Presentation Pearls

● Essential Hypertension – Chris Harrison

○ Adequate blood pressure control reduces the incidence of acute coronary syndrome 20-25%, stroke
by 30-35%, and heart failure by 50%.
○ JNC 7 - Normal 120/80; Prehypertension 120-139/80-89; Stage 1 HTN 140-159/90-99; Stage 2
>160/>100
○ Onset 25-50 years old; 10-15% Caucasian, 20-30% African Americans
○ Exacerbating factors: Obesity, sleep apnea, increased salt intake, excessive alcohol use, cigarette
smoking, NSAIDs use, polycythemia, low potassium intake
○ Target organs: heart, brain, kidneys, eyes
○ Get more than one measurement on more than one occasion to make a diagnosis; resting in a
sitting position for 5 minutes and 30 minutes minutes after coffee or cigarette
○ Labs: CBC (H/H, glucose), UA, Lipids, BMP, serum uric acid
○ First line: Caucasian- ACEi/ARB, African American- DHP CCB/Thiazide (HCTZ)
○ Beta blocker is recommended for heart failure
○ Hypertensive emergency: 180/120; reduce 25% in first hour; if stable reduce to 160/100 within 2-6
hours
■ Exceptions: Ischemic stroke - no evidence dropping pressure helps
■ Exceptions: aortic dissection - drop systolic to <100 if tolerated
■ Exceptions: patients who need thrombolytic therapy
○ Education: lose weight, stop smoking, DASH diet, reduce alcohol consumption, reduce sodium to
<2400 mg per day, maintain adequate potassium intake; maintain adequate Mg/Ca intake, aerobic
exercise 30 minutes most days of week, medication compliance
● Acute Sinusitis – Makenzie Stovall
○ Inflammation of the sinuses and, most commonly, concurrent inflammation of the nasal
mucosa lasting up to 4 weeks
○ Viral (symptoms last 7-10 days) vs. Bacterial (symptoms lasting >10 days or worsening after
5-7 days)
○ Typical Pathogens
■ Viral (rhinovirus, parainfluenza, influenza, adenovirus)
■ Bacterial (S. Pneumo, S. Aureus, M. Catarrhalis, H. Flu)
○ S/S = facial pain, hyposmia, purulent nasal discharge
○ PE = tenderness over sinuses, purulent posterior pharyngeal secretions, air fluid levels on
transillumination
○ Diagnostic evals = typically clinical diagnosis
■ X-ray may show diffuse opacification or air fluid levels
■ Further testing typically only needed in persistent or recurrent infection
○ TX
■ Viral = symptomatic treatment (nasal decongestants, analgesics, etc)
■ Bacterial = antibiotic therapy
● 1st line = amoxicillin
● Alt. Augmentin or cefdinir
● Alt. To penicillin = bactrim or Zithromax
○ Emergency/Surgical
■ Typically only in cases of persistent or recurrent
■ Complications = cavernous sinus thrombosis or intracranial abscess
■ Procedure of choice for surgery = Functional Endoscopic Sinus Surgery
● Community acquired pneumonia (bacterial) – Lauren Massey
○ Active bacterial infection of pulmonary tissue not acquired in a healthcare environment
 ○ Typical pathogens: S. pneumoniae, H. influenzae, and M. catarrhalis
○ S/Sx: fever, dyspnea, cough + sputum
○ Dx is clinical supported by imaging: usually a chest XR
○ CURB 65** score can be used to decide whether or not to admit
○ TX
■ 5-7 days of antibiotic with at least 48 hrs afebrile (common abx: Macrolide, Doxy,
Beta-lactam in various combos)
■ Consider drawing blood cultures prior to empiric tx, and de-escalating abx
■ If a pt has significant comorbidities, a respiratory fluoroquinolone is indicated
■ High risk pt can be reassessed 7-12 weeks post treatment w/ repeat chest XR
○ Prevention: smoking cessation, flu vaccine, pneumococcal vaccines-PCV13 first (childhood-
<2 y.o.), PPSV23 at 65
■ if >65 yrs and have not received PCV13-give first, then PPSV23 1 year later
● Acute otitis media – Jon Dickson
○ Infection of the middle ear lasting less than 3 weeks, Viral or Bacterial.
○ Common with Eustachian tube dysfunction or upper respiratory infection.
○ Most common: RSV, S. Pneumo
○ Symptoms: Ear pain/pressure, hearing loss, fever
○ Concerns: possible progression to perforation, mastoiditis, sepsis, meningitis.
○ Tx:
■ Antipyretics/analgesics:
● Acetaminophen, Ibuprofen
■ Antibiotics (suspected bacterial infection)
● Amoxicillin 80-100 mg/kg/day x 10 days
● Augmentin ^
● Cefdinir 14 mg/kg/day x 10 days
-Recurrence: Tympanostomy, conjugated heptavalent pneumococcal vax, avoid irritants
● Diabetes Mellitus, Type 2 – Hannah Ra
○ Definition: Insulin resistance and relative impairment of insulin secretion
○ Risk Factors: “CHAOS” chronic htn, atherosclerosis, obesity, stroke
○ Classic sx: 3 Ps “polydipsia, polyphagia, polyuria,” weight loss
○ Complications:
■ Microvascular- Eye (Retinopathy), Kidney (Nephropathy), Neuropathy
■ Macrovascular- Brain, Heart (Ath/CAD), Extremities (PVD)
○ Dx:
■ ADA- HgA1C >6.5% or FBG >126 **GOLD STD or 2hr PG/RG >200
● Screening:
○ ADA- all adults 45/older q3yrs OR BMI >25 + 1 RF
○ USPSTF- 40-70 overwt/obese q3yrs
● Tx: Lifestyle Mods 1st!
○ PO: Biguanides, SU, Meglitinides (Prandin), a-Glucosidase (Acarbose), TZD (Actos),
GLP-1 (exenatide-Byetta/liraglutide-Victoza), DPP4i (sitagliptin-Januvia/linagliptin-
Tradjenta), SGLT2i (-flozins)
○ Insulin:
■ Goal: FBG 80-130 // PPG <180
■ Dawn Phenomenon: BG high b/w 2-8am → Give or increase PM insulin
 ■ Somogyi Effect: PM hypoglycemia, then rebound hyperglycemia → decrease
PM insulin/bedtime snack
● Emergency: HHS (dehydration → increased Osm → Hyperglycemia)
-Treatment 1. IV fluids
2. Regular Insulin
3. Potassium
4. Bicarbonate- only if severe acidosis
● Rheumatoid Arthritis – Megan Albers
○ Symmetrical arthritis
○ Polyarticular
○ Autoimmune - proliferation of synovium -> granulation tissue called pannus
○ Intraarticular involvement: swelling, AM stiffness >30mins, PIP, MCP, MTP (spares DIP)
○ Extra articular: vague prodrome sx, SQ nodules, carpal tunnel, lung dz, Felty’s syndrome
(neutropenia + splenomegaly)
○ Patient: female 30s-60s w/ fam hx
○ PE: effusion, erythema, thickened synovium, boggy, decreased ROM, deformities
○ Deformities: ulnar dev, syn thickening, Boutonnières (PIP flexion), Swan-neck (DIP flex)
○ DX: +anti-CCP, +RF, +ANA
○ TX: DMARDs (1st line methotrexate + folic acid); NSAIDs, glucocorticoids
○ Maintenance, prevention, education: referral, aerobic exercise, posture, rest, assistive
devices
● Acute Myocardial Infarction – Adam Finch
○ Acute onset chest pain +/- radiation
○ Typically hx of HTN, DM, HLD, Fam/Personal hx of CAD
EKG: STEMI- ST elevation greater/equal to box all leads other than V2/V3
V2/V3- 2 or more boxes in men over 40 yoa
V2/3- 2.5/more boxes in men less than 40
v2/3- 1.5 boxes in all women
○ NSTEMI- EKG changes w/ rise and fall of Trop
○ Unstable angina- essentially just bad chest pain
○ Troponin- greater than 99% upper reference limit is abnormal, elevates within 1 hour, stays
high for 5-14 days
○ ACS: Morphine, Oxygen <90% sat, Nitro 0.4mg SL q5min x3, ASA 160-325mg chewed
○ Plavix 300mg loading dose
○ GP IIb/IIIa inhibitors- for those pts going to cath lab
○ PCI 90 min door to balloon ideal
○ Fibrinolytics- for those with symptoms less than 12 hrs who will not receive PCI within 120
min
○ NO BETA BLOCKERS FOR COCAINE PATIENTS
○ ACE/ARB for those w/ LVEF <40%, DM, HTN, CKD
● Asthma – Kaylee Keener
○ Genetic + environmental factors
○ MC chronic illness in children
○ S/sx’s: atopy, cough, wheezing, dyspnea, allergen exposure
○ PE: Expiratory wheezing, tachypneic, eczema
○ Diagnosis
■ Spirometry w/ reversible obstruction after bronchodilator.
■ Age >6yrs & incr in FEV1 >12%
 ■ Bronchoprovocation with methacholine for unclear dx
○ Classification
■ Intermittent, mild persistent, moderate persistent, or severe persistent
■ Severity based on age (0-4yrs) (5-11yrs) (>12yrs), sx frequency, nighttime
awakenings, use of SABA, activity interference, and lung function (FEV1 >80% if
intermittent)
○ Treatment
■ Clinical stepwise approach: SABA → low dose ICS → medium dose ICS OR low +
LABA
■ Emergency: FEV1 >40% albuterol neb, FEV1 <40% SABA+ipratropium, PO steroids
if no response
● Migraine Headache – Neelie Bean
○ Headache lasts 4-72 hours. Usually unilateral, throbbing, and associated with nausea,
vomiting, photophobia, or phonophobia. Can also have neuro sx
○ Two types- those w/aura and those w/out aura
○ Phases- prodromal sx, aura, migraine, resolution of migraine, postdrome sx
○ Scotoma-most common form of aura
○ Strong genetic component. More common in females and lower socioeconomic class
between age 25-55. Declines with age
○ Imaging is based on each individual patient and the type of headache they present with.
May also be obtained to rule out other differentials
○ Treatment involves abortive and prophylactic
○ Abortive-usually start with NSAIDS, aspirin, caffeine combos with mild sx. If sx not
controlled or having more moderate sx next option is triptans
○ If triptans are unsuccessful for abortive treatment can try ergotamine. Try to avoid opioids
due to rebound headache and addictive potential. Antiemetic for N/V
○ Prophylactic- Beta blockers (propranolol, timolol, atenolol), Calcium channel blocker
(verapamil), anti-seizure medication (topamax). Gabapentin second line alternative
○ Studies are still being done in regard to botox
○ Surgery is highly controversial
○ Emergency- Hydration w/ IV fluids. Antiemetic and SC sumatriptan
○ Education-avoid triggers, control stress level, appropriate diet, exercise, and sleep pattern.
Avoid birth control and smoking in patients who have aura
● HIV/AIDS - Joshua Hurt
○ Virus that attacks T-Helper (CD4+) cells
○ Spread through intercourse, shared IV drug use, and Mother-child transmission during
birth/breastfeeding
○ Acute seroconversion phase = flu-like illness
○ AIDS = recurrent severe infections or opportunistic malignancies
○ Treatment begins immediately after diagnosis with antiretroviral therapy
○ CD4 < 200, bactrim for Toxo and PCP prophylaxis
○ CD4 < 50, weekly azithromycin for MAC prophylaxis
○ Counsel patients on safe sex practices and to not use IV drugs
○ Post-exposure prophylaxis within 72 hours - Biktarvy for 28 days
● Addison Disease – Tim Higgins
○ Adrenocortical insufficiency often due to autoantibodies leading to decreased glucocorticoid
+ mineralocorticoid release (think decreased cortisol + aldosterone)
○ Most common in 30-50 year old females
 ○ S/SX: hyperpigmentation, thinning/decreased body hair, fatigue, weight loss, salt craving,
amenorrhea
○ Labs: serum cortisol is best test (peak cortisol of <500 nmol/L is diagnostic). Can also look
at salivary cortisol, baseline ACTH (primary vs secondary), or renin/aldosterone levels
○ TX
■ Replace Glucocorticoids (Hydrocortisone) + Mineralocorticoids (Fludrocortisone)
possible DHEA in females
■ Adrenal Crisis: fluids plus hydrocortisone IV
○ Educate patients about adrenal crisis - maintain an emergency glucocorticoid injection kit,
have sick day plans
● Alzheimer Disease – Elaine Kordsmeier
○ Neurodegenerative disease w/ beta amyloid plaques & tau protein neurofibrillary tangles
○ S/Sx: memory impairment- esp. loss of recent memory, impairment of executive
function/judgment/problem solving, behavior and psychological sxs
○ Exclude other causes of dementia: CMP, B12, TSH, etc..
○ Need to do mental status examination
○ TX:
■ Mild disease: ACh-esterase inhibitors (Donepezil/Aricept)
■ Moderate to severe: NMDA antagonist (Memantine/Namenda)
■ Tx secondary behavioral/psych sxs usually w/ antipsychotics or antidepressants
○ Psychosocial interventions & reducing risk factors for other comorbidities
● Sickle Cell Disease – Hannah Joseph
○ Etiology: Autosomal recessive d/o of HgbSS, most common in AA population
○ Pathophysiology
■ RBC sickling causes thrombosis, hemolytic anemia
○ S/Sx
■ Begins at 6 months (when there is a decrease in the level of fetal hemoglobin)
Dactylitis MC 1st presentation (swelling of the digits)
■ Infections- osteomyelitis, functional asplenia, aplastic crisis due to Parvo B19
■ Splenic Sequestration: vasoocclusion in spleen>> acute splenomegaly
■ Painful Occlusive crisis: abrupt onset of pain (acute chest syndrome, back,
abdominal and bone pain), Priapism
● Triggered by cold weather, etoh, hypoxia, infection, dehydration, pregnancy
○ Dx
■ Universal Neonatal screening
■ CBC with peripheral smear: Decreased Hemoglobin/Hematocrit, increased
reticulocytes, sickled erythrocytes, Howell Jolly Bodies
■ Hemoglobin Electrophoresis
○ Treatment
■ Pain control- IV fluids (D5W is best, NS can worsen sickling), Oxygen, NSAIDs,
narcotics if severe
■ Hydroxyurea- reduces frequency of pain crises
■ Folic Acid 1 mg/day
■ Immunizations
■ PCN prophylaxis from 4 months to 6y
■ Bone marrow transplant only available cure, but not usually implemented
● Acute Bronchitis – Caleb Mason
 ○ Etiology:
■ Typically a respiratory virus.
● Influenza, Adenovirus, Rhinovirus,
■ If you suspect a bacterial cause, think→ Strep pneumo, M. catarrhalis, H. flu.
○ Pathophysiology:
■ Cells of the bronchial lining tissue are irritated and the mucous membrane becomes
hyperemic and edematous.
○ S/Sx:
■ Most common→ cough that lasts for 10-20 days
■ Sore throat, HA, muscle aches, extreme fatigue
■ Fever is rare
○ PE:
■ Lymphadenopathy, wheezes, rhinorrhea, coarse rhonchi
○ Diagnosis:
■ Clinical diagnosis, most of the time
■ Tests to consider: CXR, PFT, CRP, Procalcitonin
○ Treatment:
■ Symptomatic unless you suspect a bacterial cause or your patient is in one of the
special population groups.
● Cat-scratch disease – Kyle Kreulen
○
Bacterial infection, Bartonella henselae, spread through infected cats.
○ Estimated 22000 infected in US each year
○ Transmitted through scratch, bite, or saliva in wound from infected cat.
○ S/Sx: brown/red papule/ulcer at inoculation site, fever, lymphadenopathy - axillary,
Evanescent maculopapular rash
○ Diagnostic - IFA, ELISA testing, lymph node biopsy if immunocompromised pt
○ Tx - Mild: Symptomatic tx, Moderate: Z-pack, Severe: Rifampin 10/20 mg/kg/day for 7-14
days and Cipro 500 mg BID for 7-10 days
● Chronic Obstructive Pulmonary Disease – Jacob Robertson
○ Types:
■ Chronic bronchitis (blue bloaters)
● Overweight, cyanotic, comfortable at rest. Rhonchi and wheezes.
■ Emphysema (pink puffers)
● Thin, uncomfortable at rest. Accessory muscle use. ++AP diameter. Quiet.
○ Risk factors: smoke, alpha-1-antitrypsin deficiency
○ S/Sx: cough, sputum, SOB, DOE
○ Testing: PFTs show FEV1/FVC less than 0.70. Gold I-IV classification uses FEV1
(separated at 80/50/30%). CXR may show hyperinflation (emphysema) but CT more
sensitive and specific.
○ Tx: From conservative to aggressive, use SABA/SAMA → LABA/LAMA → LABA+LAMA →
LABA+LAMA+ICS
■ Start more aggressive with advanced or uncontrolled disease. See GOLD pocket
guide for complex algorithms.
○ Prevention: Flu and pneumonia vaccines; abx during exacerbation
● Fifth Disease – Brianna Patterson
 ○ Aka erythema infectiosum: usually a benign childhood illness (exceptions: sickle-cell and
prego pts)
○ Etiology: Caused by an erythrovirus, Parvovirus B19
○ S/Sx: “slapped-cheek” rash on face and “lacy reticular rash” on extremities that spares
palms and soles (lasts 7-10 days)
○ Tx: Supportive tx and by the time rash is present kiddo can go back to school because no
longer contagious
● Graves Disease – Libby Speck
● Hodgkin Disease – Jean Matawaran
○ Orderly spread of disease from one group of lymph nodes to another
○ May be linked to EBV/mono
○ Bimodal(age): 20s or >55
○ S/Sx: Painless enlargement of one or more groups of lymph nodes (often supraclavicular or
cervical), +/- fever, +/- weight loss, +/- night sweats
○ Dx: excisional biopsy of lymph nodes showing Reed Sternberg cells, imaging for further
staging of the dz
○ Tx: low dose radiation + chemo (very specific to the patient), surgery not used for tx
● Lyme Disease – Margaret Clipperton
○ MC vector borne (tick) illness in the US-Spirochete Borrelia Burgdorferi
○ S/Sx: diplopia, fever, arthritis, erythema migrans, fatigue, myalgia, headache, carditis
○ Can cause neuro, heme, lymph, musculoskeletal complications
○ Start tx w/o blood tests (EIA/IFA + Western Blot)
○ Elevated ESR
○ Tx: Doxycycline 100 mg BID x 14-21 days, Child=Amoxicillin
○ Educate patients on checking for ticks, bug spray
● Parkinson Disease – Grace Hixson
○ Decreased dopamine in the substantia nigra, can have Lewy bodies
○ Progressive, cannot be reversed
○ Patho: dopamine cannot inhibit ACh, thus the movement issues
○ 4 Cardinal Signs (need 2 of first 3 to Dx):
■ Resting tremor
■ Rigidity (“cogwheel”)
■ Bradykinesia (shuffling gait, reduced arm swing)
■ Postural instability (late symptom)
○ Dx: at ages 45-65 y/o, Clinical Dx
○ Tx: symptomatic
■ 1st line in >65 y/o: levodopa/carbidopa (Sinemet)
■ MAO-B inhibitors: Selegiline, Rasagiline
■ Dopamine agonists: bromocriptine, pramipexole, ropinirole
■ Anticholinergics: Cogentin, for tremor
● Acute Bacterial Endocarditis – Samora Lungu
○ Bacterial infection of the valvular or endocardial lining of the heart
○ 2 main types: acute (sudden onset) and subacute (gradual)
■ prosthetic valve endocarditis can be acute or subacute
○ MC bacteria Strep. viridans and Staph. aureus
○ MC develops on the mitral valve
 ○ S/Sx- use mnemonic FROM JANE- Fever, Roth spots, Osler’s nodes, Murmur (new or
changing), Janeway lesions, Anemia, Nail hemorrhages, Emboli
○ Dx: need blood cultures 2-3 samples taken from different sites before empiric abx, ECHO,
use Duke Criteria (2 major, OR 1 major and 3 minor, OR 5 minor)
○ Tx: most patients respond to IV abx:
■ PCN-G or Vanc + Gentamicin→ native valve
■ Vanc + Gentamicin → prosthetic valve
■ surgery usually to repair damaged heart valves, persistent infection, or emergency
management
○ Educate high risk pts about prophylactic abx treatment if they are going to undergo oral or
surgical procedures
● Scarlet Fever – Marissa Goolsby
○ In children
○ Exudative pharyngitis, fever, bright red exanthem
○ Sandpaper rash
○ Tx: penicillin
● Gilbert Disease – Ford Tikson
○ Benign inherited disorder (autosomal recessive) of bilirubin glucuronidation --> elevated
levels of unconjugated bilirubin
○ Most commonly presents as intermittent periods of jaundice
○ Every lab finding is normal other than elevated unconjugated bilirubin
○ The diagnosis is supported by observing a rise in the plasma bilirubin concentration
following a low lipid, 400 kcal diet.
○ May be triggered by dehydration, fasting, intercurrent febrile disease, menstruation, stress,
and overexertion
○ May be a risk factor for toxicity from some medications, such as irinotecan, which also
require bilirubin-UGT-mediated hepatic glucuronidation prior to excretion
○ Associated with an increased risk of cholelithiasis + increased severity and duration of
neonatal jaundice
● Hashimoto’s Thyroiditis – Candice Haigh
○ AKA: Chronic Lymphocytic thyroiditis or Autoimmune thyroiditis
○ An autoimmune disorder in which antibodies are directed against the thyroid gland leading
to chronic inflammation resulting in impaired ability of the thyroid gland to produce thyroid
hormones
○ Most common hypothyroidism in US, occurs most commonly in middle aged women
○ Genetic & environmental triggers
○ Sx & physical exam
■ Weight gain, depression, chronic fatigue, menstrual irregularities dry hair/skin,
constipation
■ Non-tender goiter, puffy periorbital edema, brittle nails, bradycardia
○ Labs:
■ TSH elevated, Low T4 & T3
■ POSITIVE: Anti TPO (anti-thyroid peroxidase) elevated in 90% or anti TG (anti-
thyroglobulin) elevated in 40%
○ TX: Levothyroxine 50-200mcg
■ ´Take Levothyroxine separate by at least 4 hours from ingestion of antacids and iron containing
multivitamins since they can impair the absorption of levothyroxine
■ Surgery for obstructive sx or cosmetix
 ○ Myxedema coma/emergency: life threatening condition d/t longstanding uncompensated
hypothyroidism from stressful event (infection, MI, trauma, ext) results in AMS, lethargy or
coma, get ICU ASAP
● Kawasaki Syndrome – Megan Bachman
○ An acute febrile illness in children that is characterized by vasculitis of the medium-sized
arteries. It primary affects children younger than 5 years old.
○ The acronym "FEBRILE" is used to remember the criteria as follows:
■ Fever
■ Exanthem (mucous membrane rash)
■ Bulbar conjunctivitis
■ Rash
■ Internal organ involvement (not part of the criteria)
■ Lymphadenopathy
■ Extremity changes
○ Other acronym: Warm+ CREAM
■ C: conjunctivitis
■ R: Rash
■ E: extremity changes
■ A: Adenopathy
■ M: Mucous membrane
○ Diagnosis of complete Kawasaki disease:
■ 5 days of fever with 4-5 clinical features without explanation of other disease
○ Diagnosis of incomplete Kawasaki disease:
■ 5 days of fever + 2-3 clinical features present without explanation
○ Suggested labs:
■ CBC, liver enzymes, albumin, ESR, CRP and UA- platelets will rise on second week
of disease.
■ Usually will show: elevated Esr/CRP, leukocytosis, reactive thrombocytosis,
Normochromic normocytic anemia, Sterile pyuria.
○ Echocardiography once diagnosis is made
○ IVIG- given within the first 10 days of fever and Aspirin
○ All patients should be admitted to the hospital until fevers have resolved

● Systemic Lupus Erythematosus – Rebekah Stuck

○ Basics: Chronic, multisystem inflammatory disease characterized by autoantibody response
■ Woman, childbearing age presents with rash, joint pain, fever: think SLE
○ Patho: Environmental trigger + genetic susceptibility → autoantibody formation and immune
complex formation/deposition → tissue damage
○ S/Sx: SOAPBRAINMD - you need at least 4
■ Serositis, Oral ulcers, Arthritis, Photosensitivity, Blood disorders, Renal involvement,
Antinuclear antibodies, Immunologic phenomenon, Neuro disorders, Malar rash,
Discoid rash
■ May have false (+) on RPR for syphilis
○ Labs:
■ (+) ANA
■ (+) anti-dsDNA highly specific, 70% sensitive
 ■ (+) anti-Smith most specific, 30% sensitive
■ Decreased complement levels
■ (-) anti-histone antibodies
○ Treatment:
■ Stop smoking, avoid excessive sun exposure, moderate physical activity as tolerated
■ Hydroxychloroquine (Plaquenil) + NSAIDs (Naproxen) + corticosteroids PRN
■ IVIG for severe flares
■ Fever is grounds for hospitalization.
○ Drug Induced Lupus: resolves c d/c of offending med
■ Fever, arthralgia, myalgia, serositis
■ (+) anti-histone antibodies
■ Common offenders: hydralazine, isoniazid, methyldopa, procainamide, quinidine
● Malaria – Robert Brun
○ Potentially Life-threatening vector borne disease caused by infection with Plasmodium
protozoa. Plasmodium falciparum(most likely to cause life threatening dz.)
■ Spread by female Anopheles mosquitoes
■ Hx of travel to endemic areas
○ Cyclical Fever, lasting 1-8 hrs, shaking chills followed by sweats, repeating every 48-
72 hrs.
■ Cough, arthralgia/myalgia, fatigue, NS GI symptoms
P. falciparum: cerebral malaria can lead to coma
○ Dx: Gold Standard- Giemsa Stain thick and thin peripheral smear, preferably while patient
is febrile, repeat 12-24 hrs. X 3 days
○ Mgmt: Chloroquine 1st line, Drug resistant areas Atovaquone

● Ankylosing Spondylitis – Alexa Naceanceno

○ Typical patient: white male with age of onset late teens, early 20s
○ Primarily involves: sacroiliac joints & axial skeleton
The six “A”s of AS:
1. Atlanto-axial skeleton
2. Anterior uveitis
3. Apical fibrosis
4. Aortic regurgitation
5. Amyloidosis (renal)
6. Achilles involvement (enthesitis)
○ Presentation: low back pain, limited ROM L-spine
○ Physical exam: thoracic kyphosis, anterior uveitis
○ Dx: HLA-B27 (+), Bamboo Spine & sacroiliitis seen on imaging
○ Tx: NSAIDs are 1st line. Then TNF-alpha inhibitor
● Pertussis – Haley Spencer
○ MC in children <2yo, rarely seen in older children due to widespread vaccination
■ DTaP series in childhood, one Tdap dose as adult and with each pregnancy
○ Bordetella pertussis infection, highly contagious via respiratory droplets, usually from adult
○ 3 Stages:
■ Catarrhal Stage - 2 weeks of common URI symptoms. Most contagious period.
■ Paroxysmal Stage - intense whooping cough fits. May have post-tussive emesis and
subconjunctival hemorrhage.
■ Convalescent Stage - chronic cough, gradually resolves
 ○ Diagnosis usually clinical (2 week duration + intense cough), gold standard = PCR or culture
of nasopharyngeal swab. Lymphocytosis common.
○ Management - Supportive tx is mainstay. Antibiotic of choice is macrolides (erythromycin,
azithromycin) or bactrim if allergic; can be given for PEP within 3 wks.
● Rubeola – Madison Burks
○ Caused by Measles virus, transmitted via respiratory droplets
○ Physical exam: high fever, cough, coryza, conjunctivitis (3 Cs), Koplik spots, maculopapular
rash (cephalocaudal progression of morbilliform exanthem)
■ First: fever, second: cough, coryza, conjunctivitis, third: rash
○ Diagnosis is determined from clinical findings (can use serology, ELISA for IgM/IgG)
○ Tx: supportive care (Acetaminophen/Ibuprofen), vitamin A if severe or
immunocompromised. Antiviral agents (ribavirin & interferon) are not routinely used. Post
exposure prophylaxis: administer MMR vaccine w/in 72 hrs of immunoglobulin w/in 6 days.
○ Vaccine: MMR--first dose 12-15 months old and second dose 4-6 years old.
● Bacterial Vaginosis – Madison Scott
○ A shift in vaginal flora from normal Lactobacillus species to one of high bacterial diversity
→ leads to over growth of bacteria → high vag pH>4.5 → signature fishy smell/discharge
○ BV alone does not cause pruritus, dysuria, or burn..if does think mixed vaginitis
○ Dx GOLD standard = gram stain w/Nugent score.
■ Real life do wet mount = CLUE cells, whiff test, ph>4.5, gray-whitish discharge
○ Tx: metronidazole orally or gel or cream. OCP could be helpful w/balancing pH or probiotics
● Varicella – Emily Featherstone
○ Human alpha herpes virus. Virus can be latent in cranial nerves & dorsal root ganglia for life
■ May reactivate later in life to produce shingles
○ Spread by: respiratory droplets; direct contact w/lesions
○ Vesicular rash is classic
○ Pain, pruritus & paresthesia (others: fever, throat pain, fatigue, tachy, headache)
○ Chickenpox MC <10 y/o; shingles MC >50 y/o
■ Chickenpox: rash on scalp, face, trunk
■ Shingles: vesicles usually along one dermatome
○ Post-herpetic neuralgia
■ Pain >90 days; give antivirals w/in 72 hrs to prevent
○ Dx -- appearance of skin lesions & hx of exposure (extra: Tzanck, antibodies in blood, PCR)
○ Tx -- Oral acyclovir, calamine lotion, antihistamines, avoid aspirin (Reye syndrome)
○ Vaccines -- Chickenpox for children-adults (two doses) >/=50 y/o zoster vaccine (two doses)

● Celiac Disease – Kate Rowland

○ Autoimmune-possibly genetic→ eat gluten damages small intestine & malabsorption of
nutrients
○ Damage to small intestine: “Villous Atrophy”
○ Tissue transglutaminase deamidated gliadin = increased negative charge & binding to HLAs
○ HLA-DQ8 & DQ2 present gliadin to T cells → Inflammatory cascade
○ Dx: IGA TTG test (anti tissue transglutaminase antibody) if + → upper endoscopy w/ 6
biopsies (upper endoscopy is gold standard)
○ Biopsies Show: Reduced mucosal folds, mucosal fold scalloping, mosaic pattern
○ Sx: Abdominal Distention, diarrhea, flatulence and evidence of nutrient deficiencies
(anemia, chvostek’s, trousseau’s etc) Hyperkeratosis
 ○ Tx: Gluten Free diet, can try steroids, if refractory to steroids r/o lymphoma of intestine
○ Diet: Avoid Wheat, Rye or Barley
● Gastroesophageal reflux disease – Kim Savage
○ Decreased lower esophageal sphincter tone/irritants/increased abdominal pressure →
gastric contents reflux into the esophagus → symptoms or erosion
○ Classic triad of symptoms- heartburn, regurgitation, dysphagia
○ Alarm symptoms- anemia, hematemesis/melena, persistent vomiting, unintentional wt loss
○ Triggers- coffee/caffeine, citrus fruits, tomatoes, carbonated beverages, chocolate,
peppermint, garlic, onions, fatty/spicy/fried foods, smoking, obesity, lying down after eating
○ Considered “frequent” if >2 episodes/wk
○ Dx- clinical + trial PPI x 4-8 wks, upper endoscopy if dx unclear or alarm sx
○ Tx- lifestyle modifications +/- med management (step up or step down based on sx)
■ Antacids (TUMS, if infrequent)
■ H2 receptor antagonists (famotidine, ranitidine)
■ PPI’s (omeprazole, esomeprazole)
● The most effective
● S/E include vitamin malabsorption & bone fx
● Must be taken 30-60 minutes before first meal
○ Surgery- Nissen fundoplication (gastric fundus is wrapped around lower esophagus to
increase LES tone)
○ Complication- Barrett’s Esophagus
■ Change from squamous cells to columnar
■ 30 x increased risk for developing esophageal adenocarcinoma
● Antisocial Personality Disorder – Rebekah Tallcott
○ Pattern of disregard for and violation of the rights of others with no disregard (starting at age 15).
○ Pt must be 18 years old at least for diagnosis.
○ History of behavior as a child/adolescent must be consistent with conduct disorder.
○ 3 or more of the following should be present:
■ 1. Failure to conform to social norms (committing unlawful acts).
■ 2. Deceitfulness/repeated lying/manipulating others for your gain.
■ 3. Impulsivity/failure to plan ahead.
■ 4. Irritability and aggressiveness/fighting or assaults.
■ 5. Recklessness and disregard for safety of themselves or of others.
■ 6. Irresponsibility/failure to sustain work or honor financial obligations.
■ 7. Lack of remorse for actions.
○ 3x more common in men, cause is unknown, more common in children with alcoholic parents or
that grew up in abusive homes.
○ Dx by DSM-5, MMPI and interviewing/psych eval
○ Psychotherapy (talk therapy) is treatment of choice, but it is generally ineffective. No
medications are specific to antisocial personality disorder, but you can treat the symptoms (see
below)
■ If impulsive/aggressive: can use anticonvulsants including: Valproic acid or divalproex
sodium.
■ If transient psychotic periods: can use antipsychotics such as: Risperidone, Olanzapine, or
Quetiapine.
■ If depression: can use antidepressants including SSRIs and newer antidepressants: Zoloft,
Paxil, Prozac, Lexapro, Nefazodone, or Remeron.
■ Do not use TCAs or MAOIs (because of overdose risk)!
 ○ No surgical or emergency management needed unless they have injuries from fights/traumas or
suicide attempts.
○ Should be educated on stopping alcohol, drugs, and that it is a lifelong disease. Tends to get less
severe over time. Psychotherapy is helpful but takes a long time. Support groups are always
recommended.

Cardiology ENT Pulmonology GI Psych Endocrine

HTN Acute CAP GERD Antisocial T2DM

Acute MI Sinusitis Asthma Gilbert’s Dz Personality Addison's
Bacterial Otitis Acute Disorder Graves
Endocarditis Media Bronchitis Hashimoto’s
COPD Celiac Dz

Ortho/Rheum Neurology Heme Gynecology Infectio

us Dz

Rheumatoid Migraine Sickle Bacterial HIV

Arthritis AD Cell Dz Vaginosis Cat scratch
Ankylosing Parkinsons Hodgkins 5ths Dz
Spondylitis Kawasaki Lyme Dz
SLE Scarlett Fever
Malaria
Pertussis
Rubeola
Varicella

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