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Dr. Rohan Khandelwal
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 MUSCULOSKELETAL SYSTEM

• Arthrocentesis involves aspirating synovial fluid, blood, or pus via a needle

inserted into a joint cavity.

• Arthrocentesis is used to diagnose joint inflammation and infection.

• Electromyography measures electrical potential associated with skeletal

muscle contractions.

• Rotator cuff injuries involve a spectrum of diseases, ranging from acute

reversible tendinitis to massive tears involving the supraspinatus,
infraspinatus, and subscapularis.
• Traction is a technique for realigning a broken bone or dislocated part of the
body using weights, pulleys, and ropes.

• Typical weight for skeletal traction is 25 to 40 lb (11 to 18 kg).

• Buck’s traction is a longitudinal skin traction applied to extremity in one

direction with a single pulley, and keeping the leg in extended position
without hip flexion.
• Hot spots on the cast indicate underlying infection.

• Acute compartment syndrome is a condition in which there is an increased

pressure within a closed osteofascial compartment, resulting in impaired local
circulation.

• The anterior compartment of the leg is the most common location for
compartment syndrome.
• The presentation of acute compartment syndrome is remembered by "The
Five Ps": pain, pulselessness, paresthesia, paralysis, and pallor.

• Osteomyelitis is inflammation and destruction of bone caused by bacteria,

mycobacteria, or fungi.

• Common symptoms of osteomyelitis are localized bone pain and tenderness

along with the constitutional symptoms.
• Amputation is the surgical removal of a part of the body, such as an arm or
leg.

• Following amputation procedure, for the first 24 hours the foot of the bed
should be elevated to reduce edema.

• After 24 to 48 hours postoperatively, patient should be positioned prone to

stretch the muscles and prevent hip flexion contractures.
• The boutonniere deformity describes nonreducible flexion at the proximal
interphalangeal (PIP) joint along with hyperextension of the distal
interphalangeal (DIP) joint of the finger.

• Swan-neck deformity of the finger describes hyperextension at the proximal

interphalangeal (PIP) joint with flexion of the distal interphalangeal (DIP)
joint.
• Osteoarthritis (OA) is a type of degenerative joint disease that results from
breakdown of joint cartilage and underlying bone. The most common
symptoms are joint pain and stiffness.

• Osteoarthritis is characterized by the presence of Heberden’s nodes or

Bouchard’s nodes.

• Heberden’s nodes are hard or bony swellings that develop over the distal
interphalangeal (DIP) joints. These are present in osteoarthritis.
• Gout is a form of inflammatory arthritis caused by monosodium urate
monohydrate crystals deposition in the joints.

• Kyphosis of the dorsal spine is also known as “dowager’s hump”.

• Dual-energy X-ray absorptiometry (DXA or DEXA) is a scan that is used to

determine the density of bone to assess its strength.

• DEXA is a standard method for diagnosing osteoporosis

 NEUROLOGICAL SYSTEM

• Wernicke’s area is responsible for the comprehension of speech.

• Broca’s area is responsible for the production of speech.

• The limbic system is a collection of structures involved in processing emotion

and memory, including the hippocampus, the amygdala, and the
hypothalamus.
• Lumbar puncture refers to the insertion of a spinal needle through the L3–L4
interspace into the lumbar subarachnoid space to obtain CSF.

• Electroencephalography is the graphical recording of the electrical activity of

the superficial layers of the cerebral cortex.
• Caloric testing provides information about the function of the vestibular
portion of cranial nerve VIII and aids in the diagnosis of cerebellar and
brainstem lesions.
• Absent or disconjugate eye movements on caloric testing indicate brainstem
damage.
• Cheyne-Stokes respiration is a form of periodic breathing in which central
apneas and hypopneas alternate with periods of hyperventilation.

• Apneustic respiration is characterized by irregular respirations with pauses

at the end of inspiration and expiration.

• Pinpoint fixed pupils indicate pontine damage.

• Decorticate and decerebrate posturing are abnormal posturing responses

typically to noxious stimuli.

• Decorticate posture is an abnormal posturing in which a person is stiff with

bent arms, clenched fists, and legs held out straight.
• Decerebrate posture is an abnormal body posture that involves the arms and
legs being held straight out, the toes being pointed downward, and the head
and neck being arched backward.

• Babinski reflex refers to the dorsiflexion of the big toe and fanning of the
other toes elicited by firmly stroking the lateral aspect of the sole of the foot.

• Positive Babinski reflex is pathological in anyone older than 2 years and

represents the presence of central nervous system (CNS) disease.

• Loss of the gag reflex indicates dysfunction of cranial nerves IX and X

• Positive Brudzinski’s sign and Kernig’s sign indicate meningeal irritation.

• Brudzinski’s sign refers to an involuntary flexion of the hip and knee when
the neck is passively flexed.

• Kernig’s sign is the loss of the ability of a supine client to straighten the leg
completely when it is fully flexed at the knee and hip.

• The lowest possible Glasgow Coma Scale score is 3 points, which indicates
that a patient is in deep coma or dead.

• The highest possible Glasgow Coma Score is 15 points, which indicates that a
patient is fully awake.
• Late signs of increased intracranial pressure include increased systolic blood
pressure, widened pulse pressure, and slowed heart rate.

• The head of the bed is elevated up to 30 to 40 degrees in patients with

increased ICP.

• Trendelenburg position and flexion of the neck and hips should be avoided
in patients with increased ICP.

• A ventriculoperitoneal shunt diverts cerebrospinal fluid from the ventricles

into the peritoneum.
• A concussion, also known as a mild traumatic brain injury, is a head
injury that temporarily affects brain functioning .

• Contusion is a bruising type of injury to the brain tissue.

• Subarachnoid hemorrhages (SAH) are characterized by bleeding into the

subarachnoid space, often due to a ruptured aneurysm.

• Epidural hematoma is often associated with temporary loss of consciousness,

followed by a lucid period which then rapidly progresses to coma.

• Subdural hematoma forms slowly and results from a venous bleed.

• The halo sign is done to see if drainage from a head injury contains
cerebrospinal fluid.

• Halo sign is elicited by dipping the leaking fluid onto a 4x4 gauze. The blood
should coalesce into the center, leaving a ring if cerebrospinal fluid is
present.

• Extreme hip or neck flexion should be avoided in a patient who underwent

craniotomy.

• Following supratentorial surgery, the head of the bed should be elevated at

30 degrees to promote venous outflow through the jugular veins.
• A flat position without head elevation is prescribed following infratentorial
surgery.

• Brown-Séquard syndrome is a neurologic syndrome resulting from

hemisection of the spinal cord.

• Brown-Séquard syndrome manifests with weakness or paralysis and

proprioceptive deficits on the side of the body ipsilateral to the lesion and
loss of pain and temperature sensation on the contralateral side.

• Conus medullaris syndrome (CMS) results when there is compressive

damage to the spinal cord from T12-L2.
 RENAL AND URINARY SYSTEM

• Kidneys secrete erythropoietin to stimulate the bone marrow to produce red

blood cells.

• Anti-diuretic hormone affects the ability of the kidney to reabsorb water.

• Anti-diuretic hormone (ADH) induces expression of water transport

proteins in the late distal tubule and collecting duct to increase water
reabsorption.
• Secretion of ADH is stimulated by dehydration or high sodium intake and
by a decrease in blood volume.

• Normal arterial pH is 7.35 to 7.45

• Arterioles and venules surrounding proximal convoluted tubules and distal

convoluted tubules are called peritubular capillaries.

• Glomerular filtration rate (GFR) is defined as the volume of plasma that is

filtered by the glomeruli per unit of time.
• Normal GFR is 125 mL/min or 180 L/day.

• Creatinine is a breakdown product of creatine phosphate from muscle and

protein metabolism.

• A midstream or clean-catch urine is required for culture and sensitivity so

that any bacteria present around the urethra and on the hands do not
contaminate the specimen.
• Anuria is a condition when a person passes an insignificant amount of urine
which is less than 100 milliliters in 24 hours.

• Oliguria is defined as a urine output that is less than 400 mL daily in adults.

• Polyuria is defined as the passage of large volumes of dilute urine in excess

of 2L/m2/day.

• Blood urea nitrogen (BUN) levels indicate the extent of renal clearance of
urea nitrogenous waste products.
• Factors such as dehydration, poor renal perfusion, intake of a high-protein
diet, corticosteroid use, and gastrointestinal (GI) bleeding increase BUN
levels.

• Elevated serum creatinine and BUN levels suggest renal dysfunction.

• The creatinine clearance test provides the best estimate of the GFR.

• Acute kidney injury (AKI) is a sudden decrease in kidneyfunction that

develops within 7 days, as evidenced by an increase in serum creatinine or a
decrease in urine output.
• Uremia is defined as elevated concentrations of urea, creatinine, and other
nitrogenous end products of amino acid and protein metabolism in the
blood that are normally excreted in the urine.

• Prerenal AKI occurs due to factors outside the kidney such as reduced
intravascular volume.

• Intrarenal AKI occurs due to damage within the parenchyma of the kidney,
caused by tubular necrosis, prolonged prerenal ischemia, and intrarenal
infection.
• Postrenal AKI occurs due to obstruction between the kidney and urethral
meatus.

• CKD is a slow, progressive, irreversible loss in kidney function, with GFR

less than or equal to 60 mL/minute for 3 months or longer.

• Uremic Syndrome is a systemic clinical and laboratory manifestation of

severe and/or end-stage kidney disease due to the accumulation of
nitrogenous waste products in the blood caused by the kidneys’ inability to
filter out these waste products.
• Hemodialysis is an intermittent renal replacement therapy involving the
process of cleansing the client’s blood.

• Osmosis is the movement of fluids across a semi-permeable membrane from

an area of lower concentration of particles to an area of higher concentration
of particles.

• Diffusion is the movement of particles from an area of higher concentration

to lower concentration.

• Ultrafiltration is the movement of fluid across a semipermeable membrane

as a result of an artificially created pressure gradient.
• Arterial steal syndrome can develop in a client with an internal
arteriovenous fistula.

• Arterial steal syndrome is characterized by diversion of too much blood to

the vein leading to compromise of arterial perfusion to the hand.

• Peritoneal dialysis occurs via the transfer of fluid and solute from the
bloodstream through the peritoneum into the dialysate solution.

• Continuous renal replacement therapy (CRRT) provides continuous

ultrafiltration of extracellular fluid and clearance of urinary toxins over a
period of 8 to 24 hours.
• Continuous renal replacement therapy (CRRT) is used primarily for clients
with AKI or CKD who cannot tolerate hemodialysis.

• Cystitis (urinary tract infection [UTI]) is an inflammation of the bladder due

to an infection, obstruction of the urethra, or other irritants.

• Acute pyelonephritis is a bacterial infection causing inflammation of the

kidneys.

• Hydronephrosis occurs due to the distention of the renal pelvis and calices
caused by an obstruction of normal urine flow.
• Urolithiasis refers to the formation of urinary calculi in the ureter.

• Nephrolithiasis refers to the formation of kidney calculi in the renal

parenchyma.

• Renal colic is a pain that originates in the lumbar region and radiates around
the side and down to the testicles in men and to the bladder in women.

• Ureteral colic is a pain that radiates toward the genitalia and thighs.
• Extracorporeal shock wave lithotripsy is a procedure to break up stones
inside the urinary tract, bile ducts or pancreatic duct with a series of shock
waves generated by a machine called a lithotripter.

• Benign prostatic hypertrophy refers to a slow enlargement of the prostate

gland, with hypertrophy and hyperplasia of normal tissue.
• End-stage renal disease is defined as GFR less than 15 mL/min.

• Oliguria is an initial sign of kidney transplant rejection.

• Hyperacute rejection is usually caused by specific antibodies against the

graft and occurs within minutes or hours after grafting.

• Acute rejection occurs days or weeks after transplantation and can be caused
by specific lymphocytes in the recipient.
• Chronic rejection usually occurs months or years after organ or tissue
transplantation.

• Bruit is a rumbling or swooshing sound of blood flow through a fistula, it

can be heard by auscultation.

• Thrill is a feeling of vibration that can be palpated over the skin just above
the fistula.

• Fistula takes 4-6 weeks for maturation.

• Water-soluble vitamins, certain antibiotics and digoxin should be withheld

before dialysis.
• The dialysis disequilibrium syndrome is defined as a clinical syndrome of
neurologic deterioration that is seen in patients who undergo hemodialysis.

• Dwell time is the amount of time that the dialysate solution remains in the
peritoneal cavity is prescribed and can last for 20 to 30 minutes to 8 or more
hours.

• Dwell time should not be allowed to increase in patients with peritoneal

dialysis as it can cause hyperglycemia.
• If the outflow of drainage suddenly stops, place the patient side to side,
check the level of bag and milk (squeeze) the tube for maintaining the
outflow.

• Goodpasture syndrome is an autoimmune disease that occurs due to the

formation of autoantibodies which attack the glomerular basement
membrane.

• Glomerulonephritis is characterized by immune-mediated damage to the

basement membrane, mesangium, or the capillary endothelium, leading to
hematuria, proteinuria, and azotemia.
• Calcium stones, including calcium oxalate stones and calcium phosphate
stones, are the most common types of kidney stones.

• Staghorn calculi are renal calculi that obtain their characteristic shape by
forming a cast of the renal pelvis and calyces, thereby resembling the horns
of a stag.

• Struvite urinary stones are also known as “infectious stones” and “triple
phosphate” stones.

• Struvite stones are associated with upper urinary tract infection (UTI).
• Alkali ash diet is prescribed to increase the alkalinity of urine which helps in
dissolving uric acid and cystine urinary calculi.

• Alkali ash diet mainly consists of fruits, vegetables, and milk.

• Acid-ash foods consist of meat, fish, and poultry.

• Cauda Equina Syndrome is caused by severe compression of the nerve roots
in the thecal sac of the lumbar spine, most commonly due to an acute lumbar
disc herniation.

• Autonomic dysreflexia develops in individuals with a neurologic level of

spinal cord injury at or above the sixth thoracic vertebral level (T6).

• Autonomic dysreflexia causes an imbalanced reflex sympathetic discharge

leading to potentially life-threatening hypertension.

• Autonomic dysreflexia is commonly caused by visceral distention from a

distended bladder or impacted rectum.
• Spinal shock is a complete but temporary loss of motor, sensory, reflex, and
autonomic function that occurs immediately after injury.

• Seizures are an abnormal, sudden, and excessive discharge of electrical activity

within the brain.

• Epilepsy is a disorder characterized by chronic seizure activity and indicates

brain or CNS irritation.

• Status epilepticus can be defined as 5 minutes or more of continuous clinical

and/or electrographic seizure activity or recurrent seizure activity without
recovery between seizures.
• Partial seizure refers to abnormal neural activity localized to one area of the
cerebral hemisphere and having a discernible focal or localized onset.

• Diazepam is one of the drugs of choice for the first-line management of

status epilepticus.

• Jacksonian march seizure starts with tonic contractions in one hand or face,
which is followed by clonic movements in these parts.

• Ketogenic diet is a specialized high fat, low carbohydrates, and controlled

protein diet which is used for the management of seizures.
• Stroke or cerebrovascular accident (CVA) is a clinical term that describes a
sudden loss of neurologic function persisting for more than 24 hours which is
caused by an interruption of the blood supply to the brain.

• Transient ischemic attack may be a warning sign of an impending stroke.

• Acute ischemic stroke is caused by thrombotic or embolic occlusion of a

cerebral artery and is more common than hemorrhagic stroke.
• A stroke diagnosis using a CT scan is ideal for identifying whether
the stroke is hemorrhagic or ischemic.

• Agnosia is the inability to recognize familiar objects or persons.

• Apraxia is a neurological disorder characterized by the inability to perform

learned (familiar) movements on command, even though the command is
understood and there is a willingness to perform the movement.
• Homonymous hemianopsia refers to loss of half of the field of view on the
same side in both eyes.

• Expressive aphasia occurs due to the damage in Broca’s area of the frontal
brain.

• Receptive aphasia occurs due to the injury to Wernicke’s area of brain.

• In Neglect syndrome, which is seen in the chronic phase of stroke, the client
is unaware of the existence of his paralyzed side.
• Multiple sclerosis is a chronic, progressive, degenerative disease of the CNS
characterized by demyelinization of the neurons.

• Persons with multiple sclerosis often experience an increase in symptoms

of fatigue or weakness when exposed to high temperatures.

• Myasthenia gravis is a neuromuscular disease characterized by considerable

weakness and abnormal fatigue of the voluntary muscles.
• Myasthenic crisis is a complication of myasthenia gravis characterized by
worsening of muscle weakness, resulting in respiratory failure that requires
intubation and mechanical ventilation.

• A cholinergic crisis develops as a result of overstimulation of nicotinic and

muscarinic receptors at the neuromuscular junctions.

• The edrophonium test (Tensilon test) is used for the diagnosis of MG.
• The patient receives 2 mg intravenously (IV) of edrophonium. After each 60
second interval, the patient will receive another 2 mg IV dose until the
symptoms improve.

• Parkinson’s is a degenerative disease caused due to the damage of

dopamine-producing cells in the substantia nigra, which controls movement.

• Parkinson’s is characterized by pill rolling tremors which are tremors in

hands and fingers at rest.

• A patient with Parkinson’s disease should be provided a high-calorie, high-

protein, high-fiber soft diet with small, frequent feedings.
• Trigeminal neuralgia (TN), also known as tic douloureux, is a chronic
pain condition characterized by recurrent brief episodes of electric shock-
like pains, affecting the fifth cranial (trigeminal) nerve.

• Bell’s palsy is a non-progressive neurological disorder of the facial nerve

which is characterized by the sudden onset of facial paralysis that may be
preceded by a slight fever, pain behind the ear on the affected side and
weakness on one side of the face.

• Guillain-Barré syndrome (GBS) is a rare, rapidly progressive disease due

to inflammation of the nerves (polyneuritis) causing muscle weakness,
sometimes progressing to complete paralysis.
• Guillain-Barre syndrome is characterized by a gradual progressive weakness
of the upper extremities and facial muscles.

• The client with Guillain-Barre syndrome is at risk of respiratory

failure because of ascending paralysis.

• Amyotrophic lateral sclerosis (ALS), also known as motor neuron

disease (MND) or Lou Gehrig's disease, is a neurodegenerative disease that
results in the progressive loss of motor neurons motor neurons which
control voluntary muscles.
• Encephalitis refers to the inflammation of the brain parenchyma.

• Leakage of cerebrospinal fluid (CSF) from the ears or nose indicates basilar
skull fracture.

• The most frequent cause of autonomic dysreflexia is a distended bladder.

• Clients with myasthenia gravis are taught to space out activities over the day
to conserve energy and restore muscle strength.

• Atropine sulfate is the antidote for overdose of edrophonium.

• Hemiplegia is paralysis of the muscles of the lower face, arm, and leg on one
side of the body.

• Hemiparesis refers to the loss of strength in the arm, leg, and sometimes face
on one side of the body.

• Tetraplegia is a form of paralysis that affects both arms and both legs.

• Paaplegia is a form of paralysis that affects both legs.

• The American Spinal Injury Association (ASIA) Impairment Scale is a

standardized neurological examination to assess the sensory and motor levels
which are affected by spinal cord injury.
 GASTROINTESTINAL SYSTEM

• Paracentesis is the transabdominal removal of fluid from the peritoneal cavity

• Rapid removal of fluid from the abdominal cavity during paracentesis can
cause shock; therefore, heart rate and blood pressure must be monitored
closely.

• Patient after the liver biopsy should be placed on the right side with a pillow
under the costal margin for 2 hours to decrease the risk of bleeding.

• The urea breath test detects the presence of Helicobacter pylori, the bacteria
that cause peptic ulcer disease
• Liver enzyme levels (alkaline phosphatase [ALP], aspartate
aminotransferase [AST], and alanine aminotransferase [ALT]) are elevated
with liver damage or biliary obstruction.

• Prothrombin time is prolonged with liver damage.

• An increase in cholesterol level indicates pancreatitis or biliary obstruction.

• Increased values for amylase and lipase levels indicate pancreatitis

• The acid reflux is caused by an incompetent lower esophageal sphincter

(LES), pyloric stenosis, or motility disorder.
• Peppermint, chocolate, coffee, fried or fatty foods, carbonated beverages
decrease LES pressure and increases the risk of acid reflux.

• Gastritis is the Inflammation of stomach or gastric mucosa

• Peptic ulcer disease is characterized by discontinuation in the inner lining of

the gastrointestinal (GI) tract because of gastric acid secretion or pepsin.

• Gastric ulcer is characterized by gnawing, sharp pain in or to the left of the

mid-epigastric region which occurs 30 to 60 minutes after a meal.

• Duodenal ulcer is characterized by burning pain which occurs in the mid-

epigastric area 1½ to 3 hours after a meal and during the night.
• In patients with duodenal ulcer, pain is often relieved by the ingestion of
food.

• Esophagojejunostomy or esophagoduodenostomy is a procedure in which

stomach is removed and the esophagus is attached to the jejunum or
duodenum.

• Vagotomy is surgical division of the vagus nerve to eliminate the vagal

impulses that stimulate hydrochloric acid secretion in the stomach.

• The Billroth I operation is a type of reconstruction after a partial gastrectomy

in which the stomach is anastomosed to the duodenum.
• Partial gastrectomy, with the remaining segment anastomosed to the
jejunum; also called Billroth II procedure

• Dumping syndrome includes a group of symptoms such as diarrhea, nausea,

and light-headedness that are caused due to rapid gastric emptying
following gastrectomy.

• Symptoms of early dumping syndrome occur within 30 minutes after a meal,

while symptoms of late dumping syndrome occur 1 to 3 hours after a meal.
• Borborygmi refers to the characteristic growling or rumbling sounds heard
over the stomach and intestines due to the passage of food, fluids, and
gas pass through them.

• A high-protein, high-fat, low-carbohydrate diet is recommended for

preventing dumping syndrome

• Bariatric Surgery includes a surgical reduction of gastric capacity or

absorptive ability to produce long-term weight loss
• A hiatal hernia is also known as esophageal or diaphragmatic hernia

• Bochdalek hernias, also known as congenital diaphragmatic hernia occur

posteriorly due to the defect in the posterior attachment of the diaphragm.

• Acalculous cholecystitis occurs in the absence of gallstones and is caused by

bacterial invasion via the lymphatic or vascular system.

• Acute cholecystitis is characterized by epigastric pain that radiates to the

right shoulder or scapula
• Murphy’s sign is elicited in patients with acute cholecystitis by asking the
patient to take in and hold a deep breath while palpating the right subcostal
area.

• Murphy’s sign is positive if pain occurs on inspiration, when the inflamed

gallbladder comes into contact with the examiner’s hand.

• T-tube placement allows passive decompression and drainage of the biliary

tract

• Steatorrhea is the excretion of an excessive amount of fat in the stool, which

is diagnostic of fat malabsorption.
• The most common cause of portal hypertension is liver cirrhosis

• Normal portal pressure is generally considered to be between 5 and 10 mm

Hg.

• Gastroesophageal variceal hemorrhage is the most lethal complication of

portal hypertension.

• Endoscopic procedures such as sclerotherapy and variceal ligation can be

used to prevent the recurrence of variceal hemorrhage.
• Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a shunt (tube)
placed between the portal vein and the hepatic vein

• TIPS is performed primarily in patients with cirrhosis to relieve portal

hypertension

• Ascites is an accumulation of fluid in the peritoneal cavity due to the venous

congestion of hepatic capillaries
• End-stage hepatic failure characterized by altered level of consciousness and
neuromuscular disturbances; caused by failure of the diseased liver to
detoxify neurotoxic agents such as ammonia.

• Asterixis, also known as hepatic flap or uraemic flap, is an important sign of

metabolic encephalopathy

• Palmar erythema in patients with liver dysfunction refers to reddening of

the skin on the palmar aspect of the hands.
• Spider angioma, also known as spider naevus or spider telangiectasia, is a
vascular lesion characterized by anomalous dilatation of end vasculature
found just beneath the skin surface.

• Hepatorenal syndrome (HRS) is the development of renal failure in

patients with advanced chronic liver disease.

• Asterixis is a coarse tremor characterized by rapid, nonrhythmic extensions

and flexions in the wrist and fingers.
• Sclerotherapy is a procedure that involves the injection of a sclerosing agent
into and around bleeding varices.

• Preicteric Stage of hepatitis is characterized by flu-like symptoms such as

malaise, fatigue and anorexia

• Icteric Stage of hepatitis is characterized by the appearance of jaundice and

associated symptoms such as elevated bilirubin levels, dark or tea-colored
urine, and clay-colored stools.
• The incubation period of the hepatitis B virus ranges from 30 to 180 days

• Hepatitis B Infection is established by the presence of hepatitis B antigen–

antibody systems in the blood.

• If the serological marker (HBsAg) is present after 6 months, it indicates a

carrier state or chronic hepatitis.

• The presence of antibodies to HBsAg (anti-HBs) indicates recovery and

immunity to hepatitis B.
• Hepatitis D occurs with hepatitis B and causes infection only in the presence
of active HBV infection.

• Chronic pancreatitis is a continual inflammation and destruction of the

pancreas, with scar tissue replacing pancreatic tissue.

• Acute pancreatitis is characterized by a sudden onset of a mid-epigastric or

left upper quadrant pain with radiation to the back.

• Cullen’s sign is the discoloration of the abdomen and periumbilical area.

• Turner’s sign is the bluish discoloration of the flanks.

• Both Cullen and Turner’s signs are indicative of pancreatitis.

• Chronic pancreatitis is characterized by Steatorrhea and foul-smelling stools.

• Irritable bowel syndrome is a functional disorder characterized by chronic

or recurrent diarrhea, constipation, and/or abdominal pain and bloating.

• Ulcerative colitis is characterized by Severe diarrhea mixed with blood and

mucus
• Cohn’s disease most often affects the terminal ileum

• Crohn’s disease leads to thickening and scarring, a narrowed lumen,

fistulas, ulcerations, and abscesses.

• Appendicitis is characterized by abdominal pain that is most intense at

McBurney’s point.

• Rupture of inflamed and infected appendix may lead to peritonitis and

sepsis.
• McBurney point lies one-third of the distance laterally on a line drawn from
the umbilicus to the right anterior superior iliac spine.

• Diverticulosis is an outpouching or herniation of the intestinal mucosa

• External hemorrhoids lie below the anal sphincter.

• Internal hemorrhoids lie above the anal sphincter and cannot be seen on
inspection of the perianal area.

• Avoid the application of heat to the abdomen of a client with appendicitis.

Heat can cause rupture of the appendix leading to peritonitis, a life-
threatening condition
• Grayish-blue discoloration at the flank is known as Grey-Turner’s sign
which occurs as a result of leakage of pancreatic enzyme into cutaneous
tissue.

• Hepatitis A is transmitted by the fecal-oral route via contaminated water or

food (improperly cooked shellfish), or infected food handlers.

• Following cholecystectomy, drainage from the T-tube is initially bloody and

then turns greenish.
• The Blumberg sign, or rebound tenderness test is a clinical sign which may
be elicited on physical examination and may be indicative of peritonitis.

• Rovsing’s sign is a clinical finding that is indicative of acute appendicitis

• A positive Rovsing’s sign is characterized by right lower abdominal pain

upon palpation of the left side of the lower abdomen.
• Cholestyramine is a bile acid sequestrant that lowers blood cholesterol level.

• Dietary therapy for malabsorption syndrome includes a high-protein, high-

calorie, low-fat diet to minimize steatorrhea.

• Zollinger-Ellison syndrome (ZES) is caused by a non–beta islet cell, gastrin-

secreting tumor of the pancreas that stimulates the acid-secreting cells of the
stomach.

• String sign is evident in Crohn disease due to the reversible narrowing of

bowel lumen.
• Bowel mucosa shows Cobblestone appearance in Crophn disease

• Ulcerative colitis involves only mucosal and the submucosal layers whereas
Crohn disease has transmural (involving all the layers of bowel)
involvement.

• Crohn disease shows skip lesions.

• The mucosal layer in Crohn disease develops a deep, longitudinal

ulcerations interlaced with intervening normal mucosa.
• Hematemesis, melena, and hematochezia are symptoms of acute
gastrointestinal bleeding

• Melena refers to black stools that occur as a result of gastrointestinal

bleeding. This bleeding typically originates from the upper gastrointestinal
(GI) tract.

• Hematemesis is vomiting of fresh, red blood and indicates bleeding in the

upper GI tract.

• Hematochezia is used to describe passage of bright red or maroon-colored

blood through the rectum and typically indicates a lower tract source.
• Red beefy tongue is an indication of Vitamin B12 deficiency

• The Schilling test is a medical investigation done in patients with vitamin B₁₂
deficiency to determine the absorption of B12 from the intestinal tract.

• Celiac disease, also known as gluten-sensitive enteropathy or non- tropical

sprue, is an immune-mediated disorder of the small intestine in which
individuals are sensitive to gluten, a protein contained in wheat, barley, and
rye.
• A gluten-free rich diet such as wheat, barley, rye should be avoided in
patients with celiac disease.

• A barium enema is a radiographic (X-ray) examination of the lower

gastrointestinal (GI) tract
 ONCOLOGY
• Cancer is characterized by the loss of normal growth-controlling mechanism
of cells due to which the growth of cells is uncontrolled.

• Metastasis is characterized by the detachment of cancer cells from the primary

tumor and their migration through blood to adjacent tissue.

• Hematological cancers originate from blood cell-forming tissues, such as

leukemias, lymphomas, and multiple myeloma.
• Grading and staging are methods used to describe the tumor.

• Curative surgery is done to remove or destroy gross and microscopic tumor.

• Debulking surgery consists of removing a large portion of a locally invasive

tumor, such as advanced ovarian cancer.

• Reconstructive or rehabilitative surgery is performed to improve quality of

life by restoring maximal function and appearance, such as breast
reconstruction after mastectomy.
• Chemotherapy kills or inhibits the reproduction of neoplastic cells and kills
normal cells.
• Chemotherapy doses are individualized according to patient body surface
area (BSA)
• Nadirs is the time during which bone marrow activity and white blood cell
counts are at their lowest.
• Brachytherapy is a cancer treatment in which radioactive material sealed
inside a seed, pellet, wire, or capsule is implanted in the body using a needle
or catheter.
• In Allogeneic bone marrow transplantation, stem cell donor is usually a sibling,
a parent with a similar tissue type, or a person who is not related to the client
(unrelated donor).
• A syngeneic transplant is a special type of allogeneic transplant in which the
donor is an identical twin.
• Leukapheresis is a laboratory procedure in which white blood cells are
separated from a sample of blood.
• Bone marrow harvesting involves collecting stem cells with a needle placed into
the bone marrow.
• Stem cells are administered through the client’s central line in a manner similar
to that for a blood transfusion.
• Stem cells may be administered by IV infusion or by IV push directly into the
central line.
• Engraftment is a process in which transplanted stem cells travel through the
blood to the bone marrow, and starts forming new white blood cells, red blood
cells, and platelets.
• Engraftment usually happens within 2 to 4 weeks after a stem cell transplant.
• Engraftment occurs when the white blood cell (WBC), erythrocyte, and
platelet counts begin to rise.
• Types of Graft are:
o Auto graft: Tissue transplanted from one site to another on the same
patient
o Isograft: Transplant from a genetically identical donor, such as an
identical twin
o Homograft (Allograft): Transplant from individual of same species
o Heterograft (Xenograft): Transplant from another species
• Graft-versus-host disease (GvHD) is a systemic disorder that occurs when
the graft's immune cells recognize the host as foreign and attack the
recipient’s body cells.
• Acute Graft-versus-host disease presents within 100 days of
transplantation.
• Classic chronic GVHD presents after 100 days of transplant.
• Chronic GVHD resembles collagen vascular disorders and systemic sclerosis.
• Leukemias are a group of hematological malignancies involving abnormal
overproduction of leukocytes, usually at an immature stage, in the bone
marrow.
• Hodgkin’s disease is a malignancy of the lymph nodes that originates in a single
lymph node or a chain of nodes.
• Hodgkin’s disease is characterized by the presence of Reed-Sternberg cells in
the nodes.
• Multiple myeloma is characterized by excessive proliferation and improper
function of plasma cells found in the bone marrow.
• The client with multiple myeloma is at risk for of pathological fractures.
• The CRAB criteria consist of end-organ damage with hypercalcaemia, renal
dysfunction, anaemia and bone involvement.
• The CRAB criteria are is usually seen in multiple myeloma (MM).
• Testicular cancer most often occurs between the ages of 15 and 40 years.
• Cervical cancer is caused by infection with due to human papillomavirus
(HPV).
• Long- term use of oral contraceptives increases the risk of breast and cervical
cancer.
• Oral contraceptives (OCPs) were found to protect against ovarian and
endometrial cancers.
• Peau d'orange describes the characteristic appearance of skin overlying a
breast carcinoma.
• Peau d'orange is the edema of the overlying breast skin due to invasion of the
axillary lymphatics by tumour cells.
• A breast fibroadenoma is a painless, unilateral, benign tumor that presents as
a solid lump.
• Breast fibroadenoma commonly occurs in women between the age of 14 to 35
years.
• Fibrocystic breast changes are a common benign (non-cancerous) condition
involving thickening, lumps and cysts in the breast.
• Lymphedema is a chronic disease marked by the increased collection of
lymphatic fluid in the body, causing swelling, which can lead to skin and
tissue changes.
• Patient after the breast reconstructive surgery should be positioned in a
semi-Fowler’s position towards the unaffected side, with the affected arm
elevated above the level of the heart to promote drainage.
• A modified radical mastectomy is a procedure in which the entire breast is
removed, including the skin, areola, nipple, and most axillary lymph nodes,
but the pectoralis major muscle is spared.
• Avoid IVs, injections, blood pressure measurement, and venipunctures in
the arm on the side of the mastectomy.
• Esophageal cancer is a malignancy found in the esophageal mucosa, formed
by squamous cell carcinoma (SCC) or adenocarcinoma.
• Stoma having dark blue, purple, or black appearance indicates
compromised circulation.
• Lung cancers are generally divided into two main categories: small cell
lung cancer (SCLC) and non–small cell lung cancer (NSCLC).
• Small-cell carcinoma is a type of highly malignant cancer that most
commonly arises within the lung.
• Small cell lung cancer (SCLC) is, also known as oat cell lung cancer.
• Tumor lysis syndrome occurs when large quantities of tumor cells are
destroyed rapidly and intracellular components such as potassium and uric
acid are released into the bloodstream.
• The time that the nurse spends in the room of a client with an internal
radiation implant is 30 minutes per 8-hour shift.
• Hodgkin’s disease is a chronic progressive neoplastic disorder of lymphoid
tissue characterized by the painless enlargement of lymph nodes with
progression to the spleen and liver.
• A benign tumor lacks the ability to invade neighboring tissue or
metastasize. Malignant tumor grows in an uncontrolled way and can spread
to other parts of the body through the blood and lymph system.
• Electrosurgery uses electricity to cause thermal destruction of tissue through
dehydration, coagulation, or vaporization.
• Cryosurgery is a treatment that uses extreme cold produced by liquid
nitrogen or argon gas to destroy cancer cells and abnormal tissue.
• Metastatic breast cancer may spread to any part of the body. It most often
spreads to the bones, liver, lungs, and brain.
• Bone, lung, and liver are the most frequent sites of distant prostate cancer
metastases.
• The most common places for cervical cancer to spread are the lymph nodes,
liver, lungs and bones.
• The most common site of metastases for colorectal cancer is the liver.
• Prostate-specific antigen, or PSA, is a protein produced by normal as well as
malignant cells of the prostate gland.
• CA-125 is a protein that may be found in high amounts in the blood of
patients with ovarian cancer.
• Carcinoembryonic antigen (CEA), cancer antigen 125 (CA125) and cancer
antigen 15-3 (CA15-3) are the most widely used serum tumor markers for
breast cancer.
• Anaplasia refers to the cytologic features of cells considered to be characteristic
of malignant neoplasms.
• Retinoblastoma is the most common primary Intraocular malignancy of
childhood.
• Carcinoma in situ of the skin, also called Bowen’s disease, is the accumulation
of dysplastic epidermal cells within the epidermis only, that has failed to
penetrate into the deeper dermis.
• Invasion is the direct extension and penetration by cancer cells into neighboring
tissues.
• Positron emission tomography (PET) is a type of nuclear medicine procedure
that measures metabolic activity of the cells of body tissues.
• Neoadjuvant chemotherapy is used prior to surgical removal of a tumor.
• Adjuvant chemotherapy can be used in addition to the primary or initial
therapy to maximize its effectiveness.
• Tamoxifen is used to treat metastatic breast carcinoma in women and
men.
• An adverse effect specific to vincristine is peripheral neuropathy.
• Daunorubicin can cause cardiotoxicity noted by abnormal
electrocardiographic findings or cardiomyopathy.