πŸ‡¨πŸ‡¦ MCCQE1 High-Yield Master Notes

Canadian Exam Format Β· Color-Coded Β· Ready for Your Website

Emergency
Cardiology
Respiratory
GI
Neurology
Endocrine
Renal
Pediatrics
Psychiatry
🚨

EMERGENCY β€” Always Treat First

Anaphylaxis
➑ IM Epinephrine FIRST
  • Then: Oxygen + IV fluids
  • Then: Antihistamines + Steroids
  • Never delay epinephrine
Acute Angle-Closure Glaucoma
  • Severe eye pain + halos
  • Headache + nausea
  • Fixed mid-dilated pupil
➑ IV Acetazolamide + Ophthalmology
Testicular Torsion
  • Sudden severe testicular pain
  • High-riding testicle
  • Absent cremaster reflex
  • 6-hour window for salvage
➑ Immediate surgical exploration
Epidural Hematoma
  • Trauma β†’ lucid interval β†’ rapid decline
  • Middle meningeal artery
➑ CT: Biconvex (lens-shaped)
Subdural Hematoma
  • Elderly / alcoholic / minor trauma
  • Bridging veins
➑ CT: Crescent-shaped
Epiglottitis
  • Drooling + stridor + tripod position
  • Toxic-looking child
  • Do NOT examine throat
➑ Secure airway FIRST
❀️

Cardiology

Stable Angina
  • Chest pain with exertion
  • Relieved by rest / nitroglycerin (<5 min)
➑ Stress test for Dx
Acute MI (STEMI)
  • Crushing chest pain β†’ arm/jaw
  • Diaphoresis + nausea
➑ ECG first β†’ PCI <90 min
  • ASA + P2Y12 + anticoagulation (MONA)
Aortic Dissection
  • Tearing chest pain β†’ back
  • BP difference between arms
  • Widened mediastinum on CXR
➑ CT Angiography
  • Type A β†’ surgery | Type B β†’ labetalol
Atrial Fibrillation
  • Irregularly irregular pulse
  • No discrete P waves on ECG
➑ CHAβ‚‚DSβ‚‚-VASc β†’ DOAC
  • Rate control: beta-blocker / CCB
Aortic Stenosis
  • Classic triad: Syncope + Angina + Dyspnea
  • Harsh systolic murmur β†’ carotids
➑ Echo β†’ AVR when symptomatic
Heart Failure
  • Dyspnea + orthopnea + bilateral edema
  • Bilateral crackles
➑ BNP + Echo
  • HFrEF: ACEi + BB + diuretic + spironolactone
🫁

Respiratory

Pulmonary Embolism
  • Dyspnea + pleuritic chest pain + tachycardia
  • Normal CXR does NOT rule out PE
➑ CT Pulmonary Angiography (high prob)
  • D-dimer for LOW probability only
Pneumothorax
  • Absent breath sounds + hyperresonance
  • Tension: trachea deviates AWAY + hypotension
➑ Tension: Needle decompression 2nd ICS MCL
  • Simple large: chest tube
Asthma
  • Episodic wheeze + cough + chest tightness
  • Worse at night + reversible
➑ SABA PRN + ICS maintenance
COPD Exacerbation
  • ↑ Dyspnea + ↑ sputum + purulence
  • Smoker + chronic disease
➑ SABA + prednisone 40mg + antibiotics
  • Oβ‚‚ target: 88–92%
Tuberculosis
  • Chronic cough + night sweats + weight loss
  • Upper lobe cavitation on CXR
➑ Sputum AFB + IGRA
  • RIPE x2mo β†’ RI x4mo; ISOLATE
Community-Acquired Pneumonia
  • Fever + productive cough + lobar consolidation
  • MCC: S. pneumoniae
➑ CURB-65 guides admission
  • Outpatient: amoxicillin or azithromycin
πŸ«€

Gastroenterology

Acute Pancreatitis
  • Epigastric pain radiating to back
  • Lipase >3x ULN
  • MCC: Gallstones + Alcohol
➑ IV fluids (LR) + NPO + analgesia
Appendicitis
  • RLQ pain + fever + nausea
  • McBurney point tenderness
➑ CT abdomen β†’ laparoscopic appendectomy
  • Always Ξ²-hCG in females
Peptic Ulcer Disease
  • Duodenal β€” pain relieved by food + nocturnal
  • Gastric β€” pain worse with food + weight loss
  • H. pylori + NSAIDs = MCC
➑ PPI + H. pylori eradication
Upper GI Bleed
  • Melena = black tarry stool
  • MCC: PUD β†’ varices
➑ IV PPI + endoscopy within 24hr
Ulcerative Colitis vs Crohn
  • UC β€” bloody diarrhea + rectum always + continuous
  • Crohn β€” any GI segment + skip lesions + fistulas + perianal
➑ Colonoscopy + biopsy
Mesenteric Ischemia
  • Pain OUT OF PROPORTION to exam
  • A-fib β†’ embolic MCC
➑ CT angiography β†’ surgical emergency
🧠

Neurology

Acute Stroke
  • Sudden focal weakness / speech / vision
  • Ischemic 85% vs Hemorrhagic 15%
➑ CT head (no contrast) FIRST
  • tPA if ischemic + within 4.5hr
Subarachnoid Hemorrhage
  • "Worst headache of life" β€” thunderclap
  • Ruptured berry aneurysm
➑ CT head β†’ if negative β†’ LP (xanthochromia)
  • Nimodipine for vasospasm
Parkinson Disease
  • TRAP: Tremor (resting pill-rolling) + Rigidity + Akinesia + Postural instability
  • Micrographia + shuffling gait
➑ Levodopa/Carbidopa (most effective)
Guillain-BarrΓ© Syndrome
  • Ascending flaccid paralysis + areflexia
  • Post-infectious (Campylobacter)
  • CSF: ↑protein + normal WBC
➑ IVIG or Plasmapheresis
Bell's Palsy vs Stroke
  • Bell's β€” forehead INVOLVED (LMN)
  • Stroke β€” forehead SPARED (UMN)
➑ Prednisone + Valacyclovir within 72hr
Meningitis
  • Headache + photophobia + neck stiffness
➑ Antibiotics FIRST if delayed LP risk
  • Ceftriaxone + vancomycin Β± ampicillin + dexamethasone
βš—οΈ

Endocrinology

Hyperthyroidism
  • Weight loss + heat intolerance + tremor + palpitations
  • Low TSH + high free T4
➑ Methimazole β†’ radioiodine or surgery
Hypothyroidism
  • Weight gain + cold intolerance + fatigue + constipation
  • High TSH + low free T4
➑ Levothyroxine (synthetic T4)
Cushing Syndrome
  • Moon face + central obesity + purple striae
  • Buffalo hump + hypertension
  • MCC: Exogenous steroids
➑ 24hr urine cortisol + overnight dexamethasone suppression
Addison Disease
  • Hypotension + hyperpigmentation
  • Hyponatremia + hyperkalemia + hypoglycemia
➑ IV hydrocortisone + saline (crisis)
Pheochromocytoma
  • Episodic HTN + headache + sweating + palpitations
➑ Plasma free metanephrines
  • Alpha-blocker FIRST β†’ then beta-blocker β†’ surgery
DKA vs HHS
  • DKA β€” ketones + acidosis + type 1
  • HHS β€” glucose >33 + NO ketones + type 2
➑ IV fluids + insulin + electrolytes
🫘

Renal

Kidney Stones (Renal Colic)
  • Severe colicky flank pain β†’ groin
  • Hematuria + nausea
  • Patient writhes (cannot stay still)
➑ CT KUB (no contrast) + NSAIDs
  • Tamsulosin for stones <10mm
Nephrotic Syndrome
  • Proteinuria >3.5g/day + edema
  • Hypoalbuminemia + hyperlipidemia
➑ Renal biopsy for Dx
  • MCC adults: FSGS | children: minimal change
UTI Spectrum
  • Cystitis β€” dysuria + frequency; no fever
  • Pyelonephritis β€” fever + CVA tenderness
➑ Nitrofurantoin (cystitis) | Ceftriaxone (pyelo)
Hyperkalemia (Dangerous)
  • Peaked T waves β†’ wide QRS β†’ VF
  • ACE inhibitors + renal failure
➑ IV Calcium gluconate FIRST (stabilize membrane)
πŸ‘Ά

Pediatrics

Croup
  • Barking/seal cough + inspiratory stridor
  • Worse at night | Age 6mo–3yr
  • Parainfluenza virus
➑ Dexamethasone 0.6mg/kg PO + neb epinephrine (severe)
Pyloric Stenosis
  • Projectile NON-bilious vomiting at 2–8 weeks
  • Hypochloremic metabolic alkalosis
  • Olive-shaped mass
➑ Ultrasound β†’ correct electrolytes β†’ Pyloromyotomy
Intussusception
  • Currant jelly stool + episodic crampy pain
  • Age 6mo–2yr | Sausage-shaped mass
➑ US (target sign) β†’ Air enema reduction
Kawasaki Disease
  • Fever >5d + conjunctivitis + strawberry tongue + rash + cervical LAD + extremity changes
➑ IVIG + high-dose ASA + Echo (coronary aneurysms)
Bronchiolitis
  • Infant + URI + wheeze + crackles
  • MCC: RSV
➑ Supportive ONLY (no steroids/bronchodilators)
Neonatal Jaundice Timing
  • <24hr β€” PATHOLOGIC (hemolysis)
  • Day 2–7 β€” Physiologic
  • Day 5–14 β€” Breast milk
➑ <24hr = always investigate urgently
🧩

Psychiatry

Depression
  • Low mood + anhedonia β‰₯2 weeks
  • SIGECAPS criteria
➑ SSRI first-line + CBT
Bipolar Disorder
  • Mania: grandiosity + ↓sleep + risky behavior
➑ Lithium (mood stabilizer)
  • Monitor: Li level + TSH + renal function
  • NSAIDs β†’ lithium toxicity
Panic Disorder
  • Recurrent unexpected panic attacks
  • Anticipatory anxiety
➑ SSRI/SNRI + CBT
  • Benzodiazepines PRN short-term only
Schizophrenia
  • Delusions + hallucinations + disorganization
  • Symptoms >6 months
➑ Antipsychotics (olanzapine, risperidone)
NMS vs Serotonin Syndrome
  • NMS β€” rigidity + fever + antipsychotics β†’ dantrolene
  • SS β€” clonus + hyperreflexia + SSRIs β†’ cyproheptadine
Delirium vs Dementia
  • Delirium β€” ACUTE + fluctuating + reversible
  • Dementia β€” chronic + progressive
➑ Delirium: find and treat the CAUSE first

πŸ”΄ MCCQE1 β€” Most Repeated Exam Traps

1
Worst headache of life β†’ Subarachnoid hemorrhage β†’ CT first, then LP
2
Sudden testicular pain β†’ Torsion β†’ surgical emergency β†’ 6hr window
3
Irregularly irregular pulse β†’ Atrial fibrillation β†’ CHAβ‚‚DSβ‚‚-VASc β†’ DOAC
4
Melena β†’ Upper GI bleed β†’ IV PPI + endoscopy within 24hr
5
Chest pain relieved by rest β†’ Stable angina β†’ stress test
6
Flank pain β†’ groin β†’ Kidney stone β†’ CT KUB
7
RLQ pain + fever β†’ Appendicitis β†’ CT abdomen
8
Ascending paralysis post-infection β†’ Guillain-BarrΓ© β†’ IVIG
9
Drooling toxic child + stridor β†’ Epiglottitis β†’ airway first, NO throat exam
10
Barking cough + stridor at night β†’ Croup β†’ Dexamethasone
11
Forehead involved in facial palsy β†’ Bell's palsy (LMN) not stroke
12
Alpha-blocker before beta-blocker β†’ Pheochromocytoma pre-op
13
Thiamine before glucose β†’ Wernicke encephalopathy in alcoholic
14
Normal CXR does NOT exclude PE β†’ order CT-PA if suspected
15
Start GCA steroids immediately β†’ don't wait for biopsy (blindness risk)
16
Pain out of proportion to exam β†’ Mesenteric ischemia β†’ surgical emergency
βœ… Link copied!

πŸ₯ DR. HIGH YIELD β€” Internal Medicine Notes

Color-coded, searchable IM notes for MCCQE1

πŸ“Š

Clinical Criteria & Scores

β–Ό

πŸ«€ CHAβ‚‚DSβ‚‚-VASc β€” Atrial Fibrillation

  • CHF (1) | HTN (1) | Age >75 (2) | DM (1)
  • Stroke/TIA/TE (2) | Vascular disease (1) | Age 65-74 (1) | Female (1)
  • Max = 9 (can't count age twice)
Score β†’ Tx:
β‰₯2 β†’ Warfarin/Xa blocker/DTI  |  <2 β†’ Aspirin

🦠 Centor Score β€” Strep Pharyngitis

  • Cough (NONE) | Exudates | Anterior cervical LN | Temp >38
  • Age 3-14 (+1) | Age 15-44 (0) | Age 44+ (-1)
Score β†’ Action:
4+ β†’ Penicillin  |  2-3 β†’ Rapid strep test  |  ⚠️ Children: always rapid strep

🫁 CURB-65 β€” Pneumonia Severity

  • Confusion | Urea (BUN >7) | RR >30 | BP low (SBP<90/DBP<60) | Age β‰₯65
>2 β†’ Hospitalize
Inpatient: Fluoroquinolone  |  Outpatient Atypical: Azithromycin  |  Outpatient Typical: Amoxicillin

🩸 SEPSIS Criteria

SIRS = 2+ of: Temp >38/<36 | HR>90 | RR>20 or PaCOβ‚‚<32 | WBC>12k/<4k/>10% bands
  • Sepsis = SIRS + Source of infection
  • Severe Sepsis = SIRS + Source + End organ damage + HoTN + Lactate >4
  • Septic Shock = Severe sepsis unresponsive to fluids

πŸ’§ Light's Criteria β€” Pleural Effusion

  • Pleural protein/Serum protein >0.5 = Exudate
  • Pleural LDH/Serum LDH >0.6 = Exudate
  • Pleural LDH >2/3 upper normal = Exudate

🫁 Well's Criteria β€” PE

Score:
>4 β†’ CTA  |  <4 β†’ D-dimer
⚠️ If suspect PE β†’ Give HEPARIN before CTA!
❀️

Cardiology

β–Ό

Coronary Artery Disease Spectrum

TypePainTroponinSTTx
Asx CADNoneβ€”NoOutpatient
Stable AnginaExertionalβ€”NoStress test first
Unstable AnginaAt restβ€”NoMONACBASH
NSTEMIAt rest↑NoCath lab
STEMIAt rest↑YesSTRAIGHT TO CATH

πŸ₯ ACS Treatment β€” MONACBASH

MONACBASH:
Morphine | Oxygen | Nitrates | Aspirin 325mg (chew) | Clopidogrel | Beta-blocker (metoprolol) | ACEi (lisinopril) | Statin (atorva 80mg) | Heparin
⚠️ Inferior MI (II,III,aVF) β†’ NO nitrates! RCA β†’ bradycardia β†’ give atropine, Tx: Fluids

⚑ Arrhythmias

  • SVT (narrow QRS): Stableβ†’Vagalβ†’Adenosine | Unstableβ†’Cardioversion
  • VTach (wide QRS): Stableβ†’Amiodarone | Unstableβ†’Cardioversion
  • V-fib / Pulseless VTach β†’ Defibrillation
  • Asystole / PEA β†’ CPR
  • Torsades de Pointes β†’ IV Magnesium

πŸ«€ AV Blocks

  • 1st degree β†’ No tx
  • Mobitz I (Wenckebach) β†’ No tx
  • Mobitz II β†’ Pacemaker
  • Complete AV Block β†’ Pacemaker

πŸ«€ CHF

Decrease mortality: ACEi + BB + Spironolactone
Acute Decompensation β€” NO LIP:
Nitrates | Oxygen | Loop diuretics | Inotropes | Positioning

HTN Emergency vs Urgency

  • Emergency: 180/120 + end organ damage β†’ IV hydralazine / Nitroprusside / Labetalol
  • Urgency: 180/120 + no end organ damage β†’ Oral medications

πŸ«€ Cardiac Tamponade

Beck's Triad:
Hypotension | JVD | Muffled heart sounds
  • Pulsus paradoxus: inspiration β†’ >10 drop in SBP
  • Electrical alternans on EKG

🩺 Aortic Dissection

  • Type A (proximal to L subclavian) β†’ Surgery immediately
  • Type B (distal to L subclavian) β†’ Beta-blocker
  • Dx: CT angio (if no CKD) or TE Echo
🫁

Pulmonary

β–Ό

COPD Stages (FEV1)

  • Mild >80% β†’ Albuterol
  • Moderate 50-80% β†’ Albuterol + Ipratropium
  • Severe 30-50% β†’ Albuterol + Ipratropium + Inhaled steroid
  • Very Severe <30% β†’ All above + Long-term Oβ‚‚
Home Oβ‚‚ indications: PaOβ‚‚ <55 OR Oβ‚‚ sat <88%
Decrease mortality: Smoking cessation + Home oxygen

Asthma Stages

  • Intermittent (<2x/week) β†’ Albuterol PRN
  • Mild persistent (3-7x/week) β†’ Albuterol + Low dose ICS
  • Moderate persistent (daily) β†’ Albuterol + Medium dose ICS
  • Severe persistent (multiple/day) β†’ Albuterol + High dose ICS
⚠️ Normal/elevated PCOβ‚‚ in asthma attack β†’ INTUBATE!

⬆️ Upper Lobe Diseases

Remember:
TB | Silicosis | Aspergillus

🫁 Pneumothorax

  • Simple: ↓ breath sounds, hyperresonance, ↓ fremitus β†’ Chest tube
  • Tension: + tracheal deviation + HoTN β†’ 1st: Needle thoracentesis β†’ then chest tube

Mechanical Ventilation

  • ↑ TV or ↑ RR β†’ ↓ PCOβ‚‚
  • ↑ FiOβ‚‚ or ↑ PEEP β†’ ↑ PaOβ‚‚
  • ARDS β†’ HIGH PEEP + LOW tidal volume
πŸ«ƒ

Gastroenterology

β–Ό

πŸ”‘ Key Workup Steps

  • Suspect cholecystitis β†’ RUQ US first
  • Non-diagnostic US β†’ HIDA scan
  • Pancreatitis β†’ elevated lipase β†’ RUQ US (to find cause)
  • After cancer dx β†’ Staging with CT

🦠 SBP (Spontaneous Bacterial Peritonitis)

  • Cirrhosis + ascites + fever/abd pain
  • Dx: Paracentesis β†’ PMN >250
  • Tx: Ceftriaxone

πŸ’› Jaundice / Hyperbilirubinemia

Elevated AST/ALT mnemonic β€” ABCDEFGHI:
Autoimmune | HepB | HepC | Drugs | Ethanol | Fatty liver | Growth(tumors) | Hemodynamic(shock) | Iron(hemochromatosis)

🟀 IBD Comparison

Crohn'sUC
PatternSkip lesionsContinuous (always rectum)
DepthTransmuralMucosal only
FeaturesFistulas, strictures, oral ulcersAssoc with PSC
TxSulfasalazineSulfasalazine
Pyoderma gangrenosum = STERILE wound β†’ Tx: steroids NOT abx!

Charcot's Triad & Reynolds Pentad

  • Charcot's = RUQ pain + fever + jaundice (ascending cholangitis)
  • Reynolds Pentad = Charcot's + AMS + HoTN
🧬

Endocrinology

β–Ό

🍬 DM Diagnosis

  • 2x Fasting BG >126
  • Random BG >200 + symptoms
  • HbA1c >6.5%
Metformin CI: CHF, Renal failure (Cr >1.5) β†’ lactic acidosis!
MCC death in T2DM = MI (accelerated atherosclerosis) β€” same in RA!

DKA vs HHS

DKAHHS
pH<7.357.35-7.45
Glucose~300~1000
AG↑ (AG met acidosis)Normal
TxIV insulin + dextrose + IVF + K⁺IV insulin + IVF
⚠️ Stop insulin when AG closes in DKA!

Cushing Syndrome β€” BAMCUSHINGOID

BAMCUSHINGOID:
Buffalo hump | Amenorrhea | Moon facies | Crazy | Ulcers | Skin changes | HTN | Infection | Necrosis(femoral) | Glaucoma | Osteoporosis | Immunosuppressed | Diabetes
1st test: Low-dose dexamethasone suppression test / 24hr urine cortisol / Late-night salivary cortisol

πŸ¦‹ Thyroid Nodule Workup

  • Check TSH + thyroid U/S
  • Hyperthyroid β†’ Radioactive iodine uptake scan
  • Euthyroid nodule >1cm β†’ Biopsy
  • After medullary thyroid Ca dx β†’ check Pheochromocytoma (urine metanephrines) first!
MEN2a (PPM): Pheochromocytoma + hyperParathyroidism + Medullary thyroid Ca
🫘

Renal

β–Ό

🚨 Emergent Hemodialysis β€” AEIOU

AEIOU:
Acidosis | Electrolytes (K >6.5) | Intoxication (MALE: Methanol/Aspirin/Lithium/Ethylene glycol) | Overload (fluid) | Uremia

πŸ”¬ Urine Casts

  • Muddy brown casts β†’ ATN (shock/toxins)
  • WBC casts β†’ AIN or Pyelonephritis
  • AIN = FEAR: Fever | Eosinophilia | Azotemia | Rash

πŸ§ͺ RTA Types

  • RTA 1 β†’ Can't secrete H⁺ β†’ kidney stONEs
  • RTA 2 β†’ Can't absorb bicarb β†’ acidotic
  • RTA 4 β†’ HYPOaldosterone β†’ HYPERkalemia (only one with ↑K⁺)

πŸ’Š Hyponatremia Algorithm

  • Check osmolality: >295=hyper | 275-295=iso | <275=hypo
  • Check volume: Hyper | Eu | Hypo-volemic
  • Euvolemic + high urine Na β†’ SIADH (Tx: fluid restrict)
  • Hypovolemic + symptoms β†’ 3% hypertonic saline (correct slowly!)
⚠️ Overcorrect too fast β†’ Central Pontine Myelinolysis!
🩸

Hematology / Oncology

β–Ό

Microcytic Anemia β€” FAST

FAST:
Fe deficiency (↓ferritin, ↓serum Fe, ↑TIBC) | Anemia of chronic disease (↑ferritin, ↓serum Fe, ↓TIBC) | Sideroblastic (↑ferritin, ↑serum Fe, ↓TIBC) | Thalassemia

TTP vs HUS

  • TTP = FAT RN: Fever | Anemia | Thrombocytopenia | Renal | Neuro β†’ Tx: Plasma exchange
  • HUS = EHEC/Shigella/Uremia β†’ Hematuria + anemia + thrombocytopenia β†’ Tx: Dialysis
⚠️ NEVER give abx for EHEC β†’ predisposes to HUS!

🩸 HIT (Heparin-Induced Thrombocytopenia)

  • Plts drop ~50% within 3 days of heparin
  • STOP heparin β†’ start argatroban/dabigatran (DTI)
  • Test: +PF4 Ab + serotonin release assay

DIC

  • ↑PT + ↑PTT + ↑BT + ↑D-dimer + ↓fibrinogen + thrombocytopenia
  • Tx: Treat underlying cause + FFP + Vitamin K
🦠

Infectious Diseases

β–Ό

🫁 Pneumonia Treatment

SettingOrganismTx
Outpatient typicalStrep, H fluAmoxicillin
Outpatient atypicalMycoplasma, LegionellaAzithromycin
InpatientVariousFluoroquinolone
Hospital acquiredPseudomonasPip-tazo / Cefepime
AspirationAnaerobesClindamycin

🧠 Meningitis β€” Bugs by Age

  • <3 months (BEL): GBS + E.coli + Listeria β†’ Vanc + Ceftriaxone + Ampicillin
  • Everyone else: Strep pneumo + H flu + N. meningitidis β†’ Vanc + Ceftriaxone
  • >50yo/IC: Add Ampicillin (Listeria)
  • AIDS: Cryptococcal β†’ India ink β†’ Amphotericin

πŸ”΄ HIV CD4 Prophylaxis

  • CD4 <200 β†’ TMP-SMX (prevents PCP PNA)
  • CD4 <50 β†’ Azithromycin (prevents MAC)
  • Viral count >1000 β†’ C-section; CI to breastfeeding

πŸ”΄ TB Treatment (RIPE)

  • Active TB: RIPE Γ— 2 months β†’ then RI Γ— 4 months
  • Rifampin (orange secretions) | INH + B6 | Pyrazinamide (gout) | Ethambutol (eyes)
PPD thresholds: >15mm healthy | >10mm healthcare/foreigner | >5mm HIV/close contact
🦴

CT & Joints (Rheumatology)

β–Ό

RA vs Lupus Treatment

RALupus
MildNSAIDsNSAIDs
DMARDMTXHydroxychloroquine
FlareSteroidsSteroids

Lupus Criteria β€” SOAPBRAINMD (4/11)

SOAPBRAINMD:
Serositis | Oral ulcers | Arthralgias | Photosensitivity | Blood (pancytopenia) | Renal | ANA | Immunoglobulin (anti-dsDNA) | Neuro | Malar rash | Discoid lupus

🦢 Gout vs Pseudogout

  • Gout: Negatively birefringent crystals (yellow, needle-shaped) β†’ MTP joint
  • Pseudogout (CPPD): Positively birefringent (blue, rhomboid) β†’ chondrocalcinosis
  • Next step: Arthrocentesis
  • Tx: NSAIDs + Colchicine (CI: kidney disease)

Polymyalgia vs Polymyositis vs Fibromyalgia

  • Polymyalgia Rheumatica = STIFFNESS β†’ elderly, ↑ESR, normal CPK β†’ low dose steroids
  • Polymyositis = WEAKNESS β†’ ↑CPK β†’ steroids. Assoc with malignancy!
  • Fibromyalgia = PAIN β†’ trigger points β†’ TCA/SNRI
⚠️ Giant cell arteritis β†’ HIGH DOSE steroids (prevents blindness!)
πŸ’§

Fluids & Electrolytes

β–Ό

⚑ Hyperkalemia Treatment

  1. Check EKG β†’ if changes β†’ Calcium gluconate (stabilize membranes)
  2. Insulin + Dextrose (shift K into cells)
  3. Kayexalate (excrete K via GI)

🦴 Calcium Disorders

  • Hypercalcemia β†’ Tx: IVF
  • Hypermagnesemia: 1st sign = loss of DTRs β†’ Tx: IV calcium gluconate
  • Blood transfusions β†’ hypocalcemia (citrate binds Ca)

πŸ§ͺ PTH Axis (High Yield!)

  • PTH β†’ ↑Ca²⁺ + ↓phosphate (bone + kidney + vit D activation)
  • Primary hyperPTH β†’ ↑PTH, ↑Ca, ↓P β†’ Tx: parathyroidectomy
  • Kidney failure β†’ ↑PTH with ↓Ca + ↑P (can't activate vit D)
  • Vit D deficiency β†’ ↓Ca, ↓P, ↑PTH
  • SqCC lung β†’ PTHrP β†’ ↑Ca, ↓P, ↓PTH