Transcript for:
Medical Exam Review

hey guys it's Sarah here in this video I'm going to be going over a comprehensive nurse practitioner Board review so before I get started if you want all these in Note Form check out the link below otherwise just follow along with me here's just a quick review of everything we're going to be going over it basically covers your whole board okay we're going to start off with Dermatology so here's just some terms you have to know for instance in the board they'll say is choid so you have to know what a choid is it's an overgrowth of the scar tissue I'm not going to go through each one right now but if you want here's your list so we're going to start off with benign skin lesions so these are stuff that could be removed for cosmetic reasons but otherwise you really don't have to do anything for them so the first one I'm going to be talking about is a cherry and geoma in the boards and how it's usually described as a bright red or purple made of blood vessels and for Dermatology it's really just about knowing the key differences that make one and another one so for instance for this if you see a question that has those key words in it you're going to think charanga and then if it says like what should you do for it like I just said there benign you don't have to do anything for it unless the patient wants you know cosmetic reasons or whatever okay the next one is liver spot which is solar lentinus and that's going to be described as flat oval brown spots so flat oval Brown just think of Li spots the next one is Saka hypoplasia and that's going to be yellow small bumps usually around like the cheeks the forehead Etc your next one is SPAC keratosis and that is usually warty scaly slightly raised and the color is usually tan to black in color and the key word is that they're going to say they're pasted on so if you see something wordy pasted on then just think of that your next one is just a skin tag you know they're painless just pretty much an outgrowth of the skin so for all skin lesions in general you want to do your ABCDE just to make sure they're not cancerous um and these are all benign so just before I go on I just want to say in general when we go through the cardiac system and the respiratory we're going to going into more more detail in the pathophysiology but over here they're pretty much for the Board review just about knowing the key differences so let's go on to the next one okay so candidiasis is a yeast infection usually people are at risk for it if they have antibiotics use thyroid use basically anything that promotes yeast growth humid um environment obesity if they have skin Falls in there cuz it gets warm and they like to grow in that environment it's usually described as a white cottage chees discharge and the treatment for that is obviously going to be to have good hygiene and antifungals usually nice Statin so now I just made a chart between contact dermatitis and an atopic dermatitis atopic derti is known as eczema contact dermatitis is basically when you have something and you have a skin irritation or reaction from that let's just say a bracelet and then around that you'll see it so that's going to be your key it's going to cool you in because it's going to be the shape of whatever it is let's say you have a bracelet it's going to be the shape of that or it's going to follow the certain pattern that whatever you have a reaction to with eczema it's not going to be like that at all it's usually found in the face the neck the knees the elbows um antic cubital and the key thing for that is crusty yellow it's going to say like crusty yellow because it starts out of red little vesicles and then it goes into crusty yellow what you should know about that is is for that you're going to be giving you know emoon topical steroids like hydrocortisone if it's itching CU it could be itching you give them antihistamines and you know basically tell them don't scratch it don't touch it Etc next we go on to fitis which is a infection of the hair follicules if if it keeps spreading then it's known as fonal and when it's a cluster of them it's known as carbonal so we see over here I showed the picture so you can see the difference between fitis fenicle and cicle um if it's just fitis you you know just tell them to change out the razors warm compress Etc if it's fenical then if the absis is Big then you might need an indd otherwise you could just do warm compress etc for carbonal you always want to get a culture in sensitivity and medication next we go on to hand foot and mouth disease which is also which is caused by kakaki virus it's very common in kids especially if they go to daycare and highly contagious your symptoms are going to be fever rash but the key features is that going to be in the hand foot and mouth so as the name says over there treatment is is honestly just supportive treatment next we go into empo empo is basically a superficial bacteria infection of the skin so think about it gets a cup bacteria gets in and it's pretty simple it's very common in kids and the key feature of how it's going to be described is honey colored scab just honey color anytime you see honey color just think em antio the treatment for that is going to be a topical antibiotic ointment like mup parison but if it's all over then it could be um an oral one like clex you want them to return to school after 48 to7 2 hours after starting treatment your next one we're going to be discussing is petasis Rosia excuse my pronunciation for any of these diseases um that key feature is going to be a Harold patch and what I mean by that is if you look at the picture over here it's a huge huge oval round patch and then small ones around it so it's going to start out with the oval patch big one it's called the heral patch and then after that you're going to get little ones around it there's really nothing to do about it but it's a lot of of times tested on the exam just because of the key feature next we're going to go on to to psoriasis psoriasis is very common and when I say very common that's quite important because anything that's common will generally be tested on um anyways it's a it's a chronic inflammatory skin disorder and there's a lot of different types but they're not going to test you on which type it is all you have to know is the symptom it's going to be described as a silvery scaly anytime you see scaly it's usually pisias it's really common on the elbows as you see in the picture knees scallop um the treatment for that is pretty much long term because it's kind of chronic there's numerous topical systemic therapies that um are good based on all different things usually um like a topical cortico steroid next we're going to go on to scabies so scabies as we all know is from The Scabies might the key feature to that is itching almost always are they itching small little red bumps and another key feat is that it's going to be an inter interdigital so if you see your finger like in between the web I guess you would say so they like to ask that also treatment for that is the permethrin Cream the next one is vitiligo Vio is hypo pigmentation so you see the white spots because it's hypo pigmentation usually associated with autoimmune autoimmune disorders but but you just want to know that it does affect their body image gelot so you could refer them to Der ology for treatment to help with that next we're going to go on lipoma lipoma is a benign tumor made of fat cells it's very slow asymptomatic and you really don't have to do anything about it only if it gets really large and irritating but you're going to feel them it's like under the skin you're going to feel a round rubbery removable thing under the skin and there's really nothing to do about it on the next one is a kosis n Nidra canis which is basically it's um a hyperpigmentation of the skin a little velvety or brownish it's usually associated with endocrine or metabolic disorders like it's usually disordered with like insulin resistant obesity Etc over here I I made like a little chart between acne rosacea and acne vulgaris acne vulgaris is like your regular acne that you know of you know on your skin and stuff like that acne rosacea is a little bit different it's what it is it's a flushing and dilation of the blood vessels the treatment for that is going to be avoid the sunlight wash your face medications if needed and for acne you first want to start off just with proper cleansing mild soaps you know decrease their stress if it's mild you could give them a topical Benzel peroxide if it's moderate you give them topical and oral antibiotics like tetracycline if it's really severe you want to refer them to Dermatology to prescribe something like isot trone and something like that okay okay now we're going to compare and contrast cellulitis and a and aerosus so so cellulitis as we' seen in the picture below it's infection of the lower dermis and subcutaneous tissues aritus is a superficial form of cellulitis but affects the upper dermis and extends to The Superficial cutaneous lymph they're going to be treated the same way antibiotics but the key difference is is with cellulitis the lesions are going to be generalized and there's no well-defined margins and with aritus the lesions are going to be localized and have a clear demarcated boundaries and non perent so if you SE in the question it says clear demarcated boundaries you want to think arpus and if you SE in the question it says like pus pular then you could think more like cellulitis next we're going to go on to necrotizing fasciitis and that's actually an infection of a deep soft tissue it could lead to to destruction so you want send to the ER right away it's usually caused by bacteria entering the opening of the skin and the symptoms are going to be red or like purplish edema it's going to rapidly increase in size it's going to be painful they're going to have systemic symptoms Etc next when we go on to varel isoster which is regular chicken pox we all know how that looks but the key how they differentiate It Is by is by different stages of healing something else is also going to say different stages of healing is going to be when you're talking about abuse bruising all over the body could be different stages of healing but if it's going this way and the question asks more like you know fever and stuff like that then you want to think of chicken pox it usually starts out on the head and it Sprints the rest of the body it's contagious until all the lesions usually crust over usually about 2 weeks stays in the body and when it's reactivated it's called shingles Herer so now Herer is the key feature to that is going to be that's going to be in a dermatone pattern it usually is very painful that's another key thing and it's usually between 50 and up usually get it um treatment for that is going to be a cycle there and you want to start as soon as possible next we go on to paranesia and that is an inflammation of the skin around the finger usually like right over here usually from bacteria usually from a manicure very common especially cuz the stuff are not really clean that much um symptoms are really going to be red and swelling around the nail and it's going it could turn into an abscess sh for that if there's an abscess you always want to do I and D otherwise so good a wter and topical antibiotics like mup parison next we're going to go on to anaphylaxis as we all know what that is it's a hypers sensitivity reaction caused from a lot of different stuff medication food Etc symptoms that get hives angio idemia shortness of breath wheezing what we want to give them is you want to give them ep3 to.5 I mid outer thigh you want to repeat that every 5 to 15 minutes as needed and obviously call 91 Rocky Mountain spotty fever that is a tick related disease symptoms are going to be flu like symptoms in the spring summer time there's also going to be a rash like pachia rash that comes day four or 5 after the symptoms begin and there's a really high mortality for this so this has to be treated right away if you suspect this you treat before the labs come back treatment daxy cyclin whenever we talk a b lime D cyon we're going to go on to arthia Migra that is also talking about Lyme disease but it's a rash that comes in the early stages of lme disease come any time between day one to a month after tick bite but the key feature to this is going to look like Target Target Legion you know like target symbol so it's going to look like a bullseye rash with Central like a ring leg clearance so that's going to be your key thing Bullseye ratch Target Legion light clearance treatment like we said for lime daxy cycl the next one we should know about is minino SEMA that is actually very rare but very fatal so that's what we have to know about it one of besides for the sudden onset of high fever menitis symptoms also going to have a hemorrhagic rash that does not become pale when you pressure on it if you suspect this immediate to the Ed send them to the Ed the next next one is herp zoster thalmus and that's a reactivation of the shingles virus in the Opthalmic branch of the trial nerve the key thing that you're going to see over here that's going to stick out is a VC rash on the tip of their nose so it's going to be on the forehead scalp and the tip of the nose you want to refer them right away out okay next we go on some melanoma we just skip because we all basically know that the abcde's of melanoma next one is a different type of cancer but it has a low metastatic potential unlike melanoma which is very deadly so your basical cell carcinoma is your lumatic potential you really cause from sun exposure light skin but your symptom that's going to stick out is going to say pearly so pearly white and waxy with an ulcerative Center so pearly if you see that waxy if you see that and ulcerative Center and obviously does inhale cuz it's skin cancer the next one is subun hematoma which is a collection of blood just under the finger or toenail even and it has to be drained cuz then the blood's going to build up nowhere to go the next one that we're going to be talking about is actinic keratosis and this over here is scaly rough patch from chronic sun exposure so if you actually understand what's going on then you'll be able to answer the question cuz in the question it will say like 60 old man um likes to you know has a history of being outside then you'll be like oh sun exposure and then think you know actin kosis so this could go in become more like a Squam Mell carcinoma this you want to refer right away out next we're going to be going on to fungal skin infections so Tina is fungal skin infection they're all different types it could be capitus on the head could be petus on the feet all different types treatment is going to be topical antifungal like your AEL like your easel but if it's um on the head you want to give oral next we go on to tiny tiny aesti color and that's going to be a hypopigmentation round macul on the trunk Cham for that is also going to be your topical antifungals like katano Etc okay next we go into bites so you have your animal bites your human bites with animal bites dog bites are very common but an but cat bites are actually pretty infectious you always want to get a good hmp does the animal have rabies immunization Etc with the human bites you want to watch out for a Clos fist injury so like when they clch your fist it hits teeth cuz they're pretty high risk for infection treatment for both obviously you want to control the bleeding you want to wash it right away don't suture it if it's high risk for infection like a cat C bite um or if it's a deep wound puncture wound wounds that are more than certain am hours old Etc if it's infected you give antibiotics it's usually Augmentin and give a tetna shot if they didn't have one within 10 years if it's not infected 5 years next we go to Burns you have your first degree your second degree and your third degree so third degree is going to be a full thickness burn that's always burn center we don't take care of that the first degree you're going to have it's it's just going to be red and painful what you want to do you want to put the underw give them soap cold pack if the skin is not intact topical antibiotics aloe vera for your second degree you have your partial thickness so they might have some blistering it could be very painful also you give them silver sulfiding cream dressing Etc on the top is just really your rule of nines but it's just plain memorization there's nothing for me to go over we go on to our wounds this is just a little you know pathophysiology about wounds okay next we go on to eyes now eyes here's just you know what a normal eye should look like terms you should know so like I said if they say the patient has meiosis you have to know what meiosis is these are just terms you should know what a normal eye should look like and that's pretty much it are abnormal eye findings so if you're in primary care and you're finding this you always want to refer these Patients Out so hypertension and diabetes could affect the eye you're going to have your hypertensive retinopathy and you're going to have your diabetes retinopathy on exam for someone with hypertension you could find all these stuff over here they have the flame shape hemorrhages you have um cotton wool spots you basically have to memorize this and for your diabetes you're going to see cotton wool spots microaneurysms heart exudate neovascularization all those different stuff it just play memorization of what you could find Etc so now we go on to our disease corneal ulcer corneal ulcer is basically an open sore of the cornea caused by infection it's very common with contact lens users when we talk about the eye contact lens users are at increase for a lot of different stuff just because if you think about it they keep going like that in and out of their eye so bacteria is on their hand they put it into their eye especially a lot of people don't wash their hands before and then you're introducing it right into their eye so anyways for this you're going to see white lesions on the cornea and you want to refer them to the Ed because this could actually lead to scarring or perforation the next thing you want to refer out also to is herpes keratitis herpes keratitis is a viral as as the name says herpes eye infection caused by HSV you're going to they're going to come with eye pain photophobia blur R Vision refer them out the next one we're going to talk about is glaucoma so so glaucoma you're going to have your open angle and your acute angle closure and there's a big difference because what it what's happening is that there's an increase in the pressure in the eye that's affecting the optic nerve but with open angle it's going to be gradual so it's going to gradually built up and the reason the way you're going to know that is by the symptoms they going to start having perip Vision law slowly slowly come to central vision loss very slowly um with your acute angle closure it's just a sudden all sudden and sudden complete blockage and the the pressure is going to rise up really fast and blindness could occur so these ones you want to send out right away so next we go on to retinal detachment so retinal detachment is exactly how the name says the retina is being detached like pulled away from its normal position this is an immediate referral to the Ed also this has very specific symptoms that are going to be described number one it's going to be described like a shade or curtain in the vision or floaters flashing lights if you if you hear any of those just think of retinol Detachment next one is optic nartis that is itis is inflammation so inflammation of the optic nerve that's a lot of times associated with Ms so it'll be like the first symptom of Ms and symptoms for that that's going to be described as going to be like a donut in their Vision or blind spot in their vision and and that you want to refer them out also now here are conditions that we don't need to send to the Ed that are not immediate um emergencies number one is Bluff fritis so that is itis inflammation of the eyelid like where the eyelashes are part of it it's usually from clogged from oil symptoms are swollen red itchy Lids they could have like a little um scaly dff on their eyelashes and treatment for that is going to be like a b bab shampoo baby Johnson shampoo warm water you could give them topical antibiotic solution like the eye drops um and warm compresses and obviously teach them about good lid hygiene eliminate triggers like allergens Etc next one you have your presbyopia which is gradual loss of farsightedness this is usually starts around the age of 40 and what you should know about this is that it's a normal part of aging next one is cataracts cataracts are painless that's a key one and symptoms are going to be like difficulty during night driving blurred vision Etc next one is going to be a corneal abrasion which is basically a scratch on the corneal it could be from the here from a fingernail from tree branch anything like that the key thing over here is they're going to say they have a foreign body sensation like they're going to feel like something's in their eye you always want to rule out obviously a penetrating trauma first and and you can flush it to normal saline to remove the foreign object if you cannot refer it out you want to refer them out and give them antibiotic ointment okay next we're going to go into iritis which is inflammation of the inner eyelid so ey I just like think of inner eye like the blood vessels Etc they're going to be very sensitive to light have a headache over their eye and their whole ey is going to be red you want to refer them out to Opthalmology next one is a sub conjunctival Hemorrhage so that's when you have a blood vessel um it's kind of it just breaks so it could be from local Trauma from lifting straining Etc coughing even but what you should know about this is that it resolves on its own it may look bad but it resolves on its own usually around 1 to 3 weeks and just follow up to make sure it resolves the next one is arelis which that's going to be described as a light gray or white ring around the corneal this is caed from cholesterol so you want to do a lipid um panel for them and it's honestly normal as they each the next one is accen thala however you pronounce that and that's cholesterol yellow deposits around the eye caus this from high cholesterol so that'll stay one one lipid pamel here we're going to compare in contrast bacterial viral and allergic conjunc dividas so first of all you can see the difference and what sticks out number one is on the left side you see the yellow um you know muc peand crusty one so that's always going to be bacterial and that you're going to give antibiotics for for your viral and allergic your key distinguishing uh features cuz they're both going to be watery Etc is that one's going to be itchy so itchy is going to be the allergic watery just watery is going to be viral okay and then over here you could compare and contract these two so if you actually look at the picture the the surfer's Eye you see how it um extends on the white part see the white part extends into the color part of the eye so that's going to be your key differentiating they're both caused by chronic sun exposure and you could refer them to Opthalmology tell them to wear good sunglasses okay next we go on to the ears so over here you know quick paath of physiology and what a normal ear is supposed to look at the things you're going to have to know for here for your test is the Webbers and the ren test the Weber is that when you take a um a tuning fork you put on the forehead ask them if they could hear on both sides and which side they hear more so there should be no lateralization and by no lateralization means that they should be able to hear them both equally on both sides for the reneas test is the same thing but meaning that you're taking the same The Tuning Fork we can put it on the mastoid process when they can't hear then you're going to put on the front of their ear it should be that the ear conduction is longer than the the bone conduction if it's the opposite that the bone is longer than the ear conduction then it's conductive hair and loss if it's equal then it's sensory not hair and la so here are some ear diseases that you should know about so first one cholest is abnormal skin cyst in the middle of the air the thing that's going to stick out for this is that it's going to be described as a CIF flow like Mass so anytime you see like a cauliflower like Mass you want to think of that treatment is us be surgery you want to refer them out because we can't deal with this in Bri ret the next one is a basil skull fracture the key symptom for that is going to be the raccoon eyes and the battle sign the raccoon eyes exactly how the name sounds all around the eye and the battle sign is going to be bruising behind the ear so if someone fools or is in a trauma and you have any of those signs then immediately refer them to the EV the next one is going to be cut tius media which is an ear infection as we all know they're going to come in with regular ear pain decreased hearing muffled hearing popping sounds and they're going to be put on antibiotics so next we go on to the nose when we talk about the nose you have allergic rinitis which is inflammation of the nose caused by allergens they're going to have your regular symptoms nasal congestion itchy sneezing coughing the reason why coughing is because they'll have the postnasal drip so they'll be laying down and then they'll start coughing for that you want to give topical nasal sprays like fluticasone and if that doesn't work go onto your topical anti-histamine nasal sprays etc for nose bleed which is epistaxis you want to apply direct pressure you could give your afron if needed um you could tell them that they close to put petroleum jelly or Vaseline to their n so that it doesn't dry out if it's recurrent you could refer them to the ENT and if it's posterior nose bleed Ed emergency department so next we go on to the mouth and throat so these are just regular information about the mouth and throat and we're going to be talking about an aol's tooth so that's when a complete tooth comes out of its socket that's considered a dental emergency if it's a primary tooth then you don't have to reimplant it because because the kids's tooth will you know the other tooth will grow in if it's a permanent tooth then you want to save it you want to put it in normal saline and you want to rinse the tooth irrigate the socket and reimplant the tooth you want to have them bite down on a g and immediately refer them to the dentist if you can't reimplant it back in then you want to store the tooth and cold milk normal saline Etc so next we go on to to lucelia so luopa is a white gray patch in the mouth what you want to know about this is that cannot be brushed off so you always want to rule out oral cancer so send them out for you know they're going to have a biopsy if it's really cancer surgery um you know stop the risk factors Etc the next one is a kosur usually heals within 7 to 10 days treatment could be magic mouthwash over the counter Stuff Etc you have your geographic tongue so geographic tongue is just as the name stands you're going to have a tongue if you actually look at it it's going to be like patches it's kind of like a map which is why it's called that it's benign a lot of times they're born with it um but you should know that it could have an increased sensitivity to spices salts Etc sometimes it could even actually get like more more prominent before they have a virus could be like they're sign that they're getting sick the next one we're going to go on to is peritonsillar abscess that is an abscess that forms in the throat next to the tonsils symptoms they're going to have the key one that going to differentiate on the boards it's going to be a muffled Hot Potato voice you want to refer this patient immediately to theep okay next we go on to strep so we don't know what strep is but you should know for that you have a center criteria and this helps us to know if we should swab people helps us to you know know if we're going to think of strip so so for that you're going to have your tons solar exate tender anterior cervical adenopathy fever absent cough in general if it's 0 to one no testing no treat if it's 2 to three you could do rapid stress test for treat emperically for the treatment you're going to give them oxacillin normally if they're allergic give them aiyin which is Zac untreated T untreated strap could lead to rheumatic fever glary Fus so you do want to treat it next one we're going to be talking about is mono mono is caused by the Epstein bar virus it key features is going to be fatigue they're going to have the other features also even a sore throat but the key feature is going to be fatigue they for that what you want to watch out for is the spleen so you want to tell them no doing sports especially if their spleen en llarge and if the spleen isn't large you want to repeat an ultrasound after a few weeks Etc and over here it's just information about lymph nodes and sinuses just like a little patho okay so for your nervous system there are multiple tests test a lot of different um things I'm just going to be going over very non-specific so your cerebellum if you want to test that you could test the gate you could do a tandem walk which is basically One Foot In Front of the neck you could do your rapid Alterna movement which is basically taking your hands and going like that on your knees and you can do your heel with the shin so this is your foot your other foot's just going down it down you could do your proprioception in order to test for that do sensory information you could test them with a Romberg test which is basically you're going to put your feet together your hands are going to be straight out and you're going to close your eyes if they sway then it's positive or if they fall you're also could test your motor test you could test that with your range of motion as I'm to move everything flexion extension the pronator drift test which is they're going to hold their hands with a palm facing up eyes closed so like this eyes closed if their hands fall down then positive your dermatomes I wouldn't really get into that they don't really test on that and then here's just terminology that you should know cuz it could be in the question and they're not going to explain what it is so you do have to know your cranial nerves and this is basically a neonics that I like to use so for one you have have one nose so think of nose you have two eyes so CR nerve two is eyes three four six your eyes do tricks so three and four and six are all eyes five it Rhymes a try so I think of the trimal nerve um seven it fits perfectly in a face so I think of seven eight is like a twisted ear so that's why I think of the ear nine so nine is your gloss of fringer that was a little harder um to to come up with the pneumonic and how I just like to remember it is that nine looks like a g upside down and also it's the glossal frel so that's for gag reflex and that's pretty much it 10 is a Vegas so I think of Last Vegas like you would give Las Vegas a 10 out of 10 and so Vegas nerd your 11 your spinal accessories just think of a one and a one like in the picture like that like you could place them on each of your shoulder and 12 is your hypogly so I think of your teenager chewing gum speaking disrespectfully Etc and now we're going to go into headaches there are four different type of headaches so when someone comes in with a headache you there are some really dangerous stuff it could be that you always want to rule out like aneurysm menitis increased ICP brain tumors arach hemorrhages Etc so usually those would come with a neuro deficit or change in LLC but you always want to you know be sure it's not that but these are just your regular headaches so if someone has a cluster headache the key differentiating one for that is going to be it's going to be a sharp tearing and nasal congestion for that that's the only one that you're going to give high flow oxygen so just think of cluster like a lot a lot of oxygen in a tank and high flow oxygen migraine the key differentiating thing for that is a lot of times they have an aura and it's photosensitivity so if you see some something with headache with photosensitivity Ora just think of migraine um tension how they're going to describe it it's usually like a bandlike or squeezing and it's usually from stress you'll see like someone work so many hours or a stressed out person usually tension medication overuse is pretty simple because it's just from medication and you just going to DC the medication in general for a lot of these headaches prophylactic you give a TCA triy anti-depressant a beta blocker and during the attack you want to give like an Enid except for the cluster which is high flow you could also give them um a tripin like a sumat tripon which is the migraine medication next we go on to Gant cell arthritis which is also called temporal arthritis so that is a large vessel vasculitis that causes a headache vision loss G you know the Jew is going to hurt it almost never occurs before 50 so someone after 50 comes in with a headache you want to put this on your differential if an 18-year-old you you might not be the first thing on on your differential because it's the vasculitis the labs are going to be elevated with the inflammation so the CRP ESR are going to be elevated the only really true way to diagnose is a temple artery biopsy and they're going to be treated with steroids for several weeks next we go on to Bell poy so B posy is your cranial nerve 7 dysfunction as opposed to trinal neuralgia is your cranial neural 5 dysfunction Bel py a lot of times comes in with symptoms of a stroke because you're going to have a unilateral facial paralysis so you obviously always want to rule that out but the treatment is going to be your prazone for a week now we talk about Strokes Strokes you have your ischemic and hemorragic Es schic is basically a blacked artery hemorrhagic is bleeding in the brain they're going to come in a lot of times with the same symptoms but the one key differentiating one is going to be the worst headache of my life the worst headache of my life is usually the hemorrhagic one we all know like what the symptoms are for stroke so I'm going to skip that Tia as we all know is a mini stroke it usually lasts under 24 hours and this is key because you have to identify there areis for having an like another stroke so you want to um reduce the risk factors you know treat their hypertension high cholesterol lifestyle modifications Etc next we go into Parkinson's so Parkinson is mainly going to be under the neurologist for treatment but if you do um see someone who could have Parkinson you do want to work them up the the key one for that is going to be the Tremors rigidity but the tremors are going to be resting tremors so resting Tremors means that even at rest as opposed to essential tremors are when you like reach out for night and then they start shaking the resting Tremors just at rest they're they're they're shaking they're usually going to be treated with medication because unfortunately there's no cure for it so it's going to be like levodopa Copa Etc but this is going to be handled by neurologists multiple sclerosis comes in it's a little hard to diagnose because it's so many different um symptoms that you could be like oh it's something else like Vision balance issues muscle weakness even when they are diagnosed they could be good for like years and then they go into a lot of remission exacerbations but they could be good for years and then go in like just on and all this is going to be referred to neurologist also it's usually between the age of 30 to 50 where they are diagnosed here are some menitis signs that you could test for as we all know menitis comes in with a regular symptoms with the headache the nucle rigidity Etc these are two um signs you could do the kic sign is when as you see the picture you're going to place their knee in a 90° and slowly extend if it's painful for them that's positive for menitis the brinsky sign is that when you're going to flex their head like that their feet are automatically going to be flexed with it next we go on to Alzheimer's disease unfortunately there's no cure for that it's really just to slow the progression with medications that's going to be descri prescribed by neurologist also not you but what we should know as Primary Care is you want to be careful for their safety so are they able to drive are they risk for getting lost Etc next we go into seizures so I'm just going to be talking about two different types your absent seizures and your tonic conic absent seizures are very common in kids they kind of just like steer into space and then all a sudden they get back in so a lot of times you don't even like realize it's a seizure it's kind of just like a brief law of Consciousness or brief like steer into space and then they're just like back in so that's diagnosed through EG and it's usually honestly outr your tonic conic is your tonic is going to be straight conic is going to be the jerkiness that you're going to see that you want to put them on their side for you're afraid that they're going to aspirate and you want to handle that by neurology there's few different reasons someone could have vertigo maner disease B pbv lionitis cereal infarcts someone had benign parimal positional vertigo that's very common they're going to think like they're having like a stroke or something they're going to have sudden and vertigo anytime they move their head anyway it's going to go back into like a whole thing again and the treatment for that is Meine a test you could do you could do the dick appx maneuver um but the treatment is getting meing if someone does have vertigo but it comes with like limb weakness or slurge speech then you want to think of SEL and farch and send them to the Ed next we go on to carpal tunnel so carpal tunnel unfortunately very common because it's caused by a lot of wrist and hands like if they're typing a lot and a lot of people are on the computer or if they swing bass and stuff like that if they're moving their hand and keep typing keep opening bottles stuff like that so here are two tests that you could do to test the tanel sign is going to be you have the medium nerve you're going to tap on it and if they feel numbness or tingling then it's positive other one is the is the Fon sign and I just think of p p cuz prayer and fallons you're going to do opposite prayer so here's prayer here's opposite and then you're going ask and then you're can ask them to hold it and if they feel numbness or tingling then it's positive okay next we're going to want to go on to our mental health Psychiatric so we're not psychiatrist we're not going to do that so it's basically going to be a quick overview um cuz the are usually going to be managed by psychiatrist but as a primary care you're going to have a lot of patients who are coming in with anxiety depression these are common stuff that fortunately the whole world is dealing with so for depression you want to screen them with a phq2 if they're positive you want to do a full pH q9 and with depression you always want to ask them about suicide ideations you want to be very blunt just say do you have any thoughts of harming yourself or others if they say yes any plan any means Etc if if it's a yes you want to send them directly to the hospital have some you know ambulance come take them right away and Etc if they're not suicidal and you actually you know you're just talking to them and everything you always want to rule out just regular organic cost it could be just plain depression but it could be it's caused by hypothyroidism autoimmune disorders diabetes Etc your first line medications for depression is going to be your ssris but there are many many other medications and classes that are available with your ssris you want to um watch out that for your seratonin syndrome which has symptoms like seizures Tremors agitation and if that if you see that immediately send them to the Ed you always want to try um anti-depressants for four to 6 weeks at least until the symptoms started proving and cuz cuz in general people like to to see results from a medication so they'll take in then after a week they be like oh this doesn't work stop taking it but with these medications you have to give them some time to work and if you are going to discontinue you want to like stop it over 2 weeks so here's just list of other ones that you could go over your M maois you always want to watch out for tyramine foods and you know your lithium is going to be very therapeutic range you want to check your TR level Etc okay next we go into anxiety so that's going to be screened with a G D7 treatment for that also first line ssris and you also want you know yoga exercise Etc next we go on to alcohol use disorder so in order to check for alcohol abuse besides for the cage which is screening form that you do you want to do alt a you could do the most specific one is the gamma glutamate transfer this alone if it's elevated could clue you into alcohol abuse as opposed to the alt and the as if it's elevated doesn't mean it's alcohol abuse it could be elevated from other reasons also treatment for that you want to um you know refer them to AAA to help them you could give them medications like nxone Etc you want to watch out for the withdrawals that usually Could Happen 6 to 24 hours after but it could after the last drink but it could happen honestly whenever cuz every body is different depending on how much they drink how often Etc um treatment for that is usually like Adavan benzo aines Etc you want to if someone smokes do you want to address it at every visit like you know encourage them to quit and if they're willing to quit give them medication like asinine nicotine bupropion Etc insomnia so for insomnia there are medications but you don't want someone to be on medications for life for insomnia so you do want them to you know get in sleep you know regular sleep time no caffeine before bed no phone in bed no watching TV you know exercise yoga Etc but there are medications like Benadryl could help but don't give that to the elderly benzo um supplements like melatonin Etc next you have your bipolar they usually so by to they go from manic and they flip to depression so they're completely impulsive and then the next day they or whenever they flip they can't get out of bed treatment for that is going to be lithium this is going to be prescribed by psychiatrist and but it's a very narrow therapetic range schizophrenia is that they interpret reality just abnormally like delusions hallucinations Etc PTSD PTSD could be from any traumatic event it doesn't have to be from war it could be from rape it could be from anything pts Ste they're have like nightmares Flash B hypervigilance they think everyone's out to get them insomnia for that you want to do Psychotherapy and medication the first line would be ssris and the last one is mucan syndrome I didn't pronounce that right but it's basically when someone fakes an illness because they want attention but it could also be a mom faking their kids illness because they want attention it's very very very hard to diagnose next we go on to cardiac there's just a little anomy information about cardiac but what we should know from this is S3 is normal in kids athletes pregnant women but it's abnormal after like 40 so and for those people we don't fit the categories and if it is from them then it's indicates congestive heart failure S4 is always abnormal no matter what and that indicates a stiff left ventricle so it's giv resistant murmur I would for sure know you have your two types you have your systolic you have your diastolic if you want pneumonic asow I could I could write that pneumonic um systolic is between S1 and S2 and dallc is between S2 and S1 so when it starts again you should know which murmurs they include so systolic includes aortic stenosis and mitro regurgitations systolic murmur could radiate dallc murmur include aortic regurgitation and natural stenosis but diastolic normals are murmur are always abnormal in terms of murmur you don't have to know really the grading but just know that a grade four is when a thrill is present A Thrill is like when you can palpate the murmur hypertension hypertension is like a whole thing in itself but basically you should just know like what's considered hypertensive stage one what's considered stage two and in terms of treatment so first of all in order to diagnose it you need two different readings on two different occasions and you could ask them to keep like a blood pressure diarrhea at home etc for treatment you want them to do lifestyle modifications like weight loss healthy diet reduce your sodium medications are usually initiated first for highrisk patients like someone with um one 10% of as CBD risk if you are giving a hypertensive the first line is thide calcium chin blocker is as temp and arbs I would know that whatever you're doing whether it's starting a new medication or whether it's doing whether starting a lifestyle modification you always want to follow up every month until the blood pressure is controlled when they're on an anti hypertensive you always want to watch out for the opposite to occur like hypotensive if someone has hypert tensive urgency which is systolic blood pressure over 180 or diastolic over 120 with no sign of organ damage you want to um get that under control if someone has hypertensive emergency which means they do have signs of organ damage and you want to send them to the Ed next we go on to heart failure which is basically the heart can pump enough blood to meet the body's needs you have your different classifications from you know you have your 1 to four and your a to d you have your two different categories you have your systolic your diastolic the systolic is when the heart can pump hard enough your diastolic is when there's not enough blood filling so the difference is is that when it can pump hard enough your injection fraction is going to be less than 40 if it can fill diastolic ejection fraction could be more than 40 there are two different types you have your left sided heart failure your right side of heart failure your left side of heart failure the blood backs up to the lung so you're going to have all your pulmonary symptoms like dysania orthopnea your crackles your right sided heart failure it backs up to the blood so you're going to have like edema jbd um aites Etc it's going to be diagnosed besides for multiple stuff like EKG x-ray but usually an echo is the most is the best way they're going to put on medication ACE inhibitors arbs Arie beta blers but this is going to be managed by cardiologists if they're coming in with um they already have been diagnosed and are managed by cardiologist and they coming in in exacerbation then you want to send them to the Ed so now we're going to go over acute coronary syndrome which is basically an umbrella term where blood supplies to the heart is blocked you're going to have your unstable angena your en stemi and your stemi your unstable Ana is basically not enough blood flow is getting there to meet the blood's heart but your EKG is not might not even show anything and your tronent is not going to be elevated for the most part your en stemi is when it's partially included so n it's it's not fully but it's partially uded you're going to see on the EKG SD depressants t-wave inversions andon is going to be elevated the stemi that's going to be much more elevated to OPP in and you're going to see SD elevations hyper QT waves and that's when it's completely uded um this obviously refer the mount the Ed right away hypolipidemia you know too much cholesterol triglycerides to lower the cholesterol they're going to give your statins depending if they have cvd or 10 years 10year risk of eight scvd then you want to do besides for the lifestyle modifications which is their diet you want to put them at a high-intensity a Statin like a tvis Statin 40 to 80 Etc if um it's slower then you could decide the risk and benefits if you're going to start with a with a Statin then you go for a tar stat 20 and repeat the blood work in 6 weeks until it stabilize you always want to emphasize diet change and exercise ineffective endocarditis is very specific symptoms so that's going to be like your key ones well first of all it's an infection of the endocardium which is inal layer of the heart chamber covering the valves your key symptoms are going to be splinter hemorrhages which is under the fingernails Roth spots which is white spots in the eyes Osler nose which is like painful red raised lesions on the hands and feet Jane way lesions which can be fat circular lesions on the palms and Soles and also they might say it's like a new onset murmur so if you see any of those symptoms combined or alone you want to think of ineffective endocarditis they're going to be antibiotics to four to 6 weeks the next one is going to be an abdominal aortic aneurysm this you don't want to miss symptom they're going to come in with is sharp back pain and a pulsatile abdominal Mass that's your key ones over there if it's en llarge like over 5 cm then it's a large risk of rupture so then you're going to need to repair if not you want to send them to a vascular surgery and they'll watch it you know repeat the ultrasound Etc next we go on to DVT so DVT is a clot develop in one of the veins it's usually caused by someone not moving and coagulation disorders Etc symtoms is they're going to have pain in one leg and this could travel to the lungs and if it does it's called a pulmonary embolism and that is when you're going to start getting the real symptoms you're going to have shortness of breath chest pain Etc if that happens send them to the Ed they need a d dier they need ultrasound they need be sent to Ed home ins sign is a test that you could test for a DVT is like you see in the picture when you're going to passively dorsy flex the ankle and if it's pain it's positive next we're going to go on to pad versus PVD pad is pereral artery disease pereral vascular disease is pbd the key difference is is that p80 is you're going to have your cool pale legs heirless and shiny it's because the arteries bring blood away from the heart so there's less blood flow to the feet per vascular disease is the opposite it's when the blood they can't get back to the heart so everything's going to pull and exterminate so you're going to see the opposite you're going to see brown discoloration the legs are going to be warm edema etc for both those they're going to be diagnosed through ankle bral index and treatment is going to be to stop smoking so treatment for both is to control the cholesterol um you know lifestyle modifications stopping to smoke exercise Etc next we go on to Raymond's phenomenon that is going to be also very specific symptoms but what is happening there is in exaggerated vascular response extreme like cold Etc the specific symptoms are going to be that their hands are going to go kind of like the flat color their fingertips are going to change from White which is poor to Blue which is sinosis and red which is perfusion so white blue red and they could also have normal and tingling but those are going to be your key features you want to reworn them but slowly so you're nonalcoholic fatty liver disease it's you know they're going to have an elevated ALT a but they don't drink they don't use tyol it's usually from their diet mitro valve prolapse is a murmur that's described by midsystolic click so if you see the word midsystolic click you want to think of Mel valve prolapse it's usually benign but if it comes with symptoms like palpitations Etc then it's treated next we go to cardiac arhythmia so cardiac arhythmia is not really going to go into much detail of all these because we're not like cardiologists but a apib is very common so that I would know apib you know is when it's beating out of control just chaotic symptoms are going to come with palpitations TR of breath fatigue you want to refer them to cardiologist obviously if they're unstable they're rapid apib send them to the Ed they're usually going to be put on something like a beta bler anti-coagulant Etc if it's a new onset you also want to order EKG TSH electroly renal function BMP chonin etc for EKG like I said we're really not going to go over much but just to know I made like a little graph over here there are full W walls of the heart the lateral inferior septal anterior posterior this is just plain memorization each has a coronary artery that's supplying it like you see over here the circumflex supplies the the lateral part the right coronate artery supplies inferior part and that all you're going to see that on the leads so certain leads are going to show you different parts of it so your V1 V2 is going to show you your your septo which is the left an ter descending Etc so here's a chart for Respiratory for Respiratory it's a little hard because they all come in withness of breath Co-op you know very non-specific it's a little hard to know like exactly which one but I kind of made like a little chart for lung cancer if they keep coughing persistent coughing you want to always rule out lung cancer the blood in um especially if they have a history of smoking it's going to be diagnosed with the L do CT and obviously it's going to be treated not by as you know surgery radiation but not in Primary Care carbon monoxide poisoning that has constitutional symptoms like malaise headache mental status change they're going to have an El carboxy hemoglobin level but you should just know for that that they whole sex is going to be completely off if then first of all you want to give them 100% O2 secure their ABCs Etc ponary embolism they're going to have a sudden that's going to be CL sudden onset of shortness of breath chest pain they could even have pink frothy speedum that's going to be another one and that's going to be diagnosed with dher imaging and they're going to be put on anti- coagulations Co every symptom is under Co it honestly but your key one over here is going to be a loss of taste and smell I highly doubt they'll test about it but just in case you have to know symptom management unless they're high risk they get monol antibodies Etc COPD is going to be your daily respiratory symptoms so it's not going to be sudden like the like the pulmonary embolism it's going to be daily respiratory symptoms like coffing shortness of breath and approach that we're going to go through sooning the next page you obviously want to encourage them to quit smoking that's like the key thing that you want to do a bronchitis are going to have a cough you want to get a good hmp it's really self Li and is nothing to do chronic bronchitis going to be worsening cough sputum shortness of breath and how how it's diagnosed it's coughing mucus for 3 months for 2 years you want you want to tell them to stop smoking reduce the environmental you know irritants reduce Etc RSV is very common especially with kids it's kind of cold old like symptoms and it's honestly just supportive care symptomatic you also have your coup CP the key differentiating thing over there is going to be your barking cough it's going to sound like a seal like barking cough for that mild can manage a home supportive if they need to come to the Ed cuz the Strider Etc then they're going to be given reic Epi some steroids to open the Airways it's pretty common in kids under three for pneumonia you have your shortness of breath C green sputum for chest x-ray for the commun card pneumonia you're going to see consolidations typical pneumonia infiltrates you're going to see the CBC will also have um glucos sites with the shift to the left you're going to give them antibiotics amoxicilin dxic cycin Etc and here's some more you have your bronchiolitis that's typically going to be under 2 years old you have a very fussy infant low grade fever cough wheezing if it's not severe to supportive care AUP bronchitis can be a cough speedom production also self-limiting nothing to do so protasis is something that sticks out cuz it has your three phases it has um the first phase it's nasal congestion sneezing tearing the second phase which is intense coughing followed by the so the key feature here is going to be the whooping cough so it's going to be like cough whoop after and the last phase is going to be a chronic cough for weeks so this is going to be put on antibiotics tuberculosis is the key feature to that is going to be the night sweats fevers weight loss for them you want to do a chest exra so they're going to put on a lot of medications aside or Fon fito what you want to know for this is that when you test them if it comes that greater than 15 mm of induration then it's positive but if they have HIV then it's greater than five is positive obstructive sleep apnea if you suspect this you want to send them for a sleep study and then there's different stuff you could do like weight loss positive arway pressure etc for asthma they're going to be wheezing shortness of breath there's like a stepwise approach that I'll show you in a minute of how to do so your stepwise approach for COPD let have a not you have your different groups so group a means that they have very non-frequent symptoms so for instance they only have shortness of breath when they're climing upstairs and they have low risk for exacerbation for them you want to use a sabat PRN short activated at this your group b is going to be your moderate severe symptoms but they also have a low risk for exacerbation for them you want to use your lava or Lama for Group C you're going to have your mildor frequen symptoms with at high risk for exacerbation you're going to use your regular llama and your sa for the last group you're going to use your llama and lava and your Sava for asthma asthma you also have a step wide approach there Step 1 2 3 four and five step one is when symptoms less than two you're just going to have to memorize there's nothing that sticks out there's really no way to know this I would especially know step three in all them because they usually don't ask for like step one or step five okay now we go on to the endocrine system so we're going to skip over the pathophysiology part for the purpose of this video you know how it works and um the hormones but but we're going to go on to hypothyroidism so hypothyroidism is really common and so number one what you should know is hypothyroidism how you're going to find it it's going to be TSH so your first thing you're going to order is a TSH and if that's abnormal then you could order T3 and T4 so TSH is an inverse relationship with what you would think it is so if it's hypothyroidism then TSH is high and T3 and T4 low and the reason for that is because just think about it like this if TSH is the one that tells your brain that you have a low amount of thyroid so you're going to have low amounts of actual hormones like T3 and T4 but the but you're going to have an increase in TSH because it of the low amount of T3 and T4 anyways um causing this could be haimoto thyroiditis is one of the most common it's an or immune disorder and it gradually destroys the thyroid so your symptoms of hypothyroidism are going to be like slowing down and hyperthyroidism are going to be like the opposite like amping everything up so slowing everything down just think of like waking constipation fatigue just everything like down and very late signs could be like facial puffiness cardiac signs course here Etc your treatment is going to be Synthroid they should take it the first thing in the morning empty stomach Etc a complication of untreated hypothyroidism is myxedema coma and that's going to be just think of you know your everything that goes down for hypothyroidism like a weight gain constipation everything slowing down just think of even worse so it's going to be confusion lethargic really really really low core body temperature Etc and this is pretty fatal so you want to set them to the Ed now the opposite of hypothyroidism it's pretty self-explanatory you're going to have a decrease in TSH and high of the actual hormones like T3 and T4 causes grave disease is the most common cause it's also autoimmune disorder that overproduces the hormones T3 and T4 symptoms like I said are going to be the opposite of everything slowing down everything is like amped up like anxiety palpitations weight loss increased appetite Etc and treatment so there's PTU and there's taple so PTU is you need like a lot of lab work for that and it's given multiple times a day so it's generally not given but the only times they really give PTU is in the first trimester of pregnancy after the first trimester you you switch to tapzo um if it's grave disease the treatment radioactive iodine complications of untreated hyper thyroidism is thyroid storm and this is life frating also you want to send them to the Ed thyroid cancer we're going to skip that for now hyperprolactinemia you're going to have like menstrual dysfunction symptoms infertility Etc diabetes diabetes is really common also type one is not as common as type two the difference between them is that type one is when the body makes very little or no insulin type two is that they do have beta cells but their body prevents the insulin from working properly so the goal in type two is to stop the the destruction of the beta cells so they could secrete insulin and in type one you basically they have basically no insulin so you have to give them insulin type two your risk factors for developing that you know obesity I'm sure you'll know this unhealthy eting Etc symptoms are going to be like o your peas polydipsia polyurea polyphasia another sign is a canthus nigera was like the brown discoloration and so I would just memorize what's considered pre-diabetic and diabetic you have to just memorize that and the treatment like we all know first we go into lifestyle modifications then the first line is always met for men unless it's contraindicated and then your other ones you could go on to your tcd gp1 Etc and still not working you can add a SES basal insulin and that's not working insulin the complications of diabetes we all know it could ffect the eyes the kidneys the heart Etc and you want to prevent these complications so do yearly eye exams do foot exams um especially because they have decreased Sensations so they might not be able to pick up on something that's down there and then it could you know be in a worse state of when you could have treated it before next we go on to hypoglycemia so that's decrease in the blood sugar that could be even from too much diabetes medications treatment for this is going to be if a patient's awake you give them 15 gram of glucose and and then like orang juice let's just say and then you could retest it 15 minutes later if they're not awake or you know unconscious or stuff like that or just can't tolerate oral then the GL glucagon you give them next we going to two conditions that cause high blood sugar in the morning but they're different and then they're treated differently so the dorm phenomenon and the samoji effect and a hint I like to remember this is Dawn is down samoji is so much so down what I mean by down is they they didn't have enough insulin so then in middle of the night the blood sugar kind of just spikes and then you wake up in the morning and they have hyper glycemia even though they didn't eat anything before so the treatment for this is to increase insulin because you have down so Dawn down to little insulin you gave them in the morning so they Spike and you got to give them more the samoji effect is the opposite samoji um too much insulin and then the body senses that the blood sugar Falls so it's going to counterregulate like and produce hormones that are going to bring up the blood sugar so when you take in the morning they're going to be hypoglycemic but really it's because of the hormones so for the dorm phenomenon because it's down too little you're going to give them insulin for simoy effect you give them too much you want to decrease that insulin um another endocrine disease that is too much and too little is Addison and Cushings Addison means you give them two little cortisol Cushings give too much cortisol and I like to remember that cuz Cushing starts with the ca so cortisol you give them too much Addison give them too little and the symptoms these are going to be like specific symptoms um hyperpigmentation they look like tan bronze however the book terms it and that's going to be your Addison and their labs are everything's going to be low except for they have a high potassium and with the cushions everything's all the laps are going to be up except potassium is going to be low and there symptoms that's specific are moon face purple stri trunkal obesity Etc and last but not least is SLE systemic lupus is an orom disorder that could basically affect almost any organ and it's really hard to diagnose because it can mimic a lot of other diseases for instance you can have vague symptoms like fatigue fever weight loss or you could have other symptoms like arthritis um skin lesions it's really hard to to diagnose you know just because it's so unspecific symptoms it's commonly a flare up with photo photosensitivity and it's can be diagnosed with positive Ana test with symptoms plus labs this is not going to be handled by Primary Care this is referral to rheumatologist so we go into hematology hematology we start with some numbers you should know you know like the platelet counts what's normal abnormal and then we go into anemias so the test like to ask what's the first test you do to test for anemia number one is a CBC you always start with your CBC after that you could do your hemoglobin electr frees Etc but you always start out with your CBC now we have different terms you should know so your MCV MCV is mosle volume and how I like to remember this is V I think of an SUV so SUVs come in all different sizes and people like big ones like tahos Etc so what V is going to stand for like CV is going to stand for is it's going to tell you the size we have your macro ciic your micro ciic and your normal cic so normal is normal micro is below and macro is above and all you have to do is remember the regular range like 80 to 100 and then you know anything above macro is above 100 anything below is below 80 and the normal is in between so just think of your V like your CV it's MCV just think of your SUV comes in all different sizes next we go on to MCH so mean moscal hemoglobin concentration so that and the moscal hemoglobin both tell you the color so I just like to think of anything with the H in it like hemoglobin or is U like huee so that's color that's going to tell you the color so hemoglobin you will tells you color your tibc is a total iron binding uh capacity and this basically tells you how much transfer is just sitting there not attached so what transfer is it's it attaches to iron then it transports it throughout the body so if transfer is just sitting there that means that Iron's not attaching to it so that is an indirect measure for you and how I like to remember this is T IBC so T is total iron binding capacity and T is for a transfer next we go on to serum fertin this is the most sensitive for iron deficiency anemia specifically and it tells you how much iron is stored and then goes on to iron reticular sites are immature red blood cells in the bone marrow and how I like to remember that is reticul sites like they're ridiculous they're immature next we go on to our red cell distribution width so RDW and that's like the width the distribution so then you remember all different variations poilo cytosis is basically measure the variable shape of their R Bud cells you have different types of an you have your macro ciic your microtic and your normal cytic like we said before so your microtic one of one of the most common ones are your iron deficiency anemia and I would remember the symptoms for that some symptoms they could be having is nail pitting paa which is like they eat stuff that are not food spoon-shaped Nails regular anemia symptoms like pale fatigue and Kil kosis which is like the chapus in the corners of the mouth and a shiny red tongue gtis for that treatment is going to be Iron the most common cause is blood loss so think of your your menes diet Etc and you always want to R malignancy Etc the next one is femia that's usually gen genetic like Mediterranean I it's just when the body makes a defective hemoglobin it's diagnosed with your hemoglobin electris if it's minor there's really no treatment if it's major then they need like transfusions and you want to be concerned for iron overload normal cic so the MCV so like I said V SUV the size of it is normal you have anemia of chronic kidney disease which is basically the body doesn't make enough secondary to chronic kidney disease you have anemia of chronic disease so like autoimmune disorders um obviously with that you want to treat the underlying disorder and you have your cyos anemia that is genetic it's generally aoso recessive the red BL cells are sickle shaped so they could get stuck it's also diagnosed with hemoglobin electris and this is more common in African-Americans and it's managed by a hematologist and last but not least you have your macro ciic so the MCV is high you have your B12 Anemia what they like to ask about this for the B12 is that it has neurosymptoms.org [Music] and that's from inadequate consumption alcoholism pregnancy and you want to treat it with giving them folic acid the next one is pernicious anemia that's an autoimmune causing termination of the intrinsic factor so this leads to B12 deficiency anemia so whenever you think of pernicious anemia just think of B12 deficiency anemia so you want to treat them with B12 injections once per week for four weeks and then do monthly then you have your plastic anemia which is destruction of the stem cells so like in the bone marrow symptoms because it's not specific to red blood cells so it includes red blood cells white blood cells platelets so you're going to have your pancytopenia so you're going to have um you could have bruises infection Etc and this you want to refer to your Metalist as soon as possible next you go on to your HIV so you want screen for that you know it's mostly spread by intercourse needles Etc there are three stages first they get the flu like symptoms and they could go asymptomatic which could be for years and then they'll have the return of symptoms which you want to treat them you want to know how it's diagnosed and you want to watch out for the CD4 count cuz if it's less than 200 then then then you could call them eights and then there are risk for infection immunosuppress so no live vaccines Etc okay next we go on to our GI notes so here like on top is just basically you know it's good to know you're an anime because if someone comes in with right upper quadron pain then you want to think of you know the gold bladder not like um the ovaries right so you basically just have to know what's in every quadrant to know you know more specific diagnosis here's a cute AB abdomen so this is so this is stuff you want to treat and you always want to rule these out and send it to the Ed if they have any of these so these are specific symptoms so your penitis you're going to have your blumberg sign we're going to go through the signs another page but I also have a video on that sign you have your bleeding so you're like bleeding internally you'll have your gry Turner side your colon sign you have your cute chasis you can have your right upper quadron pain or your Murphy sign you have your C pancreatitis which is left for quadron or epigastric pain you can have your Cullen sign your great Turner sign um you have aute appendicitis which is usually your right lower quadron pain and your MC Bernie's Point sois Etc and last but not least you have your acute diverticulitis which is your left floor quadron pain so this is assessment signs that are specific to GI like Cullen sign mcnie sign Murphy sign these are all stuff you have to know and I've seen this on the test so many times and I know a lot of people who had this on the test there's G GI signs there's signs in you know for dvts ETC so what I would do is I would either watch my video where I have this in detail I'll put the link below or above and watch that it's like 10 minutes or less than 10 minutes and it will explain you everything so I'm going to skip it for now okay now we're going to go on to gird so gird we probably all know the treatment for that for mod and intermittent you want to give them a low dose H series receptor like fine or ant acids if the symptoms still persist you could increase it two times a day if it's still persists you could add on a PPI and Etc some complications you want to watch out for is baret esophagus and esophagal cancer next we go on to peptic ulcer disease it's most common cause is H pylori but could also be from incess stress could even cause it smoking Etc they're going to come with epigastric pain or even food that provokes with epigastric pain you have your gastric ulcer and your doad ulcer if it's in the stomach which is the gastric ulcer then when they eat they're going to have a lot of pain because it's in the stomach if it's in the doal which is the small intestines then it takes you know a little bit time to get the small intestines it starts in this then so then one or 1 to three hours later then they're going to start after the eight then they're going to start getting pain it's usually diagnosed through endoscopy and you want to test them for h pylori and first of all you want to treat them to remove the cause like the stress the nids ETC and you can treat them with ppis H2 blockers compare and contrast IBD and IBS so I like to think of IBD as D for disaster so IBD is more severe than IBS and the reason for that is IBD is when it involves the bowel is inflamed so it causes a lot of damage and IBS it's not and you can just look at the name one's inflammatory bowel disease so there's inflammation going on and one's irritation so the thing about this is is that with IBD with inflammation it could cause a lot of damage and they're at risk for increased um risk for colon cancer the symptoms could be quite the same but with IB S A lot of times they have mucus in the stool gassy blowy abdominal distension Etc abdominal pain and in terms of the treatment so with IBS you want to do diet stress reduction you know you always want to rule other causes Etc but with IBD it's usually with medication now under IBD so you have ulcer of colitis and Cron's disease they're both chronic inflammation from the GI track cuz remember IBD is inflammation so they're both inflammatory the difference is uler of kitis is in the large intestines and croh disease could be anywhere in the GI tract usually in the small intestines but the ult of citis is only in the large intestines and the inflammation in also of ctis is continuous in cruin dise that is not continuous and here are some risk factors symptoms are a little bit different but a lot of them are the same so they both have diarrhea they both have abdominal pain both have extraintestinal Mal manifestations both have blood in the sto but if you're talking about malur anal fulas Mal nutrition and usually cron disease I'm talking about blood in the St also have Colitis um but a little hard to differentiate so next we go on to C diff C diff is um very common with antibiotic use especially certain antibiotics and what they're going to have is severe what to read it's going to have a smell um and they could also have fever lower abdominal pain Etc but but mainly the like smelly diarrhea the treatment is going to be to obviously stop the antibiotics use contact precaution cuz it's spread that way hand hygiene and with them you want to do soap and water not alcohol and then you're going to give them treatment his vco Etc so next we go into colon cancer one of the symptoms are a change in B habit that's a big one ribbon shape like thin like pencil stool it could also be from constipation but it could also be a sign of coal VTO cancer um but usually a change in bowel habits to big one weight loss Etc it's diagnosed through colonoscopy and you want to do colonoscopy for prevention you know like like part of the screenings next we go on to um hepatitis hepatitis is itis so it's inflammation of the liver and usually due to a virus symptoms are fever malaise nausea Jones is a big one it has to do with the liver Happ to meally um and increase Al and ASD alt and ASD are always l so like we mentioned before ggt is elevated and IND indicates alcoholism Alp elevated but could also be elevated due to brone growth or disorders and and IGM is when it's active IGG is when recovery so I like to think about as G as gone and M is m is like immediate noun so now we just have a quick chart of hepatitis so you see your a b CDE e and what you should know is that which ones are chronic your BCD not your A and E A and E are both spread the same way they're fecal oral the most severe one is usually B because it's linked to liver cancer and a is usually miles you can just read through this chart the treatment is the same for all them supportive if they're not vaccinated get the vaccine they're reportable to the health department for chronic ones like B andc like I said those are the most severe you want to refer them to gastroenterologist so next we go on to our GU system so we have our kidney we have the pathopysiology on that and you know just some stuff by the red blood cells you GRE up on that but now we talk about acute renal failure Aki acute kidney injury so symptoms that usually point to the kidney are decreased urine output fluid retention edema Etc so acute kidney injury could be caused from preal which is stuff like before the kidney so um hypovolemia post renal stuff after the kidney so think of your bladder so like a bladder obstruction or intrinsic so the actual kidney acute kidney injury you fix the cause whatever causing it and then it goes away chronic kidney injury is kidney damage for more than 3 months usually the causes hypertension or diabetes which is why you always want to manage Jo so it doesn't end up in kidney failure there are three stages and the stages are based on the GFR number one kidney damage with normal GFR mild kidy functional loss moderate severe sorry not three five stages and in stage aren failure so I would know that the symptoms begin at stage three so that's why you want to refer them out to nefrologist next we go on to UTI UTI is very common you know it presents the same way urinary frequency burning pain Etc but with elderly they could have confusion is a big one and you want to think UTI if they have flank pain it could have spread to the kidney which is called pylon Artis which is when it spreads upwards to the kidney and that usually comes with fever chills Etc it's usually diagnosed through a UA by the lucaites and the nitrates if those are positive then the person has a UTI you can send it for a culture to see which exact bacteria they have it treatment for that I would know this cuz this is quite common is if someone is non-complicated so you could do Macrobid vrum Etc if someone's complicated which could be someone recurring UTI a male someone pregnant then you want to give them a c Flexin and if they pregnant you want to get them penilla I'm next we go into kidney stone they are usually coming in with a flank pain hematuria nausea vomiting Etc you want to do Labs of them and get a CAT scan of their abdomen and pelvis treatment is going to be besides for PID medication cuz because it is qu painful hydration hydration until the stone passes if it's if the stone is large then and they can't pass it on themselves then you want them um to give them like tamsulosin or something to help them next we go on to romalis and romalis is damaged muscle so when the the damaged muscle breaks down it releases content into the blood and this is pretty harmful for the kidneys so it causes them to go into cute injury this could be from stuff like a Statin too much exercise Etc you're going to you're going to diagnose it cuz they're going to have CK levels like through the roof like three like five times the normal amount and treatment is going to be fluids fluids fluids in the Ed so you're going to refer them to Ed and let them handle that now we go on to SDI SS so you have your ganaria ganaria and chyia are C treated so someone has ganara you're going to treat them for for chyia and vice versa so the treatment for ganara is going to be SE triaxone which is Rin one time dose I am the treatment for chyia is daxin 100 but so like I just said before you're treating one you're treating both of them together um then we go to syphilis what I want know about syphilis is the is a symptoms it comes in three stages so it has a chance for the diffuse rash and then it affects the whole body I would also know what medication to give them which is pelicin uh peny G I am next we're going to trick trick has specific um it's usually green grayish uh discharge you want to know about and the treatment is methanide so the next one is HIV have symptoms like fever lopy sore throw rash Etc and for them the treatment really depends on their stage if they have opportunistic infections Etc so next we go on to HPV HPV what you should know about that is it's usually genital warts and that's how can be described some sort of words an anal genital area in terms of what you should know about this I would know is that that the strain 16 and 18 are linked to cervical cancer so that's important to know when you go into your Hepatitis B hepatitis we already discussed the symptoms you're you're going to have your nausea abdominal pain um joint this is always a liver key Etc and we already said what we do before the supportive care you know referral other information is important to know anytime you treat trick you want to treat Gara when an SD is found you always want another s test if they would like to and for most of seds you want to bring the partner in also to treat and left but not least from this page we're going to go on into pelvic inflammatory disease this is actually a complication of Gara and chyia uh symptoms are going to be specific cuz they're going to tell you um besides for lower abdominal pain pelvic pain Etc they also can tell you cervical motion or adinal tenderness so if they ever hear those words or cervical fry ability then you always want to think of have a inflammatory disease treatment like we said because it's the complication of garia and comia you want to the garia and comia so you want to give this set triaxone the do cyclin Etc so thank you for watching this is part one out of two of the family n practitioner Board review examination so we're going to have one more video probably be around an hour long and then that'll be the whole Board review so like I said this doesn't go into every single detail but this is a good comprehensive review so if you have any questions or any comments or suggestions please please put it in the comment section below and if you like all this in note form so you could you know highlight or whatever you want it then check out the other link below and thank you for watching bye