## general TIPS
- I vaguely remember having a couple of sodium questions (think pretty simple like SIADH and Central vs. nephrogenic DI), a hypercalcemia question where the answer is always just give fluids,
- Also helped to take a step back when approaching questions and think first does this patient need emergent surgery (hemodynamically unstable, peritoneal signs, + FAST, etc.), or do I need to consider diagnostics? Really decreased the cognitive load cause emergent surgery was easy money. Then next step was knowing what information each test is really telling me (as opposed to trying to remember best diagnostic test for each diagnosis) so you can determine if it would appropriately change your management
- emergency med UW?

# Pediatrics
## Bilious Emesis in a kid
- stable --> abd XR
- further imaging if like contrast enema or Upper GI series
- unstable --> EX LAP
- if peritoneal signs like rigid abdomen ALSO ex LAP!

## Iron-deficient kid with occult blood in stool
- sometimes upper and lower scope won't pick this up and you must F/U w/ **T-99 scan** as this is likely a Meckel's diverticulum
- this ectopic gastric tissue *within* the diverticulum can secrete HCl leading to ulceration of intesteine
- 


## Newborn w/ abdominal distension, decreased breath sounds and low pulse ox
- likely due to posterior urethral valves that obstruct urine output and backing up fluid into the bladder, kidneys and lungs!
- diagnose with a voiding cystourethrogram and renal + bladder US

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# Colorectal
## IBD + Erythema nodosum
- more commonly seen with Crohns > UC
- delayed- type hypersensitvity reaction
- biopsy of nodules reveals "septal panniculitis", inflammation of subq fat

## Worsening anal pain for days w/ indurated, erythematous mass near anal orifice with a low grade fever
- this is a perianal abscess that is likely due to **occulsion of an anal crypt gland**

## elderly patient w just 3 days of abdominal pain, and on AbdXR there is a dilated loop of colon
- this is sigmoid volvulus!
- if she is stable and without perforation or peritonitis than she can go **flexible sigmoidoscopy to reduce it!**
- if she is not stable, than emergent sigmoid colectomy!


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# Trauma
## POD 10 from lap appy presents w/ RUQ pain, fever, leukocytosis and pulmonary manifestations
This is a subphrenic abscess! Intra-abdominal abscess is significantly higher in this population

## FAST Exam

## Upper GI Bleed NBSIM?

# Complicated SBO

## Acute Abdomen
### Detailed Hx
- how
- when
- location
- radiation
- associated symptoms
- aggravating/relieving
- previous hx
- precipating event
### Physical exam
- peritoneal signs
- rebound tenderness due to parietal peritoneum
- guarding
- abdominal wall rigidity
### Patients w/ RLQ but have an appetite means NOT appendicitis

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# Thyroid
## Primary Hyperthyroid


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# Vascular
## Peripheral Artery Disease
- smoking is the **biggest risk factor**
#### Claudication vs Exertional Angina
- claudication = chronic limb ischemia, usually seen as night and at rest pain
- wounds
- exertional = unstable angina
#### Acute limb ischemia
- pain
- pallor
- pulseless
- paresthesia
- polar "cold"

Rutherford Classification
- level 1: intact motor + sensory
- level 2A: severe pain, intact motor, NO sensory
- level 2B: severe pain, NO motor and sensory
- level 3: mottled, non-salvageable

## causes of compartment syndrome
- trauma
- bleeding
- reperfusion

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# Breast
## Benign stuff
- fibroadenoma
- get an US, this will help ddx between fibroadenoma and a cyst
- maybe get a US core needle biopsy

Complex cyst = bad, get a biopsy
complicated cyst = follow

- **Most Common Cause** of breast abscess is because of smoking
## Malignant shit
- usually spreads to bone, liver, brain but if it's in the brain patients dead
## 56 yo with painless, upper quadrant mass w/ FHx of breast cancer
- get "diagnostic imaging" = mammogram + US
- get core needle biopsy
- get pathology
- ductal, lobule, invasiveness
- tumor markers: ER, PR, her2

- ADH = not cancer, then youre also at higher risk in BOTH breasts
- DCIS = stage 0
### common types
- invasive ductal triple negative
- her2
### mgmt
- surgery
- radiation
- chemo
- anti-hormone
- SNLB

### oncotypes
if >25, she gets chemo

- for inflammatory breast cancer, surgical treatment is modified radical mastectomy

- her2+ OR triple negative = you get chemo FIRST
- chemo is ACT (because of anthracyclin)
- FOLFOX, FOLFIRONOX are used for CRC

- if you have >3 positive then you do a Axillary lymph node dissection in level 1 and level 2
- level 1 =
- level 2 =
- level 3 = deep to pec
- if they have <3 positive then they just get axillary radiation

# Diarrhea in “post-transplant” pt
CMV colitis
Tx? Ganciclovir
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## In a patient w/ potential Zenker's Diverticulum, which diagnostic method do you use?
Contrast esophagography; NOT Upper GI scope

## patient post-op w/ absent breath sounds in one lung plus mediastinal shift, pathology?
Bronchial mucus plug leading to large-volume atelectasis

## Short bowel syndrome
- SBS is defined as having **<200 cm** of jeju-ileum following small bowel resection
- minimum length of viable small bowel is 110-150 cm (if there is no colon)
- if there is colon, then you can get away with just 50-70 cm

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## central stellate = FNH
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