EBV (Epstein-Barr Virus)

• In immunocompetent individuals, EBV can cause mononucleosis, presenting with fatigue, fever, and pharyngitis, sometimes with adenopathy
• Infected B lymphocytes display viral antigens, prompting T lymphocyte stimulation and subsequent B lymphocyte destruction
• In immunocompromised individuals the loss of T lymphocyte surveillance leads to proliferation of B cells
• It also leads to post-transplant lymphoproliferative disorder (PTLD). Treatment involves reducing immunosuppressive medication, and in severe cases, using rituximab

JC Virus

• This virus causes progressive multifocal leukoencephalopathy, frequently observed in solid organ or bone marrow transplant recipients
• Symptoms include altered mental status (AMS), diplopia, seizures, ataxia, and motor deficits

CMV (Cytomegalovirus)

• This appears as giant cells with inclusion bodies
• Ganciclovir is used as treatment

Campylobacter jejuni

• It is a Gram-negative, non-spore forming, comma-shaped bacterium with oxidative positive properties
• It is the most common cause of food poisoning worldwide, transmitted via fecal-oral route
• It's contracted through contact with infected animals or consumption of poorly cooked meats, and is usually self-resolving within a week

Leishmania

• Transmitted via sandflies.
• Is endemic to the Middle East, Asia, and North Africa (Old World).
• Is also endemic to Central and South America (New World).
• Cutaneous form leads to erythematous, slightly edematous papules which increase in size and become wart-like with eschar formation
• Visceral form leads to slow onset fever, malaise, weight loss and organomegaly over several weeks to months
• Diagnosed by observing amastigotes within macrophages on blood smears or tissue biopsy

Gram Stain on Sputum

• Gram-positive bacteria stain purple.
• Gram-negative bacteria stain pink/red.

Mycobacterium Avium-intracellulare

• It leads to lymphadenitis secondary to TB
• Usually seen in immunocompetent children
• Presents as unilateral cervical adenopathy with a dominant lymph node that expands over weeks to months
• Purplish discoloration is observed over the mass
• If untreated, lymph nodes ulcerate and spontaneously drain through the skin to form a fistula
• Diagnosis is through identification of caseating granulomas and acid-fast organisms on biopsy
• Surgical excision and macrolide with ethambutol with or without rifampin are all treatments

Hemolysis

• This results in increased indirect bilirubin, because RBCs are broken down into heme and iron and Heme is broken down into bilirubin and biliverdin
• It causes increased LDH levels within RBCs
• Bone marrow induces increased production of erythrocytes leading to early release of reticulocytes

Bipolar Disorder

• Mania is treated using atypical antipsychotics, valproate, and lithium
• Depression can be treated using lithium, lamotrigine, lurasidone, and quetiapine
• Note that antidepressants can sometimes induce mania

Lung Adenocarcinoma

• Lung Adenocarcinoma frequently metastasizes to bone, causing destructive bone lesions
• Other cancers include breast, thyroid, prostate, and kidney
• Leads to Hypertrophic osteoarthropathy also

Angina vs Esophageal Spasms

• Angina symptoms include exertion, heightened emotional states, and symptoms after meals
• Angina is diagnosed with a stress test and treated with nitroglycerin
• Esophageal spasms are caused when the muscular layer of the esophagus is overactive

Postphlebitic/Post-Thrombotic Syndrome

• It is chronic venous insufficiency which develops after DVT
• Leads to remodeling, venous HTN, inflammation, and valvular incompetence
• Symptoms include edema, skin pigmentation changes, pain, vein dilation, and venous ulcer formation
• Develops weeks to months after DVT
• RF: age, obesity, recurrent DVT, proximal thrombosis, delayed initiation of antithrombotic therapy, and inadequate treatment of thrombus
• Prevention: thromboprophylaxis, early dx and tx of DVT

Superficial Phlebitis

• Leads to painful erythema, tenderness, and a palpable thickened cord along the path of the affected vein
• Typically self-limited.
• Can also reoccur in inflammatory conditions such as Buerger disease or in diseases such as pancreatic cancer in the tail and body

Thrombophlebitis

• It is inflammation is associated with an underlying thrombosis

TB Test Interpretation

• For BCG vaccinated individuals, PPD >10mm or positive blood test, and a negative chest x-ray may be seen
• Give Treatment for Latent TB for recent immigrants from a high-prevalence country, IVDU, residents in high risk settings and pediatric patients who are exposed
• Can also give Tx: 3-4mths rifamycin and isoniazid combo or 6-9mths, isoniazid monotherapy if shorter course if contraindicated or unsuccessful
• A positive PPD and negative chest x-ray suggests latent TB
• A positive PPD and positive chest x-ray suggests active TB
• A chest x-ray is needed to see primary: Ghon complex at the hilar region or secondary: cavitation at the apex

MALT Lymphoma

• It is a proliferation of monoclonal B lymphocytes.
• Causative agent: H pylori
• Detected from endoscopic biopsy that showcases sheets B-lymphocytes
• Can be treated with Quad therapy (PPI, Bismuth salt, Tetracycline, metronidazole or clindamycin) but refractory cases would require radiotherapy or immunotherapy

GERD (Gastroesophageal Reflux Disease)

• Burning epigastric and lower chest pain are associated with the consumption of large meals or triggered foods
• Symptoms often worsen with supine positioning
• Clinical diagnosis often requires PPI but a esophageal pH is gold standard
• Empiric PPI for 8 weeks then lifestyle modifications should be made
• If all else fails, Nissen fundoplication is the recommended treatment

AKI (Acute Kidney Injury)

• Presents with decreased urine output, hypertension, fluid overload and electrolyte abnormalities
• Volume overload causes LE edema, pulmonary edema causing hypoxia, and JVD
• Characterized by Acidemia, electrolyte disturbance, intoxication/ingestion, overload, uremia

Diabetic Neuropathy

• Wear shows when standing or walking
• The diabetic neuropathy is characterized by stock and glove distribution in hands and feet and also gastroparesis
• Gastroparesis is characterized by early satiety, N/V of undigested food, bloating with dysautonmia
• Gastroparesis can be diagnosed by gastric emptying study
• Gastroparesis is treated by metoclorpamide, erythromycin

Ethics - Disability Adjusted Life Years (DALY)

• DALYs encompass overall disease burden that also accounts for years of life lost due to death and years of healthy life lost due to disability, in addition to mortality and morbidity
• Age-specific death rate

Crude vs Standardized Mortality Ratio Analysis

• Crude mortality is the total number of deaths in a given population
• Standardized mortality ratio is the ratio of observed deaths to be expected deaths in a given population

Years of Potential Life Lost (YPLL)

• Calculated by the increased mortality rate that accompanied the change in legislation, not the impact of increased morbidity in nonlethal traumas

Post Hoc Analysis

• Analysis from data that has been collected and studied by investigators

Ethics Review Boards

• Needed to conduct clinical trial
• To review if study is safe

Plan Do Act Cycle

• Steps include defining the problem and the solution
• Testing new process
• Studying, measuring and analyzing data
• Integrating new process into workflow
• Consists of quality improvements

Root Cause Analysis

• Determines core issue(s) that lead the chain reaction of events
• Includes building a multidisciplinary team to meet regularly

Intention-To-Treat Analysis

• All subjects are analyzed on the basis of what they were initially assigned, as a method for preserving random assignment
• Introduces bias and decreases the benefits of randomization
• Useful for preserving randomization and limiting the effects of bias

Per-Protocol Analysis

• Analyzes subjects on basis of how they followed treatment received

Length Bias

• Screening test detects diseases with longer latency
• Overestimates effectiveness of screening programs

Medical Test Results Analysis (Power)

• Power can be defined as the ability to detect a difference between group differences
• Reduced sample sizes can decrease power
• Higher significance level and smaller variability increase pwoer

Medical Test Results Analysis (PPV)

• Proportion of positive test results that are true positives
• Increase PPV = Increase prevalence
• TP/(TP+FP)
• Example: SN 75%, SP 25%, Population 100

Medical Test Results Analysis (NPV)

• Proportio of negative test results that are true negatives
• Increase NPV = Decrease prevalence
• TN/(TN+FN)
• Example: SN 75%, SP 25%, Population 100

Number needed-to-treat (NNT)

• (1/ARR)
• Absolute risk reduction (ARR)
• Difference in outcome between intervention and placebo group
• C/(C+D) - A/(A+B)

Attributable Risk

• Difference in risk between exposed and unexposed groups
• A/(A+B) - C/(C+D)
• AR% = (RR–1)/RR x 100 or [A/(A+B) - C/(C+D)] / A/(A+B) x 100

Sensitivity

• Ability of a test to detect disease if it is present
• Can be used to rule out disease
• A/(A+C) or TP/(TP+FN) or 1-FN rate

Specificity

• Ability of a test to negative when disease is not present -- confirms a diagnosis
• Can be calculated as D/(B+D) or TN/(TN+FP) or 1-FP rate

Placebo

• Should be used in cases with non-life threatening conditions
• Standard care should be used

Relative Risk (RR)

• Risk of developing diseases divided by risk in the unexposed group
• Can also be derived by looking at the cohort studies
• =1: no association, >1 high risk, <1 low risk
• Can also be derived by looking at the A/(A+B) / C/(C+D)

Likelihood Ratio

• A high likelihood test suggests a high probability of the presence of a odd disease
• LR+ > 10 indicates a highly specific test
• LR- < 0.1 indicates a highly sensitive test
• LR+ = SN/(1-SP) or TP rate/FP rate
• LR- = (1-SN)/SP or FN rate/TN rate

Prevalence

• Number of cases of a disease divided by the total number of individuals in a selected time period

• of existing cases / total # of people in the population

Incidence

• The number of new cases

• of new cases/# of people at risk

Case Control

• Diseases cases studied vs control
• Includes comparing risk factors
• Higher odds of smokers getting COPD

Cohort Analysis

• Analyze both retrospective and prospective patients
• Includes prospective studies for present and future patients
• Helps compare diseases incidence such as higher risk of developing diseases

Cross-Sectional Analysis

• Analyze different populations prevalance
• Analyze prevalence comparing risk factors

Clinical Trial

• Analyzes treatment group vs control group patients
• Helps compare treatment methods given outcome

APGAR Score

• Low APGAR score indicates giving support
• If recovered then observe
• Non-Recovery means intubation or chest compression

Meniere Disease

• Sensorineural hearing loss due to episodic vertigo and tinnitus
• Due to increased endolymph
• Can be treated with lifestyle modification and or antihistamines such as meclizine, promethazine and or methylprednisolone

Osteosarcoma

• MC bone cancer under 30
• Causes: familial, Paget, fibrous dysplasia, or exposed to radiation
• Locally destructive to bone and can erode cortext
• Diagnostic periosteal reaction showcases disorganized osteogenesis
• Primarily affects long bones
• Leads to metastases to lungs and increases mortality rate

Kussmaul Sign

• JVD increased is not normal and signifies impaired right ventrical filling
• Indicates restrictive cardiomyopathies such as tricuspid stenosis

Sorbitol

• Commonly found as artificial sweetener
• Poorly absorbed within small bowel causing osmotic effect and draws fluid into the intestinal causing bloating and abdominal discomfort

Umbilical Hernia

• Is a failure of spontaneous closure in umbilical cord
• Resolved spontaneously by the age of 3
• Larger defects over 1.5cm are progressive and causes enlargment of the ring

Omphalocele

• Is when abnormal wall has protrusion peritoneum and intestines
• May lead to compliation

Nephrolithiasis

• Acute flank pain caused by proteinuria and hemautria
• Diagnosed by CT scan but large are removed by thiazides, sodium diet, or shock lithotripsy

Bariatric

• B1 is absorbed in the jejunum
• Leads to either wet/dry which induces Encephalopathy and gait ataxia
• Causes symmetrical neuropathy and heart failure

Zinc

• Zinc Deficieny causes disturbance in taste/smell, dermatitis

B12

• Causes dysfunction or spinalcerebellar, lateral and other damages the column, and Anemia

Vitamin A deficieny

Iron Abuse or damage

• Tx; deferoximine, lavage + x ray test

Copper damage or toxicity

• Causes Myelopathy, Anemia, Neuropathy

Roux en Y Complications

• Early and late complications such anastomotic leak sepsis and others including bowel and stricture

Bee sting (immunotherapy ) vs PPOX

• IgG antibodies or blockers

Glioblastoma

• Primary brain malignancy
• diagnosed total resection with other measures to manage

Brain arteries and other damage

• Dx with Non or contrast CT and managed as such
• Right A. vertebral damage is causes defects and the vertebal column damage is causes stroke +Locked  

NonHyper-glycemia. Hypertonic

• Causes dehydration or lack of insulin. Aggressive Tx electrolytes and fluids

Aortic Transection

• caused by trauma in chest and treated open repair or endovascular

Cardiac contusion

• causes trauma from fractures or abnormal ECG test that may reveal an biomarkers

Crisis that can be either HydroxyU

Foot and mouth

• Caused coxsakievirsus and fever

Spontaneous infection due to translocation

• E. coloc + and causes sepsis and high WBC count

Diuretics that inhibit

• Due infections and location

ZIKA

• Congenital transmission and symptoms and congenital and birth defects in the small brain

TB

• check all and manage cases

Osteolytic Lesions

• causes overgrowth and bone damage

Pneuomococal vacciene

• 15 then other within years , but give to kids within certain time range

Delerium treatment

• Treat to manage alcohol and supplements

Salivary Gland

• treat and do all the biopsy

SBO

• M/c adhesions and strictures

Cramps and consttiparion or blockage

Renal all carcinoma

CUSHINGS

• Tumor related and treat the hormone levels

Imipitigo infection with sepsis

Aortic Rupture for endocarditis

• Prophylaxis for endocarditis with infection

Translocation and life threatening Mucormycosis can occur

Aggressive sinusis with opportunistic infections

The lungs then with bleeding

• biopsysx is done then infection must be managed and treated

As we aging:

Skin thins and lose elasticity

Incontinence, GET urine samples

Transfusion: fluid overload. acute acute acute

R educe strike vs TIA

Serotonin and all damages need to manage

Wold pack

Breats cases and risks, mutations

Pericarditis versus heart cases

Pox and treatement

The brain damage from lack of perfusion blood.

Spinal and other damages

Diabetic Hyper and hyperglycemia and also all that causes

The trauma and heart

Cells related to blood cells

UTI

Trachea

Kidneys

Pregnancy

Liver

B12. Vits and all that causes and treatments

Atheromas and infection

Blood pressure and all other test

Kidney for function

BATERILA

All the heart and lung problems , fluid and so heart

The all causes

The bone disease and infections

Lung cases/

Phase trial steps

hypo/thyroid

learning disability dyslexia

hematoma

PAD- statin  CAD

Neuron damage,

Brain disease,

Heart

Aphasia

Alpa1, hypertension

Heart damage

Infection - Arthrosis

3 layers of stages

kidney

Muscles ,

Seizuree

Fetal and preggas

Bones

Causes and effects

Treatment

Test

Diagnose

All heart or brain deficencys

Note that the info is in a simple easy to read format

Study

Goodluck