1

 6 Questions. Cardiovascular: atrial fibrillation, peripheral artery disease, varicose veins,

heart failure, peripheral edema, coronary artery disease, anticoagulation, hypertension,
infectious endocarditis
o AFIB – Irregular ventricular rhythms and absence of P waves
 S/SX
 Palpitations, tachycardia, fatigue, weakness, dizziness,
lightheadedness, reduced exercise capacity, increased urination, or
mild dyspnea
 Severe: dyspnea at rest, angina, presyncope
 Management
 Acute
 Heart rate control with beta blocker or calcium channel
blocker. May need cardioversion.
 Long term
 Oral anticoagulants using CHA2DS2-VASc scoring.
 Oral anticoagulants recommended: -Males with 2
points or higher & Females with 3 points or higher.
 TX
 Warfarin (Vit K antagonist). First choice for mechanical heart
valve
 DOACs preferred otherwise.
 Target INR with warfarin:
 INR with prosthetic heart valve: 2.5 to 3.5
 INR with atrial fibrillation, or history of stroke: 2.0 to 3.0
 DOACs
 Used for atrial fibrillation, venous thrombus prophylaxis
and venous thrombus treatment. Effects achieved within
hours.
 Contraindicated in bleeding risks, kidney disease,
pregnancy, and prosthetic heart valves.
 Direct thrombin inhibitor (DTI): dabigatran (Pradaxa).
Direct factor Xa inhibitors rivaroxaban (or Xarelto) and
apixaban (or Eliquis).
 Rate control = Oral beta blocker or non-dihyropydrine CCB,
 Beta blockers are choice for patients with acute MI,
Ventricular rate increases with exercise and HF due to
systolic dysfunction.
 Digoxin sometime used.
 Narrow therapeutic index
 0.8-2
 Toxicity symptoms: arrhythmias,
gastrointestinal symptoms, confusion, and
vision changes, such as halos may be
visualized or objects may appear to have a
yellow hue (xanthopsia)

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o Peripheral artery disease – Arteries that supply limbs narrow and reduce blood
flow. Associated with atherosclerosis and stiffness.
 Risk factors:
 Hyperlipidemia, smoking, hypertension, and diabetes.
 Presentation:
 Extremity ulceration.
 Arterial: over toe joints, over the boney prominence of the
malleoli, the anterior shin, or at the base of the heel. -
Venous: malleoli (above the bony prominence) and over
the posterior calf.
 Neuropathic: pressure points of the foot (plantar surface of
the foot over the metatarsal heads and the heel).
 Claudication - pain, cramp or sense of fatigue
(reproducible discomfort of a defined group of muscles that
is caused by exercise and relieved with rest.) - Can occur
with buttock, hip, thigh, calf, foot pain (alone or in
combination).
 Diagnosis:
 ABI (Gold standard)- Ankle brachial index (ABI) is a simple test
that compares the blood pressure in the upper and lower limbs.
 An ABI of ≤0.90 has a high degree of sensitivity and specificity
for a diagnosis of PAD
 Treatment:
 Reducing cardiovascular risk factors, such as smoking cessation,
exercise therapy and a healthy diet.
 Pharmacological therapy, even revascularization may be indicated
in more severe cases.
 Stable claudication: 70 to 80% - Worsening claudication: 10 to
20% - Critical (may lead to limb ischemia): 1 to 2%
o Varicose veins -
o Heart failure – Heart cannot pump blood adequately or only with high filling
pressures. Most common in L ventricle. Classified by ejection fraction. <40% is
reduced EF. 75-50% is WNL.
 Presentation
 Classic symptoms: dyspnea, fatigue, edema.
 Additional symptoms
 exercise intolerance, unintentional weight loss, recurrent
ventricular arrhythmias, hypotension, and signs of
inadequate perfusion.
 Risk factors
 Ischemia or infarction, uncontrolled hypertension, new onset or
uncontrolled atrial fibrillation, excessive tachycardia, pulmonary
embolism, uncontrolled diabetes, thyroid dysfunction, and
substance abuse
 DX: No gold standard, based on supporting data.
 Echo

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 Assess dysfunction and possible causes

 ECG
 Rule out arrythmias, infarction. Normal rules out L HF.
 Natriuretic peptide (BNP)
 can be normal in HF with preserved EF. Used to support
not diagnose. Normal is less than 100.
 Chest radiograph
 Support diagnoses. Identify cardiomegaly, pleural effusion,
and Kerley B lines (Horizontal lines in lung periphery.
Connective tissue is edematous)
 TX:
 Diuretic (usually loop diuretics: furosemide, torsemide, or
bumetanide.), angiotensin blocker and beta blocker (Carvedilol or
metoprolol)
 SA: Diuresis and ototoxicity

o Peripheral edema
o CAD
o HTN – Normal 120/80 or less.
 DX: Ambulatory BP monitoring (ABPM) is gold standard for diagnoses.
*Out of office/home monitoring. Exceptions apply to HTN emergency or
urgency 180/120 or greater OR 160/100 or greater and end organ damage.
 Complications: Stroke, kidney failure, ocular disease, hemorrhage,
ischemia.
 Retinal micro abnormalities:
 Mild: retinal arteriolar narrowing and arteriovenous
nicking, also referred to as “nipping.”
 Moderate: hemorrhages, either flame or dot-shaped, cotton-
wool spots, hard exudates, and micro aneurysms.
 Severe: all previous retinal changes PLUS papilledema
(optic disc edema).
 Treatment – diet, exercise, and limit alcohol. Pharmacological: First line is
ACE inhibitors, ARBS, Calcium channel blockers and thiazide diuretics.
Single drug therapy is unlikely to be successful if a patient’s blood
pressure is more than 20/10 above the goal.
 ACE/ARBS – Cannot be take together. Used in HTN, CKD & HF.
 ACE = -PRILS
 Sides: hypotension, acute kidney injury, hyperkalemia, and
pregnancy complications. Terminate after 6-8 weeks.
Cough, angioedema (Life threatening)
 ARBS = -Sartans
 Like ACE but no cough.
 Contraindicated in pregnancy.
 Calcium channel blockers (Mono or adjunct). Reduction is cardiac
events. Metabolized in P450 have increased metabolized
interaction.

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 Non- dihydropyridines = Verapamil/Diltiazam. Weak

vasodilation and are used more for decreased cardiac
contractility NOT HTN.
 Side effects: Constipation, bradycardia, decreased
cardiac output, gingival hyperplasia.
 Contraindicated with Beta blockers, HF, 2nd/3rd
degree heart blocks.
 Dihydropyridines = -PINES. Potent vasodilation w/
minimal cardiac effects. Used for HTN and chronic stable
angina.
 Side effects: HA, lightheadedness, flushing,
dependent peripheral edema, gingival hyperplasia.
 For peripheral edema (common): Reduce
dose or switch to non- dihydropyridines or
add ACE/ARB. Not add dieuretics
 Thiazides diuretics (Hydrochlorothiazide)
 Contraindicated in SULFA allergies and anuria.
 Caution in elderly, Caucasian patients
(increased risk of skin CA), renal or hepatic
impairment, arrhythmias, diabetes mellitus,
seizure disorders, history of gout, or
pancreatitis.
 Thiazide LIKE diuretics (chlorthalidone,
indapamide). More effective in HTN and reducing
cardiac events than Hydrochlorothiazide.
 Side effects: hypokalemia, hyponatremia,
hypomagnesemia, hyperuricemia, hyperglycemia
and hyperlipidemia. Sleep disturbances and sexual
dysfunction.
 Decrease risk of hypokalemia by
maintaining low sodium diet and
COMBINING with an ACE or ARB. -
Avoid combining HCTZ with a CCB, may
cause acquired neutropenia.
 Alpha 1 = -OSIN. NOT 1st line for HTN. More useful with
HF
 Terazosin – HTN + BPH
 BETA blockers = -LOL. NOT 1st line for HTN. More
useful with HF
 Decrease mortality for patient post MI.
 Labetalol is choice for pregnancy HTN.
 Contraindicated in asthma due to bronchospasms
and decreased bronchodilation. Also, bradycardia.
 DO NOT stop abruptly. Taper off

o Infectious endocarditis – infection of one or more heart valves

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 Risk factors:
 Individuals with heart valve disease, a mechanical heart valve, or a
device such as a pacemaker, immunocompromised patients and
persons who use IV drugs.
 Effects men 2x as often. Elderly at higher risk.
 Presentation:
 Systemic symptoms: fever, sweats or chills, body aches
 Other symptoms
 Janeway lesions - Hemorrhagic macules found on the
palms of the hand and soles of the feet, that are not painful.
 Splinter hemorrhages - thin, red to reddish-brown lines of
blood under the nails.
 Osler nodes - Tender lesions on the finger pads and toe
pads.
 Murmur - Detected in approx. 85% of patients with IE
o
o Dyslipidemia – Abnormality elevated cholesterol or lipids leading to
atherosclerosis cardiac disease.
 TX: 1st line -STATINS (Contraindicated in pregnancy)
 Improves liver’s ability to remove cholesterol from blood.
 Indications – Atherosclerotic cardiac disease calculator for 10-year risk
 Low risk less than 5%. 5-10% moderate risk.High risk 10% or
greater. Severe risk 20% or higher
 DM w/out CVD risk factors– moderate statin therapy
 DM w/ CVD risk factors – High intensity
 LDL greater than 190 – statin. Less than use calc risk. 10%
risk + LDL 100 = statin therapy
 High potency statins = Atorvastatin 40 & rosuvaststin 20
 High risk/ established cardiac disease.
 Moderate = Lova 40, prava 40, simva 20, fluva 40 atorva 10,
rosuva 5.
 Low = Lova 20, prava 10, simva 10 fluva 20
 LDL recheck aft 6-8 weeks of starting or changing. Increase as needed.
Once stable check Q12 months. Promote lifestyle.
 Before starting STATIN
 baseline liver panel/recheck 4-12 weeks.
 TSH – hypothyroidism is potential cause of dyslipidemia.
 Adverse reactions - Myopathy, rhabdomyolysis, acute renal failure,
hepatotoxicity, pancreatitis. STOP and restart once resolved.
o

 6 Questions. Dermatology: psoriasis, tinea corporis, scabies, herpes zoster, dermal cyst,
keloid, tinea capitis, atopic dermatitis, urticaria, melanoma, acne
o Psoriasis – common inflammatory skin disease often on scalp, knees and elbows.

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 Presentation
 Silvery scales, erythematous plaques
 AUSPITZ sign
 Bleeding from peeled plaque
 TX
 Topical corticosteroids
 VITAMIN D analogs (calcitriol, calcipotriene)
o Scabies – mites. Highly contagious.
 Presentation
 Itching and redness
 TX
 Antiparasitic
 Permethrin cream 5%
 ABX, steroid creams and antihistamines to treat symptoms.
o Herpes zoster – often in 50 or older
 Presentation
 Rash of erythemous papules (typically thoracis or lower back)
 Acute neuritis (peripheral nerve inflammation)
 TX
 Antiviral and analgesics
 Ophthalmic form is emergency.
o Dermal cyst – non-cancerous bump under skin. Typically, of head and neck.
 Presentation
 Aymptomatic, pale, flesh or pearly.
 Dome shape, firm, subcutaneous nodule.
 Slow growing
 TX
 Radiology, biopsy
 Depends on location.
 Surgical removal before complications
o Keloid – thick overgrowth of tissue after injury (Scars)
 Presentation
 Thick, ridges or bumpy,
 Flesh colored, Pink, red tender, itchy
 TX
 Often. Not needed
 Corticosteroids, radiation, freezing silicone gels, surgical removal.
o Tinea capitis – Head
 Oral or topical antifungal
o Tinea Corporis -core or trunk – “Ring worm”
 Topical antifungal – “Zoles”
 Tinea confirmed with potassium hydroxide KOH
o Atopic dermatitis - Eczema
 Presentation
 Pruritus, facial, neck
 TX:

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 corticosteroid topical and emollients

o Urticaria – hives – triggered by allergies, env, food, medication etc., infections,
 stimuli
 TX
 Antihistamines
o Melanoma – most severe form of skin cancer
 Presentation
 Macule (no palpable, small), irregular borders w/ varying color
 ABC rule – Asymetric, borders irregular, color, diameter >6mm,
evolves in character
o Acne
 Vulgaris –
 mild, comedonal (clogged pore) without papulopustular
 TX
 Topical retinoid
 tretinoin
 Mild inflammatory with papulopustular
 TX
 Topical retinoid & typical antimicrobial
 Benzoyl or clindamycin
 Moderate to severe acne
 Requires systemic therapy
 TX
 Tetracyclines preferred tx for abx
 Accutane, oral abx, hormone therapy
 Isotretinoin – not with tetracyclines,
monotherapy or pregnancy

 5 Qs. Eye, Ear, Nose, and Throat: visual acuity, cataract, vertigo, diabetic retinopathy,
papilledema, hyperopia, rhinitis, hearing loss, pterygium, ototoxicity, acute sinusitis
o Acute otitis media
 Presentation

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 Otalgia (ear pain), bulging of tympanic membrane, marked

erythema, fever
 DX
 Bulging tempanic membrane
 TX
 Amoxicillin
 Augmentin – if recurrent, recent ABX use or tx failure.
 Bullous myringitis
 Severe case of AOM
 Presents with blisters erythema of tympanic membrane,
hearing loss and fever.
 TX is the same
o Acute otitis externa - “Swimmer’s ear”
 Presentation
 External otalgia (ear pain), discharge, pruritus (itchy skin)
 TX
 polymyxin B-neomycin hydrocortisone suspension drops
 ofloxacin otic drops
 7 days
 NO neomycin, gentamycin, tobramycin (ototoxic) if the tympanic
membrane’s intactness is not able to be confirmed or is visually ruptured.
o Hearing loss
 Outer or middle ear results in conductive hearing loss (Blockage) *sound
cannot pass through.
 Examples: cerumen impaction, foreign object
 Inner ear results in sensorineural hearing loss (damage to nerves, brains
central processing or tiny hair cells).
 Examples of sensioneural hearing loss: Meniere’s disease, acoustic
neuroma, labyrinthitis.
 Weber and Rinne test - Determines type of hearing loss.
 Weber: Tuning fork placed midline forehead.
 With sensorineural hearing loss, sound localizes to
unaffected ear.
 With conductive hearing loss, sound localizes to
affected ear. –
 Rinne test: tuning fork placed behind ear of affected side.
 Normal: Air conduction > bone conduction
 Abnormal: Bone conduction > air conduction
 Sudden hearing lost requires urgent referal
 Presbycusis
 progressive, symmetric hearing loss over years in the elderly
 Concern with loss of cognitive function due to hearing loss.
o
o Conjunctivitis – inflammation of conjunctiva that can be viral or bacterial or
allergic. Is very contagious and spreads through contact.
 Presentation

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 Pruritic (itchy), red eyes w/ discharge

 Purulent discharge (yellow or green) in bacterial
 Itchy with allergic
 Viral prodrome (tearing) w/ viral
 TX
 ABX reserved for bacterial.
 Fluoroquinolones are 1st line with contact lenses ( high risk
for Pseudomonas).
o Subconjunctival hemorrhage
 Bright blood
 Risks factors
 Anticoagulation therapy, trauma, vomiting, HTN, DM
 TX
 Not required, blood reabsorbs in 3 weeks
o Arcus senilis:
 Deposition of cholesterol and neutral fat in the cornea causes arcus senilis.
No tx or vision changes.
o Pinguecula:
 Yellowish raised growth on the conjunctiva, next to the cornea.
o Pterygium:
 Yellow, triangular thickening of the conjunctiva, that extends across the
cornea surface on the nasal side.
 Presents with redness and irritation. Caused by exposure to UV
light.
 TX w artificial tears.
o Hordeolum (stye):
 Acute inflammation of the eyelid, that presents with painful swelling, or a
nodule.
 May be internal (caused by inflammation of the meibomian gland) or
external (eye lash follicle).
 “Hordeolums hurt”
 Tx w/ warm compress and D/c makeup
o Foreign body and/ or corneal abrasion:
 Treatment: - Diagnose with fluorescein dye stain (after topical anesthetic
used).
 Non-contact lens user:
 Erythromycin and sulfacetamide ophthalmic ointment.
 If symptoms have not fully resolved in 1 to 3 days,
refer to an ophthalmologist. –
 Contact lens user:
 Treat with fluoroquinolone to cover against pseudomonas!
- Options include ciprofloxacin and ofloxacin eye drops, or
gentamicin ophthalmic ointment.
 Refer to an ophthalmologist.
 Update tetanus if indicated.

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 If (surface) foreign body is observed, after topical

anesthetic is applied, may be removed with cotton tipped
applicator, or with normal saline irrigation.
o Snellen chart vs Ishihara chart:
 Snellen chart: gold standard for vision screening (standard letter test) that
assesses central distant vision/ visual acuity
 Ishihara chart: screening for color blindness
o Acute angle-closure glaucoma:
 Narrowing of the anterior chamber angle blocks the drainage of the
aqueous humor, leading to increased intraocular pressure.
 Risk factors:
 Family history, age >60 years, female gender, hyperopia,
certain medications such as some anticholinergic agents,
some antihistamines, some diuretics, etc., pseudo
exfoliation
 Symptoms:
 Vision loss, headache, severe eye pain, decreased
peripheral vision and visual acuity, halos appear around
lights, photophobia, nausea, vomiting.
 Treatment:
 If acute angle-closure glaucoma is suspected refer to ER,
requires emergency care by an ophthalmologist.
o Age related macular degeneration (AMD)
 Leading cause of vision loss (specifically central vision loss) in
individuals >50 years of age and most common in individuals 65 years
and older.
 Other symptoms include blurred vision, difficulty with dim
lighting, straight lines appear wavy, seeing spots. –
 Dry AMD: most common type and causes gradual vision loss.
 Wet AMD: less common, however is more severe and progresses more
rapidly.
 May begin unilaterally and evolve to both eyes. –
 Lines may look bent, or wavy. - Amsler grid may appear distorted.
 Treatment:
 Refer to ophthalmologist if AMD is suspected.
 Diagnostic tests used include dilated eye exam and fluorescein
angiography.
 AREDs/ AREDs 2 (Age-Related Eye Disease Studies) formula
o Cataract
 Clouding of normal clear lens of the eye
 Common in aging
 Results in blurry vision
 Outpatient surgery
o Papilledema
 Swelling of optic discs due to increase ICP and swelling of optic nerve

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 Tumors, CNS inflammation, cerebral thrombosis, intracranial

HTN.
 Weight loss and diuretics (cetazolamide)
 Treat underlying cause
 May require surgery
 Can lead to blindness.
o Hyperopia “farsighted” – close objects are blurry
 curved portion of the cornea has a small surface area and is not uniform
and smooth, giving rise to a refractive error
 Tx w/ glasses, contacts or lasik.
 Sx: eye pain, blurry objects, squinting, headaches, eye straining
o diabetic retinopathy
 Micro vessels of eyes (back of eye * retina) are damaged from glucose.
 Can lead to blindness and vision loss
 Eye exams yearly are necessary
o Vertigo - Spinning sensation
 Benign positional paroxysmal vertigo (BPPV)
 Vertigo is a symptom that causes the illusion of movement that is
often worsened with head movement.
 BPPV is the most common cause for peripheral vertigo
 Presentation
 Recurrent, brief (less than 1 min) episodes
provoked by head movement.
 TX
 Epley maneuver: repositions particles/debris of
inner ear
 Central vertigo
 Examples include brainstem ischemia, cerebellar infarction,
multiple sclerosis.
 Presentation
 Severe instability, often unable to walk, or falls.
 Generally, absence of hearing loss or tinnitus
 Neurological symptoms often present
 Treatment: - Refer to ER!
o Acute viral rhinosinusitis (AVRS): (inflammation and running nose)
 Expected to resolve within 10 days and should be managed with
supportive care.
 Treatment:
 OTC analgesics and saline nasal irrigation, intranasal
glucocorticoids (Flonase)
o Acute bacterial rhinosinusitis (ABRS):
 Presentation:
 Onset with high fever, purulent nasal discharge for more than 4
weeks and severe nasal congestion, sinus pressure, facial pain or
syptoms that improve and then worsen again.
 TX

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 Amoxicillin
 If allergy to penicillin treat with doxycycline
 Severe cases may require inpatient IV ABX
o Infectious mononucleosis - Acute illness due to Epstein-Barr virus, mainly
occurring in adolescents and young adults.
 Presentation:
 Fever, pharyngitis, lymphadenopathy (generally the posterior chain
of lymph nodes) and fatigue.
 Splenomegaly can occur (in up to 50% of patients) and rarely
splenic rupture, or airway obstruction due to swelling.
 Diagnosis:
 Monospot (may be falsely negative early in infection).
 Treatment
 Acetaminophen or NSAIDS are first line.
 Corticosteroids are reserved for patients with concern for airway
obstruction.
 Educate 3-4 week minimum of NO contact sports to reduce risk of
splenic rupture.
 Confirm splenomegaly is resolved with US before resuming
sports.
o Bacterial pharyngitis
 Most common bacterial cause is Group A Streptococcus (GAS).
 Presentation:
 Fever, SUDDEN onset of sore throat, tonsillar exudates,
tender lymph nodes.
 Diagnosis:
 Rapid strep test, throat culture
 Treatment: - Penicillin x10 days
 Alternative treatment is amoxicillin, cephalexin, or
azithromycin/ clindamycin if penicillin allergy
o Epiglottitis Inflammation of the epiglottis - Most common bacterial cause is
Group A Streptococcus (GAS).
o Presentation:
 Fever, stridor, drooling, muffled (“hot potato”) voice, respiratory distress,
anxiety.
 Can progress to airway obstruction, therefore managing the airway is most
important.
 Treatment:
 Get emergency airway assistance. - Do not attempt direct
visualization. - Defer plain radiographs. - Keep patient upright and
deliver supplemental oxygen
 5 Qs. Endocrine: diabetes mellitus, hypothyroidism, hyperandrogenism, acromegaly,
hyperthyroidism, myxedema, hyperprolactinemia, polycystic ovarian syndrome
o diabetes mellitus –
 TYPE 1 – Insulin deficient (irreversible)
 TYPE 2 – Insulin resistant (Poor lifestyle)

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 Presentation 3Ps
 Labs
 A1C <5.7= normal: 5.7 – 6.4 = PRE: 6.5 < DM
 DM confirmed A1C targets
 <6 if pregnant
 7 or less in most adults
 8% in elderly
 Fasting glucose <100 normal: 100-125 = PRE: 126 or
greater + symptoms of DM = confirmed.
 Oral glucose test 140-199 = PRE:
 Asymptomatic Need 2 positive labs OR repeated
next day
 TX
 Metformin (sides: diarrhea)
 Contraindicated in kidney disease, liver, metabolic
acidosis, dehydration, sepsis and lactic acidosis.
 Lifestyle mod
 2nd line – insulin
 A1C>9% (GLP1 may be reasonable
alternative)
 - Symptomatic, hyperglycemic and
ketonuria present. (DKA)
 Glucagon -TIDE( good for cardiac)
 -FLOZIN
 -LIPTIN (not for HF)
 -ZONE (Not for HF)
 -IDE (cheap but increased risk for hypo)
o hypothyroidism – increased TSH low T3/T4
 Presentation
 Low and slow
 Fatigue, brady, cold intolerance, weight gain, constipation,
irregual menstral
 Hashimoto goes slow (most common)
 Risk factors, poor dietary intake of iodine or autoimmune
disaease
 TX
 Levothyroxine
 Recheck 4-6 weeks
 Myxedema (severe form)
 Decreased organ function
 Presents
 ALOC, hypothermia, hypotension, brady,
hypoglycemia, hyopventalation
o Hyperthyroidism – decreased TSH, elevated T4/T3
 Presentation
 High and Dry

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 Tremors, tachy, weight loss, heat intolerance

 Graves’ disease is most common form.
 Ophthalmopathy, enlarged nodules and correlating labs
 Thyroid Storm – severe version
 Rare but life-threatening infection is a risk factor
 Tachy, Gi, CNS dysfunction (agitation, psychosis or
coma)
 TX
Anti-thyroid medication (thionimides), radioactive iodine and

surgery
o Hyperandrogenism (Cushings)
 Risk factors
 Corticosteroid use, tumors, adrenal disease
 SX
 Buffalo hump, moon face, hair, decreased fertility, absent periods
 DX
 24 hour urinary cortisol excretion OR late night salivary cortisol
 TX
 Taper off corticosteroids
 ketoconazole, mitotane (Lysodren) and metyrapone (Metopirone
o Hypoandrogenism (addisons disease)
 Causes: automimmune 90%, drug use, malignancy, infection, adrenal
hemorrage or infarction
 TX
 Hydrocortisone, prednisone for increasec cortisol
 Fludrocortison acetate for aldosterone replacement
 SX – Adrenal crisis
 Shock, hypotension, flank/back/low chest pain, N/V, fatigue, fever,
hypoglycemia, vitaliago (loss of skin color or hyperpigment,
confusion, coma

o Acromegaly – Over production of growth hormone. Increased risk of heart
failure, arthritis, DM
 Presentation
 Joint pain, physical deformities, deep voice, enlarged organs.
 DX
 X rays, growth photos, blood tests, MRI/CT for tumors of pituitary
 TX
 Surgical tumor removal
 Radiation therapy
 Octreotide, lanreotide or pasireotide injections (Monthly)
 Pegvisomant injection (daily)
 Cabergoline tablets (poor effectiveness)
o Hyperprolactinemia – elevated prolactin
 Sex organ dysfunctions, gyno, lactation, low muscle mass and low hair
growth (Think steroid rebound)

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 TX
 bromocriptine and cabergoline
o polycystic ovarian syndrome – Enlarged ovaries with small fluid filled sacs
(follicles)
 Presentation
 Irregular periods, excess androgen (male hormones), fluid filles
sacs
 Risk factors
 High insulin, genetic. Increased insulin = more test also
obesity increases risk
 TX
 Clomifen
 Metformin
 Letrozole
 Lifestyle changes

 4 Qs. Gastroenterology: giardiasis, cirrhosis, pancreatitis, abdominal pain, small bowel

obstruction, hepatitis B, enterobiasis, Crohn’s disease, gastroesophageal reflux,
gastroenteritis, pyloric stenosis

 7 Qs. Hematology: anemia, acute lymphocytic leukemia, iron deficiency anemia, pernicious
anemia, lymphatic system, Rh incompatibility, beta thalassemia, sickle cell disease
o Anemia – Decreased RBC, HGB (Part of RBC that deliver 02) or HCT
(percentage of RBC in blood) Characterized by size (MCV) and color (MCH).
o TERMS
 Microcytic: small in size (100)
 Hypochromic: pale in color
 Normochromic: normal in color
 Hyperchromic: excess color
 Serum iron: how much iron is in circulation.
 Serum Ferritin: how much iron is in storage.
 Total iron binding capacity (TIBC): how many iron binding sites are
available for iron to bind to.
 Peripheral smear: a visual description of RBCs
 Pancytopenia: combination of anemia, thrombocytopenia, and neutropenia

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 Bone marrow: produces RBCs consistent in size and shape unless

something is going wrong.
 Reticulocytes: immature RBCs and takes about 3 days to mature.
 Red cell distribution width (RDW): shows how much RBCs vary in size,
in comparison to other RBCs in circulation.
o Iron deficiency anemia
 Microcytic (Small) & hypochromic (pale)
 Causes
 Bleeding (usually GI, GYN), poor dietary intake (less prevalent in
US) or reduced absorption (Celiac disease, bariatric surgery)
 Presentation
 Generally asymptomatic until HGB: HCT decreases to 30:10
 symptoms:
 Fatigue, pica (specifically pagophagia, or pica for ice), headache,
weakness, exertion dyspnea, restless leg syndrome, pallor,
alopecia, dry skin, atrophic glossitis, angular cheilitis or
koilonychia (spoon nails).
 Diagnosis:
 Low ferritin (less than 30ng/ml. However normal levels do not rule
out IDA.
 Treatment:
 Diet: increase red meat, organ meat, peas, whole grains, dark leafy
greens.
 Pharmacotherapy:
 Ferrous fumarate: 325mg of ferrous fumarate consists of
106mg of elemental iron.
 Ferrous sulfate: 325mg of ferrous sulfate consists of 65mg
of elemental iron.
 Dosing usually every other day between 65-130mg
 HGB usually normalized after 6-8 weeks of tx
 Side effects
 GI is common.
o
o Thalassemia -inherited, microcytic, and hypochromic anemia.
 Alpha thalassemia
 Beta thalassemia
 Presentation: Presentation varies greatly.
 Symptoms range from asymptomatic, to severe anemia,
extramedullary hematopoiesis (sites of erythropoiesis develop
outside of the bone marrow), skeletal and growth defects and iron
overload.
 DX:
 Normal serum iron, ferritin, RDW and TIBC (major difference
from IDA, which has low ferritin as confirmation for diagnosis.

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 Peripheral smear: anisocytosis (variation in size), poikilocytosis

(variation in shape) and target cells (RBCs that did not delete it’s
nucleus).
 Diagnostic test is Hgb electrophoresis/ genetic testing (globin gene
testing).
 TX: - Refer to hematology.
 Do NOT supplement with iron (may cause iron overload).
 Consider reproductive counseling.
o B12 (Pernicious anemia) & folate deficiency: macrocytic anemia.
 Vitamin B12 (cobalamin): present in animal derived products. –
 Factors associated with deficiency
 strict vegan diet, breast feed infant from a vitamin B12
deficient mother, or reduced absorption post bariatric
surgery, or those patients with Crohn’s or celiac disease.
 Folate (vitamin B9): present in plant based foots and fortified grains.
 Factors associated with deficiency.
 increased requirements due to pregnancy, decreased intake
(most at risk include patients that overuse alcohol, or in
persons that use goats milk as a main source of food in
infants and children), residence in a place where food
fortified with folate does not occur, patients with decreased
absorption d/t gastric bypass surgery, loss during
hemodialysis (given multivitamin to avoid this from
occurring).
 Presentation:
 Pallor, or yellowing of the skin.
 Neurologic findings more common in vitamin B12 deficiency
 Symmetric paresthesia or numbness and gait problems.
 Treatment:
 Replacement B12 or folate therapy. –
 If anemia is severe of neuro symptoms present parenteral
replacement required
o Sickle cell
 Inherited disorder characterized by presence of HGB S. Mutation of RBCs
making them less soluble. Persistent Vaso occlusion can lead to pain,
ischemia, and infarction (They stick together).
 Presentation
 Not seen at birth and usually takes months to notice.
 HBs rises as fetal HGB (Hb F) declines.
 TX
 Co-manage with hematology.
 Remain current with age appropriate, recommended
vaccinations.
 Increased risk of infection due to abnormal spleen
function)
 Prophylactic penicillin

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 Hydroxyurea for prevention of complication. Takes weeks

or months.
 Reduces pain and need for hospitalization.
 Reduces sickling by increasing fetal HGB
 DX:
 High performance liquid chromatography (HPLC)
 Isoelectric focusing (IEF)
 Gel electrophoresis.
 Polymerase chain reaction (PCR)
 DNA sequencing

o Acute lymphocytic leukemia (ALL)– Cancer of the bone marrow. Proliferation

of abnormal immature lymphocytes.
 Presentation
 Fever, fatigue, bleeding, neurological impairments, enlarged
abdomen, lymphnode swelling, weight loss, pale skin
 DX
 CBC
 Bone marrow aspiration or biopsy
 Lymph node biopsy
 Lumbar puncture
 Imaging
 Ultrasound of lymph nodes
 TX
 Induction (remission induction)
 Vincristine
 Dexamethasone or prednisone
 An anthracycline drug such as doxorubicin (Adriamycin) or
daunorubicin
 Consolidation (intensification) * if remission does NOT occur in
induction phase.
 Chemotherapy
 Maintenance
 Maintenance chemo
 May drugs from induction phase

 3 Qs. Men’s Health: benign prostatic hyperplasia, hydrocele, penile cancer, erectile
dysfunction, prostatitis, testicular torsion, epididymitis

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 5 Qs. Neurology: seizures, meningitis, neutral tube defects, migraine headaches, transient
ischemia, headaches, Parkinson disease, tension headaches
o Seizures
 Focal – single spot of brain
 Can be alert, unconscious or impaired
 Focal-bilateral starts in one spot and spreads to both sides
 Generalized
 Absence
 No motor symptoms. Person just zones out and goes offline
breifly
 Tonic clonic
 Tonic: stiffness and Loss of consciousness
 Clonic: jerking and shaking
 1-3 minutes
 Over 5 min is emergency.
 Tonic
 Muscle and body stiffen up
 Clonic
 Jerking movements only
 Atonic
 Loss of muscle tone “drop seizures”
o Meningitis
 Inflammation of the protective membranes of the brain and spinal cord.
 Can be bacterial, viral, fungal, parasitic, amebic or non infectious
 Presentation
 STIFF NECK, headache, fever
 Confusion, N/V, muscle/joint pain, pale or blotchy
skin, sleepiness, seizure, photophobia, RASH
 Babies
 Refuse to eat, irritable, high pitch
cry, stiff or floppy, unresponsive,
bulging soft spot-on head.
 DX
 Blood work
 Lumbar puncture
 CT scan
 TX
 ABX (ceftriaxone) + Vanco for penicillion sensitivity or
recent abx use. Moxifloxacin for penicillin allergy
 Fluids
 Oxygen
 Steroids to reduce inflammation (dexamethasone)

o Neutral tube defects – Neural tubes that form brain and spine do not close
properly. *Folic acid 400mcg Daily*
 Spina bifida

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 Spine exposed.
 Myelomeningocele
 Fluid sac protrudes from back w/ spinal cord and
nerves inside.
 Nerve damage Effects lower extremities
movement, bowel and urinary abilities
 Surgically closed before birth
 Meningocele
 Fluid sac protrudes w/out spinal cord inside
 Minimal or no nerve damage
 Occulta
 “Silent spina bifida”
 No fluid sac or nerve issues
 Small gap in the spine
 Often not discovered until
later childhood
 Anencephaly
 Birth without parts of brain/skull (often forebrain or cerebrum)
 Most expire shortly after birth
 TX
 Encephalocele
 Sac like protrusion of the skull
 TX is surgical.
 SX
 Loss of strength, small head, delayed growth, vision
problems. Developmental delay, seizures, lack of
coordination
o transient ischemia – (TIA) mini stroke – usually resolves within. Minutes-hours
 Risk factors
 HTN, AFIB, DM, high cholesterol,
 Presentation
 Weakness, vision impairment, slurred speech, dizziness, headache
 DX
 Clinical assessment, CT/MRI, Angiography
 TX
 Antiplatelet medication/blood thinners
 Surgery for blocked arteries (Carotid)
 TIA can be an indicator of future stroke
o Migraine – Recurrent attacks
 4 phases
 Prodrome
 Yawning, euphoria, depression, irritability, cravings, stiff
neck
 Aura
 only 25% experience, usually visual
 Headache

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 Unilateral, throbbing, pulsing, N/V, Photo or phonophobia

 Postdrome
 Exhaustion or euphoria
 DX
 Migraine w/out aura
 5+ attacks for 4-72 hours
 2 symptoms
 At least 1 photo/phonophobia or N/V
 TX
 Simple analgesics
 Triptan
 NSAIDS
 Antiemetics
 Preventative tx
 4 or more monthly
 12+ hours
 Effects life
 Beta blockers, antidepressant, anticonvulsants
o Tension headache – most common.
 Presentation
 bilateral throbbing
 TX
 Simple analgesics
 Caffein
 IV/IM ketorolac
 IV/IM dopamine blocker (prochlorperazine, metoclopramide
 Preventative tx
 Amitriptyline
o Cluster headaches
 Episodic
 MRI for rule out of structural abnormalities
 TX
 Triptan, 02, verapamil (preventative)
o Thunderclap headache
 ER
o Parkinson disease (Movement disorder, related to nerve cell damage and
decrease in dopamine
 DX
 No diagnostics can confirm
 Presentation
 Tremors, bradykinesia, ridgitity
 Tx
 MAO B inhibitor (Rasagiline, safinamide and selegiline)
 Dopamine agonists (Bromocriptine, pramipexole, ropinirole,
rotigotine)
 Carbidopa-levodopa

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 3Qs. Orthopedics: rheumatoid arthritis, meniscal tear, osteoarthritis, gout, rotator cuff,
sprain/strain, spinal stenosis, scoliosis, muscle spasm, osteosarcoma

o Osteoarthritis – Most common form of arthritis

 Presentation
 Joint pain, stiffness and locomotor restriction
 Commonly, knees, hips, interphalangeal joints, first CMC joints,
first MTP joints and joints of the lower cervical and lower lumbar
spine
 Heberden (joint closer to tip of finger) and Bouchard “between”
nodes (middle finger joints)
 DX
 Persistent usage related joint pain, 45 y/o or older, Am stiffness for
30 min or less.
 Radiography used when diagnoses is unclear to rule out
differential diagnoses. True locking of knee. Supportive but not
required.
 TX
 Non-pharmacological: weight management, exercise, braces and
assistive devices when needed.
 Pharmacological: oral and topical NSAIDs, topical capsaicin,
duloxetine, and glucocorticoid injections.

o Rheumatoid Arthritis – Symmetric inflammatory arthritis, poly arthritis
(involving three or more joints) Early recognition is key. Damage is done to joints
in early stages.
 DX
 Positive RF antibody testing
 Disease duration more than six weeks
 Elevated CRP or ESR
 TX
 Refer to rheumatology (DMARD)

o Osteoporosis - characterized by low bone mass, structure disruption, and
increased skeletal fragility. Patients won’t feel or report sx.
 Risk factors

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 Elderly, history of fracture, Caucasian and Asian patients, long

term use of steroids, cigarette smoking, excessive alcohol use, low
body weight
 DX
 Presence of a fragility fracture.
 A fragility fracture is a fracture that occurs either
spontaneously or from minor trauma.
 Dual energy X ray to calculate T score
 T score measures bone density and compares to healthy
adult
 T score -2.5 or less indicates osteoporosis
 -1 to -2.5 indicates osteopenia (Reduced bone mass)
 TX
 Lifestyle factors
 Adequate caloric intake, calcium and Vit D. Regular
exercise, no smoking or alcohol, fall prevention,
 Calcium through diet (>50 years: 1200 mg/day)
 Vitamin D: 8000 to 1000 IU/ daily
 Pharmacotherapy
 Bisphosphonates (alendronate, risedronate)
 Reduce bone breakdown and slow osteoclast cell
activity that breakdown bone for normal
remodeling.
 Contraindicated in patients with esophageal
disorders, unable to sit upright for at least 30 mins,
or severe kidney impairment (CrCl <30
o Ottawa Ankle & Foot Rules (for when to x-ray):
 Ankle: pain and tenderness in the malleolar zone or are unable to bear
weight both immediately after the injury and for four steps on exam.
 Foot: pain in the midfoot zone and have tenderness at the base of the fifth
metatarsal or at the navicular, or if they are unable to bear weight both
immediately after the injury and for four steps on exam
o Sprains (ligament injury):
 Grade I sprain results from mild stretching of a ligament with microscopic
tears.
 Presentation: mild swelling and tenderness, no joint instability.
 Treatment: Ace bandage, RICE
 Grade II sprain is a more severe injury involving an incomplete tear of a
ligament.
 Presentation: moderate pain, swelling, ecchymosis, mild joint
instability, ambulation is painful.
 Treatment: Joint immobilization, RICE, non-weight bearing until
follow up with orthopedic.
 Grade III sprain involves a complete tear of a ligament.
 Presentation: severe pain, swelling, ecchymosis, joint instability.
Unable to bear weight/ ambulate.

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 Treatment: Joint immobilization (aircast), RICE, non-weight

bearing until follow up with orthopedic
o Carpal tunnel: caused by compression of the median nerve
 Presentation: pain (often worse at night), paresthesia in hand, weakness in
the distribution of the median nerve, exacerbated with use.
 Tinel (Pins and needles) and Phalen (outer hands pressed together)
signs support diagnosis.
 Treatment options: wrist splint, glucocorticoid injections, oral
glucocorticoids, and surgery.
o de Quervain tendinopathy: thickening of the abductor pollicis longs and
extensor pollicis brevis tendons and the sheath they pass through.
 Presentation: non-traumatic, radial side wrist pain worse with movement
of thumb and wrist. Possibly enlarged/ swelling of radial side.
 Positive Finkelstein maneuver supports diagnosis.
 bend your thumb across the palm of your hand and bend your
fingers down over your thumb. Then you bend your wrist toward
your little finger (Frankenstein fist from fights)
o Common knee injuries:
 Anterior cruciate ligament tear (ACL)
 Presentation: pain, swelling, effusion, joint instability, possible
audible “pop.”
 Positive Lachman (Grasp femur and tibia and pulls tibia
forward)
 Anterior Drawer test. (Similar pulls tibia forward)
 Meniscus tear:
 Presentation: pain, swelling, substantial effusion and the patient
may lose the ability to fully extend or flex knee.
 Positive McMurray test (Patient on back bend knee and
rotate ankle)
 If suspected or confirmed ACL or meniscal tear: RICE
therapy and non- weight bearing until follow up with
orthopedic.
o Cauda equina syndrome: rare complication of lumbar spinal stenosis.
(Narrowing of spine)
 Presentation: bladder incontinence or retention, fecal incontinence, saddle
paresthesia, weakness, or bilateral leg numbness
 Requires emergent MRI!
 Other indications for imaging on initial evaluation: suspicion for
spinal infection, risk factors for metastatic cancer, and suspected
vertebral compression fracture
o Gout – inflammatory arthritis related to too much uric acid crystalizes in joints.
 Presentation
 joints, ankle, foot, knee, or toe
 Severe pain, redness, and swelling in joints, often the big toe. Attacks can
come suddenly, often at night.
 Triggered by alcohol, sugar and high purine foods (seafood, meat)

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 TX
 Anti-inflammatory medications can help relieve pain and shorten the length
of the attack.
 Patients with chronic gout can use behavioral modification such as diet,
exercise, and decreased intake of alcohol to help minimize the frequency of
attacks. Additionally, patients with chronic gout are often put on
medications such as colchicine (less preferred than anti inflammatory)

o Osteosarcoma – bone cancer
 Presentation
 bone pain and swelling
 TX
 Chemo and radiation, surgery to remove tumors.
o Scoliosis – lateral curvature of the spine
 Most cases are mild and symptom free.
 Can be painful and disabling.
 TX
 Back braces and surgery
 Physical exercise/stretching

 2 Qs. Pregnancy: fundal height, preeclampsia, birth defects, TPAL, fetal growth and
development, Naegele’s rule, hypertension in pregnancy, placenta previa, UTI during
pregnancy
o Gestational diabetes
 screening: Universal screening between 24 to 28 weeks gestation. –
 Two step method:
 First step: - One hour glucose test with 50g of oral glucose
 Positive test: glucose >135, one hour after
administration
 Second step: - Three-hour glucose test with 100g of oral
glucose
 Positive test: at least 2 elevated glucose readings
WOMEN’S HEALTH
o Preeclampsia:
 Generally, presents between 34 weeks’ gestation and up until 4 weeks
after birth.
 Risk factors: - History of preeclampsia, multiple gestation, type
one or type two diabetes, chronic hypertension, chronic kidney
disease, or certain auto immune diseases.
 Presentation
 Presents after 20 weeks gestation

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 New onset hypertension and proteinuria OR

- SBP 140 or greater, DBP 90 or greater
 New onset hypertension and evidence of
end organ damage
 Examples include a creatinine greater than
1.1, pulmonary edema, new and persistent
headache or visual symptoms.
 Diagnosis:
 Diagnosed with two separate readings at least four
hours apart.
 Treatment
 Delivery of the placenta and fetus.
o Placenta previa:
 Presentation
 Bright red vaginal bleeding that occurs from the placenta attaching
too low, covering the cervix.
 Treatment:
 Pelvic rest (no intercourse, bimanual exam, or intravaginal US) -
Refer to high risk OBGYN
o Naegele’s rule: for dating a pregnancy: estimated delivery date (EDD) is
calculated by counting back three months from the LMP and adding seven days.

 5 Qs. Psychiatry: substance abuse, depression, serotonin syndrome, Munchausen by proxy,

generalized anxiety disorder, bulimia, bipolar disorder

 6 Qs. Respiratory: asthma, hemoptysis, COPD, empyema, pleural effusion, community-

acquired pneumonia, pneumonia, tuberculosis, pertussis, croup
o Asthma – bronchial hyper responsiveness, Airway inflammation, constriction
 Presentation
 Dyspnea, chest tight, wheezing
 Severe sx
 Tachypnea, tachy, prolonged expiratory, quiet chest or
tripod breathing
 DX
 Spirometry (before and after bronchodilator)
 FEV1/FVC of <0.7

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 Increase of 10% after administration of

bronchodiolator
 TX
 Step 1 >2x weekly
 PRN Combo inhaler low dose ICS/LABA
(budesonide-formoterol (Symbicort)
 OR ICS + SABA (albuteral)
 Step 2 2+ x/week
 PRN Combo inhaler but rapid low dose ICS
 Step 3 = most days
 Combo low dose ICS/formoterol Q daily and PRN
 Step 4-6 (Severe)
 Asthma specialists
 MEdiam dose ICS QD and 12 x PRN

o Hemoptysis – coughing blood – lung cancer/reactive TB

o COPD – persistent resp sx with chronic bronchitis, emphysema or obstructive
asthma (PREVENTABLE)
 Presentation
 Dyspnea
 Productive cough w sputum
 HIGH RISK FOR PNEMONIA
 DX
 FEV1/FVC ratio less than 0.7 and NOT IMPROVED after
bronchodialator
 TX
 A
 LAMA, plus PRN SABA (preferred)
 B
 LAMA+LABA + PRN SABA
 C
 Same as B
 D
 ICS – LAMA-LABA + PRN SABA (ALL)

o Empyema
o pleural effusion -fluid between lungs and chest wall
 Causes
 TB, HF or inflammation
 SX
 Cough, sharp chest pain, SOB
 TX
 ABX and diuretics
 Chest tube (thoracotomy)

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o Community-acquired pneumonia – Infection of lungs (Streptococcus). Can be

bacterial or viral.
 Presentation
 Fever, cough, resp distress and sepsis
 DX
 Chest XRAY + symptoms
 TX
 High dose amoxicillin OR Amoxicillin clavulanate (Augmentin =
for smokers, elderly or comorbide * high risk
 Can add macrolide (Azithromycin) or doxcy to cover atypical
bacteria or those with high risk or recent abx.
 Penicillion allergy = fluoroquinolone (-FLOXACIN)
o Pneumonia vaccine – recommended in all pt over 65 or 19 with increased risk
 Pneumococcal conjugate vaccines (portion of germs, weak antigen)
(PCV13, PCV15, and PCV20) – 20 followed by 13 or 15
 Pneumococcal polysaccharide vaccine (PPSV23) - kids
o Tuberculosis – Primary, latent or reactive/post reactive
 Primary SX
 Fever and chest pain
 Chest xray often normal or hilar lympoadenopathy (enlargement of
lymph nodes) pleural effusion (fluid buildup between chest wall
and lungs)
 Reactive sx
 cough, weight loss, fatigue, chest pain, dyspnea, hemoptysis, fever
and/ or night sweats
 DX
 Chest XR
 3 sputims
 TB skin
 Or quntiferron blood
 TX

o Pertussis – (whooping cough) Highly contagious. Often in infants and kids. *
Bacterial*
 SX
 Runny nose, naal congestion, sneezing and WHOOP cough
 TX
 ABX -macrolides (azithromycine etc)

o Croup- upper airway infections that blocks breathing. CHILDREN *Viral*
 Sx
 Barking cough, fever, hoarsness, labored breathing, drooling,
stridor
 TX
 At home Tylenol
 Glucocorticoids (dexa or prednosone)

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 Nebulizer treatments (epinephrine)



4 Qs . Sexually Transmitted Infections: all

8 Qs. Urology: incontinence, UTI, renal insufficiency, enuresis, end stage renal disease

 Urinary Inconcontienence
o Risk factors: obesity, vaginal parity, older age, and family history.
o Management: - Avoid alcohol and caffeine - Pelvic floor exercises (for example
Kegels) - Continence pessaries - Bladder training
 Stress, urgency and overflow incontinence.
 UTI – 90% caused by Ecoli.
o Risks: poor hygiene, DM, immunocompromised, frequent sex, pregnancy,
spermicide.
o Uncomplicated UTI:
 s/sx– polyuria, dysuria, suprapubic pain, absence of pruritus or discharge
 Treatment: Beta-lactam (cephalexim, cefuroxime) 5-7 days.
Nitrofurantoin – avoid in pregnancy 1st tri or after 36 weeks. Avoid in
pyelonephritis. Trimethoprim/sulfamethoxazole(TMP/SMX) such as
Bactrim or Septra 3-5 days
o Complicated UTI
 Systemic symptoms such as fever, chills, or costovertebral (CVA)
tenderness, male gender, poorly controlled diabetes, pregnancy, children,
elderly, immunocompromised, recurrent UTIs, presence of kidney stones
or an obstruction, of if there is an indwelling catheter in place7-10 days.
 Treatment: Beta-lactam (7 to 10 days, if no recent abx exposure and low
risk for resistance) -TMP/SMX (7 to 10 days)
o Diagnoses: Positive nitrates, WBCs and leukocytes
o Do not treat asymptomatic bacteriuria unless pt is pregnant.
 Enuresis - “bed wetting”
o Hormonal: Under production of ADH. Can be DM symptom.
o Neurological: smaller bladder sends overactive signals to the brain
o Structural: urethra, prostate or pelvis problems. UTI, stones, enlarged prostate or
cancer.
o Medication/diet: sx of insomnia meds, bladder irritants such as alcohol or caffeine
that are diuretics.

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o Behavioral Treatment: reduce fluid intake, volume control (holding urine during
day to increase capacity), alarm setting/waking.
o Medication treatment: Not curable only treats symptoms. ADH increasing
medication. (Desmopressin, imipramine)
o Surgery
 Renal insufficiency (failure)
o Inability of kidneys to perform excretion leading to retention of nitrogenous waste
products from blood.
o AKI
 prerenal occurs secondary to reduction in extracellular volume or
reduction in circulating volume despite normal total fluid volume
(Cirrhosis, heart failure, sepsis). GFR decreases and BUN and creatinine
increase due to failure of adaptive mechanism in maintaining inter arterial
pressures through dilation of afferent arterioles and constriction of
efferent. (ARBS, ACE, NSAIDS, organ failures, hypotension)
 Intrinsic- glomeruli, vasculature, or tubulointerstitial (
 Post renal – obstruction of urinary flow (tumors, clots, stones etc.)
o CKD
 Hyperfiltration and hypertrophy of viable nephrons leads to distortion of
glomeruli damage, poor filtration, and sclerosis. (DM, HTN,
glomerulonephritis, renal vascular disease, reflux, infections)
o Diagnoses: urinalysis, dipstick, microscopy, electrolytes, casts, CK, renal US,
cystoscopy, kidney biopsy.
o Treatment:
 AKI
 Treat underlying cause, risk of hyperkalemia, Flomax or alpha
blocker for obstruction. Review medications and stop nephrotoxic
eds, monitor input/output, daily weights.
 Complications, including hyperkalemia, pulmonary edema, and
acidosis-all potential reasons to start dialysis.
 CKD
 Control HTN and DM, reduce proteinuria with ACE/ARBS they
slow progression.
 CKD classified based on stage:
 Stage 1: GFR greater than 90
 Stage 2: 60 to 89
 Stage 3: 30 to 59
 Stage 4: 15 to 29
 Stage 5: Less than 15
o End stage renal failure
 Permanent and chronic terminal illness. Transplant or dialysis required.

 7 Qs. Women’s Health: breast cancer, premenstrual syndrome, menopause, contraception,

dysmenorrhea, amenorrhea

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 Pediatric: growth and development, developmental milestones

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