Look briefly at the rhythm and name it.  Since time is valuable during the exam, your ability to name the rhythm quickly and decisively will make a difference. Verify your answers with Cardiac Rhythm Review page.

Anterior uveitis affects the front of the eye (usually the iris) and is the most common type. Only one eye is usually affected. Symptoms include: an aching, painful, red eye blurred or cloudy vision, a small pupil, an iris that may have a slightly different color sensitivity to light (photophobia), floaters (dots that move across the field [...]

Because the natural history of gallstones is generally benign, cholecystectomy is not required for patients with asymptomatic gallstones. –However, cholecystectomy for asymptomatic gallstones may be indicated under certain circumstances: Patients with large gallstones greater than 2 cm in diameter Patients with nonfunctional or calcified (porcelain) gallbladder observed on imaging studies and who are at high [...]

Epididymitisis the most common local complication of C. trachomatis infection in young males. Signs and symptoms of epididymitis include: Fever Unilateral scrotal pain Swelling Tenderness Evidence of urethritis on Gram stain Epididymal tenderness or mass on exam Up to 70% of sexually transmitted cases are due to Chlamydia trachomatis. Some sexually transmitted cases are due [...]

  Reiter’s Syndrome Bechet’s Syndrome Oral Ulcers Yes Yes Genital Ulcers Yes Yes Uveitis Iritis Yes Arthritis Yes Axial Yes Rash +/- Yes Male vs Female Males > Females Male = Female Genetics HLA B27 HLA B51 STD associated Chlamydia No Rx Doxycycline/NSAIDS Colchicine: 0.6 mg b.i.d. for mucocutaneous and joint symptoms Who?? Multiple sex [...]

Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord. Causes, incidence, and risk factors Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age. MS is caused by damage to the myelin sheath. The nerve [...]

  Grading of murmurs   Grade Description Grade 1 Very faint Grade 2 Soft Grade 3 Heard all over the precordium Grade 4 Loud, with palpable thrill. Grade 5 Very loud, with thrill. May be heard when stethoscope is partly off the chest. Grade 6 Very loud, with thrill. May be heard with stethoscope entirely [...]

The RIFLE classification of Acute Renal Failure is as follows: Risk (R) – Increase in serum creatinine level X 1.5 or decrease in GFR by 25%, or urine output <0.5 mL/kg/h for 6 hours Injury (I) – Increase in serum creatinine level X 2.0 or decrease in GFR by 50%, or urine output <0.5 mL/kg/h for [...]

Insomnia is defined as repeated difficulty with the initiation, duration, maintenance, or quality of sleep that occurs despite adequate time and opportunity for sleep that results in some form of daytime impairment. Approximately one third of adults report some difficulty falling asleep and/or staying asleep during the past 12 months, with 17% reporting this problem [...]

The main syndrome of vitamin B12 deficiency is Biermer’s disease (pernicious anemia). It is characterized by a triad of symptoms: Anemia (megaloblastic anemia) Gastrointestinal symptoms Neurological symptoms Each of those symptoms can occur either alone or along with others. The neurological complex, defined as myelosis funicularis, consists of the following symptoms: Impaired perception of deep [...]

Polyarteritis nodosa is a systemic vasculitis characterized by necrotizing inflammatory lesions that affect medium and small muscular arteries, preferentially at vessel bifurcations, resulting in microaneurysm formation, aneurysmal rupture with hemorrhage, thrombosis, and, consequently, organ ischemia or infarction.  Nonspecific, firm, tender subcutaneous nodules without livedo reticularis and/or systemic involvement may be the first sign of polyarteritis [...]

Psoriatic Arthritis is a seronegative spondyloarthropathy caused by the macrophage-induced enzymatic breakdown of bone, tendons, and cartilage. It effects 25% of people suffering from psoriasis. Psoriatic arthritis occurs more commonly in patients with tissue type HLA-B27. Treatment of psoriatic arthritis is similar to that of rheumatoid arthritis. More than 80% of patients with psoriatic arthritis will have [...]

Sporotrichosis is a subacute or chronic infection caused by the soil fungus Sporothrix schenckii.  The characteristic infection involves suppurating subcutaneous nodules that progress proximally along lymphatic channels (lymphocutaneous sporotrichosis). The primary lesion develops at the site of cutaneous inoculation, typically in the distal upper extremities. Patients with these forms are typically afebrile and not systemically [...]

Thrombosis of the splenic vein is a rare, but important, cause of variceal bleeding. The blood, blocked from its usual route, flows through the gastric veins (in the stomach), continuing towards the liver. Large gastric varices, seen on EGD, develop as the blood traverses the stomach; later, these may rupture and bleed.  Esophageal varices do not occur because the [...]

Sarcoidosis is a multisystem inflammatory disease of unknown etiology that predominantly affects the lungs and intrathoracic lymph nodes. Sarcoidosis is manifested by the presence of noncaseating granulomas in affected organ tissues. The male-to-female ratio is approximately 2:1 while the incidence peaks in persons aged 25-35 years. A second peak occurs for women aged 45-65 years. [...]

Types of Breast Nipple Discharge Discharge color Duct involvement Risk Evaluation Milky more than one galactorrhea due to medicines or anovulation confirm fat globules in the discharge, draw a serum TSH and prolactin for thyroid and hypothalamic disorders Clear, watery or yellowish one duct breast cancer or fibrocystic breast condition exam, mammogram, ductogram and cytology [...]

History Scarlet fever generally has a 1- to 4-day incubation period. Emergence of the illness tends to be abrupt, usually heralded by sudden onset of fever associated with sore throat, headache, nausea, vomiting, abdominal pain, myalgias, and malaise. The characteristic rash appears 12-48 hours after onset of fever. In the untreated patient, fever peaks by [...]

Asthma is an airway disorder that causes respiratory hypersensitivity, inflammation, and intermittent obstruction. Asthma commonly causes constriction of the smooth muscles in the airway, wheezing, and dyspnea. Exercise-induced asthma is an asthma variant defined as a condition in which exercise or vigorous physical activity triggers acute bronchospasm in persons with heightened airway reactivity. It is [...]

von Willebrand’s Disease is a mild manageable bleeding disorder in which clinically severe hemorrhage manifests only in the face of trauma or invasive procedures. The most common symptoms include nosebleeds, skin bruises, and hematomas. Prolonged bleeding from trivial wounds, oral cavity bleeding, and excessive menstrual bleeding are common. Gastrointestinal bleeding is rare. A common but nonspecific [...]

Primary hyperparathyroidism, which accounts for most hyperparathyroidism cases, results from excessive release of PTH and manifests as hypercalcemia.  Patients with hypercalcemia who have normal renal function and no malignancy must be suspected of having primary hyperparathyroidism and must be subsequently tested for elevated PTH levels. Hyperparathyroidism is often incidentally discovered during routine laboratory testing when [...]

A subarachnoid hemorrhage presents as: Sudden Severe Headache (occasionally there we be a sentinal headache at the initiation of the bleed) Nausea and/or vomiting Symptoms of meningeal irritation (ie: neck stiffness, low back pain, bilateral leg pain): These are seen in more than 75% of cases of subarachnoid hemorrhage Photophobia and visual changes Loss of [...]

Achalasia is a disorder of the esophagus that is characterized by: Episodic spasms that can mimic cardiac pain due to disorganized peristalsis.  There is elevated lower esophageal sphincter (LES) pressure. There is dysfunctional LES relaxation. The symptoms show difficulty swallowing solids and liquids with associated regurgutation while supine or asleep. The symptoms develop insidiously over [...]

History The classic clinical presentation of Boerhaave syndrome usually consists of repeated episodes of retching and vomiting, typically in a middle-aged man with recent excessive dietary and alcohol intake. These repeated episodes of retching and vomiting are followed by a sudden onset of severe chest pain in the lower thorax and the upper abdomen. The [...]

Infection Source Clinical Features Alaria americana Undercooked frog legs Disseminated fatal thoracic, gastrointestinal, retroperitoneal, and CNS manifestations; intraocular infections Echinostomiasis (16 species) Freshwater fish, aquatic plants, clams, snails, mollusks, contact with aquatic birds May be asymptomatic; mild abdominal pain, bloating, dyspepsia, diarrhea, eosinophilia Fibricola species Tadpoles Abdominal pain, diarrhea, fever, eosinophilia Fasciolopsis species Water chestnut, [...]

Acoustic neuromas are intracranial, extra-axial tumors that arise from the Schwann cell sheath investing either the vestibular or cochlear nerve.  Acoustic tumors, like other space-occupying lesions, produce symptoms by any of 4 recognizable mechanisms: (1) compression or distortion of the spinal fluid spaces, (2) displacement of the brain stem, (3) compression of vessels producing ischemia [...]

Malignant external otitis is an infection that affects the external auditory canal and temporal bone. The causative organism is usually Pseudomonas aeruginosa, and the disease commonly manifests in elderly patients with diabetes. The infection begins as an external otitis that progresses into an osteomyelitis of the temporal bone. Spread of the disease outside the external [...]

Glaucoma is a disease in which the optic nerve is damaged, leading to progressive, irreversible loss of vision. It is often, but not always, associated with increased pressure of the fluid in the eye. The nerve damage involves loss of retinal ganglion cells in a characteristic pattern. There are many different sub-types of glaucoma but [...]

Painless loss of monocular vision is the usual presenting symptom of retinal artery occlusion. Ocular stroke commonly is caused by embolism of the retinal artery. Retinal artery occlusion represents an ophthalmologic emergency, and delay in treatment may result in permanent loss of vision. Immediate intervention improves chances of visual recovery, but, even then, prognosis is [...]

Features of Basal Cell Carcinoma and Lesions of Similar Appearance Lesion Location Surface Color Outline Other features Basal cell carcinoma Most common on face, but can occur anywhere Raised, pearly, firm Normal skin color Round at first, irregular later May ulcerate Superficial basal cell carcinoma Any location Roughened Skin-colored or pink Round or irregular Resembles [...]

Features of Squamous Cell Carcinoma and Lesions of Similar Appearance   Lesion Location Surface Color Outline Other features Squamous cell carcinoma Areas exposed to sunlight, radiation or arsenicals Rough, irregular, sometimes scaly, sometimes has visible vessels, sometimes warty or with fleshy masses Skin-colored at first, sometimes reddened later Vague New lesions may appear near old [...]

Adult Still’s disease is a rare illness marked by high fevers, rash, and joint pain. It may lead to chronic arthritis. It is more commonly called adult-onset Still’s disease (AOSD). Fewer than 1 out of 100,000 people develop adult Still’s disease each year. It affects women more often than men. Still’s disease that occurs in [...]

Antiphospholipid antibody syndrome , also known as lupus anticoagulant syndrome, or Hugh syndrome  is characterized by the presence of anti-phospholipid antibodies, which are frequently linked to pregnancy losses in the pre-embryonic (<6 wk), embryonic (6-9 wk), and fetal (≥10 wk gestation) time periods. 10-20% of women with early losses are positive for the anti-phospholipid antibodies, [...]

Polymyalgia rheumatica (PMR) is a clinical syndrome characterized by severe aching and stiffness in the neck, shoulder girdle, and pelvic girdle.  It causes severe pain in the proximal muscle groups; however, no evidence of disease is present at muscle biopsy. Muscle strength and electromyographic findings are normal.  It is closely linked to giant cell arteritis [...]

Limited systemic sclerosis/scleroderma is well described by the CREST syndrome (Calcinosis, Raynaud’s phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasias). Diffuse systemic sclerosis/scleroderma is rapidly progressing and affects a large area of the skin and one or more internal organs, frequently the kidneys, esophagus, heart and lungs. Typical scleroderma is classically defined as symmetrical skin thickening, with about [...]

Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia (a heightened and painful response to pressure).  Other symptoms include severe fatigue, insomnia, and joint problems. Some patients may also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. Fibromyalgia frequently co-exists with psychiatric conditions such as depression [...]

Similar to polymyositis in muscle presentation (ie weakness of proximal muscles, minimal if any pain). Some cases of dermatomyositis actually “overlap” other autoimmune diseases such as: Sjögren’s syndrome, lupus, scleroderma, or vasculitis. Because of the link between dermatomyositis and autoimmune disease, run an ANA test. Skin findings occur in dermatomyositis but not polymyositis and are generally [...]

Patients present with proximal muscle weakness usually in the legs/thighs.  They have difficulty arising from a chair or bed, and cannot kneel or squat. Invariably the presentation is with WEAKNESS, not pain (pain should suggest PMR). Polymyositis, like dermatomyositis, strikes females with greater frequency than males. (Remember: Inclusion Body Myositis effects men more !!) 1.) [...]

A common inflammatory myositis occurring in men (usually) over 50. The disease is characterized by distal muscle weakness, most prominently demonstrated in the hand (wimpy hand shake). Prominent weakness can occur elsewhere, but look for dysphagia as a co-symptom. Drug exposure is the cause, with special attention to cocaine, alcohol, statins, steroids, and colchicine. Labs [...]

Water-soluble vitamins and their characteristics. Common food sources Major functions Deficiency symptoms Overconsumption symptoms Stability in foods Vitamin C (ascorbic acid) Citrus fruits, broccoli, strawberries, melon, green pepper, tomatoes, dark green vegetables, potatoes. Formation of collagen (a component of tissues), helps hold them together; wound healing; maintaining blood vessels, bones, teeth; absorption of iron, calcium, [...]

Fat Soluble Vitamin Facts Vitamin Source Physiological Functions Deficiency Overconsumption A (retinol) (provitamin A, such as beta carotene) Vitamin A: liver, vitamin A fortified milk and dairy products, butter, whole milk, cheese, egg yolk. Provitamin A: carrots, leafy green vegetables, sweet potatoes, pumpkins, winter squash, apricots, cantaloupe. Helps to form skin and mucous membranes and [...]

Transmission of molluscum contagiosum has been reported by direct skin contact and has occurred in wrestlers, patients of a surgeon with a hand lesion, and children sharing baths, towels, gymnasium equipment, and benches. Autoinoculation also occurs as evidenced by linear arrays of lesions on infected individuals. Molluscum contagiosum can likely be vertically transmitted, similarly to other [...]

Hepatocellular carcinoma (HCC) is a primary malignancy of the liver. Hepatocellular carcinoma is now the third leading cause of cancer deaths worldwide, with over 500,000 people affected.  The incidence of hepatocellular carcinoma is highest in Asia and Africa, where the endemic high prevalence of hepatitis B and hepatitis C strongly predisposes to the development of [...]

Patients with porcelain gallbladder are usually asymptomatic, and the condition is usually found incidentally on plain abdominal radiographs, sonograms, or computed tomography (CT) images. Surgical treatment of porcelain gallbladder is based on results from studies performed in 1931 and 1962, which revealed an association between porcelain gallbladder and gallbladder carcinoma. Porcelain gallbladder is an uncommon [...]

Most studies demonstrate a spontaneous miscarriage rate of 10-15%. However, the true rate of early pregnancy loss is close to 50% because of the high number of chemical pregnancies that are not recognized in the 2-4 weeks after conception. Most of these pregnancy failures are due to gamete failure (eg, sperm or oocyte dysfunction). In [...]

Retinal detachment occurs when subretinal fluid accumulates in the potential space between the neurosensory retina and the underlying retinal pigment epithelium. Symptoms Photopsias refer to the perception of flashing lights by the patient. It probably arises from the mechanical stimulation of vitreoretinal traction on the retina. It may be induced by eye movements and appears [...]