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Absolutely. Your list is very broad, so the best way to study it is not to memorize every disease. We can turn it into a high-yield nursing reviewer based on: What is it? → What will I see? → What should I assess? → What should I do? → What medications/treatments matter? → What is the priority/emergency? → What should I teach? Below is a condensed master reviewer. I’ll keep it nursing-focused and use simple language. ⸻ 🩺 MEDICAL-SURGICAL NURSING REVIEWER 1. ENDOCRINE SYSTEM Diabetes Mellitus Type 1 Type 2 Main problem Little/no insulin Insulin resistance + progressive insulin deficiency Usually Younger onset, but can occur any age More common in adults Treatment Insulin required Lifestyle + oral/injectable meds ± insulin Major acute problems DKA HHS Signs of hyperglycemia “3 Ps” * Polyuria – urinating frequently * Polydipsia – excessive thirst * Polyphagia – excessive hunger Other: * Fatigue * Blurred vision * Slow wound healing * Recurrent infections Hypoglycemia Think FAST: * F – Feeling shaky * A – Altered behaviour/confusion * S – Sweating * T – Tachycardia Treatment if conscious: 15 g fast carbohydrate → recheck glucose in 15 min → repeat if necessary. Examples: * Glucose tablets * Juice * Regular pop If unconscious/severe: * Glucagon if appropriate * IV dextrose in a healthcare setting DKA Usually associated with Type 1. Think: Hyperglycemia + ketones + metabolic acidosis Signs: * Dehydration * Abdominal pain * Nausea/vomiting * Fruity/acetone breath * Kussmaul respirations * Altered LOC Priority treatment: 1. IV fluids 2. Insulin 3. Monitor/correct electrolytes, especially potassium 4. Monitor glucose and acid-base status HHS Usually Type 2. * Extremely high glucose * Severe dehydration * Altered LOC * Little/no significant ketoacidosis Major nursing priority: fluid replacement and monitoring. Diabetes teaching Remember: * Foot care * Inspect feet daily * Proper footwear * Don’t walk barefoot * Don’t cut corns/calluses yourself * Monitor blood glucose * Know signs of hypo/hyperglycemia * Medication adherence * Sick-day management * Regular eye/kidney/foot assessments ⸻ ❤️ 2. CARDIOVASCULAR SYSTEM Stroke Two major types: * Ischemic → blocked blood vessel * Hemorrhagic → bleeding Recognize stroke: BE FAST B – Balance loss E – Eye/vision changes F – Face drooping A – Arm weakness S – Speech difficulty T – Time to call emergency services Nursing priorities * ABCs * Determine last known well * Neurological assessment * Blood glucose * Prepare for CT/imaging * Swallow assessment before oral food/fluids/medications * Prevent aspiration * Maintain safety Do not give food or water until swallowing is assessed. ⸻ Myocardial Infarction (MI) Think: “Time = muscle.” Common symptoms: * Chest pressure/pain * Radiation to arm/jaw/back * Dyspnea * Diaphoresis * Nausea * Anxiety Some patients, especially older adults and people with diabetes, may have atypical or minimal pain. Nursing priorities * ABCs * ECG * Vital signs * Cardiac monitoring * IV access * Blood work including cardiac biomarkers * Oxygen if hypoxemic/clinically indicated * Administer prescribed medications promptly Common medications: * Aspirin * Nitroglycerin * Antiplatelet drugs * Anticoagulants * Beta blockers * Statins Nitroglycerin Can cause: * Hypotension * Headache * Dizziness Never combine nitrates with PDE-5 inhibitors because of potentially severe hypotension. ⸻ Heart Failure Left-sided Think Lungs * Dyspnea * Crackles * Orthopnea * Pulmonary edema * Pink/frothy sputum in severe pulmonary edema Right-sided Think Body * Peripheral edema * Weight gain * JVD * Hepatomegaly * Ascites Nursing priorities * Daily weight * I&O * Respiratory assessment * Edema assessment * Fluid/sodium management as ordered * Medication adherence Sudden weight gain can indicate fluid retention. Common drugs: * Diuretics * ACE inhibitors/ARBs/ARNI * Beta blockers * Mineralocorticoid antagonists * SGLT2 inhibitors * Digoxin in selected patients Digoxin Watch for: * Bradycardia * Nausea/vomiting * Visual disturbances * Dysrhythmias Low potassium increases risk of digoxin toxicity. ⸻ Peripheral Vascular Disease Arterial Think: “Pain + Pale + Pulseless + Cold” * Cool extremity * Weak pulses * Pale colour * Pain with activity * Poor wound healing Venous Think: “Swollen + Warm + Edema” * Edema * Warm skin * Aching * Venous ulcers often near ankles ⸻ 🩸 3. HEMATOLOGY Anemia Reduced oxygen-carrying capacity. Signs: * Fatigue * Pallor * Weakness * Dyspnea * Tachycardia * Dizziness Iron-deficiency anemia May see: * Low hemoglobin * Low ferritin * Microcytic/hypochromic RBCs Iron teaching: * Take as directed * Vitamin C can improve absorption * Dark stools are common * Constipation can occur * Liquid iron may stain teeth ⸻ Leukemia Cancer of blood-forming tissues. Possible findings: * Infection → abnormal WBC function * Anemia → fatigue/pallor * Bleeding → low platelets * Bone/joint pain Think: Leukemia = infection + anemia + bleeding Nursing priorities: * Infection prevention * Bleeding precautions when indicated * Monitor CBC * Oral care * Avoid unnecessary invasive procedures * Monitor treatment adverse effects ⸻ 🍽️ 4. GASTROINTESTINAL SYSTEM Crohn’s vs Colitis Crohn’s Ulcerative Colitis Can affect anywhere mouth → anus Colon/rectum “Skip lesions” Continuous inflammation Transmural Mainly mucosal Fistulas common Bloody diarrhea common Strictures possible Toxic megacolon risk Crohn’s Watch for: * Diarrhea * Abdominal pain * Weight loss * Malnutrition * Fistulas Ulcerative colitis Watch for: * Bloody diarrhea * Abdominal cramps * Urgency * Risk of toxic megacolon ⸻ Diverticulitis Inflammation/infection of diverticula. Signs: * Usually LLQ abdominal pain * Fever * Change in bowel habits During acute inflammation: * Follow prescribed bowel-rest/diet plan * Monitor pain, fever and abdominal status * Watch for perforation/peritonitis ⸻ Colorectal Cancer Red flags: * Change in bowel habits * Blood in stool * Unexplained weight loss * Iron-deficiency anemia * Abdominal discomfort Important: Screening is important even before symptoms occur. ⸻ Constipation Risk factors: * Opioids * Immobility * Low fluid intake * Low fibre * Some medications Management: * Fluids if not contraindicated * Fibre * Activity * Bowel routine * Appropriate laxatives/stool softeners ⸻ Diarrhea Priority concerns: Fluid + electrolytes + cause Assess: * Frequency * Stool characteristics * Blood * Fever * Abdominal pain * Hydration * Recent antibiotics/travel/exposure ⸻ Peptic Ulcer Disease Major complications: * Bleeding * Perforation * Gastric outlet obstruction Warning signs: * Hematemesis * Melena * Sudden severe abdominal pain * Rigid abdomen Common causes: * H. pylori * NSAIDs ⸻ Appendicitis Classic: * Pain may begin around umbilicus and migrate to RLQ * Fever * Nausea/vomiting * Rebound/guarding may occur Priority Prevent rupture. Avoid: * Laxatives * Enemas * Applying heat to abdomen ⸻ 🚰 5. RENAL SYSTEM UTI Symptoms: * Dysuria * Frequency * Urgency * Suprapubic discomfort If infection reaches kidneys: * Fever * Flank pain * Chills * Nausea/vomiting Nursing * Obtain urine specimen correctly * Culture before antibiotics when ordered/appropriate * Encourage fluids if not contraindicated * Complete antibiotics ⸻ Renal Failure Major problems: Think: * Fluid overload * Electrolyte imbalance * Acid-base imbalance * Uremia * Anemia Possible findings: * Edema * Hypertension * Fatigue * Decreased urine output * Nausea * Confusion Particularly important: Hyperkalemia can cause life-threatening dysrhythmias. ⸻ Dialysis Hemodialysis Blood is filtered through a machine. Assess: * Weight * BP * Fluid status * Access site AV fistula Remember: “Feel + Hear” * Thrill → feel it * Bruit → hear it Protect the access: * No BP on that arm * No blood draws on that arm when avoidable * Don’t compress unnecessarily ⸻ Incontinence Types: Stress → coughing/sneezing Urge → sudden strong urge Overflow → bladder doesn’t empty Functional → can’t get to toilet Mixed → combination Management depends on cause. ⸻ 🫁 6. RESPIRATORY SYSTEM COPD Includes chronic bronchitis and emphysema. Common: * Dyspnea * Chronic cough * Sputum * Wheezing * Reduced exercise tolerance Nursing: * Position upright * Pursed-lip breathing * Energy conservation * Smoking cessation * Oxygen as prescribed * Inhaler technique Don’t automatically assume oxygen should be withheld from COPD patients. Oxygen is prescribed/titrated according to the patient’s clinical status and target saturation. ⸻ Asthma Usually reversible airway obstruction/inflammation. Symptoms: * Wheezing * Cough * Dyspnea * Chest tightness Rescue medication Short-acting bronchodilator, e.g. salbutamol. Controller Often: Inhaled corticosteroid Severe attack Red flags: * Difficulty speaking * Severe respiratory distress * Exhaustion * Altered LOC * Silent chest Silent chest = very serious. ⸻ Pneumonia Signs: * Fever * Cough * Sputum * Dyspnea * Crackles * Pleuritic chest pain Nursing: * Oxygen if needed * Antibiotics if bacterial/ordered * Hydration if appropriate * Mobilization * Cough/deep breathing * Monitor respiratory status ⸻ Lung Cancer Risk factors: * Smoking * Environmental/occupational exposures Symptoms: * Persistent cough * Hemoptysis * Weight loss * Dyspnea * Chest pain ⸻ Tuberculosis Classic: * Persistent cough * Fever * Night sweats * Weight loss * Possible hemoptysis Nursing priority Airborne precautions for suspected/confirmed infectious pulmonary TB according to institutional policy. ⸻ Atelectasis Collapsed alveoli, often after surgery. Prevention: * Deep breathing * Coughing * Incentive spirometry * Early mobilization * Adequate pain control ⸻ Pneumothorax Air in pleural space → lung collapse. Possible: * Sudden dyspnea * Chest pain * Decreased/absent breath sounds Tension pneumothorax Emergency. May cause: * Severe respiratory distress * Hypotension * Distended neck veins * Tracheal deviation * Cardiovascular collapse Requires immediate emergency treatment. ⸻ Hemothorax Blood in pleural space. Think: Respiratory compromise + blood loss. Chest tube may be required. ⸻ 🦴 7. MUSCULOSKELETAL Osteoporosis Loss of bone density. Risk: * Fractures * Vertebral compression * Hip fracture Prevention: * Weight-bearing activity * Calcium/vitamin D as appropriate * Fall prevention * Avoid smoking * Limit excessive alcohol ⸻ Fractures Priority: ABCs → bleeding → neurovascular status Assess the 6 Ps: * Pain * Pallor * Pulselessness * Paresthesia * Paralysis * Poikilothermia/coolness Neurovascular assessment is critical. ⸻ Arthritis Osteoarthritis Think: Wear and tear * Pain with activity * Stiffness * Often affects weight-bearing joints Rheumatoid arthritis Think: Autoimmune * Symmetrical joint involvement * Morning stiffness * Systemic effects ⸻ Scoliosis Abnormal lateral curvature of spine. Assess: * Posture * Shoulder/hip asymmetry * Spinal curvature * Respiratory effects if severe ⸻ Multiple Sclerosis Autoimmune demyelinating disease affecting CNS. Possible: * Weakness * Fatigue * Visual disturbances * Sensory changes * Balance problems * Bladder dysfunction Important nursing concept: Fatigue and heat can worsen symptoms. ⸻ 🦠 8. INFECTION/IMMUNE SYSTEM MRSA Methicillin-resistant Staphylococcus aureus. Key: * Resistant to several antibiotics * Contact precautions may be required * Strict hand hygiene ⸻ VRE Vancomycin-resistant enterococci. Key: * Resistant organism * Contact precautions according to facility policy * Hand hygiene * Environmental cleaning ⸻ C. difficile Often associated with antibiotic exposure. Symptoms: * Frequent watery diarrhea * Abdominal cramping * Fever VERY IMPORTANT Soap and water handwashing is preferred because alcohol-based hand sanitizer does not reliably kill C. difficile spores. Use appropriate contact/spore precautions according to facility policy. ⸻ Influenza * Fever * Cough * Myalgias * Fatigue * Headache Prevention: Annual vaccination + respiratory hygiene. ⸻ Sepsis Think: Infection + organ dysfunction Potential signs: * Fever or hypothermia * Tachycardia * Tachypnea * Altered mental status * Hypotension * Reduced urine output * Elevated lactate Nursing priority Recognize early and escalate rapidly. Expect: * Cultures * Lactate * IV fluids when indicated * Prompt antimicrobials when sepsis is suspected * Source control * Frequent reassessment ⸻ 🔬 9. DIAGNOSTIC TESTS Don’t memorize only the test. For every test ask: 1. Why is it being done? 2. What does it tell me? 3. What does the nurse do before? 4. What does the nurse do after? 5. What complications should I watch for? ⸻ CT Uses X-rays to create detailed cross-sectional images. Contrast may be used. Nursing: * Check allergies/previous contrast reactions * Assess kidney function when appropriate * Follow contrast-specific instructions ⸻ MRI Uses magnetic field. NO metal/unsafe metallic objects. Assess: * Implanted devices * Metal fragments * Claustrophobia ⸻ X-ray Useful for: * Fractures * Chest conditions * Some abdominal problems ⸻ Ultrasound Uses sound waves. Common: * Pregnancy * Abdomen * Pelvis * Blood vessels No ionizing radiation. ⸻ Mammogram Breast imaging for screening/assessment. ⸻ Endoscopy Allows direct visualization of GI tract. Nursing: * Usually NPO beforehand * Sedation may be used * Monitor airway and vital signs afterward * Ensure gag/swallow reflex has returned before oral intake when applicable ⸻ Bronchoscopy Visualizes airways. Post-procedure: * Monitor respiratory status * Watch for bleeding * Keep NPO until protective reflexes return if sedated/topical anesthetic used ⸻ Pulmonary Function Tests Measure lung function. Important for: * Asthma * COPD * Other pulmonary disorders ⸻ 🧪 10. LABORATORY VALUES For exams, know what the lab means, not just the number. CBC Hemoglobin/Hematocrit Think: oxygen-carrying capacity Low → anemia/bleeding/etc. WBC Think: infection/inflammation/immune response Platelets Think: clotting Low → bleeding risk. ⸻ INR Measures effect of warfarin therapy. Higher INR generally = increased anticoagulation and bleeding risk. Monitor for: * Bleeding * Bruising * Hematuria * Melena ⸻ Glucose Think: current blood glucose ⸻ HbA1c Think: “3-month-ish glucose picture.” Used for longer-term diabetes management. ⸻ BUN + Creatinine Think: Kidney function. Creatinine is particularly useful when evaluating renal function. ⸻ GFR Estimates kidney filtration. Lower GFR generally = worse kidney function. ⸻ Electrolytes Sodium Think: water balance + neurological function Potassium Think: heart rhythm Abnormal potassium can cause dangerous dysrhythmias. Calcium Think: bones + muscles + nerves ⸻ Cholesterol LDL “Lousy” cholesterol Higher LDL → increased cardiovascular risk. HDL “Healthy” cholesterol Generally protective. ⸻ Urinalysis Can help identify: * UTI * Protein * Blood * Glucose * Ketones * Kidney problems ⸻ Culture & Sensitivity Culture = What organism? Sensitivity = Which antibiotic is effective? ⸻ 💊 11. PHARMACOLOGY For every medication, memorize: Class → Why given → Major adverse effects → Contraindications/precautions → Nursing assessments → Patient teaching ⸻ Acetaminophen (Tylenol) Used for: * Pain * Fever Major concern: Liver toxicity with excessive dosing. ⸻ NSAIDs Examples: * Ibuprofen * Naproxen Watch for: * GI bleeding * Kidney injury * Fluid retention * Cardiovascular risks ⸻ Morphine Opioid. Watch: * Respiratory depression * Sedation * Hypotension * Constipation * Nausea Antidote for opioid-induced respiratory depression: Naloxone ⸻ Antibiotics Key nursing principle: Complete the prescribed course unless directed otherwise. Watch: * Allergic reactions * Diarrhea * Superinfection * C. difficile ⸻ Warfarin (Coumadin) Anticoagulant. Monitor: INR Major complication: Bleeding Teaching: * Consistent vitamin K intake rather than suddenly changing intake * Drug interactions matter * Report unusual bleeding ⸻ Heparin Anticoagulant. Monitor: * Bleeding * Platelets * aPTT for unfractionated heparin, depending on protocol Major complication: Bleeding Important adverse reaction: HIT – heparin-induced thrombocytopenia ⸻ Insulin Major adverse effect: HYPOGLYCEMIA Know: * Onset * Peak * Duration * Administration technique * Glucose monitoring ⸻ Nitroglycerin Used for angina. Can cause: * Headache * Hypotension * Dizziness Avoid with PDE-5 inhibitors. ⸻ Digoxin Remember: “Slow heart + low potassium = danger.” Monitor: * Apical pulse * Potassium * Signs of toxicity ⸻ Diuretics Example: Furosemide (Lasix) Causes: * Increased urine output * Decreased fluid volume Watch: * BP * Electrolytes * Dehydration * Potassium ⸻ Corticosteroids Example: Prednisone Long-term effects: * Infection risk * Hyperglycemia * Osteoporosis * Fluid retention * Skin changes * Adrenal suppression Do not abruptly stop long-term corticosteroids without medical direction. ⸻ Bronchodilators Example: Salbutamol Can cause: * Tremor * Tachycardia * Nervousness ⸻ Inhaled corticosteroids Important: Rinse mouth after use. Helps prevent oral candidiasis. ⸻ Statins Example: Atorvastatin Used to lower cholesterol. Watch: * Muscle pain/weakness * Liver-related adverse effects ⸻ Stool medications Psyllium Bulk-forming. Requires adequate fluid intake unless contraindicated. Docusate Stool softener. Stimulant laxatives Increase intestinal motility. ⸻ 🧠 12. NEUROLOGICAL Seizure During seizure: Protect, don’t restrain. * Protect from injury * Turn to side if possible * Protect airway * Remove nearby hazards * Don’t put anything in mouth * Time the seizure After: * Assess airway * Vital signs * Neurological status * Document characteristics Status epilepticus Emergency. ⸻ Increased Intracranial Pressure Think: Headache + vomiting + decreased LOC + pupil changes Late sign: Cushing’s triad * Increased BP/widened pulse pressure * Bradycardia * Irregular respirations Nursing: * Elevate head as ordered * Maintain neutral neck alignment * Avoid unnecessary stimulation * Monitor neurological status * Prevent hypoxia/hypercapnia ⸻ Parkinson’s Disease Classic: TRAP T – Tremor R – Rigidity A – Akinesia/bradykinesia P – Postural instability Nursing: * Fall prevention * Mobility support * Medication timing * Swallowing assessment * Nutrition ⸻ Spinal Cord Injury Priority: Airway + breathing + immobilization + neurological assessment Possible complications: * Neurogenic shock * Autonomic dysreflexia * Respiratory compromise * Loss of bowel/bladder control * Pressure injuries Autonomic dysreflexia Usually associated with injuries at/above T6. Signs: * Sudden severe hypertension * Headache * Flushing/sweating above injury * Bradycardia Priority: Sit patient upright and identify/remove the trigger. ⸻ 👁️ 13. SENSORY Cataracts Clouding of lens. Symptoms: * Blurred vision * Glare * Reduced visual acuity Treatment: Surgical removal when significantly affecting vision. ⸻ Glaucoma Optic nerve damage often associated with increased intraocular pressure. Key distinction: Glaucoma → pressure/optic nerve Cataract → cloudy lens Acute angle-closure glaucoma: * Severe eye pain * Headache * Halos * Nausea/vomiting * Red eye Emergency. ⸻ Hearing Loss Conductive Problem with sound transmission through outer/middle ear. Sensorineural Problem involving inner ear/auditory nerve. Communication: * Face patient * Speak clearly * Don’t shout * Reduce background noise * Verify understanding ⸻ 🔥 14. BURNS Think: Airway → Breathing → Circulation Inhalation injury Red flags: * Facial burns * Soot * Singed nasal hairs * Hoarseness * Stridor * Carbonaceous sputum Airway edema can worsen rapidly. ⸻ Burn priorities * Airway * Breathing * Circulation * Fluid resuscitation for significant burns * Pain management * Infection prevention * Temperature control * Nutrition * Wound care ⸻ 15. WOMEN’S & MEN’S HEALTH Menopause Decrease in estrogen. Common: * Hot flashes * Night sweats * Sleep problems * Vaginal dryness * Mood changes Long-term: * Bone loss * Cardiovascular considerations ⸻ Birth Control Know: * Effectiveness * How it is used * Contraindications * STI protection Most hormonal birth control does NOT protect against STIs. Condoms help reduce STI transmission. ⸻ STIs Examples: * Chlamydia * Gonorrhea * Syphilis * HPV * Herpes * HIV Nursing: * Testing * Treatment adherence * Partner notification/treatment when appropriate * Safer sex education * Prevention ⸻ Breast Cancer Warning signs: * New breast lump * Skin changes * Nipple changes/discharge * Axillary lymph node changes Know current screening recommendations and individual risk factors. ⸻ Prostate Cancer Possible: * Urinary hesitancy * Weak stream * Frequency * Hematuria Important: Early prostate cancer may have no symptoms. ⸻ 🚨 16. EMERGENCY NURSING Shock Basic concept: Tissues aren’t receiving enough oxygen/perfusion. Signs: * Tachycardia * Hypotension * Altered LOC * Cool/clammy skin in many shock states * Decreased urine output * Tachypnea Major types Hypovolemic → blood/fluid loss Cardiogenic → pump failure Distributive → vasodilation (e.g., septic/anaphylactic) Obstructive → obstruction to circulation Priority: ABCs + identify/treat cause + restore perfusion. ⸻ Hemorrhage Look for: * Tachycardia * Hypotension * Pallor * Weakness * Decreased LOC * Decreased urine output Priority: Control bleeding + support circulation + escalate. ⸻ Anaphylaxis Severe allergic reaction. Signs: * Airway swelling * Wheezing * Dyspnea * Hypotension * Hives * GI symptoms FIRST-LINE MEDICATION: IM epinephrine Do not delay epinephrine while waiting for other treatments. ⸻ 💧 17. FLUID & ELECTROLYTES Dehydration Signs: * Thirst * Dry mucous membranes * Tachycardia * Hypotension * Poor skin turgor * Decreased urine output * Weight loss ⸻ Fluid overload Signs: * Edema * Crackles * Dyspnea * Weight gain * JVD * Hypertension ⸻ Potassium Hypokalemia Think: Weak + irregular heart Causes: * Diuretics * GI losses Hyperkalemia Think: Dangerous heart rhythm Causes: * Renal failure * Tissue breakdown * Certain medications ⸻ Acid-Base Use: ROME Respiratory = Opposite Metabolic = Equal Examples: Respiratory acidosis CO₂ ↑ → pH ↓ Respiratory alkalosis CO₂ ↓ → pH ↑ Metabolic acidosis HCO₃ ↓ → pH ↓ Metabolic alkalosis HCO₃ ↑ → pH ↑ ⸻ 👶 MATERNAL-CHILD NURSING Prenatal Care Monitor: * Maternal vital signs * Weight * Blood pressure * Urine * Fetal growth * Fetal heart rate * Laboratory screening * Risk factors Important warning signs: * Vaginal bleeding * Severe headache * Visual changes * Severe abdominal pain * Fluid leakage * Decreased fetal movement * Sudden swelling/other signs of hypertensive disorders ⸻ Fetal Development High-yield concept: First trimester → organ formation Second trimester → growth and development Third trimester → maturation and preparation for birth ⸻ Labour Stage 1 Onset of true labour → complete cervical dilation. Stage 2 Complete dilation → birth of baby. Stage 3 Birth of baby → delivery of placenta. Stage 4 Immediate postpartum recovery. ⸻ Apgar At approximately 1 and 5 minutes. A P G A R A – Appearance P – Pulse G – Grimace A – Activity R – Respiration Each scored 0–2. Apgar helps assess newborn adaptation; it does not by itself diagnose asphyxia or determine long-term prognosis. ⸻ Newborn Assessment Assess: * Respiratory effort * Heart rate * Temperature * Colour * Tone * Feeding * Reflexes * Weight * Head circumference * Urine/stool ⸻ Breastfeeding Benefits: * Nutrition * Immune protection * Bonding Signs of effective feeding: * Good latch * Audible swallowing * Appropriate wet/dirty diapers * Expected weight pattern ⸻ 👶 PEDIATRIC NURSING Development General progression: Head → toe Simple → complex Large muscles → fine motor Always consider developmental stage when communicating with children. ⸻ Pediatric Safety Big priorities: * Falls * Choking * Burns * Poisoning * Drowning * Car-seat safety * Medication dosing * Safe sleep Medication principle Pediatric medications are often based on: weight (kg) Always verify calculations and concentrations. ⸻ Pediatric Asthma Same basic principles as adults: * Bronchodilator for acute symptoms * Controller medications for long-term control * Trigger avoidance * Asthma action plan ⸻ RSV Common in infants/young children. Signs: * Rhinorrhea * Cough * Wheezing * Increased work of breathing * Poor feeding Priority: Respiratory assessment and hydration. ⸻ Croup Classic: Barking cough + stridor Often worse at night. Severe respiratory distress requires urgent intervention. ⸻ Cystic Fibrosis Thick secretions affect lungs and GI system. Think: “Thick mucus + lung infections + malabsorption.” Nursing: * Airway clearance * Nutrition * Pancreatic enzymes when prescribed * High-calorie/high-protein nutrition * Infection prevention ⸻ Gastroenteritis Major concern: Dehydration. Assess: * Wet diapers/urine * Mucous membranes * Tears * Capillary refill * Weight * Activity/LOC ⸻ Pyloric Stenosis Classic: Projectile, non-bilious vomiting Often occurs in young infants. Possible: * Hunger after vomiting * Dehydration * Weight loss ⸻ ASD vs VSD ASD Hole between atria. VSD Hole between ventricles. VSD can produce: A significant murmur and increased pulmonary blood flow. ⸻ Sickle Cell Disease Problem: Abnormal hemoglobin → sickled RBCs → vaso-occlusion and hemolysis. Crisis triggers: * Dehydration * Infection * Hypoxia * Stress Management: * Hydration * Oxygen if hypoxemic * Pain management * Treat infection * Rest * Disease-specific therapies ⸻ Meningitis Think: Fever + headache + stiff neck + altered mental status May also have: * Photophobia * Vomiting * Seizures Emergency. Use appropriate isolation precautions according to suspected organism and institutional policy. ⸻ Hydrocephalus Excess CSF. Infants may have: * Increasing head circumference * Bulging fontanelle * Irritability * Poor feeding * “Sunsetting” eyes Older children: * Headache * Vomiting * Visual changes * Altered LOC ⸻ 🧠 MENTAL HEALTH NURSING Therapeutic Communication DO: * Use open-ended questions * Listen * Reflect * Clarify * Validate feelings * Maintain appropriate boundaries DON’T: * Give false reassurance * Judge * Argue * Give excessive advice * Say “everything will be fine” ⸻ Depression Symptoms: * Persistent sadness * Anhedonia * Sleep changes * Appetite changes * Fatigue * Poor concentration * Feelings of worthlessness * Suicidal thoughts Nursing priority: Assess suicide risk directly. ⸻ Bipolar Disorder Mania * Elevated/irritable mood * Increased energy * Decreased need for sleep * Rapid speech * Impulsivity * Grandiosity Nursing: * Reduce stimulation * Maintain safety * Set clear limits * Encourage nutrition/hydration * Administer medications as prescribed ⸻ Schizophrenia Positive symptoms: * Hallucinations * Delusions * Disorganized speech/behaviour Negative symptoms: * Flat affect * Social withdrawal * Reduced motivation Communication Don’t argue with delusions. Instead: Acknowledge the patient’s feelings while presenting reality. ⸻ OCD Obsessions: Intrusive thoughts Compulsions: Repetitive behaviours/mental acts ⸻ Eating Disorders Watch: * Electrolytes * Cardiac rhythm * Nutrition * Weight * Refeeding complications * Psychological safety ⸻ Substance Use Priorities: * Airway/breathing/circulation * Overdose recognition * Withdrawal * Safety * Nonjudgmental communication ⸻ 🧪 HIGH-YIELD DIAGNOSTIC TEST THINKING When you see a test question, ask: “Why are they ordering this?” Examples: CT head after sudden neurological deficit → looking for bleeding/structural abnormalities. MRI → detailed soft tissue/neurological/musculoskeletal imaging. ECG → electrical activity/ischemia/dysrhythmia. Troponin → myocardial injury. HbA1c → long-term glucose control. Creatinine/GFR → kidney function. INR → warfarin effect. Culture and sensitivity → organism + effective antimicrobial. Pulmonary function test → lung function/obstruction/restriction. ⸻ 💊 PHARMACOLOGY MASTER MEMORY MAP Instead of memorizing 100 medications individually, memorize the danger associated with each class: Drug/Class Think Insulin Hypoglycemia Opioids Respiratory depression Warfarin Bleeding + INR Heparin Bleeding + HIT Furosemide Fluid/electrolyte loss Digoxin Bradycardia/toxicity ACE inhibitors Hyperkalemia + cough/angioedema Beta blockers Bradycardia/hypotension Steroids Hyperglycemia + infection NSAIDs GI bleeding + kidney injury Statins Muscle/liver effects Bronchodilators Tachycardia/tremor Inhaled steroids Oral candidiasis Antibiotics Allergy + C. diff ⸻ 🚨 THE “PRIORITY QUESTION” METHOD When you’re stuck on an exam question, ask: 1. Is the airway threatened? If yes → AIRWAY 2. Is breathing compromised? If yes → BREATHING 3. Is circulation/perfusion compromised? If yes → CIRCULATION 4. Is there an acute neurological deterioration? Think neurological emergency. 5. Is there a safety risk? Falls, suicide, aspiration, seizures, etc. 6. Which patient is deteriorating? Unstable beats stable. ⸻ ⭐ TOP THINGS I WOULD MEMORIZE FIRST If you have limited study time, prioritize these: 🚨 Emergencies * Anaphylaxis → IM epinephrine * Stroke → BE FAST + last known well * MI → ECG + rapid intervention * Sepsis → early recognition + rapid treatment * Tension pneumothorax → emergency * Severe hypoglycemia → rapid glucose treatment * Status epilepticus → emergency * Increased ICP → neurological deterioration * Hemorrhage → control bleeding + perfusion * Severe burns → ABCs 💊 Medications * Insulin → hypoglycemia * Morphine → respiratory depression * Warfarin → INR/bleeding * Heparin → bleeding/HIT * Digoxin → pulse/potassium/toxicity * Furosemide → fluid/electrolytes * Nitroglycerin → hypotension + PDE-5 interaction * Steroids → infection/hyperglycemia * Antibiotics → allergy/C. diff * Inhaled steroids → rinse mouth 🧪 Labs * Hb → oxygen carrying * WBC → infection/immune response * Platelets → bleeding/clotting * INR → warfarin * Glucose → current sugar * HbA1c → long-term glucose * Creatinine/GFR → kidney * K⁺ → heart rhythm * Na⁺ → neurological/fluid balance * Culture → organism * Sensitivity → antibiotic choice 🩺 Nursing skills * Infection control * Medication administration * IVs * Oxygen * Suction * Tracheostomy * Chest tubes * Urinary catheter * Wound care * Ostomy care * Vital signs * Neurovascular assessment * Respiratory assessment ⸻ 📚 How I’d recommend studying this huge syllabus Don’t try to study all of these diseases in one sitting. Use system blocks: Day 1: Diabetes + cardiovascular Day 2: Respiratory + renal Day 3: GI + liver Day 4: Hematology + immune/infection Day 5: Neuro + musculoskeletal Day 6: Maternal/newborn Day 7: Pediatrics Day 8: Mental health Day 9: Pharmacology Day 10: Labs + diagnostics + clinical skills Day 11: Emergency/priority questions Day 12: Full mixed practice exam + review weak areas For each condition, make yourself answer only 5 questions: 1. What is happening? 2. What will I assess? 3. What is the biggest complication? 4. What will I do first? 5. What do I teach the patient? That approach will help you think like a nurse rather than memorize isolated facts, which matches the study framework you were given.

Primary adrenal insufficiency = problem at level of adrenal glands Causes? Addison’s disease Pathophys? Autoimmune destruction of the adrenal glands Associated with hyperpigmentation POMC is precursor to both ACTH and MSH PAI → lack of negative feedback → high ACTH Lab findings? ACTH high Aldosterone low Destruction of zona glomerulosa Renin high Hypotension → RAAS activation Electrolytes Na+ low, K+ high CBC Eosinophils high Pathophys? Glucocorticoids → eosinophil apoptosis. Lack of glucocorticoids cause eosinophilia. Dx? Cosyntropin testing → no rise in cortisol Adrenal glands aren’t working, so no response to ACTH. Tx? prednisone/hydrocortisone/dexamethasone + fludrocortisone (mineralocorticoid) Stress-dose steroids for surgery, serious illness, etc. Secondary adrenal insufficiency = problem at level of pituitary, reduced ACTH release Causes? MC is prolonged steroid use → ACTH suppression Sheehan’s syndrome (infarction of pituitary) pregnancy Pituitary tumors (ACTH-producing tumor) Lab findings? ACTH low Anterior pituitary is being inhibited Aldosterone normal Zona glomerulosa under control of RAAS system Renin normal Electrolytes Na+ & K+ unaffected (Aldosterone levels are normal) CBC Neutrophilia due to demargination (if pt was recently taking steroids) Dx? Cosyntropin testing → rise in cortisol Adrenal gland is functional Tx? Glucocorticoids Do not need to replace mineralocorticoids since adrenals are functional and aldosterone is under RAAS control Stress-dose steroids for surgery, serious illness, etc. AI with a history of nuchal rigidity and purpuric skin lesions → Waterhouse-Friedrichson syndrome Pathophys? AI 2/2 hemorrhagic infarction of the adrenal glands in the context of Neisseria meningitidis infection Adrenal synthesis enzymes If the enzyme starts with 1 → HTN (high mineralocorticoids) and hypokalemia If the second # is 1 → virilization (high androgens) E.g. 11-beta hydroxylase deficiency → HTN & virilization E.g. 21 hydroxylase deficiency → virilization only E.g. 17-alpha hydroxylase deficiency → HTN only B12 deficiency Where does B12 come from? Animal products VS folic from plants Physiology R factor in saliva binds to B12 and protects it from acidity in the stomach. R factor protector -B12 travels to the duodenum. Parietal cells produce intrinsic factor, which travels to the duodenum. Pancreatic enzymes cleave B12 from R factor and B12 then binds IF. B12-IF complex is reabsorbed in the terminal ileum Reabsorption where? Terminal ileum Causes of B12 deficiency Extreme vegan Pernicious anemia Pancreatic enzyme deficiency Cystic Fibrosis Can’t cleave B12 from R factor Crohn’s Affects terminal ileum Lab markers Homocysteine HIGH MethlyManoicAcid HIGH Presentation? Megaloblastic anemia Subacute combined degeneration (of dorsal columns + lateral corticospinal tract) Peripheral neuropathy Dx of pernicious anemia? anti-IF Ab Folate deficiency Where does folate come from? Leafy things Causes of folate deficiency Poor diet (e.g. alcoholics, elderly) Phenytoin Lab markers Homocysteine HIGH MMA normal Presentation? Megaloblastic anemia Prophylaxis in HIV+ patients CD4 < 200 → PCP TMP-SMX, inhaled pentamidine, dapsone, atovaquone CD4 < 100 → Toxoplasm Treat: TMP-SMX CD4 < 50 → MAC Treat: Azithromycin If live in endemic area, CD4 < 250 → Coccidioides Immitis E.g. Arizona, Nevada, Texas, California Treat: Itraconazole If live in endemic area, CD4 < 150 → Histoplasma Capsulatum E.g. Kentucky, Ohio, Missouri Treat: Itraconazole Diabetes insipidus Dx? Water deprivation test Measure serum osmolality & urine osmolality Deprive pt of water Remeasure serum osmolality & urine osmolality If urine osmolality doesn’t go up → suspect DI Central DI → deficiency of ADH Pathophys? Supraoptic nucleus not making enough ADH Dx? Give desmopressin → urine osmolality increases significantly Nephrogenic DI → kidneys are not responding to ADH Dx? Give desmopressin → urine osmolality doesn’t change much Tx? Hydrochlorothiazide Unless 2/2 lithium, use amiloride or triametere Causes? Lithium SSRIs Carbamazepine Demeclocycline Tx of normovolemic hypernatremia? D5W to correct free water deficit Divine says NS, but most other resources I found said correct free water deficit Tx of hypovolemic hypernatremia? Give NS first until normal volume, then give D5W Consequence of correcting hypernatremia too rapidly? Cerebral edema Osteoarthritis Presentation? Old person with joint pain that gets worse throughout the day Risk Factr? Obesity vs decreases osteoporosis Imaging findings? Joint space narrowing Subchondral sclerosis Subchondral cysts Osteophytes Arthrocentesis findings? <2000 cells Tx? 1st line acetaminophen 2nd line NSAID (e.g. naproxen) 3rd line joint replacement surgery Returned from a business conference 1 week ago + Fever + Nonproductive cough + Abdominal pain + Hyponatremia → Legionella Dx? Urine antigen Tx? FQ or macrolide MaCroLide mnemonic = Mycoplasma, Chlamydia, Legionella What are the common causes of atypical PNA? Mycoplasma, Legionella, Chlamydia MC cause? Mycoplasma CXR findings? Interstitial infiltrates HY associations C. Psittaci → birds C. Burnetii → cows, goats, sheet Mycoplasma → college student w/ walking pneumonia Midsystolic click heard best at the apex. → mitral valve prolapse “Stenosnap & Proclick” Risk Factor? Connective tissue disease Marfarn Ehlers-Danlos ADPKD bilateral renal masses Classic demographic? Young woman psychiatric Pathophys? Myxomatous degeneration MVP vs aortic dissection: cystic medial necrosis Exam maneuvers Anything that increase amount of blood in LV → murmur softer Increase preload Increase afterload Anything that decreases amount of blood in LV → murmur louder Dx? Echo Scaly, itchy skin with yellowish crusting in the winter. → seborrheic dermatitis Tx? Topical antifungals e.g. ketoconazole or selenium sulfide shampoo Classic disease distribution? Hair → e.g. cradle cap Eyebrows Episodic/intermittent HTN + HA → pheochromocytoma Genetic disease associations MEN2A MEN2B VHL in brain (hemangioma) NF-1 growth in skin Pathophys? Catecholamine-secreting tumor Location? Adrenal medulla Posterior mediastinum Organ of Zuckerkandl (chromaffin cells along the aorta) Dx? 1st step: urine metanephrines If elevated → CT abdomen If nothing found on CT → MIBG scan Tx? Alpha blocker (e.g. phenoxybenzamine, phenotaline) THEN beta blocker Most common cause of a Lower GI Bleed in the elderly → diverticulosis Dx? Colonoscopy or barium enema Recall that you acutely do a CT scan for diverticulitis, then 6 weeks later colonoscopy to r/o cancer Ppx? Eat fiber Megaloblastic anemias Blood smear findings? Hypersegmented neutrophils MCV > 100 Classic patient demographic with folate deficiency? Alcoholics Elderly person with poor nutrition Folate synthesis inhibitors Pt with molar pregnancy → methotrexate Pulmonary issue? Pulmonary fibrosis HIV+ pt with ring-enhancing lesions → pyrimethamine-sulfadiazine Pyrimethamine inhibits DHFR AIDS pt on ppx for toxo → TMP-SMX TMP inhibits DHFR Use of leucovorin? Rescue bone marrow in setting of methotrexate toxicity Mechanism? Folinic acid analog CMV presentations Esophagitis → linear ulcers Colitis → post-transplant pt Retinitis → HIV pt with CD4 < 50 Congenital CMV → periventricular calcifications + hearing loss calcifications elsewhere → toxo Histology? Owl’s eye intranuclear inclusions Tx? Gancicyclovir Resistance? UL97 kinase mutation Tx for resistance? foscarnet CD4 < 200 + severe peripheral edema + frothy urine. → FSGS in HIV pt Variant classic in HIV+ pts? Collapsing variant Tx? Steroids + cyclophosphamide + ACE-I Indinavir AE? Kidney stones triad of fever, rash, and eosinophiluria → acute interstitial nephritis Drugs cause? Penicillins Tx? Stop the drug! Can add steroids if severe Vitamin D metabolism Liver converts Vit D to calcidiol (25OH-Vit D). Calcidiol goes to kidney. Alpha-1 hydroxylase converts calcidiol to calcitriol (1,25-OH Vit D). Common causes of Vitamin D deficiency CKD → 1-alpha hydroxyalse deficiency Liver disease → can’t make calcidiol CF → malabsorption Crohn’s → malabsorption Osteomalacia vs Rickets Osteomalacia in adults Rickets in kids Tx? Calcium + vit D Lab findings? Ca++ low Phos low Low in liver disease High in kidney disease (kidneys can’t get rid of phos) PTH high (2ary hyperpara) vs liver dx PTH low Alk phos Aspiration pneumonia Risk Factor? Alcoholism Dementia Neuromuscular problems (e.g. MG, ALS) Bugs? Anaerobes foul smelling Bacteroides FUsobacterium Peptostreptococcus Klebsiella → currant jelly sputum alcoholic Tx? Clindamycin CURB-65 criteria Purpose? Who to admit Cutoff? 2+ → hospitalize C = confusion U = uremia (BUN > 20) R = RR > 30 B = BP < 90/60 Age > 65 Drugs commonly used in PNA treatment Ceftriaxone Levofloxacin fluoroquinolone Macrolides - great for atypical PNA Pharmacological management of pulmonary arterial HTN Endothelin antagonists Bosentan ambrisentan PDE-5 inhibitors Sildenafil Tadalafil Prostacyclin analogs Iloprost Epoprostenol Treprostinil Causes? Young female → idiopathic PAH Mutation? BMPR2 55 yo F presents with a 5 week history of a rash on her forehead. PE reveals scaly macules with a sandpaper texture. → actinic keratosis Risk Factor? Sun exposure Tx? Topical 5-FU Possible dangerous sequelae? Squamous cell carcinoma Most likely disease sequelae? Resolution 1ary hyperparathyroidism 2ary hyperparathyroidism 3ary hyperparathyroidism Autonomous PTH production Causes? Adenoma Parathyroid hyperplasia PTH high Ca++ high Phos low Low Ca++ → PTH production Causes? CKD PTH high Ca++ low Phos high PTH production despite normalized of Ca++ levels Causes? CKD s/p transplant PTH high Ca++ high Phos low Tx? Parathyroidectomy (remove 3.5 glands) Cinacalcet (CSR modulator) Hypercalcemia Presentation? bones, stones, groans, psychic overtones Tx? 1st step: Normal Saline Hypercalcemia of malignancy → bisphosphonates EKG finding? Shortened QT Periumbilical pain that migrates to the right lower quadrant. → appendicitis PE findings? McBurney’s point tenderness Psoas sign (flex hip pain) Obturator sign (pain with internal rotation of hip) Rovsing’s sign (palpation of LLQ → pain in RLQ) Dx? CT scan Pregnant → US Kid → US Tx? Surgery Classic drug and viral causes of aplastic anemia. Drugs? Carbamazepine Chloramphenicol Viral? Parvovirus B19 (single stranded DNA virus) Fanconi anemia Pathophys? Problems with DNA repair Fanconi anemia vs Fanconi syndrome Fanconi anemia → cytopenias + thumb anomalies + short stature + cafe-au-lait spots Fanconi syndrome → type 2 RTA (proximal) CD4 count of 94 + MRI revealing ring enhancing lesions in the cortex → toxoplasmosis Tx? Pyrimethamine-sulfadiazine Rescue agent for pt who becomes leukopenic with treatment? leucovorin Who should get steroids? Increased ICP For PCP pneumonia: O2 sat < 92 PaO2 < 70 A-a gradient > 35 Ppx? TMP-SMX for CD4 < 100 Congenital toxo Hydrocephalus Chorioretinitis Intracranial calcifications Classic methods of transmission? handling cat litter Lupus nephritis Associated autoantibody? anti-dsDNA Classic “immunologic” description? “Full house” pattern Tx? Steroids + cyclophosphamide Osteoporosis Screening population? women > 65 Screening modality? DEXA scan Dx? T-score < -2.5 Risk Factor? Postmenopauseal Low BMI Smoking Alcohol Preventive strategies? Weight bearing exercise Smoking cessation Reduce alcohol consumption Tx? 1st line: bisphosphonates + Ca/Vit D supplementation Raloxifene (SERM) Agonist in bone Blocker Antagonist in breast Classic locations of osteoporotic fractures Vertebral compression fracture Hip fracture Name the PNA Red currant jelly sputum. → Klebsiella Rust colored sputum. → Strep pneumo PNA in an alcoholic. → Klebsiella Post viral PNA with a cavitary CXR lesion. → Staph aureus PNA in a patient that has chronically been on a ventilator. → Pseudomonas MC cause of Community Acquired Pneumonia. → Strep pneumo Pharmacological management of MRSA. Vancomycin Clindamycin Linezolid Ceftaroline (5th gen cephalosporin) Tigecycline, tertracycline Pharmacological management of Pseudomonas. Ceftazidime (only 3rd gen cephalosporin) Cefepime (4th gen cephalosporin) Pip-tazo Fluoroquinolones Carbapenems Aztreonam Aminoglycosides JVD and exercise intolerance in a patient with a recent history of an URI. → dilated cardiomyopathy 2/2 viral myocarditis MC cause? Coxsackie B VS Coxsackie A: Hand foot mouth dx Drug causes myocarditis Clozapine Anthracyclines Prevention? Dexrazoxane (iron chelator) Trastuzumab reversible tx for breast cancer Classic cause in a patient with recent history of travel to S. America? Chagas T. Cruzi Potential sequelae? Achalasia Dilated cardiomyopathy Megacolon (2/2 degeneration of myenteric plexus) Massive skin sloughing (45% BSA) in a patient that was recently started on a gout medication? TEN Dx? <10% BSA → SJS >30% BSA → TEN Tx? STOP the drug IVF Topical abx to prevention infection Tetany and a prolonged QT interval in a patient with recent surgical treatment of follicular thyroid carcinoma. → hypocalcemia due to removal of parathyroids Recurrent viral infections + QT prolongation + tetany → DiGeorge syndrome Pathophys? Failure of development of 3rd/4th pharyngeal pouches Trousseau and Chvostek signs. Trousseau → inflation of BP cuff causes carpopedal spasm Chvostek → taping on cheek causes facial muscle spasm Hypocalcemia that is refractory to repletion → consider hypomagnesemia Electrolyte/drug causes of prolonged QT intervals Electrolytes? Hypocalcemia Hypomagnesemia Hypokalemia Drugs? Macrolides FloroQunlones Haloperidol Ondensatron Methadone Hypoalbuminemia and Ca balance Hypoalbumenia → decrease in total body Ca++, no change in ionized Ca++ Drop of 1 in albumin → add 0.8 to Ca++ Abdominal pain radiating to the back → acute pancreatitis Causes? #1 = Gallstones #2 = Alcohol Hypertriglyceridemia Hypercalcemia Scorpion sting Handlebar injuries Lab markers? Lipase - most sensitive Amylase Physical exam signs in pancreatitis. Cullen’s sign = periumbilical ecchymosis Grey Turner sign = flank ecchymosis Tx? NPO + IVF + pain control Meperidine is a good agent because it doesn’t cause sphincter of Oddi spasms Management of gallstone pancreatitis Dx? US then ERCP Tx? DELAYED cholecystectomy What if the patient becomes severely hypoxic with a CXR revealing a “white out” lung? ARDS noncardiogenic pulm edema PCWP? <18 mmHg NORMAL 20 yo M with red urine in the morning + hepatic vein thrombosis + CBC findings of hemolytic anemia. → paroxysmal nocturnal hemoglobinuria Pathophys? Defect in GPI anchors, which attach CD55 and CD59 to cell (they prevent complement from destroying RBC) Sleep → hypoventilation → mild respiratory acidosis → activation of complement cascade Gene mutation? PIGA Dx? Flow cytometry Tx? Eculizumab (terminal complement inhibitor) Vaccine required? pnemococal Neisseria meningitidis Chronic diarrhea and malabsorption in a HIV+ patient + detection of acid fast oocysts in stool. → cryptosporidium parvum Acid-fast organisms Cryptosporidium TB MAC Nocardia Dx? Stool O&P Tx? Nitazoxanide Route of transmission? Contaminated water Muddy brown casts on urinalysis in a patient with recent CT contrast administration (or Gentamicin administration for a life threatening gram -ve infection) → Acute Tubular Necrosis Woman with morning joint stiffness > 1 hr → Rhematoid Arthritis. Antibodies? Rheum Factor (IgM against IgG) anti-CCP - more specific HLA? DR4 Pathophys? IgM constant region activates complement → inflammation → formation of pannus (hypertrophied synovium) → damage to cartilage and bone Caplan syndrome = RA + pneumoconiosis Felty syndrome = RA + neutropenia + splenomegaly (“RANS”) Classic hand/finger findings/distribution? MCP & PIP joints of hands (DIP joints spared) Imaging findings? Symmetric joint space narrowing Tx? Methotrexate (DMARDs) If no response → TNF alpha inhibitor (e.g. infliximab) Required testing prior to starting methotrexate? PFTs Required testing prior to starting infliximab? TB Hep B/Hep C Differentiating Strep pharyngitis from Infectious Mononucleosis LND distribution Anterior cervical → Strep Posterior cervical → Mono Disease onset Acute → Strep Over weeks → Mono Organ involvement Splenomegaly → Mono Pt with sore throat takes amoxicillin and gets rash → mono NOT allergic rxn! CENTOR criteria C = absence of Cough E = tonsillar Exudates N = nodes/anterior cervical lymphadenopathy T = temp (fever) OR <15 → +1 >=45 → -1 Using CENTOR score 0/1 → don’t test, don’t treat 2/3 → rapid antigen test Positive → treat Negative → throat culture 4/5 → treat empirically Tx of Strep pharyngitis? Amoxillcin If PCN allergic → azithromycin Potential sequelae of Strep pharyngitis RF - preventable with abx PSGN Endocarditis MC cause of endocarditis? IVDU Bug? Staph aureus Valve? tricuspid Prosthetic valve endocarditis Bug? Staph epidermidis Endocarditis after dental procedure? Viridans group streptococci Strep viridans, Strep mitis, Strep mutans, Strep sanguineous Patient with malar rash and echo showing vegetations on both sides of the mitral valve → Libman-Sacks endocarditis Presentation? Fever + night sweats + new murmur Splinter hemorrhages Roth spots (retinal hemorrhages) Painless Janeway lesions + painful Osler nodes (immune phenomenon) Dx? 1st step: blood cultures TEE Tx? Abx that include Staph aureus coverage (e.g. vancomycin) for WEEKS Bugs implicated in culture negative endocarditis HACEK H = haemophilus A = actinobacillus C = cardiobacterium E = eikenella K = kingella Coxiella burnetii Blood cultures in a patient with endocarditis reveal S. Bovis (or S. Gallolyticus bacteremia). NBS? Colonoscopy Who needs antibiotic prophylaxis? Hx endocarditis Prosthetic valve Unrepaired cyanotic congenital dz Heart transplant with valve dysfunction Erythematous salmon colored patch with silvery scale on the elbows and knees. → psoriasis Tx? Topical steroids If this patient presents with joint pain (especially in the fingers)? Psoriatic arthritis Imaging? Pencil-and-cup deformity Tx? NSAIDs T of 104 + tachycardia + new onset Afib in a patient with a history of Graves disease. → thyroid storm Lab findings? TSH low T3/T4 high Tx? 1st step: propranolol 2nd step: PTU Then: Prednisone Potassium iodide (Lugul’s solution) Wolff-Chaikoff effect → large amounts of iodine inhibit thyroid hormone synthesis Biopsy revealing tennis racket shaped structures in cells of immune origin. → Langerhans cell histiocytosis Electron microscopy? Birbeck granules (tennis rackets) Marker? S100 Small bowel obstruction in a HIV patient with purple macules on the face, arms, and lower extremities. → Kaposi’s sarcoma Bug? HHV8 Tx? HAART Pathophys of vascular lesions? Overexpression of VEGF Fever + rash + eosinophiluria 10 days after a patient started an antistaphylococcal penicillin. → acute interstitial nephritis Tx? STOP drug + steroids SLE SOAP BRAIN MD S = serositis O = oral ulcers A = arthritis P = photosensitivity B = blood disorders (cytopenias) R = renal A = ANA/anti-dsDNA I = immunologic N = neurologic findings M = malar rash D = discoid rash Type 2 vs 3 HSRs in lupus Type 2 → cytopenias Type 3 → all other manifestations Lupus Ab? ANA anti-dsDNA anti-Smith Lupus nephritis → full house pattern on IF Antiphospholipid antibody syndrome → recurrent pregnancy losses Pathophys? Thrombosis of the uteroplacental arteries. MC cause of death in lupus patients? What I’ve read recently: CV disease Per Divine: Treated → infection Untreated → renal dz Also 40x risk MI Endocarditis in lupus pt? Libman-Sacks endocarditis Neonatal 3rd degree heart block → neonatal lupus Maternal autoimmune dz? Sjogren’s SLE Ab? anti-SSA/anti-Ro anti-SSB/anti-La Tx? Steroids Cyclophosphamide Hydroxychloroquine → good for skin lesions Pulmonary abscesses Bugs? Staph Anaerobes Klebsiella RF? Alcoholism Elderly Post-viral pneumonia MC location of aspiration pneumonia? Superior segment of RLL Chest pain worsened by deep inspiration and relieved by sitting up in a patient with a recent MI or elevated creatinine or URI or RA/SLE. → pericarditis EKG findings? Diffuse ST elevations + PR depression PE finding? Friction rub (“scratchy sound on auscultation”) A few days after MI → fibrinous pericarditis Weeks after MI → Dressler’s Tx? NSAIDS Consider adding on colchicine Cardiac tamponade Beck’s triad = hypotension + JVD + muffled heart sounds EKG findings? Electrical alternans Type of shock? Obstructive cardiogenic (Amboss) CO low SVR high PCWP high Tx? Pericardiocentesis or pericardial Pearly lesion with telangiectasias on the ear in a farmer. → Basal Cell Carcinoma MC type skin cancer Location? Upper lip Dx? Biopsy Tx? Mohs surgery Cold intolerance in a 35 yo white F → hypothyroidism MC cause? Hashimoto’s Histology? lymphoid follicles w/ active germinal centers Lab findings? TSH high T3/T4 low Ab? anti-TPO Anti-thyroglobulin HLA? DR3/DR5 Tx? Levothyroxine Future complication? thyroid lymphoma Massive hematemesis in a patient with a history of chronic liver disease. → ruptured varices Pathophys? L gastric vein has anastomosis with azygos veins. Increased portal pressure → backward flow from L gastric veins to azygous vein (which empties into SVC). Acute tx? IVF + octreotide + ceftriaxone/cipro + EGD w/ ligation/banding Do NOT give a beta blocker for acute tx Prophalaxsis? Beta blocker + spironolactone Other manifestations of elevated portal pressures Caput medusa Internal hemorrhoids Tx for cirrhotic coagulopathies? FFP If uremia → give desmopressin Note: Desmopressin = ADH analog → so, it can cause AE of hyponatremia 2/2 SIADH Hemophilia A Pathophys? deficiency of factor 8 Inheritance? XLR Coag labs? Bleeding time normal PTT HIGH b/c clotting problem PT normal Hemophilia B Pathophys? deficiency of factor 9 Inheritance? XLR Coag labs? Bleeding time normal PTT HIGH PT normal Hemophilia C Pathophys? deficiency of factor 11 Inheritance? AR Coag labs? Bleeding time normal PTT HIGH PT normal Bernard Soulier Syndrome Pathophys? Deficiency of GpIb Coag labs? Bleeding time HIGH PTT normal PT normal Glanzmann Thrombasthenia Pathophys? Deficiency of GpIIbIIIa Coag labs? Bleeding time HIGH PTT normal PT normal Von Willebrand’s disease Pathophys? Deficiency of vWF Inheritance? AD Coag labs? Bleeding time HIGH PTT HIGH vWF is a protecting group for factor 8 PT normal ITP Pathophys? Ab against GpIIbIIIa Classic pt? Pt with SLE Tx? Observation Steroids IVIG Splenectomy TTP Pathophys? Deficiency in ADAMTS13 enzyme → cannot cleave vWF multimers → activation of platelets → thrombosis → thrombocytopenia Presentation? microangiopathic hemolytic anemia + thrombocytopenia + renal failure + fever + neurologic problems Tx? Plasma exchange transfusion****** HUS Bugs? Shigella or E. coli O157:H7 Presentation? Fever+ microangiopathic hemolytic anemia + thrombocytopenia + renal failure + neurologic Platelet deficiency vs coagulation factor bleeds Platelet deficiency → mucosal bleeds, petechiae, heavy menses Coag factor deficiency bleeds → hemarthrosis Why do patients with CKD develop coagulopathy? Uremia → platelet dysfunction Tx? Desmopressin Note: Desmopressin = ADH analog → so, it can cause AE of hyponatremia 2/2 SIADH Exercising caution with transfusion in patients with Bernard Soulier syndrome Do NOT give transfusion that includes platelets They can have an anaphylactic rxn to GpIb (since they don’t have GpIb) Oropharyngeal candidiasis. RF? HIV Chronic ICS use TNF inhibitor Micro finding? Germ tubes at 37 C Tx oral candidiasis? Nystatin swish-and-swallow Tx invasive candidiasis? Amphotericin B Prevention of Amphotericin B toxicity? Liposomal formulation Pleural effusions Light’s criteria (must meet all 3 to be considered transudative!) LDH < 2/3 ULN LOW Pleural LDH/serum LDH < 0.6 LOW Pleural protein/serum protein < 0.5 LOW Causes of transudative effusion CHF Cirrhosis Nephrotic syndrome Note: Per UW 2021: Mechanism of transudate effusion? Decreased pulmonary artery oncotic pressure, e.g. hypoalbuminemia in nephrotic syndrome Increased pulmonary capillary hydrostatic pressure, e.g. volume overload in heart failure Causes of exudative effusion Malignancy Cancer Parapneumonic effusion Tb Note: Per UW 2021: Mechanism of exudate effusion? Inflammatory increased in vascular permeability of membrane (increased flow of interstitial edema into pleural space) Unique cause of both transudative & exudative effusions? PE Classic Pleural Effusion findings? Decreased breath sounds Dullness to percussion Decreased tactile fremitus Tx? Chest tube Chylothorax = lymph in the pleural space Pathophys? Obstruction of thoracic duct or injury to the thoracic duct Pleural fluid findings? High Triglycerides Holosystolic murmur heard best at the apex with radiation to the axilla in a patient with a recent MI. → mitral regurg 2/2 papillary muscle rupture Dx? Echo Why widely split S2? Aortic valve is closing earlier (LV is emptying into both aorta & LA) Maneuvers that increase intensity Increase preload (putting more blood in that can be regurgitated) Increase afterload Decubitus ulcers RF? Elderly Paraplegic Fecal/urinary incontinence Poor nutrition Staging Stage 1 = non-blanchable erythema Tx? Repositioning q2hrs Stage 2 = loss of epidermis + partial loss of dermis Tx? Occlusive dressing superficial Stage 3 = involves entire dermis, extending to subQ fat Does NOT extend past fascia Tx? Surgical debridement Stage 4 = muscle/tendon/bose exposed Tx? Surgical debridement General tx strategies? Repositioning + good nutritional support Marjolin’s ulcer = non-healing wound that is actually squamous cell carcinoma T1DM Pathophys? Autoimmune destruction of pancreas Ab? anti-GAD 65 (glutamic acid decarboxylase) anti-IA2 (islet tyrosine phosphatase 2) Islet cell autoantibodies Insulin autoantibodies Dx? A1c > 6.5% (twice) Fasting BG >= 126 (twice) Oral glucose tolerance test >= 200 (twice) Sxs of DM + random glucose > 200 Tx? Long-acting insulin + mealtime insulin Long-acting Glargine Detemir Rapid-acting Lispro Aspart Glulisine 3 HY complications Nephropathy Retinopathy & cataracts Neuropathy Chronic DM care A1c q3 months Foot exam annually Eye exam annually Microalbumin:Cr ratio annually Nephroprotection in DM? ACE-I GI bleed algorithm 1st step: ABCs + 2 large-bore IVs + IVFs 2nd step: NG lavage Clear fluid → go deeper Blood → UGIB → upper endoscopy Bilious fluid → have ruled out UGIB → proceed to colonoscopy See source → intervene as needed See nothing → CT angiography for large bleed Tagged RBC scan for smaller bleed Antiplatelet Pharmacology Aspirin Mechanism? Irreversibly inhibits COX-1 and COX-2 Clopidogrel/ticlopidine = P2Y12 (ADP receptor) blockers Mechanism? Inhibit platelet activation Abciximab/eptifibatide/tirofiban = GpIIbIIIa receptor blockers Mechanism? Inhibit platelet aggregation Ristocetin cofactor assay Issues with adhesion step → abnormal result Abnormal ristocetin cofactor assays: Von Willebrand disease Bernard Soulier disease Normal ristocetin cofactor assay: Glanzmann Thrombasthenia Von Willebrand disease effects on PTT? Increased Pathophys? vWF is a protecting group for Factor 8. Treatment of VWD? Desmopressin Mechanism? Increases release of vWF from Weibel-Palade bodies of endothelial cells Note: Desmopressin = ADH analog → so, it can cause AE of hyponatremia 2/2 SIADH HSV1 vs HSV2. Oral herpes → HSV1 Genital herpes → HSV2 Dx? PCR (most up-to-date) Tzanck smear (outdated, not very sensitive, nonspecific) → intranuclear inclusions Brain area affected by HSV encephalitis? Temporal lobes CSF findings in HSV encephalitis? RBCs******* Tx herpes encephalitis? Acyclovir AE? Crystal nephropathy Can’t see, can’t pee, can’t climb a tree. → reactive arthritis HLA? B27 Classic bug? Chlamydia Tx? steroids Need abx? Only if ongoing infection Can’t see, can’t pee, can’t hear a bee → Alport syndrome Inheritance? X-linked dominant Tx of NG & CT NG → treat empirically for both → ceftriaxone + azithro/doxy CT → azithro/doxy Hypovolemic Septic Neurogenic Cardiogenic CO low PCWP low SVR high*** CO high PCWP normal SVR low Tx? norepi CO low SVR low CO low PCWP high*** SVR high*** Tx anaphylactic shock? epinephrine Melanomas ABCDE A = asymmetry B = irregular borders C = color variation D = diameter > 6 mm E = evolving Dx? Full-thickness biopsy Excisional for small lesions Punch for larger lesions Most important prognostic factor → Breslow depth DM pharmacology Lactic acidosis → metformin Decreases hepatic gluconeogenesis → metformin Hold before CT w/ contrast → metformin Weight gain → sulfonylureas & TZDs (-glitizones) Diarrhea → acarbose & migliton Inhibits disaccharidases (can’t reabsorb disaccharides) Recurrent UTIs → SGLT-2 inhibitors Weight loss → GLP-1 agonists (e.g. liraglutide, exenatide) & DPP4 inhibitors (-gliptins) Contraindicated in pt with HF → TZDs PPAR-gamma receptor found in kidney → water retention Contraindication in pt with MTC → GLP-1 agonists Biggest risk of hypoglycemia? Sulfonylureas RF esophageal adenocarcinoma Barrett’s esophagus RF esophageal squamous cell carcinoma Smoking Drinking Achalasia Location esophageal adenocarcinoma? Lower 1/3 Location esophageal squamous cell carcinoma? Upper 2/3 MC US? Adenocarcinoma MC worldwide? Squamous cell carcinoma Presentation? Dysphagia to solids → dysphagia to liquids Dx? EGD Staging? CT scan or esophageal US Factor V Leiden Pathophys? Resistance to protein C Dx? Activated Protein C resistance assay Patient needs super large doses of heparin to record any changes in PTT → AT-III deficiency Recall that heparin is a AT-III activator 35 yo with a hypercoagulable disorder that does not correct with mixing studies. → antiphospholipid antibody disorder Anaphylaxis in a patient with a long history of Hemophilia A → Ab against factor 8 that cause type 1 HSR with transfusion Hx of hemophilia, diagnosed 5 years ago. Before you would give them factor 8 concentrate and PTT would normalize. Now they’re requirizing larger doses of factor 8 to normalize PTT. → inhibitor formation (antibodies against clotting factors) Skin necrosis with Warfarin → protein C/S deficiency Prothrombin G20210 mutation → overproduction of factor II Rash in dermatomal distribution → VZV infection Contraindications to VZV vaccination? Pregnant woman Kid < 1 year Severe immunosuppression (e.g. HIV with CD4 < 200) Tx? Acyclovir If resistant, foscarnet Tzanck smear findings? Intranuclear inclusions Shingles vaccination guidelines? Adults over 60 #1 cause of ESRD in the US → DM nephropathy Histology? Kimmelsteil-Wilson nodules #2 cause of ESRD in the US → hypertensive nephropathy Pt with BP 240/150. How fast should you lower BP? 25% in first 24 hrs Drugs for hypertensive emergencies? Nicardipine Clevidipine Nitroprusside AE? Cyanide poisoning Tx? Amyl nitrate + thiosulfate OR hydroxocobalamin Labelol Renal protective medications in patients with DKD or hypertensive nephropathy? ACE-I Anemia + Cranial Nerve deficits + Thick bones + Carbonic Anhydrase 2 deficiency + Increased TRAP + Increased Alkaline Phosphatase. → osteopetrosis Pathophys? Carbonic anhydrase is defective → osteoclasts cannot produce acid to resorb bone Tx? IFN-gamma Osteoclasts are a specialized macrophage IFN-gamma is an activator of macrophages Clinical diagnostic criteria for Chronic Bronchitis Diagnostic criteria? 2 years 3 months/year of chronic cough PFT findings FEV1 low FEV1/FVC ratio low RV high TLC high Which PFT market can differentiate CB from emphysema? DLCO DLCO normal → CB DLCO low → emphysema ****** Tx acute exacerbation? Abx + bronchodilators + corticosteroids (“ABCs”) Prevention? Stop smoking! Afib #1 RF? Mitral stenosis #1 RF MS? Rheumatic fever #1 RF CAD and AAA: smoking #1 RF stroke and aortic dissection: HTN MC arrhythmia in hyperthyroidism → Afib MC site of ectopic foci in Afib → pulmonary veins EKG findings? “Irregularly irregular” + no P waves Location of emboli formation? LA appendage Who should be cardioverted back to sinus rhythm? New onset (<48 hrs) Afib Anticoagulated for 3 weeks + TEE negative for clot Afib that’s refractory to medical therapy Afib & HDUS Q on T phenomenon? Depolarization during T wave (repolarization) can cause QT prolongation → Torsades → death Prevention? SYNCHRONIZED cardioversion Tx? Rate control Beta blockers ND-CCB (e.g. verapamil, diltiazem) Rhythmic control Amiodarone Reducing stroke risk in Afib? Anticoagulation for CHA2DS2VASc score >= 2 Anticoagulation options Valvular cause (e.g. MS) → warfarin Any other cause → warfarin or NOAC (apixiban) Reversal of AC Warfarin → Vit K, four-factor PCC Heparin → protamine sulfate Dabigatran → idarucizumab Crusty, scaly, ulcerating lesion with heaped up borders → squamous cell carcinoma Classic location? Below Lower lip Precursor lesion? Actinic keratosis What if it arises in a scar or chronic wound? Marjolin ulcer Hypothermia + hypercapnia + non pitting edema + hyponatremia + HR of 35 + hypotension in a patient with a history of papillary thyroid cancer → myxedema coma Tx? Levothyroxine + steroids Lab findings? TSH high T3/T4 low LDL high Acute onset “dermatologic” breakout in a patient with a recent history of weight loss and epigastric pain. → Leser–Trélat sign associated with visceral malignancy pancreatic cancer Lymph node associations Supraclavicular → Virchow’s node Periumbilical → Sister Mary Joseph What are mets to the ovaries called? Kruckenberg tumor Classic bug associated with gastric cancer? H. pylori (MALToma) Classic histological finding in the diffuse type of gastric cancer? Signet ring cells RBCs without central pallor + elevated MCHC + anemia. → hereditary spherocytosis Inheritance? AD Pathophys? Deficiency of spectrin, ankyrin, or band 3.2 Intravascular or extravascular hemolysis? Extravascular (RBCs bound by IgG, attacked by splenic macrophages) Dx? Osmotic fragility test Eosin-5-maleimide Acidified glycerol lysis test Tx? Splenectomy Post-splenectomy preventative care? Strep pneumo Hinflue vaccine Neisseria Septic shock Hemodynamic parameters CO high SVR low PCWP normal MvO2 high Tx? IVF + norepi + broad-spectrum abx (cover MRSA + Pseudomonas) E.g. vanc + pip-tazo E.g