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Skip to main content CloseBlackboard Learn NOMTHANDAZO DLADLA Activity Courses Calendar Messages Grades Tools Sign Out Privacy Terms Accessibility Menu Courses Skip to main content 2025_SOCIAL INTELLIGENCE 1 Course Faculty Ms. LINDI MANDA Instructor Details & Actions Course Description View the course description Progress Tracking On Class Collaborate Join session Attendance View your attendance Books & Tools View course & institution tools Course Content × LEARNING UNIT 1: INTRODUCTION TO SOCIAL INTELLIGENCE People cannot, not connect Introduction The Social intelligence (SI) study is geared towards equipping learners to acquire the ability to cope well with others and sharpen their interpersonal practical skills (situational awareness, presence, authenticity, clarity and empathy [S.P.A.C.E.]) in order to succeed effectively in various settings (Albrecht 1930). The holistic model - S.P.A.C.E. used in this study is for outlining, determining, and advancing SI at personal level, and it‘s shared to offer guidelines on using it as an effective diagnostic formula and developmental tool for professional and personal success. This is customized from Karl Albrecht‘s work on Social Intelligence. S.P.A.C.E. – As a different kind of smart refers to: S – Situational awareness: knowledge of, attentive to and wise about various contexts and the stimuli they exert and the reactions that arise from such stimuli P - Presence: the manner in which a person affects individuals or groups through physical appearance, mood and demeanour, and body language and how he/she occupies space in an environment A – Authenticity: honesty and sincerity C – Clarity: ability to express one‘s thoughts, opinions, ideas, and intentions clearly; comprehension of the power of languages as a medium of thought and expression; and to use language in ways that meet their needs E – Empathy: ability to be truly aware and considerate of other peoples by tuning their feelings to those of the affected persons. Some questions that arise out of all this are: 1. Where does the concept of social intelligence fit into the field of engineering? 2. How does it apply in an engineer‘s job? 3. How does it apply to the way people work together? 4. Does it apply to the way teams accomplish their missions, to the way employees serve clients, and/or the ways in which bosses and employees interact? 5. Does it apply more broadly across the ―society‖ that exists in every established organization? This module consists of the two parts: Topic 1: Introduction to Social Intelligence It offers a theoretical background to social intelligence in general Topic 2: Social Intelligence and Engineering A discussion of social intelligence broadly built around interactive activities for students to develop the relevant 21st century graduate‘s skills. Introduction to Social Intelligence While you‘re born with your own intelligence or IQ, Social Intelligence is mostly learned. It is considered as the capacity to know oneself, others and things around them. SI develops from experience with others and learning from occurrences, mishaps and successes in social settings. Simply, social intelligence can be regarded as what‘s known as ―tact‖ or ―common sense‖ or even ―street marts.‖ While societies put a huge focus on book smarts and IQ, what‘s often overlooked is that, people‘s lives are largely influenced by their relationships with one another. Mistakenly, many still believe that a measurement of one‘s smartness is through books. Contrary, research has revealed that true intelligence isn‘t only about books smart but also about street smarts. Along with this; it has also been determined that building strong social relationships is worth the effort because of various benefits including the following: · Good relationships are effective for a person because they help to boost their immune system and therefore, assist in combating diseases. · Whenever one has healthy relationships, they will always have to talk to and so, help them deal with major sources of stress, health problems and depression which can be associated to loneliness and poor relationships. · Individuals‘ daily lives are affected by the relationships they have with their significant others, such as boyfriends, spouse, children, parents, colleagues and friends. There are various perspectives on social intelligence and two dominant views are of psychometric and personality, of which are contrary on many crucial points, such as comparative assessment of individuals, but they later agree in recent work on the development of social intelligence (for reviews, see Greenspan, 1979; Greenspan, 1997). Nevertheless, that is beyond the scope of this module. Here, the concentration is on helping students develop as possible as they can, rather than turning them into SI‘s experts. 1.1 The Nature of Social Intelligence The origin of its definition is traced back in 1920 to the psychologist, Edward Thorndike who claimed that it is ―the ability to understand and manage men and women and girls, to act wisely in human relations.‖ Later in the 1930s Moss and Hunt argued that social intelligence is ―the ability to get along with others.‖ Along with this, Vernon in 1930s also described it as being ―reflected in the general ability to get along with people in general, social technique or ease in society, knowledge of social matters and susceptibility to stimuli from other members of a group, as well as insight into the temporary moods or underlying personality traits of strangers.‖ Thus, according to these authors, social intelligence bears both the cognitive features (the ability to understand people) and practical features (ability to deal with and respond towards them). However, social intelligence is often confused with various intelligences such as emotional intelligence, collective intelligence or group intelligence. Perhaps, this influenced the follow up work by Gardner in the 1980s which looked at the model of multiple intelligences with intrapersonal and interpersonal as part of them. Accordingly, he argued that ―social intelligence allows people to take advantage of the resources of others. We are finding that much of people‘s effective intelligence is, in a sense, outside the brain. This means, you can use intelligence for other people, if you know how to reach it and how to use it. Therefore, the best strategy is to mobilize other people around you.‖ Gardner purported that interpersonal intelligence covers the ability to read other people‘s moods, motives and other mental states; and intrapersonal includes the ability to access and assess one‘s own feelings and to draw on them to guide behaviour. He also viewed as the basis of emotional intelligence (EI) with a greater focus on cognition and understanding than feeling. According to Ford and Tisak, social intelligence (SI) has both convergent and divergent validity, as a better predictor of behavioural measure of social effectiveness than academic intelligence. A glaring common agreement is that SI is the ability to effectively plan and direct complicated social relationships and social realities in various environments. Honeywill suggests that it can also be regarded as is ―an aggregated measure of self and social-awareness, evolved social beliefs and attitudes and a capacity and appetite to manage complex social change.‖ Along this, Nicholas Humphrey claimed that SI defines human beings more than quantitative intelligence. In support, Gerdner indicated that SI is equivalent to interpersonal intelligence and also closely related to theory of mind. Combined proponents of SI agreed that it is distinct from general intelligence and may serve as a better predictor of behaviour. According to Zaccaro et al (1990) socially-intelligent individuals are aware of the social situation, including the problems and needs of others (social perceptiveness). They are also able to behave appropriately for different social situations (behavioral flexibility). Thus, these aspects can be seen through a) Social understanding and b) Situational-appropriate behaviour. Along with this, Kosmitzki and John described a socially intelligent person as the one who: · Understands people‘s thoughts, feelings and intentions well; · Is good at dealing with people; · Has extensive knowledge of the rules and norms in human relations; · Is good at taking the perspective of other people; · Adapts well in social situations; · Is warm and caring; and · Is open to new experiences, ideas and values. While embracing social intelligence, Salovey and Mayer in their work considered emotional intelligence as a part of social intelligence. According to them, it includes the ability to monitor feelings and emotions of themselves and others. It is the ability to distinguish between signals and use this information to manage thoughts and actions of others. Social intelligence is the ability to use emotional intelligence in social situations. It incorporates interaction with others and readiness to estimate the social situation around. However, Boyatzis and Sala purported that the problem in calling Social Intelligence as ‗intelligence‘ was to test it on the criteria of ‗intelligence‘. These researchers highlighted that, it had to be classified as an ‗intelligence‘, a concept should be: 1. Behaviourally observable 2. Related to biological and in particular neural-endocrine functioning. That is, each cluster should be differentiated as to the type of neural circuitry and endocrine system involved 3. Related to life and job outcomes 4. Sufficiently different from other personality constructs so that the concept adds value to understanding the human personality and behaviour 5. The measures of the concept, as a psychological construct, should satisfy the basic criteria for a sound measure, that is show convergent and discriminant validity. Accordingly, Goleman addressed this call by looking through biological research and focused on the neural endocrine functioning regards social intelligence. As a result, in his work he highlights that social intelligence is explains in terms of neurology and this fulfils Boyatsi‘s and Sala‘s need for social intelligence to qualify as an intelligence. Additionally, Albrecht expanded the research on multiple intelligences and identified that human beings have six basic dimension of intelligence. Among these, social intelligence is one of them, defined as ―Interacting successfully with others in various contexts‖, with a close term Emotional Intelligence defined as ―Self-insight and the ability to regulate or manage one‘s reactions to experience‖. In addition, Seal et al claimed that the term was defined as the behavioural manifestations of the interpersonal awareness of others‘ emotions, needs, thoughts, and perceptions as well as navigate the larger social environment and working with others. Goleman (2006) and Boyatzis and Goleman (2006) reclassified their array of competencies and clusters into two distinct aspects. The interpersonal clusters (social awareness and relationship management) were relabeled social intelligence (SI) competencies; and the intrapersonal clusters (self-awareness and self- management) were relabeled emotional intelligence(EI) competencies. The new term, emotional and social intelligence (ESI) helps to differentiate the behavioral manifestations of the intrapersonal awareness and management of emotions within the self (EI) from the behavioral manifestations of the interpersonal awareness of others’ emotions, needs, thoughts, and perceptions as well as navigate the larger social environment and working with others (SI). This integrated concept of ESI offers more than a convenient framework for describing human dispositions—it offers a theoretical structure for the organization of personality and linking it to a theory of action and job performance. This helped it get positioned as a competency as well. As, according to Boyatzis, a competency is an ―underlying characteristic of the person that leads to or causes effective or superior performance‖ therefore, an ESI competency got defined as an ability to recognize, understand, and use emotional information about oneself (EI) or others(SI) that leads to or causes effective or superior performance. The correlation of social and emotional intelligence approach is clearly reflected by Bar-On, who uses the concept of emotional and social intelligence. This model includes set of interrelated emotional and social competencies that determine how effectively we understand and express ourselves, how we understand and get along with other people and how we handle daily activities. In practice, they can complement each other as they complement to the abstract intelligence. Human being is a solid personality whose career is hardly separable from personal or family life. Emotional intelligence is essential for human life, because it helps to perceive, understand and manage emotions. It represents a personal, natural wisdom that allows him to live life joyfully, to overcome and solve everyday problems and achieve success. Social intelligence is the ability to relate to people, perceive social situations and properly interpret them and react accordingly. It is the ability to create harmonious interpersonal relationships and the ability to solve conflicts. One component cannot exist without the other. This definition can be elaborated to ―how people handle themselves and their relationships‖, according to Goleman, Boyatzis, & McKee. So, ESI is a set of competencies, or abilities, organized along two distinct aspect (emotional and social) in how a person: (a) is aware of himself/herself; (b) manages him/herself; (c) is aware of others; and (d) manages his/her relationships with others. Building upon and integrating the competency research, Goleman, Boyatzis, and McKee presented a model of ESI with 18 competencies arrayed in four clusters and two aspects. Researcher Shaun identified socially intelligent people as: · They have confidence in social circumstances. · They have and demonstrate a genuine interest in their fellow beings. · They are capable of adapting, understanding and responding effectively. · They express their emotions and feelings clearly and appropriately with assertiveness. · They have an awareness of the internal and external locus of control. Karl Albrecht, around 2009, elaborated the five major dimensions of social intelligence as situational radar, presence/bearing, authenticity, clarity and empathy (can be seen as an acronym SPACE). 1. Situational Radar (Awareness): the ability to read situations, understand the social context and choose behavioral strategies that are most likely to be successful 2. Presence: the external sense of one‘s self that others perceive: confidence, bearing self- respect, and self-worth. 3. Authenticity: the opposite of being phony. Authenticity is a way of behaving which engenders a perception that one is honest with one‘s self as well as others. 4. Clarity: the ability to express one‘s self clearly, use language effectively, explain concepts clearly, and persuade with ideas. 5. Empathy: the ability to create a sense of connectedness with others; to get them on your wavelength and invite them to move with and toward you. In that decade, the consistent aspects of social intelligence among all researches were: the knowledge of the social situations, accurate interpretation of the social situation and the skills to behave appropriately in that social situation. Hopkins and Bilimoria opined that to be considered socially intelligent one has to be good at human relationships. Crowne defined it as the ability to interact effectively with others in any social situation. Emmerling and Boyatzis describe social intelligence competency as the ability to be aware of, understand and act on emotional information about others that leads to effective performance. Thus, what was proposed by Thorndike during the first half of the 1900s was initially perceived similarly as a single concept by fellow researchers. However, later others began to see social intelligence as a set of two personal intelligences, divided into interpersonal and intrapersonal intelligences that include knowledge about oneself and others. Many scholars proposed a number of different ways to be socially intelligent. It has been thought of as the ability to accomplish interpersonal tasks and to act wisely in relationships. It has been seen as a capability that allows one to produce adequate behaviour for the purpose of achieving a desired goal. It is thought that SI involves being intelligent in relationships. Some researchers even believed that the social facets of intelligence may be as important as the cognitive aspects. However, most of them agreed that the Social Intelligence includes knowledge of the social situations and the skill to perceive and interpret the situations accurately, for leading one to successfully behave in the situation. In other words, it has always been seen as an ability to interact effectively with others. In an important research, Süd, Weis, & Seidel focused on more of a potential-based concept of SI, rather than behavior-based approaches and the broader concept of social competence (i.e., including both cognitive and non-cognitive abilities and skills). In the potential-based approach, SI encompasses only the cognitive abilities as necessary prerequisites for social competent behavior. Consequently, social competent behavior is part of the external criterion, not the construct. Social competent behavior, on the other hand, depends on cognitive (i.e., SI) and non-cognitive prerequisites (e.g., intentions, motivation, personality traits, values, norms, etc.). Thus, SI has been specified as a multidimensional cognitive ability construct that relies on an integrative model derived from a literature review. This model integrates both theoretical and operational definitions of SI. In its current version, the model distinguishes between the following cognitive ability domains and has been in part supported by data in a multitrait-multimethod (MTMM) study by Weis and Süd in 2007. So SI is about five qualities: Social understanding (SU) also social inference, social interpretation, or social judgment)represents the ability to understand social stimuli against the background of the given social situation. It also includes diversely labeled requirements such as the recognition of the mental states behind words, the comprehension of observed behaviors in the social context in which they occur, and the decoding of social cues. Social memory (SM) represents the ability to store and recall objectively given social information that can vary in complexity. The concept of SM was originally introduced by Moss and also appeared in works of Sternberg, Conway, Ketron, and Bernstein as memory for names and faces. Social perception (SP) represents the ability to perceive socially relevant information quickly in more or less complex situations. SP is distinguished from SU by only relying on objectively present information in order to exclude interpretative requirements. Social flexibility (SF) is the ability to produce as many and as diverse solutions or explanations as possible for a social situation or a social problem. The concept was originally introduced in Guilford‘s (1967) structure of human intellect model in the domain of divergent production of behavioural contents. Social knowledge (SK) includes knowledge of social matters, the individuals‘ fund of knowledge about the social world, or knowledge of the rules of etiquette. Unlike the remaining dimensions, SK highly depends on the social values of the environment and is not considered as a pure cognitive dimension. 1.2 Social Brain Goleman reveals that human beings have specific structures in their brains built to optimize relationships: · A spindle cell:- is the fastest acting neuron in our brain that guides our social decisions. Human brains contain more of these spindle cells than any other species. · Mirror neurons:- help us predict the behaviour of people around us by sub-consciously mimicking their movements. This helps us feel as they feel, move as they move, etc. · When a man gets a look from a woman he finds attractive, his brain secretes dopamine–a chemical that makes us feel pleasure. 1.3 Key elements of social intelligence: · Verbal fluency · Conversational skills · Knowledge of social roles and rules, as well as scripts · Effective listening skills · Understanding of how to cope well with others · Role playing · Social self-efficacy · Management skills · Intercultural and multicultural skills There‘s a lot going on behind one‘s words. While one speaks, the brain takes in micro- expressions, voice intonations, gestures and pheromones. 1.3.1 Micro-expressions: - are brief, involuntary facial expressions shown on the face of humans according to emotions experienced: · Usually occur in high-stakes situations, where people have something to lose or gain. · Occur when a person is consciously trying to conceal all signs of how they are feeling, or · When a person does not consciously know how they are feeling. · Unlike regular facial expressions, it is difficult/impossible to hide micro expression reactions. Micro-expressions cannot be controlled as they happen in a fraction of a second, but it is possible to capture someone's expressions with a high speed camera and replay them at much slower speeds. Micro-expressions express the seven universal emotions: disgust, anger, fear, sadness, happiness, contempt, and surprise. 1.3.2Voice intonations: · is the variation of pitch when one speaks (variation of levels we speak with is crucial in how we express ourselves) · one of the elements of linguistic prosody · the most important element of accent · helps to craft music of the language · it also helps the listener to follow the nature of communication Gestures and pheromones: - Pheromones give you the edge with attraction. People perceive all sorts of interesting things about one another through olfaction. It feels pretty normal – when we want something we take it, right? I‘m feeling thirsty; I‘ll grab a drink. I‘m hungry; I‘ll pick-up a snack. But you know what? This isn‘t what you should do when you desire a partner. The foundation of pick-up or game is ACQUISITION—the NEED to ACQUIRE a girl or man. This is the absolute, unquestioned and accepted law of game. The whole pick-up framework is built upon this. Simply, they are stimuli that elicit a reaction. Accordingly, people who have high SI have a greater awareness of their proto- conversations. 1.3.3 The Proto-conversation Goleman identifies two aspects of proto-conversations: Social Awareness: Your response to others (the manner in which you do so is crucial) Primal Empathy: Sensing other other‘s feelings and putting yourself in theirshoes Attunement: Listening with full receptivity Empathic Accuracy: Understanding others‘ thoughts and intentions Social Cognition: Understanding the social world and the working of a webof relationships Social Facility: Knowing how to have smooth, effective interactions Synchrony: Interacting smoothly Self-presentation: Knowing how you come across Influence: Shaping the outcome of social interactions Concern: Caring about others‘ needs 1.3.4 Your Social Triggers Social awareness is the capability to reckon that people and places trigger different emotions and this affects our ability to connect. Think about a time you felt excited and energized by an interaction. Now think of a time when you felt drained and defeated after an interaction. Along this, Goleman presents a theory on how our brain processes social interactions: The Low Road is our instinctual, emotion-based way we process interactions. It‘s how we read body-language, facial expressions and then formulate gut feelings about people. The High Road is our logical, critical thinking part of an interaction. We use the high road to communicate, tell stories and make connections. Why are these important? The Low Road guides our gut feelings and instincts. For example, if people didn‘t come to your birthday parties as a kid, you might feel a pang of anxiety when thinking about your own birthday as an adult–even if you have plenty of friends who would attend. Your High Road tells you that you are a grown up and things have changed, but your Low Road still gives you social anxiety. I call these social triggers. You should be aware of your unconscious social triggers to help you make relationship decisions. Knowing your Low Road social triggers helps your High Road function. Here‘s how you can identify yours: What kinds of social interactions do you dread? Who do you feel anxious hanging out with? When do you feel you can‘t be yourself? 1.3.5 Your Secure Base Whether you are a cheerful extrovert or a quiet introvert, everyone needs space and a place to recharge. Goleman suggests that‘s a ―secure base.‖ This is a ritual place or an activity that helps one process emotions and occurrences. A secure base is helpful for two main reasons. 1. It gives one a place to recharge before interactions so they don‘t get burnt out. 2. It helps one process and learn from each social encounter. 3. You can improve your Social Intelligence, you just need to prioritize it. Broken Bonds One of the biggest pitfalls in social intelligence is a lack of empathy. Goleman calls these Broken person treats Bonds. Philosopher Martin Buber coined the idea of the ―I-It‖ connection which happens when one another like an object as opposed to a human being. Imagine you have just lost a family member. You get a phone call from a friend offering condolences. Immediately you sense the obligation of the caller. They are distracted, you can hear the typing of keys in the background. Their wishes are cold, memorized and insincere. The call Case study: Cynthia receives an email from her friend, Joyce, every 60 days to grab lunch. Joyce‘s emails are always similar. When Cynthia realized the similarity in the emails, she started to think of herself as Joyce‘s ―calendar alert‖ that Joyce had set-up. Cynthia went low thinking as merely an item on Joyce‘s to do list. Cynthia analyzed that Joyce felt she ‗should‘ do lunch to keep in touch. But this led to their lunches to be perfunctory, predictable and boring to Cynthia. So, Cynthia stopped saying yes to grabbing lunch with her friend. · Don‘t interact because you feel that you ‗should.‘ · Say no to obligations if you can. · Interact with empathy or don‘t interact at all. 2. Positively Infectious When someone smiles at you, it‘s hard not to smile back. The same goes for other facial expressions. When your friend is sad and begins to tear up, your own eyes will often get moist. Why? These are your mirror neurons in action–part of your Low Road response to people. ―Hang out with people whose moods you want to catch. ―If moods are catching, gravitate towards people who will infect you with the good ones‖ 3. Adopt to Adapt Empathy works in such a way that one‘s Low Road automatically mirrors the people around them. Our brain copies the people around us, so we feel as they feel. This in turn helps us understand them, where they are coming from and even be better at predicting their reactions. ―Many paths of the low road run through mirror neurons. The neurons activate in a person based on something that is experienced by another person in the same way is experienced by the person himself. Whether pain (or pleasure) is anticipated or seen in another, the same neuron is activated.‖ makes you feel worse, not better.-Goleman, 41 4. Beware the Dark Triad Goleman shares the dark triad of people: · The narcissistic personality is when someone has an inflated view of themselves, a huge ego and a sense of entitlement. · The Machiavellian personality is when someone is manipulative and consistently exploits the people around them. · The psychopath personality is someone who is impulsive, remorselessness and extremely selfish. Goleman summarizes the dark triad motto as: Others exist to adore me. 5. Mindblind Mindblind is the inability to sense what is happening in the mind of someone else. The key to mindsight is compassion. ―In short, self-absorption in all its forms kills empathy, let alone compassion. When we focus on ourselves, our world contracts as our problems and preoccupations loom large. But when we focus on others, our world expands. Our own problems drift to the periphery of the mind and so seem smaller, and we increase our capacity for connection – or compassionate action.‖ – Goleman, 54 Goleman claims that people are wired for altruism. People are inherently good. However, sometimes they forget how good it makes them feel to be good. Dr. Baron-Cohen devised something called the Empathy Quotient. This is a quiz to test your empathy levels. While he devised the test for adults on the Aspergers or Autism Spectrum, but this quiz has been found to be very helpful. 6. A People Prescription ―The most striking finding on relationships and physical health is that socially integrated people, those who are married, have close family and friends, belong to social and religious groups, and participate widely in these networks, recover more quickly from disease and live longer. Roughly eighteen studies show a strong connection between social connectivity and mortality.‖ – Goleman, 247. 1.3.6 Synthesis of ways to develop your social intelligence: How to develop social intelligence? According to Goleman ―friends make you healthy;‖ healthy happy life is positive relationships. Your partner, friends, colleagues and children, support your soul as well as our immune system. This has been realized through studies that have found that kinds words, physical touch, a song from childhood improve the vital signs of the sick and even fatally ill. Therefore, investing in your relationships is worth the effort. Simply put, following are ways in which you can develop your social intelligence: · Willingness and dedication to learn · Paying more attention to social happenings around you · Develop yourself to be a better speaker · Networking · Try to listen more to others (active listening) · Inquisitiveness to know more about social situations · Learn more about your own behaviour · Acquire knowledge on social successes and failures 1.3.7 Let’s look at the kinds of smart for you to be to figure that out and answer: Gardner, a developmental psychologist and Harvard professor name, developed in the 80s and 90s. In his book Frames of Mind: The Theory of Multiple Intelligences, Gardner developed the approach that intelligence is spectrum composed of different kinds of minds and therefore people learn, remember, and understand in different ways. He initially listed 7 types of intelligences, and later added the 8th (naturalist). This is what it looks like: 1. Visual-Spatial Intelligence People who are strong in visual-spatial intelligence are good at visualizing things. These individuals are often good with directions as well as maps, charts, videos, and pictures. Strengths Visual and spatial judgment Characteristics People with visual-spatial intelligence: · Read and write for enjoyment · Are good at putting puzzles together · Interpret pictures, graphs, and charts well · Enjoy drawing, painting, and the visual arts · Recognize patterns easily Potential Career Choices If you're strong in visual-spatial intelligence, good career choices for you are: · Architect · Artist · Engineer 2. Linguistic-Verbal Intelligence People who are strong in linguistic-verbal intelligence are able to use words well, both when writing and speaking. These individuals are typically very good at writing stories, memorizing information, and reading.1 Strengths Words, language, and writing Characteristics People with linguistic-verbal intelligence: · Remember written and spoken information · Enjoy reading and writing · Debate or give persuasive speeches · Are able to explain things well · Use humour when telling stories Potential Career Choices If you're strong in linguistic-verbal intelligence, good career choices for you are: · Writer/journalist · Lawyer · Teacher 3. Logical-Mathematical Intelligence People who are strong in logical-mathematical intelligence are good at reasoning, recognizing patterns, and logically analyzing problems. These individuals tend to think conceptually about numbers, relationships, and patterns.4 Strengths Analyzing problems and mathematical operations Characteristics People with logical-mathematical intelligence: · Have excellent problem-solving skills · Enjoy thinking about abstract ideas · Like conducting scientific experiments · Can solve complex computations Potential Career Choices If you're strong in logical-mathematical intelligence, good career choices for you are: · Scientist · Mathematician · Computer programmer · Engineer · Accountant 4. Bodily-Kinesthetic Intelligence Those who have high bodily-kinesthetic intelligence are said to be good at body movement, performing actions, and physical control. People who are strong in this area tend to have excellent hand-eye coordination and dexterity. Strengths Physical movement, motor control Characteristics People with bodily-kinesthetic intelligence: · Are skilled at dancing and sports · Enjoy creating things with his or her hands · Have excellent physical coordination · Remember by doing, rather than hearing or seeing Potential Career Choices If you're strong in bodily-kinesthetic intelligence, good career choices for you are: · Dancer · Builder · Sculptor · Actor 5. Musical Intelligence People who have strong musical intelligence are good at thinking in patterns, rhythms, and sounds. They have a strong appreciation for music and are often good at musical composition and performance. Strengths Rhythm and music Characteristics People with musical intelligence: · Enjoy singing and playing musical instruments · Recognize musical patterns and tones easily · Remember songs and melodies · Have a rich understanding of musical structure, rhythm, and notes Potential Career Choices If you're strong in musical intelligence, good career choices for you are: · Musician · Composer · Singer · Music teacher · Conductor 6. Interpersonal Intelligence Those who have strong interpersonal intelligence are good at understanding and interacting with other people. These individuals are skilled at assessing the emotions, motivations, desires, and intentions of those around them. Strengths Understanding and relating to other people Characteristics People with interpersonal intelligence: · Communicate well verbally · Are skilled at nonverbal communication · See situations from different perspectives · Create positive relationships with others · Resolve conflicts in group settings Potential Career Choices If you're strong in interpersonal intelligence, good career choices for you are: · Psychologist · Philosopher · Counselor · Salesperson · Politician 7. Intrapersonal Intelligence Individuals who are strong in intrapersonal intelligence are good at being aware of their own emotional states, feelings, and motivations. They tend to enjoy self-reflection and analysis, including daydreaming, exploring relationships with others, and assessing their personal strengths. Strengths Introspection and self-reflection Characteristics People with intrapersonal intelligence: · Analyze their strengths and weaknesses well · Enjoy analyzing theories and ideas · Have excellent self-awareness · Understand the basis for his or her own motivations and feelings Potential Career Choices If you're strong in intrapersonal intelligence, good career choices for you are: · Philosopher · Writer · Theorist · Scientist 8. Naturalistic Intelligence Naturalistic is the most recent addition to Gardner‘s theory and has been met with more resistance than his original seven intelligences. According to Gardner, individuals who are high in this type of intelligence are more in tune with nature and are often interested in nurturing, exploring the environment, and learning about other species. These individuals are said to be highly aware of even subtle changes to their environments. Strengths Finding patterns and relationships to nature Characteristics People with naturalistic intelligence: · Are interested in subjects such as botany, biology, and zoology · Categorize and catalog information easily · Enjoy camping, gardening, hiking, and exploring the outdoors · Dislikes learning unfamiliar topics that have no connection to nature Potential Career Choices If you're strong in naturalistic intelligence, good career choices for you are: · Biologist · Conservationist · Gardener · Farmer Some questions to address on your own are: What are you smart on? What evidence do you have that made you reach that decision? What do others say aboutyour smart/s? Topic 2: Social Intelligence in relation to Engineering Introduction Internationally it has been witnessed that engineering students need more skills than engineering education. Competitive graduates require relevant skills that has honed them to be dynamic and function effectively in the workplace and society. Lack of Social Intelligence skills, also known as Social Intelligence quotient (SI) skills in students affect their performance and has been regarded to be leading to higher drop-out rates and poor quality of the engineering. Recent literature emphasizes a need for engineering to integrate necessary non-engineering skills such as SI and emotional intelligence (EI) skills. These two are closely related and tend to be confused. However, there’s a thin line between them. Research, professional bodies and experts have identified that the graduate engineer requires many skills and a great deal of knowledge when entering the workforce. Crucial elements such as interpersonal skills, as well as teamwork and a strong sense of motivation are regarded to be particularly relevant in this era of globalization, occurring in a dynamic speed and dictates environment in which the modern engineer must interact. Real Engineering and RealLife The heavy traditionalism of many courses have the perspective of teaching only real engineering especially, defining and isolating problems and achieving technical solutions. Exposure to this culture of traditionalist engineering education not only discourages reflection, but also generates future engineers who both lack and do not appreciate the value of the skills of reflection. Along with that, do engineering studies actively discourage the ESI factor by the very nature of the traditionalist style of teaching in this field? Such traditionalist teaching imparts engineering as a discipline rather than as a career. The Evolution of EngineeringEducation Overtime, engineering has progressively become less and less of a stand-alone subject. Other disciplines have influenced and became increasingly integrated in engineering curricula in order to increase the sharpness of a university‘s graduates, thereby responding to industry demands, e.g. management, business strategy, marketing, philosophy, communication, ethics, environmentalism, sustainability, etc. Engineers‘ attitudes to the soft skills area, incorporating people, ideas and self- reflection, have to be tackled at a fundamental level. Universities along employers have identified necessary skills that need to be integrated into the curricula. These are complemented with abilities that are valued by both universities and particularly employers, and they include some of the following: · Self- and context-awareness. · Decision-making and action planning. · Research and analysis. · Communication skills. · Critical reflection. · Problem solving · Creativity Cognisant of the fact that, the above-mentioned soft skills are part of engineering profession (engineering skills necessary in the fields of engineering) these characteristics can be effectively incorporated as parts of the elements of SI/ESI. These are subjects in humanities that have been regarded to play an active role in the education of future engineers who can reflect and display sensitivity to both individuals and society. Create the Future Socially intelligent engineers have the opportunity to manifest future changes and actively create the future. Indeed, Cooper and Sawaf state that: ... successfully intelligent leaders and managers continually question many of the assumptions that others accept ... [and] they challenge it perceiving the deeper risks and limitations, and in many cases find ways to transcend it ... They know the future is not something we wait for; it is something we must actively help create. And emotional intelligence plays a vital role. Social intelligence Unit 1
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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
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