Chronicles of an Inner City Hospital Resident Doctor #11

Howdy, StemSocial friends! I'm a 3rd year resident doctor in an inner city hospital. This is a blog to document some of the experiences I encounter as a training doctor, and some of the things that I learn in the process. After all, being a physician means that I'll be learning some fascinating topics for the rest of my career, and seeing how I can use those to help patients.

)

Image Source

The next multiple entries in this series will be notes that I take from my question bank; I am using these posts as a way to bolster my attention the questions and to consolidate the information I learn. They are my own summaries of key points within the questions that I am practicing, so do not take them as medical gospel – rather, as learning points from which to further build knowledge. If the topics appear scattered, it is because the questions are randomized. Once I complete my board examination I will resume these chronicles with a more story-like approach, as with my prior entries. Let's get started with today's key points:

• Neck/facial + arm swelling --> Superior Vena Cava syndrome --> if history of smoking most likely small cell lung cancer (central location)
• Asbestosis --> old building, plumbing, shipyards, welding
• Anthrax (inhalational) --> work with farm animals/wool, flu-like symptoms then shortness of breath / respiratory failure, widened mediastinum; spore-producing rod; Ciprofloxacin/Levofloxacin or Doxycycline
• Community-acquired pneumonia (adults) --> Strep pneumo, H influenzae, Moraxella (SHiM); inpatient treatment = levofloxacin/moxifloxacin or ceftriaxone + azithromycin; outpatient treatment = azithromycin/clarithromycin/doxycycline
• Thyroidectomy --> parathyroid gland removal --> hypoparathyroidism --> hypocalcemia (PTH correlates positively with Ca, inversely with phosphorus) --> Trousseau's sign (carpopedal spasm w/ BP cuff) + Chvostek's sign (facial spasm when nerve is tapped) + QT prolongation
• Hypercalcemia from malignancy or primary hyperparathyroidism --> kidney stones, bone pain, abdominal pain, altered mental status; IV hydration, Lasix, calcitonin, bisphosphonates
• Hypokalemia (from GI loss / diarrhea or chronic kidney disease) --> flattened T waves, myalgias, muscle cramps, constipation, hyporeflexia; hyperkalemia (excess ingestion, chronic kidney disease) --> peaked T waves, cardiac arrhythmias (sinus bradycardia, sinus arrest, V tach, V fb, asystole), give calcium gluconate + insulin/D5
• Unconjugated hyperbilirubinemias: Crigler-Najjar (Type 1 = severe, Type 2= less severe; due to UDPGT absence/reduction); Gilbert (reduced UDPGT, jaundice when stressed/ill)
• Conjugated hyperbilirubinemias: Dun-Johnson (MRP2 protein missing, benign, black liver); Rotor (hepatic storage defect, benign, normal appearing liver)
• Primary biliary cirrhosis --> jaundice, pruritis, antimitochondrial antibodies
• Sturge-Weber --> port-wine stain on face, seizures, visual field loss (all due to vascular malformations), intellectual/developmental delays; GNAQ gene
• Rendu-Osler-Weber --> AD, hereditary hemorrhagic telangiectasia (bleeding episodes, seizures, skin/mucosa telangiectasias)
• Beckwith-Wiedemann (wide baby --> overgrowth disorder)
• Osteopenia --> DEXA T-score -1 to -2.5, osteoporosis --> DEXA T-score <-2.5
• Medial meniscus tear --> valgus (lateral to medial) stress, + McMurray test (extend knee + externally rotate --> click + pain)
• Lateral meniscus tear --> varus (medial to lateral) stress, + McMurray test (extend knee + internally rotate --> click + pain)
• Meniscus vs. ligament tear (anterior cruciate ligament or medical collateral ligament) --> with meniscus, locking sensation + can walk; with ligaments, no locking sensation, can't bear weight
• ACL --> popping, joint effusion, + anterior drawer and Lachman tests
• MCL --> popping, + valgus tress test, joint effusion
• Cavernous hemangioma / hepatic hemangioma --> small blood collection within liver (hyperechoic, well-defined, <3 cm); if asymptomatic, no follow-up required; if >5 cm, then CT or MRI; if >10 cm or growing > 3mm per year, then surgery
• Anal cancer --> bleeding, pain, weight loss, incomplete emptying (tenesmus), inguinal adenopathy; usually squamous cell carcinoma; risk factors = smoking, HPV, receptive anal intercourse

I hope you've enjoyed these little notes of topics I learned as a resident in an inner city hospital. I'll have many more stories and learning experiences coming in the future, so stay tuned.

Sources:

1. https://lakesidemedicalcare.com/history-osteopathic-medicine/
2. COMQUESTMED (my question bank for learning information)
3. Me 😊

Disclaimer: this blog is for entertainment (and possibly educational) purposes only. This is not medical advice. If you have any questions or concerns about your own health, please contact a healthcare provider.

Here are the previous editions of this blog:
Chronicles of an Inner City Hospital Resident Doctor #10
Chronicles of an Inner City Hospital Resident Doctor #9
Chronicles of an Inner City Hospital Resident Doctor #8
Chronicles of an Inner City Hospital Resident Doctor #7
Chronicles of an Inner City Hospital Resident Doctor #6
Chronicles of an Inner City Hospital Resident Doctor #5
Chronicles of an Inner City Hospital Resident Doctor #4
Chronicles of an Inner City Hospital Resident Doctor #3
Chronicles of an Inner City Hospital Resident Doctor #2
Chronicles of an Inner City Hospital Resident Doctor #1

^{If you’ve enjoyed the content of this post, are feeling down and need a shoulder to lean on, or would like to make someone’s day a bit better, or found an interesting post you’d like to share that you believe deserves a compliment, please join the FreeCompliments community. We welcome everyone with open arms. :)}

^{Here’s a permanent invite link to the FreeCompliments Discord!}