STEP - mLpenguin

Sign in Subscribe

STEP

A collection of 93 posts

TTN vs RDS (Hyaline membrane disease)

TTN vs RDS (Hyaline membrane disease)

FeatureTransient Tachypnea of the Newborn (TTN)Respiratory Distress Syndrome (RDS)CauseDelayed absorption of fetal lung fluidSurfactant deficiency leading to alveolar collapseTimingTerm or near-term infantsPreterm infants, especially < 28-30 weeksOnsetWithin 2 hours of birthWithin minutes to a few hours of birthResolutionSelf-limited, resolves in 24-72 hoursProgressive without treatmentRisk FactorsCesarean delivery, no labor,

Abnormal Heart Rhythms and their Management

In progress Atrial Super ventricular tachycardia (SVT) * Hemodynamic status * Stable - Adenosine * Unstable - Cardioversion Pulsless rhythm, PEA * CPR V Fib, Pulsless Vtach = Defib

Seborrheic Keratosis

Seborrheic Keratosis

Seborrheic keratoses represent one of the most frequently encountered benign skin lesions in clinical practice. Despite their ubiquity, these growths often cause significant patient anxiety due to their sometimes alarming appearance and potential mimicry of malignant lesions. Understanding their clinical characteristics, diagnostic features, and management options is essential for providing

Basal Cell Carcinoma (BCC)

Basal Cell Carcinoma (BCC)

Basal cell carcinoma (BCC) represents the most frequently encountered invasive skin malignancy in clinical practice, yet it's often underestimated due to its low metastatic potential. While BCC rarely spreads to distant sites, dismissing it as "non-malignant" can be a dangerous misconception that leads to devastating local

Squamous Cell Carcinoma (SCC)

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma (SCC) represents a significant challenge in dermatologic oncology, accounting for approximately 20% of nonmelanoma skin cancers in the United States. While less common than basal cell carcinoma, SCC carries a notably higher metastatic potential, making early recognition and appropriate management crucial for optimal patient outcomes. SCC primarily

Actinic Keratosis (AK)

Actinic Keratosis (AK)

Actinic keratosis (AK) is a squamous cell carcinoma that is confined to the epidermis. If they extend deeper into the skin, it is termed squamous cell carcinoma (SCC). However, the conversion from AK to invasive SCC is very small. Squamous Cell Carcinoma (SCC)Squamous cell carcinoma (SCC) represents a significant

Hypertension

Start With Definitions * Normal: <120 / <80 mmHg * Elevated: 120-129 / <80 mmHg * Stage 1 HTN: 130-139 / 80–89 mmHg * Stage 2 HTN: ≥140 / ≥90 mmHg But in the ED, the key terms are: * Hypertensive Urgency: Severe BP elevation (≥180/≥120) without acute target-organ damage. * Hypertensive Emergency: Severe BP

Diabeties

Diabetes in the ER: The Big Three Presentations 1. Hyperglycemic Emergencies * Diabetic Ketoacidosis (DKA) * Common in type 1 but can occur in type 2. * Triad: Hyperglycemia, ketonemia/ketonuria, metabolic acidosis. * Presentation: Polyuria, polydipsia, abdominal pain, nausea/vomiting, Kussmaul respirations, fruity breath, AMS in severe cases. * Hyperosmolar Hyperglycemic State (HHS) * Typically

Cephalosporins

If penicillins are the friendly old neighbors of the antibiotic world, cephalosporins are their well-dressed cousins: broad coverage, versatile, and ready to step in when things get serious. * Class: β-lactam antibiotics (same core structure as penicillins; inhibit bacterial cell wall synthesis by binding PBPs). * Mechanism: Bactericidal, time-dependent killing. * General Trends

Asthma

* Definition: Chronic inflammatory disorder of the airways with reversible airflow obstruction and bronchial hyperresponsiveness. * Typical presentation: Episodic wheeze, cough, dyspnea, chest tightness, often worse at night or early morning. * Common triggers: Allergens, viral URIs, exercise, cold air, smoke, occupational exposures. Pathophysiology * Inflammation: Th2-mediated → ↑ IL-4 (IgE), IL-5 (eosinophils), IL-13 (mucus). * Bronchospasm:

COPD

COPD is an obstructive persistent, progressive airflow limitation that is not fully reversible, usually caused by chronic exposure to noxious particles (most often cigarette smoke). * Main Phenotypes: * Chronic bronchitis: Productive cough ≥ 3 months/year for ≥ 2 consecutive years. * Emphysema: Destruction of alveolar walls → loss of elastic recoil → hyperinflation. Pathophysiology * Chronic

Physical Exam Tests

Physical Exam Tests

ACL Injury * Lachman test * Patient lies supine with knee flexed at 20-30° * Stabilize femur with one hand, grasp proximal tibia with other * Pull tibia anteriorly; assess for excessive forward movement or soft endpoint * Anterior Drawer test * Patient lies supine with knee flexed at 90° * Sit on foot to stabilize, grasp

Burn Fluid Equation and Distribution

Burn Fluid Equation and Distribution

Burn Equation: 4mL * kg * % body burned * 4mL * 75kg * 50% = 15,000mL = 15L With half the fluid given in the first 8 hours and the remainder over the next 16 hours = Total of 24hrs * \(\frac{15}{2} = \text{7.5L}\) given within the first 8hrs * \(\frac{15}{2} = \text{7.5L}

Clinical Trials

Clinical Trials

Phase I - "Is it Safe?" * Purpose: Safety, toxicity, pharmacokinetics, pharmacodynamics * Participants: Small number of healthy volunteers (or patients with the disease if drug is toxic, e.g., chemo) * 20-80 (1 zero) * Key Point: First-in-human → assess safe dosage range and side effects Phase II - "Does it

Temporal Arteritis

Temporal Arteritis

Caused by granulomatous inflammation of medium- and large-sized arteries. Most commonly affects branches of the external carotid artery, especially the temporal artery. Strongly associated with Polymyalgia Rheumatica (PMR) Older woman with headache, jaw pain while chewing, scalp tenderness, and elevated ESR - treat immediately with steroids to prevent vision loss,

Dysmenorrhea

Primary Dysmenorrhea is painful menses due to excess prostaglandin production by the endometrium → uterine contractions and ischemia. There is no identifiable pelvic pathology. Typically begins 6–12 months after menarche (after ovulatory cycles start) Clinical Presentation * Crampy lower abdominal pain that starts 1–2 days before menstruation * Peaks on the

Bronchiectasis

Due to chronic inflammation, this causes permanent dilation of bronchi due to recurrent infections or impaired mucociliary clearance. This trapped mucus further causes the chronic infection cycle and airway damage Etiologies * Cystic fibrosis (most common in U.S.) * Recurrent bacterial or viral infections (e.g. post-TB, pertussis) * Immunodeficiencies (e.g.

Multiple Myeloma

Multiple Myeloma

Caused by malignant proliferation of plasma cells producing monoclonal immunoglobulin (M protein) that usually affects older adults (~60-70 years). This causes bone marrow infiltration and osteolytic bone lesions. Clinical Features (CRAB) * C: HyperCalcemia → confusion, constipation, polyuria * R: Renal failure (due to light chain cast nephropathy) * A: Anemia (normocytic, normochromic) * B:

Ovarian Torsion

Ovarian Torsion

Caused by twisting of the ovary and sometimes fallopian tube around the vascular pedicle. This leads to venous and lymphatic obstruction, then arterial compromise → ischemia. It is most often caused by an ovarian cyst or mass (especially >5 cm) Epidemiology * Mostly affects reproductive-age women * Also can occur in children

Pernicious Anemia

Pernicious Anemia

Caused by autoimmune destruction of parietal cells in the stomach. This leads to decreased Intrinsic factor → ↓ B12 absorption in terminal ileum. * Associated with autoimmune gastritis & other autoimmune diseases (e.g., thyroiditis, vitiligo) Clinical Features * Macrocytic anemia (MCV >100) * Loss of B12 * Neurologic symptoms (specific to B12 deficiency): * Peripheral

Restless Legs Syndrome (RLS)

Restless Legs Syndrome (RLS)

A neurological sensorimotor disorder characterized by uncomfortable urges to move the legs, especially at rest and during the evening/night. Pathophysiology: * Dopamine dysregulation in the CNS * Often associated with iron deficiency (↓ brain iron levels affect dopamine pathways) 1. Urge to move the legs, usually with uncomfortable sensations 2. Worse at

Vomiting vs Laxatives

Vomiting vs Laxatives

* Vomiting = loss of gastric acid → metabolic alkalosis * Laxatives = loss of bicarbonate-rich intestinal fluid → metabolic acidosis Vomiting * Metabolic alkalosis * Increased H+ loss from stomach acid → Retained HCO3- * ↓ Cl- * ↓ Urine Cl- (Kidney tries to retain) * ↓ K+ * Hypovolemia Laxative Abuse * Metabolic acidosis * ↓ HCO3- → lost in diarrhea * ↓ Cl- * ↑ Urine Cl- saline laxatives * ↓ Urine Cl-

Hyperparathyroidism

Hyperparathyroidism

PTH Actions - Core Physiology PTH raises serum calcium and lowers serum phosphate by: * ↑ Bone resorption → ↑ Ca²⁺ and ↑ phosphate * ↑ Activation of vitamin D → ↑ GI absorption of Ca²⁺ and phosphate * ↑ Renal calcium reabsorption (DCT) → ↑ Ca²⁺ * ↓ Renal phosphate reabsorption (PCT) → ↓ phosphate (phosphaturia) * Normal state: ↑ Ca²⁺, ↓ phosphate Primary Hyperparathyroidism * Hyperfunction of parathyroid cells

AML, CML, ALL, CLL

AML, CML, ALL, CLL

Acute Myeloid Leukemia (AML) * Definition: Malignant proliferation of myeloblasts (>20% blasts in bone marrow). * Common in: Adults, especially >60 years. * Risk factors: Previous chemotherapy/radiation, myelodysplastic syndromes, exposure to benzene. * Presentation: Fatigue, anemia, infections, bleeding (petechiae, bruising). * Labs: * ↑ WBC with blasts * ↓ Platelets, anemia * Auer rods (pathognomonic) * Diagnosis: Bone

Neuropathic Arthropathy (Charcot Joint)

Neuropathic Arthropathy (Charcot Joint)

Progressive degeneration and destruction of a joint due to loss of sensory innervation (proprioception and pain). This leads to repeated trauma and joint damage without the patient noticing pain. Causes * Diabetes mellitus (most common cause in the US; affects feet and ankles) * Syphilis (tabes dorsalis) – historically common cause; affects knees,