EPETITIO R OR N & RE N F QUICKTABLES C O G N ITI O Index: 1. Cardiology 2. Pulmonary 3. Gastroenterology 4. Nephrology 5. Hematology Oncology 6. Infectious Disease a. b. c. d. e. f. g. h. i. a. b. c. d. e. f. g. a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. a. b. c. d. e. f. g. a. b. c. d. e. f. g. a. b. c. d. Coronary Artery Disease 1 Congestive Heart Failure 2 Valve Disease3 Cardiomyopathy4 Pericardial Disease4 Syncope5 Hypertension5 Cholesterol5 ACLS6 Asthma8 Lung Cancer8 Pleural Effusion9 DVT PE9 COPD10 ARDS10 Interstitial Lung Disease 11 Gallbladder Disease12 Esophagitis13 Esophageal Disorders 14 Peptic Ulcer Disease 15 Misc. Gastric Disorders 15 Acute Diarrhea16 Chronic Diarrhea16 Cirrhosis and Ascites 17 Cirrhosis Etiologies18 Malabsorption19 Diverticular Disease19 Colon Cancer20 Gi Bleed21 Acute Pancreatitis22 Inflammatory Bowel Disease 22 Jaundice23 Viral Hepatitis23 Acute Kidney Injury 24 Sodium25 Calcium25-26 Potassium27 Kidney Stones27 Cysts and Cancer 28 Acid Base28 Macrocytic Anemia30 Microcytic Anemia30 Normocytic Anemia31 Leukemia32 Lymphoma32 Plasma Cell Dyscrasia 33 Bleeding, Thrombocytopenia 34 Antibiotics36 HIV36 TB37 Sepsis37 Q u i c k T a b l e s © OnlineMedEd Index: e. f. g. h. i. j. k. l. Brain Inflammation 38 Lung Infection38 UTI39 Genital Ulcers39 Skin Infections40 Endocarditis41 Antibiotics 41 Surgery41 7. Endocrinology 8. Neurology 9. Rheumatology a. b. c. d. e. f. g. a. b. c. d. e. f. g. h. i. a. b. c. d. e. f. Anterior Pituitary42 Posterior Pituitary43 Thyroid Nodules43 Men Syndromes43 Thyroid Disorders44 Adrenals45 Diabetes46 Stroke48 Dizziness48 Seizure49 Tremor50 Headache50 Back Pain51 Dementia52 Coma52 Weakness53 Approach To Joint Pain 54 Lupus55 Rheumatoid Arthritis 55 Other Connective Tissue Dz 56 Monoarticular Athropathies 56 Seronegative Arthropathies 57 10. Dermatology a. b. c. d. e. f. g. h. Blistering Disease58 Papulosquamous Dermatoses 58 Eczematous Dermatoses 59 Hypersensitivity Reactions 59 Hyperpigmentation60 Hypopigmentation61 Skin Infections61 Alopecia62 11. Pediatrics a. b. c. d. e. f. g. h. i. j. k. l. m. n. Constipation64 Neonatal Jaundice64 Vomiting65 Seizures65 Gi Bleed66 Allergies66 Peds Rash67 Peds Preventable Trauma 68 Vaccinations68 ENT69 Pediatrics CT70 Upper Airway / Stridor 71 Lower Airway71 Immunodeficiencies 72 Q u i c k T a b l e s © OnlineMedEd Index: o. p. q. r. s. Ortho Peds73 Pediatric Ophtho74 Urology Peds75 Sickle Cell76 Abuse76 12. Psychiatry a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. Defense Mechanisms 78 Anxiety Disorders79 Impulse Control Disorders 80 Eating Disorders80 Mood Disorders I And II 81 Delusional Disorders82 Personality Disorders 83 Peds Psych84 Dissociative Disorders 85 Addiction85 Drugs of Addiction: Intoxication and Withdrawal 86 Sleep I And II 87 Psych Pharm88-89 Psych Cognition90 Psych Somatoform – DSM-IV 90 13. Gynecology a. b. c. d. e. f. g. h. i. j. k. l. m. n. Gynecologic Cancers 92 Gestational Trophoblastic Disease 93 Incontinence93 Adnexal Mass94 Pelvic Anatomy95 Gyn Infections96 Vaginal Bleeding 1: Premenarche 97 Vaginal Bleeding 2: Reproductive Years 97 Vaginal Bleeding 3: Reproductive Age 98 Primary amenorrhea99 Secondary Amenorrhea 100 Infertility101 Menopause101 Virilization102 14. Obstetrics a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. r. Physiology Of Pregnancy 104 1st Visit Labs And Initial Care 104 Quad Screen105 Third Trimester Labs 105 Medical Disease106 Normal Labor107 Abnormal Labor108 Third Trimester Bleeding 108 L&D Pathology109 Advanced Early Testing 110 Eclampsia110 Multiple Gestation111 Post-Partum Hemorrhage 111 Early Antenatal Testing 112 Isoimmunization112 Perinatal Infections113 OB Operations114 Contraception115 Q u i c k T a b l e s © OnlineMedEd Index: 15. Surgery: General a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. Pre-op Evaluation116 Post-op Fever116 Chest Pain117 Altered Mental Status 117 Abdominal Distention 118 Wound118 Fistula119 Decreased Urinary Output 119 Obstructive Jaundice120 Esophagus121 Small Bowel121 Pancreas122 Leg Ulcers122 Colorectal123 Breast Cancer124 Pediatrics First Day 125 15. Surgery: Specialty a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. Pediatrics Weeks To Months 126 Surgical Hypertension 126 Endocrine127 CT Surgery128 Pediatrics CT129 Vascular130 Adult Ophtho131 Skin Cancer132 Pediatric Ophtho133 Neurosurgery Bleeds134 Neurosurgery Tumors 134 Urologic Cancer135 Urology Peds136 Urologic Miscellaneous 137 Ortho Injury138-139 Ortho Hand140 Ortho Peds141 15. Surgery: Trauma a. b. c. d. e. f. g. h. Shock142 Head Trauma143 Neck Trauma143 Chest Trauma144 Abdominal Trauma145 Burns146 Bites146 Toxic Ingestion147 16. Preventative Medicine a. b. c. d. e. f. Biostats148 Prevention 149 Confidence Interval 149 Bias149 Vaccines150 Screening150 Q u i c k T a b l e s © OnlineMedEd Coronary Artery Disease Myocardial Infarction Path: ACUTE Treatment Options Occlusion of a coronary vessel ASA FIRST drug to give Pt: Chest pain that is worse with exertion, better with rest, relieved with nitrates in a hypertensive, diabetic, dyslipidemic smoker, who is old Nitrates Second Angioplasty No Clopidogrel needed, only in single-vessel disease Dx: ST segment changes = STEMI Biomarker Elevation = NSTEMI Stress Test = CAD Coronary Angiogram = best test Bare-Metal Stent Clopidogrel x 1 month, only in single-vessel disease Drug-Eluting Stent Clopidogrel x 1 year, only in single-vessel disease CABG Left Mainstem equivalent or multi-vessel disease tPA No PCI is available within 60 minutes transport time Door-toballoon 90 minutes Tx: Morphine, Oxygen, nitrates, Aspirin (MONA) Beta-Blocker, Ace-inhibitor, Statin, Heparin (BASH) Coronary Angiography with Stent (single vessel disease) CABG (multi-vessel disease) tPA if no transport available (60 minutes) R isk F actors and CHRONIC Treatment Options Beta-Blocker G oals BP < 140 / < 90, HR < 70 Ace-inhibitor BP < 140 / < 90 Hypertension <140 / < 90 Diabetes A1c < 7.0 Smoking Cessation Dyslipidemia LDL < 100, better < 70 HDL > 40, better > 60 Age Woman > 55 Man > 45 Story Prasugrel = Clopidogrel Physical Aspirin Anti-Platelet Clopidogrel Anti-Platelet Statins LDL < 100 (prefer < 70) Stress Testing Imaging EKG Test of choice, no baseline abnormality Left sided / Substernal Nonpositional Echo EKG abnormalities, no CABG Worse with exertion Nonpleuritic Nuclear Better with rest Nontender CABG, Baseline wall defects, LBB Exercise Test of choice, no contraindication to exercise with feet Pharm Any reason why they can’t get on a treadmill, of any kind. Dobutamine and Adenosine essentially identical Testing Stable Unstable Angina Angina nstemi stemi Pain Exercise @ rest @ rest @ rest Relief Rest + Nitrates Ø Ø Ø Trops Ø Ø ↑ ↑ ST ∆s Ø Ø Ø ↑ Complications of MI RV Failure Right Sided ECG No Nitrates Aneurysm Diagnosed by Echo Arrhythmia Vtach / Vfib – ventricular ectopy from dying cells Brady / Blocks – AV nodal dysfunction Q u i c k T a b l e s © OnlineMedEd 1 Cardio Cardiology chapter 1: Cardiology ACLS Rhythm Vfib Vtach Torsades SVT 1° Block 2° Type 1 2° Type 2 3° Block Rhythms to treatment Drug Electricity Amio Shock Amio Shock Mag Shock Adenosine Shock Atropine Pace Atropine Pace Pace Pace No pulse Shock delivered Anything All codes VT/VF Codes PEA, Asystole Codes CPR CPR CPR Epi Epi, Amio Epi Afib with RVR Path: Underlying stressor Ischemia, Infection, Structural heart Pt: Palpitations, Asymptomatic Dx: ECG Tx: NO HEART FAILURE: BB or CCB HEART FAILURE: Dig, Amio Shock: Shock Afib Path: PIRATES mnemonic Ischemia, Infection, Structural heart Pt: Palpitations, Asymptomatic Dx: ECG Tx: Rate control = Rhythm Control (AFFIRM) Rhythm: Cardioversion after TTE, TEE, one month of anticoagulation Rate: BB, CCB Rate: Anticoagulate with CHADS2 C CHF H HTN A Age > 75 D Diabetes S Stroke S Stroke Score 0 – Aspirin Score 1 – Rivaroxaban, Apixaban Score 2 + Coumadin or -axabans 6 Q u i c k T a b l e s © OnlineMedEd Vfib Vtach Torsades SVT Sbrady Stach 1 ° Block 2 ° Type 1 2 ° Type 2 3 ° Block Afib Aflutter Idioventricular Asystole chapter 3: Gastroenterology Cirrhosis Etiologies Wilson’s Disease Primary Biliary Cirrhosis Path: Copper secretion deficiency, deposits in eyes, basal ganglia, and liver Path: Women, Intrahepatic, Microductal disease Pt: Chorea, Kaiser-Fleischer Rings, Cirrhosis Pt: Asymptomatic 40 year old female who gets cirrhosis Dx: Multiple tests available. NEVER: Serum Copper Option: Ceruloplasmin low Option: Urine Copper high 1st: Slit Lamp looking for eye findings Best: Biopsy Dx: Serology = AMA Biopsy shows disease Tx: Transplant Tx: Penicillamine → Transplant Free: Picture of an eye + question about cirrhosis Autoimmune Hepatitis Path: Women with autoimmune disease Pt: May be insidious, or may be acute with AST, ALT in the 1000s Dx: Serology = Anti Smooth Muscle, Anti-LKM Biopsy = best test Tx: Steroids initially Transplant Hemochromatosis Path: No “off” signal for iron absorption Pt: Bronze Diabetes = Diabetes, Cirrhosis, and Hyperpigmentation. ♂: Amenorrhea, ♀ Dx: Iron Tests First Test: Ferritin – very elevated Best: Biopsy showing elevated iron Tx: Deferoxamine (Desferal) or phlebotomy Transplant will result in recurrence Alpha-1 Antitrypsin Deficiency Path: Elastase goes unchecked because Antitrypsin is trapped in liver. Genotype PiMM normal, PiZZ worst form NASH/NAFL Path: Fatty liver from Fatty People Pt: Diabetes, Dyslipidemia, Obesity, and cirrhosis without evidence of another disease causing cirrhosis Dx: Ultrasound 1st Biopsy best Tx: Weight loss, diabetes control, transplant Etiology Advanced Organizer “VW HAPPENS” Pt: Cirrhosis and Emphysema Dx: Biopsy = PAS positive macrophages Best: genotype V Viral Hepatitis (B, C) W Wilson’s Disease Tx: Protease (emphysema) Transplant (liver) H Hemochromatosis A Alpha-1 Antitrypsin P Primary Sclerosing Cholangitis Primary Sclerosing Cholangitis Path: Autoimmune disease in men, extrahepatic disease, macroductal disease Pt: Biliary stasis and cirrhosis, may also have ulcerative colitis, men Dx: Serology = p-ANCA ERCP = Beads on a string Biopsy = Onion Skinning Fibrosis Tx: Cholestyramine symptomatic relief Stents maybe, make transplant harder Transplant , but may/will recur 18 Q u i c k T a b l e s © OnlineMedEd P Primary Biliary Cirrhosis E Ethanol N Non-Alcoholic Steatohepatitis S Something else… fulminant diseases Autoimmune Hepatitis Afla-toxin Acetaminophen Budd-Chiari Shock Liver Portal Vein Thrombosis chapter 7: Endocrinology Anterior Pituitary 3 Levels of Feedback and Endocrine Reg of the Ant Pituitary Hypothalamus GnRH TRH CRH Portal Circulation Pituitary Systemic Circulation Target Organ Metabolic Effect ↓ ↓ FSH/LH TSH ACTH GH Ovaries Estrogen Progesterone Ovulation Thyroid T3 T4 Metabolism Adrenals Cortisol Liver ILGF Stress Growth ↓ Prolactinoma Path: Autonomously secreting prolactin Most common pituitary lesion Pt: Women: Galactorrhea, Amenorrhea, Microadenomas, No Vision Change Men: Decreased libido, Gynecomastia, Macroadenomas, Vision Changes, Dx: Medication list 1st: TSH Then: Prolactin Levels Best: MRI Tx: Bromocriptine or Cabergoline Surgery f/u: Surgery is NOT first line therapy for prolactinomas; it is for all other secreting pituitary tumors and macroadenomas Acromegaly Path: Growth hormone = things that can grow Child = Long bones (Gigantism) Adult = visceral organs Pt: Cardiomegaly → DIA heart failure Diabetes Wide-spaced teeth Hat/ring/shoe size increases Coarse features, CARPAL TUNNEL Big hands Dx: Growth Hormone ILGF-1 Glucose Suppression Test MRI Tx: Surgery first Octreotide or Cabergoline (adjunct) f/u: Glucose Suppression Test = give glucose, test is positive (abnormal) if the GH does not change Wait Carpal tunnel is more associated with RA than Acromegaly… don’t be tricked 42 GHRH ↓ Q u i c k T a b l e s © OnlineMedEd ↓ ↓ ↓ ↓ Cushing’s Syndrome See Adrenal ACUTE Pan Hypopituitarism Path: Infection, Infarction, Surgery, Rads Pt: TSH: Lethargy, Coma ACTH: Hypotension, Tachycardia GH/LH/FSH: Irrelevant Dx: Clinical Hormone (Cortisol and T4) Tx: Replace end hormones f/u: Sheehan’s: Pregnancy, bloody delivery Apoplexy: Tumor outgrows blood supply and dies, necrosis CHRONIC Pan Hypopituitarism Path: Autoimmune, Deposition, Cancer GH / FSH / LH sacrificed so that TSH and ACTH can persist Pt: ↓ Libido, changes in menstruation ↓ Growth Dx: Insulin Stimulation Test ˗˗ Growth Hormone fails to rise MRI Tx: Reverse underlying cause Replace hormones as needed Empty Sella Syndrome Path: Normal variant Pt: Asymptomatic Dx: MRI Tx: Reassurance chapter 9: Rheumatology Approach To Joint Pain Single Joint Septic Crystals Acute Septic, Trauma, Crystal, Reactive Isolated Septic Crystal vs Degenerative Osteoarthritis vs vs vs Multiple Joints Osteoarthritis, Lupus, Rheumatoid Scleroderma, Myositis, Seronegatives Chronic Osteo, Lupus, Rheumatoid, Scleroderma, Myositis, Seronegatives Systemic Manifestations Seronegative (IBD) Lupus (Face, CNS, Renal, Heart, Lung) Rheumatoid (Nodules, Serositis) Reactive (Oral + Genital Ulcer) Inflammatory Everything Else Clear NonInflammatory Clear Yellow, White Opaque WBC <2 <2 >2, <50 >50 Polys <25% <25% ≥ 50% ≥ 75% - - - + None Osteoarthritis Everything Else Infection Normal Appearance Gram/Cx Dz Inflammatory Sepsis Antibody Interpretation Antinuclear Antibodies Sensitive Lupus Anti-Histone Antibodies Specific Drug-Induced Lupus Anti-ds-DNA Antibodies Specific Lupus + Renal Involvement Anti-Smooth Muscle Ab Autoimmune Hepatitis Anti-Mitochondrial Antibodies Primary Biliary Cirrhosis Anti-Centromere Antibodies Scleroderma (CREST) Anti-Ro+La Antibodies Sjogren’s Anti-CCP Antibodies Rheumatoid Arthritis Anti-RF Antibodies Rheumatoid Arthritis Anti-Jo Antibodies Polymyositis Anti-Topoisomerase Antibodies Systemic Scleroderma 54 Q u i c k T a b l e s © OnlineMedEd chapter 11: Pediatrics Pediatric Ophtho Type Chemical Time 24 hrs Purulent Non-purulent Gonorrhea Day 2-5 Purulent Chlamydia Day 7-12 Retinoblastoma Pt: Newborn screen in the neonatal unit with an abnormal light reflex Dx: Red reflex (normal) = Pure White Retina “white thing in the BACK of the eye” Tx: Surgery Radiation Therapy (NEVER) f/u: Osteosarcoma Amblyopia Path: Cortical Blindness Bilateral, Topical Erythro then IV ceftriaxone Silver Nitrate Ppx Unilateral Oral + Topical Erythro Can turn into pneumonia Silver Nitrate PPx Congenital Cataracts Path: Present at birth → TORCH infections Not present at birth → Galactose Deficiency Pt: White cloudy lesions in front of their eye “white thing in FRONT of the eye” Dx: Clinical Tx: Surgical Removal Retinopathy of Prematurity Path: Premature baby, oxygen toxicity Pt: Suspect in any premature neonate especially if any of the “other 3” are present None Dx: Ophtho Exam = growths of retina None Fix the problem that could lead to cortical blindness Tx: Laser Ablation f/u: The “other three” Necrotizing Enterocolitis Bronchopulmonary Dysplasia Intraventricular Hemorrhage Pt: Strabismus, Cataracts, another cause, leads to cortical blindness Dx: Tx: Strabismus Path: “Lazy eye” Pt: Baby with one eye that focuses while the other does not Almost ALWAYS a photograph question Dx: Light reflects at different points on both eyes Tx: If present at birth ˗˗ Patch the good eye ˗˗ Surgery if all else fails Glasses if developed after birth 74 Tx Caused by ppx can turn to blindness Muco-purulent Path: Rb gene mutation Problems Bilateral Q u i c k T a b l e s © OnlineMedEd This is a duplicate from surgery. chapter 12: Psychiatry Psych Pharm SSRIs Safe Fluoxetine Paroxetine Sertraline Citalopram Anti-Depressants ↓ Libido Serotonin Syndrome = fever, myoclonus, altered mental status GI, Insomnia Atypicals Bupropion Venlafaxine Mirtazapine Trazodone Minimal Sex SE, ↑ Risk of Seizures Diastolic HTN Weight Gain Sedation, Priapism TCAs Amitriptyline Nortriptyline Imipramine Desipramine Used for enuresis Seconds as neuropathic pain Can be Lethal (Convulsions, Coma, Cardiac) → Wide QRS → EKG! Has Anti-Ach properties (dry mouth, sedation, Uretention, Constipation) Phenelzine Tranylcypromine Selegiline HTN Crisis when mixed together, lack of washout or eating of tyramine (red wine/ cheese) Orthostatic HoTN + Weight Gain Most Dangerous MAO-Is Rarely used Lithium Mood Stabilizers Teratogen First-Line, Drug of Choice Nephrotoxic > 1.5 Bipolar, Acute Mania, Depression Causes Nephro DI Augmentation Narrow TI Valproate First Line if Li contraindicated Bipolar, Seizures Teratogen (Spina bifida) Thrombocytopenia Agranulocytosis Pancreatitis Carbamazepine Second Line Stabilizer Trigeminal Neuralgia Teratogen (Cleft palate) Rash, SJS AV Block Lamotrigine Second Line Stabilizer Newer anticonvulsant Blurred Vision SJS Anxiolytics Abort panic attack Treats EtOH withdrawal Addictive Withdrawal Seizure SSRIs First-Line long term treatment for chronic anxiety: OCD, PTSD, AD See Anti-Depressants. Ø useful in acute attack β-Blockers Performance Anxiety Bradycardia, Asthma Bupropion Backup to SSRI Avoid in bulimia (causes seizures) Haloperidol Diphenhydramine Lorazepam Depot form Enhances Sedation Anxiolytics Called a “B52” Benzos 88 Q u i c k T a b l e s © OnlineMedEd Psychiatry Psych Pharm Antipsychotics Typicals Haloperidol Fluphenazine Thioridazine Chlorpromazine Are more potent so have better effect but also more side effects D2 only so good for + sxs only For noncompliance, use depot (Haloperidol) NMS (fever, ↑ CK, rigidity, AMS) Stop drug Give Dantrolene Highest risk of EPS Gynecomastia, Sedation, Anti-Ach Less potent but also has less side effects Both D2C and 5-HT1 so work on - and + sxs Currently “first line” for psychosis EPS, Gynecomastia, Sedation, Anti-Ach (small risk) QTc prolongation DM and Weight Gain The best antipsychotic The most selective for D2C and 5HT1 (+ and -) Drug of last resort Agranulocytosis Requiring CBC q week Atypicals Risperidone Quetiapine Olanzapine Aripiprazole Ziprasidone Clozapine Unique to itself Akathisia Extrapyramidal Side Effects A Feeling of Restlessness ↓ Dose Acute Dystonia Involuntary muscle contractions, hand ringing, torticollis, and oculogyric crisis Anti-Cholinergic Dyskinesia Parkinsonism Anti-Cholinergic Tardive Dyskinesia Irreversible hyper-sensitization of dopamine-R = suppressible oral-facial movements Stop Drug, sxs initially worsen ↓ SE profile Combative ER patient Haloperidol + Benzo + Diphenhydramine The “B52” Sedating Noncompliant Psychotic Haloperidol depot q 1wk Old Psychotic Atypical or High-Potency Typical ↓ Sedation Hospitalized and off their meds Atypical, ↑ Dose q Day until maxed, then try another Everything else has failed Clozapine Best, most dangerous Fever, Rigidity, AMS, ↑ CK Dantrolene, order CPK, ICU NMS Q u i c k T a b l e s © OnlineMedEd Psych Choosing the Right Drug Compliant Young Adult, Any atypical po without complications 89 chapter 14: Obstetrics Advanced Early Testing Procedure Week Goal Risk of Loss Extra Ultrasound All Confirm IUP Fetal Age, Well- None Being 1st Tri = + 1 wk 2nd Tri = + 2 wk 3rd Tri = + 3 wk Transcranial Doppler > 20 weeks Fetal Anemia No risk NO ACCESS Amniocentesis > 16 weeks AFP, Genetic Material 1 / 200 > 16 weeks: Genetic > 24 weeks: Anemia > 36 weeks: L:S Chorionic Villus Sampling 10-12 weeks Genetic Screens, Karyotypes, ?? Abortion 1/100 Elective abortion still possible in 1st tri PUBS > 20 weeks Fetal Anemia 1/30 Access for transfusion Eclampsia Disease BP Timing U/A Sxs Treatment Chronic HTN > 140 / > 90 Sustained BEFORE 20 weeks Ø Ø α-methyldopa Hydralazine Labetalol Transient HTN > 140 / > 90 Sustained AFTER 20 weeks Ø Ø α-Methyldopa, Hydralazine, Metoprolol Returns to normal 12 weeks after Mild PreE > 140 / > 90 Sustained AFTER 20 weeks > 300mg/dL Ø > 36: Mg + deliver < 36 Develop Severe PreE > 160 / > 110 Sustained AFTER 20 weeks > 5g/dL + Mag + Deliver (C/S) Eclampsia ---- ----- ---- Seizing Mag + Deliver (C/S) HELLP Hemolysis Elevated Liver Enzymes Low Platelets Mag + Deliver (C/S) Path: ?? Vasoconstriction Alarm Sxs: Hemoconcentration, Edema → 3rd Spacing Epigastric / RUQ Abdominal Pain → Glisson’s Capsule Stretch Headache, Vision Δs → Vasospasm Labs: CBC, LFT, U/A ˗˗ Proteinuria → Eclampsia ˗˗ HELLP → HELLP Syndrome Seizing → Eclampsia 110 Q u i c k T a b l e s © OnlineMedEd chapter 15: Surgery: General Breast Cancer Breast Cancer Path: Estrogen - Obesity, Nulliparity, Early Menarche, Late Menopause, HRT Genes – BRCA ½, Radiation Pt: Asymptomatic Screen Breast Lump, Breast Mass Dx: Mammogram Core Needle Biopsy Tx: Lumpectomy + radiation = Mastectomy Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection if positive Chemo ˗˗ Her 2 Neu + ˗˗ Trastuzumab ˗˗ ER/PR + ˗˗ Tamoxifen (pre-menopausal) ˗˗ Anastrozole (post-menopausal) ˗˗ All ˗˗ Doxorubicin or Daunorubicin (anthracycline) based regimen Breast Cancer Screen USPTF: 50q2, start at 50, every 2 years ACS: 40q1, start at 40, every 1 year All: Mammogram → Core Needle Biopsy BRCA: MRI Diagnostic Dilemma: The Young Woman < 30 gets a different set of rules Then Then Then OR OR OR < 30 = Reassurance x 2-3 cycles < 30 + persists = Ultrasound < 30 + cyst on ultrasound = FNA < 30 + cyst resolves = reassurance Mammogram and Core Needle Biopsy if… > 30 Ultrasound shows mass Aspirate is bloody Cyst recurs after aspiration 124 Q u i c k T a b l e s © OnlineMedEd Pick the treatment Local Surgical Therapy Disease: Lumpectomy + Radiation OR Mastectomy Sentinel Lymph Node Biopsy and then Axillary Lymph Node Dissection if + Spread Systemic Therapy Disease: Chemo: Doxorubicin, Paclitaxel Her2neu: Trastuzumab ER/PR: SERMS (Pre-Menopausal) ER/PR: Aromatase-I (PostMenopausal) Know Your Treatments Tamoxifen: Better, ↑ DVT, ↑ Endo Ca Raloxifene: Worse, ↓ DVT, ↓ Endo Ca Trastuzumab: Heart Failure, Reversible, EARLY Doxorubicin: Heart Failure, Irreversible, LATE Daunorubicin: The other Doxorubicin ALND: Sentinel Lymph Node First Preventative Medicine Prevention Bias Levels of Prevention Primary Prevent onset of dz Vaccines, diet/exercise Secondary Prevent progression of dz Screening, hypertension meds Tertiary Prevent complications of dz Surgery, rehab All medicine falls under 1 of these 3. Confidence Interval Associations Null CI includes 1 Effect Size Furthest from 1 Power Narrowest range Bias in Studies/Screens Lead Time Pt of diagnosis changes, but no effect on outcome, artificially ↑ survival time Length Time Deadly dz is found less often, bias that assumes finding dz means it’s less dangerous, artificially makes screening ↑ Overdiagnosis Diagnosis is ↑ but has Ø effect on mortality, is meaningless. Artificially ↑ survival stats Selection Pt group isn’t chosen at random, can’t get meaningful comparisons, skews outcome Measurement Using different tools to measure same thing, can’t get meaningful comparisons, skews outcome Information Pts know something that affects their actions, skews outcome Publication Null/negative results less likely to be published, skews available data Confounding 3rd variable that has a noncasual relationship with exposure AND outcome, why correlation doesn’t = causation Methods to Eliminate Bias Randomization Blinding Standardization Statistical Controlling **Bias is addressed in study design.** Prevent Q u i c k T a b l e s © OnlineMedEd 149