authority figures. It does not involve th
nisinisconduct disorder.
differentiated from primary psychotic disorders by fluctuating levels of consciousness, acute onset, and association with an
hrine reuptake inhibitors (e.g. duloxetine) have analgesic properties that can be helpful in treating patients with comorbid depres
y.
dered if a patient becomes agitated or restless when an antipsychotic is changed or the dosage is increased. Treatment options
otic
drome isless
with potential to cause
a life-threatening extrapyramidal
condition associatedsymptoms, and/or
with the use starting treatment
of antipsychotics. with propranolol,
It is characterized benztropine,
by delirium, highor a benzodi
fever, auton
and leukocytosis.
er may be misdiagnosed with a somatic symptom disorder due to preoccupation with unexplained symptoms and a history of h
characteristic physical symptoms that resolve within minutes should raise clinical suspicion for panic disorder.
eatment
sm spectrumfor attention
disorderdeficit
(ASD)hyperactivity disorder
in the preschool and in school-aged
school-age yearschildren.
has beenThey are highly
shown effective and
to significantly generally
improve well tolerated
outcomes. If there
valuation should be undertaken and individualized educational/behavioral services offered as soon as possible.
ychotics (e.g. quetiapine, lurasidone) are effective in the depressed phase of bipolar illness. Antidepressant monotherapy shou
a medical emergency characterized by delusions, hallucinations, and disorganized thoughts or behavior often accompanied by
most patients require hospitalization to ensure safety.
ethylphenidate, amphetamines)
xy-methamphetamine) are aamphetamine
is a synthetic first-line treatment for attention
with mild deficit properties.
hallucinogenic hyperactivity disorder
It can causein euphoria,
school-aged children.
increased sexual
ypertension, tachycardia, hyperthermia, serotonin syndrome, and hyponatremia. Coma, seizures, and death may occur.
is an evidence-based treatment for major depression that carries a low risk for complications. It is a first-line treatment for majo
or severely depressed elderly patients who are not eating or drinking and require rapid intervention.
tic stress disorder (PTSD) commonly have symptoms of sleep disturbance, impaired concentration, and negative mood. A histo
startle
curs response
in boys are clues
age 14-17 and for
may PTSD.
involve multiple common household chemicals. Users may display characteristic perioral skin
hotic disorder is characterized by the acuteshort
aracterized by a rapid onset and relatively onsetduration.
of delusions and/or hallucinations that are temporally associated with the use
rly at high doses, are often implicated in new-onset
e dopamine (D2) receptor (e.g. antipsychotics, metoclopramide) psychotic symptoms
may cause in patients who may
extrapyramidal have no current
symptoms, underlying
including psychi
acute dystonia
nduced parkinsonism typically presents with bradykinesia, rigidity, and tremor.
cidal
umatic ideation must for
experience be parents
hospitalized for safetyaand
that requires theand
direct parents mustresponse
empathic be informed.fromParental consent
the physician thatisalleviates
ideal but not requiredThe
self-blame. for hp
to emotions
bligated that arise
to protect without
patient prematurely
confidentiality. providing
Unless reassurance
a patient is at activeor discussing
risk of harmmedical management.
to self or others, physicians cannot disclose in
ent.
o are hopeless about treatment can lead the physician to become frustrated and confrontational and to desire to refer the patie
d a collaborative
greatest approachhomicide.
risk in completing with limited goals
Other are the most
important effective
risk factors approaches.
include a history of violence, substance abuse, and high levels
vised to limit access to firearms.
apy focuses on reducing automatic negative thoughts and avoidance behaviors that cause distress. It is effective as monothera
ge of psychiatric disorders.
sexualdisorders
mood assaultsfrequently
are at highcome
risk for developing
to the post-traumatic
office with physical rather stress
thandisorder,
psychologicdepression,
symptoms.andEvaluation
suicidality. should include screeni
enjoy
AD) is usual activities.by a fear of social situations and anxiety about embarrassment. In the performance-only subtype, anxiety
characterized
hould be differentiated from panic disorder (unexpected panic attacks) and specific phobia (stimulus not related to social anxiety
acterized
ails by difficulty
to respond discarding
to an initial possessions
selective serotonin regardless of their (SSRI)
reuptake inhibitor actual value. It is best
trial, patients treated
should bewith cognitive-behavioral
switched therapy
to another first-line ant
n-norepinephrine reuptake inhibitor, bupropion, mirtazapine, or serotonin modulators.
on of choice
order for treatment-resistant
intentionally produce signs and schizophrenia
symptoms for and
theshould
purposebe considered
of assuminginthe patients whoFactitious
sick role. have failed > 2 antipsychotic
disorder drug t
should be differe
for an external incentive.
develop comorbid depression
of antidepressant-related can benefit
suicidal thoughts from
andtreatment
behaviors with antidepressant
in some children and medications
adolescentsandmust
psychotherapy
be weighedtoagainst
improvethetheir
efficq
n depression.
erized Patients
by recurrent, should be
unexpected carefully
panic attacksmonitored
and fears forabout
suicidality
futureatattacks
the beginning of antidepressant
and/or maladaptive behaviortherapy.
related to the attacks.
avoidance of > 2 situations in which escape or obtaining help may not be possible.
pine, and lamotrigine are first-line maintenance treatments for bipolar disorder.
erized
es oneby or marked fear of aand
more delusions specific object orofsituation.
the absence Cognitive-behavioral
other prominent therapy using
psychotic symptoms. Apartexposure techniques
from the impact is the preferred
of delusional beliefs,
s with no insight are unable to determine that their psychotic experiences are not real. To build rapport, it is important to acknow
srsing specific
are the delusions
first-line or hallucinations.
treatment for psychosis. Long-acting injectables should be considered for nonadherence after tolerability and
ations. Clozapine should be considered
drome is a potentially life-threatening for patients
condition that who have failed
can occur at least 2 antipsychotic
after administration trials. medications. Symptoms incl
of antipsychotic
etus, and autonomic
drug-induced instability.aCreatine
parkinsonism, kinase level and
type of extrapyramidal white blood
symptom (EPS).cellTreatment
count mayoptions
be elevated.
include antipsychotic dose reduction
to another
ychotics antipsychotic
cause metabolicwith
sidea effects
lower potential to cause
(e.g. weight gain, EPS, if feasible. dyslipidemia) to varying degrees. Routine monitoring fo
hyperglycemia,
nssant
patients
withtaking second-generation
mild stimulant properties thatantipsychotics. Olanzapine
can be particularly helpfulandfor
clozapine
depressedarepatients
associated
withwith
low the greatest
energy, risk. concentrat
impaired
o aid smoking cessation.
triggered depressive symptoms should be assessed for major depressive and adjustment disorders. Normal stress reactions a
r can beordiagnosed
istress significantiffunctional
depressive impairment.
symptoms following the loss of a loved one are sufficiently severe to meet diagnostic criteria. C
with more persistent and pervasive sadness, feelings of hopelessness and worthlessness, and suicidal ideation.
netooxidase
discuss inhibitors
sensitive such asinphenelzine
issues the presenceshould avoidmembers.
of family foods rich All
in tyramine
patients ofasall
the interaction
ages of suchlevels
and functional food-drug combinations
should be given thec
e threat to themselves should be hospitalized (involuntarily, if necessary) for treatment and stabilization. This principle also appl
ent.and usually benign parasomnia of childhood. They occur during non-REM sleep and are characterized by fear, crying and/o
on
sade clinically.
exert Parents
their effects should
through be reassured
dopamine that episodes
antagonism. are self-limited
The blocking and may
of dopamine typically resolve
result within 1-2 years. which can lead
in hyperprolactinemia,
-generation
order antipsychotic
is characterized risperidone
by chronic is mostmood
depressed likelyand
to increase
> 2 otherprolactin.
depressive symptoms lasting > 2 years. Treatment with antide
nd quality of life.
rsonality disorder involves a pervasive pattern of preoccupation with orderliness, rigid rules, perfectionism, and control. It is diff
e lackwith
rfere of clear obsessionsinand
independence compulsions.
everyday activities are a key feature that distinguishes dementia (major neurocognitive disorder) fro
ve functional impairments that necessitate assistance.
tive changes
oids are used include occasional
to improve physique forgetfulness,
and athletic word-finding
performancedifficulty, and sleep with
but are associated pattern changesadverse
numerous that do effects,
not impact activities
including of
acne,
profiles, virilization, testicular failure, and possible mood and behavior changes.
drome (NMS) typically presents with altered mental status, fever, muscle rigidity, and autonomic instability. Stopping the causa
current unexpected panic attacks, fears of future attacks, and avoidance behavior. Diagnosis requires differentiation from other
acks and typically
oxication ruling out medical
present causes.
with conjunctival injection, dry mouth, tachycardia, and increased appetite. Psychomotor impairment,
rracterized
doses. by at least 1 persistent delusion and no other prominent psychotic symptoms. Apart from the impact of the delusion
ors and serotonin-norepinephrine reuptake inhibitors are first-line medications for treating generalized anxiety disorder that can
diazepines
nonadherence shouldis abe reserved
common for nondepressed
cause of relapse andpatients without a in
rehospitalization history of substance
patients abuse whoLong-acting
with schizophrenia. fail to respond to or cannot
injectable antips
ral antipsychotics but relapse frequently due to medication nonadherence.
sants (e.g. selective
diagnosed serotonin
when major reuptake
depressive or inhibitors) are theco-occur
manic episodes first-linewith
medication
psychotictreatment
symptoms for in
obsessive-compulsive
a patient with a historydisorder.
of persisten
ms.
order (dysthymia) refers to a depressed mood lasting most days for > 2 years. It includes patients with pure dysthymia and thos
s.
,have
and hyperglycemia
somatic symptoms are common complications
that overlap of treatment
those of depression with
(e.g. second-generation
sleep antipsychotics.
disturbance, appetite Olanzapine
change, poor energy).and clozapine
However, if th
ss, guilt, loss of interest, and suicidal thoughts, major depression should be considered, with a low threshold
hly recurrent illness that requires long-term maintenance pharmacotherapy to decrease the risk of recurrent mood episodes. Cli for beginning treatm
ss significant side effects or contraindications prohibit use.
suspected
der in an individual
is characterized with weight
by excessive anxietyloss, behavioral
about multiplechanges,
issues, inand erythemawith
conjunction of the
> 3nasal
of themucosa.
following symptoms for at least 6
ility, muscle tension, and impaired sleep.
ventions are indicated for patients with a recent psychotic episode who have significant ongoing contact with family members. M
isk ofofrelapse
sode in patients with
major depressive schizophrenia.
disorder should continue antidepressants for an additional 6 months following acute response to reduc
severe episodes should be considered
nt is a selective serotonin reuptake inhibitor for maintenance treatment (1-3 years
or serotonin-norepinephrine reuptakeor indefinitely).
inhibitor. Cognitive-behavioral therapy can als
ment.
ure defense mechanism in which the individual displaces negative feelings associated with a person or situation onto a 'safer',
efense mechanism that involves transforming unacceptable feelings and impulses into their extreme opposites.
hospitalization include being a danger to self or others and/or grave disability. Hospitalization may be implemented on an involu
zolam, a short-acting
ated with benzodiazepine,
intent and plan for self-harm.isThe
associated
first stepwith significant
in the withdrawal
care of patients withsymptoms, including
active suicidality a risk
is to for generalized
ensure seizu
their safety by ad
y).
proach should focus on the patient's suffering and impaired functioning without challenging the patient's beliefs. Once rapport is
and
mptomtreatment
disorderfor it withfrom
benefit cognitive-behavioral therapy
regularly scheduled and/or antidepressants.
appointments, which establish a strong physician-patient relationship and limit d
aracterized by the sudden onset of neurological symptoms with clinical findings that are incompatible with recognized neurologi
ed by stress.
with an increased
diagnoses can giverisk of seizures.
informed It isas
consent contraindicated in patients
long as they have withmeaning
capacity, seizure disorders, anorexia and
that their judgment nervosa, or bulimia nervosa.
decision-making abilities a
eansformation
nonadherence of aindistressing
an empathic event
and into a situation devoid
nonjudgmental mannerofand emotion
try to to avoid confrontation
understand of uncomfortable
behavior from emotional compon
the patient's perspective. This
aacterized
united plan.
by persistent and recurrent maladaptive gambling behavior that results in impairment or distress. Significant financial
consequences.
eves
control disorder
symptoms characterized
causing by an inability
marked distress to resist the
and impairment impulse
that developto within
steal objects
3 monthsof low monetarytovalue
in response or notItneeded
a stressor for per
is not diagnos
er (e.g. major depressive disorder). The treatment of choice is psychotherapy that focuses on improving coping skills and prom
cerebral
fective ventricles
disorder is theassessing
requires most consistently replicated
the longitudinal neuroimaging
course finding
of the illness and in schizophrenia.
determining if the patient has had at least 2 weeks
de. Schizoaffective disorder is distinguished from schizophrenia by the presence of mood symptoms for a significant portion of
olves isolated
presents withimpairment in autobiographical
severe agitation, memory. Ifstrength,
delusions of enhanced the amnesia is accompanied
psychosis, analgesia,bymultidirectional
travel or wandering, the specifier
nystagmus, of 'w
hypertensio
nd aggression
can are psychiatric
present with managed with benzodiazepines.
symptoms, including irritability, agitation, and psychosis. Common physical signs include tachycar
s.
be suspected in patients with muscle and joint aches, nausea, diarrhea, abdominal cramping, rhinorrhea, and pupillary dilation.
yalcohol
not life-threatening.
use who develop tremulousness, unstable vital signs, and/or seizures shortly after hospital admission should be assess
ate-duration benzodiazepine
der is characterized available
by a persistent in intravenous
pattern form, is preferred
of social avoidance, feelings in of
theinadequacy,
inpatient setting, particularly in patients
and hypersensitivity withbeginn
to rejection como
ersonality disorder are socially detached and prefer to be alone. They can be differentiated from individuals with avoidant perso
em due to fears of rejection. They lack the eccentric cognitions and perceptual distortions characteristic of schizotypal personali
sorder is characterized by excessively dependent and submissive behaviors, indecisiveness, and fear of being left to manage a
sorder
sorder is
is characterized
characterized by
by an exaggerated pattern
a long-standing sense ofofself-importance, needand
eccentric behaviors for social
admiration, sense
anxiety of entitlement,
despite and lackwith
familiarity. Patients of emp
this
thoughts, and perceptual disturbances that are subthreshold for a psychotic disorder.
iting include parotid gland hypertrophy, pharyngeal erythema, dental caries, scars or calluses on the hand, and electrolyte abno
be
us).differentiated
QRS duration from bulimia
> 100 msecnervosa by significantly
has been low an
associated with body weight. risk of arrhythmias and/or seizures and is an indication fo
increased
on-making capacity have the right to refuse procedures and treatment. The physician should address any modifiable obstacles t
be
ativeoffered if the patient
anesthetic reconsiders. causes nystagmus. It can also cause dissociative feelings, psychotic and violent behavio
that characteristically
nal production or exaggeration of physical or psychological symptoms for secondary gain. Malingering should be suspected wh
erhere is a discrepancy
involves between symptoms
excessive preoccupation and objective of
and overestimation findings.
the seriousness of > 1 somatic complaints and is associated with hig
order is characterized by a persistent pattern of unstable relationships, mood lability, impulsivity, and recurrent suicidal behavio
savioral focus (e.g.exposure
after prolonged dialectical
to behavioral
antipsychotictherapy).
drugs and is characterized by abnormal involuntary movements of the mouth, tongu
reduction or discontinuation is not feasible, using valbenazine or deutetrabenazine or switching to clozapine should be conside
r manic
suicideepisode(s)
is a historywith
of suicide attempt(s).
or without a history of major depressive episodes. Bipolar II is distinguished from bipolar I by hypomanic
rpsychotic symptoms)
is differentiated from and a history ofby
schizophrenia >1 depressive
the duration ofepisodes.
symptoms. In schizophreniform disorder, symptoms must last for > 1 m
athe
requires symptoms to persist for > 6 months.
treatment of psychotic patients who do not respond to other antipsychotics. Patients must undergo regular monitoring of ab
d agranulocytosis.
bsessive-compulsive disorder are exposure and response prevention techniques based on cognitive-behavioral therapy and se
f extrapyramidal symptom associated with antipsychotic treatment. It is most commonly seen with high-potency first-generation
cs
ral (benztropine)
nervous system or antihistamines
stimulant that is(diphenhydramine).
frequently used to treat attention deficit hyperactivity disorder. Common side effects of stim
insomnia.
on is an activating antidepressant with a favorable side effect profile (e.g. no weight gain or sexual side effects), making it a goo
ual dysfunction.
assified as performance-only social anxiety disorder in DSM-5. Pharmacologic treatments include as-needed β blockers or benz
ents
drome isaapersonal
with or family history
rare but potentially of substance
life-threatening use disorder
emergency or when
associated cognitive
with the useand sedative side effects
of antipsychotics could impair
(neuroleptics). perform
Patients wh
ntensive supportive care can be treated with dopamine agonists and dantrolene.
ychotics (SGAs) are serotonin 2A and dopamine D2 antagonists. The added serotonin receptor binding and lower dopamine bi
al adverse
s can causeeffects.
hyperprolactinemia secondary to their dopamine blockade effect. Risperidone has a high frequency of prolactin ele
mas are capable of producing
rapid relief of anxiety and are very high for
indicated levels
the of prolactin (> of
management 200 ng/mL).
acutely symptomatic and functionally impaired patients with pan
py are preferred for long-term treatment.
y recurrent illness that requires maintenance pharmacotherapy. In patients with severe and frequent mood episodes, the combi
psychotic is used
antidepressant asisfirst-line
trial generallycombination
consideredpharmacotherapy.
to be 6 weeks. Physicians should continue antidepressants at therapeutic dosages f
in treatment.
cterized by a repetitive pattern of violating basic social norms and the rights of others. Common manifestations include truancy
ng physical
e week priorfights with others.
to menses and resolve during the follicular phase. Assessment should begin with a menstrual diary to determine t
apy, be
ould varenicline,
screened and bupropion
for suicidal are first-line
ideation, intent, treatments for smoking
and plan. Actively cessation.
suicidal patientsThey shouldand
with intent be used in conjunction
plan will with
often need to becounse
hospit
rder involves a pervasive pattern of violating the rights of others and lack of remorse. Individuals must be > age 18 for diagnos
efirst-line
age 15. options for bipolar disorder maintenance treatment. Lithium is excreted unchanged by the kidneys and should general
he risktreatment
or the of systemic of toxicity and long-term
acute mania nephrotoxic therapy
and for maintenance effects. in bipolar disorder. Long-term side effects include hyperparathyro
pidus,
who arechronic
agitatedkidney disease,
and have and
acute thyroid
mania dysfunction,
consists as well asmedication
of antipsychotic teratogenic(administered
effects. intramuscularly if needed) to control
ere mania often require a combination of an antipsychotic and mood stabilizer to manage symptoms effectively.
recurrent binge eating and compensatory behaviors. In contrast to patients with anorexia nervosa, those with bulimia nervosa a
tion in patients
evelop moderatewith anorexia
to severe nervosa
major includeshould
depression unstable
be vital signs, cardiac
considered dysrhythmias,
for treatment with bothelectrolyte derangements,
psychotherapy and severel
and antidepressants.
nsomnia
n alcoholand weight loss
withdrawal due to that
syndrome its side effects
typically of appetite
presents afterstimulation
12 hours ofand sedation.and resolves within 48 hours after the last dr
abstinence
ts whoforare
cess fully oriented
procedures and with relatively
or treatment stable vitalfor
must be conducted signs.
all patients, including those admitted involuntarily for substance intoxic
cal procedure or treatment must be voluntary.
abuse in the elderly may include unexplained pain, injuries in multiple stages of healing, or injuries in unusual locations. Elderl
chological
equest for abuse, sexual abuse,
physician-assisted and neglect.
suicide should include exploring the patient’s reasons for the request. Once the patient’s concern
iative care interventions to address specific issues and improve quality of life.
to accept gifts from patients include the cost, type, and timing of the gift and the motivation behind giving it. Gifts should not be
ode potentially affecting their judgment.
ce Portability and Accountability Act, patients have the legal right to obtain copies of their medical records within a specified tim
timally done in a face-to face meeting that allows the physician to better assess the patient's emotional reactions and provide e
ministering these agents to avoid causing a life-threatening
orticoids (e.g. fatigue, depressed mood), and androgens (e.g.
to selective serotonin reuptake inhibitors, which prolong
od
ith disorders,
episodes ofand
CNSrelational issues.
dysfunction. When MS is suspected,
changeable or inconsistent features, and are not consistent
of PNES is video-electroencephalogram of an event
pairment at first. PDD may be distinguished from dementia
diagnosed.
yperprolactinemia include amenorrhea, galactorrhea,
lence, wakefulness-promoting agents such as modafinil are
paradoxical agitation.
on (e.g. pause, blank stare) with preserved postural tone.
s of depression should raise concern for major depressive
ehavior disorder, and parkinsonism. Severe sensitivity to
ntal status, autonomic instability, and neuromuscular
seminated
on intravascular coagulation.
include psychotherapy and/or pharmacotherapy.
wledged first, followed by a discussion of the diagnosis of
d autonomic dysregulation. Symptoms typically resolve
tractions. Cyproheptadine is used to decrease central
be motivated by internal factors, such as psychosocial
lfonylureas or insulin.
Trauma-focused cognitive-behavioral therapy and/or
d cognitive-behavioral therapy is the preferred initial
zodiazepines, medications that enhance the inhibitory effect
training and pharmacotherapy with antipsychotics,
a whispered voice test should be conducted. Audiometric
dressing modifiable risk factors. Aggressive treatment of
.should be differentiated from an experienced gender identity
diazepines
e behaviorsare theas
such treatment of comparing
checking, choice. with others, and
surgical treatments.
eristic. Presenting features include irritability, anorexia,
delusions, hallucinations) lasting between 1 day and 1 month.
h a fear of separation. Individuals often have symptoms of
or intimacy. Paranoid ideation often results in social anxiety
atment of bipolar depressive episodes includes the
quent distress. The most effective treatment is
ramate.
ky eating is accompanied by behavioral rigidity, poor growth,
nd actions. These behaviors must be present since early
e physician-patient relationship, it may manifest as difficulty
abdomen is indicated as part of the initial diagnostic
dications (e.g. levodopa, pramipexole), or a combination of
sidered.
e therapy and exposure techniques to help the patient
aumatic stress disorder. Trauma-focused cognitive-
ep, and trouble concentrating. Children with anxiety
prodromal phase marked by social withdrawal and academic
ary friends.
-night salivary cortisol assay, and overnight low-dose
ssion, alogia, social withdrawal, and diminished interest in

s. Self-injury is common but not required for diagnosis.
ve play, aiding in the development of emotional and social
velop as a result of prolonged exposure to antipsychotic
of psychosis.
ce the risk of relapse. It focuses on educating the family
vidual is still able to function in areas unrelated to the
ch can be treated with a low-potency, second-generation
oss may also occur. Glucocorticoid dose reduction, or
tion, and elevated pulse and blood pressure within 12-48
vomiting, diarrhea) signs. The treatment of choice is
sands
seenthat increases personality
in borderline with sympathetic activity.
disorder tend to fluctuate
ed speech. Signs of sympathetic stimulation (e.g.
other
iatric primary psychiatric
side effects disorders. include euphoria,
of glucocorticoids
ver, an abrupt change from baseline, together with
episode.
ncharacteristic angry
p. Manic patients mayoutbursts andand
feel rested aggressive
energetic behavior.
despite
rejection, and mood reactivity (ability to respond to positive
ed REM latency and slow-wave sleep, as well as increased
eatment (especially in combination) are likely to be effective.
h > 2 major depressive episodes.
ehavior.
based cognitive-behavioral therapy. Selective serotonin
epetitive behaviors or mental acts (compulsions) in response
ety
aticdisorders.
themes in play, rather than clearly formulated
r an antipsychotic agent. The benzodiazepine lorazepam is
blurting out of thoughts and frequent interruption of others.
uage appropriately. It can result in behavioral difficulties and
epression. Antidepressant monotherapy should be avoided
eare
context of a manic
common. Manic or major depressive
episodes episode.
may include psychotic
or depressive episodes. Lithium therapy should be
ng school-age years. Features include social awkwardness,
depression from adjustment disorder and normal adolescent
e, weight loss) may overlap with those of cancer and its
onsidered.
6 weeksBupropion,
essant. before considering the next dopamine
a norepinephrine step in treatment.
reuptake
ons and/or hallucinations, often with depressive themes.
s at 5 days and resolves within 2 weeks. Postpartum
d/or impairment. It is not diagnosed if a patient meets
particularly appropriate for severely depressed patients
severity of symptoms. Pervasive sadness and anhedonia
ent setting. Patients with active suicidal ideation and both a
mal
polarsensory
disorderperception. Food selectivity
or major depressive is common.
disorder. Catatonia is
disease is associated with high levels of 14-3-3 protein in the
osis is usually present as well, but normal pupil size does not
verse respiratory
commonly presentsdepression.
in children age 6-15 and may result in
nd social skill deficits. Accompanying features include facial
weating. Measurement of thyroid functioning is the first step
eatment.
tion, anxiety, dizziness) and late side effects (e.g. sexual
der. It is oftentypically
at response requires
accompanied by4-6 weeks ofwith
discomfort continued
the use.
an alleviate suffering and improve quality of life.

. Cosmetic
sive treatments
behaviors and surgery
are unplanned should
and out be avoided.
of proportion to the
se disorder. Acamprosate and naltrexone are first-line
ade amnesia with preserved long-term memory,
y in alcoholand
aphoresis usemay
disorder than in otherbymalnourished
be accompanied states.
anxiety and panic
nderlying
half-life medical
and lack ofcauses of psychiatricBenzodiazepines
active metabolites. symptoms. with
sk for toxic drug buildup.
or toxic epidermal necrolysis may occur in 0.1%. Any
ess, insomnia, palpitations, and tremors. Energy drinks
Among psychotherapies, cognitive-behavioral therapy and
AN consists of nutritional rehabilitation and psychotherapy.
ns and/or hallucinations. First-line treatment consists of an
uently improve with time. Patients with anxiety disorders are
mal
ng fordose.
the deceased, and maladaptive ruminative thoughts
ort that resolve after menses. It is not diagnosed when
premenstrual phase.
ould be monitored
onitoring every 6-12regularly,
months. especially at higher doses.
Lithium-induced
he patient's behavior and by an extensive inability to recall
erapy.
on (most commonly fall-winter onset and spring-summer
nia is distinguished from mania by less severity, no psychotic
opriate anger, impulsivity, and abandonment fears. Stress-
djunct toconcentrating,
difficulty psychotherapyirritability,
or to treatmuscle
comorbid disorders.
tension, and sleep
stressor. The diagnosis is appropriate when the patient does
icide attempts), or episodes lasting > 2 years are candidates
bipolar disorder. This is especially important prior to being
ntinuation to
attributed of loss
the offending
of semen.medication.
When evaluating culture-bound
festations, and consequences of a diagnosis
6 months duration. The differential given syndrome.
includes mood
epartment with acute psychosis. Standard workup of new-
generation antipsychotic (e.g. quetiapine) may be cautiously
orality, apathy, and executive dysfunction. Unlike Alzheimer
s differentiated from bulimia nervosa by the absence of
sm and a hypokalemic, hypochloremic metabolic alkalosis.
hmias, weakness,
nic disorder. muscle cramps,
Benzodiazepines are constipation).
reserved for patients who
he
oidsprevious level of
(e.g. heroin, functioning.
codeine). Semi-synthetic (e.g.
tected on standard testing.
in patients with history of substance use disorder to avoid
lidine. Dextromethorphan may cause a false-positive
oids.
der, or a legal history. Review of the state's prescription
g-term
therapyprescription opioid misuse. Fluoxetine is the drug of
and/or pharmacotherapy.
sity of suicidal thoughts. Confidentiality should not be
cludes cognitive-behavioral therapy and nutritional
ed in opioid-free patients without significant liver disease
episode of major depression accompanied by delusions
ion and hallucinations. These medications should be used
n again at times of transition, such as going to preschool.
essment.
disorder include inconsistencies in the patient's symptoms,
spiratory depression are seen, co-ingestion with other
e.g. neuropathies, anxiety, mood changes, psychosis), and
ommonlyinsomnia,
anxiety, in the firsttremors,
6 months of treatment.
psychosis, and seizures. In
s should be carefully screened for alcohol use disorder.
ory drugs - and lithium can increase serum lithium levels and
xcessively restrictive diets, or distorted body image should
a likely attempt has been made and the risk of further self-
me to their primary care provider with insomnia, fatigue, and
features include fatigue, hypersomnia, increased dreaming,
auses. Untreated obstructive sleep apnea can present with
ia and hallucinations. Physical signs of sympathetic nervous
ntion deficit hyperactivity disorder. An episodic (not chronic)
r mathematics). Dyslexia is a common learning disorder
o lithium can increase serum lithium levels and lead to
rtisol levels.
used cognitive-behavioral therapy can be beneficial for
ment. The initial approach involves providing nonjudgmental
atment to theatonia.
e of muscle individual's medical patients
If awakened, and mental healthfully
become needs.
alert
problematic
s, even if thehyperactive behavior.
initial symptoms are somatic, should be
appear during treatment or following antipsychotic dose
bility, and high fever. Serum creatine kinase and white blood
edtheasevening
a primary
withcause
earlyof NMS. awakening; and increased
morning
ssive symptoms that are subthreshold for diagnosing major
oms lasting for > 2 weeks should be evaluated for
e reuptake inhibitors are first-line treatments for post-
avoidance, and hyperarousal lasting > 3 days and < 1 month
reated with carbidopa-levodopa. Psychotic symptoms can
imavanserin).
ing to avoidance behavior. Exposure-based cognitive-
ns can cause serotonin syndrome. Switching from most
ring. Lorazepam and electroconvulsive therapy are the
hallucinations (e.g. bugs crawling under the skin). Other
c/hypnopompic
be differentiated hallucinations,
from non-REMsleep sleepparalysis).
terrors, which are
s such as medical disorders or substance use. Common
ion,from
efit andearly
epilepsy.
treatment with selective serotonin reuptake
are associated with metabolic effects to varying degrees.
ssociated
n syndrome. withTreatment
the lowestconsists
risk. of restarting a serotonergic
m of subcortical dementia found almost exclusively in
with transition or change. It is characterized by a marked fear
readiness to change. When the patient does not
personal
on SSRI goals.
therapy but have fatigue, weight gain, or a history
and lacrimation. Temperature is usually normal and delirium
gures. It does not involve the more severe violations of
set, and association with an underlying condition and/or
tients with comorbid depression and chronic pain, including
ncreased. Treatment options include reducing the dose,
y, delirium,
benztropine,
high or a benzodiazepine.
fever, autonomic instability, severe rigidity,
ymptoms and a history of high health care use. The
c disorder.
and generally
improve well tolerated.
outcomes. If there is any concern about ASD, a
as possible.
pressant monotherapy should be avoided in patients with
vior often accompanied by mood symptoms. Due to the high
school-aged
euphoria, children.
increased sexual desire, and empathy.
nd death may occur.
a first-line treatment for major depression with psychotic
and negative mood. A history of trauma, dissociative
characteristic perioral skin changes ('glue sniffer's rash').
lly associated with the use of a new medication.
ms,current
o underlying
including psychiatric
acute dystonia, illness.
parkinsonism, akathisia, and
ideal but not

alleviates requiredThe
self-blame. for hospitalization.
physician should be prepared to
nt.
hysicians cannot disclose information to family members
d to desire to refer the patient to another provider. Clear
ance abuse, and high levels of impulsivity. Parents of
It is effective as monotherapy or in combination with
ality. should include screening for depression by inquiring

ation
ance-only subtype, anxiety occurs only in performance-
not related to social anxiety).
cognitive-behavioral therapy.
ched to another first-line antidepressant. Options include a
siled > 2 antipsychotic

disorder drug trials. from malingering, in
should be differentiated
hotherapy
be weighedtoagainst
improve thetheir quality
efficacy of of life.
antidepressants and the
nt therapy.
avior related to the attacks. Some patients will develop
techniques is the preferred

mpact of delusional beliefs,treatment.
the individual is still able to
ort, it is important to acknowledge the patient's experience
erence after tolerability and dosage parameters are
medications. Symptoms include high fevers, lead-pipe
ntipsychotic dose reduction, treatment with benztropine or
grees. Routine monitoring for the development of these side
he greatest
nergy, risk. concentration, hypersomnia, and weight
impaired
. Normal stress reactions are distinguished by lower severity
o meet diagnostic criteria. Compared to normal grief, major
dal ideation.
chlevels
al food-drug combinations
should be given thecan result in hypertensive
opportunity to meet with crisis.
their
ion. This principle also applies to minors, even without
erized by fear, crying and/or screaming, and amnesia of the
n 1-2 years. which can lead to galactorrhea, amenorrhea,
olactinemia,
ears. Treatment with antidepressants and/or psychotherapy
onism, and control. It is differentiated from obsessive-
neurocognitive disorder) from normal age-related changes.
trse
do effects,
not impact activities
including of daily
acne, living.gynecomastia, hepatic
baldness,
stability. Stopping the causative medication is the most
es differentiation from other anxiety disorders that may
e. Psychomotor impairment, anxiety, and paranoia may also
the impact of the delusion or delusions, functioning is not
ed anxiety disorder that can also potentially treat comorbid
fail to respond
ong-acting to or cannot
injectable tolerate antidepressants.
antipsychotics are useful for patients
e-compulsive disorder.
nt with a history of persistent psychosis for > 2 weeks in the
th pure dysthymia and those with intermittent or persistent
.poor
Olanzapine
energy).and clozapine
However, carryare
if there theadditional
greatest symptoms
risk.
hreshold for beginning
current mood treatment.
episodes. Clinically effective medication
a.ng symptoms for at least 6 months: Restlessness, fatigue,

tact with family members. Minimizing conflict and stress in
ing acute response to reduce the risk of relapse. Patients
-behavioral therapy can also be used as a first-line
n or situation onto a 'safer', more acceptable object or
opposites.
be implemented on an involuntary basis if necessary.
a risk
to for generalized
ensure seizures
their safety by andthem
admitting confusion.
to a psychiatric unit
nt's beliefs. Once rapport is established, the patient should
atient relationship and limit diagnostic testing and
e with recognized neurological conditions. Conversion
drvosa, or bulimia nervosa.

decision-making abilities are determined to be intact at the
mfortable emotional components.

patient's perspective. This will help build rapport and
istress. Significant financial losses and damaged
value or notItneeded
a stressor for personal
is not diagnosed use.
if symptoms meet the criteria
oving coping skills and promoting a return to functioning.
nt has had at least 2 weeks of psychotic symptoms in the
s for a significant portion of the illness.
andering,
nal the specifier
nystagmus, of 'with tachycardia,
hypertension, dissociative fugue'
and is given.
sical signs include tachycardia, hypertension, hyperthermia,
rrhea, and pupillary dilation. These subjective symptoms are
dmission should be assessed for alcohol withdrawal.
ularly in patients
ensitivity withbeginning
to rejection comorbid in
liver disease. or early
adolescence
dividuals with avoidant personality disorder, who desire
stic of schizotypal personality disorder.
ar of being left to manage alone.
entitlement, and lackwith
familiarity. Patients of empathy.
this disorder typically exhibit
e hand, and electrolyte abnormalities. The binge-purge type
zures and is an indication for treatment with sodium
s any modifiable obstacles to treatment. If the patient still
ychotic and violent behavior, severe hypertension, and
ng should be suspected when a patient is reluctant to be
s and is associated with high levels of medical care
d recurrent suicidal behavior. Treatment involves
ements of the mouth, tongue, face, trunk, or extremities.
ozapine should be considered.
from bipolar I by hypomanic episodes (less severe, less
mptoms must last for > 1 month but < 6 months. The
rgo regular monitoring of absolute neutrophil counts due to
-behavioral therapy and selective serotonin reuptake
igh-potency first-generation antipsychotics and is best
Common side effects of stimulants include decreased
ide effects), making it a good choice for patients with weight
s-needed β blockers or benzodiazepines. Benzodiazepines
effects could impair
(neuroleptics). performance.
Patients who do not improve with cessation
ding and lower dopamine binding affinity of SGAs reduce the
h frequency of prolactin elevation. In comparison to
y impaired patients with panic disorder. Antidepressants and
mood episodes, the combination of lithium or valproate and
nts at therapeutic dosages for at least 4-6 weeks before
nifestations include truancy, lying for gain or to avoid
nstrual diary to determine the relationship of symptoms to
dwill
in conjunction with
often need to becounseling and
hospitalized forsupportive therapy.
stabilization and to
ust be > age 18 for diagnosis and have a history of conduct
kidneys and should generally be avoided in patients with
ects include hyperparathyroidism with hypercalcemia,
cularly if needed) to control behavioral disturbances.
s effectively.
hose with bulimia nervosa are normal weight to overweight.
derangements,
erapy and severelyMirtazapine
and antidepressants. low body weight.
is a preferred choice
hin 48 hours after the last drink. Unlike delirium tremens, it
ntarily for substance intoxication or mental illness. Consent
in unusual locations. Elderly individuals are also at risk for
Once the patient’s concerns and fears are identified, the
iving it. Gifts should not be accepted from patients
cords within a specified timeframe.

nal reactions and provide empathy and necessary support.
QID Subject System Topic
Common Variable Objective
Common variable immunodeficiency is characterized
19992 Pediatrics Allergy & I Immunodeficiency
X-Linked recurrent sinopulmonary infections
X-linked agammaglobulinemia should after
bepuberty
suspected andi
19834 Pediatrics Allergy & I Agammaglobulinemia
X-Linked deficient antibody response to vaccines
X-linked agammaglobulinemia as well as m
is an immunodeficienc
19631 Pediatrics Allergy & I Agammaglobulinemia
Hypogammaglobulinemi sinopulmonary infections, chronic enteroviral
Transient hypogammaglobulinemia of infancymeningis a se
19628 Pediatrics Allergy & I a nadir (age > 6 months). Patients may
Anaphylaxis is a life-threatening, multisystem disorde be asymptoma
17055 Pediatrics Allergy & I Anaphylaxis
Common Variable manifestations
Common variable include gastrointestinal,
immunodeficiency neurologic,
(CVID) is cause an
12519 Pediatrics Chronic Granulomatous adolescence
Allergy & I Immunodeficiency with recurrent
Chronic granulomatous sinopulmonary
disease is an X-linked andimmun
gastro
12518 Pediatrics Allergy & I Disease
Immunodeficiency to infections
Severe such as
combined Staphylococcus aureus
immunodeficiency presents in infan
4762 Pediatrics Allergy & I Disease Treatment requires urgent stem
Chronic Granulomatous Chronic granulomatous disease is caused by impaire cell transplantation.
4495 Pediatrics Allergy & I Disease neutrophil function
Preterm infants testing
should (e.g. routine
receive dihydrorhodamine
immunizations 12
4479 Pediatrics Allergy & I Immunizations patients,
Anaphylaxis,but mild intercurrent
unstable neurologic illness is not a and
disorders, contrain
ence
4258 Pediatrics Allergy & I Leukocyte
Immunizations
Adhesion acellular pertussis
Leukocyte adhesion vaccine
deficiencyare contraindications
presents with delayed for fu
4143 Pediatrics Allergy & I Deficiency Marked leukocytosis
Selective IgA deficiency withisneutrophil
the most common predominance primary is
3993 Pediatrics Allergy & I Selective IgA
Decision MakingDeficiency disease. With severe deficiency, production
Physicians must respect parents' medical decision fo of anti-Ig
3236 Pediatrics Allergy & I Capacity
Chronic Granulomatous refusing vaccination anddisease
Chronic granulomatous document the discussion
presents with recurre in
3198 Pediatrics Allergy & I Disease
Immunodeficiency burst
Severe (e.g. dihydrorhodamine
combined immunodeficiency testing)isisadiagnostic.
life-threaten
3197 Pediatrics Allergy & I Disease bacterial), and extremely low
Primary humoral immunodeficiency syndromes lymphocyte concentratiprese
3196 Pediatrics Allergy & I Hyper-IgM
X-Linked Syndrome by high IgM levels, low IgG and
X-linked (or Bruton) agammaglobulinemia presentsIgA, and normal lymp w
3195 Pediatrics Allergy & I Agammaglobulinemia absent. Hereditary angioedema results from deficiency or dys
2769 Pediatrics Allergy & I Angioedema
X-Linked associated
X-linked (orpruritus
Bruton)or urticaria.
agammaglobulinemia is characte
2134 Pediatrics Allergy & I Agammaglobulinemia lymphoid tissue and develop recurrent
Experimental studies (e.g. randomized control trials) sinopulmonary
20090 Pediatrics Biostatistic Case Control Studies
Infant Of Diabetic observational
systolic ejection studies
murmur do with
not provide
or without enough scientific
hypotension
20421 Pediatrics CardiovascuMother
Infant Of Diabetic age
(e.g.1propranolol),
due to normalization
which reduce of insulin
LVOT levels.
obstruction by
20006 Pediatrics CardiovascuMother the LVOT and aorta (due to reduction
Severe aortic coarctation, which increases in contractility)
left ventric
19977 Pediatrics CardiovascuAortic Coarctation
Ventricular Septal cardiogenic shock upon closure of
Ventricular septal defects (VSDs) cause left-to-rightthe ductus arterios s
16280 Pediatrics CardiovascuDefect the heart.
Aortic In infants,
coarctation canVSDs
present maywith present
acutewithheart tachypn
failure
11968 Pediatrics CardiovascuAortic Coarctation restores newborn
Routine systemic care bloodincludes
flow by screening
shunting blood from c
for critical
8820 Pediatrics CardiovascuNeonatal Evaluation infants.
A patent ductus arteriosus (PDA) is associated with a
4912 Pediatrics CardiovascuPDA Small PDAsisare
Myocarditis mostoften asymptomatic
commonly caused, and in detected
children, inc by
4854 Pediatrics CardiovascuMyocarditis cardiomegaly, hepatomegaly).
hypoxic, or 'tet' spells. Placement of patients in a kne
4842 Pediatrics CardiovascuTetralogy of Fallot hypoxemia.
Pericardial effusion can occur after cardiac surgery a
4826 Pediatrics CardiovascuPericardial Effusion
Ventricular Septal enlarged cardiac silhouette
Large ventricular septal defects on chestcause x-ray
growthis characte
failure,
4705 Pediatrics CardiovascuDefect
Congenital Cardiac an apical diastolic rumble due to increased
As the patent ductus arteriosus closes, ductal-depen blood flow
4661 Pediatrics CardiovascuDefects obstructed.
Vascular rings Prostaglandin
are congenital E1 maintains
malformations the patency
of the gro
4497 Pediatrics CardiovascuVascular
CongenitalRing
Cardiac improves with neck extension. Esophageal symptom
4260 Pediatrics CardiovascuDefects
Ventricular Septal Transposition of the great
The classic ventricular septalvessels
defect is murmur
a congenital cya
is a hars
3990 Pediatrics CardiovascuDefect and size with
Patients of the defect and
congenital longto rule out other defects.
QT syndrome are at risk M
3910 Pediatrics CardiovascuLong QT Syndrome and high sympathetic
Innocent cardiac murmurs activity.
resultβ blockers
from normal (e.g.blood
proprafl
3546 Pediatrics CardiovascuPhysiologic Murmur early or mid-systolic
Newborns with DiGeorge in timing.
syndromeManagement(22q11.2consists
microd
3545 Pediatrics CardiovascuDiGeorge Syndrome absent thymus. Patients are at risk
Patients with Turner syndrome are at increased risk for potentially life-f
3543 Pediatrics CardiovascuTurner Syndrome evaluate for bicuspid aortic valve, coarctation of the a
Tetralogy of Fallot can present with hypercyanotic 'te
3541 Pediatrics CardiovascuTetralogy of Fallot Squatting
Complete increases
atrioventricularafterload,
septal which
defect increases
is the mostblood co
3539 Pediatrics CardiovascuDown Syndrome ejection murmur due to increased
Kawasaki disease is characterized by > 5 days of fevpulmonary flow fro
3079 Pediatrics CardiovascuKawasaki Disease lymphadenopathy.
Patients with a history Echocardiogram
of acute rheumatic is indicated
fever arefor aa
2712 Pediatrics CardiovascuRheumatic
HypertrophicFever prevents streptococcal infections and
decrease outflow obstruction, thereby decreasing the limits the progr
2691 Pediatrics CardiovascuCardiomyopathy
Hypertrophic administration)
cardiomyopathycause (HCM)worsening
can lead of to LV
fataloutflow tract o
left ventricul
2688 Pediatrics CardiovascuCardiomyopathy young
Trisomy individual.
18 (Edwards syndrome) is characterized by
2468 Pediatrics CardiovascuTrisomy 18 common
Tetralogyinofthese Fallotpatients
presentsand presents
with with a holosy
hypercyanotic 'tet' sp
2429 Pediatrics CardiovascuTetralogy of Fallot the
Kawasaki disease is characterized by fever > 5 at
left upper sternal border reflects turbulence daysthe
2312 Pediatrics CardiovascuKawasaki Disease Laboratory
These patients findings
should thatalsosuggest
undergoinflammation
screening(e.g. echoc th
20325 Pediatrics DermatologyHemangioma anomalies)
Alopecia areata syndrome.
is characterized by patchy, painless
17143 Pediatrics DermatologyHair Loss conditions (e.g. autoimmune
Bedbug bites present as small, thyroid disease).
pruritic, Treatm
erythematous
16887 Pediatrics DermatologyInsect Bites and Stings supportive,
papules; but definitive
a roughened skin treatment
texture; requires
and mottled, eradicati
perif
16847 Pediatrics DermatologyKeratosis Pilaris salicylic
Tinea acid,most
pedis urea).commonly presents with a pruritic r
16834 Pediatrics DermatologyTinea
Skin and Soft Tissue scrapings. A variety
Bullous impetigo presents of topicalwithantifungal
enlarging,agents yellow(e.g.
fluid
16581 Pediatrics DermatologyInfections with oral antibiotics.
Pityriasis rosea is a self-limited exanthem that classic
13401 Pediatrics DermatologyPityriasis Rosea Management
Streptococcal is reassurance
perianal dermatitisalone, although
presents symptoc
in young
12765 Pediatrics DermatologyDiaper Dermatitis antibiotics.
Tinea versicolor is a common skin eruption character
12404 Pediatrics DermatologyTinea Versicolor noticeable
Scabies is an after sun exposure
intensely pruriticasrashthecharacterized
surrounding skin by
12357 Pediatrics DermatologyScabies is topical 5% permethrin or oral ivermectin.
12338 Pediatrics DermatologyMelanocytic nevus A congenital melanocytic nevus presents within the fi
10742 Pediatrics DermatologyChild Abuse Child
Tinea abuse
capitisinisthe form of deliberate
a superficial scald injuries
dermatophytosis that mo is
10553 Pediatrics DermatologyTinea
Henoch-Schönlein alopecia with inflammation,
Henoch-Schönlein purpura is lymphadenopathy,
an IgA-mediated and vascu sc
7764 Pediatrics DermatologyPurpura the most common
Seborrheic dermatitisrenalin manifestation.
infants is characterized by a
4711 Pediatrics DermatologySeborrheic Dermatitis First-line treatment options
Tinea corporis is a superficial include
fungalemollients and no
infection charact
4704 Pediatrics DermatologyTinea inspection
Superficial and can be
infantile confirmed with
hemangiomas are potassium
benign capillarhydr
4404 Pediatrics DermatologyHemangioma Complicated
Sun avoidance lesions
is themay bestrequire
form oftreatment with β blo
photoprotection. S
4313 Pediatrics DermatologySunburn as immediately
Eczema herpeticum after isswimming.
a primary herpes simplex virus
4104 Pediatrics DermatologyHSV Infection lymphadenopathy
Congenital dermal are typical.
melanocytosis is commonly found
3755 Pediatrics DermatologyDermal
ErythemaMelanocytosis
Toxicum usually fade spontaneously during childhood.
3122 Pediatrics DermatologyNeonatorum
Staphylococcal Scalded Erythema
Staphylococcal toxicum neonatorum
scalded is a benign
skin syndrome neonatal
is caused by r
2778 Pediatrics DermatologySkin Syndrome irritability, and skin
Atopic dermatitis in tenderness
infants presents is followed by general
with pruritus, and
2758 Pediatrics DermatologyAtopic Dermatitis children and adults. Topical emollients
Allergic contact dermatitis is caused by T cell-mediate are the first-lin
2756 Pediatrics DermatologyContact Dermatitis
Tracheoesophageal (e.g. poison ivy, nickel).
tube advancement beyond the proximal esophagus.
19194 Pediatrics Ear, Nose & Fistula anomalies), all patients
The eustachian tubes serve who to have TEF with
equalize EA shoul
pressure and
18424 Pediatrics Ear, Nose & Otitis Media tube dysfunction, including ear fullness/discomfort,
Otitis media with effusion (OME) is defined by middle he
18175 Pediatrics Ear, Nose & Otitis Media mobility.
Congenital Management
cytomegalovirus is observation
infection withis thefollow-up
most com fo
17170 Pediatrics Ear, Nose & Cytomegalovirus progressive
In children, aormidline,
delayed-onset,
cystic neck unilateral
mass that or bilateral
moves h w
17012 Pediatrics Ear, Nose & Thyroglossal Duct Cyst of the thyroid gland.
16980 Pediatrics Ear, Nose & Foreign Body
Recurrent Aspiration
Respiratory Unilateral, purulent rhinorrhea
Vertical transmission of humaninpapillomavirus
a young child subtyp is ofte
16392 Pediatrics Ear, Nose & Papillomatosis vocal
Choanal cords.
atresia is a congenital obstruction of the pos
16319 Pediatrics Ear, Nose & Choanal Atresia during feeding and improves when crying. The diagno
Acute rhinosinusitis presents with upper respiratory s
16142 Pediatrics Ear, Nose & Sinusitis bacterial rhinosinusitis in patients who are afebrile wi
16087 Pediatrics Ear, Nose & Laryngomalacia Laryngomalacia
Laryngomalacia presents is the most with inspiratory
common cause stridor due
of stridor
16086 Pediatrics Ear, Nose & Laryngomalacia and
Otitisimproves with prone positioning.
externa ('swimmer's ear') is a painful infection o
15994 Pediatrics Ear, Nose & Otitis Externa maceration, and introduction
Otitis externa ('swimmer's ear') of is
bacteria.
characterized by pa
15992 Pediatrics Ear, Nose & Otitis Externa antipseudomonal treatment is appropriate
After securing the airway in patients with epiglottitis, unless com i
15945 Pediatrics Ear, Nose & Epiglottitis species) and vancomycin (targeting Staphylococcus
Epiglottitis is a rare but potentially fatal infection that au
15942 Pediatrics Ear, Nose & Epiglottitis confirm the diagnosis
Cholesteatomas resultby fromrevealing an enlargedofepiglo
the accumulation kera
15148 Pediatrics Ear, Nose & Cholesteatoma conductive hearing loss, and examination
Repeated ear infections can result in conductive hea often revea
4090 Pediatrics Ear, Nose & Hearing Loss conducted in allfor
Oral antibiotics children
acute presenting
otitis mediawith social
should be or lan
admin
3972 Pediatrics Ear, Nose & Otitis Media indicated for persistent
Choanal atresia should or berecurrent
suspected infection.
in an otherwise
3872 Pediatrics Ear, Nose & Choanal Atresia the oropharynx is suggestive of the
Acute bacterial rhinosinusitis is distinguished from a vdiagnosis.
3285 Pediatrics Ear, Nose & Sinusitis Treatment
Otitis externais with oral antibiotics.
('swimmer's ear') is characterized by pa
3260 Pediatrics Ear, Nose & Otitis Externa canal can increase the risk.
Peritonsillar abscess is characterized The most by common patho
fever, phary
2847 Pediatrics Ear, Nose & Peritonsillar Abscess the uvula. Treatment involves needle aspiration or inc
2832 Pediatrics Ear, Nose & Mastoiditis Acute mastoiditisinischildren
Cholesteatomas a complication
can either of acute otitis medo
be congenital
2831 Pediatrics Ear, Nose & Otitis Media typical presenting
Acute otitis media,symptomsa commonofcause cholesteatomas,
of otalgia in andyou
2830 Pediatrics Ear, Nose & Otitis Media TM mobility).
Laryngomalacia presents in infants with inspiratory st
2432 Pediatrics Ear, Nose & Laryngomalacia structures
Epiglottitis during
presents inspiration.
with abrupt Concurrent gastroesoph
onset of fever, dysph
2196 Pediatrics Ear, Nose & Epiglottitis upright/forward positioning with neck
The differential diagnosis for polyuria and dilute urine hyperextension)
18554 Pediatrics Endocrine, DDiabetes Insipidus and primary polydipsia.
Galactosemia is characterized Following water
by the deprivation,
inability to metau
17281 Pediatrics Endocrine, DGalactosemia have vomiting,
aggravated jaundice, hepatomegaly,
by increasing growth hormone and levels at p
16721 Pediatrics Endocrine, DDiabetes Mellitus abnormalities.
for prolonged exercise, basal insulin should be decre
16709 Pediatrics Endocrine, DDiabetes Mellitus intake, particularly
Nutritional if training sessions
rickets classically occurs in are > 60 minut
exclusively bre
16223 Pediatrics Endocrine, DRickets (widened wrists, radial/ulnar bowing).
Galactosemia is an inborn error of metabolism that p Lower extremit
16118 Pediatrics Endocrine, DGalactosemia
Congenital Adrenal product of galactose,
Classic congenital leadshyperplasia
adrenal to cataracts.occurs Managemen
due to
16030 Pediatrics Endocrine, DHyperplasia (46,XX) have
Precocious virilized
puberty is genitalia
the onset(e.g. underdeveloped
of secondary sexual
13626 Pediatrics Endocrine, DPrecocious Puberty maturation.
Gaucher disease is a lysosomal storage disease with
12495 Pediatrics Endocrine, DInfant
Gaucher Disease
of Diabetic pain, failure
Fetal to thrive,during
hyperglycemia and hepatosplenomegaly.
the first trimester is assoc Pres
12423 Pediatrics Endocrine, DMother birth injury, and hypoglycemia.
uptake of phosphorus, potassium, and magnesium, leNeonatal hypoglycem
8871 Pediatrics Endocrine, DRefeeding Syndrome complications
Constitutional involve
growth delay the muscular (e.g. weakness,
is characterized by shortr
4830 Pediatrics Endocrine, DShort Stature height
Diabetic is ketoacidosis
typically normal. (DKA) presents with polyuria, a
4514 Pediatrics Endocrine, DDiabetic
CongenitalKetoacidosis
Adrenal metabolic acidosis.
Non-classic congenital adrenal DKA is characterized
hyperplasia byisana osmo
cause
4239 Pediatrics Endocrine, DHyperplasia cystic acne), accelerated growth
Central (gonadotropin-dependent) precocious pubert and bone age, and l
3875 Pediatrics Endocrine, DPrecocious Puberty Patients
Precocious withpuberty,
central the PP onset
requireofan MRI of the
secondary brainch
sexual t
3868 Pediatrics Endocrine, DPrecocious Puberty activation
Prematureofadrenarche
the hypothalamic-pituitary-gonadal
is caused by early activation axis oa
3867 Pediatrics Endocrine, DPrecocious Puberty axillary
congenitalhair,hypothyroidism,
acne, and bodybut odor
theinmajority
a child with a nor
of infants
3721 Pediatrics Endocrine, DHypothyroidism worldwide.
Infants with congenital hypothyroidism initially appear
3662 Pediatrics Endocrine, DHypothyroidism
Congenital Adrenal umbilical
Deficiencyhernia. For this reason,
of 21-hydroxylase screening
is the most commonnewborns ca
3600 Pediatrics Endocrine, DHyperplasia
Glycogen Storage hydroxyprogesterone levels are
Glucose-6-phosphatase deficiency (type I glycogen s diagnostic.
3192 Pediatrics Endocrine, DDisease hyperuricemia, and hyperlipidemia.
disability, fair complexion, eczema, and Patients typically
a musty or 'm
3123 Pediatrics Endocrine, DPhenylketonuria health and development.
Craniopharyngiomas are benign, slow-growing tumor
2648 Pediatrics Endocrine, DCraniopharyngioma hemianopsia
Thelarche (typicallyand signs the offirstpituitary
sign ofhormone
puberty) deficienc
is norma
19190 Pediatrics Female ReprPuberty early stages of puberty.
The adolescent well-child visit should include contrac
16614 Pediatrics Female ReprContraception provider-patient
Von Willebrand disease relationship and to decrease
is a common bleedingthe rate
disord
12279 Pediatrics Female ReprVon Willebrand Disease and PT are
Primary normal, activated
amenorrhea is the absencePTT may be normal by
of menarche or
9566 Pediatrics Female ReprTurner Syndrome characteristics.
Patients with Turner The first step in have
syndrome management is a pel
primary amenor
9563 Pediatrics Female ReprTurner Syndrome estrogen
Prepubertal on girls
the hypothalamic-pituitary-ovarian
with vaginal foreign bodies typically axis r
4870 Pediatrics Female ReprV aginal Foreign
Abnormal Body anesthetic application and either vaginal irrigation wit
Uterine
4769 Pediatrics Female ReprBleeding In adolescents
Mammary glandwho have recently
enlargement, undergone
leukorrhea, andmenarc
mild u
4244 Pediatrics Female ReprNeonatal Evaluation estrogen exposure. No work-up
Fibroadenoma is the most common cause of breast mis indicated.
4242 Pediatrics Female ReprB Androgen Insensitivity decrease
reast Mass Patients within mass size or
androgen tenderness.
insensitivity syndrome are ge
4217 Pediatrics Female ReprSyndromes bilateral cryptorchid testes;
Primary amenorrhea in patients with short therefore, management
stature anin
4142 Pediatrics Female ReprTurner Syndrome which results
Müllerian in low estrogen
agenesis, levels. These
failure of Müllerian ductlow estrog
developm
3911 Pediatrics Female ReprAmenorrhea ovarian orgynecomastia
Pubertal external genital development.
is common Therefore,
in adolescent boyp
3783 Pediatrics Female ReprG ynecomastia
Abnormal Uterine The condition usually resolves within a year.
3773 Pediatrics Female ReprBleeding The
The most common pill
levonorgestrel cause(i.e.ofPlan
vaginal
B) arebleeding
a readilyin the
avail n
3241 Pediatrics Female ReprContraception seeking pregnancy prevention
Ectopic pregnancy, which occurs options
whenmay receive c
a developing
2421 Pediatrics Female ReprEctopic Pregnancy bleeding. Therefore, all commonly
Primary dysmenorrhea reproductive-ageoccurs women
in adolesce with
2395 Pediatrics Female ReprD ysmenorrhea
Abnormal Uterine cramping and other
In adolescents, associated
the immature symptoms (e.g. fatigu
hypothalamic-pituitary-o
2390 Pediatrics Female ReprBleeding vaginal
Primarybleeding
amenorrhea is managed with high-dose
is the absence of menarcheoral contin g
2388 Pediatrics Female ReprAmenorrhea distinguishes between central (low/normal
Necrotizing enterocolitis is a life-threatening condition FSH) and
19996 Pediatrics GastrointestiNecrotizing Enterocolitis premature
Toxic megacoloninfants.can Initial management
develop is bowel rest,
as a complication of ini
19826 Pediatrics GastrointestiToxic Megacolon are typicallylactase
Secondary ill-appearing
deficiency with caused
fever, abdominal
by intestinal disten
ep
19783 Pediatrics GastrointestiLactose Intolerance diarrhea, crampy abdominal pain,
Hirschsprung disease typically presents in neonates and bloating.
19683 Pediatrics GastrointestiHirschsprung Disease bowel loops).
expulsion of gas Contrast
and stool enema is performed
on rectal to identify
examination is cl
19669 Pediatrics GastrointestiHirschsprung Disease proximally dilated colon.
Splenic rupture presents with acute abdominal pain, a
19656 Pediatrics GastrointestiSpleen Rupture mononucleosis,
A button battery alodged viral infection associatedcan
in the esophagus with splen
cause
17857 Pediatrics GastrointestiForeign Body Ingestion autoimmune
battery, and management
thyroiditis) areisatimmediate
particularly endoscopic
high risk. P r
16584 Pediatrics GastrointestiCeliac Disease confirmed
Biliary serologically
atresia with anti-tissue
is characterized transglutamin
by progressive fibrosis
16271 Pediatrics GastrointestiBiliary Atresia hyperbilirubinemia. Diagnostic evaluation
Biliary atresia is the fibrosis and obliteration of extrah of biliary an
16270 Pediatrics GastrointestiBiliary Atresia (leading
Vascularto paleencircle
rings stools) theandtrachea
accumulates
and/orinesophagus
the blood
16101 Pediatrics GastrointestiVascular Ring recurrent food impactions.
Although most cases of intussusception are idiopathi
15592 Pediatrics GastrointestiMeckel Diverticulum those outside the typical age range. Meckel diverticu
13552 Pediatrics GastrointestiEsophagitis Eosinophilic
Intussusception esophagitis
is an abdominalpresentsemergency.
with dysphagia,Affected ep
12517 Pediatrics GastrointestiIntussusception Abdominal ultrasound
Giardia duodenalis is diagnostic
disrupts and reveals
the epithelial a targ
tight junctio
12415 Pediatrics GastrointestiChronic Diarrhea to a month. Left
Constipation is auntreated,
common chronic problemgiardiasis
in toddlers candueresultto
8955 Pediatrics GastrointestiConstipation polyethylene glycol) should be initiated
The rotavirus vaccine effectively prevents most cases promptly to so
8951 Pediatrics GastrointestiIGastroesophageal
mmunizations complication.
Gastroesophageal reflux is common in infants due to
4926 Pediatrics GastrointestiReflux Disease should be reassured by the infant's adequate weight
4925 Pediatrics GastrointestiAcute Diarrhea Moderate to severe
Jejunal atresia presentsdehydration
with biliousin children
vomitingshould
and abd be
4890 Pediatrics GastrointestiIntestinal Atresia and
Colicother vasoconstrictive
is a diagnosis of exclusionsubstances.
characterized by cry
4856 Pediatrics GastrointestiColic includes reassurance and review of soothing techniqu
4851 Pediatrics GastrointestiIntussusception Intussusception
Niacin (vitamin B3) presents
deficiencyin children
causesage 6-36 months
pellagra, which
4839 Pediatrics GastrointestiNiacin Deficiency dementia. Severe cases can be fatal.
Meckel diverticulum often presents in young toddlers
4838 Pediatrics GastrointestiMeckel Diverticulum pertechnetate
If bilirubin levels scan,
are which
below can identify ectopic
the phototherapy gastric
threshol
4818 Pediatrics GastrointestiNeonatal Jaundice supply is inadequate,
Breastfeeding jaundicesupplementation
manifests as unconjugatedwith cow's mil hy
4817 Pediatrics GastrointestiNeonatal Jaundice stooling, which leads to suboptimal
Vitamin B2 (riboflavin) is a water-soluble vitamin that bilirubin eliminatio
4302 Pediatrics GastrointestiRiboflavin Deficiency a malnourished
Gastroschisis is patient with angular
an abdominal cheilitis,
wall defect stomatit
lateral to th
4290 Pediatrics GastrointestiGastroschisis Management includes neonatal
Meconium ileus is due to inspissated meconium and surgical correction.
4183 Pediatrics GastrointestiCystic Fibrosis level
Biliaryofatresia
the ileum. Meconium ileus
is characterized is virtually
by fibrosis of the diagnos
extra
3970 Pediatrics GastrointestiBiliary Atresia hepatomegaly. Diagnosis is with
Failure to thrive and recurrent respiratory symptomscholangiography, an
3926 Pediatrics GastrointestiCystic Fibrosis resulting in steatorrhea,
Beckwith-Wiedemann vitamin deficiencies,
syndrome and poo
(BWS) is characteriz
3835 Pediatrics GastrointestiW ilms Tumor Pyloric
Hypertrophic with BWS
Infantile are at increased
hypertrophic pyloricrisk of developing
stenosis presentsWilms with pt
3465 Pediatrics GastrointestiStenosis metabolic
When > 2 alkalosis.
magnets are Treatment
ingestedconsists of intravenou
and identified in the
3417 Pediatrics GastrointestiForeign Body Ingestion Reyenecrosis, and perforation.
syndrome presents with vomiting, encephalopa
3194 Pediatrics GastrointestiR eye Syndrome
Hypertrophic Pyloric children with viral
Infantile hypertrophic infection.
pyloric stenosis is most commo
3078 Pediatrics GastrointestiStenosis Abdominal ultrasonography
Biliary cysts are congenital or confirms
acquired the diagnosis.of
dilatations
2945 Pediatrics GastrointestiBiliary Cyst characteristic
Reye syndrome findings. Biliary cysts
is a dangerous require surgical
complication in childre
2896 Pediatrics GastrointestiReye Syndrome mental status changes
Celiac disease results inare typical
small manifestations
intestinal malabsorptio of f
2773 Pediatrics GastrointestiCeliac Disease herpetiformis.
The ingestion of a sharp foreign body is associated w
2656 Pediatrics GastrointestiForeign Body Ingestion object
Suspect in vitamin
the esophagus,
A deficiency stomach,
in a 2or orproximal
3-year-old duode
child
2480 Pediatrics GastrointestiVitamin A Deficiency and follicular hyperkeratosis of the
deficiency anemia. Iron supplementation should be s shoulders, buttock
2479 Pediatrics GastrointestiIron Deficiency Anemia started
Breastfed on infants
vitaminhave D supplementation.
a decreased risk of developin
2478 Pediatrics GastrointestiBreastfeeding lower rates of type 1 diabetes
Physiologic jaundice of the newborn mellitus is and childhood
a common, be
2475 Pediatrics GastrointestiNeonatal Jaundice clearance, and increased enterohepatic
Necrotizing enterocolitis should be suspected in newb recycling.
2474 Pediatrics GastrointestiNecrotizing Enterocolitis hypotension,
Hirschsprung and congenital
disease is due heart disease.
to failure The crest
of neural hallm
2467 Pediatrics GastrointestiHirschsprung Disease obstruction
Meconium ileus (e.g. should
abdominal distension,inabsent
be suspected newborns rectal
wi
2466 Pediatrics GastrointestiCystic Fibrosis obstruction).with
Malrotation Most newborns
midgut volvuluswithusually
meconium ileus in
presents han
2465 Pediatrics GastrointestiVolvulus perforation.
Food An upper gastrointestinal
protein-induced allergic proctocolitis contrast
should study
be i
2464 Pediatrics GastrointestiMilk Protein Allergy and soy products(i.e.
Intussusception or switching
telescoping to bowel)
a hydrolyzed
is mostformulcomm
2463 Pediatrics GastrointestiIntussusception abdominal mass is not always present.
Bilious emesis and abdominal distension in a preterm
2456 Pediatrics GastrointestiN ecrotizing Enterocolitis
Cyclic Vomiting and portal venous
In children, recurrent, air. self-limiting episodes of profuse
2453 Pediatrics GastrointestiSyndrome identifiable
Duodenal atresia triggers is (e.g. stress,
strongly infection)
associated or a
with person
Down sy
2452 Pediatrics GastrointestiIGeneral
ntestinalSafety
Atresia surgical repair.
Airway foreign bodies are most common in toddlers d
19252 Pediatrics General PrinConcerns choke,
Childrenincluding hot dogs,
should remain in apeanuts,
rear-facing wholecargrapes,
seat as an lo
19251 Pediatrics General PrinCar Safety Seat
Screening And as determined by the manufacturer.
Early recognition and treatment of depression can pr There is no abso
19249 Pediatrics General PrinSurveillance depression.
Hypotonia is a common finding in neonates with Dow
15506 Pediatrics General PrinDown Syndrome upslanting
Cardiac sequelaepalpebral fissures, adisease
of Kawasaki protruding tongue,
include coronan
15468 Pediatrics General PrinKawasaki Disease or treatment delay.
14852 Pediatrics General PrinKawasaki Disease
Developmental Kawasaki disease presents with fever lasting > 5 day
12515 Pediatrics General PrinMilestones Disorders
Healthy infants of speech
normally(e.g.losedelayed
up toarticulation)
7% of birth weigh and la
7726 Pediatrics General PrinNeonatal Weight Loss by
Developmental age 10-14
Children age 9days.months should be able to grasp objec
4823 Pediatrics General PrinMilestones 18 months. Delayed verbal milestones should be ass
Developmental By age 12 months, an infant's weight triples and heig
4822 Pediatrics General PrinMilestones
Developmental pincer
A healthy grasp, saying 1 infant
6-month-old word other
should than
be 'mama'
able to sitandmo 'd
4199 Pediatrics General PrinMilestones
Intraosseous Vascular Primitive
Intraosseous Morolines
andcan grasp be reflexes disappear
placed rapidly when before
emerg 6
3418 Pediatrics General PrinAccess and patience
Epiglottitis than central
is most commonly venous
due access.
to Haemophilus infl
2845 Pediatrics General PrinEpiglottitis muffled voice, drooling, and stridor.
2433 Pediatrics General PrinEnuresis
Peutz-Jeghers Bedwetting
Peutz-Jeghers is normal
syndrome beforeis aage 5. Mastery
genetic conditionof nightti
chara
20076 Pediatrics Hematology Syndrome an increased risk for malignancy. Upper
Splenic sequestration is a potentially life-threatening and lower en
19731 Pediatrics Hematology Sickle Cell electrophoresis.
Splenic sequestration RBCscrisis become is a entrapped withincomp
life-threatening the
19690 Pediatrics Hematology Sickle Cell hypovolemic shock. Treatment
Exchange transfusion focusesofonischemic
is the treatment the restorastr
19672 Pediatrics Hematology Sickle Cell hyperviscosity, thereby limiting further
Penicillins and cephalosporins can cause drug-induce occlusion.
19139 Pediatrics Hematology Hemolytic Anemia acute anemia tumor
Spontaneous and signs lysisofsyndrome
hemolysiscan (e.g. jaundice,
occur in patie
18771 Pediatrics Hematology Tumor Lysis Syndrome due to the formation of uric acid and calcium-phosph
16134 Pediatrics Hematology Hodgkin Lymphoma Prolonged
isolated fever and
urticaria that lymphadenopathy
improves with transfusion (particularly
cessa s
15680 Pediatrics Hematology Blood Transfusion transfusion can be resumed
Glucose-6-phosphate without additional
dehydrogenase deficiency evalua
is a
15640 Pediatrics Hematology G6PD Deficiency
Hemolytic Uremic medications such as nitrofurantoin should be avoided
15584 Pediatrics Hematology Syndrome Treatment
Patients with of chronic
infections due to thrombocytopenia
immune Shiga toxin-producing have
15567 Pediatrics Hematology ITP repeated pharmacologic interventions
Inhibitor development occurs in 25% of patients with (e.g. glucocort
15494 Pediatrics Hematology Hemophilias bleeding
β-thalassemia frequency.
major is characterized by increased he
15472 Pediatrics Hematology Thalassemia risk for iron overload.
The presence of γ tetramers Therefore, chelation Barts)
(hemoglobin therapy onish
15459 Pediatrics Hematology Thalassemia count, and target
Iron studies cells on peripheral
are performed smear.
prior to hemoglobin electr
15458 Pediatrics Hematology Thalassemia
Hereditary thrombocytosis) and concomitant
splenomegaly, and a family history suggestive of hemthalassemia (e.g. G
15406 Pediatrics Hematology Spherocytosis
Hereditary concentration and negative
Hereditary spherocytosis direct
(HS) is an Coombs
inherited test.
disorde
Acute Lymphoblastic elevated mean corpuscular hemoglobin
Acute lymphoblastic leukemia often presents with bru concentration
15320 Pediatrics Hematology Leukemia
Acute Lymphoblastic lymphadenopathy and hepatosplenomegaly.
15319 Pediatrics Hematology Leukemia Bone pain and pancytopenia
Neuroblastoma is a childhoodinmalignancy
a child are derived
concerning fro
14443 Pediatrics Hematology Neuroblastoma characteristic features include periorbital ecchymoses
4876 Pediatrics Hematology Iron Deficiency Anemia Excessive cow's
Thalassemia minor milk consumption
typically presents (> with
24 oz/day)
microcytic com
4875 Pediatrics Hematology Thalassemia the anemia.
Iron deficiency anemia is common in infants and todd
4858 Pediatrics Hematology Wiskott-Aldrich
Iron Deficiency Anemia red blood cell count
Wiskott-Aldrich are also
syndrome seen.
is an Treatment
X-linked disorder consist
cha
4847 Pediatrics Hematology Syndrome and is characterized by a significant
Hydroxyurea is used in patients with sickle cell diseas reduction in plate
4825 Pediatrics Hematology Sickle Cell increase
Polycythemia in fetal hemoglobin,
is defined which dilutes
as a hematocrit the>amoun
level 65%
4819 Pediatrics Hematology Polycythemia organ perfusion and can cause respiratory
Acute hemolytic transfusion reaction is an uncommon distress, h
4671 Pediatrics Hematology Blood Transfusion hemoglobinuria
Sickle cell disease within 1 hourcauses
normally of transfusion
normocytic,initiation.
hem
4468 Pediatrics Hematology Folic Acid Deficiency deficiency, a macrocytic anemia with an inappropriate
4439 Pediatrics Hematology Sickle Cell Sickle
Fanconi cell disease
anemia is the
is the most
most common
common cause
cause of of ped
conge
4438 Pediatrics Hematology Aplastic Anemia stature, thumb anomalies, and abnormal skin pigmen
4359 Pediatrics Hematology Splenectomy Howell-Jolly bodies are nuclear remnants within red b
4342 Pediatrics Hematology Sickle Cell Pneumococcal
Osteonecrosis, vaccination
or avascularplus penicillin
necrosis, is aprophylaxis
common c
4341 Pediatrics Hematology Sickle Cell joints, leukocytosis, or elevated inflammatory
Hemophilic arthropathy is a consequence of recurren marker
4249 Pediatrics Hematology Hemophilias arthropathy
Patients withiscysticreduced by prophylactic
fibrosis are at risk for treatment
fat-soluble withv
4187 Pediatrics Hematology Cystic Fibrosis
Hemolytic Uremic the activation
Hemolytic of coagulation
uremic factors II,occurs
syndrome typically VII, IX,inand X.
childre
3896 Pediatrics Hematology Syndrome hemolytic anemia with schistocytes on peripheral sm
Patients with sickle cell disease can develop aplastic
3838 Pediatrics Hematology Sickle Cell common cause.arises from neural crest cells, which a
Neuroblastoma
3824 Pediatrics Hematology Neuroblastoma chain can present as
Diamond-Blackfan isolated
anemia is aHorner syndrome
congenital, (i.e. cp
pure red
3818 Pediatrics Hematology Aplastic Anemia triphalangeal thumbs.
3787 Pediatrics Hematology Sickle Cell Most patients which
Hydroxyurea, with sickle
works cell
bytrait lead normal,
increasing health
fetal hemog
3786 Pediatrics Hematology Sickle Cell with a dose-limiting side effect of myelosuppression (
3785 Pediatrics Hematology Sickle Cell Dactylitis
Anemia ofcan be the earliest
prematurity is the manifestation
most commonofcause vaso-oc of
3774 Pediatrics Hematology Preterm Newborn studies show decreased hemoglobin
Splenic sequestration crisis, or pooling of red blood c and hematocrit
3713 Pediatrics Hematology Sickle Cell splenomegaly
Howell-Jolly bodies in youngare patients. Laboratory
nuclear remnants of testing
red blood
3647 Pediatrics Hematology Sickle Cell expected findings on peripheral
Immune thrombocytopenia smear.
typically presents with iso
3440 Pediatrics Hematology ITP
Hemolytic Uremic spontaneously and require
Hemolytic uremic syndrome is characterizedobservation alone,byregard
the tr
3438 Pediatrics Hematology Syndrome
Hemolytic Uremic diarrhea caused
Hemolytic uremicby Escherichia
syndrome, coli O157:H7
which is most commonlor, less
3437 Pediatrics Hematology Syndrome
Acute Lymphoblastic anemia,
Acute thrombocytopenia,
lymphoblastic leukemia andis acute
the most kidney
commoninjury.ca
3284 Pediatrics Hematology Leukemia
Hereditary the diagnosis.
Hereditary spherocytosis, caused by a defect of red b
3282 Pediatrics Hematology Spherocytosis hemolytic anemia
Aplastic anemia should with an beincreased
suspectedmean in any corpuscula
patient w
3200 Pediatrics Hematology Aplastic Anemia with fatty infiltration.
and activation of coagulation factors II (prothrombin),
3089 Pediatrics Hematology Vitamin K Deficiency laboratory evaluation
The characteristic reveals findings
laboratory prolonged PT with
of iron or w
deficienc
2875 Pediatrics Hematology Iron Deficiency Anemia
Hereditary decreased transferrin saturation,
Hereditary spherocytosis typicallyand increased
manifests as atotal
tria
Acute Lymphoblastic hyperbilirubinemia, spherocytosis,
Acute lymphoblastic leukemia is most commonly see and family history
2867 Pediatrics Hematology Leukemia blasts on peripheral
Hemarthrosis smeartrauma
after minor and bone marrow biopsy
is suspicious for a b
2426 Pediatrics Hematology Hemophilias
Community Acquired PT, and normal platelet count.
Community-acquired pneumonia in school-aged child
19838 Pediatrics Infectious D Pneumonia fever, prolonged
many forms cough,CAP,
of bacterial and patients
bilateralwith
crackles on lung
19837 Pediatrics Infectious D Mycoplasma
Rocky Mountain azithromycin
and ankles, involvesis first-line; β-lactams areand
the palms/soles, ineffective
then spreabeca
19832 Pediatrics Infectious D Spotted Fever important laboratoryisclues.
Miliary tuberculosis caused Empiric doxycycline shou
by lymphohematogeno
19349 Pediatrics Infectious D Tuberculosis and spleen.
Primary It is most
pulmonary common among
tuberculosis infantsbeand
(TB) should im
suspe
19348 Pediatrics Infectious D Tuberculosis
Group B Streptococcal effusion),
Streptococcusparticularly
agalactiaeif they haveBrisk
(group factors for TB e
Streptococcus
19311 Pediatrics Infectious D Infection
Molluscum onset infection
Molluscum most commonly
contagiosum, a benignpresents at age 4-5com
skin infection wee
19310 Pediatrics Infectious D Contagiosum typically
Acute HIVreassurance
infection often andcauses
observation.
unexplained fever, m
19266 Pediatrics Infectious D HIV causes of these symptoms have been excluded.
19170 Pediatrics Infectious D Amebiasis
Group B Streptococcal Travel-associated
Group B Streptococcus diarrheais thelasting > 2 weekspathogen
most common is most
18960 Pediatrics Infectious D Infection ray shows
Purpura is diffuse alveolar opacities,
a late manifestation often with pleura
of meningococcal me
18596 Pediatrics Infectious D Meningococci consumption. Laboratory
Antimicrobial chemoprophylaxis against evidence of DIC includes th
18593 Pediatrics Infectious D Meningitis onset untilmeningitidis
Neisseria 24 hours after appropriate
reproduces antibiotic
primarily initiati
in the nas
18592 Pediatrics Infectious D Meningitis ordered for all potentially infected patients
Viral encephalitis typically presents with altered ment until they h
18465 Pediatrics Infectious D Encephalitis suggestive of herpes simplex virus encephalitis.
18411 Pediatrics Infectious D Otitis Media Risk
Acutefactors for developing
otitis media with tympanic acutemembrane
otitis media(TM) includeper
18164 Pediatrics Infectious D Otitis Media amoxicillin-clavulanate
Norovirus is the most common gastroenteritis in thehU
is indicated in a patient who
17748 Pediatrics Infectious D Acute Diarrhea abdominal
Campylobacter pain gastroenteritis
1-2 days after is exposure.
most commonlyTreatment causis
17637 Pediatrics Infectious D Acute Diarrhea mild and self-limited,
Travelers' diarrhea isrequiring
a generally symptomatic care only.
mild, self-limited illn
17499 Pediatrics Infectious D Acute Diarrhea sanitation. Enterotoxigenic Escherichia
supportive care and close follow-up in well-appearing coli
17494 Pediatrics Infectious D Acute Diarrhea Escherichia
Bronchiolitiscoli is aO157:H7.
viral lower respiratory tract infection
17488 Pediatrics Infectious D Bronchiolitis and treatment is supportive (e.g. nasal saline and suc
Acute, unilateral cervical lymphadenitis in children typ
17427 Pediatrics Infectious D Lymphadenopathy causative
Neonatal sepsisorganisms in patients
typically causeswith a historysymptom
nonspecific of perio
17310 Pediatrics Infectious D Neonatal Sepsis ampicillin
Pertussis and gentamicin
is a highly to treatinfection
contagious the mostcharacterize
common p
16770 Pediatrics Infectious D Pertussis transmission
Untreated acute and,bacterial
in somerhinosinusitis
cases, may shortencan leadillness
to in
15725 Pediatrics Infectious D Sinusitis status, and/or focal neurologic changes. Urgent CT s
12458 Pediatrics Infectious D Acute Diarrhea Gastroenteritis caused by Shigella
Postexposure prophylaxis sonnei
is indicated forpresents
newborns acb
12341 Pediatrics Infectious D Chicken Pox specific immunoglobulin
Nontyphoidal Salmonella to is the infants, cause
a common who are of too
bacte yo
12310 Pediatrics Infectious D Acute Diarrhea usually begin within
Characteristic features 3 days and include
of congenital fever, vomitin
cytomegalovirus
12292 Pediatrics Infectious D Cytomegalovirus contact with infected
The prevalence body fluids
of measles (e.g. reduced
has been saliva) and tran
drastic
12267 Pediatrics Infectious D Immunizations small fraction of patients
The varicella-zoster virusmay develop
vaccine a fever and mi
is recommended fo
12260 Pediatrics Infectious D Immunizations that is mild but contagious.
Cat-scratch disease, caused by Bartonella henselae
11984 Pediatrics Infectious D Bartonella the setting of cat exposure are sufficient to make a cl
9849 Pediatrics Infectious D Herpangina
Retropharyngeal Herpangina is caused by Coxsackie virus infection. It
4891 Pediatrics Infectious D Abscess Retropharyngeal
Brain abscess frequently
abscess in children in childrenpresents
presentswith withhe fe
4865 Pediatrics Infectious D Brain Abscess hematogenous spread of bacteria.
Congenital syphilis presents with nonspecific signs of
4852 Pediatrics Infectious D Syphilis highly suggestive
Acute bacterial of congenital
rhinosinusitis syphilis
should be include
considered snuffl in
4850 Pediatrics Infectious D Sinusitis are viral upper respiratory infections
Orbital cellulitis can be differentiated from preseptal cand allergic rhini
4845 Pediatrics Infectious D Orbital Cellulitis severe infection that
Acute, unilateral can lymphadenitis
cervical lead to permanent is anvisual
infectionim
4843 Pediatrics Infectious D Lymphadenopathy (e.g. clindamycin)
The most commonshould causestarget themeningitis
of viral most common are ente ba
4833 Pediatrics Infectious D Meningitis normal
Rabies to is aslightly elevated protein,
fatal, neurotropic and normal
viral disease glucos
transmitted
4814 Pediatrics Infectious D Rabies an incubation period of 1-3 months, patients develop
4734 Pediatrics Infectious D Rubella Congenital
Ticks should rubella
be removedsyndrome withpresents with cataracts,
a small forceps as soo
4662 Pediatrics Infectious D Lyme Disease doxycycline) for Lyme disease
Staphylococcus aureus and Streptococcus pyogenesis not required.
4353 Pediatrics Infectious D Lymphadenopathy markedly tender. Suppuration
Palpable cervical lymph nodesisare common.
common in childre
4351 Pediatrics Infectious D Lymphadenopathy lymph nodes can be observed for
Meningococcal meningitis presents most commonly i resolution.
4265 Pediatrics Infectious D Meningitis shock. Cerebrospinal
All nonimmune, fluid shows
asymptomatic, evidence
healthy of bacteri
patients age >
4186 Pediatrics Infectious D Herpes Zoster receive fever
Scarlet the varicella
is caused vaccine
by groupshould receive varicella
A Streptococcus
3969 Pediatrics Infectious D Scarlet Fever prominent along
Macrolides skin folds (e.g.are
(e.g. azithromycin) axillae, groin) and
the first-line medic oft
3906 Pediatrics Infectious D Pertussis of immunization
Pertussis shouldstatus.
be suspected with paroxysmal coug
3905 Pediatrics Infectious D Pertussis years.
A monoarticular effusion of the knee in an adolescen
3900 Pediatrics Infectious D Lyme Disease juvenile arthritis,aureus
Staphylococcal and serum is thesickness,
most common all of pathogen
which are
3830 Pediatrics Infectious D Cystic Fibrosis
Intestinal Helminth pneumonia in adults
Pinworm infection and contributes
typically presents to life-threatening
with nocturnal pe
3791 Pediatrics Infectious D Parasites 'tape
Neonatal tetanus can occur in infants bornortopyrantel
test'. Treatment is with albendazole unimmu
3788 Pediatrics Infectious D Tetanus spasms, and hypertonicity. Treatment
Congenital toxoplasmosis classically presents with includes antibidi
3676 Pediatrics Infectious D Toxoplasmosis cat feces or raw or undercooked
Group B Streptococcus (GBS) is the most common ca meat.
3671 Pediatrics Infectious D Meningitis intrapartum
HIV infectionantibiotics,
in infancy but these with
presents measures
failure do not de
to thrive,
3670 Pediatrics Infectious D HIV suggestive
Maternal-fetal of HIV, and PCRofreaction
transmission the rubellatesting
virus confirms
is mos
3663 Pediatrics Infectious D Rubella defects (e.g. patent ductus arteriosus),
Gonococcal conjunctivitis occurs in infants born to un and cataracts
3660 Pediatrics Infectious D Neonatal Conjunctivitis
Skin And Soft Tissue Prophylactic erythromycin ophthalmic ointment admin
3642 Pediatrics Infectious D Infections Nonbullous impetigo
Sickle cell disease is characterized
(SCD) causes functionalby papules
asplenia and
3640 Pediatrics Infectious D Sickle Cell receive
Bacterialvaccination
meningitis and penicillin
in infants prophylaxis.
presents with fever Pneumand
3633 Pediatrics Infectious D Meningitis and properly manage bacterial meningitis.
Intestinal Helminth
3612 Pediatrics Infectious D Parasites
Infectious Enterobius
Acute airway vermicularis
obstruction(pinworm)is a rare but infection is highly
potentially fatal
3611 Pediatrics Infectious D Mononucleosis oropharyngeal inflammation and severe
Septic arthritis should be suspected when a patient tonsillar enlah
3577 Pediatrics Infectious D Septic Arthritis drainage and intravenous
Staphylococcal aureus and Salmonella antibiotics are needed to p
3571 Pediatrics Infectious D Sickle Cell clindamycin) and gram-negative
Bordetella pertussis causes whooping (e.g. ceftriaxone) cove
cough, a vaccine
3458 Pediatrics Infectious D Pertussis
Infectious whoop. Physical
Infectious examination
mononucleosis may reveal
is most commonlyevidence
causedof in
3444 Pediatrics Infectious D Mononucleosis hepatosplenomegaly.
Acute rheumatic fever Aispolymorphous,
a complication maculopapula
of untreated
3443 Pediatrics Infectious D Rheumatic Fever migratory arthritis.
3442 Pediatrics Infectious D Adrenal Insufficiency In an infant withmeningitis
Meningococcal meningococcemia,
is a common watch out for
cause Wa
of bac
3441 Pediatrics Infectious D Meningitis rapidly
Malaria(over
should 12-24 hours), and
be suspected in the
anydisease canespec
ill patients, be co
3423 Pediatrics Infectious D Malaria be orderedcellulitis
Preseptal for parasite is an detection and quantification.
infection located anterior to th N
3326 Pediatrics Infectious D Preseptal Cellulitis
Laryngotracheobronchiti does not cause visual changes, ophthalmoplegia, pai
3288 Pediatrics Infectious D s Croup is a viral
Nontypeable illness most
Haemophilus commonly caused by par
influenzae,
3286 Pediatrics Infectious D Sinusitis presentsiswith
Rubella a mild> 10 days that
illness of persistent
presents nasal discharge
with low-grade
3266 Pediatrics Infectious D Rubella adults, especially females, may also
Staphylococcal aureus causes foodborne illness due to have arthralgias
3250 Pediatrics Infectious D Acute Diarrhea may not be present. Colonized food handlers usually tra
3077 Pediatrics Infectious D Measles The
Mumpstreatment
presents of measles
with feverisand supportive;
parotitis.however,
Althoughvita m
3009 Pediatrics Infectious D Mumps
Infectious more common in older or unvaccinated
Infectious mononucleosis is characterized by prolong individuals.
3007 Pediatrics Infectious D Mononucleosis 3-4 weeks due to the risk of splenic rupture.
3005 Pediatrics Infectious D Osteomyelitis Osteomyelitis
Newborns of mothers is a bacterial infection
of hepatitis of the(HBV)
B virus bone infec
that
2906 Pediatrics Infectious D Hepatitis B of birth. is a mild illness characterized by low-grade fe
Rubella
2783 Pediatrics Infectious D Rubella spreads
Measles cephalocaudally.
is characterized by Forchheimer
a prodromespots (erythe
of cough, co
2782 Pediatrics Infectious D Measles transmitted by the airborne route.
Varicella (chickenpox) is characterized by successive
2768 Pediatrics Infectious D Herpes Zoster widespread
Septic arthritisimmunization with a 2-dose
should be suspected series. with a
in children
2447 Pediatrics Infectious D Septic Arthritis surgical drainage.
The prodrome of measles includes fever, cough, cory
2431 Pediatrics Infectious D Measles pathognomonic
Neonatal sepsisof and measles.
meningitis Following
presentthe prodrome,
with nonspec
2428 Pediatrics Infectious D Neonatal Sepsis stable neonates
Group A Streptococcus with suspected sepsis, blood,
(GAS) pharyngitis presentsurine,wi
2193 Pediatrics Infectious D Mucocutaneous
Pharyngitis always be(i.e.
Balanitis confirmed
inflammation by rapid streptococcal
of the glans penis) antigen
is comt
20351 Pediatrics Male ReprodCandidiasis discharge is present, and budding yeast on potassium
17298 Pediatrics Male ReprodPenile Injury Hematuria in thetesticular
Intra-abdominal setting oftorsion
direct penile
shouldtrauma is con
be suspecte
16083 Pediatrics Male ReprodCryptorchidism
Congenital Adrenal palpation.
Congenital adrenal hyperplasia is most commonly du
16029 Pediatrics Male ReprodHyperplasia
Hypospadia and Excess androgen
Hypospadias leads to virilization
is characterized (e.g. underdeve
by a ventrally displaced
16028 Pediatrics Male ReprodEpispadia
Hypospadia and needed
Severe hypospadias is characterized by a urethralcirc
for hypospadias repair, and conventional m
15987 Pediatrics Male ReprodEpispadia indicative of a disorder of sex development
Cryptorchidism, or an undescended testis, is ideally c and warra
8956 Pediatrics Male ReprodCryptorchidism However, even after surgery,
Newborn hydroceles typically the risk of
present testicular
with painless gers
2373 Pediatrics Male ReprodHydrocele spontaneously by age 1 year.
19606 Pediatrics MiscellaneouPatient Safety The Plan-Do-Study-Act
CHARGE syndrome (coloboma, and Plan-Do-Check-Act
heart defects, atresipara
16322 Pediatrics MiscellaneouChoanal Atresia be diagnosed
Short stature, clinically
amenorrhea, in theand newborn period.
aortic coarctation are
4765 Pediatrics MiscellaneouTurner Syndrome dysgenesis.
Characteristic features of Turner syndrome include w
4764 Pediatrics MiscellaneouTurner Syndrome
Sexually Transmitted presents at birth with non-pitting carpal and pedal ed
4140 Pediatrics MiscellaneouInfection Screening Sexually
Friedreichactive
ataxiawomen age < 25 are at increased
is a neurodegenerative disorder tha risk
3985 Pediatrics MiscellaneouFriedreich Ataxia (e.g. arrhythmia, congestive heart failure) due to hype
Kallmann syndrome is a disorder of migration of fetal
3912 Pediatrics MiscellaneouAmenorrhea secretion, patients have hypogonadotropic hypogona
3871 Pediatrics MiscellaneouPrecocious Puberty McCune-Albright syndrome is characterized by periph
3821 Pediatrics MiscellaneouPrader-Willi Syndrome The
Marfanmain featuresisofan
syndrome Prader-Willi
autosomalsyndrome dominant are hypo
disorder
3686 Pediatrics MiscellaneouMarfan Syndrome hypermobility;
Duchenne muscular upward lens dislocation;
dystrophy presentsand withaortic
grossroo m
3669 Pediatrics MiscellaneouDuchenne Dystrophy
Henoch-Schönlein creatine kinase, and genetic analysis
Henoch-Schönlein purpura (HSP) is an IgA-mediated typically confirm
3554 Pediatrics MiscellaneouPurpura with HSP are
Duchenne at increased
muscular dystrophy risk for ileoileal
should intussusce
be suspected
3544 Pediatrics MiscellaneouDuchenne Dystrophy protein expression
Infants with Edwards within the muscle.
syndrome (trisomy 18) common
2488 Pediatrics MiscellaneouTrisomy 18 and rocker-bottom feet. The mortality
Sydenham chorea is an autoimmune complication rate in the first of
20307 Pediatrics Nervous SysChorea antigens in the basal ganglia. Neuropsychiatric
Apnea of prematurity is caused by immature respirato manif
20276 Pediatrics Nervous SysRespiratory Physiology additional
Abusive head testing is required
trauma should in beasuspected
well-appearing in aninfan
infa
20077 Pediatrics Nervous SysChild Abuse includes CT scan of the head to detect
Athletes with possible cervical spine injury should hav subdural hem
19272 Pediatrics Nervous SysSpinal Cord Injury radiographically.
Retinitis pigmentosa is a genetic condition resulting in
19038 Pediatrics Nervous SysRetinitis Pigmentosa examination
Migraines aremay show retinal
classically episodic, pigment deposition
unilateral, in a
throbbin
19006 Pediatrics Nervous SysMigraine acetaminophen) and a triptan (e.g.
Microcephaly refers to head circumference > 2 stand sumatriptan) in re
18788 Pediatrics Nervous SysMicrocephaly next step is
Tuberous to measure
sclerosis complexparental is anhead circumference
inherited neurocuta
18787 Pediatrics Nervous SysTuberous Sclerosis
Sturge-Weber can manifest later in life. Other characteristic
Glaucoma in infants typically presents with tearing, features p
18737 Pediatrics Nervous SysSyndrome
Von Hippel-Lindau congenital anterior chamber angle
Von Hippel-Lindau disease, an autosomal dominant c anomaly. Evaluati
18700 Pediatrics Nervous SysDisease hemangioblastomas,
Tuberous sclerosis complex pheochromocytomas,
(TSC) is an autosomal and renad
18696 Pediatrics Nervous SysTuberous Sclerosis cell tumors in the brain
Myelomeningocele is anand open cardiac
neuralrhabdomyomas.
tube defect in w
18665 Pediatrics Nervous SysHydrocephalus displacement
Macrocephaly is a head circumference > 97ththrough
of the medulla and cerebellum percen
18664 Pediatrics Nervous SysHydrocephalus syndromic features, no signs of increased
Hydrocephalus (excess cerebrospinal fluid) causes v intracrania
18663 Pediatrics Nervous SysHydrocephalus and developmental delay.
A cephalohematoma In patients
is a collection ofwhose anterior
blood between
18604 Pediatrics Nervous SysScalp Hematomas scalp swelling that does not cross suture lines. Mana
18582 Pediatrics Nervous SysHerpes Zoster
Intraventricular The classic
Preterm triad of are
newborns herpes zoster oticus
at increased (i.e.
risk of Ramsay
developing
18572 Pediatrics Nervous SysHemorrhage Because
Hemorrhagic IVH stroke
can bepresents
asymptomatic, with suddenall preterm neon
headache,
18571 Pediatrics Nervous SysHemorrhagic
Post ConcussionStroke malformation (AVM)).
Post-concussion syndromeHead is CT scan of a ruptured
characterized by prolon AV
18456 Pediatrics Nervous SysSyndrome patients improve
Concussion withinby
is caused 3 months.
rapid rotational acceleration
18429 Pediatrics Nervous SysConcussion emotional changes)
Concussion, or mild without
traumatic evidence of structural
brain injury, is characte int
18426 Pediatrics Nervous SysConcussion cognitive and physical rest for 24-48
Imaging should be avoided in children with minor hea hours, followed
18425 Pediatrics Nervous SysConcussion injury, vomiting
Concussion is aor severe
form headache,
of mild traumatic signs
brain ofinjury
basilar re
18284 Pediatrics Nervous SysConcussion amnesia associated with abnormalities
because they may lack other typical findings of menin in coordinatio
18061 Pediatrics Nervous SysSeizures mental status.
Craniopharyngiomas are benign, slow-growing, calcif
17518 Pediatrics Nervous SysBrain Tumors stalk compression
Choroid plexus papilloma can causeis a panhypopituitarism
benign intraventricular (e.g
17517 Pediatrics Nervous SysHydrocephalus hydrocephalus
excessive daytime presents with enlarging
sleepiness, are a common,head circumfe
yet oft
17088 Pediatrics Nervous SysMyotonic
IdiopathicDystrophy
Intracranial behavioral issues.
Although idiopathic intracranial hypertension typically
16456 Pediatrics Nervous SysHypertension and vision hemorrhage
Subgaleal abnormalitiesis(e.g. caused blurryby vision, enlarged
the shearing of v
16407 Pediatrics Nervous SysScalp Hematomas galea
ICH can cause obstructive hydrocephalus, leading tos
aponeurotica, causing diffuse, fluctuant scalp
16273 Pediatrics Nervous SysHydrocephalus hypertension).
Chiari I malformation is characterized by inferior disp
16250 Pediatrics Nervous SysChiari Malformation frequently asymptomatic,
Tuberous sclerosis complex presentation
should be may occur in
suspected in aa
16245 Pediatrics Nervous SysTuberous Sclerosis Associated tumors include subependymal
Pallid breath-holding spells are triggered by fear or pa nodules an
16073 Pediatrics Nervous SysBreath Holding Spells sleepiness and confusion. Diagnosis is clinical and re
In Rett syndrome, a period of normal development is
15794 Pediatrics Nervous SysRett Syndrome disturbance.
Signs of increasedOther intracranial
features include pressurebreathing
in youngabnorm
chil
15238 Pediatrics Nervous SysHydrocephalus ventriculomegaly, mass effect, and impending
Among patients with meningitis, a viral etiology is sug hernia
15232 Pediatrics Nervous SysMeningitis concentration.
Friedreich ataxia Mumps virus is capable
is an autosomal of causing
recessive, neurode vira
15219 Pediatrics Nervous SysFriedreich Ataxia vibratory
Sydenham sense
chorea,andaproprioception
sequela of group alsoAoccur due to
Streptococc
13756 Pediatrics Nervous SysChorea Hypotonia
Sensorineural andhearing
behavioral losschanges
is the most are common
commonly se
sequ
12291 Pediatrics Nervous SysCytomegalovirus symptomatic
Posterior fossa CMVtumors(e.g.typically
hepatosplenomegaly,
present with signs jaundicof
11981 Pediatrics Nervous SysBrain Tumors
Developmental common posterior fossa tumors are
Normal development of an 18-month-old child include pilocytic astrocyt
7741 Pediatrics Nervous SysMilestones
Developmental sign of gross motor
Two-year-old children delay.
with appropriate language dev
4874 Pediatrics Nervous SysMilestones stranger
Breath-holding spells aretogenerally
should be able understand at least
benign and half
charaof
4872 Pediatrics Nervous SysBreath Holding Spells these spells are typically harmless and children still d
4871 Pediatrics Nervous SysHydrocephalus Increasing
Simple febrile head circumference
seizures are typicallyand benign
signs ofandincrease
occur
4841 Pediatrics Nervous SysFebrile Seizure unnecessary,
Seizures and management
are characterized is withloss
by sudden supportive
of conscioca
4378 Pediatrics Nervous SysSeizures
Guillain-Barré occur with tonic-clonic
Guillain-Barré syndrome movements.
most commonly presents wi
4271 Pediatrics Nervous SysSyndrome (e.g. spirometry) of
Direct spread of bacteria fromforced vitalotitis
capacitymedia and negative
(OM) or m
4248 Pediatrics Nervous SysBrain Abscess neurologic deficits. Diagnosis is confirmed
Todd paralysis is a transient, focal weakness or para by visualiz
4155 Pediatrics Nervous SysSeizures
Cervical Artery self-limited and usually resolve within 36 hours.
4117 Pediatrics Nervous SysDissection Posterior oropharyngeal injuries can result in internal
4049 Pediatrics Nervous SysNeurofibromatosis Neurofibromatosis
Sudden infant death type 1 is a genetic
syndrome (SIDS)condition
refers to assoc
the u
3907 Pediatrics Nervous SysSIDS firm bedding, and room-sharing without
Lesch-Nyhan syndrome is caused by a deficiency in bed-sharing.
3817 Pediatrics Nervous SysLesch-Nyhan Syndrome progress
intellectual todisability,
chorea, dystonia,
downward andlens spasticity in early
dislocation, andc
3687 Pediatrics Nervous SysHomocysteine events.
phonophobia; nausea; vomiting; and a visual, auditor
3672 Pediatrics Nervous SysMigraine
Intraventricular management.
IntraventricularTriptans
hemorrhage may be is atried if these
common measure
complicatio
3666 Pediatrics Nervous SysHemorrhage head
Parinaudcircumference.
syndrome occurs in most patients with pine
Guillain-Barré Pineal
Guillain-Barrétumors
gland syndrome can also cause
typically persistent
presents withheada
ascen
3664 Pediatrics Nervous SysSyndrome pathogenesis of this syndrome is
Myotonic dystrophy is an autosomal dominant disord the immune-mediat
3661 Pediatrics Nervous SysMyotonic Dystrophy and
In hand muscles),
children, low-grade dysphagia,
astrocytomas and cardiac conducti
are the most com
Intraventricular cortex.
The primary risk factor for intraventricular hemorrhag
3657 Pediatrics Nervous SysGuillain-Barré
Hemorrhage as well asillness
Diarrheal signs of acute
(e.g. blood loss (e.g.
Campylobacter jejunianemia, tac
3630 Pediatrics Nervous SysSyndrome ascending weakness and hyporeflexia.
Patients with neurofibromatosis type 1 are Other commo
at increas
3550 Pediatrics Nervous SysNeurofibromatosis evaluates
Abusive head for an intracranial
trauma mass.common cause of d
is the most
3396 Pediatrics Nervous SysChild Abuse traction, resulting
a lucid interval. in subdural
Rapid hematoma and expansion
retinal hemorrhage
leads to
3297 Pediatrics Nervous SysEpidural Hematoma pupillary dilation, contralateral hemiparesis).
injury, vomiting or severe headache, signs of basilar
3218 Pediatrics Nervous SysConcussion skull fracture.
jaundice, vomiting, hepatomegaly, and possibly seizu
3193 Pediatrics Nervous SysGalactosemia substances in urine, whichpresents
Idiopathic Intracranial Intracranial hypertension suggests galactosuria.
with headache, vis
3081 Pediatrics Nervous SysHypertension
Sturge-Weber derivatives (e.g. isotretinoin)
Sturge-Weber syndrome is a neurocutaneous can cause increased int
disorde
2763 Pediatrics Nervous SysSyndrome venous
Seizure malformations
should be considered affectinginthe anybrain andwith
patient eye.anSe e
2680 Pediatrics Nervous SysSeizures perioral cyanosis, evidence of tongue
Neurofibromatosis type 1 (NF1) is an autosomal dom biting, and urin
2669 Pediatrics Nervous SysNeurofibromatosis increased risk of seizures,
Cephalohematoma learning disabilities,
is a subperiosteal hemorrhage andth o
2472 Pediatrics Nervous SysScalp Hematomas assisted
descending deliveries
flaccid increase
paralysis.the The risk of developing
diagnosis shouldce b
2469 Pediatrics Nervous SysBotulism been fed honey. Human-derived botulism
Niemann-Pick disease type A is due to sphingomyelin immune glo
2445 Pediatrics Nervous SysNiemann-Pick milestone regression. Although Tay-Sachs disease p
Fetal alcohol syndrome is one of the most common p
2444 Pediatrics Nervous SysFetal Alcohol Syndrome palpebral
Cerebral palsyfissures,is a smooth philtrum, motor
non-progressive and thin vermilio
dysfunctio
2443 Pediatrics Nervous SysCerebral Palsy (e.g.
Hearinghypertonia,
loss is a hyperreflexia).
common sequela of
2442 Pediatrics Nervous SysMeningitis as
Fragile X syndrome, anhearing
possible to identify X-linked loss and improve
disorder due to outco
a trin
2441 Pediatrics Nervous SysFragile X Syndrome motor delays, findings include a long
Friedreich ataxia is an autosomal recessive, neurode face, prominent
2439 Pediatrics Nervous SysFriedreich Ataxia testing reveals originate
Focal seizures an excessive number
in a single of trinucleotide
cerebral hemisph
2280 Pediatrics Nervous SysSeizures respond
Optic nerve injuries (e.g. contusion, avulsion) may se
to external stimuli. In contrast to absence oc
19127 Pediatrics OphthalmoloOcular Trauma relative afferent pupillary defect in
Lens dislocation typically occurs after blunt trauma tothe injured eye.
19041 Pediatrics OphthalmoloOcular Trauma echocardiography
Orbital compartment to detect
syndrome associated
causes aortic
eye pain rootand
dis
19040 Pediatrics OphthalmoloOcular Trauma eyelid, proptosis)
Photokeratitis is an and an afferent
acute corneal pupillary
injury duedefect. Ma
to ultravi
19039 Pediatrics OphthalmoloOcular Trauma exposure
Myopia, orfor severe, bilateraliseye
nearsightedness, pain and photopho
characterized by incre
18897 Pediatrics OphthalmoloRefractive Errors&
Dacryostenosis risk of retinal detachment and macular
Congenital nasolacrimal duct obstruction is typically d degeneration.
17225 Pediatrics OphthalmoloDacryocystitis of the eyelashes
Strabismus (ocular butmisalignment)
clear conjunctivae. presents Initial
with manag
eye d
17184 Pediatrics OphthalmoloRetinoblastoma detect retinoblastoma,
Amblyopia is a functional a life-threatening
reduction in thecause visualofacuit
stra
17179 Pediatrics OphthalmoloAmblyopia normal eye, amblyopia from an uncorrected
Allergic conjunctivitis is an IgE-mediated hypersensiti refractive
12664 Pediatrics OphthalmoloConjunctivitis allergen avoidance and topical therapy (e.g. antihista
8784 Pediatrics OphthalmoloOrbital Cellulitis Symptoms of orbitalatcellulitis
Vision is evaluated include proptosis,
every well-child visit, as earlyophthd
4531 Pediatrics OphthalmoloVision Screening well as in cooperative 3-year-olds.
Neurofibromatosis type 1 is a genetic disorder that ca
4202 Pediatrics OphthalmoloNeurofibromatosis develop
Chlamydial optic pathway gliomas,
conjunctivitis typically which oftenatmanifest
presents age 5-1
3758 Pediatrics OphthalmoloNeonatal Conjunctivitis therapy (e.g. azithromycin) because
errors and strengthening the affected eye by patching topical treatmen
3711 Pediatrics OphthalmoloStrabismus visual acuityor
Leukocoria, of white
the deviated
pupillaryeye. reflex, in an infant or yo
3681 Pediatrics OphthalmoloRetinoblastoma other red flags.
Gonococcal conjunctivitis presents in the first 2-5 day
3329 Pediatrics OphthalmoloGonococcal Infection Prevention
Trachoma isisdue achieved by thewith
to infection application
Chlamydia of atrachoma
topical
2857 Pediatrics OphthalmoloConjunctivitis causes
Many commoninversion of the eyelashes
medications and scarring ofeye
(e.g. cyclopentolate the
20488 Pediatrics Poisoning & Anticholinergics inhibitor,
Drowned may be considered
patients often require to treat severesupport
respiratory anticholinto
20184 Pediatrics Poisoning & Drowning mechanical ventilation should
Patients with stings from Hymenoptera be performed.
20066 Pediatrics Poisoning & Insect Bites and Stings cm inexhaustion
Heat size) contiguous with the site
is characterized byofhyperthermia
the sting. (ty
19385 Pediatrics Poisoning & Heat Related Illness unlike botulism
Infant in exertional occurs heatinstroke.
childrenManagement
age < 1 afterincludeexpos
13219 Pediatrics Poisoning & Botulism constipation, irritability, oculobulbar weakness (e.g. a
12418 Pediatrics Poisoning & Methemoglobinemia Patients with acquired
Methemoglobinemia symptomatic
presents methemoglobine
with cyanosis after exp
12417 Pediatrics Poisoning & Methemoglobinemia the administration of oxygen; however,
Targeted screening for elevated blood lead levels PaO2 is norm
sho
4837 Pediatrics Poisoning & Lead Poisoning capillary testing, repeat testing by
Patients with acute iron poisoning have abdominal pa venous blood draw
3827 Pediatrics Poisoning & Iron Poisoning
Organophosphate Laboratory
bronchospasm, evaluation
musclereveals an anion gap metabolic
fasciculations/weakness, diar
3134 Pediatrics Poisoning & Poisoning irrigation of skin) to prevent cutaneous
Acute iron poisoning can occur after accidental inges absorption an
2655 Pediatrics Poisoning & Iron Poisoning the primarystudy
diagnostic therapy.of choice to evaluate the extent of in
2378 Pediatrics Poisoning & Caustic
Small forIngestion
Gestational cause
Fetal growth restrictiondamage.
further mucosal (FGR) is characterized by est
18795 Pediatrics Pregnancy, CAge most
Neonatal herpes simplex virus infectioninsufficiency
commonly due to uteroplacental typically resu (e
12200 Pediatrics Pregnancy, CHSV
SmallInfection
for Gestational weeks
Small for 2-3gestational
of life with age seizure
infantsandhave temporal
a weightlobeunder
hem
4889 Pediatrics Pregnancy, CAge
Infant of Diabetic hypothermia,
Excessive maternal and hypocalcemia.
hyperglycemia causes fetal hype
4223 Pediatrics Pregnancy, CMother brachial nerve palsy,
Immediate routine neonatal clavicleresuscitation
fracture). includes dry
4174 Pediatrics Pregnancy, CNeonatal Evaluation warmth and allows
Fetal hydantoin early breastfeeding
syndrome results from in initiation.
utero expos
2572 Pediatrics Pregnancy, CTeratogens palate, and distal phalangeal hypoplasia.
Birth weight > 4 kg, shoulder dystocia, and vacuum d
2485 Pediatrics Pregnancy, C Clavicle
Child And Adolescent clavicular
Fracture Physiciansfractures
are in a heal unique rapidly without
position complications
to answer adolesc
19056 Pediatrics Psychiatric/ Mental Health normalizing discussions of sex, removing
In children and adolescents with depression, conside stigma and
15895 Pediatrics Psychiatric/ Suicide
Child And Adolescent has possible
Pediatric major thoughts
depression of suicide must undergo
may present emerg
with irritabilit
15894 Pediatrics Psychiatric/ Mental Health
Attention Deficit should betreatment
First-line considered. for attention deficit hyperactivity d
15854 Pediatrics Psychiatric/ Hyperactivity Disorder
Autism Spectrum tolerability.
Impaired development of joint attention is a key featu
15143 Pediatrics Psychiatric/ Disorders
Attention Deficit and poor response-to-name when called.
15121 Pediatrics Psychiatric/ Hyperactivity
Developmental Disorder The non-stimulant atomoxetine is an appropriate trea
15118 Pediatrics Psychiatric/ Milestones Stranger
Rett syndromeanxietyoccursis a normal
mainlypart of development
in girls and is character cha
15092 Pediatrics Psychiatric/ Rett Syndrome after a period
Language of normal
disorder development.
is common Seizures are
and characterized byc
15091 Pediatrics Psychiatric/ Language Disorder
Reactive Attachment limited vocabulary,
Early childhood abuse sentence structure
or neglect and functional
can result in disrupt
15047 Pediatrics Psychiatric/ Disorder of emotional and social withdrawal
New-onset psychosis in an adolescent with neurologi as well as a lack o
15046 Pediatrics Psychiatric/ Wilson Disease transport,
Suicide is leading
a leading tocause
copperofaccumulation in the liver
death in adolescents an
9848 Pediatrics Obsessive Compulsive locking unloaded firearms and ammunition in separat
Psychiatric/ Suicide
8923 Pediatrics Psychiatric/ Disorder First-line
It is normal treatment
for curious of pediatric obsessive-compulsive
young children to touch their o
4924 Pediatrics Psychiatric/ Sexual Abuse
Developmental typically brief, intermittent, and distractible. Age-inapp
4898 Pediatrics Psychiatric/ Milestones Normal
Neonatalcreative
abstinence and healthy
syndrome behaviors
is caused for by
young
infantchil
w
4893 Pediatrics Psychiatric/ Opioids
Attention Deficit sleeping, tremors, seizures, sweating,
The diagnosis of attention deficit hyperactivity disorde sneezing, tach
4855 Pediatrics Psychiatric/ Hyperactivity Disorder important
Patients with toolTourette
for assessing behavior
syndrome haveinhighthe rates
schoolofen p
3760 Pediatrics Psychiatric/ Tourette Syndrome
Impulse Control disorder.
Pyromania is characterized by intentional and repeat
3386 Pediatrics Psychiatric/ Disorders pleasure or relief.
3384 Pediatrics Psychiatric/ Anxiety Trichotillomania
Children with selective is a behavioral
mutism are disorder
verbalcharacterize
at home bu
3380 Pediatrics Psychiatric/ Selective Mutism
Autism Spectrum prevent long-term educational and
Autism spectrum disorder is characterized by abnorm social impairment.
3379 Pediatrics Psychiatric/ Disorders language and intellectual ability may be diagnosed la
3375 Pediatrics Psychiatric/ Tourette Syndrome
Autism Spectrum Treatment
Children with options
impaired for Tourette disorder include
social communication, habit
restrict
2516 Pediatrics Psychiatric/ Disorders
Physician Patient intellectual
Autism spectrum impairmentdisorder mayshould
be present.
be suspected in chi
2471 Pediatrics Psychiatric/ Communication
Attention Deficit physicians
A diagnosisshould take adeficit
of attention sensitive approachdisorder
hyperactivity that con
2470 Pediatrics Psychiatric/ Hyperactivity Disorder Apnea
to academic difficulty,isADHD
of prematurity caused often results in impaired
by immature central r
20277 Pediatrics Pulmonary &Respiratory Physiology Hypoxic-ischemic
ventilation and caffeine. brain injury (e.g. drowning) can lea
20198 Pediatrics Pulmonary &Drowning
Neonatal Respiratory Cushing
Bronchopulmonary dysplasiaby
triad, characterized is hypertension,
a chronic complicatiobradyc
20121 Pediatrics Pulmonary &Distress Syndrome findings
Necrotizinginclude a decreased
enterocolitis shouldnumber and septation
be suspected in an eo
19998 Pediatrics Pulmonary &Necrotizing
Respiratory Enterocolitis
Syncytial intestinalis on abdominal
Viral bronchiolitis typicallyx-ray is diagnostic.
presents in children age <
19296 Pediatrics Pulmonary &Virus
Obstructive Sleep findings include peribronchial cuffing, increased inters
17967 Pediatrics Pulmonary &Apnea Obstructive sleep apneacirculatory
Transfusion-associated in childrenoverload
can present can with
occu
17425 Pediatrics Pulmonary &Blood Transfusion respiratory
The risk of pneumothorax is increased in premature pn
distress, hypertension, tachycardia, and
16261 Pediatrics Pulmonary &Pneumothorax increased
Congenitalbrightness
diaphragmatic on the affected
hernia side.
results in Hemodyna
herniation
16228 Pediatrics Pulmonary &Diaphragmatic Hernia side, a barrel-shaped chest, and
Foreign body aspiration should be considered a scaphoid abdome
in a pa
15731 Pediatrics Pulmonary &Foreign Body Aspiration hyperinflation and mediastinal shift;
Laryngotracheobronchiti Croup is a viral infection in which edema and narrowi however, x-ray fi
14717 Pediatrics Pulmonary &sObstructive Sleep epinephrine decreases airway inflammation.
14272 Pediatrics Pulmonary &Apnea
Transient Tachypnea Of Nighttime snoring andofgasping
Transient tachypnea for airisisasuspicious
the newborn self-limitedfoc
13645 Pediatrics Pulmonary &Newborn section.
DrowningInfants present
is defined shortly afterimpairment
as respiratory birth with respira
after s
13474 Pediatrics Pulmonary &Drowning respiratory distress syndrome.
Bronchopulmonary Bronchopulmonary dysplasia (chronic lung disease o
12516 Pediatrics Pulmonary &Dysplasia
Community Acquired prolonged
Parapneumonic mechanical ventilation
effusions occur after or oxygen
bacterial supplem
pneum
12421 Pediatrics Pulmonary &Pneumonia
Parapneumonic distress
Empyemas occur after bacterial pneumonia leads clo
can be managed with oral antibiotics and to
12420 Pediatrics Pulmonary &Effusion & Empyema leukocyte counts > 50,000/mm3, and Gram stain/cult
12419 Pediatrics Pulmonary &Pleural Effusion
Respiratory Distress Chylothorax is an exudative effusion due to disruption
4831 Pediatrics Pulmonary &Syndrome Respiratory
A large thymic distress syndrome
silhouette is caused
is a normal finding by onsurfactan
fronta
4829 Pediatrics Pulmonary &Mediastinal Masses in other children should raise concern
Anaphylaxis is a severe allergic reaction characterize for pneumonia
4699 Pediatrics Pulmonary &Anaphylaxis intramuscular
Intramuscular epinephrine
epinephrine is is the
the first-line
treatment fo
4638 Pediatrics Pulmonary &Anaphylaxis should
Staphylococcus aureus is the most common immunoth
be referred to an allergist for venom cause of b
4030 Pediatrics Pulmonary &Cystic Fibrosis
Immotile Cilia pneumonia, frequent hospitalizations, or recurrent skin
3974 Pediatrics Pulmonary &Syndrome
Respiratory Syncytial Kartagener
Bronchiolitissyndrome, a subgroup
is most commonly causedof primary ciliary d
by respiratory
3553 Pediatrics Pulmonary &Virus vulnerable to complications
Not all patients such as
with cystic fibrosis areapnea and respir
identified throu
3531 Pediatrics Pulmonary &Cystic Fibrosis pancreatic insufficiency
Endotracheal intubation (e.g. poor growth,ventilation
and mechanical deficiencya
3459 Pediatrics Pulmonary &Asthma arrest. Signs
Severe coughing of respiratory
paroxysms failure include altered
can increase intra-alveomen
3457 Pediatrics Pulmonary &Pneumothorax pneumomediastinum.
Epiglottitis presents with acute onset of respiratory dii
The first step in management
3289 Pediatrics Pulmonary &Epiglottitis
Neonatal Respiratory is endotracheal
Respiratory intubation
distress syndrome in a controlled
should be setting. suspected
2473 Pediatrics Pulmonary &Distress Syndrome fine
Sudden-onset respiratory distress with unilateralinclu
reticular granularity of the lungs. Treatment hype
2451 Pediatrics Pulmonary &Foreign Body Aspiration aspirated object.
The first step in management of a newborn with susp
2435 Pediatrics Pulmonary &Diaphragmatic
Laryngotracheobronchiti decompress
Hernia Croup, a viralthe stomach
infection thatand bowel.
causes Bag-and-mask
subglottic edema
2424 Pediatrics Pulmonary &s nebulized epinephrine.
Primary nocturnal enuresis is defined as nighttime ur
20251 Pediatrics Renal, UrinaEnuresis the greatest
Nocturnal risk factor
enuresis for developing
secondary this condition.
to obstructive sleep ap
20249 Pediatrics Renal, UrinaEnuresis Evaluation is with nocturnal polysomnography.
Encopresis (i.e. fecal incontinence) is typically a sign
20248 Pediatrics Renal, UrinaEnuresis managing
Chronic kidneycomorbid constipation
disease is a cause(e.g. laxativeand
of daytime therapnig
20247 Pediatrics Renal, UrinaEnuresis tract infections. Evaluation includes
Secondary enuresis, or new-onset nighttime wetting obtaining a serum
20246 Pediatrics Renal, UrinaEnuresis psychological
(previously mental stressor. The first WAGR
retardation). step in syndrome
evaluation sho is
16615 Pediatrics Renal, UrinaWilms Tumor ultrasound is performed
Posterior urethral valvesevery
present 3 months
in newborn in infancy
boys wit an
15955 Pediatrics Initial
Renal, UrinaPosterior Urethral Valve A evaluation
secondary includesshould
varicocele renal be andsuspected
bladder ultrasounin a pre
15922 Pediatrics Renal, UrinaWilms Tumor ultrasound
A is indicated to evaluate
voiding cystourethrogram for anatomical
is indicated to assesscau for
15867 Pediatrics Renal, UrinaUrinary Tract Infection Urinary
ultrasound,tracthigh fever with
infections an unusual
typically improvepathogen,within 48or s
hou
15830 Pediatrics Renal, UrinaUrinary Tract Infection bladder ultrasonography should be
Urinary tract infections are most commonly caused b obtained to evalu
15829 Pediatrics Renal, UrinaUrinary Tract Infection
Poststreptococcal leukocyte
Postinfectiousesterase on urinalysis isischaracteristic.
glomerulonephritis a complicationEm of
14531 Pediatrics Renal, UrinaGlomerulonephritis mesangium and basement membrane, resulting in he
4853 Pediatrics Renal, UrinaHypernatremia Isotonic solutions
Renal tubular such isascaused
acidosis normalby saline
a defect are the fluid
in either
4828 Pediatrics Renal, UrinaRenal Tubular Acidosis chronic,
Posteriornormal
urethral anion gapare
valves metabolic
the mostacidosis.
commonTreatm cause
4548 Pediatrics Renal, UrinaPosterior Urethral Valve characterized by pulmonary hypoplasia,
Hyposthenuria is the inability of the kidneys to conce flat facies, a
4436 Pediatrics Renal, UrinaSickle Cell
Henoch-Schönlein and normal serum sodium.
Henoch-Schönlein purpura is an IgA-mediated small
4279 Pediatrics Renal, UrinaPurpura (hematuria +/- proteinuria).
Urinary tract infections (UTIs) Renal biopsycommonly
are most shows IgA cad
4196 Pediatrics Renal, UrinaUrinary Tract Infection sexual
Minimalactivity.
changePositive
diseaseurinary
is the mostnitrites supportcause
common the pro
4059 Pediatrics Renal, UrinaGlomerular Disorders patients
Minimal Change age < 10.
Minimal change Steroids
disease is thearemost
the treatment
common of choico
cause
4018 Pediatrics Renal, UrinaGlomerulopathy steroids.
Urinary tract infection should be suspected in an infa
4005 Pediatrics Renal, UrinaUrinary Tract Infection Urinalysis
Cystinuria andis anurine culture
inherited are the
disease first steps
causing in evalu
recurrent r
3949 Pediatrics Renal, UrinaRenal Calculi should raise suspicion for the diagnosis. Urinalysis sh
Membranous Membranous nephropathy is a common cause of nep
3940 Pediatrics Renal, UrinaNephropathy risk factor,
Severe and vaccination
vesicoureteral refluxreduces
can cause thisrecurrent
risk. or c
3694 Pediatrics Renal, UrinaUrinary Tract Infection made by voiding cystourethrogram.
Children age < 2 years with a first febrile urinary tract
3692 Pediatrics Renal, UrinaUrinary Tract Infection lead to recurrent
Vesicoureteral UTIs.
reflux is a risk factor for recurrent urin
3688 Pediatrics Renal, UrinaVesicoureteral Reflux due to chronic interstitial
Wilms tumor is the most common inflammation renaland fibrosis. in
malignancy
3552 Pediatrics Renal, UrinaWilms Tumor Abdominal pain and hypertension may also be prese
3548 Pediatrics Renal, UrinaDiabetes Mellitus
Hypertrophic Pyloric Enuresis in the setting of polyuria, polydipsia, and we
2794 Pediatrics Renal, UrinaStenosis Pyloric stenosisispresents
Desmopressin the first-lineat age 3-5 weeks with for
pharmacotherapy nonbno
2513 Pediatrics Renal, UrinaEnuresis as monotherapy, it has a high rate of relapse on disc
2457 Pediatrics Renal, UrinaWilms Tumor
Poststreptococcal Wilms tumor (nephroblastoma)
Acute poststreptococcal is the most common
glomerulonephritis occurs 1-r
2241 Pediatrics Renal, UrinaGlomerulonephritis edema.
Transient Complement
proteinuria is component
a commonC3 is low.
cause of isolated p
2234 Pediatrics Renal, UrinaProteinuria normal first morning urine protein/creatinine
Alport syndrome is a progressive disease that ratio and
presen
2233 Pediatrics Renal, UrinaAlport Syndrome normal, and
Chronic renal biopsy
constipation shows
is a risk longitudinal
factor for recurrent splitting
cyst
2226 Pediatrics Renal, UrinaConstipation leads to urinary stasis.
Henoch-Schönlein purpura is an IgA-mediated vascu
20498 Pediatrics RheumatologIgA Vasculitis petechiae/purpura
Clubfoot is a developmental plus > 2 ofdeformity
the following:of thearthralgia
talus bo
20381 Pediatrics RheumatologClubfoot casts.
School-age children should participate in > 1 hour of
19191 Pediatrics RheumatologPhysical Exercise performed
Duchenne muscularproperly, such dystrophyas with directbe
should supervision
considereda
17059 Pediatrics RheumatologDuchenne Dystrophy
Juvenile Idiopathic can
The also lead to dilated
oligoarticular form of cardiomyopathy
juvenile idiopathic andarthritis
conduct(
16831 Pediatrics RheumatologArthritis
Juvenile Idiopathic ophthalmologic
polyarticular JIAscreening is indicated
are predominantly because
female, and uveiti
the in
Lower Extremity Long treatment.
Toddler's fractures, or spiral tibial fractures, are seen
16357 Pediatrics RheumatologBone Fracture may be suspicious
Greenstick fracturesforofnonaccidental
the forearm are trauma
common if theinhis
ch
16356 Pediatrics RheumatologGreenstick Fracture immobilization to prevent refracture,
Transient synovitis is a self-limiting, inflammatory hip and no long-term
16341 Pediatrics RheumatologTransient Synovitis
Slipped Capital Femoral the knee.
Slipped Most femoral
capital patientsepiphysis,
are afebrile whichwith occurs
normal most labor
16326 Pediatrics RheumatologEpiphysis growth plate. Bilateral
Acute, atraumatic involvement
hip pain in children is common
is typically and m
caus
16295 Pediatrics RheumatologTransient Synovitis with features
Calcaneal concerning
apophysitis is aforcommon
septic arthritis
cause of (e.g.heelinabi
pa
16008 Pediatrics RheumatologCalcaneal Apophysitis findings. Treatment is supportive.
minority of patients have continued symptoms despit
15848 Pediatrics RheumatologSeptic Arthritis addition
Neisseriaofgonorrhoeae
an antibiotic contracted
that coversvia aerobic gram-neg
unprotected sex
15847 Pediatrics RheumatologSeptic Arthritis Concurrent
In patients with features of gonococcal
juvenile idiopathicmucosal
arthritis infection
who have(ea
15846 Pediatrics RheumatologSeptic Arthritis synovial
The leukocyteofcount
presentation septic> arthritis
50,000/mm3 with can
in infants a neutro
be s
15845 Pediatrics RheumatologSeptic Arthritis swelling.
14464 Pediatrics RheumatologGenu Varum Symmetric
Metaphyseal genu
cornervarum, or bowed
fractures, legs, is typically
or bucket-handle ph
fractu
14172 Pediatrics RheumatologChild Abuse
Juvenile Idiopathic to evaluate
Systemic for additional
juvenile idiopathic occult fractures.
arthritis is an autoinflamm
Juvenile Idiopathic lymphadenopathy are common,
Systemic juvenile idiopathic arthritis is and quotidian
characterized fevers
12409 Pediatrics RheumatologArthritis evaluation
Osteoid osteoma typically is reveals
a benign, leukocytosis,
bone-forming thrombocyto
tumor tha
11441 Pediatrics RheumatologBone Tumor inflammatory medication. Radiograph
Osteosarcoma is the most common primary bone tum demonstrates a
8772 Pediatrics RheumatologBone
UpperTumor
Extremity Long and tender mass.
Compartment Classicisx-ray
syndrome a rarefindings includeof'sunb
complication sup
4873 Pediatrics RheumatologBone Fracture may include increasing swelling and
Transient synovitis presents with hip pain and limp in pain that is unre
4857 Pediatrics RheumatologTransient Synovitis
Osgood-Schlatter afebrile with normal
Osgood-Schlatter laboratory
disease, results (i.e.
a common cause white bloo
of knee
4849 Pediatrics RheumatologDisease
Slipped Capital Femoral activity, and examination
Slipped capital femoral epiphysisreveals prominence
(SCFE), which andcaus
ten
4844 Pediatrics RheumatologEpiphysis Obesity
Patients iswith a risk
Down factor, but SCFE
syndrome are may also be seen
at increased risk oi
4840 Pediatrics RheumatologDown Syndrome incontinence,
Acute rheumatic gaitfever,
changes, or weakness.
a complication of streptococca
4836 Pediatrics RheumatologRheumatic Fever elevated acute-phase reactants.
Patients with Kawasaki disease are at risk for develo
4835 Pediatrics RheumatologKawasaki Disease intravenous
Kawasaki diseaseimmunoglobulin and characterized
is a vasculitis aspirin decreases by fev c
4834 Pediatrics RheumatologKawasaki Disease
Osteogenesis mucositis,
Osteogenesis andimperfecta
polymorphous is anrash.
autosomal dominant c
4832 Pediatrics RheumatologImperfecta features include blue sclerae, hearing
Congenital muscular torticollis is a postural loss, neck
and short
defo
4761 Pediatrics RheumatologTorticollis fibrotic neck mass may be present on examination,
Langerhans cell histiocytosis frequently presents with a
4642 Pediatrics RheumatologBone Tumor hepatosplenomegaly,
Serum sickness-like reaction and cough.is most commonly caus
4584 Pediatrics RheumatologDrug Allergy lymphadenopathy. The abnormalities
Drooping of the contralateral hemipelvis should
below resolve
its nor
4534 Pediatrics RheumatologTrendelenburg Sign
Legg-Calve-Perthes gluteus medius and minimus muscles,
Legg-Calve-Perthes disease (idiopathic osteonecrosi which are inne
4533 Pediatrics RheumatologDisease motion and thigh muscle
Spondylolisthesis atrophyslippage
is the anterior may be present on
of a vertebr
4064 Pediatrics RheumatologBack Pain exacerbated
Lyme arthritisby is lumbar extension.
the hallmark of late Lyme disease du
3836 Pediatrics RheumatologLyme Disease
Osteogenesis bearing, afebrile patient. Synovial
Osteogenesis imperfecta is an autosomal fluid analysis
dominantshowc
3770 Pediatrics RheumatologImperfecta fractures, joint hypermobility, short stature, and heari
3684 Pediatrics RheumatologRadial
Neonatal
HeadEvaluation Metatarsus
Radial headadductus
subluxation is aoccurs
congenitalwhenfoot deformity
infants in
or child
3668 Pediatrics RheumatologSubluxation supination.
Growing Reduction
pains by forearm
are bilateral, hyperpronation
lower-extremity painsor thas
3555 Pediatrics RheumatologGrowing Pains
Radial Head normal
Subluxation of the radial head is common in preschoo
physical examination. Treatment consists of
3416 Pediatrics RheumatologSubluxation hyperpronation
Adolescent idiopathic confirms the diagnosis.
scoliosis (i.e. lateral curvature o
3406 Pediatrics RheumatologScoliosis
Legg-Calve-Perthes include female sex, age < 12, premenarchal
Legg-Calve-Perthes disease, or avascular osteonecr status, s
3404 Pediatrics RheumatologDisease
Slipped Capital Femoral rays maycapital
Slipped be normal
femoralin early disease
epiphysis but demonstrate
is characterized by
3403 Pediatrics RheumatologEpiphysis
Developmental Hip due to impaired ossification of the growth plate. Trea
3402 Pediatrics RheumatologDysplasia Suspected
Ewing sarcomas developmental
are malignantdysplasia
tumors of that
the hip
occur(e.g.
moa
2629 Pediatrics RheumatologBone Tumor findings and characteristic
Rickets presents 'onion skinning'
with craniotabes (soft skull (i.e. lamell
bones),
2486 Pediatrics RheumatologVitamin D Deficiency increased skin pigmentation,
Transient synovitis of the hip limited sun exposure,
is a benign, self-limitingan
2446 Pediatrics RheumatologTransient Synovitis well-appearing
According to human and afebrile
factors without laboratory
engineering, eviden
the most eff
19652 Pediatrics Social ScienPatient Safety
Ethical Principles in human effort. An example is a heparin
Parental consent is required prior to providing non-em infusion pump
19133 Pediatrics Social ScienHealthcare
Ethical Principles in Assent fromofthe
Disclosure an child is ideal but
HIV diagnosis tonot required
a child to proc
with perinat
19132 Pediatrics Social ScienHealthcare transmission.
Parent-requested The drug
provider should
testing respect
without the family'
the knowledge
19061 Pediatrics Social ScienInformed Consent about thewho
Parents limitations of drug testing,
are themselves minors andcan evaluation
give consen o
4846 Pediatrics Social ScienInformed Consent treatment for
Physicians their child.
should have a high suspicion for abuse in
4320 Pediatrics Social ScienChild Abuse parentscaring
When with active
for an drug/alcohol
unemancipated abuse.
minor, informed c
3624 Pediatrics Social ScienInformed Consent care in urgent situations without waiting for parental c
3235 Pediatrics Social ScienRefusal Of Treatment In a non-emergency situation in which a parent refus
odeficiency is characterized by decreased immunoglobulin production due to impaired differentiation of B cells into plasma cells
nfections
emia should after
bepuberty
suspected andinhave lowimmunized
a fully IgG plus low childIgAwho and/or
has IgM, as well as
Haemophilus decreased
influenzae typeantibody response
b infection. to vaccines.
Laboratory studies reveal
se to vaccines as well as markedly reduced CD19+ B lymphocytes on flow cytometry.
emia is an immunodeficiency characterized by impaired B-cell maturation and antibody production. Commonly associated cond
chronic enteroviral
bulinemia of infancymeningoencephalitis,
is a self-limited disorder andcharacterized
prolonged diarrheal by low illness.
IgG (but normal leukocytes and antibody response to vaccine
atients
tening, multisystem disorder that typically involves the skin or mucosadisease.
may be asymptomatic or have recurrent infections and atopic in association with the cardiovascular or respiratory syst
odeficiency (CVID) is caused by abnormal B-cell differentiation, leading the
strointestinal, neurologic, and ocular symptoms. Management includes prompt administration
to decreased immunoglobulin of intramuscular epinephrine.
production. CVID typically
nt sease is an X-linked immunodeficiency disorder due to NADPH oxidase abnormalities, resulting in decreased formation ofissupe
sinopulmonary and gastrointestinal (e.g. Giardia) infections, failure to thrive, and chronic pulmonary disease. Treatment int
hylococcus aureus,
odeficiency presents Serratia,
in infancyandwithfungi.
severe infections, failure to thrive, and chronic diarrhea. Absence of T cells and dysfunction
tsease
stem cell transplantation.
is caused by impaired intracellular killing by phagocytes. Pneumonia, cutaneous abscesses, and suppurative adenitis ar
(e.g. dihydrorhodamine
ceive routine immunizations 123according
or nitroblue to tetrazolium
chronologictesting).
age rather than age corrected for gestation. Live virus vaccines are withhe
rent illness is not a contraindication to vaccination.
urologic disorders, and encephalopathy (e.g. coma, decreased consciousness, prolonged seizures) within a week of administra
eiencyare contraindications
presents with delayed for future administration
umbilical of pertussis-containing
cord separation, recurrent skin and vaccines.
mucosalHowever,
bacterialuncomplicated
infections (withoutseizures are not.and
purulence),
sneutrophil
the most common predominance primary is common.
immune deficiency, and can present with recurrent sinopulmonary and gastrointestinal infections as
ciency, production
parents' medical decision for their of anti-IgA antibodies
children,can lead
with thetoexception
anaphylaxis during of
of refusal blood transfusion.
life-saving treatment. Physicians must counsel paren
document the discussion in the medical chart. In addition,
sease presents with recurrent cutaneous and pulmonary infections with catalase-positive physicians should be aware of the vaccination
organisms (e.g.exemption laws in
Staphylococcus thei
aureus
ine testing)isisadiagnostic.
odeficiency life-threatening condition caused by defective T cell maturation. Affected patients present with failure to thrive, r
ow lymphocyte
deficiency syndromes concentrations.
present with Treatment
recurrentrequires
or severe stem cell transplantation.
sinopulmonary infections. Hyper-IgM syndrome is due to a defect in the
G and IgA, and normal lymphocyte populations.
maglobulinemia presents with recurrent sinopulmonary or gastrointestinal infections in late infancy. Serum immunoglobulins an
esults from deficiency or dysfunction of C1 inhibitor and is characterized by recurrent episodes of edema (e.g. face, limbs, genit
caria.
maglobulinemia is characterized by severely decreased immunoglobulins due to a failure of B-lymphocyte maturation. Affected
lop recurrent sinopulmonary
. randomized control trials) can andhelp
gastrointestinal
establish causal infections once protection
relationships whereas from transplacental
observational studiesmaternal antibody
(e.g. case wanes.
series) only sugge
not provide enough scientific evidence to make clinical decisions (e.g. treating patients
with or without hypotension and respiratory distress. Characteristic echocardiographic findings of a thickened interventricular se with new drugs or therapies).
neduce
of insulin
LVOT levels.
obstruction by increasing LV filling time and end-diastolic volume (due to reduction in heart rate) and decreasing t
to reduction
which increases in contractility).
left ventricular afterload, can present in the neonatal period with congestive heart failure (e.g. respiratory distr
losure of the ductus
(VSDs) cause left-to-right arteriosus.
shunting that leads to volume overload of the right ventricle, increased pulmonary circulation, and vo
ssentmaywith present
acutewith heart tachypnea,
failure and tachycardia,
cardiogenicand shockpoor feeding
upon dueof
closure tothe
high-output heart failure
ductus arteriosus. and pulmonary
Administration overcirculation.
of prostaglandin E1 m
ow
ludes by screening
shunting blood from congenital
for critical the pulmonary heartartery
diseaseto the(e.g.aorta (right-to-left). lesions, cyanotic heart disease) with pre- and post-d
ductal-dependent
s (PDA) is associated with a continuous flow murmur due to constant movement of blood from the high-pressure aorta to the low
mptomatic
monly caused, and in detected
children, incidentally on routine
by viral infection cardiac presents
and typically auscultation.
following a viral prodrome with signs of heart failure (e.g. respi
galy).
cement of patients in a knee-chest position during a hypercyanotic spell increases systemic vascular resistance, increases pulm
ccur after cardiac surgery and typically presents with distant, 'muffled' heart sounds and signs of decreased cardiac output (e.g
e on chest
efects cause x-ray
growth is characteristic.
failure, easy fatigability, and heart failure. They classically produce a holosystolic murmur that is loudest at
due to increased
iosus closes, ductal-dependent blood flow across the mitral
congenital valve.
heart disease presents with cyanosis if pulmonary blood flow is obstructed or hypote
nital malformations of the great vessels that encircleand
E1 maintains the patency of the ductus arteriosus andiscompress
life-savingthe in trachea
infants with ductal-dependent
and/or congenitalsymptoms
esophagus. Respiratory heart disease.
may
sion. Esophageal symptoms include dysphagia, vomiting, and difficulty feeding.
vessels
ptal defect is murmur
a congenital cyanotic
is a harsh, heart defect
holosystolic that typically
murmur best heard presents
at thewithin the first
left lower 24 hours
sternal border. ofEchocardiography
life with cyanosis and a single
should lo
be perf
ong to rule out other defects.
QT syndrome are at risk Mostfor small ventricular
polymorphic septal defects
ventricular closethat
tachycardia spontaneously
leads to syncopeand require no treatment.
or sudden cardiac death, especially d
vity. β blockers (e.g. propranolol, nadolol) dampen sympathetic activity
s result from normal blood flow from a structurally normal heart. The intensity is typically grade I or II and and shorten the QT interval at high heart rates
decreases to standin
with reduce
ming.
syndromeManagement(22q11.2consists of observation
microdeletion syndrome) andclassically
reassurance. have conotruncal cardiac defects (e.g. transposition of the great arterie
arerome are at increased risk for cardiovascular abnormalitiestoand
at risk for potentially life-threatening hypocalcemia due parathyroid
should undergo hypoplasia.
cardiac evaluation (e.g. echocardiography, 4-e
c valve, coarctation of the aorta, and aortic root dilation.
esent with hypercyanotic 'tet' spells due to right ventricular outflow tract (RVOT) obstruction and right-to-left shunting in the setti
oad,
septal which
defect increases
is the most blood flow across
common heartthe RVOT,
defect whichsyndrome.
in Down in turn improves
Clinicalcyanosis.
features can include heart failure in early infancy, a
creased pulmonary flow from the atrial septal defect.
acterized by > 5 days of fever and > 4 of the following: nonexudative conjunctivitis, mucositis (e.g. 'strawberry tongue'), rash, ex
ardiogram
acute is indicated
rheumatic fever are for all patients
at risk at diagnosis
of progressive to assess
rheumatic for coronary
heart artery
disease from aneurysms.
recurrent group A Streptococcus pharyngitis. Trea
ections and limits the progression of heart disease.
ion, thereby decreasing the intensity of the murmur. Maneuvers that decrease LV cavity size by decreasing preload (e.g. Valsa
an lead of
sening to LV
fataloutflow tract obstruction
left ventricular and increase
outflow tract obstruction theandintensity of thearrhythmias.
ventricular murmur. HCM is the most common cause of sudden
drome) is characterized by micrognathia, microcephaly, rocker-bottom feet, overlapping fingers, and absent palmar creases. Ve
tsand presents
with with a holosystolic
hypercyanotic 'tet' spells due murmur at the leftoflower
to obstruction sternal
the right border. outflow tract during exertion. The harsh crescendo-de
ventricular
er reflectsby
acterized turbulence
fever > 5 at daystheinstenotic
additionpulmonary
to > 4 of theartery.
following clinical features: conjunctivitis, mucositis, rash, extremity changes,
uggest
o undergo screening echocardiography and MRI of erythrocyte
inflammation (e.g. thrombocytosis, elevated the head to sedimentation
assess for PHACE rate) (posterior
support the diagnosis.
fossa malformations; hemangiom
terized by patchy, painless hair loss with no erythema, scaling, or scarring. It is an autoimmune disorder and is often associated
ne thyroid
small, disease).
pruritic, Treatment
erythematous includes
papules, oftentopical or intralesional
arranged in a linear corticosteroids.
pattern on exposed A recurring
areas and course
eachiswith
common, but hemorrhagic
a central most patient
nreatment
texture; requires
and mottled, eradication of theerythema.
perifollicular bugs. Exacerbations are common in cold, dry weather. Treatment includes emollients a
nly presents with a pruritic rash between the toes. The diagnosis is usually made clinically but can be confirmed with a potassiu
pical
withantifungal
enlarging,agentsyellow(e.g. miconazole,
fluid-filled, flaccidterbinafine, tolnaftate)
bullae that leave is effective
a collarette for treatment,
of scale but This
after rupture. nystatin is not is
condition effective.
caused by
mited exanthem that classically begins with a solitary, large herald patch followed by clusters of smaller oval lesions oriented in
nce alone,
rmatitis although
presents symptomatic
in young children relief
as anof erythematous,
pruritus (e.g. antihistamines,
sharply demarcatedtopicalperianal
corticosteroids) may be indicated.
rash associated with pruritus and pain. Tr
mon skin eruption characterized by light macules on the trunk and upper extremities in adults. In children, the eruption typically
sure
uriticasrashthecharacterized
surrounding skin becomes
by small darker. papules and burrows in the axillae, periumbilical area, genitalia, and interdigital
erythematous
or oral ivermectin.
nevus presents within the first few months of life as isolated hyperpigmented patches with an increased density of hair follicles.
deliberate
al scald injuries
dermatophytosis that most is characterized
commonly occurs by burns with sharp
in children andlines of demarcation, uniform
immunocompromised depth,
patients. lack ofasplash
It causes scaly, marks, and sp
erythematous
n,
a islymphadenopathy,
an IgA-mediated and scarring.
vasculitis thatOral griseofulvin
presents or terbinafine
with palpable purpuraare onthe
thepreferred initial treatment
lower extremities, options.
arthralgia/arthritis, abdominal pain,
manifestation.
nfants is characterized by a scaly, oily rash affecting the scalp, eyelids, nasolabial folds, postauricular area, and umbilicus. Spon
scial
include
fungalemollients and non-medicated
infection characterized shampoos.
by pruritic, scaly, erythematous plaques with a raised border and central clearing. The diagno
nfirmed with potassium hydroxide
ngiomas are benign capillary tumors of childhood. examination of skin
They scrapings. Topical during
typically appear antifungals (e.g.
the first clotrimazole,
weeks terbinafine)
of life, initially are first-line
grow rapidly, and r
require
form oftreatment with β blockers.
photoprotection. Sunscreen with sun protection factor > 30 should be applied 15-30 minutes prior to sun exposure and
mming.
primary herpes simplex virus infection associated with atopic dermatitis. Painful vesicles, 'punched-out' erosions, and hemorrhag
cal.
ocytosis is commonly found in African, Asian, and Hispanic infants and presents as gray-blue macules, most commonly on the s
ly during childhood.
orum
kin is a benign
syndrome neonatal
is caused by rash characterized
exfoliative by blanching
toxin-producing strains erythematous papules
of Staphylococcus andand
aureus pustules. It resolves
typically occurs inspontaneously
infants and young with
sness is followed
presents by generalized
with pruritus, and scaly erythema,
erythematoussuperficial
lesionsflaccid
on theblisters, and epidermal
face, chest, shedding
and extensor with light
surfaces of thepressure (i.e. Nikolsky
extremities. Flexural ins
alis emollients
caused byare the first-line treatment.
T cell-mediated (delayed, type IV) hypersensitivity and presents with erythema, edema, and vesicles > 12 hours a
d the proximal esophagus. Because TEF with EA often occurs with VACTERL association (vertebral, anal, cardiac, tracheoesop
ho have
ve to TEF with
equalize EA should
pressure undergo
and drain screening
the middle ear echocardiography and
through physiologic renal ultrasonography.
opening and closing. Inflammation can cause obstruction
g(OME)
ear fullness/discomfort, hearing loss, and tinnitus. Examination reveals
is defined by middle ear fluid without tympanic membrane (TM) inflammationtympanic membrane retraction.
(e.g. bulging, erythema). Examination sho
observation
us infection is the most common cause of nonhereditary sensorineural hearing loss in children. The long-term
with follow-up for resolution because chronic OME is associated with speech delay and infection ishearing loss.asym
frequently
nset, unilateral
tic neck or bilateral
mass that moves hearing loss laterisinlikely
with swallowing childhood.
a thyroglossal duct cyst. A thyroglossal duct cyst forms from retained epitheli
rhea inpapillomavirus
uman a young child subtypes
is often due to a11
6 and retained intranasal
can cause foreign
recurrent body. papillomatosis, which results in hoarseness due to fing
respiratory
enital obstruction of the posterior nasopharynx. Because neonates are obligate nasal breathers, bilateral choanal atresia prese
ves when crying. The diagnosis is supported if a small catheter cannot be passed from the nares into the oropharynx.
nts with upper respiratory symptoms (e.g. rhinorrhea, congestion, cough) and facial pain/pressure, with or without fever. Viral rh
patients who are afebrile with mild symptoms that improve within 10 days. Treatment is supportive care (e.g. nasal saline/irrigat
with
st inspiratory
common cause stridor due to
of stridor in dynamic
infants andcollapse
is dueoftothe supraglottic
collapse of the tissues on inspiration.
supraglottic Stridor
tissues during increasesStridor
inspiration. in periods of increas
increases with
positioning.
ear') is a painful infection of the external auditory canal. It often occurs after outdoor water exposure due to alterations in ear c
ion of is
ear') bacteria. Pseudomonas
characterized by pain,aeruginosa
erythema,isand the edema
most common pathogen.
of the external auditory canal. It frequently occurs after water exposure or
nt is appropriate unless complicated by diabetes mellitus, HIV, or
in patients with epiglottitis, initial treatment consists of broad-spectrum antibioticinfection that has spread
therapy beyond
with the external
ceftriaxone auditory canal.
(targeting
(targeting
otentially Staphylococcus
fatal infection thataureus).
presents with acute onset of fever, sore throat, and signs of upper airway obstruction (e.g. stridor, d
evealing an enlarged epiglottis
m the accumulation of keratin debris (thumb sign).
and squamous epithelial cells within a tympanic membrane retraction pocket. Symptoms i
and examination often reveals a pearly
an result in conductive hearing loss, which may white massbe behind
confused an with
intact tympanic
certain membrane.
pervasive and behavioral disorders of childhood. Hear
presenting with social or language deficits.
otitis media should be administered to children with high fever, severe pain, or bilateral disease. Amoxicillin is first-line therapy,
erecurrent
suspected infection.
in an otherwise well-appearing newborn with cyanosis worsened by feeding and relieved by crying. Failure to pass
ive of the diagnosis.
itis is distinguished from a viral upper respiratory infection by the presence of severe, persistent, or worsening symptoms (e.g.
biotics.
ear') is characterized by pain, erythema, edema, and discharge; it frequently occurs after swimming. Loss of cerumen, trauma
k. The most by
haracterized common pathogen ispain,
fever, pharyngeal Pseudomonas aeruginosa.
and earache. Examination findings include trismus, muffled voice, and swelling of perito
lves needle aspiration or incision and drainage plus antibiotic therapy.
mplication
n can eitherof acute otitis media.
be congenital It is characterized
or acquired secondaryby to fever,
chronic otalgia,
middleand earmastoid
disease.process inflammation
New-onset withordisplacement
hearing loss of the
chronic ear drainag
ms ofcause
mon cholesteatomas,
of otalgia in andyounggranulation
children, tissue and skin debris
is characterized may ear
by middle be seen within retraction
inflammation pockets
(e.g. tympanic of the tympanic
membrane membrane
[TM] bulging +/-
in infants with inspiratory stridor that worsens in the supine position and improves in the prone position. Laryngoscopy shows c
on. Concurrent
abrupt gastroesophageal
onset of fever, reflux should
dysphagia, drooling, be treated.distress.
and respiratory Laryngomalacia
Signs of usually
impending resolves spontaneously
airway by ageanxiety
obstruction include 18 months.
and tr
gfor
with neck hyperextension).
polyuria and dilute urine includes central or nephrogenic diabetes insipidus (DI) or primary polydipsia. The water deprivation
ollowing water
rized by the deprivation,
inability urine osmolality
to metabolize galactoseremains unchanged
(found in breast andincow's
DI butmilk)
increases in primary
to glucose, polydipsia.
resulting in galactose accumulation an
hepatomegaly, and Escherichia coli sepsis. Hyperbilirubinemia may be conjugated (i.e. liver dysfunction)
growth hormone levels at puberty. Other findings seen with insulin resistance include acanthosis nigricans, and/or unconjugated
central (i.
obesity, elev
asal insulin should be decreased as well. Patients with diabetes who initiate a strenuous exercise regimen should also be couns
nglly sessions
occurs in are > 60 minutes
exclusively in duration.
breastfed infants without vitamin D supplementation. Presentation includes craniotabes (soft skull bone
nar
n error of metabolism that presents inoccurs
bowing). Lower extremity bowing the firstonce
week patients are weight-bearing.
of life with vomiting, jaundice, hypotonia, and hepatomegaly. Progressive de
l hyperplasia occurs due to 21-hydroxylase deficiency, which leads toformula).
s to cataracts. Management is a galactose-free diet (e.g. soy-based the buildup of 17-hydroxyprogesterone and testosterone.
italia
onset(e.g. underdeveloped
of secondary phallus) and nonpalpable
sexual characteristics before agegonads.
8 in girlsElectrolyte
and age 9 abnormalities
in boys. Initialdo not develop
evaluation until age
includes 1-2 weeks.
obtaining a bone a
somal storage disease with the accumulation of glucocerebroside in macrophages of the bone, liver, and spleen; this accumula
ghepatosplenomegaly. Presentation
the first trimester is associated ranges
with from mild to
malformations; severe,
fetal and diagnosis
hyperglycemia after can occur
the first at any age.
trimester is associated with perinatal co
emia. Neonatal hypoglycemia is the most common complication among infants of diabetic mothers.
tassium, and magnesium, leading to electrolyte deficiency. Cardiac manifestations include arrhythmias and congestive heart fa
aymuscular (e.g. weakness,
is characterized by shortrhabdomyolysis),
stature (height atgastrointestinal (e.g. diarrhea,
the < 2nd percentile) and normalelevated
linear transaminases), and neurologic
growth velocity after age 3. Puberty(e.g.and
tremobo
A) presents with polyuria, abdominal pain, and fatigue and is often precipitated by infection. Laboratory results demonstrate hyp
srenal
characterized
hyperplasia byisana osmotic
cause ofdiuresis that reduces total body
gonadotropin-independent potassium
precocious even Patients
puberty. though serum potassium
can have maysecondary
premature be normalsexual
or elev
growth and
pendent) bone age,
precocious and low/normal
puberty LH levels. by premature breast and pubic/axillary hair development, advanced bone ag
(PP) is characterized
equire
nset ofan MRI of the
secondary braincharacteristics
sexual to evaluate forina girls
tumor prior
age < 8toand
starting
boys GnRH
age < 9,agonist therapy.
has both central and peripheral causes. Central pre
amic-pituitary-gonadal axis and presents with increased levels of FSH and LH.
caused by early activation of adrenal androgens and is more common in obese children. Typical presentation includes precocio
m,dybutodor
theinmajority
a child with a normal
of infants with bone age. hypothyroidism are asymptomatic. Thyroid dysgenesis is the most common cause o
congenital
pothyroidism initially appear normal at birth, but gradually develop apathy, weakness, hypotonia, large tongue, sluggish movem
eason,
ase screening
is the newborns
most common causefor ofhypothyroidism,
congenital adrenalalonghyperplasia
with phenylketonuria and galactosemia,
and classically is standardly salt-wasting,
presents with dehydration, performed inand all sta
vi
els are diagnostic.
eficiency (type I glycogen storage disease, von Gierke disease) presents at age 3-4 months with hypoglycemia (often with seiz
lipidemia.
eczema, and Patients typically
a musty have abody
or 'mousy' doll-like face,
odor. thin diagnosed
Infants extremities,early
short stature,newborn
through and a protuberant
screening andabdomen
treated(due
withtolow-phenylal
hepatomeg
benign, slow-growing tumors found in the suprasellar region and typically appear calcified on neuroimaging. Presenting sympto
pituitary
st sign ofhormone
puberty) deficiencies
is normal in girls(e.g.age
diabetes
> 8 andinsipidus, growth failure).
is characterized by firm, often tender, breast buds posterior to the nipple. Brea
visit should include contraceptive counseling and discussion of safe sex practices. Contraceptive counseling is an opportunity t
s a and
hip common to decrease
bleedingthe rates ofthat
disorder unintended pregnancies
causes impaired andadhesion
platelet sexually and
transmitted infections.
is the most common cause of heavy, regular menses
ted PTT may be normal or prolonged.
e absence of menarche by age > 15 in girls with secondary sexual characteristics (e.g. breast development) or age > 13 in girls
tep in have
rome management is a pelvic ultrasound
primary amenorrhea and lack of to breast
evaluate the female due
development reproductive tract. levels associated with gonadal dysgenesis
to low estrogen
amic-pituitary-ovarian
nal foreign bodies typically axis results in increasedvaginal
have malodorous FSH and LH. An absent
discharge X chromosome
and vaginal on karyotype
spotting, commonly analysis
secondary to is diagnostic.
retained toilet pap
d either vaginal irrigation with warm fluid or removal with a swab.
recently
ment, undergone
leukorrhea, andmenarche,
mild uterine thebleeding
immature arehypothalamic-pituitary-ovarian
common, benign, and transient axis
in results
newborns. in anovulation
These are and causes responses
physiologic abnormal utto
ork-up
t common is indicated.
cause of breast mass in an adolescent. An adolescent patient with a suspected fibroadenoma should be re-examine
tenderness.
sensitivity syndrome are genotypically male (46,XY) but appear phenotypically female. These patients are at increased risk of te
s; therefore,
atients management
with short stature and includes
aortic an elective gonadectomy.
coarctation is suggestive of Turner syndrome. Patients typically have ovarian dysgenesis (i.
egen levels. These
of Müllerian ductlow estrogen levels
development, causes cause a lack of
an absent negative feedback
uterus,cervix, and upperon the
thirdhypothalamic-pituitary-ovarian
of the vagina (i.e. blind vaginal axis, resulting
pouch). in
Müller
lcommon
development. Therefore,
in adolescent boyspatients
duringhave primary due
mid-puberty amenorrhea with associated
to transiently normal female
increased estrogen. Breastexternal genitalia
tissue can and secondary
be present s
unilaterally
olves within a year.
.ofPlan
vaginal
B) arebleeding in the
a readily neonatal
available andperiod is maternal
effective emergency withdrawal of estrogen.
contraception option The
that bleeding is self-limited,
prevent pregnancy and no treatment
by delaying ovulation.isInr
ntion
occurs options
whenmay receive confidential
a developing blastocyst medical
implantscarein anwithout parental
extrauterine consent.
location (e.g. fallopian tube), can present with nausea/vomitin
productive-age women with these symptoms require pregnancy testing.
mmonly occurs in adolescents after the establishment of ovulatory menstrual cycles. Excessive endometrial prostaglandin prod
ciated symptoms (e.g. fatigue) during
ure hypothalamic-pituitary-ovarian menses.
axis causesSymptoms
anovulation typically
and can decrease
result in with age.
heavy, irregular menstrual bleeding. In hemodyna
ged with high-dose oral contraceptive therapy to stabilize the endometrium
e absence of menarche in girls age > 13 with no secondary sexual characteristics. In patients and stop the acute with
bleeding.
a uterus, the best next step i
ntral (low/normal FSH) and peripheral (high FSH) causes of amenorrhea.
s a life-threatening condition that causes feeding intolerance, abdominal distension, gastrointestinal bleeding, and pneumatosis
management is bowel rest,
elop as a complication in addition
of infectious to blood
colitis cultureswith
(particularly and loperamide
empiric antibiotics.
use) due to transmural inflammation and smooth muscle
with fever, abdominal distension, and colonic dilation on imaging.
ncy caused by intestinal epithelial damage (e.g. gastroenteritis, celiac disease) leads to carbohydrate (i.e. lactose) malabsorpti
nal pain,
cally and bloating.
presents in neonates with decreased stooling, increased rectal tone, and signs of intestinal obstruction (e.g. bilious emesi
ema is performed
l on rectal examination to identify the level
is classic. of obstruction.
Evaluation includes a contrast enema, which reveals a transition zone between a distal, narro
with acute abdominal pain, anemia, and shock due to intraperitoneal hemorrhage. Atraumatic rupture is a rare, potentially fatal
ection associatedcan
the esophagus with splenomegaly.
cause tissue corrosion, necrosis, and life-threatening perforation. A circular object with a halo sign on ches
reisatimmediate
particularlyendoscopic removal. patients often have growth delay, nonspecific gastrointestinal symptoms, and microcytic ane
high risk. Pediatric
th anti-tissue
ized transglutaminase
by progressive fibrosis andantibodies orof
obliteration byextrahepatic
duodenal biopsy.
bile ducts. It typically presents at age 2-8 weeks with jaundice, acho
ostic evaluation of biliary anatomy begins with ultrasound
is and obliteration of extrahepatic bile ducts. Bilirubin production of the right
and upper quadrant.
conjugation continue at a normal rate, but bilirubin cannot
d accumulates in the blood (causing direct hyperbilirubinemia and jaundice).
e trachea and/or esophagus. Compression of the trachea may present with stridor; compression of the esophagus may present
.tussusception are idiopathic and occur in patients age 6-36 months, a pathologic lead point should be considered in those with
age range. Meckel diverticulum (diagnosed by Meckel or 99m technetium pertechnetate scan) is the most common lead point.
presents with dysphagia,
ominal emergency. epigastric
Affected pain,
patients havevomiting,
episodes and
of food impaction.
inconsolable Endoscopy
crying, with
with legs eosinophils
drawn on esophageal
to the abdomen due to biopsy is dia
pain, followe
diagnostic and reveals
ts the epithelial a targetbetween
tight junctions sign, which represents
small intestinal aenterocytes,
bowel segment telescoping
leading into another. (e.g. oily, nonbloody, foul-smell
to acute malabsorption
n chronic
problemgiardiasis
in toddlerscandue
result in severe weight
to transition to solidloss
foodand vitamin
and cow's deficiencies.
milk, toilet training, and school entry. In addition to dietary modific
d be initiated promptly to soften stools.
ctively prevents most cases of rotavirus gastroenteritis. It is contraindicated in patients with a history of intussusception due to
s common in infants due to a shorter esophagus, incomplete closure of the lower esophageal sphincter, and greater time spen
he infant's adequate weight gain and be advised to hold the infant upright after feeds.
dration
with in children
bilious vomitingshould be treateddistension.
and abdominal with an intravenous
Abdominalbolus
x-rayofreveals
isotonica fluid.
triple bubble sign and gasless colon. Risk factors inclu
elusion
substances.
characterized by crying for no apparent reason for > 3 hours a day for > 3 days a week in an otherwise healthy infant ag
review of soothing techniques.
in children
ency causesage 6-36 months
pellagra, with
which is periodic abdominal
characterized pain.aAphotosensitive
by diarrhea, target sign ondermatitis,
ultrasoundand should prompt symptoms
neurologic reduction with air orfrom
ranging water
im
can be fatal.
presents in young toddlers as painless lower gastrointestinal bleeding without abdominal pain, diarrhea, or vomiting. Diagnosis
w can
h identify ectopic
the phototherapy gastric mucosa.
threshold, breastfeeding jaundice can be managed by optimizing lactation and increasing breastfeeding freq
plementation with cow's milk-based
anifests as unconjugated hyperbilirubinemia formula canand be considered,
dehydration but first
in the breastfeeding should
week of life. not be
Affected discontinued.
infants may also have decreased
uboptimal bilirubin elimination and increased enterohepatic circulation of bilirubin.
a water-soluble vitamin that is present in meat, eggs, yeast, dairy products, green vegetables, and enriched foods. Riboflavin de
th angular
minal cheilitis,
wall defect stomatitis,
lateral glossitis,cord
to the umbilical normocytic-normochromic anemia,
insertion site with herniation of and seborrheic
uncovered dermatitis.
bowel. Gastroschisis is an isolated defec
onatal surgical correction.
inspissated meconium and classically presents with delayed passage of meconium, in addition to signs of intestinal obstruction
um
izedileus is virtually
by fibrosis diagnostic
of the for cystic
extrahepatic fibrosis,
bile duct and which causes
presents at agechronic sinopulmonary
2-8 weeks with directdisease.
hyperbilirubinemia (e.g. jaundice, acholic
is with cholangiography, and treatment is hepatoportoenterostomy with or without
rent respiratory symptoms should raise concern for cystic fibrosis (CF). Pancreatic insufficiency liver transplant.
occurs in CF and causes fat an
tamin deficiencies, and poor weight gain.
ndrome (BWS) is characterized by macrosomia, macroglossia, hemihyperplasia, umbilical hernia/omphalocele, and neonatal hy
dricrisk of developing
stenosis presentsWilms tumor andnonbilious
with projectile, hepatoblastoma,
emesis abdominal ultrasoundabdominal
and an olive-shaped and α-fetoprotein level testing
mass. Prolonged are recommended.
vomiting causes a hyp
ment consists
gested of intravenous
and identified rehydration
in the esophagus orand normalization
stomach, immediate of electrolytes
endoscopic prior to pyloromyotomy
removal is required, even to decrease the riskpatients,
in asymptomatic of posto
with vomiting, encephalopathy, hepatic dysfunction, and abnormal behavior leading to seizures and lethargy. Caregivers should
n.
ric stenosis is most common in first-born boys age 3-5 weeks who are fed formula. Nonbilious, projectile vomiting causes dehy
hy confirms
al or acquiredthedilatations
diagnosis.of the biliary tree. They may be single or multiple, and extrahepatic or intrahepatic. Abdominal pain, jau
iary
erouscysts require surgical
complication excision.
in children who receive aspirin for virus-induced fever. Hyperammonemia, transaminitis, coagulopathy, naus
e typical manifestations of fulminant
small intestinal malabsorption and can hepatic failure
present with and encephalopathy.
weight loss and iron deficiency anemia. Common associations include type
oreign body is associated with a high risk of perforation and can be fatal. Endoscopic removal should be performed immediatel
stomach,
ncy in a 2or orproximal
3-year-old duodenum.
child with impaired adaptation to darkness, photophobia, dry scaly skin, xerosis conjunctiva, xerosis cor
sis of the shoulders, buttocks,
upplementation should be started andatextensor surfaces. breastfed preterm infants and continued until age 1 year. All exclusively
birth in exclusively
lementation.
decreased risk of developing otitis media; respiratory, gastrointestinal, and urinary tract infections; and necrotizing enterocolitis.
etes
e newborn is and
mellitus childhood
a common, cancer.
benign Theofonly
cause absolute
indirect infant contraindication
hyperbilirubinemia on days to breastfeeding
2-4 is galactosemia.
of life. Mechanisms include increased bilirubin
enterohepatic recycling.
hould be suspected in newborns with temperature instability, feeding intolerance, abdominal distension, and bloody stools. Risk
tal
ue heart disease.
to failure The crest
of neural hallmark
cell x-ray finding
migration andispresents
air withinwith
the failure
bowel wall (pneumatosis
to pass meconium intestinalis).
within 48 hours after birth. Characteristic
al distension, absent rectal air) and increased tone with release of stool on rectal examination.
e suspected in newborns with failure to pass meconium, in addition to bilious emesis and dilated loops of small bowel on imagin
rns withusually
olvulus meconium ileus in
presents have cystic fibrosis.
neonates with bilious vomiting and abdominal distension. Untreated volvulus can progress to frank b
trointestinal
rgic contrast
proctocolitis shouldstudy
be is the gold standard
suspected for diagnosing
in a well-appearing infantmalrotation.
with painless, bloody stools. Symptoms resolve by eliminating m
hing
copingto bowel)
a hydrolyzed
is mostformula.
common in children age 6-36 months and causes episodic abdominal pain, currant jelly stools, and letha
ways present.
minal distension in a preterm neonate are highly suggestive of necrotizing enterocolitis. Abdominal x-ray findings include pneum
-limiting episodes of profuse vomiting and nausea without an apparent cause suggests cyclic vomiting syndrome. Key historica
tress,
gly infection)
associated or a
with personal/family
Down syndrome andhistory of migraines.
presents with bilious vomiting in the first 2 days of life and a 'double bubble' sign on ab
most common in toddlers due to mouthing behaviors, increased mobility, and small airway diameter. Anticipatory guidance inc
, apeanuts, whole
rear-facing cargrapes,
seat as and
longraw vegetables,
as possible anduntil age 4.to a forward-facing car seat only once they surpass the height or weig
transition
nufacturer. There is no
tment of depression absolute
can preventheight, weight,
suicide, or cause
a major age thatof determines the transition.
death in adolescents. Therefore, all adolescents age > 12 should be
nding in neonates with Down syndrome. Poor muscle tone and a weak suck are key findings. Additional features of Down synd
res, adisease
asaki protruding tongue,
include and a artery
coronary single aneurysms
palmar crease.
and ventricular dysfunction. These complications are more common in infants
ts with fever lasting > 5 days, in addition to conjunctivitis, mucositis, rash, extremity edema, and cervical lymphadenopathy.
delayed
ose up toarticulation) and language
7% of birth weight (e.g.
in the first receptive
5 days language
of life. delay)isare
No treatment often associated
required withbreastfeeding
and exclusive hearing loss. should
The firstbestep in man
continued
ould be able to grasp objects, pull to stand, babble, say some words, and respond to their name. Some separation anxiety is de
al milestones should be assessed with an audiological evaluation.
ant's weight triples and height increases by 50%. Developmental milestones include standing unassisted and learning to walk in
rd other
ant should than
be 'mama' andmomentarily
able to sit 'dada', and on
following
proppeda 1-step
hands,command with a gesture.
transfer objects between hands, and respond to name. Stranger anxie
reflexes disappear before 6 months, but Babinski is typically still present.
placed rapidly when emergency access is necessary and peripheral access cannot be obtained. Intraosseous access can be p
only due access.
venous to Haemophilus influenzae type b, and incompletely vaccinated individuals are at the highest risk. Manifestations include
nd stridor.
ore
is aage 5. Mastery
genetic of nighttime
condition continence
characterized can take months
by hyperpigmented to years, andmacules,
mucocutaneous boys generally achieve this
gastrointestinal milestone
polyps later
that can thanand
bleed girls.
ca
gnancy. Upper and lower endoscopies are performed regularly to screen for polyps and cancer.
potentially life-threatening complication of sickle cell disease, an inherited red blood cell (RBC) disorder characterized by the p
come
is is a entrapped withincomplication
life-threatening the spleen, causing
of sickleacute anemiainand
cell disease tender
which red splenomegaly.
blood cells become entrapped within the spleen. Patients
he treatment of ischemic stroke in patients with SCD. Replacing sickledfluids
ment focuses on the restoration of circulatory volume with intravenous cells and
with packed
healthy red
red blood
blood cell
cellstransfusion.
increases oxygen-carr
miting further occlusion.
orins can cause drug-induced immune hemolysis by binding to the surface of red blood cells and triggering an IgG antibody res
f hemolysis
syndrome (e.g.
can jaundice,
occur dark who
in patients urine) within
have hours of antibiotic
hematologic administration.
malignancies with high tumor burden or rapid replication rate. It typically
c acid and calcium-phosphate stones and/or complications (e.g. cardiac arrhythmia) from hyperkalemia.
hadenopathy (particularly
oves with transfusion supraclavicular)
cessation are commonadministration.
and diphenhydramine manifestationsIfof noHodgkin
signs oflymphoma.
anaphylaxisReed-Sternberg
are present (e.g. cells on lymph
wheeze, angin
ed without additional
hydrogenase deficiencyevaluation.
is an X-linked disorder associated with episodes of hemolytic anemia during oxidative stress. In order to
furantoin should be avoided.
ue
unetothrombocytopenia
Shiga toxin-producing haveEscherichia
platelets <coli O157:H7 isfor
100,000/mm3 supportive
> 1 year.care only. Antibiotics
Splenectomy increase
is an option the risk
for those of persistent
with developingbleeding
hemolyt
nterventions
urs in 25% of(e.g. glucocorticoids,
patients with severe anti-D, intravenous
factor VIII deficiency.immunoglobulin).
It should be considered in a patient with bleeding refractory to replacem
aracterized by increased hemoglobin A2 and hemoglobin F on electrophoresis due to absent β globin expression. Patients are
refore, chelation Barts)
ers (hemoglobin therapyonishemoglobin
required to analysis
improve issurvival.
consistent with α-thalassemia. Laboratory studies typically reveal a microcytic
peripheral smear.
d prior to hemoglobin electrophoresis in patients with microcytic anemia suspicious for iron deficiency (e.g. heavy menses, low
omitant
ly historythalassemia
suggestive (e.g. Greek origin,
of hemolytic anemia family history).
requiring splenectomy. Laboratory findings include elevated reticulocytes and mean c
e direct Coombs test.
(HS) is an inherited disorder caused by a defect in red blood cell membrane proteins, leading to spherocyte formation and hem
ar
emiahemoglobin concentration
often presents in anpetechiae,
with bruising, infant with and
prolonged
bleedingneonatal
due to jaundice
impaired is suggestive
platelet of HS.in the bone marrow. Other comm
production
patosplenomegaly.
nia
oodinmalignancy
a child are derived
concerning
fromfor acute lymphoblastic
primitive leukemia.
sympathetic ganglia. Otherpresentation
Classic characteristic findingsan
includes include fever,mass
abdominal pallor,
andbruising,
systemicandsyh
lude periorbital ecchymoses (i.e. orbital metastases) and opsoclonus-myoclonus syndrome.
sumption
lly presents(> with
24 oz/day) commonly
microcytic anemiacauses microcytic,
and a normal irondistribution
red cell deficiency anemia with
width. An a low erythrocyte
elevated reticulocytecount
countand elevated
reflects red bloo
a compensa
common in infants and toddlers who drink excessive amounts of cow's milk. In addition to a decreased hemoglobin level, a low
so seen.
is an Treatment
X-linked consists
disorder of empiric
characterized byoral
theiron
triadtherapy.
of thrombocytopenia, eczema, and recurrent infections. The thrombocytopen
significant reduction in platelet volume and size.
atients with sickle cell disease to decrease pain crises, the need for transfusions, and episodes of acute chest syndrome. The p
bin, which dilutes
s a hematocrit the>amount
level 65% in of sickle
term hemoglobin.
neonates. Risk factors include excessive transfusion, intrauterine hypoxia, and maternal dia
cause respiratory distress, hypoglycemia,
on reaction is an uncommon, life-threatening reaction and poor feeding.
due to transfusion of mismatched blood (e.g. ABO incompatibility), which
our of transfusion initiation. Continued hemolysis
ly causes normocytic, hemolytic anemia with compensatory can lead toreticulocytosis.
acute renal failure, disseminated
Chronic hemolysisintravascular coagulation,
without adequate folic acidand sh
intak
nemia with an inappropriately low reticulocyte count.
most common
st common causecauseof of pediatricbone
congenital stroke, and diagnosis
marrow failure and can
is be
dueconfirmed by hemoglobin
to defective DNA repair. electrophoresis.
In addition to pancytopenia, characteri
, and abnormal skin pigmentation.
uclear remnants within red blood cells typically removed by the spleen. Their presence strongly suggests asplenia or functional
nlarplus penicillin
necrosis, is aprophylaxis can preventofalmost
common complication sickle all
cellcases of pneumococcal
disease. sepsis
Patients typically in patients
report chronic with sickle
groin, cell
thigh, oranemia.
buttock pain witho
vated inflammatory markers.
a consequence of recurrent hemarthroses and is associated with hemosiderin deposition leading to synovitis and fibrosis within
sprophylactic
are at risk fortreatment withvitamin
fat-soluble factor concentrates.
(i.e. A, D, E, and K) deficiency due to fat malabsorption from pancreatic insufficiency. Vitami
on factors II, VII, IX, and X. Vitamin
me typically occurs in children who have K deficiency leads to easy
recently recovered bruising,
from mucosal
a diarrheal illnessbleeding,
and whoand prolonged
have prothrombin
acute renal time.
injury, thrombocy
histocytes on peripheral smear.
sease can develop aplastic crises characterized by an acute drop in hemoglobin, a reticulocyte count < 1%, and no splenomeg
m neural crest cells, which are precursors to the sympathetic ganglia and adrenal medulla. Neuroblastoma arising in the cervica
ated
a is aHorner syndrome
congenital, (i.e. cell
pure red ptosis, miosis,
aplasia anhidrosis).by macrocytic anemia and several congenital abnormalities, such as cleft p
characterized
cell
s bytrait lead normal,
increasing healthy lives.
fetal hemoglobin Painless
levels, hematuria
is indicated is the most
in patients withcommon complication.
sickle cell disease who have frequent vaso-occlusive crises
ffect of myelosuppression (neutropenia, anemia, thrombocytopenia).
est
he manifestation
most commonofcause vaso-occlusive
of anemia disease
in preterm in sickle
infants.cell disease
It is due to and presents
diminished with the acute
erythropoietin onsetshortened
levels, of bilateralred
hand andcell
blood foot
lifesws
hemoglobin and hematocrit and a relatively low reticulocyte count.
is, or pooling of red blood cells in the spleen, in sickle cell disease presents with signs of severe, acute anemia (e.g. tachycardi
atients. Laboratory
uclear remnants of testing
red blooddemonstrates
cells that arenormocytic anemia,by
usually removed reticulocytosis, and thrombocytopenia.
a functional spleen. Due to functional asplenia in sickle cell patie
pheral smear.
a typically presents with isolated thrombocytopenia after a viral infection. Children with isolated cutaneous symptoms (e.g. pete
meobservation
e alone,byregardless
is characterized ofhemolytic
the triad of platelet count. Those
anemia, with bleeding should
thrombocytopenia, receive
and acute glucocorticoids,
kidney anti-D, ortypically
injury. Presentation intravenous
occurs imma
richia
me, coli O157:H7
which or, less commonly,
is most commonly caused byShigella.
a Shiga toxin-producing strain of Escherichia coli (serotype O157:H7), is characterized b
a, and
emia is acute kidney
the most injury.cancer in children and presents with signs of bone marrow failure. The presence of > 25% lymphobla
common
caused by a defect of red blood cell membrane proteins, often presents with refractory jaundice and splenomegaly on examina
e suspectedmean
increased in any corpuscular
patient withhemoglobin
pancytopenia concentration.
following drug intake, radiation exposure, or viral infection. Bone marrow will demo
ion factors II (prothrombin), VII, IX, and X. Symptoms include easy bruising, mucosal bleeding, gastrointestinal bleeding, and/o
eals prolonged
ory findings PT with
of iron or without
deficiency anemiaprolonged PTT.
are decreased mean corpuscular volume (MCV), increased red blood cell distribution wid
uration, and increased total iron binding capacity
typically manifests as a triad of Coombs-negative hemolytic (TIBC). Theanemia,
peripheral smear and
jaundice, will show small, hypochromic
splenomegaly. It should bered blood cells.
suspected in pat
ocytosis, and family history of anemia. Eosin-5-maleimide binding and acidified glycerol
emia is most commonly seen in boys age 2-5 and presents with anemia, thrombocytopenia, and a normal or elevated white bloolysis tests are diagnostic.
r and bone
trauma marrow biopsy
is suspicious is characteristic.
for a bleeding disorder (e.g. hemophilia), and coagulation studies should be obtained. Hemophilia present
ount.
umonia in school-aged children is frequently due to atypical bacteria such as Mycoplasma pneumoniae. The presentation is gen
AP,nd patients
bilateralwith
crackles on lung examination.
Mycoplasma pneumonia typically have patchy or reticulonodular bilateral pulmonary infiltrates (rather than lobar
β-lactams are ineffective because
palms/soles, and then spreads centrally; the organism lacksevolves
it usually a cell wall.
to petechial lesions over time. Thrombocytopenia, elevated aminotran
s.sedEmpiric doxycycline should be initiated while awaiting
by lymphohematogenous dissemination of Mycobacterium tuberculosis confirmation with serology.
from the lungs to other organs, resulting in micronod
mmon among infants and immunocompromised hosts with
ulosis (TB) should be suspected in children with chronic cough and characteristicpoor T-cell function and chest
is often associated
x-ray findings with
(e.g.false-negative tuberc
hilar lymphadenopa
ey haveBrisk
(group factors for TBare
Streptococcus) exposure (e.g. homeless
gram-positive shelter).
cocci in pairs and chains on culture. It can cause early-onset neonatal sepsis or late-onse
monly presents
a benign at age 4-5common
skin infection weeks with bacteremia,
in children, meningitis,
presents and/or focal infection
with flesh-colored (e.g. cellulitis-adenitis).
papules with central umbilication. Lesions resolve within
observation.
causes unexplained fever, maculopapular rash, and aseptic meningitis. It should be suspected in sexually active or high-risk pa
s have been excluded.
ahelasting > 2 weekspathogen
most common is most commonly
in early-onset parasitic, andpneumonia.
neonatal Entamoeba histolytica
Symptomsinfection should be suspected
include respiratory in returning
distress (e.g. travelers
retractions, tachypw
ration
opacities, often with pleural
of meningococcal effusions.
meningitis and suggests disseminated intravascular coagulation (DIC), which is characterized by clottin
evidence of DIC includes thrombocytopenia,
hylaxis against Neisseria meningitidis is indicated elevated PT contacts
for close and PTT,(regardless
and low fibrinogen.
of vaccination status) who have had exposure du
appropriate antibiotic initiation. Medication regimens include rifampin,
roduces primarily in the nasopharynx, and infectious particles are readily aerosolized through ciprofloxacin, or ceftriaxone
coughingandand
should be given
respiratory as soon
procedures
nfected
presents patients until they
with altered mentalhavestatus
been in treated withtoantibiotics
addition for 24 hours.
fever, headache, seizure, and focal neurologic findings. Temporal lobe abnor
plex virus encephalitis.
g acutemembrane
mpanic otitis media(TM) include young age
perforation (6-18presents
typically months),with lackacute
of breastfeeding, day care
otalgia, otorrhea, andattendance,
an erythematousand passive smoke exposure
and perforated TM. Am
ndicated in a patient who has received amoxicillin within the past 30 days.
mmon gastroenteritis in the United States and is often implicated in outbreaks on cruise ships and in schools. Patients develop v
after is
eritis exposure.
most commonly Treatment is supportive,
caused by undercookedand symptoms
poultry and generally
presentsresolve within
with fever, 2-3 days.pain, and mucus-filled (sometimes blood
abdominal
iring symptomatic
enerally care only.
mild, self-limited illness that presents acutely with watery diarrhea and abdominal pain in a patient who has traveled to a
cfollow-up
Escherichia coli is the most
in well-appearing children. common Empiric
etiology.antibiotics are not recommended due to the increased risk of hemolytic uremic sy
er respiratory tract infection that presents in children age < 2 with cough, congestion, diffuse wheezes/crackles, and respiratory
ve (e.g. nasal saline and suctioning).
ymphadenitis in children typically presents with an erythematous, tender, warm lymph node, as well as possible fever and fluctu
atients
causeswith a historysymptoms,
nonspecific of periodontal disease
including or dental
irritability, caries
poor via local
feeding, andspread
lethargy.of bacteria.
An abnormal leukocyte count is common. Empiri
to treat the most common pathogens, including group B Streptococcus,
agious infection characterized by a whooping cough. Infants are at high risk of life-threatening Escherichia coli, and Listeria
apneamonocytogenes
and cyanosis. Empiric anti
erhinosinusitis
cases, may shorten illness duration.
can lead to intracranial extension of infection, such as brain abscess. Symptoms include focal headache, early-m
logic changes. Urgent CT scan of the head reveals a ring-enhancing lesion.
Shigella sonnei
is indicated forpresents
newborns acutely
born towith high fever,
mothers abdominal
with varicella cramping,
developing 5 and
daysmucoid
before and/or bloody
to 2 days afterdiarrhea.
delivery. ItProphylaxis
may be associated
is achie
os the infants, who are too young to receive live varicella-zoster virus vaccine.
a common cause of bacterial foodborne illness in the United States. Most cases arise from undercooked poultry or improperly
scongenital
and include fever, vomiting,
cytomegalovirus diarrhea,
(CMV) and abdominal
infection pain.
include microcephaly and periventricular calcifications. Pregnant women most com
y fluids (e.g. saliva) and transmit the infection
es has been reduced drastically by measles-mumps-rubella vaccination. vertically to the fetus via placental transfer.
The vaccine has an excellent safety profile, but within 1
may develop a fever and mild rash that resolve without treatment.
vaccine is recommended for all children at ages 1 and 4 to prevent primary varicella infection. The live-attenuated vaccine virus
s.
sed by Bartonella henselae, most commonly presents with a mild papular or nodular skin lesion and ipsilateral lymphadenitis of g
e are sufficient to make a clinical diagnosis of cat-scratch disease.
Coxsackie virus infection. It typically presents with fever and oropharyngeal vesicles and ulcers on the posterior soft palate, pal
in childrenpresents
frequently presentswithwithheadache,
fever, dysphagia,
fever, focalmuffled voice, and
neurologic pain and
deficits, withseizure.
neck extension.
CyanoticLateral neckheart
congenital soft-tissue
disease x-rays will fact
is a risk sho
bacteria.
nts with nonspecific signs of congenital infection (jaundice, hepatosplenomegaly, blueberry muffin spots, and growth restriction)
enital syphilis
itis should be include
consideredsnuffles (copious
in children withrhinorrhea) and a discharge/congestion
cough or nasal maculopapular rash that thatmay desquamate
persists or become
for > 10 days withoutbullous.
improvement.
infections and allergic rhinitis.
ferentiated from preseptal cellulitis by the presence of pain with extraocular movements, visual changes, proptosis, or ophthalm
ead to permanent
ymphadenitis is anvisual
infectionimpairment
in children or intracranial complications
age < 5 characterized (e.g.
by an infection,
enlarged, thrombosis).
markedly tender, warm, erythematous cervical no
s of viral meningitis are enteroviruses, such as group B coxsackievirus. Cerebrospinal fluid and
target the most common bacteria, including Staphylococcus aureus, Streptococcus pyogenes, anaerobes.
analysis shows mild pleocytosis with
dpic protein, and normal glucose.
viral disease transmitted to humans by exposure to saliva from an infected animal through a bite. Paresthesia of the bite wo
3 months, patients develop encephalopathy, dysautonomia, and hydrophobia, followed by coma and death.
me
withpresents with cataracts,
a small forceps as soonpatent ductustoarteriosus,
as possible reduce theand risksensorineural
of a tickbornehearing
illness. loss.
If theInfection is best prevented
tick is attached by vaccination
for < 36 hours, antimicro
ease is not required.
nd Streptococcus pyogenes are the most common causes of acute, unilateral cervical lymphadenitis in children. Affected nodes are
tion
odesisare common.
common in children and young adults. In the absence of worrisome features (e.g. > 2 cm, firm, immobile lymph nodes
rved for resolution.
presents most commonly in teens and young adults with an abrupt onset of rapid progression of fever, headache, myalgias, pe
d shows
matic, evidence
healthy of bacterial
patients age > 1meningitis
year with (e.g.
varicellalow exposure
glucose, high
shouldprotein, neutrophilic
receive postexposure leukocytosis).
prophylaxis with the varicella vaccine.
ne should
group receive varicella
A Streptococcus immunoglobulin
(S. pyogenes) and presentsinstead.
with fever, pharyngitis, circumoral pallor, strawberry tongue, and rash. The cl
sycin)
(e.g.are
axillae, groin) and
the first-line often results
medications in desquamation.
for pertussis treatment and postexposure prophylaxis. All close and high-risk contacts should
ected with paroxysmal cough and post-tussive emesis, even if patients are fully immunized. Vaccination reduces infection risk b
of the knee in an adolescent is most often caused by trauma, bacterial infection, or inherited blood disorder. Less common caus
m sickness,
the most commonall of pathogen
which areisolated
typicallyinaccompanied by achildren
infants and young preceding/ongoing rash. (CF). Pseudomonas aeruginosa
with cystic fibrosis
yontributes
presents to life-threatening
with decline
nocturnal perianal in pulmonary
pruritus and canfunction.
cause vulvar and perianal erythema. Diagnosis is confirmed by visualization
ith albendazole or pyrantel pamoate.
ur in infants born to unimmunized mothers, frequently following umbilical stump infection. Affected infants present in the first few
y.classically
Treatmentpresents
includeswithantibiotics
diffuse and tetanus immune
intracerebral globulin.
calcifications and ventriculomegaly. Maternal acquisition of toxoplasmosis is mos
cooked meat.
BS) is the most common cause of neonatal sepsis. Prevention of early onset GBS infection includes maternal screening before
t these with
esents measures
failure do not decrease
to thrive, the risk of late-onset
lymphadenopathy, (> 7 days)
and opportunistic GBS sepsis.
infections (e.g. Pneumocystis pneumonia, severe thrush). Sele
CR reaction testing confirms the diagnosis.
n of the rubella virus is most teratogenic during the first trimester. The classic triad of congenital rubella syndrome includes sen
soccurs
arteriosus), andborn
in infants cataracts.
to untreated mothers and presents at age 2-5 days with severe conjunctivitis that can ulcerate, scar, and
ophthalmic ointment administered shortly after birth is highly effective in preventing gonococcal conjunctivitis.
aracterized by papules
causes functional and due
asplenia pustules with overlying
to recurrent splenic honey-colored crusting.
infarction. Therefore, Topicalare
patients antibiotics
at risk of(e.g. mupirocin)infection
overwhelming are the treatmen
with enc
enicillin prophylaxis. Pneumococcus remains the most common cause of sepsis in patients with SCD.
ants presents with fever and signs of meningeal irritation as well as increased intracranial pressure. Lumbar puncture should be
terial meningitis.
pinworm) infection
s a rare but is highly
potentially fatalcontagious andofmanifests
complication infectiousasmononucleosis.
nocturnal perianal pruritus.
Patients First-line
have treatment
dysphagia is with pyrantel
and respiratory pamoate
distress, with exo
on and severe
suspected when tonsillar enlargement.
a patient Treatment
has acute fever, includes
joint pain, corticosteroids.
inability to bear weight, elevated erythrocyte sedimentation rate, and leuko
antibiotics are needed to prevent permanent joint destruction.
d Salmonella are the most common causes of osteomyelitis in children with sickle cell disease. Therefore, empiric antibiotics should
gative (e.g. ceftriaxone)
s whooping coverage.
cough, a vaccine-preventable disease characterized by severe coughing episodes, which are often associated with post-t
on may reveal evidence of increased capillary
is most commonly caused by the Epstein-Barr pressure (e.g.presents
virus and facial petechiae, subconjunctival
with fever, hemorrhage).
malaise, exudative pharyngitis, cervical lymphade
olymorphous, maculopapular rash frequently develops after administration of amoxicillin but
a complication of untreated Streptococcus pyogenes pharyngitis. Major clinical features include carditis,does not chorea,
represent a true drug
erythema alle
margina
coccemia,
is a common watch out for
cause Waterhouse-Friderichsen
of bacterial meningitis in childrensyndrome, which is presents
and classically characterized by a sudden
with fever, lethargy,vasomotor collapse
nuchal rigidity, andand skin r
petechia
, and
ted in the
anydisease canespecially
ill patients, be complicated
those by
with shock, multiorgan
a history failure,
of febrile disseminated
paroxysms, who have intravascular
traveled tocoagulation, and death.
an endemic-tropical region. Thi
etection
fection located anterior to the orbital septum. In contrast to orbital cellulitis, preseptal cellulitis does not involve orbital fat to from
and quantification. Nonimmune children are at highest risk of death, but the sickle cell trait confers some protection extr
anges, ophthalmoplegia, painful eye movements, or proptosis.
st commonly
influenzae, caused by parainfluenza
Streptococcus pneumoniae, and virus. It presents
Moraxella with fever,
catarrhalis arehoarseness,
the most common inspiratory stridor,
bacterial and aofharsh,
causes acute barking,
bacterialseal-lik
rhinos
fatpersistent
presents nasal dischargefever,
with low-grade and cough.
a maculopapular rash with cephalocaudal spread, and posterior auricular and suboccipital lym
,uses
may also have arthralgias and/or
foodborne illness due to the ingestionarthritisofthat can persist
preformed after
toxins. the rash
Vomiting resolves.
is the pre-eminent symptom and usually begins 1-6 hours
zed food handlers usually transmit S. aureus to food during preparation.
erisand
supportive;
parotitis.however,
Althoughvitamin
mumpsAisreduces
generally morbidity and mortality
self-limited, rates can
complications in children
includewith severe
orchitis, measles
aseptic and should
meningitis, be adminis
pancreatitis, an
unvaccinated individuals.
is characterized by prolonged fever, pharyngitis, fatigue, lymphadenopathy, and splenomegaly. Sports (especially contact spor
of splenic rupture.
alepatitis
infection of the(HBV)
B virus bone infection
that typically presents
should receivewith feverimmunization
passive and focal bony pain.
with Infection
hepatitis is most globulin
B immune often caused by hematogenous
and active immunizations
haracterized by low-grade fever, lymphadenopathy (particularly suboccipital, posterior auricular, and posterior cervical), and a m
byForchheimer
a prodromespots (erythematous
of cough, coryza, and papules on the soft
conjunctivitis palate)
followed by may be seen.
a maculopapular rash that spreads in a cephalocaudal pattern. T
e route.
characterized by successive crops of intensely pruritic vesicles. The disease is usually self-limiting and has been significantly re
with a 2-dose
suspected series. with acute onset of fever and joint pain and swelling. Management includes arthrocentesis, empiric paren
in children
includes fever, cough, coryza, and nonpurulent conjunctivitis. Koplik spots, small white lesions on the buccal mucosa, may als
s. Following
ingitis presentthe prodrome,
with nonspecifica maculopapular rash appears
symptoms, including on the
irritability, face and spreads
temperature instabilityin(fever
a cephalocaudal and centrifugal
or hypothermia), pattern.
poor feeding, and
pected sepsis, blood,
AS) pharyngitis urine,
presents and
with cerebrospinal
fever, fluid, cultures
tonsillar exudates, shouldanterior
and tender be obtained followed
cervical by administration
lymphadenopathy. of empiric
Unlike antibiotics
in adults, GAS ph
apid
n of thestreptococcal
glans penis)antigen testinginoruncircumcised
is common throat culture toddlers
prior to initiation
due to poorof antibiotics. Penicillin
genital hygiene. and amoxicillin
Candida are the should
albicans infection preferred
be trea
con
budding yeast on potassium hydroxide microscopy confirms the diagnosis. Treatment includes proper hygiene and a topical an
ftorsion
direct penile
shouldtrauma is concerning
be suspected for urethral
in a patient injury and should
with cryptorchidism prompt
and an acuteretrograde
abdomen.urethrography.
Infants may have irritability, inconsolable
plasia is most commonly due to 21-hydroxylase deficiency, which results in decreased cortisol and increased 17-hydroxyproges
ozed
virilization (e.g. underdeveloped
by a ventrally phallus,
displaced urethral hypospadias)
opening and dorsalinhooded
femaleforeskin.
(46,XX) infants.
Urologic evaluation is required prior to circumcision b
epair, and conventional circumcision techniques may be unsafe.
aracterized by a urethral meatus located at the perineum or scrotum, an underdeveloped penis/glans, and severe penile curvat
sex development
escended testis, isand warrants
ideally karyotype
corrected analysis and
with orchiopexy bypelvic
age 1 ultrasound.
year to reduce the risk of complications (e.g. infertility, testicular
ery, the risk of testicular germ cell tumor remains elevated compared to the general
ally present with painless scrotal swelling that transilluminates on examination. population.
Management includes observation and reassur
ear.
nd Plan-Do-Check-Act
boma, paradigms
heart defects, atresia are quality
choanae, improvement
retardation tools. They are 4-step
of growth/development, cyclical processes
and genitourinary and earwith the goal of is
abnormalities) continual
associateim
theand
a, newborn period.
aortic coarctation are features of Turner syndrome. Patients are at increased risk of osteoporotic fracture due to estrogen
Turner syndrome include webbed neck, horseshoe kidney, and nail dysplasia. Congenital lymphedema occurs due to dysgene
-pitting carpal and pedal edema.
ge < 25 are at increased
rodegenerative risk of
disorder that sexually presents
classically transmitted infections and
in adolescents require
with annualataxia
progressive screening for Chlamydia
and dysarthria. trachomatis
The and Neiss
most common caus
ve heart failure) due to hypertrophic cardiomyopathy.
disorder of migration of fetal GnRH and olfactory neurons that results in delayed puberty (i.e. primary amenorrhea) and anosmia
ypogonadotropic hypogonadism (low FSH). In these patients, karyotype (genotype) is consistent with phenotype.
me is characterized by peripheral precocious puberty, irregular café-au-lait macules, and polyostotic fibrous dysplasia (e.g. recur
der-Willi syndrome
utosomal dominant are hypotonia,
disorder hyperphagia,
that results and obesity.
from mutations of thePatients
fibrillin-1are at risk
gene. for sleep
Affected apnea,
patients typetall
have 2 diabetes mellitus,
stature; long, thin and
extreg
sophy
dislocation;
presentsandwithaortic
grossroot dilation.
motor delay (e.g. delayed independent walking), Gower sign, and progressive muscle weakness. Initi
tic analysis typically confirms
a (HSP) is an IgA-mediated vasculitis the diagnosis.
that presents most common in children with palpable purpura, abdominal pain, arthralgia
dophy
risk for
should be suspected in a boy age intestinal
ileoileal intussusception due to edema and
< 5 with proximal bleeding.
muscle weakness and calf pseudohypertrophy. Patients have marked
the muscle.
drome (trisomy 18) commonly have microcephaly, prominent occiput, fetal growth restriction, and micrognathia, as well as close
he mortality complication
utoimmune rate in the first
of year
groupofAlife approaches 95%.
Streptococcus infection caused by molecular mimicry, in which antistreptococcal antibodies
glia. Neuropsychiatric manifestations include
aused by immature respiratory centers in the pons and chorea, milkmaid
medullagrip,
and hypotonia, emotional
affects virtually lability,
all preterm and obsessive-compulsive
infants < 28 weeks gestation.beh Di
ed in a well-appearing infant with a classic presentation in the first few days of life.
uld be suspected in an infant with nonspecific vomiting and an acute, unexplained change in behavior, even in the absence of a
vicalto
ead detect
spine subdural
injury shouldhemorrhage.
have their cervical spine motion restricted (e.g. log roll technique, application of a rigid cervical collar) u
genetic condition resulting in progressive degeneration of the retina. Patients have progressive night blindness and peripheral v
tinal pigment
episodic, deposition
unilateral, in addition
throbbing to retinal
headaches vessel attenuation
commonly triggered byand opticfasting,
stress, disc pallor.
and/or dehydration. Acute management include
ptan (e.g. sumatriptan) in refractory cases.
ad circumference > 2 standard deviations below the mean (i.e. < 2nd percentile). In a child with normal development and an oth
arental
ex is anhead circumferences
inherited neurocutaneous to assess for benign
disorder familial microcephaly.
characterized by benign hamartomas of various organs. Epilepsy is a frequent findin
Other characteristic features include periungual
ally presents with tearing, photophobia, blepharospasm, and an fibromas and subependymal
enlarged cornea nodules.
and globe. Patients with Sturge-Weber syndro
ber
e, an autosomal dominant condition caused by a mutation of a tumor suppressor gene,pressure.
angle anomaly. Evaluation of glaucoma includes tonometry to measure intraocular leads to various neoplasms, including C
ochromocytomas, and renal cell carcinomas.
ex (TSC) is an autosomal dominant neurocutaneous disorder characterized by distinct skin features and benign tumor formatio
d cardiac
open neuralrhabdomyomas.
tube defect in which TSC should be suspected
the meninges and spinalin infants with infantile
cord protrude throughspasms and ash-leaf
the skin. It is oftenspots.
associated with a Chiari II m
lla and cerebellum through the foramen magnum), as well as obstructive hydrocephalus.
ircumference > 97th percentile. The condition is most likely benign (e.g. familial) in a patient with normal development and norm
gns of increased
erebrospinal fluid)intracranial pressure).
causes ventricular Management
dilation is reassurance
and increased intracranialandpressure.
observation.Children may have a rapidly enlarging head c
In patients whose anterior fontanelle has closed, headache, vomiting,
collection of blood between the skull and periosteum caused by the rupture of subperiosteal hypertension, and papilledema may occur.
vessels during delivery. Examinatio
ot cross suture lines. Management is with reassurance and observation because most cephalohematomas resolve without inte
sincreased
zoster oticus (i.e.
risk of Ramsay Hunt
developing syndrome)hemorrhage
intraventricular includes severe (IVH)ear
duepain, ipsilateral
to the presence facial paralysis,
of the germinal and a vesicular
matrix, rash
a fragile, in thevasc
highly ex
mptomatic,
ents with sudden all preterm neonates
headache, focalborn at < 32 deficits,
neurologic weeks gestation
and altered require
mentalscreening headfactors
status. Risk ultrasound.
in children include vascular malform
ad e isCT scan of a ruptured
characterized AVM typically
by prolonged showsconcussion
(> 4 weeks) an intraparenchymal
symptoms bleed (i.e. hyperdense
(e.g. headache, fluid collectionManagement
sleep disturbance). with irregularismargins
sympto
months.
rapid rotational acceleration of the brain during head trauma. Diagnosis is based on clinical findings of neurologic disturbance (
ut evidence
matic of structural
brain injury, intracranial
is characterized by injury. Treatment
neurologic symptoms is physical and cognitive
(e.g. headache, rest followed
difficulty by a gradual
concentrating) withoutreturn to activity.
structural intracrania
td for 24-48 hours, followed by a gradual return to play with slowly increasing physical intensity.
in children with minor head trauma and no high-risk features for intracranial injury (i.e. altered mental status, loss of consciou
headache,
mild traumatic signs
brain ofinjury
basilar skull fracture).
resulting in transient impairment of normal neuronal function. Typical symptoms include headache, dis
abnormalities in coordination, speech,
her typical findings of meningitis (e.g. nuchal attention, or emotions.
rigidity). Additional features warranting LP include signs of increased intracranial p
benign, slow-growing, calcified tumors within the suprasellar region. Tumor compression of the optic chiasm can result in bitem
use
is a panhypopituitarism (e.g.mass
benign intraventricular growth
thatfailure,
causes pubertal delay).
increased production of cerebrospinal fluid, leading to ventriculomegaly and hydro
with enlarging head circumference and signs of increased
ness, are a common, yet often underrecognized, feature. The intracranial pressure.
childhood phenotype (age of onset < 10) often presents with intel
ranial hypertension typically presents in obese women of childbearing age, it can also be seen in children who are not obese. H
e.g. blurry
caused by vision, enlarged
the shearing blind spot)
of veins between are the
often predominant
dural sinuses andin the prepubertal
scalp population.
due to scalp Papilledema
traction during is the
delivery. hallmark
Blood examin
accumulates
eng diffuse, fluctuant
hydrocephalus, scalptoswelling.
leading Rapid
a bulging hemorrhage
fontanelle, upwardexpansion can lead and
gaze impairment, to hypovolemic shock, disseminated
signs of increased intravascular
intracranial pressure c
(e.g. irri
haracterized by inferior displacement of the cerebellar tonsils through the foramen magnum, and syringomyelia is a commonly a
presentation
ex should be may occur in
suspected in adolescence/adulthood
a patient with refractory with occipital
epilepsy, headache exacerbated
developmental by activity
delay, intellectual and Valsalva
disability, maneuvers.
and characteristic skin
es subependymal nodules and cardiac rhabdomyomas.
are triggered by fear or pain from minor trauma and are characterized by pallor/diaphoresis with brief loss of consciousness t
. Diagnosis is clinical and requires no testing.
d of normal development is followed by regression of speech, loss of purposeful hand use accompanied by stereotypical hand m
es include
anial breathing
pressure abnormalities,
in young autistic
children include features,intractable
irritability, and seizures.
vomiting, lethargy, and a bulging fontanelle. Urgent brain imaging
ffect, and impending herniation.
ngitis, a viral etiology is suggested when cerebrospinal fluid analysis reveals a mildly elevated white blood cell count and protei
us is capable
osomal of causing
recessive, viral meningitisdisease
neurodegenerative in unvaccinated individuals.
that typically presents in adolescence with progressive ataxia, dysarthria, scolios
uela of group A Streptococcus (GAS) infection, is the primary columns.
ioception also occur due to degeneration of the dorsal spinal cause of chorea (i.e. abnormal, jerky movements that disappear d
s is the most common sequela of congenital cytomegalovirus (CMV).with
changes are commonly seen, and evaluation includes GAS testing To throat
reduceculture and
the risk of antistreptolysin O andtherapy
hearing loss, antiviral antideoxyribo
should
epatosplenomegaly, jaundice, periventricular calcifications).
pically present with signs of cerebellar dysfunction (e.g. ataxia) and increased intracranial pressure (e.g. headache, vomiting, pa
numors are pilocytic
18-month-old childastrocytoma and medulloblastoma.
includes a 10-25-word vocabulary, running, kicking, scribbling, and pretend play. The inability to walk or ru
h appropriate language development should have a vocabulary of > 50 words, combine words into 2-word phrases, and follow 2
ogenerally
understand at least
benign and half of a 2-year-old's
characterized speech.
by a brief period of apnea and skin color change associated with an emotional trigger. Pare
harmless and children still develop normally.
rence and benign
e typically signs ofandincreased
occur inintracranial
children agepressure
6 monthsin children should
to 5 years. They beareevaluated with an
generalized, lastimaging study such
< 15 minutes, and as
do anot
CTrecur
scanwith
of
ement is withloss
d by sudden supportive care (e.g. antipyretics)
of consciousness, and tone,
loss of postural reassurance.
and a postictal state with delayed return to baseline neurologic functi
vements.
most commonly presents with ascending weakness and areflexia, and can progress to involve respiratory and bulbar muscles. S
vital capacity
rom otitis mediaand negative
(OM) inspiratory
or mastoiditis canforce is indicated
cause a temporal to brain
monitor for impending
abscess. respiratorycan
The presentation failure.
include severe headache, mor
osis is confirmed by visualization of a ring-enhancing lesion on CT scan or MRI of the brain.
ent, focal weakness or paralysis (e.g. hemiplegia) that occurs in the postictal period after a focal-onset (+/- secondary generaliz
solve within 36 hours.
njuries can result in internal carotid artery dissection or thrombus formation, which can present with hemiplegia, facial droop, an
is a genetic
rome (SIDS)condition
refers to associated with café-au-lait
the unexplained macules,
death of infants age <axillary
1. SIDSand inguinal
risk freckling,
is decreased Lisch
with smokenodules, and neurofibromas
avoidance, (pe
pacifier use, sle
sharing
caused without bed-sharing.
by a deficiency in hypoxanthine-guanine phosphoribosyltransferase. Neurologic findings begin with developmental del
nward lens dislocation, andchildhood.
nia, and spasticity in early Cardinal findings
hypercoagulability. Treatment include self-mutilation
involves and gouty arthritis.
vitamin supplementation and antiplatelet or anticoagulation t
miting; and a visual, auditory, or linguistic aura. First-line treatment in children includes acetaminophen, nonsteroidal anti-inflam
ay
ge be is atried if these
common measures are
complication not effective.
of prematurity and can present with acute neurologic changes (e.g. seizure, apnea), a bulging fon
s in most patients with pineal gland masses (pinealomas) and presents as limitation of upward gaze, bilateral eyelid retraction,
also cause
ypically persistent
presents withheadache
ascendingand vomitingand
weakness duediminished/absent
to obstructive hydrocephalus.
deep tendon reflexes following a recent gastrointestinal or re
rome is the immune-mediated demyelination of peripheral nerve fibers.
autosomal dominant disorder that presents in adolescence or early adulthood with grip myotonia (delayed muscle relaxation), p
hagia,
rocytomas and are
cardiac conduction
the most common anomalies. Testicular
type of central atrophy/infertility
nervous system tumor. can also occur.
New-onset seizures may be the initial presentation of a
intraventricular hemorrhage is prematurity due to fragile germinal matrix vessels. Symptomatic newborns may have apnea, se
blood loss (e.g.
mpylobacter jejunianemia, tachycardia).
infection) is the mostCranial
frequentultrasound
precipitantisof
diagnostic.
Guillain-Barré syndrome (GBS), an acute demyelinating polyneuro
atosis type 1 are at increased risk for optic pathway gliomas, whichneuropathic
hyporeflexia. Other common findings of GBS include paresthesia, can presentpain,
with and autonomic
headache dysfunction.
and decreased visual acuity. MR
ial mass.
he most common cause of death from child abuse. Repetitive acceleration-deceleration forces cause shearing of the subdural b
ural and expansion
matoma retinal hemorrhages.
leads to elevated intracranial pressure (e.g. impaired consciousness, nausea/vomiting, headache) and unca
teral hemiparesis).
headache, signs of basilar skull fracture). Observation for 4-6 hours may be an alternative option if mental status is normal and
omegaly, and possibly seizures (due to hypoglycemia) in the first few days of life. The diagnosis is supported by the presence o
hpresents
suggests galactosuria.
with headache, vision changes, papilledema, and/or abducens nerve (CN VI) palsy. Growth hormone, tetracyclines, an
in) can cause
s a neurocutaneous increased intracranial
disorder pressure.
characterized by Withdrawal of these medications
a capillary malformation leads
(port-wine to along
stain) symptom
the resolution.
trigeminal nerve distribution a
ecting the brain and eye. Seizures, intellectual disability, and visual field defects can occur.
ered in any patient with an episode of sudden loss of consciousness followed by a postictal state of sleepiness and confusion. O
ce of tongue
(NF1) biting, and dominant
is an autosomal urinary incontinence.
neurocutaneous disorder associated with café-au-lait macules and axillary and inguinal freckli
,ubperiosteal
learning disabilities,
hemorrhage that presents ingliomas.
and optic pathway the first day of life with a firm, well-demarcated scalp swelling that does not cross sutu
se
sis. The diagnosis should be considered whenManagement
the risk of developing cephalohematomas. is with observation
a previously healthy because
infant presents most resorb
with bulbar spontaneously.
palsies, constipation, and hypoto
derived botulism immune globulin is the treatment of choice.
pe A is due to sphingomyelinase deficiency and presents at age 2-6 months with areflexia, hepatosplenomegaly, a 'cherry-red' m
hough Tay-Sachs disease presents in a similar manner, hepatosplenomegaly and areflexia are not seen.
one of the most common preventable causes of birth defects, behavioral problems, and cognitive impairment. The pathognom
hogressive
philtrum, motor
and thin vermilion with
dysfunction border.
prematurity as the leading risk factor. The most common findings are delayed gross motor mi
exia).
n sequela of Streptococcus pneumoniae meningitis due to inflammatory damage to the cochlea and/or labyrinth. Audiologic testing
aring
-linked loss and improve
disorder due to outcomes if hearing
a trinucleotide repeatrehabilitation
expansion inistheneeded.
FMR1 gene, is the most common cause of inherited intellectual di
lude a long face, prominent forehead, protruding ears, and macro-orchidism.
osomal recessive, neurodegenerative disease that typically presents in adolescence with progressive ataxia and loss of positio
nve number
a single of trinucleotide
cerebral hemisphere repeat
andsequences.
can spread to involve both hemispheres, causing impairment of awareness (with or without
contusion, avulsion) may occur indirectlyseizures
i. In contrast to absence seizures, focal followingare associated
head trauma due withtoa shearing
postictal forces
phase onandthe
areoptic
not provoked by hyperventilatio
canal. Patients have an acu
defect in the injured eye.
occurs after blunt trauma to the eye. However, ectopia lentis following minimal or no trauma should prompt evaluation for Marfa
ct
romeassociated
causes aortic
eye pain rootand
disease.
vision loss due to rapidly increased intraorbital pressure from trauma. Examination shows a tight orb
afferent pupillary defect. Management
corneal injury due to ultraviolet (UV) light is immediate
exposure insurgical decompression
the absence to prevent
of UV-protective permanent
eyewear. vision
Patients loss. seek medical a
generally
eral
ss, iseye pain and photophobia.
characterized by increased Punctate staining ofdiameter
anterior-posterior the corneas using
of the eye,fluorescein dye isdistance
causing blurred characteristic.
vision. High myopia (> 6 diopt
and macular degeneration.
uct obstruction is typically due to incomplete canalization of the distal duct, resulting in blockage of normal tear flow. Infants ha
conjunctivae.
gnment) presentsInitial
with management
eye deviation, involves lacrimal
asymmetric sac massage
corneal light andseveral times daily
red reflexes, and an to abnormal
open the duct.
cover test. Dilated funduscop
fe-threatening
reduction in thecause
visualofacuity
strabismus.
of one or both eyes and is caused by disturbances in binocular vision during early childhood. Beca
om an uncorrected refractive error
n IgE-mediated hypersensitivity to environmental may not present until theand
allergens normal eye iswith
presents occluded.
ocular pruritus, bilateral conjunctivitis, and clear di
pical therapy (e.g. antihistamines, mast cell stabilizers).
itiswell-child
ry include proptosis, ophthalmoplegia,
visit, as early detection of eye andabnormalities
visual changes.canBacterial sinusitis isvision
prevent long-term the most
loss.common predisposing
Formal visual factor for
acuity testing orbit
is recom
ear-olds.
is a genetic disorder that causes café-au-lait macules, freckling in skinfolds, Lisch nodules, and neurofibromas. Approximately
omas,
ypically which oftenatmanifest
presents age 5-14 with
daysunilateral
with mildvision loss,
eyelid proptosis,
swelling, esotropia,
chemosis, andand optic
watery ordisc pallor.
mucopurulent discharge. Affected infants
n)hebecause topical treatments are not effective.
affected eye by patching or applying drops to blur vision in the normal eye. Without treatment, strabismus can lead to ambly
ed eye.
lary reflex, in an infant or young child should prompt immediate referral to an ophthalmologist to evaluate for retinoblastoma. St
presents in the first 2-5 days of life with eyelid swelling, copious and purulent eye drainage, and conjunctival injection, causing
thewith
on application
Chlamydiaof atrachomatis
topical erythromycin
serotypes ointment
A, B, andsoon aftertrachoma
C. Acute birth. presents with follicular conjunctivitis and inflammation. R
yelashes and scarring of the cornea.
ns (e.g. cyclopentolate eye drops) can cause anticholinergic toxicity, especially in children or the elderly. Physostigmine, a reve
ed to treat
quire severesupport
respiratory anticholinergic toxicity.
to correct hypoxia. In patients who are unable to protect their airway or who are hypoxic despite supp
ould be performed.
Hymenoptera species can develop exaggerated local allergic responses called large local reactions, characterized by swelling, e
h the site
cterized byofhyperthermia
the sting. (typically < 40 C [104 F]) associated with weakness, dizziness, profuse sweating, headache, and/or na
troke. Management
children age < 1 afterincludes
exposurecooling (e.g. cool of
(e.g. ingestion water
honey)shower) and oral hydration
to Clostridium botulinum with salt-containing
spores. fluids.
Impaired acetylcholine release into the
ulobulbar weakness (e.g. absent gag reflex, ptosis), hyporeflexia, progressive hypotonia, and eventual paralysis.
mptomatic methemoglobinemia
ents with cyanosis after exposure or to
high
an levels of methemoglobin
oxidizing can benitrites,
agent (e.g. dapsone, treatedanesthetics).
with methylene blue
Pulse or high-dose
oximetry ascorbic
saturation acid.
is typical
en; however,
evated PaO2
blood lead is normal.
levels should be performed in children with risk factors (e.g. home built before 1978). Due to the potential of f
sting by venous blood
oisoning have abdominal pain,draw should be performed
diarrhea, to verify ain
and hematemesis; high blood they
addition, lead may
level.develop hypovolemic shock within a few hours
eals an anion gap metabolic
sciculations/weakness, acidosis,
diarrhea, and x-ray
vomiting, may show
lacrimation) andradiopaque
can rapidly tablets.
lead to respiratory failure. Management includes decon
nt cutaneous absorption and treatment with atropine followed by pralidoxime.
occur after accidental ingestion of prenatal vitamins and presents with abdominal pain, hematemesis, shock, and anion gap me
to evaluate the extent of injury. Attempting to neutralize the alkali with vinegar or lavage is dangerous as these interventions m
mage.
GR) is characterized by estimated fetal weight < 10th percentile or birth weight < 3rd percentile. Asymmetric FGR, in which hea
eroplacental
virus infectioninsufficiency (e.g. from
typically results maternal chronic
vertical hypertension)
transmission duringindelivery.
the second/third trimester.in newborns with CNS disease (i.e. e
The presentation
ure andhave
infants temporal lobeunder
a weight hemorrhage.
the 10th percentile for gestational age at birth and may have complications such as hypoxia, polycy
cemia.
glycemia causes fetal hyperglycemia and hyperinsulinemia. Neonates may be macrosomic, increasing the risk of shoulder dys
cle fracture). includes drying, stimulating, and warming. Healthy newborns should be placed on the mother's chest for skin-to
al resuscitation
ebreastfeeding initiation.
results from in utero exposure to an antiepileptic (e.g. phenytoin, carbamazepine) and presents with microcephaly, a wide ante
eal hypoplasia.
der dystocia, and vacuum delivery are risk factors for neonatal clavicular fractures. Management includes reassurance and gen
apidly without
e position complications.
to answer adolescents' questions about sexuality. Keys to promoting open discussion include providing a private setti
ftssex, removing stigma and discomfort
with depression, considerations by beingtreatment
for inpatient nonjudgmental,
includeand avoiding
suicidal assumptions
ideation, by using open-ended
poor psychosocial support, andand gender-ne
lack of psych
suicide must undergo emergency assessment for safety.
n may present with irritability rather than depressed mood. If a patient displays irritability along with social withdrawal and acade
ention deficit hyperactivity disorder in school-age children is with stimulant medications (e.g. methylphenidate, amphetamines) d
joint attention is a key feature of autism spectrum disorder in young children. Other possible features include the preference for
me when called.
xetine is an appropriate treatment for child and adolescent attention deficit hyperactivity disorder when parents prefer a nonstim
mal
inlypart of development
in girls characterized
and is characterized by loss byofcrying
speech when
andan unfamiliarhand
purposeful personuse,approaches. It typically
gait disturbance, peaks athand
stereotypical age 8-9 months ana
movements,
evelopment.
mmon Seizures are
and characterized bycommon and
persistent increaseininthe
difficulties prevalence with
acquisition andage.
use of language due to deficits in comprehension and/or
nce structure and functional use of language.
neglect can result in disrupted attachment to caregivers and difficulty forming healthy relationships. Reactive attachment disord
nthdrawal
adolescentas well
withas a lack of positive
neurologic response
dysfunction to attempts
(e.g. tremor, to comfort.raises concern for Wilson disease. Pathogenesis involves
parkinsonism)
eerofaccumulation in the liver
death in adolescents andand basal
often ganglia.
involves firearms. Males with mood disorders and impulsivity are at increased risk. Removin
and ammunition in separate containers, decreases the risk of suicide.
iatric obsessive-compulsive
ung children to touch their own disorder includes
or other young selective
children'sserotonin
genitals, reuptake inhibitors and/or
undress themselves cognitive-behavioral
or others, psychotherapy
and make masturbatory move
, and distractible. Age-inappropriate knowledge or simulation of sexual acts, however, should raise concern for possible abuse.
hy behaviors
drome is causedfor by
young
infantchildren include
withdrawal imaginary
to opiates andfriends,
usuallypretend
presents play, and
in the storytelling
first few dayswith fanciful
of life. details.
It is characterized by irritability,
s, sweating, sneezing, tachypnea, poor feeding, vomiting, and diarrhea.
deficit hyperactivity disorder is based on clinical evaluation of symptoms and associated impairment in 2 different settings. Tea
ng behavior
ndrome haveinhigh
the rates
schoolofenvironment.
psychiatric comorbidity, with a significantly increased risk for attention deficit hyperactivity disorder an
ed by intentional and repeated fire setting with no obvious motive. Patients have a fascination with fire and deliberately start fires
vioralare
utism disorder
verbalcharacterized by recurrent
at home but refuse hairinpulling.
to speak specificIt social
resultssettings,
in irregular patchesatofschool.
commonly hair loss
It iswith broken hair
considered shafts ofdisorder
an anxiety differin
onal and social impairment.
is characterized by abnormal social development and extreme behavior rigidity, with onset in early development. Higher-functio
ability may be diagnosed later, when deficits become more apparent with increased social demands.
urette disorder include
cial communication, habit reversal
restricted training,
interests, antidopaminergic
and repetitive behaviorsagents,
requireand α2 adrenergic
assessment receptor
for autism agonists.
spectrum disorder. Variable de
ayshould
be present.
be suspected in children with impaired social interactions, restricted interests, or repetitive behaviors. When parents ha
sensitive approachdisorder
eficit hyperactivity that considers
(ADHD)both parents'
should views, educates
be considered themwith
in children about the spectrum
symptoms of developmental
of inattention, disorders,
impulsivity, and enc
and hyperactivity
HD often
aused results in impaired
by immature family andcenters
central respiratory peer relationships.
and presents with respiratory pauses, often with bradycardia and desaturation. T
jury (e.g. drowning) can lead to widespread neuronal cell death, cerebral edema, and increased intracranial pressure (ICP). Se
ed by
asia is hypertension, bradycardia,
a chronic complication and irregular
of prematurity respirations.
caused by the arrest of pulmonary development and characterized by a prolonged
sed number and septation of alveoli.
hould be suspected in an enterally fed, premature or very-low-birth-weight infant with nonspecific apnea, lethargy, and abdomin
x-ray is diagnostic.
presents in children age < 2 years with cough and increased work of breathing (e.g. tachypnea, retractions). Diagnosis is typic
hial cuffing, increased interstitial markings, and the absence of focal consolidation.
n childrenoverload
rculatory can present
can with
occursecondary enuresis.
when a large volume Severe cases
of blood can result
product in cardiovascular
is rapidly complications.
transfused, particularly in children age < 3 with ch
rtension, tachycardia, and pulmonary edema within 6 hours of transfusion initiation. Management
is increased in premature neonates, particularly those with respiratory distress syndrome who are receiving include diuresis (e.g. furosem
mechanical ventila
hehernia results in herniation of abdominal contents into the thoracic cavity. Patients have respiratory distress at birth with absent
affected side. Hemodynamic instability or signs of tension pneumothorax (e.g. mediastinal shift) warrant emergency needle
st, andbea considered
hould scaphoid abdomen. Chest
in a patient withx-ray showscough
persistent intrathoracic bowelfollowing
or wheezing loops and a displaced
a choking cardiac
episode. silhouette.
X-ray may reveal classic findin
tinal shift; however, x-ray findings also may be normal, and bronchoscopy is indicated if
n which edema and narrowing of the proximal trachea result in a barky cough and inspiratory stridor. Treatment clinical suspicion remains high.
with corticoster
rway inflammation.
sping for airisisasuspicious
e newborn self-limitedfor obstructive
condition sleep
caused byapnea,
delayed which is commonly
resorption caused of
and clearance by pulmonary
adenotonsillarfluidhypertrophy
and is moreincommon
children.in inf
hortly afterimpairment
spiratory birth with respiratory distress
after submersion in and fluid
liquid. in the interlobar
Aspirated fissures
liquid causes on chest and
hypoxemia x-ray.
can wash out pulmonary surfactant, lea
ome.
asia (chronic lung disease of the neonate), which causes a persistent oxygen requirement, is commonly seen in premature infan
ntilation
occur after or oxygen
bacterialsupplementation.
pneumonias lead to pleural inflammation and exudation of fluid into the pleural space. Small effusions in c
cterial pneumonia leads close
with oral antibiotics and outpatient
to bacterial follow-up.
colonization of Moderate or large
pleural fluid. effusions
Key pleural fluidrequire drainage.
findings include pH < 7.2, glucose < 60 mg/dL
0/mm3, and Gram stain/culture positive for bacteria.
ve effusion due to disruption of lymphatic flow within the thoracic duct. Pleural fluid analysis demonstrates milky-white fluid with
rome
s a normalis caused by on
finding surfactant deficiency.
frontal chest Important
x-ray in children risk
agefactors
< 3 yearsinclude prematurity
due to its relatively andlarge
maternal diabetes mellitus.
size compared to the young child's t
aise concern for pneumonia or malignancy, depending on the clinical context.
llergic reaction characterized by hypotension or symptoms involving > 2 organ systems after exposure to an allergen. Foods ar
e is is the
the first-line
treatment for anaphylaxis, and additional doses may be required for refractory symptoms. Patients with anaphy
llergist
the most common immunotherapy.
for venom cause of bacterial pneumonia in young children with cystic fibrosis, especially in those with coexisting influenza i
italizations, or recurrent skin infections, intravenous vancomycin should be included for empiric therapy against methicillin-resistan
subgroup
monly of primary
caused ciliary dyskinesia,
by respiratory is characterized
syncytial virus and manifests by as
a classic triad of situssymptoms,
upper respiratory inversus, recurrent sinusitis, and
wheezing/crackles, andbronchiectasi
respiratory d
nsfibrosis
such as apnea and respiratory failure.
are identified through newborn screening. Therefore, the presence of nasal polyps, recurrent sinopulmonary infections
e.g. poor growth,ventilation
nd mechanical deficiencyareof indicated
fat-solubleinvitamins) should
patients with prompt
severe an evaluation.
asthma unresponsive to maximal medical therapy and who have
yms failure include altered
can increase mental pressure
intra-alveolar status, minimal aeration,
and cause air tohypercarbia, and worsening
leak into subcutaneous hypoxemia.
tissues (i.e. subcutaneous emphysema), resul
e first step in management is chest x-ray to confirm the diagnosis and rule out pneumothorax.
acute onset of respiratory distress (e.g. stridor, tripod positioning), dysphagia, and drooling. First-line management of patients w
in a controlled
rome should be setting.
suspected when a premature infant presents with grunting, flaring, and retractions immediately after birth. Ches
fdistress
the lungs. with unilateralincludes
Treatment early continuous
hyperinflation positive
and mediastinal airon
shift pressure
x-ray areventilation.
concerning for foreign body aspiration. Rigid bronchosc
ment of a newborn with suspected congenital diaphragmatic hernia (CDH) is endotracheal intubation. A gastric tube should also
atand bowel.
causes Bag-and-mask
subglottic edema ventilation
and narrowing,can exacerbate
presents with respiratory
barky coughdecline
andand should be
inspiratory avoided.
stridor. Patients with stridor at rest are tre
s is defined as nighttime urinary incontinence in a child age > 5 who has not achieved a prolonged period of nighttime dryness.
developing
dary this condition.
to obstructive sleep apnea should be considered in a child who has bed-wetting in addition to inattention, behavioral conce
al polysomnography.
ntinence) is typically a sign of stool impaction, which can cause or worsen nocturnal enuresis. Resolution of enuresis is often a
ipation
a cause(e.g. laxativeand
of daytime therapy).
nighttime urinary incontinence and should be suspected in a child with fatigue, hypertension, proteinur
n includes obtaining a
ew-onset nighttime wetting afterserum creatinine level and
a > 6-month renal
period imaging.
of urinary continence, may be caused by an underlying medical condition (e
he first step in evaluation is urinalysis.
ation). WAGR syndrome should be considered in a child with 2 or more of the associated conditions. In patients with WAGR syn
very 3 months
present in newbornin infancy
boys withand bladder
early childhood
distension,for early detection
decreased urineofoutput,
Wilms tumor.
and respiratory distress (due to oligohydramnios and
renal be
hould andsuspected
bladder ultrasound and voiding
in a prepubertal boy withcystourethrogram.
a soft, coiled ('bag of worms'), right-sided scrotal mass that fails to decompress w
evaluate
m for anatomical
is indicated to assesscauses leading tourologic
for predisposing venous abnormalities
compression (such as a venous thrombus
(e.g. vesicoureteral reflux) in or abdominal
a child with > mass).
2 febrile urinary trac
h an unusual
pically improvepathogen,
within 48or signsofofappropriate
hours chronic kidney disease.
antibiotic therapy. In children with persistent symptoms (e.g. fever), antibiotics sho
should be obtained to evaluate for anatomic abnormalities
e most commonly caused by gram-negative bacteria (e.g. Escherichia or the development
coli) and of a renal
can abscess.
present with fever and fussiness in an infant
nalysis is characteristic. Empiric therapy with a third-generation cephalosporin is recommended.
ephritis is a complication of group A streptococcal impetigo or pharyngitis. Pathogenesis involves deposition of immune comple
nt membrane, resulting in hematuria, edema, and hypertension.
normalby
caused saline are the
a defect fluid of
in either choice for
hydrogen initial resuscitation
excretion or bicarbonatein severe hypovolemic
reabsorption hypernatremia.
in the kidney. In infancy, it most commonly present
paremetabolic acidosis. Treatment consists of oral bicarbonate replacement.
the most common cause of urinary tract obstruction in newborn boys. Oligohydramnios from urinary obstruction can lead to
ry hypoplasia,
ility of the kidneys flat to
facies, and limburine
concentrate deformities.
and can occur in patients with sickle cell disease and sickle cell trait. Patients have poly
m.a is an IgA-mediated small vessel vasculitis that manifests with palpable purpura on the lower extremities, arthralgia/arthritis, ab
). Renal
TIs) biopsycommonly
are most shows IgAcaused deposition in the mesangium.
by Escherichia coli ascending the urethra to the bladder. Women often develop UTIs with dysu
s the most common cause of nephrotic syndromeurine
inary nitrites support the presence of E. coli, and culture is diagnostic.
in preadolescent children. Renal biopsy shows normal kidney architecture bu
s are the treatment of choice.
s the most common cause of nephrotic syndrome in young children. Renal biopsy is not required for initial diagnosis as the con
uld be suspected in an infant with fever > 39 C (102.2 F) with no identifiable source because presentation can be nonspecific (e
re are the
disease first steps
causing in evaluation.
recurrent renal stone formation. A personal history of recurrent kidney stones from childhood and a positive fam
the diagnosis. Urinalysis shows typical hexagonal crystals. The urinary cyanide-nitroprusside test is used as a qualitative scree
y is a common cause of nephrotic syndrome (edema, proteinuria, and hypoalbuminemia) in adolescents and adults. Active hepa
nuxreduces
can cause thisrecurrent
risk. or chronic pyelonephritis. Complications include parenchymal scarring, hypertension, and renal insuffici
throgram.
th a first febrile urinary tract infection (UTI) should receive 1-2 weeks of antibiotics and a renal and bladder ultrasound to evalua
risk factor for recurrent urinary tract infections and, if untreated, can lead to renal scar formation, hypertension, and chronic ren
nflammation
ommon renaland fibrosis. in children. Although it usually presents as an asymptomatic abdominal mass, hematuria may occur
malignancy
rtension may also be present.
polyuria, polydipsia, and weight loss is suggestive of new-onset type 1 diabetes mellitus.
at age
line 3-5 weeks with for
pharmacotherapy nonbilious,
nocturnalprojectile
enuresis.vomiting after each
It can provide feed. Protracted
immediate improvementvomiting
whenproduces
behaviorala hypochloremic, hypokalem
modifications and alarm t
high rate of relapse on discontinuation of therapy.
oma) is the most common
lomerulonephritis occurs 1-4 renal malignancy
weeks in children.
after group It typically
A streptococcal presents or
pharyngitis with an asymptomatic
impetigo. unilateral
Patients may abdominal mass.
be asymptomatic or have
ponent C3 is low.
common cause of isolated proteinuria in children and is often triggered by fever, stress, exercise, or hypovolemia. Confirmation
protein/creatinine
ressive disease that ratio and normal
presents repeat urinalysis
with recurrent hematuria once the provoking
in boys age < 10,factor is removed.
often with a family history of renal failure and/or hearin
shows
risk longitudinal
factor splitting
for recurrent of the
cystitis glomerular
in toddlers. basement
Impacted membrane.
stool can cause rectal distension, which in turn compresses the bladder, pr
a is an IgA-mediated vasculitis most commonly seen in children. Diagnosis is clinical, and no further testing is required in patien
2 ofdeformity
tal the following:
of thearthralgia,
talus boneabdominal
and presentspain,asand renalplantar
a fixed, disease. Skin foot
flexed biopsy
thatisisperformed
adducted forandatypical
internallyor incomplete presentatio
rotated. Initial treatmen
d participate in > 1 hour of daily activity, such as aerobic exercise with or without strength (or resistance) training. Strength train
as
ophy with directbe
should supervision
consideredand in ause of proper
toddler techniques
boy who in a cognitively
has weakness, delayedmature
walking, child.
and bilateral calf enlargement. The absence o
ardiomyopathy and conduction abnormalities. Patients should be screened
juvenile idiopathic arthritis (JIA), the most common subtype, is characterized by arthritis with an echocardiogram
involving < and ECG.
4 joints. Patients are classic
is indicated because uveitis is a serious potential complication of oligoarticular JIA that
ominantly female, and the incidence peaks during adolescence and the toddler years. Nonsteroidal anti-inflammatorycan cause irreversible vision loss
drugsif untr
(e.g
ral tibial fractures, are seen in children during the first few years of walking. Injury typically occurs following a twisting motion du
naccidental
e forearm are trauma
common if theinhistory
childrenis due
inconsistent or ifstrong
to relatively the child is not yet ambulatory.
periosteum, which limits the fracture line from extending through the w
refracture, and no long-term complications are expected.
lf-limiting, inflammatory hip condition most common in children age 3-8. Presentation may include limp (with ability to bear weig
re afebrile
piphysis, with occurs
which normal most laboratory
commonlystudies (e.g. obese
among white blood cell count,
adolescents, C-reactive protein)
is characterized and small,
by proximal bilateral
femoral hip effusions.
displacement relative to
olvement is common and may present with chronic hip, thigh, or knee pain and a waddling gait.
n in children is typically caused by transient synovitis, which presents in well-appearing children who are often afebrile and able
aorcommon
septic arthritis
cause of (e.g.
heelinability
pain intochildren
ambulate,
wholeukocytosis)
play running require
or jumpingbilateral hipTenderness
sports. ultrasound, with
at theorbase
without arthrocentesis,
of the heel and withtocalca
distin
portive. symptoms despite a few days of vancomycin treatment, which usually indicates infection with a gram-negative bacter
continued
at coversvia
ntracted aerobic gram-negative
unprotected pathogens,
sexual intercourse cansuch asdisseminated
cause a third-generation cephalosporin
gonococcal infection, (e.g. ceftriaxone).
presenting with monoarticular arthritis w
ococcal mucosal
iopathic arthritis infection
who have(e.g. an cervicitis) are of
atypical flare usually absent,
a single joint,and
suchsynovial fluidpain
as severe culturewithmay be negative.
nighttime awakening, septic arthritis shou
c> arthritis
50,000/mm3 with can
in infants a neutrophil
be subtlepredominance
and may include supports
fever, the
lackdiagnosis.
of movement Treatment is immediate
of the involved joint, antibiotic
excessivetherapy.
fussiness (e.g. during
r bowed
ures, legs, is typically
or bucket-handle physiologic
fractures, occurfrom
when birth
anand resolves
extremity by ageor2.twisted.
is pulled Management
These is reassurance
fractures andflag
are a red observation.
for child abuse and
occult fractures.
ic arthritis is an autoinflammatory disorder of childhood characterized by arthritis for > 6 weeks and fever for > 2 weeks. Hepato
mmon, and is
ic arthritis quotidian feversby
characterized (spiking oncefever
quotidian daily)forare
> 2often
weeks,accompanied by for
fixed arthritis an >evanescent pinka rash.
6 weeks, and pink macular rash that worsens
s leukocytosis, thrombocytosis, elevated inflammatory markers, and anemia.
ign, bone-forming tumor that presents with increasing pain that is worse at night and is unrelated to physical activity; the pain im
tRadiograph
common primarydemonstrates
bone tumora single small, round
in children lucency.
and young adults and typically involves the metaphyses of long bones. Physical exam
x-ray findings include 'sunburst' periosteal
s a rare complication of supracondylar humerus fractures,reaction and Codman triangle.
particularly those that are displaced or occur in conjunction with forea
welling and pain that is unresponsive to escalating analgesics.
nts with hip pain and limp in young children following a mild viral illness. In contrast to septic arthritis, patients are typically well-a
atory
e, results (i.e.
a common causewhite bloodpain
of knee cellincount,
young inflammatory
adolescents,markers).
is causedTreatment is rest
by a traction and nonsteroidal
apophysitis anti-inflammatory
of the tibial medicatio
tubercle. Patients typicall
reveals prominence and tenderness over the tibial tubercle.
piphysis (SCFE), which causes hip pain and limp, is characterized by displacement of the proximal femur relative to the femoral
ut
omeSCFEare may also be seen
at increased risk ofinatlantoaxial
tall, thin adolescents
instability.during
When periods of accelerated
symptomatic, growth.
atlantoaxial instability can present with upper motor neu
s, or weakness.
complication of streptococcal pharyngitis, is diagnosed clinically using the Jones criteria, which include fever, migratory polyarth
ctants.
sease are at risk for developing coronary artery aneurysms and thrombosis and should be routinely evaluated by echocardiogra
lin and characterized
sculitis aspirin decreases cardiac
by fever for >risk.
5 days and > 4 of the following findings: nonexudative conjunctivitis, extremity changes, cer
ous rash.
is an autosomal dominant connective tissue disorder that presents with frequent fractures, joint hypermobility, and dentinogene
collishearing
rae, loss, neck
is a postural and short stature.
deformity due to tightening of the sternocleidomastoid muscle and presents with ipsilateral head tilt and
osis frequently presents with lytic bonerange
e present on examination, and limited lesions of and
motion of the neck increases
an eczematous the riskpresenting
rash. Additional of positional plagiocephaly.
signs can include central diabete
cough.
ion is most commonly caused by β-lactams and sulfa drugs. Symptoms arise 1-2 weeks after exposure and include fever, urtic
bnormalities
eral hemipelvis should
below resolve with horizontal
its normal withdrawallevel of the offending
during agent. stance constitutes a positive Trendelenburg sign. It is caused
monopedal
mus muscles, which
ase (idiopathic are innervated
osteonecrosis of theby the superior
femoral gluteal
epiphysis) nerve. presents in young children with progressive leg pain and/or a
classically
atrophy may be present
nterior slippage on examination,
of a vertebral body due toand x-ray shows
bilateral defectsaofflattened
the parsand fragmented(spondylolysis).
interarticularis femoral head. Classic presentation is an
xtension.
ark of late Lyme disease due to Borrelia burgdorferi infection. The presentation is most commonly a monoarticular arthritis of th
Synovial fluid analysis
is an autosomal dominantshows inflammation,
connective tissuebut Gram stain
disorder caused andbyculture are usually
mutations in the typenegative.
I collagen (COL1A1) gene. Patients typica
ity, short stature, and hearing loss.
congenital
ccurs whenfoot deformity
infants in which
or children are the
liftedforefoot
or pulledturns
by inward.
the hand In or
thearm.
majority of cases,
The child the keeps
typically foot is the
flexible
handand in athe condition
pronated resolv
position
forearm
al, hyperpronation
lower-extremity painsor supination
that occur at plusnightflexion is diagnostic
in children age 2-12and therapeutic.
years. Children with growing pains have no systemic symptoms
ion. Treatment consists of observation, parental
head is common in preschool children. The classic mechanism is swingingreassurance, massage, andor over-the-counter
pulling a child by pain medications.
the arm. Full recovery after close
he diagnosis.
iosis (i.e. lateral curvature of the spine) typically progresses until growth and bone ossification are complete. Risk factors assoc
12, or
ase, premenarchal status, skeletal
avascular osteonecrosis immaturity,
of the femoral head,and initial severe
typically curvature.
presents in boys age 3-12 with insidious-onset hip or (referred) kn
piphysis is characterized by proximal femoral displacement relative to thefragmentation,
rly disease but demonstrate abnormalities (e.g. femoral head flattening, femoral head along sclerosis) with chronic
the growth plate.symptoms.
Patients with hyp
on of the growth plate. Treatment is surgical stabilization of the physis to prevent further slippage.
l dysplasia
gnant tumors of that
the hip
occur(e.g. asymmetric
most commonly gluteal/thigh/inguinal
in the pelvis and long creases,
bones apparent leg-length discrepancy)
of white, adolescent boys. Localizedin early
paininfancy shouldcab
and swelling
cniotabes
'onion skinning'
(soft skull (i.e. lamellated
bones), enlargedperiosteal reaction)joints,
costochondral and 'moth-eaten'
and progressiveappearance
genu varum.on x-ray.Risk factors for nutritional rickets due to
on, limited sun exposure, and insufficient dietary intake (e.g. exclusive breastfeeding
hip is a benign, self-limiting condition in children age 3-8 that typically presents with acute hip/thigh without vitaminpain
D supplementation).
and limp following a vir
rs engineering, the most effective error-prevention strategies include computerized automation and forcing functions, anti-inflam
e without laboratory evidence of significant infection or inflammation. Treatment is supportive, including nonsteroidal which pro
ed prior to providing non-emergency medical care for a minor who does not qualify for confidential care (e.g. pregnant) excess
is a heparin infusion pump with dosing algorithms (automating mathematical conversions) and preset limits ('blocking' or is no
eal but not required to proceed with treatment.
nosis to a child with perinatally acquired infection should occur by adolescence to foster patient autonomy, increase medication
r should
sting respect
without the family'sofconcerns
the knowledge an adolescentand offer joint
is not participation inResponding
recommended. establishingtoa the timeline
requestandshould
plan for disclosure.
include exploration of the
ug testing,
ves minors and
can evaluation
give consent of to
themedical
patient careprivately.
for their child. However, consent is not required in emergency situations, and pare
high suspicion for abuse in children with sudden changes in mood, behavior, or academic work, as well as in children with stre
lcohol abuse.
ancipated minor, informed consent from one parent or guardian is considered legally sufficient to justify proceeding with therapy
without waiting for parental consent.
tion in which a parent refuses potentially life-saving treatment for their child, the physician should seek a court order mandating
of B cells into plasma cells. Patients typically develop
sponse to vaccines.
n. Laboratory studies reveal low immunoglobulin levels with
Commonly associated conditions include recurrent
ntibody response to vaccines) due to prolonged physiologic
vascular or respiratory system. Other common
nintramuscular epinephrine.
production. CVID typically presents in early adulthood or
decreased formation ofissuperoxide
ry disease. Treatment intravenous immunoglobulins.
anions and susceptibility
e of T cells and dysfunctional B cells are diagnostic.
and suppurative adenitis are common. Diagnosis is made by
ve virus vaccines are withheld in immunocompromised
within a week of administration of the diphtheria-tetanus-
icated
ns seizures
(without are not.and severe periodontal disease.
purulence),
gastrointestinal infections as well as atopic and autoimmune
sicians must counsel parents about the health risks of
ation
s (e.g.exemption laws in
Staphylococcus their state.
aureus, Serratia). Abnormal oxidative
esent with failure to thrive, recurrent infections (viral, fungal,
me is due to a defect in the CD40 ligand and is characterized
Serum immunoglobulins and B cells are markedly low to
ema (e.g. face, limbs, genitalia, bowel, larynx) without
hocyte maturation. Affected patients have small or absent
ernal
.g. caseantibody wanes.
series) only suggest associations. Results of
gs or therapies).
hickened interventricular septum spontaneously regress by
heart rate) and decreasing the pressure gradient between
ailure (e.g. respiratory distress, poor feeding) and
ulmonary circulation, and volume overload of the left side of
ulmonary overcirculation.
ation of prostaglandin E1 maintains ductal patency, which
isease) with pre- and post-ductal pulse oximetry in all
gh-pressure aorta to the low-pressure pulmonary artery.
s of heart failure (e.g. respiratory distress, murmur,
ar resistance, increases pulmonary blood flow, and improves
creased cardiac output (e.g. tachycardia, tachypnea). An
ic murmur that is loudest at the left lower sternal border and
flow is obstructed or hypotension if systemic blood flow is
t congenitalsymptoms
Respiratory heart disease.
may include biphasic stridor that
ith cyanosis and

cardiography a single
should loud S2. to determine the location
be performed
ntreatment.
cardiac death, especially during periods of rapid heart rate
atand
high heart rates
decreases to standing.
with reduce the risk ofmurmurs
Benign these complications.
are also
sposition of the great arteries, truncus arteriosus) and an
e.g. echocardiography, 4-extremity blood pressures) to
t-to-left shunting in the setting of exertion or agitation.
rt failure in early infancy, a fixed split S2, and a systolic
trawberry tongue'), rash, extremity changes, and cervical
ptococcus pharyngitis. Treatment with penicillin prophylaxis
creasing preload (e.g. Valsalva, abrupt standing, amyl nitrite
common cause of sudden death in an otherwise healthy
d absent palmar creases. Ventricular septal defect is
n. The harsh crescendo-decrescendo systolic murmur over
s, rash, extremity changes, and cervical lymphadenopathy.
nosis.
malformations; hemangiomas; arterial, cardiac, and eye
rder and is often associated with other autoimmune
common,
with but hemorrhagic
a central most patientspunctum.
have regrowth over time.
Management of bites is
atment includes emollients and topical keratolytics (e.g.
e confirmed with a potassium hydroxide preparation of skin
nndition
is not is
effective.
caused by Staphylococcus aureus, and treatment is
aller oval lesions oriented in a 'Christmas tree' pattern.
e indicated.
ed with pruritus and pain. Treatment is with β-lactam
dren, the eruption typically involves the face. It is most
ea, genitalia, and interdigital web spaces. First-line treatment
sed density of hair follicles.

ack
usesofasplash
scaly, marks, and spared
erythematous patchflexural creases.
that can progress to
options.
gia/arthritis, abdominal pain, and renal disease. Hematuria is
ar area, and umbilicus. Spontaneous remission is common.
central clearing. The diagnosis is usually apparent on
le, terbinafine)
, initially are first-line
grow rapidly, treatment.
and regress spontaneously.
s prior to sun exposure and reapplied every 2 hours as well
ut' erosions, and hemorrhagic crusting along with fever and
es, most commonly on the sacrum and buttocks. The spots
esolvesinspontaneously
occurs infants and young within 2 weeksA of
children. birth. of fever,
prodrome
ofght
thepressure (i.e. Nikolsky
extremities. sign).
Flexural involvement is common in
a, and vesicles > 12 hours after contact with the allergen
, anal, cardiac, tracheoesophageal, renal, and/or limb
tion can cause obstruction and symptoms of eustachian
ction.
rythema). Examination shows air-fluid levels and poor TM
long-term
infection ishearing loss.asymptomatic in infants but can cause
frequently
forms from retained epithelium from the embryologic descent
s in hoarseness due to finger-shaped growths on the true

ateral choanal atresia presents with cyanosis that worsens
o the oropharynx.
with or without fever. Viral rhinosinusitis is more likely than
are (e.g. nasal saline/irrigation).
easesStridor
ation. in periods of increased
increases airflow(e.g.
with exertion (e.g.crying,
crying,feeding)
feeding).
e due to alterations in ear canal pH, loss of cerumen, skin
curs after water exposure or trauma to the canal. Topical
he external
xone auditory
(targeting canal. influenzae and Streptococcus
Haemophilus
y obstruction (e.g. stridor, drooling). Plain x-rays may help
raction pocket. Symptoms include persistent otorrhea and
disorders of childhood. Hearing tests should be routinely
oxicillin is first-line therapy, and amoxicillin-clavulanate is
d by crying. Failure to pass a catheter through the nares into
worsening symptoms (e.g. cough, nasal discharge).
g. Loss of cerumen, trauma, and foreign materials in the ear
voice, and swelling of peritonsillar tissues with deviation of
nloss
withordisplacement of the auricle.
chronic ear drainage despite antibiotic therapy are
of the tympanic membrane on
membrane [TM] bulging +/- erythema) otoscopy.
and effusion (e.g. poor
ion. Laryngoscopy shows collapse of the supraglottic
neously by ageanxiety
uction include 18 months.
and tripod positioning (i.e.
ipsia. The water deprivation test can differentiate between DI
psia.
galactose accumulation and hypoglycemia. Patients may
on) and/or
gricans, unconjugated
central (i.e. hemolytic
obesity, elevated anemia). and lipid
blood pressure,
gimen should also be counseled to increase carbohydrate
craniotabes (soft skull bones) and forearm deformities
patomegaly. Progressive deposition of galactitol, a by-
gesterone and testosterone. Genotypically female newborns
op until age
ncludes 1-2 weeks.
obtaining a bone age evaluation to assess skeletal
, and spleen; this accumulation results in cytopenias, bone
.
associated with perinatal complications such as macrosomia,
ias and congestive heart failure. Other common
,after
and neurologic
age 3. Puberty(e.g.and
tremor,
boneseizure)
age aresystems.
delayed, and adult
ory results demonstrate hyperglycemia and an anion gap
sium maysecondary
emature be normalsexual
or elevated.
characteristics (e.g. pubic hair,
opment, advanced bone age, and an elevated LH level.
ipheral causes. Central precocious puberty is due to early
esentation includes precocious development of pubic and
s the most common cause of congenital hypothyroidism
ge tongue, sluggish movement, abdominal bloating, and an
andardly performed inand
dration, salt-wasting, all states.
virilization. Elevated 17-
poglycemia (often with seizures), lactic acidosis,
bdomen
d treated(due
withtolow-phenylalanine
hepatomegaly). diets can expect normal
maging. Presenting symptoms include bitemporal
posterior to the nipple. Breast buds can be unilateral in the
ounseling is an opportunity to develop a trusting health care
e of heavy, regular menses in adolescents. Platelet counts
opment) or age > 13 in girls without secondary sexual
ed with gonadal dysgenesis. Lack of feedback inhibition by
analysis
ondary to is diagnostic.
retained toilet paper. Initial management is topical
on and
are causes responses
physiologic abnormal uterine bleeding. maternal
to transplacental
oma should be re-examined after her menstrual period for a
ts are at increased risk of testicular cancer due to their
have ovarian dysgenesis (i.e. primary ovarian insufficiency),
ry-ovarian
blind vaginalaxis, resulting
pouch). in highagenesis
Müllerian FSH levels.
does not affect
ealcan
genitalia and secondary
be present sexual
unilaterally characteristics.
or bilaterally and is often tender.
mited, and no treatment

cy by delaying ovulation.isInrequired.
most states, adolescents
present with nausea/vomiting, pelvic pain, and vaginal
dometrial prostaglandin production results in lower abdominal
rual bleeding. In hemodynamically stable patients, heavy
ing.
uterus, the best next step is an FSH level test, which
bleeding, and pneumatosis intestinalis (air in bowel wall) in
mmation and smooth muscle paralysis of the colon. Patients
te (i.e. lactose) malabsorption and transient symptoms of
struction (e.g. bilious emesis, abdominal distension, dilated
one between a distal, narrowed aganglionic segment and a
e is a rare, potentially fatal complication of infectious
ect with a halo sign on chest x-ray is consistent with a button
mptoms, and microcytic anemia. The diagnosis can be
8 weeks with jaundice, acholic stools, and direct
mal rate, but bilirubin cannot be excreted into the intestines
he esophagus may present with dysphagia, vomiting, or
be considered in those with recurrent intussusception or
most common lead point.
on esophageal
bdomen due to biopsy is diagnostic.
pain, followed by asymptomatic periods.
g. oily, nonbloody, foul-smelling diarrhea) typically lasting up
n addition to dietary modification, laxative therapy (e.g.
y of intussusception due to the small risk of this
cter, and greater time spent in the supine position. Parents
ess colon. Risk factors include prenatal exposure to cocaine

otherwise healthy infant age < 3 months. Management
pt reduction with
c symptoms air orfrom
ranging water-soluble contrast enema.
impaired concentration to
hea, or vomiting. Diagnosis is with a technetium-99m
creasing breastfeeding frequency. If the mother's milk
continued.
s may also have decreased urine output and delayed
nriched foods. Riboflavin deficiency should be suspected in
s.
oschisis is an isolated defect with no associated conditions.
gns of intestinal obstruction with or without perforation at the
nemia (e.g. jaundice, acholic stools, dark urine) and
urs in CF and causes fat and protein malabsorption,
phalocele, and neonatal hypoglycemia. Because patients
testing
nged are recommended.
vomiting causes a hypochloremic, hypokalemic
on decrease the riskpatients,
in asymptomatic of postoperative apnea.
to prevent bowel entrapment,
lethargy. Caregivers should avoid administering aspirin to
ectile vomiting causes dehydration and weight loss.
hepatic. Abdominal pain, jaundice, and a palpable mass are
aminitis, coagulopathy, nausea, vomiting, hepatomegaly, and
n associations include type 1 diabetes and dermatitis
d be performed immediately when imaging confirms a sharp
osis conjunctiva, xerosis cornea, keratomalacia, Bitot spots
l age 1 year. All exclusively breastfed infants should also be
nd necrotizing enterocolitis. Breastfed infants also have
actosemia.
s include increased bilirubin production, decreased bilirubin
sion, and bloody stools. Risk factors include prematurity,
rs after birth. Characteristic findings include complete bowel
ps of small bowel on imaging (i.e. terminal ileum
ulus can progress to frank bowel ischemia, bloody stools, and
oms resolve by eliminating maternal consumption of dairy
urrant jelly stools, and lethargy. A palpable, sausage-shaped
ray findings include pneumatosis intestinalis (intramural air)
ng syndrome. Key historical features include a history of
a 'double bubble' sign on abdominal x-ray. Treatment is
r. Anticipatory guidance includes avoidance of foods that can
surpass the height or weight limit of their specific car seat,
escents age > 12 should be screened annually for
onal features of Down syndrome in newborns include
are more common in infants and those with prolonged fevers
vical lymphadenopathy.
g loss. should
eeding The firstbestep in management
continued. is a should
Birth weight hearingbe
test.
regained
ome separation anxiety is developmentally normal at age 9-
sted and learning to walk independently, using a 2-finger
nd to name. Stranger anxiety also develops around this age.
raosseous access can be performed with less required skill
risk. Manifestations include rapid onset of fever, sore throat,
s milestone
olyps later
that can thanand
bleed girls.
cause iron deficiency anemia, and
order characterized by the presence of hemoglobin S on
within the spleen. Patients have anemia, splenomegaly, and
cell
cellstransfusion.
increases oxygen-carrying capacity and improves
ggering an IgG antibody response. Patients typically develop
d replication rate. It typically presents with acute renal failure
mia.
-Sternberg
present (e.g. cells on lymph
wheeze, node biopsy
angioedema, are diagnostic.
hypotension), the
oxidative stress. In order to prevent hemolysis, oxidative
serisk of persistent
with developingbleeding
hemolytic
anduremic syndrome. despite
thrombocytopenia
eding refractory to replacement therapy or with increased
in expression. Patients are transfusion-dependent and at
typically reveal a microcytic anemia, an elevated erythrocyte
y (e.g. heavy menses, low erythrocyte count, reactive
ed reticulocytes and mean corpuscular hemoglobin
erocyte formation and hemolysis. Hemolytic anemia with an
bone marrow. Other common findings are nontender
fever,mass
minal pallor,
andbruising,
systemicandsymptoms
hepatosplenomegaly.
(e.g. weight loss). Other
count
countand elevated
reflects red blood cell
a compensatory distribution
bone marrow width.
response to
ed hemoglobin level, a low mean corpuscular volume and
tions. The thrombocytopenia is the most consistent feature
ute chest syndrome. The primary mechanism of action is an
e hypoxia, and maternal diabetes. High blood viscosity limits
ABO incompatibility), which causes fever, flank pain, and
ascular
out coagulation,
adequate folic acidand shock.
intake increases the risk for folate
esis.
to pancytopenia, characteristic features include short
gests asplenia or functional hyposplenism.

ckle cell
thigh, oranemia.
buttock pain without warmth or erythema of the
synovitis and fibrosis within the joint. The risk of hemophilic
creatic insufficiency. Vitamin K is an important cofactor in
onged prothrombin
cute renal time.
injury, thrombocytopenia, and microangiopathic
nt < 1%, and no splenomegaly. Parvovirus B19 is the most
astoma arising in the cervical paravertebral sympathetic
bnormalities, such as cleft palate, webbed neck, and
quent vaso-occlusive crises. It is a relatively safe therapy
of bilateralred
hortened hand andcell
blood foot
lifeswelling andblood
span, and tenderness.
loss. Laboratory
ute anemia (e.g. tachycardia, pallor, shock) and
asplenia in sickle cell patients, Howell-Jolly bodies are
neous symptoms (e.g. petechiae) usually recover
s, anti-D, ortypically
esentation intravenous
occurs immunoglobulin.
after resolution of prodromal
O157:H7), is characterized by microangiopathic hemolytic
esence of > 25% lymphoblasts in the bone marrow confirms
d splenomegaly on examination and laboratory evidence of a
ion. Bone marrow will demonstrate profound hypocellularity
rointestinal bleeding, and/or intracranial hemorrhage;
d blood cell distribution width (RDW), decreased serum iron,
ochromic
should bered blood cells.
suspected in patients with reticulocytosis,
re diagnostic.
ormal or elevated white blood cell count. The presence of
tained. Hemophilia presents with a prolonged PTT, normal
iae. The presentation is generally mild and often includes
infiltrates (rather than lobar infiltrate). Treatment with
topenia, elevated aminotransferases, and hyponatremia are
rgans, resulting in micronodular lesions in the lungs, liver,
d with
gs (e.g.false-negative tuberculosis
hilar lymphadenopathy, test results. pleural
consolidation,
t neonatal sepsis or late-onset disease in young infants. Late-
is). Lesions resolve within 6-12 months. Management is
ation.
xually active or high-risk patients when more common
ected in returning
ess (e.g. travelers
retractions, with prolonged
tachypnea) bloody
and hypoxia, anddiarrhea.
chest x-
h is characterized by clotting factor and platelet
who have had exposure during the 7 days before symptom
nd should
g and be given
respiratory as soon as
procedures. possible.
Droplet precautions should be
dings. Temporal lobe abnormalities and edema are highly
nd
ouspassive smoke exposure.
and perforated TM. Amoxicillin is first-line therapy;
schools. Patients develop vomiting, watery diarrhea, and
ucus-filled (sometimes bloody) diarrhea. Disease is typically
patient who has traveled to a resource-limited area with poor
risk of hemolytic uremic syndrome associated with
es/crackles, and respiratory distress. Diagnosis is clinical,
as possible fever and fluctuance. Anaerobes are often the
te count is common. Empiric therapy is intravenous
monocytogenes.
a and cyanosis. Empiric antibiotics (e.g. azithromycin) reduce
de focal headache, early-morning vomiting, altered mental
rrhea. ItProphylaxis
elivery. may be associated withbyseizures
is achieved in children.
administering varicella-
ooked poultry or improperly refrigerated food. Symptoms
Pregnant women most commonly acquire CMV through
nt safety profile, but within 1-3 weeks after immunization a
ive-attenuated vaccine virus can cause a varicella-like rash
psilateral lymphadenitis of gradual onset. These symptoms in
he posterior soft palate, palatine pillars, tonsils, and uvula.

kheart
soft-tissue
diseasex-rays will factor
is a risk show aforwidened prevertebral
brain abscess due tospace.
pots, and growth restriction). More specific findings that are
or become
days withoutbullous.
improvement. The 2 most common risk factors
nges, proptosis, or ophthalmoplegia. Orbital cellulitis is a
m, erythematous cervical node. Empiric antibiotic therapy
robes. mild pleocytosis with lymphocytic predominance,
shows
e. Paresthesia of the bite wound is characteristic, and after
d death.
st prevented
ed by vaccination
for < 36 hours, prior
antimicrobial to conception.
prophylaxis (e.g. single-dose
children. Affected nodes are enlarged, erythematous, and
firm, immobile lymph nodes; systemic symptoms), palpable
ver, headache, myalgias, petechial rash, nuchal rigidity, and
s with the varicella vaccine. At-risk patients who cannot
ry tongue, and rash. The classic 'sandpaper' rash is
nd high-risk contacts should be given prophylaxis regardless
tion reduces infection risk but immunity wanes over 5-10
isorder. Less common causes include late Lyme disease,
nas aeruginosa is the most common cause of CF-related
s confirmed by visualization of eggs and/or pinworms on the
nfants present in the first few weeks of life with trismus,
on of toxoplasmosis is most commonly due to ingestion of
maternal screening before delivery and prophylaxis with
monia, severe thrush). Selective loss of CD4+ cells is
ella syndrome includes sensorineural hearing loss, cardiac
that can ulcerate, scar, and blind without prompt treatment.
njunctivitis.
mupirocin) are the treatment
whelming infection of choiceorganisms
with encapsulated for localized infection.
and should
D.
Lumbar puncture should be performed promptly to diagnose
nt is with pyrantel
respiratory pamoate
distress, or albendazole.
with examination findings of marked
edimentation rate, and leukocytosis. Emergency surgical
re, empiric antibiotics should include antistaphylococcal (e.g.
often associated with post-tussive emesis and an inspiratory
ge).
aryngitis, cervical lymphadenopathy, and
ot represent
s, chorea, a true drug
erythema allergy. subcutaneous nodules, and
marginatum,
somotor
nuchal collapse
rigidity, andand skin rash due to Symptoms
petechiae/purpura. adrenal hemorrhage.
progress
ulation, and death.
endemic-tropical region. Thick and thin blood smears should
onfers
not some
involve protection
orbital fat to from severemuscles,
extraocular complications.
and therefore
nd aofharsh,
ses acute barking,
bacterialseal-like cough.which commonly
rhinosinusitis,
uricular and suboccipital lymphadenopathy. Adolescents and
nd usually begins 1-6 hours after exposure. Diarrhea may or
sles and should

meningitis, be administered
pancreatitis, to hospitalized
and deafness. patients.
Complications are
orts (especially contact sports) should be avoided for at least
caused by hematogenous
in and active immunizationspread of Staphylococcus
with HBV vaccine within aureus.
12 hours
posterior cervical), and a maculopapular exanthem that
n a cephalocaudal pattern. This highly contagious infection is
nd has been significantly reduced in the United States by
throcentesis, empiric parenteral antibiotics, and prompt
he buccal mucosa, may also develop and are
dal and centrifugal
hermia), pattern.
poor feeding, and lethargy. In hemodynamically
tration
y. Unlikeof empiric antibiotics.
in adults, GAS pharyngitis in children should
xicillin
cans are the should
infection preferred
be treatment
consideredoptions.
when thick, white
per hygiene and a topical antifungal.
ave irritability, inconsolable crying, and pain with abdominal
ncreased 17-hydroxyprogesterone and androgen production.
uired prior to circumcision because the foreskin may be
ns, and severe penile curvature. This condition may be
ns (e.g. infertility, testicular torsion, testicular malignancy).
es observation and reassurance, as most cases resolve
rwith the goal of is

abnormalities) continual improvement.
associated with defects in CHD7 and can
otic fracture due to estrogen deficiency from ovarian
ema occurs due to dysgenesis of the lymphatic system and
mydia
ria. trachomatis
The and Neisseria
most common cause of gonorrhoeae.
death is cardiac dysfunction
y amenorrhea) and anosmia. Due to the lack of GnRH
th phenotype.
fibrous dysplasia (e.g. recurrent fractures).
etall
2 diabetes mellitus,
stature; long, thin and gastric rupture.
extremities; arachnodactyly; joint
sive muscle weakness. Initial screening reveals elevated
abdominal pain, arthralgia/arthritis, and hematuria. Children
ophy. Patients have markedly reduced or absent dystrophic
crognathia, as well as closed fists with overlapping digits
antistreptococcal antibodies cross-react with neuronal
dtsobsessive-compulsive
< 28 weeks gestation.behaviors.
Diagnosis is clinical, and no
or, even in the absence of a trauma history. Evaluation
n of a rigid cervical collar) until injury is ruled out clinically or
blindness and peripheral vision loss. Funduscopic
Acute management includes simple analgesia (e.g.
mal development and an otherwise normal examination, the
Epilepsy is a frequent finding that often begins in infancy but
s with Sturge-Weber syndrome are at increased risk due to a
ious neoplasms, including CNS and retinal
and benign tumor formation, including subependymal giant
pots.
associated with a Chiari II malformation (i.e. inferior
rmal development and normal examination (e.g. no
e a rapidly enlarging head circumference, behavior changes,
ma may occur.
during delivery. Examination reveals a firm, nonfluctuant
atomas resolve without intervention.
d a vesicular
matrix, rash
a fragile, in thevascularized
highly external auditory
area incanal.
the brain.
en include vascular malformations (e.g. arteriovenous
ection with irregularismargins).
ce). Management symptomatic care because most
of neurologic disturbance (e.g. headache, noise sensitivity,
adual return
without to activity.
structural intracranial injury. Initial treatment is with
ntal status, loss of consciousness, severe mechanism of
toms include headache, disorientation, dizziness, and/or
s of increased intracranial pressure & prolonged altered
chiasm can result in bitemporal hemianopsia, and pituitary
ventriculomegaly and hydrocephalus. In infants,
10) often presents with intellectual impairment and
ldren who are not obese. Headaches may be less obvious,
ema
elivery.is the hallmark
Blood examination
accumulates betweenfinding.
the periosteum and
sseminated intravascular coagulation, and death.
tracranial pressure (e.g. irritability, vomiting, bradycardia,
ingomyelia is a commonly associated condition. Although
nd
lity,Valsalva maneuvers.
and characteristic skin findings (e.g. ash-leaf spots).
rief loss of consciousness that may be followed by
nied by stereotypical hand movements, and gait
nelle. Urgent brain imaging is necessary to evaluate for
blood cell count and protein level and normal glucose
ve ataxia, dysarthria, scoliosis, and cardiomyopathy. Loss of
movements that disappear during sleep) in children.
tolysin O andtherapy
oss, antiviral antideoxyribonuclease
should be giventiters.
to neonates with
e.g. headache, vomiting, papilledema). In children, the most
y. The inability to walk or run independently by this age is a
-word phrases, and follow 2-step commands. In addition, a
h an emotional trigger. Parents should be reassured that
tudy such
nutes, and as
do anot
CTrecur
scanwithin
of the24
brain.
hours. Diagnostic testing is
o baseline neurologic functioning. Tongue lacerations can
atory and bulbar muscles. Serial pulmonary function testing
.ude severe headache, morning vomiting, fever, and focal
et (+/- secondary generalization) seizure. Symptoms are
hemiplegia, facial droop, and aphasia.

ules, and neurofibromas
avoidance, (peripheral
pacifier use, sleeping nerve
in the sheath
supine tumors).
position with
egin with developmental delay and hypotonia in infancy and
iplatelet or anticoagulation to prevent thromboembolic
en, nonsteroidal anti-inflammatory agents, and supportive
izure, apnea), a bulging fontanelle, and a rapidly increasing
e, bilateral eyelid retraction, and light-near dissociation.
recent gastrointestinal or respiratory infection. The
elayed muscle relaxation), progressive weakness (e.g. facial
the initial presentation of a tumor originating in the cerebral
wborns may have apnea, seizures, and a bulging fontanelle
ute demyelinating polyneuropathy characterized by
dysfunction.
decreased visual acuity. MRI of the brain and orbits
e shearing of the subdural bridging veins and vitreoretinal
miting, headache) and uncal herniation (e.g. ipsilateral
mental status is normal and there are no signs of a basilar
upported by the presence of non-glucose reducing
h hormone, tetracyclines, and excessive vitamin A and its
esolution.
igeminal nerve distribution and leptomeningeal capillary-
sleepiness and confusion. Other common findings include
axillary and inguinal freckling. Patients with NF1 have an
ing that does not cross suture lines. Forceps- or vacuum-
bes,spontaneously.
constipation, and hypotonia, even if the infant has not
lenomegaly, a 'cherry-red' macula, and developmental
een.
mpairment. The pathognomonic facial features are small
are delayed gross motor milestones in infancy and spasticity
labyrinth. Audiologic testing should be performed as soon
se of inherited intellectual disability. In addition to speech and
ve ataxia and loss of position and vibratory sense. Genetic
awareness (with or without automatisms) and inability to
provoked by hyperventilation.
canal. Patients have an acute decrease in visual acuity and a
prompt evaluation for Marfan syndrome, including
xamination shows a tight orbit (e.g. periorbital swelling, hard
ision
nts loss. seek medical attention 6-12 hours after
generally
tic. High myopia (> 6 diopters of correction) increases the
sion.
normal tear flow. Infants have increased tearing and crusting
ct.
ver test. Dilated funduscopic examination is performed to
during early childhood. Because of compensation from the
al conjunctivitis, and clear discharge. Treatment includes
predisposing
visual factor for
acuity testing orbital cellulitis.
is recommended starting at age 4 as
rofibromas. Approximately 15% of children with this disorder
discharge. Affected infants should receive oral macrolide
rabismus can lead to amblyopia, a functional reduction in
luate for retinoblastoma. Strabismus and nystagmus are
njunctival injection, causing blindness if untreated.
nctivitis and inflammation. Repeated or chronic infection
erly. Physostigmine, a reversible acetylcholinesterase
o are hypoxic despite supplemental oxygen, intubation with
characterized by swelling, erythema, and warmth (up to ~10
eating, headache, and/or nausea. Mentation remains normal,
fluids.
cetylcholine release into the neuromuscular junction causes
ual paralysis.
or high-dose
ximetry ascorbic
saturation acid. low and does not improve with
is typically
78). Due to the potential of falsely elevated results with
mic shock within a few hours due to gastrointestinal losses.
anagement includes decontamination (removal of clothes,
s, shock, and anion gap metabolic acidosis. Deferoxamine is
us as these interventions may trigger vomiting, which may
ymmetric FGR, in which head circumference is normal, is
rns with CNS disease (i.e. encephalitis) typically occurs in
ons such as hypoxia, polycythemia, hypoglycemia,
ing the risk of shoulder dystocia and its complications (e.g.
he mother's chest for skin-to-skin care, which provides
h microcephaly, a wide anterior fontanelle, cleft lip and
ludes reassurance and gentle handling, as most neonatal
ude providing a private setting, assuring confidentiality,
alopen-ended
support, andand gender-neutral
lack of psychiatric questions.
follow-up. Any child who
social withdrawal and academic decline, major depression
phenidate, amphetamines) due to their efficacy, safety, and
s include the preference for solitary play, lack of eye contact,
en parents prefer a nonstimulant medication.

peaks athand
otypical age 8-9 months and
movements, andresolves by age
head growth 2 years.
deceleration
s in comprehension and/or production. Typical signs include
Reactive attachment disorder is characterized by a pattern
ase. Pathogenesis involves defective hepatocellular copper
at increased risk. Removing firearms from the home, or
de-behavioral psychotherapy.
make masturbatory movements. These behaviors are
concern for possible abuse.
lcharacterized
details. by irritability, a high-pitched cry, poor
nt in 2 different settings. Teacher evaluations are an
icit hyperactivity disorder and/or obsessive-compulsive
e and deliberately start fires to reduce tension and feel
broken hair
nsidered shafts ofdisorder
an anxiety differingand
lengths.
should be treated early to
development. Higher-functioning individuals with normal
.
agonists.
ctrum disorder. Variable degrees of language and
ehaviors. When parents have differing levels of concern,
pmental disorders,
mpulsivity, and encourages
and hyperactivity further
in 2 or more evaluation.
settings. In addition
ycardia and desaturation. Treatment involves noninvasive
acranial pressure (ICP). Severely increased ICP can cause
aracterized by a prolonged oxygen requirement. Histologic
pnea, lethargy, and abdominal distension. Pneumatosis
ractions). Diagnosis is typically clinical, but chest x-ray
ytions.
in children age < 3 with chronic anemia. Signs include
clude diuresis
eceiving (e.g. furosemide).
mechanical ventilation. Transillumination reveals
warrant
distress at birth with absentthoracostomy.
emergency needle breath sounds on the affected
silhouette.
ay may reveal classic findings of unilateral lung
picion remains
. Treatment high.
with corticosteroids with or without nebulized
hypertrophy
and is moreincommon
children.in infants delivered by cesarean
ut pulmonary surfactant, leading to insidious onset of acute
only seen in premature infants, especially in those requiring
space. Small effusions in children without respiratory
H < 7.2, glucose < 60 mg/dL, neutrophil-predominant
trates milky-white fluid with elevated triglycerides.

betes
paredmellitus.
to the young child's thorax. Opacities in this location
ure to an allergen. Foods are the most common trigger, and
toms. Patients with anaphylaxis to Hymenoptera stings
se with coexisting influenza infection. For patients with severe
y against methicillin-resistant S. aureus.
sinusitis,
/crackles,and
andbronchiectasis.
respiratory distress. Neonates are especially
nt sinopulmonary infections, digital clubbing, and signs of
dical therapy and who have signs of impending respiratory
aneous emphysema), resulting in spontaneous
management of patients with impending respiratory failure
mmediately after birth. Chest x-ray includes characteristic
aspiration. Rigid bronchoscopy can identify and remove the
A gastric tube should also be placed immediately to
ts with stridor at rest are treated with corticosteroids and
period of nighttime dryness. A family history of bed wetting is
nattention, behavioral concerns, and/or tonsillar hypertrophy.
lution of enuresis is often achieved by successfully
ue, hypertension, proteinuria, and/or a history of urinary
derlying medical condition (e.g. urinary tract infection) or a
In patients with WAGR syndrome, screening abdominal
ue to oligohydramnios and subsequent lung hypoplasia).
that fails to decompress when supine. Abdominal
dominal
with > mass).
2 febrile urinary tract infections, abnormal renal
s (e.g. fever), antibiotics should be broadened, and renal and
er and fussiness in an infant. The presence of nitrites and
eposition of immune complexes in the glomerular
, it most commonly presents with failure to thrive due to a

nary obstruction can lead to Potter sequence, which is
cell trait. Patients have polyuria, low urine specific gravity,
mities, arthralgia/arthritis, abdominal pain, and renal disease
ten develop UTIs with dysuria, hematuria, and pyuria after
rmal kidney architecture but is not routinely obtained in
initial diagnosis as the condition is highly responsive to
tation can be nonspecific (e.g. fussiness, poor feeding).
childhood and a positive family history for nephrolithiasis
used as a qualitative screening procedure.
ents and adults. Active hepatitis B infection is an important
ertension, and renal insufficiency. Definitive diagnosis is
bladder ultrasound to evaluate for abnormalities that may
pertension, and chronic renal insufficiency. Scarring is focal
mass, hematuria may occur in up to one-fourth of patients.
a hypochloremic,
al hypokalemic
modifications and metabolic
alarm therapy alkalosis.
have failed. When used
aynilateral abdominal mass.

be asymptomatic or have hematuria, hypertension, and
hypovolemia. Confirmation of the diagnosis includes a
of renal failure and/or hearing loss. Complement levels are
compresses the bladder, prevents complete voiding, and
testing is required in patients with palpable
al
nallyor rotated.
incomplete presentations.
Initial treatment is stretching with serial molding
ance) training. Strength training is safe and effective when
enlargement. The absence of dystrophin in cardiac muscle
and ECG.
4 joints. Patients are classically girls age < 5. Regular
reversible vision loss
anti-inflammatory drugsif untreated.
(e.g. naproxen) are the first-line
llowing a twisting motion during a minor fall. Spiral fractures
rom extending through the width of the bone. Treatment is
mp (with ability to bear weight), hip pain, or pain referred to
bilateral
oral hip effusions.
displacement relative to the femoral head along the
are often afebrile and able to ambulate. However, patients
hout arthrocentesis,
e of the heel and withtocalcaneal
distinguish between theare
compression conditions.
diagnostic
with a gram-negative bacterium. These patients require the
one).
ith monoarticular arthritis with or without a pustular rash.
kening, septic arthritis should be considered. An elevated
biotic
essivetherapy.
fussiness (e.g. during diaper changes), or asymmetric
andflag
red observation.
for child abuse and should prompt a skeletal survey
fever for > 2 weeks. Hepatosplenomegaly and
macular rash that worsens during fever. Laboratory
physical activity; the pain improves with nonsteroidal anti-
f long bones. Physical examination typically shows a large
cur in conjunction with forearm fractures. Initial symptoms
, patients are typically well-appearing, weight-bearing, and
anti-inflammatory medications
al tubercle. Patients (e.g. pain
typically have ibuprofen).
exacerbated by
emur relative to the femoral head along the growth plate.
esent with upper motor neuron findings, urinary/fecal
de fever, migratory polyarthritis, erythema marginatum, and
evaluated by echocardiography. Early treatment with
itis, extremity changes, cervical lymphadenopathy,
ermobility, and dentinogenesis imperfecta. Additional
with ipsilateral head tilt and contralateral chin deviation. A
giocephaly.
can include central diabetes insipidus, lymphadenopathy,
sure and include fever, urticarial rash, arthralgia, and
ndelenburg sign. It is caused by weakness or paralysis of the
ogressive leg pain and/or a limp. Decreased hip range of
. Classic presentation is an adolescent with low back pain
monoarticular arthritis of the knee that occurs in a weight-
L1A1) gene. Patients typically present with recurrent
ble and
hand in athe condition
pronated resolves
position andspontaneously.
refuses attempted forearm
have no systemic symptoms, normal activity levels, and
medications.
rm. Full recovery after closed reduction by forearm
omplete. Risk factors associated with curve progression
us-onset hip or (referred) knee pain and an antalgic gait. X-
th chronic
owth plate.symptoms.
Patients with hypothyroidism are at increased risk
cy) in early
alized paininfancy shouldcan
and swelling be be
evaluated with hip
accompanied byultrasound.
systemic
for nutritional rickets due to vitamin D deficiency include
npain
D supplementation).
and limp following a viral illness. Patients are generally
ding
forcing functions, anti-inflammatories
nonsteroidal which promote correct(e.g.action
ibuprofen).
with minimal
set limits ('blocking' excess drug administration).
are (e.g. pregnant) or is not emancipated (e.g. married).
onomy, increase medication compliance, and prevent
ndfor disclosure.
include exploration of the parents' concerns, education
rgency situations, and parents cannot refuse life-saving
well as in children with stressful family environments or
stify proceeding with therapy. Physicians should also provide
ek a court order mandating treatment.

Hemophilia A is an X-linked recessive disorder. On a
10505 Obstetrics &Biostatistic X-Linked Inheritence unaffected
Women with son, or anhypertension
chronic unaffected daughter.who are pregnant
15979 Obstetrics &CardiovascuPrimary Hypertension tolerated
patients. The development of new atrialcan
calcium channel blocker that be usedcain
fibrillation
4715 Obstetrics &CardiovascuMitral Stenosis
Secondary edema.
Oral contraceptives (OCs) commonly cause a mild el
3914 Obstetrics &CardiovascuHypertension those who develop
The first-line agentshypertension
for management whileoftaking OCshyp
essential sh
2400 Obstetrics &CardiovascuPreeclampsia therapies. Angiotensin-converting
Vitiligo creates flat, white macules enzyme inhibitors
with distinct bordea
15393 Obstetrics &DermatologyVitiligo typically
Diabetesasymptomatic.
insipidus (DI) isTreatment
characterized includes corticoste
by polyuria (e
18558 Obstetrics &Endocrine, DDiabetes Insipidus concentration and fluid intake. During
Postpartum thyroiditis is an autoimmune disorder cha pregnancy, pre
12398 Obstetrics &Endocrine, DHypothyroidism associated
Levothyroxine withrequirements
anti-thyroid peroxidase
increase during autoantibodie
pregnan
8888 Obstetrics &Endocrine, DHypothyroidism adjustments based on TSH and
Sheehan syndrome (postpartum ischemic necrosis total T4 using pregnao
4678 Obstetrics &Endocrine, DHypopituitarism lactation failure (prolactin deficiency)
Secondary amenorrhea is amenorrhea for > 3 month as well as hypo
4220 Obstetrics &Endocrine, DAmenorrhea
Thyroid Disorder In pregnancy
Thyroid test, followed
hormone production by serum
increases prolactin,
duringTSH,pregnaan
4124 Obstetrics &Endocrine, DPregnancy
Congenital Adrenal free) thyroidcongenital
Nonclassic hormone levels.adrenalhCG directly stimulates
hyperplasia is caused
2425 Obstetrics &Endocrine, DHyperplasia elevated 17-hydroxyprogesterone level.
Infants born to women with Graves' disease are at ris
2423 Obstetrics &Endocrine, DHyperthyroidism tachycardic,
Patients withand gain weight
cytology results poorly.
that show Methimazole
bacterial vag plu
20446 Obstetrics &Female ReprVulvovaginitis (e.g. wet mount microscopy, potassium hydroxide wh
20373 Obstetrics &Female ReprE ctopicInflammatory
Pelvic Pregnancy Patients
Actinomyceswith an ectopicgastrointestinal
is normal pregnancy require florasurgical
and may m
20280 Obstetrics &Female ReprDisease Actinomyces
Recurrent urinary on Pap tracttesting in asymptomatic
infections (> 3 episodes women
in a y
19952 Obstetrics &Female ReprUrinary Tract Infection atrophy, decreased bulk and elasticity
Partial ovarian torsion typically presents with intermittof the bladder
19799 Obstetrics &Female ReprOvarian Torsion torsion
Uterine can
arterysuddenly develop
embolization can complete
be usedtorsion,
to treat which
symp
19644 Obstetrics &Female ReprUterine Fibroids tinged vaginal discharge. Patients
menopausal symptoms (e.g. dyspareunia due to vulv with no signs of inf
19330 Obstetrics &Female ReprMenopause serum FSH level.
Postpartum fecal or flatal incontinence can occur due
19118 Obstetrics &Female ReprFecal Incontinence weakened
A common cause anal sphincter
of fecal tone, asymmetric
incontinence sphincter
is external an
19117 Obstetrics &Female ReprFecal Incontinence decreased
Ovarian torsion, or rotation of the ovary around the ind
anal sphincter tone. Patients can have a
19051 Obstetrics &Female ReprOvarian Torsion tenderness.
Ovarian cystOvarian
rupture,torsion
a common is a gynecologic
cause of acute, emergeunila
19050 Obstetrics &Female ReprOvarian Cyst free fluid.
Pelvic organ Hemodynamically
prolapse (POP)stable patientswith
may present are pelvic
mana
18973 Obstetrics &Female ReprPelvic Organ Prolapse and are
The mostmanaged
commonwith risk reassurance
factor for pelvic andorgan
observation
prolaps
18971 Obstetrics &Female ReprPelvic Organ Prolapse pelvic floor
Pelvic organinjury.
prolapse, the herniation of pelvic organs
18970 Obstetrics &Female ReprP elvic Organ
Pelvic Prolapse
Inflammatory vaginal wall (i.e. rectocele) classically have chronic c
18954 Obstetrics &Female ReprDisease
Pelvic Inflammatory Acute cervicitis can
The combination present and
of dysuria withsterile
first-trimester
pyuria isbleedi
a com
18953 Obstetrics &Female ReprDisease nucleic
Persistent nipple pain with breastfeeding is typicallygd
acid amplification testing for chlamydia and
18898 Obstetrics &Female ReprBreastfeeding causes are poor infant positioning
Depot medroxyprogesterone acetate and(DMPA)
improper latch
[Depo-
18742 Obstetrics &Female ReprContraception particularly
Patients with those who have
endometrial contraindications
hyperplasia are at riskto intrau
for p
18564 Obstetrics &Female ReprEndometrial Cancer intrauterine device).
During early pregnancy, the corpus luteum produces
18494 Obstetrics &Female ReprOvarian Torsion weeks
Urinarygestation. Patients
tract infections who have
typically cause the corpusurinar
dysuria, luteu
18487 Obstetrics &Female ReprU rinary Tract
Congenital Infection
Adrenal bladder
Nonclassicirritation and spasm.
congenital adrenalPositive leukocyte
hyperplasia occurs ester
du
18473 Obstetrics &Female ReprHyperplasia
Intimate Partner hirsutism, acne) and abnormal uterine
Intimate partner violence has a high prevalence and bleeding.
18368 Obstetrics &Female ReprViolence medical
Victims of visits.
sexual assault (e.g. date rape) are at risk f
18366 Obstetrics &Female ReprSexual Assault counseling
Sexual assault in addition
victims to aremedical
treatedcare (e.g. postexpo
empirically for sex
18365 Obstetrics &Female ReprS exual Assault
Postoperative after counseling patients on the risks and benefits of
18283 Obstetrics &Female ReprComplication Postoperative incisional pain in the absence of signs
Postpartum Patients with gestational diabetes mellitus are at incre
18282 Obstetrics &Female ReprComplication test
Sexualat 6-12
abuse weeks
of thepostpartum.
elderly may present with postme
18059 Obstetrics &Female ReprSexual Assault should prompt sexual abuse screening
Cervical cancer, an AIDS-defining illness andin be reportw
patients
17715 Obstetrics &Female ReprCervical Cancer bleeding,
Patients who a painless
undergo ulcerative lesion, andfor
cervical conization painless
cervical in
17509 Obstetrics &Female ReprCervical Cancer these
Uterinepatients
sarcoma require more
typically frequent
presents withcervical cancer
postmenopau
17508 Obstetrics &Female ReprUterine Fibroids factor
In the due to its estrogen
evaluation of an adnexalagonist effects
mass, on the uteru
ultrasound con
16824 Obstetrics &Female ReprOvarian Cancer papillary projections). Patients with these
Ulipristal is a highly effective emergency contraceptio suspicious
16589 Obstetrics &Female ReprContraception intercourse.
Estrogen-containing contraception methods are contr
16588 Obstetrics &Female ReprContraception intrauterine
Unexplained,device)abnormal andvaginal
the copper-containing
bleeding intraut
16484 Obstetrics &Female ReprContraception unexplained vaginal bleeding
Recurrent pregnancy loss (> require further pregnanc
3 consecutive evaluatio
16304 Obstetrics &Female ReprUterine Fibroids hysteroscopic
Postmenopausal myomectomy,
bleeding is awhich common restores normalfin
presenting in
16258 Obstetrics &Female ReprEndometrial Cancer endometrial
Initial evaluationbiopsy or transvaginal
of mixed ultrasound. includ
urinary incontinence
15957 Obstetrics &Female ReprUrinary Incontinence bladder training).
Obstructed labor in resource-limited areas is the mos
15946 Obstetrics &Female ReprUrinary Incontinence anurethral
A area of diverticulum,
raised, red granulation
which is antissueabnormalon the anter
localize
15926 Obstetrics &Female ReprUrinary Incontinence mass on the anterior vaginal wall that
A vesicovaginal fistula, an aberrant connection betwe has an associa
15808 Obstetrics &Female ReprUrinary Incontinence painless
A urethralleakage of urine
diverticulum as abnormal
is an the bladder constantly
localized outpod
15802 Obstetrics &Female ReprUrinary Incontinence dysuria, postvoid
Endometriosis dribbling,
is the ectopicdyspareunia, and a tende
implant of endometrial ti
15720 Obstetrics &Female ReprEndometriosis pelvic pain, dysmenorrhea, dyspareunia,
Uterine leiomyomata (fibroids) are common, benign m and infertilit
15713 Obstetrics &Female ReprUterine Fibroids menstrual
Endometriosis, bleeding, pelvic
ectopic pain, andtissue
endometrial bulk symptoms.
implants w
15708 Obstetrics &Female ReprEndometriosis (e.g. cervical motion tenderness), dysmenorrhea, dys
15617 Obstetrics &Female ReprFetal Heart Tracing Fetal
Primary tachycardia
dysmenorrhea is defined
occursas due
a fetal heart rate endo
to increased base
15532 Obstetrics &Female ReprDysmenorrhea associated
Dysmenorrhea, systemic symptoms
or painful menses, (e.g.
is malaise).
common in First-li
repr
15531 Obstetrics &Female ReprDysmenorrhea secondary cause (e.g. endometriosis)
Primary dysmenorrhea occurs due to increased endo include age >2
15530 Obstetrics &Female ReprDysmenorrhea findings
Condyloma of midline
acuminatalower(anogenital
abdominalwarts) pain withoccurassocia
due t
15456 Obstetrics &Female ReprWarts nonsexual contact (e.g. autoinoculation),
Asherman syndrome (the development of intrauterine the associa
15336 Obstetrics &Female ReprAmenorrhea tissue.
Asherman Thesyndrome,
risk of adhesion formation
the formation of increases
intrauterine with
ad
15333 Obstetrics &Female ReprAndrogen
Amenorrhea Insensitivity amenorrhea that
phenotypically does with
female not respond to a progesterone
breast development and f
15222 Obstetrics &Female ReprSyndromes hair.
Vaginal squamous cell carcinoma is due to persisten
15211 Obstetrics &Female ReprVaginal Cancer response, which allows for persistent HPV infection a
15189 Obstetrics &Female ReprVulvar Carcinoma Vulvar
Maturelichen
cystic sclerosus
teratomascommonlyare benignpresents
germ cell intumors
prepub
15174 Obstetrics &Female ReprOvarian Cancer with calcified,
Ovarian torsion hyperechoic areas. Treatment
causes acute-onset, is withpa
severe pelvic s
15173 Obstetrics &Female ReprOvarian Cancer of premenopausal
Primary adnexal masses
ovarian insufficiency (POI) is and have an in
diagnosed elev
w
15167 Obstetrics &Female ReprAmenorrhea primordial follicle depletion, resulting in estrogen defic
15141 Obstetrics &Female ReprLabial Adhesion Labial
Müllerianadhesions,
agenesisorcausesfused labial
primary minora, typicallydue
amenorrhea affe
15140 Obstetrics &Female ReprAmenorrhea source; therefore,ofrenal
Clinical features malformations are tumor
an androgen-secreting common (e.ga
15138 Obstetrics &Female ReprOvarian Cancer and clitoromegaly.
dehydroepiandrosterone sulfate (DHEAS) level are ty
15136 Obstetrics &Female ReprOvarian Cancer typically due to an adrenal
genitalia and female external tumor.
genitalia development,
15131 Obstetrics &Female ReprAmenorrhea Cell
Sertoli-Leydig these patients.
Sertoli-Leydig cell tumors are testosterone-secreting
15130 Obstetrics &Female ReprTumor mass.
Granulosa cells are the primary component of the ov
15128 Obstetrics &Female ReprOvarian Cancer results
Granulosa in high
cell estradiol
tumors are levels that affect
malignant sex breast tissue
cord-stroma
15119 Obstetrics &Female ReprOvarian Cancer to associated
Patients endometrial
with Müllerian hyperplasia
agenesis from chronic
have primary ameno u
15111 Obstetrics &Female ReprAmenorrhea external female genitalia develop independently of th
Imperforate hymen is a defect in the female genital o
15110 Obstetrics &Female ReprAmenorrhea with hymenal
Patients incision and
with unilateral, drainage. or persistent ni
spontaneous,
14831 Obstetrics &Female ReprBreast Cancer breast
Primaryultrasound, which in combination
ovarian insufficiency (POI) occurs increases
due to acc the
14788 Obstetrics &Female ReprAmenorrhea risk
fromfactor for POI is FMR1
the transformation gene
zone, premutation
patients with anforunsatifragi
14777 Obstetrics &Female ReprC ervical Cancer
Postpartum curettage).
Uterine atony is the most common cause of postpartu
14774 Obstetrics &Female ReprHemorrhage
Hidradenitis bleeding,
Hidradenitis thesuppurativa
best next step is ainchronic
management
inflammatory is admin co
14770 Obstetrics &Female ReprSuppurativa nodules and abscesses that can develop
Vulvar lichen planus is a chronic inflammatory disord into draining
14769 Obstetrics &Female ReprVulvar Carcinoma have
testingassociated
and do notvaginal
requireand oral lesions.
additional Treatment
evaluation (e.g.
14768 Obstetrics &Female ReprEndometrial Cancer cancer (e.g. obesity).
14767 Obstetrics &Female ReprEndometrial Cancer Postmenopausal
Breast pain is typicallywomen with endometrial
benign when it is cyclic cells(i.e.
on Pa as
14766 Obstetrics &Female ReprBreast Cancer reassurance and symptom management
Patients with cervical intraepithelial neoplasia 3 on bi (e.g. suppor
14761 Obstetrics &Female ReprCervical Cancer cervical cancer
Vulvar lichen and/or progression
sclerosus is a risk factor to cancer.
for the develop
14757 Obstetrics &Female ReprVulvar Carcinoma require vulvar biopsy
hysteroscopic to evaluate
myomectomy, whichforimproves
vulvar cancer.heavy m
14753 Obstetrics &Female ReprAbnormal
Uterine Fibroids
Uterine recurrent pregnancy loss).
14752 Obstetrics &Female ReprBleeding Endometrial
Labial adhesions,polypsortypically
fused labia present
minora,withareregular
mostmon com
14720 Obstetrics &Female ReprL
Wound Dehiscence And Altered mental status (e.g. confusion, agitation) cansy
abial Adhesion necessary. Topical estrogen is first-line therapy for b
14552 Obstetrics &Female ReprEvisceration suspected significant intra-abdominal
A Sertoli-Leydig cell tumor, a sex cord-stromal tumor bleeding requir
14529 Obstetrics &Female ReprOvarian Cancer breast atrophy,
Long-acting, vulvovaginal
reversible atrophy). (e.g. copper-c
contraceptives
14257 Obstetrics &Female ReprContraception estrogen-containing
Elevated prolactin levels contraceptives
associated(e.g. with hypertensio
breastfeedin
14208 Obstetrics &Female ReprDyspareunia vaginal changes (e.g. dryness, loss
Vulvar squamous cell carcinoma often occurs second of rugation). Trea
14197 Obstetrics &Female ReprVulvar Carcinoma have vulvar irritation,
In menopausal patientsintermittent
with moderatebleeding, and avaso
to severe unif
14038 Obstetrics &Female ReprMenopause plus-progesterone therapy. In contrast, patients witho
13941 Obstetrics &Female ReprC ontraception
Abnormal Uterine Hormonal
Adolescents contraception, such as thecycles
often have anovulatory progestin-relea
with irreg
12524 Obstetrics &Female ReprBleeding unregulated endometrial proliferation.
Vulvovaginal candidiasis is characterized by white va
12507 Obstetrics &Female ReprVulvovaginitis Recurrent candidiasis
In premenopausal women,warrantsadnexalevaluation
massesforare diabete
typic
12506 Obstetrics &Female ReprOvarian Cancer cysts are managed with observation
Toxic shock syndrome, due to Staphylococcus aureus and repeat exam
involving
12502 Obstetrics &Female ReprToxic Shock Syndrome Pelvic theprolapse
organ palms and is thesoles. Treatment
descent of pelvic includes
organs flut
12500 Obstetrics &Female ReprPelvic Organ Prolapse Uterine
multiparity, postmenopausal
procidentia is a form age, hysterectomy,
of pelvic organ prolapse and
12499 Obstetrics &Female ReprPelvic Organ Prolapse Physiologic
management with pessary
leukorrhea is a placement
white, odorless is appropriate
mucoid cei
12480 Obstetrics &Female ReprVulvovaginitis discharge reveals no evidence of inflammation
Bacterial vaginosis typically presents with malodorou or infe
12479 Obstetrics &Female ReprVulvovaginitis test,
Breastand clue cells onismicroscopic
development typically the examination.
first manifestation
12477 Obstetrics &Female ReprPuberty development require no further evaluation.
A significant risk factor for recurrent cystitis (i.e. > 2 e
12476 Obstetrics &Female ReprUrinary Tract Infection trimethoprim-sulfamethoxazole)
Imperforate hymen is an anatomic cancause
reduce the rate ao
of primary
12474 Obstetrics &Female ReprImperforate Hymen typically
Hormonereveals a smooth,
replacement therapyblue,isbulging
indicated vaginal
in themas trea
12447 Obstetrics &Female ReprM enopause
Undiagnosed 10 years.
Pregnancy can present in a perimenopausal woman
12439 Obstetrics &Female ReprPregnancy
Pelvic Inflammatory should
Patientsbeage evaluated
< 18 may withbean hCG level.
treated for sexually transm
Pelvic Inflammatory without the patient's permission.
Tubo-ovarian abscess is a complication of pelvic infla
12426 Obstetrics &Female ReprDisease debris on ultrasound.
12350 Obstetrics &Female ReprCervical Cancer Cervical
Cervical cancer may present
insufficiency with irregular
is a structural weakness bleeding,
of the
12349 Obstetrics &Female ReprIncompetent Cervix conization) is a risk factor because it shortens the ce
12345 Obstetrics &Female ReprC ervical
Pelvic Cancer
Inflammatory Cervical intraepithelial
Pelvic inflammatory neoplasia
disease (PID)3 canis a behigh-grade,
complicate pr
12343 Obstetrics &Female ReprDisease symptoms (e.g. fever, lower abdominal pain), and are
Atypical glandular cells (AGC) on a Pap test may be
12328 Obstetrics &Female ReprCervical Cancer endometrial
Pap testing may biopsy.be discontinued in patients age 65 w
12327 Obstetrics &Female ReprC ervical Cancer
Polycystic Ovary immunocompromised
Severe nodulocystic acne status).
may be the initial sign of h
12303 Obstetrics &Female ReprDisease clinical or laboratory evidence
Herpes simplex virus (HSV) infection of hyperandrogenism,
typically resolve
12296 Obstetrics &Female ReprHSV Infection frequent over time. Antivirals (e.g.
Genital herpes simplex virus infection can presentacyclovir, valacyclwi
12201 Obstetrics &Female ReprHSV Infection with laboratory testing via a viral culture
Patients with postmenopausal bleeding require evalu or PCR.
12194 Obstetrics &Female ReprEndometrial Cancer TVUS,
Atypicalthose with an
glandular endometrium
cells on Pap testing < 4 maymm require
indicateno e
12193 Obstetrics &Female ReprEndometrial Cancer unopposed estrogen exposure (e.g.
Endometrial adenocarcinoma can present with abnor obesity, chronic
12192 Obstetrics &Female ReprEndometrial Cancer most common risk factors are obesity and chronic an
12178 Obstetrics &Female ReprC ervical
Pelvic Cancer
Inflammatory Cervical
Microscopy conization
is not usedis used to diagnosis
in the treat high-grade of acute cervica
cerv
12162 Obstetrics &Female ReprDisease Nucleic acid amplification testing is
The genitourinary syndrome of menopause, or atroph the gold standard
12161 Obstetrics &Female ReprVaginal Atrophy renders the urogenital
Vesicovaginal fistulas maytissues thin,
occur dry,pelvic
after and inelastic,
surgery
12143 Obstetrics &Female ReprUrinary Incontinence vagina.
Absolute contraindications to combination hormonal c
12130 Obstetrics &Female ReprContraception placed on hormone-free contraceptives
12129 Obstetrics &Female ReprE ndometrial
Bartholin Cancer
Duct Cyst And Women with and
Observation postmenopausal bleeding require
expectant management a Pap
are recomm
12112 Obstetrics &Female ReprAbscess
Bartholin Duct Cyst And incision
Bartholinandduct drainage,
cysts arefollowed by Word
soft, mobile, cathetermass
nontender plac
12111 Obstetrics &Female ReprAbscess
Bartholin Duct Cyst And examination.
Large, symptomatic Bartholin duct cysts
12110 Obstetrics &Female ReprAbscess mass located behind the posterior labium majus with
12094 Obstetrics &Female ReprOvarian Cancer Mature
Ovariancystic
torsion teratomas
presentsare withbenign ovarian germ
lower abdominal paincela
12093 Obstetrics &Female ReprOvarian Cancer removal of any contributory adnexal masses.
12074 Obstetrics &Female ReprCervical Cancer Advanced
Vulvar lichen cervical cancer
sclerosus is amay present
chronic as vaginaldiso
inflammatory ble
12063 Obstetrics &Female ReprVulvar Carcinoma Treatment
dyspareunia is due
with tohigh-potency
narrowing oftopical corticosteroids
the vaginal introitus
12055 Obstetrics &Female ReprDyspareunia severe symptoms.
Genitourinary syndrome of menopause causes an es
12054 Obstetrics &Female ReprVaginal Atrophy incontinence,
cell tumors dependsrecurrent upon urinary tractconcomitant
possible infections). Treat
endo
12053 Obstetrics &Female ReprOvarian Cancer biopsy.
Advanced ovarian cancer may present with a pelvic m
12052 Obstetrics &Female ReprOvarian Cancer abdominal
Ovarian cancercavity. can present as an adnexal mass with
12051 Obstetrics &Female ReprOvarian Cancer malignancy
A are a solid
palpable adnexal mass mass with thickexamination
on physical septations and is
12050 Obstetrics &Female ReprOvarian Cancer ovarian canceruteri
Leiomyomata in premenopausal
(fibroids) are a patients.
proliferation of smo
12027 Obstetrics &Female ReprUterine Fibroids anemia andmammography
Screening an irregularly enlarged
is generally uterus.
initiated at age
12026 Obstetrics &Female ReprBreast Cancer hormone
A woman has a 1 in 8 lifetime risk of breast contribute
replacement therapy, all of which cancer. A
12021 Obstetrics &Female ReprBreast Cancer aspects include exercise and breastfeeding.
Adenomyosis typically presents in women age > 40 a
12020 Obstetrics &Female ReprDysmenorrhea symmetrically enlarged contraception
All hormone-containing uterus. is absolutely co
12012 Obstetrics &Female ReprContraception contraception.
Submucous fibroids arise from the myometrium imme
12004 Obstetrics &Female ReprUterine Fibroids bleeding and can
Urinary stress prolapse through
incontinence can be a the cervical os,
presenting sym pr
11987 Obstetrics &Female ReprUterine Fibroids modality
Unilateraltobloody
diagnose nipplefibroids is ultrasonography
discharge is the hallmarkofpre th
11972 Obstetrics &Female ReprIntraductal Papilloma condition from other
Sjö gren syndrome benign
is an and malignant
autoimmune disorder breast pat
charact
11915 Obstetrics &Female ReprDyspareunia sicca.
UterineExtraglandular features include
leiomyomata (fibroids) are the arthritis,
most commonRayna
8953 Obstetrics &Female ReprUterine Fibroids show an irregular uterine contour that may be palpab
8948 Obstetrics &Female ReprUterine Fibroids Pelvic ultrasound
A ruptured ovarianiscystthe preferred
presents with initialacute
imagingonsetmoda
of
8941 Obstetrics &Female ReprOvarian Cyst showing free fluid in the pelvis from leaking
Ovarian torsion occurs due to rotation of the ovary ar cyst cont
8939 Obstetrics &Female ReprOvarian Cancer unilateral lower abdominal
Human papillomavirus (HPV) pain and a tender,
vaccination palpabl
is recomme
8917 Obstetrics &Female ReprCervical Cancer cancer screening with Pap testing begins at age 21 in
measurement is necessary. Even if the mass has no
8903 Obstetrics &Female ReprOvarian Cancer exploration.
Premenstrual syndrome causes both physical and af
8899 Obstetrics &Female ReprPremenstrual Syndrome symptom
The increased diary adipose
that revealstissue recurring
associated symptoms in the
with obesity
8892 Obstetrics &Female ReprAnovulation hypothalamic-pituitary-ovarian
Candida vulvovaginitis is caused axisbyand result in of
overgrowth anov
7005 Obstetrics &Female ReprVulvovaginitis Treatment
Endometriosis options
(i.e. include
endometrial oral (e.g.
tissue fluconazole)
implants outsid and
7003 Obstetrics &Female ReprEndometriosis On examination,
First-line treatment patients
of vulvar may havesclerosus
lichen lateral cervical
is withdis
4811 Obstetrics &Female ReprVulvar Carcinoma preventing
Vulvar lichen disease
sclerosus progression.
is a chronic inflammatory con
4810 Obstetrics &Female ReprVulvar Carcinoma punch biopsy is recommended
Interstitial cystitis (painful bladder to confirm
syndrome) the is
diagnos
an idi
4807 Obstetrics &Female ReprInterstitial Cystitis features may include dyspareunia
HELLP syndrome is life-threatening to the mother and and urinary freque
4796 Obstetrics &Female ReprPreeclampsia status.
HELLP syndrome is a complication of preeclampsia th
4795 Obstetrics &Female ReprPreeclampsia and systemic inflammation,
False-negative non-treponemal activation
serology of the
(e.g.coagulat
rapid p
4792 Obstetrics &Female ReprSyphilis syphilis are treated empirically with
Primary syphilis is marked by the formation of a singl intramuscular ben
4791 Obstetrics &Female ReprSyphilis bilateral lymphadenopathy is often present.
4774 Obstetrics &Female ReprEndometriosis Patients withwith
Laparoscopy endometriosis
visualization areand at an increased
biopsy risk o
of endometr
4773 Obstetrics &Female ReprE ndometriosis
Polycystic Ovary hormonal contraceptive therapy
Polycystic ovarian syndrome (PCOS) is characterized have failed.
4768 Obstetrics &Female ReprDisease anovulation from failed
The initial menstrual follicular
cycles maturation.are irregul
in adolescents
4767 Obstetrics &Female ReprA novulation
Pelvic Inflammatory hormone.
Chlamydial infection diagnosed by nucleic acid ampli
4766 Obstetrics &Female ReprDisease NAAT is negative.
4759 Obstetrics &Female ReprEctopic Pregnancy An intrauterine pregnancy should be seen with transv
4758 Obstetrics &Female ReprCervical Cancer A high-grade
Inability squamous
to conceive afterintraepithelial lesion Pap tes
6 months of unprotected int
4756 Obstetrics &Female ReprInfertility menstrual cycles and decreased oocyte
Physiologic galactorrhea is usually bilateral and can b number and
4543 Obstetrics &Female ReprNipple Discharge Galactorrhea
Unilateral bloody should
nipple be discharge
evaluated is with a pregnancy
always pathologt
4542 Obstetrics &Female ReprIntraductal Papilloma presentation
Congenital aromatase of intraductal papilloma.
deficiency is a rare enzyme de
4496 Obstetrics &Female ReprOvarian Cancer genitalia with ambiguous
Functional hypothalamic amenorrhea external genitalia.
is due to suppr
4480 Obstetrics &Female ReprAmenorrhea decreased bone mineral density
Secondary amenorrhea is relatively common due to estrogen defi
in fema
4283 Obstetrics &Female ReprAmenorrhea estrogen
Granulosadeficiency
cell tumors, result
a typein decreased
of ovarianbone mineral
sex cord-stro
4230 Obstetrics &Female ReprOvarian Cancer precocious
Stress urinary puberty and an occurs
incontinence adnexaldue mass.to weakened p
4224 Obstetrics &Female ReprUrinary Incontinence from increased
Infertility is failureintra-abdominal
to achieve pregnancy pressure after (e.g. 12
jogging
mon
4194 Obstetrics &Female ReprPelvic
Infertility
Inflammatory standard
All sexually test and is
active performed
women age <as25part of the
should initial ev
undergo a
4158 Obstetrics &Female ReprDisease infertility if left untreated. Nucleic
Vasomotor symptoms, insomnia, and irregular mense acid amplification te
4136 Obstetrics &Female ReprM
Androgen Insensitivity with
enopause these insensitivity
Androgen symptoms. syndrome is due to a non-func
3913 Obstetrics &Female ReprSyndromes amenorrhea
Endometriosis (duecantopresent
lack of with
female internal genitalia),
dysmenorrhea and d
3862 Obstetrics &Female ReprEndometriosis combination oral contraceptives, which treat inflamm
3861 Obstetrics &Female ReprDyspareunia Genito-pelvic
Ovarian failurepain/penetration
may occur secondary disorder to ischemotherap
characteriz
3814 Obstetrics &Female ReprAmenorrhea increased
Condylomata FSHacuminata,
and LH due or to lack of feedback
anogenital warts, are inhibi
cau
3757 Obstetrics &Female ReprWarts lesions that may be friable. Treatment
Vaginal squamous cell carcinoma typically presents w is with topical
3745 Obstetrics &Female ReprVaginal Cancer persistent
Patients with human papillomavirus
the genitourinary infection.ofDiagnosis
syndrome menopau
3744 Obstetrics &Female ReprMenopause First-line treatment is vaginal lubricants
Intertrigo typically presents erythematous plaques and moisturizwi
3656 Obstetrics &Female ReprVulvovaginitis Candida
Mittelschmerz is a physiologic cause of unilateral abdi
albicans, which often occurs during times of
3480 Obstetrics &Female ReprMenstrual Cycles ovulation.
HypogonadotropicReassurance is indicated
hypogonadism once
(low FSH acute
andpatho
estra
3371 Obstetrics &Female ReprAmenorrhea illness. First-line treatment involves management of a
3370 Obstetrics &Female ReprOvulation Cervical mucus just prior to ovulation is profuse, clea
Primary ovarian insufficiency, cessation of ovarian fu
3368 Obstetrics &Female ReprA menorrhea
Polycystic Ovary gonadotropin-releasing
Polycystic ovary syndrome hormone
(PCOS) andcauses
FSH levels and
infertility
3367 Obstetrics &Female ReprDisease induced with letrozole
Primary infertility (an aromatase
is failure to conceiveinhibitor) in pati
after a year o
3365 Obstetrics &Female ReprInfertility infertility such as tubal obstruction
Combination oral contraceptive pills are the first-line t from prior pelvic in
3359 Obstetrics &Female ReprContraception increased risk of venous
Elevated prolactin thromboembolism.
levels inhibit Weight g
gonadotropin-releasin
3340 Obstetrics &Female ReprAmenorrhea anovulation
The levonorgestrel and amenorrhea.
intrauterine device (IUD) provides
3339 Obstetrics &Female ReprContraception Progestin-containing
Ultrasound dating with IUDs
fetalhave the added
crown-rump benefit of
measuremen
3278 Obstetrics &Female ReprPrenatal Care on measurement
Adenomyosis discrepancies
typically presents on a second
in women age or>third
40 w
3120 Obstetrics &Female ReprDysmenorrhea enlarged, boggy, globular, and
Ovarian cancer is most commonly diagnosed in adva tender.
2613 Obstetrics &Female ReprOvarian Cancer patients
A simplewithout
breast cyst an adnexal
is a common,mass. benign, palpable b
2611 Obstetrics &Female ReprBreast Mass mass and would
The hallmark yield clearPaget
of mammary fluid. Close
disease interval follow
is a painful
2607 Obstetrics &Female ReprBreast Cancer disease
Tamoxifen have an underlying
is used as adjuvant breast
therapy adenocarcinoma.
in hormone-p
2606 Obstetrics &Female ReprBreast Cancer effect. Tamoxifen
Endometriosis is aiscommon
associated causewithofincreased
pelvic pain, riskdys
of
2546 Obstetrics &Female ReprEndometriosis an endometrioma,
Endometrial which has
hyperplasia, the appearance
a precursor of a un
to endometrial
2418 Obstetrics &Female ReprE ndometrial
Pelvic Cancer
Inflammatory adipose
Pelvic inflammatory disease (PID) may present of
tissue increases peripheral conversion withanf
Polycystic Ovary antibiotics includesyndrome
Polycystic ovary high fever, inability
(PCOS) to take oral
presents with ant
hyp
2413 Obstetrics &Female ReprDisease for endometrial hyperplasia and
Tamoxifen is an estrogen antagonist on breast tissue cancer due to unregu
2410 Obstetrics &Female ReprB reast Cancer
Selective Estrogen of endometrial
Raloxifene is a polyps,
selective hyperplasia,
estrogen receptor and cancer.modulator
2408 Obstetrics &Female ReprReceptor Modulator at high risk for breast cancer. Contraindications
Stress urinary incontinence typically presents with inclu
lea
2398 Obstetrics &Female ReprUrinary Incontinence weakened pelvic floor musculature and urogenital mu
2394 Obstetrics &Female ReprDysmenorrhea Patients
containing with primary dysmenorrhea
intrauterine device is the most haveeffective
cyclic, loweem
2393 Obstetrics &Female ReprContraception combination oral contraceptives,
Combination oral contraceptive pills (OCPs) can wors levonorgestrel, ulipr
2392 Obstetrics &Female ReprC ontraception
Abnormal Uterine reduce
Womenthe agerisk < 45 of with
endometrial
abnormal and ovarian
uterine cancer.who
bleeding
2391 Obstetrics &Female ReprBleeding endometrial
Diffuse breast biopsy.
erythema, warmth, pain, and edema w
2346 Obstetrics &Female ReprBreast Cancer that may be metastatic
Lactational mastitis presents on initial
withpresentation.
flu-like symptoms,
2344 Obstetrics &Female ReprMastitis therapy against methicillin-sensitive Staphylococcus au
2330 Obstetrics &Female ReprGestational
Acute Abdomen A pregnancy
frequent site of test should be Choriocarcinoma
metastasis. administered to any wom
should
2299 Obstetrics &Female ReprIrritable
Trophoblastic
BowelDisease on chest
(e.g. x-ray.and/or
diarrhea Diagnosis is confirmed
constipation). by an elevated
Symptoms often p
18051 Obstetrics &GastrointestiSyndrome
Nonalcoholic Fatty Liver normal, and pregnant patients with an appropriate dil
17126 Obstetrics &GastrointestiDisease Nonalcoholic
Viral hepatitisfatty should liverbedisease
considered typically presentspatie
in pregnant in p
16601 Obstetrics &GastrointestiH epatitis C Bowel
Inflammatory prenatal
Pregnancy visits.
is a high-risk period for patients with ulcer
16429 Obstetrics &GastrointestiDisease small for gestational
Pregnant patients, particularly age. Remission those with should ideallyof
a history be
16225 Obstetrics &GastrointestiAcute Pancreatitis as the underlying
Protracted vomiting etiology.
can cause esophageal rupture (B
16198 Obstetrics &GastrointestiEsophageal Rupture precordial
Pregnant women aresound
crunching on auscultation
at increased (Hamman
risk for gallstone fo
16170 Obstetrics &GastrointestiC holangitis
Acute Fatty Liver Of hyperbilirubinemia) (Charcot triad).
Acute fatty liver of pregnancy typically occurs in the t Patients with seve
16137 Obstetrics &GastrointestiPregnancy elevated
Symptomatic aminotransferases)
cholelithiasis (biliary and fulminant liver failur
colic) is common in
16121 Obstetrics &GastrointestiCholecystitis intermittent obstruction of the cystic
Acute appendicitis typically presents with fever, naus duct.
16072 Obstetrics &GastrointestiAppendicitis postpartum
Acute appendicitis due to displacement
can present with of the appendix
right adnexalby tent
16071 Obstetrics &GastrointestiAppendicitis peritoneal signs, and
Acute appendicitis normal adnexa
in pregnancy may on havepelvic ultraso
an atypica
8910 Obstetrics &GastrointestiA ppendicitis Of
Dermatoses delayed
Intrahepaticdiagnosis and increased
cholestasis of pregnancy risk for complication
presents with p
2925 Obstetrics &GastrointestiPregnancy particularly
Acute hemolytic with transfusion
markedly elevated reactiontotal is a bile
rareacids.
but pote
17675 Obstetrics &Hematology Blood Transfusion flank pain, hemoglobinuria, and disseminated intrava
Hypotension, dyspnea, and disseminated intravascul
17674 Obstetrics &Hematology Blood Transfusion hemodynamic stabilizationisand
Pseudothrombocytopenia preventionerror
a laboratory of renal
charac in
16710 Obstetrics &Hematology Thrombocytopenia
Rhesus not
Anti-Drequire
immune additional
globulin evaluation
should beoradministered
follow-up andtoare an
4193 Obstetrics &Hematology Alloimmunization delivery or procedures, the Kleihauer-Betke
ABO incompatibility typically occurs between a mothe test is us
4162 Obstetrics &Hematology ABO Incompatibility are
Toxic usually
shock asymptomatic
syndrome, caused at birth
by or have mild anemi
Staphylococcus aure
19316 Obstetrics &Infectious D Toxic
PelvicShock Syndrome
Inflammatory rash. Treatment includes fluid replacement
16075 Obstetrics &Infectious D Disease Pelvic
Primary inflammatory
herpes simplex disease virus(PID)
(HSV)typically presents
infections can pr w
10068 Obstetrics &Infectious D HSV Infection patients can have painful urination and a sterile pyuri
4806 Obstetrics &Infectious D HSV Infection
Asymptomatic Cesarean
birth weight) delivery is indicated
associated in womenasymptomatic
with untreated with active ge
4472 Obstetrics &Infectious D Bacteriuria nitrofurantoin.
The incidence of vertical transmission of HCV infectio
4272 Obstetrics &Infectious D Hepatitis C B if they are
Treatment notpenicillin
with already immune. is required for all pregnant p
4156 Obstetrics &Infectious D Syphilis mediated reaction.
Bacterial vaginosis presents If the test with
is positive,
a gray, patients
malodorous are
3707 Obstetrics &Infectious D Vulvovaginitis Treatment ofvaginalis
Trichomonas bacterialisvaginosis
a common is with
cause metronidazole
of vaginitis
3679 Obstetrics &Infectious D Vulvovaginitis microscopy
to intrapartum reveals
zidovudinemotile,(AZT) flagellated ovoid protozoa
administration, cesa
3678 Obstetrics &Infectious D HIV achieve optimal viral load reduction
Trichomonas vaginalis is a common sexually transmitt (< 1,000 copies/m
3655 Obstetrics &Infectious D Vulvovaginitis
Pelvic Inflammatory microscopy.
The 2 most common Patients and causes theirof sexual
acutepartners
cervicitisare
aretrea
3639 Obstetrics &Infectious D Disease
Hyperemesis discharge,
Severe vomiting cervical(e.g.friability)
hyperemesis can be gravidarum)
treated empiricall
is a c
2806 Obstetrics &MiscellaneouGravidarum PaCO2.
Preventive migraine therapy may benefit patients with
18968 Obstetrics &Nervous SysMigraine blockers (e.g. propranolol,
Local anesthetic metoprolol).
systemic toxicity, a potential complic
17125 Obstetrics &Nervous SysAnesthesia
Idiopathic Intracranial seizures.
Idiopathic intracranial hypertension is most common
16457 Obstetrics &Nervous SysHypertension MRI of thepatients
Pregnant brain followed
with prior by cervical
lumbar puncture.
surgery (e.g. col
20305 Obstetrics &Pregnancy, C Preterm Labor 16-24 weeks gestation to guide
Ectopic pregnancy (EP) (i.e. pregnancy implanted potential preventiveinm
19917 Obstetrics &Pregnancy, C Ectopic Pregnancy Medical
Pregnanttherapypatients is with
with an methotrexate
incidental short (MTX) [Otrexup
cervix on u
19915 Obstetrics &Pregnancy, C Preterm
PostpartumLabor of preterm delivery are offered vaginal
Placenta accreta is often diagnosed on second-trime progesterone,
19900 Obstetrics &Pregnancy, C Hemorrhage postpartum
Placenta accreta hemorrhage
occurs due because the placenta
to direct placentalisvilli
mor at
19898 Obstetrics &Pregnancy, C Placenta Accreta continued placental bleeding due
Abruptio placentae, the premature detachment of the to dense adhesions
19730 Obstetrics &Pregnancy, C Antepartum Bleeding abnormalities.
Normal labor canRisk factors
cause include
mucoid tobacco
vaginal or cocain
bleeding (i.e.
19729 Obstetrics &Pregnancy, C Antepartum Bleeding maternal-fetal
Abruptio statusis(i.e.
placentae normal vitalseparation
the premature signs, category
of the
19726 Obstetrics &Pregnancy, C Antepartum Bleeding contractions, and
nonadherence abnormalities
is considered, theondiscussion
the fetal heart
should rateb
19703 Obstetrics &Pregnancy, C Asthma the controller and rescue medication.
19585 Obstetrics &Pregnancy, C Normal Pregnancy Variegated nevi, particularly
Meralgia paresthetica is caused those bythat change (e.g.
compression of thc
19583 Obstetrics &Pregnancy, C Meralgia Paresthetica associated with pregnancy is typically self-limiting an
19582 Obstetrics &Pregnancy, C Back Pain Maternal
Coccydynia musculoskeletal
(tailbone pain)changes can occur in pregnancy
after vaginal (e.g
de
19580 Obstetrics &Pregnancy, C Back Pain clinical; treatment is with reassurance
Abruptio placentae is the premature separation of the and analgesics
19415 Obstetrics &Pregnancy, C Antepartum
Substance Use Bleeding frequency
Screening contractions.
pregnant patients Risk forfactors includeuse
substance cocaine
requir
19412 Obstetrics &Pregnancy, C Disorders
Postpartum normalizing
Secondary (late) postpartum hemorrhage is heavyack
experimentation with substances and va
19301 Obstetrics &Pregnancy, C Hemorrhage endometritis, and placental site subinvolution.
19232 Obstetrics &Pregnancy, C Multiple Gestation Dichorionic-diamniotic
Listeria monocytogenes twin pregnancies
is a common are identified
foodborne infect
19188 Obstetrics &Pregnancy, C Listeria During pregnancy, L. monocytogenes
ACE inhibitors and angiotensin II receptor blockers can cause transp a
19122 Obstetrics &Pregnancy, C Teratogens kidneys) and oligohydramnios.
Persistently absent or minimal variability on fetal hea
19116 Obstetrics &Pregnancy, C Fetal Heart Tracing variability
Cervical cancer(e.g. fetal CNSpresents
typically depression). with irregular vagin
19113 Obstetrics &Pregnancy, C Cervical Cancer during pregnancy.
Preeclampsia can present up to 6 weeks postpartum
19019 Obstetrics &Pregnancy, C
Preeclampsia should be evaluated
Acetaminophen is thewith CT scan
first-line of the head.
treatment option for m
Migraine nonsteroidal
Moderate-intensity exercise is recommendedsecond
anti-inflammatory drugs (in the for mos t
Prenatal Care have
Tuberousantepartum
sclerosis bleeding,
complexorishave an underlying diso
a neurocutaneous me
Tuberous Sclerosis organs (e.g. skin,
Proper nutrition in brain,
pregnancykidney). Inheritance
includes is autoso
appropriate we
Normal Pregnancy normal prepregnancy BMI should gain 11.4-15.9 kg (
Normal Pregnancy Patients
Chemicalwith an underweight
pneumonitis prepregnancy
is typically a self-limited BMIinflam
and
Aspiration Pneumonia dyspnea,
Stress urinaryhypoxemia,
incontinenceand alveolar
is common infiltrates
after in the ded
vaginal
Urinary Incontinence the immediate
Postpartum postpartum
thyroiditis, a formperiod (i.e. < 6 autoimmun
of painless weeks afte
Hyperthyroidism and T3 levels)
Magnesium and low
sulfate uptake
toxicity on a radioactive
typically presents with iodine
sig
Preeclampsia and initiation of calcium gluconate
Patients with magnesium sulfate toxicity typically havto reverse neurom
Preeclampsia
Postpartum cessation
Significantofobstetric
magnesium sulfate
bleeding (e.g.and administration
postpartum hemor o
Hemorrhage
Heparin Induced acute pulmonary embolus), thrombocytopenia, and p
Thrombocytopenia
18551 Obstetrics &Pregnancy, C Heparin-induced
Preeclampsia withthrombocytopenia
severe features increases typically presents
the risk
Preeclampsia formation, particularly in patients
Magnesium sulfate, commonly used in obstetrics for with severe hyperte
Preeclampsia trigger
Elevated a myasthenic
maternal serum crisisα-fetoprotein
due to the inhibition
(MSAFP) of leve
ace
Neural Tube Defects Therefore,
Inadequatepatients
maternalwith elevated
folate intakelevels require
is a major riskfetal
factou
Neural Tube Defects cerebrum,
Patients with a calvarial
gestational defect, an abnormal cerebellum
thrombocytopenia are asym
Thrombocytopenia
Postpartum Gestational thrombocytopenia is benign
The risk of intimate partner violence (IPV) increases and self-limit
Complication
18280 Obstetrics &Pregnancy, C for IPV istorsion
Ovarian required to decrease
typically causesthe risk of maternal
intermittent lower ab an
Ovarian Torsion can occurpatients
Pregnant in all reproductive-aged
with asymptomatic women, particularl
bacteriuria are
Urinary Tract Infection symptoms. Because a third of patients
Patients with acute pyelonephritis who do not improv do not comple
Urinary Tract Infection abscess.
During pregnancy, patients with sickle cell disease ha
Sickle Cell hypercoagulable
Acute pyelonephritis state.in pregnancy typically presents w
Urinary Tract Infection complications (e.g. sepsis,
Acute pyelonephritis in pregnancy pretermtypically
delivery), managew
presents
Urinary Tract Infection complications (e.g. maternal sepsis, preterm delivery
Normal Postpartum Lochia is physiologic
Indomethacin tocolysis vaginal
(i.e. tobleeding after deliveryisd
inhibit contractions)
Preterm Labor closure ofwith
Patients theprior
fetal uterine
ductus surgery
arteriosus, (e.g. although
cesarean its deli
ben
Antepartum Bleeding progressively
Vasa previa isdecreasing
a rare conditioncontraction
in which amplitude,
the fetal and vess
Antepartum Bleeding fetal vessel is with emergency cesarean
Cervical insufficiency is a structural weakness of the delivery bec
Incompetent Cervix with
Vasamild symptoms
previa is a rare(e.g. increased
condition in whichvaginal
fetaldischarge
vessels
Antepartum Bleeding painless, minimal vaginal bleeding
Prior uterine surgery, particularly prior classical and rapid fetal det
cesar
Uterine Rupture fetal decelerations,
The most common cause and anofirregular abdominal(amnio
oligohydramnios mass
Oligohydramnios leakage
Maternalofvascular
clear vaginal
disease fluid.
(e.g. type 1 diabetes melli
Oligohydramnios the
Maternal sickle cell diseasefetal
high risk of intrauterine causes demise, patients with
vaso-occlusion th
Oligohydramnios with decreased fetal movement
associated polyhydramnios. Because it is commonly and oligohydramnios
Down Syndrome Limb) association,orthe
Polyhydramnios, presence
excessive of duodenal
amniotic atresia (r
fluid volume
Polyhydramnios risk
Mostofcases
obstetric complications (e.g.
of polyhydramnios (i.e. preterm
amnioticprelabor
fluid inde
Polyhydramnios managed.
In breastfeeding postpartum patients, progestin-only
Contraception not increase
In patients atthromboembolism
high risk for preeclampsia risk or affect(e.g.breastfe
type 1 d
Preeclampsia function and dictates management (i.e. delivery timin
Preeclampsia Patients at high risk for preeclampsia (e.g. multiple g
Preeclampsia
Postpartum Patients
atony dependsat highon riskpatient
for preeclampsia
contraindications:(e.g. preeclamp
Methyler
Hemorrhage
Rhesus tranexamic acid is used with caution
Ectopic pregnancies can cause Rh(D) alloimmunizati in patients with h
Alloimmunization women require anti-D
Retroperitoneal hematomas immunoglobulin
may occurafter an ectopi
postpartum d
Cesarean Delivery obvious source of bleeding. Hemodynamically
Leiomyomata uteri are more likely to degenerate duri unstab
Uterine
RuptureFibroids
Of The fibroid can cause severe
Short interpregnancy abdominal
intervals (e.g. <pain;
6-18uterine
monthstend be
Membranes
Rupture Of The preterm prelabor rupture of membranes,
Intra-amniotic infection (chorioamnionitis) is a complic and low birth
Membranes
Rupture Of The amniotic
Uncomplicated infection requireprelabor
preterm therapeuticruptureantibiotics
of membran and
Membranes
Rupture Of The Delivery is at 34 weeks
Preterm prelabor rupturegestation or sooner
of membranes, if complic
rupture of m
Membranes
Rupture Of The intra-amniotic infection, umbilical
Genitourinary tract infection, particularly asymptomatcord prolapse, and
Membranes
Acute Fatty Liver of treatment,
Acute fatty and liverreculturing
of pregnancy for test of cure
presents are third
in the recomm trim
Pregnancy liver failure (e.g. profound hypoglycemia).
Malignant hyperthermia is a rare, life-threatening con Due to high
Malignant Hyperthermia rigidity.
of urinaryTreatment
obstruction, is immediate cessation
including bladder of the anes
distension an
Posterior
Group Urethral Valve
B Streptococcal (from decreased
Pregnant patientsurine positiveoutput) can cause
for group B pulmonary
Infection
Group B Streptococcal low risk for anaphylaxis receive
Vertical transmission of group B Streptococcus cefazolin
Infection
Rectus Abdominis current pregnancydiastasis
Rectus abdominis or thoseiswho delivered a
a weakening ofprior infa
the linea
Diastasis
Urinary Tract Management
Hydronephrosis is conservative
in pregnancywith occursobservation and rea
due to ureteral
Obstruction bilateral renal enlargement
If fetal presentation (right > breech)
(e.g. cephalic, left) withisdilated
uncerta re
Labor Management safest route ofthe
to fit through delivery.
maternal pelvis, is a common cause
Labor Management posterior).
hours without). Second-stage arrest is managed with
Labor Management distress,
Active phase and maternal
arrest is no conditions in whichinthe
cervical change > 4Valsalv
hours
Labor Management contractions.
The first stage of labor is divided into 2 phases: the d
Labor arrest is managed by cesarean la
Labor Management Patients with normal labor progression
Sexually transmitted infections (STIs) in pregnancy c and reassurin
Syphilis undergo STI screening
Uterine tachysystole, orat> the initial prenatal min,
5 contractions/10 visit, may
and
Fetal Heart Tracing
Gestational between contractions (e.g. late decelerations). Mana
Trophoblastic Disease Complete
Sinusoidalhydatidiform
fetal heart rate moles typically
tracings are present
typicallywith assoc fir
Fetal Heart Tracing acidemia)previa
Placenta and requires
occurs when urgentthe cesarean
placenta delivery.
extends ov
Antepartum Bleeding placenta previa
Placenta previa,occursand persistent
when thecases placenta are covers
managed thew
Antepartum Bleeding monitoring
Women with is herpes
typicallysimplexreassuring.
virus receive antiviral pr
HSV Infection delivery require cesarean
Patients with congenital Zika syndrome delivery to help preventhave
typically ver
Zika Virus Of
Dermatoses occur
Melasma, secondary
an acquired to an hyperpigmentation
infected Aedes mosquito; disorderther tha
Pregnancy
Dermatoses Of Melasma is clinically diagnosed and
Intrahepatic cholestasis of pregnancy presents in the typically resolves
Pregnancy acids (> 10 µmol/L).
Hyperemesis gravidarum Management
is a severe includes
form ofursodeox
nausea
Multiple Gestation hCG and progesterone levels.
Breech presentation occurs when the fetal buttocks o
Fetal Malpresentation cavity,
Patientsthereby limiting III
with category fetal
fetalmobility and preventing
heart rate tracings arefe
Fetal Heart Tracing intrauterine
bilateral enlarged, resuscitative interventions;
cystic ovaries; and thirdthose who do
spacing le
Infertility
Postpartum failure, and death.
Postdural puncture headaches after neuraxial anesth
Complication
Postpartum upright,
Perinealimproves
lacerations when are supine)
commonwithin after 72 hoursdeliver
vaginal of the
Complication
14755 Obstetrics &Pregnancy, C managed
chains), which conservatively
does not release (e.g. nonsteroidal
oxygen to the anti-inflam
tissues
Fetal Hydrops demise.
Parvovirus B19 infection in pregnancy can cause
Fetal Hydrops B19 infection may
Monochorionic twinbe asymptomatic
gestations can be in complicated
adults but is by c
Multiple Gestation vessels supplying the umbilical cords of each twin.
Neuraxial anesthesia (e.g. epidural) can cause symp
Anesthesia decelerations. Management
Cervical insufficiency, is withweakness
a structural left lateralofpatient
the ce
Incompetent Cervix are managed with a prophylactic
Pregnant women should be evaluated for tuberculosi cerclage performed
Tuberculosis followed with chest
both of which x-ray to differentiate
help decrease neonatal HIV latent infectio
infection ri
HIV zidovudine.
Twin pregnancies are at increased risk for preterm de
Multiple Gestation preeclampsia)
A uterine size-datesand fetal (e.g. fetalexists
discrepancy growth restriction)
when the fun
Polyhydramnios greater-than-dates
Intrauterine synechiae (i.e. Asherman syndrome) isma
discrepancy by promoting fetal a
Amenorrhea cavity, patients often have amenorrhea,
Secondary syphilis causes a diffuse maculopapular r infertility, and
Syphilis soles.
Late-/post-term pregnancies are at increased risk for
Post-term Pregnancy test and amniotic
Superficial surgical fluid
sitevolume.
infectionPatients with oligohyd
(i.e. cellulitis) can oc
Postoperative
Postpartum Fever induration and erythema. Risk factors include obesity
Hemorrhage
Postpartum Vaginal
Patientshematoma is a potentially
with von Willebrand disease life-threatening
may present pos wi
Hemorrhage normal. Treatment
Management of acute
of preterm bleedingrupture
premature includes of desmo
membr
Chorioamnionitis fever, fetal
Patients withtachycardia),
systemic lupus delivery is indicatedhave
erythematosus to decrean
SLE anti-SSB (La) antibodies. Patients
Pubic symphysis diastasis can occur after a traumati may develop fetal
Normal Postpartum conservative
Parvovirus B19 with supportive
infection care.
in pregnancy can cause sev
Parvovirus high-output
Congenital cytomegalovirus occurs due to hydrops
fetal heart failure, subsequent transplace fe
Cytomegalovirus intracranial calcifications,
Maternal infection intrahepatic
with Toxoplasma gondiicalcifications, a
Toxoplasmosis infection
Vaccineswiththat characteristic
are safe during ultrasound
pregnancy findings
includeofinac bila
Immunizations
Maternal Substance pregnancy and should be administered to all pregnan
Abuse
Pelvic Inflammatory Amphetamine
Acute cervicitisabuse during
presents pregnancy
with postcoitalisbleeding,
associated muw
Disease pathogens, Chlamydia trachomatis
with loss of pregnancy symptoms or and light vaginal blee
Abortion
Gestational intrauterine pregnancy.
Trophoblastic
Gestational Disease
12312 Obstetrics &Pregnancy, C Hydatidiform
Patients with mole can present
hydatidiform molewith are at preeclampsia
risk for gestatio wit
Trophoblastic
Postpartum Disease are undetectable
Postpartum for at least
endometritis is a6polymicrobial
months. As pregnancy infection c
Endometritis
Gestational gentamicin due to its broad-spectrum
Hydatidiform mole, a type of gestational trophoblastic coverage.
Trophoblastic Disease
Gestational from
A markedly elevated
hydatidiform mole, a type β-hCG levels. Thetrophoblas
of gestational theca lute
Gestational include
A an enlarged
complete hydatidiformuterus filled
mole canwith a heterogeneou
present with pelvic
Wernicke-Korsakoff an enlarged
Wernicke uterus with a heterogeneous
encephalopathy is a complication mass comp
of hypere
Syndrome
Hyperemesis dysfunction, and gait ataxia.
Hyperemesis gravidarum is a severe, persistent form
Gravidarum ketonuria.
Second stage arrest of labor occurs when there is ins
Labor Management occiput
Shoulder anterior)
dystociacontributes
is the inability to cephalopelvic
to deliver thedisprop fetal sh
Shoulder Dystocia head into the perineum after it delivers
Increased insulin resistance is a physiologic change (e.g. turtle sigo
Gestational Diabetes
Group B Streptococcal diabetes occurs
Patients with when
group insulin resistance
B Streptococcus (GBS) exceeds pro
Infection high risk for vaginal
Intermittent vertical leakage
transmission or wetnessto the neonate
may be prese (i.e.
Urinary Incontinence experiencing
Transverse lie, stress
whenurinary
the fetal incontinence if no fluid em
spine is perpendicular
Prenatal Care cephalic presentation
Rectovaginal fistulas may by termoccur (i.e. > 37
after weeks gestat
obstetric traum
Rectovaginal Fistula tan-brown discharge) through the
Preeclampsia is defined as new-onset hypertension vagina. Dark red, vp
Preeclampsia growth restriction/small
A hemodynamically for gestational
unstable patient with agehemoperito
infants du
Ectopic Pregnancy by ultrasound
Umbilical cordshowing
compression a gestational
impedessac at the upperb
fetal-placental
Fetal Heart Tracing evidenced by recurrentare
Variable decelerations variable
an abrupt decelerations)
decrease are in theat
Fetal Heart Tracing decelerations are typically due to umbilical cord comp
Acute postpartum urinary retention causes an inabilit
Urinary Incontinence
Antepartum Fetal perineal
Quiet fetal trauma,
sleep andis theregional neuraxial
most common anesthesia.
cause of a non
Testing test is extended (e.g. 40-120 min)
Intra-amniotic infection, also known as chorioamnionito ensure that feta
Fetal Heart Tracing
Postpartum flora
Genitalthrough the cervix
tract trauma (e.g.and is associated
vaginal laceration) withis prolon
a com
Hemorrhage particularly after operative vaginal
A monochorionic monoamniotic twin pregnancy has a delivery.
Multiple Gestation entanglement
Subserosal and and fetal demise;uterine
pedunculated therefore, patients re
leiomyomata c
Uterine Fibroids enlarged uterus and size-date discrepancy
therefore, pelvic rest (i.e. no digital cervical examinat during pre
Antepartum Bleeding trimester
Labor andultrasound
vaginal deliveryto evaluate for previa resolution.
are contraindicated after a
Uterine Rupture
Postpartum uterine rupture require laparotomy
Placenta accreta, which occurs when uterine villi attaand
Hemorrhage factors
Uterine include
inversion, priorin cesarean
which the delivery,
uterine fundus historyinverts
of dila
Uterine Inversion vagina. Patients can
Uterine inversion have discontinuation
requires severe abdominal pain, he
of uteroton
Uterine Inversion may be required
Cell-free fetal DNA if initial
testing attempts at manualand
is a noninvasive reduction
highl
Prenatal Care confirmed by chorionic villus sampling or amniocente
Nonstress Test An abnormal
Patients biophysicalfetal
with decreased profile score (e.g.
movement 4/10)unde
should is c
Nonstress Test nonreactive. A biophysical profile should
Early decelerations are uniform, shallow deceleration be performe
Fetal Heart Tracing end of the contraction. Early decelerations are a beni
Ectopic Pregnancy Ruptured ectopic pregnancy
Fetal macrosomia is a risk factortypically presentsdystoci
for shoulder with a
Brachial Plexus ‘waiter’s tip’ posture.
A short cervix at < 24Management
weeks gestation, involvesevenobservati
with no
Preterm Labor decreases the risk for preterm labor.
Pregnant patients with a history of cervical surgery (e
Preterm Labor standard
Breastfeeding for further
is theevaluation
recommended of these sourcepatients’ risk.
of nutrition
Breastfeeding
Postpartum varicella infection, herpetic breast lesions, current ch
Hemorrhage
Postpartum The
atonymost common
presents withcause
profuse of vaginal
postpartum hemorrhage
bleeding and a s
Hemorrhage
4808 Obstetrics &Pregnancy, C > 4000 g (8.8 lb).
Chorioamnionitis Intra-amniotic
Intra-amniotic infections are usually polymicrobial;
infection (chorioamnionitis) typically pretre
Chorioamnionitis fundal
Shoulder tenderness,
dystocia, an andobstetric
maternalemergency,
leukocytosis. is impact
Shoulder Dystocia gentle traction. Initial management is
Patients with gestational diabetes mellitus are initially the McRoberts
Gestational Diabetes consistentlyisabove
Eclampsia associated the target range), then
with increased insulin and
maternal or o
Preeclampsia control, andisexpedient
Eclampsia the most common delivery. cause of new-onset s
Proteinuria headaches,edema
Pulmonary vision changes).
is a life-threatening complication o
Preeclampsia pressure, and decreased
HELLP syndrome is a potential albumin.manifestation of seve
HELLP Syndrome raise suspicion for the
Maternal hypertensive crisis occurssyndrome. The when abdominal
the systolicpain
Preeclampsia control
gestation.include hydralazine,
Patients with evidencelabetalol, and nifedipine.
of end-organ dama
Preeclampsia is associated with increased morbidity.
Primary Hypertension Hypertension increaseshypertension
Chronic or pre-existing the risk of superimposed
is defined aspre as
Primary Hypertension measurements taken at least 4 hours
Crucial elements of intrauterine fetal demise (IUFD) e apart.
IUFD and antiphospholipid
Intrauterine fetal demise antibody
shouldsyndrome.
be suspected However,
when of
IUFD
Group B Streptococcal necessary
Intrapartumtoantibiotic
confirm the diagnosis.
prophylaxis is administered to p
Infection vertical
Intrauterine fetal demise refers to fetal death for
transmission: rupture of membranes at >> 20
18 w
IUFD
Osteogenesis unknown.
Osteogenesis imperfecta is an autosomal dominant d
Imperfecta multiple fetal fracturesisand
Breast engorgement commonwith intrauterine
3-5 days after fetaldelive
dem
Breast Engorgement Improvement
Universal screening is expected as breastfeeding
for syphilis is required at is the
establis
first
Syphilis treated with intramuscular benzathine penicillin G.
Influenza infection during pregnancy is associated wit
Prenatal
Rhesus Care vaccine.
Blood typing Vaccination
and antibodyis safescreening
in every trimester
should beand du
perfo
Alloimmunization should receive anti-D immune globulin. Anti-D immun
Hypopituitarism Sheehan
Klumpke palsy syndrome is a complication
is a rare complication of of shoulder
massive obs dys
Brachial Plexus ipsilateral Horner syndrome.
result, normal renal adaptations in pregnancy include
Normal Pregnancy serum blood urea nitrogen and creatinine.
Anesthesia Hypotension
Low back pain is is
a common
common side in theeffect
third of epiduralofane
trimester pre
Normal Pregnancy
Hyperemesis behavioral modifications, exercise, heating pads, and
Gravidarum
Antiphospholipid Pregnant
Patients with patients who are
recurrent pregnancyunderweight
loss plusor do annot gai
unpro
Syndrome autoimmune disorder that causes a hypercoagulable
Preeclampsia Eclampsia
Preeclampsia is the most common
is new-onset cause of new-onset
hypertension plus proteins
Preeclampsia a 24-hour
Septic pelvic urine collection for total
thrombophlebitis protein
refers (gold stand
to a postoperati
Thrombophlebitis Treatment
grade fever.includes anticoagulation
These changes and broad-spectr(
are hormone-mediated
Normal Postpartum with routine
Patients withpostpartum
late-term (>care. 41 weeks gestation) and po
Prenatal Care indication for delivery.
Symmetric fetal growth restriction They are therefore
(FGR) routinely ev
Fetal Growth Restriction occurs
Asymmetricin thefetal secondgrowth andrestriction
third trimesters
(FGR)and is due
is due to set
Fetal
GroupGrowth Restriction pronounced
B Streptococcal Group B Streptococcusthan the restriction
(GBS) screening in head growth. Symm
is by rectova
Infection reduce
Because the the risk of early-onset
risks of administering neonatal GBS infection
tocolytics outweig
Preterm Labor
Rupture Of The vaginal delivery can be managed
Patients who have uncomplicated preterm prelabor expectantly. Thoseru
Membranes
3274 Obstetrics &Pregnancy, C development.
The priority forDelivery patientsiswith indicated if there
lethal fetal are signs
anomalies suo
Labor Management preterm
Conscientiouslabor for neonatal
refusal benefit isoccurs
of treatment not indicated.
when a pro
Abortion requests, are obligated to refer
Labor is painful, regular contractions that cause the patient in a timely
cervi
Labor Management Patients
Preterm labor refers to regular contractions causing cl
in false labor can be discharged home with
Preterm Labor plus corticosteroids
presentation (to reduce the risk
and contraindications of neonatal
to vaginal deliveryre
Prenatal Care gestation.
Because oxytocin has a similar structure to antidiuret
Hyponatremia clonic
Active seizures.
phase arrest occurs at a cervical dilation of > 6
Labor Management phase
A arrest isprofile
biophysical managed (BPP) byiscesarean
performed delivery.
in patients a
Post-term Pregnancy imminentfurther
requires risk of evaluation
fetal demise; withinasuch cases, delivery
biophysical profile (
Fetal Heart Tracing
Antepartum Fetal reassurance
The maternaland routineofcare.
sensation decreased fetal movemen
Testing require further investigation
All healthy women with uncomplicated of fetal status with nonstr
pregnancies a
Prenatal Care activities with high fall risk should
Immunity to rubella is routinely evaluated at the initiabe avoided.
Prenatal Care measles-rubella
Dyspnea is common vaccine. Postpartum
in pregnancy andvaccination
most oftenpre oc
Normal Pregnancy drive to increase tidal volume. The
Trisomy 18 is characterized by a normal inhibin A lev hyperventilation le
Down Syndrome the markers
Elevated are normal.
maternal serum α-fetoprotein is seen in feta
Omphalocele pregnancy. An ultrasound
Hypertension during pregnancy shouldinbe performed
a patient withto ev
edem
Glomerular Disorders flare
2563 Obstetrics &Pregnancy, C complicated
Magnesium sulfate byisnephritis.
commonly administered for ecl
Preeclampsia somnolence, areflexia,
Induction of labor for vaginal respiratory suppression).
delivery is the best optio Bec
IUFD acceptance
Septic abortion of the mostdiagnosis;
commonly however,
occurs retention
after an unsteof th
Abortion uterine tenderness.
An inevitable abortion Septic
presents abortion
withisvaginal
a medical eme
bleeding
Abortion
Rhesus gestation
Anti-D immune in the globulin
lower uterine (RhoGAM) segment.is indicated in uns
Alloimmunization of feto-maternal blood mixing.
A complete abortion refers to the passage of the prod
Abortion subside. Ultrasonography reveals an empty uterus.
An inevitable abortion presents with heavy vaginal ble
2541 Obstetrics &Pregnancy, C Abortion indicated for hemodynamically
Blunt abdominal trauma (e.g. motor unstable patients.
vehicle collision)
2535 Obstetrics &Pregnancy, C Antepartum Bleeding hemorrhagic shock require replacement
Patients with prior uterine surgery (e.g. cesarean deli of intravascu
2532 Obstetrics &Pregnancy, C Antepartum Bleeding may present
Uterine rupturewith intensepresents
typically abdominal withpain,
severe vaginal
abdom ble
2531 Obstetrics &Pregnancy, C Antepartum Bleeding examination may show
Abruptio placentae palpable placental
is premature fetal partsseparation
(e.g. an ir
2530 Obstetrics &Pregnancy, C Antepartum Bleeding bleeding, and a firm,istender
Abruptio placentae uterus. Risk
the premature factors of
separation inclu
the
2528 Obstetrics &Pregnancy, C Antepartum Bleeding high-frequency contractions. Complications
Placenta previa occurs when the placenta covers the include m
2524 Obstetrics &Pregnancy, C Antepartum Bleeding contraindicated
Placenta previa in thesewhen
occurs patients; therefore,covers
the placenta cesareanthe
2523 Obstetrics &Pregnancy, C Antepartum Bleeding therefore, fetal heart rate tracings
Hyperandrogenism in pregnancy is commonly due to are typically reactiv
2415 Obstetrics &Pregnancy, C Ovarian Cancer ovarian
Patientsmasses are observed
at > 37 weeks gestation andwithmanaged
breechexpectapresent
2412 Obstetrics &Pregnancy, C Prenatal Care have
The triad of vaginal bleeding, lower abdominal pain,de
a successful procedure have lower cesarean a
2411 Obstetrics &Pregnancy, C Ectopic Pregnancy ultrasound showing a gestational sac
acute pain, vaginal bleeding, and abnormalities on fe at an ectopic si
2407 Obstetrics &Pregnancy, C Antepartum Bleeding endothelial
Maternal dysfunction.
adaptations to pregnancy include increases
2406 Obstetrics &Pregnancy, C Normal Pregnancy benign the
During symptoms
secondthat andresult from theseplacental
third trimesters, changes.hor
2404 Obstetrics &Pregnancy, C Gestational Diabetes gestation should undergo routine
Medroxyprogesterone side effects may be similar screening for gestato p
2389 Obstetrics &Pregnancy, C Contraception
Antiphospholipid month should be evaluated for pregnancy.
Antiphospholipid-antibody syndrome (APS) is a proth
2256 Obstetrics &Pregnancy, C Syndrome thrombocytopenia. Patients with APS require anticoa
19413 Obstetrics &Psychiatric/ Stimulants Amphetamine intoxication
Postpartum depression can present
is common and,with hypertens
if left untreat
18726 Obstetrics &Psychiatric/ Depression
Obsessive Compulsive depression must be assessed for
Pregnancy and the postpartum period are associatedsuicidal ideation.
16495 Obstetrics &Psychiatric/ Disorder frequently
Postpartumcenter around
depression hasfears of contaminating
a high incidence andand is ofh
15949 Obstetrics &Psychiatric/ Peripartum Depression Edinburgh Postnatalvalproate
The anticonvulsant Depression is aScale).
teratogen associate
15103 Obstetrics &Psychiatric/ Neural Tube Defects and
Postpartum psychosis is characterized by anforacute
require maintenance pharmacotherapy bipolao
15037 Obstetrics &Psychiatric/ Postpartum Psychosis symptoms, agitation, and severe insomnia.
Pseudocyesis is a condition in which a nonpsychotic
2552 Obstetrics &Psychiatric/ Pseudocyesis enlargement)
Presentation of and the belief
asthma that she
is similar is pregnant.
in pregnant and Eva
non
14564 Obstetrics &Pulmonary &Asthma
Amniotic Fluid activity. Adequate control with an
immediate postpartum period. The diagnosis is madeinhaled corticostero
2405 Obstetrics &Pulmonary &Embolism maternal and fetal
Endometriosis is theoutcomes.
ectopic implantation of endomet
20161 Obstetrics &Renal, UrinaHematuria implants typically have cyclic hematuria, dysuria, sup
17121 Obstetrics &Renal, UrinaUrinary Incontinence Patients injury
Ureteral with multiple
can occur sclerosis
duringcan develop urgency
gynecologic surgery
16241 Obstetrics &Renal, UrinaUreter Injury volume of intra-abdominal
Pregnancy can cause worsening fluid (uroperitoneum),
of diabetic nephropa but
16147 Obstetrics &Renal, UrinaDiabetic Nephropathy
Urinary Tract occurs later in pregnancy; findings prior
Ureteral injury presents postoperatively with ureteral to 20 weeks
16033 Obstetrics &Renal, UrinaObstruction prompt diagnosis
Nephrolithiasis and treatment,
typically presents irreversible
with flank pain renalthatda
4294 Obstetrics &Renal, UrinaRenal Calculi
Asymptomatic modality's
Asymptomatic low risk of fetal (ASB)
bacteriuria radiation exposure. when a
is diagnosed
4256 Obstetrics &Renal, UrinaBacteriuria ASB during
Patients withpregnancy
postpartum increases the risk ofthe
urinary retention, acute py
inabili
4225 Obstetrics &Renal, UrinaUrinary Retention for diagnosis and treatment.
2397 Obstetrics &Renal, UrinaUrinary Incontinence
Carpal Tunnel Stress
Carpal urinary incontinence
tunnel syndrome is loss ofinurine
is common with increa
pregnancy. Mo
4636 Obstetrics &RheumatologSyndrome excessive flexion during sleep. In most
Major risk factors for osteoporosis include advanced cases, sympt
4122 Obstetrics &RheumatologOsteoporosis smoking.
Cognitive In patients
bias with osteoporosis,
(i.e. mental shortcuts, patterns the riskincorre
for fra
20095 Obstetrics &Social ScienPatient Safety diagnoses basedbarriers
Hierarchy-based on initialand impressions
intimidation and failure to
19739 Obstetrics &Social ScienPatient Safety safety culture
safe action interventions
without human effort.(e.g. simulation,
An example debriefin
is forcin
19648 Obstetrics &Social ScienPatient Safety
Physician Patient the possibility of error.
19103 Obstetrics &Social ScienCommunication When delivering
Directive counseling unexpected,
is ethically serious news, when
appropriate physician
onl
19063 Obstetrics &Social ScienInformed Consent previa should be counseled that cesarean delivery is
Routine prenatal care should include an
19059 Obstetrics &Social ScienInformed Consent description of indications,
Conflict of interest occurs risks,
when and benefits of
the process and an o
inform
19058 Obstetrics &Social ScienInformed Consent
Directive/Surrogate alternatives
In the absenceandofprovide care that
an advance is most
directive, likely to yie
managemen
18485 Obstetrics &Social ScienDecision Maker decisions on his
Patients may or her
desire best judgment
a cesarean of what
delivery in thethe pat
absen
17233 Obstetrics &Social ScienCesarean Delivery
Decision Making these patients
Pregnant women to another obstetric
with capacity haveprovider.
the same right to
3748 Obstetrics &Social ScienCapacity interests of the fetus.
ed recessive disorder. On average, carrier mothers and unaffected fathers have a 25% chance of having a son with hemophilia
ffected
rtensiondaughter.
who are pregnant or considering pregnancy should be managed with a medication safe for use in pregnancy. Extende
nt of new atrialcan
blocker that be usedcan
fibrillation in nonpregnant patients
further increase and safely
transmitral continued
gradient and leftinto pregnancy.
atrial pressure, with dramatic worsening of pulmonary
) commonly cause a mild elevation in blood pressure and can sometimes lead to overt hypertension. OCs should not be used in
ension whileoftaking
anagement OCshypertension
essential should discontinue
during the medication.
pregnancy are labetalol and methyldopa. Calcium channel blockers and hydralazin
nverting enzyme inhibitors and angiotensin receptor
macules with distinct borders due to melanocyte destruction, and blockers are contraindicated
is often associated in pregnancy.
with autoimmune disease (e.g. type 1 diab
reatment includes corticosteroids and phototherapy.
characterized by polyuria (e.g. 24-hr urinary output > 3 L) and excretion of an inappropriately dilute urine with low specific gravi
ake. During pregnancy,
n autoimmune pre-existing mild
disorder characterized by DI symptoms
a possible briefcan worsen duephase,
hyperthyroid to increased turnover
a self-limited of antidiuretic
hypothyroid hormone.
phase, and an ultimate
id peroxidase autoantibodies. Painless (silent) thyroiditis is a similar disorder, but by convention
nts increase during pregnancy. Patients with hypothyroidism should increase their levothyroxine dose at the time pregnancy is not diagnosed within a year
is do
H and total
partum T4 using
ischemic pregnancy-specific
necrosis of the anterior norms.
pituitary) is a potentially life-threatening complication of massive postpartum hemorrha
deficiency) as well as hypotension and
amenorrhea for > 3 months in women with previouslyanorexia (secondary
regular adrenal
menses insufficiency).
(or > 6 months in women with previously irregular mens
by
onserum prolactin,
increases duringTSH, and FSH
pregnancy level testing.
to cope with metabolic demands. Estrogen causes an increase in thyroxine-binding globulin, lea
els.
enalhCG directly stimulates
hyperplasia is caused by TSH receptors,
a partial causing
deficiency of increased production
21-hydroxylase of thyroid
and typically hormones.
presents with hyperandrogenism (e.g. irregula
esterone level.
h Graves' disease are at risk for thyrotoxicosis due to passage of maternal TSH receptor antibodies across the placenta. Affect
ght
ults poorly.
that showMethimazole plus a β blocker
bacterial vaginosis on Pap are given
testing to symptomatic
should patients
be asked about until the(e.g.
symptoms condition self-resolves
malodorous vaginalover a few weeks
discharge). Symptto
py, potassium hydroxide whiff testing) and treated if the diagnosis is confirmed. Asymptomatic patients do not require treatment
regnancy
strointestinal require
florasurgical
and maymanagement
colonize thewhen
genitalthey
tracthave medicalsometimes
in women, contraindications
causingtosevere
methotrexate (e.g. breastfeeding)
pelvic inflammatory disease.orHowev
are h
ng in asymptomatic
ections (> 3 episodes women does
in a year ornot
> 2indicate
episodes active pelvic infection
in 6 months) commonlyand occur
does not require treatment.
in postmenopausal patients due to estrogen defic
and elasticity of the bladder trigone and urethra, and increased vaginal pH. Treatment
ically presents with intermittent, self-resolving episodes of unilateral pelvic pain due to temporary ovarian is with vaginal estrogen.
vessel occlusion. Pati
elop complete torsion, which requires diagnostic laparoscopy.
n can be used to treat symptomatic uterine fibroids. The procedure causes fibroid infarction and necrosis, which can lead to pe
Patients with no due
.g. dyspareunia signstoofvulvovaginal
infection (e.g. fever, purulent
atrophy). Diagnosis discharge,
in womenleukocytosis) receivenormal
without previously expectant
menses management.
(e.g. prior hysterectomy)
incontinence can occur due to external anal sphincter injury associated with a third- or fourth-degree obstetric perineal laceratio
tone, asymmetric
incontinence sphincter
is external analcontraction, or a palpable
sphincter injury defect
associated withon examination.
obstetric trauma, Evaluation
which caniscause
with endoanal ultrasonography.
direct sphincter muscle injury a
tone. Patients can have a delayed or intermittent presentation due to the gradual loss of compensatory pelvic floor
n of the ovary around the infundibulopelvic ligament, classically presents with nausea/vomiting; new-onset, severe unilateral stability with
pe
on is a gynecologic emergency and requires diagnostic laparoscopy.
mmon cause of acute, unilateral lower abdominal pain in reproductive-aged women, typically appears on ultrasound as a thin-w
lly stable
OP) patientswith
may present are pelvic
managed with observation
pressure and reassurance.
or urinary dysfunction (e.g. retention, stress urinary incontinence). However, many patient
assurance andorgan
ctor for pelvic observation
prolapse only.
is multiparity because pregnancy causes pelvic floor muscle weakening from chronic, increased in
e herniation of pelvic organs (e.g. rectum) into the vagina, occurs due to damage to the levator ani muscle complex. Patients wi
) classically have chronic constipation and a vaginal bulge.
nt withsterile
a and first-trimester
pyuria isbleeding
a common andpresentation
mucopurulent forendocervical discharge.urethritis
Chlamydia trachomatis Patients in
with acute cervicitis
sexually are treated
active women. empirically
Patients with thiswc
htesting for chlamydia
breastfeeding and gonorrhea.
is typically due to nipple injury, which can present with bilateral nipple abrasions and bloody nipple discharge. T
sitioning and improper latch-on
one acetate (DMPA) [Depo-Provera] technique.
is an effective, injectable contraceptive that does not require daily administration. It is a saf
ve contraindications to intrauterine devices (IUDs) and/or
hyperplasia are at risk for progression to endometrial estrogen-containing
cancer. contraceptives.
Patients who desire future fertility are treated with progestin thera
he corpus luteum produces progesterone, which prepares the endometrium for implantation, promotes implantation, and mainta
who have
pically causethe corpusurinary
dysuria, luteumurgency,
removedand(e.g.frequency
oophorectomy)
but mayprior
alsotopresent
10 weeks
withgestation require
more subtle progesterone
symptoms, supplementation
including acute-onset u
sm. Positive leukocyte esterase on urine dipstick or urinalysis supports the diagnosis.
enal hyperplasia occurs due to partial 21-hydroxylase deficiency and typically presents in reproductive-aged women with signs
ormal
has a uterine bleeding. and significant morbidity and mortality and is under-reported. Therefore, screening is required in all wom
high prevalence
(e.g. date rape) are at risk for long-term psychologic consequence (e.g. post-traumatic stress disorder). Therefore, they should
medical
e treatedcare (e.g. postexposure
empirically for sexually prophylaxis, emergencyincluding
transmitted infections, contraception).
chlamydia, gonorrhea, and trichomoniasis. Postexposure prop
on the risks and benefits of therapy.
ain in the absence of signs of infection, fluid collection, and wound dehiscence is managed with observation and reassurance.
diabetes mellitus are at increased risk for developing type 2 diabetes mellitus. Therefore, these patients are screened with a 2-h
rtum.
ly may present with postmenopausal bleeding, pelvic pain, behavioral changes, and signs of genital trauma (e.g. perineal lacer
se screening
-defining illness andin be reported
patients withimmediately
HIV, is caused to adult protective
by high-risk services.
strains (types 16 and 18) of human papillomavirus. Cervical cancer
ative lesion, and painless inguinal lymphadenopathy.
vical conization for cervical intraepithelial neoplasia 3 and have surgical margins free of disease remain at risk for recurrent dys
re frequent
presents withcervical cancer screenings
postmenopausal bleeding with
andrepeat Papmass
a uterine and HPV that cotesting
causes bulk at 1symptoms
and 2 years postprocedure.
(e.g. pelvic pressure, constipation). Ta
agonist effects on the uterus.
nexal mass, ultrasound concerning for ovarian malignancy include complex appearance and abnormal internal features (e.g. irr
entsemergency
ive with thesecontraception
suspicious adnexal option mass findings pregnancy
that prevents require further evaluation.
by delaying ovulation and impairing implantation. It can be taken u
aception methods are contraindicated in patients at increased risk for thromboembolism. Progestin-only contraceptives (e.g. lev
he
ginalcopper-containing intrauterine device
bleeding is a contraindication may be offered
to intrauterine device to these patients.
insertion because it may indicate an underlying condition (e.g. endome
ng require further evaluation (e.g. endometrial biopsy).
(> 3 consecutive pregnancy losses) may be caused by submucosal fibroids due to impaired embryo implantation or growth. Pa
my,is awhich
common restores normalfinding
presenting intrauterine anatomy and
of endometrial reduces
cancer. the riskallofpatients
Therefore, future pregnancy loss.
with postmenopausal bleeding require endometr
nsvaginal ultrasound.
urinary incontinence includes a voiding diary to classify predominant type of urinary incontinence (e.g. stress, urgency) and to d
rce-limited areas is the most common cause of vesicovaginal fistula worldwide. Vesicovaginal fistula presents with a continuous
nulation
hich is antissue
abnormalon the anterioroutpouching
localized vaginal wall.of Diagnosis is with
the urethral pelvicinto
mucosa examination
surrounding andtissues,
bladdercandyecause
test. dyspareunia. Patients typ
nal wall that has an associated purulent discharge.
n aberrant connection between the bladder and the vagina, can have a delayed presentation years after pelvic radiotherapy. Th
as abnormal
an the bladder constantly
localized drains intoofthe
outpouching thevagina.
urethral mucosa that can collect urine, resulting in inflammation of the surrounding tis
g, dyspareunia, and a tender anterior
pic implant of endometrial tissue in the abdomen vaginal wall and
mass that expresses
pelvis, which mayacause purulent or bloody
chronic urethral discharge.
inflammation, pain, and fibrosis. Indicatio
a, dyspareunia, and infertility. Patients with asymptomatic endometriosis require observation
oids) are common, benign myometrial tumors that can cause a variety of symptoms but may be diagnosed incidentally. and reassurance only. Indicatio
cdometrial
pain, andtissuebulk symptoms. Patients with asymptomatic fibroids require observation and reassurance
implants within the intra-abdominal cavity, can cause chronic inflammation and fibrosis. Therefore, patients ca only.
erness), dysmenorrhea, dyspareunia, and distorted pelvic anatomy (e.g. cervical displacement).
ed as due
curs a fetal heart rate endometrial
to increased baseline > 160/min and is commonly
prostaglandin production associated
during menses with that
maternal
causesfever due hypercontractility
uterine to intra-amniotic infection (chor
(e.g. crampy
ptoms
menses, (e.g.
is malaise).
common in First-line treatment is women
reproductive-aged with nonsteroidal
and is divided anti-inflammatory drugs, whichand
into primary (physiologic) inhibit prostaglandin
secondary synthesis.
(pathologic) causes.
dometriosis) include age > 25 at onset, unilateral (non-midline) pelvic pain, lack of systemic
curs due to increased endometrial prostaglandin production during menses that causes uterine hypercontractility and hyperton symptoms, and abnormal uterine b
abdominal
nogenital warts) pain withoccurassociated systemic
due to infection symptoms
with (e.g. nausea, vomiting,
human papillomavirus diarrhea).
and can present First-line
as friable, treatment
raised is with
papules. nonsteroidal
Although many caan
utoinoculation),
development ofthe association
intrauterine with disease
adhesions) transmission
is a possible via directofgenital
complication contactsurgery
intrauterine requires assessment
(e.g. curettage)for sexualbyabuse.
caused scarring an
on formation increases with a concomitant intrauterine infection (e.g. septic abortion).
formation of intrauterine adhesions, often occurs following intrauterine surgery (e.g. suction curettage). Patients with Asherman
h respond to a progesterone
breast development challenge
and female due genitalia;
external to obliteration of thethey
however, endometrium.
have no female internal genitalia (e.g. uterus, ovaries) and m
rcinoma is due to persistent infection with human papillomavirus (HPV) infection high-risk types 16 and 18. Chronic tobacco us
r persistent HPV infection and squamous cell metaplastic changes.
ommonly
re benignpresents
germ cellintumors
prepubertal
commongirls in
with pruritus and thin,
premenopausal whiteThese
women. lesions of the vulva and
heterogeneous perianal
tumors (e.g.region. Treatment
hair, teeth) appearison
with su
sono
c areas. Treatment
cute-onset, is withpain
severe pelvic surgical removal
due to ovarian torotation
reduce impeding
the risk ofcirculation
ovarian torsion.
and causing ischemia. Mature cystic teratomas (derm
al
ncy (POI) is diagnosed in women age < 40 with secondary amenorrhea andcomposition.
masses and have an elevated risk of torsion due to their heterogeneous signs of ovarian failure (i.e. elevated FSH). POI occ
n, resulting in estrogen deficiency (e.g. vaginal atrophy, thin endometrium).
ds labial
primaryminora, typicallydue
amenorrhea affect prepubertal
to the girls due tooflow
failed development theestrogen production.
uterus, cervix, Topical
and upper 1/3estrogen creamUrogenital
of the vagina. is first-linedevelopment
therapy for s
alformations are tumor
drogen-secreting common and
(e.g. patients require
Sertoli-Leydig evaluation
cell tumor) withsigns
include a renal
of ultrasound.
frank virilization such as voice deepening, male-pattern b
sulfate (DHEAS) level are typically due to an ovarian source (e.g. Sertoli-Leydig cell tumor). In contrast, elevated DHEAS and n
lnal
tumor.
genitalia development, resulting in a phenotypically female infant. During puberty, increased testosterone levels result in vir
are testosterone-secreting sex cord-stromal tumors that can present with rapid-onset virilization (e.g. bitemporal hair thinning),
imary component of the ovarian stroma and convert testosterone to estradiol via aromatase. Malignant proliferation of these ce
vels that affect
malignant sex breast tissue (e.g.
cord-stromal tumorstenderness, fibrocystic
of the ovary changes)
that secrete and Patients
estradiol. the uterine lining (e.g.
typically postmenopausal
present thickened
with a large ovarian massendom
and
hyperplasia from chronic unopposed estrogen exposure).
enesis have primary amenorrhea due to an absent uterus, cervix, and upper 1/3 of the vagina (i.e. blind vaginal pouch). Howev
develop independently of the Müllerian duct system, patients have normal external genitalia and secondary sexual characteristi
efect in the female genital outflow tract resulting in hematocolpos. The accumulated material causes pain and sometimes difficu
drainage. or persistent nipple discharge require age-based imaging to evaluate for breast cancer. Imaging in women age > 3
pontaneous,
n combination
ncy (POI) occurs increases the detection
due to accelerated of intraductal
ovarian lesions (e.g.
follicle depletion papilloma)
in women age <that
40,commonly
resulting incause nippleamenorrhea,
secondary discharge. elevated
1one,
gene premutation
patients with anforunsatisfactory
fragile X syndrome.
colposcopy (i.e. entire squamocolumnar junction cannot be visualized) require endocervica
common cause of postpartum hemorrhage, and first-line treatment includes bimanual uterine massage and high-dose oxytocin
ep
s ainchronic
management is administration
inflammatory of tranexamic
condition typically found inacid, an antifibrinolytic
intertriginous agent
areas (e.g. that prevents
inguinal region).the
Thebreakdown of blood
lesions occur due toclots to ac
occlude
hat can inflammatory
chronic develop into draining
disordersinus tracts
that can and result
present in significant
with multiple scarring.
glazed, erythematous vulvar erosions bordered by white striae (i.e.
and oral lesions. Treatment is with topical corticosteroids.
additional evaluation (e.g. endometrial biopsy) unless they are symptomatic (i.e. abnormal uterine bleeding) or at high risk for e
with
nign endometrial
when it is cycliccells(i.e.
on Pap testing with
associated require an endometrial
menses), bilateral, biopsy to evaluate
and diffuse with nofor endometrial
associated hyperplasia/cancer.
examination abnormalities (e.g. bre
m management (e.g. supportive bra, nonsteroidal anti-inflammatory drugs).
aepithelial neoplasia 3 on biopsy (e.g. endocervical curettage) require cervical conization, a type of excisional biopsy, due to the
ogression
a risk factorto cancer.
for the development of vulvar cancer. Therefore, patients with a history of lichen sclerosus and a new unifocal vulv
valuate
my, whichforimproves
vulvar cancer.
heavy menstrual bleeding and restores normal uterine anatomy, thereby decreasing infertility and future pre
.
dllylabia
present withare
minora, regular
mostmonthly
commonly menses
seen and additional intermenstrual
in prepubertal bleeding.production.
girls with low estrogen Symptomatic endometrial
Partial adhesions polyps are treated
are typically w
asymp
en is first-lineagitation)
. confusion, therapy forcansymptomatic
be a sign of lesions.
hemorrhagic shock due to intra-abdominal bleeding, particularly among elderly postoper
a-abdominal bleeding require urgent laparotomy.
r, a sex cord-stromal tumor, is a testosterone-secreting ovarian tumor. Patients can have virilization (e.g. clitoromegaly) and sig
nal atrophy). (e.g. copper-containing intrauterine devices) are highly effective for pregnancy prevention and can be used in pati
ntraceptives
aceptives (e.g.
associated with hypertension).
breastfeeding suppress GnRH release and induce a hypoestrogenic postpartum state. Patients may experience
ness, loss of rugation).
cinoma often occurs secondary Treatment to is supportive
persistent with non-hormonal
human papillomavirus lubricants and moisturizers.
infection, which is associated with chronic tobacco use. Pat
mittent bleeding, and a unifocal, friable mass commonly located on the labia majora.
ith moderate to severe vasomotor symptoms (i.e. hot flashes), first-line treatment is with menopausal hormone therapy. Patient
y. In contrast, patients without a uterus require estrogen-only therapy (e.g. transdermal estrogen patch).
such as thecycles
novulatory progestin-releasing
with irregular, subdermal implant,
heavy menstrual can bedue
bleeding usedtofor
anmenstrual
immature hygiene (e.g. to decrease
hypothalamic-pituitary menstrual
axis. bleeding)
Progesterone in
norma
proliferation.
s characterized by white vaginal discharge, pruritus, erythema, and excoriations. Risk factors include diabetes mellitus, immuno
rrants
n, adnexalevaluation
massesforare diabetes
typically mellitus.
benign, are related to ovulation, and resolve spontaneously. Therefore, premenopausal patients
bservation and repeat examination.
ue to Staphylococcus aureus bacteremia and associated exotoxin release, presents with fever, hypotension, tachycardia, and a d
oles. Treatment
e descent includes
of pelvic organs fluid replacement,
through the vaginaantibiotic
and cantherapy,
presentandwithremoval of the foreign
pelvic pressure, body.
urinary retention, incontinence, and obstru
sal
rm age, hysterectomy,
of pelvic organ prolapseand obesity.
in which the entire uterus herniates through the vagina along with the anterior and posterior vagina
ya placement is appropriate
white, odorless in poordischarge
mucoid cervical surgical candidates withoccurs
that typically multiple comorbidities.
midcycle due to increasing estrogen levels prior to ovulation. M
ence of inflammation or infection (e.g. rare polymorphonuclear leukocytes).
ly presents with malodorous, thin, white vaginal discharge in the absence of vulvovaginal inflammation. It is characterized by a
roscopic
pically the examination.
first manifestation of puberty and is followed by menarche within 2-2.5 years. Premenarchal patients age < 15 with no
urther evaluation.
recurrent cystitis (i.e. > 2 episodes in 6 months or > 3 episodes in a year) in women is sexual intercourse. Postcoital antibiotic
azole)
anatomic cancause
reduce the rate amenorrhea.
of primary of recurrence.Pubertal patients typically present with cyclic lower abdominal pain, amenorrhea, and h
, blue,isbulging
erapy indicated vaginal
in themass that swells
treatment with increased
of vasomotor symptoms intra-abdominal pressure.
(e.g. hot flashes, night sweats) in women age < 60 who have underg
a perimenopausal woman with insomnia, fatigue, weight gain, amenorrhea, and an enlarged uterus. Patients with amenorrhea
an hCG level.
treated for sexually transmitted infections without parental consent. Confidentiality should be maintained, and details of the vis
ission.
a complication of pelvic inflammatory disease; it presents with fever, abdominal pain, and a complex multiloculated adnexal mas
ent with irregular

structural weaknessbleeding,
of the vaginal discharge,
cervix that causes and a visible
painless raised
cervical cervical
dilation andlesion. Immediate
potential biopsy is pregnancy
second-trimester necessary to confirm
loss. Prior the
con
because it shortens the cervix and may alter its structural integrity.
oplasia
se (PID)3 can
is a be
high-grade, premalignant
complicated lesion(e.g.
by perihepatitis that Fitz-Hugh-Curtis
requires treatment with cervical
disease). conization,
Patients typicallyahave
type right
of excisional biopsy. pain i
upper quadrant
er abdominal pain), and are young, sexually active, and not using barrier contraception.
GC) on a Pap test may be due to either cervical or endometrial adenocarcinoma. Evaluation of AGC requires colposcopy, endo
ntinued in patients age 65 who have had adequate Pap testing without prior high-grade cervical lesions or cervical cancer risk f
us).
may be the initial sign of hyperandrogenism in patients with polycystic ovary syndrome. The diagnosis is based on the presenc
ence of hyperandrogenism,
V) infection typically resolves menstrual irregularities,
spontaneously within aand polycystic
week of lesionovaries on ultrasound.
development. However, HSV is associated with recurrent d
rus infection can present with painful, pruritic, vesicular or ulcerative lesions; dysuria; and of
als (e.g. acyclovir, valacyclovir) are used to decrease symptom duration and the number recurrences.
inguinal lymphadenopathy. Clinical di
a viral culture or PCR.
usal bleeding require evaluation for endometrial cancer with either a transvaginal ultrasound (TVUS) or endometrial biopsy. In
ometrium
n Pap testing < 4 may
mm require
indicateno additional evaluation.
endometrial In contrast,
hyperplasia/cancer, women
which with an endometrium
is confirmed via endometrial> 4biopsy.
mm require an endometrial
Endometrial biop
hyperplasia/
osure
oma can (e.g. obesity,
present chronic
with anovulation)
abnormal and subsequent
uterine bleeding uncontrolled
and is diagnosed endometrial biopsy.
via endometrial proliferation.
Risk factors are related to excessive
are obesity and chronic anovulation.
dthe
to diagnosis
treat high-grade
of acutecervical intraepithelial
cervicitis neoplasia.
due to its low Potential
sensitivity complications
and inability to detectinclude cervical
the most commonstenosis, cervical
pathogens, incompetence,
Chlamydia trachom
testing is the gold standard for diagnosis.
me of menopause, or atrophic vaginitis, causes vulvar and vaginal atrophy from loss of epithelial elasticity due to low estrogen l
sues
y occur thin, dry,pelvic
after and inelastic, making
surgery (e.g. them more susceptible
hysterectomy) and presenttoasinjury (e.g. petechiae,
a continuous, vestibular
painless, fissures) and
watery discharge frombleeding.
urine leaking (i.e.
s to combination hormonal contraceptives include a history of antiphospholipid antibody syndrome or thromboembolism
ontraceptives (e.g. copper intrauterine device).
usal
nt bleeding require
management a Pap test forfor
are recommended evaluation of cervicalBartholin
an asymptomatic cancer and
cysteither an endometrial
as spontaneous biopsymay
resolution or transvaginal ultrasound
occur. Symptomatic to
cyst
owed
oft, by Word
mobile, cathetermasses
nontender placement.
at the base of the labia majora at the 4 and 8 o'clock positions. These cysts can be asymptomat
olin duct cysts can present with vaginal discomfort and pressure with sexual activity, walking, or sitting. Physical examination re
posterior labium majus with possible extension into the vagina. Treatment of symptomatic Bartholin duct cysts is with
re benign
with ovarian germ
lower abdominal cell
pain andtumors that contain
ultrasound findingsallof3 an
germ cell layers
adnexal massand withcan haveDoppler
absent sebaceous
flow.fluid and hair on
Laparoscopy is gross appeara
required for de
ry adnexal masses.
amay present
chronic as vaginaldisorder
inflammatory bleedingthat
withcauses
a cervical lesion.
intense Smoking
vulvar is aExamination
pruritus. risk factor for squamous
findings cellthin,
include cervical carcinoma.
wrinkled vulvar skin, ofte
tency topical corticosteroids.
wing of the vaginal introitus and dryness from loss of natural lubrication. Treatment is with lubricants or moisturizers; vaginal est
of menopause causes an estrogen deficiency that results in urogenital atrophy and can present with multiple urinary symptoms
inary tractconcomitant
possible infections). Treatment
endometrial is cancer
with non-hormonal moisturizers;
(e.g. uterine-sparing vaginal
surgery, estrogen is prescribed
chemoradiation); therefore,forthenon-improving
best next steporinsevere
these
may present with a pelvic mass and ascites. Management involves exploratory laparotomy with cancer resection and staging w
nt as an adnexal mass with pelvic pain and bloating due to abnormal proliferation of ovarian or tubal epithelium or peritoneum.
ass with thickexamination
on physical septations and the evaluated
is best presence of by ascites.
pelvic ultrasonography to rule out malignant features. CA-125 testing has low spe
opausal
ds) are a patients.
proliferation of smooth muscle cells within the myometrium. Heavy menstrual bleeding is a hallmark, and patients may
enlarged
is generallyuterus.
initiated at age > 50 due to increasing risk of breast cancer with age. Other important risk factors include nulliparity
rapy,
ime risk of breast contribute
all of which to increased
cancer. Alcohol lifetimeisestrogen
consumption exposure. risk factor, and reduced intake will decrease the risk of bre
a dose-dependent
and breastfeeding.
esents in women age > 40 and is characterized by dysmenorrhea; heavy menstrual bleeding; progressive chronic pelvic pain; a
erus.
ontraception is absolutely contraindicated in patients with breast cancer. A copper intrauterine device is a safe, effective, hormo
from the myometrium immediately under the endometrial lining and protrude into the uterine cavity. They commonly cause hea
cethrough
e can be a the cervical os,
presenting presenting
symptom with a typicaluteri
of leiomyomata labor-like pain
(fibroids) dueduetoto cervical
direct distension
pressure on thebybladder
the solid mass.
from an irregularly enlarge
ids is ultrasonography of the pelvis.
scharge is the hallmark presenting symptom of an intraductal papilloma, a benign breast condition. Lack of breast mass or lym
gn and malignant
utoimmune disorder breast pathology.by inflammation of the exocrine glands. Typical features include dry mouth, autoimmune siala
characterized
ures include
oids) are the arthritis,
most commonRaynaud phenomenon,
pelvic tumor seendyspareunia,
in women. They cutaneous
can cause vasculitis, interstitial
prolonged lungbleeding
menstrual disease, with
and dysmenorrhea
non-Hodgkin lymp and
contour that may be palpable in the abdomen as a globular mass.
eferred
esents withinitialacute
imaging modality
onset for suspected
of unilateral gynecological
pelvic pain, tumors.byIt strenuous
often precipitated has high sensitivity
activity orfor diagnosing
sexual uterine
intercourse. fibroids
Pelvic and ov
ultrasound
elvis from leaking
e to rotation of thecyst contents.
ovary around the infundibulopelvic ligament, causing ovarian vessel occlusion and ischemia. It classically pr
lPV)pain and a tender, palpable
vaccination is recommended adnexal mass. HPV-related
to prevent Diagnosis is disease;
clinical, and
it is management is with emergency
typically administered to those agelaparoscopy.
11-26 but can be give
p testing begins at age 21 in immunocompetent patients regardless of age of onset of sexual activity.
y. Even if the mass has no malignant features on ultrasound, an elevated CA-125 level is concerning and requires
auses both physical and affective symptoms, which commonly include fatigue, bloating, hot flashes, mood swings, and irritabilit
s recurring
sue associated symptoms in the increases
with obesity luteal phasethe(i.e. 1-2 weeks
peripheral prior to of
conversion menses) that resolve
androgens withamenses.
to estrone, type of estrogen. Chronically eleva
arian axis and result in anovulation and abnormal uterine bleeding.
caused by overgrowth of Candida albicans and typically presents with vulvovaginal erythema, vaginal pruritus, and discharge wit
e oral (e.g.
metrial tissuefluconazole) and intravaginal
implants outside (e.g.can
of the uterus) clotrimazole) antifungals.and infertility due to chronic intra-abdominal inflammation
cause dysmenorrhea
may
var havesclerosus
lichen lateral cervical
is withdisplacement or cervical
superpotent topical motion tenderness.
corticosteroids (e.g. cloβsol), which decreases chronic inflammation, thereby imp
ession.
a chronic inflammatory condition that can present with vulvar pruritus, white vulvar plaques, and loss of normal architecture (e.
nded
bladder to confirm
syndrome) the isdiagnosis and rule
an idiopathic, out vulvar
chronic cancer.
condition characterized by pain that is exacerbated by bladder filling and relieved b
pareunia and urinary frequency and urgency.
eatening to the mother and fetus. Delivery is the cornerstone of treatment and is warranted at > 34 weeks gestation or with det
plication of preeclampsia that involves thrombocytopenia, microangiopathic hemolytic anemia, and increased liver enzymes. Th
n, activation
nemal serology of the coagulation
(e.g. rapid plasma cascade,
reagin)and platelet consumption.
is common in primary syphilis. Patients with negative serology and strong clinical evid
cally with intramuscular benzathine penicillin G.
d by the formation of a single, painless chancre that begins as a papule and becomes a non-exudative ulcer with indurated bord
y is often present.
is areand
ation at an increased
biopsy risk of infertility.
of endometrial implantsResection
is the onlyof definitive
endometriosis
way toimproves
diagnoseconception rates.It is indicated when nonsteroidal a
endometriosis.
herapy have failed.
me (PCOS) is characterized by irregular menses and clinical or biochemical evidence of hyperandrogenism. Patients with PCO
licular maturation.are irregular and anovulatory due to hypothalamic-pituitary-gonadal axis immaturity and insufficient secretion
s in adolescents
nosed by nucleic acid amplification testing (NAAT) should be treated with azithromycin or doxycycline. Concurrent treatment is
should be seen with transvaginal ultrasound at serum β-hCG levels of 1500-2000 IU/L. If the level is < 1500 IU/L, serum β-hCG
ntraepithelial lesion Pap test
6 months of unprotected result requires
intercourse colposcopic
in women age > 35examination and
is considered biopsy This
infertility. of cervical abnormalities
can occur due to a ovarian
due to diminished high riskreser
of p
reased
s usuallyoocyte number
bilateral andbe
and can quality.
milky (most common), yellow, brown, gray, or green. Hyperprolactinemia is the most common ca
valuated with a pregnancy test,
scharge is always pathologic. Bloody serumdischarge
prolactin, without
TSH, and possible MRI of
a corresponding the brain.
breast mass or nipple changes in the setting of norma
liciency
papilloma.
is a rare enzyme deficiency that prevents the conversion of androgens to estrogens. It causes virilization of female fetu
external
amenorrhea genitalia.
is due to suppression of the hypothalamic-pituitary-ovarian axis by strenuous exercise, caloric restriction, or chronic
density due to
relatively common estrogen deficiency.
in female athletes and results from hypothalamic amenorrhea (e.g. GnRH deficiency). The subsequent dec
in decreased bone mineral density.
ype of ovarian sex cord-stromal tumor, secrete high levels of estrogen and inhibin. Therefore, juvenile-subtype granulosa cell tu
n adnexaldue
e occurs mass.to weakened pelvic floor muscles that cause urethral hypermobility and reduced bladder support. Patients typicall
minal
eve pressure after
pregnancy (e.g. 12
jogging).
months of regular, unprotected sexual intercourse. Male factor infertility is the etiology in many couples
rmed
age <as25part of the
should initial evaluation.
undergo annual screening for Chlamydia trachomatis and Neisseria gonorrhoeae due to high rates of asymptom
Nucleic acid amplification
somnia, and irregular menses could testing is the
be gold standard
due to for the screening
hyperthyroidism and diagnosis
or menopause of these
in middle-age organisms.
women. Serum TSH and FSH leve
ndrome is due to a non-functioning androgen receptor that results in genotypically male (46,XY) patients appearing phenotypica
of with
nt female internal genitalia),
dysmenorrhea and deepnormal breast andSymptomatic
dyspareunia. female external genitalia
patients development,
are offered empiricand minimal
medical or nowith
therapy axillary and pubic
nonsteroidal hair
anti-in
ptives, which treat inflammation and suppress ovarian stimulation of endometriosis.
ation disorder
secondary to ischemotherapy
characterizedand by pain on attempted
presents vaginal penetration
with amenorrhea and signs ofthat precludes
estrogen sexual (e.g.
deficiency intercourse.
vaginal dryness). Ovarian fa
ue to lack of feedback inhibition from estrogen.
or anogenital warts, are caused by the low-risk strains of human papillomavirus (e.g. types 6 and 11) and typically present as n
e. Treatment
rcinoma is with
typically topical with
presents medications (e.g. trichloroacetic
vaginal bleeding, malodorous acid) or surgical
discharge, andexcision.
an irregular lesion. Risk factors include age > 60,
mavirus infection. Diagnosis is by biopsy of the lesion, which determines the
nary syndrome of menopause (i.e. atrophic vaginitis) can have vaginal pruritis, dyspareunia,depth of invasionthin
of atypical cells.with decreased ela
vulvar skin
snal lubricants and
erythematous moisturizers;
plaques those with
with associated no symptom
satellite lesionsimprovement are treated
within intertriginous areaswith vaginal
(e.g. estrogen.
inguinal and axillary folds). A common
ten occurs during times of immunosuppression (e.g. systemic corticosteroid use). Treatment
ogic cause of unilateral abdominal pain in young women. The pain occurs in the middle of the menstrual includes topical
cycleazoles
(days (e.g. clotrim
10-14), co
indicated once acute pathology is excluded.
onadism (low FSH and estradiol) causes irregular menses and infertility via loss of pulsatile GnRH secretion precipitated by wei
t involves management of any underlying causes.
to ovulation is profuse, clear, thin, and corresponds with an LH surge. This physiologic finding is not an indication of infection.
ncy, cessation of ovarian function at age < 40, may present with infertility, irregular menses, and menopausal symptoms. It is ch
ormone
e (PCOS) andcauses
FSH levels anddue
infertility a low to estrogen
anovulation level.
and may present with irregular menses, enlarged ovaries, and signs of insulin res
aromatase inhibitor) in patients with PCOS.
e to conceive after a year of unprotected sexual intercourse in a nulliparous patient age < 35. A hysterosalpingogram
struction
eptive pillsfrom
are prior pelvic infection.
the first-line therapy for primary dysmenorrhea in sexually active patients. Side effects include breakthrough blee
hromboembolism. Weight
nhibit gonadotropin-releasing hormonegain is usually not an thereby
release, adversesuppressing
effect. LH and FSH production. As a result, women who are brea
hea.
erine device (IUD) provides highly efficacious, long-acting, reversible contraception that works by thickening cervical mucus an
salhave the added
crown-rump benefit of amenorrhea
measurement and minimal
in the first trimester systemic
is the side effects.
most accurate way to determine estimated gestational age (EGA). EGA
ancies on a second or third trimester ultrasound.
esents in women age > 40 with chronic pelvic pain, dysmenorrhea, and heavy menstrual bleeding. On physical examination, the
, and tender.
ommonly diagnosed in advanced stages and therefore has a high mortality rate. There is no screening test for ovarian cancer in
al mass.
common, benign, palpable breast mass in women that has no echogenic debris or solid components on ultrasound. Aspiration c
ar fluid. Close
y Paget disease interval follow-up
is a painful, with
itchy, clinical breast
eczematous, examination
and/or ulceratingis rash
indicated tonipple
on the monitorthatforspreads
recurrence.
to the areola. The majority of
ng breast adenocarcinoma.
uvant therapy in hormone-positive breast cancer and has mixed agonist and antagonist activity on estrogen receptors. Hot flash
ciated
on cause withofincreased
pelvic pain,riskdyspareunia,
of endometrial andcancer anddue
infertility venous thromboembolism.
to ectopic implants of endometrial tissue in the abdominopelvic cavity. Im
has the appearance
a precursor of a unilocular,
to endometrial hypoechoic
cancer, occurs due toadnexal mass endometrium
unregulated on ultrasound.proliferation. Obesity is a major risk factor for endom
peripheral
se (PID) may present with fever, diffuse lower abdominal pain, andestrogen
conversion of androgens to estrone, thereby increasing levels cervical
mucopurulent and causing unopposed
discharge. uterine
Indications forestrogen
inpatientexp
tre
ver, inability to take oral antibiotics, and risk of nonadherence to treatment.
e (PCOS) presents with hyperandrogenism (e.g. severe acne, hirsutism, androgenic alopecia) and irregular menses. Patients w
ia and cancer
antagonist on due
breastto unregulated
tissue and isendometrial
used in the proliferation
treatment and from unopposed
prevention estrogen
of breast stimulation.
cancer. Tamoxifen is an estrogen agonist in t
perplasia, and cancer.
estrogen receptor modulator with estrogen antagonist activity in the breast and uterus and agonist activity in the bone. It is used
cer. Contraindications
e typically presents with include
leakage a history
of urineofwith
venous thromboembolism.
increased intra-abdominal pressure (e.g. intercourse). It is common in postmenop
sculature and urogenital mucosa atrophy. Treatment includes pelvic floor muscle exercises or surgical midurethral sling placeme
menorrhea
vice is the mosthaveeffective
cyclic, lower abdominal
emergency pain duringmethod
contraception mensesand andmaya normal pelvictoexamination.
be offered First-line
nulliparous women treatment
and is with
adolescents. nonst
Emerge
ptives,pills
eptive levonorgestrel,
(OCPs) can ulipristal) are less effective.
worsen hypertension. Patients with well-controlled hypertension may use OCPs but should have their bl
etrial and ovarian cancer.
normal uterine bleeding who have failed medical management (e.g. oral contraceptives) require evaluation for endometrial hype
warmth, pain, and edema with a peau d'orange appearance are hallmark features of inflammatory breast carcinoma. This is an
initial
nts withpresentation.
flu-like symptoms, focal unilateral breast pain with surrounding erythema and induration, and axillary lymphadenopathy
n-sensitive Staphylococcus aureus (e.g. dicloxacillin, cephalexin), analgesics, and continued breastfeeding.
be administered to any
s. Choriocarcinoma woman
should of childbearing
be suspected age before
in postpartum performing
women any
with an diagnostic
enlarged testsirregular
uterus, such asvaginal
x-rays or CT scans
bleeding, that invols
pulmonary
is confirmed
tipation). by an elevated
Symptoms β-hCG and
often precede level.
are exacerbated by pregnancy. Laboratory evaluation (e.g. complete blood count, inflam
ents with an appropriate dilutional (normocytic) anemia do not require colonoscopy.
sease typically
onsidered presentspatients
in pregnant in patients
withwith type 2 diabetes
a hepatocellular mellitus,
pattern obesity,
of liver injury and
(e.g.elevated
elevatedaminotransferases
aminotransferases),with an AST/ALT
even rati
in those with
period for patients with ulcerative colitis (UC) as there is often worsening disease activity that can lead to fetal complications, inc
Remission
larly should
those with ideallyof
a history behypertriglyceridemia,
achieved before conception. Most medications
are at increased used to control UC
risk for triglyceride-induced are considered
pancreatitis. safe lipid
A serum for continu
panel c
.ause esophageal rupture (Boerhaave syndrome). Patients typically have severe chest/back pain and may have pneumomedias
d on auscultation
creased (Hamman
risk for gallstone sign). Esophageal
formation perforation
and subsequent acute is a surgical which
cholangitis, emergency.
typically presents with fever, right upper quadrant
cot
ncy typically occurs in the third trimester due to microvesicular fatty infiltration of mental
triad). Patients with severe cases may also develop hypotension and altered status.leading to liver inflammation (e.g
hepatocytes,
ses) and fulminant
(biliary liver failure
colic) is common (e.g. profound
in pregnancy due hypoglycemia, thrombocytopenia).
to increased gallstone Management
formation. Patients is immediate
have recurrent right delivery.
upper quadrant and
the cystic duct.
y presents with fever, nausea, vomiting, and right lower quadrant pain. Diagnosis of acute appendicitis is mainly clinical, but aty
ementwith
esent of the appendix
right adnexalby the enlarged
tenderness anduterus. Treatment
may mimic is with
obstetric appendectomy.
or gynecologic conditions. Patients with acute appendicitis typicall
mal adnexa on pelvic ultrasound.
nancy may have an atypical presentation (e.g. right mid-to-upper quadrant or flank pain) due to displacement of the appendix b
creased
f pregnancyrisk for complications
presents (e.g. that
with pruritus appendiceal
is worse rupture, fetal demise).
on the hands and feet.Management
Patients are at is increased
with surgery.
risk of fetal complications, incl
nelevated
reactiontotal
is a bile
rareacids.
but potentially fatal condition due to transfusion of mismatched blood (e.g. ABO incompatibility). Patients ca
a, and disseminated intravascular coagulation within minutes to hours of transfusion. Diagnosis is with a positive direct Coombs
nd disseminated intravascular coagulation may occur. Management includes immediate cessation of the transfusion and admini
nisand preventionerror
a laboratory of renal injury.
characterized by platelet aggregation in vitro. It is generally confirmed when peripheral smear reveals larg
uation or follow-up and are not at
hould be administered to any Rh D-negativerisk for bleeding.
mother who delivers an Rh D-positive baby. The standard dose is usually adequate
ally occurs between a mother with blood group O andaan
e Kleihauer-Betke test is used to determine whether higher
infantdose
with is needed
blood due
group A to
or the increased
B, which risk of mild
can cause fetal hemolytic
blood cellsdisease
enter
at birth
used by or have mild anemia,
Staphylococcus aureus and may develop
bacteremia neonatal jaundice
and associated exotoxinthat typically
release, responds
typically to phototherapy.
presents with fever, hypotension, tachycar
fluid replacement and antibiotic therapy with clindamycin plus vancomycin.
se (PID)
rus (HSV)typically presents
infections with abnormal
can present vaginalsymptoms
with systemic bleeding and(e.g.pelvic
fever,pain.
malaise) and a cluster of painful ulcers with associated te
urination and a sterile pyuria. Primary HSV is managed with antivirals (e.g. acyclovir, valacyclovir), which decrease symptom se
ateduntreated
with in womenasymptomatic
with active genital herpes lesions
bacteriuria. The mostat delivery
commontopathogen
reduce the risk for neonatal
is Escherichia herpes simplex
coli. First-line virus
antibiotics infection.
include cephalexin
ransmission of HCV infection is ~2%-5%. All patients with chronic hepatitis C infection, including pregnant women, should be im
mmune.
s required for all pregnant patients with syphilis to prevent fetal complications. Patients with penicillin allergy should receive skin
est with
nts is positive,
a gray, patients
malodorousare desensitized
discharge; notoassociated
penicillin prior to receiving
vulvovaginal treatment with
inflammation; and intramuscular
epithelial cellspenicillin G benzathine.
coated with bacteria (i.e. cl
ginosis
common is with
causemetronidazole or clindamycin,
of vaginitis and regardless
typically presents with aofmalodorous,
pregnancy status.
thin, frothy, yellow-green vaginal discharge with an eleva
e,(AZT)
flagellated ovoid protozoa.
administration, cesarean delivery, and postexposure ART prophylaxis for the infant - can decrease the risk of neonatal H
reduction (< 1,000 copies/mL) may deliver
a common sexually transmitted infection thatvaginally without
presents with AZT.
a thin, malodorous vaginal discharge; cervical friability; and motile, ovoi
heirofsexual
ses acutepartners are
cervicitis treated
are with oral
Chlamydia metronidazole
trachomatis and should
and Neisseria abstain from
gonorrhoeae. sexualwith
Patients activity for findings
clinical a week until treatment
consistent withhas beenc
acute
y) can be gravidarum)
eremesis treated empirically with ceftriaxone
is a common and azithromycin.
cause of metabolic alkalosis, which is characterized by elevated pH with elevated HCO3 an
py may benefit patients with severe migraine headaches (e.g. > 4 times per month, significant impairment). During pregnancy,
, toxicity,
metoprolol).
a potential complication of epidural analgesia, can cause CNS overactivity (e.g. perioral numbness, metallic taste, tinn
ertension is most common in obese women of childbearing age and can present with positional headaches, pulsatile tinnitus, a
by cervical
or lumbar puncture.
surgery (e.g. cold knife conization) are at increased risk for preterm delivery. These patients require a transvaginal c
guide potential preventiveinmeasures
.e. pregnancy implanted (e.g. vaginal
an extrauterine location)progesterone).
can be diagnosed by a persistent rise in β-hCG level following diagnostic d
ethotrexate
incidental short cervix on ultrasound (cervical length <that
(MTX) [Otrexup], a folate (B9) antagonist 2.5inhibits
cm) areDNA synthesisrisk
at increased in rapidly dividing
for preterm cells (e.g.
delivery. trophoblasts).
Patients with an incide
ered vaginal progesterone, which maintains uterine relaxation and decreases the risk of preterm
diagnosed on second-trimester ultrasound revealing a low-lying placenta, myometrial thinning, and numerous placental lacunae labor.
because
due to directthe placenta
placentalisvilli
morbidly
attachmentadherent
to theand attempted
uterine removalPatients
myometrium. can disrupt the placental
typically lacunae,
have difficulty withcausing
placentalprofuse bleeding.
detachment foll
ing due to dense adhesions to the uterine wall. Treatment is with hysterectomy (with the placenta
emature detachment of the placenta from the uterine wall, presents with painful vaginal bleeding, uterine tenderness, contractio left in situ) to prevent life-thre
s include
mucoid tobacco
vaginal or cocaine
bleeding use, hypertension,
(i.e. bloody and abdominal
show), particularly trauma.
during active labor, due to rapid cervical dilation. Patients with increased
normal vitalseparation
premature signs, category
of the Iplacenta
tracing) can fromcontinue
the uterusexpectant management.
prior to fetal delivery and typically presents with abdominal pain, vaginal b
alities
ed, theondiscussion
the fetal heart rate
should tracing.
begin with Uterine overdistension
a nonjudgmental inquiry(e.g.
intotwin
the gestation,
patient’s usesevere polyhydramnios)
of medication, focusing is aonrisk factor.
when, how, and
medication.
rly
ausedthosebythat change (e.g.
compression color,
of the shape),
lateral femoralrequire evaluation
cutaneous nerveandandbiopsy in pregnant
presents with pain andandnonpregnant
paresthesiawomenover the due to the
upper possibi
outer thig
y is typically self-limiting and resolves postpartum.
)changes
can occur in after
pregnancy
vaginal(e.g. joint laxity,
delivery due topelvis
coccyx widening)
displacementcan lead to pelvic
as the girdle pain
fetus passes arising
through theinmaternal
the pubicpelvis
symphysis
duringand/or sac
labor and
eassuranceseparation
premature and analgesics
of the because
placenta the frommajority of cases
the uterine resolve
wall prior spontaneously.
to fetal delivery. Patients typically have acute abdominal pain; a
isk factors include cocaine and tobacco use, which cause placental
nts for substance use requires a nonjudgmental approach that encourages her to be forthcomingvasoconstriction, ischemia, and hemorrhage.
about all substances used. W
on with substances and acknowledging the influence of the peer group are strategies
um hemorrhage is heavy vaginal bleeding occurring > 24 hours after delivery. Common causes include retained for facilitating open discussion and accur
products of con
al site subinvolution.
an common
pregnancies are identified
foodborne infectionondueultrasound with 2 intrauterine
to consumption gestations,
of contaminated food 2(e.g.
placentas, and 2 amniotic
unpasteurized milk, delisacs.
meats) and typically cau
ocytogenes can cause transplacental fetal infection and possible intrauterine fetal demise.
ensin II receptor blockers are teratogens. The use of either medication during pregnancy can cause fetal renal hypoplasia (e.g.
nios. variability on fetal heart rate monitoring typically indicates fetal metabolic acidosis. However, certain medications (e.g. opio
nimal
depression).
presents with irregular vaginal bleeding (e.g. postcoital) and a friable, exophytic cervical mass. Suspicious cervical lesions requi
t up to 6 weeks postpartum with headache and hypertension. Patients with preeclampsia are at increased risk of stroke, and th
CT
t-linescan of the head.
treatment option for migraines during pregnancy. Second- and third-line options include addition of opioids (e.g. acetamin
atory
se is recommendedsecond
drugs (in the for most trimester
pregnant only).
women. However, exercise is contraindicated in patients who are at risk for preterm deliv
g, or have an underlying medical
ex is a neurocutaneous disorder that causes condition thatseizures,
could becharacteristic
exacerbated skinby exercise.
findings (e.g. shagreen patches, periungual fibromas)
dney). Inheritance is autosomal dominant; therefore, males and
ncy includes appropriate weight gain, vitamin and mineral supplementation, avoidance females are equally affected.
of harmful substances, and safe handlin
I should gain 11.4-15.9 kg (25-35 lb) during pregnancy and increase caloric intake by 350 kcal/day in the second trimester and
ght prepregnancy
ypically a self-limitedBMIinflammatory
and inadequate gestational
response caused weight gainpulmonary
by direct are at increased risk of
injury from pregnancy-related
aspirated complications
acidic gastric (e.g. lo
contents. Patients
cealveolar
is common infiltrates
after in the dependent
vaginal delivery due lungtosegments
pelvic floorwithin
musclehours of aspiration.
weakness (resulting in urethral hypermobility) and stretch injury to
morm period (i.e. < 6 weeks after delivery) are managed with observation
of painless autoimmune thyroiditis occurring within 12 months of delivery, and reassurance because
can present with the condition
signs is typically self-lim
of hyperthyroidism (e.g. w
take on a radioactive iodine uptake scan.
y typically presents with signs of progressive neuromuscular inhibition (e.g. areflexia, respiratory depression). Treatment is with
uconatetoxicity
sulfate to reverse neuromuscular
typically have absentparalysis and prevent
patellar reflexes and cardiac arrest.
respiratory depression; toxicity can progress to respiratory paralysis a
sulfate and administration of calcium gluconate.
ing (e.g. postpartum hemorrhage) can cause disseminated intravascular coagulation. This condition typically presents with blee
), thrombocytopenia, and prolonged PT and PTT.
cytopenia typically presents
features increases the risk of with thrombocytopenia
acute and paradoxical
stroke due to endothelial thrombosis
cell damage, (e.g. pulmonary
dysregulation embolus)
of cerebral bloodwithin 5-10 days
flow, cerebral of h
vasos
atients with severe hypertension (i.e. systolic > 160 or diastolic > 110 mm Hg).
monly used in obstetrics for seizure prophylaxis (e.g. in preeclampsia with severe features), is contraindicated in patients with m
sα-fetoprotein
due to the inhibition
(MSAFP) of levels
acetylcholine release.
can identify fetuses with neural tube defects but may be due to other benign causes (e.g. multiple
levated levels require fetal ultrasound.
e intake is a major risk factor for fetal neural tube defects (e.g. anencephaly). Anencephaly is diagnosed by fetal ultrasound, wh
ect, an abnormal cerebellum
hrombocytopenia or brainstem,
are asymptomatic (i.e. noand polyhydramnios.
bruising, bleeding, or anemia) and typically have mildly reduced platelet counts of 1
enia is benign and self-limited and is managed with
er violence (IPV) increases during the postpartum period due to increasedreassurance and observation.
emotional, physical, and financial stressors. Therefor
ease the risk of maternal and infant morbidity.
auses intermittent lower abdominal pain followed by sudden-onset, severe, non-radiating unilateral pain with associated nause
ve-aged
ymptomatic women, particularly
bacteriuria are at those
increasedwith arisk
history of ovarian cysts.
for complications (e.g. pyelonephritis, preterm labor) and require antibiotic treatme
nephritis who do not improve within 48-72 hours of broad-spectrum treatment,
rd of patients do not completely eradicate the bacteriuria with initial intravenousa antibiotic
repeat urine culture
therapy (i.e. test
require of cure)with
evaluation is required
renal u
s with sickle cell disease have an increased incidence of acute vaso-occlusive pain episodes (e.g. abdominal pain) due to incre
egnancy typically presents with fever, maternal and fetal tachycardia, and costovertebral angle tenderness. Due to the high risk
, pretermtypically
egnancy delivery), management
presents with fever,is with inpatient
maternal andadmission and empiric
fetal tachycardia, andintravenous
flank pain orantibiotics (e.g. ceftriaxone).
costovertebral angle tenderness. Due to
nal sepsis, preterm delivery), management is with hospitalization and empiric intravenous antibiotics (e.g. ceftriaxone).
naltobleeding
e. after deliveryisdue
inhibit contractions) to endometrial
indicated in patientsshedding and regeneration.
with preterm labor at < 32 Itweeks
can last up to 6 Indomethacin
gestation. to 8 weeks postpartum.
tocolysis can cause o
arteriosus,
surgery although
(e.g. cesareanits delivery)
benefits typically outweighrisk
are at increased these
for risks.
uterine rupture, which can present with abdominal pain, fetal heart rat
contraction
dition amplitude,
in which the fetal and lossoverlie
vessels of fetalthe station. Management
cervix, making them is prone
with emergency
to tear andlaparotomy and cesarean
bleed with rupture delivery. or contractio
of membranes
ency cesarean delivery because of the high risk of fetal exsanguination and demise.
structural weakness of the cervix that causes spontaneous, painless cervical dilation and potential second-trimester pregnancy
increased vaginal
dition in which fetaldischarge, light vaginal
vessels overlie bleeding,
the cervix, making pelvic
thempressure); on examination,
prone to tear with rupture ofbulging amniotic
membranes or membranes
the onset of may bePatie
labor. see
bleedingprior
icularly andclassical
rapid fetal deterioration
cesarean delivery,or demise.
is a significant risk factor for uterine rupture, which can present with sudden-onset abd
nofirregular
oligohydramnios (amniotic fluid index < 5fetal
abdominal mass (i.e. protruding cm)parts).
at term gestation is spontaneous rupture of membranes. Patients typically hav
uid.
e (e.g. type 1 diabetes mellitus) can cause uteroplacental insufficiency, which typically presents with fetal growth restriction (FG
e fetal
se demise,
causes patients with
vaso-occlusion thatFGR canrequire
result inumbilical
placental artery Doppler
infarction, ultrasound
ischemia, andtosubsequent
assess placental perfusion
uteroplacental and the need
insufficiency. for urg
Uteropla
ement
os. and oligohydramnios
Because it is commonly seen (i.e. amniotic
in Down fluid index <
syndrome 5 cm)
and due to decreased
VACTERL (Vertebral, fetal
Analperfusion.
atresia, Cardiac, Tracheoesophageal fistul
sence of duodenal atresia requires evaluation for other fetal malformations (e.g.
sive amniotic fluid volume (> 24 cm), can occur due to impaired fetal swallowing (e.g. tracheoesophagealventricular septal defects). fistula). Patients with
ons (e.g. preterm prelabor rupture of membranes) due to uterine overdistension and increased intra-amniotic
mnios (i.e. amniotic fluid index > 24 cm) are idiopathic and asymptomatic. Patients at term gestation with mild, asymptomatic pressure. po
um patients, progestin-only contraception methods (e.g. subdermal progestin-releasing implant) are preferred and may be initia
olism risk or affect
preeclampsia (e.g.breastfeeding.
type 1 diabetes mellitus, multiple gestation), a 24-hour urine collection for total protein at the initial prenatal
agement (i.e. delivery timing) if hypertension develops later in pregnancy.
eeclampsia (e.g. multiple gestations) are initiated on low-dose aspirin prophylaxis for preeclampsia prevention.
eeclampsia (e.g. preeclampsia
contraindications: Methylergonovinein prioris pregnancy)
contraindicatedare initiated on low-dose
in hypertensive aspirin
patients, prophylaxis
carboprost during pregnancy
tromethamine for preeclamp
is contraindicated in
ith caution in patients with hypercoagulability.
cause Rh(D) alloimmunization in Rh(D)-negative women due to fetomaternal blood mixing and maternal anti-D antibody produc
munoglobulin
as may occurafter an ectopic
postpartum duepregnancy.
to uterine artery injury, leading to massive blood loss and hemodynamic instability despite minim
g. Hemodynamically unstable
ore likely to degenerate during pregnancypatients withbecause
a suspected retroperitoneal
myometrial blood flowhematoma require
shifts towards theemergency
developinglaparotomy.
fetus and placenta. An i
abdominal pain; uterine tenderness; a palpable, firm, and tender mass; and signs of inflammation
rvals (e.g. < 6-18 months between delivery and next pregnancy) are associated with an increased risk of pregnancy complicatio(e.g. leukocytosis).
of membranes, and
horioamnionitis) is alow birth weight.
complication of preterm prelabor rupture of membranes. Due to the increased risk of maternal morbidity an
therapeutic antibiotics and immediate
relabor rupture of membranes at < 34 weeks delivery, regardless
gestation of gestational
is managed age. with prophylactic latency antibiotics, corticostero
expectantly
estation or sooner
of membranes, if complications
rupture of membranes develop
< 37(e.g.
weeks intra-amniotic infection,
gestation before placental
the onset abruption).
of labor, requires inpatient management due to th
mbilical cord prolapse, and preterm labor.
on, particularly asymptomatic bacteriuria, is a risk factor for preterm prelabor rupture of membranes. Therefore, universal urine
for test
ncy of cure
presents are third
in the recommended in pregnancy.
trimester with hepatic inflammation (e.g. epigastric/right upper quadrant pain, leukocytosis, elevated am
hypoglycemia). Due to high maternal
a rare, life-threatening condition that presents and fetal after
mortality rates, management
anesthetic induction withissudden-onset
immediate delivery.
fever, tachycardia, tachypnea (e.g.
ediate cessation
uding bladder of the anesthetic
distension and administration
and hydronephrosis. of dantrolene.
Significant obstruction can result in an increased risk of fetal morbidity and morta
eput) can cause
for group pulmonary (GBS)
B Streptococcus hypoplasia.
receive intrapartum antibiotic prophylaxis to prevent early-onset neonatal GBS disease
eceive cefazolin.
roup B Streptococcus (GBS) during vaginal delivery causes early-onset neonatal GBS infection (e.g. sepsis, pneumonia). Patien
seiswho delivered a
a weakening ofprior infantalba
the linea withbetween
early-onset GBS infection
the rectus abdominis aremuscles
at high risk
thatfor
cantransmission;
present as atherefore,
nontenderthese patients
abdominal require
bulge in pi
ive with
ncy observation
occurs and reassurance.
due to ureteral compression from uterine enlargement and decreased ureteral peristalsis due to increased progeste
nt
cephalic, breech) is uncertain onpelvises
(right > left) with dilated renal and proximal
digital cervical ureters.aPhysiologic
examination, transabdominalhydronephrosis of pregnancy
ultrasound should requirestono
be performed additional
confirm fetalm
pelvis, is a common cause of labor protraction. Other risk factors include inadequate contractions, maternal obesity, and fetal m
age arrest is managed with operative vaginal delivery (e.g. vacuum-assisted). Other indications for operative vaginal delivery in
nditions in whichinthe
cervical change > 4Valsalva
hours with maneuver is not
adequate recommended.
contractions (> 200 Montevideo units averaged over 10 minutes), or no change in >
is managed by cesarean delivery.
divided into 2 phases: the latent phase (0-6 cm) and the active phase (> 6-10 cm). Normal labor progression in the active phase
rtions
progression
(STIs) inand reassuring
pregnancy canmaternal-fetal
cause obstetric status
and are
fetalmanaged expectantly.
complications (e.g. preterm prelabor rupture of membranes, congenital
the initial prenatal visit, and high-risk patients (e.g. age < 25,
5 contractions/10 min, may cause fetal compromise (e.g. hypoxemia, acidemia) prior STI) require repeat
due toscreening in the
interruption third trimester.
of intervillous blood flow an
. late decelerations). Management is with supportive measures and discontinuation of uterotonic agents (e.g. oxytocin).
oles typically
tracings are present
typicallywith first-trimester
associated vaginal
with severe bleeding,
fetal anemia.uterine sizeagreater
They are than
category gestational
III tracing that age, andan
reflects ultrasound
increasedwith
risk aof'snow
fetal
gentthe
hen cesarean
placenta delivery.
extends over and covers the cervix and is typically diagnosed incidentally on ultrasound. Prior cesarean delive
stent
en thecases are covers
placenta managed thewith
cervixcesarean deliverywith
and presents at 36-37 weeks
painless gestation.
vaginal bleeding after 20 weeks gestation. Blood loss is primarily
ssuring.
ex virus receive antiviral prophylaxis from 36 weeks gestation until delivery to decrease the risk of active lesions at delivery. Pa
delivery
ika to help
syndrome preventhave
typically vertical transmission
severe microcephalyand associated
neonatal infection;
with thinincerebral
contrast,cortices
those with
and no lesions
multiple can undergo
intracranial vaginal deliC
calcifications.
ected Aedes mosquito;
perpigmentation disordertherefore, maternal
that commonly travel
occurs to tropical,
during mosquito-infested
pregnancy, regions
typically presents should
with be avoided.
bilateral, symmetric macules on sun-e
nosed and typically resolves postpartum. It is managed with avoidance of sun exposure
f pregnancy presents in the third trimester with pruritus that is worse on the hands and feet with no associatedand broad-spectrum sunscreen use
rash. Diagnosis
agement
is a severe includes
form ofursodeoxycholic
nausea and vomiting acid and delivery at that
in pregnancy 37 weeks gestation.
typically occurs during the first trimester. A common risk factor is a t
vels.
rs when the fetal buttocks or feet are the closest fetal part to the cervix. A risk factor for breech presentation is uterine leiomyom
al mobility
etal and preventing
heart rate tracings arefetal cephalic engagement.
at increased risk of fetal hypoxia and subsequent fetal acidemia, hypoxic brain injury, and demise. I
nterventions; those who do not improve
ovaries; and third spacing leading to intravascular with initialvolume
management and(e.g.
depletion are hemoconcentration).
remote from delivery Severerequire complications
immediate cesarean
includedelivthro
ches after neuraxial anesthesia (e.g. epidural) occur due to unintentional dural puncture. Patients typically develop a positional
upine)
ommonwithin
after 72 hoursdelivery
vaginal of the procedure andcause
and typically often perineal
have associated nausea,
edema and vomiting,
pain with and neck
urination. stiffness. perineal lacerations (e
Uncomplicated
e.g. nonsteroidal
elease anti-inflammatory
oxygen to the drugs,insitz
tissues. This results baths).
severe fetal hypoxemia, high-output heart failure, hydrops fetalis (e.g. skin edema,
n pregnancy can cause non-immune fetal hydrops, or excessive fluid accumulation in the interstitium (e.g. pericardial or pleural
mptomatic
tions can bein complicated
adults but is by
commonly
twin-twinacquired by respiratory
transfusion syndrome, transmission fromcondition
a potentially fatal young children who typically
that results have a slapped-che
from unbalanced vascular a
bilical cords of each twin.
. epidural) can cause sympathetic block, resulting in maternal hypotension and decreased placental perfusion, as evidenced by
ent is withweakness
tructural left lateralofpatient positioning,
the cervix, causesintravenous fluid bolus,
painless cervical and
dilation, vasopressors
resulting (e.g. phenylephrine).
in second-trimester pregnancy loss. Patients with a
hylactic cerclage performed in the first trimester to decrease the risk of recurrence.
be evaluated for tuberculosis using the same diagnostic approach as nonpregnant patients. A positive tuberculin skin test or inte
o differentiate
se neonatal HIV latent infection
infection risk.versus activepatients
In contrast, disease.with a viral load < 1,000 copies/mL are candidates for vaginal delivery and d
ncreased risk for preterm delivery (i.e. < 37 weeks gestation) due to spontaneous preterm labor and medically indicated deliver
e.g. fetalexists
epancy growth restriction)
when complications.
the fundal height measures larger (or smaller) than expected for gestational age. Gestational diabetes mell
pancy by promoting fetal macrosomia
e. Asherman syndrome) is a complication and/or increased amniotic
of intrauterine surgeriesfluid
suchvolumes (i.e. polyhydramnios).
as hysteroscopic myomectomy or curettage. Due to the
es amenorrhea, infertility, and a negative progesterone withdrawal test.
a diffuse maculopapular rash along the skin-cleavage lines of the trunk (i.e. Christmas tree pattern) that extends to the extrem
es are at increased risk for uteroplacental insufficiency and intrauterine fetal demise. Therefore, these patients undergo routine
ume.
fectionPatients with oligohydramnios,
(i.e. cellulitis) a marker for
can occur after cesarean placental
delivery and insufficiency, require immediate
present with postpartum fever (>delivery.
38 C more than 24 hours after deli
Risk factors include obesity and emergency surgery (e.g. inadequate skin antisepsis or antibiotic prophylaxis).
otentially
nd disease life-threatening
may present postpartum complication
with a postpartum that presents
hemorrhage with a vaginal
and prolonged bleedingmass
time.and possiblePTT
Activated hypovolemic shock or
may be normal due to ma
prolong
e bleedingrupture
premature includesof desmopressin.
membranes diagnosed at < 34 weeks gestation is typically expectant. However, in patients with overt signs
delivery is indicatedhave
us erythematosus to decrease maternal
an increased riskand neonatalcomplications.
of obstetric morbidity. Neonatal lupus can occur due to passive placental transfe
Patients may develop fetal atrioventricular block, which appears
s can occur after a traumatic delivery and presents with radiating suprapubic on fetal heart ratethat
pain tracing as persistent
is exacerbated by bradycardia.
ambulation or weight-b
ive care.
n pregnancy can cause severe fetal anemia due to viral cytotoxicity to fetal erythrocyte precursors. Fetal anemia increases card
ure,occurs
us subsequent
due to hydrops fetalis (vertical)
transplacental (e.g. skintransmission.
edema, ascites), and possible
Ultrasound findingsfetal demise. with congenital cytomegalovirus infection
consistent
intrahepatic
xoplasma calcifications,
gondii can occur and fromfetal growth restriction.
consumption of undercooked or cured meat or contact with cat feces. T. gondii can be vertically
ring pregnancy include inactivated influenza, Tdap, intracranial
c ultrasound findings of bilateral ventriculomegaly, and Rho(D)basal ganglia calcifications,
immunoglobulin. ascites,
The inactivated and growth
seasonal restriction.
influenza vaccine is
administered to all pregnant patients as soon as it becomes available.
g pregnancy
with postcoitalisbleeding,
associated with pretermdischarge,
mucopurulent delivery, preeclampsia, abruptio
and a friable cervix. placentae,
Empiric fetal growth
treatment restriction, and
with azithromycin and ceftriaxone
intrauterine feta
chomatis
mptoms or and Neisseria
light vaginalgonorrhoeae.
bleeding. Findings include a closed cervix, decreasing β-hCG levels, and an ultrasound revealing a non
esent
molewith preeclampsia
are at with severe
risk for gestational features neoplasia.
trophoblastic at < 20 weeks gestation. of
Management The preeclampsia
hydatidiform resolves
mole after treatment
is by suction curettage,offollowed
the hydatid
by
ast 6 months. As pregnancy makes it difficult to determine the significance of a rising β-hCG level, contraception
s a polymicrobial infection characterized by fever > 24 hours postpartum, purulent lochia, and uterine tenderness. The antibiotic is required dur
d-spectrum
of gestational coverage.
trophoblastic disease, can present with theca lutein cysts, bilateral multiloculated ovarian cysts that are associat
-hCG
pe levels. Thetrophoblastic
of gestational theca lutein cysts resolve
disease, after treatment
can present of thebleeding,
with vaginal hydatidiform
overtmole when the β-hCG
hyperthyroidism, and level decreases.
a markedly elevated hCG
s filled
mole with
can a heterogeneous,
present multicystic
with pelvic pressure, mass.size larger than expected for gestational age, and an ultrasound showing bilatera
uterine
yheterogeneous
is a complication mass composed ofgravidarum
of hyperemesis cystic spaces.that Management includesdeficiency.
results from thiamine uterine evacuation with suction
Classic presenting curettage.
symptoms include ence
ia.
is a severe, persistent form of nausea and vomiting of pregnancy that results in a weight loss of > 5% of prepregnancy weight,
bor occurs when there is insufficient fetal descent after pushing > 3 hours in nulliparous patients (> 2 hours in multiparous patie
es to cephalopelvic
nability to deliver thedisproportion,
fetal shoulders the most
with common
usual cause
obstetric of secondWarning
maneuvers. stage arrest.
signs include a prolonged first or second stage of
ter it delivers (e.g. turtle sign). Maternal obesity, which predisposes to fetal
ce is a physiologic change of pregnancy due to increased levels of placental somatomammotropin macrosomia, is an important risk factor.
(e.g. human placental lactog
ulin resistance exceeds production and results in maternal hyperglycemia.
ptococcus (GBS) asymptomatic bacteriuria or urinary tract infection in their current pregnancy (regardless of treatment) are hea
mission
ge or wetness to the neonate (i.e. early-onset
may be present in patients neonatal infection).
with either prelaborThese patients
rupture require intrapartum
of membranes GBS prophylaxis
or stress urinary (e.g.Patients
incontinence. penicillin)
wita
yetal
incontinence if no fluid emerges
spine is perpendicular to the longfromaxis
the of
cervix on Valsalva
the uterus, maneuver
is common andgestational
at early nitrazine and fernMost
ages. testing are negative.
fetuses spontaneously con
erm (i.e. > 37 weeks gestation); therefore, preterm transverse lie is managed expectantly.
occur after obstetric trauma (e.g. third- or fourth-degree perineal lacerations), and patients typically have incontinence of flatus
ugh the vagina.
s new-onset Dark red, velvety
hypertension rectal mucosa
plus proteinuria or signsmay
of be seen ondamage
end-organ the posterior
after vaginal
20 weekswall.
gestation. Fetal complications include
rble
gestational age infants due to chronic uteroplacental insufficiency.
patient with hemoperitoneum due to ruptured ectopic pregnancy requires emergency surgical exploration. Diagnosis of a co
gestational
on impedessac at the upperblood
fetal-placental outerflowcorner of the uterine
by occluding fundus. blood vessels. Patients who have umbilical cord compression w
the umbilical
ariable
e an abrupt decelerations)
decrease in arethe
at fetal
risk of fetalrate
heart hypoxemia
to a nadirand requirebyintervention
followed withtomaternal
a rapid return baselinerepositioning and possible
and are not always amnioinfus
associated with c
y due to umbilical cord compression and are common after rupture of membranes.
retention causes an inability to void as well as overflow incontinence due to pudendal nerve injury and bladder atony. Risk facto
onal neuraxial
ost common anesthesia.
cause of a nonreactive nonstress test (e.g. no accelerations). Because a fetal sleep cycle can last as long as 40 m
120 min) to ensure that
so known as chorioamnionitis, fetal activity outside
is a cause ofof sleep
fetal is captured.
tachycardia (baseline heart rate > 160/min). Intra-amniotic infection is caused
nd is associated with prolonged rupture of membranes and
vaginal laceration) is a common cause of postpartum hemorrhage. Therefore, a protracted labor course.
the cervix, vagina, and perineum are
e vaginal delivery.
mniotic twin pregnancy has a single placenta and no intertwin membrane on ultrasound. Monochorionic monoamniotic twin preg
emise; therefore,
ated uterine patients require
leiomyomata can cause inpatient monitoring.
bulk-related Delivery
symptoms typically
(e.g. pelvic occurs by sensation
pressure, 32-34 weeks gestation via
of incomplete cesarean
voiding). delivery
Leiomyoma
date discrepancy
no digital cervical during pregnancy.
examination or intercourse) is recommended. Asymptomatic patients (i.e. no vaginal bleeding) undergo routin
aluate for previa resolution.
y are contraindicated after a classical cesarean delivery or extensive myomectomy due to significant risk of uterine rupture
parotomy
ccurs when anduterine
cesarean
villi delivery.
attach directly to the myometrium, presents with placental adherence and hemorrhage at the time of att
ean delivery, history
h the uterine fundus inverts of dilation
and and curettage,
prolapses and the
through advanced maternal
cervix or vagina age.
after delivery, typically appears as a firm, rounded mass
severe abdominal pain, heavy vaginal bleeding, and a non-palpable
discontinuation of uterotonics (e.g. oxytocin) and immediate manual replacement uterine fundusof on
theabdominal examination.
uterus to prevent exsanguination. Uter
ttempts at manual reduction are unsuccessful.
g is a noninvasive and highly sensitive and specific screening test for fetal aneuploidy. It is performed at > 10 weeks gestation, a
us sampling or amniocentesis.
profile score (e.g.
etal movement 4/10)undergo
should is consistent with fetal
antenatal fetal testing
hypoxia. Prompt
with deliverytest
a nonstress is indicated due to by
(NST) followed theahigh probability
biophysical of fetal
profile or ademise.
contract
l profile should be performed if labor is contraindicated.
niform, shallow decelerations with gradual onset that occur symmetrically with contractions. They nadir at the peak of contractio
rly decelerations are a benign finding caused by fetal head compression, which leads to a physiologic vagal response.
ncy typically
k factor presentsdystocia.
for shoulder with amenorrhea,
Excessivediffuse
traction abdominal
on the headpain,
and and hemodynamic
neck instability.
during a difficult Management
delivery involves
can result in urgent surg
Erb-Duchenne pa
agement involves observation alone because most infants recover arm function spontaneously within
eks gestation, even with no prior preterm labor, significantly increases the risk of preterm labor. Progesterone administration ma a few months.
term labor.
history of cervical surgery (e.g. cold knife conization) are at increased risk for preterm labor. Transvaginal ultrasound measurem
ation
mmended of these patients’
source risk. for infants age < 6 months. However, there are contraindications to breastfeeding that include activ
of nutrition
c breast lesions, current chemotherapy, and active substance use (e.g. cocaine, phencyclidine).
seof vaginal
postpartum hemorrhage
bleeding and a soft is uterine
('boggy') atony. Initial treatment
and enlarged uterus. includes bimanual
Risk factors includeuterine massage
prolonged labor,and uterotonic
induction agents
of labor, (e.g. ox
operative
re usually polymicrobial;
horioamnionitis) treatmentinispatients
typically presents with broad-spectrum
with premature intravenous antibiotics
or prolonged rupture and expedited delivery
of membranes as maternalto decrease neonatala
fever, maternal
aternalemergency,
stetric leukocytosis. is impaction of the fetal anterior shoulder behind the maternal pubic symphysis that results in the inability to d
diabetes mellitus are initiallymaneuver
agement is the McRoberts recommended (i.e. flexion
dietaryofmodification
the patient’sandhips back against
exercise. her modification
If dietary abdomen) and application
fails to produce ofeuglycemia
suprapubic
get increased
with range), then insulin and
maternal or oral antiglycemic
fetal morbidity and medications
mortality. are indicated.
Treatment of eclampsia includes magnesium sulfate for seizure recurr
ivery. cause of new-onset seizures in pregnant patients with hypertension. It is associated with proteinuria and signs of central
mmon
es).
e-threatening complication of severe preeclampsia. It is caused by increased systemic vascular resistance, capillary permeabilit
albumin.
ential manifestation of severe preeclampsia. Right upper quadrant pain, hemolytic anemia, elevated liver enzymes, and low pla
ndrome.
sis occurs Thewhenabdominal pain blood
the systolic is duepressure
to liver swelling
is > 160with
mmdistension
Hg or the of the hepatic
diastolic (Glisson's)
pressure is > 110capsule.
mm Hg for > 15 minutes. First-lin
e, labetalol, and nifedipine.
vidence of end-organ damage (e.g. severe headache, visual changes, severe transaminitis, elevated creatinine) have preeclam
ed morbidity.
he risk of superimposed
pertension is defined aspreeclampsia,
a systolic blood abruptio
pressure placentae,
> 140 mm fetal
Hggrowth
and/orrestriction,
a diastolic preterm labor, and
blood pressure > 90stillbirth.
mm Hg before 20 weeks
east 4 hours apart.
terine fetal demise (IUFD) evaluation include fetal autopsy, fetal karyotype, placental examination, and maternal laboratory test
shouldsyndrome.
body be suspectedHowever,
when often no etiology
fetal Doppler is found for
sonography IUFD.
fails to detect a fetal heart rate in patients with decreased or absent fetal m
diagnosis.
phylaxis is administered to prevent neonatal group B Streptococcus (GBS) infection in patients with an unknown GBS status and
ure oftomembranes
efers fetal death forat >> 20
18 weeks
hours, gestation
intrapartum andfever,
prior and fetalexpulsion.
to fetal prematurityThe(<etiology
37 weeks cangestation).
be maternal, placental, or fetal in origi
is an autosomal dominant disorder characterized by mutations in type 1 collagen. Type II osteogenesis imperfecta, the most se
dmmon
with intrauterine fetaldelivery
3-5 days after demise.when
Other findings include
colostrum limbby
is replaced deformities, fetal growth
milk. Symptoms restriction,
include and a fullness,
bilateral breast hypoplastic thoracic cavity
tenderness, and
as breastfeeding is established.
yphilis is required at the first prenatal visit to identify patients at risk for transplacental transmission and associated obstetric and
benzathine penicillin G.
pregnancy is associated with increased morbidity and mortality. All pregnant patients should be vaccinated during influenza sea
yfescreening
in every trimester
should beand during breastfeeding.
performed at the first prenatal visit. An Rh (D)-negative woman with a negative antibody screen is unsens
mune globulin. Anti-D immune globulin should be given at 28-32 weeks gestation and again after delivery if the baby is Rh positi
omplication of
omplication of shoulder
massive obstetrical
dystocia causedhemorrhage.
by injuryIschemic pituitary
to the 8th cervicalnecrosis
and 1stmay resultnerves.
thoracic in amenorrhea,
Presentation lactational failure,
can include andpar
hand pe
me.
ations in pregnancy include increased renal blood flow, glomerular filtration rate, and urine protein excretion. These changes re
n and creatinine.
n in
n side
theeffect
third of epiduralofanesthesia.
trimester pregnancy due The tocause of hypotension
postural is blood redistribution
changes, weakened to the lower
abdominal muscles, and extremities
joint/ligamentandlaxity.
venous pooling
Conserva
exercise, heating pads, and massage. Pregnancy-related back pain usually resolves after delivery.
e underweight
egnancy loss plusor do
annot gain an appropriate
unprovoked venous and/oramount of weight
arterial during(e.g.
thrombosis pregnancy
transientareischemic
at increased risk
attack) for have
may fetal growth restriction
antiphospholipid
causes a hypercoagulable state. Management is with chronic anticoagulation.
mmon cause of new-onset
et hypertension seizures
plus proteinuria in asigns
and/or pregnant patient. Additional
of end-organ damage atmanifestations include hypertension,
> 20 weeks gestation. Proteinuria is proteinuria,
best evaluatedheadache
by a u
for total protein (gold standard).
bitis refers to a postoperative or postpartum infected thrombosis of the deep pelvic or ovarian veins. Patients have persistent fe
agulation
es and broad-spectrum
are hormone-mediated (e.g.antibiotics.
increased oxytocin/prolactin levels, decreased estrogen/progesterone levels). Patients with the
are.
41 weeks gestation) and post-term (> 42 weeks gestation) pregnancies are at increased risk for oligohydramnios, a marker for
ey are therefore
striction (FGR) beginsroutinely evaluated
in the for thisand
first trimester andisother
due tomarkers of placental
fetal conditions such insufficiency
as aneuploidy,(e.g.congenital
late decelerations).
anomalies, and intrauter
third trimesters and is due to maternal conditions that cause placental insufficiency (e.g. hypertension).
estriction (FGR) is due to second and third trimester placental insufficiency (e.g. hypertension) that results in a restriction of abd
iction
BS) in head growth.
screening Symmetricculture
is by rectovaginal FGR isperformed
due to congenital
at 36-38disorders or first trimester
weeks gestation. Patientsinfections.
with a positive GBS culture require intrap
nset neonatal GBS infection.
nistering tocolytics outweigh the risks of preterm delivery at > 34 weeks gestation, patients in preterm labor at > 34 weeks gest
anaged
plicatedexpectantly.
preterm prelabor Thoserupture
with contraindications
of membranes atto<vaginal34 weeksdelivery (e.g. are
gestation breech presentation)
managed should
expectantly withundergo cesarean
antibiotics delive
and corticos
ndicated if there
th lethal fetal are signs
anomalies of intra-amniotic
such as anencephaly infection, deteriorating
is to minimize fetal/maternal
maternal morbidity and status, or at 34
mortality. weeks gestation.
Obstetric care is maternally focu
lreatment
benefit isoccurs
not indicated.
when a provider refuses to provide care due to moral conflict. Providers who cannot, in good conscience, prov
refer the patient
ontractions that cause in a timely fashion
cervical change.to another provider
False labor whoirregular
is mild, can. contractions that cause no cervical change and ultimately r
be discharged home with labor precautions.
gular contractions causing cervical dilation and/or effacement at < 37 weeks gestation. Patients in preterm labor at < 32 weeks
duce the risk
dications of neonatal
to vaginal deliveryrespiratory
(e.g. prior distress syndrome)
classical cesareanasdelivery,
well as magnesium sulfate
placenta previa), ECV(forisfetal
not neuroprotection).
performed and patients undergo
imilar structure to antidiuretic hormone, prolonged or excessive oxytocin administration can cause severe hyponatremia, cerebr
s at a cervical dilation of > 6 cm and is defined as no cervical change for > 4 hours with adequate contractions or > 6 hours with
by
) iscesarean
performed delivery.
in patients at risk for uteroplacental insufficiency (e.g. > 41 weeks gestation). Chronic hypoxemia causes an abn
nise;
withinasuch cases, delivery
biophysical is typically
profile (BPP). indicated.
A normal BPP score is 8-10 of 10. Patients with a nonreactive nonstress test result and norm
care.
f decreased fetal movement may be due to fetal hypoxemia or acidemia and is concerning for increased risk of demise. Patient
on of fetal status
ncomplicated with nonstress
pregnancies testing.
are encouraged to perform moderate-intensity exercise for 20-30 minutes on most or all days of the w
should be avoided.
inely evaluated at the initial prenatal visit. Patients without immunity are vaccinated in the immediate postpartum period with the
Postpartum
egnancy andvaccination
most oftenprevents
occurs due future infection
to normal but avoidschanges.
physiologic the theoretical risk progesterone
Increased of congenital rubella.
triggers the sensation of dyspnea
ume. The hyperventilation leads to an expected respiratory alkalosis (decreased
ed by a normal inhibin A level and low MSAFP, estriol, and β-hCG. Open neural tube defects and PaCO2) with metabolic compensation
abdominal and
wall defects sligh
cause
α-fetoprotein is seen in fetal abnormalities such as open neural tube defects, gastroschisis, and omphalocele. It is also elevate
shouldinbe
nancy performed
a patient withto evaluate
edema, the
joint fetalaanatomy.
pain, malar rash, and urinalysis with proteinuria and red blood cell casts is most likely due
itis.
mmonly administered for eclamptic seizure prevention and fetal neuroprotection. All patients on magnesium should be monitored
spiratory
nal deliverysuppression). Because
is the best option for magnesium
management is of
excreted primarily
intrauterine fetal by the kidneys,
demise at > 24 patients with renalThe
weeks gestation. insufficiency arebe
delivery can at delayed
increas
sis;
monly however,
occurs retention of the fetus
after an unsterile for several
and/or incompleteweeks can leadfor
procedure toan
coagulopathy.
elective abortion; it presents with fever, heavy vaginal bleed
csents
abortion
with vaginal bleeding, lower abdominal pain, and a dilated cervixbroad-spectrum
is a medical emergency that requires prompt treatment with without expulsionantibiotics and surgical
of the products evacuation
of conception. of the
Ultraso
ine segment.
RhoGAM) is indicated in unsensitized, Rh-negative women at 28 weeks gestation or within 72 hours of any procedure or inciden
xing.
s to the passage of the products of conception through the cervix at < 20 weeks gestation. The cervix then closes, and the asso
reveals an empty uterus.
sents with heavy vaginal bleeding, cramping, and a dilated cervix without passage of gestational tissue. Surgical management
callymotor
e.g. unstable patients.
vehicle collision) in pregnancy can cause severe maternal bleeding and hemorrhagic shock (e.g. abruptio placentae)
esurgery
replacement of intravascular
(e.g. cesarean delivery) volume,
are at transitioning
increased risk from crystalloid
for uterine to blood
rupture, product resuscitation
a disruption of the uterineas soon
wall as possible.
typically associated wit
abdominal pain, vaginal bleeding, fetal heart rate tracing abnormalities, and loss of
resents with severe abdominal pain, intra-abdominal and/or vaginal bleeding, and an abnormal fetal heart rate tracing (e.g. latefetal station.
alpable fetal partsseparation
mature placental (e.g. an irregular
from the protuberance).
uterine wall that can lead to fetal hypoxia and maternal hemorrhage. Patients typically hav
er uterus. Risk factors
premature separation of the placenta frominclude uterine overdistension,
the uterine hypertension,
decidua prior to abdominal trauma,
fetal delivery. and tobacco
It typically use.with painful vaginal ble
presents
ns. Complications
hen the placenta covers include the maternal hemorrhage,
cervix, creating hypovolemic
the potential shock, antepartum
for massive and disseminatedhemorrhageintravascular coagulation.
from cervical dilation. Labor and
atients; therefore, cesarean delivery is typically performed at 36-37 weeks gestation.
hen the placenta covers the cervix and typically presents with painless vaginal bleeding after 20 weeks gestation. Blood loss is
tracingsisare
gnancy typically due
commonly reactive early inbilateral
to benign, the diseaseovarianprocess.
masses such as luteomas and theca lutein cysts. Patients with virilization d
rved and managed expectantly, as the
station with breech presentation are offered external cephalic symptoms and masses version,
spontaneously regress
a procedure after delivery.
in which the fetus is manually rotated to cep
ure have lower cesarean delivery rates compared with those who are managed expectantly.
ng, lower abdominal pain, and adnexal tenderness is suspicious for an ectopic pregnancy. Diagnosis is made by a positive pre
ng, and sac
tational at an ectopic
abnormalities site, heart
on fetal most commonly
rate tracing.the fallopian
Chronic tube.
hypertension, regardless of blood pressure control, is a risk factor due
regnancy include increases in cardiac output, plasma volume, and tidal volume. A systolic ejection murmur, peripheral edema,
ult trimesters,
rd from theseplacental
changes.hormones create increased maternal insulin resistance and can result in pathologic maternal hyperglyc
routine screening
e effects may be similar for gestational
to pregnancy diabetes
symptomsmellitus.
(e.g. breast tenderness, weight gain, fatigue). Women of childbearing age with
dsyndrome
for pregnancy. (APS) is a prothrombotic autoimmune disorder that can present with recurrent pregnancy losses, arterial or venous
ts with APS require anticoagulation (e.g. low-molecular-weight heparin in pregnant patients) to decrease the risk of complicatio
can present
common and,with hypertension,
if left untreated, can diaphoresis, dilated pupils,
result in impaired and a generalized
maternal-infant bonding andtonic-clonic
increased seizure (due
risk for to hyponatremia).
suicide and/or harming the
ssed for suicidal ideation.
artum period are associated with increased risk for new onset, recurrence, or exacerbation of obsessive-compulsive disorder. O
sears
a highof contaminating
incidence andand harming
is often the baby. Therefore, all women (regardless of prior psychiatric history) require
under-reported.
ession
ate is aScale).
teratogen associated with major congenital malformations, particularly neural tube defects. Patients trying to become p
characterized by anforacute
pharmacotherapy bipolar disorder
onset should be
of delusions, switched to aand
hallucinations, medication with a
disorganized lower risk
behavior of teratogenicity
within the first 2 weeks(e.g.postpartum.
lamotrigine).It is
onsevere insomnia.
in which a nonpsychotic woman presents with signs and symptoms of early pregnancy (e.g. amenorrhea, morning sickness,
ef that she is
similar in pregnant pregnant. and Evaluation
nonpregnant excludes
patientspregnancy,
and includes typically via a negative
intermittent pregnancyshortness
cough, wheezing, test and an ultrasound
of breath, andthat
chestreveals a
tightne
with an
riod. Theinhaled
diagnosis corticosteroid is recommended
is made clinically, and managementfor thoseiswith persistentAmniotic
supportive. asthma fluid
to prevent
embolism maternal and fetal
syndrome complications.
is rare, unpredictable,
mes.
pic implantation of endometrial glands and stroma in the abdominopelvic cavity that can cause pain symptoms based on implan
clic hematuria, dysuria, suprapubic tenderness, and negative urine culture.
rosis can
during develop urgency
gynecologic surgery due incontinence due to loss
to the proximity of the ofureter
corticalto (i.e. upper motor
the ovarian neuron)vessels.
and uterine inhibition of detrusor
Patients contraction.
with unilateral ureteral
l fluid (uroperitoneum),
rsening of diabetic nephropathy, but typically havetonormal
leading voiding, elevated
hypertension, serum creatinine levels,
creatinine, and andfrankurinalysis
proteinuria. duePreeclampsia
to the functioningalso contralat
causes h
findings prior to 20 weeks gestation are usually due to pre-existing nephropathy.
ostoperatively with ureteral obstruction and subsequent hydronephrosis (e.g. nonradiating focal back pain, unilateral costoverte
atment,
resents irreversible
with flank pain renalthatdamage
radiates can to occur.
the groin and hematuria. Ultrasound of the kidneys and ureters is used for diagnosis duri
radiation exposure.
(ASB) is diagnosed when a clean-catch urine culture from an asymptomatic patient grows > 100,000 colony-forming units/mL o
creases the risk ofthe
urinary retention, acute pyelonephritis,
inability to void > 6all patients
hours afterrequire
vaginalurine culture
delivery, mayscreening
have dribblingat the ofinitial
urine prenatal visit andincontinence.
from overflow treatment asUin
nt.
ce is loss ofinurine
s common with increased
pregnancy. abdominal
Most patients with pressure
mild symptoms(e.g. lifting,
respond coughing, laughing).
to nocturnal wrist First-line
splinting, treatment
which holds is with pelvicinfloor
the wrist mu
a neutra
leep. In most
oporosis include cases,advancedsymptoms age, resolve spontaneously
postmenopausal status, after
andchildbirth.
low body weight. Modifiable risk factors include excessive alcohol
osteoporosis,
l shortcuts, patterns incorrectly influencing clinical reasoning) is aaleading
the risk for fragility fracture is highest in those with prior history
causeofoffragility
diagnosticfracture.
errors. Anchoring and confirmatio
impressions and failure to consider alternate diagnoses despite contradictory information.
and intimidation by team leaders can be active (e.g. verbal outbursts) or passive (e.g. condescension) and increases risk of adv
ns effort.
(e.g. simulation,
An example debriefings) reduce error
is forcing function, or hardriskstops
by improving teamorcollaboration,
in a process leader responsiveness,
design (e.g. epidural and psychological
solution bags incompatible saf
with perip
ted, serious
hically news, when
appropriate physicians
only 1should prepare
treatment theispatient
option andreasonable
medically determine how the patient
and has clearly prefers
superiortoevidence-based
receive the information.
support. Patie
ed that cesarean delivery is medically necessary.
uld include an informed consent discussion that anticipates clinical complications that may necessitate a cesarean delivery. This
risks,
when and benefits of
the process and an opportunity
informed consenttois address
influenced theorpatient's
biased byspecific concerns
a provider's and questions.
self-interest. Providers are obligated to inform pa
are that is most likely to yield the greatest benefit to the patient.
ance directive, management of an incapacitated patient is based on the principle of substituted judgment. The surrogate decisio
st judgment
arean of what
delivery in thethe patientofwould
absence haveorwanted.
maternal fetal indications. Providers who are uncomfortable performing cesarean deliveries
obstetric provider.
pacity have the same right to refuse treatment (e.g. emergency cesarean delivery) as nonpregnant patients, even if the decision
aving a son with hemophilia, a silent carrier daughter, an
use in pregnancy. Extended release nifedipine is a well-
atic worsening of pulmonary congestion and pulmonary
. OCs should not be used in patients with hypertension, and
nnel blockers and hydralazine are acceptable alternate
ne disease (e.g. type 1 diabetes mellitus). Patients are
urine with low specific gravity despite normal serum sodium
idiuretic hormone.
oid phase, and an ultimate return to a euthyroid state. It is
ot diagnosed within a year
e at the time pregnancy of childbirth.
is detected, with subsequent dose
ssive postpartum hemorrhage. It typically presents with
h previously irregular menses). Initial evaluation includes a
yroxine-binding globulin, leading to increased total (but not
erandrogenism (e.g. irregular menses, hirsutism) and
across the placenta. Affected infants are irritable,
esolves
s vaginalover a few weeks
discharge). to months.
Symptomatic patients are screened
nts do not require treatment.
e.g. breastfeeding)
flammatory disease.orHowever,
are hemodynamically unstable.
incidental findings of
atients due to estrogen deficiency, which causes vulvovaginal
estrogen.
arian vessel occlusion. Patients with intermittent partial
crosis, which can lead to pelvic pain and profuse, blood-
anagement.
s (e.g. prior hysterectomy) is confirmed by an elevated
e obstetric perineal laceration. Patients typically have
oanal
ect ultrasonography.
sphincter muscle injury and/or denervation, resulting in
ory pelvic floor stability with
-onset, severe unilateral age.
pelvic pain; and adnexal
ars on ultrasound as a thin-walled ovarian cyst with pelvic
ce). However, many patients with POP are asymptomatic
ng from chronic, increased intra-abdominal pressure and
muscle complex. Patients with prolapse of the posterior
tis are treated

women. empirically
Patients with thiswith ceftriaxone
clinical and azithromycin.
presentation require
bloody nipple discharge. The most common underlying
ily administration. It is a safe choice for most women,
treated with progestin therapy (e.g. progestin-releasing
es implantation, and maintains the pregnancy through 10
gesterone supplementation
ms, including to prevent
acute-onset urinary pregnancy
incontinence loss.
due to
ve-aged women with signs of hyperandrogenism (e.g.
ening is required in all women of child-bearing age at routine
er). Therefore, they should be offered psychosocial
oniasis. Postexposure prophylaxis for HIV is individualized
ervation and reassurance.

ents are screened with a 2-hour (75-g) oral glucose tolerance
trauma (e.g. perineal laceration). Concerning findings
omavirus. Cervical cancer can present with postcoital
main at risk for recurrent dysplasia and cancer. Therefore,
cedure.
pressure, constipation). Tamoxifen use is a significant risk
mal internal features (e.g. irregular thickened septations,
plantation. It can be taken up to 120 hours after unprotected
only contraceptives (e.g. levonorgestrel-releasing
ying condition (e.g. endometrial cancer). Patients with
o implantation or growth. Patients are managed with
l bleeding require endometrial evaluation with either
.g. stress, urgency) and to determine optimal treatment (e.g.
presents with a continuous, watery vaginal discharge and
t.e dyspareunia. Patients typically have a palpable, tender
fter pelvic radiotherapy. There is typically continuous,
mation of the surrounding tissue. Patients often exhibit
discharge.
pain, and fibrosis. Indications for treatment include chronic
assurance only.
gnosed incidentally. Indications for treatment include heavy
e only.
osis. Therefore, patients can develop chronic pelvic pain
ntra-amniotic
ercontractilityinfection (chorioamnionitis).
(e.g. crampy lower abdominal pain) and
rostaglandin synthesis.
ondary (pathologic) causes. Clinical features suggestive of a
ms, and abnormal
ercontractility and uterine bleeding.
hypertonicity. This results in the classic
ment is with nonsteroidal anti-inflammatory
papules. Although many cases in children are drugs.
due to
ment for sexual abuse.
tage) caused by scarring and obliteration of endometrial
ge). Patients with Asherman syndrome typically have
(e.g. uterus, ovaries) and minimal to no axillary or pubic
and 18. Chronic tobacco use decreases the normal immune
egion. Treatment
hair, teeth) appearison
with superpotent
sonogram topical corticosteroids.
as complex ovarian cysts
ature cystic teratomas (dermoid cysts) are common causes
(i.e. elevated FSH). POI occurs due to accelerated ovarian
eam is first-linedevelopment
na. Urogenital therapy for symptomatic lesions.embryologic
is from a common
e deepening, male-pattern baldness, increased muscle bulk,
ast, elevated DHEAS and normal testosterone levels are
tosterone levels result in virilization (e.g. clitoromegaly) in
g. bitemporal hair thinning), amenorrhea, and a large pelvic
ant proliferation of these cells (i.e. granulosa cell tumor)
menopausal thickened
h a large ovarian massendometrium).
and postmenopausal bleeding (due
blind vaginal pouch). However, because the ovaries and
ondary sexual characteristics.
pain and sometimes difficulty with defecation. Treatment is
Imaging in women age > 30 includes mammography plus
ipple discharge. elevated FSH, and low estrogen levels. A
dary amenorrhea,
alized) require endocervical sampling (e.g. endocervical
age and high-dose oxytocin. In patients with persistent
eakdown of blood
esions occur clots
due to to achieve
occluded hemostasis.
follicles that cause painful
ordered by white striae (i.e. Wickham striae). Patients often
bleeding) or at high risk for endometrial hyperplasia and
erplasia/cancer.
ation abnormalities (e.g. breast mass). Patients benefit from
excisional biopsy, due to the high risk of concurrent invasive
sus and a new unifocal vulvar lesion (e.g. firm, white plaque)
sing infertility and future pregnancy complications (e.g.
metrial
hesionspolyps are treated
are typically with hysteroscopic
asymptomatic, polypectomy.
and no treatment is
arly among elderly postoperative patients. Patients with
(e.g. clitoromegaly) and signs of estrogen deficiency (e.g.
ion and can be used in patients with contraindications to
te. Patients may experience dyspareunia due to atrophic
h chronic tobacco use. Patients with vulvar cancer often
al hormone therapy. Patients with a uterus require estrogen-
ch).
ease menstrual
y axis. bleeding)
Progesterone in adolescents
normalizes with disabilities.
menstruation by stabilizing
e diabetes mellitus, immunosuppression, and antibiotic use.
re, premenopausal patients with simple-appearing ovarian
nsion, tachycardia, and a diffuse, red, macular rash
n, incontinence, and obstructed voiding. Risk factors include
nterior and posterior vaginal walls. Conservative
n levels prior to ovulation. Microscopic examination of the
ion. It is characterized by a vaginal pH > 4.5, a positive whiff
al patients age < 15 with normal breast and pubic hair
course. Postcoital antibiotic prophylaxis (e.g. nitrofurantoin,
nal pain, amenorrhea, and hematocolpos. Pelvic examination
age < 60 who have undergone menopause within the past
. Patients with amenorrhea and other signs of pregnancy
ained, and details of the visit cannot be shared with others
multiloculated adnexal mass with thick walls and internal
is necessary
er pregnancy to confirm
loss. Prior the diagnosis.
cone biopsy (e.g. cervical
e right
of excisional biopsy. pain in addition to classic PID
upper quadrant
C requires colposcopy, endocervical curettage, and
ons or cervical cancer risk factors (e.g. tobacco use,
sis is based on the presence of 2 of 3 manifestations:
associated with recurrent disease, which can become less
nces.
mphadenopathy. Clinical diagnosis requires confirmation
) or endometrial biopsy. In women who initially undergo a
require
y. an endometrial
Endometrial biopsy.
hyperplasia/cancer is typically due to
rs are related to excessive uterine estrogen exposure; the
sis, cervical
thogens, incompetence,
Chlamydia and preterm
trachomatis delivery.
and Neisseria gonorrhoeae.
sticity due to low estrogen levels. The hypoestrogenic state
es) and
arge frombleeding.
urine leaking (i.e. pooling of clear fluid) into the
r thromboembolism. Patients with these conditions should be
r transvaginal
ay ultrasound
occur. Symptomatic to evaluate
cysts for endometrial
or abscesses are treatedcancer.
with
e cysts can be asymptomatic and found incidentally on
ng. Physical examination reveals a soft, mobile, nontender
duct cysts is with incision and drainage.
and hair on
paroscopy is gross appearance.
required for detorsion of the adnexa and
ervical
in, carcinoma.
wrinkled vulvar skin, often with perianal involvement.
or moisturizers; vaginal estrogen is used for persistent or
multiple urinary symptoms (e.g. dysuria, urgency
or
thenon-improving
best next steporinsevere symptoms.
these patients is an endometrial
ncer resection and staging with inspection of the entire
l epithelium or peritoneum. Ultrasound features suggesting
CA-125 testing has low specificity for initial screening of
hallmark, and patients may present with acute symptoms of
sk factors include nulliparity, obesity, and prolonged
will decrease the risk of breast cancer. Protective lifestyle
ssive chronic pelvic pain; and a boggy, tender,
e is a safe, effective, hormone-free, long-term method of
They commonly cause heavy and prolonged menstrual
olid mass.
r from an irregularly enlarged uterus. The best imaging
Lack of breast mass or lymphadenopathy differentiates this
ry mouth, autoimmune sialadenitis, and keratoconjunctivitis
ase, with
ding and dysmenorrhea
non-Hodgkin lymphoma.
and miscarriage. Examination may
osing uterine
tercourse. fibroids
Pelvic and ovarian
ultrasound pathology.
can confirm the diagnosis by
nd ischemia. It classically presents with acute-onset,
ecyage
laparoscopy.
11-26 but can be given from age 9 to 45. Cervical
y.
g and requires further imaging and possible surgical
mood swings, and irritability. Diagnosis is supported with a
estrogen. Chronically elevated estrone levels disrupt the
l pruritus, and discharge with a normal vaginal pH (3.8-4.5).
tra-abdominal inflammation and pelvic anatomy distortion.
c inflammation, thereby improving symptoms and potentially
s of normal architecture (e.g. loss of labia minora). A vulvar
ladder filling and relieved by voiding. Additional clinical
weeks gestation or with deteriorating maternal or fetal
ncreased liver enzymes. The pathogenesis involves hepatic
ology and strong clinical evidence (e.g. chancre) of primary
ve ulcer with indurated borders. Mild to moderate, painless,
icated when nonsteroidal anti-inflammatory drugs and

ogenism. Patients with PCOS may have infertility due to
y and insufficient secretion of gonadotropin-releasing
e. Concurrent treatment is not indicated if the gonorrhea
s < 1500 IU/L, serum β-hCG should be repeated in 2 days.

alities due to a ovarian
to diminished high riskreserve,
of progression to cervical
characterized cancer.
by regular
mia is the most common cause of physiologic galactorrhea.
nges in the setting of normal mammography is the classic
es virilization of female fetuses, resulting in normal internal
caloric restriction, or chronic illness. Patients are at risk for
ency). The subsequent decreased LH secretion and
ile-subtype granulosa cell tumors typically present with
er support. Patients typically have intermittent loss of urine
he etiology in many couples; semen analysis is the gold
e to high rates of asymptomatic infection that can lead to
nisms.
Serum TSH and FSH levels should be measured in patients
ents appearing phenotypically female. Patients have primary
or
apynowith
axillary and pubicanti-inflammatory
nonsteroidal hair. drugs and/or
ourse. dryness). Ovarian failure is characterized by

vaginal
1) and typically present as nontender, verrucous genital
k factors include age > 60, chronic tobacco use, and
pical cells.with decreased elasticity, and a pale, dry vagina.
lvar skin
gen.
d axillary folds). A common cause is an overgrowth of
es topical
trual cycleazoles
(days (e.g. clotrimazole,
10-14), ketoconazole).
corresponding with the time of
ecretion precipitated by weight loss, stress, or chronic
an indication of infection.
nopausal symptoms. It is characterized by elevated
ries, and signs of insulin resistance. Ovulation can be
erosalpingogram is used to diagnose an anatomic cause of
s include breakthrough bleeding, hypertension, and
esult, women who are breastfeeding exclusively experience
ickening cervical mucus and impairing implantation.
gestational age (EGA). EGA should not be changed based
On physical examination, the uterus is symmetrically
ng test for ovarian cancer in asymptomatic, average-risk
on ultrasound. Aspiration can provide relief to a painful
e.the areola. The majority of patients with mammary Paget
strogen receptors. Hot flashes are the most common side
he abdominopelvic cavity. Implants on the ovary may form
a major risk factor for endometrial hyperplasia because
pposed uterine
e. Indications forestrogen
inpatientexposure.
treatment of PID with parenteral
rregular menses. Patients with PCOS are at increased risk
n is an estrogen agonist in the uterus and increases the risk
ctivity in the bone. It is used to treat osteoporosis in women
It is common in postmenopausal women due to a
al midurethral sling placement.
-line
n and treatment is with
adolescents. nonsteroidal
Emergency anti-inflammatory
contraceptive drugs.
pills (e.g.
CPs but should have their blood pressure monitored. OCPs
uation for endometrial hyperplasia/cancer with an
reast carcinoma. This is an aggressive form of breast cancer
d axillary lymphadenopathy. Treatment includes antibiotic
ding.
-rays
ginal or CT scans
bleeding, that involve
pulmonary ionizing and
symptoms, radiation.
multiple infiltrates
complete blood count, inflammatory markers) is typically
rases with
erases), an AST/ALT
even rationegative
in those with < 1. screening tests at initial
ad to fetal complications, including preterm delivery and
considered
eatitis. safe lipid
A serum for continuation throughout
panel can confirm pregnancy.
hypertriglyceridemia
d may have pneumomediastinum with crepitus or a
fever, right upper quadrant pain, and jaundice (i.e. direct
ng to liver inflammation (e.g. right upper quadrant pain,
ediate
nt right delivery.
upper quadrant and/or epigastric pain from
itis is mainly clinical, but atypical presentations can occur
h acute appendicitis typically have fever, nausea, vomiting,
placement of the appendix by the uterus. This can result in
k of fetal complications, including intrauterine fetal demise,
incompatibility). Patients can develop fever, hypotension,
th a positive direct Coombs test.
the transfusion and administration of intravenous fluids for
ripheral smear reveals large clumps of platelets. Patients do
ard dose is usually adequate at 28 weeks gestation. After
sk of mild
ause fetal hemolytic
blood cellsdisease
entering
of the
the maternal
newborn.circulation.
Affected infants
erapy.
ever, hypotension, tachycardia, and a diffuse, red, macular
ful ulcers with associated tender lymphadenopathy. Some

which decrease symptom severity and duration.
plex virus
tibiotics infection.
include cephalexin, amoxicillin-clavulanate, or
egnant women, should be immunized against hepatitis A and
n allergy should receive skin testing to confirm an IgE-
penicillin G benzathine.
coated with bacteria (i.e. clue cells) on microscopy.
nal discharge with an elevated pH (> 4.5). Wet mount
rease the risk of neonatal HIV infection. Women who
al friability; and motile, ovoid-shaped organisms on
eek
ingsuntil treatment
consistent withhas beencervicitis
acute completed to mucopurulent
(e.g. prevent reinfection.
d pH with elevated HCO3 and a compensatory elevation in
irment). During pregnancy, first-line prevention is with β
mbness, metallic taste, tinnitus) and generalized tonic-clonic
daches, pulsatile tinnitus, and papilledema. Diagnosis is with
nts require a transvaginal cervical length measurement at
level following diagnostic dilation and curettage (D&C).
cells
very.(e.g. trophoblasts).
Patients with an incidental short cervix and no history
bor.
numerous placental lacunae. Patients are at risk of
,hcausing
placentalprofuse bleeding.
detachment following fetal delivery and
fterine
in situ)
tenderness, contractions, andmaternal
to prevent life-threatening hemorrhage.
fetal heart rate tracing
on. Patients with increased bloody show and reassuring
h abdominal pain, vaginal bleeding, high-frequency uterine
nios)
cusing is a
onrisk factor.
when, how, and how often the patient uses both
t women
ia due
over the to the
upper possibility
outer of melanoma.
thigh. Meralgia paresthetica
pubic symphysis
rnal pelvis duringand/or sacroiliac
labor and joints.
delivery. The diagnosis is
ave acute abdominal pain; a rigid, tender uterus; and high-
hemorrhage.
out all substances used. When interviewing adolescents,
open discussion
ude retained and accurate
products reporting.
of conception, postpartum
celisacs.
meats) and typically causes a self-limited gastroenteritis.
fetal renal hypoplasia (e.g. bilateral, underdeveloped fetal
ertain medications (e.g. opioids) can also cause decreased
cious cervical lesions require biopsy, which is typically safe
eased risk of stroke, and those with focal neurologic deficits
on of opioids (e.g. acetaminophen-codeine), antiemetics, and
are at risk for preterm delivery (e.g. cervical insufficiency),
tches, periungual fibromas), and benign tumors of various
ubstances, and safe handling of foods. Patients with a
n the second trimester and 450 kcal/day in the third.
elated complications
c gastric (e.g. low
contents. Patients birth weight,
typically preterm
develop delivery).
acute-onset
mobility) and stretch injury to the pudendal nerve. Patients in
condition is typically self-limited.
s of hyperthyroidism (e.g. weight loss, tremor, elevated T4
pression). Treatment is with cessation of magnesium sulfate
ss to respiratory paralysis and cardiac arrest. Treatment is
typically presents with bleeding and/or thrombosis (e.g.
bolus)
l bloodwithin 5-10 days
flow, cerebral of heparin and
vasospasm, exposure.
vascular microthrombi
indicated in patients with myasthenia gravis because it may
benign causes (e.g. multiple gestation, incorrect dating).
osed by fetal ultrasound, which typically reveals an absent
reduced platelet counts of 100,000-150,000/mm3.
inancial stressors. Therefore, routine postpartum screening
pain with associated nausea and vomiting. Ovarian torsion
d require antibiotic treatment even in the absence of
(i.e. test
quire of cure)with
evaluation is required.
renal ultrasound to assess for a renal
abdominal pain) due to increased metabolic demands and a
erness. Due to the high risk of severe maternal and fetal
. ceftriaxone).
al angle tenderness. Due to the high risk of severe
(e.g. ceftriaxone).
eks
thacinpostpartum.
tocolysis can cause oligohydramnios and premature
dominal pain, fetal heart rate tracing abnormalities,
arean
of delivery. or contractions. Management of a ruptured
membranes
second-trimester pregnancy loss. Patients typically present
tic
or membranes
the onset of may bePatients
labor. seen. with vasa previa may have
sent with sudden-onset abdominal pain, vaginal bleeding,
anes. Patients typically have normal fetal growth and
fetal growth restriction (FGR) and oligohydramnios. Due to
rfusion and the need
ental insufficiency. for urgent delivery.
Uteroplacental insufficiency may present
c, Tracheoesophageal fistula, Esophageal atresia, Renal,
efects).
ageal fistula). Patients with polyhydramnios are at higher
a-amniotic pressure.
with mild, asymptomatic polyhydramnios are expectantly
preferred and may be initiated immediately because they do
rotein at the initial prenatal visit establishes baseline renal
prevention.
ng pregnancy
amine for preeclampsia
is contraindicated prevention.
in patients with asthma, and
rnal anti-D antibody production. Therefore, Rh(D)-negative
mic instability despite minimal abdominal pain and no
cy
inglaparotomy.
fetus and placenta. An infarcted, degenerating uterine
.g. leukocytosis).
sk of pregnancy complications including preterm labor,
isk of maternal morbidity and mortality, patients with intra-
ency antibiotics, corticosteroids, and inpatient monitoring.
tient management due to the risk of placental abruption,
Therefore, universal urine culture screening, timely
n, leukocytosis, elevated aminotransferases) and fulminant
achycardia, tachypnea (e.g. difficulty ventilating), and muscle
of fetal morbidity and mortality because oligohydramnios
eonatal GBS disease. Patients with a penicillin allergy that is
sepsis, pneumonia). Patients with GBS bacteriuria in their
ore, these
ender patients
abdominal require
bulge intrapartum
in pregnant antibiotic prophylaxis.
or postpartum patients.
s due to increased progesterone. Ultrasound findings include
ancy requirestono
e performed additional
confirm fetalmanagement.
presentation and determine the
maternal obesity, and fetal malposition (e.g. occiput
operative vaginal delivery include maternal exhaustion, fetal
minutes), or no change in > 6 hours with inadequate
gression in the active phase is > 1 cm every 2 hours.
of membranes, congenital infection). Therefore, all patients
he third trimester.
of intervillous blood flow and inadequate recovery time
ents (e.g. oxytocin).
and
ts an ultrasound
increasedwith
risk aof'snowstorm' appearance
fetal complications (e.g.and no fetus.
hypoxemia,
ound. Prior cesarean delivery is a major risk factor for
ion. Blood loss is primarily maternal; therefore, initial fetal
ctive lesions at delivery. Patients with active lesions during
ns can undergo
intracranial vaginal delivery.
calcifications. Congenital Zika syndrome can
oided.
ymmetric macules on sun-exposed areas of the face.
ectrum
associatedsunscreen use.
rash. Diagnosis is confirmed by elevated total bile
A common risk factor is a twin gestation due to elevated
entation is uterine leiomyomas, which can distort the uterine
c brain injury, and demise. Initial management is with
re immediate cesarean
e complications includedelivery.
thromboembolism, multiorgan
pically develop a positional headache (i.e. worsens when
ess.
cated perineal lacerations (e.g. no fever or purulence) are
ps fetalis (e.g. skin edema, ascites), and subsequent fetal
m (e.g. pericardial or pleural effusions, ascites). Parvovirus
ypically have a slapped-cheek
from unbalanced facial rash.between the
vascular anastomoses
perfusion, as evidenced by recurrent late fetal heart rate
ne).
gnancy loss. Patients with a history of cervical insufficiency
ve tuberculin skin test or interferon γ release assay should be
es for vaginal delivery and do not require intrapartum
medically indicated deliveries secondary to maternal (e.g.
e. Gestational diabetes mellitus causes a uterine size-
. or curettage. Due to the scarring of the endometrial
my
n) that extends to the extremities, including the palms and
se patients undergo routine fetal monitoring with a nonstress
.ore than 24 hours after delivery) as well as incisional
ophylaxis).
Tpovolemic shock or
may be normal due to massive
prolonged, occult
and bleeding.
platelet count and PT are
, in patients with overt signs of intra-amniotic infection (e.g.
to passive placental transfer of maternal anti-SSA (Ro) and
tent
d by bradycardia.
ambulation or weight-bearing. Treatment is
Fetal anemia increases cardiac output, which can lead to
al cytomegalovirus infection include bilateral periventricular
s. T. gondii can be vertically transmitted, resulting in fetal
and
asonalgrowth restriction.
influenza vaccine is safe during every trimester of
riction, and ceftriaxone

mycin and intrauterineisfetal
useddemise.
to cover the most common
ultrasound revealing a nonviable (e.g. no fetal heartbeat)
fter treatment
ction curettage,offollowed
the hydatidiform mole. levels until levels
by serial β-hCG
ontraception
e tenderness.isThe
required during
antibiotic the surveillance
regimen period.
is clindamycin plus
rian cysts that are associated with ovarian hyperstimulation
Gd level decreases.
a markedly elevated hCG level. Ultrasound findings
ultrasound showing bilateral theca lutein ovarian cysts and
ction curettage.
ng symptoms include encephalopathy, oculomotor
% of prepregnancy weight, electrolyte abnormalities, and
2 hours in multiparous patients). Fetal malposition (e.g. non-
ged first or second stage of labor and retraction of the fetal
tant human
e.g. risk factor.
placental lactogen) production. Gestational
dless of treatment) are heavily colonized with GBS and at
prophylaxis (e.g.Patients
y incontinence. penicillin) and
with do not
these require GBS
symptoms are screening.
likely
ng are negative.
fetuses spontaneously convert to longitudinal lie and
have incontinence of flatus and feces (e.g. a malodorous,
Fetal complications include oligohydramnios and fetal
xploration. Diagnosis of a cornual ectopic pregnancy is made
mbilical cord compression with > 50% of contractions (as
ing always
not and possible amnioinfusion.
associated with contractions. Variable
nd bladder atony. Risk factors include prolonged labor,
cle can last as long as 40 minutes, a nonreactive nonstress
amniotic infection is caused by migration of vaginal or enteric
d perineum are inspected thoroughly after vaginal delivery,
nic monoamniotic twin pregnancies are at risk of cord
ation via
mplete cesarean
voiding). delivery. can cause an irregularly
Leiomyomata
nal bleeding) undergo routine obstetric care and third-
risk of uterine rupture. Laboring patients at high risk of
emorrhage at the time of attempted placental delivery. Risk
ars as a firm, rounded mass protruding through the cervix or
xamination.
revent exsanguination. Uterine relaxants and laparotomy
d at > 10 weeks gestation, and abnormal results are
probability of fetal
hysical profile or ademise.
contraction stress test if the NST is
dir at the peak of contraction and return to baseline at the
gic vagal response.
gement involves
result in urgent surgical
Erb-Duchenne evaluation.
palsy with the characteristic
n a few months.
esterone administration maintains uterine quiescence and
ginal ultrasound measurement of cervical length is the gold
astfeeding that include active untreated tuberculosis,
d uterotonic
nduction agents
of labor, (e.g. oxytocin).
operative vaginal delivery, and fetal weight
ivery to decrease
maternal neonataland
fever, maternal andfetal
maternal morbidity.
tachycardia, uterine
at results in the inability to deliver the shoulders with routine
nd application
fails to produceofeuglycemia
suprapubic (i.e.
pressure.
blood glucose levels are
um sulfate for seizure recurrence prevention, blood pressure
einuria and signs of central nervous system dysfunction (e.g.
stance, capillary permeability, pulmonary capillary hydrostatic
liver enzymes, and low platelet count in a pregnant patient
e.g for > 15 minutes. First-line drugs for blood pressure
d creatinine) have preeclampsia with severe features, which
d90
stillbirth.
mm Hg before 20 weeks gestation during 2 separate
and maternal laboratory testing for fetomaternal hemorrhage
decreased or absent fetal movement. Ultrasound is
n unknown GBS status and the following risk factors for
al, placental, or fetal in origin, but the etiology is most often
esis imperfecta, the most severe form, is associated with
at hypoplastic thoracic cavity.
fullness, tenderness, and warmth, without fever.
nd associated obstetric and fetal complications. Syphilis is
inated during influenza season with the inactivated influenza
e antibody screen is unsensitized (not alloimmunized) and
very if the baby is Rh positive.
a, lactational
tation failure,
can include andparalysis
hand persistent hypotension.
(i.e. ‘claw hand’) and
xcretion. These changes result in a physiologic decrease in
remities andlaxity.
nt/ligament venous pooling from
Conservative sympatheticincludes
management blockade.
k for have
may fetal growth restriction antibody
antiphospholipid and preterm delivery.
syndrome, an
nsion,
uria is proteinuria, headache,
best evaluated andprotein-to-creatinine
by a urine visual changes. ratio or
. Patients have persistent fever unresponsive to antibiotics.
ne levels). Patients with these normal findings are managed
ohydramnios, a marker for placental insufficiency and an
celerations).
tal anomalies, and intrauterine infection. Asymmetric FGR
on).
results in a restriction of abdominal growth that is more
e GBS culture require intrapartum antibiotic prophylaxis to
m labor at > 34 weeks gestation with no contraindications to
uld
withundergo cesarean
antibiotics delivery.
and corticosteroids to promote in utero fetal
eks gestation.
etric care is maternally focused, and typical management of
t, in good conscience, provide treatment that a patient
ical change and ultimately resolve without intervention.
reterm labor at < 32 weeks should receive a tocolytic agent
oprotection).
ormed and patients undergo cesarean delivery at 37 weeks
evere hyponatremia, cerebral edema, and generalized tonic-
ontractions or > 6 hours with inadequate contractions. Active
c hypoxemia causes an abnormal BPP and suggests
nstress test result and normal BPP score receive
ased risk of demise. Patients with decreased fetal movement
on most or all days of the week. Contact sports and
e postpartum period with the live-attenuated mumps-
s the sensation of dyspnea and stimulates central respiratory
bolic
bdominalcompensation and
wall defects slightly
cause an elevated
elevated PaO2.
MSAFP; the rest of
phalocele. It is also elevated in a multiple-gestation
cell casts is most likely due to systemic lupus erythematosus
nesium should be monitored for signs of toxicity (e.g.
insufficiency
The arebe
delivery can at delayed
increased to risk fortime
allow toxicity.
for parental
h fever, heavy vaginal bleeding, purulent discharge, and
nd
ductssurgical evacuation
of conception. of the uterus
Ultrasound (e.g.reveals
typically suctionacurettage).
nonviable
of any procedure or incident in which there is any possibility
ix then closes, and the associated pain and bleeding
sue. Surgical management (e.g. suction curettage) is
ck (e.g. abruptio placentae). Trauma patients with
s soon
wall as possible.
typically associated with contractions. Uterine rupture
heart rate tracing (e.g. late decelerations). Abdominal
hage. Patients typically have abdominal pain, vaginal
use.with painful vaginal bleeding; a firm, tender uterus; and
ents
r coagulation.
cervical dilation. Labor and vaginal delivery are
eks gestation. Blood loss is primarily maternal in origin;
s. Patients with virilization during pregnancy and bilateral
us is manually rotated to cephalic presentation. Patients who
s is made by a positive pregnancy test and a transvaginal
e control, is a risk factor due to underlying maternal
murmur, peripheral edema, and dyspnea are common but
hologic maternal hyperglycemia. All women at 24-28 weeks
men of childbearing age with absence of menses for > 1
y losses, arterial or venous thrombosis, and mild
ease the risk of complications.
due to hyponatremia).
suicide and/or harming the baby. Patients showing signs of
sive-compulsive disorder. Obsessions and compulsions
history) require screening for postpartum depression (e.g.
Patients trying to become pregnant who are taking valproate
genicity (e.g.postpartum.
st 2 weeks lamotrigine).It is typically accompanied by mood
norrhea, morning sickness, abdominal distension, breast
an ultrasound
of breath, andthat reveals
chest a normal,
tightness empty with
that worsen uterus.
physical
and fetal complications.
rome is rare, unpredictable, and associated with poor
symptoms based on implant location. Patients with bladder
detrusor
ents contraction.
with unilateral ureteral laceration develop a large
to the functioning
Preeclampsia also contralateral kidney and
causes hypertension andureter.
proteinuria but
k pain, unilateral costovertebral angle tenderness). Without
rs is used for diagnosis during pregnancy because of this
0 colony-forming units/mL of a single bacteria. Because
atal visit andincontinence.
m overflow treatment asUrethral
indicated.
catheterization is indicated
ment
ch is with
holds pelvicinfloor
the wrist muscle
a neutral (Kegel)
position andexercises.
prevents
s include excessive alcohol intake, sedentary lifestyle, and
. Anchoring and confirmation biases lead to premature
n) and increases risk of adverse events. Teamwork and
ness, and psychological
ags incompatible safety of catheters)
with peripheral junior teamthat
members.
eliminate
eceive the information.

dence-based support. Patients with complete placenta
e a cesarean delivery. This process should include a clear
s are obligated to inform patients of all medically reasonable
ment. The surrogate decision-maker is obligated to base
orming cesarean deliveries on maternal request should refer
atients, even if the decision does not represent the best
Subject QID Error to fix Suggestions
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Surgery 4552 4552 Objective in UWorld seems to be updated now: Rapid hematoma (eg, epidural) expa
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you please Wrap column D as well so can see theDone
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you Highlight the objectives of newly added questions
age Complaints
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Currently Available Questions On UWorld 1 O

Medicine Obstetric Pediatrics PsychiatrySurgery

nstic test is the

e sensitivity and specificity of a test.

ratic liver injury by

in determining prevalence of an outcome, and can serve to

some clinicians to present probabilities regarding outcomes

ment and placebo groups is seen.

and difficult-to-measure confounders.

t does not necessarily imply causality.

nt study, p should be < 0.05. This corresponds to a 95%

are assessed. Case control studies determine the outcome

the cutoff value will increase sensitivity (fewer false

and also and

f secondary hyperparathyroidism in chronic renal failure.

laxis for esophageal

city is a common cause of ALF that may be potentiated by

ve had solid organ transplantation. Many patients also

Urine culture is required to establish the underlying

, compression) as a result of brachial artery cannulation.

tion below the level of the lesion.

ma, corneal opacification, and a mid-dilated pupil. Gonioscopy

nts with diabetic retinopathy.

reased tactile may

such as the distal digits. The resulting digital tissue necrosis

tion and discontinuation

LA-B27 is not specific for AS and not necessary for

ing the patient handoff process.

fore honoring it.

ortant component of the physician-patient relationship.

the most common

ning on chest x-ray. It is a serious condition that requires

Valsalva maneuvers) or loud noises (Tullio phenomenon).

ay progress during pregnancy.

l, posterior to the pectoralis minor muscle. The pectoralis

d associated axillary lymphadenopathy. Management

indicating end-organ hypoperfusion and dysfunction.

t deep, long-standing diabetic wounds are polymicrobial with

creased risk for recurrent

ion of upward eye movement.

may cause referred pain (e.g. to the left shoulder).

neurogenic tumors are (e.g.

ore health care decisions are made.

ssion, alogia, social withdrawal, and diminished interest in

h > 2 major depressive episodes.

an alleviate suffering and improve quality of life.

ideal but not

ality. should include screening for depression by inquiring

siled > 2 antipsychotic

techniques is the preferred

a.ng symptoms for at least 6 months: Restlessness, fatigue,

drvosa, or bulimia nervosa.

mfortable emotional components.

cords within a specified timeframe.

ith cyanosis and

sed density of hair follicles.

s in hoarseness due to finger-shaped growths on the true

mited, and no treatment

ess colon. Risk factors include prenatal exposure to cocaine

gests asplenia or functional hyposplenism.

quent vaso-occlusive crises. It is a relatively safe therapy

he posterior soft palate, palatine pillars, tonsils, and uvula.

sles and should

rwith the goal of is

SoCal's UW Step 2 CK EOs (UTD 10 Nov)

SoCal's UW Step 2 CK EOs (UTD 10 Nov)