Medicine

Core Ethical Principles

Mnemonic Principle
Just Justice
Always Autonomous
Be Beneficence
Nice Nonmaleficence

Differential Diagnosis {VINDICATE}

  • Vascular
  • Infection & Inflammation
  • Neoplasia & Nutrition
  • Degeneration & Drugs
  • Idiopathic
  • Congenital
  • Autoimmunity
  • Trauma & Toxins
  • Endocrine & Exocrine

Activities of Daily Living (ADL) {DEATH}

  • Dressing
  • Eating
  • Ambulating
  • Toileting
  • Hygiene

Eastern Cooperative Oncology Group (ECOG) Performance Scale

Evaluation of Family Function {APGAR}

  • Adaptability
  • Partnership
  • Growth
  • Affection
  • Resolve

Lethal Triad {CAH}

  • Coagulopathy
  • Acidosis
  • Hypothermia

Leading Causes of Death in General Population

  • Heart :: cardiovascular disease
  • Cancer
  • Lung :: chronic respiratory disease
  • Brain :: cerebrovascular disease
  • Accident

Leading Causes of Death in Newborns

  • Congenital anomalies
  • Small for gestational age (SGA)
  • Sudden infant death syndrome (SIDS)

Risk Factors for Sudden Infant Death Syndrome (SIDS)

Maternal Factors

  • Substance use
  • Age < 20 years

Infant Factors

  • Prematurity
  • Low birth weight
  • Sleep environment
  • Smoke exposure

Complications of Prematurity

  • Patent ductus arteriosus (PDA)
  • Bronchopulmonary dysplasia (BPD)
  • Neonatal respiratory distress syndrome (NRDS)
  • Necrotizing enterocolitis (NEC)
  • Cerebral palsy
  • Intraventricular hemorrhage (IVH)
  • Periventricular leukomalacia (PVL)
  • Retinopathy of prematurity

Complications of Postmaturity

  • Macrosomia
  • Oligohydramnios
  • Hypoglycemia
  • Polycythemia
  • Meconium aspiration syndrome (MAS)
  • Persistent pulmonary hypertension of the newborn (PPHN)

Classification of Birth Weights (BW)

Classification BW (g)
Extremely low (ELBW) < 1000
Very low (VLBW) 1000 ~ 1500
Low (LBW) 1500 ~ 2500
Normal (NBW) 2500 ~ 4000
High (HBW) > 4000

Apgar Score

New Ballard Score {HAPPSS}

  • Heel to ear
  • Arm recoil
  • Popliteal angle
  • Posture
  • Scarf sign
  • Square window

Contraindications to Breastfeeding

  • Galactosemia
  • HIV
  • HSV on breasts
  • Tuberculosis
  • Sepsis
  • Chemotherapy
  • Substance use

Conditions Associated with Enlarged Anterior Fontanel

  • Congenital hypothyroidism
  • Rickets
  • Achondroplasia
  • Elevated intracranial pressure (ICP)

VACTERL Association {VACTERL}

  • Vertebral anomalies
  • Anorectal malformation
  • Cardiac anomalies :: ventricular septal defect (VSD)
  • Tracheoesophageal fistula (TEF)
  • Esophageal atresia (EA)
  • Renal anomalies
  • Limb anomalies

Presentation of Potter Sequence {POTTER}

  • Pulmonary hypoplasia
  • Oligohydramnios
  • Twisted face
  • Twisted skin
  • Extremity defects
  • Renal failure

Primary Survey for Trauma {ABCDE}

  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure

Presentation of Non-accidental Trauma (NAT)

  • Burns
  • Fractures
    • Rib fractures
    • Corner [Bucket handle] fractures
    • Spiral fractures
  • Hemorrhage
    • Subdural hemorrhage
    • Retinal hemorrhage
  • Neisseria gonorrhoeae

Levels of Consciousness {ALOSC}

  • Alert
  • Lethargic
  • Obtunded
  • Stuporous
  • Comatose

Glasgow Coma Scale (GCS)

Eye Opening

Item Score
Spontaneous 4
Respond to command 3
Respond to pain 2
Absent 1

Verbal Response

Item Score
Oriented 5
Confused 4
Inappropriate 3
Incomprehensible 2
Absent 1

Motor Response

Item Score
Obedient 6
Localization of pain 5
Withdrawal from pain 4
Flexion to pain 3
Extension to pain 2
Absent 1

Etiology of Altered Mental Status (AMS) {AEIOU-TIPS}

  • Acidosis
  • Electrolyte disturbances
  • Intoxication
  • Oxygen
  • Uremia
  • Trauma
  • Infection
  • Psychosis
  • Sugar
  • Seizures
  • Strokes
  • Syncope

Coma Cocktail {DONT}

  • Dextrose
  • Oxygen
  • Naloxone
  • Thiamine

Etiology of Syncope

  • Orthostatic
  • Cardiac
  • Neurologic
  • Reflex
    • Vasovagal [Neurocardiogenic]
    • Situational
  • Psychogenic

Etiology of Fever

  • Infection
  • Neoplasm
  • Autoimmunity
  • Drugs
  • Endocrine

Workup of Fever

  • Complete blood count (CBC)
  • Throat swab ± Sputum culture
  • Chest radiography
  • Urinalysis ± Urine culture
  • Wound inspection

Grading of Pitting Edema

Grade Depth Duration
1 2 mm ≤ 2 seconds
2 4 mm 2 seconds ~ 1 minute
3 6 mm 1 ~ 2 minutes
4 8 mm ≥ 2 minutes

Classification of Edema

Edema Etiology Pitting
Exudate Inflammation +
Transudate Hydrostatic pressure +
  Oncotic pressure +
Lymphedema Lymphatic obstruction -

Grading of Peripheral Pulses

Grade Description
0 Absent
1 Diminished
2 Normal
3 Increased
4 Bounding

Etiology of Cardiopulmonary Arrest {5H5T}

  • Hypothermia
  • Hypovolemia
  • Hypoxia
  • Hydrogen
  • Hypokalemia & Hyperkalemia
  • Tamponade
  • Tension pneumothorax
  • Thrombosis :: myocardial infarction
  • Thrombosis :: pulmonary embolism
  • Toxins

Blood Pressure

Condition Definition
Hypotension < 90/60 mmHg
Hypertension > 140/90 mmHg
Hypertensive urgency > 180/120 mmHg

Classification of Shock

Shock PCWP CO SVR MAP Treatment
Hypovolemic ↓ (1°) ↓ ↑ ↓ Fluids
Cardiogenic ↑ ↓ (1°) ↑ ↓ Inotropes
Diuretics
Venodilators
Distributive - ↑ ↓ (1°) ↓ Vasopressors

Types of Distributive Shock

  • Anaphylactic shock
  • Septic shock
  • Neurogenic shock

Classification of Hypovolemic Shock

Class Loss HR BP RR Urine
I < 15% < 100 - 12 ~ 20 > 30 mL/h
II 15 ~ 30% 100 ~ 120 - 20 ~ 30 20 ~ 30 mL/h
III 30 ~ 40% 120 ~ 140 ↓ 30 ~ 40 5 ~ 15 mL/h
IV > 40% > 140 ↓ > 35 < 5 mL/h

Management of Hypertension

Hypertensive Urgency

  • ACEI :: Captopril
  • β1 antagonists :: Labetalol
  • Venodilators & Vasodilators
    • Ca channel blockers
    • α2 agonists
    • Nitrates

Hypertension {ABVD}

  • ACEI & ARB
  • β1 antagonists
  • Vasodilators
  • Diuretics

Etiology of Dyspnea

  • Anemia
  • Hemoglobinopathy
  • ↓ Tidal volume
  • V/Q mismatch
  • Psychological

Etiology of Hypoxemia [↓ PaO2]

  • PaCO2 :: normal
    • A-a gradient :: normal [Low FiO2]
    • A-a gradient :: high
      • O2 :: uncorrectable [Shunt]
      • O2 :: correctable
        • V/Q :: normal [Diffusion limitation]
        • V/Q :: mismatch [Dead space]
  • PaCO2 :: high [Hypoventilation]

Etiology of Hypercapnia [↑ PaCO2]

  • Hypoventilation
  • Severe V/Q mismatch

Etiology of Elevated LDH

  • Hemolytic anemia
  • Germ cell tumors
  • Tumor lysis syndrome

Pain Relieved By Leaning Forward

  • Pericarditis
  • Pancreatitis

Routine Health Maintenance Screening

Disease Population Age (years) Tests Interval (years)
HIV All 15 ~ 65 - Once
Hypertension All All - 2
Hyperlipidemia Male > 35 - Once
  Female > 45 - Once
Diabetes All > 45 FBG Once
AAA Male smoker 65 ~ 75 Ultrasound Once
Osteoporosis Female > 65 DEXA 2