Cardio Study Notes PDF

Lien Nguyen, PA-S2 cardio CARDIOMYOPATHY Tx: unstable - atropine, temp cardiac pacing Stop offending meds, if symptomatic - pacemaker Dilated Cardiomyopathy Reduced contraction strength and...

Lien Nguyen, PA-S2 cardio CARDIOMYOPATHY Tx: unstable - atropine, temp cardiac pacing Stop offending meds, if symptomatic - pacemaker Dilated Cardiomyopathy Reduced contraction strength and dilated AV blocks ventricles, systolic dysfunction Delayed conduction through AV node or below, 30-40yo prolonged PR interval, atrial/ventricular Idiopathic, coxsackie virus, CMV, adenovirus, dissociation ischemic, toxins, drugs In AV node: 1st, 2nd Mobitz type I Exertional dyspnea, S3 gallop Below AV node: 2nd Mobitz type II, 3rd Echo: LV dilation, thin ventricular walls 1st degree: prolonged PR interval CXR: cardiomegaly, pulmonary edema 2nd degree Mobitz I: progressive PR lengthening, Tx: ACEI, BB, diuretics dropped QRS 2nd degree Mobitz II: fixed PR, dropped QRS Hypertrophic Obstructive Cardiomyopathy 3rd degree: complete atrial-ventricular dissociation Autosomal dominant genetic disorder LVH, RVH, Tx: unstable—atropine, pacing; stable—monitor or diastolic dysfunction pacemaker if symptomatic Early adulthood, sudden cardiac death young athlete Bundle Branch Block Dyspnea, syncope, harsh systolic murmur Delayed conduction in bundle branches crescendo-decrescendo LLSB (increased with Prolonged QRS, terminal conduction delay valsalva/standing, decreased with squatting/leg Tx: if symptomatic permanent pacemaker raise) ECG: widened QRS, terminal conduction delay Echo: LV hypertrophy, thickened septum Tx: symptomatic—pacemaker; asymptomatic— Tx: BB, CCBs (verapamil), Myomectomy, alcohol monitor septal ablation AVOID: nitrates, diuretics, ACEI/ARBs, digoxin Atrial Fibrilation Irregular atrial activity, loss of atrial contraction Restrictive Cardiomyopathy Risk factors: age, HTN, CAD, CHF, valvular disease, Non-dilated stiff ventricle, decreased compliance, hyperthyroidism diastolic dysfunction Irregularly irregular rhythm, no distinct P waves Amyloidosis, sarcoidosis, hemochromatosis Tx: rate control (BB, CCBs), anticoagulation (DOACs, Peripheral edema, JVD (kussmaul’s sign), ascites, warfarin), rhythm control (cardioversion, hepatomegaly antiarrhythmics) Echo: atria dilation Atrial Flutter CONDUCTION DISORDERS/DYSRHYTHMIAS Macro-reentrant circuit in the atria, regular atrial contractions Sinus Arrhythmia Risk factors: COPD, CHF, valvular disease variation in heart rate during the respiratory cycle “Sawtooth” flutter waves, regular ventricular rate Tx: rate control (BB, CCBs), rhythm control Sinus Node Dysfunction (cardioversion), anticoagulation Abnormal SA node action potential Sinus node degeneration/fibrosis, meds, infiltrative dx, inflammatory dx Exercise intolerance, fatigue, dizziness, CP, SOB Atrial Tachycardia Ventricular Fibrillation Rapid atrial rates, abnormal automaticity or re-entry Chaotic ventricular activity, no cardiac output Palpitations, lightheadedness, syncope ECG: irregular, no identifiable QRS complexes ECG: narrow complex tachycardia with P waves Tx: immediate defibrillation, CPR before each QRS Tx: BB, CCBs, antiarrhythmics, catheter ablation Ventricular Tachycardia Rapid ventricular rhythm, wide QRS complexes Bradycardia Monomorphic or polymorphic Heart rate < 60 bpm, decreased impulse Tx: unstable—cardioversion; stable—antiarrhythmics formation/conduction (amiodarone, lidocaine); consider ICD placement Causes: vagal stimulation, drugs (BB, CCBs), hypothyroidism Sxs: fatigue, dizziness, syncope Congenital Heart Disease Tx: asymptomatic—no Tx; unstable—atropine, pacing Atrial Septal Defect Idioventricular Rhythm Left-to-right shunting between atria Ventricular escape rhythm, rate 20-40 bpm Ostium secundum most common, associated with Wide QRS, no P waves Down syndrome Tx: unstable—pacing; treat underlying cause Wide, fixed split S2, systolic ejection murmur at LUSB CXR: cardiomegaly, increased pulmonary vasculature Junctional Rhythms Tx: observation if small; surgical or percutaneous Rhythms originating at AV junction, rate 40-60 bpm closure if symptomatic ECG: narrow QRS, inverted or absent P waves Tx: asymptomatic—monitor; unstable—pacing Coarctation of Aorta Narrowing of the aortic arch, increased afterload Premature Contractions Associated w Turner syndrome, bicuspid aortic valve Premature depolarization of atria (PACs) or ventricles UE HTN, LE hypotension, diminished femoral pulses, (PVCs) claudication ECG: early beat, compensatory pause CXR: rib notching, "3 sign" Tx: asymptomatic—no Tx; symptomatic—BB Tx: balloon angioplasty, stent placement, surgical repair QT Prolongation Prolonged ventricular repolarization, risk for Torsades Patent Ductus Arteriosus Causes: drugs (antiarrhythmics, macrolides, Persistent ductus arteriosus after birth, left-to-right antipsychotics), hypokalemia, hypocalcemia, shunting hypomagnesemia Associated with prematurity, congenital rubella Tx: stop offending agents, Mg sulfate for Torsades Continuous "machine-like" murmur at LUSB, bounding pulses Torsades de Pointes Tx: NSAIDs (indomethacin, ibuprofen) to close; Polymorphic ventricular tachycardia in the setting of surgical ligation if refractory prolonged QT Causes: drugs, electrolyte abnormalities, congenital Patent Foramen Ovale QT prolongation Failure of foramen ovale to close, potential right-to- ECG: twisting QRS complexes left shunting Tx: IV Mg sulfate, pacing if recurrent Often asymptomatic, can cause paradoxical embolism Infective Endocarditis or cryptogenic stroke Infection of endocardium/valves, common pathogens: Dx: bubble study on echo S. aureus, Strep viridans, Enterococcus Tx: closure if symptomatic or stroke occurs Fever, new murmur, Janeway lesions, Osler nodes, splinter hemorrhages Tetralogy of Fallot Dx: blood cultures, echo (vegetation), Duke criteria PROVe: Pulmonary stenosis, RVH, Overriding aorta, Tx: IV antibiotics based on culture (empiric: VSD vancomycin + ceftriaxone), valve surgery if indicated Cyanosis, "tet spells" relieved by squatting, harsh systolic murmur LUSB Myocarditis CXR: "boot-shaped" heart Inflammation of myocardium, viral causes most Tx: surgical repair, PGE1 to maintain ductal patency common (coxsackie, adenovirus) preoperatively Chest pain, dyspnea, arrhythmias, HF Sxs ECG: nonspecific ST changes, troponin elevation Transposition of the Great Vessels Echo/MRI: LV dysfunction, myocardial edema Aorta and pulmonary artery are switched, cyanotic Tx: supportive, treat underlying cause, manage HF heart defect Associated with diabetic mothers Pericardial Effusion Severe cyanosis at birth, single loud S2 Excess fluid in pericardial sac, often secondary to CXR: "egg on a string" appearance pericarditis or malignancy Tx: surgical arterial switch, PGE1 to maintain ductus Distant heart sounds, dyspnea, tamponade if severe arteriosus ECG: low voltage QRS, electrical alternans Echo: fluid collection around heart Ventricular Septal Defect Tx: observation if small; pericardiocentesis if large or Left-to-right shunting through septal defect symptomatic Most common congenital heart defect, associated with trisomies Pericarditis Harsh holosystolic murmur at LLSB Inflammation of pericardium, MCC viral Dx: echo showing defect Sharp pleuritic chest pain, worse supine, improved Tx: observation if small; surgical repair if symptomatic sitting up or large defect Pericardial friction rub, diffuse ST elevation, PR depression on ECG Traumatic, infectious, and inflammatory heart Tx: NSAIDs, colchicine; steroids if refractory or conditions contraindications to NSAIDs Cardiac Tamponade Vascular disease Accumulation of fluid in pericardium, impaired ventricular filling Aortic Aneurysm Beck's triad: hypotension, JVD, muffled heart sounds Dilation of aorta >50% normal diameter Pulsus paradoxus, tachycardia, dyspnea Risk factors: atherosclerosis, smoking, HTN ECG: low voltage QRS, electrical alternans Often asymptomatic; rupture causes severe back/abd Echo: pericardial effusion with diastolic collapse of pain, hypotension chambers Dx: US (screening), CT/MRI (pre-op planning) Tx: pericardiocentesis Tx: monitor if 5.5 cm or symptomatic Aortic Dissection Phlebitis/Thrombophlebitis Tear in intima of aorta, creating a false lumen Inflammation of a vein, with or without thrombus Severe tearing chest/back pain, pulse deficit, BP formation discrepancy Pain, erythema, induration along vein CXR: widened mediastinum; CT angio: intimal flap Dx: clinical; US to rule out DVT Tx: Type A (ascending)—emergent surgery; Type B— Tx: NSAIDs, compression, anticoagulation if thrombus medical (BB, nitroprusside) extends Arterial Embolism/Thrombosis Varicose Veins Acute occlusion of an artery by clot or embolus Dilated, tortuous superficial veins due to valve 6 Ps: pain, pallor, pulselessness, paresthesia, incompetence paralysis, poikilothermia Leg pain, heaviness, visible veins, worse with Dx: Doppler US, CTA prolonged standing Tx: anticoagulation (heparin), thrombectomy, Dx: clinical, venous Doppler US thrombolysis Tx: compression stockings, sclerotherapy, vein stripping if severe Arteriovenous Malformation Abnormal connection between artery and vein Venous Insufficiency Sxs vary by location; may cause seizures, bleeding, or Chronic venous hypertension due to valve bruits dysfunction Dx: MRI, angiography Leg edema, stasis dermatitis, ulcers at medial Tx: observation if asymptomatic; surgery or malleolus embolization if symptomatic Dx: clinical, venous US Tx: compression therapy, leg elevation, Deep Venous Thrombosis ablation/surgery if refractory Clot formation in deep veins, most common in LE Unilateral leg swelling, pain, erythema, warmth Hypertension Dx: venous US, D-dimer Tx: anticoagulation (heparin → warfarin or DOACs) Sxs: often none; severe cases may have headache, dizziness, or visual changes Giant Cell Arteritis Dx: BP ≥130/80 (confirmed on multiple readings), assess for end-organ damage Chronic vasculitis of large/medium vessels, associated Tx: lifestyle changes (DASH diet, exercise, salt with PMR reduction), medications (ACEI, ARBs, CCBs, thiazides) HA, jaw claudication, vision loss, scalp tenderness Dx: elevated ESR/CRP, temporal artery biopsy Primary Hypertension Tx: high-dose corticosteroids immediately Chronic hypertension with no identifiable cause (essential hypertension) Peripheral Artery Disease Risk factors: age, family history, obesity, sedentary Atherosclerosis causing arterial narrowing, ischemia lifestyle, high sodium intake Intermittent claudication, decreased pulses, cool Sxs: asymptomatic unless severe extremities Dx: clinical diagnosis of exclusion Dx: ABI 190 in familial cases) Tx: high-intensity statins (e.g., atorvastatin, rosuvastatin), consider PCSK9 inhibitors for familial hypercholesterolemia Hypertriglyceridemia Elevated triglycerides, risk for pancreatitis if severe (>500 mg/dL) Sxs: often asymptomatic; may cause eruptive xanthomas Dx: fasting lipid panel (↑ TG) Tx: fibrates (gemfibrozil, fenofibrate), omega-3 fatty acids, niacin, statins Low HDL Cholesterol Associated with increased cardiovascular risk Sxs: none Dx: fasting lipid panel (↓ HDL 40-50 degrees). Spinal Disorders Spinal Stenosis Ankylosing Spondylitis Narrowing of the spinal canal, often due to Chronic inflammatory disease primarily affecting degenerative changes, leading to compression of spine and sacroiliac joints, leading vertebrae fusion. spinal nerves. Sxs: low back pain, stiffness (worse in the morning or Sxs: low back pain, leg pain, numbness, weakness, after inactivity), improvement with exercise, limited exacerbated by walking and relieved by sitting spinal mobility. (neurogenic claudication). Dx: clinical features, positive HLA-B27, X-ray showing Dx: clinical evaluation, MRI or CT myelography to sacroiliitis, bamboo spine in advanced disease. assess stenosis. Tx: NSAIDs for pain, physical therapy, TNF inhibitors Tx: conservative (NSAIDs, physical therapy), epidural (e.g., etanercept, infliximab) for severe disease. steroid injections, surgery (laminectomy) for refractory cases. Herniated Disk Disease Spondylolisthesis Sxs: neck or back pain, numbness, tingling, weakness, Forward displacement of a vertebra over the one paralysis in severe cases, signs of spinal cord injury beneath it, commonly at the L5-S1 level. (e.g., loss of sensation, paralysis). Sxs: lower back pain, radicular symptoms (numbness, Dx: clinical evaluation, imaging (X-ray, CT, MRI) to tingling, weakness) if nerve roots are compressed. assess for fractures, dislocations, or soft tissue injury. Dx: X-ray showing vertebral slippage, CT or MRI for Tx: immobilization, surgical intervention for fractures, further evaluation. dislocations, or spinal cord injury, rehabilitation. Tx: physical therapy, NSAIDs, bracing for mild cases, surgery (spinal fusion) for severe cases. Chest/Rib Disorders Spondylolysis Stress fracture of the pars interarticularis (part of the Deformities vertebra), often at L5. Congenital or acquired abnormalities of the chest or Sxs: low back pain, especially with activity, tenderness ribs, including pectus excavatum (sunken chest) or over the affected vertebra. pectus carinatum (pigeon chest). Dx: X-ray, CT, or MRI showing defect in the pars Sxs: visible chest wall deformity, possible associated interarticularis. respiratory compromise, pain. Tx: rest, bracing, physical therapy, surgical Dx: clinical evaluation, imaging (X-ray, CT) for intervention for persistent or severe cases. structural assessment. Tx: observation for mild cases, surgical correction Sprain/Strain (e.g., Nuss procedure for pectus excavatum) for Injury to ligaments (sprain) or muscles/tendons moderate to severe deformities. (strain), often from overuse or trauma. Sxs: localized back pain, muscle spasms, limited range Fractures of motion, swelling. Fractures of the ribs, clavicle, or sternum, often due to Dx: clinical evaluation, imaging (X-ray/MRI) to rule out trauma. fractures or other structural injuries. Sxs: localized pain, tenderness, difficulty breathing, Tx: rest, ice, NSAIDs, physical therapy for bruising, crepitus in severe cases. strengthening, and stretching. Dx: clinical examination, chest X-ray or CT for confirmation and evaluation of associated injuries Torticollis (e.g., pneumothorax, hemothorax). Abnormal, persistent twisting of the neck, often Tx: analgesia (NSAIDs or opioids), rib immobilization caused by muscle spasm. with a rib belt (in some cases), and respiratory Sxs: neck pain, stiffness, head tilted to one side, chin support. Surgery for displaced fractures or significant rotated to the opposite side. complications. Dx: clinical evaluation, X-ray to rule out other conditions. Compartment Syndrome Tx: physical therapy, muscle relaxants, botulinum Increased pressure within a muscle compartment, toxin injections for severe cases. often following trauma or injury, leading to ischemia and potential tissue damage. Trauma Sxs: severe pain out of proportion to the injury, Injuries to the spine, including fractures, dislocations, swelling, tightness, diminished pulses, sensory and soft tissue damage. deficits, and paralysis in severe cases. Dx: clinical diagnosis, elevated intracompartmental pressure (measured via a pressure monitor). Tx: emergent fasciotomy to relieve pressure and Tx: IV antibiotics, surgical drainage of the infected prevent irreversible damage. joint, joint immobilization. Lower Extremity Disorders Avascular Necrosis Loss of blood supply to bone tissue, leading to bone death, most commonly affecting the femoral head. Degenerative Diseases Sxs: pain in the hip, groin, or thigh, exacerbated by weight-bearing, limited range of motion. Osteoarthritis Dx: clinical evaluation, X-ray, MRI showing bone A chronic degenerative joint disease characterized by collapse, joint space narrowing. cartilage breakdown, commonly affecting weight- Tx: pain management, physical therapy, core bearing joints. decompression, joint replacement in advanced cases. Sxs: joint pain, stiffness, decreased range of motion, swelling, crepitus. Developmental Dysplasia Dx: clinical evaluation, X-rays showing joint space Hip instability or dislocation in newborns or infants, narrowing, osteophytes, subchondral sclerosis. often due to abnormal hip socket formation. Tx: NSAIDs, physical therapy, corticosteroid injections, Sxs: asymmetrical leg length, limited hip abduction, joint replacement in severe cases. clunking sensation on physical exam. Dx: clinical examination (Barlow and Ortolani tests), hip ultrasound or X-ray for confirmation. Infectious Diseases Tx: Pavlik harness for infants, closed or open reduction, and hip surgery for older children. Osteomyelitis Infection of the bone, typically caused by bacteria, Extensor Mechanism Injuries often following trauma, surgery, or hematogenous Injury to the quadriceps tendon, patellar tendon, or spread. other components of the knee extensor mechanism, Sxs: localized bone pain, swelling, redness, fever, often from trauma or overuse. chills, drainage from wound (in some cases). Sxs: pain, swelling, inability to extend the knee fully, Dx: clinical symptoms, blood cultures, elevated instability, tenderness over the patella or tendon. ESR/CRP, X-rays, MRI, and bone biopsy for definitive Dx: clinical evaluation, MRI for soft tissue injuries, X- diagnosis. rays to rule out fractures. Tx: IV antibiotics, surgical debridement, and long-term Tx: rest, NSAIDs, physical therapy, surgical repair in oral antibiotics in chronic cases. severe cases. Septic Arthritis Fractures/Dislocations Infection of the joint space, usually bacterial, resulting Fractures and dislocations of the lower extremity, in acute inflammation and joint damage. such as femur, tibia, fibula, ankle, or hip. Sxs: acute joint pain, swelling, erythema, fever, Sxs: deformity, severe pain, swelling, bruising, loss of warmth, decreased range of motion. function. Dx: clinical evaluation, joint aspiration for synovial Dx: clinical evaluation, X-rays for fracture diagnosis, fluid analysis (elevated WBC, positive cultures), blood CT or MRI for complex fractures or soft tissue cultures, and imaging to assess joint damage. involvement. Tx: reduction (closed or open), immobilization, Sxs: often asymptomatic but may present with surgical fixation (plates, screws, or rods) for displaced localized pain, swelling, or pressure effects depending fractures. on location. Dx: clinical evaluation, imaging (X-rays, MRI), biopsy Osgood-Schlatter Disease for confirmation. Inflammatory condition affecting the tibial tuberosity Tx: observation for non-symptomatic cases, surgical in growing adolescents, commonly seen in athletes. removal if symptomatic or causing complications. Sxs: anterior knee pain, swelling at the tibial tuberosity, pain exacerbated by activity. Malignant Dx: clinical evaluation, X-ray showing prominence or Malignant neoplasms are cancerous growths that fragmentation of the tibial tuberosity. have the potential to invade surrounding tissues and Tx: rest, ice, NSAIDs, stretching and strengthening metastasize to distant organs. Common malignant exercises, rarely surgery in severe cases. neoplasms of the bone include osteosarcoma, Ewing's sarcoma, and chondrosarcoma. Slipped Capital Femoral Epiphysis (SCFE) Sxs: pain, swelling, pathologic fractures, systemic Displacement of the femoral head from the femoral symptoms like fever and weight loss in advanced neck, most commonly in obese adolescents during cases. growth spurts. Dx: clinical evaluation, imaging (X-rays, CT, MRI), Sxs: hip or knee pain, limp, inability to bear weight on biopsy for histological examination. the affected leg. Tx: surgical resection, chemotherapy, radiation Dx: clinical evaluation, X-ray showing posterior and therapy depending on the type and stage of the inferior displacement of the femoral head. cancer. Tx: non-weight-bearing, surgical fixation with screws to prevent further slippage. Paget Disease of Bone A chronic bone disorder characterized by excessive Soft-Tissue Injuries bone resorption followed by disorganized new bone Injuries to muscles, tendons, ligaments, and other formation, resulting in weakened bones that are soft tissues, including sprains, strains, and contusions. prone to deformity and fractures. Sxs: pain, swelling, bruising, limited mobility. Sxs: often asymptomatic, but can include pain (due to Dx: clinical evaluation, MRI for ligament or tendon bone deformities or fractures), joint pain, hearing loss tears, X-ray to rule out fractures. (if skull is involved), and bowing of the legs. Tx: R.I.C.E. , NSAIDs, physical therapy, and surgical Dx: elevated ALP in blood tests, X-ray showing repair for severe tears. thickened, deformed bone, bone scan for assessment of disease activity. Tx: bisphosphonates (e.g., alendronate) to inhibit Neoplasms bone resorption, calcitonin, pain management, and surgery for fractures or deformities. Benign Benign neoplasms are non-cancerous growths that do not spread to other parts of the body. They can Thoracic Outlet Syndrome occur in various tissues, including bone, soft tissue, A condition where there is compression of the and organs. Common benign neoplasms include neurovascular structures (brachial plexus, subclavian osteochondromas, fibromas, and lipomas. artery, or vein) as they pass through the thoracic outlet, leading to symptoms in the upper extremities. Sxs: pain, numbness, tingling, weakness, and/or swelling in the shoulder, arm, and hand, often exacerbated by arm elevation or certain postures. Symptoms can vary depending on the structure involved (neural or vascular). Dx: clinical evaluation, provocative maneuvers (e.g., Adson's test), imaging (X-ray, MRI, CT, or ultrasound), nerve conduction studies. Tx: physical therapy to improve posture and muscle strength, pain management, corticosteroid injections, surgical decompression in severe cases. Upper Extremity Disorders Fractures/Dislocations Fractures and dislocations of the upper extremity, including the clavicle, humerus, radius, ulna, and hand bones. Sxs: severe pain, swelling, bruising, deformity (in dislocations), limited range of motion, and inability to bear weight or use the affected extremity. Dx: clinical examination, X-rays to confirm fractures or dislocations, CT or MRI for complex injuries or soft tissue involvement. Tx: reduction (closed or open) for fractures, splinting or immobilization, surgical fixation (plates, screws) for displaced fractures or unstable dislocations. Soft-Tissue Injuries Injuries to the muscles, tendons, ligaments, and other soft tissues in the upper extremities, including sprains, strains, and contusions. Sxs: pain, swelling, bruising, tenderness, limited motion, or instability. Dx: clinical evaluation, MRI or ultrasound to assess the extent of the injury, X-ray if bone involvement is suspected. Tx: R.I.C.E. for acute injuries, NSAIDs for pain relief, physical therapy, and surgical intervention for severe tears or ruptures. obygyn Pregnancy Tx: methotrexate or surgery (salpingectomy/salpingostomy) Abruptio Placentae Premature separation of the placenta from the Fetal Distress uterine wall Signs of hypoxia (abnormal HR, late decels, absent Painful vaginal bleeding, abdominal pain, uterine variability) tenderness, fetal distress Dx: nonstress test, biophysical profile, fetal scalp pH Dx: clinical, US may show retroplacental clot Tx: maternal oxygen, repositioning, emergent delivery Tx: stabilize mother, emergent delivery if severe if needed Breech Presentation Gestational Diabetes Fetal buttocks or feet presenting first Hyperglycemia during pregnancy Detected on Leopold maneuvers or US Dx: glucose challenge test, confirm with 3-hour GTT Tx: external cephalic version if ≥37wks; cesarean Tx: lifestyle changes, insulin if needed, monitor delivery often recommended glucose postpartum Cervical Insufficiency Gestational Trophoblastic Disease Painless cervical dilation, leading to second-trimester Abnormal trophoblastic proliferation (e.g., molar pregnancy loss pregnancy) Dx: transvaginal US (short cervix dates, high β-hCG, Tx: cerclage placement "snowstorm" on US Tx: suction curettage, monitor β-hCG, chemo for Cesarean and Operative Delivery choriocarcinoma Indications: breech, fetal distress, placenta previa, previous C-section Hypertensive Disorders of Pregnancy Operative vaginal delivery: forceps or vacuum Chronic HTN: BP ≥140/90 before 20wks extraction Gestational HTN: BP ≥140/90 after 20wks, no Tx: pre-op antibiotics for cesarean; post-op VTE proteinuria prophylaxis Preeclampsia: gestational HTN + proteinuria or end- organ damage Classifications of Abortion Eclampsia: preeclampsia + seizures Threatened: bleeding, closed os, viable fetus Tx: BP control (labetalol, hydralazine), magnesium Inevitable: bleeding, open os, no passage of tissue sulfate (seizure prophylaxis), delivery Incomplete: bleeding, open os, some products expelled Labor/Delivery Complete: no bleeding, closed os, all products - Stage 1: latent (slow dilation), active (rapid expelled dilation) Missed: no bleeding, closed os, fetal demise - Stage 2: full dilation to delivery Tx: expectant, misoprostol, or surgical (D&C) - Stage 3: delivery of placenta Tx: supportive care, augmentation if needed Ectopic Pregnancy (oxytocin) Implantation outside uterine cavity (MC in fallopian tube) Multiple Gestation Unilateral pelvic pain, vaginal bleeding, adnexal mass Twins or higher-order pregnancies; risks: preterm Dx: β-hCG, TVUS (empty uterus) labor, preeclampsia Dx: US (chorionicity/amnionicity) Rupture of membranes before labor onset Tx: monitor for complications, planned delivery timing Dx: sterile speculum exam, nitrazine test, fern test Tx: monitor if term; antibiotics and corticosteroids if preterm Placenta Previa Placenta covering cervix, painless vaginal bleeding in Rh Incompatibility 3rd trimester Rh-negative mother with Rh-positive fetus; risk of Dx: transabdominal then TVUS alloimmunization Tx: pelvic rest, planned cesarean delivery at 36-37wks Dx: indirect Coombs test, fetal MCA Doppler if anemia suspected Postnatal/Postpartum Care Tx: RhoGAM at 28wks and postpartum if baby Rh+ Focus on uterine involution, lactation, mood monitoring Shoulder Dystocia Tx: contraception discussion, postpartum depression Difficulty delivering fetal shoulders after head screening "Turtle sign," brachial plexus injury risk Tx: McRoberts maneuver, suprapubic pressure, Postpartum Hemorrhage delivery maneuvers Blood loss >500mL vaginal or >1000mL cesarean delivery Umbilical Cord Prolapse Causes: uterine atony, trauma, retained placenta, Cord slips ahead of presenting part, risking coagulopathy compression Tx: uterine massage, oxytocin, surgical intervention if Dx: palpation or visible cord needed Tx: elevate presenting part, emergent cesarean delivery Postpartum Pituitary Disorders Sheehan Syndrome: ischemic necrosis from severe hemorrhage Vaginal/Vulvar Disorders Symptoms: lactation failure, amenorrhea, fatigue Dx: low pituitary hormones Bartholin Gland Cysts Tx: hormone replacement Obstruction of Bartholin gland duct, leading to fluid accumulation Postpartum Psychiatric Disorders Painless lump near vaginal opening, can become Blues: mild mood changes 2wks, impaired function Dx: clinical exam, culture if abscess suspected Psychosis: severe symptoms, delusions, hallucinations Tx: warm sitz baths, drainage, marsupialization, Tx: therapy, antidepressants (depression), antibiotics for abscess hospitalization (psychosis) Cystocele Preconception/Prenatal Care Prolapse of the bladder into the vaginal wall Optimize health pre-pregnancy, assess risks Symptoms: pelvic pressure, urinary incontinence, Dx: labs (CBC, blood type, infectious disease incomplete voiding screening), US for dating Dx: pelvic exam (cystocele bulge), urodynamics if Tx: folic acid, prenatal vitamins, vaccinations needed Tx: pelvic floor exercises, pessary, surgery if Prelabor Rupture of Membranes (PROM) symptomatic  management, surgical excision, hysterectomy for Prolapse severe cases. Pelvic organ descent (uterus, bladder, rectum) due to weakened pelvic floor Leiomyoma (Uterine Fibroids) Symptoms: vaginal bulging, urinary or fecal Benign tumors of the smooth muscle of the uterus. incontinence, pelvic pressure Sxs: heavy menstrual bleeding, pelvic pain or Dx: pelvic exam (graded by descent level), possibly pressure, urinary frequency, infertility, miscarriage. imaging Dx: pelvic exam, ultrasound, hysteroscopy, MRI Tx: pelvic floor exercises, pessary, surgery (e.g., (especially for submucosal fibroids). uterine suspension, colpocleisis) Tx: observation if asymptomatic, medical treatment (e.g., GnRH agonists, progestins), myomectomy, Rectocele hysterectomy, or uterine artery embolization for Prolapse of the rectum into the vaginal wall symptomatic cases. Symptoms: difficulty with defecation, pelvic pressure, vaginal bulge Uterine Prolapse Dx: pelvic exam, possibly defecography The descent of the uterus into the vaginal canal due Tx: pelvic floor exercises, surgery if severe (e.g., to weakened pelvic floor muscles and ligaments. posterior colporrhaphy) Sxs: pelvic pressure, urinary incontinence, vaginal bulging, difficulty emptying the bladder or bowel. Vaginitis Dx: clinical examination (speculum exam and pelvic Inflammation of the vagina, often due to infection or examination), grading of prolapse (1st-4th degree). irritation Tx: pelvic floor exercises (Kegel exercises), pessary for Bacterial Vaginosis: grayish discharge, fishy odor, clue mild cases, surgical options (e.g., vaginal or cells on microscopy abdominal hysterectomy, uterine suspension, or Candidiasis: thick white discharge, pruritus, hyphae pelvic floor repair) for severe prolapse. on KOH prep Trichomoniasis: frothy yellow-green discharge, erythema, mobile trichomonads on wet mount Neoplasms of the Breast and Reproductive Tract Tx: antibiotics (metronidazole for BV and Benign Neoplasms of the Breast trichomoniasis), antifungals for candidiasis 1. Fibroadenoma Benign, solid tumors composed of glandular and fibrous tissue. Uterine Disorders Sxs: painless, firm, mobile mass, usually discovered on routine breast exam. Endometriosis Dx: clinical examination, mammogram, A condition where tissue similar to the uterine lining ultrasound, biopsy (if necessary). grows outside the uterus, often on the ovaries, Tx: observation, excision for symptomatic or fallopian tubes, or the pelvic peritoneum. enlarging masses. Sxs: dysmenorrhea, chronic pelvic pain, dyspareunia, infertility, heavy menstrual bleeding. 2. Fibrocystic Changes Dx:laparoscopy for definitive diagnosis, pelvic Non-cancerous changes in the breast tissue that ultrasound, MRI (helpful in identifying deep infiltrating cause lumps or tenderness, often related to the endometriosis). menstrual cycle. Tx: hormonal therapies (e.g., combined oral Sxs: cyclic breast pain, palpable nodules. contraceptives, progestins, GnRH agonists), pain Dx: clinical exam, ultrasound, mammography,  aspiration of cysts (if needed). Tx: chemotherapy (neoadjuvant), mastectomy, Tx: symptomatic relief (e.g., NSAIDs, warm radiation therapy, hormonal therapy. compresses), supportive bras, cyst aspiration. 3. Intraductal Papilloma Benign growth within a milk duct that may cause Benign Neoplasms of the Reproductive Tract bloody nipple discharge. 1. Ovarian Cysts Sxs: unilateral bloody nipple discharge, small Fluid-filled sacs on the ovaries, typically benign. palpable mass. Sxs: often asymptomatic; if symptoms occur, Dx: mammogram, ultrasound, ductography, pelvic pain or pressure. biopsy. Dx: pelvic ultrasound, clinical examination. Tx: excision of the papilloma. Tx: observation for simple cysts, surgical removal for large or symptomatic cysts. Malignant Neoplasms of the Breast 1. Invasive Ductal Carcinoma (IDC) 2. Uterine Leiomyomas (Fibroids) Most common type of breast cancer, originating Benign smooth muscle tumors of the uterus. in the milk ducts and spreading to surrounding Sxs: heavy menstrual bleeding, pelvic pressure, tissue. urinary symptoms, infertility. Sxs: firm, non-mobile breast mass, nipple Dx: pelvic ultrasound, MRI. discharge, skin changes (e.g., dimpling). Tx: observation, medication (e.g., GnRH agonists), Dx: mammogram, ultrasound, biopsy, MRI for myomectomy, hysterectomy for symptomatic staging. fibroids. Tx: surgery (lumpectomy or mastectomy), radiation therapy, chemotherapy, hormonal Malignant Neoplasms of the Reproductive Tract therapy (e.g., tamoxifen), HER2-targeted therapy 1. Cervical Cancer (if applicable). MC cause high-risk strains of HPV. Sxs: abnormal vaginal bleeding, post-coital 2. Invasive Lobular Carcinoma (ILC) bleeding, pelvic pain, vaginal discharge. Less common breast cancer originating in the Dx: Pap smear, colposcopy, biopsy, HPV testing. milk-producing lobules. Tx: surgery (cone biopsy, hysterectomy), Sxs: thickening of the breast tissue, ill-defined radiation, chemotherapy. mass, often without clear borders. Dx: mammogram, ultrasound, biopsy, MRI. 2. Endometrial Cancer Tx: surgery (lumpectomy or mastectomy), Cancer of the lining of the uterus, often radiation therapy, chemotherapy, hormonal associated with estrogen exposure. therapy. Sxs: postmenopausal bleeding, abnormal vaginal bleeding. 3. Inflammatory Breast Cancer Dx: transvaginal ultrasound, endometrial biopsy. A rare, aggressive form of breast cancer Tx: surgery (hysterectomy), radiation therapy, characterized by redness, warmth, and swelling of chemotherapy, hormonal therapy. the breast. Sxs: rapid breast enlargement, redness, peau 3. Ovarian Cancer d'orange (orange peel-like skin), pain. Often diagnosed at an advanced stage, may be Dx: clinical exam, biopsy, ultrasound, asymptomatic in early stages. mammogram, MRI for staging. Sxs: bloating, pelvic or abdominal pain, urinary  urgency or frequency, changes in bowel habits. Dx: pelvic ultrasound, CT scan, CA-125 blood test, biopsy. Tx: surgery (oophorectomy, hysterectomy), chemotherapy, targeted therapy. 4. Vaginal Cancer Rare cancer, often related to HPV infection. Sxs: abnormal vaginal bleeding, pelvic pain, vaginal mass, discharge. Dx: pelvic exam, biopsy, colposcopy. Tx: surgery (vaginal resection), radiation therapy, chemotherapy. 5. Vulvar Cancer Often presents as a mass/ulceration on vulva. Sxs: itching, pain, or a lump in the vulva, bleeding, changes in skin color or texture. Dx: pelvic examination, biopsy. Tx: surgery (vulvectomy), radiation therapy, chemotherapy. infectious Bacterial Diseases Dx: nucleic acid amplification test (NAAT) of urine or swabs. Bartonella Tx: azithromycin or doxycycline. A genus of bacteria that includes species causing diseases like cat scratch fever and trench fever. Cholera Sxs: fever, lymphadenopathy, rash, fatigue. Cat A bacterial infection caused by Vibrio cholerae, often scratch disease presents with lymphadenopathy near from contaminated water or food. the site of the scratch or bite. Sxs: profuse watery diarrhea, vomiting, dehydration, Dx: PCR, serology, or biopsy. and electrolyte imbalances. Tx: doxycycline or azithromycin. Dx: stool culture. Tx: rehydration (oral or IV), antibiotics (e.g., Botulism doxycycline, azithromycin). Caused by Clostridium botulinum toxin affecting the neuromuscular junction. Clostridioides difficile Infection Sxs: descending paralysis, dysphagia, respiratory A toxin-producing bacterium that often occurs after failure, dilated pupils, dry mouth. antibiotic use, leading to colitis. Dx: clinical presentation, detection of toxin in serum, Sxs: watery diarrhea, fever, abdominal cramping, stool, or food. leukocytosis. Tx: botulinum antitoxin, supportive care, mechanical Dx: stool PCR for C. difficile toxins. ventilation if needed. Tx: metronidazole or vancomycin, avoid further antibiotics. Campylobacter jejuni Infection A bacterial infection from contaminated food, Diphtheria particularly poultry. A respiratory infection caused by Corynebacterium Sxs: watery or bloody diarrhea, abdominal cramps, diphtheriae, characterized by a pseudomembrane in fever, nausea. the throat. Dx: stool culture or PCR for Campylobacter. Sxs: sore throat, fever, pseudomembrane formation, Tx: supportive care, antibiotics (e.g., azithromycin) in dysphagia, difficulty breathing. severe cases. Dx: throat culture or PCR. Tx: diphtheria antitoxin, antibiotics (penicillin or Chancroid erythromycin). A sexually transmitted infection caused by Haemophilus ducreyi, characterized by painful genital Gonococcal Infections ulcers. Caused by Neisseria gonorrhoeae, these infections Sxs: painful, soft genital ulcers, swollen lymph nodes. are sexually transmitted. Dx: clinical presentation, gram stain, culture of lesion Sxs: urethritis, cervicitis, dysuria, purulent discharge. exudates. Can cause pelvic inflammatory disease (PID) and Tx: azithromycin or ceftriaxone. systemic infections. Dx: NAAT of urine or genital swabs. Chlamydia Tx: ceftriaxone plus azithromycin. A common sexually transmitted infection caused by Chlamydia trachomatis. Methicillin-Resistant Staphylococcus aureus (MRSA) Sxs: asymptomatic in many cases, dysuria, pelvic pain, A resistant form of Staphylococcus aureus causing vaginal discharge. skin infections and potentially severe systemic infections. Sxs: painful, red, swollen abscesses or cellulitis, fever, Sxs: muscle rigidity, spasms, lockjaw, difficulty sepsis in severe cases. swallowing. Dx: culture and sensitivity testing. Dx: clinical diagnosis. Tx: vancomycin, clindamycin, or trimethoprim- Tx: tetanus immunoglobulin, antibiotics sulfamethoxazole. (metronidazole), muscle relaxants, and wound cleaning. Rheumatic Fever An inflammatory disease following Group A Fungal Diseases Streptococcus throat infection, leading to cardiac, joint, and skin symptoms. Blastomycosis Sxs: migratory arthritis, carditis, erythema A fungal infection caused by Blastomyces marginatum, sydenham chorea, subcutaneous dermatitidis, typically found in soil and decaying nodules. organic matter. Dx: Jones criteria (history of sore throat, and clinical Sxs: fever, cough, chest pain, skin lesions, weight loss. findings). Dx: culture, histopathology, serology. Tx: antibiotics to eradicate streptococcus, anti- Tx: itraconazole, amphotericin B for severe cases. inflammatory treatment (aspirin or corticosteroids), long-term prophylaxis with penicillin. Candidiasis A yeast infection caused by Candida species, often Rocky Mountain Spotted Fever Candida albicans. A tick-borne illness caused by Rickettsia rickettsii. Sxs: oral thrush (white patches in the mouth), vaginal Sxs: fever, rash (petechial), headache, history of tick discharge, itching, and erythema. exposure. Dx: clinical evaluation, KOH prep, culture. Dx: serology or PCR. Tx: antifungals (e.g., fluconazole, nystatin). Tx: doxycycline. Coccidioidomycosis Salmonellosis A fungal infection caused by Coccidioides species, An infection caused by various species of Salmonella, typically in the southwestern U.S. often from contaminated food. Sxs: fever, cough, chest pain, fatigue, erythema Sxs: fever, abdominal cramps, diarrhea (sometimes nodosum, and disseminated disease in severe cases. bloody), nausea. Dx: serology, PCR, culture. Dx: stool culture. Tx: fluconazole or itraconazole for localized, Tx: supportive care, antibiotics (e.g., ciprofloxacin) for amphotericin B for disseminated cases. severe cases. Cryptococcosis Shigellosis Caused by Cryptococcus neoformans, often in An intestinal infection caused by Shigella bacteria. immunocompromised individuals. Sxs: bloody diarrhea, abdominal cramping, fever. Sxs: cough, chest pain, fever, meningitis, and Dx: stool culture. headache in severe cases. Tx: ciprofloxacin or azithromycin in severe cases. Dx: serum cryptococcal antigen test, culture, lumbar puncture for CNS involvement. Tetanus Tx: amphotericin B, fluconazole. Caused by the toxin from Clostridium tetani, often following a wound. Histoplasmosis Caused by Histoplasma capsulatum, typically from Sxs: diarrhea (sometimes bloody), abdominal bird or bat droppings. cramping, fever, liver abscess. Sxs: fever, cough, chest pain, fatigue, weight loss, and Dx: stool ova and parasites, serology. potential disseminated infection. Tx: metronidazole or tinidazole, followed by Dx: serology, culture, chest X-ray. iodoquinol. Tx: itraconazole for mild cases, amphotericin B for severe or disseminated cases. Giardiasis Caused by Giardia lamblia, often contracted from Pneumocystis contaminated water. Pneumocystis jirovecii causes pneumonia (PCP), Sxs: diarrhea, abdominal bloating, flatulence, nausea. commonly in immunocompromised patients. Dx: stool ova and parasites, Giardia antigen test. Sxs: fever, cough, dyspnea, hypoxia. Tx: metronidazole or tinidazole. Dx: chest X-ray, sputum PCR, bronchoalveolar lavage for diagnosis. Helminth Infestations Tx: trimethoprim-sulfamethoxazole, corticosteroids Parasitic worm infections, including roundworms, for severe cases. tapeworms, and flukes. Sxs: abdominal pain, diarrhea, weight loss, malnutrition. Mycobacterial Diseases Dx: stool ova/parasites, serology for specific worms. Tx: albendazole, mebendazole, praziquantel, Atypical Mycobacterial Disease depending on the type. Infections caused by non-tuberculous mycobacteria, often presenting with pulmonary, skin, or lymphatic Malaria involvement. A parasitic infection caused by Plasmodium species, Sxs: chronic cough, fever, weight loss, skin nodules. transmitted by Anopheles mosquitoes. Dx: culture, PCR, acid-fast bacilli (AFB) stain. Sxs: fever, chills, headache, anemia, splenomegaly. Tx: combination therapy with macrolides, rifampin, Dx: blood smear, rapid diagnostic tests. and ethambutol. Tx: chloroquine, artemisinin-based combination therapies (ACTs). Tuberculosis A chronic bacterial infection by Mycobacterium Pinworms tuberculosis, primarily affecting the lungs. Caused by Enterobius vermicularis, a common Sxs: cough, hemoptysis, weight loss, night sweats, intestinal parasite in children. fever. Sxs: anal itching, especially at night. Dx: tuberculin skin test (TST), chest X-ray, sputum Dx: tape test, stool exam. culture for AFB. Tx: mebendazole, albendazole, or pyrantel pamoate. Tx: multi-drug regimen (isoniazid, rifampin, pyrazinamide, ethambutol for active TB). Toxoplasmosis Caused by Toxoplasma gondii, often contracted from contaminated food or cat feces. Parasitic Diseases Sxs: flu-like symptoms, lymphadenopathy, ocular involvement, encephalitis in immunocompromised Amebiasis individuals. Caused by Entamoeba histolytica, often from Dx: serology, PCR. contaminated water. Tx: pyrimethamine and sulfadiazine with folinic acid.  A bacterial infection that can be transmitted from Trichomoniasis mother to newborn during delivery, potentially A sexually transmitted infection caused by causing sepsis and meningitis. Trichomonas vaginalis. Sxs: fever in the newborn, respiratory distress, Sxs: vaginal discharge, itching, dysuria, and often lethargy. asymptomatic in men. Dx: culture of vaginal or rectal swab during labor. Dx: wet mount of vaginal secretions, NAAT. Tx: intravenous antibiotics (penicillin) during labor. Tx: metronidazole or tinidazole. Prion Diseases Perinatal Transmission of Disorders Sepsis/Systemic Inflammatory Response Syndrome Congenital Varicella (SIRS) Varicella infection during pregnancy, especially in the A life-threatening condition involving widespread first trimester, can lead to birth defects. inflammation in response to infection or injury. Sxs: skin lesions, eye problems, limb deformities, Sxs: fever, tachycardia, hypotension, tachypnea, neurological damage in the fetus. altered mental status. Dx: clinical signs, PCR for varicella zoster virus. Dx: blood cultures, clinical signs, and SIRS criteria. Tx: varicella zoster immune globulin for exposed Tx: broad-spectrum antibiotics, IV fluids, vasopressors infants, antivirals for pregnant women. for hypotension. Herpes Simplex Virus (HSV) HSV infection can be transmitted to the neonate during delivery. Spirochetal Diseases Sxs: skin lesions, neurological damage, encephalitis. Dx: PCR or viral culture. Lyme Disease Tx: acyclovir for neonatal HSV infection. A tick-borne illness caused by Borrelia burgdorferi. Sxs: erythema migrans (bull's-eye rash), fever, fatigue, Human Papillomavirus (HPV) musculoskeletal pain. Genital HPV infections may cause warts or lead to Dx: serology (ELISA and Western blot), clinical cervical cancer. presentation. Sxs: genital warts, possible complications during Tx: doxycycline or amoxicillin. childbirth (laryngeal papillomatosis). Dx: pap smear, HPV DNA testing. Syphilis Tx: topical treatments for warts, vaccination for A sexually transmitted infection caused by prevention. Treponema pallidum. Sxs: painless chancre, followed by rash, mucosal Zika Virus lesions, and potentially systemic involvement in later Zika virus infection during pregnancy can cause birth stages. defects such as microcephaly. Dx: serologic tests (VDRL, RPR, FTA-ABS). Sxs: mild febrile illness, rash, joint pain, conjunctivitis. Tx: penicillin G. Dx: serology, PCR. Tx: supportive care. Viral Diseases Group B Streptococcus (GBS) Coronavirus Infections Sxs: acute retroviral syndrome (fever, rash), Caused by SARS-CoV-2 and other coronaviruses, opportunistic infections, weight loss, night sweats. these infections can lead to respiratory illness or Dx: HIV RNA PCR, HIV antibodies, CD4 count. systemic manifestations. Tx: antiretroviral therapy (ART). Sxs: fever, cough, shortness of breath, anosmia, and in severe cases, ARDS. Human Papillomavirus Infections Dx: PCR for SARS-CoV-2. A common STI, often asymptomatic but can cause Tx: supportive care, antivirals (e.g., remdesivir), genital warts and lead to cervical cancer. monoclonal antibodies. Sxs: genital warts, potential cervical dysplasia. Dx: Pap smear, HPV DNA testing. Cytomegalovirus Infections Tx: wart removal, vaccination for prevention. A herpesvirus that often causes asymptomatic infection but can be severe in immunocompromised Influenza individuals and newborns. A viral respiratory infection with seasonal outbreaks. Sxs: fever, lymphadenopathy, hepatosplenomegaly, Sxs: fever, cough, sore throat, muscle aches, fatigue. jaundice in neonates. Dx: rapid flu test, PCR. Dx: PCR, serology, histopathology. Tx: oseltamivir (Tamiflu), supportive care. Tx: antivirals (e.g., ganciclovir) for severe cases. Measles Epstein-Barr Virus Infections A highly contagious viral infection. A herpesvirus causing infectious mononucleosis. Sxs: cough, coryza, conjunctivitis, maculopapular rash, Sxs: fever, sore throat, lymphadenopathy, Koplik spots. splenomegaly. Dx: clinical presentation, PCR. Dx: heterophile antibody test (Monospot), serology. Tx: supportive care, vitamin A for severe cases. Tx: supportive care, avoid contact sports due to spleen enlargement. Mumps A viral infection affecting the parotid glands. Erythema Infectiosum Sxs: swelling of the parotid glands, fever, headache. Also known as fifth disease, caused by parvovirus Dx: clinical diagnosis, PCR. B19. Tx: supportive care. Sxs: "slapped cheek" rash, lacy body rash, mild fever. Dx: clinical presentation, PCR. Polio Tx: supportive care. A viral infection caused by the poliovirus, leading to paralysis. Herpes Simplex Virus Infections Sxs: fever, fatigue, muscle weakness, flaccid paralysis. HSV causes oral and genital lesions. Dx: PCR, stool culture. Sxs: painful blisters, ulcers, fever, and Tx: supportive care. lymphadenopathy. Dx: viral culture, PCR. Rabies Tx: acyclovir, valacyclovir. A viral infection that affects the central nervous system, typically transmitted via animal bites. HIV/AIDS Sxs: fever, hydrophobia, agitation, paralysis, Human Immunodeficiency Virus causes progressive encephalitis. immune deficiency, leading to AIDS. Dx: clinical signs, direct fluorescent antibody test on tissue samples. Tx: rabies immune globulin and post-exposure vaccination. Roseola A viral infection, usually in children, caused by human herpesvirus 6. Sxs: high fever followed by a rash that starts on the trunk. Dx: clinical presentation. Tx: supportive care. Rubella A viral infection that can cause birth defects if contracted during pregnancy. Sxs: mild fever, rash, lymphadenopathy. Dx: serology, PCR. Tx: supportive care, rubella vaccination for prevention. Varicella-Zoster Virus Infections Causes chickenpox in children and shingles in adults. Sxs: pruritic vesicular rash, fever, malaise. Dx: clinical diagnosis, PCR. Tx: acyclovir for shingles, varicella vaccine for prevention. endocrine  blurred vision. Adrenal Disorders Dx: fasting glucose ≥126 mg/dL, HbA1c ≥6.5%, glucose tolerance test. Cushing Syndrome Tx: lifestyle changes, oral antidiabetics (e.g., Excess cortisol, often due to corticosteroid use or metformin), insulin if necessary. adrenal tumors. Sxs: central obesity, moon face, buffalo hump, purple striae, proximal muscle weakness, hypertension, Hypogonadism glucose intolerance. Dx: 24-hr urinary free cortisol, late-night salivary Decreased function of the gonads leading to low sex cortisol, dexamethasone suppression test, imaging hormone production. (CT/MRI). Sxs: decreased libido, infertility, fatigue, Tx: taper corticosteroids, surgery for tumors, medical gynecomastia, amenorrhea in females. management (e.g., ketoconazole). Dx: low testosterone or estrogen, high or low gonadotropins (LH/FSH). Pheochromocytoma Tx: hormone replacement therapy (testosterone, Catecholamine-secreting adrenal tumor. estrogen/progesterone). Sxs: episodic hypertension, palpitations, diaphoresis, headaches. Dx: plasma or urine metanephrines, CT/MRI of the Metabolic Syndrome adrenal glands. Cluster of conditions increasing cardiovascular risk. Tx: preoperative alpha-blockade, surgical removal. Sxs: central obesity, hypertension, hyperglycemia, Primary Adrenal Insufficiency (Addison Disease) hyperlipidemia. Destruction of adrenal glands leading to cortisol and Dx: 3 of the following: high waist circumference, high aldosterone deficiency. triglycerides, low HDL, hypertension, elevated fasting Sxs: fatigue, weakness, hypotension, glucose. hyperpigmentation, salt craving. Tx: lifestyle modification, treat individual risk factors. Dx: low cortisol, high ACTH, ACTH stimulation test, electrolytes (hyponatremia, hyperkalemia). Neoplasms Tx: glucocorticoids (hydrocortisone) and mineralocorticoids (fludrocortisone). Multiple Endocrine Neoplasia (MEN) Genetic syndromes with tumors in multiple endocrine glands. Diabetes Mellitus Sxs: depends on subtype (MEN 1, 2A, 2B); Type 1 DM hyperparathyroidism, pheochromocytoma, medullary Autoimmune destruction of pancreatic beta cells. thyroid cancer. Sxs: polyuria, polydipsia, polyphagia, weight loss. Dx: genetic testing, hormone levels, imaging. Dx: fasting glucose ≥126 mg/dL, HbA1c ≥6.5%, Tx: management of individual tumors. autoantibodies. Tx: insulin therapy. Neoplastic Syndrome Paraneoplastic syndromes associated with tumors Type 2 DM secreting hormones. Insulin resistance and relative insulin deficiency. Sxs: varied depending on the hormone; Cushing Sxs: often asymptomatic, fatigue, polyuria, polydipsia, syndrome, hypercalcemia, SIADH. Dx: hormone levels, imaging. Dwarfism Tx: treat underlying cancer, manage hormone excess. GH deficiency in childhood. Sxs: short stature, delayed growth. Primary Endocrine Malignancy Dx: low IGF-1, lack of GH response to stimulation Includes adrenal, thyroid, or pituitary cancers. tests. Sxs/Dx/Tx: dependent on tumor type and location. Tx: GH replacement. Pituitary Adenoma Parathyroid Disorders Benign tumor; may secrete hormones. Sxs: headache, vision changes, hormone Hyperparathyroidism excess/deficiency. Excess PTH causing hypercalcemia. Dx: MRI, hormone levels. Sxs: stones (kidney), bones (pain), groans (abdominal Tx: surgery, medications based on hormone excess. pain), psychiatric overtones. Dx: high PTH, high calcium, low phosphate. Prolactinoma Tx: surgery, bisphosphonates. Prolactin-secreting adenoma. Sxs: galactorrhea, amenorrhea, infertility. Hypoparathyroidism Dx: high prolactin, MRI. Low PTH causing hypocalcemia. Tx: dopamine agonists (cabergoline, bromocriptine). Sxs: tetany, Chvostek sign, Trousseau sign, paresthesia. SIADH Dx: low PTH, low calcium, high phosphate. Excess ADH causing water retention. Tx: calcium and vitamin D supplementation. Sxs: hyponatremia, low serum osmolality, concentrated urine. Dx: labs, clinical presentation. Pituitary Disorders Tx: fluid restriction, salt tablets, demeclocycline. Acromegaly/Gigantism Excess GH; gigantism if onset before epiphyseal plate Thyroid Disorders closure. Sxs: enlarged hands/feet, coarse facial features, joint Goiter pain. Enlarged thyroid gland. Dx: elevated IGF-1, lack of GH suppression with Sxs: neck swelling, dysphagia, respiratory symptoms. glucose. Dx: TSH, ultrasound. Tx: surgery, somatostatin analogs. Tx: treat underlying cause, surgery if obstructive. Cushing Disease Hyperthyroidism ACTH-secreting pituitary tumor. Excess thyroid hormone. Sxs/Dx/Tx: see Cushing Syndrome. Sxs: weight loss, heat intolerance, palpitations, tremors. Diabetes Insipidus Dx: low TSH, high T3/T4. ADH deficiency or resistance. Tx: antithyroid meds (methimazole), beta blockers, Sxs: polyuria, polydipsia, dilute urine. radioactive iodine, surgery. Dx: water deprivation test, ADH test. Tx: central: desmopressin; nephrogenic: thiazides. Hypothyroidism Low thyroid hormone. Sxs: fatigue, cold intolerance, weight gain, bradycardia. Dx: high TSH, low T3/T4. Tx: levothyroxine. Thyroid Nodules Solitary or multiple; may be benign or malignant. Sxs: asymptomatic or compressive symptoms. Dx: ultrasound, FNA biopsy. Tx: surgery, observation. Thyroiditis Inflammation of the thyroid gland. Sxs: tender thyroid (subacute), hyper/hypothyroid phases. Dx: ESR, thyroid antibodies, clinical exam. Tx: NSAIDs, beta blockers, levothyroxine (if hypothyroid). heme  Dx: low protein C or S levels, functional assays. Coagulation Disorders Tx: anticoagulation, protein C concentrate for severe deficiency. Clotting Factor Disorders Deficiency or dysfunction of clotting factors Antithrombin III Deficiency Sxs: prolonged bleeding, hemarthrosis. Inherited or acquired deficiency causing Dx: prolonged PT/PTT, specific factor assays. hypercoagulability. Tx: factor replacement therapy. Sxs: recurrent DVTs or PEs, resistance to heparin. Dx: antithrombin activity assay, low antithrombin Hemophilia levels. Genetic deficiency of clotting factors VIII Tx: anticoagulation, antithrombin concentrate for (Hemophilia A) or IX (Hemophilia B). acute thrombosis. Sxs: spontaneous bleeding, hemarthrosis, prolonged bleeding after trauma. Antiphospholipid Syndrome (APS) Dx: prolonged aPTT, normal PT, specific factor Autoimmune disorder with antiphospholipid assays. antibodies causing hypercoagulability. Tx: factor VIII/IX replacement, desmopressin (mild Sxs: recurrent miscarriages, arterial/venous Hemophilia A). thrombosis, livedo reticularis. Dx: positive lupus anticoagulant, anticardiolipin Von Willebrand Disease antibodies, anti-β2 glycoprotein I antibodies. Most common inherited bleeding disorder, due to Tx: lifelong anticoagulation with warfarin after deficient or defective von Willebrand factor. thrombotic events, low-dose aspirin for Sxs: mucosal bleeding, easy bruising, prophylaxis. menorrhagia. Dx: prolonged bleeding time, decreased von Thrombocytopenias Willebrand factor activity, abnormal ristocetin Low platelet count; causes include ITP, DIC, drug- cofactor assay. induced. Tx: desmopressin (mild cases), vWF-containing Sxs: petechiae, purpura, mucosal bleeding. factor VIII concentrates. Dx: CBC, peripheral smear, bone marrow biopsy (if needed). Factor V Leiden Mutation Tx: treat underlying cause, steroids, IVIG, platelet Inherited mutation causing resistance to activated transfusion. protein C, leading to hypercoagulability. Sxs: recurrent DVTs or PEs, especially in young Immune Thrombocytopenic Purpura (ITP) patients. Autoimmune destruction of platelets, often Dx: activated protein C resistance assay, genetic idiopathic or post-viral. testing. Sxs: mucocutaneous bleeding (petechiae, Tx: anticoagulation during thrombotic events, epistaxis), bruising, no splenomegaly. prophylaxis for high-risk situations. Dx: isolated thrombocytopenia, normal PT/aPTT, increased megakaryocytes on BM biopsy. Protein C or S Deficiency Tx: corticosteroids, IVIG, splenectomy (refractory Deficiency of anticoagulant proteins leading to cases), rituximab. increased clot formation. Sxs: recurrent venous thrombosis, neonatal Thrombotic Thrombocytopenic Purpura (TTP) purpura fulminans (severe deficiency).  Deficiency of ADAMTS13 enzyme, leading to Anemia microthrombi formation. Reduced red blood cells or hemoglobin. Sxs: pentad: thrombocytopenia, microangiopathic Sxs: fatigue, pallor, dyspnea, tachycardia. hemolytic anemia, fever, renal dysfunction, Dx: CBC, reticulocyte count, iron studies, B12/folate neurological symptoms. levels. Dx: schistocytes on peripheral smear, low Tx: depends on type (e.g., iron for IDA, B12 for ADAMTS13 activity, normal PT/aPTT. megaloblastic). Tx: plasmapheresis, corticosteroids, rituximab (refractory cases). Leukopenia Low white blood cell count. Hemolytic Uremic Syndrome (HUS) Sxs: frequent infections. Often follows infection with E. coli O157:H7, Dx: CBC with differential. causing endothelial damage. Tx: treat underlying cause, G-CSF for severe cases. Sxs: triad: thrombocytopenia, microangiopathic hemolytic anemia, acute renal failure. Cytoses Dx: schistocytes, elevated BUN/Cr, normal PT/aPTT. Polycythemia Tx: supportive care (fluids, electrolytes), dialysis (if Elevated red blood cells. severe), avoid antibiotics and antimotility agents. Sxs: headache, dizziness, pruritus after bathing. Dx: CBC, EPO levels, JAK2 mutation. Disseminated Intravascular Coagulation (DIC) Tx: phlebotomy, hydroxyurea. Systemic activation of coagulation leading to widespread clotting and bleeding. Thrombocytosis Sxs: bleeding at multiple sites (IV lines, gums), Elevated platelet count. petechiae, organ dysfunction. Sxs: asymptomatic or thrombotic events. Dx: elevated D-dimer, low fibrinogen, prolonged Dx: CBC, bone marrow biopsy. PT/aPTT, thrombocytopenia, schistocytes. Tx: treat underlying condition, antiplatelet therapy. Tx: treat underlying cause, transfusion (platelets, FFP, cryoprecipitate), heparin (if thrombotic dominant). Hereditary Disorders Heparin-Induced Thrombocytopenia (HIT) G6PD Deficiency Immune-mediated reaction to heparin, leading to X-linked enzyme defect causing hemolysis with platelet activation and thrombosis. triggers. Sxs: thrombocytopenia, new thrombosis, skin Sxs: jaundice, dark urine, anemia after oxidative necrosis at heparin injection sites. stress. Dx: 4Ts score, anti-PF4 antibodies, serotonin Dx: G6PD activity assay. release assay. Tx: avoid triggers, supportive care. Tx: stop heparin, start non-heparin anticoagulant Hemochromatosis (argatroban, fondaparinux), avoid heparin in Iron overload from genetic mutation. future. Sxs: fatigue, joint pain, bronze skin, diabetes. Dx: high ferritin, transferrin saturation, genetic testing. Cytopenias Tx: phlebotomy, chelation therapy. Sickle Cell Disease (deferoxamine), splenectomy (severe cases), stem Abnormal hemoglobin leading to vaso-occlusion. cell transplant (curative). Sxs: pain crises, anemia, infections. Dx: hemoglobin electrophoresis. Tx: hydroxyurea, transfusions, supportive care. Immunologic Disorders Thalassemia Disorders affecting immune function. Genetic defect in globin chain synthesis. Sxs/Dx/Tx: vary widely depending on condition (e.g., Sxs: microcytic anemia, fatigue, pallor. aplastic anemia, PNH). Dx: hemoglobin electrophoresis. Tx: transfusions, chelation, bone marrow transplant. Neoplasms, Premalignancies, and Malignancies Alpha Thalassemia Reduced alpha-globin chain production due to Acute/Chronic Lymphocytic Leukemia (ALL/CLL) gene deletions. Lymphocyte proliferation. Sxs: Sxs: fatigue, infections, lymphadenopathy. Silent carrier (1 gene deletion): asymptomatic. Dx: CBC, flow cytometry, bone marrow biopsy. Alpha thalassemia trait (2 deletions): mild Tx: chemotherapy, immunotherapy. microcytic anemia. Hemoglobin H disease (3 deletions): moderate Acute/Chronic Myelogenous Leukemia (AML/CML) to severe anemia, hepatosplenomegaly, bone Myeloid proliferation; CML linked to BCR-ABL. deformities. Sxs: fatigue, weight loss, splenomegaly. Hydrops fetalis (4deletions): incompatible w life. Dx: CBC, bone marrow biopsy, genetic testing. Dx: microcytic hypochromic anemia, normal iron Tx: chemotherapy, tyrosine kinase inhibitors (CML). studies, hemoglobin electrophoresis (HbH). Tx: folate supplementation, avoid oxidative Lymphoma stressors (sulfa drugs), transfusions, splenectomy Malignant lymphocyte proliferation (severe cases), stem cell transplant (definitive). Sxs: lymphadenopathy, fever, weight loss. Dx: biopsy, imaging, PET scan. Beta Thalassemia Tx: chemotherapy, radiation. Reduced beta-globin chain production due to point mutations. Hodgkin Lymphoma Sxs: B-cell malignancy characterized by Reed- Minor (heterozygous): mild microcytic anemia, Sternberg cells. usually asymptomatic. Sxs: painless lymphadenopathy (often cervical, Intermedia (mild homozygous): moderate supraclavicular), B symptoms (fever, night sweats, anemia, splenomegaly, bone deformities. weight loss), pruritus, alcohol-induced lymph Major (Cooley's anemia): severe anemia, growth node pain. delays, hepatosplenomegaly, frontal bossing, Dx: excisional lymph node biopsy (Reed- jaundice. Sternberg cells), PET/CT for staging. Dx: microcytic hypochromic anemia, target cells Tx: chemotherapy (ABVD regimen: Adriamycin, on smear, elevated HbA2 and HbF on hemoglobin Bleomycin, Vinblastine, Dacarbazine), radiation electrophoresis. (early stages), stem cell transplant (refractory Tx: regular transfusions, iron chelation cases).  Non-Hodgkin Lymphoma Diverse group of lymphoid malignancies, primarily involving B-cells or T-cells. Sxs: painless lymphadenopathy, B symptoms (less common than in Hodgkin), extranodal involvement (GI tract, skin, CNS). Dx: tissue biopsy, PET/CT for staging, flow cytometry for subtype classification. Tx: depends on subtype and stage: Indolent (e.g., follicular): watchful waiting (early), chemo-immunotherapy (R-CHOP: Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone). Aggressive (e.g., diffuse large B-cell lymphoma): R-CHOP, stem cell transplant (refractory cases). Multiple Myeloma Plasma cell malignancy. Sxs: bone pain, hypercalcemia, anemia, renal dysfunction. Dx: serum/urine electrophoresis, bone marrow biopsy. Tx: chemotherapy, stem cell transplant. Myelodysplasia Ineffective hematopoiesis leading to cytopenias. Sxs: fatigue, infections, bleeding. Dx: CBC, bone marrow biopsy. Tx: supportive care, chemotherapy. Transfusion Reaction Immune response to transfused blood. Sxs: fever, chills, hypotension, hemolysis. Dx: Coombs test, repeat blood typing. Tx: stop transfusion, supportive care.