Sandbox:UT

Wikidoc Internal Medicine Texbook
Subject	Endocrinology		Gastroenterology		Rheumatology		Pulmonology		Nephrology		Hematology		Total
Number of Microchapters	Total	Left	Total	Left	Total	Left	Total	Left	Total	Left	Total	Left	Total
Number of Microchapters	71	39	96	89	54	47	58	46	59	64	51	47	332
Projected Microchapters	50		111		59		59		80		59		418
Days Projected If one chapter takes 10 days/fellow Number of fellows = 15 15 chapters are completed in 10 days	35 days		75 days		40 days		40 days		55 days		40 days		280 days
Review Processing Time (days)	14		14		14		14		14		14		84 days
Expected Time for each Chapter (days)	49		89		54		54		69		54		364 days
Expected Time line	October 2017, 1st week		January 2018,1st week		February 2018, 4th week		April 2018, 3rd week		July 2018, 1st week		August 2018, 4th week

Wikidoc Other Textbooks
Subject	Psychiatry		Neurology		Peds/Developmental		Dermatology		ObGyn		Ophthalmology		Nutrition		Total
Number of Microchapters	Total	Left	Total	Left	Total	Left	Total	Left	Total	Left	Total	Left	Total	Left	Total
Number of Microchapters	36	36	77	71	49	49	18	14	33	27	18	17	17	15	229
Projected Microchapters	45		89		60		17		35		21		19		286
Days projected If one chapter takes 10 days/fellow Number of fellows = 15 15 chapters are completed in 10 days	30 days		60 days		40 days		14 days		21 days		16 days		15 days		196 days
Review Processing Time (days)	14		14		14		14		14		14		14		98 days
Expected Time for each Chapter (days)	44		74		54		28		35		30		29		294 days
Expected Time Line	October 2018, 3rd week		January 2019, 1st week		March 2019, 1st week		April 2019, 1st week		May 2019, 2nd week		June 2019, 2nd week		July 2019, 2nd week

Viral Hepatitis

Hepatitis A

Other

• EBV hepatitis
• CMV hepatitis
• HSV hepatitis
• Coxsackie B virus hepatitis

Non-infectious Hepatitis

Alcoholic hepatitis

a-1 antitrypsin defieciency

Autoimmune hepatitis

Obstructive hepatitis

Drug related hepatitis

Toxin related hepatitis

Ischemic hepatitis

•Gall stone
•Tumor

•Isoniazid
•NSAIDs
•Beta-lactam antibiotics
•Sulfa-containing drugs
•HAART

Chemicals

Chest Pain

Classification

Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
	Stable Angina^[1]	Sudden (acute)	2-10 minutes	Heaviness/pressure/ tightness/squeezing/ burning (Levine's sign) Retrosternal or left sided chest pain	-	-	+/-	-	Nausea and vomiting Diaphoresis	Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes	Transient third heart sound (S3 - ventricular filling sound) and fourth heart sound (S4 - atrial filling sound)	Cardiac enzymes normal	Exercise EKG: ST-segment depression	Exercise Stress Testing: Decreased myocardial perfusion Transthoracic echocardiography: Ejection fraction <50 percent	Coronary angiography
	Unstable Angina^[2]^[3]^[4]	Acute	10-20 minutes	Same as stable angina but often more severe	-	-	+	-	Nausea and vomiting Diaphoresis Presyncope Palpitations	Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes	Reverse splitting of the second heart sound Rales or crackles Elevated jugular venous pressure	Cardiac biomarkers [Cardiac troponin I, cardiac troponin T and MB isoenzyme of creatine kinase (CK-MB)] normal	ST-depression New T wave inversions Transient ST-elevation	Echocardiography: Ejection fraction <50 percent Exercise Stress Testing: Decreased myocardial perfusion	Invasive coronary angiography
	Myocardial Infarction^[5]^[6]^[7]^[8]	Acute	Commonly > 20 minutes	Same as stable angina but often more severe	-	-	+	-	Nausea and vomiting Diaphoresis Presyncope Palpitations Lateral displacement of the apical impulse	Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes	Hypotension Tachycardia S4 gallop Paradoxical splitting of S2 Mitral regurgitation murmur	Elevated cardiac enzymes ↑B-Type Natriuretic Peptide	ST elevation MI (STEMI) Non-ST elevation MI (NSTEMI) or Non Q wave	Echocardiography: ↓ EF CCTA: Coronory artery stenosis CMRI: Coronory vessels stenosis MPI on SPECT or PET scanning: Decreased myocardial perfusion.	CCTA combined with MPI
Cardiac	Vasospastic/ Prinzmetal/ Variant Angina^[9]^[10]	Gradual in onset and offset	Episodic, gradual in onset and offset.	Chest discomfort described as squeezing, tightness, pressure, constriction, strangling, burning, heart burn, fullness in the chest, a band-like sensation, knot in the center of the chest, lump in the throat, ache, and heavy weight on chest	-	-	+	-	Nausea, sweating, dizziness, dyspnea, and palpitations Associated with other vasospastic disorders, such as Raynaud's phenomenon and migraine headache	Multiple drugs (ephedrine-based products, cocaine, marijuana, alcohol, butane, sumatriptan, and amphetamines) Food-born botulism Guide wire or balloon dilatation while doing PCI Magnesium deficiency	Tachycardia, hypertension, diaphoresis, and a gallop rhythm	Urine drug screen may be positive for cocaine or other drugs	Transient (less than 15 minutes) ischemic ST changes in multiple leads A tall and broad R wave, Disappearance of the S wave A taller T wave Negative U waves	Stress testing: normal noninvasive stress test, exercise-induced spasm with ST-segment elevation, Stress echocardiography with ergonovine provocation: Vasospasm of coronory vessels Coronary arteriography: Epicardial spasm	Coronary arteriography

UTI

Uppper

Lower

Pyelonephritis

Cystitis

Prostatitis

Uretheritis

Asymptomatic Bacteriuria

Pyelonephritis

Etiology

Pathogen

Duration and Treatment

Acute Bacterial*Chronic bacterial*Inflammatory chronic*Non-inflammatory chronic*Asymptomatic

Non-infectious

Infectious

*Traumatic cystitis*Interstitial Cystitis*Eosinophilic cystitis*Hemorrhagic cystitis*Foreign body cystitis*Cystitis cystica*Emphysematous cystitis*Cystitis glandularis

*Bacteria*Fungi*Viruses*Parasites

*Acute uncomplicated cystitis*Complicated cystitis*Recurrent/Chronic Cystitis

*urinary crystals*Chemicals*Stevens-Johnson syndrome*Spermicides

Code to Fix Refereneces

Journal Reference

Raas-Rothschild A, Spiegel R (2010 Jan 28). "Mucolipidosis III Gamma". GeneReviews®. PMID 20301784. Check date values in: |access-date=, |date= (help); |access-date= requires |url= (help)

Book Reference

^[11]

Pathology image reference/website

^[12]

Radiopedia Image reference

^[13]

Color codes for table

Image copying

Image copying with text

Table for D/D of cystitis

Diseases	Urinalysis	Urine Culture	Gold Standard	Fever	Suprapubic Tenderness	Discharge	Inguinal Lymphadenopathy	Hematuria	Pyuria	Frequency	Urgency	Dysuria	Past medical history	Other Findings
Diseases	Diagnostic tests			Physical Examination				Symptoms					Past medical history	Other Findings
Cystitis	Nitrite +ve Leukocyte estrase+ve WBCs RBCs	>100,000CFU/mL	Urinary culture	✔	✔	-	✔	✔	✔	✔	✔	✔	Recent catheterisation Pregnancy recent intercourse Diabetes Personal or Family History of UTI Known abnormality of the urinary tract BPH or HIV	Imaging studies help differentiate the type May company back pain, nausea, vomiting and chills
Urethritis	Positive leukocyte esterase test or >10 WBCs Mucous threads in the morning urine	-	Gram stain Mucoid or purulent discharge	✔	-	Urethral discharge	✔	-	✔	-	-	✔	Prior STDs Urinary tract infections New sexual partner Recent intercourse Recent catheterisation	Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, tachypnea
Bacterial Vulvovagintis	-	-	Gram Stain	✔	-	Vaginal discharge	✔						Number and type of sexual partners (new, casual, or regular) Prior STDs Previous history of symptomatic BV in female partner (in homosexual women)	Fishy odor from the vagina (Whiff test) Thin, white/gray homogeneous vaginal discharge Microscopy (wet prep) and vaginal pH Clue cells
Cervicitis	-	-	culture for gonococcal cervicitis	✔	-	endocervical exudate		-	✔	-	-	✔	Abnormal vaginal bleeding after intercourse or after menopause Abnormal vaginal discharge Painful sexual intercourse Pressure or heaviness in the pelvis	1-a purulent or mucopurulent endocervical exudate 2-Sustained endocervical bleeding easily induced by a cotton swab 3->10 WBC in vaginal fluid, in the absence of trichomoniasis, may indicate endocervical inflammation caused specifically by C. trachomatis or N. gonorrhea
Prostatitis	10-20 leukocytes for acute and chronic bacterial subtypes	Identifies causative bacteria (in bacterial subtypes)	Urine Culture	✔	-	-		-	✔	✔	✔	✔	Urogenital disorders Recent catheterization or other genitourinary instrumentation History of UTIs	In acute prostatitis, palpation reveals a tender and enlarged prostate^[1][3] In chronic prostatitis, palpation reveals a tender and soft (boggy) prostate^[1] A prostate massage should never be done in a patient with suspected acute prostatitis, since it may induce sepsis
Epididymitis	Hematuria may be seen	✔	Culture	✔	✔	+/- urethral discharge	✔	✔	-	✔	✔	✔	Scrotal pain: starts gradually, is usually unilateral and localized posterior to the testis Scrotal swelling Scrotal wall erythema Constitutional symptoms: feeling of hotness, chills, nausea and vomiting	*Ultrasound in patients with acute testicular pain to assess for testicular torsion If equivocal do surgical exploration
Syphilis (STD)	-	-	Darkfield Microscopy	+/-	-	-	✔	-	-	-	-	-	History of STD HIV Immunosupression Previous history of chancre	May be asymptomatic Painless chancre in primary syphilis Secondary syphilis may have generalised features and condylomata late Tertiary syphilis can have neurosyphilis, cardiovascular syphilis and gummas
BPH	Recommended Hematuria may be seen	-	DRE + Serum PSA	-	-	-		✔	-	✔	✔	✔	Sudden inability to urinate Urinary tract infections Urinary stones Damage to the kidneys Blood in the urine	Involves mainly central or transitional zone Hyperplasia rather than hypertrophy Obstruction of the urethra Nocturia
Neoplasms	Recomended Hematuria may be seen	-	Imaging and biopsy	+-	-		✔	✔	-	✔	✔	-	Sudden inability to urinate Recurrent urinary tract infections Weight loss and other constitutional symptoms	Cachexia Gradual progression
Pyelonephritis	Leukocytes Nitrite +ve	Identifies causative bacteria	Imaging and culture	✔	✔ + Flank Pain	✔	✔	✔	✔			✔	History of Pyelonephritis Recent history of Hospitalisation Nephrolithiasis Immunosupression	Costovertebral angle tenderness Patient is in acute distress Look for obstructive causes

References

↑ Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL (December 2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): e354–471. doi:10.1161/CIR.0b013e318277d6a0. PMID 23166211.
↑ Tatum JL, Jesse RL, Kontos MC, Nicholson CS, Schmidt KL, Roberts CS, Ornato JP (January 1997). "Comprehensive strategy for the evaluation and triage of the chest pain patient". Ann Emerg Med. 29 (1): 116–25. PMID 8998090.
↑ Ornato JP (August 1999). "Chest pain emergency centers: improving acute myocardial infarction care". Clin Cardiol. 22 (8 Suppl): IV3–9. PMID 10492848.
↑ Gibler WB (August 1995). "Evaluation of chest pain in the emergency department". Ann. Intern. Med. 123 (4): 315, author reply 317–8. PMID 7611601.
↑ Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K (June 1996). "Chest pain in family practice. Diagnosis and long-term outcome in a community setting". Can Fam Physician. 42: 1122–8. PMC 2146490. PMID 8704488.
↑ Klinkman MS, Stevens D, Gorenflo DW (April 1994). "Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network". J Fam Pract. 38 (4): 345–52. PMID 8163958.
↑ Bösner S, Becker A, Haasenritter J, Abu Hani M, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Seitz G, Baum E, Donner-Banzhoff N (2009). "Chest pain in primary care: epidemiology and pre-work-up probabilities". Eur J Gen Pract. 15 (3): 141–6. doi:10.3109/13814780903329528. PMID 19883149.
↑ Ebell MH (March 2011). "Evaluation of chest pain in primary care patients". Am Fam Physician. 83 (5): 603–5. PMID 21391528.
↑ PRINZMETAL M, KENNAMER R, MERLISS R, WADA T, BOR N (September 1959). "Angina pectoris. I. A variant form of angina pectoris; preliminary report". Am. J. Med. 27: 375–88. PMID 14434946.
↑ Kaski JC, Crea F, Meran D, Rodriguez L, Araujo L, Chierchia S, Davies G, Maseri A (December 1986). "Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina". Circulation. 74 (6): 1255–65. PMID 3779913.
↑ Braunwald, Eugene. Heart Disease- Fourth Edition. Harvard Medical School: W. B. SAUNDERS COMPANY. p. 1137. ISBN 0-7216-3097-9.
↑ Libre Pathology https://librepathology.org/wiki/File:Cystitis_cystica_et_glandularis_-_alt_--_intermed_mag.jpg Accessed on Jan 13, 2017
↑ Radiopaedia.org. Case courtesy of Dr David Little. From the case <a href="https://radiopaedia.org/cases/39307">rID: 39307

[pmid23166211-1] Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL (December 2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): e354–471. doi:10.1161/CIR.0b013e318277d6a0. PMID 23166211.

[pmid8998090-2] Tatum JL, Jesse RL, Kontos MC, Nicholson CS, Schmidt KL, Roberts CS, Ornato JP (January 1997). "Comprehensive strategy for the evaluation and triage of the chest pain patient". Ann Emerg Med. 29 (1): 116–25. PMID 8998090.

[pmid10492848-3] Ornato JP (August 1999). "Chest pain emergency centers: improving acute myocardial infarction care". Clin Cardiol. 22 (8 Suppl): IV3–9. PMID 10492848.

[pmid7611601-4] Gibler WB (August 1995). "Evaluation of chest pain in the emergency department". Ann. Intern. Med. 123 (4): 315, author reply 317–8. PMID 7611601.

[pmid8704488-5] Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K (June 1996). "Chest pain in family practice. Diagnosis and long-term outcome in a community setting". Can Fam Physician. 42: 1122–8. PMC 2146490. PMID 8704488.

[pmid8163958-6] Klinkman MS, Stevens D, Gorenflo DW (April 1994). "Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network". J Fam Pract. 38 (4): 345–52. PMID 8163958.

[pmid19883149-7] Bösner S, Becker A, Haasenritter J, Abu Hani M, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Seitz G, Baum E, Donner-Banzhoff N (2009). "Chest pain in primary care: epidemiology and pre-work-up probabilities". Eur J Gen Pract. 15 (3): 141–6. doi:10.3109/13814780903329528. PMID 19883149.

[pmid21391528-8] Ebell MH (March 2011). "Evaluation of chest pain in primary care patients". Am Fam Physician. 83 (5): 603–5. PMID 21391528.

[pmid14434946-9] PRINZMETAL M, KENNAMER R, MERLISS R, WADA T, BOR N (September 1959). "Angina pectoris. I. A variant form of angina pectoris; preliminary report". Am. J. Med. 27: 375–88. PMID 14434946.

[pmid3779913-10] Kaski JC, Crea F, Meran D, Rodriguez L, Araujo L, Chierchia S, Davies G, Maseri A (December 1986). "Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina". Circulation. 74 (6): 1255–65. PMID 3779913.

[Heart_Disease-11] Braunwald, Eugene. Heart Disease- Fourth Edition. Harvard Medical School: W. B. SAUNDERS COMPANY. p. 1137. ISBN 0-7216-3097-9.

[Libre1_Pathology-12] Libre Pathology https://librepathology.org/wiki/File:Cystitis_cystica_et_glandularis_-_alt_--_intermed_mag.jpg Accessed on Jan 13, 2017

[https://radiopaedia.org/-13] Radiopaedia.org. Case courtesy of Dr David Little. From the case <a href="https://radiopaedia.org/cases/39307">rID: 39307

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