Sandbox:UT

Solitary thyroid nodule

Cystic nodule

Spongiform nodule

Solid nodule

Without malignant features

Hyperechoic or isoechoic or partially cystic nodule with eccentric solid areas

Hypoechoic solid nodule with smooth margins WITHOUT the following features: Microcalcifications Extrathyroidal extension Taller than wider shape

Hypoechoic solid nodule or solid hypoechoic component of a partially cystic nodule WITH one or more of the following features: Irregular margins Microcalcifications Taller than wide shape Rim calcifications with small extrusive soft tissue component Evidence of extrathyroidal extension

Very low suspicion of malignncy

Low suspicion for malignancy

Intermediate suspicion of malignancy

High suspicion of malignancy

Estemated risk of malignancy

<3%

5 to 10%

10 to 20%

>70 to 90%

FNA if nodule is larger that 2cm

FNA if nodule is larger that 1.5cm

FNA if nodule is larger that 1cm

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
	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
	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

Non-infectious Hepatitis

Alcoholic hepatitis

Non-alcoholic steatohepatitis (NASH)

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

Obsessive compulsive disorder RSG

Obsessive compulsive disorder

Screen for OCD; if present, assess severity and associated conditions*

Mild to moderate OCD, Patient has good insight

Severe OCD OR Pateint has poor insight OR Moderate to severe co-occuring hoarding, tics, depresion or anxiety disorder

Improvement within 12 weeks?

Improvement within 12 weeks

Negative Culture ❑ Complete 5 day Antibiotic Course

Confirmed SBP ❑ Narrow the spectrum based on the susceptibility to complete the 5 day course

Culture Negative ❑ No Antibiotics indicated

Culture Positive ❑ Bacterascites: Repeat diagnostic paracentesis when the culture growth is discovered

Classification

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

Journal Reference

Raas-Rothschild A, Spiegel R (2010 Jan 28). "Mucolipidosis III Gamma". GeneReviews®. PMID 20301784.

Color codes for table

BLUE: |align="center" style="background:#4479BA; color: #FFFFFF;" | GRAY: |style="background: #F5F5F5; padding: 5px text-align:center" | +
KHAKI:|style="background: #F0E68C; padding: 5px text-align:center" | +
PALE TORQOUI...:|style="background: #AFEEEE; padding: 5px text-align:center" | -
Brown:|style="background: #A52A2A; padding: 5px text-align:center" | +

Image copying

Image copying with text

CT Scan Emphysematous Cystitis

Table for D/D of cystitis

Diseases	Diagnostic tests			Physical Examination				Symptoms					Past medical history	Other Findings
	Urinalysis	Urine Culture	Gold Standard	Fever	Suprapubic Tenderness	Discharge	Inguinal Lymphadenopathy	Hematuria	Pyuria	Frequency	Urgency	Dysuria
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